ICM - Block 3 - Part 1

davidwurbel7's version from 2016-07-26 19:26


Question Answer
The knee include the presence of knee pain plus at least three of the following characteristics - Age greater than 50 years, Morning stiffness lasting less than 30 minutes, Crackling or grating sensation (crepitus), Bony tenderness of the knee, Bony enlargement of the knee or No detectable warmth of the joint to the touchKnee Osteoarthritis
The presence of hand pain plus at least three of the following characteristics - Bony enlargement of at least 2 or more of 10 selected joints, Bony enlargements of two or more distal interphalangeal (DIP) joints, Fewer than three swollen metacarpophalangeal (MCP) joints or Deformity of at least 1 of the 10 selected jointsHand Osteoarthrtis
The presence of hip pain plus at least two of the following characteristics - A normal erythrocyte sedimentation rate (ESR) or C-RP, the presence of bony outgrowths (osteophytes) on x-rays or the presence of joint space narrowing on x-rays or indicating a loss of cartilageHip Osteoarthrtis
This marker is seen before RF in rheumatoid arthritisAnti–Citrullinated Protein Antibody


Question Answer
Pain during passive ROMIntra-articular Condition
Pain during active ROMExtra-articular Condition
A synovial WBC count of 20 - 200Normal
A synovial WBC count of 200 - 2000Osteoarthritis
A synovial WBC count of greater than 2000 Rheumatoid Arthritis
Urate deposits in cartilage, tendons, bursae, soft tissues, and synovial membranesTophi

Diseases of the Breast

Question Answer
The most common area of the breast to have presence of cancer is this areaUpper Outer Quadrant
The amount of glandular tissue and fibrous connective tissue contribute to thisBreast Density
The higher the breast density the greater the risk for thisCancer
Secretory tubuloalveolar glands and ducts, forms 15 to 20 septated lobes and Lobules. These drain into milk-producing ducts and sinuses that open onto the surface of the areola, or nippleGlandular Tissue
Provides structural support in the form of fibrous bands or suspensory liga- ments connected to both the skin and the underlying fasciaFibrous connective tissue
Surrounds the breast, predominantly in the superficial and peripheral areasAdipose tissue
Hormone needed for the production of milkProlactin
Hormone needed for the let down of milkOxytocin
Extra or supernumerary nipples along this often mistaken for a common mole. This has no pathologic significanceMilk Line
Located inside the anterior axillary fold. Drains the anterior chest wall and much of breastPectoral Lymph Nodes
Located deep in posterior axillary fold. Drains posterior chest wall and a portion of the armSubscapular Lymph Nodes
Located along upper humerus. Drains most of the armLateral Lymph Nodes
The ideal time to perform a breast exam is this5-7 day after onset of menstruation


Questions about a breast mass
“Where is it located?”
“How long has it been present?”
“Any change in size?”
“Any variation with the menstrual cycle?”
Is it painful?
Is it tender?


Question Answer
Usually firm, round, mobile, non tender. Generally seen ages 15-25Fibroadenoma
Usually soft to firm, round, mobile; often tender. Generally seen ages 25-50Cysts
Nodular, ropelikeFibrocystic changes
Irregular, stellate, firm, not clearly delineated from surrounding tissue. Generally seen in ages over 50.Cancer:
Any mass seen in the breast in a patient over the age of 50Cancer Until Proven Otherwise


Questions about Nipple discharge
Nature of the discharge: serous, bloody, milky, purulent
Color, consistency, quantity
Association with mass
Unilateral or bilateral
Spontaneous or to be expressed by pressing
Relationship with menses
Pre or post menopausal
Association with drugs (contraceptive pills, estrogen etc)


Question Answer
Nipple discharge appears only after squeezing the nipplePhysiological
Nipple discharge appears spontaneous, milky, bilateralGalactorrhea
Nipple discharge appears spontaneous, persistent, nonlactational, bloody, unilateralPapilloma or Breast Cancer
Nipple discharge appears purulentBreast Abscess


Questions about Skin Changes
“Did you notice any difference in the skin over your breast or your nipple? “When did it start?


