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197 Cards in this Set
- Front
- Back
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Layers of the abdominal wall
If I introduce a needle what would I go through? |
skin
Camper's fascia Scarpa's fascia EOM IOM Transverse abdominus muscle Transversalis fascia Peritoneum |
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What is the EOM?
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forms the inguinal ligament
also known as the EOA (aperneruosis) rolls into a fibrous band from ASIS to pubic tubercles > important surgical landmark Stays anterior and helps form anterior rectal sheath |
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what is the IOM?
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superior to the Arcuate Line
forms the anterior and posterior rectus sheath inferiorly it forms the Cremastor. Periotoneum is only thing posterior to rectus sheath here |
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does the transversalis fascia have very much strength?
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NO forms an envelope around the interior of the abdominal cavity
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What is the anterior layer of the rectus sheath made up of?
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EO, IO
arcuate line EO, IO, TA |
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what is the posterior rectal sheath made up of?
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IO, TA
arcuate line TF, P |
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What is the importance of Langer's lines and incisions called cleavage lines?
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is a term used to define the direction within the human skin along which the skin has the least flexibility
These lines correspond to the alignment of collagen fiers within the dermis. Usually a surgical cut is carried out in the direction of Langer's line and incisions made parrallel to Langer's lines generally heal better and produce less scaring |
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in respect to Langer's line, which direction should surgical incisions be made?
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parallel to the Langer's lines
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What is the Rovsing's sign?
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Rovsing sign palpation of LLQ causes pain in RLQ because of peritoneal irritation secondary to an appendicitis
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what is McBurney's sign?
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McBurney's sign rebound tenderness at McBurney's point.
1/3 way up from the ASIS from the umbilicus > appendicitis |
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what is the Illiopsoas sign?
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positive ililopsoas sign = pain
secondary to an inflamed appendix there are varied methods to do it just put tension on IP since the iliopsoas is retroperitoneal It is elicited by performing the psoas test by passively extending the thigh of a patient lying on their side with knees extended, or asking the patient to actively flex their thigh at the hip while examiner pushes downward against it |
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how does a classical case of appendicitis present?
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Periumbilical then to RLQ pain
Pre-vomitus, rigidity, fever, constipation, + sign f/iliopsoas test |
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Murphy's sign
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+ in cholecystitis
Classically Murphy's sign is tested for during abdominal examination Performed by asking the patient to breath out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (approximate location of gallbladder) The patient is then instructed to inspire Normally during inspiration the abdominal contents are pushed downward as the diaphragm moves down. If the patient stops breathing in as the gallbladder is tender and in moving downward comes in contact with the examiners fingers Winces with a catch in breath Test is considered positive |
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what is Murphy's sign testing for
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gallbladder disease
Cholecystitis |
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Cullen sign
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is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
Bleeding from aortic aneurysm, pancreatitis, ruptured ectopic pregnancy |
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Grey Turner signs
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refers to bruising of the flanks from pancreatitis and retroperitoneal bleeding
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Romberg's sign
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test of the body's sense of proprioception which requires healthy functioning of the dorsal columns of the spinal cord
Used to investigate cause of loss of motor coordination (ataxia) |
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what does a + Romberg's sign indicate
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+ Romberg's sign suggests that the ataxia is sensory in nature that is depending on loss of proprioception
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If patient is not Ataxic but has a positive Romberg's sign what does this indicate?
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suggests that ataxia is cerebellar in nature
depending on localized cerebellar dysfunction instead |
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Obturator (test) sign
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+ sign = pain
secondary to an inflamed appendix perform the psoas test |
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what is the Illiopsoas sign?
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positive ililopsoas sign = pain
secondary to an inflamed appendix there are varied methods to do it just put tension on IP since the iliopsoas is retroperitoneal It is elicited by performing the psoas test by passively extending the thigh of a patient lying on their side with knees extended, or asking the patient to actively flex their thigh at the hip while examiner pushes downward against it |
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how does a classical case of appendicitis present?
