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292 Cards in this Set
- Front
- Back
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The 4 P's of Penile disorders?
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Phimosis: unretractable foreskin/ Paraphimosis: retracted foreskin that can't be pulled back into normal position/ Priapism: erection that does not subside/ Peyronie's disease: fibrous scar tissue in penis that causes it to be crooked
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Balanitis is?
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infection of the penis (often fungal)
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Hypospadius is?
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Urethral orifice on ventral side of penile shaft
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What is the prostratic utricle?
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"pouch of prostate" located in prostratic urethra- it contracts and opens the surrounding ejaculatory ducts so semen can pass
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Which nervous system controls sexual arousal?
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the parasympathetic
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Which nervous system controls climax?
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the sympathetic
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How many million sperm ejaculated?
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20-100 million
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What is the most common type of hernia?
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Indirect inguinal (pt's are often children & young males)
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Which hernia is more common over 40 y/o?
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Direct inguinal (more in males)
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Which type of hernia is more common in females and rare in children?
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femoral
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What are the 6 components of the neurological exam?
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mental status; canial nerve exam; motor exam; deep tendon reflex testing; sensory testing; coordination & gait assessment
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What is a perfect score for the MMSE?
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30 points
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How many points on MMSE for orientation in time & space?
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10
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How many points for concentration on MMSE? (ex: spell WORLD backwards)
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5
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How many points on the MMSE for identifying each of the following: naming obj; name 2 obj not in room; following a 3 step seq command; remembering the obj you asked them about in the beginning; following 2 comman seq?
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3 points each
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What part of the hand does the ulnar nerve control?
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pinky & 1/2 of the 4th finger
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What part of the hand does the median nerve control?
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?
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What part of the hand does the radial nerve control?
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?
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What are kyphosis and lordosis?
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Kyphosis is when back swings outward on top/ Lordosis is when it waves in
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What center controls swallowing?
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deglutition center
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What protects the stomach lining from HCL & pepsin and makes food more slippery?
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The secretory/mucus cells in stomach
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What breaks down into pepsin in an acid environment?
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pepsinogen
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What do parietal cells secrete?
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HCL & intrinsic factor
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What do G cells in the antrum secrete?
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gastrin (also found in the duodenum and pancreas
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Intrinsic factor is needed to absorb _____ in the small intestine?
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Vit B12
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Ghrelin stimulates______
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hunger
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What is gastrin?
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Major digestive enzyme
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What inhibits hunger?
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leptin
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When listening for bowel motility what amount of sounds are normal?
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5 to 30 sounds per minute with occassional borborygmi
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What does it mean if there are no bowel sounds?
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something baaaaad
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Tinkling sound in the intestines is normal? T/F
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Falso
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How long does it take for food to pass thru completely?
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40 hours (4 hrs from ST into Duodenum/4 hrs for SI into LI then about 32 through colon & out)
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What % of immunity producing lymphocytes for the whole body are found in the Peyer's patches in SI?
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80%
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The upper 1/2 of S.I. is …
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jejunum
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The lower 1/2 of SI is called…
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ileum
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How long is the SI?
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12-14 ft.
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What enzyme breaks starches into sugar?
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Amylase
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What eny\zyme breaks Fat into glycerides?
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Lipase
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1st 3 Cranial Nerves?
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1- Olfactory, 2- optic, 3-oculomotor
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Nerve IV
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Trochlear -adduction & intorsion of eye
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Nerve V?
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Trigeminal- chewing, sensation of face
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Nerve VI?
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Abducens: abduction
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VII?
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Facial nerve: taste for anterior 2/3 of tongue
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VIII?
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Auditory; hearing & balance
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IX?
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Glossoopharyngeal; taste posterior 1/3 of tongue; gag reflex; sensation to soft palate
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X?
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Vagus- motor to soft palate; parasympathetic fibers to HT, LU & GI
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XI?
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Spinal Accessory; motor control of SCM & trapezius (shrug of shoulders)
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XII?
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Hypoglossal; motor control of the tongue
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Motor System: An efferent nerve __________
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causes an effect; a reaction like muscle contraction or secretion
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Motor system: Sensory: an afferent nerve is one that _______
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receives information for processing
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What is a fasciculation?
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spontaneous twitching
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_____ or ______ diseases may show fasciculations?
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ALS or MS
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In the Motor Exam decreased or flaccid tone means______?
