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PCM > Physical Exam of Abd/ Motivational Interviewing/Male GU Exam > Flashcards

Physical Exam of Abd/ Motivational Interviewing/Male GU Exam Flashcards

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1
Q

Dysphagia

A

Trouble swallowing

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2
Q

Hematemesis

A

Vomiting blood

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3
Q

Melana

A

Black stool

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4
Q

Visceral Pain

A

Colic pain - hollow organ caused by distention or stretching, crescendo/decrescendo pattern, not well localized

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5
Q

Parietal Pain

A

Caused by inflammation of the peritoneum, steady aching pain that is usually well localized

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6
Q

Referred Pain

A 
From a distant site:
Gallbladder: Right Shoulder 
Spleen: Left Shoulder 
Pancreas or Aorta: Back 
Kidney: Loin to groin
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7
Q

Components and order of the abdominal exam

A

Inspection, auscultation, percussion, palpation, rectal exam, special techniques

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8
Q

How far should you expose in the abd exam?

A

Form xiphoid to pubis

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9
Q

Where is the best place to auscultate the abd?

A

RLQ - best place to listen to cecum

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10
Q

What are normal bowel sounds?

A

High pitched tinkle

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11
Q

When do you report absent bowel sounds?

A

After no sounds for 2 min

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12
Q

Borborygmi

A

Increased hyperactive bowel sounds, low pitched rumbling, hyperperistalisis

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13
Q

Abdominal bruits and locations

A 
Soft sound made by disrupted arterial flow through a narrowed artery "hissing sound"
Aortic: btw umbilicus and xiphoid
Renal a.: Lateral to aorta 
Iliac: lateral to umbilicus 
Femoral a.: along inguinal ligament
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14
Q

Percussion evaluates the presence of

A

Gaseous distention, fluid, solid masses, size and location of liver and spleen

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15
Q

Tympany

A

Most common, indicates presence of gas in the stomach and small bowel

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16
Q

Liver Percussion

A

Right mid clavicular line - resonant (lungs) to dull (liver) to tympanic (intestine)

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17
Q

Normal/Abnormal Liver Size

A

Normal 10cm

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18
Q

Fluid wave and shifting dullness indicates

A

ascites

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19
Q

Describe fluid wave

A

Assistants hands placed midline - tap on one flank while palpating the other, easily palpable impulse suggests ascites

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20
Q

Describe shifting dullness

A

Percuss pt abd on their back and then on their side - note where the sound changes form tympany to dull and the shift of the sound when the pt turns on their side (organs move to top and fluid shifts to bottom)

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21
Q

Light palpation

A

Looks for tenderness and areas of muscular spasm or rigidity - use finger tips with gentle motion

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22
Q

Deep palpation

A

Evaluates organ size, abnormal masses, aorta, deep pain - one hand on the other

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23
Q

Rebound tenderness

A

Evaluates for peritoneal tenderness and inflammation - slowly gently and deeply palpate, if there is pain test is +, includes rovings sign

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24
Q

Roving’s sign

A

Referred rebound tenderness, press on the LLQ and release, positive if pain in the RLQ

