500 - Quiz #2 Study Guide

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1 NSG 500 Study Guide Quiz #2 1. HEENT a. Normal v. abnormal findings with aging With age, the buccal mucosa becomes less shiny, the teeth appear longer because of receding gums, the nasal mucosa are drier, the tongue may appear more fissured, and more bristly hairs appear in the nose, especially in men. Normal = Bristly hairs in the vestibule, age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea. b. Types of headaches/symptoms Cluster – unilateral, at night, precipitated by alcohol, more often in men c. How to assess for PERRLA; what is expected to occur Pupillary reaction test = observes pupils’ response to light Accommodation test = pupils’ reaction to light d. How to assess near and far vision 20/50 = can read letters standing 20 feet from chart that avg person can read at 50 feet Adequate visual field = correspondence with visual field of examiner Peripheral vision = confrontation test Myopia = nearsighted; minus lens Hyperopia = farsighted; plus lens e. How to use an ophthalmoscope Optic disc = focus on blood vessel in retina and follow vessel as it converges into larger vessels Used to assess macula f. What is strabismus and psuedostrabismus; where might you see this StrabismoScope is used for detecting strabismus (eye misalignment)

2 Photoscreening is used to detect amblyopia (lazy eye) and strabismus to obtain images of pupillary reflexes and red reflexes Pseudostrabismus is the false appearance of strabismus caused by a flattened nasal bridge or epicanthal folds . Generally disappears by about 1 year of age. Use the corneal light reflex to distinguish pseudostrabismus from strabismus. An asymmetric light reflex may indicate a true strabismus. g. Significance of cobblestoning Cobblestoning = Allergic reaction h. Weber v. Rinne test, what is normal finding; what abnormal results indicate Placement: Tuning fork: Rinne = mastoid bone, Weber = midline top of head Rinne = indicates sensorineural loss; helps distinguish whether the patient hears better by air or bone conduction. Ask patient to tell you when sound is no longer heard. Time interval of bone and then air conduction in seconds. Compare seconds. Air should be twice as long as bone. Weber = unilateral hearing loss; Ask the patient whether the sound is heard equally in both ears or is better in one ear (lateralization of sound). Weber: No lateralization, but will lateralize to ear occluded by patient Conductive: Sound heard better in affected ear unless sensorineural loss Sensorineural: Sound lateralizes to better ear unless conductive loss Sensorineural = disorder of inner ear Conductive = otosclerosis or cerumen impaction Sensorineural hearing loss first occurs with high-frequency sounds and then progresses to tones of lower frequency. i. Tonsil grading 1+ = Visible 2+ = Halfway between tonsillar pillars and the uvula

3 3+ = Nearly touching the uvula 4+ = Touching each other j. Symptoms/signs of TM rupture The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa. Rupture = foul smelling discharge, sharp pain, decreased hearing k. Symptoms of obstruction; above and below the glottis Sx: inspiratory stridor, hoarse cough, nasal flaring, suprasternal retraction Severe = stridor is inspiratory and expiratory, cough has barking character, retractions involve suprasternal and intercostal place, cyanosis Above the glottis = stridor is quieter, voice is muffled, swallowing is difficult, cough is not a factor Below the glottis = stridor is louder, rasping, voice is hoarse, swallowing not affected, harsh cough, barking, positioning of head is not factor l. How to examine the ear, adults v. children Adult = Tilt patient’s head toward the opposite shoulder, straighten the external auditory canal by pulling the auricle up and back; insert the speculum to a depth of 1 or 1.5 cm (0.5 inch) Child = otoscopic and oral exam should be done at end of exam m. Risk factors for cataract development Family hx, steroids, UV light, cigarette smoking, DM, aging Cataracts = clouding Opacities of the red reflex may indicate presence of cataracts Opacities or dark spots of the red reflex may indicate the presence of congenital cataracts in newborns. n. Indicators of hypertensive retinopathy during the eye exam Mild : Retinal arteriolar narrowing, arteriovenous nicking, opacity (copper wiring) of arteriolar wall