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lower motor neuron problems (in peripheral nerve)
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In the Motor exam, increased tone, spasticity means problems in______?
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upper motor neuron problems ( in spinal cord or the brain)
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Resting tremors are ____disease? Intention tremors are ____ disease?
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Parkinson resting tremor; MS intention tremor
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Reflexes: Hyperactive reflexes indicate_______? Reduced reflexes indicate________?
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Hyperactive= upper motor neuron dysfunction (CNS disease) ; Reduced reflex: lower motor neuron dysfunction, hypothyroidism
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What does the cerebellum do?
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integrates information from sensory & motor nervous systems
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Disorders in the Cerebellum will manifest as?
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gait problems, speech, abnormal eye movements & tremors
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What are the 4 manifestations of cerebellar disorders?
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1- Ataxia (def abilityto judge req speed power & distance needed- like being drunk) 2- Dysarthria-difficulty saying words correctly 3- Hypotonia- decreased muscle tone 4- Nystagmus- twitching of eye muscles
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What are the 5 primary sensations?
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Pain, touch, temp, vibration, joint position (these test spinal & midbrain function)
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What % of all adults drink?
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55%
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what % of high school seniors drink?
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60%
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What % of people abuse alcohol?
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5%
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more High school seniors drink now than 20 years ago? T/F?
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False, less
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Where is alcohol absorbed in the body?
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Stomach lining (only other thing is aspirin)
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Alcohol abuse is defined as more than ___oz for men and ___oz for women…
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3 oz men, 2 oz women
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Study by Kaiser shows that 2 drinks/day increases or decreases longevity?
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increases by 50% (may also decrease heart disease)
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All psychoactive drugs increase the availability of ______ as well as other neurotranmitters such as _________,________ & ________.
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Dopamine: serotonin, GABA & glutamate
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Schedule 1 drugs have the highest abuse potential? T/F
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True (these are LSD, heroin +pot)
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Schedule 2 drugs have no abuse potential? T/F
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False, still high..these are cocaine, amphetamines, opiates, barbiturates
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Schedule 3 & 4 drugs are no longer considered to have abuse potential? T/F
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False just lowerthan 1 & 2
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Can schedule 1 drugs be prescribed?
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No
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Schedule 2 drugs require a single script? T/F
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False, triplicate
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Prozac, Welbutrin, Zoloft, Lexapro are all ______?
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SSRI's
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Barbiturates, Valium & Alcohol are considered stimulants or depressants?
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Depressants
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In the past 10 years pot usage in 10th graders has increased by 50% or decreased?
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increased from 20% of 10th graders to 40%.
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What drug kills more than any other?
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Tobacco! 443,000 died last year.
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Tobacco: protective measures are?
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production of mucus, mucociliary escalator, nasal irritation w/sneeze, irritation of trachea or bronchi w/ cough reflex.
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What are the 3 harmful components of tobacco smoke?
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Tar, nicotine, carbon monoxide
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Which element of tobacco causes the following: irritation of bronchial lining, infection, scarring, decreased O2 absorption, increased mucus?
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Tars
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What aspect of tobacco poisons the ciliary activity paralyzing the mucocilary escalator?
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nicotine
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How does Tobacco affect cholesterol?
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poisons the enzyme system for cholesterol and fatty acid removal in the blood vessel walls
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Which aspect of tobacco causes increasing rates of heart disease and atherosclerosis?
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Carbon Monoxide
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Tobacco companies need to find _____people a day to start smoking to make up for the ____ that will die today.
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1500/1500
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The External Sphicter is under _____control & is ______ muscle
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Voluntary; striated
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Internal sphincter is under _________ control and is ________ muscle
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involuntary; smooth muscle
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The rectum is above the anus and is ___cm long
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12 cm
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Prostate enlarges in men over the age of ____
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50 yrs old
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The prostate is divided into R/L lobes by a ________
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sulcus
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Prostate provides the fluid for _________ and nourishes _________.
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fluid for ejaculation & nourishes sperm
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BPH affects ____% of 50-60 y/o and ____% of 80 y/o
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50% of 50-60 y/o & 90% of 80 y/o
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Hypertrophy is when …
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the cells get bigger causing growth in an organ (most common)
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Hyperplasia is when….
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cell numbers increase causing increase in organ size (tumors; prostate enlargement)
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BPH has increased cell numbers or size?
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increase cell #'s - is a hyperplastic process
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BPH believed to be caused by combo of?
