Exam 4 Terminology - PAP 580

Adipose tissue, or fat, surrounds the breast, predominantly in the superficial and peripheral areas. The proportions of these components vary with age, the general state of nutrition, pregnancy, exogenous hormone use, and other factors. Adipose tissue represents the majority of the breast.

A small ring of color around a center portion, as about the nipple of the breast. Both the nipple and the areola are supplied with smooth muscle that contracts to express milk from the ductal system during breast-feeding.

palpable most frequently. They lie along the chest wall, usually high in the axilla and midway between the anterior and posterior axillary folds. Into them drain channels from three other groups of lymph nodes, which are seldom palpable (lateral, subscapular, pectoral)

located along the upper humerus. They drain most of the arm.

posterior, located along the lateral border of the scapula; palpated deep in the posterior axillary fold. They drain the posterior chest wall and a portion of the arm.

anterior, located along the lower border of the pectoralis major inside the anterior axillary fold. These nodes drain the anterior chest wall and much of the breast.

Fibrous bands that extend from under the skin and attach to the underlying muscle, supporting the glandular tissue

composed of ~15-20 septated lobes in each breast

lymph nodes located below the clavicle, lymph drains from the central axillary nodes to the infraclavicular and supraclavicular nodes.

Bumps in areola – (sebaceaous glands) protect and lubricate the nipple

Site of opening for the lactiferous ducts. Both the nipple and the areola are supplied with smooth muscle that contracts to express milk from the ductal system during breast-feeding.

lymph nodes located above the clavicle, lymph drains from the central axillary nodes to the infraclavicular and supraclavicular nodes.

Fibrous connective tissue provides structural support in the form of fibrous bands or suspensory ligaments connected to both the skin and the underlying fascia. (Cooper's ligaments)

A small portion of mammary tissue that extends into the axillary region, axillary tail

Irregularly shaped, firm or hard tumor that is typically fixed to the skin, and underlying tissue. Non-tender, not clearly delineated.  Look for retraction

A fluid-filled sac within the breast. One can have one or more breast cysts. Often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm. Breast cysts can be painful and may be worrisome but are generally benign. They are most common in pre-menopausal women in their 30s or 40s. They usually disappear after menopause, but may persist or reappear when using hormone therapy.  Breast cysts can be part of fibrocystic disease. The pain and swelling is usually worse in the second half of the menstrual cycle or during pregnancy.

• benign neoplasm (tumor) of glandular epithelium and is usually accompanied by a significant increase in connective tissue stroma
• More common in black women, general age 15-25, single occurrence, round/disc-like/lobular, firm, well-delineated, mobile, no tenderness or retraction.

commonly palpable as nodular, ropelike densities in women ages 25–50. They may be tender or painful. They are considered benign and are not viewed as a risk factor for breast cancer.

Firm disc of glandular enlargement of breast tissue in males. (Distinguish from the soft fatty enlargement of obesity - "pseudo-gynecomastia")

a nipple that, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus. Women and men can have inverted nipples. Can be an indicator of a cancerous tumor located beneath the nipple.

a benign breast tumour that typically occurs in the peri-partum period, non-tender, well circumscribed

an infection of the breast. It usually only occurs in women who are breastfeeding their babies.  Treat with antibiotics.

• breast tenderness
• ask about timing of menstrual cycle, quality of pain, location, any trauma, etc

This uncommon form of breast cancer usually starts as a scaly, eczemalike lesion that may weep, crust, or erode. A breast mass may be present. Suspect Paget’s disease in any persisting dermatitis of the nipple and areola. Can present with invasive breast cancer or ductal carcinoma in situ.

