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AANP FNP: Adult > GYN/Men's health > Flashcards

GYN/Men's health Flashcards

(68 cards)

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1
Q

Secondary amenorrhea

A
  • cessation of menstrual flow after establishment of normal cycle
  • pregnancy test, refer for other studies
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2
Q

What grade of abnormal Pap must you refer?

A

CIN 2 on the Bethesda Classification

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3
Q

Cervical cancer screening guidelines

A
  • Start screening at 21 years old
  • Screen every 3 years with cytology, and starting age 30, may start screening every 5 years with cytology and HPV co-test
  • Stop screening at age 65
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4
Q

Causes of vulvovaginitis

A
  • trichomonas
  • bacterial vaginosis
  • candidiasis
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5
Q

Trichomonas: sx, dx, tx

A

Sx: discharge, pruritis, erythema, “strawberry patches” on cervix and vagina, dyspareunia, dysuria
Dx: microscopy on saline slide
Tx: metronidazole 2gm po x1, or 500mg PO BID x7 days

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6
Q

Bacterial vaginosis: sx, dx, tx

A

Sx: watery gray discharge, fishy smell, spotting
Dx: microscopy on saline slide shows clue cells, Whiff test (KOH slide)
Tx: metronidazole 2gm PO x1, or 500mg PO BID x7 days, or gel BID x5 days

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7
Q

Candidiasis: sx, dx, tx

A

Sx: thick, white, curd-like discharge, erythema and pruritis
Dx: microscopy on KOH slide shows pseudo-hyphae (spag&mb)
Tx: topical or oral antifungal

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8
Q

Some common pathogens for pelvic inflammatory disease

A

Chlamydia trachomatis, Neisseria gonorrhea, E. coli

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9
Q

Symptoms of pelvic inflammatory disease

A

fever/chills, nausea/vomiting, vaginal discharge, dysuria, dyspareunia, pelvic pain, infertility, positive for cervical motion tenderness, adnexal tenderness, abdominal tenderness

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10
Q

Pelvic inflammatory disease: dx, tx

A

Dx: STI testing, elevated ESR/CRP, ultrasound
Tx: empiric, broad-spectrum antibiotic coverage recommended
- Regimen A: Ofloxacin, OR Levofloxacin +/- metronidazole
- Regimen B: Cefoxitin + Probenecid + Doxy +/- metronidazole OR
Ceftriaxone + Doxy +/- metronidazole

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11
Q

Primary dysmenorrhea

A

Occurs in adolescents shortly after onset of menses and no pelvic pathology is identified.

Result of high levels of prostaglandin.

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12
Q

Secondary dysmenorrhea

A

Occurs in women > age 20. More likely associated with some form of pelvic disease.

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13
Q

How to treat primary dysmenorrhea

A

Prostaglandin inhibitors (ibuprofen, naproxen, indomethicin), oral contraceptive pills, exercise, high fiber diet and reduction of sugar/caffeine/salt

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14
Q

Oligomenorrhea

A

infrequent, irregular bleeding

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15
Q

Polymenorrhea

A

Frequent, irregular bleeding

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16
Q

Menorrhagia

A

Excessive, prolonged bleeding with regular frequency

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17
Q

Metrorraghia

A

bleeding between cycles

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18
Q

Menometrorrhagia

A

prolonged, frequent, excessive, irregular bleeding

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19
Q

Intermenstrual bleeding

A

Variable quantity between cycles

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20
Q

Diagnostic tests for abnormal uterine bleeding

A

hCG (r/o ectopic pregnancy), prolactin, TSH, CBC, PAP, STI screen, UA

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21
Q

What is the most common cause of serosanguinous nipple discharge?

A

Intraductal papilloma (usually benign, requires excisional biopsy)

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22
Q

Fibrocystic breast disease: symptoms, management

A

Sx: tenderness related to cycle, mobile, nipple discharge usually not present
Tx: warm soaks, low sodium diet

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23
Q

Breast cancer: symptoms

A

family hx, firm, immobile, painless mass, may have dimpling, nipple retractions, bloody discharge, lymphadenopathy

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24
Q

Normal age span where menopause occurs?

