MOD 12

Question 1

AUB

Answer 1

abnormal uterine bleeding

Question 2

Amenorrhea

Answer 2

absence of menses

Question 3

dysmenorrhea

Answer 3

painful menses

Question 4

Dyspareunia

Answer 4

painful sexual intercourse

Question 5

menometrorrhagia

Answer 5

abnormally heavy bleeding at irregular intervals

Question 6

menopause

Answer 6

cessation of menses

Question 7

menorrhagia

Answer 7

abnormally heavy and prolonged menstrual period at regular intervals

Question 8

metrorrhagia

Answer 8

bleeding occurring irregularly

Question 9

oligomenorrhea

Answer 9

infrequently occurring menses at intervals greater than 35 days

Question 10

polymenorrhea

Answer 10

menses at intervals of 21 days or fewer

Question 11

premenstrual syndrome

Answer 11

etiology: a group of physical, emotional, and behavioral s/s associated with the menstrual cycle.

incidence: 5-10% disabling symptoms

pathophys: s/s begins with the luteal phase of the menstrual cycle

s/s: begin with the luteal phase of the menstrual cycle

Rx: medication, application of heat; hormone meds, and antidepressants

Question 12

Menopause

Answer 12

etiology: transition from reproductive capability to cessation of menses: may span 10-15 years; age 51 or older

patho phys: follicles are unresponsive to gonadotropin stim → decreased production of estrogen → LH/FSH fluctuate to stim ovaries → ovarian failure

s/s: Dysparenuria, vaginal atrophy/dryness, vasomotor instability (HOT FLASHES), osteoporosis, DEPRESSION/ MOOD SWINGS,

Rx: symptomatic treatment with hormone replacement therapy, avoid caffeine

Question 13

Ovarian Cyst

Answer 13

cystic lesion and functional cyst
Etiology: The most common cause of enlarged ovaries - is usually benign. Caused by fluid-filled egg sac that does not release on schedule. the cyst takes up space in pelvis.

S/S: range from NO to significant pain
-low back and pelvic from mid-cycle to menses
-usually resolves spontaneously without tx by the next menstrual cycle
-Tx: NSAIDs, possibly surgery to remove cyst or ovary

Question 14

polycystic ovary syndrome

Answer 14

etiology: endocrine disorder (EXCESS LH compared to FSH) - possibly genetic. no cure at the present time. affects 1 in 10 women.

pathophys: unbalanced hormones lead to ovulation and menstrual irregularities that cause polycystic ovaries to develop. lack of progesterone may predispose women to increased CA

LEADING CAUSE OF FEMALE INFERTILITY

Question 15

polycystic ovary syndrome s/s

Answer 15

Male pattern baldness (due to higher level of male hormones)

metabolic syndrome with insulin resistance (and subsequent obesity)

irregular menstrual cycles

Question 16

Rx: for polycystic ovary syndrome

Answer 16

relief of symptoms; replacement (bc pills), anti-androgen drugs; antidiabetic drug (such as metformin to treat insulin resistance); laparoscopic ovarian drilling procedure (see PCOS video above)

Question 17

Leiomyoma (uterine fibrosis)

Answer 17

etiology: unknown. benign growths in the muscular lining of the uterus

Incidence:30% Caucasians/ 50% blacks by age 50; decreases with menopause

S/s: can be asymptomatic or cause heavy menses and dysmenorrhea

Rx: menopause, hysterectomy, myomectomy

Question 18

Endometriosis

Answer 18

Etiology: unknown cause. Growth of endometrial tissue outside the uterus such as on the ovaries, bowel, or bladder

Pathophys: Bleeding from endometriosis goes into the surrounding tissue and causes pain as well as significant pelvic adhesions

Adhesions cause: obstruction, constrictions, or distortion of pelvic/ abdominal organs that can cause blockages (pain on defecation), bladder constrictions (dysuria), and infertility (blockage or malformation of fallopian tubes

