Podcast
Questions and Answers
A 72-year-old woman reports bloody nipple discharge, denies trauma, and has a history of hypertension and colon cancer surgery. Her family history includes ovarian and colon cancer. Examination reveals a fixed 1-cm axillary node. What is the most likely cause of her nipple discharge?
A 72-year-old woman reports bloody nipple discharge, denies trauma, and has a history of hypertension and colon cancer surgery. Her family history includes ovarian and colon cancer. Examination reveals a fixed 1-cm axillary node. What is the most likely cause of her nipple discharge?
- Breast cancer (correct)
- Benign breast abnormality
- Galactorrhea
- Ductal ectasia
A 44-year-old female presents with dry skin over her right nipple, a palpable lump, and fatigue. Examination reveals an eczema-like crust on the nipple and a 2-cm nontender mass. Which visible skin change of the breast does she most likely have?
A 44-year-old female presents with dry skin over her right nipple, a palpable lump, and fatigue. Examination reveals an eczema-like crust on the nipple and a 2-cm nontender mass. Which visible skin change of the breast does she most likely have?
- Telangiectasia
- Nipple retraction
- Peau d'orange sign
- Paget's disease (correct)
A 56-year-old woman notices a change in her left nipple's direction over two months. She has a history of hypertension, smokes, and drinks regularly. Examination reveals a flattened nipple deviating laterally and a 4-cm mass with fixed axillary nodes. Which visible skin change of the breast does she have?
A 56-year-old woman notices a change in her left nipple's direction over two months. She has a history of hypertension, smokes, and drinks regularly. Examination reveals a flattened nipple deviating laterally and a 4-cm mass with fixed axillary nodes. Which visible skin change of the breast does she have?
- Nipple retraction (correct)
- Paget's disease
- Peau d'orange sign
- Erythema
A 19-year-old female presents with clear nipple discharge from her right breast after nipple squeezing. Her medical history is unremarkable, and pregnancy is ruled out. What cause of nipple discharge is the most likely in her circumstance?
A 19-year-old female presents with clear nipple discharge from her right breast after nipple squeezing. Her medical history is unremarkable, and pregnancy is ruled out. What cause of nipple discharge is the most likely in her circumstance?
A 23-year-old female presents with darkened skin in her armpits. She has acne, mild obesity, and irregular periods. Her mother has type 2 diabetes. On examination, dark, velvet-like skin is noted in the axilla. What disorder of the breast or axilla is she most likely to have?
A 23-year-old female presents with darkened skin in her armpits. She has acne, mild obesity, and irregular periods. Her mother has type 2 diabetes. On examination, dark, velvet-like skin is noted in the axilla. What disorder of the breast or axilla is she most likely to have?
A 43-year-old female finds a painful, enlarged lymph node under her left arm. She reports pain with movement. She had a normal mammogram two months prior and performs monthly self-exams. Examination reveals a tender, movable lymph node with hot skin. She remembers cutting her hand gardening a week prior. What disorder of the axilla is most likely responsible for her symptoms?
A 43-year-old female finds a painful, enlarged lymph node under her left arm. She reports pain with movement. She had a normal mammogram two months prior and performs monthly self-exams. Examination reveals a tender, movable lymph node with hot skin. She remembers cutting her hand gardening a week prior. What disorder of the axilla is most likely responsible for her symptoms?
A 63-year-old nurse finds an enlarged, hard, fixed lymph node under her right arm. She has a history of hypertension and COPD and quit smoking two years ago. Examination reveals a 2-cm hard, fixed lymph node and a 1-cm nontender lump in the tail of Spence. What disorder of the axilla is most likely responsible for her symptoms?
A 63-year-old nurse finds an enlarged, hard, fixed lymph node under her right arm. She has a history of hypertension and COPD and quit smoking two years ago. Examination reveals a 2-cm hard, fixed lymph node and a 1-cm nontender lump in the tail of Spence. What disorder of the axilla is most likely responsible for her symptoms?
A 40-year-old woman is concerned about her risk of developing breast cancer because her sister had unilateral breast cancer at age 38. The patient's menarche was at age 11. She had her first child at 26 and her second at 28. Her mother had unilateral breast cancer in her 70s. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
A 40-year-old woman is concerned about her risk of developing breast cancer because her sister had unilateral breast cancer at age 38. The patient's menarche was at age 11. She had her first child at 26 and her second at 28. Her mother had unilateral breast cancer in her 70s. Which risk factor of her personal and family history most puts her in danger of getting breast cancer?
A 51-year-old woman learns her sister with premenopausal breast cancer is BRCA1 positive. She wants to know her risk of developing breast cancer if she also tests positive for the BRCA1 gene. At her age, what is her approximate risk of getting breast cancer if she has the BRCA1 gene?
A 51-year-old woman learns her sister with premenopausal breast cancer is BRCA1 positive. She wants to know her risk of developing breast cancer if she also tests positive for the BRCA1 gene. At her age, what is her approximate risk of getting breast cancer if she has the BRCA1 gene?
A 14-year-old male is brought in by his parents due to breast enlargement. He denies drug use and has recently noticed changes in his penis, testicles, and pubic hair pattern. Examination shows enlarged, slightly tender breast tissue on both sides. What is the most likely cause of his gynecomastia?
A 14-year-old male is brought in by his parents due to breast enlargement. He denies drug use and has recently noticed changes in his penis, testicles, and pubic hair pattern. Examination shows enlarged, slightly tender breast tissue on both sides. What is the most likely cause of his gynecomastia?
A patient is concerned about a dark skin lesion on her anterolateral abdomen. It has remained unchanged, with no discharge or bleeding. On examination, there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is the most likely diagnosis?
A patient is concerned about a dark skin lesion on her anterolateral abdomen. It has remained unchanged, with no discharge or bleeding. On examination, there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is the most likely diagnosis?
A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no family history of breast cancer. What is the most likely diagnosis?
A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no family history of breast cancer. What is the most likely diagnosis?
Which of the following lymph node groups is most commonly involved in breast cancer metastasis?
Which of the following lymph node groups is most commonly involved in breast cancer metastasis?
When is the optimal time for a woman to perform a breast self-examination in relation to her menstrual cycle?
When is the optimal time for a woman to perform a breast self-examination in relation to her menstrual cycle?
Mrs. Patton, a 48-year-old woman, presents with a breast mass. Without any other information, what is the approximate probability of this mass being cancerous?
Mrs. Patton, a 48-year-old woman, presents with a breast mass. Without any other information, what is the approximate probability of this mass being cancerous?
According to the American Cancer Society recommendations, how often should a woman between the ages of 40 and 54, with average risk, undergo a screening mammogram?
According to the American Cancer Society recommendations, how often should a woman between the ages of 40 and 54, with average risk, undergo a screening mammogram?
Which of the following findings on breast examination is most likely benign?
Which of the following findings on breast examination is most likely benign?
Which pattern of palpation is considered the most effective for detecting breast cancer during a clinical breast exam?
Which pattern of palpation is considered the most effective for detecting breast cancer during a clinical breast exam?
Which statement is true regarding women who have had a unilateral mastectomy?
Which statement is true regarding women who have had a unilateral mastectomy?
Which of the following is true regarding breast self-examination (BSE)?
Which of the following is true regarding breast self-examination (BSE)?
A 35-year-old woman presents with cyclical breast pain and tenderness, along with multiple mobile, rubbery masses in both breasts that fluctuate with her menstrual cycle. What is the most likely diagnosis?
A 35-year-old woman presents with cyclical breast pain and tenderness, along with multiple mobile, rubbery masses in both breasts that fluctuate with her menstrual cycle. What is the most likely diagnosis?
A 25-year-old woman discovers a single, well-defined, mobile, and non-tender breast mass during a self-exam. It feels like a 'marble' in her breast. What is the most likely diagnosis?
