Chapter 34

Question 1

diagnostic evaluation of breast disorders

Answer 1

• U/S exam can differentiate fluid filled cysts from solid tissue (more likely to be malignant)
• fine needle aspiration (FNA): can be done to remove fluid or small tissue fragments for analysis of cells
• core biopsy: uses a larger needle to obtain a cylinder of tissue from an area of questionable breast tissue
• open/surgical biopsy: performed to remove all/part of the lump if other conditions exist like bloody fluid aspirated, recurrence of cyst after 1 or 2 aspirations, solid dominant mass, serous/serosanguineous nipple discharge, signs suspicious of inflammatory breast cancer, suspicious mammography

Question 2

Fibrocystic Breast Changes

Answer 2

• benign breast disorder
• common changes that occur during the reproductive years before menopause
• fibrosis (thickening) of breast tissue occurs in early stages
  
  • cysts form later
• not cancerous, but if involved in terminal breast ducts may inc risk of cancer
• common symptoms: pain and tenderness
  
  • pain is bilateral and most noticeable during PMS
  • pain likely due to imbalance of estrogen to progesterone ratio
• to help manage: wear supportive bra, avoid caffeine and stimulants, oral contraceptives
  
  • can use some pharmacological methods like Danazol to suppress estrogen production but this can only be ued for 4-6 mos

Question 3

Fibroadenoma

Answer 3

• benign breast tumor
• most common during teens-20s
• firm, freely mobile nodules that may or may not be tender
• do not change during mentrual cycle
• usualy located in upper, outer quadrant
• tx: careful observation to ensure that it is stable
  
  • may excise the mass if changes in size

Question 4

ductal ectasia

Answer 4

• benign
• occurs as a woman approaches menopause
• characterized by dilation of collecting ducts, which become distended and filled with cellular debris
  
  • this initiates an inflammatory response which results in a mass near the areola that feels firm/irregular, enlarged axillary nodes, nipple retraction and discharge
• must have a biopsy b/c S/S are similar to breast cancer

Question 5

intraductal papilloma

Answer 5

• benign
• often develops just before or during menopause
• occurs when papillomas (small elevations) develop in the epithelium of the ducts under the areola
  
  • as it grows, it causes trauma and erosion w/in the ducts that leads to serous/bloody discharge from the nipple
• U/S and mammography aid in dx
• tx: excision of mass plus analysis of nipple discharge

Question 6

nursing considerations for benign disorders of breast tissue

Answer 6

• acknowledge anxiety
  
  • they may find it helpful to learn that most breast disorders are benign
• explain diagnostic procedures
  
  • teach about what the procedure entails and how long the woman will have to wait for results

Question 7

carcinoma in situ

Answer 7

• malignant neoplasm in surface tissue
• lumpectomy is usually performed

Question 8

incidence of malignant tumors of the breast

Answer 8

• white women after age 35 have a higher incidence than African American women
  
  • but African American women have a higher incidence until the age of 35
• African American women have a higher risk of dying from breast cancer
  
  • b/c of faster growing tumors and diagnosed more often at a more advanced stage
• Asian American, Hispanic, and Native Indian have a lower risk of developing cancer

Question 9

risk factors for malignant turmors of the breast

Answer 9

• mutations in BRCA1/2 are thorught to be responsible for most cases of familial breast and ovarian cancer
• mutation of CHEK-2 has higher risk of development of breast cancer in men and women
• mutation of p53 tumor suppressor gene has been assoc with breast cancer

Question 10

inflammatory breast cancer

Answer 10

• has cutaneous findings w/ invasive involvement in the dermis
• rare but more likely to occur in younger or African American women
• aggressive and may manifest as a pink or red skin rash
• tenderness, itching, or breast edema may be present
  
  • often seems like an infection, so prescribed abx, so if the rash doesn’t go away, contact HCP

Question 11

staging of breast cancer

Answer 11

• based on TNM: tumor, node, metastasis
• Stage 1: small tumor w/o lymphatic involvement in the local area or metastases
• Stage 4: indicates spread to LNs and metastases to distant organs