S/S: may be asymptomatic or cause severe debilitating pain

Rx: pain meds; estrogen suppressing drugs; surgery to remove endometriosis lesions; total hysterectomy and removal of fallopian tubes and ovaries

Question 19

Vaginitis

Answer 19

infection of the vagina

Etiology: infection (usually fungal), atrophy due to aging, chemicals

Pathophys: alteration of vaginal flora→overgrowth of normal flora or growth of pathogen

S/s: itching, burning, abnormal vaginal discharge, (cottage cheese looking and malodorous)

Rx: treat underlying cause with antifungal meds

Question 20

Vaginitis has diff causes depending on the age of the patient

Answer 20

Premenarchal girls: poor hygiene, intestinal parasites, the presence of foreign bodies

childbearing women: c. albicans (fungus - “yeast”), trichomonas vagninalis (protozoa)

Menopausal women: atrophic vaginitis (hormone changes)

Question 21

Candidiasis

Answer 21

Etiology: fungal infection with candida albicans. Vaginal yeast infections are one of the most frequent reasons that women go to the doctor.

Incidence: antibiotic use, pregnancy, uncontrolled diabetes, compromised immune system,not usually transmitted sexually unless through oral sex

S/s: thick white creamy or clumpy or cottage cheese looking vaginal discharge, itching, redness, burning pain with urination, dyspareunia

Rx: antifungal meds and prevention

Question 22

Cervitis

Answer 22

infection of the cervix

Etiology: sexually transmitted disease, and trauma

pathopys: trigger →cervix becomes red, edematous, muco-purulent discharge (if infectious) → infections may ascend to PID if untreated

S/s: dysuria, spotting/bleeding, vague pain, dyspareunia (painful sex)

Rx: antibiotics- treat partners, avoid reinjury

Question 23

Bartholinitis

Answer 23

infection of bartholin glands

Etiology: bacterial infections, STD’s

Pathophys: contamination of opening of bartholin’s gland → infection/ trauma obstructs flow of secretions → swelling, pain, erythema

Rx: warm compresses, antibiotics, incision and drainage

Question 24

Pelvic inflammatory disease definition

Answer 24

Pid is an infection and inflammation of the uterus, ovaries, and other female reproductive organs which causes scarring in these organs. this can lead to infertility, pelvic pain, abscesses, and other serious problems.

Question 25

Etiology of PID

Answer 25

gonorrhea and chlamydia are the most common causes of PID women are at greater risk if they are sexually active and younger than 25; or have more than one sex partner

Question 26

S/s of PID

Answer 26

pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination

Question 27

Uterine cancer

Answer 27

(endometrial) 40% of GYN CA; most common in postmenopausal women. increase risk due to age, late menopause, never giving birth, infertility, obesity/ diabetes,/ high bp, and hormone replacement estrogen treatment S/s: RED FLAG SIGN IS PAINLESS ABNORMAL VAGINAL BLEEDING IN 90% OF CASES

Question 28

Cervical cancer

Answer 28

20% of Gyn CA 40-45 peak incidence- one cause is HPV virus. The highest risks are females who have had more than 10 sexual partners and early age start of sexual activity DX: pap smear (obtain cells from the cervix to examine in the cervical cells for atypical changes) Rx: chemotherapy, radiation, and brachytherapy, hormone and other meds, also surgery

Question 29

Ovarian cancer

Answer 29

according to the CDC ovarian cancer causes more deaths than any other cancer of the female reproductive system. There are no screening tests for ovarian cancer Note: the CA-125 test is not specific to ovarian CA

Question 30

Peyronie's disease

Answer 30

Etiology: begins with an inflammatory process that results in dense fibrous plaque (hard mass formation) on the tunica albuginea of the penis Incidence: increased with diabetes, keloid formation, 50% spontaneous remission Pathophys: inflammation → plaque fibrosis → abnormal penile curvature with erection S/s: Painful erection, dyspareunia (painful sexual intercourse), unable to penetrate partner Rx: meds to break down the collagen that causes the curvature; penile traction (acute phase); surgical implant (chronic phase)