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4 Moderate : Hemorrhage (blot, dot, or flame-shaped), cotton-wool spots, hard exudates, and microaneurysms Malignant/Severe : Some or all of the preceding signs, plus optic disc edema (papilledema) Retinal hemorrhages and cotton wool spots are associated with hypertensive retinopathy. o. Evaluation of hearing in pediatrics Use a bell, whisper, or rub your fingers together as a sound stimulus, taking care that the infant responds to sound rather than to the air movement generated. 0-3mo = startles at loud noise 4-6mo = turns head toward sound 7-12mo = responds to name/listens p. Nasal exam findings for allergies, drug abuse, infections Allergic response = bluish gray turbinates or pale pink nasal turbinates that are swollen/boggy Cocaine = When individuals nasally sniff cocaine, signs of recent use include rhinorrhea, hyperemia, and edema of the nasal mucosa Infection = Increased redness of the mucosa 2. Respiratory a. Diaphragmatic excursion; what is normal, if abnormal what does it indicate Is the movement of the thoracic diaphragm that occurs with inhalation and exhalation. The technique for diaphragmatic excursion is to percuss along the scapular line, after the patient inhales deeply, and to mark the site when resonance changes to dullness, representing the diaphragm. The sequence is repeated with exhalation. Percuss along the scapular line until you locate the lower border, the point marked by a change in note from resonance to dullness. Measure and record the distance in centimeters between the marks on each side. The excursion distance is usually 3 to 5 cm.

5 The diaphragm is usually higher on the right than on the left because it sits over bulk of liver. Its descent may be limited by several types of pathologic processes: pulmonary (e.g., as a result of emphysema), abdominal (e.g., massive ascites, tumor), or superficial pain (e.g., fractured rib). b. Normal resp rate to HR ratio Ratio of respiratory rate to the heart rate is approximately 1:4. c. How to perform percussion on the thorax First, examine the back with the patient sitting with head bent forward and arms folded in front. This moves the scapulae laterally, exposing more of the lung. Then ask the patient to raise the arms overhead while you percuss the lateral and anterior chest. For all positions, percuss at 4- to 5-cm intervals over the intercostal spaces, moving systematically from superior to inferior and medial to lateral. Adopt the one most comfortable for you and use it consistently. Resonance, the expected sound, can usually be heard over all areas of the lungs. Hyper-resonance associated with hyperinflation may indicate emphysema, pneumothorax, or asthma. Dullness or flat-ness suggests pneumonia, atelectasis, pleural effusion, or asthma. d. Sequence of the exam; how this varies with infants or children Sequence the same. Intrathoracic sounds are easier to hear, and hyperresonance is common in the young child. With either direct or indirect percussion, it is easy to miss the dullness of an underlying consolidation. If you sense some loss of resonance, give it as much importance as you would give frank dullness in the adolescent or adult. Also, with percussion, your finger can learn to feel the dull areas, a tactile sense that comes in handy at times with a crying child. The dull areas are sensed as having more resistance than resonant areas because they move less. e. Age related changes, newborns and older adults Alveoli collapsed at birth. Increases rapidly in first 2 years. Slows by 8 years old.

6 The chest of the newborn is generally round, the AP diameter approximating the lateral diameter, and the circumference is roughly equal to that of the head until the child is about 2 years old. The barrel chest that is seen in many older adults results from loss of muscle strength in the thorax and diaphragm, coupled with the loss of lung resiliency. Skeletal changes associated with aging include an emphasis of the dorsal curve of the thoracic spine that contributes to a barrel chest. f. Altered physical exam findings for emphysema, COPD, tumor, pleural effusion, laryngeal obstruction Emphysema = Barrel chest; liver displaced downward; diminished breath and voice sounds; Tachypnea, Pursed lips; decreased elastic recoil of the lung, clubbing of fingers/toes; Decreased or absent fremitus may be caused by excess air in the lungs or may indicate emphysema; percussion = Hyper-resonance associated with hyperinflation may indicate emphysema Mediastinal crunch (Hamman sign) is found with mediastinal emphysema; heard best on left side Pleural effusion and lobar pneumonia are more dense than air, with an expected finding of dullness to percussion . Diminished and delayed respiratory movement (lag) on affected side. Laryngeal obstruction = stridor COPD = Lungs hyperinflated; limited mobility of diaphragm; Audible wheezing, rhonchi; Cyanosis, Distention of neck veins, peripheral edema (in presence of right-sided heart failure) Tumor = may cause cough, wheezing, and hemoptysis. Peripheral tumors without airway obstruction may be asymptomatic. With airway obstruction, a postobstructive pneumonia can develop with consolidation. g. Disorders that may result in altered resp rate, bradypnea or tachypnea Tachypnea = seen with metabolic acidosis; protective splinting from pain of broken rib or pleurisy. Massive liver enlargement or abdominal ascites may prevent descent of diaphragm.

