Know that in a 47-year-old man ED is usually ___________ rather than testosterone -
ANSWER-psychologic
Erectile dysfunction may be from psychogenic causes, especially if - ANSWER-early
morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
- ANSWER-may be fixed to skin or underlying tissues (may cause dimpling of skin or
retraction when arms are lifted over head or hands are pressed against hips)
Fibroadenoma and cysts mobility - ANSWER-very mobile/mobile
Know that a high proportion of breast masses are noted during ________ - ANSWER-
BSE
Breast stage 1 - ANSWER-preadolescent- elevation of nipple only
Breast stage 2 - ANSWER-breast bud stage- elevation of breast and nipple as a small
mound; enlargement of areolar diameter
breast stage 3 - ANSWER-further enlargement of elevation of breast and areola, with no
separation of their contours
breast stage 4 - ANSWER-projection of areola and nipple to form a secondary mound
above the level of breast
breast stage 5 - ANSWER-mature stage- projection of nipple only; areola has receded
to general contour of the breast (although in some individuals the areola continues to
form a secondary mound)
,Know where pain is located with pancreatitis: acute - ANSWER-epigastric, may
radiation straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
Know where pain is located with pancreatitis: chronic - ANSWER-epigastric, radiating to
back
Know how hepatitis A is transmitted - ANSWER-Transmitted through fecal-oral route.
Fecal shedding followed by poor handwashing contaminates water and foods leading to
infection of household and sexual contacts
Stress incontinence - ANSWER-the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that exceed
urethral resistance. Causes include childbirth and surgery, postmenopausal atrophy of
the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence - ANSWER-detrusor contractions are stronger than normal and
overcome the normal urethral resistance. The bladder is typically small. Mechanisms:
Decreased cortical inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of
voiding reflexes ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence - ANSWER-detrusor contractions are insufficient to overcome
urethral resistance, causing urinary retention. The bladder is typically flaccid and large,
even after an effort to void. Mechanisms: obstruction of the bladder outlet ie: BPH or
tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at
S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic
neuropathy.
functional incontinence - ANSWER-the patient is functionally able to reach the toilet in
time because of impaired health or environmental conditions. Mechanism: problems in
mobility resulting from weakness, arthritis, poor vision, or other conditions. Also
environmental factors such as an unfamiliar setting, distant bathroom facilities, bed rails,
or physical restraints.
Incontinence secondary to medications - ANSWER-drugs may contribute to any type of
incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic blockers,
and potent diuretics
Know where lymph nodes should be with strep - ANSWER-· Strep throat àstreptococcal
pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the posterior
pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy - ANSWER-tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
Know what to be concerned about if you note an irregular rectal mass - ANSWER-· Any
masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the an us or rectum may form a clogged or
, draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent mucus. Consider
anoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against - ANSWER-· Prevents infection from HPV
subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
· Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers
in females as well as anal cancer, precancers, and gen ital warts in both female and
males
· Vaccinated women should still get cervical cancer screening because vaccines do not
prevent all HPV subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing - ANSWER-· Climbs
well, runs easily
· Pedals a tricycle
· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient -
ANSWER-· Measure the fundal height if gestational age is >20 weeks - fundus should
reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape measure
when you can firmly feel that bone.
· Extend the tape measure to the very top of uterine fundus and note the number of cm
measured.
o Subject to error between 16-36 weeks
· Number should roughly equal the number of weeks of gestation
o If fundal height is >4cm than expected -multiple gestation, large fetus, extra amniotic
fluid, uterine leiomyoma
o If fundal height is < 4cm than expected - low-level amniotic fluid, missed abortion,
intrauterine growth retardation, or fetal anomaly
The _______ _______ occupies most of the anterior cardiac surface - ANSWER-right
ventricle
Know what bleeding between periods is called - ANSWER-Abnormal uterine bleeding,
Intermenstrual bleeding
Know types of vaginosis - ANSWER-Trichomonal vaginitis, Candidal Vaginitis, Bacterial
vaginosis
miliaria rubra - ANSWER-Scattered vesicles on an erythematous base, usually on the
face and trunk, result from obstruction of the sweat gland ducts; disappears
spontaneously within weeks
Know the characteristics of a breast cyst - ANSWER-Usually soft to firm, round, mobile
and often tender. Most common between the ages of 25-50
Know the signs of peritonitis - ANSWER-When tender area is palpated for guarding,
early voluntary guarding may be replaced by involuntary muscular rigidity and signs of
peritoneal inflammation. There may also be RLQ pain on quick withdrawal or deferred
rebound tenderness.