Question 31

Priapism

Answer 31

Etiology: idiopathic, or due to neurological injury, involuntary prolonged (>4 hrs) abnormal and painful erection that either continues beyond or is unrelated to sexual stim Incidence: Most common in sickle cell disease, cancers, or neurologic disorders. Can be caused by stroke or spinal cord injury Pathophys: trigger→penile erection→ tissue ischemia→ necrosis. UROLOGIC EMERGENCY BECAUSE OF TISSUE DEATH THAT WILL LEAD TO IMPOTENCE S/S: excruciating painful erection Rx: iced enemas, spinal anesthesia, aspiration

Question 32

Inguinal hernia

Answer 32

Etiology: weakness or opening in the inner groin canal - occurs when soft tissue, protrudes through a weak point in ab muscles Incidence: 70%-80% of all hernia cases and is surprisingly common in men Pathophys: soft tissue, particularly lower intestines, starts to come through the lower ab wall through small hole or tear in the wall fo the inguinal canal S.s: asymptomatic if small. But in serious cases the hernia could allow a loop of bowel could slip through the wall and get trapped leading to strangulation of an intestinal loop Dx: turn your head and cough exam is done while standing to palpate for inguinal canal weaknesses and or tissue pushing through the weekend area. Standing and causing causes internal pressure to accentuate the tissue bulge so it can be detected easier Rx: gently push the hernia back into the ab when lying down. same day surgery could also be done.

Question 33

Cryptorchidism

Answer 33

undescended testicle Etiology: in utero developmental delay Incidence: 20% premature boys, 75%-90% descended by age 1 Pathophys: failure of testes to descend into scrotal sac RISK OF TESTICULAR CANCER by 4-10 times higher reduced fertility possibly due to length of time the testes were in the abs s/s: no testes palpable in scrotum. may do laparoscopy to confirm diagnosis since other imaging is not reliable Rx: non (wait to see if the testicle descends spontaneously by age 1 to maximize fertility) *orchiopexy is a surge to move an undescended testicle into the scrotum and permanently fix it there

Question 34

testicular torison

Answer 34

Potential urologic EMERGENCY Etiology: Twisting of spermatic cord that suspends the testis Incidence: increased in neonates and adolescents. Spontaneous onset, especially for boys at puberty. Pathophys: inadequate attachment of testes to tunica vaginalis → spermatic cord twists → ischemia and loss of the testis S/s: extreme testicular pain (sudden onset), scrotal edema, nausea/ vomiting, creamsteric reflex is absent Rx: manual or surgical reduction within 6 hours to save the testis (elevation of the scrotum increases pain)

Question 35

Epididymitis

Answer 35

Etiology: inflammation of the epidymis secondary to UTI or STD Incidence: < 35 years old = STD; > 35 years old = UTI Pathophys: pathogen ascension from urethra or bladder → inflammation. RF: sexual activity, heavy physical exertion, and bicycle / motorcycle riding S/S: acute scrotal/ inguinal pain, urethral discharge, dysuria Rx: antibiotics, scrotal support (elevation of scrotum RELIEVES PAIN)

Question 36

Prehn sign

Answer 36

when checking prehn sign during and exam the affected scrotum is elevated this action relieves pain of epididymitis but exacerbates the pain of torsion. the elevation takes the weight of the testis off the epididymal suspension

Question 37

Prostatitis

Answer 37

etiology: idiopathic, bacteria pathophys: inflammation/ infection S/S: Pain (rectal or low ab and back which may be worse with BM's), urinary frequency/urgency, pain with erection, painful ejaculation, fever (infection), enlarged/ tender prostate. Can give false positive PSA test Rx: bed rest, anti-inflammatories, antibiotics

Question 38

Benign Prostatic hyperplasia

Answer 38

Etiology: nonmalignant enlargment of prostate. Age related but otherwise unknown etiology Incidence: 70% in 60-70 year old males, 80% in 70+ year old males. Pathophys: Diminished hormone→ glandular cells hyperplasia → urethral obstruction.