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7 Bradypnea = may indicate neurologic or electrolyte disturbance, infection, conscious response to protect against pain of pleurisy or irritative phenomenon. Exhibited in those with excellent physical fitness. h. What is tactile fremitus; how to perform, what does it indicate if decreased or increased; ie. in pneumonia, emphysema Is the palpable vibration of the chest wall that results from speech Can be conducted with palmar surface of both hands and ulnar aspect. Best felt posteriorly and laterally at the level of the bifurcation of the bronchi Increased = consolidation, heavy bronchial secretions, compressed lung; fluids or mass Decreased = emphysema, pleural effusion, bronchial obstruction; excess air i. Auscultation techniques of bronchophony, pectoriloquy , egophony Bronchophony = clarity and loudness of spoken sounds Extreme in presence of consolidation of lungs Whisper heard clearly = whispered pectoriloquy Nasal quality spoken voice = egophony Air-filled lung tissue is an insulator of sound. j. How to differentiate crackles from rhonchi To distinguish crackles from rhonchi, auscultate the lungs before and after the patient coughs. Rhonchi, because they represent secretions in larger airways, can clear with coughing. k. What are the whispered voice tests Mask untested ear. Stand behind and to the side of seated patient at arm’s length from nontested ear. Exhale fully before whispering random combination of six letters and numbers. Ask patient to repeat. If unable to repeat more than 50% of sounds, hearing impairment is likely and should be referred. Good specificity in adults 50-70. In children, whisper words that have meaning for them.

8 3. CV/PV a. Sequence of the exam b. Use of stethoscope for high v low pitch sounds Diaphragm = best transmits high-pitched sounds (S2) Bell = best transmits low-pitched sounds (S3-S4) c. Significance of location of the PMI An apical point of maximal impulse (PMI) palpated beyond the left fifth intercostal space may indicate left ventricular hypertrophy. In dextrocardia, the PMI would be displaced to the right. d. Significance of a heave A heave or lift is a more vigorous apical impulse. If the apical impulse is more vigorous than expected, it is referred to as a heave or lift. e. Significance of JVD Jugular vein distention = left-sided heart failure To assess a patient’s jugular veins, he or she should first be placed in supine position. The level at which the jugular venous pulse is visible indicates right atrial pressure. Jugular venous system = right side of heart f. What do S1 and S2 indicate; where are they heard best S1 = mitral and tricuspid valves closing; marks beginning of systole; coincides with the rise of the carotid pulse. S2 = aortic and pulmonic valves closing; marks start of diastole; heard greatest at pulmonic site The major heart sounds are normally created by valves closing. g. Where are murmurs best heard/quality of murmurs of aortic stenosis, aortic regurg, pulmonic stenosis, mitral stenosis Murmur grade IV or more can be felt (thrill).

9 Diseased valves = common cause of murmurs. Aortic Stenosis = Suprasternal notch and/or 2nd and 3rd right intercostal space Pulmonic Stenosis = Suprasternal notch and/or 2nd and 3rd left intercostal space Mitral Regurg = Apex; Mitral Stenosis = Apex Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. A thrill indicates a disruption of the expected blood flow related to a defect in the closure of one of the semilunar valves, which is seen in aortic or pulmonic stenosis, pulmonary hypertension, or atrial septal defect. h. Grading of murmurs; descriptions I = Barely audible II = Quiet but audible III = Moderately loud IV = Loud, associated with thrill V = Very loud, thrill easily palpable VI = Very loud, thrill palpable and visible i. How to accentuate murmurs; mitral valve murmurs Mitral stenosis = Heard with bell at apex, patient in left lateral decubitus position Mitral regurgitation = Heard best at apex; loudest there, transmitted into left axilla Mitral valve prolapse = Heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright j. Normal JVP A value of less than 9 cm H 2 O is the expected value. k. Causes of edema, symptoms