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Periumbilical then to RLQ pain
Pre-vomitus, rigidity, fever, constipation, + sign f/iliopsoas test |
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Murphy's sign
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+ in cholecystitis
Classically Murphy's sign is tested for during abdominal examination Performed by asking the patient to breath out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (approximate location of gallbladder) The patient is then instructed to inspire Normally during inspiration the abdominal contents are pushed downward as the diaphragm moves down. If the patient stops breathing in as the gallbladder is tender and in moving downward comes in contact with the examiners fingers Winces with a catch in breath Test is considered positive |
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what is Murphy's sign testing for
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gallbladder disease
Cholecystitis |
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Cullen sign
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is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
Bleeding from aortic aneurysm, pancreatitis, ruptured ectopic pregnancy |
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Grey Turner signs
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refers to bruising of the flanks from pancreatitis and retroperitoneal bleeding
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Romberg's sign
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test of the body's sense of proprioception which requires healthy functioning of the dorsal columns of the spinal cord
Used to investigate cause of loss of motor coordination (ataxia) |
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what does a + Romberg's sign indicate
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+ Romberg's sign suggests that the ataxia is sensory in nature that is depending on loss of proprioception
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If patient is not Ataxic but has a positive Romberg's sign what does this indicate?
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suggests that ataxia is cerebellar in nature
depending on localized cerebellar dysfunction instead |
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Obturator (test) sign
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+ sign = pain
secondary to an inflamed appendix perform the psoas test |
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what is Markle (test) sign?
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patient stands, raises up on their toes, relaxing to allow heels to hit floor jarring body, patient can also lay supine and examiner can jar their heels
+ heel jar test is good sign of peritonitis may indicate appendicitis Peritonitis may result from any number of conditions |
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Describe pain representation for pancreatitis
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lying absolutely still
doesn't move Jar test HURTS |
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Describe the pain representation for appendicitis
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Periumbilical
RLQ pain pain, pre-vomitis, rigidity, fever, constipation, + signs f/iliopsoas test |
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describe the pain representation seen for Cholecystitis
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can NOT sit still
Gallbladder kidney stones Tube is stretched |
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describe pain representation for renal lithiasis
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intense
flank extending groin pain and genitals may be episodic may start at costovertebral angle and go to groin |
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describe the representation for GERD
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Gastroesophageal reflux disease
buring/gnawing pain in mid-epigstrium worsens with reclining |
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When palpating the liver what should be the pattern of dullness?
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Span of liver dullness RMCL & midsternal line
Right mid-clavicular line: 6-12 cm Sternal line: 4-8 cm |
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What do you palpate the spleen for?
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Check the spleen for splenomegaly.
If yes, this is abnormal until proven otherwise Spleen should not be palpable |
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What is shifting dullness representative up clinically?
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Shifting dullness: when patient rotates positions the fluid levels will change places causing dullness to change places
Indicates Right heart failure... backs up to the liver |
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Describe the details about the lymphatics system
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lymphatics not found in brain or placenta
primary function to defend the body against the invasion of microorganisms protects, removes damaged cells, and provides a partial barrier against malignant cell maturation |
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T-cell lymphocytes characteristics
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4-5X more numerous
longer lifespan respond to intracellular infections |
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B-cell lymphocytes characteristics
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produce Antibodies
have Ig on cell surface last only 3-4 days |
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How do you evaluate the lymphatic system?
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palpate lymph nodes along drainage path and spleen
note size, shape, soft, spongy, hard, fixed, changes |
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Describe normal lymph node characteristics
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tender to palpate
warm and red matted, indistinct, may be fixed Slow enlargement over time |
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Describe a malignant lymph node
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non-tender to palpation
minimally inflamed matted, usually hard in texture, fixed in position Rapidly enlarging without inflammation SUPRACLAVICULAR |
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What are ominous physical findings in lymph evaluation?
