EXAM 2 Flashcards
(149 cards)
1
Q
first line tx for persons without cognitive impairments who present with urge incontinence:
A
pelvic floor muscle exercises
bladder retraining
2
Q
Pharmacological therapy with _______ is an option for tx urge incontinence if behavioral therapy is unsuccessful; b/c of adverse effects, these agents are not recommended in _____
______
A
anticholingergics
older adults
3
Q
most common types of urge incontinence in women:
A
urge, stress and mixed
less common: overflow and functional
4
Q
overflow incontinence is often caused by adverse effects of ________ drugs or by _____ ______ innervation from neurologic dx
A
anticholinergic
impaired detrusor
5
Q
what kind of UI?
s/s: loss of urine accompanied or preceded by strong desire to void; may be accompanied by frequency and nocturia
- most common is older adults with a strong association with stroke
A
urge incontinence
6
Q
what kind of UI?
s/s: loss of urine with physical exertion or increases in intr- abdominal pressure ( sneezing, coughing, laughing)
- most common in younger women, second more common type in older adults
A
stress incontinence
7
Q
conservative mgmt of urge incontinence:
A
weight loss; fluid reduction; constipation management; bladder training; pelvic floor muscle exercises; electrical stimulation of the posterior tibial nerve
8
Q
pharmacological mgmt of urge incontinence:
A
anticholinergic drugs
beta adrenergic agonists
botox
intravaginal estrogen
9
Q
surgical mgmt of urge incontinence:
A
neuromodulation ( implanted sacral nerve stimulation)
10
Q
conservative mgmt of stress incontinence:
A
weight loss, smoking cessation, fluid reduction, constipation mgmt, pelvic floor muscle exercises, extracorporeal magnetic innervation, electrical stimulation, mechanical devices ( pessary, urethral plugs)
11
Q
pharmacologic stress incon. mgmt:
A
alpha adrenergic agonists
cymbalta
12
Q
surgical mgmt of stress incontinence:
A
sling procedures
(suburethral sling with tension free vaginal tape, pubovaginal sling, midurethral sling)
urethropexy
periurthral injections of bulking agents
13
Q
natural menopause occurs around ___ years old
A
52
14
Q
premature menopause describes menopause before age ___
A
40
15
Q
metorrhagia
A
irregular cycles with heavy, prolonged flow
16
Q
oligomenorrhea
A
long cycles with scant flow
17
Q
polymenorrhea
A
short cycles with regular flow
18
Q
diff dx for dysfunctional uterine bleeding in non - pregnant women
A
trauma: blunt force, penetrating force, foreign bodies
infectious: vaginitis, cervicitis, endometritis
DUB: ovulatory, anovulatory, andenomyosis
benign growths:
uterine leiomyomas, cervical polyps
malignancy: vulvar, cervical, uterine, ovarian,
systemic dx: weight loss, stress, excessive exercise, hypothyroid, hyperthyroid, hyperprolactinemia, liver failure, renal failure
medications: anticoags, antipsychotics, corticosteroids, tamoxifen, SSRI’s, metformin
contraceptives
19
Q
adenomyosis
A
endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus. The displaced endometrial tissue continues to act as it normally would — thickening, breaking down and bleeding — during each menstrual cycle. An enlarged uterus and painful, heavy periods can result.
20
Q
Dysfunctional uterine bleeding diagnostics, start with:
A
pregnancy test & CBC
inspect perineum, speculum exam including pap smear and cervical cultures,
bimanual exam
rectal exam
if H&P don’t point toward medical or infectious cause, source of bleeding not identified:
US and gyn consult
21
Q
structural causes of AUB:
A
polyp
adenomyosis
leiomyomas
malignancy and hyperplasia
22
Q
non structural causes of AUB:
A
coagulopathy
ovulation dysfunction
endometrial
iatrogenic
23
Q
types of fibroids
A
submucosal: under the lining of the womb, can grow on stalk ( pedunculated)
intramural: within the wall of the womb, most common type, may distort the uterine cavity or cause irregular external uterine contour
subserosal: on the outer wall of the uterus and usually causes no s/s till it grows large enough to cause interference to adjacent organs, sometimes they have stalk.
