NUR 3065 Health Assess Exam 3 Study Guide Updated, Exams of Nursing

Download NUR 3065 Health Assess Exam 3 Study Guide Updated and more Exams Nursing in PDF only on Docsity! 1 Health Assess Exam 3 Study Guide (Review Quizzes 10-12) Quiz 10: 1. Your 20 yo male patient is ℅ growths on his penile shaft. He noticed them first about 6 weeks ago, and he thinks there are more now. Denies pain with intercourse or urination. He has had 3 former partners and has been with his current girlfriend for 6 months. She is on the pill so they do not use condoms. Denies fever, weight loss, night sweats. His PMH is unremarkable. He is in college part time and works in construction and is engaged to be married and has no children. On exam, you see several moist papules along all sides of the penile shaft and two on the cornea. He has been circumcised. On palpation of his inguinal region, there is no inguinal lymphadenopathy. Which abnormality of the penis does patient most likely have? -Condylomata acuminata 2. A 29 yo married computer programmer is ℅ “something strange” going on in his scrotum. Last month he felt a lump in his left testis and is still there. He has had some aching in the left testis but denies pain with urination or intercourse. Palpation of his scrotum is unremarkable on the right side but indicates a large mass on the left. You attempt to place your finger through the left inguinal ring but cannot get above the mass. What disorder of the testes is most likely the diagnosis? -Scrotal hernia 3. A 22 yo male presents in your clinic ℅ pain in his testicle and penis. The pain began last night and has steadily become worse. He hurts when he urinates. He has not attempted intercourse since the pain began. He has tried Tylenol and Ibuprofen without improvement. Denies fevers or night sweats. He has had 4 previous sexual partners and has had a new partner for the last month. She is using oral contraceptives and they do not use a condom. On exam, you see a young man lying on his side, mildly ill. His temp is 100.2. There are no visible lesions on the penis or discharge from the meatus. The scrotum appears normal. Palpation of the testes reveals severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges notes with bearing down. Urinalysis shows WBC and bacteria. What diagnosis of the male genitalia is most likely? -Acute epididymitis 4. A 15 yo high school football player is in your clinic, ℅ severe testicular pain since 8am this morning. Denies sexual activity. Unable to urinate due to pain. He is nauseated and is vomiting. He is lying on the exam table, uncomfortably shifting 2 his position. His BP is 150/100, pulse is 110, respirations are 24. There are no lesions on the penis and no discharge from the meatus. The scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. Prostate exam is normal. His cremasteric reflex is absent on the left but is normal on the right. The urine sample by catheter is normal. You send him to the ER, what do you think it could be? -Torsion of the spermatic cord 5. Frank is a 24 yo man who presents with multiple vesicles and burning erosions on the shaft of his penis and some tender inguinal adenopathy. Which of the following is most likely? -Herpes 6. Your 22 yo female patient ℅ severe burning with urination, fever of 101, and aching all over. She takes oral contraceptives. She reports one new partner within the last month. Palpation of the inguinal nodes reveals bilateral lymphadenopathy. There are more than 10 shallow ulcers along each side of the vulva. She is very tender at the introitus. Urine has some WBC but no RBC or bacteria. Which disorder of the vulva is most likely? -Genital herpes 7. Your 30 year old female patient is c/o bad-smelling vaginal discharge with mild itching for about 3 weeks. Douching did not help. Denies painful urination or intercourse. She noticed the smell increased after intercourse and during her period last week. There are no lesions on the perineum. No lymphadenopathy. On speculum examination, there is a thin gray-white discharge. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled border (clue cells). What type of vaginitis best describes the findings? -Bacterial vaginosis 8. Which of the following represents metrorrhagia? -Bleeding between periods 9. Which is a sign of benign prostatic hyperplasia? -Nocturia 10. Which is true of prostate cancer? -Ethnicity is risk factor Quiz 11: 1. During the delivery of a male infant, you are there to assess the Apgar score. He was born through an intact pelvis and had no complications during labor or 5 -Bright lighting 4. Which of the following questions is part of the screening for physical disability? -Are you able to go shopping for groceries or clothes? 5. It is summer and an 82 year old woman is brought to you from her home after seeing her primary care doctor 2 days ago. She was started on an antibiotic at that time. Today, she comes to the emergency room not knowing where she is or what year it is. What could be a likely cause of this? -Delirium 6. Blood pressure abnormalities found more commonly in Western elderly include which of the following? -Elevation of the systolic BP 7. Claire, 82 years old, is hospitalized for assessment since she has fallen several times in her home. Which assessments are indicated at this time? a. Orthostatic vital signs b. Review of her medications c. Assessment of gait and balance d. All of the above 8. Mrs. Geller is somewhat quiet today. She has several bruises of different colors on the ulnar aspects of her forearms and on her abdomen. She otherwise has no complaints and her diabetes and HTN are well managed. Her son from out of state accompanies her today and has recently moved in to help her. What should you suspect? -Elder abuse 9. A patient comes to you for the appearance of purple patches on his forearms that have been present for several months. They remain for several weeks, then fade. He denies a history of trauma. Which of the following is likely? -Actinic purpura 10. For patients with a conductive hearing loss, a noisy environment might actually help. -True (Male Reproductive System) 1. Conditions of the male genitalia a. Hypospadias: birth defect where the opening of the urethra is on the 6 underside of the penis instead of at the tip b. Peyronie’s Disease: Penis problem caused by scar tissue, called plaque, that forms inside the penis. It can result in a bent, erect penis. Could cause painful sex and erectile dysfunction c. Carcinoma: cancer is painless, hard, firm mass d. Genital Warts: caused by certain types of HPV, spread by skin-to-skin contact with someone who is infected e. Genital Herpes Simplex: caused by herpes virus. Causes pain, itching, sores. You don’t have to have visible sores to be contagious. Symptoms: Cracked, raw, red areas, small blisters that break open and cause painful sores f. Primary Syphilis: small, painless open sore or ulcer(chancre) on the genitals, mouth, skin, or rectum. Heals by itself in 3-6 weeks. Enlarged lymph nodes in area of sore g. Chancroid: Infection of genital skin or mucous membranes caused by haemophilus ducreyi and characterized by papules, painful ulcers, and enlargement of inguinal nodes leading to suppuration. h. Scrotal Edema: enlargement of scrotal sac due to injury or underlying medical condition. May be caused by accumulation of fluid, inflammation or abnormal growth in scrotum. i. Hydrocele: swelling in the scrotum occurs with fluid collects in the thin sheath surrounding a testicle. Common in newborns and usually disappears by age 1. Older boys and men get this due to inflammation or injury. TRANSILLUMINATION used and will appear a soft red; while a tumor will not transmit light j. Scrotal Hernia: Develop with swelling or injury of the scrotum. Inguinal hernia occurs if a small part of the intestine drops into the scrotum with the testes. Intestine can form a lump in the scrotum. k. Cryptorchidism: one or both of the testes fail to descend from the abdomen into the scrotum l. Small Testis: average length of testicle is 4.5-5.1 cm. Testicles that are less than 3.5 cm are small. m. Acute Orchitis: inflammation of one or both testicles. Bacterial or viral infections can cause orchitis or the cause is unknown. The mumps virus can cause this. n. Tumor: A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign). o. Spermatocele and cyst of the epididymis: cyst:mass contains clear fluid spermatocele: mass contains fluid and sperm cells p. Varicocele of the spermatic cord: abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles back to the heart. Feels like a bag of worms/spaghetti. Most commonly found above the left testicle. q. Acute Epididymitis: clinical syndrome consisting of pain, swelling, inflammation of the epididymis that lasts less than 6 weeks. Sometimes testis is also involved, which would be called epidiymo-orchitis. 