Patient Assessment Test 2 Set 4

Front 1

During bimanual exam if when moving cervix SIDE TO SIDE pt complains of PAIN=...

Back 1

PID

Front 2

During bimanual exam you FEEL MASSES ON UTERUS=...

Back 2

fibroid cancer

Front 3

Between bimanual uterus and rectal exam...

Back 3

CHANGE GLOVES!!!!

Front 4

Bimanual Rectovaginal exam is best for... (3)

Back 4

1)reaching 1inch higher into pelvis
2)good exam for retroverted uterus
3)CAN FEEL CANCERS BETTER****

Front 5

External Hemorrhoids (3)

Back 5

1)varicose veins that originate below the anorectal line
2)can protrude, cause itching, bleeding and pain on defecation
3)thrombosed (shiny blue masses)
4)PT WILL COMPLAIN OF PAIN****
5)watch for strain, blood on TP and itching

Front 6

Internal hemorrhoids (4)

Back 6

1)varicose veins that originate above the anorectal junction
2)not palpable or painful unless thrombosed
3)bleeding may occur w/ or w/o defecation
4)proctoscopy is req'd for dx
5)PT WILL NOT COMPLAIN OF PAIN****

Front 7

Anorectal fissue (4)

Back 7

1)cracks in epithelium
2)linear/rock shaped ulcers less than 5mm in length
3)occur in posterior midline
4)arise from trauma during defecation

Front 8

Atrophic Vaginitis (4)

Back 8

1)loss of rugal folds resulting in thin, shiny, mucosa
2)bleed easily (friability)
3)vaginal erosions
4)pt will complain about NOT enjoying sex anymore

Front 9

Best tx for External hemorrhoids

Back 9

INCR FIBER = decr strain = decr blood vessel dilation

Front 10

Bacterial vaginosis
a)characteristics (2)
b)tx

Back 10

a1)thin white or gray discharge
a2)FISHY ODOR (during whiff test w/ or w/o KOH)

b)flagyl

Front 11

Candidiasis (2)

Back 11

1)white curdy discharge w/ itching
2)check for DM or h/o of Abx use

Front 12

Genital warts tx (3)

Back 12

1)chriotherapy
2)laser
3)aldera for a few small spots

Front 13

Condyloma Acuminatum in females (2)

Back 13

1)HPV
2)associated w/ cervical cancer

Front 14

Syphilitic chancre characerteristic in females(2)

Back 14

1)PAINLESS ULCER

a)can also get condyloma latum (secondary lesion of syphilis)

Front 15

Herpes in females characteristics (2) and tx

Back 15

1)painful lesions/ulcers****
2)pain on urination****

1)antivirals to decr outbreaks/transmission

Front 16

Chlamydia in females (2)

Back 16

1)may be asymptomatic
2)see symptoms of PID

Front 17

Gonorrhea in females (2)

Back 17

1)purulent discharge from cervical os ****
2)green discharge = barthalum abcess****

Front 18

Trichomoniasis symptoms (2)****

Back 18

1)frothy green discharge
2)strawberry cx (cervix?)

Front 19

____(2) in kids genital area = suspicion of sex abuse b/c...

Back 19

1)SCABIES
2)MOLLUSCUM

these are ONLY STD's in children

Front 20

Only treat PMS if... and what with...(2)

Back 20

affecting something like work/school

OC's
SSRI's

Front 21

PMS physical symptoms (5)

Back 21

1)bloating
2)breast pain
3)ankle swelling
4)sense of incr height
5)HA

Front 22

PMS psychological symptoms (5)

Back 22

1)irritable/aggressive
2)depression
3)libido change
4)food cravings
5)nervous

Front 23

Cervicitis (3)

Back 23

1)red, edema cervix
2)purulent yellow discharge
3)can be from gonorrhea, chlamydia, herpes

Front 24

Uterine bleeding (4) and tx

Back 24

1)dysfxnal uterine bleeding = irregular menstrual intervals
2)menorrhagia = excessive bleeding w/ passage of clots
3)ovulation bleeding = singe episode of spotting b/w menses is common
4)Postmenopausal Vaginal Bleeding = go to Dr. to rule out cancer

Only tx w/ HRT's if bleeding is problematic to pt

Front 25

Endometriosis (2 and 1tx)

Back 25

1)growth of endometrial tissue outside of uterus
2)causes pain, dysmenorrhea and ABNORMAL BLEEDING