Question 12

lumpectomy

Answer 12

• involves wide local excision of the tumor to microscopically clean margins for tumors that are small relative to the breast size
• AKA breast conservation tx
• can be performed w/o deformity
• some axillary LNs are removed to identify stage of breast cancer

Question 13

mastectomy

Answer 13

• simple mastectomy: removal of the entire breast
  
  • axillary dissection is omitted, but some LNs may be removed
  • can also be used prophylactically, but if no cancer present, does not eradicate risk for later breast cancer
  • do not take BP on affected side

Question 14

radiation therapy

Answer 14

• a type of adjuvant therapy
• known to improve chance of long term survival
• uses high energy rays to destroy cancer cells that remain in the breast, chest wall, and underarm area after surgery
  
  • also irradiate LNs above clavicle and the internal mammary LNs
• skin over affected area may have rxn similar to sunbrun
• lymphedema is more likely to occur if axillary LNs are treated

Question 15

chemotherapy

Answer 15

• designed to kill the proliferating cancer cells
• combo of drugs and # of tx varies for each woman
• may both precede and follow tumor removal
• often kill normal cells (esp those rapidly dividing like in mucosa, blood cells, and platelets)
  
  • often leads to sore, bleeding gums; susceptibility to infection; loss of head/body hair; menstrual irregularities; anemia (and fatigue)
• antiemetics are often used for woman on chemo

Question 16

hormone therapy

Answer 16

• reduce production of estrogen b/c many tumors are estrogen/progesterone receptor positive
• tamoxifen: estrogen blocking drug
  
  • some tumors become resistant and the drug may actually stimulate their growth
  • may elevate calcium, cholesterol, and triglycerides
• anastrzole, exemestane, and letrozole: aromatase inhibitors which hinder production of estrogen
• raloxifene: estrogen modifier which reduces osteoporosis by blocking estrogen receptors

Question 17

immunotherapy

Answer 17

• trastuzumab (herceptin) is a biologically based therapy that targets cell pathways that promote cancer growth
  
  • some tumore produce excessive amounts of the HER-2 protein which promotes cell growth, but this drug blocks this protein to inhibit growth of cancer cells

Question 18

nursing considerations of breast cancer

Answer 18

• emotional support and accurate info need to be provided to the woman
  
  • woman needs time to express her feelings
  • nurse should be empathetic
• provide a clear understanding of procedures and care to help reduce anxiety
• lymphedema: caused by blockage drainage of lymphatic system in the arm on the side of the mastectomy
  
  • compression arm sleeves help control lymphedema
• discharge teaching: self care and need for continued care/tx
  
  • teach how to reduce risk of infection, how to care for arm on affected side, S/Es post op and from meds,
  • teach how to empty drains

Question 19

amenorrhea

Answer 19

• absence of menses
• normal: before menarche, during pregnancy, during puerperium and lactation, and after menopause
• abnormal: at other times

Question 20

when should mentrual periods begin?

Answer 20

• mentrual periods should begin w/in 2 yrs of breast development
  
  • b/w the ages of 9-15 yo

Question 21

primary amenorrhea

Answer 21

• considered if onset of menstrual periods has not occurred by 16.5 yo, particularly if associated sexual changes have not taken place
  
  • may be suspected if the girl is more than 1 yr older than the ages at which her mother/sisters had menarche
• causes:
  
  • genetic: ovarian failure
    
    • may occur in girl w/ Turner’s Syndrome (X); hormonal imbalances; cancer
  • systemic
    
    • low body weight for height (athletes, eating disorders), chronic stress, hypothyroidism, CNS dz, drug use
• mgmt: depends on cause
  
  • counseling
  • hormone therapy

Question 22

secondary amenorrhea

Answer 22

• cessation of menstruation for 6 mos or more in a woman who had established a pattern of menstruation, or absence for duration of 3 normal cycles
• causes:
  
  • pregnancy
  • systemic dz: DM, TB, hypothyroidism, CNS lesions, hormonal imbalance, poor nutrition, hormonal contraceptives
  • stressors
• tx: tx the cause
  
  • pregnancy test
  • hormone level testing
  • tx of anovulation
  • ID of other abnormalities
    
