Exam 2 PDF - Medical Past Paper

59 q 98 pts 100 min s/s vaginal infections o differentiate between BV and trichmonas BV is characterized by an imbalance of vaginal flora, primarily an overgrowth of anaerobic bacteria, while TV is a sexually transmitted protozoan parasite. BV Symptoms: Often...

59 q 98 pts 100 min s/s vaginal infections o differentiate between BV and trichmonas BV is characterized by an imbalance of vaginal flora, primarily an overgrowth of anaerobic bacteria, while TV is a sexually transmitted protozoan parasite. BV Symptoms: Often includes a fishy odor, vaginal discharge, and irritation, but can be asymptomatic. TV Symptoms: May present with itching, burning, and a frothy discharge, but many cases are asymptomatic common causes of ED – multifactorial Radial prostatectomy, organic causes like vascular, neurogenic, hormonal, anatomic, drug induced, or psychological. Ask open ended questions to get a patient history and and focus on detecting enodcrine, vascular, and neurological deficits and penile abnormalities. Cranial Nerves o Relexs that responds  o What do you test to elicit it olfactory I 1-smell Optic II 2- vision using snellen chart and peripheral vision (cover 1 eye and move pen into visual field) Occulomotor III 3- ocular movements (follow pen with eyes), response to light, look away come back accommodation Trochlear IV 4- ocular movements (follow pen with eyes), response to light, look away come back accommodation Trigeminal V 5- testing sensory when lightly touching cornea, testing motor in clenching teeth Abducens VI 6- ocular movements (follow pen with eyes), response to light, look away come back accommodation Facial VII 7- sharp and dull, testing motor region when touching cornea, show teeth, puff cheeks, smile, taste on anterior 2/3 surface Vestibulocochlear VIII 8- whipser test, weber, rine Glossophayngeal IX 9- Taste on posterior surface, gag relfex, say ahh Vagus X 10- gag reflex, say ah Spinal Accessory XI 11- shoulder and neck muscle strength using shrug and turn head to side Hypoglossal XII 12- move tounge side to side and stick out  Quadrants of abdomen What quadrant for which differential Other clinical signs indicative of acute appendicitis include Rovsing’s sign, Psoas sign, and a positive obturator sign. Rovsing's sign is said to be positive if pressure over the person’s left lower abdominal quadrant causes pain in the right lower abdominal quadrant. The Psoas sign is elicited in an individual lying on their left side while their right thigh is flexed backward. While in this position, the inflamed appendix may press against the right Psoas muscle, which connects the lumbar vertebrae to the femur. This can cause pain, triggering the individual to shorten the muscle by drawing up the right knee. Additionally, the appendix may also lie against the right obturator internus muscle, a deep muscle of the hip joint. The obturator sign can be elicited in an individual by flexing their right knee to a 90 degree angle while a clinician internally rotates the hip by moving the ankle away from the body. Pain associated with this maneuver can be indicative of an inflamed appendix. Rebound tenderness - why do we asses and and how to assess Rebound tenderness is a critical clinical sign used in the assessment of acute appendicitis, providing valuable diagnostic information. It is assessed by applying pressure to the abdomen and then quickly releasing it, observing for pain that occurs upon release. This technique is essential for differentiating between appendicitis and other abdominal conditions, as it indicates irritation of the peritoneum. The clinician applies firm pressure to the abdomen, typically in the right lower quadrant, and then releases it. The presence of pain upon release indicates rebound tenderness Cough test, bedbumptest, When is an abdominal exam needed – you will get a chief complaint and asked which need to be examined When there is abdominal pain. Or radiating pain. The surgical abdomen is rgidity, severe tenderness, and rebound tenderness, absent bowel sounds Know what assessment findings are positive in PID – what exams do we do and what is a positive sign. o What is a normal and abnormal Pelvic Inflammatory Disease (PID) is primarily diagnosed through clinical assessment, with specific examination findings indicating a positive diagnosis. Key positive signs include adnexal tenderness (pelvic), cervical motion tenderness, and vaginal