A 25-year-old woman discovers a single, well-defined, mobile, and non-tender breast mass during a self-exam. It feels like a 'marble' in her breast. What is the most likely diagnosis?
In which quadrant of the breast is breast cancer most commonly found?
In which quadrant of the breast is breast cancer most commonly found?
A 50-year-old woman is undergoing a routine mammogram. The radiologist reports the presence of microcalcifications in a cluster. What is the next appropriate step in management?
A 50-year-old woman is undergoing a routine mammogram. The radiologist reports the presence of microcalcifications in a cluster. What is the next appropriate step in management?
A patient undergoing treatment for breast cancer develops lymphedema in her ipsilateral arm. Which of the following is the most appropriate initial management?
A patient undergoing treatment for breast cancer develops lymphedema in her ipsilateral arm. Which of the following is the most appropriate initial management?
A 60-year-old woman, postmenopausal, presents with spontaneous, unilateral, serosanguinous nipple discharge. She reports no breast pain or masses. What is the most likely diagnosis?
A 60-year-old woman, postmenopausal, presents with spontaneous, unilateral, serosanguinous nipple discharge. She reports no breast pain or masses. What is the most likely diagnosis?
What is the most common causative organism in acute mastitis?
What is the most common causative organism in acute mastitis?
A breastfeeding mother develops acute mastitis. What management is most appropriate?
A breastfeeding mother develops acute mastitis. What management is most appropriate?
Which of the following is not a risk factor for breast cancer?
Which of the following is not a risk factor for breast cancer?
What is the most common type of breast cancer?
What is the most common type of breast cancer?
A patient is diagnosed with HER2-positive breast cancer. What targeted therapy is most commonly used in this situation?
A patient is diagnosed with HER2-positive breast cancer. What targeted therapy is most commonly used in this situation?
A patient is diagnosed with estrogen receptor-positive breast cancer. What hormonal therapy is most commonly used in premenopausal women?
A patient is diagnosed with estrogen receptor-positive breast cancer. What hormonal therapy is most commonly used in premenopausal women?
Which of the following clinical manifestations is highly suggestive of inflammatory breast cancer?
Which of the following clinical manifestations is highly suggestive of inflammatory breast cancer?
During a breast examination, you note thickening of the skin and prominent pores over the entire breast. This finding is most consistent with what condition?
During a breast examination, you note thickening of the skin and prominent pores over the entire breast. This finding is most consistent with what condition?
A woman with a strong family history of breast cancer is considering prophylactic mastectomy. What is the primary goal of this procedure?
A woman with a strong family history of breast cancer is considering prophylactic mastectomy. What is the primary goal of this procedure?
A patient who has undergone a mastectomy is at risk for developing phantom breast syndrome. What is the best treatment?
A patient who has undergone a mastectomy is at risk for developing phantom breast syndrome. What is the best treatment?
A 33-year-old female presents with a history of fibrocystic changes in her breasts. She reports increased breast tenderness and nodularity prior to menstruation. Which of the following is the most appropriate initial recommendation?
A 33-year-old female presents with a history of fibrocystic changes in her breasts. She reports increased breast tenderness and nodularity prior to menstruation. Which of the following is the most appropriate initial recommendation?
A 28-year-old woman, 12 weeks pregnant, notices a small, mobile, non-tender breast mass during a self-exam. She is concerned about breast cancer. What is the most appropriate next step?
A 28-year-old woman, 12 weeks pregnant, notices a small, mobile, non-tender breast mass during a self-exam. She is concerned about breast cancer. What is the most appropriate next step?
A 35-year-old woman with a family history of breast cancer (mother and maternal aunt) is considering chemoprevention. Which medication is most appropriate for reducing breast cancer risk in high-risk premenopausal women?
A 35-year-old woman with a family history of breast cancer (mother and maternal aunt) is considering chemoprevention. Which medication is most appropriate for reducing breast cancer risk in high-risk premenopausal women?
A 68-year-old woman presents with a painless, hard, immobile mass in her left breast discovered during a routine self-exam. Mammography reveals a suspicious lesion with microcalcifications. What is the most appropriate next step in management?
A 68-year-old woman presents with a painless, hard, immobile mass in her left breast discovered during a routine self-exam. Mammography reveals a suspicious lesion with microcalcifications. What is the most appropriate next step in management?
A 55-year-old woman is diagnosed with early-stage invasive ductal carcinoma that is estrogen receptor-positive, progesterone receptor-positive, and HER2-negative. After surgical resection and radiation therapy, what is the most appropriate adjuvant hormonal therapy?
A 55-year-old woman is diagnosed with early-stage invasive ductal carcinoma that is estrogen receptor-positive, progesterone receptor-positive, and HER2-negative. After surgical resection and radiation therapy, what is the most appropriate adjuvant hormonal therapy?
A 45-year-old woman presents with a new, unilateral, spontaneous nipple discharge. The discharge is clear and occurs intermittently. She denies any breast masses or skin changes. What is the most appropriate initial diagnostic test?
A 45-year-old woman presents with a new, unilateral, spontaneous nipple discharge. The discharge is clear and occurs intermittently. She denies any breast masses or skin changes. What is the most appropriate initial diagnostic test?
A 30-year-old breastfeeding woman presents with fever, chills, and localized breast pain and redness in her right breast. Examination reveals a tender, firm area of induration. What is the most appropriate initial treatment?
A 30-year-old breastfeeding woman presents with fever, chills, and localized breast pain and redness in her right breast. Examination reveals a tender, firm area of induration. What is the most appropriate initial treatment?
A 62-year-old woman is diagnosed with inflammatory breast cancer. Which of the following clinical findings is most characteristic of this condition?
A 62-year-old woman is diagnosed with inflammatory breast cancer. Which of the following clinical findings is most characteristic of this condition?
A 48-year-old woman who is BRCA2 positive is contemplating risk-reducing strategies. Besides prophylactic mastectomy, which of the following is also shown to reduce the risk of ovarian cancer in these patients?
A 48-year-old woman who is BRCA2 positive is contemplating risk-reducing strategies. Besides prophylactic mastectomy, which of the following is also shown to reduce the risk of ovarian cancer in these patients?
During a clinical breast exam on a 58-year-old woman, you note a firm, non-tender mass fixed to the chest wall. Which of the following is the most concerning feature of this finding?
During a clinical breast exam on a 58-year-old woman, you note a firm, non-tender mass fixed to the chest wall. Which of the following is the most concerning feature of this finding?
A 52-year-old woman reports accidentally leaking urine when coughing or sneezing. She is 2 years postmenopausal and has a history of four vaginal deliveries. Which type of urinary incontinence is most likely?
A 52-year-old woman reports accidentally leaking urine when coughing or sneezing. She is 2 years postmenopausal and has a history of four vaginal deliveries. Which type of urinary incontinence is most likely?
A 46-year-old male with a history of cirrhosis presents with black stools, jaundice, ascites, and spider angiomas. What is the most likely cause of the black stools?
A 46-year-old male with a history of cirrhosis presents with black stools, jaundice, ascites, and spider angiomas. What is the most likely cause of the black stools?
A 21-year-old female reports frequent diarrhea with cramping, alternating with occasional constipation. She denies fever or weight loss. Symptoms worsen with stress. What is the most likely diagnosis?
A 21-year-old female reports frequent diarrhea with cramping, alternating with occasional constipation. She denies fever or weight loss. Symptoms worsen with stress. What is the most likely diagnosis?
A 42-year-old female reports chronic constipation, fatigue, weight gain, irregular periods, and cold intolerance. Her abdominal examination is unremarkable but reflexes are delayed. What is the most likely cause of her constipation?
A 42-year-old female reports chronic constipation, fatigue, weight gain, irregular periods, and cold intolerance. Her abdominal examination is unremarkable but reflexes are delayed. What is the most likely cause of her constipation?