    • PCOS: characterized by acne, excess weight, body hair

Question 23

nursing considerations w/ amenorrhea

Answer 23

• emotional support
• teaching about adequate nutrition and exercise as well as discouraging rigourous dieting
• weight control may reduce factors related to PCOS

Question 24

abnormal uterine bleeding

Answer 24

• menorrhagia: prolonged or heavy bleeding
• metrorrhagia: bleeding that is irregular and occurs b/w periods
• menometrorrhagia: combo of the previous 2

Question 25

etiology of abnormal uterine bleeding

Answer 25

• pregnancy complications (ie spontaneous abortion)
• anatomic lesions, either benign or malignant, of vagina, cervix, or uterus
• drug induced bleeding, such as breakthrough bleeding that may occur in woman taking hormonal contraceptives
• systemic disorders, such as DM, uterine myomas (fibroids), and hypothyroidism
• failure to ovulate

Question 26

abnormal uterine bleeding: mgmt

Answer 26

• evaluation may include pregnant test, coagulation studies, and test to determine if ovulation is occurring
• hormone and liver function tests as well as tests to determine anemia are done
• U/S may be used to look for polyps
• hormone tx: progestin-estrogen combo oral contraceptives that suppress ovulation and allow a stable endometrial lining to form
• surgical therapy: D&C to remove polyps or to diagnose endometrial hyperplasia
• may use laser ablation to remove the endometrial lining w/o hysterectomy

Question 27

abnormal uterine bleeding: nursing considerations

Answer 27

• encourage women to seek medical attn promptly when irregular or prolonged bleeding occurs
• help woman keep record of bleeding episodes and amount of blood lost
  
  • noting vaginal bleeding and pads/tampons saturated each day
• encourage importance of adequate nutrition and discourages rigorous dieting
• provide support for women who fear that irregular bleeding indicates a serious dz
  
  • but do not offer false reassurance

Question 28

menopause

Answer 28

• the end of mentruation
  
  • climacteric: the entire process of menopause including endocrine, somatic, and psychic changes that occur at the end of the reproductive period
• premenopause: early part of climacteric
  
  • before menstruation but after the woman experiences some of the climacteric S/S like irregular menses
• perimenopause: include premenopause, menopause, and at least 1 yr after menopause
• postmenopause: phase after menopause when menstrual periods have ceased
  
  • unexpected bleeding during this period should be investigated ASAP b/c may indicate endometrial cancer

Question 29

age of menopause

Answer 29

• avg age is 51.5 yrs
• natural climacteric takes place over 3-5 yrs
• menopause can be induced or created artificially at any age
  
  • surgical removal of ovaries or destruction of the ovaries by radiation/chemo causes abrupt cessation of ovarian function
  • most common reason for these procedures is tx of cancer or endometriosis

Question 30

physical changes of menopause: ovulation, estrogen, hot flashes

Answer 30

• ovulation is sporadic and mentrual periods are irregular during premenopause
  
  • eventually ovulation, menstruation, and secretion of ovarian hormones cease
• estrogen declines and organs of reproduction regress
  
  • labia: thin and pale
  • vaginal mucosa: atrophies
    
    • vaginal tissue loses lubrication and dyspareunia is common
    • frequent vaginal infections–>atrophic vaginitis
  • LDL increases and HDL decreases
• hot flashes: result of vasomotor instability
  
  • cause is associated with inc secretion of gonadotropins
  • more frequent at night and fatigue often results

Question 31

physical changes of menopause: testosterone, osteoporosis, heart dz

Answer 31

• decreased testosterone levels:
  
  • changes in libido
  • mood changes
  • sleep changes b/c of dec tryptophan (serotonin precursor)
• osteoporosis risk inc
• heart dz risk inc

Question 32

physical effects on the woman’s body from menopause

Answer 32

• remains orgasmic
• pendulous breasts
• atrophy of ovaries, vagina, and fallopian tubes
• thinning of pubic hair
• labial regression
• vaginal dryness
• smooth, thin mucosa w/ decreased ruggae and elasticity
• vaginal pH inc

Question 33

psychological aspects of menopause

Answer 33

• influenced by:
  
