final exam ACA

knowing SOGI helps determine

which organs may be present, which preventative screenings are indicated, pregnancy potential, appropriate STI screening

The 5 P’s for sexual HX

partners, practices, protection from STI, PMHx of STI, pregnancy plans

UOQ of breast is

most common site for breast CA

UIQ of breast is where

pathologies are closer to the sternum

the apical nodes are the

final common pathway for all of the axillary lymph nodes

lymphatic drainage of the breast is of

great importance in the spread of carcinoma

Breast tissue for males includes

small nipple and areola situated above a thin disc of undeveloped breast tissue

gynecomastia

benign breast enlargement in males due to increase in estrogen, decrease in testosterone levels, SE of meds. Proliferation of palpable glandular tissue >2cm

Pseudogynecomastia

enlargement of male breasts due to excess fat deposits rather than glandular growth

abnormal findings for breast exam

nipple inversion, retraction, peau d’orange, visible masses (urgent), nipple discharge that is blood

retraction maneuvers include

lean forward, hands on hips, arms above head

normal findings of retraction maneuvers

symmetrical, hang freely without retractions, pulling or dimpling

Peau d’orange

pores are exaggerated, seen in inflammatory breast CA and pts who had radiation to breast

nipple retraction

nipple goes inwards, can be normal or abnormal, asymmetric is abnormal

best pattern for palpation of breasts

concentric circles

fibroadenomas

soft, usually firm, very mobile. round or lobular, benign condition

symptoms of mastitis

tender breast, fever, localized erythema, pt is postpartum and breastfeeding

symptoms of breast abscess

fluctuant palpable mass, fever, tender breast, localized erythema

findings of breast that suggest malignancy

hard mass, fixed, irregular borders, skin dimpling, nipple retraction, blood nipple discharge/indurations, unilateral changes

red flag findings for breast

hard fixed mass, bloody nipple discharge, supraclavicular nodes, skin thickening, peas d’orange, new unilateral inversion

if pt has left breast infection or breast CA and left armpit node swelling, this is called

ipsilateral axillary lymphadenopathy

hypospadias

urethral opening is on ventral surface so underside of the penis

abnormal findings upon inspecting scrotum and penis

hypospadias, lesions, edema, excoriations

abnormal finding upon inspecting urethral meatus

spontaneous discharge

peyronie’s disease

curvature of penis during erection

epidermoid cyst

benign slow growing lump filled with dead skin cells and keratin

venereal wart

genital warts

cystocele

prolapsed bladder

cystourethrocele

bladder and urethra sag into vaginal canal due to weakened pelvic muscles

rectocele

rectum bulges into vaginal canal

bartholin gland infection

round swollen tender mass

normal BUN

5-20

Normal USG

1.003-1.030

High USG means

dehydration, dark urine

Low USG means

below 1.003 and urine is vey clear

lower UTI includes

cystitis, urethritis, prostatits

Upper UTI includes

pyelonephritis (danger zone)

Pyelonephritis s/sx

infection of kidney itself, high fever, flank and back pain, CVA tenderness, N/V, chills, suprapubic tenderness

Uncomplicated UTI

simple UTIs so lower UTI and is treated with abx

s/sx of lower UTI

pyuria, dysuria, frequency, urgency, cloudy urine

urinalysis for uncomplicated UTI (Lower UTI)

WBCs, RBCs, nitrates, growth of bacteria

glomerulonephritis

inflammation of glomeruli

glomerulonephritis s/sx

hematuria, proteinuria, fluid overload, HTN, flank pain, low GFR, tea colored urine, NO WBCs plus symptoms of typical UTI

interstitial cystitis

chronic bladder pain without UTI, urinalysis comes back negative but pt will have UTI s/sx

testicular torsion

twisting of the spermatic cord due to trauma and blood supply gets cut off and results in ischemia, requires immediate surgery

testicular torsion s/sx

swollen testicle, high riding testicle, unilateral pain, absent cremastueric reflex

testicular cancer

firm, painless lump and swelling found on testicles, solitary mass

varicocele

pt reports dull, aching, heavy sensation in their testicles and when you palpate it feels like a bag of worms. this occurs when blood doesn’t flow properly

cremastueric reflex

when you stroke the inner thigh, the testicle on that same side moves upward. abnormal if testicle does not rise

