question

What is the number one risk factor for breast cancer?

answer

Age

question

HPV Vaccination

answer

Males age 11-12 thru 21 y/o. HPV responsible for genital warts, anal cancer, penile cancer, HPV in women

question

Know different types of breast masses (4 types)

answer

Fibroadenoma -smooth, rubbery, round, mobile, nontender Cyst - soft to firm, round, mobile, tender Fibrocystic changes - nodular, ropelike Cancer - irregular, firm, mobile OR fixed to surrounding tissue

question

What are the recommendations for breast self exam?

answer

USPSTF recommends against self breast examination

question

Know the tail of Spence

answer

female breast is divided into 4 quadrants based on horizontal and vertical line passing thru the nipple; 5th area above upper outer quadrant is tail of spence

question

What are the different shapes, sizes, types of speculum?

answer

Plastic or metal, small, med, or large Pedersen is flat and narrow Graves is wider and curved

question

Which speculum is used for sexually active women that are nonparous?

answer

Medium pedersen is most comfortable

question

Which speculum is used for small introitus (virgen or elderly)?

answer

Narrow bladed Pedersen

question

Which speculum is used for parous women or women with vaginal prolapses?

answer

Graves speculum

question

What are the symptoms of STI? Which STI lacks symptoms?

answer

-Chlamydia: often asymptomatic or subtle in females; white penile discharge -Gonorrhea: yellow penile discharge; rash -Syphilis: penile ulcers(chancre) -Herpes: genital ulcers; cold sores

question

Inguinal hernias

answer

-Inspect both sides of groin to compare; -Palpate anterior inferior margin of scrotum, more upward toward external ring, invaginating scrotal skin behind peripubic fat; Follow spermaticord up toward inginal ligament, hook laterally to internal interior ring, ask pt to cough, palpate for mass as it moves against tip of index finger

question

Scrotal Hernia

answer

will be mass into scrotum (large, painful, or pulsatile)

question

Femoral hernia

answer

place fingers on anterior thigh in region of femoral canal, ask pt to cough or strain, note swelling/tenderness

question

Breast self exam advice

answer

BSE is best timed 5-7 days after menses, when hormonal stimulation of breast tissue is low

question

How to perform female breast exam? (proper techniques)

answer

-Systemic up-and-down search pattern, varying palpation pressure and a circular motion with the fingerpads; Best time to check 5-7 days after menstrual period -Inspection: fully expose chest looking for skin changes, symmetry, contours, retraction. -4 views to use (arm at side - skin, size and symmetry, contour, nipple; arms overhead - bringing out dimpling or retraction; hands on hips; leaning forward) PALPATION - patient should be supine, palpate from clavicle to bra line, mid-sternum to posterior axillary line and then the tail of spence. Pads of hands, vertical strip pattern, take your time (3min/breast), small concentric circles applying light, medium, and deep pressure at each point. Lateral examination, patient places same side hand over head. BREAST TISSUE - consistency varies, notably at lower ridge, irregular but symmetry, note NODULES location, size, shape, consistency, circumscribed, tenderness, mobility. NIPPLE - palpate & compress areola, note discharge (color, consistency, quantity of discharge).

question

Male breast exam

answer

Inspection - nipple and areola Palpation - areola and breast tissue for nodules, not in fatty deposition or normal disc or enlarged > 2 cm Examine in sitting position (preferred) or supine Repeat left and right. Abnormal is > 2 cm matted together, fixed, firm/hard

question

Mammography recommendations (USPSTF)

answer

50-74 y/os biennially (every 2 years); 75 y/os, insufficient evidence to recommend

question

Mammography recommendations (American Cancer Society)

answer

40-45 y/o-optional annual screening; 45-54 y/o-annual screening; >/= 55 y/o-biennial screening; continue screening if good health and life expectancy is >/= 10 y/o's

question

Mammography recommendations (American College of Obstetricians and Gynecologists)

answer

;/= 40 y/o-annually

question

USPSTF Recommendations for Chlamydia screening

answer

young women under 24 y/o

question

USPSTF Grade A Recommendation for screening for HIV

answer

Screen 15-65 y/o and pregnant women

question

American Cancer Society Recommendation for Testicular Cancer

answer

Recommend this should be a part of the general physical exam; No recommendation for self exam

question

Assessing possible peritonitis

answer

Positive cough test, guarding, rigidity, rebound tenderness, and percussion tenderness. Start with one finger then hand -Rovsings sign!

