GI: Female + Male GU Flashcards
(167 cards)
1
Q
the axillary tail of breast tissue extends into which fold?
A
anterior axillary fold
2
Q
most vessels from breast drain into which lymph node
A
axillary LN
3
Q
which LNs are most likely to be palpable
A
central nodes
4
Q
which nodes drain into central nodes? (3)
A
pectoral
subscapular
lateral nodes
5
Q
Mastalgia
MC presenting sympt for?
A
breast pain
MC presenting symp for BCA
6
Q
Galactorrhea
*what increases the risk of it being pathogenic?
A
discharge of milk containing fluid unrelated to pregnancy
*risk of it being pathogenic increases if its bloody, unilateral, spontaneous, women >40 or with a mass
7
Q
what four positions do you need to inspect female PT
A
arms at sides
arms over head
arms on hips
leaning forward
8
Q
how do you determine the origin of nipple discharge
what to note with discharge
A
compressing areola with index finger
- color
- consistency
- quanity
- exact location
9
Q
what is better, a painful or painless nodule>
A
Painful
10
Q
Peau d’orange
- describe it
- cause?
- sign of?
A
SIGNS OF BCA skin color thickening prominent pores cased by edema of skin produced by lympahtic blockage
11
Q
peau d’orange
skin dimpling, flattening, changes in contour
nippel inverrsion
paget disease of nipple
A
signs of BCA
12
Q
smooth, rubbery, round, mobile, nontender, describes what kind of mass
A
fibroadenoma
13
Q
usually soft to firm, round, mobile, often tender
A
cysts
14
Q
nodular, ropelike
A
fibrocystic changes
15
Q
irregular, firm, may be mobile or fixed to surrounding tissue
A
CA until proven otherwise
16
Q
preferable to do axilla exam with the patient in what position
A
sitting (not supine)
17
Q
enlarged nodes can be from?
A
- immunizations
- infection
18
Q
nodes >1 cm
+firm or hard
+matted together or fixed (immobile)
suggests?>
A
malignancy
19
Q
Breasts pendulous with diffuse fibrocystic changes. Single firm 1 x 1 cm mass, mobile and nontender, with overlying peau d’orange appearance in right breast, upper outer quadrant at 11 o’clock.” SUGGESTIVE OF?
A
possible BCA
20
Q
describe how inguinal hernias can form
A
when loops of bowel force their way through weak areas of the inguinal canal
21
Q
locations for hernias
A
inguinal
femoral
22
Q
yellow penile discharge ?
A
GC***/ chlamydia
23
Q
swelling in groin may indicate ?
A
mumps orchitis
scrotal edema
testicular CA
24
Q
testicular painless nodule
A
consider testicular CA
25
age group testicular CA is MC diagnosed in
20-34YO
26
you can feel the hernia touch fingertip after asking PT to cough--- direct or indirect?
indirect hernia
27
hernia bulges anteriorly and pushes the side of finger forward after PT coughs--indirect or direct
direct
28
which is MC? Indirect or direct
Indirect
29
who is most likely to get femoral hernias?
women
30
hernia is below the inguinal ligament, appears more lateral
- can be hard to differentiate from lymph nodes
* *what kind of hernia?
Femoral hernia
31
do femoral hernias go into the scrotum?
no
32
above inguinal ligament, close to the pubic tubercle (near the external inguinal ring)
*what hernia is this
direct
33
do direct hernias go into the scrotum?
rarely
34
hernia is above inguinal ligament, near its midpoint (the internal inguinal ring) *what kind of hernia
indirect
35
Does indirect hernia go into the scrotum
often
36
phimosis
inability to retract the foreskin
37
paraphimosis
tight prepuce that once retracted.. but cannot be returned
38
which is worse: phimosis or paraphimosis?
paraphimosis--
39
single red PAINLESS ulcer/ chancre
syphillus
40
HPV genital warts also called
condyloma acuminata
41
veins of spermatic cord are twisted
| "bag of worms"
varicocele
42
non-tender fluid filled mass under scrotum
hydrocele
43
can the fingers palpate above the mass for a hydrocele?