7 r. Torsion of the spermatic cord: Testicle rotates and twists reducing blood flow that leads to scrotum. Severe pain and swelling. Abdominal pain, nausea and vomiting, frequent urination. Most common in ages 12-18 but can happen at any age. s. Tuberculous Epididymitis: one of the causes of chronic epididymal lesions. Difficult to diagnose in the absence of renal involvement. Patients present with fever, dysuria, severe and acute scrotal pain. Scrotum is usually hot, swollen, tender. 2. Torsion of spermatic cord, hydrocele, orchitis, prostatitis, epididymitis, inguinal hernia, varicocele, testicular carcinoma, normal vas deferens, condylomata acuminate, genital herpes a. Prostatitis: Inflammation of the prostate. painful, difficult frequent urinating. Blood in the urine, groin pain, abdominal pain, low back pain, fever and chills. Malaise and body aches, urethral discharge, painful ejaculation or sexual dysfunction b. Inguinal hernia: bulge in the area of either side of your pubic bone which becomes more obvious when standing, cough or straining. Burning or aching at the bulge. c. Condylomata acuminata: anogenital warts. caused by HPV. variably sized and shaped soft papules or plaques on anogenital skin d. Vas deferens: these ducts transport sperm from the epididymis to the ejaculatory ducts 3. Syphilitic chancre, penile carcinoma, scrotal edema, scrotal hernia a. Already listed above 4. Disorders of rectum, anus – anal fissure, external/internal hemorrhoid, cancer, BPH, prostate CA, rectal prolapse a. Anal fissure: small tear in the thin, moist tissue that lines the anus. May occur when you pass hard or large stool. May cause pain and bleeding with bowel movements. b. Hemorrhoid: also called piles, these are swollen veins in your anus and lower rectum, similar to varicose veins. Number of causes although they are often unknown. c. BPH: benign prostatic hyperplasia, enlarged prostate. Nocturia is a symptom. d. Prostate cancer: side effects are urinary dysfunction, erectile dysfunction, infertility, loss of bladder control, difficulty stopping and starting stream. Prostate cancer is the leading cancer diagnosed in men in the United States, and the third leading cause of death. African American, male, high- fat diet, and age are risk factors. Feels like hard stone e. Rectal prolapse: rectum loses its normal attachments inside the body 10 Menarche: d. The first menstrual cycle Polymenorrhea: e. <21 days between menses Oligomenorrhea: f. Infrequent bleeding Menorrhagia: g. Excessive bleeding 2. Female disorders – genital herpes, trichomonas vaginitis, candida vaginitis, bacterial vaginosis, atrophic vaginitis, tubal pregnancy, PID, ovarian cyst, bartholin’s gland infection, vulvar CA, syphilis, vaginismus a. Genital herpes: same as in males b. Trichomonas vaginitis: the protozoan parasite that is the cause of the STI trichomoniasis. Can be in men and women, men are usually asymptomatic. Transmission through direct contact. Symptoms: frothy greenish vaginal discharge, musty odor, itching, painful urination. Signs: “strawberry” cervix which is a red cervix with pinpoint areas of exudation. Tested with a cervical smear c. Candida vaginitis: Yeast infection. Causes inflammation, itchiness, thick, white discharge from the vagina. d. Atrophic Vaginitis: dryness of the vagina. Usually happens after menopause. Symptoms: painful intercourse and increased UTIs e. Tubal Pregnancy: ectopic pregnancy (fertilized egg implants outside the uterus) that occurs in the fallopian tube. Signs: might miss period, discomfort in the belly, tender breasts, belly pain, vaginal bleeding, nausea, vomiting. f. PID: Pelvic Inflammatory Disease. Usually occurs when bacteria spreads from vagina to the uterus, fallopian tubes, or ovaries. Untreated STDs can cause PID. Symptoms: pelvic pain, fever, maybe vaginal discharge g. Ovarian Cyst: fluid-filled sacs in ovary. Usually form during ovulation. Most women don’t have symptoms. Could have irregular periods, pain during sex, irregular bowel movements. h. Bartholin’s Gland Infection: glands are located on each side of vaginal opening to lubricate the vagina. Painless swelling. If fluid in cyst becomes infected you may have pus and inflamed tissue. i. Vulvar cancer: Rare cancer on the outer vaginal lips. Symptoms are lumps, itching, bleeding j. Vaginismus: muscle spasm in the pelvic floor muscles. Can make it painful or difficult to have sex, have a GYN exam or insert tampon. k. Cyst: An abnormal, usually noncancerous growth filled with liquid or a 11 semisolid substance, sometimes causing pain. If it is filled with pus, it is not a cyst l. UTI: Cloudy urine and first symptom is usually dysuria 3. Breast CA, lymphadenopathy (also can apply to males) a. Breast cancer: Signs and Symptoms: swelling of breast, skin irritation or dimpling, breast or nipple pain, nipple retraction, redness, scaliness, thickening of nipple or breast skin, nipple discharge, change in breast size and shape, lumps inside breast or underarm b. Lymphadenopathy: Adenopathy disease of lymph nodes, they are abnormal in size or consistency. Produce swollen or enlarged lymph nodes. Immune system glands usually enlarge in response to a bacterial or viral infection, but sudden swelling of many lymph nodes may indicate cancer. 4. Peau d’orange a. Describes anatomy with the appearance and dimpled texture of an orange peel caused by cutaneous lymphatic edema. Seen in cancers, but not always cancerous. Lymphedema is caused by lymphatic system blockage resulting in swelling of the extremities 5. Paget’s disease a. Disease of the bone, interferes with normal recycling process in which new bone tissue gradually replaces old bone tissue. Over time it can cause bones to become fragile and misshapen. Risk factors are age and family history of disease. Most common in pelvis, skull, spine and legs. Second most common bone disorder after osteoporosis (Putting It All Together-Musculoskeletal & Nervous System) 1. Signs – Tinels, phalen, neers, Hawkins, psoas, obturator, brudzinski, kernig, straight leg raise - Tinel’s sign- tingling with tapping over the median nerve as it enters the carpal tunnel. Test used to assess for irritated median nerve and carpal tunnel syndrome. - Will produce “pins and needles” feeling. 12 - Symptoms may include hand pain, wrist pain, hand numbness Phalen’s sign- numbness or tingling with pressing backs of hands together in acute flexion for 60 seconds --Testing for carpal tunnel syndrome The test is positive if the patient experiences tingling in the thumb, index finger, middle finger and the lateral half of the ring finger. Neer’s- press on scapula with one hand, raise patient’s arm with other and see if they have pain --Test for impingement of rotator cuff, tendons or bursa in shoulder Hawkin’s- Flex patient’s shoulders and elbow to 90 degrees with palm facing down, rotate arm internally. If either one produces pain, it is a positive test, possibly indicating a rotator cuff tear Psoas- test for appendicitis. Tested on the patient’s right leg, patient flexes right hip against examiner’s hand. Also tested by patient rolling on left side and extend the leg at the right hip Obturator: testing for appendicitis. Patient lies on back, hip and knee both flexed, hip internally rotates. If painful = inflamed appendix Brudzinski: Test for meningitis. Patient lies supine, nurse pushes head up to flex neck toward chest and spontaneous flexion of hips and knees occurs. Severe neck stiffness 15 9. Gait a. Walking across the room shows us: posture, balance, arm swing, movement of the legs. b. Types of gait: steppage - The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking, hemiplegic - includes impaired natural swing at the hip and knee kept straight with leg circumduction, parkinson - slow, short-strided shuffling, retropulsion - disorder of locomotion associated especially with Parkinson's disease that is marked by a tendency to walk backwards. Coordination Romberg test Pronator drift Patient stands for 20–30 seconds with both arms straight forward, palms up, and eyes closed; tap arms briskly downward. Pronation and downward drift of the arm is a positive test.