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DHT & aging
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In BPH symptomatic men will take medication to…
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block the conversion of testosteron to DHT
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Dr. Robi said he feels herbal products are equal, less than or better than western drugs for prostate conditions?
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equal or better
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Who is most at risk for Prostatitis?
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Older men with severe BPH
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Treatment for Prostatitis?
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hopitalization 2-3 days with IV antibiotics
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What is the most common cancer in American Men?
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Prostate- 2nd leading cause of cancer death in men
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What is the Gleason Grading System?
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Score given to prostate cancer pt based on microscopic appearance. Higher the score the more aggressive.
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Gleason rating is from lowest ____ to highest_____
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2 to 10: higher the score the worse it is
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TNM Staging: T=? N=? M=?
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T: extent of primary tumor; N: is there nodal invasion; M: is there metastatis
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Radiation treatment options for prostate therapy? (name 2)
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Standard external beam approach: trans-rectal implantation of radon seeds: 5 year survival rates are equal to surgery.
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The difference betw M/F rectal relationship to pelvis?
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In females the anterior rectal wall is in contact w/ vagina
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Correct positions for anal exam in infant, children & women:
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Lithotomy position (supine, legs apart, knees flexed.
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Correct position for anal exam in adult men?
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bent over w/chest on exam table
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Internal hemorrhoids location:
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above the dentate covered w/colon mucosa
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External hemmorhoids location:
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below dentate line covered w/ squamous epithelium of anal canal
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Internal hemorrhoids problem shows:
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bright red bleeding onto stool or into toilet: usually not painful but may protrude
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External hemmorhoids may require:
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surgical drainage, straining can cause blood clot, extrememly painful, occurs in pregnany women.
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What is proctitis?
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inflammation of rectum, painful constipation & discharge caused by STD
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Anal abscesses & fistulas are foud where?
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in dentate line & are infected then burrow upward into soft tissue to form larger secondary abscess. (can be caused by poor hygeine, common in Crohns)
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For Pruritis Ani what should and shouldn't be used?
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1% hydrocotisone ointment NOT cream (will make it worse!)
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Rectovaginal fistula:
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causes vaginitis and the passage of stool out of the vagina
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Rectovesical fistula:
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rectum to bladder: causes a continuous urinary tract infection until corrected.
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Rectal fistula:
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an abnormal connection between the rectum and the bladder or vagina
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Stoma:
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bringing the colon or ileum to the outside of the body, with intestinal discharge collected in a bag
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Sigmoid colostomy:
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very common, to bypass the rectum, temporarily or permanently-
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Ileostomy:
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after removal of the colon for cancer or ulcerative colitis
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The MMSE: is a highly reliable and valid mini-test for abnormalities of
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cognition, orientation, language, recall, mental concentration
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highly reliable and valid mini-test for abnormalities of cognition, orientation, language, recall, mental concentration
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The MMSE
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most important part of the mental process and what goes first in mental conditions particularly delerium
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persons orientation
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not lost in early dementia
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persons orientation
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mmse know how many things in room
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5
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name how many things seen today
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1
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how many points for varying degree of orientation in time and space?
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where are you, what are your plans for today, what date is it, day of week? What did yesterday? Do tomorrow?
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10 points
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count backwards from 100
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5 points
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how many points for correctly naming objects in the room?
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3 points
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how many points for correctly naming object seen today not in room
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3 points
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points for a two-things together command: “close your eyes and put your hands over your closed eyes”; “pick up this pencil and write a sentence on this piece of paper with it".?
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3 points
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points for recalling the 3 objects you asked them to name at the beginning of the test?
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3 points
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total points in mmse?
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30 points
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people who have problems with 2 sequential commands have problems with what part of the brain?