discharge, which are critical in the clinical evaluation of suspected PID cases. Normal Findings: Absence of tenderness or discharge typically indicates no PID. Cervical Cancer Guidelines o What age groups o When do we start paps – 21 o How often – every 3 yrs until you turn 30 and then every 5 @65 if you are negative 3 times in a row withing the last 5 years you can stop o Contested with HPV (usually can clear on your own) What is an acute abdmonial emergency  o Triple A - Abdominal Aortic Aneurism General aspects of heartburn o How to relieve it Heartburn, a common symptom of gastroesophageal reflux disease (GERD), is characterized by a burning sensation behind the sternum due to stomach acid refluxing into the esophagus. Effective management of heartburn involves a combination of lifestyle modifications and pharmacological interventions. Lifestyle changes such as dietary adjustments and weight management are foundational, while medications like antacids, histamine-2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) offer varying degrees of relief. Dietary Adjustments: Avoiding foods that trigger heartburn, such as chocolate, peppermint, fatty foods, caffeine, citrus, and tomatoes, can reduce episodes(McRorie, 2017). Meal Management: Eating smaller meals and avoiding large meals can help minimize symptoms(McRorie, 2017). Weight Management: Reducing body weight can decrease abdominal pressure, thereby reducing heartburn risk Murphys sign o What does it mean if its positive o How do you elicit it o Diagnosis it goes with A positive Murphy's sign indicates the presence of pain in the right upper quadrant during palpation, particularly when the patient inhales, suggesting acute cholecystitis. This clinical sign is elicited by palpating the subcostal region while the patient takes a deep breath; if pain occurs and the patient abruptly stops inhaling, the sign is considered positive. A positive Murphy's sign significantly raises the suspicion for acute cholecystitis. Headaches o Tension – cluster – migraine ▪ Criteria ex.Quality , pain, uni/bi lateral, other symptoms o What is an emergent ER referral o Common treatments ▪ What to try before prescription medication o Whats an aura o What are the differentials Emergent ER referrals are wort headache ever (SAH), Meningismus/stiff neck (meningitis), decreased LOC, vomiting with no nauseas, and abrupt onset of pain Headache types: Tension – Headband or Hair band around the head, BI, most common in adult women, sustained muscle contraction. Lasts for hours to days and recurrs over weeks or months, frontotemporal bandlike. NONthrobbing, mild, gradual, TMJ – frontal or temporal pain, UNI/BI, increased with chewing Cluster – UNI ocular/periocular, intense boring, searing, knifelike, associated with red conjuctiva and tearing. They are vascular. Less common than migraines and happen mostly in men. They are abrupt and often during the night. Steadily increase in severeity but can last 15 min to 2 hrs. Remission may last months to years. Episodes are clustered in days and weeks. Is burning, piercing, neuralgic. Associated with alcohol injestion, ptosis Migrain classic – UNI, dilation fo cerebral arteries, photophobia, dizziness, WITH AURA, precipated by bright lights, noise, tension. Associated with phonophobia Migrain common – UNI, photophobia, dizziness, WITHOUT AURA, throbbing with rapid onset. Hits peak within hours and recurrs daily,weekly, or less than that. Accompanied by nausea, photophobia, exacerbation Mixed – combination of muscular and vascular, usually with family history, pain is throbiing and constant during waking hours with tightness pressure and muscle contraction Temporal Arteritis – UNI/BI, throbbing, Palpate for enlarged arteries Traction – sneezing, coughing, bending is worse, blurred vision A brain tumor is gradual onset, deep aching pain, worse in the AM, worse with cough sneeze strain An aura is a twinkling or swirling lights, ascending paresthesia (numbness), weakness, aphasia To treat rest in a dark quiet environment or sleep. If tension mild analgesics like NSAIDS. If Meningal irritation relief from lying recumbent(side) and still Normal liver span when percussing 6-12 Finding in hands with arthritis both types. Osteo -NONINFLAMMA Rheumatoid – INFLAMMA; swan-neck deformity, ulnar deviation of metacrpophalangeal joint, boutonniere deformity of thumb  How to assess for sciatic pain Straight leg raise test- assess lumbar disc