Clinical Pearls Test 2

通報

問題一覧

Intense flank pain extending to groin and genitals. Also fever, hematuria, and + Kehr sign (left shoulder pain)

Renal calculi

What condition would cause diarrhea with someone who is actually constipated?

Fecal impaction

What position should a pelvic exam be peformed in?

Lithotomy

Discharge from these glands may indicate and infection (gonococcal)

Skene and urethral glands

Infection of this glad is usually filled with pus (staph or gonococcal), but a non-tender mass here may indicate a cyst

Bartholin gland

How would you test for vaginal tone, uterine prolapse, and urinary incontinence?

Ask the patient to squeeze the vaginal opening around your finger to assess tone, and then ask them to bear down to assess prolapse and incontinence

How do you assess for cervical tenderness or pain?

Grasp the cervix gently between your fingers and move it from side to side 1 to 2 cm in each direction

If tenderness or pain is noted while moving the cervix what could that indicate?

Pelvic inflammatory disease or ruptured tubal pregnancy

What age group has the highest risk of developing testicular cancer?

20 to 34 years old

Cause: twisting of testis Age: newborn to adolescence Onset of pain: acute Vomiting: common Anorexia: common Fever: uncommon Dysuria: uncommon Suppporting fidings: absence of cremasteric reflex on side of acute swelling and scrotal discoloration

Testicluar torsion

Cause: bacterial (STI or UTI) Age: adolescence to adulthood Onset of pain: gradual Vomiting: uncommon Anorexia: uncommon Fever: possible Dysuria: possible Suppporting fidings: recent sexual activity, fever, pyuria, thickened nodular epididymis

Epididymitis

What should your prostate feel like?

Pencil eraser

A rubbery, boggy prostate indicates?

Benign hypertrophy

A hard, stony, nodular prostate may indicate?

Carcinoma, prostatic calculi, or chronic fibrosis

A tender, fluctuant, soft prostate may indicate?

Prostatic abcess

Stool isi greenish black, viscous, contains occult blood; first stool is sterile

Newborn meconium

Transitional stool: thin, slimy, brown to green

3-6 days old

Mushy, loose, seedy, golden (mustard) yellow; frequency varies from after each feeding to every few days; non-irritating to skin

Breast-fed

Light yellow, characteristic odor; irritating to skin

Formula-fed

Bleeding is most common and often asymptomatic. Patients may report change in bowel habits, abdominal pain or tenderness, and family hx of colon polyps and cancer.

Colorectal cancer

What does the Lachman test assess?

Anterior cruciate ligament integrity

What does the Anterior and Posterior Drawer Test assess?

Anterior and posterior cruciate ligament integrity

What does straight leg raising test for?

L4, L5, S1 nerve root irritation

Motor: jaw opening and clenching, chewing, and mastication Sensory: sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, tongue, ear, facial skin

Trigeminal CN

Motor: turn head, shrug shoulders, some actions on phonation

Spinal accessory CN

Ask the patient to close their eyes. While holding the great toe or finger by the lateral aspects, from a neutral position raise or lower the digit and ask the patient which direction you are moving it. This is an example of?

Proprioception

The patient's posture is stooped, and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping.

Parkinsonian gait

Using two sterile needles or two points of a paper clip, alternatively place one or two points simultaneously on the skin 2 to 8 mm apart, and ask the patient to determine whether one or two sensations are felt.

Two-point discrimination

Patient identifies a familiar object by touch.

Stereognosis

Draw a letter or number on the body (without actually marking the skin) and ask the patient to identify it.

Graphesthesia

What is the nerve level of the plantar reflex?

L5, S1, and S2

What is the nerve level of the patellar reflex?

L2, L3, and L4

Brisk, hyperactive, with intermittent or transient clonus

+4 DTR

Tremors that disappear with intended movement or sleep that progressess to pin-rolling of fingers and head tremor. Freezing of voluntary movements, and numbness, tingling, and muscle soreness may occur. Difficulty swallowing; drooling.

Parkinson's disease

-To identify conditions that may interfere with a person's ability to participate in a sport. -To identify health problems that increase the risk of injury or death during sports participation. -To help select an appropriate sport for a person's particular abilities and physical status.

Goals of preparticipation physical evaluation (PPE)

Two conditions that are considered absolute contraindicaitons to sports participation.

Carditis and fever

Low energy with or without disordered eating, menstrual dysfunction, and low bone density is know as? What causes it?

