Exam 1 PD Objectives

From Iusmicm

Revision as of 23:01, 12 January 2012

Lange: Chapter 1: I Have a Patient with a Problem: How do I figure out the possible causes?

• Pages 1-9
• Define the steps in the diagnostic process.
• Define sensitivity, specificity and likelihood ratio.
• Understand how true negatives, false negatives, false positives and true positives are determined.

Chapter 8: Chest Pain

• Pages 130-148

• Know the differential diagnosis of chest pain by anatomical organization.
• Know the key factors in the history and on physical examination and initial diagnostic evaluation that accompany each of the following diagnoses:
  • Stable Angina
  • GERD
  • Myocardial Infarction
  • Unstable Angina
  • Aortic Dissection
  • Pleural Effusion
  • Acute Pericarditis

Chapters 13 & 14: The Chest and the Cardiac Examinations

• Pages 362-390, Pages 391-437

Chapter 15: Peripheral Vascular System

• Pages 438-454
• Define and describe the components for the physical examination of the peripheral vascular system.
• Differentiate ulcers caused by arterial insufficiency and venous insufficiency.
• Define and differentiate intermittent claudication and pseudoclaudication.
• Differentiate skin changes caused by arterial insufficiency and venous insufficiency.
• Identify important risk factors for the development of thrombus formation.
• Recognize the symptoms of emboli affecting various organ systems.
• Clinically correlate abnormal findings when found on the examination of the arterial system. The student should be able to correlate and interpret the physical finding with the following disease processes: abdominal aortic aneurysm, renal artery stenosis, coarctation of the aorta, obstructive aortoiliofemoral disease, atherosclerosis of the carotid artery, and peripheral vascular disease.
• Define and differentiate generalized lymphadenopathy, localized lymphadenopathy, lymphangitis, and lymphedema.
• Define and appropriately apply the Allen test on a patient. The student should be able to interpret the findings of this test.

Chapter 16: Breast

• Pages 455-476
• Differentiate the clinical significance of a lump that enlarges during the premenstrual and menstrual stages of the cycle and the breast lump which does not change during the menstrual cycle.
  • A breast lump that enlarges during premenstrual / menstrual stages is likely physiological nodularity

• Describe and identify the changes of the skin and nipple which are strongly suggestive of neoplasm.
  • Characteristics associated with neoplastics changes of the breast include nipple discharge, nipple inversion, skin changes overlying a mass.

• Describe the different types of nipple discharge. Differentiate and identify the different types of nipple discharge and their clinical significance.
  • Types of nipple discharge include: serous (thin, watery, yellowish), bloody, and milky.
  • NB: both serous and bloody types of discharge can be associated with malignancy so the the presence of discharge is more important than the type of discharge.
  • Serous discharge commonly results from intraductal papilloma in one of the large subareolar ducts, with oral contraceptive use, or with carcinomas.
  • Bloody discharge commonly results from intraductal papilloma (as with serous discharge), too.

• Describe the components of the physical examination of the breast and the proper positioning of the patient for each component.
  • The components of the breast PE include inspection (seated; hands on hips; hands pulling apart a shoulder level; hands above head; leaninig forward), axillary examination (pt seated; arm held up away from axilla), and paplation (pt lying; hand above head; shoulder on table; potentially leaned toward opposite side to distribute breast over chest wall).

• Describe the following changes of the breast: erythema, edema, and dimpling. Identify and describe the differential diagnosis for each of the above physical findings.
  • Erythema: Erythema is an important symptom of breast carcinoma.
  • Edema: Edema is characterized by the prominent pores and is an important sign of malignancy called peau d'orange. (Lymphatics are clogged by emboli of tumor tissue.)
  • Dimpling: The presence of dimpling warrants further investigation.

• Describe the proper physical exam technique for axillary examination. Describe and name which lymph node regions that should be palpated on physical examination.
  • With the pt seated and arm abducted away from the body (lay arm over examiner's shoulder), pectoral muscle relaxed, make dime-size circles with the pads of the fingers (without losing contact with the skin), working superiorly. Palpate the anterior and posterior aspects of the axilla. Adduct the arm as one moves superiorly to allow for deep, superior palpation. Freely moving nodes (3-5 mm) are common and usually due only to lymphadenopathy.

• Describe the characteristics which should be used to describe a breast mass which is found on physical examination.

• Based on a clinical description, differentiate between cystic disease, a benign adenoma, and a malignant tumor.

Chapter 19: Female Genitalia

• Pages 549-583.
• Identify and describe the components of the physical examination of the female genitalia.
• Recognize abnormalities that can be found on each component of the exam.
• Recognize and differentiate the clinical features of genital ulcerations.
• Describe and give recommendations for screening for cervical cancer for a patient based on the American cancer Society recommendations.
• Define and recognize the following sequelae of pelvic floor relaxation: cystocele, rectocele, and uterine descent.
• Define and differentiate the following: amenorrhea, menorrhagia, metorrhagia, menometrorrhagia, and postmenopausal bleeding.

Chapter 22: Integrating the exam

• 696-706