  • the woman’s expectations
  • accurate knowledge
  • general physical well-being
  • family view
  • marital stability
  • socio-cultural expectations
• greater stability = easier transition
• often times menopause brings about coming to terms with aging: no longer can have a child, becoming grandparents
• S/S: mood swings, depression, irritability, agitation, insomina, fatigue

Question 34

recommendations during menopause

Answer 34

• consult HCP about botanical preparations
• maintain/establish adequate nutrition
• use water soluble lubricants
• regular exercise
• kegel exercises
• modest caffeine and alcohol
• drink 8 glasses of H2O

Question 35

therapy for menopause

Answer 35

• hormone replacement therapy (HRT): combination of estrogen and progesterone replacement therapy
  
  • ACOG stopped recommending it in 2002
  • WHI:
    
    • inc risk of breast cancer and heart dz w/ combo of estrogen and progesterone replacement therapy
    • inc risk of strokes w/ estrogen replacement therapy
• contraindications: unexplained uterine bleeding, endometrial cancer
  
  • also smoking, HTN, diabetes, CV dz, renal/liver dz, seizures, migraines, gallbladder/pancreatic dz

Question 36

nursing considerations during menopause

Answer 36

• help women understand the changes that may occur
• edu about risks and benefits of HRT if prescribed
• teach them about the recommendations for uring water soluble lubricants to relieve vaginal dryness and dyspareunia
  
  • do Kegel exercises to counteract genital atrophy
  • drink at least 8 glasses of water/day to dec conc of urine, flushes urine from bladder, and reduces bacterial growth
  • wipe front to back to prevent cystitis

Question 37

osteoporosis

Answer 37

• characterized by dec bone density which leaves the bones porous, fragile, and susceptible to fracture
  
  • fractures most common in vertebrae, wrists, and hips (but also in forearms, feet, toes)
• assoc with lower estrogen and androgen levels

Question 38

risk factors of osteoporosis

Answer 38

• combination of peak bone density and rate of bone loss influences severity of osteoporosis
• small boned, fair skinned white women of northern European descent and Asian women are at greatest risk for osteoporosis
• family hx of dz
• late menarche
• early menopause
• sedentary lifestyle
• smoking, drinking alcohol, consumption of excessive caffeine
• drug intake of cortiocosteroids, some anticonvulsants, or aromatase inhibitors for rbeast cancer may reduce bone density
• inadequate intake of vit D and calcium

Question 39

S/S of osteoporosis

Answer 39

• first noticeable sign is loss of height and back pain that occurs when vertebrae collapse
• later signs include dowager’s hump (when vertebrae can no longer support the upper body in an upright position), waist disappears, abdomen protrudes as rib cage moves closer to the pelvis
• dx requires a hx, exam, and bone mineral analysis

Question 40

DXA bone density scan

Answer 40

• may be recommended if:
  
  • over 50 and have a broken bone
  • you are a woman over 65 or a man over 70
  • yo are in menopause or past menopause and have risk factors
  • you are a man age 50-69 w/ risk factors
• uses low dose x-rays to measure bone density in the hip and spine
  
  • can confirm osteoporosis and detect low density before a frx and predict a frx
  • repeated scans determine rate of bone loss and monitor tx effectiveness

Question 41

prevention of osteoporosis

Answer 41

• dec alcohol, caffeine, smoking
• Fosamax (alendronate) or Bisphosphonate to slow bone thinning and improve thickness
• Evista (raloxifene): prevents/txs and decreases cholesterol
• calcium: 1200-1500 mg/day
• vitamin D: 400-800 units/day
• regular weight bearing/resistance exercise
• diet high in vitamins E, D, and B complex
• protein: 80 grams/day

Question 42

Bisphosphonates

Answer 42

• class of drugs that slows bone thinning and improves thickness
• used to prevent and tx postmenopausal osteoporosis
• may be contraindicated if a woman has an ulcer or dysphagia or esophagitis
• ie Alendronate, Ibandronate, Risedronate, Zoledronic acid
• may inc risk of venous thromboembolism and death from stroke

Question 43

nursing considerations for osteoporosis

Answer 43

• counsel women about lifestyle factors that can cause bone loss: smoking, alcohol, caffeine
• counsel adolescents and young women about factors to promote ideal peak bone density
• prevention of falls
  
