ABDOMEN

1. ABDOMEN

2. 1. Abdominal bruits may indicate: • Renal Stone • Pancreatitis • Aortic Aneurysm • Ulcer

3. 1. Abdominal bruits may indicate: • Renal Stone - colic quality • Pancreatitis - knifelike; epigastric • Aortic Aneurysm • Ulcer - burning pain

4. 2. A technique known as _____ is used to assess a free floating object in the abdomen. • Ballance • Ballottement • Cullen Sign • Striae

5. 2. A technique known as _____ is used to assess a free floating object in the abdomen. • Ballance • Ballottement • Cullen Sign - bluish umbilical discoloration; intraabdominal bleeding • Striae - stretch marks

6. 3. You hear loud bowel sounds while standing next to a patient. You would document this as: • Ballance • Striae • Cullen Sign • Borborygmi

7. 3. You hear loud bowel sounds while standing next to a patient. You would document this as: • Ballance • Striae • Cullen Sign • Borborygmi

8. FYI • High Pitched Tinkling ~ Intestinal Obstruction

9. 4. A clinician may wish to use a bimanual technique for abdominal palpation when: • Palpating superficial organs • Determining the presence of excessive peritoneal fluid • Meeting muscle resistance while performing deep palpation • Validating abdominal tenderness in the infant

10. 4. A clinician may wish to use a bimanual technique for abdominal palpation when: • Palpating superficial organs • Determining the presence of excessive peritoneal fluid • Meeting muscle resistance while performing deep palpation • Validating abdominal tenderness in the infant

11. 5. Mr. Smith is a 65 y/o patient who presents to your clinic. On exam you are unable to palpate the liver or kidneys on the patient. Which of the following techniques will help assess tenderness to these organs? • Direct, continuous, firm pressure over the organ for several minutes • Percussion for size • Indirect fist percussion • Percussion for tympany

12. 5. Mr. Smith is a 65 y/o patient who presents to your clinic. On exam you are unable to palpate the liver or kidneys on the patient. Which of the following techniques will help assess tenderness to these organs? • Direct, continuous, firm pressure over the organ for several minutes • Percussion for size • Indirect fist percussion • Percussion for tympany

13. 6. A bluish periumbilical discoloration known as ______ is indicative of intraabdominal bleeding. • Romberg-Howship • Appley • Cullen sign • Ballance

14. 6. A bluish periumbilical discoloration known as ______ is indicative of intraabdominal bleeding. • Romberg-Howship • Appley • Cullen sign • Ballance

15. 7. Mrs. Smith is a 54 y/o patient who presents to your clinic. Which of the following examination findings is indicative of peritoneal irritation or appendicitis? • Palpation of rebound tenderness • Percussion of shifting dullness over the abdomen • Auscultation of a bruit over the abdominal aorta • Percussion of dullness over the suprapubic area

16. 7. Mrs. Smith is a 54 y/o patient who presents to your clinic. Which of the following examination findings is indicative of peritoneal irritation or appendicitis? • Palpation of rebound tenderness - another term: Blumberg Sign • Percussion of shifting dullness over the abdomen • Auscultation of a bruit over the abdominal aorta • Percussion of dullness over the suprapubic area

17. BREASTS & AXILLAE

18. Ms. Smith is 23 y/o patient who presents for her yearly physical exam. Which statement made by Ms. Smith would make the examiner suspect fibrocystic changes? • “I have a lump in my breast that is not tender.” • “ My right breast is larger than the left.” • “I feel lumps before my period.” • “My nipples are darker than before my baby was born.”

19. Ms. Smith is 23 y/o patient who presents for her yearly physical exam. Which statement made by Ms. Smith would make the examiner suspect fibrocystic changes? • “I have a lump in my breast that is not tender.” • “ My right breast is larger than the left.” • “I feel lumps before my period.” • “My nipples are darker than before my baby was born.”

20. 2. Mrs. Smith is diagnosed w/ advanced inflammation or carcinoma of the breast. Which of the following clinical findings would you expect? • Peaud’orange appearance • Orange peel appearance • Dimpling • None of the above • All of the above

21. 2. Mrs. Smith is diagnosed w/ advanced inflammation or carcinoma of the breast. Which of the following clinical findings would you expect? • Peaud’orange appearance • Orange peel appearance • Dimpling • None of the above • All of the above

22. 3. Which of the following could NOT be considered a risk factor for breast CA for a 43 y/o woman? • Mother died of breast CA • Menarche at age 11 • Early onset of menopause • 50 y/o sister currently w/ breast CA • History of alcoholism

23. 3. Which of the following could NOT be considered a risk factor for breast CA for a 43 y/o woman? • Mother died of breast CA • Menarche at age 11 • Early onset of menopause • 50 y/o sister currently w/ breast CA • History of alcoholism

24. 4. Which of the following is the correct position in which to place the patient for breast palpation? • Supine w/ the arms at the side and a pillow under the neck • Supine w/ the arms over the head & small pillow under the shoulder of the side being assessed • Left lateral position with are bent backward • Sitting slightly forward with the breasts hanging away from the chest with hands on the hip

25. 4. Which of the following is the correct position in which to place the patient for breast palpation? • Supine w/ the arms at the side and a pillow under the neck • Supine w/ the arms over the head & small pillow under the shoulder of the side being assessed • Left lateral position with are bent backward • Sitting slightly forward with the breasts hanging away from the chest with hands on the hip

27. 5. A small nipple on the upper inner thigh is: • A ductal enlargement • A supernumerary nipple • A malignant breast tumor • A clogged milk duct