24
Q
failure to menstruate by age 14 w/out sex characteristics or 16 with sex characteristics is:
A
amenorrhea
secondary amenorrhea: pregnancy is #1 reason
lack of menstrual cycles for 3 or more months in a female who has achieved menarche
25
evaluation of amenorrhea:
Urine HCG - #1
CMP, TSH, FSH, LH, prolactin
testosterone, DHES for androgen excess ( look for associated physical changes)
progesterone challenge to eval for outflow integrity and pituitary gonadal function( if bleeding occurs, consider an ovulation as cause, if no bleeding, consider low estrogen)
26
amenorrhea tx:
if progesterone challenge neg: oral estrogen /progesterone
if challenge pos: adequate estrogen - administer progesterone for 10 days each month to prompt cycle
consult with GYN/endocrinology
27
eval for menorrhagia:
```
CBC including platelets
coags ( PT/INR, PTT and LFTS)
TSH
transvaginal ultrasound for fibroids
endometrial biopsy especially is > 35 or risk for hyperplasia, PCOS, endometriosis, adenomyosis
```
28
UA results: heavy proteinuria and lipiduria indicate?
nephrotic syndrome
29
UA results: hematuria with dysmorphic RBC's, RBC casts and proteinuria is indicative of?
glomerulonephritis
30
UA: pigemented granular casts ( muddy brown casts) and renal tubular epithelial cells alone or in casts suggest?
acute tubular necrosis
31
UA with WBC's ( including neutrophils and eosinophils) ,WBC casts, RBC's and small amounts of protein suggest?
interstitial nephritis and pyelonephritis.
32
proteinuria is excessive protein in excretion in the urine, greater than _______ mg/24h in adults
150-160
33
proteinuria of more than 1g/day=
| less than 1g/day=
glomerular in origin
multiple causes along nephron segment
34
functional proteinuria: benign process stemming from stressors such as:
acute illness, exercise, "orthostatic proteinuria"
35
overload proteinuria causes:
results from overproduction of circulating, filtrable plasma proteins or myoglobinuria in rhabdomyolysis OR hemoglobinuria in hemolysis
36
glomerular proteinuria is seen in:
diabetic nephropathy
increased permeability of albumin across a damaged GBM
results from effacement of epithelial cell foot processes and altered glomerular permeability with an increased filtration fraction of normal plasma proteins
37
tubular proteinuria causes:
acute tubular necrosis, toxic injury, drug induced interstitial nephritis, hereditary metabolic disorders
results from faulty reabsorption of normally filtered proteins in the proximal tubule
38
hematuria is significant if:
there are more than three red cells pre high power field on at least two occasions
39
most common extraglomerular sources of hematuria:
cysts, calculi, interstitial nephritis and renal neoplasia
40
glomerular causes of hematuria:
IgA nephropathy, thin GBM dx, membranoproliferative glomerulonephritis, systemic nephritic syndromes, hereditary glomerular dx
41
The GFR measures the ____________ ultra filtered across the glomerular capillaries and correlates with the ability of the kidneys to ________
amount of plasma
filter fluids and various substances
42
GFR in normal individuals is usually:
100-120
43
unexplained acute kidney injury or CKD, acute nephritic syndromes, unexplained proteinuria and hematruria, previously identified and treated lesions, SLE and other systemic dx associated with kidney dysfunction, suspected transplant rejection all indicate need for:
percutaneous needle biopsy
44
essential of dx of acute kidney injury:
rapid increase in serum creatinine
oliguria can be associated
s/s depend on cause: pre renal, intrarenal, post renal
45
pts with acute kidney injury of any type are at a _______ for all cause mortality, whether or not there is _______
higher risk
substantial renal recovery
46
essential of dx of acute tubular necrosis
acute kidney injury
ischemic or toxic insult with underlying sepsis
urine sediment with pigmented granular casts and renal tubular epithelial cells is pathognomic but not essential