question

Right lymphatic duct

answer

drains fluid from right side of head, neck, thorax, and right upper limb into R internal jugular and right subclavian veins

question

Thoracic duct

answer

collects from rest of body and empties into the junction of left internal jugular and left subclavian veins. All filtered thru interspersed LN's

question

Guidelines for Colorectal screening; USPSTF recommendation

answer

Guidelines recommend against screening with fecal occult blood testing following a digital rectal exam until age 75 y/o; USPSTF: screening for persons 50-75 y/o. Several methods DCBE (double contrast barium enema), CT screening

question

Cervical cancer screening guidelines

answer

Start at age 21, do about every 3 years, stop at age 65

question

Classification of Pap smear cytology: Bethesda System

answer

-Epithelial cell abnormalities: precancerous and cancerous lesions such as: squamous cells, including atypical squamous cells (ACS), which may be of undetermined significance (ACS-US); Low-grade squamous intraepithelial lesions (LSIL), including mild dysplasia; high-grade squamous intraepithelial lesions (HSIL), including moderate/severe dysplasia with features suspicious for invasion; and invasive squamous cell carcinoma -Grandular cells: including atypical endocervical cells or atypical endometrial cells, specified or not otherwise specified (NOS); atypical endocervical cells or atypical grandular cells, favor neoplasia; endocervical adenocarcinoma in situ; and adenocarcinoma

question

Ovarian Cancer: RFs and Screening

answer

5th leading cause of cancer-related death for women 2/3's of women affected ; 55y/o Most diagnosed late - metastatic disease No effective screening tests 3 symptoms merit attention - Abdominal distention, abdominal bloating, urinary frequency. Problematic due to similar sx's for other dz USPSTF recommend against screening RF = family hx and presence of BRCA1 & BRCA2 gene mutation, first degree relative with breast or ovarian CA, obesity, nulliparity, HRT

question

USPSTF recommendation on STI counseling

answer

Recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STI

question

Where is the pap smear collected from?

answer

Squamocolumnar junction of cervix

question

Dysphagia

answer

difficulty swallowing

question

Odynophagia

answer

painful swallowing

question

Visceral pain

answer

occurs in hollow abdominal organs, or when solid organ capsules stretched, can be difficult to localize. Ischemia also stimulates fibers. Gnawing, burning, cramping, or aching. May cause systemic response-sweating/pallor/nausea/vomiting

question

Parietal pain

answer

originates from parietal peritoneum-peritonitis. Steady, aching, more severe than Visceral, localized over structure, aggravated by movement, coughing. Want to stay still

question

Colorectal cancer

answer

3rd leading cause of death; Lifetime risk 5%

question

Colorectal cancer RFs

answer

age, adenomatous polyps, FHx, chronic inflammatory disease, red meat, tobacco use, excessive EtOH, obesity

question

Referred pain

answer

pain felt in a part of the body other than its actual source

question

Which hepatitis is worse? Why?

answer

Hepatitis C; No immunizations and can lead to liver cancer

question

Addictions

answer

increasingly viewed as chronic relapsing behavioral disorders with substance induced alterations of brain neurotransmitters resulting in tolerance, physical dependence, sensitization, craving, and relapse

question

Urinary tract symptoms

answer

difficulty urinating, frequency, nocturia, urine volume/odor/color, dysuria, leaking or loss, strength or stream, straining, hesitation

question

Lithotomy position

answer

Drape pt appropriately and then assist her into the lithotomy position; Place one heel then another in the stirrups; Ask her to slide all the way down the examining table until her buttocks extends slightly beyond the edge; -Urethra is anterior to vagina which is anterior to rectum

question

Know terms gravida and para; Ex)G2F1L1A1

answer

Gravida=total number of pregnancies; Para=outcomes of pregnancies (full term, premature, abortion, living) Ex) G2F1L1A1=2 pregnancies, 1 full term and living, 1 abortion

question

Testicular Self-Examination (TSE) recommendations (USPSTF and ACS)

answer

USPSTF and American Cancer Society have not recommended routine TSE

question

Male genitalia examination: Best way to palpate

answer

Btwn thumb and fingers, note induration or tenderness

question

What age group of men are at most risk for testicular cancer?

answer

Men 15-34 y/o

question

What organs are in Right Upper Quadrant (RUQ)?

answer

Liver, gallbladder, pylorus of stomach, duodenum, hepatic flexure of colon, and head of pancreas

question

What organs are in Left Upper Quadrant (LUQ)?

answer

Spleen, splenic flexure of colon, stomach, body and tail of pancreas, and transverse colon

question

What organs are in LLQ?

answer

Sigmoid colon, descending colon, left ovary

question

What organs are in RLQ?