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SUPRACLAVICULAR nodes: most common place to find metastatic disease, because they are located at the end of both major afferent vessels
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What is Virchow's node?
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Left supraclavicular region, indicates abdominal/thoracic malignancy
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where in the lymph system does Lung cancer normally present ?
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Lung cancer presents in supracalvicular nodes on both sides of the neck
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How is a lymph node biopsy performed?
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is a test in which a lymph node or piece of lymph node is removed for examination under microscope
There are two ways to sample may be obtained: 1. Needle biopsy a needle biopsy involves inserting a needle into a node to obtain the sample 2. Open biopsy (excisional): an open biopsy consists of surgically removing all or part of a node |
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what are the goals of a neurological exam ?
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to localize the lesion
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How do you grade reflexes
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0=absent
1=reduced/very minimal response/hypoactive 2= Normal 3 = increased hyperactive 4= clonus 5= sustained clonus |
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How does one grade pulses
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+4/4 palpable pulse
+3/4 full/increased +2/4 spected (about average) +1/4 diminished 0/4 absent |
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How do you grade a heart murmur?
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1: barely audible
2: soft, but readily detectable 3: prominent, no thrill 4: Loud, palpable thrill 5: Very loud with a thrill 6: Audible w/stethescope off of the chest |
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Vesicular sounds
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heard over most of lungs
frilds, low pitch soft, short expirations |
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Bronchovesicular sounds
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heard over main bronchus area, and over upper right posterior lung field
medium pitch, expiration equals inspiration |
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Bronchial sounds
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heard ONLY over trachea
high pitch, loud, and long expirations Expirations > Inspirations |
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describe the divisions of the Right lung
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has upper, middle, and lower lobe
The upper and middle lobes are separated by the horizontal fissure and the lower lobe is separated by the right oblique fissure |
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Describe the divisions of the Left lung
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only has an upper and lower lobe
separated by oblique fissure |
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Parotid gland
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Parotid ducts are located behind the angle of the mandible.
Ducts are stensen ducts that open into the buccel mucosa opposite the second molar on the upper jaw |
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Submandibular gland
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located beneath the jaw and have Wharton's ducts that open on each side of the frenulum under the tongue
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What is the Rinne test for?
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Rinne test: compares air to bone conduction
Tuning fork placed on mastoid until patient no longer hears it, then places lateral to the EAC Bone conduction > Air conduction indicates conductive hearing loss |
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what is the Weber test for?
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compares bone conduction in the two ears
Tuning fork is placed in midline of skull lateralization to affected ear in conductive deafness lateralization to unaffected ear in unilateral nerve hearing loss |
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Describe why most breast cancers are found in the UOQ of the breast.
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Lymphatic channels traveling through the axilla, along the sternum, and above and below the clavicle, so this is where most cancers are found
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Describe some signs of breast cancers
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Signs: asymmetry, dimpling, retraction, edema, peau d'orange, nipple ulcers/deviation/bloody discharge
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what is peau d'orange indicative of?
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breast cancer
-edema caused by blocked lymph drainage in advanced inflammatory carcinoma, appears thickened with enlarged pores |
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describe fibrocystic disease
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benign cyst formation caused by ductal enlargement is associated long follicular or luteal phase of the menstrual cycle
The lesions are filled with fluid and are usually bilateral and multiple |
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What is Paget's disease?
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malignant breast cancer with symptoms that include flaky or scaly skin on the nipple, straw-colored or bloody nipple discharge, skin and nipple changes in only one breast or the flattened nipples
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what hormones affect the breast?
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Prolactin stimulates milk production
Oxytocin stimulates milk ejection Estrogen causes breast growth |
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What is HPV?