Edema of the skin is produced by lymphatic blockade. It appears as thickened skin with enlarged pores—the so-called peau d’orange (orange peel) sign. It is often seen first in the lower portion of the breast or areola.

the presence of supernumerary breasts (>1 pair)

the presence of supernumerary nipples (>1 pair)

As breast cancer advances, it causes fibrosis (scar tissue). Shortening of this tissue produces dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia (dilation of collecting ducts).

extra nipples (>1 pair)

• inappropriate discharge of milk-containing fluid, is abnormal if it occurs 6 or more months after childbirth or cessation of breast-feeding.
• Ask about color, spontaneous or with compression, medications, etc

no glandular tissue; areola follows the skin contours of the chest (prepubertal)

breast bud forms, with small area of surrounding glandular tissue; areola begins to widen

breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast

increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast

breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla.

Latin for nipple

bladder infection

painful, burning or difficulty urinating

Disorders of the urinary tract may also cause kidney pain, often reported as flank pain at or below the posterior costal margin near the costovertebral angle. It may radiate anteriorly toward the umbilicus. Kidney pain is a visceral pain usually produced by distention of the renal capsule and typically dull, aching, and steady.

abnormally frequent voiding

blood in urine

leaking urine

urinating more than once in the night

increase in urination in a 24 hour period ~3L

felt in the perineum and occasionally in the rectum

ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney, an inflammation of the kidney and upper urinary tract that usually results from cystitis

Disorders in the urinary tract may cause pain in either the abdomen or the back. Bladder disorders may cause suprapubic pain. In bladder infection, pain in the lower abdomen is typically dull and pressure-like. In sudden overdistention of the bladder, pain is often agonizing; in contrast, chronic bladder distention is usually painless.

Ureteral pain is dramatically different. It is usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium. Ureteral pain results from sudden distention of the ureter and associated distention of the renal pelvis. Ask about any associated fever, chills, or hematuria.

An abnormal narrowing of the urethra due to inflammation or scarring from prior urethral or prostate surgery, disease or injury, and rarely, due to external pressure from an enlarging periurethral tumor Risk factors STDs, repeated urethritis, BPH, pelvic injury, trauma or surgery to pelvic region; congenital strictures are rare, as are true strictures in ♀.

inflammation of the urethra that is usually caused by an infection (STD), symptoms include: burning, discharge, difficulty urinating (discharge distinguishes urethritis from cystitis)

an unusually intense and immediate desire to void, sometimes leading to involuntary voiding or urge incontinence

Men with partial obstruction to urinary outflow often report hesitancy in starting the urine stream, straining to void, reduced caliber and force of the urinary stream, or dribbling as voiding is completed.

(CVA) Acute angle between 12th rib and vertebral column, tenderness associated with renal disease

Regulation of the water and electrolyte balance in the body. Filtration and excretion of waste products. Maintenance of acid/base balance.

The long, narrow duct that conveys urine from the kidney to the urinary bladder

canal through which urine is discharged from the bladder and through which semen is discharged in the male, passageway from the bladder to the outside for the discharge of urine

(Kidney stones) Solid accumulations of material that form in the tubal system of the kidney. Kidney stones cause problems when they block the flow of urine through or out of the kidney. When the stones move along the ureter, they cause severe pain

A hepatic bruit suggests carcinoma of the liver or alcoholic hepatitis. Arterial bruits with both systolic and diastolic components suggest partial occlusion of the aorta or large arteries. Partial occlusion of a renal artery may explain hypertension.

Abdominal masses may be categorized in several ways: physiologic (pregnant uterus), inflammatory (diverticulitis of the colon), vascular (an abdominal aortic aneurysm), neoplastic (colon cancer), or obstructive (a distended bladder or dilated loop of bowel). Use deep palpation for physical assessment. This is usually required to delineate abdominal masses. Again using the palmar surfaces of your fingers, press down in all four quad-rants. Identify any masses; note their location, size, shape, consistency, tenderness, pulsations, and any mobility with respiration or pressure from the examining hand.

Tenderness may originate in the abdominal wall. When the patient raises the head and shoulders, this tenderness persists, whereas tenderness from a deeper lesion (protected by the tightened muscles) decreases.

an abdominal condition that requires immediate surgical intervention

Signs are maximal in the right upper quadrant. Check for Murphy’s sign: sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy’s sign of acute cholecystitis - painful inflammation of the gallbladder's wall.