--positive test means upper motor neuron disorder 10. Increased ICP a. The most common cause of high ICP is a blow to the head. The main symptoms are headache, confusion, decreased alertness, and nausea vomiting. A person's pupils may not respond to light in the usual way. Hypertension and a widening pulse pressure (the difference between the systolic and diastolic BP) 11. Migraines a. a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound. 12. Fine motor vs gross motor development a. Fine motor skills refers to the movements we make with the small muscles of the hands. b. Gross motor skills involve movement of the large muscles in arms, legs, and torso. Gross motor activities include walking, running, skipping, jumping, throwing, climbing and many others. 13. Types of seizures a. Focal seizures: These start in a particular part of your brain, and their names are based on the part where they happen. They can cause both physical and 16 emotional effects and make you feel, see, or hear things that aren’t there. b. Generalized seizures: These happen when nerve cells on both sides of your brain misfire. They can make you have muscle spasms, black out, or fall. 6 Types of Generalized Seizures Tonic-clonic (or grand mal) seizures: Your body stiffens, jerks, and shakes, and you lose consciousness. Sometimes you lose control of your bladder or bowels. They usually last 1 to 3 minutes -- if they go on longer, someone should call 911. That can lead to breathing problems or make you bite your tongue or cheek. Clonic seizures: Your muscles have spasms, which often make your face, neck, and arm muscles jerk rhythmically. They may last several minutes. Tonic seizures: The muscles in your arms, legs, or trunk tense up. These usually last less than 20 seconds and often happen when you’re asleep. But if you’re standing up at the time, you can lose your balance and fall. Atonic seizures: Your muscles suddenly go limp, and your head may lean forward. If you’re holding something, you might drop it, and if you’re standing, you might fall. These usually last less than 15 seconds, but some people have several in a row. Myoclonic seizures: Your muscles suddenly jerk as if you’ve been shocked. Absence (or petit mal) seizures: You seem disconnected from others around you and don’t respond to them. You may stare blankly into space, and your eyes might roll back in your head. They usually last only a few seconds, and you may not remember having one. They’re most common in children under 14. 14. Types of tremors a. Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. (Parkinson’s) b. Action tremor occurs with the voluntary movement of a muscle. 15. Vasovagal syncope a. occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly 16. Decorticate vs decerebrate rigidity a. Decorticate: cerebral hemispheres. Posture is stiff with bent arms, clenched fists and legs straight. Arms are bent into the body b. Decerebrate: diencephalon, midbrain, pons. Posture is arms straight out to the 17 side with wrists flexed out, legs kind of angled inward. (Putting It All Together, Skin-Integumentary System) 1. Acanthosis nigricans A skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and neck. Acanthosis nigricans typically occurs in people who are obese or have diabetes. More rarely, it can be a warning sign of a cancerous tumor in an internal organ, such as the stomach or liver. 2. Lyme disease Causes a rash, often in a bull's-eye pattern, and flu-like symptoms. Joint pain and weakness in the limbs also can occur. Deer ticks can carry the bacteria that causes Lyme disease. An infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete 3. Herpetic stomatitis, oral candidiasis 20 i. Listen to the mass with a stethoscope. If bowel sound are heard, its a hernia ii. Shine a strong light from behind the scrotum through the mass(transillumination). If a red glow is observed, it's probably not a hernia. 16. Disorders of rectum a. anus – (anal fissure) A small tear in the lining of the anus. b. external/internal hemorrhoid -Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. c. Cancer - A cancer of the colon or rectum, located at the digestive tract's lower end. d. BPH (Benign prostatic hyperplasia) - Age-associated prostate gland enlargement that can cause urination difficulty. i. Men older than 70 years are at greatest risk. Therefore, the nurse should review patterns of urination e. prostate CA - f. rectal prolapse - A condition that occurs when part of the large intestine slips outside the anus. 17. Gynecomastia - Swollen male breast tissue caused by a hormone imbalance. a. Many adolescent boys develop gynecomastia one or both sides. Although usually slight, it can be very embarrassing. Generally resolves within a few years (Infant, Child & Adolescent) 17. Order of pediatric exam (Bates pg. 821) 1. General Survey and Vital Signs 2. Somatic growth: Length, Weight, Head Circumference 3. Vital Signs Blood Pressure, Pulse, RR, Temperature 4. Skin: Inspection, Palpation 5. Head: Sutures and Fontanelles, Skull Symmetry and Head circumference, Facial Symmetry 6. Eyes: inspection, Ophthalmoscopic Examination 7. Ears 8. Nose and Sinuses 9. Mouth and Pharynx 10. Neck 11. Thorax and Lungs: Inspection, Palpation, Auscultation 12. Heart: Inspection, Palpation, Auscultation, Heart murmurs 13. Breast 14. Abdomen: Inspection Auscultation, Percussion, Palpation 15. Male Genitalia/ Female Genitalia 16. Rectal Exam 17. Musculoskeletal Exam 18. Nervous System: Mental Status, Motor Function and Tone, Sensory Function, Cranial 21 Nerves, Deep tendon reflexes, Primitive Reflexes, Development 18. Neuro-nystagmus -wandering or shaking eye movement) a. Persists after a few days after birth or persisting after the maneuver described on the left (Bates pg. 830) may indicate poor vision or central nervous system disease. 19. fetal alcohol syndrome Alcohol exposure during the pregnancy that causes brain damage and growth issues. Defects caused are not reversible 20. down syndrome Also known as Trisomy 21 (3 copies on chromosomes). Causes mentally challenges, low nasal bridge, protruding tongue, low set ears, and poor muscle tone. Risk increases with maternal age above 35. (Female Reproductive System) Disorders of the menses 21. Metrorrhagia Bleeding that occurs in between periods. 22. Amenorrhea Absence of menstrual cycle for at least 3 cycles 23. Dysmenorrhea Painful menstruation 24. Menarche First menstruation Female disorders 25. genital herpes - Lesion of the vulva - Shallow, small painful ulcers on red bases point to infection from genital herpes simplex virus 1 or 2 - Ulcers may take 2-4 weeks to heal - Recurrent outbreaks of localized vesicles then ulcers are common 26. trichomonas vaginitis - Cause: trichomonas vaginalis, a protozoan- not always caused sexually - Discharge: yellowish green or gray, possibly frothy; often profuse and pooled in vaginal fornix; may be malodorous - Other symptoms: pruritus; urinary pain, dyspareunia - Vulva and vaginal mucosa: vestibule and labia minora erythematous; reddened with small red granular spots or petechiae in posterior fornix. Looks normal in mild cases. - Lab evaluation: scan saline wet mount 27. candida vaginitis - Cause: candida albicans, a yeast (normal overgrowth of vaginal flora)- may factors including antibiotic therapy 22 - Discharge: white and curdy; thin or thick; not profuse or malodorous - Other symptoms: pruritus; vaginal soreness; pain on urination, dyspareunia - Vulva and vaginal mucosa: may be inflammed and swollen; reddened with white patched of discharge; mucosa may bleed if patches scraped off; looks normal in mild cases - Lab evaluation: scan potassium hydroxide preparation for blanching hyphae of candida 28. bacterial vaginosis - Cause: bacterial overgrowth, probably from anaerobic bacteria; often transmitted sexually - Discharge: gray or white, thin, homogenous, malodorous; coats vaginal walls; usually not profuse, may be minimal - Other symptoms: unpleasant fishy or musty genital odor reported to occur after intercourse - Vulva and vaginal mucosa: appear normal - Lab evaluation: scan saline wet mount for clue cells, sniff for fishy odor after apply potassium chloride, test vaginal secretions for pH > 4.5 29. atrophic vaginitis Atrophic vaginitis is a vaginal disorder that usually happens after menopause. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed https://www.medicalnewstoday.com/articles/189406.php 30. tubal pregnancy An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; thus, the fertilized egg in a tubal pregnancy cannot develop properly and must be treated. An ectopic pregnancy happens in 1 out of 50 pregnancies. https://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/ 31. PID- Pelvic Inflammatory Disease a. Most commonly caused by STIs such as chlamydia b. 10%- 15% of untreated STIs turn into PID for c. Polymicrobial infection with 8%-40% risk of infertility d. ⅓- ½ cases attributed to co-infection of chlamydia with Neisseria gonorrhoeae e. Infection rates highest in women 20- 24 years old and second highest in women 15- 19 years old f. African American women and American Indian/Alaska Native women have the highest infection rates 32. ovarian cyst a. Ovarian cysts are fluid-filled sacs or pockets in an ovary or on its surface. b. Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few 25 painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. b. After the initial infection, the syphilis bacteria can lie dormant in your body for decades before becoming active again. Early syphilis can be cured, sometimes with a single injection of penicillin. Without treatment, syphilis can severely damage your heart, brain or other organs, and can be life-threatening, or be passed from mother to an unborn child. c. Symptoms: Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don't always occur in the same order. You may be infected with syphilis and not notice any symptoms for years. d. Causes: The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person's sore during sexual activity. e. Risk factors: i. Engage in unprotected sex ii. Have sex with multiple partners iii. Are a man who has sex with men iv. Are infected with HIV, the virus that causes AIDS f. Prevention: i. Abstain or be monogamous. ii. Use a latex condom. iii. Avoid recreational drugs. https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc- 20351756 36. Vaginismus a. Involuntary spasms of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible b. Cause may be physical or psychological 37. Breast CA What are some risk assessments for breast cancer? Seeking information about gender, race/ethnicity, menstrual history, combination oral contraceptive use, history of childbirth, breastfeeding, genetic risk factors (BRCA1 and/or BRCA2), alcohol abuse, tobacco use, combined and estrogen-alone menopausal hormone therapy (MHT), abnormal breast biopsy results, personal history of breast cancer, overweight or obesity (especially after menopause), physical inactivity, previous chest radiation, family history. Palpable masses: All breast masses require careful assessment. Breast cancer 4% with breast complaints 5% with nipple discharge 11% with lump or mass 26 Second leading cause of cancer death in women. What are some common signs and symptoms related to the breasts and axillae? -retraction -abnormal contour -skin dimpling -nipple retraction and deviation-- usually nipples point towards you, but if they deviate then this could indicate cancer -edema of skin-- orange peel skin. no change in color but looks like an orange peel with dimpling--- block somewhere in the lymphatic system. goes to sentinel node. (gatekeeper) Breast Self-Examination (BSE) -BSE remains an important tool in the detection of breast cancer -women should be told about the benefits and limitations of BSE. Any breast changes should be reported to her health care provider -the American Cancer Society recommends BSE as an option for women beginning in their 20s Abnormalities: Galactorrhea: lactation not associated with childbearing Abnormalities: Mastitis: inflammation and infection of the breast tissue Abnormalities: Gynecomastia: breast enlargement in men Abnormalities: fibrocystic changes: benign fluid-filled cyst formation caused by ductal enlargement Abnormalities: fibroadenoma: benign tumors composed of stromal and epithelial elements that represent a hyper plastic or proliferative process in a single terminal ductal unit Abnormalities: Malignant breast tumors -ductal cancer arises from the epithelial lining of ducts -lobular cancer originates in the glandular tissue of the lobules Abnormalities: fat necrosis: begin breast lump that occurs as an inflammatory response to local injury INSPECTION: Inspect the breasts with the patient in sitting position and disrobed to the waist Look for skin changes (color, thickening, and unusually prominent pores), size and symmetry, contour, characteristics of the nipples (size, shape, direction in which they point, rashes, ulceration, and discharge) Ask the patient to raise her arms above her head or press them against the hips as this can bring out dimpling or retraction PALPATION: Patient supine Fingerpads of 2nd, 2rd, 4th fingers Vertical strip pattern Small, concentric circles 27 Light-- usual pressure, medium, deep pressure--- larger or more tissue ** adjust pressure based on pt in front of you Consistency of tissues Tenderness-- clock method Nodules ---- pattern is inside out and towards. small concentric circles. not a deep pressure unless absolutely needed. RECORDING FINDINGS: Contour Symmetry Masses, lumps-- remember quads and clock Dimpling Retraction-- even if normal still note it. Edema Discharge-- note color, consistency, etc Skin Prior surgeries Initially you may want to use sentences As you become more familiar with terms you can use phrases “Breasts symmetric and without masses. Nipples without discharge.” “Breasts pendulous with diffuse fibrocystic changes. Single firm 1 x 1 cm mass, mobile and non- tender, with overlying peau d’orange appearance in right breast, upper outer quadrant at 11 o’clock.” To describe your findings, divide the breast into four quadrants Horizontal and vertical lines crossing the nipple Note that the axillary tail of breast tissue extends into the anterior axillary fold As an alternative method, localize findings as the time on the face of a clock and distance in centimeters from the nipple 30 Obturator Test:hip and knee flexed. Passive Internal and External rotation of knee. Positive if pain increases appendicitis brudzinski's sign: lay flat, passively flex the PTs knee, if they reflexively flex the kee/hip it's a positive sign. When flexing the neck, there is involuntary flexion of the hips and knees. Possible meningitis Kernig’s sign: lay flat, have PT flex at knees/hips, then passively straighten their leg up into the air, flex the leg at the knee and hip when the patient is supine. Attempt to straighten the leg. There is pain in the lower back and resistance to straightening the leg at the knee. if pain in the neck or back, positive sign. Possible meningitis Staright Leg raise: Pt lies supine - Raise the pts relaxed straightened leg until pain occurs, then dorsiflex the foot (i.e. pull toes towards shin)- Positive Test: Dorsiflexion makes the low back pain worse - Record the degree of elevation the pain occurs, the quality and distribution of the pain, and the effects of dorsiflexion. Note:- Tight hamstrings are NOT a positive for this test, pain MUST be in the low back. 42. Carpal tunnel: Space-occupying lesion or direct pressure within the carpal canal increases pressure on the median nerve, resulting in compression. Compression of the median nerve leads to demyelination and subsequent axonal degeneration, which interrupts normal function. Exact cause unknown. Assessment-Physical Findings: Inability to make a fist. Positive Hoffman-Tinel sign, Positive Phalen sign, Positive hand elevation test. Fingernails may be atrophied, with surrounding dry, shiny skin 43. Neuro exams – Know the spelling a. stereognosis lace a key or familiar object in the patient’s hand and ask the patient to identify it b. Graphesthesia outlinealarge number in the patient’s palm and ask the patient to identify the number 44. Cerebellar vs vestibular vs sensory vs motor systems The cerebellum receives information from the sensory systems, the spinal cord, and other parts of the brain and then regulates motor movements. The cerebellum coordinates voluntary movements such as posture, balance, coordination, and speech, resulting in smooth and balanced muscular activity. It is also important for learning motor behaviors Vestibular system: The vestibular system is a sensory system is responsible for providing our 31 brain with information about motion, head position, and spatial orientation; it also is involved with motor functions that allow us to keep our balance, stabilize our head and body during movement, and maintain posture Motor system Three kind of motor pathways impinge on the anterior horn cell. a. Corticospinal (Pyramidal) Tract- Voluntary movement and integrated skilled Muscle Tone Inhibition b. Basal Ganglia System Automatic Movements (Walking) Muscle Tone c. Cerebellar System Motor activity, equilibrium, posture Sensory system: Sensory pathways impulses participate not only in reflex activity, but also give rise to conscious sensation, calibrate body position in space, and help regulate internal autonomic functions like blood pressure, heart rate, and respiration. To evaluate the sensory system, you will test several kinds of functions a. Pain and temperature (spinothalamic) b. Position and vibration (posterior columns) c. Light touch (both spinothalamic and posterior columns) Spinal Reflex: DTR • Ankle Reflex (S1) • Knee Reflex (L2,3,4) • Supinator (Brachioradialis) Reflex (C5,6) • Biceps Reflex (C5,6) • Triceps (C6,7) • AbdominalReflex – Upper (T8,9,10) – Lower (T10,11,12) • PlantarResponses(L5-S1) 45. Cauda equina, sciatic, low back pain, rotator cuff tear symptoms Cauda equina: The lumbar and sacral roots travel the longest intraspinal distance and fan out like a horse’s tail at L1-2. To avoid injury to spinal cord, most lumbar punctures are performed at L3-L4 0R L4-L5 vertebral interspaces. Bates ( p Sciatic ( Radicular low back pain): Shooting pain below the knee, commonly into the lateral leg (L5) or posterior calf ( s1) typically accompanies low back pain. Patients rert associated paresthesias and weakness. Bending, sneezing, coughing, straining during bowel movements often worsen pain.(Bates P.636) 32 Low back pain: Aching pain in the lumbosacral area may radiate into lower leg especially along L5 OR S1 dermatomes. Refers to anatomic or functional abnormality In the absence of neoplastic, infectious, or inflammatory disease. Usually acute less than 3 months. Idiopathic, benign, and self -limiting, represents 97% of symptomatic low back pain. Commonly work related and occurring in patients 30-50 years. Risk factors include heavy lifting , poor conditioning, and obesity. Rotator cuff tear symptoms: weakness, atrophy of the supraspinatus and infraspinatus muscles, pain, crepitus and tenderness. ( bates P. 640) 46. MS disorders – rheumatoid arthritis a. Chronic inflammation of the synovial membranes with secondary erosion of adjacent cartilage and bone, and damage to ligaments and tendons. b. Common locations Hands, feet, wrists, knees, elbows, ankle c. Oten chronic with remissions and exacerbations. Gout a. An inflammatory reaction to microcrystals of sodium urate b. Base on the big toe ( first metatarsophalangeal), the instep or dors of the feet, knees, and elbow c. Sudden, often at night, after injury , surgery, or excessive food or alcohol intake d. Trauma: a deeply distressing or disturbing experience neck pain: Aching pain in the cervical paraspinal muscle ligament with associated muscles spasm, stiffness and tightness the upper back and shoulder lasting up to 6 weeks. No associated radiation, paresthesias, or weakness. Headache may be present. Neck pain_ whiplash : Often beginning the day after surgery . Occipital headache, dizziness, malaise,and fatigue may be present. Chronic whiplash syndrome if symptoms last more that 6 months, present in 20- 40% injuries Bursitis/ Bursae: are pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joints structures. The most common place for bursitis or shoulders, elbow and hips. 47. Fibromyalgia a. Widespread musculoskeletal pain and tender points. May accompany other disease. ( Mechanisms unclear) b. Common locations 35 50. Increased ICP Not sure what she wants here either Book states when to examine babies fontanelles for fullness because that exhibits increased intracranial pressure 51. Migraines ● Most frequent cause of headache seen in office practice ● Most debilitating ● Last up to 3 days ● Red flags for secondary causes ○ Recent onset less than 6 months ○ Onset after 50 years of age ○ Acute onset like “thunderclap or worst headache of my life” ○ Marked elevated blood pressure ○ Presence of rash or signs of infection ○ Presence of cancer HIV or pregnancy ○ Vomiting ○ Recent head trauma ○ Persistent neurological defects ● Possible life threatening causes ○ Meningitis ○ Subdural or intracranial hemorrhage ○ Tumor 52. Fine motor vs gross motor development Not sure what she is looking for ● Gross ○ Crawling running and jumping ○ Rolling over ● Fine ○ Picking up small objects ○ Holding spoon ○ Wiggling finger and toes 53. Types of seizures Can have impaired consciousness or not ● Focal ○ Page 735 in book (it’s a lot) ● Tonic clonic/ grand mal ○ Tonic phase ■ Loses consciousness suddenly ■ Body stiffness ■ Extensor rigidity ■ Breathing stops (cyanotic) ○ Clonic phase ■ Rhythmic muscular contractions 36 ■ Breathing resumes, noisy ■ Excessive salivation ■ Injury ■ Tongue biting ■ Urinary incontinence - Person can have amnesia afterwards and recall no aura ● Absence ○ No aura recalled ○ Some confusion ○ Sudden lapse of consciousness ○ Memomentary blinking, staring, or movements of hands and lips but not falling ○ Two types ■ Typical ● Less than 10 seconds ● Stops suddenly ■ Atypical ● More than 10 seconds ● Myoclonic ○ Sudden, brief, rapid jerks ○ Trunk or limbs ○ Associated with a variety of disorders ● Myoclonic Atonic (drop attack) ○ Sudden LOC ○ No movement ○ Injury may occur ● Pseudoseizures ○ Psychological disorder that mimics a seizure ○ Movement has personal symbolic significance ○ Do not follow neuroanatomic pattern ○ Injury uncommon 54. Types of tremors ● Parkinson’s disease (resting tremor) ○ Low frequency ○ Unilateral ○ Rigidity ○ bradykinesia ● Essential tremors ○ High frequency ○ Bilateral ○ Upper extremities with both limb movements and sustained posture ○ Subside when limb is relaxed ○ Head voice and leg tremor may also be present ● Restless leg syndrome ○ 6-12% of US population 37 ○ Unpleasant sensation in legs ○ Especially at night ○ Gets worse with rest ○ Improves with movement 55. Vasovagal syncope Syncope is wooziness, fainting, or blacking out caused by a sudden drop in heart rate and blood pressure. Vasovagal syncope is the neurocardiogenic syncope which occurs in response to a stressor, trigger, or traumatic stimuli (such as standing too long, excess heat, emotional shock, sight of blood, etc.) Precipitated by fearful or unpleasant event. This is the most common cause of syncope. Prodromal symptoms include pallor, diaphoresis, or nausea, and slow onset/offset, vagally mediated hypotension. 56. Decorticate vs decerebrate rigidity- abnormal postures for coma patients Decorticate rigidity - upper arms tight to sides, elbows flexed, with wrists and fingers flexed at chest. Implies a destructive lesion on corticospinal tracts in or near cerebral hemispheres. Decerebrate rigidity - jaw clenched, neck extended, arms adducted & extended stiffly at sides. Can occur spontaneously or in response to stimulus. Indicative of lesion on diencephalon, midbrain, or pons, or body states such as hypoxia or hypoglycemia. (Putting It All Together, Skin-Integumentary System) 57. Acanthosis nigricans We saw this on Tina in shadowhealth. Characterized by dark, velvety discoloration in body folds and creases, resulting in thickening of skin. Typically seen on neck, groin, and axillae, and associated with obesity and diabetes, or indicative of internal maligancy. 