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Human Papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans
While the majority of the nearly 200 known types of HPV cause no symptoms in people, some types can cause warts, while others can lead to cancers of the cervix, vulva, vagina, and anus in women Cancers of the anus and penis in men |
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Anteverted uterus
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the cervix and fundus are tipped forward
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Anteflexed uterus
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the fundus is pointing forward relative to the cervix, anterior of the uterus is concave
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Retroverted uterus
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the cervix and uterus are tipped backwards
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Retroflexed uterus
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the fundus is pointing backwards
Anterior of uterus is convex |
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Steps to the pelvic exam
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Steps to the pelvic exam
-eye contact, meanings push the drape down so you can maintain facial contact, positioning, coverings/drapings > pull b/w legs have patients empty bladder before exam -insert the speculum at 45 angle, exerting pressure on the posterior wall, rotate the blade horizontally looking for the cervix Feel for uterus, move it as suspended ligaments, not SUPPOSE to have any discomfort Can't always find ovaries |
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what are you looking for in the pelvic exam?
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CERVIX
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Nulliparous
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NO babies
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Parous
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formerly with child
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Multigravidous
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lots of babies
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Everted
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endocervical canal extended out
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Bartholin cyst or abscess
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is formed when a Bartholin's gland is blocked, causing fluid-filled cyst to develop
A Bartholin's cyst is not an infection although it can be caused by an infection, inflammation, or physical blockage to the Bartholin's ducts If infection sets in, the results is a Bartholin's abscess |
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Candidiasis
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creamy white papules on oral mucosa that bleed when scraped, is a fungal infection (mycosis) of any of the Candida species (all yeast) of which Candida albicans is the most common
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Condyloma
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refers to an infection of the genitals
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Condyloma acuminata
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gential warts
caused by human papilloma virus subtypes 6, 11, and others |
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Condyloma Latum
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white lesions associated with secondary syphilis
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Glaucoma
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the outflow mechanism at the anterior chamber angle is blocked to passage of aqueous, thus pressure builds and pushes disc inward
There is an open angle and closed angle |
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Papilledema
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papilledema: bilateral disc edema (swelling) causing an enlarged blind spot due to intracranial pressure pushing outward on the disc
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what are Paton's lines
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radial retinal lines cascading from the optic disc, enlarged blind spot, cotton wool spots
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Drusen bodies
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drusen bodies are small yellow or white deposits that form in the retina or on the optic nerve head
-accumulations of extracellular material that build up in the eye |
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Is the detection of a few drusen bodies normal with aging?
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YES
most people over the age of 40 having at least some drusen however large amounts of drusen in the macula is one of the most common early signs of age related macular degeneration |
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How can drusen bodies be detected
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eye doctors can detect drusen bodies during a comprehensive dilated eye exam
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what is a sign of macular degeneration?
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large amounts of drusen bodies in the macula is one of the most common early signs of age related macular degeneration
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Miosis
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papillary constriction usually less than 2 mm in diameter
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Stabismus
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the eye do not line up when focusing, more commonly known as crossed eyes
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Anisocoria
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unequal pupils
due to disruption in the efferent motor pathways traveling in oculomotor or in the sympathetics |
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Macule
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a flat, circumscribed area that is change in the color of the skin
less than 1 cm in diameter examples: freckles, flat moles, petechiae, measles, scarlet fever |
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Papule
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an elevated firm, circumscribed area
less than 1 cm in diameter ex: warts, elevated moles, lichen planus |
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Patch
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a flat, nonpalpable, irregular shaped macule greater than 1 cm in diameter
ex: Vitiligo, port-wine stains, Mongolian spots, cafe au lait patch |
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Plaque
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elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter
ex: Psoriasis, seborrheic and actinic keratoses |
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Tumor
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elevated and solid lesion
may or may not be clearly demarcated deeper in dermis greater than 2 cm in diameter ex: neoplasms, benign tumor, lipoma, hemangioma |
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Vesicle
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elevated, circumscribed superficial, not into dermis, filled with serous fluid
less than 1 cm in diameter |
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what type of primary skin lesion is varicella (chicken pox) and herpes zoster (shingles) an example of?
