Exam 4 Review:
Know the risk factors for basal and squamous cell cancer
Age > 50, fair skin, male gender, smoking, HPV, weakened immune system
Understand the order in which you would examine the external and internal genitalia. p
437
Steps to examine internal and external female genitalia:
-Inspect pubic hair, inspect and palpate labia, inspect urethral meatus/vaginal opening for
discharge/polyps, milk the skene glands, palpate the bartholin glands, inspect and palpate
perineum, inspect for prolapse and urinary incontinence as the patient bears down, inspect
perineal area and anus, insert speculum, inspect cervix, collect specimens, inspect vaginal walls
-Bartholin glands are posterior and lateral to the introitus
Know how to educate patients regarding STI and safe sex practices
Use a barrier such as a condom every time, regularly get tested for STIs/have Paps/pelvic exams,
washing hands/toys with soap and water, avoid drinking alcohol/using drugs, do not douche after
intercourse, look on you and your partner for signs of sores, blisters, rashes, or discharge
What are some normal and abnormal finding during breast examinations
Abnormal: nipple discharge, new inversion of nipple, hard fixed lump
Fibrocystic changes: benign fluid-filled cyst formation caused by duct enlargement. Tender and
painful breasts with palpable lumps that fluctuate with menses
Fibroadenoma: benign tumor. Painless lump that does not fluctuate with menstrual cycle
Malignant breast tumor: Painless lump, palpable mass, poorly delineated borders, fixed, hard,
nontender, dimpling, thickened appearance
A patient is reporting to your clinic with complaint of low back pain. He reports the onset
was a year ago but is worsening. Denies recent or past injuries. He is complaining of
radicular symptoms but denies any bowel or bladder incontinence. Think about the
differential diagnosis for this condition. What subjective and objective data questions
would you ask and why
Herniated disc w/ nerve compression, foraminal or lumbar stenosis, nerve root injuries, diabetic
neuropathy
Does your pain improve when lying down? (herniated disc)
Do you have problems with heel walking or toe walking? (herniated disc)
Do you have pain with walking or standing? (lumbar stenosis)
Does your pain improve with sitting or bending forward? (lumbar stenosis)
Does it hurt to raise your leg with the knee extended when your neck is slightly flexed?
(herniated disc/nerve root irritation)
Do you have a personal or family history of diabetes? (diabetic neuropathy)
Know the clinical presentation for cholecystitis and appendicitis, and an enlarged spleen
, Cholecystitis: inflamed gallbladder most commonly due to obstruction of cystic duct
RUQ pain with radiation around the mid torso to the right scapula, pain is abrupt and
severe, 2-4 hours
Appendicitis: periumbilical pain initially, then moves to RLQ
Enlarged spleen – able to palpate, percussion is dull. LUQ pain, referred to L shoulder
Be able to identify what are normal and abnormal reflexes for both adults and infants
Plantar reflex - plantar flexion of toes when lateral side stroked - normal
o Babinski sign - dorsiflexion of great toe/fanning of other toes - expected in
children < 2 years (not normal for adult)
Abdominal reflex - slight movement of umbilicus to each area of stimulation - normal
Cremastic reflex - stroke the inner thigh, testicle/scrotum rise on stroked side - normal
Review how to perform the barlow and ortolani tests and what each test indicates p 553
Barlow-Ortolani maneuver: detects hip dislocation or subluxation during first year of life
- flex hip/knee to 90 degrees
Barlow maneuver: grasp the leg with your thumb on the inside of the thigh, adduct the
thigh and gently apply downward pressure on the femur to disengage the femoral head
from acetabulum, positive sign is a clunk or sensation is felt
Ortolani maneuver: slowly abduct the thigh while maintaining axial pressure, fingertips
on greater trochanter, exert a lever movement in opposite direction so fingertips press the
head of the femur back toward acetabulum center, if the head of the femur slips back into
acetabulum with a palpable clunk, suspect hip subluxation or dislocation. High-pitched
clicks are common and expected.