Hook your left thumb or the fingers of your right hand under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. Alternatively, if the liver is enlarged, hook your thumb or fingers under the liver edge at a comparable point. Ask the patient to take a deep breath. Watch the patient’s breathing and note the degree of tenderness. A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy’s sign of acute cholecystitis.

bleeding from the GI tract. The most common underlying conditions are peptic ulcer, Mallory-Weiss syndrome, esophageal varices, diverticulosis, ulcerative colitis, and carcinoma of the stomach and colon. Vomiting of bright red blood or passage of coffee ground vomitus indicates upper GI bleeding, usually from the esophagus, stomach, or upper duodenum. Aspiration of the gastric contents, lavage, and endoscopy are performed to determine the site and rate of bleeding. Tarry black stools indicate a bleeding source in the upper GI tract; bright red blood from the rectum usually indicates bleeding in the distal colon. GI bleeding is treated as a potential emergency

• increased frequency of stools with increased stool weight (patients usually refer to increased liquidity of stools)
• Acute diarrhea = lasting less than 2 weeks
• Chronic diarrhea = lasting at least 4 weeks

loss of the desire to eat

abnormal bulging or swelling of a portion of the aorta

an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased. Appendicitis is a medical emergency, and if it is left untreated the appendix may rupture and cause a potentially fatal infection. Right lower quadrant signs are typical of acute appendicitis but may be absent early in the course (McBurney’s point). The typical area of tenderness is illustrated. Explore other portions of the right lower quadrant as well as the right flank.

abnormal accumulation of fluid in the abdomen

pain caused by acute transient obstruction of the cystic duct, usually due to passage of a gallstone

prolonged gurgles of peristalsis, rumbling noise produced by the movement of gas through the intestines

condition caused by rapidly developing (acute) or long-term (chronic) interruption in the excretion of bile (a digestive fluid that helps the body process fat)

fewer than 3 bowel movements per week, +/- associated straining, hard stools, sensation of blockage or incomplete evacuation

endocrine (hormonal) disorder resulting from excessive exposure to the adrenal hormone cortisol, pt exhibits: striae, skin atrophy, purpura, ecchymoses, telangiectasias, acne, moon facies, buffalo hump, hypertrichosis

• increased frequency of stools with increased stool weight (patients usually refer to increased liquidity of stools)
• Acute diarrhea = lasting less than 2 weeks
• Chronic diarrhea = lasting at least 4 weeks

Inflammation of a diverticulum, especially of the small pockets in the wall of the colon that fill with stagnant fecal material and become inflamed.

the passage of bloody stools

• vague term referring to symptoms originating from the upper GI tract
• Functional – with no anatomic correlate for pain, also known as “nonulcer” dyspepsia
• Organic – associated with a specific diagnosis

difficulty in swallowing

hypoactive bowel activity, characterized by abdominal distention, bloating, nausea and flatulence

gastroesophageal reflux disease, characterized by recurrent bouts of heartburn, acid reflux, or regurgitation

a sensation of a lump or tightness in the throat unrelated to swallowing

a rising retrosternal burning pain aggravated by certain foods or positions

vomiting of bright red blood or “old” blood (looks like coffee grounds)

chronic degenerative disease in which normal liver cells are damaged and are then replaced by scar tissue

Enlargement of the liver and the spleen

same as jaundice - yellow pigmentation of the skin and sclerae

A distention of the abdomen resulting from the accumulation of gas or air in the intestine or peritoneal cavity. Also called tympany

• hollow sounds in abdomen
• (resonant refers to lung sounds)

Can cause constipation, blockage in intestines. Protuberant abdomen that is tympanitic throughout. Can be caused by Cancer of the Rectum or Sigmoid Colon, Fecal Impaction, diverticulitis, volvulus, intussusception, or hernia)

common intestinal condition characterized by abdominal pain and cramps; changes in bowel movements (diarrhea, constipation, or both); gassiness; bloating; nausea; and other symptoms. There is no cure for IBS. Much about the condition remains unknown or poorly understood; however, dietary changes, drugs, and psychological treatment are often able to eliminate or substantially reduce its symptoms.