answer

Cecum, appendix, ascending colon, right ovary

question

Common or Concerning symptoms: Cardiac

answer

CP, palpitations, SOB, orthopnea(worse when supine), postural nocturnal dyspnea(sudden orthopnea while sleeping), edema, syncope -(always ask pt baseline activity/exercise)

question

Know S1 and S2 sounds; How to palpate?

answer

S1 is btwn diastole and systole (AV valves close); can feel on carotid artery during upstroke S2 is btwn systole and diastole (SL valves close)

question

Pansystolic/Holosystolic murmur

answer

Starts with S1 and stops at S2 w/o a gap

question

Midsystolic murmur

answer

Begin after S1 and stops before S2, brief gaps are audible btwn the murmur and heart sound

question

Late systolic murmur

answer

usually starts mid or late systole and persists up to S2

question

Early diastolic murmur

answer

starts immediately after S2 w/o a gap, then fades into silence before S1

question

Mid Diastolic murmur

answer

starts a short time after S2, may fade away or merge into late diastolic murmur

question

Continuous murmur

answer

Some congenital and clinical conditions produce continuous murmur

question

Crescendo, Decrescendo, Crescendo decrescendo, plateau murmurs

answer

C: grows louder D: grows softer CD:rise and fall Plateau:same intensity thruout

question

In male breast exam, what is most concerning?

answer

Asymmetry

question

Breast cancer prevelance in women

answer

Breast cancer in up to 11% of women; 1-8 women; 80% of cases occur after 50 y/o; leading cause of cancer death in women

question

Modifable RFs for Breast Cancer

answer

breastfeeding < 1 yr., postmenopausal obesity, use of HRT, cigarette smoking, alcohol ingestion, physical inactivity, contraception type.

question

Grading of murmurs

answer

Grade 1 - very faint, heard only after listener has "tuned in"; may not be heard in all positions Grade 2 - quiet, but heard immediately after placing the stethoscope on the chest Grade 3 - moderately loud Grade 4 - loud, with palpable thrill Grade 5 - Very loud, with thrill. May be heard with the stethoscope is partly off the chest Grade 6 - very loud, with thrill. May be heard with stethoscope entirely off the chest

question

Where to auscultate aortic, pulmonic, tricuspid, mitral/apex valves

answer

Aortic: Rt 2nd ICS Pulmonic: Lt 2nd ICS Tricuspid: Lower Lt sternal border, 4th ICS Mitral/Apex: Lt 5th ICS, medial to midclavicular line

question

When to use diaphragm and bell for unique sounds

answer

Diaphragm=high pitch sounds (aortic regurgitation, S1, S2, murmurs) Bell=low pitch sounds (mitral stenosis, bruits)

question

Cardiovascular risk factors

answer

family hx, cigarette smoking, poor diet, physical inactivity, obesity, HTN, dyslipidemia, DM, pulse/high HR

question

Screening for cardiovascular risk factors

answer

Begin routine screening at 20 y/o for individuals with RFs for CVD

question

Criteria for DM

answer

Any one of the following: 1)HbA1c of 6.5% or higher 2)Fasting blood glucose of 126 mg/dL or higher 3)2 hour plasma glucose level of 200 mg/dL 4)Random plasma glucose of 200 mg/dL or higher with symptoms of hyperglycemia

question

Abnormal pulse: Paradoxical pulse

answer

Greater than normal drop in systolic BP during inspiration. Can check with cuff at systolic level (normal variant is 3-4 mmHg) if higher then be suspect and check closely

question

Abnormal pulse: Carotid artery thrills and bruits

answer

detection of vibrations or thrills (cat purring) during palpation. Bruits can be detected thru auscultation of the carotid arteries- murmur like turbulent sound (Best if pt stops breathing for 15 seconds, listen with diaphragm and repeat with bell. Place at upper end of thyroid cartilage below angle of jaw)

question

Special population at risk for CVD

answer

-Women and African Americans -Women's leading cause of death is CVD -AA men and women show marked ethnic disparities against white pops in US -Smokers

question

What is JVP

answer

Jugular Venous Pressure: reflects right arterial pressure (central venous pressure) and right ventricular end diastolic pressure JVP is estimated from right internal jugular vein; We see a wave prior to S1 when right atrium contracts and again during sytole when blood enters from the vena cava(Pt should be around 30 degrees elevated, supine)

question

Two cardiac maneuvers and what you are listening for during cardiac exam

answer

Left lateral decubitus: use bell at PMI to listen for mitral stenosis Aortic regurgitation: pt leans fwd, use diaphragm, exhale fully, stop breathing, left sternal border and apex

question

Peripheral vascular- grading of pulse

answer

3+ = bounding pulse 2+ = brisk, expected, normal 1+ = diminished, weaker than expected 0 = absent, unable to palpate