Question Answer
These skin changes skin retraction, Edema of the skin: peau d’orange, Nipple retraction and deviation and Paget’s disease of nippleCancer
The skin change of redness most likely is an indication of thisMastitis


Question Answer
Spontaneous flow of milk from the breast unassociated with childbirth or nursingGalactorrhea
Benign enlargement of breast tissue in males. Usually associated with benign pubertal changes. Not physically harmful. Indicator of other more serious underlying conditions, such as testicular cancer or a side effect of drugs or genetic disorders. Increase in the ratio of estrogen/androgensGynecomastia
Gynecomastia can be a sign of this genetic conditionKlinefelter Syndrome
Ketaconazole, cimetidine, antiandrogens, spironolactone are drugs that can cause thisGynecomastia
Gynecomastia due to ageSenile Gynecomastia
inflammation of the breast in connection with pregnancy, breastfeeding or weaningPuerperal Mastitis
Stasis of milk, trauma, infection, tight clothing increases the chances of thisMastitis
Clinical features include pain, tenderness, redness and swelling of breast. Fever, Purulent nipple discharge and Abscess formation in worst casesMastitis
The most common bacteria to cause mastitisS. aureus
Treatment for this includes massage and application of heat prior to feeding, antibiotics and possibly aspiration (FNAC) or drainage. Rarely, surgical resection. Continue breast feedingMastitis
Mastitis seen in non-pregnant or non-lactating womanMammary duct ectasia
The most common cause of a greenish nipple dischargeFibroadenoma
The second most common cause of a greenish nipple dischargeMammary duct ectasia
Clinical features include nipple retraction, inversion, pain, greenish nipple dischargeMammary duct ectasia
This condition is due to blocking of lactiferous ductsMammary duct ectasia
a non cancerous breast MASS presenting with a dominant mass. Noncancerous tumor, composed of fibrous and glandular tissue which doesn’t become malignant. Slowly growing ,painless, firm, solitary, very mobilefibroadenoma
a usually tender lumpy, bumpy masses found in the breastFibrocystic Breast Change
Also called a breast mousefibroadenoma
A rare lesion of breast, clinically important because it produces a mass which is almost indistinguishable from carcinomas even with imaging studies. Trauma is the main causeFat Necrosis
The most common cause of bloody nipple discharge in women age 20-40Intraductal papilloma
Intraductal papilloma near the nipple, solitary, develops in the period nearing menopauseCentral Intraductal Papilloma
Intraductal papilloma away from nipple, multiple, found in younger women. High risk of cancerPeripheral Intraductal Papilloma
A malignant condition that outwardly may have the appearance of eczema with skin changes involving the nipple of the breast. Initially looks like contact dermatitis. Eczema like rash, skin of nipple and areola becomes red, itchy, scaly. Straw colored or bloody dischargePaget's Disease of the Breast
Usually over 50 years. Painless mass in the breast. Usually single. Irregular shape. located in the upper outer quadrant. Firm or hard in consistency Not well delineated from surrounding tissue. Immobile: Fixation to the chest wall. Painless axillary lymphadenopathy. Nipple retraction and Skin dimpling or retraction. Hepatomegaly or bone pain if metastasis has occurred.Breast Cancer

Female Genital System

Question Answer
Lower abdominal/pelvic pain with ovulation during mid-cycleMittelschmerz
Occurring 4 to 10 days before the onset of menses for at least three consecutive cycles, cessation of signs & symptoms within 4 days of onset of menses and interference with daily activities. Psychological symptoms include tension, irritability, depression, mood swings, angry outbursts, anxiety, confusion, crying spells, sleep disturbance, poor concentration and social withdrawal. Physical symptoms include weight gain, bloating, edema, headaches and breast tendernessPremenstrual Syndrome (PMS)
Infrequent bleeding (> 35 days apart)Oligomenorrhea
Frequent, regular menses (≤ 21days apart)Polymenorrhea
Bleeding at irregular intervals (cervical /endometrial carcinoma, polyps, hormonal contraception)Metrorrhagia
Excessive amount or duration(>8 d); (submucosal leiomyoma or fibroid, bleeding disorders)Menorrhagia
Excessive blood at irregular intervalsMenometrorrhagia
Painful menstruation felt as a bearing down, aching or cramping sensation in the lower abdomen & pelvisDysmenorrhea
Discomfort/ pain during intercourse suggests local inflammation, in an older woman atrophic vaginitisDyspareunia
Abnormal menstrual bleeding in absence of pathology is consideredDysfunctional Uterine Bleeding
Chronic LAP + Dysmenorrhea + Dyspareunia + Infertility suggestsEndometriosis
LAP + fever 7-10 days after menses, with/without adnexal mass+ tenderness suggestsAcute PID
Sudden LAP + Adnexal Mass suggestsOvarian torsion or twisted ovarian cyst
LAP + Amenorrhea + Vaginal spottingEctopic Pregnancy
Bulge of bladder into anterior vagina. Incontinence, pressure sensationCystocele
Herniation of rectum into posterior wall of vagina. Pressure sensation, difficulty in emptying bowelsRectocele

