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Physical Exam 9-10

Quiz questions for Week 12-13-14 quizzes

QuestionAnswer
What is milk line ...
Significance of milk line ...
Name lymph nodes breast drains into see below
Name order of lymph nodes breast drains into pectoral, subscapular, lateral drain into CENTRAL. central drains into infra- and supraclaviculr
When is galactorrhea considered abnormal when it happens >6 months post-partum or cessation of breastfeeding
Name the palpable masses of the breast at different ages Fibroadenomas, 15-25. From 25-50, cysts, fibrocystic changes, ca. After 50... don't ask. During pregnancy and/or lactation: Lactating adenomas, cysts, mastitis, (ca)
What are the characteristics of the palpable masses of the breast at different ages (see table)
Risk factors for breast ca postmenopausal obesity, use of HRT, alcohol use, and physical inactivity, BRCA1 or BRCA2 gene mutation
Relative strength of risk factors for breast ca ??
Which breast ca risk factors can be modified? postmenopausal obesity, HRT use, physical inactivity, ETOH
Protective factor of breast ca pregnancy, breastfeeding,
What are BRCA-1 and BRCA-2 genes anti-tumor genes
What are the criteria for identifying women at risk for mutation of BRCA genes, necessitating referral for genetic testing? First-degree relative with known BRCA mutation. ≥2 relatives with dx of ovarian cancer. ≥2 relatives with dx of breast cancer before age 50, and ≥1 is 1st-degree relative. ≥3 relatives with dx of breast cancer, and ≥1 occurred before age 50.
Relation of mammogrphic breast density with causation of breast ca density in more than 60-75% of the breast are at 4-6 times greater risk of BC than women with no breast density
Recs for mammography screening every 1 to 2 years for women in their 40s. All groups recommend annual screening mammograms in women 50 or older.
Recs for CBE every 3 years in women 20 to 40 years, and annually after 40 years
Recs for BSE no longer recommended
Four views of inspection of the breast arms at sides, arms over head, arms pressed against hips, and leaning forward
Causes of redness in the skin local infection or inflammatory carcinoma. Thickening and prominent pores suggest BC
Causes of flattening of normal convex breast suggests BC
What is nipple retraction? What might it signify? (may also be broadened and thickened) suggests ca
Possible findings on palpation of breast in ca When a cancer or its associated fibrous strands are attached to both the skin and the fascia overlying the pectoral muscles, pectoral contraction can draw the skin inward, causing dimpling
Cause of gynecomastia Gynecomastia arises from an imbalance of estrogens and androgens, sometimes drug related
Causes of male breast ca BRCA2 mutations, obesity, family history of male or female breast cancer, testicular disorders, work exposure to high temperatures orexhaust emission
Significance of tender cords. suggest mammary duct ectasia, a benign but sometimes painful condition of dilated ducts with surrounding inflammation, masses
Findings and significance of acenthosis nigricans in the axilla Deeply pigmented, velvety axillary skin. (One form is associated with internal malignancy.)
Causes of enlarged axillary LN nfection of the hand or arm, recent immunizations or skin tests in the arm, or part of a generalized lymphadenopathy
Features of malignant axillary LN (≥1 cm) and firm or hard, matted together, or fixed to the skin or to underlying tissues
Name the 4 groups of LN in axilla pectoral, subscapular, lateral, central
Location of 4 groups of LN in axilla pectoral are anterior, subscapular are posterior, lateral are superio, central are deep into axila fossa
Areas of drainage of each of 4 groups of LN in axilla (this was on quiz. seems like the answer he wants is that all 4 axilla LN drain into infra- and supraclavicular)
To what other LN might malignant cells from breast metastasize? infra and supraclavicular
Nonpuerperal galactorrhea. What is it? Milky discharge unrelated to a prior pregnancy and lactation
Nonpuerperal galactorrhea. What are its causes? hypothyroidism, pituitary prolactinoma, dopamine agonists (e.g., many psychotropic agents and phenothiazines)
Causes of spontaneous unilateral bloody nipple discharge intraductal papilloma, ductal carcinoma in situ, or Paget’s disease of the breast
Signs of recurrent of breast ca after mastectomy Masses, nodularity, and change in color or inflammation, especially in the incision line
How to instruct pt. how to perform BSE ...
3 most common causes of breast nodules fibroadenoma (a benign tumor), cysts, and breast ca
Differeces between different types of breast nodules, in aspect does he want symmetrical vs. irregularly shaped and freely mobile vs. fixed here?
"Retraction signs" of BC Dimpling, changes in contour, retraction or deviation of the nipple. (Everything EXCEPT peu d'orange!)
Other possible causes of breast retraction fat necrosis and mammary duct ectasia
peau d'orange sign of breast thickened skin with enlarged pores (d/t local edema b/c of blocked lymphatics). "often a sign of advanced ductal carcinoma of breast or the highly aggressive inflammatory cancer"
What sign would lead you to suspect Paget's disease of the nipple? scaly, eczemalike lesion that may weep, crust, or erode (suspect Paget's if any persisting dermatitis of the nipple and areola)
Causes of thickening and prominent pores over skin (peau d'orange) local edema b/c of blocked lymphatics. often a sign of advanced DC of breast or inflammatory cancer
Significance of tender nodules Hard, irregular, poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest ...
Deeply pigmented, velvety axillary skin suggests acanthosis nigricans (one form is associated with internal malignancy)
Dysmenorrhea= painful menses
Causes of secondary dysmenorrhea pregnancy, lactation, menopause
Causes of postcoital bleeding polyps, cancer, atrophic vaginitis
Causes of amenorrhea followed by heavy bleeding threatened miscarriage or dysfunctional uterine bleeding
Types of sexual dysfunction in women decreased desire, arousal, lubrication, failure to climax
Causes sexual dysfunction low estrogen, illness, psych
Dyspareunea painful intercourse
Causes of SF dyspareunea usually atrophic vaginitis
Causes of deep dyspareunea PID/"pelvic disorder", pressure on (normal) ovary
Vaginismus involuntary spasm of vaginal muscle at intercourse
Causes of vaginismus physical, psychological
Cervical cancer screening guidelines Annually 21-30. 31-66/70: Every 2-3 years afterwards (UNLESS prev pos Pap or h/o cervical cancer, or h/o high-risk HPV, immune compromised, DES exposure in utero)
HPV immunization recs Rachel says 12/13 to 26, both sexes?
HPV vaccine efficacy Rachel says 99%?
Most common STD HPV
Mode of HIV transmission in women k
Red flag(s) warranting HIV testing k
Menopause definition absence of menses for 12 consecutive months
Psychological changes @ menopause k
Physiological changes @ menopause hot flashes, flushing, sweating, sleep disturbances
Causes of delayed puberty in woman familial, chronic illness, hypothalamus problem, anterior pituitary problem, ovarian
Signs of pediculosis pubis excoriations at base of pubic hair follicle (itchy, small red maculopapules)
Impact of imperforate hymen may delay menarche
SIgns of PID on cervical exam tender, bilateral adnexal masses (pain and muscle spasms often make them impossible to delineate). pain upon mvt of cervix
Causes of palpable ovaries in postmenopausal woman tumor or cyst
Risk of impaired strength in muscles of pelvic floor? uterine prolapse
syphilitic chancre firm, painless (often inside in women)
secondary syphilis CONDYLOMA LATUM (round or oval flat topped papules covered by exudate=
carcinoma of vulva ULCERATED or raised RED vulvar lesion
Physiologic vaginal discharge is clear or white, perhaps with white clumps of epithelial cells (no odor)
Trichomonal vaginal discharge itches and pain on urination (but NO PAIN on intercourse, NO vaginal soreness)
If you have itching and pain on urination AND soreness of vagina AND pain on intercourse, what is it probably? Candida
If it is just fishy or musty smelling, what is it probably bacterial
Candida is white and curdy. NO ODOR
Trichomonas is yellow-green or gray. PROFUSE. bad smell
Bacterial is also bad smell (with the protozoal one) but gray or white and THIN. "homogenous"
infection of Bartholin gland signs, sx (ACUTE) tense, hot tender abscess
infection of Bartholin gland signs, sx (CHRONIC) nontender cyst (could be small, could be large)
Common cyst or abscess of glands just outside vagina opening. Treatment (home, drainage, ABX) depends on the size, pain and whether the cyst is infected. Bartholin's cyst
Causes of libido loss psychogenic (e.g., depression), endocrine dysfunction, sfx fm meds
Causes of ED psychogenic (e.g., depression), low testosterone, reduced blood flow to hypogastric arterial system (includes cremasteric and pubic branches), impaired neural innervation
Causes of PE meds, surgery, neurological deficits, lack of androgens
Infections from oral-penile contact gonorrhea, chlamydia, syphilis, herpes, HIV, HPV
Phimosis short, tight foreskin
Paraphimosis long, tight foreskin
Balantitis swollen, inflamed glans
Balnoposthitis swollen, inflamed glans + foreskin
Significane of induration on ventral surface suggests "ventral stricture," duh, (or CARCINOMA!!)
Gonococcal discharge yellow
Non-gonococcal discharge clear or white
Cryptorchidism undescended testicle
Common scrotal swellings INDIRECT inguinal hernia, hydrocele, scrotal edema
Causes of tender, painful scrotal swelling acute epididymitis, acute orchitis, torsion of sperm cord, strangulated inguinal hernia
Presentation of testicular cancer early on presents only as painless nodule
Age range for testicular cancer 15-35
How to detect scrotal swelling due to serous fluid TRANSILLUMINATION (fluid will produce red blow; normal testis (and tumor!) will not transilluminate
Location of bulge for INDIRECT inguinal hernia above IL, about midway
Location of bulge for DIRECT inguinal hernia above IL, close to pubis
Incarcerated hernia cannot push shit back in
Strangulated hernia blood supply cut off
How to do testicular self-exam k
Hypospadia opening on underside
Peyronie's palpable hard plaque on dorsal side with crooked possibly painful erections
hydrocele nontender fluid-filled mass within the tunica vaginalis
how to dx hydocele fluid will transilluminate (glow red), (You can also get your fingers in above it, apparently.)
Four common STD lesions of male genitalia herpes, syphilis, HPV, what else??
chancre vs. chanroid first one is painless?
Causes of small (<2cm) , Fire testes KlineFelter's syndrome
Causes of small, SOFT testest cirrhosis, myotonic dystrophy, estrogen exposure, hypopituitarism
Presentation of acute orchitis Painful, swollen, inflamed, tender testis
Causes of acute orchitis Mumps (other viral infections)
Variocele bag of worms, venous, usually on Left testicle
Torsion of testicle: An acutely painful & swollen organ that is retracted upwards in the scrotum (which becomes red and edematous)
Created by: mrbarr