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25
Is the spleen palpated under normal conditions?
No
26
Palpation of Aorta - Normal Size
Normal aorta 2.5-3 cm wide
27
Aortic aneurysm
Pathologic dilation, can be associated with bruit, assessed with ultrasound and CT
28
Percussion of kidney - Lloyds Sign
At level TV12 - gently hit over costovertebral angle on either side of the spine - pain over the kidney indicates inflammatory or infectious process
29
What if a pt FOBT is +?
Requires thorough evaluation for colorectal cancer (CRC). Preferable colonoscopy but sigmoidoscopy and air contrast barium enema are also acceptable
30
Obturator sign
Place right leg in figure 4 - press the right knee while holding down the left hip
31
What signs will be positive in appendicitis?
Rovings, Psoas, and Obturator
32
What imaging test is most sensitive to appendicitis?
CT scan - 90-98% sensitive
33
If you expect appendicitis in a female pt what MUST you do?
Perform a pregnancy test
34
Acute cholecystitis
Obstruction of the cystic duct usually by a gallstone, sometimes a neoplasm
35
What symptoms are indicative of acute cholecystitis? What sign is +?
Biliary colic pain, pain radiation to right shoulder Fat, female, fertile, fair flatulent Murphys sign
36
What is the diagnostic triad for acute cholecystisis?
RUQ pain, fever and leukocytosis
37
What is Murphys sign?
RUQ pain, sudden arrest of inspiration during palpation of the liver and GB
38
What will lab tests of an acute cholecystisis pt reveal?
Leukocytosis with left shift, serum bilirubin may be mildly elevated, AST/ALT can be elevated, Ultrasound detects stones, thickening of GB wall, dilated bile duct and fluid, HIDA scan (radionuclide biliary scan)
39
Role of Expert
Provide information in a manner pt can hear without feeling offensive, validates all perspectives, costs and benefits, then allows pt to make decision for themselves
40
Why do people change behavior?
Because they decide it is what they want to do - benefits outweigh the costs
41
What are the six stages of change?
Precotemplation, contemplation, preparation, action, maintenance, relapse
42
Describe precontemplation
Pt not thinking about change, may be resigned to behavior, may have tried to change in the past but failed so gives up, denial, believes the consequences aren't serious
43
Describe contemplation
Pt weighing cost/benefits, ambivalence about change, giving up something enjoyable makes them feel a loss, barriers and benefits, I know I need to but
44
Describe preparation
Experimenting with small change, prepare to make specific change, small dietary changes, brand of cigarettes, decrease in drinking
45
Describe action
Taking definitive action, much praise necessary to maintain
46
Describe maintenance
Maintaining over time, ongoing support and encouragement, continued appreciation of gains
47
Describe relapse
Normal part of the process of change, pt usually feels demoralized, not starting back at zero, recognized continued attempts to try not focus on the sense of failure
48
Define motivational interviewing
Directive, client centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence
49
General principles of motivational interviewing
Express empathy - pt feels heard and validated, less defensive Support self-efficacy - pt is in control of their lives Roll with resistance Develop discrepancy - change occurs when a pt wants to be someplace other than where they are
50
Name 5 behaviors inclusive in motivational interviewing
Seeking to understand the persons frame of reference Expressing affirmation and acceptance Exploring without prejudice pt options Monitoring the pt readiness to change Affirming the clients freedom of choice and self direction
51
Is direct persuasion an effective method for resolving ambivalence?
No
52
T/F Readiness to change is not a patient trait but a fluctuating product of interpersonal interaction
True
53
Name and describe the 3 columns of vascular erectile tissue
Corpus spongiosum - contains the urethra | Corpora cavernoas - two bilateral
54
tunica vaginalis
serous membrane covering the testes
55
vas deferens
cordlike tube, transports sperm from epididymis to urethra
56
Spermatic cord
Contains vas deferens, blood vessels, nerves, and muscle fibers
57
Prostate lobe has how many lobes and where is prostate cancer most common?
5 lobes - anterior, posterior, middle and two later | Most common in posterior lobe
58
Indirect hernia
Most common in men and women Above the inguinal ligament Often into the scrotum
59
Direct hernia
Less common, usually in men, rare in women Above the inguinal ligament Rarely into the scrotum
60
Femoral hernia
Least common but more common in men than women Below inguinal ligament Never into scrotum
61
Components of the Male GU Exam
Penis, scrotum, hernias, prostate and special techniques
62
Inspection of Penis involves
Skin, hair, foreskin, glans (tip) and meatus - compression of glans to check for discharge
63
Describe the prostate gland
Bi-lobed, heart shaped, constancy of your nose, about the size of a walnut, inferior aspect of the posterior lobe is best palpated on a DRE
64
Hypospadias
Congenital displacement of the urethral meatus on the inferior surface of the penis along the urethral groove - important in new born exam - also associate with congenital renal abnormalities
65
Phimosis
Foreskin can't retract over the penis, very painful in erection, hygiene issues - circumcise
66
Paraphimosis
Foreskin cannot be retracted back over the glans - circumcise
67
Hydrocele
Fluid filled mass within the tunica vaginalis - transilluminates with light
68
Cryptorchidism
Undescended testicle, usually atrophies, increased risk for cancer

PCM (4 decks)

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