A 22-year-old male presents with severe abdominal pain radiating to his back after heavy alcohol consumption, accompanied by vomiting. Examination reveals tenderness in the left upper quadrant and epigastric region. What is the most likely diagnosis?
A 22-year-old male presents with severe abdominal pain radiating to his back after heavy alcohol consumption, accompanied by vomiting. Examination reveals tenderness in the left upper quadrant and epigastric region. What is the most likely diagnosis?
A 76-year-old male reports abdominal pain, constipation, and low-grade fever. Examination reveals tenderness in the left lower quadrant. What is the most likely diagnosis?
A 76-year-old male reports abdominal pain, constipation, and low-grade fever. Examination reveals tenderness in the left lower quadrant. What is the most likely diagnosis?
A 77-year-old male with a history of colon cancer presents with weight loss and fatigue. Examination reveals an abnormal liver and a positive fecal occult blood test. What further liver abnormality is most likely?
A 77-year-old male with a history of colon cancer presents with weight loss and fatigue. Examination reveals an abnormal liver and a positive fecal occult blood test. What further liver abnormality is most likely?
A 26-year-old male has right lower quadrant abdominal pain, nausea, vomiting, decreased appetite, fever, rebound tenderness, and guarding. What is the most likely cause of his pain?
A 26-year-old male has right lower quadrant abdominal pain, nausea, vomiting, decreased appetite, fever, rebound tenderness, and guarding. What is the most likely cause of his pain?
A 15-year-old male reports chronic diarrhea, cramping, gas, and watery stools after meals, especially after school lunches. He denies weight loss or fever. What is the most likely explanation for his chronic diarrhea?
A 15-year-old male reports chronic diarrhea, cramping, gas, and watery stools after meals, especially after school lunches. He denies weight loss or fever. What is the most likely explanation for his chronic diarrhea?
A 27-year-old policewoman reports severe left-sided back pain radiating to her groin, dysuria, and hematuria. Examination is unremarkable except for tenderness at the left costovertebral angle. What is the most likely type of urinary tract pain?
A 27-year-old policewoman reports severe left-sided back pain radiating to her groin, dysuria, and hematuria. Examination is unremarkable except for tenderness at the left costovertebral angle. What is the most likely type of urinary tract pain?
A 20-year-old reports abdominal pain beginning at the umbilicus with nausea and vomiting. The pain worsens with movement and localizes to the right iliac fossa. What is the most likely diagnosis?
A 20-year-old reports abdominal pain beginning at the umbilicus with nausea and vomiting. The pain worsens with movement and localizes to the right iliac fossa. What is the most likely diagnosis?
A 55-year-old male presents with recent onset epigastric pain lasting 30 minutes or longer. What conditions should be considered?
A 55-year-old male presents with recent onset epigastric pain lasting 30 minutes or longer. What conditions should be considered?
A 33-year-old female has intermittent lower abdominal pain for approximately one week each month which is independent of menses. She experiences relief with defecation, and a change in form and frequency of bowel movements. Which of the following is most likely?
A 33-year-old female has intermittent lower abdominal pain for approximately one week each month which is independent of menses. She experiences relief with defecation, and a change in form and frequency of bowel movements. Which of the following is most likely?
A 60-year-old male presents with vomiting. He denies seeing bright red blood, but notes a dark, granular substance resembling coffee grounds. What do you suspect?
A 60-year-old male presents with vomiting. He denies seeing bright red blood, but notes a dark, granular substance resembling coffee grounds. What do you suspect?
A daycare worker presents with jaundice. She denies IV drug use, blood transfusion, and recent sexual activity, she regularly changes diapers. What type of hepatitis is most likely?
A daycare worker presents with jaundice. She denies IV drug use, blood transfusion, and recent sexual activity, she regularly changes diapers. What type of hepatitis is most likely?
A 29-year-old female presents with right flank pain that moves to the lateral abdomen and then into the right lower quadrant. Which is most likely?
A 29-year-old female presents with right flank pain that moves to the lateral abdomen and then into the right lower quadrant. Which is most likely?
A 60-year-old woman presents with urinary incontinence and is unable to reach the bathroom quickly enough when she gets the urge to urinate but has normal mobility. Which of the following is most likely?
A 60-year-old woman presents with urinary incontinence and is unable to reach the bathroom quickly enough when she gets the urge to urinate but has normal mobility. Which of the following is most likely?
Which of the following represents the proper sequence of an abdominal examination?
Which of the following represents the proper sequence of an abdominal examination?
A 62-year-old is recently hypertensive, requiring three medications. Her father had a heart attack at 58. Her blood pressure is 168/94, despite medication adherence. What should you do next?
A 62-year-old is recently hypertensive, requiring three medications. Her father had a heart attack at 58. Her blood pressure is 168/94, despite medication adherence. What should you do next?
A 64-year-old man was told his liver is enlarged. He has emphysema from smoking. On examination liver edge is palpable 4 centimeters below the costal arch. What would you do next?
A 64-year-old man was told his liver is enlarged. He has emphysema from smoking. On examination liver edge is palpable 4 centimeters below the costal arch. What would you do next?
A teenager with leukemia presents with left upper quadrant pain and a rough grating noise is heard. What is this sound?
A teenager with leukemia presents with left upper quadrant pain and a rough grating noise is heard. What is this sound?
You are palpating the abdomen and feel a small mass. Which of the following would you do next?
You are palpating the abdomen and feel a small mass. Which of the following would you do next?
A 14-year-old presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
A 14-year-old presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
A young patient presents with a left-sided abdominal mass in her left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?
A young patient presents with a left-sided abdominal mass in her left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?
An 84-year-old man presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
An 84-year-old man presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
You note that with deep palpation of a 72-year-old smoker you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?
You note that with deep palpation of a 72-year-old smoker you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?
Mr. Maxwell has noticed he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?
Mr. Maxwell has noticed he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?
Which of the following is consistent with obturator sign?
Which of the following is consistent with obturator sign?
An elderly woman with a history of coronary bypass reports severe, diffuse, abdominal pain. During your examination, the pain is strangely not made worse by pressing on the abdomen. What do you suspect?
An elderly woman with a history of coronary bypass reports severe, diffuse, abdominal pain. During your examination, the pain is strangely not made worse by pressing on the abdomen. What do you suspect?
A 28-year-old reports a painless “spot” on his penis noticed two days ago. Examination shows a firm, 6-mm red, oval ulcer with an indurated base proximal to the corona. There is no prepuce because of neonatal circumcision. In the inguinal region, there is nontender lymphadenopathy. What is the most likely diagnosis?
A 28-year-old reports a painless “spot” on his penis noticed two days ago. Examination shows a firm, 6-mm red, oval ulcer with an indurated base proximal to the corona. There is no prepuce because of neonatal circumcision. In the inguinal region, there is nontender lymphadenopathy. What is the most likely diagnosis?
A 20-year-old presents with growths on his penile shaft for about 6 weeks. He denies pain with intercourse or urination. They are moist papules along all sides of his penile shaft and even two on the corona. On palpation of his inguinal region, there is no inguinal lymphadenopathy. Which penile issue does this patient most likely have?
A 20-year-old presents with growths on his penile shaft for about 6 weeks. He denies pain with intercourse or urination. They are moist papules along all sides of his penile shaft and even two on the corona. On palpation of his inguinal region, there is no inguinal lymphadenopathy. Which penile issue does this patient most likely have?
A 29-year-old reports a lump in his left testis, and aching pain in his left testis but denies any pain with urination or sexual intercourse. He has groin surgery when he was a baby. On rectal examination, his prostate is unremarkable. You cannot get above the mass. What disorder of the testes is most likely the diagnosis?