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10 Edema accompanied thickening/ulceration is frequently associated with deep venous obstruction or venous valvular incompetence. Edema related to valvular incompetence or an obstruction of a deep vein (usually in the legs) is caused by the mechanical pressure of increased blood volume in the area served by the affected vein. In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is edema. If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema. l. Bruit significance A bruit is an auscultated arterial murmur. May reflect blood flow turbulence and indicate vascular disease. A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. m. Symptoms of Raynaud’s v. arterial disease Raynaud’s improves with rewarming affected area. With primary Raynaud phenomenon, there is a triphasic demarcated skin pallor (white), cyanosis (blue), and reperfusion (red) in the extremities. Arterial = Necrosis/blue toe syndrome n. Differentiating venous from arterial disease Venous = warm, thick skin; ulcers are generally found on the medial or lateral aspects of the lower limbs. Induration, edema, and hyperpigmentation are common associated findings. Arterial = necrotic, feet/toes; cool, thin skin

11 Arterial ulcers develop as the result of damage to the arteries due to lack of blood flow to tissue. Venous ulcers develop from damage to the veins caused by an insufficient return of blood back to the heart. o. Vascular/hemodynamic changes that occur during pregnancy In pregnancy, blood pressure is lowest during the second trimester. p. Abnormalities in the infant/findings for Tetralogy of Fallot Dyspnea with feeding, poor growth, exercise intolerance Paroxysmal dyspnea with loss of consciousness and central cyanosis hypercyanotic episode or tetralogy spell) Parasternal heave and precordial prominence, systolic ejection murmur over the third intercostal space, sometimes radiating to left side of neck; single S 2 is heard Older children develop clubbing of fingers and toes. May develop heart failure if not surgically corrected Cyanosis during hypercontractile episodes, associated with agitation/crying q. What is a venous hum in a child, what does it indicate A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. 4. Breast: a. Evaluation of breast lumps In a woman complaining of a breast lump, it is most important to ask about its relationship to menses. Remember that the breast tissue extends from the second or third rib to the sixth or seventh rib, and from the sternal margin to the midaxillary line. It is essential to include the tail of Spence in palpation.

12 Chest wall sweep = Have the patient sit with arms hanging freely at the sides. Place the palm of your right hand at the patient’s right clavicle at the sternum. Sweep downward from the clavicle to the nipple, feeling for superficial lumps. Repeat the sweep until you have covered the entire right chest wall. Repeat the procedure using your left hand for the left chest wall Bimanual Digital Palpation = Place one hand, palmar surface facing up, under the patient’s right breast. Position your hand so that it acts as a flat surface against which to compress the breast tissue. With the fingers of the other hand, walk across the breast tissue, feeling for lumps as you compress the tissue between your fingers and your flat hand. Repeat the procedure for the other breast Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well- delineated borders. Fibroadenoma = Painless lumps that do not fluctuate with the menstrual cycle b. Risk factors for breast lumps c. Performing a breast exam The finger pads are used for breast palpation because they are more sensitive than the fingertips. To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla. Inspect the breasts in the following positions: Arms extended overhead. Hands pressed against hips. Pressing hands together (an alternative way to flex the pectoral muscles). Leaning forward from the waist. Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. d. Risk factors for breast cancer

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13 Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily. e. Sequence of breast exam Sequence does not matter, but a systematic approach will help ensure that all portions of the breast are examined Vertical strip technique = begin at the top of the breast and palpate, first downward, then upward, working your way down over the entire breast. More thorough than the concentric circle technique. Concentric circle technique = begin at the outermost edge of the breast tissue and spiral your way inward toward the nipple. Wedge method = palpate from the center of the breast in radial fashion, returning to the areola to begin each spoke. Regardless of the method, glide your fingers from one point to the next. Avoid lifting your fingers off the breast tissue because doing so makes it easy to miss tissue. f. Normal changes during pregnancy Venous network, darkened nipples, development of raised sebaceous glands known as Montgomery tubercles. Sensation of fullness with tingling, tenderness, and a bilateral increase in size Telangiectasias (called spider angiomas or vascular spiders) may develop on the upper chest, arms, neck, and face as a result of elevated levels of circulating estrogen. g. Recommendations for screening for breast cancer While breast cancer screening is beneficial in reducing mortality, it also carries potential harms. Potential harms include false-positive and false-negative results, additional testing and biopsies,

