Male/ Female GU

Question 1

uterine prolpase

Answer 1

First degree:The cervix droops into the vagina.

Second degree:The cervix comes down to the opening of the vagina.

Third degree:The cervix is outside the vagina.

Fourth degree:The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

Question 2

procidentia

Answer 2

4th degree uterine prolapse

The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

Question 3

insertion of speculum

Answer 3

45 degree angle

Question 4

nabothian cysts

Answer 4

Inclusion cyst of the endocervical glands
May resemble cervical pathology
Normal variant

Question 5

transformation zone

Answer 5

Under the influence of estrogen, the columnar epithelium will convert into squamous epithelium (METEPLASIA). This is where cellular abnormalities occur and cervical cancer can arise.

Question 6

Version

Answer 6

Version is the relationship between the fundus of the uterus and the vagina

*** retroversion: means that uterus is tipped back towards the sacrum (posterior to vagina)

Question 7

flexion

Answer 7

Flexion is the relationship between the fundus of the uterus and the cervix

Question 8

hernias in women?

Answer 8

Indirect hernia is the most common inguinal hernia in women.

Femoral hernia is more common in women than in men

Question 9

what lines breast lactifeous sinus? vs. major ducts?

Answer 9

stratified squamous epithelium

major ducts: lined with single layer of columnar or cuboidal cells

Question 10

where does the breast extend?

Answer 10

• breast extends from the level of the second or third rib to the inframammary fold at the sixth or seventh rib.

It extends transversely from the lateral border of the sternum to the anterior axillary line.

The deep or posterior surface of the breast rests on the fascia of the pectoralis major, serratus anterior, and external oblique abdominal muscles, and the upper extent of the rectus sheath.

The axillary tail of Spence extends laterally across the anterior axillary fold. The upper outer quadrant of the breast contains a greater volume of tissue than do the other quadrants.

Question 11

arterial supply of breast

Answer 11

principal supply:

(1) perforating branches of the internal mammary artery;
(2) lateral branches of the posterior intercostal arteries;
(3) branches from the axillary artery

also:
- medial mammary arteries
- lateral mammary branches (pecs major)

Question 12

when is the optimal time to examine breast?

Answer 12

5-7 days following the LMP - breast is at its smallest

Question 13

positions for breast inspection

Answer 13

arms at sides, arms over head, hands against hips and leaning forward

Following inspection in the seated position with the arms at the sides, inspect the breast in four additional positions:
Arms over head
Hands against hips
Palms pressed together)
Arms extended and bent forward at the waist

Question 14

highest risk other than previous breast cancer?

Answer 14

family hx of cancer

presentation: 
90% present with a lump 
20% as a painful lump 
10% with nipple changes 
3% with nipple discharge 
5% with skin contour changes. 
Breast pain/mastalgia alone is a very uncommon presentation of breast cancer

Question 15

breast cancer staging?

Answer 15

stage 1: 5cm
- inflamm. breast cancer - 50% 5 year

stage 4 = distant mets

Question 16

balantitis

Answer 16

inflammation of the glans

Question 17

hypospadias

Answer 17

opening of urethral meatus is on underside of penis

Question 18

epispadius

Answer 18

opening of urethral meatus is on upper aspect of penis

Question 19

phimosis

Answer 19

inability to retract foreskin over glans

Question 20

paraphimsosi

Answer 20

inability to pull foreskin back to normal position over the glans

Question 21

age of peak onset of testicular cancer?

Answer 21

20 y/o

• transilluminate any scrotal masses: Hydrocele and sometimes epididymal cyst allow light passage, other scrotal masses do not.

Question 22

hydrocele

Answer 22

Non tender

Mass is contained within the scrotum (fingers can get above the mass)

Can be transilluminated

May be present at birth or in pediatric population

• remnant of hernia sac that closes and fills with water

Question 23

inguinal hernia

Answer 23

Non tender

Mass extends into the inguinal canal

Usually unilateral

May or may not be able to transilluminate

May be present at birth or in pediatric population

Question 24

epididymitis

Answer 24

very tender, gradual onset

Exquisitely tender

May be history of dysuria

Very difficult to distinguish from orchitis

Does not transilluminate

Gradual onset

Question 25

orchitis

Answer 25

Presentation and physical findings identical to epididymitis

very tender, gradual onset

Exquisitely tender

May be history of dysuria

Very difficult to distinguish from orchitis

Does not transilluminate

Gradual onset

Question 26

testicular torsion

Answer 26

Usually early to mid teens (10-16)

Abrupt onset

Very severe pain

Affected testicle is usually elevated in scrotum

Rapid diagnosis is essential-testis will undergo necrosis within a few hours (have 4 hour window to fix it)

Question 27

varicocele

Answer 27

Painless
Very gradual onset
Feels like a “bag of worms” on palpation
Does not transilluminate
May be bilateral

Question 28

testicular cancer

Answer 28

Painless
Gradual onset
Testicle may feel very hard and enlarged
Does not transilluminate

Question 29

inguinal hernia inspection

Answer 29

Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening

Inspect the inguinal canal and the femoral triangle for bulging

Have the patient perform a valsalva maneuver (Having the patient bear down is better than having them cough

Unless the hernia is quite large, it is unlikely that you will detect it on inspection

Question 30

indirect inguinal hernia

Answer 30

The hernia sac exits through the internal inguinal ring

May pass with the cord toward and sometimes into the scrotum

Most common

Seen in newborns as a congenital defect

lateral to the inferior epigastric artery

Question 31

direct inguinal hernia

Answer 31

The hernia sac exits through a tear in the floor of the canal (Transversalis fascia)

May pass with cord toward and sometimes into the scrotum

Generally caused straining

lie medial to the inferior epigastric artery

Question 32

femoral hernia

Answer 32

The hernia sac exits inferior to the inguinal ligament and into the femoral triangle

More common in women than men but not the most common hernia in women

Question 33

external hemorrhoids

Answer 33

May account for rectal bleeding

Sensory innervated so thrombosis causes exquisite pain

varicosities – seen in pts. w/ liver disease and with esophgeal disease

bleeding is most common c/o external hemorrhoids

if find external hemorrhoids don’t stop there – need to also check for colon cancer

Question 34

internal hemorrhoids

Answer 34

Bleed more often than external and may bleed more profusely

No sensory nerve endings so they are painless

seen via colposcopy

Question 35

anal fissure

Answer 35

Tear in the anal mucosa

Very painful

Common in people who are chronically constipated and strain moving bowels

Question 36

anorectal fistula

Answer 36

An abnormal tract between the rectum and the perianal region

Almost always caused by an abscess such as those found in Crohn’s disease

Question 37

anal secondary syphilis

Answer 37

Can assume a variety of appearances but there is usually overgrowth of tissue in a chancrous shape

Painless and usually asymptomatic

Question 38

anal cancer

Answer 38

Squamous cell

Generally painless until the surface becomes ulcerated

Usually presents with bleeding so it is often ignored in people with hemmorrhoids

Question 39

palpation of rectum/ prostate

Answer 39

Ask the patient to bear down or take a deep breath to relax the external sphincter

As the patient exhales, wait for the sphincter to relax and slowly advance the finger into the rectum

Direct your finger anteriorly

• normal size of prostate: 4cm diameter, prodtrudes 1cm into rectum
• if larger worry of BPH
  Rubbery-Benign prostatic hypertrophy
• Fluctuant or Tender-Prostatitis
• Rigidity- Carcinoma