A 29-year-old reports a lump in his left testis, and aching pain in his left testis but denies any pain with urination or sexual intercourse. He has groin surgery when he was a baby. On rectal examination, his prostate is unremarkable. You cannot get above the mass. What disorder of the testes is most likely the diagnosis?
A 32-year-old reports months of aching on the right side of his testicle. As the day progresses, the aching increases, and he also notes infertility. His testes lack discrete masses. On placing your finger through the right inguinal ring, you feel what seems like a bunch of spaghetti. What abnormality of the scrotum does he most likely have?
A 32-year-old reports months of aching on the right side of his testicle. As the day progresses, the aching increases, and he also notes infertility. His testes lack discrete masses. On placing your finger through the right inguinal ring, you feel what seems like a bunch of spaghetti. What abnormality of the scrotum does he most likely have?
A 48-year-old reports a swollen scrotum that began a few weeks ago. The condition worsens with standing but improves when lying down and also reports weight gain and shortness of breath. On examination, you palpate generalized swelling, with no discrete masses, and crackles in the lungs. What abnormality of the scrotum is most likely the diagnosis?
A 48-year-old reports a swollen scrotum that began a few weeks ago. The condition worsens with standing but improves when lying down and also reports weight gain and shortness of breath. On examination, you palpate generalized swelling, with no discrete masses, and crackles in the lungs. What abnormality of the scrotum is most likely the diagnosis?
A 36-year-old reports a painless mass in his scrotum found 3 days ago during a testicular self-examination. Examination reveals a soft cystic-like, 2 cm lesion over his right testicle. There is no difficulty getting a finger through either inguinal ring. What disorder of the scrotum does he most likely have?
A 36-year-old reports a painless mass in his scrotum found 3 days ago during a testicular self-examination. Examination reveals a soft cystic-like, 2 cm lesion over his right testicle. There is no difficulty getting a finger through either inguinal ring. What disorder of the scrotum does he most likely have?
A 22-year-old reports pain in his testicle and penis for the last 12 hrs, as well as pain when he urinates but denies any improvement using Tylenol and ibuprofen. After palpating, you note tenderness at the superior pole of the normal-sized left testicle and tenderness when you palpate the structures superior to the testicle through the scrotal wall in addition to WBC and bacteria in a urine analysis. What diagnosis of the male genitalia is most likely in this case?
A 22-year-old reports pain in his testicle and penis for the last 12 hrs, as well as pain when he urinates but denies any improvement using Tylenol and ibuprofen. After palpating, you note tenderness at the superior pole of the normal-sized left testicle and tenderness when you palpate the structures superior to the testicle through the scrotal wall in addition to WBC and bacteria in a urine analysis. What diagnosis of the male genitalia is most likely in this case?
A 15-year-old reports severe testicular pain with nausea and vomiting with an unremarkable urine analysis. On examination, the scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the cremasteric reflex is absent on the left. What is the most likely diagnosis for this young man's symptoms?
A 15-year-old reports severe testicular pain with nausea and vomiting with an unremarkable urine analysis. On examination, the scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the cremasteric reflex is absent on the left. What is the most likely diagnosis for this young man's symptoms?
A 16-year-old reports an enlarged and tender left testicle with a sore throat, cough, and runny nose for the last 3 days. On examination, his scrotum is red and tense on the left and urine analysis also unremarkable. What abnormality of the testes does this teenager most likely have?
A 16-year-old reports an enlarged and tender left testicle with a sore throat, cough, and runny nose for the last 3 days. On examination, his scrotum is red and tense on the left and urine analysis also unremarkable. What abnormality of the testes does this teenager most likely have?
A 45-year-old reports spots on his scrotum for several months that have gotten bigger. On examination, visualization of his scrotum shows three yellow nodules 2–3 millimeters in diameter that are firm and nontender. What abnormality of the male genitalia is this most likely to be?
A 45-year-old reports spots on his scrotum for several months that have gotten bigger. On examination, visualization of his scrotum shows three yellow nodules 2–3 millimeters in diameter that are firm and nontender. What abnormality of the male genitalia is this most likely to be?
A 47-year-old man has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
A 47-year-old man has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Induration along the ventral surface of the penis suggests which of the following?
Induration along the ventral surface of the penis suggests which of the following?
A tender, painful swelling of the scrotum should suggest which of the following?
A tender, painful swelling of the scrotum should suggest which of the following?
On examination, you note what feels like a “bag of worms” in the left scrotum, superior to the testicles. Which of the following is most likely?
On examination, you note what feels like a “bag of worms” in the left scrotum, superior to the testicles. Which of the following is most likely?
A 58-year-old man presents with a low-grade fever, constipation and abdominal pain. He has normal bowel sounds and tenderness in the left lower quadrant. Which of the following is the most likely diagnosis?
A 58-year-old man presents with a low-grade fever, constipation and abdominal pain. He has normal bowel sounds and tenderness in the left lower quadrant. Which of the following is the most likely diagnosis?
A 42-year-old woman reports chronic constipation, fatigue, weight gain, irregular periods, and cold intolerance. Examination reveals delayed reflexes. What is the most likely cause of her constipation?
A 42-year-old woman reports chronic constipation, fatigue, weight gain, irregular periods, and cold intolerance. Examination reveals delayed reflexes. What is the most likely cause of her constipation?
During an abdominal exam on a patient with a history of leukemia and an enlarged spleen, a rough grating noise is heard in the left upper quadrant. What does this sound indicate?
During an abdominal exam on a patient with a history of leukemia and an enlarged spleen, a rough grating noise is heard in the left upper quadrant. What does this sound indicate?
After multiple failed attempts at treating her hypertension, you consider secondary causes. Where should you listen for renal artery bruits?
After multiple failed attempts at treating her hypertension, you consider secondary causes. Where should you listen for renal artery bruits?
After palpating the abdomen, you feel a small mass. What should you do next?
After palpating the abdomen, you feel a small mass. What should you do next?
A 14 year old is presenting with a sore throat. On examination you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
A 14 year old is presenting with a sore throat. On examination you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?
A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?
Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?
Which type of hepatitis is most likely when a daycare worker presents to your office with jaundice and denies IV drug use, blood transfusion, and travel?
Which type of hepatitis is most likely when a daycare worker presents to your office with jaundice and denies IV drug use, blood transfusion, and travel?
A 29-year-old had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?
A 29-year-old had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?
Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?
Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?
Which is the proper sequence of examination for the abdomen?
Which is the proper sequence of examination for the abdomen?
Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling what is left in the filter after brewing coffee. What do you suspect?
Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling what is left in the filter after brewing coffee. What do you suspect?
Monique is a 33-year-old who has intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?
Monique is a 33-year-old who has intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?
Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered first?
Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered first?
Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant, and he hesitates to walk. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely?
Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant, and he hesitates to walk. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely?
A 27-year-old policewoman presents with severe left-sided back pain radiating to her groin and blood in her urine. She has tenderness just inferior to the left costovertebral angle. What type of pain is she most likely to have?
A 27-year-old policewoman presents with severe left-sided back pain radiating to her groin and blood in her urine. She has tenderness just inferior to the left costovertebral angle. What type of pain is she most likely to have?
What is the most likely explanation for this patient's chronic diarrhea: A 15-year-old has diarrhea after meals accompanied with cramps, abdominal pain, distension, and gas?
What is the most likely explanation for this patient's chronic diarrhea: A 15-year-old has diarrhea after meals accompanied with cramps, abdominal pain, distension, and gas?
What abnormality of the penis does this patient most likely have: A 20-year-old presents with multiple moist papules along all sides of his penile shaft?
What abnormality of the penis does this patient most likely have: A 20-year-old presents with multiple moist papules along all sides of his penile shaft?
What abnormality of the scrotum does this patient most likely have: A 32-year-old has aching on the right side of the testicle that increases as the day progresses. He has felt this aching for several months?