1)tx is OCs

Front 26

Leiomyoma of Uterus (fibroid tumor) (4)

Back 26

1)most common neoplasm of female genital tract
2)frequently asymptomatic in non-pregnant women
3)if large can be felt w/ bimanual exam
4)CONFIRMED W/ ULTRASOUND TO RULE OUT OTHER CANCERS

Front 27

Ovarian Cysts (5)

Back 27

1)associated w/ pain when enlarges or ruptures

2)can be associated w/ polycystic overian syndrome to cause...
a)infertility
b)hirsutism
c)obesity

Front 28

Ectopic Pregnancy (2 and 4 symptoms)

Back 28

1)pregnancy arising from implantation of ovum outside uterus
2)98% are tubual (implant in fallopain tube)

3)cardinal symptoms
a)amenorrhea or irregular bleeding/spotting
b)pelvic pain
c)pelvic mass formation
d)(+) pregnancy test

Front 29

Male Tanner Stage 1

Back 29

preadolescent--no pubic hair

Front 30

Male Tanner Stage 2 (3)

Back 30

1)slight pigmentation
2)longer straight hair
3)downy at base of penis/scrotum

Front 31

Male Tanner Stage 3 (2)

Back 31

1)dark, pigmented, curly hair
2)at base of penis

Front 32

Male Tanner Stage 4 (2)

Back 32

1)pubic hair is adult type
2)but not in extent (no further than inguinal fold)

Front 33

Male Tanner Stage 5

Back 33

1)hair is spread to medial surface of thighs, but NOT upward

Front 34

Male Tanner Stage 6

Back 34

1)pubic hair is spread along linea alba to umbilicus

Front 35

G1 Male growth stage

Back 35

1)testes, scrotum, penis all same size as young child

Front 36

G2 Male growth stage (4)

Back 36

1)enlargement of scrotum/testes
2)scrotum gets redder, thinner, wrinkled
3)redness in NOT reythematous looking
4)penis no larger

Front 37

G3 Male growth stage (3)

Back 37

1)enlargement in penis, especially in length
2)further enlargement of testes
3)descent of scrotum

Front 38

G4 Male growth stage (3)

Back 38

1)continued enlargement of penis and sculpturing of glans (tip of penis)
2)incr pigmentation of scrotum
3)"not quite adult stage"

Front 39

G5 Male growth stage (2)

Back 39

1)scrotum ample
2)penis reaching nearly to bottom of scrotum

Front 40

Induration?

Back 40

hardness of penis

Front 41

Epididymides (5)

Back 41

1)inflammation associated w/ UTI
2)very tender
3)scrotum red
4)scrotal elevation may relieve pain
5)DIFFERENTIATE FROM TESTICULAR TORSION

Front 42

Testicular torsion
a)what is it (course)
b)age of onset
c)onset of pain
d)vomiting?
e)fever?
f)dysuria?
g)other sx

Back 42

a)twisting of testis on cord
b)newborn to adolscent
c)ACUTE
d)common
e)uncommon
f)uncommon
g)scrotal discoloration

Front 43

Epididymis
a)what is it (course)
b)age of onset
c)onset of pain
d)vomiting?
e)fever?
f)dysuria?
g)other sx (2)

Back 43

a)infexn--UTI/STD
b)adolescent to adults
c)gradual onset
d)Uncommon
e)possible
f)possible
g)pyruia, nodular epididymis

Front 44

Hypospadias?

Back 44

urethral meatus (opening) is on ventral side of glans

Front 45

Priapism (3 and 2causes)

Back 45

1)prolonged erection
2)painful
3)idiopathic

1)sickle cell
2)trazodone

Front 46

Peyronie disease

Back 46

fibrous band in corpus cavernosum results in deviation of penis during erection

Front 47

Penile cancer you see...

Back 47

painless ulceration that DOES NOT HEAL

Front 48

Phimosis

Back 48

1)inability to retract foreskin back over the glans due to stenosis or narrowing of perputial orifice

Front 49

Paraphimosis/Balanitis

Back 49

Para- inability to replace foreskin after retracted

Bala- inflammation of glans

Front 50

Syphilis in men you see...