Question 39

S/S in benign prostatic hyperplasia

Answer 39

Similar to UTI, incomplete emptying of the bladder, straining to void, frequency, urgency, weak/decreased urine stream, incontinence, nocturia, urine retention and backflow up the ureters can lead to kidney failure. can give false positive PSA test

Question 40

RX for benign prostatic hyperplasia

Answer 40

Temporary Tx: urinary catherterization surgical intervention canc ause impotence (during transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section fo the prostate that is blocking urine flow.

Question 41

Testicular CA

Answer 41

1% of male CA; 15-35 yrs old- self exam to check for painless mass. Highest risk among men who have a history undescended testicle as an infant or who have a family hx, HIGH CURE RATE. Rx: removal (orchiectomy) of affected testical and chemo

Question 42

Prostate CA

Answer 42

3rd highest cause of cancer deaths in America. Most common male cancer

Question 43

Prostate CA RF

Answer 43

over 50 (60% > 65 years) Family HX Black men Diet

Question 44

Prostate S/s

Answer 44

Early stage: no initial s/s so prostate cancer has usually metastasized before discovered late stage: s/s can be similar to s/s of bph (urgency, frequency, nocturia, hematuria or blood in ejaculate)

Question 45

Sites of metastasis for prostate CA

Answer 45

lungs (via lymph system) and spinal column/ pelvis (bone pain is often the 1st presenting s/s)

Question 46

How to diagnosis prostate CA

Answer 46

Combination of two tests - PSA blood test and DRE physical exam 1. Prostate specific antigen (PSA) blood test and prostate biopsy if PSA is high (PSA can also be high in BPH and prostatitis) 2.Digital rectal exam (DRE): finger up the butt to check size of prostate and to palpate abnormal bumps if present. less effective in detecting prostate CA than PSA tests but may find CA in men with normal PSA level 3. Transrectal ultrasound may detect cancers that are too small to be detected by DRE

Question 47

Screenig recommendations for prostate CA

Answer 47

Age 50 for men who are at average risk of prostate cancer and are expected at least 10 more years age 45 for men at high risk- like African Americans and men who have first degree relative Age 40 for men at even higher rsk

Question 48

CDC estimates how many std infections each year

Answer 48

20 million new std infections each year half of them among young people ages 15 to 24.3 the cost of stds to the u.s. health care system is estimated to be as much as $16 billion annually STD can lead to reproductive organ scarring STD can be caused by viruses bacteria and parasites

Question 49

Trichomoniasis

Answer 49

etiology: protozoa incidence: anyone, but greater with multiple sexual partners pathophys: parastitic infection 3rd most commonly reported std can also be transmitted via fomites. (like swimming pools and hot tups) Infextion with trick makes it easier to get infected with other STD pathogens S/s: Frequently asymptomatic in men, in women there is a thick foamy or frothy foul smelling green discharge RX: antiprotozoal meds

Question 50

Human papillomavirus

Answer 50

Etiology: virus (over 150 diff types of HPV) in most cases, HPV goes away on its own and does not cause any health problems in 1-2 years (80-90% of sexually active people will be infected with a tupe of HPV) Pathophys: virus is spread by having vaginal, oral, anal, sex with someone who has the virus S/s: possibly genital warts, evidence of cervical cancer (positive pap smear), cancer of the throat or penis or anus Rx: HPV vaccination for males and female (series of 2-3 injections over 6 months)

Question 51

Herpes simplex virus (genital herpes)

Answer 51

etiology: viral infection with herpes simplex 1 (cold sores found around the mouth) or herpes simplex 2 (genital herpes) Incidence: anyone but having multiple sex partners increase the risk for contracting virus Pathophys: viral infection transmission b y direct contact with active lesions or by virus-containing fluid such as saliva or cervial secretions os virus can be transmitted when there are no visible lesions or evidence of active disease; recurrence is common. Herpes can be passed on to babies during childbirth causing a potentially fatal disease in baby.

