Test 5 Flashcards
(113 cards)
1
Q
menopause defeinition
A
without period for 12 months 45-55yrs of age
2
Q
for females of reproductive age always ask:
A
the first day of their last period
3
Q
bigest pelvic acute concern?
A
ectopic pregnancy
4
Q
ACOG Guidelines for PAPS
A
- Begins at age 21 (regardless of behavior, risk factors, and age of first sex
- 21-29 yr olds - cytology every 3 years no HPV testing
- 30-65 yr old- cytology and HPV testing every 5 years; cytology alone every 3 years; HPV alone not recommended
- After 65 yrs - depends on previous resuts; previous negative; 3 consecutive neg or 2 consecutive co-test= no further testing; continue screening if CIN2, CIN3 or adenocarcinoma; hysterectomy = no further testing if cervix removed and no history of CIN2 or higher; screening continues every 3 years for next 20 years
5
Q
ACOG guidelines do not apply if:
A
- HIV infection
- Immunosuppression
- Exposure to diethylstilbestrol (DES) in utero
- History of cervical cancer
6
Q
HPV vaccine guidelines:
A
- Targets HPV-16 and HPV-18
- 2 most common cancer causing HPV types
- Vaccine does not protect against 30% of cervical cancer caused by HPV types other than 16 and 18
- Nearly 100% protection if women are not exposed to the virus and get the vaccine
- Less level of protection if a woman was already exposed to HPV 16 or 18
- May not see impact of vaccine for 15-20 years, thus still need to screen regularly
- Now given to both sexes
7
Q
Stage 1 Tanner of Penis
A
- 9-13yrs
- trace pubic hair
- small amount of lengthening of the penis and testicles
- infrequent erections
8
Q
Stage 2 Tanner of Penis
A
- 11-13 yrs
- height 3in per year
- hair thickens and darkens
- testicles lengthen
- sac thins and reddened
- body lean
- more infrequent erections
9
Q
Stage 3 Tanner of Penis
A
- 14yrs
- penis continues to grow in length
- testicle sac grows
- hair very prominent
- nipples sensitive
- voice changes/breaks
10
Q
Stage 4 Tanner of Penis
A
- 15 yrs
- height of 4in per year
- testicles lengthens
- penis considerably thickens
- armpit hair begins
- pubic hair fully covered
- acne begins
- voice deepens
11
Q
Stage 5 Tanner of Penis
A
- 16-18yrs
- adolescence complete
- penis and testicle full size
- body growth slowly stops
- pubic hair to inner thighs
- hair chin and cheeks
- muscle development
12
Q
direct hernia
A
- less common
- men>40yr
- rare women
- above inguinal ligament, close to pubic tubercle
- rarely into scrotum
- bulges anteriorly and pushes the side of examiners finger forward
13
Q
Indirect hernia
A
- most common
- both sexes
- often children, maybe adults
- above inguinal ligament near midpoint
- often into scrotum
- comes down inguinal canal and touches fingertip
14
Q
femoral hernia
A
- least common
- more common in women than men
- below inguinal ligament
- more lateral than inguinal hernia
- hard to differentiate from lymph node
- never scrotum
- inguinal canal is empty
15
Q
scrotum drains its lymph into the
A
inguinal nodes
16
Q
penis drains its lymph into the
A
inguinal nodes
17
Q
testes drain its lymph into the
A
abdomen
18
Q
melena color of stool
A
black tarry sticky stool
usually higher GI
GERD, peptic ulcer, gastritis
19
Q
black color of stool
A
non-sticky
iron, licorice, bismuth salts
20
Q
hematochezia color of stool
A
red blood
usually in colon, rectum, or anus
colon cancer, polyps, diverticula, hemorrhoids, anal fissue, inflammatory conditions of the colon and rectum
21
Q
reddish, nonbloody cold of stool=
A
ingestion of certain foods
22
Q
Prostate cancer screening
A
- start age 50
- start at 45 if African American , father or brother with prostate cancer before 65
- if tested: PSA with or without rectal; frequency of testing depends on level
23
Q
PSA Test
A
Biomarker for early detection Limitations Elevated in benign conditions False positives False negatives Unnecessary testing Biopsy Level interpretation Common cutpoint for biopsy is 4.0 ng/ml Over diagnosis Side effects with treatment
24
Q
Digital Rectal Exam
A
Low sensitivity: 59%
Specificity: 94%
Detects tumors on the posterior and lateral aspects
Misses 25-35% of tumors arising in other areas
Abnormal findings need to be investigated
25
Colorectal Cancer Screening
