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nr509 - advanced assessment > Week 7 - Male/Female Genatalia, Rectum, Prostate, Pregnancy > Flashcards

Week 7 - Male/Female Genatalia, Rectum, Prostate, Pregnancy Flashcards

1
Q

Vaginal discharge may be caused by….

A
  1. Candida
  2. Bacterial vaginosis
  3. Trichomonas vaginalis
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2
Q

Mucopurulent discharge from the cervix can be caused by….

A
  1. Chlamydyia trachomatis
  2. Neisseria gonorrhoeae
  3. Herpes simplex
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3
Q

What should you do when a breast lump is reported?

A
  • Identify precise location
  • How long has it been present
  • History of trauma
  • Tender
  • Change in size or variation with menstrual cycle
  • Change in breast contour, dimpling, swelling, puckering of skin on breastS?
  • Changes in nipple –> skin changes, itchiness, redness, flaking
  • Family history of breast cancer
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4
Q

Components of a breast exam - Woman

A
  • Inspect the breasts in four views: arms at sides, arms over head, arms pressed against hips, and leaning forward (skin appearance, size, symmetry, contour, nipple characteristics).
  • Palpate the breasts (consistency, tenderness, nodules, nipple for color, consistency, and quantity of any discharge).
  • Inspect the axillae (rash, irritation, infection, unusual pigmentation).
  • Palpate the axillary nodes (size, shape, delimitation, mobility, consistency, and any tenderness).
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5
Q

Components of a breast exam - Man

A
  • Inspect the nipple and areola (nodules, swelling, ulceration).
  • Palpate the areola and breast tissue (nodules).
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6
Q

When doing a breast exam what should you look for?

A
  • Consistency of tissues
  • Tenderness
  • Nodules
  • Location (clock or quadrants)
  • Size (cm)
  • Shape – round/cystic, disc like, irregular
  • Consistency – soft, firm, hard
  • Delimitation – well circumscribed or not
  • Tenderness
  • Mobility
  • Hard, irregular poorly circumscribed nodules fixed to the skin or underlying tissues strongly suggest cancer
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7
Q

What to look for when palpating the nipples?

A
  • Thickening of nipple and loss of elasticity suggest cancer
  • Bloody discharge –> cancer
  • Clear, serous, green, black or non-bloody discharge are usually benign
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8
Q

What does assessment of the axillae involve?

A

Inspection
- Rash, irritation, infection, unusual pigmentation

Palpation
- Left axilla (use right hand and vice versa)
- Large nodes, firm, hard, matted together or fixed to skin suggest malignancy

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9
Q

Gynecomastia

A

Benign breast enlargement in men. Caused by increased estrogen, decreased testosterone and medication side effects

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10
Q

Anatomy of the breast

A

Mammary gland lobules
- Lactiferous ducts
- nipple/areola

Divided into four quadrants or use a 12 hour clock + the tail of spence

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11
Q

Axillary lymph nodes

A
  • Anterior group
  • Posterior group
  • Lateral group
  • Central group
  • Apical group
  • Infraclavicular group
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12
Q

Factors that may indicate breast cancer

A
  • Redness – local infection, inflammatory carcinoma
  • Thickening and prominent pores
  • Flattening of normally convex breast
  • Asymmetry in nipple direction
  • Eczematous changes with rash, scaling, ulceration of the nipple extended to areola
  • Nipple inversion
  • Breast dimpling or retraction
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13
Q

At what age should mammography start?

A

Age 40

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14
Q

What are three types of breast tumors?

A

Fibroadenoma (benign tumor)
- Up to age 55
- Single or multiple
- Soft or firm
- Well deliniated
- Mobile
- Nontender
- Round, disclike lobular

Cysts
- 30-50
- Single or multiple
- Round
- Soft to firm, elastic
- Well delineated
- Mobile
- Tender

Cancer
- 30-90 (more common over 50)
- Usually single
- Irregular edge
- Firm or hard
- Not clearly delineated from other tissues
- Fixed to skin or underlying tissues
- Nontender

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15
Q

Self-breast examinations

A

Should be done 5-7 days after menses.

