Chamberlain NR 509 Final Exam 2023

Chamberlain NR 509 Final Exam 2023 1. Know that in a 47-year-old man ED is usually rather than testosterone: psychologic 2. Erectile dysfunction may be from psychogenic causes, especially if: early morning erection is preserved. it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, and diabetes 3. When performing a breast exam, know what abnormal masses should do when the arm: may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted over head or hands are pressed against hips) 4. Fibroadenoma and cysts mobility: very mobile/mobile 5. Know that a high proportion of breast masses are noted during - : BSE 6. Breast stage 1: preadolescent- elevation of nipple only 7. Breast stage 2: breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar diameter 8. breast stage 3: further enlargement of elevation of breast and areola, with no separation of their contours 9. breast stage 4: projection of areola and nipple to form a secondary mound above the level of breast 10. breast stage 5: mature stage- projection of nipple only; areola has receded to general contour of the breast (although in some individuals the areola continues to form a secondary mound) 11. Know where pain is located with pancreatitis: acute: epigastric, may radia- tion straight to the back of other areas of the abdomen; 20% with severe sequelae of organ failure 12. Know where pain is located with pancreatitis: chronic: epigastric, radiating to back 13. Know how hepatitis A is transmitted: Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water and foods leading to infection of household and sexual contacts 85. Internal hemorrhoid: enlargements of the normal vascular cushions located above the pectinate line, usually not palpable. May cause bright red bleeding, especially during defecation. They may also prolapse through the anal canal and appear as reddish, moist, protruding masses. 86. Polyps of the rectum: fairly common and variable in size and number, they can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult or impossible to feel even when in reach of the examining finger. Endoscopy and biopsy are needed for differentiation of benign from malignant lesions. 87. Cancer of the rectum: usually firm, nodular, rolled edge. 88. Know what causes a split S2: During inspiration the right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the neighboring left ventricle. This delays the closure of the pulmonic valve, P2, splitting S2 into its two audible components. Can be heard at the 2nd and 3rd left intercostal spaces close to the sternum. 89. Know that the Buerger test is for : - chronic arterial insufficiency 90. Postural color changes of chronic arterial insufficiency: if pain or dimin- ished pulses suggest arterial insufficiency, consider looking for postural color changes using the Buerger test. Raise both legs to about 90 degrees for up to 2 min until there is maximal pallor of the feet. Then ask the patient to sit up with legs dangling down, compare both feeting noting the time required for: Return of pinkness of the skin, normally about 10 sec or less Filling of the veins of the feet and ankles, normally about 15 91. Know the causes of increased jugular venous pressure: Elevated JVP is highly correlated with both acute and chronic heart failure. It is also seen in tricuspid stenosis, chronic pulmonary hypertension, SVC obstruction, cardia tamponade, and constrictive pericarditis