47
prerenal causes are the most common of acute kidney injury, and due to:
renal hypoperfusion
48
decreased renal perfusion can be caused by:
a decrease in intravascular volume, a change in vascular resistance, low cardiac output
49
causes of volume depletion leading to decreased renal perfusion:
hemorrhage, GI losses, dehydration, excessive diuresis, extravascular space sequestration, pancreatitis, burns, trauma, peritonitis
50
changes in vascular resistance leading to decreased renal perfusion:
sepsis, anaphylaxis, anesthesia, after load reducing drugs, renal artery stenosis
51
low cardiac output is a state of ______ renal arterial blood flow. this occurs in states of:
low effective
cardiogenic shock
heart failure,
pulmonary embolism, pericardial tamponade, arrhythmias, valvular disorders
52
BPH is the _______ of the prostate ( not associate with or a precursor to cancer) that can lead to ________, likely as the result of an enlargement in _______ and an increase in the number of __________
enlargement
bladder outlet obstruction
prostatic connective tissue
epithelial and smooth muscle cells
53
In BPH, bladder detrusor ____ occurs as a result of difficulty emptying bladder with increased bladder outflow obstruction
hypertrophy
54
chronic incomplete bladder emptying causes _____ and predisposes to _______ and _____ with secondary inflammatory changes including ______
stasis
calculus formation and infection
prostatitis and UTI
55
DX of BPH:
digital rectal exam : prostate is enlarged, rubbery and has lost median sulcus
UA to rule out infection/other dx
postvoid residual test, transracial ultrasound, prostate biopsy
56
a systematic eval for ________ must be done on any man who has an abnormal prostate exam with or without urinary s/s
prostate cancer
57
BPH s/s:
increased frequency of urination, decreased force of stream, nocturia, sensation of incomplete emptying, urinary urgency, hesitancy, a need to strain or push to initiate or maintain urination to more fully empty the bladder
58
drugs with _______effect can cause acute urinary retention in men with BPH, as can _____ and _____
anticholinergic ( tricyclic antidepressants, antihistamines)
opioid use and inactivity
59
caffeine, alcohol and artificial sweeteners are all ______ that can worsen _________
bladder irritants
urinary frequency
60
BPH tx:
tamsulosin ( Flomax), alpha 1 receptor antagonists
5 alpha reductase inhibitors: finasterid (proscar) dutasterid ( avodart)
Cialis - phosphodiesterase inhibitor ( this cannot be taken with alpha blockers or nitrates)
61
surgical intervention for BPH:
transurethral resection of the prostate
open prostatectomy
minimally invasive thermal and laser interventions
62
herbal/nutritional NPH therapy:
saw palmetto, rye, pumpkin
63
fibrocystic condition of breast is a _____ breast disorders with the following characteristics:
benign
painful, often multiple, usually bilateral masses in the breast
rapid fluctuation in the size of the masses in common
frequently, pain occurs or worsens and size increases during premenstrual phase of cycle
most common age is 30 -50 yrs, rare in postmenopausal women not receiving hormonal replacement.
64
diagnostics for mass in pt with fibrocystic condition:
mammography and ultrasonography
ultrasonography alone can be used in pts under 30
suspicious lesions should be biopsied with fine needle aspiration cytology. if mass nonmalignant on cytology doesn't resolve over several months, excise or biopsy with core needle
65
fibrocystic mass tx:
pt with previous dx of fibrocystic or classic presentation: aspiration of cyst to alleviate pain and confirm diagnosis.
wear supportive bra
66
if on aspiration of fibrocystic mass no fluid is obtained, fluid is bloody, mass persists or recurrs after aspiration, then:
biopsy should be performed
67
a typical fibroadenoma of the breast is:
round or ovoid, rubbery, discrete, relatively movable, nontender mass 1-5 cm in diameter.