  • make environment safe: ample lighting, no loose electrical cords, nonskid backing on rugs, grab bars , handrails

Question 44

S/S of ovarian cancer

Answer 44

• bloating
• pelvic or abdominal pain
• trouble eating or feeling full quickly
• feeling the need to urinate urgently or often
• fatigue
• upset stomach or heartburn
• back pain
• dyspareunia
• constipaion or menstrual changes
• persistent vaginal itching
• blood in stool

Question 45

risk factors for ovarian cancer

Answer 45

• menses started at <12 yo
• no child or first child after 30 yo
• late menopause (>55 yo)
• infertility
• family hx of ovarian, breast, or colorectal cancer
• personal hx of breast cancer

Question 46

prevention of ovarian cancer

Answer 46

• oral contraception
• breast feeding and pregnancy
• tubal ligation
• hysterectomy
• prophylactic oophorectomy

Question 47

ovarian cancer: diagnosis

Answer 47

• pelvic exams
• transvaginal sonography
• CA-125 tests
• BRCA test

Question 48

ovarian cancer treatment

Answer 48

• earliest stage: total abdominal hysterectomy, bilateral salpingo–oophorectomy, removal of ovarian tissue
• surgery followed by chemo
  
  • but sometimes do chemo to reduce tumor’s size, then a hysterectomy or a salpino-oophorectomy

Question 49

Pelvic Inflammatory Dz

Answer 49

• infection of the upper genital tract
• can lead to ectopic pregnancy or infertility
• more likely to develop if under 25 b/c cervix is not mature which inc the susceptibility to infectious organisms
  
  • also inc risk of infection if multiple sex partners
  • douching inc risk for PID b/c canges natural vaginal flora

Question 50

etiology of PID

Answer 50

• most from C. trachomatis and N. gonorrhoeae
  
  • some also caused by E. coli, streptococcus, group B strep. CMV
• organism invades endocervical canal where they cause cervicitis
  
  • the organisms ascend and infect the endometrium, fallopian tubes, and pelvic cavity
• chronic inflammatory response results in tubal scarring and peritubal adhesions which interfere with conception or w/ transport of fertilized ovum thru the obstructed falloppian tubes to the uterus

Question 51

S/S of PID:

Answer 51

• pelvic pain
• fever
• purulent vaginal discharge
• anorexia
• irregular bleeding
• physical exam: abdominal or adnexal (accessory organ) tenderness and tenderness of the uterus/cervix during bimanual exam
• labs:
  
  • leukocytosis: inc WBC
  • inc sedimentation rate
  • positive cultures

Question 52

mgmt of PID

Answer 52

• IV abx–broad spectrum
  
  • cefoxitan
  • cefotetan
  • clindimycin + gentomycin
    
    • usually changed to PO after 48 hrs and total duration of abx is usually 14 days
• laparoscopy can rule out surgical emergencies like appendicitis or ectopic pregnancy and to obtain cultures

Question 53

nursing considerations for PID

Answer 53

• prevent STDs to prevent PID: teach about this and how to prevent
  
  • primary prevention: avoiding exposure to dz or preventing acquisition during exposure
    
    • limiting # of sexual partners, avoid intervourse w/ those who had multiple partners, avoiding high risk behaviors like injectable drugs, condoms
  • secondary prevention: keeping a lower genital tract infection from ascending to the upper genital tract
    
    • seek medical attn promptly, periodic medical assessment, taking meds as prescribed

Question 54

toxic shock syndrome (TSS)

Answer 54

• caused by a strain of S. aureus
• rare, potentially fatal
• toxin alters capillary permeability which allows intravascular fluid to leak from the blood vessels, leading to hypovolemia, hypoTN, and shock
  
  • toxin also causes tissue damage and defects in coagulation
• assoc with high absorbency tampons, cervical caps, diaphragm

Question 55

danger signs of TSS

Answer 55

• suddenly spinking a fever (102 F, 38.9 C)
• siarrhea
• vomiting
• muscle aches, sore throat
• sunburn like rash
• hypoTN

Question 56

nursing considerations for TSS

Answer 56

• tx includes fluid replacement, vasopressor drugs, antimicrobial therapy
• instruct women to:
  