14 overdiagnosis (diagnosis of lesions that would not become clinically significant) and subsequent treatment, pain from testing, and adverse psychologic responses. h. What is gynecomastia, what does it indicate Breast enlargement in male breasts Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention. 5. GI: a. Sequence of GI physical exam Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence is because palpation and percussion can alter the frequency as well as the intensity of bowel sounds. b. Peristalsis; normal, physiologic control of peristalisis Peristalsis = the movement of food and digestive products, regulated by the autonomic nervous system. Peristalsis is not usually visible and when detected may indicate an intestinal obstruction. c. Bowel sounds, what might these indicate if increased, decreased, absent Decreased bowel sounds occur with peritonitis and paralytic ileus. Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. Increased bowel sounds occur with diarrhea. d. History findings for colon cancer Linked to poor diet, obesity, aged 50+, smoking, family hx, African American, jewish, low fiber, high red meat, DM, physical inactivity Start colorectal cancer starting at age 50 years and continue until age

15 75 years. Screening for colorectal cancer in adults ages 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. e. How to percuss size of the liver, normal size, adaptation in exam for obese person When percussing, a dull tone is expected to be heard over the liver. It is best to report the size of the liver in two ways: liver span as determined from percussing the upper and lower borders, and the extent of liver projection below the costal margin. When the size of a patient’s liver is important in assessing the clinical condition, projection below the costal margin alone will not provide enough comparative information. Be sure to specify which landmarks were used for future measurement comparison (e.g., midclavicular line). Begin liver percussion at the right midclavicular line over an area of tympany. Always begin with an area of tympany and proceed to an area of dullness because that sound change is easiest to detect. Percuss upward along the midclavicular line to determine the lower border of the liver. The area of liver dullness is usually heard at the costal margin or slightly below it. Mark the border with a marking pen. A lower liver border that is more than 2 to 3 cm (.75 to 1 inch) below the costal margin may indicate organ enlargement or downward displacement of the diaphragm because of emphysema or other pulmonary disease. To determine the upper border of the liver, begin percussion on the right midclavicular line at an area of lung resonance around the third intercostal space. Continue downward until the percussion tone changes to one of dullness; this marks the upper border of the liver. Mark the location with the pen. The upper border is usually in the fifth intercostal space. An upper border below this may indicate downward displacement or liver atrophy. Dullness extending above the fifth intercostal space suggests upward displacement from abdominal fluid or masses. Measure the distance between the marks to estimate the vertical span of the liver. The usual span is approximately 6 to 12 cm (2.5 to 4.5 inches). A span greater than this may indicate liver

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16 enlargement, whereas a lesser span suggests atrophy. Age and gender influence liver size. Liver span is usually greater in males and in tall individuals. Liver dullness is usually detected around the seventh intercostal space. The usual span at the midsternal line is 4 to 8 cm (1.5 to 3 inches). Spans exceeding 8 cm suggest liver enlargement. f. GI findings for Cushing’s disease, pregnancy, liver cirrhosis, diastasis recti Striae from pregnancy or obesity begin as a pink or purple color then turn silvery white; striae associated with Cushing disease stay purplish. g. Friction rub of liver, what will it sound like An abdominal friction rub is rare and can be identified when high-pitched sounds are auscultated in association with respirations. h. How to palpate aorta, what is normal finding v. abnormal finding Palpate deeply slightly to the left of the midline and feel for the aortic pulsation. If the pulsation is prominent, try to determine the direction of pulsation. A prominent lateral pulsation suggests an aortic aneurysm. If you are unable to feel the pulse on deep palpation, an alternate technique may help. Place the palmar surface of your hands with fingers extended on the midline. Press the fingers deeply inward on each side of the aorta and feel for the pulsation. In thin individuals, you can use one hand, placing the thumb on one side of the aorta and the fingers on the other side i. Special tests to evaluate for appendicitis Iliopsoas Muscle Test = The patient raises the leg from the hip while the examiner pushes downward against it Aaron sign = Pain or distress occurs in area of patient’s heart or stomach on palpation of Appendicitis McBurney point McBurney sign = Rebound tenderness and sharp pain when McBurney point is palpated McBurney point = an anatomic landmark one-third of the distance from the anterior superior iliac spine to the umbilicus. The appendix is displaced upward and laterally, away from it.