it is a common benign neoplasm occurring most frequently in younger women, usually within 20 yrs of puberty
68
dx of fibroadenoma:
needle biopsy or cytologic exam
69
in non pregnant, non lactating women serous nipple discharge often means:
most likely benign FCC ( fibrotic cyst changes) such as duct ectasia
70
in non pregnant, non lactating women bloody nipple discharge often means:
more likely to be neoplastic, papilloma, carcinoma
71
in non pregnant, non lactating women unilateral nipple discharge often means:
either neoplastic or non neoplastic
72
in non pregnant, non lactating women nipple discharge and an associated mass often means:
more likely neoplastic
73
in non pregnant, non lactating women milky nipple discharge often means:
endocrine disorders, medications
74
in non pregnant, non lactating women nipple discharge related to menses, premenopausal and/or taking hormones often means:
Fibrocystic breast
75
post renal causes of acute kidney injury occur when obstruction leads to _______, causing kidney parenchymal damage, with marked effects on ________ and _______ and a decrease in _____
elevated intraluminal pressure
renal blood flow and tubular function
GFR
76
post renal causes of acute kidney injury:
urethral obstruction, bladder dysfunction or obstruction, obstruction of both ureters or renal pelvises.
in men, BPH is most common cause.
can also be caused by cancer, retroperitoneal fibrosis, neurogenic bladder.
77
post renal acute kidney injury s/s:
pts may be anuric or polyuric, may complain of lower abdominal pain.
on exam, pt may have enlarged prostate, distended bladder, or detectable mass
labs may show high urine osmolality, low urine sodium, high BUN: creatinine ratio.
78
intrinsic acute kidney injury sites:
tubules, interstitial, vasculature and glomeruli
79
most common type of intrinsic acute kidney injury:
acute tubular necrosis
80
most likely cause of acute tubular necrosis:
```
ischemic insult ( prolonged hypotension, hypoxemia, volume depletion, shock, sepsis)
toxic insult ( aminoglycosides: streptomycin is least nephrotoxic, gentamicin and tobramycin equally nephrotoxic; amphotericin B after a dose of 2-3 g; vancomycin, IV acyclovir, cephalosporins; contrast dye; cyclosporine
```
underlying sepsis
81
characteristics of interstitial nephritis:
fever, transient maculopapular rash; acute/chronic kidney injury; pyuria, WBC casts, hematuria
82
characteristics of glomerulonephritis:
hematuria, dysmorphic red cells, red cells casts, mild proteinuria
dependent edema and HTN
acute kidney injury
83
Uremia, the build up of metabolic waste products, can result in uremic syndrome, the s/s of which are:
fatigue and weakness; anorexia, N/V, metallic taste in mouth, irritability, memory impairment, twitching, insomnia, restless legs, paresthesias, decreased libido and menstrual irregularities
84
s/s of uremia warrant ________ and _________for initiation of dialysis
immediate hospital admission
nephrology consult
85
metabolic bone dx of CKD is seen as early as stage three and usually has the following pattern:
hyperphosphatemia, hypocalcemia, hypovitaminosis D, resulting in secondary hyperparathyroidism. This can lead to vascular calcification, increasing risk for CVD.
86
in men younger than 35 yrs, epididymitis is usually caused by:
C. trachomatis
| or N. gonorrhoeae
87
in men older than 35 yrs, epididymitis is usually caused by:
secondary to prostatitis and due to gram neg organism
88
s/s of epididymitis:
irritative voiding symptoms; fever; acutely painful, enlarged epididymus; urethritis, scrotal swelling and penile discharge. pain often radiates up the spermatic cord to the ipsilateral lower and.