herniation by raising leg while supin identifying angles the would be a possible issue. A severe pain that radiates from the back into the hip and outer side of the leg caused by compression of the sciatic nerve. Most common cause of back pain Bad posture What findings will you see in appendicitis Early – felt in periumbilical area with modest tenderness Middle – RLQ and severe tenderness Late – Generalized pain and peritoneal signs What are your steps when dealing with ankle injurys o How do we assess o What findings mean need x-ray o If the need x-ray what do we do o What treatment Inspect for swelling,discoloration,misalignment. Palpate for the same and heat. Use functional tests like walking, range of motion. You can inspect when they walk into the room. Anterior and posterior drawer tests for ankle instability. Thompson test for ruptured achilles. Assessment 1. History: Ask about how the injury occurred, the level of pain, and any previous injuries. 2. Visual Inspection: Look for swelling, bruising, deformities, or open wounds. 3. Palpation: Gently feel around the ankle to identify tender areas. 4. Range of Motion: Check how much the ankle can move in different directions. 5. Special Tests: Perform tests like the Anterior Drawer Test or Talar Tilt Test to assess ligament damage. Findings Indicating Need for X-ray Severe Pain: Especially if it's localized to a specific area. Deformity: Any visible deformity or misalignment of the ankle. Inability to Bear Weight: If the person can't put any weight on the ankle. Signs of Fracture: Such as a "snap" sound at the time of injury, or if the ankle looks out of place. If X-ray is Needed Immediate Care: Immobilize the ankle using a splint or brace. Medical Attention: Seek medical help to get the X-ray done. Follow-Up: Follow the doctor's advice based on the X-ray results. Treatment 1. RICE Protocol: Rest, Ice, Compression, and Elevation. 2. Medication: Pain relievers like ibuprofen or acetaminophen. 3. Physical Therapy: Exercises to restore strength and flexibility. 4. Supportive Devices: Use of braces or crutches as needed. 5. Surgery: In severe cases, surgical intervention might be necessary. What tests we use for knees – how its done and what its testing for o Acl – mcl- miniscule ROM tests for flexibility and function; kick leg back and forth. Lachman test – ACL intergrity, lying supin pulling tibia forward; if positive ACL injury Anterior drawer – anterior stability of knee and ACL, supine knees flexed pull tibia anteriorly; increased movement compared to unaffected knee means ACL damage Pivot shift – Anerolateral instability with ACL, flexing the knee while applying a valgus force; tibial translation may revel laxity in ACL McMurray – meniscal tear, flexing and extending the knee while applying rotational force to elicit a clicking sound or pain indicating potential damage based on location Valgu/varus - assess integrity of medial and lateral collateral ligaments, knee flexed lateral and medial forces applied to gauge stability; excessive movment indicates ligamentous injury Parasympathetic and sympathetic o What nerves/ spinal cord segments control each sympathetic nervous system arises from the thoraco-lumbar segment of the spinal cord. responses include increased blood pressure, heart rate, and vasoconstriction, etc. parasympathetic nervous system arises from the craniosacral segment of the spinal cord. decreasing blood pressure, heart rate, stimulation of peristalsis  Common changes in the older adult when it comes to nuero Reduction in nervecells,cerebral blood flow, and metabolism. Slower reflexes, delayed responses, and changes in balance so increased risk of falls, nervous system affected by all other body systems. Changes in sleep patterns at stage 3 and 4 2 types of strokes o What area of the brain o What findings – ex. Speech,rombergs,drift Strokes are primarily categorized into two types: ischemic and hemorrhagic. Ischemic strokes, which are more prevalent, occur due to blockages in the blood vessels supplying the brain, while hemorrhagic strokes result from bleeding within the brain. The clinical manifestations and affected brain areas vary depending on the type and location of the stroke. The left parietal lobe is a common site for ischemic strokes, often leading to speech and motor function impairments. Hemorrhagic strokes, on the other hand, are frequently associated with symptoms like coma and seizures due to increased