----Average risk
Starting at 50 years both male and female
Annual Fecal occult blood
Multiple stool take home kit
Positive result-colonoscopy
Sigmoidoscopy every 5 years with fecal occult blood every 3 years
Screening colonoscopy every 10 years
Another option: double contrast barium enema or computed tomography colonography every 5 years
----Increased risk
Inflammatory bowel disease or family history of an inherited polyposis syndrome
Colonoscopy every 3-5 years
26
Prostatitis Acute
```
Presents fever, UTI and low back pain
Gland
Tender, swollen, “boggy” & warm
E coli
Under 35 STI
```
27
Prostatitis chronic
```
Recurrent UTI
Asymptomatic of dysuria, mild back pain
Gland
Normal
E coli
```
28
Benign Prostatic Hyperplasia
```
Nonmalignant
50% of 50 year olds
Urgency, frequency, nocturia, decrease stream, incomplete emptying
Gland
Normal or symmetrically enlarged
```
29
Prostate Cancer
Gland
Hardness
Irregular
Obscured median sulcus
30
Anal fissure
Painful
Location
Most are midline posteriorly
Swollen sentinel skin tag
31
Polyps
Fairly common
Variable size and number
Pedunculated or sessile
Soft and difficult to feel
32
Anorectal Fistula
Inflammatory tract
Opens into rectum or anus and skin or viscus
Usually caused by abscess
33
Hemorrhoids internal prolapsed
```
Enlargement of vascular cushions
Above pectinate line
Not palpable
Bright red bleeding
Prolapse
Reddish moist
```
34
Hemorrhoids external thrombosed
Dilated veins
Below pectinate line
Usually asymptomatic unless thrombosed
Tender, blue, swollen and ovoid
35
Apendages of the skin
```
Hair
Nails
Sebaceous glands
Eccrine sweat glands
Apocrine sweat glands
```
36
hair types:
- Vellus – short, fine, inconspicuous and relatively unpigmented
- Terminal hair - coarser, thicker, more conspicuous, and usually pigmented examples would be scalp hair and eyebrows
37
nails:
- p33 in lab manual
- Nail plate
- Nail bed
- Cuticle
- Nail root
- Nail plate
- Lunula
- Proximal nail fold
38
Sebaceous glands
- Secrete sebum – a lipid rich substance that keeps the skin and hair from drying out
- Largest sebaceous glands are found on the face and upper back
- Absent from soles and palms
- Production of sebum is dependent on gland size , which is directly influenced by androgen secretion
39
Eccrine sweat glands
- Open directly on the surface of the skin
- Help to regulate body temperature through water secretion
- Located mainly in the axillae, forehead, palms and soles
- Absent in the nail beds and some mucosal surfaces i.e. lip margins
40
Apocrine glands
- Larger and deeper than eccrine glands
- Specialized structures – axillae, nipples, areolae, anogenital area, eyelids, and external ears
- Reach maturity only at puberty
- Secretion can increase in times of stress
- Odorless
- Bacterial decomposition of apocrine sweat produces body odor
41
‘ABCDEs’ Early recognition of possible Melanoma
A – for Asymmetry of one side compared to the other
B – irregular Borders, ragged, notched, or blurred
C – variation in color – esp. blue and black mixed
D – for Diameter > 6 mm
E – for Evolution or change in size, symptoms, or morphology
42
‘HARMM’ Melanoma Risk Model
- History of previous melanoma
- Age over 50
- Regular dermatologist absent
- Mole changing
- Male gender
43
Risk factors for Basal & Squamous Cancer
- Age - > 50
- Chronic exposure to sunlight, UVA & UVB
- Fair, freckled, ruddy complexion
- Light colored hair and eyes
- Sunburn easily
- Childhood blistering burns
- Geographic – equator or high altitudes
- Repeated trauma or irritation
- Exposure to harmful chemicals
44
Normal mole*
- Uniformly tan or brown
- All look alike
- Round or oval
- Clear defined borders
- Flat or smooth
- Less than 6 mm
- Typical adult 10-40
- Waist, scalp, breast, sun exposed areas
45
Dysplastic mole*
- Varied appearance
- Irregular borders, notches
- Fades in surrounding skin
- Smooth, scaly, rough, irregular
- Greater than 6 mm
- Anywhere often on back, below waist, scalp, breast, buttocks
46
Schamroth’s Sign
- clubbing – nail base angle < 180
| - Associated with Cardiovascular, respiratory diseases as well as inflammatory bowel disease, cirrhosis
47
common causes of bounding pulses (with lower extremities?)?
