Exam I Flashcards
Visceral/colic vs Parietal pain
Visceral/colic pain – source is a hollow organ caused by distention/stretching. Pain comes and goes, not well localized.
Parietal pain – caused by inflammation of peritoneum, aching pain that is well localized
Borborygmi
increased/hyperactive sounds, low pitched rumbling, hyperperistalsis
Percussion of Abdomen
Fluid wave: pt puts hand on midline, you tap one flank and palpate with the other
Shifting dullness – percuss on back then side to find where fluid is filled until
Should result in resonant [lungs] –> dull [liver] –> tympanic [intestine]
Kidneys should be percussed at the back
Lloyd’s sign – costovertebral angle tenderness tested by lightly hitting CVA with fist
Rovsing’s sign
referred rebound tenderness. Press on LLQ and release, positive if pain is in RLQ
Appendicitis
come in after a few days of pain, d/t obstruction of appendicular lumen [fecal/foreign matter, tumor, lymphoma]
History – anorexia, nausea, vomiting, fever, pain in RLQ
Test for RLQ pain/tenderness, decreased/absent bowel sounds, Rovsings sign, Psoas sign [stretch psoas], obturator sign
Acute cholecystitis
obstruction of cystic duct via gallstone, or maybe neoplasm
Pain can refer/radiate to shoulder
RUQ postprandial pain, biliary colic pain
History of anorexia, nausea, vomiting, obesity, fever
-Five F’s: female, fat, fertile, fair, flatulent
Murphy’s sign – RUQ pain and arrest of inspiration during palpation of liver/gallbladder
Diagnostic triad – RUQ pain, fever, leukocytosis
Lobes of Prostate
5 total
posterior most common for cancer
Indirect Hernia
into scrotum, the more common type
STDs and lab findings
Chlamydia – WBC
Gonorrhea – WBC w/ Gm- intracellular diplococcic
Trichomonas – WBC with moving organisms
GEN probe –> ghlamydia, GC
Hypospadias
congenital displacement of urethal meatus on inferior surface of penis, along urethral groove. Assoc with renal abnormalities
Phimosis
inability to retract foreskin, erections are painful.
Paraphimosis – foreskin cannot be retracted back over glans
Hygiene issues, tx – circumcision
Hydrocele
fluid filled sac between testicle + tunica vaginalis, transilluminates with light
Cryptorchidism
undescended testicle, usually atrophied. Inc risk for cancer
Primary syphilis
primarily caused by treponema pallidum
Chancre – painless round/oval erosion or ulcer, nontender enlarged inguinal lymph nodes
FTA-ABS – positive, or dark field microscopy –> confirmatory test, will see spirochetes
Secondary syphilis – unexplained rash on the body, palms of hand, or soles of feet
Herpes
cluster of small vesicles, burning + painful. Dx via opening vesicle and swab the clear fluid –> should hold virus
Scabies
parasitic disease, caused by a mite, needs direct skin contact. Nocturnal itching, topically treated
Gonococcal Urethritis
purulent discharge of gonorrhea, faster onset, gram staining –> gram-negative intracellular diplococci
Nongonococcal urethritis
[chlamydia] – slower onset, mucoid or purulent discharge, with polymorphonuclear lymphocytes
Menopause
absence of menses for 12 consecutive months [usually age 48-55]
Post-menopausal bleeding 6mo after cessation of menses –> risk factor [cancer]
Post-menopausal vaginal epithelium –> no rugae [d/t no estrogen]
Dysmenorrhea
painful periods beyond usual
Could be endometriosis, cervical stenosis, infection, or congenital anomaly
For pain, use prophylactic NSAIDs 24hrs before
Types of Periods
- Amenorrhea – absence of menses [pregnancy]
- Polymenorrhea – menses at abnormal frequences
- Oligomenorrhea – infrequent menses
- Menorrhagia – excessive bleeding
- Metrorhagia – bleeding between periods
- Post-coital bleeding – after sexual intercourse [STD, polyp]
Obstetric history
Gravida – how many pregnancies
Para – outcome of pregnancies
T – to term at > 37wks
P – premature
A – abortion
Bartholin’s glands
can get cysts/cancers/abcesses [at 5, 7 o’clock position]
Skene’s glands
may open internally [associated with urethra at 10, 2 o’clock]
Pushing up on skene’s glands may cause white discharge from urethra –> possible STI [chlamydia]