  • Use three fingers
  • Lying down
  • Circular movements up and down
  • Repeat standing with hand behind the head
  • Let us know if you find any changes
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16
Q

Concerning symptoms found on breast self-examination.

A

Mass
- Location
- How long
- Change in size
Dimpling/puckering of skin
Pain
Nipple discharge

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17
Q

What physiologic changes do the breasts go through as the woman ages?

A

The glandular ducts begin to atrophy and are replaced by adipose tissue.

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18
Q

Male genital exam

A
  • Inspect the skin, prepuce, and glans (ulcers, scars, nodules, inflammation).
  • Inspect the urethral meatus (discharge), and, if indicated, strip or “milk” the penile shaft.
  • Palpate the shaft of the penis (induration, tenderness).
  • Inspect the scrotum including skin, hair, and contour (lesion, swelling, veins, bulging masses, asymmetry).
  • Palpate each testis including the epididymis and spermatic cord (presence, size, shape, consistency, symmetry, tenderness, masses, nodules).
  • Perform special techniques as indicated:
  • Evaluate for groin hernias:
  • Inspect for a groin bulge.
  • Palpate for an inguinal hernia (direct or indirect).
  • Palpate for a femoral hernia.
  • Evaluate for scrotal mass.
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19
Q

Questions prior to male genital exam

A

Penile discharge>
- Yellow –> gonorrhea
- White –> chlamydia

Amount
Fever
Chills
Rash
Associated symptoms
Sores or growths
pruritis or itching
Swelling or pain

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20
Q

Anatomy of the penis

A

Penis – formed by three columns of vascular erectile tissue
- Corpus spongiosum (contains the urethra)
- Corpora cavernosa x2

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21
Q

Phimosis

A

Tight foreskin that cannot be retracted

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22
Q

Paraphimosis

A

tight foreskin that once retracted cannot be returned

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23
Q

Balantitis

A

Inflammation of the penile glans

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24
Q

Hypospadias

A

congenital ventral displacement of the urethral meatus (to bottom of penis)

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25
Q

Hydrocele

A

nontender, fluid filled mass, transilluminates – palpable within the scrotum

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26
Q

Screening for STIs in men

A

Previous history of herpes, gonorrhea, or syphilis
What kind of sex are you having? –> symptoms at various openings
Concerns for HIV?
Systemic illness or other symptoms
- Sore throat
- Diarrhea
- Rectal bleeding
- Anal itching/pain

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27
Q

Genital warts

A
  • Single or multiple papules or plaques of variable shapes
  • Caused by HPV
  • Itching and pain
  • May disappear without treatment
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28
Q

Primary syphilis

A

Small red papule and painless erosion up to 2 cm

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29
Q

Genital herpes

A
  • Small scattered or grouped vehicles on glans or shaft of penis
  • Associated with headache, fever, malaise, arthralgias, local pain and edema
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30
Q

Cryptorchidism

A

undescended testicle

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31
Q

Scrotal swelling suggests…

A
  • Acute ependymitis
  • Acute orchitis
  • Testicular torsion
  • Strangulated inguinal hernia
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32
Q

Risk factors for testicular cancer

A
  • Undescended testicle
  • White male
  • Family history
  • Kleinefleter syndrome
  • HIV infection
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33
Q

Strangulated hernia

A

Blood supply is compromised. Usually has these symptoms:
- Nausea and vomiting
- Tenderness

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34
Q

Incarcerated hernia

A

Cannot be easily returned to the abdominal cavity

35
Q

HPV vaccination recommendation

A

Usually age 11 or 12 -26 years old (can start at age 9). Two dose series - second dose 6-12 months after first dose