intracranial pressure. Clinical Findings Speech Disorders: o Right-hemisphere strokes can lead to various speech disorders, including aphasia and dysarthria(Dyukova et al., 2010). Romberg’s Test and Drift: o These are not specifically mentioned in the provided contexts, but are generally used to assess balance and motor function, which can be affected by strokes. Mcbruneys test McBurney’s point 1.5-2in from the navel, refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis. Individuals with appendicitis will typically experience a sudden onset of pain, beginning in the area behind the navel. It can then shift to the lower right abdomen, where the appendix is located. Associated symptoms include low-grade fever, nausea, vomiting, constipation, diarrhea, and abdominal bloating. A physical exam may reveal rebound tenderness over McBurney’s point. Rebound tenderness is a clinical sign in which there is pain upon removal of pressure rather than application of pressure to the abdomen. What do we use to screen for prostate cancer Prostate-specific antigen (PSA) blood test: This test checks the level of PSA in the blood, which can be elevated if prostate cancer is present. Levels above 10 is cancer Digital rectal exam (DRE): A physical exam where the doctor inserts a gloved finger into the rectum to feel for any abnormalities in the prostate. Prostate biopsy: If the PSA test result is abnormal, a biopsy may be needed to confirm the presence of cancer. A prostate cancer gene 3 (PCA3) RNA test: This test may be used for certain patients.  Prostate cancer screening primarily utilizes prostate-specific antigen (PSA) testing, with guidelines suggesting screening typically begins at age 55 for average-risk men, while high-risk groups may start as early as 45. Levels above 10 is cancer If 70 or older with less that 10-15 years left. They will not screen Second most common cancer in men. Adenocarcinoma is the most common subtype. Deep tendon reflex's what spinal nerve root are you worried about. Biceps= c5/6 Brachio=c5/c6 What findings with radiculopathy pain from lumbar spinal injury Lumbar radiculopathy, often referred to as sciatica, is a condition characterized by neurogenic pain in the back and lower extremities due to compression or irritation of the lumbar nerve roots. This condition is commonly caused by herniated discs, foraminal stenosis, and other structural lesions, leading to symptoms such as pain, numbness, tingling, and muscle weakness in the affected nerve root distribution. The L5 and S1 nerve roots are most frequently involved, with disc herniation being the predominant cause. The condition is more prevalent in males (60%) compared to females (40%), with an average patient age of 45 years. a positive Lasègue’s straight leg raising sign being indicative of radiculopathy. What type of history do I use for chief complain – comprehensive, focused, detailed ROS Comprehensive History Definition: A thorough exploration of the patient's medical history, including past medical, surgical, family, and social history.  Application: Used when the patient's condition is complex or when they present with multiple symptoms that require a broad understanding of their health background. Example: In cases where a patient has a chronic illness with multiple comorbidities, a comprehensive history helps in understanding the full scope of their health issues(Henderson et al., 2011). Focused History Definition: A targeted approach that concentrates on the chief complaint and related systems. Application: Ideal for acute settings, such as emergency departments, where time is limited, and the primary goal is to address the immediate concern. Example: For a patient presenting with chest pain, a focused history would concentrate on cardiovascular and respiratory systems to quickly identify potential life-threatening conditions(Nierenberg, 2020) (Sonnenberg & Gogel, 2002). Detailed Review of Systems (ROS) Definition: An in-depth inquiry into each body system to uncover any additional symptoms that may not be directly related to the chief complaint. Application: Useful when the initial assessment does not provide enough information to make a diagnosis, or when the symptoms are vague and require further clarification. Example: A detailed ROS might be necessary for a patient with nonspecific symptoms like fatigue or dizziness, where multiple systems could be involved(Tierney & Henderson, 2004). Different types of