40 abdomen, resulting in an unfilled scrotum. Risk increased for testicular cancer. Small Testis Small, soft testes suggesting atrophy are seen in cirrhosis, myotonic dystrophy, use or estrogens, and hypopituitarism. Acute Orchitis The testis is acutely inflamed, painful, tender, and swollen. It may be difficult to distinguish from the epididymis. Scrotum may be reddened. Usually unilateral. Tumor of the Testis Usually appears as a painless nodule. Any nodule within the testis warrants investigation for malignancy. Spermatocele and Cyst of the Epididymis A painless, movable cystic mass just above the testis. Both transilluminate. Varicocele of the Spermatic Cord Refers to varicose veins of the spermatic cord usually found on the left. It feels like a “Soft bag of worms” separate from the testis, and slowly collapses when the scrotum is elevated in the supine patient. Acute Epididymitis An acutely inflamed epididymis is tender, and swollen and may be difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. It occurs chiefly in adults. Torsion of the Spermatic Cord Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The 41 scrotum becomes red and edematous. Surgical Emergency. ...And another group’s haha the more info the better :) 1. Torsion of spermatic cord ● Twisting of the testicle on its spermatic cord ● Produces an acutely painful, tender, and swollen organ that is often retracted upward in the scrotum ● If the presentation is delayed, the scrotum becomes red and edematous ● No associated urinary infection ● Most common in neonates & adolescents, but can occur at any age 42 ● Surgical emergency due to obstructed circulation 2. Hydrocele ● A nontender, fluid-filled mass within the tunica vaginalis ● It transilluminates, and the examining fingers can palpate above the mass within the scrotum ○ Transillumination of the scrotum - light will pass through the clear fluid of the hydrocele causing the scrotum to appear red (see Bates pg. 844) ● Common in newborns and usually resolve by 18 months without treatment ● Frequently coexists with inguinal hernias ● Older boys and adults can develop a hydrocele due to inflammation or injury within the scrotum 3. Orchitis = inflamed testicle ● Acute orchitis - the testis is acutely inflamed, painful, tender, and swollen ● The testes can be difficult to distinguish from the epididymis ● The scrotum may be reddened ● Seen in mumps and other viral infections ● Usually unilateral (one testis, not both) 4. Prostatitis = a frequently painful condition that involves inflammation (swelling) of the prostate and sometimes the areas around the prostate (Prostate is the walnut-sized gland located between the bladder and the penis (just in front of the rectum - secretes fluid that nourishes & protects sperm) ● Most common cause of UTIs in men ● Can be caused by a bacterial infection or just simply inflamed ● Almost always treatable with antibiotics ● Symptoms: pain in the perineum, pain on defecation, aches and pains in the joints or muscles and the lower back, blood in the urine, pain or burning during urination, painful ejaculation 45 near its midpoint ○ e. All of the above SET 2: RANDA 7. varicocele: Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” in the spermatic cord above the testis, and if prominent, appears to distort the contours of the scrotal skin. A varicocele collapses in the supine position, so examination should be both supine and standing. If the varicocele does not collapse when the patient is supine, suspect a left spermatic vein obstruction within the abdomen 8. testicular carcinoma: testicular carcinoma: when detected early, excellent prognosis. Risk factors: ● cryptocidism, confers a high risk for testicular carcinoma in the undescended testicle; ● a history of carcinoma in the contralateral testicle;* ● mumps orchitis; an inguinal hernia; a hydrocele in childhood and a positive family history. Perform TSE (testicular self exam) and seek med attention if you find: painless lump, swelling, enlargement of either testicle, pain or discomfort in a testicle, feeling of heaviness or sudden fluid collection in the scrotum, dull ache in the lower abdomen or groin 9. normal vas deferens : I can’t find what should we know about this It is a cord like structure that transports sperms from tail of the epididymis along a somewhat circular route to the urethra. The vas ascends from the scrotal sac into the pelvic cavity through the inguinal canal, then loops anteriorly over the ureter to the prostate behind the bladder. There it merges with the seminal vesicle to form the ejaculatory duct, which traverses the prostate and empties into the urethra. 10. condylomata acuminate (genital warts) Appearance: Single or multiple papules or plaques of variable shapes; may be round, acuminate (or pointed), or thin and slender. May be raised, flat, or cauliflowerlike (verrucous). • Causative organism: Human papillomavirus (HPV), usually from subtypes 6, 11; carcinogenic subtypes rare, approximately 5–10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts. • Can arise on penis, scrotum, groin, thighs, anus; usually 46 asymptomatic, occasionally cause itching and pain. • May disappear without treatment. 11. genital herpes: Appearance: Small scattered or grouped vesicles, 1–3 mm in size, on glans or shaft of penis. Appear as erosions if vesicular membrane breaks. 2. Causative organism: Usually herpes simplex virus 2 (90%), a double-stranded DNA virus. Incubation: 2–7 days after exposure. 3. Primary episode may be asymptomatic; recurrence usually less painful, of shorter duration. 4. Associated with fever, malaise, headache, arthralgias; local pain and edema, lymphadenopathy. 5. Need to distinguish from genital herpes zoster (usually in older patients with dermatomal distribution) and candidiasis. 12. Syphilitic chancre: Appearance: Small red papule that becomes a chancre, or painless erosion up to 2 cm in diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated. Chancre heals within 3–8 weeks. • Causative organism: Treponema pallidum, a spirochete. Incubation: 9–90 days after exposure. • May develop inguinal lymphadenopathy within 7 days; lymph nodes are rubbery, nontender, mobile. • Twenty to 30% of patients develop secondary syphilis while chancre still present (suggests coinfection with HIV) . • Distinguish from genital herpes simplex; chancroid; granuloma inguinale from Klebsiella granulomatis (rare in U.S.; four variants, so difficult to identify). SET 3: Brian 13. penile carcinoma Cancers of the penis: Each type of tissue in the penis contains several types of cells. Different types of penile cancer can start from these cells. The differences are important because they determine the seriousness of the cancer and the type of treatment needed. 47 Almost all penile cancers start in skin cells of the penis. Squamous cell carcinoma- About 95% of penile cancers start in flat skin cells called squamous cells. Squamous cell carcinoma (also known as squamous cell cancer) can start anywhere on the penis. Most of these cancers start on the foreskin (in men who have not been circumcised) or on the glans. These tumors tend to grow slowly. If they're found at an early stage, they can usually be cured. Verrucous carcinoma: A verrucous carcinoma growing on the penis is also known as Buschke-Lowenstein tumor.This is an uncommon form of squamous cell cancer that can start in the skin in many areas. This cancer looks a lot like a large genital wart. Verrucous carcinomas tend to grow slowly but can sometimes get very large. They can grow deep into nearby tissue, but they rarely spread to other parts of the body. Carcinoma in situ (CIS): This is the earliest stage of squamous cell cancer of the penis. In this stage, the cancer cells are found only in the top layers of skin. They have not yet grown into the deeper tissues. Depending on where the CIS is on the penis, doctors may use other names for the disease. • CIS of the glans is sometimes called erythroplasia of Queyrat. • CIS on the shaft of the penis (or other parts of the genitals) is called Bowen disease. Melanoma is a type of skin cancer that starts in melanocytes, the cells that make the brownish color in the skin that helps protect it from the sun. These cancers tend to grow and spread quickly. They're more dangerous than the more common basal and squamous cell types of skin cancer. Melanomas are most often found in sun-exposed skin, but rarely they occur in other places like the penis. Only a very small portion of penile cancers are melanomas. For more information about melanoma and its treatment, see Melanoma Skin Cancer. Basal cell carcinoma (also known as basal cell cancer) is another type of skin cancer that can develop on the penis. It makes up only a small portion of penile cancers. This type of cancer is slow- growing and rarely spreads to other parts of the body. Adenocarcinoma (Paget disease of the penis):This very rare type of penile cancer can develop from sweat glands in the skin of the penis. It can be very hard to tell apart from carcinoma in situ (CIS) of the penis. 