Know where pain is with diverticulitis - ANSWER-LLQ
ANSWER-psychologic
Erectile dysfunction may be from psychogenic causes, especially if - ANSWER-early
morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
- ANSWER-may be fixed to skin or underlying tissues (may cause dimpling of skin or
retraction when arms are lifted over head or hands are pressed against hips)
Fibroadenoma and cysts mobility - ANSWER-very mobile/mobile
Know that a high proportion of breast masses are noted during ________ - ANSWER-
BSE
Breast stage 1 - ANSWER-preadolescent- elevation of nipple only
Breast stage 2 - ANSWER-breast bud stage- elevation of breast and nipple as a small
mound; enlargement of areolar diameter
breast stage 3 - ANSWER-further enlargement of elevation of breast and areola, with no
separation of their contours
breast stage 4 - ANSWER-projection of areola and nipple to form a secondary mound
above the level of breast
breast stage 5 - ANSWER-mature stage- projection of nipple only; areola has receded
to general contour of the breast (although in some individuals the areola continues to
form a secondary mound)
,Know where pain is located with pancreatitis: acute - ANSWER-epigastric, may
radiation straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
Know where pain is located with pancreatitis: chronic - ANSWER-epigastric, radiating to
back
Know how hepatitis A is transmitted - ANSWER-Transmitted through fecal-oral route.
Fecal shedding followed by poor handwashing contaminates water and foods leading to
infection of household and sexual contacts
Stress incontinence - ANSWER-the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that exceed
urethral resistance. Causes include childbirth and surgery, postmenopausal atrophy of
the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence - ANSWER-detrusor contractions are stronger than normal and
overcome the normal urethral resistance. The bladder is typically small. Mechanisms:
Decreased cortical inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of
voiding reflexes ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence - ANSWER-detrusor contractions are insufficient to overcome
urethral resistance, causing urinary retention. The bladder is typically flaccid and large,
even after an effort to void. Mechanisms: obstruction of the bladder outlet ie: BPH or
tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at
S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic
neuropathy.
functional incontinence - ANSWER-the patient is functionally able to reach the toilet in
time because of impaired health or environmental conditions. Mechanism: problems in
mobility resulting from weakness, arthritis, poor vision, or other conditions. Also
environmental factors such as an unfamiliar setting, distant bathroom facilities, bed rails,
or physical restraints.
Incontinence secondary to medications - ANSWER-drugs may contribute to any type of
incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic blockers,
and potent diuretics
Know where lymph nodes should be with strep - ANSWER-· Strep throat àstreptococcal
pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the posterior
pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy - ANSWER-tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
Know what to be concerned about if you note an irregular rectal mass - ANSWER-· Any
masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the an us or rectum may form a clogged or
, draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent mucus. Consider
anoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against - ANSWER-· Prevents infection from HPV
subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
· Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers
in females as well as anal cancer, precancers, and gen ital warts in both female and
males
· Vaccinated women should still get cervical cancer screening because vaccines do not
prevent all HPV subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing - ANSWER-· Climbs
well, runs easily
· Pedals a tricycle
· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient -
ANSWER-· Measure the fundal height if gestational age is >20 weeks - fundus should
reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape measure
when you can firmly feel that bone.
· Extend the tape measure to the very top of uterine fundus and note the number of cm
measured.
o Subject to error between 16-36 weeks
· Number should roughly equal the number of weeks of gestation
o If fundal height is >4cm than expected -multiple gestation, large fetus, extra amniotic
fluid, uterine leiomyoma
o If fundal height is < 4cm than expected - low-level amniotic fluid, missed abortion,
intrauterine growth retardation, or fetal anomaly
The _______ _______ occupies most of the anterior cardiac surface - ANSWER-right
ventricle
Know what bleeding between periods is called - ANSWER-Abnormal uterine bleeding,
Intermenstrual bleeding
Know types of vaginosis - ANSWER-Trichomonal vaginitis, Candidal Vaginitis, Bacterial
vaginosis
miliaria rubra - ANSWER-Scattered vesicles on an erythematous base, usually on the
face and trunk, result from obstruction of the sweat gland ducts; disappears
spontaneously within weeks
Know the characteristics of a breast cyst - ANSWER-Usually soft to firm, round, mobile
and often tender. Most common between the ages of 25-50
Know the signs of peritonitis - ANSWER-When tender area is palpated for guarding,
early voluntary guarding may be replaced by involuntary muscular rigidity and signs of
peritoneal inflammation. There may also be RLQ pain on quick withdrawal or deferred
rebound tenderness.
Know where pain is with diverticulitis - ANSWER-LLQ