How do you perform a tinel and phalen’s test? Be sure to know the difference
Tinel test: palms up and light tapping over median nerve at the wrist – carpal tunnel
Phalen’s test: back of hands together with fingers pointed down, maintain flexion of wrist at 90
degree angle – carpal tunnel
Review table 22.2 and know what each test assess for
Musculoskeletal tests:
Neer test & Hawkins test: shoulder rotator cuff impingement or tear
Katz hand diagram, thumb abduction test, tinel sign, phalen test: median nerve integrity
Straight leg raising: L4, L5, S1 nerve root irritation
Femoral stretch test: L1, L2, L3, L4 nerve root irritation
Ballottement and Bulge sign: effusion in knee
McMurray test: torn meniscus in knee
Anterior/Posterior drawer test: ACL/PCL injury
Varus-valgus stress test: medial or lateral collateral ligament instability in knee
Lachman test: ACL integrity
Thomas test: flexion contracture of hip
Trendelenburg sign: weak hip abductor muscles
Understand how to assess for scoliosis
Adam’s forward bend test:
Know the risk factors for basal and squamous cell cancer
Age > 50, fair skin, male gender, smoking, HPV, weakened immune system
Understand the order in which you would examine the external and internal genitalia. p
437
Steps to examine internal and external female genitalia:
-Inspect pubic hair, inspect and palpate labia, inspect urethral meatus/vaginal opening for
discharge/polyps, milk the skene glands, palpate the bartholin glands, inspect and palpate
perineum, inspect for prolapse and urinary incontinence as the patient bears down, inspect
perineal area and anus, insert speculum, inspect cervix, collect specimens, inspect vaginal walls
-Bartholin glands are posterior and lateral to the introitus
Know how to educate patients regarding STI and safe sex practices
Use a barrier such as a condom every time, regularly get tested for STIs/have Paps/pelvic exams,
washing hands/toys with soap and water, avoid drinking alcohol/using drugs, do not douche after
intercourse, look on you and your partner for signs of sores, blisters, rashes, or discharge
What are some normal and abnormal finding during breast examinations
Abnormal: nipple discharge, new inversion of nipple, hard fixed lump
Fibrocystic changes: benign fluid-filled cyst formation caused by duct enlargement. Tender and
painful breasts with palpable lumps that fluctuate with menses
Fibroadenoma: benign tumor. Painless lump that does not fluctuate with menstrual cycle
Malignant breast tumor: Painless lump, palpable mass, poorly delineated borders, fixed, hard,
nontender, dimpling, thickened appearance
A patient is reporting to your clinic with complaint of low back pain. He reports the onset
was a year ago but is worsening. Denies recent or past injuries. He is complaining of
radicular symptoms but denies any bowel or bladder incontinence. Think about the
differential diagnosis for this condition. What subjective and objective data questions
would you ask and why
Herniated disc w/ nerve compression, foraminal or lumbar stenosis, nerve root injuries, diabetic
neuropathy
Does your pain improve when lying down? (herniated disc)
Do you have problems with heel walking or toe walking? (herniated disc)
Do you have pain with walking or standing? (lumbar stenosis)
Does your pain improve with sitting or bending forward? (lumbar stenosis)
Does it hurt to raise your leg with the knee extended when your neck is slightly flexed?
(herniated disc/nerve root irritation)
Do you have a personal or family history of diabetes? (diabetic neuropathy)
Know the clinical presentation for cholecystitis and appendicitis, and an enlarged spleen
, Cholecystitis: inflamed gallbladder most commonly due to obstruction of cystic duct
RUQ pain with radiation around the mid torso to the right scapula, pain is abrupt and
severe, 2-4 hours
Appendicitis: periumbilical pain initially, then moves to RLQ
Enlarged spleen – able to palpate, percussion is dull. LUQ pain, referred to L shoulder
Be able to identify what are normal and abnormal reflexes for both adults and infants
Plantar reflex - plantar flexion of toes when lateral side stroked - normal
o Babinski sign - dorsiflexion of great toe/fanning of other toes - expected in
children < 2 years (not normal for adult)
Abdominal reflex - slight movement of umbilicus to each area of stimulation - normal
Cremastic reflex - stroke the inner thigh, testicle/scrotum rise on stroked side - normal
Review how to perform the barlow and ortolani tests and what each test indicates p 553
Barlow-Ortolani maneuver: detects hip dislocation or subluxation during first year of life
- flex hip/knee to 90 degrees
Barlow maneuver: grasp the leg with your thumb on the inside of the thigh, adduct the
thigh and gently apply downward pressure on the femur to disengage the femoral head
from acetabulum, positive sign is a clunk or sensation is felt
Ortolani maneuver: slowly abduct the thigh while maintaining axial pressure, fingertips
on greater trochanter, exert a lever movement in opposite direction so fingertips press the
head of the femur back toward acetabulum center, if the head of the femur slips back into
acetabulum with a palpable clunk, suspect hip subluxation or dislocation. High-pitched
clicks are common and expected.
How do you perform a tinel and phalen’s test? Be sure to know the difference
Tinel test: palms up and light tapping over median nerve at the wrist – carpal tunnel
Phalen’s test: back of hands together with fingers pointed down, maintain flexion of wrist at 90
degree angle – carpal tunnel
Review table 22.2 and know what each test assess for
Musculoskeletal tests:
Neer test & Hawkins test: shoulder rotator cuff impingement or tear
Katz hand diagram, thumb abduction test, tinel sign, phalen test: median nerve integrity
Straight leg raising: L4, L5, S1 nerve root irritation
Femoral stretch test: L1, L2, L3, L4 nerve root irritation
Ballottement and Bulge sign: effusion in knee
McMurray test: torn meniscus in knee
Anterior/Posterior drawer test: ACL/PCL injury
Varus-valgus stress test: medial or lateral collateral ligament instability in knee
Lachman test: ACL integrity
Thomas test: flexion contracture of hip
Trendelenburg sign: weak hip abductor muscles
Understand how to assess for scoliosis
Adam’s forward bend test:
