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Flashcards in Week 12: GU Deck (38)
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1

What are the current recommendations regarding self-breast exams?

Self-exams recommended for women with very high risk for breast cancer or in a setting with limited resources

2

What are the current recommendations regarding breast cancer screening?

  • Mammography
    • USPSTF: 50-74 years biennially, start <50 years if patient has high risk factors
    • American Cancer Society: 40-45 years: optional annual screening, 45-54 years: annual screening; >55 years biennial screening with option to continue annual screens; continue screening if good health and life expectancy >10 years
    • American College of Obstetricians and gynecologists: offer screening starting at 40; screening every 1-2 years based on shared decision making; continue screening until 75
    • Consider life expectancy, continue screening if expected to live for at least another 10 years
    • Shared decision making is important for all
  • BRCA1 & BRCA 2 Mutations: Begin assessing family history when pt is in her 20s

3

What are the seven characteristics of a breast nodule that should be described? 

  1. Location: left or right; by quadrant and clock with centimeters from the nipple
  2. Size: in cm
  3. Shape: round or cystic, disc-like, or irregular in contour
  4. Consistency: soft, firm or hard
  5. Delimitation: well circumscribed or not
  6. Tenderness
  7. Mobility

4

What history, exam findings and risk factors are consistent with a fibroadenoma? Cyst? Cancer? 

  • Fibroadenoma
    • History: 15-25 years, puberty and young adulthood up to age 55 years
    • Exam: smooth, rubbery, round, mobile, nontender
  • Cyst
    • History: 25-50 years, regress after menopause except with estrogen therapy
    • Exam: soft-firm, round, mobile, often non-tender
  • Cancer
    • History: 30-90 years, most common after 50 years
    • Exam: irregular, firm, mobile or fixed to surrounding tissue, nontender
    • 50+: Consider cancer 1st until proven otherwise

5

What are some visible signs of breast cancer?

  • Retraction signs
  • Skin dimpling
  • Nipple retraction and deviation
  • Skin edema (orange peel sign)
  • Paget disease of the nipple: scaly, eczema-like lesion on the nipple that may weep, crust or erode

6

What could milky nipple discharge indicate? Bloody? Clear, serous, green or black? 

  • Clear, serous, green, black or nonbloody discharges that are multi-ductal are usually benign
  • Milky discharge unrelated to prior pregnancy/lactation = nonpuerpural galactorrhea
    • causes = hyperthyroidism, pituitary prolactinoma, dopamine antagonists (psychotropics and phenothiazines)
  • Pathologic: spontaneous, unilateral, bloody, associated with a mass, typically over the age of 40; typically occurs in 1-2 ducts

7

What are considered normal findings of the breasts of newborns? 

  • Often enlarged from maternal estrogen - takes a few months to resolve
  • May be engorged with a white liquid called "witches milk" which should resolve within 1-2 weeks

8

What is premature thelarche? 

  • Breast development occurs without other signs of puberty or hormonal abnormalities
  • Premature breast enlargement - infant to 6 yrs old
  • Usually benign and temporary

9

What are the current recommendations regarding testicular self-exams? 

  • USPSTF does not recommend screening in asymptomatic adolescents and adults
  • ACS: does not recommend routine screening but to be aware of testicular cancer and see a provider should they notice any lumps

10

What symptoms and exam findings are consistent with a testicular torsion? 

  • Acutely painful, tender and swollen organ retracted upwards in the scrotum
  • Cremasteric reflex nearly always absent on affected side
  • Scrotum may become red and edematous
  • No associated urinary infection

11

What is the cremasteric reflex and how is it performed? 

Performed by gently stroking upward or downward along the medial aspect of the thigh; testis on the side being stroked will move upward

12

What is the difference between a direct and indirect inguinal hernia? 

Indirect inguinal hernias: develop at the internal inguinal ring where the spermatic cord exits the abdomen

Direct inguinal hernias: arise more medially due to weakness in the floor of the inguinal canal and are associated with straining and heavy lifting

13

What exam findings are consistent with gonococcal urethritis vs. nongonococcal urethritis? 

Nongonoccocal urethrits: scanty white or clear discharge

Gonococcal urethritis: purulent, cloudy or yellow discharge

14

What are some benefits of circumcision? 

  • Reduced risk of:
    • urinary tract infections (UTIs)
    • penile cancer
    • some sexually transmitted infections (STIs), including heterosexually acquired HIV, syphilis, herpes and human papillomavirus (HPV).

15

What is a hypospadias? Chordee? 

Hypospadias: congenital displacement of the urethral meatus to the inferior surface of the penis; meatus may be subcoronal, midshaft or at the junction of the penis and scrotum

Chordee: fixed, downward bowing of the penis, usually accompanied by hypospadias

16

What are considered to be normal scrotal findings of the newborn? 

  • Rugae should be present in a term newborn
  • Scrotal edema may be present
  • 10mm in width and 15 mm in length

17

What exam findings are consistent with a hydrocele? 

  • Nontender, fluid-filled mass in tunica vaginals
  • Transilluminates
  • Fingers can palpate above the mass

18

What exam findings are consistent with a hernia in the newborn/infant? 