yellow pigmentation of the skin and sclerae

Liver tumors or hepatic tumors are tumors or growths on or in the liver. Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. These growths can be benign or malignant (cancerous). They may be discovered on medical imaging (even for a different reason than the cancer itself), or may be present in patients as an abdominal mass, hepatomegaly, abdominal pain, jaundice, or some other liver dysfunction.

unpleasant sensation of an imminent need to vomit

no passage of feces or gas

pain with swallowing

inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis is characterized by recurring or persistent abdominal pain with or without steatorrhea (excess fat in feces) or diabetes mellitus. Epigastric tenderness and rebound tenderness are usually present, but the abdominal wall may be soft.

(somatic) severe, steady, aching pain localized over an inflamed structure

an ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 70-90% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach; however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs.

an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process

characterized by the presence of multiple cysts (hence, "polycystic") in both kidneys. The cysts are numerous and are fluid-filled resulting in massive enlargement of the kidneys. The disease can also damage the liver, pancreas, and in some rare cases, the heart and brain. The two major forms of polycystic kidney disease are distinguished by their patterns of inheritance. Autosomal Dominant Polycystic Kidney Disease (ADPKD) and the less-common Autosomal Recessive Polycystic Kidney Disease (ARPKD).

palpable above pubic bone

can be from fat, pregnancy, gas, tumor, ascitic fluid

A state in which pain is felt on the release of pressure over a part. Suggests peritoneal inflammation.

pain that is felt at a site distant from the disordered structure

reflux of gastrointestinal contents into the esophagus or mouth or both

Parietal pain (somatic) severe, steady, aching pain localized over an inflamed structure

occurs when abdominal organs are distended or stretched; often dull, achy, poorly localized

forceful oral expulsion of gastric contents associated with contraction of abdominal and chest wall muscles

linear crack or tear visable at anus or within the anal canal, examination is painful, multiple fissures and swollen thickened skin suggest pruritis ani

small tube that connects the anus or rectum with the skin, may ooze blood, pus or fecal matter, may be associated with underlying abscess

External and internal anal sphincters hold the anal canal closed

separates the skin of the anus from the mucous membrane of the rectum

the musculomembranous sac in the anterior part of the pelvic cavity that serves as a reservoir for urine, which it receives through the ureters and discharges through the urethra.

bleeding, change in bowel habits, obstructive symptoms (feeling of incomplete evacuation and tenesmus), abdominal pain and bloating

red or maroon colored stools, due to bleeding in the colon, rectum or anus (LGI)

pouches of dilated veins, either internal or external, may cause BRBPR (bright red blood per rectum)

one of a pair of muscles of the pelvic diaphragm that stretches across the bottom of the pelvic cavity like a hammock, supporting the pelvic organs. It is a broad thin muscle that separates into the pubococcygeus and the iliococcygeus. It originates from the ramus of the pubic bone, the spine of the ischium, and a band of fascia between the pubis and the ischium; it inserts into the last two segments of the coccyx, the anococcygeal raphe, the sphincter ani externus, and the central tendinous point of the perineum.

passage of black, tarry (sticky, shiny) stools, due to bleeding in the esophagus, stomach, or duodenum (UGI)

inflammation of the rectum & anus, acute or chronic, characterized by rectal pain, tenesmus, discharge or bleeding

a gland surrounding the bladder neck and urethra in the male; it contributes a secretion to the semen, only the lateral lobes and median sulcus are palpable

anal itching, may be due to poor hygiene, physical trauma, infection, contact irritants, foods, hemorrhoids

tissue growths that arise from the wall of the rectum and protrude into it. They may be either benign or malignant (cancerous).

terminal portion of the large intestine, extending from the sigmoid flexure to the anal canal.

a constant urge to defecate with associated pain, cramping and involuntary straining

three inward foldings in rectal wall

excess fat in feces

a progressive disease that affects the skin and connective tissue (including cartilage, bone, fat, and the tissue that supports the nerves and blood vessels throughout the body) overproduction of abnormal collagen, accumulates throughout the body, causing hardening (sclerosis), scarring (fibrosis), and other damage

Bleeding when menstrual period is not expected, menstrual flow is lighter or heavier than what is normal, bleeding at a time in life when it is not expected, such as before age 10, when pregnant, or after menopause.