17 Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. j. How to evaluate CVA tenderness, what might this indicate CVA tenderness = present with renal abscess, renal calculi Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. Fever and costovertebral angle (CVA) tenderness distinguish pyelonephritis from uncomplicated urinary tract infections (UTIs) k. What is the most common congenital anomaly of the GI tract Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. l. How to identify ascites Glistening, taut appearance suggests ascites. Shifting dullness (shifts to dependent side), fluid wave The most sensitive maneuvers for detecting ascites are flank dullness (84%) and the presence of bulging flanks (81%), both of which have a specificity of 59%. The most specific test is the presence of a fluid wave (90%), although its sensitivity is fair (62%). Percuss for areas of dullness and resonance with the patient supine. Because ascites fluid settles with gravity, expect to hear dullness in the dependent parts of the abdomen and tympany in the upper parts where the relatively lighter bowel has risen. Mark the borders between tympany and dullness. There are several physical examination maneuvers used to detect the presence of ascites. 6. GU a. What are the anatomic structures of female system The labia minora join posteriorly at a junction called the fourchette . Adnexa of the uterus = fallopian tubes and the ovaries

18 Bartholin glands are found posteriorly on each side of the vaginal orifice and open onto the sides of the vestibule. The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. b. What is menopause Menopause is defined as 1 year without menses. Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes. c. What is the sequence of the female gyn exam, how to insert a speculum Lubricate with water. Gel lubricant may interfere with study. Press the introitus downward; insert the closed speculum obliquely. Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely. d. Sequence of specimen collections for pap test, vaginal discharge specimen collection Cytology Pap = rotate brush several times into the cervical os. Withdraw brush and stroke lightly on a glass slide. Spray slide with fixative. e. How to evaluate for trichomonas, bacterial vaginosis, candida, gonorrhea; findings on wet mount Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5). Large proportion of “clue cells” on wet mount slide = bacterial vaginosis. Hyphae = candidiasis, flagella = trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount. f. Recommendation for first pelvic exam Take time to explain what you will be doing.

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19 An interview without the parent is necessary to obtain an accurate sexual history, including sexual abuse and intimate partner violence, and to discuss sexual play. A pediatric speculum with blades that are 1 to 1.5 cm wide can be used and should cause minimal discomfort. If the adolescent is sexually active, a small adult speculum may be used. g. Pregnancy; signs of pregnancy, how to identify position of the fetus Symphysis pubis = pelvic joint that moves later in pregnancy Cervical changes = softens (Goodell sign) and appears bluish (Chadwick sign). At 20 weeks of gestation, the fundal height reaches the level of the umbilicus. Leopold maneuvers = assessment of fetal position h. Risk factors for testicular cancer Cryptorchidism is a risk factor for testicular cancer. i. How to identify an inguinal hernia The most common type of hernia in children and young males is an indirect inguinal hernia. Hernias found within the inguinal canal are called indirect hernias. j. Causes of testicular pain Epididymitis and torsion are painful. Testicular torsion is a surgical emergency. Genital herpes presents as painful superficial vesicles on an erythemic base. k. Subjective findings for Peyronie disease Fibrous band in the corpus cavernosum Bending and/or indentation of the erection Loss of penile length May have pain with erection Family history of the condition History of Dupuytren contracture (finger joint flexion contractures) l. How to perform transillumination of the testes, why is it helpful

20 Transillumination is indicated for masses of the scrotum. A hydrocele is a soft scrotal mass that occurs from fluid accumulation and therefore transilluminates.

500 - Quiz #2 Study Guide

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