50 uncomfortable, it rarely results in an emergent medical problem. However, it can be quite embarrassing and often has a significant negative impact on patients’ quality of life. 21. Gynecomastia -when the breast appears enlarged, distinguish between the soft fatty enlargement of obesity and the firm disc of glandular enlargement caused by an imbalance of estrogen and testosterone, called gynecomastia. (Infant, Child & Adolescent) 22. Order of pediatric exam New born: Infancy (0-12) Early Childhood (1-4 years_ Middle Child (5 years+) – Careful observation of activity – Head, neck, heart, lungs, abdomen, genitourinary system - Perform non- disturbing maneuvers early – Perform potentially distressing maneuvers near the end; – Start with the child seated – examine the eyes, palpate neck, percuss/auscultate – Move child to supine position – examine abdomen, Physical examination is more straightforward; the same sequence that is used in adults can be used starting in this age group – Lower extremities, back – Ears, mouth e.g., ears, mouth, and abdomen musculoskeletal, nervous system; examine genitalia last – Eyes whenever they open spontaneously – End the examination with the patient upright; look at the – Skin (throughout the exam) throat and ears oVernix caseosa: present at birth o Lanugo: shed within the first few weeks of life 51 – Nervous system -Hips Physical development, cognitive and language development, social and emotional development, health history(birth, past family, health maintenance), health patterns, physical examination(general survey and vital signs), somatic growth(length, weight, head), then HEAD TO TOE. -Thorax and Lungs: -inspection, palpation, auscultation -Heart -abdomen -inspection, palpation, auscultation, -inspection, auscultation, percussion and palpation 23. Neuro-nystagmus -Nystagmus, a fine rhythmic oscillation of the eyes or an involuntary jerking movement of the eyes with quick and slow components. 52 - Nystagmus occurs normally when a person watches a rapidly moving object such as a passing train -Nystagmus in cerebellar disease, especially with gait ataxia and dysarthria (increases with retinal fixation) and vestibular disorders (decreases with retinal fixation) -Although nystagmus may be present in all directions of gaze, it may appear or become accentuated only on deviation of the eyes 24. fetal alcohol syndrome -Babies born to women with chronic alcoholism are at increased risk for growth deficiency, microcephaly, and intellectual disability. Facial characteristics include short palpebral fissures, a wide and flattened philtrum (the vertical groove in the midline of the upper lip), and thin lips. SET 5: Dani 25. Down syndrome: The child with Down syndrome (trisomy 21) usually has a small, rounded head, a flattened nasal bridge, oblique palpebral fissures, prominent epicanthal folds, small, low-set, shell- like ears, and a relatively large tongue. Associated features include generalized hypotonia, transverse palmar creases (simian lines), shortening and incurving of the 5th fingers (clinodactyly), Brushfield spots (see p. 915), mild to moderate cognitive impairment. Brushfield Spots Strabismus: These abnormal speckling spots on the iris suggest DownSyndrome. (Female Reproductive System) Disorders of the menses: Causes vary by age group and include pregnancy, cervical or vaginal infection, cancer, cervical or endometrial polyps or hyperplasia, fibroids, bleeding disorders, hormonal contraception, or replacement therapy. Postcoital bleeding suggests cervical polyps or cancer, or in an older woman, atrophic vaginitis. 26. Metrorrhagia: “intermenstrual bleeding”, bleeding in between menstrual cycles (abnormal, should only be bleeding during 55 34. atrophic vaginitis ● Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls due to reduction in estrogen levels. Vaginal atrophy occurs most often after menopause. ● Secondary causes: breast feeding, low estrogen oral contraceptives, antiestrogenic drugs ● For many women, vaginal atrophy not only makes intercourse painful, but also leads to distressing urinary symptoms. ● S/S: ○ Vaginal dryness ○ Vaginal burning ○ Vaginal discharge ○ Genital itching ○ dyspareunia ○ Burning with urination ○ Urgency with urination ○ More urinary tract infections ○ Urinary incontinence ○ Light bleeding after intercourse ○ Discomfort with intercourse ○ Decreased vaginal lubrication during sexual activity ○ Shortening and tightening of the vaginal canal 56 ● What to do: lubricants, intravaginal cleansing with water or acetic acid solutions 35. tubal pregnancy ● aka ectopic pregnancy ● This is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes ● S/S: abnormal bleeding, tenderness/pain in pelvic or abdomen ● 36. Pelvic Inflammatory Disease (PID) ● An infection of a woman’s reproductive organs usually caused by an STI (typically one that is left untreated; e.g. chlamydia trachomatis); sometimes caused by normal bacteria in the vagina ● It is a polymicrobial infection with an 8-40% risk of tubal infertility depending on the number of episodes ● A third to half of cases are attributed to co-infection of Chlamydia with Neisseria gonorrhoeae ● Infection rates are highest in women 20-24 y/o and second highest in women 15-19 y/o ● If diagnosed early, it can be treated. Treatment will not undo any damage that has already happened to your reproductive system ● Primary symptom is pain in the lower abdomen. May feel a tightness/pressure in the reproductive organs, or an occasional dull ache SET 7: DR. Strange 37. ovarian cyst -Ovarian cysts are fluid-filled sacs or pockets in an ovary or on its surface -Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months. -symptoms include: -Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst -Fullness or heaviness in your abdomen -Bloating 57 38. bartholin’s gland infection -Bartholin Gland Infection Causes of a Bartholin gland infection include trauma, gonococci anaerobes like bacteroides and peptostreptococci, and Chlamydia trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small. 39. vulvar CA, syphilis -Primary Syphilis -Syphilitic Chancre- This firm painless ulcer from primary syphilis forms ∼21 days after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina, and heals regardless of treatment in 3–6 weeks. 40. Vaginismus -Vaginismus refers to an involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible. -The cause of vaginismus may be physical or psychological 41. Breast cancer -The most significant risk factors for breast cancer are age, BRCA status, and breast density on mammogram. Personal history of breast cancer, family history, and reproductive factors affecting duration of uninterrupted estrogen exposure are also important. -Thickening and prominent pores suggest breast cancer. This position may reveal an asymmetry of the breast or nipple not otherwise visible. Retraction of the nipple and areola suggests an underlying cancer. -Hard, irregular, poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest breast cancer -A hard, irregular, eccentric, or ulcerating nodule suggests breast cancer. -Male breast cancer constitutes only 1% of breast cancer cases, peaking in frequency around age 71 -Masses, nodularity, and change in color or inflammation, especially in the mastectomy incision line, suggest recurrence of 60 ■ Flexion of knees and hips as a result of neck flexion = pos sign ■ Without meningeal inflammation legs should remain relaxed. ● Kernig ○ Whenever you suspect meningeal inflammation from MENINGITIS or subarachnoid hemorrhage. ○ Flex the patient’s leg at both the hip and the knee, and then straighten the knee. Discomfort behind the knee during full extension occurs in many normal people, but this maneuver should not produce pain. ● Straight leg raise ○ To assess for HERNIATED DISC 45. Carpal tunnel ● Pain or numbness of the first three fingers & half of ring finger, but not in the palm, especially at night. ○ Occurs from repetitive motion with wrists flexed (keyboard use). ● Loss of sensation in distribution of the MEDIAN nerve: palmar surface of thumb, index, middle, and medial 4th fingers. ● How to assess? ○ Weak abduction of the thumb --> most accurate test! ○ Tinel’s sign ○ Phalen’s sign ○ Weak hand grip A patient who presents to clinic complaining of hand pain says she was told by a friend that it most likely is carpal tunnel syndrome. Upon assessing the patient, you note the following findings. Which would be suggestive of carpal tunnel syndrome? a. Hand pain when holding both hands in acute extension. b. Numbness and tingling when tapping over the course of the radial nerve. c. Symptoms related to compression are evident in all of the fingers. d. None of the above. 