36
Q

Female genitalia exam

A
  • Obtains permission; selects chaperone
  • Explains each step of the examination in advance
  • Drapes the patient from midabdomen to knees; depresses the drape between the knees to provide eye contact with patient
  • Avoids unexpected or sudden movements
  • Chooses a speculum that is the correct size
  • Warms the speculum with tap water
  • Monitors the comfort of the examination by watching the patient’s face and obtaining verbal feedback
  • Uses excellent but gentle technique, especially when inserting the speculum
37
Q

Uterus anatomy

A
  • Isthmus – lower portion
  • Corpus – body portion
  • Fundus – upper portion
38
Q

Three layers of the uterine wall

A
  • Perimetrium - outer layer
  • Myometrium – distensible smooth muscle
  • Endometrium – inner layer
39
Q

Adnexa

A

Ovaries, fallopian tube and supporting tissues

40
Q

Functions of the pelvic floor

A
  • Aid in sexual function
  • Urinary and fecal continence
  • Stabilization of connecting joints
41
Q

Menarche

A

Onset of menses

42
Q

Dysmenorrhea

A

pain with menses, often with bearing down, aching, or cramping sensation in the lower abdomen or pelvis

43
Q

Premenstrual syndrome (PMS)

A

cluster of emotional, behavioral, and physical symptoms occurring 5 d before menses for three consecutive cycles

44
Q

Abnormal uterine bleeding

A

bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding

45
Q

Menopause

A

absence of menses for 12 consecutive months, usually occurring between ages 48 and 55 yrs

46
Q

Postmenopausal bleeding

A

bleeding occurring 6 mo or more after cessation of menses

47
Q

Bacterial vaginosis

A
  • Bacterial overgrowth from anerobic bacteria often sexually transmitted
  • Gray, white, thin, homogenous, malodorous discharge often coats vaginal walls
  • Fishy smell
48
Q

Candidiasis

A
  • Overgrowth of vaginal yeast
  • White curdy discharge
  • Pruritis, vaginal soreness, pain on urination
  • Vulva and surrounding skin may be inflamed
49
Q

Pelvic examination steps

A

Perform an external examination:
- Assess sexual maturity (if adolescent).
- Inspect the mons pubis, labia, perineum (inflammation, ulceration, discharge, swelling, nodules, any lesions).

Perform an internal examination:
- Inspect the cervix (color, position, surface characteristics, any ulcerations, nodules, masses, bleeding, discharge).
- Inspect the vagina (masses, lesions, or abnormal discharge or bleeding).

Perform a bimanual examination:
- Palpate the cervix (position, shape, consistency, regularity, mobility, tenderness).
- Palpate the uterus (size, shape, consistency, mobility, any tenderness or masses).
- Palpate the ovaries (size, shape, consistency, mobility, any tenderness).
- Assess the pelvic floor muscles (strength and tenderness).

Perform a rectovaginal examination (if indicated).

50
Q

Pelvic inflammatory disease

A

Caused by “spontaneous ascension of microbes from the cervix or vagina to the endometrium, fallopian tubes, and adjacent structures.”

  • 85% of cases involve STIs or bacterial vaginosis affecting the fallopian tubes (salpingitis) or the tubes and ovaries (salpingo-oophoritis), primarily N. gonorrhoeae and C. trachomatis.

Symptoms
- adnexal, cervical, and uterine compression tenderness.
- If not treated, a tubo-ovarian abscess may ensue; 18% of treated patients report infertility after 3 yrs. Infection of the fallopian tubes and ovaries may also follow childbirth or gynecologic surgery.

51
Q

Mucopurulent cervicitis

A

Purulent discharge from the cervical os usually trachomatic, gonorrhea, herpes

52
Q

Carcinoma of the cervix

A

Extensive irregular cauliflower like growth

53
Q

Myoma

A

Benign uterine tumors. single or multiple and vary greatly in size, occasionally reaching large proportions. They feel like firm irregular nodules that are continuous with the uterine surface.