```
F - Fever
A- Aortic insufficiency
C - Complete heart block
T - Thyrotoxicosis
S - Systolic hypertension
```
48
bounding pulses caused by and associated with?
associated with wide pulse pressure where the difference bw diastolic and systolic pressure is greater than 60mmHg
49
delay associated with pulses of capillary refill of toes... 2 potentials?
vasospasm or structural changes to the large vessels
50
pitting edemas caused by:
heart failure (protein rich edema)press firmly for 5sec and if indent remains for 5sec its piting edema
51
non-pitting edema caused by
lack of protein in exudate - kidney or liver problem
52
pitting edema grading:
1+ 2mm
2+ 4mm
3+ 6mm
4+ 8mm
53
macule definition
primary lesion non palpable skin change <.5cm
54
patch definition
primary lesion non palpable skin change >.5cm
55
papule definition
primary lesion palpable solid <.5cm
56
nodule definition
primary lesion palpable solid .5-1cm
57
tumor definition
primary lesion palpable solid >1cm
58
plaque definition
primary lesion palpable solid >.5cm flat, elevated surface formed by coalescence of papules
59
vesicle definition
primary lesion clear fluid filled <.5cm
60
bulla definition
primary lesion clear fluid filled >.5cm
61
pustule definition
primary lesion cloudy pus filled <.5cm
62
abscess definition
primary lesion cloudy pus filled >.5cm
63
secondary lesion:
- either the result of progressive changes in the primary lesion or are caused by external causes
- Type: Erosion, crust, scale, fissure, ulcer, lichenification, atrophy, excoriation, scar, keloid
64
verruca
secondary skin lesion
red and black dots in white lesion
-wipe alchol on it and it will vasodialate
65
in-grown toe nail
pustule or abcess
66
thickened nails are not always...
FUNGAL! Sometimes just thick toe nails
67
distinguish thick toe nails:
```
(TOE CLYPT)
T: trauma
O: onychmycosis
E: eczema
C: circulatory problems
L: lichen planus
Y: yellow nail syndrome
P: psoriasis
T: tumor
```
68
dry skin due to:
- Insufficient number of sweat glands or autonomic dysfunction (diabetes)
- Tinea pedis
- Psoriasis
- Eczema
69
ulceration due to
- break down and loss of dermis and epidermis
- due to vascular disease and or anesthetic neuropathy
- poor blood supply or completely numb
- if the ulcer is red itll probably heal as long as you take the pressure up
70
charcot foot
usually in diabetics where bones in foot loose shape
71
Spinothalamic tract
- small fibers
- sharp and dull pain (nociceptive)
- temperature
- crude touch - complaint of burning or cramping
72
posterior colum
- large fibers
- position
- vibration
- fine touch - complaint of pins and needles or electric shock
73
Touch simuli: testing
- Represents a measure of low threshold mechanoreception
- abnormality indicates small fiber disease
- Using a 5.07 Semmes-Weinstein monofilament (10 gms of pressure), apply pressure to the 1st, 3rd, & 5th, metatarsal heads, the 1st, 3rd, & 5th toes, the plantar arch, the plantar heel, beneath the 5th metabase and the dorsal midfoot
- Normal is detecting filament in at least 7/10 areas. The inability to detect the pressure in more than 3 areas suggests the potential for neurotrophic ulceration
74
Vibration testing:
- use a 128 cycles/sec tuning fork over the IPJ of the hallux
- ask the patient to tell you when it stops vibrating
- -->if vibration sense decreased, proceed more proximally until vibration felt
- loss of vibration in < 10 seconds is abnormal at any age
- indicates large fiber disease
- done over IP joint just behind nail
75
Sharp stimuli testing
- Ask the patient to close his eyes. Break a Q-tip in half and use each end to touch the skin
- Ask a three-part question: “Which is sharper, the first touch, the second touch, or are both the same?”