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cerebelum
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people with problems with the _______will get first command correct but not second one
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cerebelum
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tumors in the head eyes ears and throat, encephalitis, but not meningitis, brain lessions from drugs, infections, neaurological diseases, head trauman can cause
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cranial nerve abnormalities
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I nerve
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olfactory
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II nerve
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optic
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III nerve
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ocular
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NerveIII ocular is for
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pupillary constriction; elevate and depress the eye
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IV nerve
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troclear
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IV – Trochlear nerve is for
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adduction (towards the midline) and intorsion of the eye
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V – Trigeminal nerve is for
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sensation of the face; motor control of the muscles of chewing
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V nerve
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Trigeminal
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sensation of the face; motor control of the muscles of chewing
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trigeminal
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V – Trigeminal
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sensation of the face; motor control of the muscles of chewing
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VI – Abducens
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abduction (away from the midline) of the eye
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VI nerve
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Abducens
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abduction (away from the midline) of the eye
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abductens
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VII – Facial
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muscles of facial expression; taste for anterior two-thirds of tongue
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VII nerve
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facial
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VIII – Auditory
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(often called the vestibulocochlear nerve): hearing and balance
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VIII nerve
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Auditory
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(often called the vestibulocochlear nerve): hearing and balance
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auditory
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IX – Glossopharyngeal
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taste for posterior third of tongue; sensation to soft palate; gag reflex
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IX nerve
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Glossopharyngeal
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taste for posterior third of tongue; sensation to soft palate; gag reflex
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glossopharyngeal nerve
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X – Vagus
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motor to soft palate and pharynx; gag reflex; position of uvula; also parasympathetic fibers to heart, lungs, GI tract
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X nerve
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vagus
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motor to soft palate and pharynx; gag reflex; position of uvula; also parasympathetic fibers to heart, lungs, GI tract
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vagus nerve
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XI – Spinal accessory
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motor control of sternocleidomastoid muscle and trapezius muscle (shrug of the shoulders)
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Xi nerve
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spinal accessory
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motor control of sternocleidomastoid muscle and trapezius muscle (shrug of the shoulders)
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spinal accessory
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XII – Hypoglossal
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motor control of the tongue
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motor control of the tongue
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XII – Hypoglossal
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testing for olfacrtory nerve I
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do you have a good sense of smell?
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If you detect there may be decreased sense of smell
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have two substances in ziplok baggies or small bottles such as ground coffee and cloves.
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Have pt. close his eyes so he doesn’t see what you have.
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Test by occluding one nostril and have the patient identify one of these substances, then switch to the other nostril and the other substance.
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Do not use perfume or cologne (many pts. are sensitive to it)
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testing for optic nerve III
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test for general visual acuity (chart not necessary)
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test pupillary light reflex: direct and consensual
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test four quadrant visual fields with your fingers
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testing for oculomotor nerve III
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all eye muscle movements except adduction (trochleal n.) and abduction (abducens n.)
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pupillary light reflex (both II and III nerves)
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look for a droopy eyelid if nerve is non-functioning or weak.
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testing for troclear nerve IV
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test for adduction of both eyes (look inward)
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testing for abducens nerve VI
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abduction of eyes (lateral gaze)
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testing for facial nerve VII
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test for the muscles of facial expression: ask patient to forcibly close eyes, smile, puffing air into cheeks, and wrinkle the forehead
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partial paralysis makes the eyes look bigger on the affected side
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testing for acoustic (auditory) nerve VIII
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two divisions: cochlear nerve; hearing acuity /vestibular nerve: balance;
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Initial test: rub fingers together on one side and mock rub them on the other: ask patient to determine which side the fingers are actually rubbing.
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testing for acoustic (auditory) nerve (II) VIII
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Weber test: tuning fork struck and placed in the middle of the forehead: lateralizes to bad ear with conduction defects, good ear with nerve defects
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Rinné test: vibrating fork held against the mastoid bone to check for air conduction better than bone conduction (normal)
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Weber test: auditory nerve
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tuning fork struck and placed in the middle of the forehead: lateralizes to bad ear with conduction defects, good ear with nerve defects
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testing for trigeminal nerve
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Sensation to the scalp and face: test with pin, may use cotton swab for light touch
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Motor branch to muscles of chewing: examiner hold jaw closed and ask pt. to open jaw against this force (should be able to do it)
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tetsting for vestibular nerve (3) VIII
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VIII (Vestibular) nerve:
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ask for complaints of dizziness/ vertigo
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check for nystagmus with lateral eye movements
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testing for glossopharyngeal nerve IX
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sensory arm of the gag reflex (sensation to posterior pharynx):
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taste for posterior third of tongue (not usually done)
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can initiate gag reflex if indicated (not routinely done unless pt. has difficulty in swallowing)
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testing for vagus nerve X
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motor arm of gag reflex: ask pt. to say, “Ahh”; motor to uvula – with nerve weakness, uvula will deviate away from weak side
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testing for Spinal Accessory nerve XI
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ask pt to shrug shoulders: look for asymmetry
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testing for Hypoglossal Nerve XII
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motor to the tongue: ask pt to protrude tongue: if one nerve is weak tongue will protrude toward the weak side
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Motor is an ______ nerve that causes ___ ________?