hepatitis and how they are transmitted Risk factors involving peptic ulcers  Orthopedic test s/s of UTI Symptoms of Lower UTI Frequency and Urgency: Patients often experience an increased need to urinate and a sense of urgency, even when the bladder is not full(Mohanam & Shanmugam, 2024). Dysuria: Painful or burning sensation during urination is a common symptom(Mohanam & Shanmugam, 2024). Hematuria: Presence of blood in the urine can occur, leading to pink, red, or cola-colored urine(Mohanam & Shanmugam, 2024). Symptoms of Upper UTI Fever and Chills: These systemic symptoms are more common in upper UTIs, such as pyelonephritis(Mohanam & Shanmugam, 2024). Flank Pain: Pain in the back or side, below the ribs, is indicative of kidney involvement(Mohanam & Shanmugam, 2024). Nausea and Vomiting: These symptoms may accompany severe infections like pyelonephritis(Mohanam & Shanmugam, 2024). Common Pathogens Escherichia coli: The most frequent causative agent of both complicated and uncomplicated UTIs(Grabe, 2012) (D et al., 2018). Other Bacteria: Klebsiella spp., Proteus spp., Staphylococcus aureus, and Enterococcus spp. are also common pathogens(Mohanam & Shanmugam, 2024) (D et al., 2018). scrotal examination o normal findings o what does the spermatic cord feel like o prostate feels like o tests feels like Normal: testicles: movable, rubbery with a smooth surface, and smooth on top (where epididymis is) spermatic cord: straight and feel like thick strands of string 1. The testis has the consistency of a hard-boiled egg or rubber ball  2. The epididymis is located on the superior posterior surface of the testicle and is soft and wormlike Abnormal findings as you feel toward your prostate include firm, bumpy, non-smooth, enlarged, and/or tender areas. Prostate is normally 4x3x2 and heart shaped. A normal testicle is smooth and slippery, like a peeled hard-boiled egg; check for lumps, swelling A normal spermatic cord is like a thick, straight noodle; change is like a “bag of noodles” s/s of colorectal cancer HPI Hematochezia/Melena Abdominal pain or rectal pain Change in bowel habits Unexplained iron deficient anemia Tenesmus and/or decreased stool caliber S/S of obstruction Physical Exam Rectal Exam Should be done to palpate for mass and perform fecal occult blood test Physical exam findings can vary and may be normal Screening should begin at age 45 for normal risk patients common causes of constipation o what assessment findings – auscultation, percussion, palpation ex. Impacted stool Common Causes of Constipation Dietary Factors: Low fiber intake and inadequate fluid consumption are significant contributors to constipation. A diet lacking in fruits, vegetables, and whole grains can lead to harder stools and difficulty in bowel movements(Bardsley, 2017). Lifestyle Factors: Sedentary lifestyle and lack of physical activity can slow down intestinal transit, leading to constipation. Additionally, stress and changes in routine, such as travel, can exacerbate the condition(Alame & Bahna, 2012) (Bardsley, 2017). Medications: Certain medications, including opioids, antacids, and antidepressants, can cause constipation as a side effect(Bardsley, 2017). Medical Conditions: Conditions such as irritable bowel syndrome, diabetes, and hypothyroidism can contribute to constipation. In children, faecal impaction is a severe form of constipation where stool becomes hard and difficult to pass(Kishanrao, 2024) (Kyle, 2010). Assessment Findings Auscultation: Bowel sounds may be reduced or absent in cases of severe constipation, indicating decreased intestinal activity(Kyle, 2010).  Percussion: A distended abdomen with tympanic sounds may be noted due to gas accumulation(Kyle, 2010). Palpation: A palpable mass in the left iliac fossa may indicate faecal impaction. In severe cases, a rectal examination may reveal a large amount of stool in a dilated rectum(Kishanrao, 2024) (Kyle, 2010). Triple As – Abdominal Aortic Aneurism An abdominal aortic aneurysm is an enlarged area in the lower part of the body's main artery, called the aorta. o Risk factors – modifiable and non Smoker Male sex Atherosclerosis Family hx AAA Advanced Age Connective tissue disease Uncontrolled HTN o What demographics am I seeing Sudden severe pain, may radiate to back or flank, SOB, hypotension, pulsatile abdominal mass (near belly button), ecchymosis (retroperitoneal hematoma) o s/s cullens – red belly button grey-turner – bruise on flank/side