Cervicits

inflammation of the cervix, burning with urination, vaginal discharge, dyspareunia (pain before, during, or after sex),

ovarian torsion s/sx

sudden severe unilateral lower abdominal pain or pelvic pain, N/V unilateral adnexal tenderness, guarding with palpation

BPH s/sx

urinary frequency, urgency, hesitancy, intermittent stream, nocturne, incomplete bladder emptying

normal size of prostate

2.5 cm by 4 cm, heart shaped palpable groove

red flag GU findings

gross hematuria, Fournier Gangrene, urinary retention, priapism, testicular torsion, ovarian torsion

Hydrocele

a collection of fluid around the testicle. painless swelling, positive tanslumination

inguinal hernia

pt who does a lot of heavy lifting, have pt bear down or cough and can feel it

bladder cancer

painless hematuria

crystal arthropathy

crystals buildup inside a joint, this includes gout

s/sx of crystal arthropathy

sudden, severely painful, red, hot swollen joint

how many vertebrae for lumbar

5

how many vertebrae for cervical

7

how many vertebrae for thoracic

12

how many vertebrae for sacrum

5

how many vertebrae for coccyx

4

spheroidal joint aka ball and socket

shoulder, hip

hing joint

elbow, knee, ankle, interphalangeal joints of hand and feet

condylar joint

TMJ, wrist, knuckles

cartilaginous joints

intervertebral joint, symphysis pubis, sternomanubrial joint

fibrous joints

sutures of the skull, sacrum

carpel tunnel comes from

the compression of the median nerve

arch in the foot helps give

bounce, reduce stress, weight load and impact

fascia

thick connective supportive tissue surrounding structures of the feet

articular structures

intra-articular ligament, junta-articular bone, synovium, joint capsule, synovial fluid, articular cartilage

findings when there is an issue with articular structures

crepitus, tenderness/swelling, deformity

if there is an issue with articular structures then it limits

active and passive ROM due to mechanical blockage, pain, stiffness

extra-articular structures includes

bursae, periarticular ligaments, tendon, fascia,

extra-articular pain occurs from

inflammation of bursae, tendons, tendon sheaths, tendinitis, sprains of ligaments, or muscle strain

problems with extra-articular structures limits

active ROM only, passive is normal

gout is due to

diet high in purine and breaks down into uric acid and the buildup causes gout

foods to avoid to prevent gout flareup

alcohol, red meat, organ meat, sugary drinks, certain seafood

osteoarthritis

degenerative joint disease where the cartilage cushioning the ends of bones gradually break down, causing bones to rub against each other

s/sx of OA

herbeden nodes (DIP), Bouchard nodes (PIP), morning stiffness less than 30 mins, worsens with activity and better with rest

lordosis

swayback, inward curve of spine

grade 1 strength

visible muscle contraction with no or trace movement

grade 2 strength

limb movement, but not against gravity

grade 3 strength

movement against gravity but not resistance

grade 4 strength

movement against at least some resistance supplied by the examiner

grade 5 strength

full strength

spurling test (cervical spine) checks for

pinched nerve root in the neck aka cervical radiculopathy

Spurling test (cervical spine)

pt extends and turns their head toward painful side. the examiner applies gentle down pressure (axial compression) to the top of the head

Positive finding of spurling test

Pain radiating down the arm, numbness, tingling, electric shock sensation. pain should radiate from neck to the shoulder, arm, or hand

straight leg raise/crossed straight leg raise tests for

lumbar root/nerve compression

crossed straight leg raise (well-leg straight raise) is when

raise the unaffected/opposite leg and if there is pain then it is positive for sciatica, more specific test

empty can

put arms front with thumb facing downwards and examiner pushes downward while pt resists. Positive finding is their is pain or weakness

Drop arm test

examiner raises the pts arm then asks pt to slowly lower it. Positive finding if arm suddenly drops or pt can’t smoothly control lowering

Drop arm test and empty can test for

supraspinatus injury/tear aka rotator cuff injury

Neer test

stabilize scapula and raise pts straight arm overhead. Positive finding is shoulder pain

Hawkins test

shoulder and elbow flexed to 90 degrees and the examiner internally rotates the shoulder. Positive finding is shoulder pain

Neer and Hawkins test for

shoulder impingement