A

Age 45-55

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25
Definition of menopause/perimenopause
one year after last bleeding episode=menopause | when irregular bleeding/symptoms start=perimenopause
26
Some body changes that occur with menopause
skin dryness increased risk CAD mood changes, depression vulvovaginal dryness/atrophy
27
What three factors help make the decision of whether or not to use hormone therapy for menopause symptoms?
Family or personal history of breast cancer? Family or personal history of MI/CAD? Hyperlipidemia? Family or personal history of uterine cancer?
28
Osteoporosis: risk factors
``` Female, white, Asian, petite frame, elderly Early menopause or estrogen deficiency Family history Smoking or alcohol abuse Sedentary lifestyle Certain meds/disease: steroids, thyroid ```
29
Female athlete triad
- Risk for osteoporosis at young age 1. Eating disorder and/or excessive exercise 2. Amenorrhea 3. Decreased estrogen, resulting in bone loss
30
Results of the DEXA scan (bone density)
T scores > -1.0 SD is normal -1.0 to -2.5 is osteopenia (consider calc w/vit D, wt bearing exercise)
31
Bone density testing recommendations
All women ≥ 65 years old | All postmenopausal women
32
Treatment for osteoporosis
Prevention is key: avoid risk factors weight bearing exercise Calcium supplementation or increase calcium in diet Drug therapy: ERT, bisphosphonates
33
Calcium supplement recommendations
11-24yo: 1200-1500mg/day 25-49yo: 1000mg/day 50-64yo- 1500mg/day (if not on ERT, or 1000mg/day on ERT) ≥65yo: 1500mg/day
34
Dietary sources of calcium
Dairy products Sardines, fish with bones Green leafy vegetables Vitamin D supplements to increase absorption
35
Definition of SLE
multisystem, inflammatory disorder that affects primarily women of childbearing age
36
S/sx of SLE
Fever, anorexia, malaise, weight loss, butterfly rash, alopecia, Raynaud's, joint symptoms, vasculitis, nephritis, abdominal pains
37
SLE: dx, tx
Dx: ANA positive in about 95 percent of patients Tx: bed rest, naps, avoid fatigue, sun protection, NSAID, steroids
38
UA: presence of nitrate
> Specificity,
39
UA: presence of esterase
> Sensitivity,
40
Commonly used antibiotics for lower UTI
Bactrim, Cipro, Augmentin Other options: amoxicillin, levofloxacin, nitrofurantoin 3 day course is optimal for uncomplicated
41
Treatment of acute pylenonephritis
14 day course Bactrim, Cipro, other quinolone, Augmentin, Aminoglycosides (Gentamycin, Tobramycin) Severe cases or those with nausea/vomiting should be hospitalized
42
Stress incontinence
urine leakage from activities with increased pressure on bladder (lifting, coughing, sneezing, exercise, laughing)
43
Urge incontinence
Caused by strokes, infections, stones, neoplasms urgency, involuntary urinary loss, nocturia, frequency, large amounts frequently referred to as "Overactive bladder"
44
Primary amenorrhea
- absence of menarche by age 16 | - consider pregnancy test, refer to endocrinology
45
Management of incontinence
Stress- timed voids, pessary, surgery, "squeeze before you sneeze" Urge- Kegels, medication, "freeze and squeeze" Patient teaching: weight loss, fluid management, avoid caffeine
46
Medications for incontinence
Oxybutynin (Ditropan) | Tolterodine (Detrol)
47
Tanner staging for girls: breast development
1. Preadolescent breasts 2. Breast buds with areolar enlargement 3. Breast enlargement without separate nipple contour 4. Areola and nipple project as secondary mound 5. Areola recedes, nipple retracts, adult breast
48
Tanner staging for boys: Penis
1. Preadolescent 2. Enlargement and roughen/reddening of scrotum 3. Penis enlongates 4. Penis enlarges in width and glans develops, rugae appear 5. Adult shape and appearance
49
Epididymitis: causative organisms
35yo, bacteria from bladder
50
Epididymitis: Sx
symptoms like UTI + scrotal edema (grapefruit) enlarged, tender epididymis Positive Prehn's sign (pain relieved with lifting scrotum)
51
Epididymitis: Dx, Tx
Dx: STI testing, urine culture, scrotal US Tx 35yo: Bactrim PO BID x10 days OR Cipro 250mg PO BID x10days
52
Acute bacterial prostatitis: causative organisms
Gram negative bacteria (especially E. coli) | In younger men: Chlamydia
53
Acute bacterial prostatitis: Sx
UTI symptoms + prostate swollen, warm, tender/boggy
54
Acute bacterial prostatitis: Dx, Tx
Dx: Urine culture Tx: refer if urinary retention evident; no sex until resolves Bactrim, Levaquin, Ofloxacin
55
BPH incidence
By age of 50, 50 percent of men will have | By age of 80, 80 percent of men will have
56
BPH sx
urgency/frequency, nocturia, dribbling, retention May have bladder distention Prostate nontender with enlargement, smooth, rubbery consistency with possible nodules
57
BPH dx/tx
``` Dx: UA, PSA, DRE Tx: Refer as needed Alpha blockers (Terazosin, tamsulonsin) 5-alpha-reductase inhibitors (Finasteride, dutaseride) to shrink prostate Saw palmetto effective for some patients ```
58
When to start routine DRE
Age 40
59
When to start routine PSA
Age 50
60
Prostate cancer sx
Usually asymptomatic, BPH symtpoms, adenopathy, bladder distention, prostate palpates HARDER THAN NORMAL with OBSCURE BOUNDARIES and nodules may be present
61
Prostate cancer dx/tx
Dx: PSA values >4 is suspicious (watch trend and for spikes) although about 40 percent with prostate cancer present with normal PSA; prostate ultrasound (to check for solid nodules), biopsy Tx: Refer
62
Normal PSA values
age 40-49:
63
Risk factors for prostate cancer
African American | high fat diet may contribute
64
Top 4 killers of adults in US
1. Heart disease 2. Cancer (F: Lung, Ovarian; M: Lung, Prostate); M+F: Lung, Colorectal) 3. Lower respiratory disease (asthma, COPD, pneumonia) 4. CVA
65
Erectile dysfunction: possible causes
``` Stress/psychosocial atherosclerosis diabetes recreational drugs/smoking medications (thiazide, beta blocker, H2 blocker, antidepressant, NSAID, antihistamine, antiepileptics, muscle relaxers) ```
66
Treatment of ED with PDE
sildanefil (Viagra)- onset 30min, lasts 4hrs, without food vardenafil (Levitra)- like sildanefil tadalafil (Cialis)- onset 15min, lasts 36hrs, with/without food
67
Normal creatitine clearance values in adults
Males
68
Normal BUN and Creat and BUN/Cr ratio
BUN: 10-20 Creat: 0.5-1.5 BUN/Cr ratio: 10 to 1

AANP FNP: Adult (14 decks)

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