- Inability to detect sharp from dull supports the diagnosis of a small fiber disease
76
temperature testing
- Omit if pain sensation is normal
- Touch the skin with hot and cold water test tubes
- Lack of temperature sensation suggests small fiber disease
77
Position sense (proprioception): testing
- Passively move the great toe up and down by grasping along the sides of the interphalangeal joint only a few mms. and ask patient which direction you are moving the toe (PT EYES CLOSED)
- Reduced perception (including falsely perceived motion) indicates large-fiber disease
78
Small fiber disease list
- Semmes-Weinstein monofilament
- Sharp-dull
- Temperature
79
Large fiber disease
- Vibration
| - Proprioception
80
tendon reflex tests the
SENSORY REFLEX
81
stroke patients have what kind of tendow relfex test?
Hpyerreflexive (4/4)
82
polio patients have what kind of reflex?
hyporeflexive 0/4
83
Deep reflexes
- Deep reflexes: Often have to use reinforcement (Jendrassie maneuver) to facilitate observation of reflexes in the lower extremity
- Knee reflex: innervated by L 2, 3, 4
- Ankle reflex: innervated by S 1, 2
84
Knee reflex indicates issue with
L2,3,4
85
Jendrassie maneuver
having patient pull hands apart so that brain stops thinking about the reflex you are tryin to perform
86
ANkle reflex indicates issue with
S1 and 2
87
Superficial reflex or plantar response (L4, L5, S1, S2)
- Elicited by stroking the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball
- Toes normally plantarflex
- If there is dorsiflexion of the great toe and fanning of the other toes, it indicates upper motor neuron disease **(Babinski response)**
88
All-in-one test
- Hop-in-place with each foot
- Ability to do this indicates:
- intact motor system in the legs
- normal cerebellar function
- good position sense.
89
peripheral neuropathy is suggested by:
patient is able to stand on tiptoes but not on heels
90
spinal lesion is suggested by
patient is able to stand on heels but not on tiptoes
91
how to check for disorders of the autonomous nervous system
- Pulse rate changes with deep breathing: With normal vagal nerve input to the heart, the pulse rate at rest will increase with inspiration and decrease with expiration
- Orthostatic dizziness and changes in blood pressure: A drop of > 30 mm Hg systolic and > 15 mm Hg diastolic recorded 60 to 90 seconds after standing following 5 minutes of supine rest
92
premature infant range
27-36 weeks
93
most accurate way to determine gestational age:
use last menstrual period
94
tool used to estimate gentational age?
Ballard Score - done within first 24 hrs of life based on how the kid looks.
95
baby head growth after birth?
1cm/mo for first year
96
fontanel closure ant/post
posterior first at 6-9mo and ant bw 18 and 24 mo
97
most reliable indicator of infants nutritional status?
weight
98
Moro reflex
- Abrupt removal of support of infant’s head in a supine position results in extension and abduction of the upper extremities only.
- This reflex is lost at around 5 months
99
Sucking reflex
-A fingertip introduced into an infant’s mouth will trigger simultaneous movement of the tongue and pharynx to allow for milk to be squeezed out of a nipple and propelled toward the esophagus.
100
Grasp reflex
- As pressure from a finger is made against the palm of a baby, the fingers curl around the other person’s finger
- Disappearance by 4-6mo of age
101
Rooting reflex
- When the cheek is lightly touched, the infant turns his head toward the stimulus and purses his lips
- Disappearance by 4-6mo of age
102
Stepping or Placing reflex
- When the newborn is supported vertically and the plantar surfaces of the feet are placed on a flat surface, the legs extended and partially support the infant.
- If the infant is then lightly propelled, he makes walking movements with good coordination and relatively steady positioning of the feet in a “stepping movement”.
- This reaction persists for about six weeks
103
Tonic neck reflex
- With the infant supine, turning of the head results in ipsilateral extension of the arm and leg in a “fencing” posture
- Disappearance by 4-6mo of age
104
Parachute reflex
- With the infant sitting, tilting to either side results in extension of the ipsilateral arm in a protective fashion
- Appears at 6-8 months of age
- Persists throughout life
105
The AP diameter to lateral diameter ratio during the first three years of life?
DECREASES
| -RIB CAGE IS MORE CIRCULAR THAN ADULT
106
birth RR:
40-60 per min
107
1-6 mo RR
20-50 per min
108
60mo to 2 yrs RR
20-40 per min
109
3 years RR
20-30 per min
110
6 year RR
16-22 per min
111
adolescent RR
12-20 per min
112
physical exam on respiration note
RATE AND EFFORT!
113
most common palpable mass in an infant=
enlarged kidney
