Breasts
1. What are the current recommendations regarding self-breast exams?
a. Recommendations for Screening:
i. USPSTF: Mammo [50-74 y.o. biennially] CBE [>40] SBE [NR]
ii. ACA: Mammo [40-45 optional annual; 45-54 annual; >55* biennial] CBE: NR SBE:
NR
iii. ACOG: Mammo [>40 annual] CBE: [20-39 q1-3 yrs; 40-annual] SBE: [encourage breast
self-awareness]
2. What are the current recommendations regarding breast cancer screening?
3. What are the seven characteristics of a breast nodule that should be described? P 602
a. Location—by quadrant or clock, with centimeters from the nipple
b. Size—in centimeters
c. Shape—round or cystic, disc-like, or irregular in contour
d. Consistency—soft, firm, or hard
e. Delimitation—well circumscribed or not
f. Tenderness
g. Mobility—in relation to the skin, pectoral fascia, and chest wall. Gently move the
breast near the mass and watch for dimpling. Next, try to move the nodule or
mass with the patient’s arm relaxed along the side of her body and then again
while she presses her hand against her hip.
4. What history, exam findings and risk factors are consistent with a fibroadenoma? Cyst?
Cancer? P 610
5. What are some visible signs of breast cancer? P 610
6. What could milky nipple discharge indicate? Bloody? Clear, serous, green or black?
Milky Discharge Milky discharge unrelated Causes include
to a prior pregnancy and hyperthyroidism, pituitary
lactation is nonpuerperal prolactinoma, and
galactorrhea. dopamine antagonists,
including psychotropics
and phenothiazines
Bloody Discharge Spontaneous unilateral
bloody discharge from
one or two ducts
warrants further
evaluation for intraductal
papilloma, shown in
Figure 18-16, ductal
carcinoma in situ, or
Paget disease of the
breast.
, Clear Discharge Clear, serous, green,
black, or nonbloody
discharges that are
multiductal are usually
benign
7. What are considered normal findings of the breasts of newborns?
The breasts of the newborn in both males and females are often enlarged from maternal
estrogen effect; this may last several months. The breasts may also be engorged with a
white liquid, sometimes colloquially called “witch’s milk,” which may last 1 or 2 weeks.
8. What is premature thelarche?
a. In premature thelarche, breast development occurs, most often between 6
months and 2 years. Other signs of puberty or hormonal abnormalities are not
present.
Male Genitalia and Hernias
1. What are the current recommendations regarding testicular self-exams?
a. The U.S. Preventive Services Task Force (USPSTF) advised against screening
for testicular cancer in asymptomatic adolescent or adult males (grade D).19
Although the American Cancer Society (ACS) does not recommend routine
testicular self-examination (TSE) for screening, it advises men to be aware of
testicular cancer and to see a clinician right away if they find a lump in a testicle.
The clinician may wish, however, to teach the TSE to enhance a patient’s health
awareness and self-care, especially for high-risk patients. Box 20-1 provides
instructions for TSE
b. For high-risk patients, review the risk factors for testicular carcinoma:
cryptorchidism, which confers a high risk for testicular carcinoma in the
undescended testicle; history of carcinoma in the contralateral testicle; mumps
orchitis; inguinal hernia; hydrocele in childhood; and positive family history.
2. What symptoms and exam findings are consistent with a testicular torsion? p693
3. What is the cremasteric reflex and how is it performed? p1025
a. Examination by palpation of the scrotum and testes of a young boy may cause
the testis to retract upward into the inguinal canal (cremasteric reflex) and
thereby appear to be undescended. Examine the child when he is relaxed
because anxiety stimulates the cremasteric reflex. Have the boy lie down, and
with warm hands, palpate the lower abdomen, working your way downward
toward the scrotum along the inguinal canal. This will minimize retraction of the
, testes into the canal. If you can detect the testis in the scrotum it is descended,
even if it spends much time in the inguinal canal. A retractile testis can be
brought into the scrotum and remains there, while an undescended testis may be
able to be brought into the scrotum but readily pops up into the inguinal canal.
b. The cremasteric reflex can be elicited by gently stroking upward or downward
along the medial aspect of the thigh. The testis on the side being stroked will
move upward.