What abnormality of the scrotum does this patient most likely have: A 32-year-old has aching on the right side of the testicle that increases as the day progresses. He has felt this aching for several months?
What abnormality of the scrotum is most likely the diagnosis: A 48 year old reports a swollen scrotum that worsens with standing and improves when lying down. He also reports weight gain and shortness of breath?
What abnormality of the scrotum is most likely the diagnosis: A 48 year old reports a swollen scrotum that worsens with standing and improves when lying down. He also reports weight gain and shortness of breath?
What abnormality of the testes does this teenager most likely have: A 16-year-old reports an enlarged and tender left testicle with a sore throat, cough, and runny nose for the last 3 days?
What abnormality of the testes does this teenager most likely have: A 16-year-old reports an enlarged and tender left testicle with a sore throat, cough, and runny nose for the last 3 days?
What abnormality of the male genitalia is this most likely to be: A 45-year-old reports spots on his scrotum for several months that have gotten bigger?
What abnormality of the male genitalia is this most likely to be: A 45-year-old reports spots on his scrotum for several months that have gotten bigger?
Which would lead you to suspect a hydrocele versus other causes of scrotal swelling?
Which would lead you to suspect a hydrocele versus other causes of scrotal swelling?
Which of the following is consistent with metrorrhagia?
Which of the following is consistent with metrorrhagia?
Jean has just given birth 6 months ago and is breast-feeding her child. She has not had a period since giving birth, what does this most likely represent?
Jean has just given birth 6 months ago and is breast-feeding her child. She has not had a period since giving birth, what does this most likely represent?
Mrs. Jaeger is a 67–year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered initially?
Mrs. Jaeger is a 67–year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered initially?
Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?
Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?
Linda is a 29-year-old who had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?
Linda is a 29-year-old who had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?
What disorder of the vulva is most likely in this case if a patient has more than 10 shallow ulcers along each side of the vulva?
What disorder of the vulva is most likely in this case if a patient has more than 10 shallow ulcers along each side of the vulva?
What diagnosis best fits this description of her examination: 42-year-old presents with 2- to 3-mm, round, yellow nodules on the left labia?
What diagnosis best fits this description of her examination: 42-year-old presents with 2- to 3-mm, round, yellow nodules on the left labia?
What type of vaginitis best describes her findings: A 30-year-old presents with bad-smelling vaginal discharge with some mild itching, present for about her 3 weeks?
What type of vaginitis best describes her findings: A 30-year-old presents with bad-smelling vaginal discharge with some mild itching, present for about her 3 weeks?
What vaginitis does this patient most likely have if she presents with a thick, white, curdy discharge and has recently finished antibiotics for a sinus infection?
What vaginitis does this patient most likely have if she presents with a thick, white, curdy discharge and has recently finished antibiotics for a sinus infection?
What form of vaginitis is this patient most likely to have: A 55-year-old presents with 6 months of vaginal itching and discomfort with intercourse?
What form of vaginitis is this patient most likely to have: A 55-year-old presents with 6 months of vaginal itching and discomfort with intercourse?
What anal disorder that best describes her symptoms of pain with defecation and occasional blood on the toilet paper?
What anal disorder that best describes her symptoms of pain with defecation and occasional blood on the toilet paper?
A patient presents with abdominal pain that started near the umbilicus and then localized to the right lower quadrant. Which condition is most likely?
A patient presents with abdominal pain that started near the umbilicus and then localized to the right lower quadrant. Which condition is most likely?
A patient reports intermittent lower abdominal pain that is relieved by defecation and associated with changes in bowel movement frequency. Which of the following is the most likely diagnosis?
A patient reports intermittent lower abdominal pain that is relieved by defecation and associated with changes in bowel movement frequency. Which of the following is the most likely diagnosis?
A patient is suspected of having ascites. Which finding is most supportive of this diagnosis?
A patient is suspected of having ascites. Which finding is most supportive of this diagnosis?
A patient with cirrhosis presents with black, tarry stools. What is the most likely cause?
A patient with cirrhosis presents with black, tarry stools. What is the most likely cause?
Which of the following is the most appropriate sequencing for performing an abdominal examination?
Which of the following is the most appropriate sequencing for performing an abdominal examination?
What finding during a male genitalia exam is concerning for testicular torsion?
What finding during a male genitalia exam is concerning for testicular torsion?
A patient presents with a cluster of small, painful ulcers on the vulva. What is the most likely diagnosis?
A patient presents with a cluster of small, painful ulcers on the vulva. What is the most likely diagnosis?
Which is most likely to cause vaginal bleeding in a postmenopausal woman?
Which is most likely to cause vaginal bleeding in a postmenopausal woman?
A patient presents with a foul-smelling vaginal discharge, a pH greater than 4.5, and clue cells on microscopy. Which condition is most likely?
A patient presents with a foul-smelling vaginal discharge, a pH greater than 4.5, and clue cells on microscopy. Which condition is most likely?
What is the significance of a palpable, hard, irregular prostate nodule during a digital rectal exam?
What is the significance of a palpable, hard, irregular prostate nodule during a digital rectal exam?
A 25-year-old man reports aching pain in his right testicle that increases throughout the day and feels like a 'bag of worms' on examination. What abnormality is likely present?
A 25-year-old man reports aching pain in his right testicle that increases throughout the day and feels like a 'bag of worms' on examination. What abnormality is likely present?
A woman reports urinary incontinence only when coughing or sneezing. Which type of incontinence is most likely?
A woman reports urinary incontinence only when coughing or sneezing. Which type of incontinence is most likely?
A young male presents with painful swelling in his scrotum, fever, and dysuria. Urinalysis is positive for bacteria. Which is the most likely diagnosis?
A young male presents with painful swelling in his scrotum, fever, and dysuria. Urinalysis is positive for bacteria. Which is the most likely diagnosis?
Following a bout of severe diarrhea, a patient complains of significant anal pain during defecation and notices bright red blood on the toilet paper. What is the likely cause?
Following a bout of severe diarrhea, a patient complains of significant anal pain during defecation and notices bright red blood on the toilet paper. What is the likely cause?
A male patient reports erectile dysfunction but states that he experiences normal early morning erections. What is the most likely cause?
A male patient reports erectile dysfunction but states that he experiences normal early morning erections. What is the most likely cause?
Which finding on a prostate examination is most concerning for prostate cancer?
Which finding on a prostate examination is most concerning for prostate cancer?
A patient reports intermittent painless vaginal bleeding between menstrual periods. What describes this condition?
A patient reports intermittent painless vaginal bleeding between menstrual periods. What describes this condition?
A 60-year-old postmenopausal woman presents with new-onset vaginal bleeding. What initial step is most crucial?
A 60-year-old postmenopausal woman presents with new-onset vaginal bleeding. What initial step is most crucial?
During a pelvic exam, you visualize a mucoid mass on the cervix that bleeds easily when touched. What diagnosis is most likely?
During a pelvic exam, you visualize a mucoid mass on the cervix that bleeds easily when touched. What diagnosis is most likely?
A premenopausal woman presents with new onset hypertension unresponsive to three medications what is your next step?
A premenopausal woman presents with new onset hypertension unresponsive to three medications what is your next step?
Flashcards
Breast Cancer (Nipple Discharge)
Breast Cancer (Nipple Discharge)
Nipple discharge that is unilateral and bloody, potentially accompanied by a fixed lymph node.
Paget's Disease
Paget's Disease
An uncommon form of breast cancer that starts as an eczema-like, scaly skin change around the areola.
Nipple Retraction
Nipple Retraction
A flattened or pulled-in nipple, possibly with thickened surrounding skin.