Accessory or adjoining anatomical parts, such as ovaries and oviducts in relation to the uterus

absence of menstrual periods

anterior recess in the upper part of the vagina caused by the protrusion of the uterine cervix into the vagina

glands embedded in the vestibule of the vagina and function to maintain moisture

The opening of the uterine cervix which is covered by squamous epithelium

small cylindrical organ about an inch or so long and less than an inch around that makes up the lower part and neck of the uterus. The cervix separates the body and cavity of the uterus from the vagina

small erectile body situated at the anterior portion of the vulva and projecting between the branched extremities of the labia minora forming its prepuce and frenulum

a sac or recess formed by a fold of the peritoneum dipping down between the rectum and the uterus; called also rectouterine pouch

painful cramps during menstruation

Difficult or painful sexual intercourse

(uterine tube) a slender tube extending from the uterus toward the ovary on the same side, for passage of oocytes to the cavity of the uterus and the usual site of fertilization

A membranous fold of tissue that partly or completely occludes the external vaginal orifice

entrance into a canal or hollow organ, such as the vagina

the constricted part of the uterus between the cervix and the body of the uterus

The two outer rounded folds of adipose tissue that lie on either side of the vaginal opening and that form the external lateral boundaries of the vulva

The two thin inner folds of skin within the vestibule of the vagina enclosed within the cleft of the labia majora

The first menstrual period, usually during puberty

end of menstruation

Excessively heavy menstrual flow with cycles of normal length. It is also called hypermenorrhea

the cyclic, physiologic discharge through the vagina of blood and muscosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs usually at approximately four-week intervals, except during pregnancy and lactation, throughout the reproductive period (puberty through menopause).

Bleeding from the uterus that is not associated with menstruation

the rounded fleshy prominence over the symphysis pubis in the female

infrequent or very light menstruation

the female gonad: either of the paired female sexual glands in which oocytes are formed

pain in the pelvis, as occurs in appendicitis, oophoritis (inflammation of an ovary), and endometritis. The character and onset of pelvic pain and any factors that alleviate or aggravate it are significant in making a diagnosis

a span of 4 to 6 years preceding menopause when menstrual cycles and blood flow may be irregular. As estrogen levels decline, osteoporosis begins, and women are at increased risk for cardiovascular disease

The pelvic floor and associated structures occupying the pelvic outlet, bounded anteriorly by the pubic symphysis, laterally by the ischial tuberosities, and posteriorly by the coccyx. The region between the thighs, bounded in the male by the scrotum and anus and in the female by the vulva and anus

abnormally frequent menstruation

bleeding after sexual intercourse

posterior recess in the upper part of the vagina caused by the protrusion of the uterine cervix into the vagina

bleeding from the reproductive system that occurs six months or more after menstrual periods have stopped due to menopause

symptoms that occur between ovulation and the onset of menstruation. The symptoms include both physical symptoms, such as breast tenderness, back pain, abdominal cramps, headache, and changes in appetite, as well as psychological symptoms of anxiety, depression, and unrest

• a fold capping the clitoris, formed by union of the labia minora and the clitoris on the female genitalia
• loose fold of skin that covers the glans of the penis (foreskin) on males

A pocket formed by the deflection of the peritoneum from the rectum to the uterus