  • tampon use:
    
    • wash hands before insertion
    • change tampons q4 hrs to prevent excessive bacterial growth
    • do not use superabsorbent tampons
    • use pads during hours of sleep
  • diaphragm/cervical cap:
    
    • wash hands
    • do not use during menstrual period
    • remove w/in time recommended

Question 57

cystocele

Answer 57

• occurs when weakened anterior wall of the vagina can no longer support the weight of urine in the bladder, so the bladder protrudes downward into vagina
  
  • results in incomplete emptying of bladder
• cystitis likely to occur
• stress urinary incontinence may occur due to the urethral displacement when the urethra bulges into the anterior vaginal wall

Question 58

enterocele

Answer 58

• prolapse of upper posterior vaginal wall b/w the vagina and rectum
• most assoc with herniation of pouch of Douglas (fold of peritoneum dips down b/w rectum and uterus)
• often accompanies uterine prolapse

Question 59

rectocele

Answer 59

• occurs when posterior vagina becomes weak and thin
  
  • each time woman strains at defecation, feves are pushed against the thin wall and cause further stretching until the rectum protrudes into vagina
• if large, may have problems emptying rectum
• some women facilitate bowel elimination by applying pressure along the posterior vaginal wall to keep rectocele from protruding during bowel movement

Question 60

uterine prolapse

Answer 60

• occurs when cardinal ligaments are unduly stretching during pregnant and do not return to normal
  
  • allows the uterus to sag backward and downward into vagina
• common if woman has had many vaginal deliveries or when infants are large
• significance: when uterus is displaced, it impinges on other structures in lower abdomen
  
  • bladder, rectum, and small intestine can protrude thru vaginal wall

Question 61

symptoms of uterine prolapse

Answer 61

• most obvious during menopausal period
  
  • b/c estrogen diminishes leading to atrophy of the supporting structures
• most common:
  
  • feelings of pelvic fullness
  • dragging sensation
  • pelvic pressure
  • fatigue
  • low backache
  • sexual problems related to arousal, orgasm, and painful vaginal intervourse

Question 62

mgmt of uterine prolapse

Answer 62

• tx depends on woman’s age, physical condition, sexual activity, and degree of prolapse
• surgery may be needed
• pessary: device to support pelvic structures that is inserted into the vagina
  
  • must be inspected and changed frequently

Question 63

nursing considerations for uterine prolapse

Answer 63

• PFMT (kegel exercises): isometric, contract and relax slowly 8-12 times for 6-8 sec each and do 3 sets
  
  • should not tighten muscles of abdomen, thighs, and buttocks
  • exhale and keep mouth open and avoid bearing down
  • continue for rest of life
• evaluate urinary incontinence: can be stress or urge
  
  • overactive bladder may also occur and is accompanied by sensations of urgency and nocturia
  • may need bladder training
  • do not restrict fluid
  • weight mgmt
  • limit caffeine and alcohol
  • skin care
  • social isolation

Question 64

4 types of hysterectomies

Answer 64

• partial hysterectomy: only uterus removed
• total hysterectomy: both uterus and cervix are removed
• total hysterectomy w/ bilateral salpino-oophorectomy: both ovaries, fallopian tubes, uterus, and cervix are removed
• radical hysterectomy: both ovaries, fallopian tubes, uterus, cervix, and LNs are removed

Question 65

STIs

Answer 65

• can have an STI and not know it
• can know about an STI and not be honest
• genital skin/genital skin contact, oral/genital skin contact, oral/anal contact, blood, sexual fluids can spread an STI
• latex condoms are very effective
• abstinence and mutual monogamy w/ an uninfected partner is ideal

Question 66

Trichomoniasis

Answer 66

• protozoan
• thrives in an alkaline environment
• S/S: purulent vaginal discharge that is thin or frothy, malodorous, and yellow-green or brownish gray
  
  • pH of discharge is usually greater than 4.5
  • vulvar itching, edema, and redness may occur
• tx: metronidazole
  
  • 2 g in a single oral dose
  • avoid alcohol while on medication and for 24 hours after last dose
  • sexaul partners should refrain from intercourse until cure is established