4. What is the different between a direct and indirect inguinal hernia?
a. There are two types of inguinal hernias: Direct: Develops over
time due to straining and is caused by weakness in the
abdominal muscles. Most common in adult males and rare in
children. Indirect: Caused by a defect in the abdominal wall that
will typically have been present since birth.
b. How can you tell the difference between a direct and indirect
inguinal hernia?
c. A direct inguinal hernia protrudes directly forwards when
the patient stands up whereas the indirect hernia shows a
more oblique route downwards towards the scrotum. A hernia
which goes into the scrotum is always indirect.
d.
5. What exam findings are consistent with gonococcal urethritis vs. nongonococcal
urethritis?
a. Purulent, cloudy or yellow discharge sometimes signals gonococcal urethritis;
scanty white or clear discharge can signal nongonococcal urethritis. The quality
of the discharge is a useful clue but is insufficient to diagnose a specific type of
urethritis. A definitive diagnosis requires Gram stain and culture
6. What are some benefits of circumcision? Reduced hiv and sti
7. What type of anticipatory guidance would the FNP provide to the child of the
uncircumcised male?
a. In uncircumcised males, the foreskin should be easily retractable by
adolescence. This is also an opportunity to discuss normal hygiene. Discuss
testicular examination in older boys by age 18 years.
8. What is a hypospadias? Chordee?
a. A fixed, downward bowing of the penis is a chordee; this may accompany a
hypospadias
b. Hypospadias refers to an abnormal location of the urethral orifice to some point
along the ventral surface of the glans or shaft of the penis (see Table 25-13, Male
Genitourinary System, p. 1077). The foreskin is incompletely formed ventrally.
9. What are considered to be normal scrotal findings of the newborn? The premature
newborn?
1. What are the current recommendations regarding self-breast exams?
a. Recommendations for Screening:
i. USPSTF: Mammo [50-74 y.o. biennially] CBE [>40] SBE [NR]
ii. ACA: Mammo [40-45 optional annual; 45-54 annual; >55* biennial] CBE: NR SBE:
NR
iii. ACOG: Mammo [>40 annual] CBE: [20-39 q1-3 yrs; 40-annual] SBE: [encourage breast
self-awareness]
2. What are the current recommendations regarding breast cancer screening?
3. What are the seven characteristics of a breast nodule that should be described? P 602
a. Location—by quadrant or clock, with centimeters from the nipple
b. Size—in centimeters
c. Shape—round or cystic, disc-like, or irregular in contour
d. Consistency—soft, firm, or hard
e. Delimitation—well circumscribed or not
f. Tenderness
g. Mobility—in relation to the skin, pectoral fascia, and chest wall. Gently move the
breast near the mass and watch for dimpling. Next, try to move the nodule or
mass with the patient’s arm relaxed along the side of her body and then again
while she presses her hand against her hip.
4. What history, exam findings and risk factors are consistent with a fibroadenoma? Cyst?
Cancer? P 610
5. What are some visible signs of breast cancer? P 610
6. What could milky nipple discharge indicate? Bloody? Clear, serous, green or black?
Milky Discharge Milky discharge unrelated Causes include
to a prior pregnancy and hyperthyroidism, pituitary
lactation is nonpuerperal prolactinoma, and
galactorrhea. dopamine antagonists,
including psychotropics
and phenothiazines
Bloody Discharge Spontaneous unilateral
bloody discharge from
one or two ducts
warrants further
evaluation for intraductal
papilloma, shown in
Figure 18-16, ductal
carcinoma in situ, or
Paget disease of the
breast.