Back 50

painless ulcer (chancre) often @ base of glans

Front 51

Gonorrhea sx in men (4)

Back 51

1)purulent green/yellow discharge at urethral opening
2)lips of meatus red/swollen
3)ask if pt had unprotected sex in past 2-4days
4)can see frequency/urgency as disease spreads thru urethra

Front 52

Chlamydia in men (4)

Back 52

1)10% asymptomatic
2)mucopurulent discharge at urethral meatus
3)meatus stuck together in morning with dried secretions
4)dysuria and incr frequency

Front 53

Chlamydia and Gonorrhea in men

Back 53

IF PT HAS ONE THEY WILL USUALLY HAVE THE OTHER SO BE SURE AND CHOOSE A TX THAT TX'S BOTH

Front 54

Trichomonas in men sx (4)

Back 54

1)10-50% asymptomatic
2)urethral discharge
3)dysuria and incr frequency
4)urethral irritation

Front 55

Condyloma acuminatum sx (3)

Back 55

1)soft, red lesions
2)arises b/c of infexn w/ papovavirus (genital warts)
3)MAY BECOME MALIGNANT

Front 56

Herpes in men sx

Back 56

1)PAINFUL VESICLES THEN ULCERS

Front 57

Condyloma Latum (4)

Back 57

1)lesions of secondary syphilius
2)occur 6-12wks after infexn
3)flat, round, oval papules
4)covered by gray exudate

Front 58

Molluscum Contagiosum (4)

Back 58

1)lesions that are pearly gray
2)umbilicated/smooth and dome shaped
3)ON GLANS OF PENIS
4)SEEN IN PPL PLAYING CONTACT SPORTS

Front 59

Lymphogranuloma Venereum (2 and 1tx)

Back 59

1)caused by chlamydia
2)initally painless
3)treat w/ tetracycline or doxy

Front 60

Spermatocele (3)

Back 60

1)cystic swelling on epididymis
2)not as large as hydrocele
3)WILL TRANSILLUMINATE

Front 61

Orchitis (3)

Back 61

1)acute inflammation of testis
2)complication of mumps in adolscents/adults
3)UNILATERAL

Front 62

Hydrocele (2)

Back 62

1)fluid accumulation in tunica vaginalis
2)WILL TRANSLUMINATE

Front 63

Varicocele (2)

Back 63

1)dilation of veins within spermatic cord
2)LOOKS/FEELS LIKE "BAG OF WORMS"

Front 64

Testicular cancer (4)

Back 64

1)most common tumor in males age 15-30
2)most are malignant
3)NON-painful
4)does NOT transilluminate

Front 65

Direct Hernias (2)

Back 65

1)intestine comes thru external inguinal ring; rarely enters scrotum
2)pushes against side of finger on exam

Front 66

Indirect Hernias (5)

Back 66

1)more freq in young men
2)intestine comes thru internal inguinal ring
3)can remain in canal, exit external ring OR enter scrotum
4)touches finger tips on exam
5)EXAMINE BOTH SIDES; indirect hernia on one side strongly suggests possibility of bilateral herniation

Front 67

Femoral Hernias (4)

Back 67

1)intestines thru femoral ring, femoral canal and fossa ovalis
2)LEAST COMMON type of hernia
3)more common in females
4)inguinal canal EMPTY on exam

Front 68

Perianal abcess?

Back 68

area of swelling, erythema, pain

Front 69

Perianal fissure (3)

Back 69

1)tear in anal mucosa
2)usually caused by traumatic passage of large, hard stool
3)pain, itching, bleeding

Front 70

Prostate should feel ____ on exam

Back 70

RUBBERY LIKE PENCIL ERASER

Front 71

Grades of Prostate enlargement (4)

Back 71

I- 1-2cm protrusion
II- 2-3cm protrusion
III- 3-4cm protrusion
IV- over 4cm protrusion

normally won't feel anything on prostate exam

Front 72

BPH
a)gland feels...
c)symptoms (3)

Back 72

a)ENLARGED

b1)hard time peeing/hesitancy
b2)leaking/decr force of stream
b3)urgency

Front 73

Prostatitis (4)

Back 73

1)gland is acutely tender/enlarged
2)fever
3)urethral discharge
4)irritative voiding

Front 74

Prostate cancer (3)

Back 74

1)gland feels hard, irregular
3)obstructive sx
3)low back pain if metastizes to bone

Front 75

Occult blood?

Back 75

test any fecal material from rectal exam for blood using a guaiac procedure