Benign Nipple Discharge
Benign Nipple Discharge
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Acanthosis Nigricans
Acanthosis Nigricans
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Infectious Lymphadenopathy
Infectious Lymphadenopathy
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Metastatic Lymph Nodes
Metastatic Lymph Nodes
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Breast Cancer Risk Factor
Breast Cancer Risk Factor
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BRCA1 Gene
BRCA1 Gene
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Gynecomastia
Gynecomastia
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Supernumerary Nipple
Supernumerary Nipple
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Palpable Male Breast Tissue
Palpable Male Breast Tissue
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Central Axillary Nodes
Central Axillary Nodes
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Best Time for Self-Exam
Best Time for Self-Exam
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Risk of Breast Mass
Risk of Breast Mass
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Breast Screening Frequency
Breast Screening Frequency
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Asymmetrical Breasts
Asymmetrical Breasts
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Breast Palpation Pattern
Breast Palpation Pattern
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Unilateral Mastectomy Care
Unilateral Mastectomy Care
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Breast Self-Exam Detection
Breast Self-Exam Detection
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Stress Incontinence
Stress Incontinence
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Cause of Black Stools: Esophageal Varices
Cause of Black Stools: Esophageal Varices
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Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS)
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Constipation due to Hypothyroidism
Constipation due to Hypothyroidism
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Acute Pancreatitis
Acute Pancreatitis
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Acute diverticulitis
Acute diverticulitis
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Metastatic Liver Abnormality
Metastatic Liver Abnormality
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Acute Appendicitis
Acute Appendicitis
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Osmotic Diarrhea
Osmotic Diarrhea
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Ureteral Pain
Ureteral Pain
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Pain Progression in Appendicitis
Pain Progression in Appendicitis
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Causes of Epigastric Pain
Causes of Epigastric Pain
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Irritable Bowel Syndrome Symptoms
Irritable Bowel Syndrome Symptoms
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"Coffee Grounds" Vomit
"Coffee Grounds" Vomit
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Hepatitis A risk
Hepatitis A risk
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Pain pattern of ureteral stone
Pain pattern of ureteral stone
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Urge incontinence
Urge incontinence
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Abdominal Exam Sequence
Abdominal Exam Sequence
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Listening For Renal Artery Bruits
Listening For Renal Artery Bruits
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Emphysema Liver Exam
Emphysema Liver Exam
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Splenic Rub
Splenic Rub
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Abdominal Wall Mass Test
Abdominal Wall Mass Test
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Enlarged Spleen Location
Enlarged Spleen Location
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Enlargement of kidney vs mass
Enlargement of kidney vs mass
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Sign of Enlarged Bladder
Sign of Enlarged Bladder
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Exam findings of Pulsatile Mass
Exam findings of Pulsatile Mass
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Findings of Ascites
Findings of Ascites
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Obturator's Sign
Obturator's Sign
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Pain but pressure doesn't make it worse?
Pain but pressure doesn't make it worse?
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Syphilitic Chancre
Syphilitic Chancre
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Penile warts
Penile warts
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Scrotal Hernia
Scrotal Hernia
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Abnormality of Scrotum: Varicocele
Abnormality of Scrotum: Varicocele
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Abnormality of Scrotum: Scrotal Edema
Abnormality of Scrotum: Scrotal Edema
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Disorder of Scrotum: Hydrocele
Disorder of Scrotum: Hydrocele
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Disorder of Male Genitalia: Acute epididymitis
Disorder of Male Genitalia: Acute epididymitis
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Swollen Testicles: Torsion
Swollen Testicles: Torsion
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Disorder of testes: Acute orchitis
Disorder of testes: Acute orchitis
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Epidermoid cysts
Epidermoid cysts
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Check for Psychological function
Check for Psychological function
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Condition: Paraphimosis
Condition: Paraphimosis
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Urethral Stricture of Ventral Side
Urethral Stricture of Ventral Side
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Diagnosis of Tender Swelling
Diagnosis of Tender Swelling
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Suspect Varicocele
Suspect Varicocele
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Tests for Swelling of scrotum
Tests for Swelling of scrotum
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Exam of Infant testicle
Exam of Infant testicle
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Exam for Herina with Abdominal pain
Exam for Herina with Abdominal pain
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Shaft of Penis has something is: Herpes
Shaft of Penis has something is: Herpes
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Study Notes
- The breasts and axillae are examined to detect abnormalities and assess cancer risks.
Nipple Discharge
- Bloody nipple discharge, especially when unilateral and accompanied by a fixed lymph node, is highly indicative of breast cancer.
- Clear, unilateral nipple discharge that occurs only with compression is often benign, but persistent discharge warrants further investigation.
Visible Skin Changes
- Paget's disease manifests as a scaly, eczema-like rash around the nipple that may weep, crust, or erode, and requires evaluation for breast cancer if unresponsive to topical treatments.
- Nipple retraction, characterized by a flattened or inverted nipple with possible thickening of surrounding skin, is a late sign of breast cancer.
Acanthosis Nigricans
- Acanthosis nigricans, presenting as dark, velvet-like skin in the axilla, is often associated with polycystic ovarian syndrome (PCOS) and insulin resistance, but can sometimes indicate an internal malignancy.
Axillary Lymph Nodes
- Enlarged, hot, tender, and red axillary lymph nodes typically indicate an infection, often related to a skin wound in the drained area.
- Hard, nontender, and fixed axillary lymph nodes are indicative of metastatic disease, such as breast cancer.
Breast Cancer Risk Factors
- A first-degree relative with premenopausal breast cancer is a significant risk factor, increasing risk by a factor of 3.1.
- A woman with the BRCA1 gene has a 50% risk of developing breast cancer by age 50.
Gynecomastia
- Gynecomastia, breast enlargement in adolescent males, is commonly due to hormonal changes during puberty.
Supernumerary Nipple
- Supernumerary nipples appear as small, circular, evenly pigmented lesions along the "milk line."
Palpable Breast Tissue in Men
- Palpable breast tissue under the areola is common in adult men.
Lymph Node Involvement in Breast Cancer
- The central lymph nodes in the axilla are the most common site of breast cancer metastasis.
Breast Self-Examination (BSE)
- BSE is most effective when performed 5-7 days after menses.
- A large percentage of breast masses are detected via BSE.
- The vertical strip pattern is considered the most effective palpation pattern.
Breast Mass
- Approximately 10% of women presenting with a breast mass are diagnosed with breast cancer.
Screening Recommendations
- Clinical breast exams are advised every 3 years for women.
Breast Asymmetry
- Asymmetry in breast size is generally a benign finding.
Mastectomy Patients
- Post-mastectomy patients should be regularly examined for local recurrence along the surgical scar.
Urinary Incontinence
- Stress incontinence typically occurs with increased intra-abdominal pressure from coughing, sneezing, or laughing.
- Stress incontinence is usually due to weakness of the pelvic floor with inadequate muscle support of the bladder.
- Vaginal deliveries and pelvic surgery are often associated with stress incontinence.
- Postmenopausal women are more prone to stress incontinence.
- Kegel exercises are usually recommended to strengthen the pelvic floor muscles.
- Urge incontinence involves the inability to get to the bathroom quickly enough when sensing the need to urinate and is secondary to detrusor overactivity.
- Overflow incontinence occurs with anatomic obstruction like prostatic hypertrophy, urethral stricture, or neurogenic bladder.
- Functional incontinence results from lack of mobility severe enough to impair getting to the bathroom quickly enough.
Black Stools
- Esophageal varices are a likely cause of black stools in alcoholic patients with significant cirrhosis.
- Symptoms of cirrhosis include jaundice, ascites, spider hemangiomas, and dilated veins on the abdomen (caput medusa).
Diarrhea
- Irritable bowel syndrome (IBS) causes loose bowel movements with cramps but no systemic symptoms.
- IBS is more likely in young women with alternating symptoms of loose stools and constipation.