28. 5. A small nipple on the upper inner thigh is: • A ductal enlargement • A supernumerary nipple • A malignant breast tumor • A clogged milk duct

29. FEMALE GENITALIA

30. Ms. Smith is 33 y/o patient who presents to your office. During your exam you suspect PID. Which finding is suggestive of PID? • Enlargement of the ovaries • Unilateral labial swelling, redness, & tenderness • An everted cervix • Pain resulting from movement of the cervix

31. Ms. Smith is 33 y/o patient who presents to your office. During your exam you suspect PID. Which finding is suggestive of PID? • Enlargement of the ovaries • Unilateral labial swelling, redness, & tenderness • An everted cervix • Pain resulting from movement of the cervix

32. 2. Ms. Smith is 43 y/o patient who presents for a complaint of genitalia pain. While palpating the introitus of the vagina, the patient jumps and complains of severe tenderness. A mass is palpated that is warm to touch. With whicj of the following problems are these clinical findings consistent? • Cancer of the cervix • Acute genital wart infection • A cystocele • Inflammation of the bartholin glands

33. 2. Ms. Smith is 43 y/o patient who presents for a complaint of genitalia pain. While palpating the introitus of the vagina, the patient jumps and complains of severe tenderness. A mass is palpated that is warm to touch. With whicj of the following problems are these clinical findings consistent? • Cancer of the cervix • Acute genital wart infection • A cystocele • Inflammation of the bartholin glands

34. Location: Bartholin – Below / Posterolateral / 5 & 7 o’clock

35. 3. Ms. Smith is a 25 y/o patient who presents to your clinic for routine exam. On exam you notice a slit-shaped cervical os. Which of the following data in her history explains this finding? • The patient has had multiple sex partners • The patient has had infection w/ HPV • The patient had a previous abortion • The patient has had multiple sex partners

36. 3. Ms. Smith is a 25 y/o patient who presents to your clinic for routine exam. On exam you notice a slit-shaped cervical os. Which of the following data in her history explains this finding? • The patient has had multiple sex partners • The patient has had infection w/ HPV • The patient had a previous abortion • The patient has had multiple sex partners

37. Common appearances of the cervix. A, Normal nulliparous cervix. The surface is covered with pink squamous epithelium that is uniform in consistency. The os is small and round. B,Parous cervix. Slit appearance of os. C,Multigravidous, Slit, Lacerated Chadwick: Bluish Appearance of Cervix Forehead ~ No Effacement Tip of Nose ~ Effacement; Softening of Cervix

38. MALE GENITALIA

39. Mr. Smith is 33 y/o patient who presents to your office for a yearly physical exam. On exam you not that the foreskin of the penis is very tight, preventing it from retracting over the glans. Which of the following conditions best describes this clinical finding? • Paraphimosis • Phimosis • Spermatocele • Epispadias

40. Mr. Smith is 33 y/o patient who presents to your office for a yearly physical exam. On exam you not that the foreskin of the penis is very tight, preventing it from retracting over the glans. Which of the following conditions best describes this clinical finding? • Paraphimosis - inability to pull the foreskin forward from a retracted position B. Phimosis - Tightness of the foreskin that results in an inability to retract it C. Spermatocele - Painless, fluid-filled epididymal mass that contains spermatozoa D. Epispadias - Congenital defect in which the urinary meatus opens on the dorsum of the penis

41. 2. ____ is an inflammation of the glans penis. • Hydrocele • Balanitis • Epididymitis • Varicocele

42. 2. ____ is an inflammation of the glans penis. • Hydrocele - Nontender, serous fluid mass within the tunica vaginalis • Balanitis - inflammation of the glans penis C. Epididymitis - Inflammation of the epididymis (tightly coiled, comma-shaped structure overlying the posterolateral surface of the testis). • Varicocele - Abnormal tortuosity and dilation of spermatic veins; spermatic cord is described as feeling like a bag of worms; condition is not painful but involves a pulling or dragging sensation

43. 3. Moving the finger along the vas deferens is associated w/: • Palpating for tender testes • Observing for phimosis • Observing for hydrocele • Palpating for inguinal hernia

44. 3. Moving the finger along the vas deferens is associated w/: • Palpating for tender testes • Observing for phimosis • Observing for hydrocele • Palpating for inguinal hernia

45. 4. Mr. Smith is 40 y/o patient who presents to your office for a yearly physical exam. On exam you note that the foreskin of the penis is retracted over the glans & is unable to relax into its normal position. Which of the following conditions best describes this clinical finding? • Balanitis • Spermatocele • Paraphimosis • Epispadias

46. 4. Mr. Smith is 40 y/o patient who presents to your office for a yearly physical exam. On exam you note that the foreskin of the penis is retracted over the glans & is unable to relax into its normal position. Which of the following conditions best describes this clinical finding? • Balanitis • Spermatocele • Paraphimosis • Epispadias

47. 5. Which of the following conditions would best use the assessment technique of transillumination? • Palpating for inguinal hernia • Palpating for tender testes • Observing hydrocele • Observing phimosis

48. 5. Which of the following conditions would best use the assessment technique of transillumination? • Palpating for inguinal hernia • Palpating for tender testes • Observing hydrocele • Observing phimosis

49. Anus, Rectum, Prostate

50. Mr. Tucker is a 56 y/o patient who presents to your office with a c/o rectal pain. On exam you are palpating the lateral & posterior rectal walls. You should expect to palpate: • A bulging from the bladder wall • Tissue folds from the valves of Houston • Small nodules from internal hemorrhoids • A smooth, even, & uninterrupted surface