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NURS 522 final exam > Final exam questions > Flashcards

Final exam questions Flashcards

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1
Q

Describe the role of FSH and LH in male fertility

A

FSH and testosterone is required for spermatogenesis. LH is required for testosterone secretion

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2
Q

Describe the role of FSH and LH is female fertility

A

FSH is required to grow the follicle, LH is required for ovulation. estrogen is released from the ovary during follicular stage whereas LH is required for progesterone release from the corpus luteum

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3
Q

Describe the steps of PSA follow up based on the lab results

A

PSA <1 = 4 years repeat
PSA 1-3 = 2 years repeat
PSA >3 = More frequent testing

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4
Q

When do you stop PSA testing

A

6o yrs and a PSA of < 1
70yrs old
within 10 years of life expec

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5
Q

Define primary amenorrhea

A

no menarch by 16 years
no secondary sexual characteristics by 14 years
no menarch after 1 year of tanner stage 5

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6
Q

pneumoic for tanner stages in girls

A

No body elevates 2 mountains in adulthood
Breast: none, bud, elevated, 2 mounds, adult
Shes not a small cat
Pubic Hair: none, small, course and curley, adult, thighhs

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7
Q

What are the causes of gynecomastia

A
  1. Homrmone imbalance - resolution in 3 years
  2. If occurs before puberty refer to pediatrican
  3. Can be causes by anabolic steroids, kelienfelter syndrome, MJ
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8
Q

Differential for male infertility

A

Pre testicular:

Post testicular:

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9
Q

What is primary dysmenorrhea

A

Pain in the absence of pathology

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10
Q

What is secondary dysmenorrhea

A

Pain secondary to pathology such as endometriosis etc

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11
Q

Mifegymiso use

A

7-9 weeks - currently 63 days (looking to stretch to 70 days)
u/s for dates
Combination of mifepristone and misoprostol

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12
Q

Most common cause of urinary incontinence in men

A

BPH
Followed by neurogenic
Medication

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13
Q

Name 3 PDE5 medications and their dose and schedule

A

Sidinafil - 1hr before sex, 50-100mg lasts 4 hrs
Vardinafil same as sidniafil, 10-20mg, same as sidinafil
Tadinafil - long duration, take 60mins prior, 10-20mg. or daily 2.5-5mg

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14
Q

What medications can cause urinary concerns in men

A

Allergy, seditives, antichologenics, cardiology, psych meds

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15
Q

PDe5 ihhibitor side effects

A

Most common is headache. Contraindicates in nitrate use (must wait 24-48hrs), with unstable hypertension, cardiac, may cause hypertension with alpha antagonists (BPH)
Side effects, blue vision, hearing loss

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16
Q

Treatments for primary dysmenorrhea

A

NSAIDs - 2-3 days prior to onset of pain and first couple of days of menses
Combined OC or progesterone IUD

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17
Q

Symptoms for endometriosis

A

Deep pain, lower back pain, chronic pelvic pain

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18
Q

What investigations can be used for suspected endometriosis

A

Use U/S to rule out ovairian cysts and fibroids

GOld standard is laproscopty

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19
Q

Endometrial medical management

A

1st line is OCC or progestine (5-20mg OD 50% get break through bleeding or depo provera
2nd line is mirena

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20
Q

What investigations can be used for suspected endometriosis

A

Use U/S to rule out ovarian cysts and fibroids

GOld standard is laproscopty

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21
Q

Endometrial medical management

A

1st line is OCC or progestin (5-20mg OD 50% get break through bleeding or depo Provera
2nd line is mirena

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22
Q

Fibroid medical management

A
  • IUD
  • GnRh agonist - shrinks but will grow back within 12 months
  • Selective progesterone eg ulipristal acetate
  • Oral contraceptive
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23
Q

Differential for Female infertility

A

CUP - O
Cervical, strictures
Ovulatory - PCOS, POF, prolactinoma, thyroid, cusihings
peritoneal - endometriosis
Uterine/tubal - PID, adhesions, previous etcopic, fibroids