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Vesicle
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Excoriation
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loss of epidermis
linear hollowed out crusted area ex: abrasions, scratches, scabies |
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Fissure
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linear crack or break from the epidermis to the dermis, may be moist or dry
ex: athletes foot, cracks at the corner of the mouth |
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Ulcer
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loss of epidermis and dermis
concave and varies in size ex: decubiti, stasis ulcers |
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Crust
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blood or purusielent exudates
slightly elevated size varies brown/black/tan/or stawberried colored ex: scab or abrasion, eczema |
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Atrophy
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Thinning of skin surface
ex: striae, aged skin |
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Scale
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headed-up keratinized cells
flaky skin irregular thick or thin dry/oily variations in size Example: flaking skin with seborrheic dermatitis following scarlet fever or flaking of skin follwoing a drug reaction dry skin |
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Primary vs. Secondary lesions
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excoriations: resulting from scratching of primary lesion and is the loss of the epidermis
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Melanoma
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skin cancer of melanocytes
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how is skin cancer determined?
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ABCD
Asymetery Border irregular Color blue or black diameter > 6 mm |
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Basal cell carcinoma
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the most common malignant neoplasm
usually found on the face and arises from basilar layer of skin |
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Squamous cell cancer
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malignant tumor arises from the epithelium
occurs in sun-exposed areas the lesions are soft, mobile, elevated masses with a surface scale |
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Seborrheic keratosis
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pigmented raised, warty lesions, usually appearing on the face and trunk
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Direct inguinal hernia
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second most common
through external ring only via a weak part in fascia older males 40-50 usually |
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Indirect inguinal hernia
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most common
through the internal ring > external ring into the scrotum |
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Femoral-abd. hernia
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contents pass through the fossa ovalis or femoral canal
More common in women Least common |
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what is a reducible hernia
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if the contents of a hernia sac can be easily replaced into the abdomen
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Irreducible/incarcerated hernia
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if the contents of the hernia sac cannot be replaced into the abdomen
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what happens if the blood supply to an irreducible hernia
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when the blood supply of the irreducible or incarcerated hernia is interrupted, the hernia is striangulated and gangrene may quickly ensue
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Phimosis
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cannot retract the foreskin
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paraphimosis
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inablity to replace foreskin to normal after retraction past the glans, which is not good b/c it can lose blood supply
or the glans can get gangrene |
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Peyonie's disorder
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wicked curvature to the penis due to fibrous band in the corpous cavernosum
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Hypospadius
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ventral urethral opening
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primary hypospadius
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urethral ventral but still in the glans penis
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Secondary hypospadius
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urethral opening ventral along the shaft
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tertiary hypospadius
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urethral opening orifice at the base of the penis
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Epispadius
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dorsal urethral opening
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Testicular tumors
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mas in testes = 99% malignant
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mass outside of testes
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= 99% benign tumor
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Painful vs. non-painful tumor
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non-painful masses commonly are testicular malignancy
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What should be done to any mass that is found in the scrotum
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Transilluminate it!
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Cryptorchidism
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undescended testis
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Orchitis
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acute inflammation of the testis
associated with mumps and results in atrophy |
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What if a pre-teen male patient comes into the emergency room complaining of acute testicular pain! what should you think?
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Testicular torsion
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what is the difference between the chief complaint and history of complaint?
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chief complain= the problem that the patient came in with
History of complaint: PQRST |
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PQRST
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Pallative-provocative: what makes this better or worse
Qualtiy: is it burning, stabbing, sharp, dull, heavy Radiation: does this feeling go anywhere? Severity: 0-10 scale Timing: certain time of day/night? how frequent? how long does it last? |
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SOAP note
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Subjective: PQRST
Objective: lab values, physical findings, radiology, studies, vital signs Assessment: quick rundown of the patient, differential diagnosis Plan: what I plan to do for the patient |
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Order of Examination for Abdomen/digestive
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Inspect
Ausculatate Percuss Palpate |
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where you percuss the abdomen what are you percussing for?