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efferent
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Sensory is an ______ nerve that ________ ________ for processing
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afferent nerve
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when examining bulk you look for 2 things?
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atrophy
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when examining muscle tone look for 4 things?
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fasciculations, tremors, flaccid tone, spasticity
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Fasciculations
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spontaneous twitching (we’re all familiar with this)
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In a strong muscle fasciculations mean?
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fatigue, tension, or too much caffeine; twitching is often around the eye, or in a shoulder
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In an abnormally weak muscle twitching means?
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denervation from injury or peripheral neuropathy, or motor neuron disease such as ALS or MS
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to test for spasticity
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Ask pt to fully relax:
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While pt. is sitting, hold upper arm and hand and move arm and hand through range of motion
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While pt. is lying down (supine) lift knee off the table: if normal or flaccid heel stays on the table; if spastic it rises off the table
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lower motor neuron problems (in the peripheral nerve)
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Decreased or flaccid tone
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upper motor neuron problems (in the spinal cord or the brain)
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Increased tone, spasticity
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such as Parkinson disease (resting tremor) or multiple sclerosis (intention tremor)
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Tremors extrapyramidal dysfunction
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What is Breast enlargement during pregnancy caused by?
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progesterone
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What does the pituitary secrete at the time of delivery?
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Prolactin
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The secretion of prolactin at birth causes what?
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production of milk
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What causes milk ducts to contract and force milk to nipples?
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oxytocin
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What is the "let-down reflex"
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when breast tissue produces more milk when infant is suckling
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How long does full milk production take?
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72 hours of breast feeding
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What is Colostrum?
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thin yellow fluid preceding milk production
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What is contained in Colostrum?
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vitamins, minerals, glucose, and antibodies.
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Lactating mothers need high intake of?
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fluids, calcium, protein
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Post-partum thrombophlebitis is common and mothers may take _________ or __________ for this problem even if nursing.
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Coumadin and heparin
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What is galatorrhea?
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Milk production in non breast feeding men & women
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What causes galactorrhea?
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excess prolactin secretion from pituitary
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Galactorrhea may also result in _________ & __________ in both men and women.
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amenororrhea and decreased libido
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What are some of the causes of galactorrhea?
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tranq's, over exercise, stress, pregnancy, pituitary tumors, hypothyroidism, MS, renal failure
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Drugs that suppress body levels of dopamine are the most common cause of ____
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prolactin hyper-secretion
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What effect does Dopamine have on prolactin secretion?
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represses
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What are the 5 D's in nipple exam?
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Discharge, Depression, Discoloration, Dermatologic changes, Deviation
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Under 40 how often should woman's breast be examined? Over 40?
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Under 1- years Over: every year
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When should a woman start getting mammography?
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yearly at 40
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Self breast exam should be done at what point during a woman's cycle?
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3-7 days after period
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Self breast exam should be done supine w/fingers of the opposite hand? T/F
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T
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Multiple painful an tender lumps in both breasts is indicative of?
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Fibrocystic disease
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Fibrocystic disease most monnon in ages?
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30-50
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What hormone is causative in Fibrocystic disease?
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Estrogenic
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In fibrocystic disease the fluid filled lesions are treated how?
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aspirated by a MD
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If aspriated fluid from a fibrocystic lesion is bloody what should she do?
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get a biopsy
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Does caffeine help or exacerbate fibrocystic disease?
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exacerbate
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What are the signs of Fibroadenoma?
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Mass is movable not fixed to surrounding tissue, firm rubbery solitary masses usually in the 20's or 30's.
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Do fibroadenomas need to be removed?
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no, not unless patient wants. Multiples are found in 15% of patients who have them
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intraductile papillomas may masquerade as?
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cancer..should be removed b/c they can degenerate into cancer
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What are the 3 types of breast biopsies?
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1- Fine needle aspiration 2- Core needle aspiration (most accurate for pathologist to read) 3- Radiographic-directed excisional biopsy (actual operation)
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What % of suspicious breast lumps are cancerous?
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40%
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What % of biopsies are false negative biopsies?
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10%
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1 in ___ women will develop breast cancer.
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8 in some places 7
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Mammography misses _____% of cancers?
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10%
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DCIS has 5 year survival rate of ______?
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99%
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When cancer is localized to breast overall cure rate is?