A person’s potential for responding with sexual arousal to persons of the opposite sex (i.e., heterosexual orientation), same sex (i.e., homosexual orientation), or both (i.e., bisexual orientation)

biochemical and physiological response to sexual stimulation that occurs in men and women after puberty

near the urethra, glands which are rarely seen in human females

zone on the cervix at which squamous epithelium and columnar epithelium meet; changes location in response to a woman's hormonal status

external opening of the urethra

the hollow muscular organ in female mammals in which the blastocyst normally becomes embedded and in which the developing embryo and fetus is nourished. Its cavity opens into the vagina below and into a uterine tube on either side

The genital canal in the female, leading from the opening of the vulva to the cervix of the uterus

painful spasm of the vagina due to involuntary muscular contraction, usually severe enough to prevent intercourse; the cause may be organic or psychogenic

inflammation of the vagina

the space between the labia minora into which the urethra and vagina open

the external genital organs of the female, including the mons pubis, labia majora and minora, clitoris, and vestibule of the vagina

• Irritation and itching of the genital area
• Inflammation (irritation, redness, and swelling) of the labia majora, labia minora, or perineal area
• Vaginal discharge
• Foul vaginal odor
• Discomfort or burning when urinating

inflammation of the glans penis, usually due to infection

inflammation of both the head of the penis and the foreskin

the rounded proximal border of the glans penis

undescended testicles

The process by which semen(made up in part of prostatic fluid) is ejected by the erect penis.

Dome-shaped white or yellow pap-ules or nodules formed by occluded follicles filled with keratin debris of desquamated follicular epithelium. Epidermoid cysts are common, frequently multiple, and benign.

an elongated cordlike structure along the posterior border of the testis; its coiled duct provides for storage, transit, and maturation of spermatozoa and is continuous with the ductus deferens

An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. It occurs chiefly in adults, most commonly with Chlamydia infection. Coexisting urinary tract infection or prostatitis supports the diagnosis.

an opening in the aponeurosis of the external oblique muscle for the spermatic cord or round ligament

the medial part of the femoral sheath lateral to the base of the lacunar ligament

the cap-shaped expansion of the corpus spongiosum at the end of the penis

a bulge or protrusion of an organ through the structure or muscle that usually contains it.

• a circumscribed collection of fluid, especially in the tunica vaginalis of the testis or along the spermatic cord
• Differentiate from a lymphoma by trans-illumination of testicle

a developmental anomaly in which the urethra opens inferior to its normal location; usually seen in males, with the opening on the underside of the penis or on the perineum

often called erectile dysfunction, is the inability to achieve or maintain an erection long enough to engage in sexual intercourse

Confined or trapped, as a hernia. A hernia is incarcerated when its contents cannot be returned to the abdominal cavity.

the oblique passage in the lower anterior abdominal wall, through which passes the round ligament of the uterus in the female, and the spermatic cord in the male.

an aperture in the transverse fascia for the spermatic cord or round ligament

Manifestation of the sexual drive

• inflammation of the testis, accompanied by swelling, pain, fever, and a sensation of heaviness in the affected area
• treatment takes longer than for simple urethritis

The highest point of sexual excitement, marked by strong feelings of pleasure and marked normally by ejaculation of semen by the male and by vaginal contractions within the female. Also called climax.

A tightening of the foreskin of the penis that may close the opening of the penis.

occurs when male sexual climax (orgasm) occurs before a man wishes it or too quickly during intercourse to satisfy his partner

appearance of pubic hair

age of first ejaculation (heralded by nocturnal sperm emissions and appearance of sperm in the urine)

a prominent tubercle at the lateral end of the pubic crest

The musculocutaneous sac that encloses the testes and is formed of skin, a network of nonstriated muscular fibers, cremasteric fascia, the cremaster muscle, and the serous coverings of the testes and epididymides

either of the paired sacculated pouches attached to the posterior urinary bladder; the duct of each joins the ipsilateral ductus deferens to form the ejaculatory duct.

venereal disease; any of a diverse group of infections transmitted by sexual contact; in some this is the only important mode of transmission, and in others transmission by nonsexual means is possible.