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liver border
spleen alternating typmpany/dullness due to stool, gas, fluid, etc. Assess for masses (dull), protuberant (distented), abdomen due to the "Fs" |
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Order of H & P performance and positioning
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be adaptable
when examining a system do it the same every time sequence may change but when examining a body system do it the same every time Dictate the same every time |
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Ankle brachial index
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A BP is taken in the leg using a thigh cuff for popliteal or standard on the tibial and then compared to a BP taken in the arm
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When do you perform a brachial index test?
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patient is under 40 and with history of hypertension
Elderly with suspected PVD |
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why do you perform a brachial index test?
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powerful predictor of cardiovascular mortality
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What does a great leg-arm pressure difference indicate in a ankle brachial index test?
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A greater leg-arm pressure difference (systolic leg pressure > 20 mmHg than arm pressure) is seen with extensive/calcified peripheral arterial disease
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How do you auscultate the heart
(All Physicians Take Money) |
1. Upper right sternal border (aortic semilunar valve): 2nd R intercostal space
2. Upper left sternal border (pulmonary semilunar valve): 2nd L intercostals space 3. Lower left sternal border (tricuspid AV valve): 4th L intercostals space 4. Apex (mitral AV valve): 5th intercostal space |
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what is PMI?
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point of maximal impulse
the point at which the apical impulse is most readily seen or felt Normally find apex of heart (under left boob) |
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what does it mean if the apex of your heart is displaced to the side?
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Something is wrong
Laterally downward increased CO , left ventricular hypertrophy, heart failure Left of sternal border: right ventricular hypertrophy to the right: dextrocardia, diaphragmatic hernia, distended stomach, pulmonary abnormality |
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what does a broad PMI mean?
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BAD
means poor systolic function |
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what does a narrow PMI mean?
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NORMAL
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Significance of murmurs S1
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ventricular systole starts
closure of mitral and tricuspid (both AV) valves heard at the apex |
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what is the S2 heart sound?
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ventricular systole ends
closure of aortic and pulmonic (both semilunar) valves at the base of the heart |
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what is an S3 heart sound?
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early diastole
filling of volume overloaded ventricle (rapid ventricular filling) Low pitched, bell, apex |
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What is an S4 heart sound?
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S4 is late diastole/pre-systolic sound
atrial contraction filling non-compliant ventricle Low pitched, bell, apex |
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what is the significance of S3 and S4
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during diastole, ventricles fill in 2 steps: an early passive flow of blood from atria followed by more vigorous atrial ejection
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Tilt test
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the procedure test for causes of syncope by attempting to cause syncope by having the patient lie flat on a special table or bed while connected to ECG and blood pressure monitors
The table then creates a change in posture from lying to standing |
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Thrills
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a fine, palpable rushing vibration, palpable murmur, often, but not always, over the base of the heart in the area of the right and left second intercostals space.
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what do thrills indicate
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it generally indicates a disruption of the expected blood flow related to some defect in the closure of one of the semi-lunar valves, pulmonary hypertension, or atrial septal defect
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why is splitting of S1 and S2 considered to be normal in children?
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This is because the tendancy of the anteroposterior diameter of the chest to increase with age
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Rubs
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irritated organ rubbing against wall
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Pleural friction rubs
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low pitched grating, rubbing, or creaking sounds on inspiration
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Pulsus Paradoxus
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fall in systolic pressure during inspiration (>10) amplitude decreases on inspiration, cardiac tamponade, airway obstruction, and SVC obstruction
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Pulsus tardus et parvus
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small, weak > decreased LV stroke volume, narrow pulse pressure, inc. resistance
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Pulses Tardus
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delayed onset to peak > aortic stenosis can be a severe form
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Biseverance Pulse
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two systolic peaks > pure AR or mixed AS/AR; goes away when heart failure worsens
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Increased Wide Pulse
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normal with exercise, abnormal with aortic regurgitation, abnormal with high output states
-fever, anemia, pregnancy |
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Decreased Narrow
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heart failure
atherosclerosis |
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Pulsus Alternans
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alteration of the strength of the pulse, assoication with S3 or severe LV systolic failure
aka alternating pulse |
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Bruit-a murmur or unexpected sound
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carotid bruit can occur due to valvular aortic stenosis, ruptured chordate tendinae of mitral valve, severe aortic regurgitation, vigorous left ventricular ejection (children), obstructive disease in carotid arteries (atherosclerotic, fibromuscular hyperplasia, arteritis)
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where do you check for carotid artery bruis?