54
Q

Cervical cancer screening

A
  • PAP smear yearly
  • 21-25 three year cytology screening
  • 30-65 Q3 years cytology, Q5 years w/cytology and HPV testing together
  • No screening under 21 or over 65
55
Q

Risk factors for cervical cancer

A
  • Multiple sex partners
  • Early age of sexual activity
  • Inadequate screening
  • Immunosuppression
  • Long term use of oral contraceptives
  • Coinfection with chlamydia
  • Smoking
  • More than three full term pregnancies
56
Q

Technique for anorectal and prostate exam

A
  • Properly position the patient for the exam (left side)
  • Inspect sacrococcygeal and perianal areas (lesions, ulcers, inflammation, rash, excoriation)
  • Inspect the anus (lesion, mass, skin breakdown)
  • Perform a digital rectal examination
  • Assess anal sphincter tone
  • Palpate the anal canal and rectal surface (mass, tenderness, mucosal breaks, nodules, irregularities, induration)
  • In person with prostates, palpate the prostate gland (size, shape, mobility, consistency, nodule tenderness)
57
Q

Anatomy of the prostate

A
  • Lies around the urethra
  • Apex – pointed bottom
  • Right and left lateral lobes (palpable)
  • Posteromedial (posterior) lobe
  • Cannot palpate anterior and median lobes (no contact with rectal wall)
58
Q

How to identify anorectal cancer?

A

Firm, nodular with rolled edge on palpation

59
Q

Screening for prostate cancer

A

Test for PSA - prostate specific antigen - a blood test
- Testing from age 55-69
- annually (ACS) or biannually (AUA)

60
Q

Risk factors for prostate cancer

A
  • Age
  • Ethnicity
  • Family history (having it or early diagnosis – before 55)
  • Smoking
  • Diets high in animal fat
  • Obesity
  • Cadmium exposure
61
Q

Proctitis symptoms and cause

A

Symptoms
- Fever
- Urinary symptoms
- Frequency
- Urgency
- Dysuria
- Incomplete voiding
- Low back pain
- Gland feels swollen, tender, boggy, warm
- Most caused by E Coli or Enterococcus and Proteus spp (also gonorrhea or claymidia)

62
Q

Techniques of exam for pregnant woman

A
  • Assess general health, emotional state, nutritional status, and neuromuscular coordination.
  • Measure height and weight. Calculate BMI.
  • Measure the blood pressure at every visit.
  • Inspect the head and neck (facial skin changes or edema, hair condition and distribution, conjunctival pallor, nasal congestion or epistaxis, teeth and gum health, thyroid masses or nodules).
  • Inspect, percuss, and auscultate the thorax and lungs.
  • Palpate location of the apical impulse.
  • Auscultate the heart (S1 splitting, murmurs, venous hum or mammary souffle).
  • Inspect the abdomen (striae, scars, size, shape, and contour).
  • Palpate the abdomen (masses, fetal movement, uterine contractility and fundal height).
  • Auscultate fetal heart tones (location, rate and rhythm).
  • Inspect the external genitalia (labial varicosities, cystoceles, rectoceles, lesions, sores, Bartholin and Skene gland tenderness and cysts).
  • Inspect the internal genitalia by performing speculum and bimanual examinations.
  • Speculum examination: Inspect the cervix (color, shape, os closure) and vaginal walls (color, relaxation, rugae, and discharge). Perform a Pap smear if indicated.
  • Bimanual examination: Palpate the cervix (length, os), uterus (shape, consistency, and position), adnexa (masses, tenderness), pelvic floor strength.
  • Inspect the anus (masses or hemorrhoids).
  • Examine the extremities (varicosities, edema) and elicit reflexes (hyperreflexia).
  • Perform Leopold maneuvers (if indicated).
63
Q

Gravidity

A

the number of time that a woman has been pregnant

64
Q

Parity

A

the number of time that she has given birth to a fetus >=24 weeks (alive or stillborn)

65
Q

GTPAL

A

G - Gravidity - number of times she has been pregnant
T - Term - # pregnancies carried to term
P - pre term births - 20-36 weeks
A - abortion - number of pregnancies lost before 20 weeks
L - living children

66
Q

Miscarriage

A

Pregnancy loss before 20 weeks

67
Q

Ectopic pregnancy

A

Occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding.