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24
Q

Differential for male infertility

A

Testicular - Varicoseal (most common), post infections lesions, post infection reduction infertility (mumps), Klienfelter, previous

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25
What is Klinefelter syndrome
Primary hypogonadism, often associated with gynecomastia, being tall, more adipose, reduced fertility
26
what is the difference between primary and secondary hypogonadism
``` Primary = testicular failure (disease of the testies) Secondary = Disease of the hypothalamus or pituitary ```
27
what do the lab results for primary vs secondary look like
``` Primary = high FSH/LH & low testosterone and sperm count Secondary = Low/norm fsh/lh and low testosterone and sperm ```
28
Labs for fertility in women
Day 3 LH/FSH, prolactin, TSH, estrodiol, DHE | Day 21 progesterone
29
Definitions of menopause
Sterilisity if <50 and no period x 2 year or >50 and no period x 1 year. Premature if < 40 yrs Cessation of menstruation x 1 year
30
How soon before menopause does perimenopause start
About 4 years prior with irregular periods
31
When do vasomotor symptoms occur
increase as stages of menopause progress and should decrease within 4 years of final period
32
Labs are not recommended but if drawn what would indicate menopause
Low estrodiol <20
33
Can oral contraceptive be used in perimenopause?
Yes if no contraindications eg smoking, HTN, liver., migraine with aura, VTE, hx of breast ca. Use lowe dose for vasomotor symptoms. However postmenopausal use is not advised as it is much higher than HT
34
Differential for AUB in premenopausal women
Polyps, Adymisosis, Leiomyomas, coagulaopathies, ovarian dysfunction, endometrial, inatorpic, nyd
35
Medical tx of AUB in premenopausal women
NSAIDS = reduce heavy bleeding COC = continuous use Depot or LNG-IUS
36
what is the minimum number of days that progesterone should be used as HT
minimum is 16 days but best if estrogen is continuously aposed
37
what is the name of a progestrone only noethidrone pill
micronor
38
name one oral and one transdermal combined HT
``` Transdermal = Climera Oral = premplus ```
39
Can an LNG-IUD be used in menopause
Yes with oral estrogen. It has been shown to be more effective than cyclical administration of E and P.
40
what are the sideeffects of estrogen
Nausa, breast pain
41
what are the estrogen side effects
breast pain, moodiness, fatigue, fluid retention. Micronized progesterone has less side effects
42
what women should be offered transdermal vs oral therapy
1. malabsorption 2. increased vte risk 3. hypertriglycerimia 4. obese or with metobolic syndrome
43
can progesterone be used to combat vms
yes, megstorl (20mg) or micronized (300mg) a day is better than a placebo. No defined link between breast ca and progesterone but possible....
44
who cannot use HRT
1. Undiagnosed AUB 2. Liver dysfunction 3. CHD 4. Stroke 5. Active VTE 6. Hormone dependant ca
45
what would you expect to see in LH/FSH for POF
high LH as not being inhibited by oocyles (inhibin b)
46
what drugs can be uses for osteoporosis
Biophonbhates RANKL inhibitors SERMS PTH Analogs
47
What are the sideeffects of biophosphates
GI, abdo pain, msk pain, rare esphophigitis. Must take with fluid and not lie down 30 mins after. Watch Ca
48
What are the Side effects of denosumab (RANKL inhibitor)
Necrotic jaw, nausia, limb pain, rash, watch Ca
49
SERM side effects (Tamoxifen)
vasodilation, vaginal attrophy, bone denisty stops with medication cesation, incrased risk of DVT
50
Balanitis xerotica obliterans:
lichen sclerosis et atrophicus in men, White blanching can be constrictive secondary to chronic inflamation
51
Lichen Sclerosis
``` white, symetrical to anus Often itchy, shiney and thin skin Vaginal atrophy evident Common post menopausal - probably autoimmune tx: Steroids x 6 weeks then maintenence ```
52
Lichen simplex chronicus