Question 67

Bacterial Vaginosis

Answer 67

• normal flora replaced
• tissue trauma and vaginal intercourse may be contributing factors
  
  • as well as multiple partners, douching, and lack of vaginal lactobacilli
• S/S: thin, grayish white vaginal discharge w/ a fishy odor
• tx: based on re-establishing normal flora
  
  • metronidazole: can relieve symptoms and improve vaginal flora
  • clindamycin: alternative
  • refrain from sexual intercourse until cured and use a condom

Question 68

chlamydia trachomatis

Answer 68

• most common STD
  
  • most common in sexually active teens and young adults
• often asymptomatic in young women
  
  • should be suspected if male partner is treated for nongonococcal urethritis and when culture for gonorrhea is negative, but woman has symptoms similar to gonorrhea
• if untreated, can ascend and scar fallopian tubes–>PID, infertility, ectopic pregnancy
• tx: eradicate both chlamydia and gonorrhea
  
  • azithromycin, doxycycline, ofloxacin, levofloxacin, erythromycin
  • treat al sexual partners
  • must use condom until cured

Question 69

Gonorrhea

Answer 69

• caused by neisseria gonorrhea
• often asymptomatic in women
  
  • S/S: purulent discharge, dysuria, dyspareunia
• assoc with PID (inc risk of infertility and ectopic pregnancy)
• tx: can use the same drugs as chlamydia tx as well as ceficine, ceftriaxone, and ciprofloxacin
  
  • tx all sexual partners and avoid intercourse and wear condom until cure established

Question 70

syphilis

Answer 70

• caused by Treponema pallidum
• Primary: painless chancre usually on genitals or lips
  
  • highly contagious
• Secondary: occurs 2 mos after initial infection
  
  • enlargement of spleen and liver, skin rash, HA, anorexia, skin rash, skin eruptions on vulva
• Latent: for several years
• Tertiary: follows latent phase and may involve the heart, blood vessels, and CNS
  
  • general psychosis and paralysis may result
• lab tests: Venereal dz Research Lab (VDRL) serum test to check for antibodies; rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) confirm a positive VDRL
• penicillin G is most effective

Question 71

herpes genitalis

Answer 71

• caused by HSV: type 1 and 2
  
  • type 1: oropharyngeal infection
  • type 2: genital lesions
• transmission thru direct contact w/ infected person
• w/in 2-12 days after primary infection, vesicles (blisters) cluster on genitals
  
  • may cause severe pain, tenderness, dyspareunia, and flulike symptoms
  • when symptoms abate, virum remains dormant in nerve ganglia and reactivates in times of stress, fever, and menses
• no cure exists by antivirals help reduce/suppress symptoms, shedding, and reoccurrence (acyclovir)
  
  • abstain from sex during times of active lesions
  • C/S if blister present

Question 72

human papilloma virus (HPV)

Answer 72

• genital warts
• dry, wart like growths may be small and discrete, or they may cluster and resemble cauliflower
  
  • most commonly on vulva, vagina, cervix, or anus
• assoc with cervical cancer, so need frequent pap smears
• tx: goal is to remove warts to prevent transmission
  
  • topical tx: podophyllin, TCA, and BCA
  • cryotherapy (extreme cold)
  • laser vaporization
  • all sexual partners must be treated and sexual contact should be avoided if lesions are present
    
    • use a condom to reduce transmission

Question 73

candidiasis

Answer 73

• moniliasis and yeast infections are the most common forms
• cause is related to a change in vaginal pH that allows accelerated growth of Candida albicans
  
  • change in pH likely with pregnancy, DM, OC use, abx, spermicide
• more common in sexually active women although not a STD
• male partners may experience erythema and itching of the glans penis
• S/S: vaginal and perineal itching, vulvar and vaginal tissue are inflamed and cause burning on urination, white “cottage cheese” discharge
• tx: butoconazole, miconazole, clotrimacole, terconazole, tioconazole
  
  • most nonprescription meds are used for 3-7 days
  • oral fluconazole can be used w/ prescription
    
    • if severe, then may need another dose in 4 days
• recurrent yeast infections that resist tx are assoc with DM and HIV infection