YES
44
can the fingers palpate above the mass for a scrotal hernia?
no
45
what is epididymitis
| MCC for kids and MCC adults
inflammation of epididymis
MMC Kids: N. gonorrhea & C. trachomatis
MMC Adults: E. coli and pseudomonas
46
testicular torsion
* MC PT population?
* define
younger
Life threatening and sudden onset
*testicle twists around on its spermatic cord, obstructs blood flow to kidney********
47
TOC for testicular torsion
US
48
ABSENT cremasteric reflex indicates?
testicular torsion
49
“Circumcised male. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally, smooth, without masses. Epididymis is nontender. No inguinal or femoral hernias.”
normal exam findings
50
“Uncircumcised male; prepuce easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally; right testicle smooth; 1 × 1 cm firm nodule on left lateral testicle. It is fixed and nontender. Epididymis nontender. No inguinal or femoral hernias.”
suspicious of testicular CA
51
define adnexa
ovaries and fallopian tubes
52
normal range for cycle
24-32 days
53
normal range for menses
3-7 days
54
what do we want to r/o if PT has postmenopausal bleeding
want to be concerned about endometrial CA
55
amenorrhea
absence of menses
56
dysmenorrhea
pain with menses--often with bearing down, aching or cramping sensation at the lower abdomen or pelvis
57
polymenorrhea
menstrual cycle that is shorter than 21 days
58
menorrhagia
heavy or prolonged menstrual bleeding
59
metrorrhagia
bleeding b/w periods
| *abnormal bleeding*
60
causes of secondary dysmenorrhea
```
endometriosis
adenomyosis (endometriosis in muscular layer of uterus)
PID
endometrial polyps
```
61
secondary causes of amenorrhea
```
pregnancy
lactation
menopause
low body wt
hypothalamic-pituitary-ovarian-dsyfunction
```
62
post coital bleeding suggests
cervical polyps
CA
or in older women: atrophic vaginitis
63
Para?
| break down the specifics
```
outcome of pregnancies
F P A L
*full term
*premature
*abortion (spontaneous or therapeutic)
*Living Child
```
64
Gravida?
total number of pregnancies
65
woman has two living children and only two pregnanies.. write the G/P
G2 P2002
66
define dyspareunia
discomfort during intercourse
| *can be a sign of sexual dysfunction
67
list the vulvovaginal symptoms
vaginal discharge
| dysuria
68
list the proper sequence for a pelvic exam
1. examine external genitalia
2. perform speculum exam
3. perform bimanual exam
4. perform rectovaginal exam (if indicated)
69
describe the Pedersen speculum
smaller and more narrow
70
what is the bimanual exam?
index and middle finger inserted into vagina
| *thumb is abducted and ring and little ringer flexed into palm
71
Cervical motion tenderness
| suggests?
pain with moving the cervix
| suggests PID
72
list two things that make lesions on the vulva
HPV
| Herpes
73
name three DZs causing vaginal discharge
yeast infection
BV
Trichomonas
74
list three different bulges and swellings of the vulva/vagina/urethra
Cystocele (bladder protruding out....cysto- means bladdr)
Rectocele
Bartholin (labial swelling)
75
yellow drainage from cervical OS can suggest?
| -can lead to?
```
GC Chlamydia (cervicitis)
can lead to PID
```
76
when is carcinoma of the cervix usually visible?
later stages of dz
77
list some abornamlities of the uterus
prolapse
bleeding
myomas (fibroids)
endometrial CA
78
list some Adnexa issues
Ovarian cysts
Ovarian CA
Ruptured tubal pregnancy (ectopic pregnancy)
PID
79
Ectoptic Pregnancy
| MC occur where?
90% occur in fallopian tube
may not be able to feel adnexal mass
LIFE THREATENING IF RUPTURE
80
PID
| MC cause?
85% caused by STD
| +CMT
81
what is the MCC of acute pelvic pain
2nd mC?
3rd mc?
1st: PID
2: ruptured ovarian cyst
3. appendicitis
82
which is the MC CA in US?
prostate
83
1 in ___ men will be diagnosed with prostate CA
1 in 8
84
RF for prostate CA
1. Age: rises rapidly >50
2. Race/ethnicity: MC in AA men
3. FAm hx
4. gene changes: inherited mutations of BRCA 1 BRCA 2
5. diet
6. chemical exposures (firefighters have incr risk)
7. prostatitis (inflammation of PG)
85
information about screening tests for prostate CA
not very accurate
| grade D rating
86
who should NOT get screened for prostate CA
asymptomatic men regardless of age, race or fam hx
| *harms of screening outweigh benefits*
87
CONS to prostate screening
1. high rate of false positive
2. over diagnosis and over tx
3. tx complications--ED and incontinence
4.