``` Leathery Persistant itchy - often at night Can follow an infection or atopy tx: High dose steroid Sleep managment ```
53
Lichen Planus
Mild to severe itching but can be errosive Can present oral, nasal, anal, scalp, nails, skin Systemic and immune modulated Focus on mucosa during exam
54
What can chaseberry be used for?
PMS and PDD. Its a hormone modulator effecting FSH
55
What is the cause of migrane with aura
Inability to metabolize estrogens or polymorphism in genes to encode sex hormones or metabolites of hormonal pathways
56
Well circumsized, red velverty penile lesion
either bowens disease or erthroplasia of queyrt | Carcinoma in situ: tx 5fu
57
Perly papules
Look like HPV Dome, skin coured Often on head
58
Penile lichen planus
topical corticosteroids | often occurs in mucus memebranes as systemic
59
Contact dermatitis
red puritis often condoms | Mild OTC corticosteroid
60
Fordyce spots
little yellowish bumps often found in mouth but also genitils
61
Bowenoid papulosis
smaller, often multiple papules on | the shaft of the penis biopsy as can be carcinoma
62
Peyronie’s disease treatment
Oral vitamin E and K para-aminobenzoate • Surgical replacement of fibrosis with patch graft • Local injections of verapamil, high-potency corticosteroids, or collagenase clostridium histolyticum • Ultrasound or radiation therapy or a prosthesis
63
hematospermia
normally bening or secondary to prostate biopsy low risk in men <50 Worry if lasts longer than 1 month, constitutional symptoms, palpable mass, urinary obstructive symptoms
64
How is low testosterone/hypogonadism diagnosed?
Measure testosterone in the morning (7am-11am) or within 3 hours of waking if low then order (FSH, LH, Prolactin, SHBG, cFT or cBAT, TSH, ferritin, CBC and PSA. Primary (testicular) = Low test and high LH/FSH Secondary (pituitary/hypothalamic) = Low test and normal LH/FSH
65
what is the purpose of serum testosterone total testing
single most important test in diagnosing hypogondism Low value indicates hypogondism It measures total testosterone accuratly reflecting secretion
66
when is free testosterone measurment used?
rarley
67
how many times should total serum testosteone be measured
at least a couple of times, between 8-10am
68
Differential for obstructive azoospermia
``` Iatrogentic= tubal ligation Infection = STI retrograde ejaculation - prostate sx congential absence of the vas 2/3rds of cases are obstructive ```
69
non obstructive azoospermia
mumps chemo/radiation cripytochorism torsion/trauma Klienfelter - lacks seminiferus tubules and germ cells Hypogonadotropic hypogonadism - usually primary no secondary sex characteristics, otherwise due to a tumor
70
define hypogonadotropic
Overaies or testies do not produce sex hormones
71
define Hypogonadotropic hypogonadism
it is where hypogonadotropic is caused by the pituitary or hypothalamus
72
what kinds of cancer can be found in the vagina and which is the most common
``` Squamous cell is the most common Vulva from HPV 16 - 33 Cervical from HP 16-18 Adenocarcinoma - rises from barthalon gland (post meno) or from DES exposure - very rare Pagets, sarcoma, basal cell ```
73
what is an abnormal prolactin level
>20
74
screening a young woman with 1st degree relative with breast CA
1+ first degree relatives with invasive breast CA – annual | mammo 5-10 yrs younger than youngest case, no earlier than 25, no later than 40. CBE at 25
75
Breast CA screening for women with hx of chest wall radiation
Hx of chest wall radiation <30 yo – Annual mammo + screening breast MRI starting 5-10 yrs after radiation, no earlier than 25, no later than 40
76
what age for breast ca screening
50-74 every 2 years | can start at 40 yrs but womans preference only
77
tanner stages boys
``` no exams in preschool new big exam in 2nd school bigger and longer exams in highschool Bigger, longer and wider exams to get into univerity University has adult exams ```

NURS 522 final exam (3 decks)

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