, Clear Discharge Clear, serous, green,
black, or nonbloody
discharges that are
multiductal are usually
benign
7. What are considered normal findings of the breasts of newborns?
The breasts of the newborn in both males and females are often enlarged from maternal
estrogen effect; this may last several months. The breasts may also be engorged with a
white liquid, sometimes colloquially called “witch’s milk,” which may last 1 or 2 weeks.
8. What is premature thelarche?
a. In premature thelarche, breast development occurs, most often between 6
months and 2 years. Other signs of puberty or hormonal abnormalities are not
present.
Male Genitalia and Hernias
1. What are the current recommendations regarding testicular self-exams?
a. The U.S. Preventive Services Task Force (USPSTF) advised against screening
for testicular cancer in asymptomatic adolescent or adult males (grade D).19
Although the American Cancer Society (ACS) does not recommend routine
testicular self-examination (TSE) for screening, it advises men to be aware of
testicular cancer and to see a clinician right away if they find a lump in a testicle.
The clinician may wish, however, to teach the TSE to enhance a patient’s health
awareness and self-care, especially for high-risk patients. Box 20-1 provides
instructions for TSE
b. For high-risk patients, review the risk factors for testicular carcinoma:
cryptorchidism, which confers a high risk for testicular carcinoma in the
undescended testicle; history of carcinoma in the contralateral testicle; mumps
orchitis; inguinal hernia; hydrocele in childhood; and positive family history.
2. What symptoms and exam findings are consistent with a testicular torsion? p693
3. What is the cremasteric reflex and how is it performed? p1025
a. Examination by palpation of the scrotum and testes of a young boy may cause
the testis to retract upward into the inguinal canal (cremasteric reflex) and
thereby appear to be undescended. Examine the child when he is relaxed
because anxiety stimulates the cremasteric reflex. Have the boy lie down, and
with warm hands, palpate the lower abdomen, working your way downward
toward the scrotum along the inguinal canal. This will minimize retraction of the
, testes into the canal. If you can detect the testis in the scrotum it is descended,
even if it spends much time in the inguinal canal. A retractile testis can be
brought into the scrotum and remains there, while an undescended testis may be
able to be brought into the scrotum but readily pops up into the inguinal canal.
b. The cremasteric reflex can be elicited by gently stroking upward or downward
along the medial aspect of the thigh. The testis on the side being stroked will
move upward.
4. What is the different between a direct and indirect inguinal hernia?
a. There are two types of inguinal hernias: Direct: Develops over
time due to straining and is caused by weakness in the
abdominal muscles. Most common in adult males and rare in
children. Indirect: Caused by a defect in the abdominal wall that
will typically have been present since birth.
b. How can you tell the difference between a direct and indirect
inguinal hernia?
c. A direct inguinal hernia protrudes directly forwards when
the patient stands up whereas the indirect hernia shows a
more oblique route downwards towards the scrotum. A hernia
which goes into the scrotum is always indirect.
d.
5. What exam findings are consistent with gonococcal urethritis vs. nongonococcal
urethritis?
a. Purulent, cloudy or yellow discharge sometimes signals gonococcal urethritis;
scanty white or clear discharge can signal nongonococcal urethritis. The quality
of the discharge is a useful clue but is insufficient to diagnose a specific type of
urethritis. A definitive diagnosis requires Gram stain and culture
6. What are some benefits of circumcision? Reduced hiv and sti
7. What type of anticipatory guidance would the FNP provide to the child of the
uncircumcised male?
a. In uncircumcised males, the foreskin should be easily retractable by
adolescence. This is also an opportunity to discuss normal hygiene. Discuss
testicular examination in older boys by age 18 years.
8. What is a hypospadias? Chordee?
a. A fixed, downward bowing of the penis is a chordee; this may accompany a
hypospadias
b. Hypospadias refers to an abnormal location of the urethral orifice to some point
along the ventral surface of the glans or shaft of the penis (see Table 25-13, Male
Genitourinary System, p. 1077). The foreskin is incompletely formed ventrally.
9. What are considered to be normal scrotal findings of the newborn? The premature
newborn?