Reducible scrotal mass

Do not transilluminate

19

How would the FNP classify Tanner stages in males?

  • Pubic hair
    • Stage 1: preadolescent - no pubic hair except fine body hair
    • Stage 2: sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly at the base of the penis
    • Stage 3: darker coarser, curlier hair spreading sparsely over the pubic symphysis
    • Stage 4: coarse and curly hair, area covered greater than stage 3 but not entire and does not spread to the thighs
    • Stage 5: hair adult in quantity and quality, spreads to medial surfaces of the thighs but not over abdomen
  • Genital
    • Stage 1: preadolescent - same size and proportions as childhood
    • Stage 2: slight or no enlargement of the penis; larger tests, scrotum larger, somewhat reddened and altered in texture
    • Stage 3: penis larger in length, testes/scrotum further enlarged
    • Stage 4: penis further enlarged in length and breadth with development of the glans; testes/scrotum further enlarged, scrotal skin darkened
    • Stage 5: penis, testes and scrotum adult in size and shape

20

What is considered delayed puberty in the male? What are some common causes?

Suspected in boys who have no signs of pubertal development by 14 years old

Causes: constitutional delay, primary or secondary hypogonadism, congenital GnRH deficiency

21

What are the current cervical cancer screening recommendations? 

  • start pap smear at age 21
  • 21-29 years: pap every 3 years
  • 30-65: pap every 3 years or HPV testing alone or pap plus high-risk HPV testing every 5 years
  • Stop at age 65, assuming three consecutive negative results on cytology or two consecutive negative results on cytology plus HPV testing within 10 years before cessation of screening, with the most recent test performed within 5 years

22

What is the difference between perimenopause and menopause? 

  • Menopause: cessation of menses for 12 months
    • Menstrual periods cease between 45-42 years
  • Perimenopause: progressive stages of cyclical bleeding, accompanied by vasomotor symptoms (hot flashes, flushing, sweating)

23

What questions are important to ask when assessing for risk for STIs? 

  • # of sexual partners in the last 3-6 months
  • Need to assess sexual orientation, gender identity and sex assigned at birth

24

When considering acute pelvic pain, what are some life threatening conditions that should be on your differential? 

  • Ectopic pregnancy - most important because it can rupture
  • Ovarian torsion
  • Appendicitis

25

Trichomonal vaginitis: what would be expected exam findings for discharge, symptoms, vulva/vaginal mucosa and wet mounts?

Discharge: profuse frothy yellowish green or gray malodorous

Symptoms: pruritis, pain on urination, dyspareunia

Vulva and vaginal mucosa: vestibule and labia minora may be erythematous, vaginal mucosa may be diffusely reddened, small red granular spots or petechiae in the posterior fornix, mild cases has normal mucosa

Wet mounts: scan saline wet mount for trichomonads

26

What are some normal configurations of the hymen in the prepubertal child? 

  • Septate
  • Crescent shaped
  • Annular

27

How would the FNP classify Tanner Stages (Sexual Maturity Rating) in females?

  • Breasts
    • Stage 1: preadolescent - elevation of nipple only
    • Stage 2: breast bud stage, elevation of breast and nipple as a small mound, enlargement of areolar diameter
    • Stage 3: further enlargement of elevation of breast and areola, no separation of their contours
    • Stage 4: projection of areola and nipple to form a secondary mound above level of the breast
    • Stage 5: mature stage - projection of nipple only, areola has receded to general contour of the breast
  • Pubic hair (same as boys)
    • Stage 1: preadolescent - no pubic hair except fine body hair
    • Stage 2: sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly along the labia
    • Stage 3: darker coarser, curlier hair spreading sparsely over the pubic symphysis
    • Stage 4: coarse and curly hair, area covered greater than stage 3 but not entire and does not spread to the thighs
    • Stage 5: hair adult in quantity and quality, spreads to medial surfaces of the thighs but not over abdomen

28

What is considered delayed puberty in the female? What are some common causes? 

No breasts or pubic hair by 12

Causes: inadequate gonadotropin from the anterior pituitary due to defective hypothalamic GnRH production; anorexia, turner syndrome (will fall below the 3rd percentile in height) or chronic disease

29

What is primary vs. secondary amenorrhea? What are some possible causes? 

  • Primary: no menses by age 16
    • Causes: anatomic or genetic
  • Secondary amenorrhea: cessation of periods after they have been established
    • Causes: low body weight, pregnancy, lactation, menopause, stress, eating disorders, excessive exercise

30

What are some physical signs of sexual abuse in the pediatric patient? (Strong - 6, Possible - 7)

  • Strong
    • Lacerations
    • Ecchymoses
    • Newly healed scars on hymen
    • Lack of hymenal tissue from 3-9 o clock while supine
    • Healed hymenal transections
    • Perianal lacerations
  • Possible
    • Marked and immediate dilatation of the anus
    • Hymenal notch or cleft that extends  >50% of the inferior hymenal rim
    • Condyloma acuminata in a child older than 3 yrs
    • Bruising, abrasions, lacerations or bite marks of labia or perihymenal tissue
    • Herpes of the anogenital area beyond the neonatal period
    • Purulent or malodorous discharge
    • Herpetic lesions