68
Q

Gestational age calculation

A

Count the number of weeks and days since the LMP

69
Q

Estimated date of delivery

A
  • 40 weeks from the first date of the LMP
  • Take the LMP add 7 days, subtract 3 months and add 1 year
70
Q

Screening and lab tests suggested during pregnancy

A
  • Rh(D) compatability screening
  • Syphilis
  • Bacteriuria
  • Hep B
  • HIV
  • Iron deficiency
  • Gestational diabetes
  • Perinatal depression
  • Domestic violence
71
Q

Vitamin supplements during pregnancy

A
  • Daily prenatal vitamin with 600IU vit D and 1000mg calcium
  • Folic acid
  • Iron supplementation
72
Q

Nutrition recommendations during pregnancy

A

Avoid
- Unpasteurized milk/foods
- Raw & undercooked seafood, eggs, meat
- Pate, meat spreads, smoked salmon
- Hot dogs, lunch meat, cold cuts (unless served steaming hot)

Take
- 2-3 servings per week of fish/shellfish (low mercury – salmon, shrimp, pollock, tuna, tilapia, cod, catfish)

73
Q

Exercise recommendation during pregnancy

A

30+ minutes of moderate exercise most days

74
Q

Preeclampsia

A

SBP ≥140 or DBP ≥90 after 20 weeks on two occasions at least 4 hours apart in a woman with previously normal BP or BP ≥160/110 confirmed within minutes and proteinuria ≥300 mg/24 hours, protein to creatinine ratio ≥0.3, or dipstick 1+ OR:

New-onset hypertension without proteinuria and any of the following: thrombocytopenia (platelets <100,000/μL), impaired liver function (liver transaminase levels more than twice normal), new renal insufficiency (creatinine >1.1 mg/dL or doubles in the absence of renal disease), pulmonary edema, or new-onset cerebral or visual symptoms

75
Q

Gestational hypertension

A

SPB >140 or DBP >90

76
Q

Hyperemesis gravidarum-

A

N/V with weight loss that exceeds 5% of pre-pregnancy weight

77
Q

Gestational Diabetes

A

A 50-g oral glucose tolerance test (OGTT) is administered and venous glucose checked 1 hour after the glucose load, with screening thresholds of 130 to 140 mg/dL used at various institutions.

Patients with a positive 50-g screen then undergo a 100-g, 3-hour diagnostic OGTT. Patients are diagnosed with gestational diabetes when two or more values are abnormal on the 3-hour OGTT

78
Q

Immunizations recommended during/after pregnancy

A
  • Tdap (27-36 weeks gestation)
  • Inactivated flu vaccine
  • Rubella titer –> vaccine given after delivery if not immune
79
Q

USPSTF Recommendations for Breast Cancer Screening

A
  1. Breast exam annually for women 40+
  2. Mammography for women 50-74 biannuallly
  3. no breast self-exam
  4. breast self-awareness
80
Q

Testicular cancer

A
  1. Painless nodules
  2. 15-34 year olds - peak
  3. Palpable inguinal lymph nodes
81
Q

STI discharge in men

A

Penile discharge is :

white -chlamydia
yellow - gonorrhea
chancre - syphyllis

82
Q

STIs in women

A

Vaginal discharge is:

yellow - chlamydia
yellow - gonorrhea
chancre, large flat top lesions - syphyllis

83
Q

Safe vaccines during pregnancy

A
  • TDAP
  • inactivated flu
  • pneumococcal
  • meningococcal
  • Hep A & B

nr509 - advanced assessment (9 decks)

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