89
Prehn sign:
a reduction in pain when the scrotum is elevated above the symphysis pubis
noted in pts with acute epididymitis
90
Gonorrhea, one of the most common STIs, has a incubation period of:
1 to 5 days
91
s/s of gonorrhea infection in men:
dysuria with a milky, occasionally blood tinged penile discharge.
however, men are often asymptomatic
92
tx for uncomplicated gonorrhea infection
single dose ceftriaxone 250 mg IM plus either single dose azithromycin 1g PO or doxycycline 100 mg PO bid x 7 days
93
most common cause of bacterial prostatitis in older men:
E. Coli and pseudomonas
94
most common cause of bacterial prostatitis in younger men or men at risk for STIs:
gonorhea, chlamydia or both
95
white, pigmented or thickened vulvar or vaginal lesions should be ______ to obtain an accurate diagnosis and rule out_______
biopsied
pre/malignant condition
96
skin changes associated with menopause include:
decreased skin thickness and elasticity, loss of collagen, increased laxity and wrinkling
97
combined HT started after age ___ increase the risk of dementia
65
98
while working up a non pregnant patient with secondary amenorrhea, the prolactin serum assay results show a level of 29 ng/ml. appropriate mgmt would include:
referring to an endocrinologist
levels higher than 20 ng/ml indicate need to refer
All of these women should be screened for thyroid disease because hypothyroidism can sometimes cause hyperprolactinemia
99
Initial laboratory testing for women with amenorrhea without hyperandrogenism should include:
serum prolactin (PRL), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH) to test for hyperprolactinemia, ovarian failure, and thyroid disease, respectively.
100
In cases of secondary amenorrhea, If there is clinical evidence of hyperandrogenism (hirsutism, acne, scalp hair loss [alopecia]), ________should be measured in addition to the initial laboratory tests.
serum total testosterone
101
In cases of secondary amenorrhea,women with normal serum PRL and TSH, a low or normal serum FSH concentration, and no history of uterine instrumentation are likely to have:
a hypothalamic-pituitary disorder or PCOS.
102
Hypothalamic amenorrhea can also be seen with systemic illness such as:
as celiac disease and type 1 diabetes mellitus
103
A high serum follicle-stimulating hormone (FSH) concentration indicates:
POI, formerly referred to as premature ovarian failure.
104
The overall goals of management in women with secondary amenorrhea include:
Correcting the underlying pathology, if possible
●Helping the woman to achieve fertility, if desired
●Preventing complications of the disease process (eg, estrogen replacement to prevent osteoporosis)
105
Women with primary ovarian insufficiency (POI) should receive:
estrogen therapy for prevention of bone loss.
This can be either an oral contraceptive (if the patient is having intermittent ovarian function and does not wish to become pregnant) or replacement doses of estrogen and progestin.
106
31 y/o F with hx of long distance running has 9% body fat, which of the following findings would an NP expect?
A)Regular menses and a basal body temperature that indicates lack of ovulation
B)Regular menses and a basal body temperature that indicates ovulation
C) Irregular menses and basal body temperature that indicates ovulation
D)Irregular menses and a basal body temperature that indicates lack of ovulation
D)Irregular menses and a basal body temperature that indicates lack of ovulation
14% body fat is considered adequate for reg menses and ovulation. A woman with less than 10% body fat will ovulate and menstruate very irregularly or not at all.
107
A 19 y/o female patient is requesting to start on Depo-Provera injections as her method of birth control. She informs you that she has had four sexual partners in the past year. Her last menstrual period was 12 days ago and she had unprotected intercourse 3 days ago. The most appropriate management for this patient would be to:
A) Advise her to use another method of birth control for now and to return to the clinic at the start of her next menses to start the Depo-Proveram provide counseling on sexually transmitted diseases.
B)Perform a qualitative pregnancy test, with negative results administer Depo-Provera 150mg IM, provide sexually transmitted disease education.
C)Administer Depo-Provera 75mg IM and educate the patient on the use of condoms.
D)Administer Depo-Provera 150mg IM and counsel the patient on sexual transmitted diseases.
Advise her to use another method of birth control for now and to return to the clinic at the start of her next menses to start the Depo-Proveram provide counseling on sexually transmitted diseases.