Question 52

Note about Herpes simplex virus

Answer 52

both types 1&2 can be found in either the mouth or genital area as a result of oral sex practices. The virs resides on nerve ganglia and migrates to the skin/ mucuosa surface when in active phase.

Question 53

Three stages of Herpes simplex virus

Answer 53

Primary: initial outbreak of virus occurs as blisters Latency: virus remains dormant in ganglia recurrent stage: virus is reactivated, travels along peripheral nerves to site of initial infection, causing characteristics symptoms

Question 54

Recurrent infections of herpes simplex may be triggered by

Answer 54

general illness fatigue physical or emotional stress immunosuppression due to aids or such meds as chemo or steroids trauma to the affected area including sex menstruation

Question 55

S/S of herpes simplex virus

Answer 55

Painful blisters (pustules) break open and cause ulcerations, flu-like symptoms with the initial outbrea; recurrent outbreaks proceeded by burning or itching, less painful than initial outbreak (there are either painful genital sores present or NO s/s at all no in between)

Question 56

Rx: of herpes simplex virus

Answer 56

antiviral meds for treatment of active outbreaks and suppression therapy

Question 57

Patient teaching of herpes simplex virus

Answer 57

People with HSV-2 are 3 to 5 times more likey to get HIV upon exposure

Question 58

Relationship between chlamydia and gonorrhea

Answer 58

chlamydia and gonorrhea are difficult to tell apart without testing because they have similar s/s an cause similar reproductive system damage. They are often found together in the same infected person

Question 59

Chlamydia trachomatis increases chances of what

Answer 59

increases risk of acquiring HIV infection

Question 60

Chlamydia trachomatis

Answer 60

etiology: bacteria incidence: anyone but greater with multiple partners, can be transmitted to baby during vag birth. can cause PID and infertility Pathophys: bacterial infection S/s: frequently asymptomatic; dysuria, genital pain, dyspareunia, vaginal/penal discharge that is mucopurulent, ab pain, chlamydia can infect the rectum throat urethra and cervix Rx: antibiotic therapy

Question 61

Gonorrhea

Answer 61

etiology: bacteria incidence: anyone but greater with multiple partners, common std. can cause PID and infertility. passed to baby during birth pathophys: bacterial infection s/s: frequently asymptomatic; genital sores, painful urination, abnormal discharge, menstrual irregularities, urinary symptoms Rx: antibiotic therapy

Question 62

Note about syphillis

Answer 62

syph is contagious only in the first two states (primary and secondary) but not in tertiary stage

Question 63

Syphillis

Answer 63

etiology: bacteria spread through kissing and sex; passed to the baby during preg or childbirth incidence: anyone but the greater risk with multiple sex partners patho phys: bacterial infection. transfers through the placenta to the fetus causing premature birth, stillborn babies, congenital defects and active infection in the infant. divided into 3 stages

Question 64

Stages of syphillis

Answer 64

primary stage: chancre (painless ulceration) formation around the penis, vagina, mouth, and anus secondary stage: rash on palms/ soles of feet. Also fever, sore throat, nausea, and mucosal or wart-like genital lesions called dcondulomata lata tertiary stage: central nervous system lesions (brain damage); cardiovascular damage (scaring of the aorta); Gumma formation. gummas are most commonly found in liver but can also be in brain, heart, skin, bone, testis, and other tissues. neurological disorders or heart valve disease. damage is permanent despite antibiotic tx.

Question 65

S/s of syphillis

Answer 65

initially, a hard painless sore (chancre) appears on the genital area. secondly rash develops on the palms of the hands; if untreated syphilis may progress to heart disease blindness paralysis brain damage and death

Question 66

Rx for syphillis

Answer 66

antibiotic therapy (usually penicillin)