61 46. Neuro exams – stereognosis (spell it correctly!), graphesthesia ● Assess discriminative sensation to test the ability of the sensory cortex to analyze and interpret sensations. ○ Stereognosis - place a key or familiar object in their hand and have them identify it. ○ Graphesthesia - outline a large # in their palm and have them identify it. 47. Cerebellar vs vestibular vs sensory vs motor systems ● Cerebellar ○ Rhythmic movement ○ Steady posture ○ Equilibrium ● Vestibular ○ Balance and coordinating eye, head, and body movements. ● Sensory ○ Position sense ● Motor ○ Muscle strength Coordination of muscle movement requires that four areas of the nervous system function in an integrated way. Coordinating eye, head, and body movements applies to which area of the nervous system? a. Motor system b. Cerebellar system c. Vestibular system d. Sensory system 48. Cauda equina symptoms ● Back pain associated with constipation and urinary retention. ● A tumor can cause this Sciatic Symptoms 62 ● Shooting pain below the knee, commonly into the lateral leg (L5) or posterior calf (S1). ● Typically accompanies low back pain. ● Paresthesias & weakness. ● Bending, sneezing, coughing, straining during bowel movements often worsen pain. SET 9: Nate. 49. low back pain & Rotator cuff tear symptoms ● Neer’s impingement sign ○ Press on scapula with one hand, raise pt’s arm with other. ● Hawkin’s impingement sign ○ Flex pt’s shoulder and elbow to 90⁰ with palm facing down. Rotate arm internally. ○ If either one produces pain, it is a positive test, possibly indicating a rotator cuff tear. ● Symptoms: ○ Pain at rest and at night, particularly if lying on the affected shoulder ○ Pain when lifting and lowering your arm or with specific movements ○ Weakness when lifting or rotating your arm ○ Crepitus or crackling sensation when moving your shoulder in certain positions 50. MS disorders ● Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). ● In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves. ○ Demylination is any disease of the nervous system in which the myelin sheath of neurons is damaged ● Signs and symptoms ○ MRI shows sclerotic patches through the brain and spinal cord, Fatigue, Visual disturbances: nystagmus, blurred vision, diplopia, Slurred speech, Spasticity and/or weakness of extremities, paresthesia, numbness and pain, Emotional lability, depression, Intentional tremors, Spastic bladder 65 especially after extended activity. These symptoms tend to build over time rather than show up suddenly. Here are ways OA may affect different parts of the body: ● Hips. Pain is felt in the groin area or buttocks and sometimes on the inside of the knee or thigh. ● Knees. A “grating” or “scraping” sensation occurs when moving the knee. ● Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red. There may be pain at the base of the thumb. ● Feet. Pain and tenderness is felt in the large joint at the base of the big toe. There may be swelling in ankles or toes. Set 10.5 Arya Stark (the best stark, sorry tony) <- Thank You Erin :) your welcome (::: 58. Gait (abnormalities of gait are well described with pictures on table 20-4 in my version of the book In the chapter on nervous system, which is ch. 20 in my book!) ● When assessing gait you ask the patient to walk around the room or down the hall and have them turn and come back. ○ Observations ■ Posture ■ Balance ■ Swinging of the arms ○ Abnormalities ■ Lack of coordination: ATAXIA ● Cerebellar dx ○ Leg movement ● Then, have then walk heel to toe in a straight line AKA Tandem Walking 66 ● walk on toes then heels. ○ Observations: ■ Plantar flexion ■ Dorsiflexion ■ Balance ○ abnormalities : ■ Distal muscle weakness ■ Oversensitivity to heel walking (corticospinal damage) ● Hop in place on each foot ○ If px cant do it then they may be weak, lack position sense, or have cerebellar dysfunction. ● Shallow knee bend ○ Make sure to support px ○ Abnormalities ■ Suggestion proximal weakness, quad weakness, or both. ● Rising from sitting position without arm support ○ Better option for px who may be frail or unsteady (fall risk) ○ Abnormalities ■ Arise from proximal muscle weakness and pelvic girdle muscle weakness. 59. Increased ICP ● Can’t find much in the book on this if anyone has any clueee help ,,, BUT ● Increased ICP is directly related to increased ICP. ○ With a headache, if it is relieved by coughing, sneezing, or head movements→ intracranial pressure is a likely cause. 60. Migraines ● Migraines are the most frequent cause of heachaches seen in office practice because they are the most debilitating type of 67 headaches. ● Headache red flags: ○ Recent onset within last 6 months ○ Onset after 50 years of age ○ Acute onset “worst headache of my life” ○ Increase BP ○ Presence of rash/infection ○ Cancer ○ HIV ○ Pregnancy ○ Head trauma ● Always assess headaches with OLD CART ● Migraine headache is often preceded by an aura or prodrome, and is highly likely if three of the five “POUND” features are present: Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral;Nausea or vomiting; Disabling or intensity causing interruption of daily activity.21,22 SET 11:Heather 61. Fine motor vs gross motor development Fine motor: small movements such as picking up small objects or holding a spoon (use of small muscle groups) Gross motor: Movements that use big muscle groups like sitting up or walking. Fine motor skills develop through neurologic maturation and environmental manipulation. 62. Types of seizures Seizures are classified into two groups. 1. Generalized seizures affect both sides of the brain. ● Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space. ● Tonic-clonic seizures, also called grand mal seizures, can 70 flexed. This posture implies a destructive lesion of the corticospinal tracts within or very near the cerebral hemispheres. When unilateral, this is the posture of chronic spastic hemiplegia. Decerebrate Rigidity (Abnormal Extensor Response) - In decerebrate rigidity, the jaws are clenched and the neck is extended. The arms are adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. The legs are stiffly extended at the knees, with the feet plantar flexed. This posture may occur spontaneously or only in response to external stimuli such as light, noise, or pain. It is caused by a lesion in the diencephalon, midbrain, or pons, although may also arise from severe metabolic disorders such as hypoxia or hypoglycemia. While decorticate posturing is still an ominous sign of severe brain damage, decerebrate posturing is usually indicative of more severe damage in the brain stem. (Putting It All Together, Skin-Integumentary System) *For the sake of keeping this study guide from getting crazy I will refer you to module 4 skin lesion chart. * Set 12: Tony Stark 66. Acanthosis nigricans(Integumentary condition) -Acanthosis Nigricans A skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened. Most often, seen in the armpits, groin and neck. Frequently associated with obesity and diabetes. - 67. Lyme disease(systemic/skin condition) -Target lesions have a bulls-eye appearance:Example: Lyme disease -Lyme disease is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete that is carried by deer ticks. -Lyme disease manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages.2 71 68. Herpetic stomatitis(mouth disease) -Tender ulcerations on the oral mucosa are surrounded by erythema. Herpetic stomatitis is a viral infection of the mouth that causes sores and ulcers. -Herpetic stomatitis is an infection caused by the herpes simplex virus (HSV), or oral herpes. Young children commonly get it when they are first exposed to HSV. The first outbreak is usually the most severe. HSV can easily be spread from one child to another. 69. oral candidiasis(mouth disease)-Oral Candidiasis (“thrush”) Herpetic Stomatitis This infection is common in infants. The white plaques do not rub off. Thrush is a yeast infection due to Candida. Shown here on the palate, it may appear elsewhere in the mouth (see p. 322). Thick, white plaques are somewhat adherent to the underlying mucosa. -Predisposing factors include -(1) prolonged treatment with antibiotics or corticosteroids and -(2) AIDS