A sebaceous secretion, especially the whitish cheesy secretion that collects under the prepuce of the penis or around the clitoris

the structure extending from the abdominal inguinal ring to the testis, comprising the pampiniform plexus, nerves, ductus deferens, testicular artery, and other vessels.

A hernia is strangulated when the blood supply to the entrapped contents is com-promised. Suspect strangulation in the presence of tenderness, nausea, and vomiting, and consider surgical intervention.

The male reproductive gland, the source of spermatozoa and the androgens, normally occurring paired in an external scrotum. Also called didymus, orchis

Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection. Torsion, most common in adolescents, is a surgical emergency because of obstructed circulation.

varicosity of the pampiniform plexus of the spermatic cord, forming a scrotal swelling that feels like a “bag of worms.”

(ductus deferens) the excretory duct of the testis which joins the excretory duct of the seminal vesicle to form the ejaculatory duct.

Indirect inguinal hernias develop at the internal inguinal ring, where the spermatic cord exits the abdomen.

Direct inguinal hernias arise more medially from weakness in the floor of the inguinal canal and are associated with straining and heavy lifting.

protrusion of a loop of intestine into the femoral canal

expulsion from the uterus of the products of conception before the fetus is viable, whether naturally occuring or elective

an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result of the body's defensive reaction to foreign material.

forward-bent

forward-leaning

the primary sore of syphilis, occurring at the site of entry of the infection. Firm and painless (in contrast to herpes)

• the syndrome of endocrine, somatic, and psychic changes occurring at menopause in women.
• similar changes occurring in men owing to normal diminution of sexual drives with the aging process.

that portion of the inferior aperture of the thorax formed by the articulated cartilages of the seventh to tenth (that is, false) ribs.

an abnormal closed epithelium-lined cavity in the body, containing liquid or semisolid material.

hernial protrusion of the urinary bladder, usually through the vaginal wall

the upper and middle region of the abdomen, located within the sternal angle

Ask the patient or an assistant to press the edges of both hands firmly down the midline of the abdomen. This pressure helps to stop the transmission of a wave through fat. While you tap one flank sharply with your fingertips, feel on the opposite flank for an impulse transmitted through the fluid. Unfortunately, this sign is often negative until ascites is obvious, and it is sometimes positive in people without ascites. An easily palpable impulse suggests ascites. A positive fluid wave, shifting dullness, and peripheral edema make the diagnosis of ascites highly likely with ratios of 3 to 6.

an auscultatory sound caused by the rubbing together of two serous surfaces, as in pericardial rub

involuntary urine loss which may arise from impaired cognition, musculo-skeletal problems, or immobility.

A pregnant woman

the lower abdominal region below the umbilical region and between the right and left iliac regions.

A deficient amount of menstrual flow at the regular period

sclerosis or hardening

A thick, whitish discharge from the vagina or cervical canal

a type of surgery used to treat breast cancer. It is considered "breast-conserving" surgery because in a lumpectomy, only the malignant tumor and a surrounding margin of normal breast tissue are removed

the surgical removal of the breast for the treatment or prevention of breast cancer.

space between lateral lobes of prostate, palpable on prostate exam (rectally)

Blood supply to the bowel and mesentery blocked from thrombosis or embolus (acute arterial occlusion), or reduced from hypoperfusion. May present as pain in periumbilical region at first, then become diffuse. Symptoms include vomiting, diarrhea (sometimes bloody), constipation, shock; more common in older patients

the classification of a woman by the number of live-born children and stillbirths she has delivered at more than 20 weeks of gestation. Commonly parity is noted with the total number of pregnancies and represented by the letter P or the word para

When assessing for possible appendicitis: Flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This maneuver stretches the internal obturator muscle. Right hypogastric pain constitutes a positive obturator sign, from irritation of the obturator muscle by an infamed appendix.

benign or malignant growth on an ovary. An ovarian cyst can disappear without treatment or become extremely painful and have to be surgically removed

hanging loose or lacking proper support

When assessing for possible appendicitis: Place your hand just above the patient’s right knee and ask the patient to raise that thigh against your hand. Alternatively, ask the patient to turn onto the left side. Then extend the patient’s right leg at the hip. Flexion of the leg at the hip makes the psoas muscle contract; extension stretches it. Pain in the right lower quadrant during left-sided pressure is a positive Rovsing’s sign.

