Aquifer Cases
Risk of breast cancer increases with a family history in which relatives? - ANSFirst degree
relatives only
Self breast exams increase the number of _______ performed. - ANSBiopsies
Clinical breast exams performed by physicians have: - ANSLow sensitivity
High false positive rate
Good breast exam consists of (2): - ANS1. Visual inspection
2. Palpation
Position of breast exam: - ANS1. Visual inspection: upright with gown lowered to waist
2. Palpation: back to exam table with hands placed over head
Palpation of breast should be performed using? (3) - ANSVertical strip pattern
Pads of the middle 3 fingers
Varied pressure (light, medium & deep)
Which lymph nodes should be palpated in breast exam? (2) - ANSAxillary
Supraclavicular
Position of pelvic exam: - ANSHead of the table 30-45 degrees
Ask patient to slide down the edge of the table
Relax knees down to the edge of the table and relax knees beyond angle of the stirrups
What lubricant should be used on the speculum? - ANSWarm tap water or gel lubricant avoiding
the tip of the speculum
To expose the introitus what fingers should be used? - ANSIndex and middle finger of the
non-dominant hand (peace sign)
How should the speculum be inserted? - ANS1. Separate labia
2. Insert the speculum at 45-degree angle, pointing slightly downward
3. Once past the introitus, rotate the speculum to the horizontal position
The bills of the speculum should be opened? - ANS2-3 cm
What instruments are used to perform a Pap smear? - ANS1. Spatula
2. Cytobrush
,Spatula used for a Pap smear samples the _____? - ANSEctocervix
Cytobrush used in a pap smear samples the _____? - ANSEndocervix
The bimanual exam is not indicated for patients with: - ANSOvarian cancer
How to perform the bimanual exam: - ANS1. Middle and index finger of the non-dominant hand
are inserted into the patient's vagina
2. Move the cervix laterally (look for motion and non-tender)
3. Place non-gloved hand on abdomen just superior to the symphysis pubis - feel for uterus
4. Move pelvic hand to each lateral fornix, try to capture each ovary between your abdominal
and pelvic hand
Guidelines for cervical cancer screening: - ANSBegin @21 yo
21-29 every 3 years
30-65 screen every 5 years with HPV test or 3 years with cytology alone
Over 65 yo with history of 3 negative tests within the last 10 years can stop cervical screening
High risk groups for cervical carcinoma (6): - ANS1. Compromised immunity
2. HIV +
3. History CIN
4. Exposed to DES in utero
5. Early onset intercourse
6. Multiple lifetime partners
Characteristics of a good screening exam : - ANS1. Accurate (sensitivity & specificity)
2. Able to detect asymptomatic phase
3. Minimal associated risk
4. Reasonable cost
5. Acceptable to patient
6. Have an available tx for the disease
Sensitivity measures: - ANSTP/TP + FN
Minimizes FN
Specificity measures: - ANSTN/ TN + FP
Minimizes FP
Lung cancer should be screened for: - ANSPatients 55-80 with 30+ year smoking history
Current smoker or quit within the prior 15 years
USPSTF recommendation for breast cancer? - ANSBiennial screen women 50 - 74 yo
Prior to 50 should be on individual basis
,American cancer society recommendation for breast cancer screen? - ANS40-44 yo choice to
start annual breast exam
45-54 yo mammogram every year
55 yo or older mammogram every 2 years/ or choice to continue yearly
Evaluate a breast lump: - ANS1. Precise location of the lump
2. How it was first noticed
3. How long it was present
4. Presence of discharge
5. Any change in size of the lump
What can be used to distinguish a cystic or solid mass from a breast? - ANSUltrasound
If a fluid is aspirated from a fluid cyst, the fluid can be sent for?