88
what does USPSTF say about men 70YO + about prostate CA screening
against the PSA-based screening
89
what is the PSA screening test
prostate specific antigen test
90
PSA
antigen produced naturally by prostate cells
91
if PT agrees, how often is PSA screening done
every 1-2 years
92
when should providers stop offering PSA screening
when PT reaches 70 YO
OR
whenever their life expectancy drops below 10
93
is there a PSA level that garuntees a PT has or does not have prostate CA?
no... but higher than usual level is found can INDICATE prostate CA..
94
what is the diagnostic gold standard for prostate screening
Prostate biopsy
95
how can you lower risk of Prostate CA
```
healthy weight
physical activity
healthy diet
vit E
ASA daily
```
96
what is the 3rd most frequently diagnosed CA in both men and women
colorectcal CA
97
what is the 3rd leading cause of death in US
colorectcal CA
98
RFs for colorectal CA
- increasing age
- hx
- adenomatous polyps
- IBD
- fam hx
- male
- AA
- tobac use
- read meat consumption
- ETOH
- obesity
99
screening tests for Colorectcal CA (4)
1. stool tests that detect occult fecal blood
2. colonoscopy
3. flexible sigmoidoscopy
4. imaging tests--double contrast barium enema
100
USPSTF guidelines for colorectcal CA screening:
1. 50-70
2. 76-85
3. 85+
1. high sensitivity FOBT annually, sigmoidoscopy every 5 years, colonoscopy every 10 years
2. Screening not advised because benefits small in comparison to risks
3. do not screen
101
what does primary dysmenorrhea resut from
increased prostaglandin prod during the luteal phase of the menstrual cycle---when estrogen and progesterone levels decline
102
how many days does it take to call it Polymenorrhea
less than 21 day intervals b/w menses
103
define oligomenorrhea
infrequent bleeding
104
what age range does menopause usually occur
48-55 (median 51)
105
cessation of menses for 12 months, progresing through several stages of erratic cyclical bleeding
+hot flashes
+flushing
+sweating
PERImenopause
106
what three general symptoms are linked to menopause
sleeping issues
vaginal symps
vasomotor symps
107
name three causes of postmenopasual bleeding
endometrial CA
hormone replacement tx
uterine and cervical polyps
108
amenorrhea followed by heavy bleeding suggests?
abortion
or
dysfunctional uterine bleeding related to lack of ovulation
109
superficial vaginal pain may suggest?
local inflammation
atrophic vainitis
inadequarte lubrication
110
deeper vaingal pain may suggest?
pelvic disorders
| pressure on a normal ovary
111
vainismus
invol spasm of muscles surrounding the vaginal orifice that makes penetration during intercourse painful r impossible
112
what are two red flags for PID
recent IUD insertion
| STIs
113
mild unilateral pain lasting for a few hours to a few days arising at midcycle
* what is this called
* what can cause it
Mittelschmerz "ovulation pain"
* ruptured ovarian cyst
* tubo-ovarian abscess
* ovulation
114
chronic pelvic pain is a red flag for?
sexual abuse
115
what is another cause of chronic pelvic pain
pelvic floor spasms from myofasicla pain
116
at what age to start screening for cervical CA
21
117
when to start vaccinating HPV
11-12
or
beofre their first sexual encounter
*can start as early as 9*
118
what are the strains of HPV that the vaccine cover
| *which causes genital warts
6 and 11---- cause 90% of gential warts
| 16 and 18
119
do condoms eliminate the risk of cervical HPV?
no
120
chlamydial infection is a cause of ?