- Stress and certain foods usually worsen IBS symptoms.
- Osmotic diarrhea is often related to lactose intolerance and follows meal ingestion, with crampy abdominal pain, distension, and gas.
- Lactose intolerance is more common in African-Americans, Latinos, Native Americans, and Asians.
Constipation
- Hypothyroidism can cause constipation, cold intolerance, weight gain, fatigue, and irregular menstrual cycles.
- Delayed reflexes and thyromegaly may aid in diagnosing hypothyroidism.
- Medication will usually correct hypothyroid symptoms.
Abdominal Pain
- Acute pancreatitis causes epigastric and left upper quadrant pain that often radiates into the back, along with severe abdominal pain and vomiting.
- Acute pancreatitis is often linked to a history of gallbladder disease or recent alcohol ingestion.
- Medications like proton pump inhibitors can also cause pancreatitis.
- Treatment for acute pancreatitis includes hydration, pain management, and bowel rest.
- Acute diverticulitis is caused by localized infections within colonic diverticula and presents with constipation, fever, and abdominal pain.
- Mesenteric ischemia classically presents in older people with a history of vascular disease elsewhere and the pain isn't worsened by examination, despite its severity.
Liver Abnormalities
- Metastasis of colon cancer to the liver usually creates hard, irregular nodules that can sometimes be palpated on examination.
- A smooth, large, tender liver is often seen in hepatitis.
- A liver edge palpable far below the costal arch shouldn't be ignored.
- Emphysema with flattening of the diaphragms can push a normal-sized liver below the costal arch.
- Normal liver size is 6–12 centimeters in the mid-clavicular line.
Appendicitis
- Appendicitis commonly presents with periumbilical pain that localizes to the right lower quadrant at McBurney's Point and is one third of the way between the anterior superior iliac spine and the umbilicus on the right.
- Rebound and guarding are common in appendicitis.
- Remote rebound or Rovsing's sign is also seen when appendicitis is advanced.
- Bowel movements are usually unaffected in appendicitis.
Kidney Stone Pain
- Kidney stone pain causes dramatic, severe, colicky pain at the costovertebral angle that radiates across the flank and down into the groin.
Referred Pain
- Epigastric pain can be caused by peptic ulcer, pancreatitis, or myocardial ischemia.
Vomiting
- Vomiting of "coffee grounds" indicates blood exposed to the stomach environment, commonly from a bleeding peptic ulcer.
- Rapid bleeding from the stomach or upper gastrointestinal source can produce bright red blood in the stool.
- Conversely, bright red blood seen with emesis may originate from the stomach.
- Black, sticky stools also can accompany upper GI bleeding.
Hepatitis
- Hepatitis A is likely in daycare workers due to regular diaper changes and the lack of contact with blood and body fluids.
- Vaccine against hepatitis A is recommended for daycare workers.
Shifting Pain
- Presentation of right flank pain spiraling down to the groin is typical of a ureteral stone.
Abdominal Examination Techniques
- Abdominal examination sequence: inspection, auscultation, percussion, palpation.
- Palpation may cause bowel noise when the bowels are not moving, therefore auscultation is performed before percussion and palpation in an abdominal examination.
- Renal artery bruits are usually heard best in the upper quadrants and are often associated with hypertension.
- For suspected renal artery bruits, examine the abdomen carefully for soft, high-pitched sounds with systole.
- A bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal. To determine the difference have patients hold their breathe to quiet the room, and simultaneously feel their pulse,
- Determine size of mass by palpating with the abdominal wall tensed when palpating for mass
- Palpate with abdominal wall tensed, instruct patient to lift their head.
- Abdominal wall masses can be observed, whereas intra-abdominal masses are more concerning.
Splenic Rub
- A rough, grating noise over the left upper quadrant represents a splenic rub, which can accompany splenic infarction.
Spleen Examination
- The Presence of dullness with inspiration should increase your attention to further examination of the spleen, although dullness can occur in normal patients too.
Kidney vs Spleen Enlargement
- A left upper quadrant mass is more likely to be a kidney if there is no palpable "notch," you can push your fingers between the mass and the costal margin, there is normal tympany over this area, and you cannot push your fingers medial and deep to the mass.
Masses
- Smooth lower abdominal mass in the midline which is minimally tender likely represents an enlarged bladder, possibly from prostatic hypertrophy.
Pulsatile Mass
- Pulsatile mass in the abdomen should be followed up with ultrasound as soon as possible, as risk of aortic rupture is greatly increased once it measures over 4cm.
Ascites Diagnosis
- A diagnosis of ascites is supported by shifting dullness: tympany that changes location with patient position.
- This is because gas-filled loops of bowel tend to float with more fluid gathering in dependent areas.
- A fluid wave and edema would support ascites diagnosis as well.
Special Maneuvers
- Obturator sign: Pain with stretching of the internal obturator muscle because of inflammation, is also seen in appendicitis.
- Rovsing's sign: Pain distant from the site used to check rebound tenderness indicate peritonitis
- Psoas sign: Pain with extension of the right thigh while the patient is on patient's left side or while pressing her knee against you hand with thigh flexion.
- Murphy's sign: Palpation in the right upper quadrant that causes pain severe enough to stop inhalation, consistent with inflammation of gallbladder.
Ischemic Pain
- Ischemic pain can be severe but is not made worse with palpation.
Syphilis
- Primary syphilis causes a larger ulcer that is firm and painless.
- Consider further HIV status questions and workup.
Genital Warts
- Warts are generally painless papules along the shaft and corona.
- Warts are likely to spread and are caused by the human papilloma virus, transmitted through sexual contact.
- Discuss prevention of STIs and the HPV vaccine.
Scrotal Hernias
- Scrotal hernias occur when the small intestine passes through a weak spot of the inguinal ring, examiner cannot get a finger above the hernia into the ring.
- Hernias are often caused by increased abdominal pressure, such as in weight lifting.
- Patients who have a hernia on one side often have another hernia on the opposite side.
Varicoceles
- Varicoceles are varicose veins surrounding the spermatic cord, coming through the inguinal ring.
- Varicoceles feel like spaghetti and are often referred to as a "bag of worms."
- Increased veins affect the temperature of the testes, often causing infertility problems.
- A unilateral varicocele on the right or a varicocele which does not resolve in the supine position deserves further workup.
Scrotal Edema
- Scrotal edema is a generalized swelling of the scrotum due to a systemic illness.
- No discrete masses are palpated with scrotal edema.
- Scrotal edema is commonly associated with congestive heart failure and hypoalbuminemia.
Hydrocele
- The hydrocele is a fluid-filled cyst originating within the tunica vaginalis.
- An examining finger can be placed over the mass into the inguinal ring.
- Hydroceles often transilluminate light, whereas solid tumors do not.
Epididymitis
- Epididymitis is an infection of the epididymis superior to the testicle.
- Epididymitis can often be caused by sexually transmitted disease and can cause burning with urination and scrotal pain
- Palpate the spermatic cord through the scrotum by pinching medially and sliding pinched fingers laterally, spermatic cord will pass between fingers and be tender if involved.
Torsion
- Torsion is caused by the twisting of the testicle on its spermatic cord and blood vessels, will lead to severe pain.
- Scrotum will become red and tense. Torsion is usually seen in adolescents and is a true surgical emergency.
- The presence of a cremasteric reflex is reassuring, but a thorough evaluation must take place as soon as possible.
Orchitis
- Acute orchitis causes an inflamed, tender testicle.
- The scrotum will be red and tense with acute orchitis.
- Acute orchitis is usually unilateral and often associated with viral infections such as mumps.
Epidermoid Cysts
- Epidermoid cysts are firm, yellowish, painless cysts on the scrotal skin.
- Epidermoid cysts are very common and are benign.
Sexual Dysfunction
- Early morning erections are indicative of normal physiologic function.