Family physician can perform a _____ in their office. - ANSCytology
Fine needle aspiration
What are the major independent risk factor for coronary artery disease? (6) - ANS1. HDL <40
mg/dl
2. Diabetes
3. Smoking
4. History of premature CHD is a first degree relative
5. Sedentary lifestyle
6. Obesity
What is the mnemonic for history taking PQRST mean? - ANSP- Provocation
Q- Quality
R- Region
S- Severity
T- Temporal elements
*A- Associated symptoms
What events can trigger angina? (4) - ANS1. Cold
2. Emotional stress
3. Meals
4. Sexual intercourse
A wide extension of chest pain increases the probability it is due to _______. - ANSMyocardial
infarction
Differential diagnosis for a 50 yo women with palpitations? (8) - ANS1. Dysrhythmias
2. Valvular heart disease
3. Hyperthyroidism
, 4. Coronary heart disease (CHD)
5. Anxiety/Panic disorder
6. Vasomotor symptoms pf climacteric (menopause)
7. Anemia
8. Drugs
Presentation of hypothyroidism? - ANSBradycardia
What historical items would suggest a cardiac cause of palpitations? (4) - ANS1. Duration of
palpitations for greater than 5 minutes
2. Description of irregular beat
3. Previous history of heart disease
4. Male sex
How would palpitations present in a patient which is caused by anemia? - ANSAcutely and
associated with tachycardia
What on physical exam would suggest an arrhythmic cause of palpitations? - ANSVisible neck
pulsations
What is the most common structural heart abnormality presenting with palpitations? - ANSMitral
valve prolapse
A mid systolic click with a holosystolic murmur: - ANSMitral valve prolapse
Which valvular conditions are associated with palpitations? (3) - ANS1. Mitral valve prolapse
2. Hypertrophic obstructive cardiomyopathy
3. Aortic stenosis
Systolic murmur @ left sternal border increases with valsalva maneuver: - ANSHypertrophic
cardiomyopathy
Harsh crescendo-decresendo murmur radiates into the carotid arteries: - ANSAortic stenosis
What mannerisms are associated with anxiety? (4) - ANS1. Fidgeting
2. Hand wringing
3. Difficulty making eye contact
4. Worried facies
What can be do to evaluate a patients palpitations? (7) - ANS1. Electrocardiogram - conduction
abnormality
2. Holter monitor - portable ECG reads over 24-48 hrs, dysrhythmia
3. Loop recorder - monitor heart for wks to months
4. Echocardiogram - rule out valvular disease
Risk of breast cancer increases with a family history in which relatives? - ANSFirst degree
relatives only
Self breast exams increase the number of _______ performed. - ANSBiopsies
Clinical breast exams performed by physicians have: - ANSLow sensitivity
High false positive rate
Good breast exam consists of (2): - ANS1. Visual inspection
2. Palpation
Position of breast exam: - ANS1. Visual inspection: upright with gown lowered to waist
2. Palpation: back to exam table with hands placed over head
Palpation of breast should be performed using? (3) - ANSVertical strip pattern
Pads of the middle 3 fingers
Varied pressure (light, medium & deep)
Which lymph nodes should be palpated in breast exam? (2) - ANSAxillary
Supraclavicular
Position of pelvic exam: - ANSHead of the table 30-45 degrees
Ask patient to slide down the edge of the table
Relax knees down to the edge of the table and relax knees beyond angle of the stirrups
What lubricant should be used on the speculum? - ANSWarm tap water or gel lubricant avoiding
the tip of the speculum
To expose the introitus what fingers should be used? - ANSIndex and middle finger of the
non-dominant hand (peace sign)
How should the speculum be inserted? - ANS1. Separate labia
2. Insert the speculum at 45-degree angle, pointing slightly downward
3. Once past the introitus, rotate the speculum to the horizontal position
The bills of the speculum should be opened? - ANS2-3 cm
What instruments are used to perform a Pap smear? - ANS1. Spatula
2. Cytobrush
,Spatula used for a Pap smear samples the _____? - ANSEctocervix
Cytobrush used in a pap smear samples the _____? - ANSEndocervix
The bimanual exam is not indicated for patients with: - ANSOvarian cancer
How to perform the bimanual exam: - ANS1. Middle and index finger of the non-dominant hand
are inserted into the patient's vagina