question

Peripheral artery disease

answer

-stenotic, occlusive and aneurysmal disease of abdominal aorta/mesenteric/renal branches, and arteries of lower extremities -Pain can arise from skin, musculoskeletal or nervous system -Note skin changes to lower extremities and report of claudication symptoms (with activity) -Risk of death from MI/stroke triples in adults with PAD -ABI(ankle-brachial index) can be used to diagnose PAD

question

Warning signs/symptoms of PAD

answer

-Fatigue, aching, numbness or pain that limits walking or exertion in the legs; if present, identify the location. Ask also about erectile dysfunction -Any poor healing or nonhealing wounds of the legs or feet -Any pain present when at rest in the lower leg or foot and changes when standing or supine -Abdominal pain after meals and associated "food fear" and weight loss -Any first-degree relatives with an abdominal aortic aneurysm (AAA)

question

PAD RFs

answer

; 65 y/o ; 50 y/o with hx of diabetes or smoking Leg symptoms with exertion Nonhealing wounds

question

What is edema? What is pitting edema?

answer

accumulation of excessive fluid in extra vascular interstitial space; pitting= Pressing thumb firmly for 2 seconds over the: dorsum of each foot and behind each medial malleolus and over the shins Pitting - a depression caused pressure from your thumb

question

Venous tenderness or cords in calf

answer

can accompany DVT

question

ALLEN TEST BUERGER TEST VERICOSE VEINS VENOUS VALVES

answer

ALLEN TEST - compares patency of ulnar ; radial arteries BUERGER TEST - looks for arterial insufficiency by looking at postural color changes. VERICOSE VEINS - test for mapping by compression VENOUS VALVES - trendelenberg test

question

Know the artery layers and its unique qualities

answer

Intima - single continuous lining of endothelial cells with remarkable metabolic properties (innermost) Media - smooth muscle cells, dilate and constrict to accommodate BP and flow Adventitia - connective tissue with nerve fibers and vasa vasorum (outermost) Atherosclerosis (not a layer) - chronic inflammatory disease initiated by injury to vascular endothelial cells, promoting atheroma plaque formation and vascular lesions of hypertension

question

Layers of the veins

answer

Intima - nonthrombogenic Media - rings of elastic tissue and smooth muscle Externa - connective tissue Leg veins have weaker structures - susceptible to irregular dilation, compression, ulceration, and tumor invasion

question

PAD etiology

answer

Approximately 8 million ppl or 6-12% of pop (;40 y/o) affected; Silent in nearly 50%; Risk of death from MI/CVA triples in adults with PAD

question

Definitions of different uterine bleeding

answer

Menarche—age at onset of menses Dysmenorrhea—pain with menses, often with bearing down, aching, or cramping sensation in the lower abdomen or pelvis Premenstrual syndrome (PMS)—a cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for three consecutive cycles Amenorrhea—absence of menses Abnormal uterine bleeding—bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding Menopause—absence of menses for 12 consecutive months, usually occurring between ages 48 and 55 years Postmenopausal bleeding—bleeding occurring 6 months or more after cessation of menses

question

Abnormal Bleeding patterns: Polymenorrhea Oligomenorrhea Menorrhagia Metrorrhagia Postcoital bleeding

answer

Polymenorrhea - less than 21-day intervals between menses Oligomenorrhea - infrequent bleeding Menorrhagia - excessive flow Metrorrhagia - or intermenstrual bleeding Postcoital bleeding-bleeding after sex

question

Male exam: What do the structures feel like?

answer

Epididymis-light pressure, feels cordlike and minimally nodular Spermatic cord/vas deferens-feels stiff and tubular Prostate-rubbery and nontender with no evidence of fixity in surrounding tissue

question

Risk factors for testicular cancer

answer

-most common solid cancer of young men btwn ages 15-34 -history of carcinoma in the contralateral testicle, mumps, orchitis, inguinal hernia, hydrocele as child, positive family hx

question

Know clock on women exam

answer

-think of woman's breast as the face of a clock starting at 12 noon and moving towards 1 o'clock. Continue around the entire circle until you reach 12 noon again. We can use clock to determine locations of masses, nodes, lumps, etc. Also don't forget tail of spence!

question

Cardiac output

answer

the amount of blood pumped by the heart per minute CO=HRxSV Normally 5-6 liters/min at rest

question

What is important to remember when taking a sexual health history

answer

be sure to maintain a neutral, nonjudgmental tone so that your patients feel safe and trust you with their concerns

question

Most prevelant HPV types

answer

HPV 16 and 18 (70%)

HPD Exam 2 (Cardio, breast, abd, peripheral vascular, male/female genitalia) – Flashcards

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