Female Genital Exam

Question Answer
Bluish discoloration of the cervix from venous congestion and can be observed by 8-10 weeksChadwick Sign
Start screening at age of21 year old
Women up to 30 screen every3 years
Women from age 30 to 65 years: pap smear and HPV testing every5 years
Weakness of pelvic floor muscles and supporting ligaments of uterusUterine Prolapse

Neck Exam

Question Answer
Rapid growth and tenderness suggests thisInflammatory Process
Firm, painless, and slowly enlarging masses suggests thisMalignant Process
A neck mass in an adult over the age of 40 should be considered neoplastic in origin unless proven otherwise, particularly in the setting of tobacco or alcohol use
An adult with a lump in the lateral neck has cancer until proved otherwise
Question Answer
Carotid body tumor, Metastatic squamous cell carcinoma (SCC), Pharyngeal pouch, Cystic hygromas, Laryngocele, Salivary gland tumors and TorticollisAcquired Lateral Swelling
Bronchial cyst is this typeCongenital Lateral Swelling
Thyroglossal cyst, Dermoid cyst and Thymic cystCongenital Midline Swelling
Plunging ranulaAcquired Midline Swell
This can occur either in the midline or laterallyRhabdomyosarcoma
Congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second bronchial cleft in embryonic life. The mass is painless (but tender), firm, smooth, well circumscribed, 2 to 5 cm in diameter.Bronchial cleft cyst
Arises near the bifurcation of the common carotid artery. It appears in middle life and grows very slowly. Shaped liked a potato. Freely movable laterally, but cannot be moved in the long axis of the artery. Initially cystic, but later becomes hard. Usually pulsatile. Palpation produces pupillary dilatation and hypertensionCarotid Body Tumor
Intermittent swelling in the side of the neck (usually left), which can be induced by swallowing water. Associated with gurgling in the neck, especially during swallowing, and regurgitation of food during eating or lying on the side. When there is excessive pressure within the lower pharynx the weakest portion of the pharyngeal wall balloons outZenker’s Diverticulum (Pharyngeal Pouch)
It is a cystic teratoma containing many solid tissues. Usually the dermoid cyst is a cavity under the skin that contains tissues normally present in the outer layers of the skin. These are congenital, benign and usually contain thick white paste-like material. Occurs in the midline, anywhere from the chin to the jugular notch. Presents with a painless, nonpulsatile, fluctuant mass in the suprasternal notch. It is not adherent to trachea and does not move upward with protrusion of the tongueDermoid cyst
It is a type of mucocele found on floor of the mouth. Swelling of a connective tissue containing mucin, from a ruptured salivary gland after traumaPlunging Ranula
May cause bleeding with any Thyroid Surgery or TracheostomyInferior Thyroid Vein
ectopic location of thyroid tissue at the base of the tongueLingual thyroid
ectopic location of thyroid tissue along this developmental tract to formThyroglossal duct cysts
ectopic location of thyroid tissue that migrates too far into the mediastinumsubsternal (retrosternal) thyroid
Swellings around the hyoid bone are most likely to represent a thyroglossal duct remnant. About 80% of these lie below the level of the hyoid bone and an important clinical feature is that they elevate or move with protrusion of the tongueThyroglossal cyst
The initial test of choice in most patients with suspected Thyroid Disease is thisTSH Test
The patient elevate both arms until they touch the sides of the face. A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minutePemberton’s sign
Pemberton’s sign can be suggestive of thisIntra Thoracic or Substernal Goiter
Solitary nodules, Nodules in younger patients, Nodules in males, History of radiation treatment to the head and neck, Nonfunctional nodules (cold nodules), Firm on palpation, Fixation to surrounding tissues and Enlarged cervical nodes characteristics suggest thisThyroid Cancer
Clinical findings include Hyperthermia, Fever, vomiting, diarrhea, Marked weakness, Muscle wasting, Extreme restlessness, Delerium, Seizures, Coma, Hepatomegaly + mild jaundice and Cardiovascular collapse + shockThyroid Storm
Treatment for this is Large doses Propylthiouracil, Propranolol po or IV every 4 hours, Dexamethasone IV, Cooling Blanket, Iodides, Oxygen, IV Dextrose and other IV solutions based on serum electrolytes, Antibiotics if infection is present and Monitor in ICUThyroid Storm