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Physical Exam 9-10
Quiz questions for Week 12-13-14 quizzes
| Question | Answer |
|---|---|
| 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
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