A trio of conditions and is caused by insufficient calorie intake and/or excessive enery expenditure

Always do this on a older adult

Functional assessment noting their ADLs

Name the quadrants of the breast

Upper inner, upper outer w/ Tail of Spence, lower inner, and lower outer

Increasing fat deposits. The areola forms a secondary elevation above the breast.

Tanner 4

Areola is part of the general breast contour and is strongly pigmented. Nipple projects.

Tanner 5

Breasts and areola enlarged. No contour seperation.

Tanner 3

What is the initial position for a breast exam?

Sitting

What physical findings would you notice on a breast exam in a patient with suspected breast cancer?

Skin dimpling and flattening of the nipple

A male teen with bilateral subareolar masses or enlargment may need special patient education such as?

Reassure parents it will likely resolve on its own or could be caused by alcohol or marijuana consumption

What is the anticipatory guidance for parents of a newborn with breast tissue?

It is likely caused by maternal estrogen and will resolve in about 2 weeks

Organs: liver and gallbladder, pylorus, duodenum, head of pancreas, right adrenal gland, portion of right kidney, hepatic flexure of colon, and portions of ascending and transverse colon

RUQ

Organs: left lobe of liver, spleen, body of pancreas, left adrenal gland, portion of left kidney, splenic flexure of colon, portions of transverse and descending colon

LUQ

Organs: lower pole of right kidney, cecum and appendix, portion of ascending colon, bladder, ovary and salpinx, uterus, right spermatic cord, right ureter

RLQ

Organs: lower pole of left kidney, sigmoid colon, portion of descending colon, bladder, ovary and salpinx, uterus, left spermatic cord, left ureter

LLQ

After asking the patient to empty their bladder and having them lay supine what else would help to relax their abdomen?

Placing a pillow under their head and having them flex their knees

If you hear no bowel sounds for more than 5 minutes what is the next step?

Abdominal CT and referral to GI

Differentials you consider if CVA tenderness is positive?

Renal calculi vs pyelonephritis vs renal abcess

Subjective: mild or absent symptoms, foul vaginal discharge, painful intercourse and urination, irregular menses, and upper abdominal pain Objective: Acute - very tender, bilateral guarding and cannot tolerate exam; Chronic - bilateral, tender, irregular, and fairly fixed adnexal areas

PID

Proprioception what does it mean?

Body awareness

What is the #1 objective finding for testicular cancer?

Testicular pain

Soft, painless, wartlike lesions that may form cauliflower-like masses

Condyloma Acuminatum

Painless lesions with central umbillication from which a thick creamy core can be expressed

Molluscum Contagiosum

Solitary, painless lesion; firm, round, small ulcer with indurated borders with a clear base

Syphilitic Chancre

Healed lesions that are flat, round, or oval papules covered by gray exudate

Condyloma Latum

Painless lesions, internal or external, and may report burning or pain with urination

Genital Herpes

How to use speculum? How do you insert it?

Insert finger inside the vaginal introitus and apply downward pressure, and wait until you feel the patient relax. Spread the labia minora then slowly insert the speculum at an oblique angle along the path of least resistance slightly downward the length of the vaginal canal.

DTR why does it matter?

Absent reflexes may indicate neuropathy or lower extremity neuron disorder. Hyperactive reflexes suggest an upper neuron disorder.

Spinal nerve level C5 and C6

DTR Biceps

Spinal nerve level C5 and C6

DTR Brachioradial

Spinal nerve level C6, C7, and C8

DTR Triceps

Spinal level S1 and S2

DTR Achilles

Baseball, boxing, cheerleading, diving, extreme sports, field hockey, football tackle, gymnastics, ice hockey, lacrosse, martial arts, rodeo, rugby, skiing downhill and jumping, snowboarding, soccer, team handball, ultimate frisbee, water polo, wrestling.

Contact sport

Badmiton, bodybuilding, bowling, canoeing or kayaking, crew or rowing, curling, dance, field events, discus, javelin, shot-put, golf, orienteering, power lifting, race walking, riflery, rope jumping, running, sailing, scuba diving, swimming, table tennis, tennis, track.

Non-contact sport

#1 reasons for sports injury

Not warming up

Frequent BM what is baby eating?

Mother's milk

If there is no passage of stool in an infant within 24 hrs of birth suspect?

Rectal atresia

A consistently empty rectum in the presence of constipation in an infant

Hirschsprung disease

During pregnancy the stool may be dark green or black, and pregnant patients may also have diarrhea or constipation as a result of?

Iron supplements

What does the Bartholin gland do?

Lubricate the vagina

Wnat does the Skene glad do?

Lubricate the urethra

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