Consisting of or containing pus

hernial protrusion of part of the rectum into the vagina

backward-bent

posterior to the peritoneum

Arranged or shaped like a star; radiating from a center. With respect to the cervical os, this can be a type of laceration to the cervix from delivery. With respect to breast cancer the shape of a breast mass.

The footholds in a lithotomy table

involuntary escape of urine due to strain on the orifice of the bladder, as in coughing or sneezing.

backward-leaning

When assessing for possible appendicitis: Check for Rovsing’s sign and for referred rebound tenderness. Press deeply and evenly in the left lower quadrant. Then quickly withdraw your fingers. Pain in the right lower quadrant during left-sided pressure is a positive Rovsing’s sign.

Numerous holocrine glands in the dermis that usually open into the hair follicles and secrete an oily, semifluid sebum

Instrument used for examining the vagina, come in two basic shapes, named for Pedersen and Graves. Both are available in small, medium, and large sizes. The medium Pedersen speculum is usually most comfortable for sexually active women. The narrow-bladed Pedersen speculum is best for the patient with a relatively small introitus, such as a virgin or an elderly woman. The Graves specula are best suited for parous women with vaginal prolapse.

enlargement of the spleen

the beginning of development of the breasts at puberty

clotted, pertaining to a blood vessel in which a thrombus has formed

urinary incontinence preceded by a sudden, uncontrollable impulse to urinate

one-sided, lower abdominal pain that occurs in women at or around the time of an egg is released from the ovaries (ovulation).

process of closely attending to what the patient is communicating, being aware of the patient's emotional state, using verbal and non-verbal skills to encourage the speaker to continue and expand upon important concerns

simple repetition of the patient's last words, encourages the patient to expand on factual details and feelings

the capacity of the clinician to identify with the patient and feel the patient's pain as the clinician's own.

Sharing power with the patient over their medical care by: evoking patient's perspective, conveying interest in the person not just the problem, following the patient's lead, elicit and validate emotional content, share information with the patient (especially at transition points during visit), make clinical reasoning transparent to patient, reveal the limits of your knowledge

questions aimed to elicit more focused responses

shows sustained interest in the patient's feelings and deepest disclosures - moving from open-ended to focused questions, using questions to elicit graded response, series of questions, multiple choices for answers, clarifying what the patient means, encouraging with continuers, using echoing

"hmmm", "mm-hm", "go on", encourages the patinet to say more

Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, Timing

general questions, can elicit a number of responses, allow full freedom of response

Onset, Palliating/Provoking Factors, Quality, Radiation, Site, Timing

provider indicates understanding of patient's story and encourages the patient to express deeper feelings

when building relationships with your patients, be explicit about your commitment to an ongoing partnership - make the patient feel that regardless of what happens with their illness, you envision continuing their care

encourages patient to express what is most important to them, personal concerns in addition to symptoms

identifying and acknowledging the patient's feelings, later after examination/lab studies interpret for patient what you think is happening and deal openly with expressed concerns.  Reassurance comes from making the patient feel confident that problems have been fully understood and are being addressed.

• Location
• Quality
• Severity
• Timing/Onset
• Setting
• Aggrevate
• Alleviate
• Associated symptoms

self-disclosure-part of relationship building skills-and indirect inquiry- "I had a similar experience, it made me feel...."

giving a capsule summary of the patient's story during the course of the interview serves to show you have been listening carefully, identifies what you know and don't know, let's the patient add any other information or correct any misunderstandings

Patients may be apprehensive during a health care visit, to put them more at ease, tell them when you are changing directions during the interview.  Moving from one part of the history to the next, or moving to the physical examination. "Now I would like to examine you, I'll step out while you change into a gown."

to affirm the patient by acknowledging the legitimacy of his/her emotional experience