```
urethritis
cervicitis
PID
ectopic pregnancy
infertility
chronic pelvic pain
```
121
RFs for chlyamida
<26
multiple partners
prior hx of STIs
122
in liquid based cytology, what can be filtered out
blood cells
123
what can delay menarche
an imperforate hymen
124
delayed puberty is often ?
familial or related to chronic illness or reflect disorders of hypothalamus, AP gland or ovaries
125
excoriation or itchy small red maculopapules suggest?
pediculosis pubis --found at the base of pubic hairs
126
enlarged clitoris is seen with?
masculinizing endocrine disorders
127
lateral displacement of the cervix is seen with?
endometriosis
128
RFs for vaginal CA
diethylstilbestrol (DES) exposure in utero
| HPV infection
129
stool in the rectum may simulate a?
rectovaginal mass-- but the stool can be dented by digital pressure
130
uterine enlargement suggests?
preg
uterine myomas
malignancy
131
how many years after menopause do the ovaries become atrophic
3-5
132
is it a good or bad sign to palpate an ovary in a postmenopausal woman
not good-- they should not be palpable since they atrophy post menop
133
common findings for ovarian CA
pelvic pain
bloating
incr abdominal sie
UT s/s
134
MC type of hernias in women
indirect
135
vaginal mucosa and cervix coated with thin white homogenoous discahrge with fishy odor
BV
136
bulge of upper two thirds of the anterior vaginal wall, together with the bladder above it
-what is it
cystocele
137
small red benign tumor visible at the posterior urethral meatus
MC in postmenop women and usually causes no symps
Urethral caruncle
138
labial swelling--- feels tense, hot, very tender abscess
| +/- pus emerging from the duct or erythema around the duct opening
Bartholin gland infection
139
swollen red ring around the urethral meatus
prolapsed ureathal mucosa
140
entire anterior vaginal wall together with the bladder and urerthra produces a bulge
cystourethrocele
141
white-yellowish in color... small firm round cystic nodule in the labia suggests?
+dark punctum marking the blocked opening
epidermoid cyst
142
warty lesions on the labia and within the vestibule
condyloma acuminata from HPV
143
painless ulcer
syphilis
144
large raise round or oval flat topped gray or white lesions
and
rash and mucous membrane sores in the mouth, vagina or anus
condylomata lata
145
shallow ulcers on red base
herpes
146
ulcerated or raised red vulvar lesion
vulvar carcinoma
147
discharge: yellowish green or gray possibly frothy, often profuse and pooled in the vaginal fonix--may be malodorous
+pruritis
+pain on urination
trichomonal vaginitis
148
discharge: white and curdy, may be thi but typically thick, not as profuse, not malodours
candidal vaginitis
149
discharge: gray or white, thin, homogenous, malodorous, coasts the vaginal walls, usually not profuse, may be minimal
+fishy odor
BV
150
describe a cyst vs a tumor
cyst--smooth and compressible
| tumor--solid and nodular
151
size of a small cyst is under?
6 cm diameter
152
RF for ectopic preg
```
tubal damage from PID
hx
prior tubal surgery
>35 YO
IUD
subfertility
assisted reproductive techniques
```
153
adnexal, cervical and uterine compression tenderness hallmark of?
PID
154
anal fissures are seen in?
CD
| procitits
155
swollen, thickened fissured perianal skin with excoriations?
Pruritus ani
156
tender purulent reddened mass with fever or chills suggests?
anal abscess
157
induration caused by?
inflammation
scarring
malignancy
158
cyst located in the midline superficial to the coccyx or the lower sacrum
-see an opening of a sinus tract (sometimes with a small tuft of hair surrounded by a halo or erythema)
Pilonidal cyst
159
external or internal hemorrhoids are below the pectinate line
External
160
external or internal hemorrhoids are above the pectinate line
internal
161
painful oval ulceration of the anal canal MC in the midline posteriorly
anal fissue
162
what is an ano-rectal fistual
inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus
163
sessile vs pedunculated polyps
sessile--lie on mucosal surface
| pedunc--stalk
164
prostate gland feels: tender, swollen, boggy and warm
acute bacterial prostatitis
165
spontaneous unilateral bloody discharge from one or two breast ducts
intraductal papilloma
ductal carcinoma in situa
paget disease
166
```
clear
serour
green
black
or nonbloody
discharges all sugest?
```
BENING findings
167
causes for nonpurerperal galactorhhea
hyperT
pituitary prolactinoma
dopamine antagonists (psychotropics and phenothiazines)