2. Move the cervix laterally (look for motion and non-tender)
3. Place non-gloved hand on abdomen just superior to the symphysis pubis - feel for uterus
4. Move pelvic hand to each lateral fornix, try to capture each ovary between your abdominal
and pelvic hand
Guidelines for cervical cancer screening: - ANSBegin @21 yo
21-29 every 3 years
30-65 screen every 5 years with HPV test or 3 years with cytology alone
Over 65 yo with history of 3 negative tests within the last 10 years can stop cervical screening
High risk groups for cervical carcinoma (6): - ANS1. Compromised immunity
2. HIV +
3. History CIN
4. Exposed to DES in utero
5. Early onset intercourse
6. Multiple lifetime partners
Characteristics of a good screening exam : - ANS1. Accurate (sensitivity & specificity)
2. Able to detect asymptomatic phase
3. Minimal associated risk
4. Reasonable cost
5. Acceptable to patient
6. Have an available tx for the disease
Sensitivity measures: - ANSTP/TP + FN
Minimizes FN
Specificity measures: - ANSTN/ TN + FP
Minimizes FP
Lung cancer should be screened for: - ANSPatients 55-80 with 30+ year smoking history
Current smoker or quit within the prior 15 years
USPSTF recommendation for breast cancer? - ANSBiennial screen women 50 - 74 yo
Prior to 50 should be on individual basis
,American cancer society recommendation for breast cancer screen? - ANS40-44 yo choice to
start annual breast exam
45-54 yo mammogram every year
55 yo or older mammogram every 2 years/ or choice to continue yearly
Evaluate a breast lump: - ANS1. Precise location of the lump
2. How it was first noticed
3. How long it was present
4. Presence of discharge
5. Any change in size of the lump
What can be used to distinguish a cystic or solid mass from a breast? - ANSUltrasound
If a fluid is aspirated from a fluid cyst, the fluid can be sent for?
Family physician can perform a _____ in their office. - ANSCytology
Fine needle aspiration
What are the major independent risk factor for coronary artery disease? (6) - ANS1. HDL <40
mg/dl
2. Diabetes
3. Smoking
4. History of premature CHD is a first degree relative
5. Sedentary lifestyle
6. Obesity
What is the mnemonic for history taking PQRST mean? - ANSP- Provocation
Q- Quality
R- Region
S- Severity
T- Temporal elements
*A- Associated symptoms
What events can trigger angina? (4) - ANS1. Cold
2. Emotional stress
3. Meals
4. Sexual intercourse
A wide extension of chest pain increases the probability it is due to _______. - ANSMyocardial
infarction
Differential diagnosis for a 50 yo women with palpitations? (8) - ANS1. Dysrhythmias
2. Valvular heart disease
3. Hyperthyroidism
, 4. Coronary heart disease (CHD)
5. Anxiety/Panic disorder
6. Vasomotor symptoms pf climacteric (menopause)
7. Anemia
8. Drugs
Presentation of hypothyroidism? - ANSBradycardia
What historical items would suggest a cardiac cause of palpitations? (4) - ANS1. Duration of
palpitations for greater than 5 minutes
2. Description of irregular beat
3. Previous history of heart disease
4. Male sex
How would palpitations present in a patient which is caused by anemia? - ANSAcutely and
associated with tachycardia
What on physical exam would suggest an arrhythmic cause of palpitations? - ANSVisible neck
pulsations
What is the most common structural heart abnormality presenting with palpitations? - ANSMitral
valve prolapse
A mid systolic click with a holosystolic murmur: - ANSMitral valve prolapse
Which valvular conditions are associated with palpitations? (3) - ANS1. Mitral valve prolapse
2. Hypertrophic obstructive cardiomyopathy
3. Aortic stenosis
Systolic murmur @ left sternal border increases with valsalva maneuver: - ANSHypertrophic
cardiomyopathy
Harsh crescendo-decresendo murmur radiates into the carotid arteries: - ANSAortic stenosis
What mannerisms are associated with anxiety? (4) - ANS1. Fidgeting
2. Hand wringing
3. Difficulty making eye contact
4. Worried facies
What can be do to evaluate a patients palpitations? (7) - ANS1. Electrocardiogram - conduction
abnormality
2. Holter monitor - portable ECG reads over 24-48 hrs, dysrhythmia
3. Loop recorder - monitor heart for wks to months
4. Echocardiogram - rule out valvular disease