- Impotence psychological issues and marital difficulties may be the root cause in some patients. It is important to check patient history if unsure of early morning erections,
- Postage stamp test: ring of postage stamps or other perforated stickers is placed around the penis while in the flaccid state. If the perforations are broken, it is likely an erection has occurred.
Phimosis and Paraphimosis
- Phimosis describes a foreskin which cannot be retracted.
- Paraphimosis is a tight prepuce which, once retracted, cannot be returned.
- Balanitis involves an inflammation of the glans, whereas balanoposthitis involves inflammation of both the glans and the prepuce.
Penile Induration
- Urethral stricture may cause induration of the ventral surface of the penis.
- Peyronie's disease often causes induration on the dorsal proximal penis.
Causes of scotal pain
- Tender, painful swelling of the scrotum can be a medical emergency-acute epididymitis, strangulated inguinal hernia, and torsion of the spermatic cord must all be investigated.
Varicose vs Hydrocele
- Varicoceles are common in normal men, often found in the left scrotum or bilaterally and should normally resolve in the supine position.
- Requires further investigation if they occur only on the right side or do not resolve in the supine position.
- Hydrocele versus other testing hydrocele will have the following.
- Cystic structure transilluminates well. Possible to use an otoscope to transilluminate the scrotum.
- Scrotal examination: should be able to get above mass on palpation and bowel sounds should not be present.
- Edema: thickened skin which can be measured by gently pinching a section of the scrotum itself.
Testicular Examination
- This is not an uncommon finding, and the testis must often be "milked" into the scrotum from the inguinal canal.
- Six months is too long to wait, but urology referral is unnecessary unless the testicle cannot be brought into the scrotum.
- An intra-abdominal testis is at much higher risk for testicular cancer.
Abnormal Strain
- Even in the presence of a hernia, absolute symmetry to inspection may be preserved.
- Pain with straining and bowel sounds heard in the scrotum further support the diagnosis of indirect hernia.
Genital Erosions
- The multiplicity of lesions as well as the burning quality of the pain would lead one to suspect herpes simplex.
- Syphilis usually presents with a single chancre which is generally painless.
- Chancroid forms a single, jagged, deep ulcer and gonorrhea usually results in a burning discharge without skin lesions.
Genital Herpes
- Genital herpes consists of small, shallow, painful ulcers.
- Primary infections are often associated with fever, malaise, and regional lymphadenopathy.
- The outbreak occurs generally between 1 and 3 weeks after exposure.
- Herpes is contagious and the majority of transmission occurs without the presence of obvious lesions.
- Transmission during passage through the birth canal can cause serious illness in affected newborns.
Vaginal examination: Cyst
- These cysts are small, firm, round cystic nodules in the labia that are nonpainful.
- These do not represent a sexually transmitted infection, but rather a blocked sebaceous gland.
Bacterial Vaginosis
- Bacterial vaginosis generally has a homogenous, grayish-white, thin discharge.
- The pH will be over 4.5 and the KOH wet prep releases a strong fishy odor, known as a "positive whiff test."
- Any basic pH fluid (semen or blood) will cause the fish-like odor to occur, often after intercourse, as with this patient.
- The wet prep will show clue cells, which are epithelial cells with borders stippled by bacteria.
Candida Vaginitis
- Candida is associated with a thick, white, curd-like discharge that causes severe pruritus.
- The pH will be normal (£4.5) and the KOH whiff test will be normal.
- The wet prep often shows yeast spores and budding hyphae. Candida is very common in diabetics and after recent use of antibiotics.
- Is not thought to be sexually transmitted.
Atrophic Vaginitis
- The itching and pain with intercourse in atrophic vaginitis are due to the decreased amount of estrogen after menopause. There is generally scant discharge and the wet prep and KOH whiff test are unremarkable.
Cervical Polyps
- Cervical polyps are polyps of endometrial cells arising from either the uterus or the cervix.
- Cervical polyps are benign and usually painless but can bleed during intercourse.
P.I.D.
- P.I.D. is common in young sexually active woman and is usually caused by bacteria that have been sexually transmitted.
- It is often associated with fever, pelvic pain, and a purulent cervical discharge. On examination there is often cervical motion tenderness and adnexal swelling and pain.
- A purulent discharge is often seen in the cervical os.
- Causes of cervical infection are gonorrhea, Chlamydia, and sometimes herpes.
- Barrier methods of contraception may prevent transmission of these diseases, whereas the contraceptive patch or pill will not.
Tubal Pregnancies
- Tubal pregnancies start to cause pain as the fetus grows too large to be contained in the tube.
- Eventually the tube begins to rupture and bleeding ensues, leading to hypotension, tachycardia, and syncope.
- On visualization of the cervix, the purple to bluish color of pregnancy may be seen.
Ovarian Cysts
- Ovarian cysts often occur just before the onset of menses.
- Are also common in a disease known as polycystic ovarian syndrome.
- Other symptoms of this disorder are acne, hirsutism (increased hair growth), irregular periods, obesity.
- This disorder runs in families and later manifestations include diabetes, high blood pressure, and coronary artery disease. Single cysts on the right side can mimic the symptoms of appendicitis.
Bartholin’s gland infection
- Bartholin's gland infections cause a red-hot tender abscess at the duct opening to the Bartholin's glands. Gonococci, Chlamydia, and other organisms often cause them. Size is variable; if chronic, the infection can present as a nontender cyst.
Bleeding
- Menorrhagia; heavy menses.
- Metrorrhagia; bleeding btwn periods.
- Oligomenorrhea; infrequent menses.
- Polymenorrhea; menstruation with less than 21 days.
Vaginismus
- Involuntary contraction of the muscles around the vaginal opening-psychosocial history is important.
H.P.V.
- HPV is the most common STI in the United States and is by far the most common cause of cervical cancers.
- Currently, HPV types 6, 11, 16, and 18 are targeted because these are among the most common types causing cervical cancer is important to administer.
Anal Disorder
- Anal fissures often occur after severe diarrhea or constipation. They cause bright blood on the toilet paper and are extremely painful during defecation. A small ulceration or fissure is observed proximal to the anus.
- A swollen, bluish ovoid mass is most likely a thrombosed external hemorrhoid. Narcotics can cause severe constipation, leading to this disorder.
- Anorectal cancer has bright red blood in the toilet over time. An irregular hard mass in the rectum. It is not uncommon for these masses to be friable (bleed easily), even with gentle manipulation. Also look for weight loss.
- Prostate caner can have an irregular firm nodule
- Anorectal fistula can commonly cause a leakage of stool, even when the patient is not having a bowel movement. They are common after infections, especially after trauma to the anal musculature (such as in a fourth-degree perineal tear). With more chronic gastrointestinal symptoms, this finding may lead you to suspect Crohn's disease.
- Internal hemorrhoids are common during pregnancy, look for red swollen. And it worsens with bearing down.
B.P.H.
- BPH becomes more prevalent during the fifth decade and is often associated with the urinary symptoms of hesitancy in starting a stream, decreased strength of stream, nocturia, and leaking of urine. On examination an enlarged, symmetric, firm prostate is palpated.
Prostatitis
- Prostatitis generally causes increased frequency of urination, pain with urination, and lower back pain. On digital rectal examination a warm, tender, boggy prostate will be palpated, also examine for warm tender boggy prostate along examination.
- In young men the etiology is often a sexually transmitted disease such as chlamydia or gonorrhea. This man's substance abuse problem should also be discussed with him.
Rectal Polyp
- Rectal polyp commonly has soft smooth peduculated mass on wall of rectum .
Technique
- Pectinate or dentate line marks the division between the anal canal and rectum .
- Key parts of a good rectal examination: Lubricating the entire finger and removing excess lubricant.Being patient while the anal sphincter relaxes.Preparing the patient for each step.
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