Correct answer as Depo must be administered within 5 -7 days of the onset of menses, it can be given after the 7th day but this patient had unprotected intercourse and pregnancy could have occurred which disallows it being given at this time.
108
A 20 y/o patient is seeing the nurse practitioner for their wellness physical and informs you that she is newly married and does not want to become pregnant. She is using the basal body temperature method of birth control and asks you to confirm when she should avoid unprotected intercourse. The most appropriate response by the nurse practitioner would be:
A)Whenever her BBT is elevated
B)From the end of her menstrual cycle until the BBT has been low for 5 days
C)Whenever the BBT is elevated then lowers
D)From the beginning of the menstrual cycle until the BBT has been slighlty increased for 1-3 days
From the beginning of the menstrual cycle until the BBT has been slighlty increased for 1-3 days
109
The nurse practitioner is seeing a 18 year female for their wellness physical and first pap smear. During the encounter the patient asks the NP what can HPV (Human papillomaviris) cause?
The nurse practitioners best response is:
A)If a person would contract this and it is not treated it can lead to infertility
B)If a person would contract this and it is not treated it can lead to the development of Herpes Simplex II
C)If a person would contract this and it is not treated it can cause cervical dysplasia
D)If a person would contract this and it is not treated it can cause molluscum contagiosum.
If a person would contract this and it is not treated it can cause cervical dysplasia
HPV can lead to the development of of genital wars which can cause cervical dysplasia and cervical cancer
110
A 70-year-old female patient visits the adult nurse practitioner for a yearly evaluation. Which physical examination finding receives the highest priority for immediate treatment?
A)Atrophy of vaginal rugae
B)Pessary in place
C)Cystocele present
D)Palpable ovary
Palpable ovary
Ovaries at this age should not be palpable, A palpable ovary at this age is worrisome for ovary cancer
111
Mary, age 50, desires hormone replacement therapy (HRT) for her hot flashes, which she can't stand. You've discussed the pros and cons and given her some alternative suggestions. Her mother had a history of osteoporosis. You have decided to initiate therapy for 1 year. She asks you if she also needs to take calcium or vitamin D for prevention of osteoporosis. How do you respond?
A) “If you are getting sufficient exercise, you don't need to take calcium and vitamin D.”
B)“Research has shown that HRT alone is sufficient to protect against osteoporosis.”
C)“Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption.”
D)“If you decide to take calcium and vitamin D, you can stop the HRT.”
“Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption.”
Prevention includes the HRT along with Ca+ and Vit D supplement ( as listed in this answer) and exercise
112
The nurse practitioner is seeing a 21 y/o female who is taking an oral contraceptive (OC). She complains of having acne breakouts on her current pill forumuation. How should you adjust the estrogen in the OC?
Increase the estrogen content.
| It is most appropriate to increase the estrogen amount the the OC to counteract the progestin effects
113
The patient that you are seeing for their yearly health visit inquires about why she needs progesterone in addition to her estrogen for hormone replacement?
The nurse practitioner responds that "women who have an intact uterus need to add progesterone to their prescribed estrogen because progestin:
reduces the incidence of endometrial hyperplasia and cancer
114
The majority of breast carcinomas are found in which anatomical site in the breast?
in the upper outer quadrant
60% are found in the outer quadrant
115
Chronic kidney dx is defined as:
GFR < 60 for 3 months with/without kidney damage
OR
kidney damage for 3 months, with/without decreased GFR, manifested by either
116
a case finding approach to screening for CKD is suggested. This means:
and who should be tested?
testing for CKD only in people at increased risk
hx of DM, HTN, CVD, HIV, Hep C, virus infection, malignancy, autoimmune dx, nephrolithiasis, recurrent UTIs
aboriginal
fam hx of CKD
sickle cell trait
chronic tx with potentially nephrotoxic drugs ( lithium, PPIs, NSAIDs).