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75-90%
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When axillary lymph nodes are involved in breast cancer, 5 year survival drops to ______ 10 year ______?
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45% & 25%
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With distant metastasis 5 year survival? 10 year?
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5-10% and 2%
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BRCA1 gene mutation on chromosome 17 predicts a ____% of breast cancer?
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85%
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Mons pubis
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Release pheremones- covered with hair after puberty
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Labia Majora
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Large lips-usually closed- separate for urination & sex
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Labia Minora
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surround opening to the urethra & vagina. Engorge with sexual excitement. Mucos membranes keep it moist.
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Bartholin's glands
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on both sides of vagina, secretes fluid for intercourse
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Introitus
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Opening of the vagina
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Urethra
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located just above vagina
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Skene's glands
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Female enjaculation- female prostate- related to tissues of "g" spot
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Clitoris
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erogenous erectile tissue like penis
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Hymen
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membrane strectching accoss vagina in virgin. (often: Fenestrated: small openings)
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Uterus
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corpus and cerbix, glands that secrete mucus
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Pelvic Diaphragm
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important for defecation & female climax- with puborectalis and puboccygeus considered levator muscles.
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Uterine Lining
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Endometrium, becomes thick and hyperplastic in anticipation of pregnancy
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Erogenous area
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labia minora, clit & hood, G-spot (Graffenberg spot)
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Skene's Glands
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Orgasm & ejaculation
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Cervical mucus
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impenetrable to sperm & bacteria just before and during ovulation
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Bartholin's Glands Infection
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Can affect children and the glands will swell like walnuts, can be a staph infection
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Harvesting enough cells for Pap-smear
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sometimes need to rub the cervix with the tool to actually get it to bleed even
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Retroversion of the Uterus
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1st, 2nd & 3rd degree: 3rd compresses sigmoid and can cause constipation: many women who have had children get this.
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Pessaries
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Plastic devices, inserted in vagina that hold the uterus to stop prolapse
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Surgery for uterine prolapse are to do what?
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Strengthen the tendons to hold the uterus. For instnace in the round ligaments weaken.
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Ovaries house how many eggs
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400,000 immature eggs: 400 are released in a woman's lifetime.
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Corpus Luteum
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Means yellow body
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Hormone Cycle:
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1- one matures fully & meiosis divides 23 pairs of chromosomes into 23 separate ones 2- egg bursts through lining of the ovary 3- captured by fimbria of fallopian tube 4- remaining follicle becomes a corpus luteum which secretes progesterone
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Fertilization:
|
Male ejaculation: up to 500 million sperm: 1000 might reach egg: release hyaluronididase to penetrate the zona pellicula
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|
|
After egg has selected sperm, electromagnetic wave prevents another sperm from entering
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HCG:
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Secreted by fertilized egg tissue to maintain the corpus luteum & mobilizes body fat from mother to feed the fetus
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Gamete
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term for eggs and sperm
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Dyspareunia
|
painful intercourse
|
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Superficial Dyspareunia
|
inadequate foreplay; bacterial/fungal infection/1st intercourse with tearing of hymen
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Deep Dyspareunia
|
deep in vagina: infection, endometriosis, fibroids, retroversion/prolapse
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Dyspareunia
|
Can be caused by psychological factors
(painful sexual intercourse) |
|
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Vaginismus
|
involuntary contraction of the vaginal muscles: treated with stretching with dialators and kegel exercises
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Vulvodynia
|
Chronic Vulva pain: Caused by: allergens, diabetes and bacteria/infections
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Decreased Libido:
|
emotional, depression, etc..hormones, drugs: beta blockers, contraceptives, alcohol
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Sexual Arousal Disorder
|
persistent inability for a woman to produce vaginal lubrication
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Orgasmic Disorder
|
1 in 10 don't reach climax: 50% of women reach climax each time
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PMS
|
affects 1/3 of all PM women
|
|
|
PMS treated with:
|
accurate journaling, understanding, exercise, SSRI & prozac
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Dysmenorrhea
|
pelvic pain during period
|
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Primary Dysmennorhea
|
affects 75% of all women, severe in 5-10%. Tends to peak in teenage years. Can be treated with NSADIS
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Secondary Dysmennorrhea
|
due to organix cause other than pelvic congestion: endometriosis, fibroids, PID, cervical stenosis; usually treated by removing the IUD or fibroid etc..
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Spectatoring
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"watching" yourself during sex and thinking about how the other person is feeling.
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