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check for carotid artery bruits at anterior margin of SCM
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Angina/Angina pectoralis
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stable angina is chest pain or discomfort that typically occurs with actively or stress
the pain is usually begins slowly and gets worse over the next few minutes before going away It quickly goes away with medication or rest, but may happen again with additional activity or stress |
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Creases on a baby's foot, what does this tell us?
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Premies: none
Normally: develop from toe to heel |
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describe the physical findings on a premature baby
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feet have no creases
ears are more floppy with less recoil prominent labia minora (F) or no rugae yet (M) almost translucent skin can see vasculature |
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Meconium (infant)
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first baby poop
black and tarry if passed prior to delivery, it's a marker of intrauterine stress |
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Rectal temperature (infant exam)
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for the first 12 months
although pulse is more sensitive to illness |
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Apnea (infant exam)
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must last longer than 20 seconds to qualify, and they belly-breath until 6 months
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True or False
Jaundice in the first 24 hours is normal. |
False
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Cephalohematomas (infant exam)
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blood is under the calvairal (skull) bones, won't cross suture lines
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Caput Edema (infant exam)
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fluid under scalp, will cross suture lines (caput succedeaneum)
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Peripheral cyanosis (infant exam)
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normal, called acrocyanosis, red discoloring
blue cyanotic |
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Central cyanosis (infant exam)
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requires a second glance, look is the mucosa of the mouth
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Monglian spots (infants)
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dark blue, fade with time, most common on sacrum, ankles shoulders
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when should you do the more invasive parts of an exam on a pediatric patient?
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LAST
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Diastasis recti
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separation of muscles on the trunk
Separation in the midline usually between xiphoid and umbilicus is a common finding when the rectus abdominus muscles do not approximate each other Ordinarily there is no need to repair this However herniation through rectus abdominus muscles is a problem |
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Umbilical hernia
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protrusion of omentum and intestine and intestine through the umbilical opening, forming a visible and palpable bulge
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what is the apgar score?
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the apgar score is determined by evaluating the newborn baby one five simple criteria on a scale from zero to two, then summing the five values thus obtained
The resulting Apgar score ranges from zero to 10 |
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Internal hemorrhoids
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above the pectinate line/dentate line
common cause for painless rectal bleeding |
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External hemorrhoids
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below the pectinate line/dentate line
not seen at rest, but protrude when standing and painful |
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what is the significance of hematochezia in infants?
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may be the result of swallowing maternal blood at the time of delivery
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Peri-anal abscess
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risk factors for perianal abscess: Crohn's, IBD, Hematologic disease
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Anal cancer
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usually squamous cell
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What is Condyloma acumiante?
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Anal warts
Cells at the basal layer are invaded by HPV. Causes mucosal microabrasions |
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Gravida
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number of pregnancies
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Para
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number that went to term, number that were premies, abortions (spontaneous select), number of living children
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G4P2113
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Woman that has had:
4 pregnancies 2 full term pregnancies 1 premature 1 spontaneously aborted 3 are now living |
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How do you determine the Estimated Date of Confinement (due date)?
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Naegeel's Rule:
due date equals FIRST day of last menstrual period + 1 year - 3 months + 1 week |
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When a woman is pregnant, the ithsmus of the uterus gets softened. What is the sign name?
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Hegar-softening of the uterine ithsmus (6-8 weeks)
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Leopold's maneuvers
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female is past 6 months pregnant
doctor puts hand on belly to see where the head, back, legs are. looking to see where the baby lie |