117
tests to screen for CKD:
urine test for albumin
blood test for creatinine
renal ultrasonography for select individuals such as those with a family hx of polycystic kidney dx
118
a rapid increase in creatinine from 0.8 to 1.2 within 8 hrs represents:
AKI
119
a change in creatinine from 0.9 to 1.4 is about _____ loss of kidney function
50%
120
patients that require assessment for complications of decreased GFR include:
moderately ( stage 3) or severely ( stage 4) decreased GFR
risk factors for faster decline in GFR
CVD
proteinuria
hematuria
consultation and or co mgmt with kidney dx care team during stage 3 is recommended, as is referral to nephrologist at stage 4.
121
info to send with referral to nephrologist for CKD pt:
medication hx
exam
urine dipstick result for hematuria and quantization of proteinuria
blood tests: CBC, urea, electrolytes, HbA1c if diabetic; if available, Calcium, albumin, phosphate, cholesterol
previous tests of renal function with dates
imaging: renal ultrasound
122
commonly prescribed drugs that should be renal dosed in CKD:
DM meds
HTN meds
Cholesterol meds
Abx
antidepressants
analgesics
123
JNC recommendation for tx of HTN in pts with CKD:
ACE1 and ARB
124
if a pt decides he wants to be screened for prostate cancer, PSA tests should be done at intervals ranging from every __ to __ yrs
2 -4
125
if a pt decides he wants to be screened for prostate cancer,
stop screening after age __ or earlier when comorbities limit life expectancy to less than __ yrs or the pt decides they want to stop screening
69
10
126
long term calcium supplementation is recommended in postmenopausal women as its use reduces the risk of fracture by about:
50 %
127
the typical HT regimen contains_____ or less of the estrogen dose of COC
1/4
128
phytoestrogens are:
chemical substances similar to estrogen, in particular estrodiol, that are found in more than 300 plants including apples, carrots, coffee, potatoes, yams, soy products, flaxseed, ginseng, bean sprouts, red clover sprouts, sunflower seeds, rye, wheat, sesame seed, linseed, black cohosh and bourbon
129
which body area has the greatest concentration of estrogen receptors?
vulva
130
average age of onset of perimenopause:
40 -45 yrs
131
during asymptomatic HSV2 infections, genital shedding of virus occurs approximately ____ % of days
10%
132
which agent is most effective against C. Trichomatis?
azithromycin
133
tx of vulvovaginitis caused by candida albicans includes:
clotrimazole cream
134
annual screening for C. Trachomatis infection is recommended for
sexually active women 25 yrs of age and younger
135
guidelines recommend considering initiating tx with an ESA for pts with CKD and hg of :
less than 10 mg/dL
136
creatinine is best described as:
a product related to skeletal muscle metabolism
137
creatinine clearance usually ________ GFR
approximates
138
ACEI can limit the progression of some forms of renal dx by:
reducing efferent arteriolar resistance
139
what is azotemia?
elevation of BUN and creatinine levels
140
renal failure associated electrolyte imbalances
hyperkalemia
hyperphosphatemia
hypocalcemia
bicarbonate deficiency(metabolic acidosis)
141
the use of which medications can precipitate acute renal failure in a pt with bilateral renal artery stenosis?
ACEI
| ARBs
142
if Urine sodium is low, urine osmolality is high, elevated BUN, normal serum creatinine, dx is:
pre renal azotemia
143
if urine sodium is low, urine osmolality is high, BUN and Cr are WNL, dx is:
post- renal azotemia
144
urine sodium high, urine osmolality is low, BUN: Cr is low, dx:
intrarenal injury
145
dx confirmation of glomerulonephritis confirmation requires a ______
kidney biopsy
146
in children and the elderly, ________ can contribute to bladder instability and increase the risk of a UTI
constipation
147
hemorrhagic cystitis is characterized by ______ voiding symptoms
irritative
148
the most likely causative organism in community acquired UTI in women of child bearing years is:
E. Coli
149
most common form of incontinence in elders, caused by detrusor overactivity causing uninhibited bladder contractions
urge incontinence
