Blueprint Test 4 Flashcards
Current recommendations for prostate cancer screening
PSA (prostate specific antigen) testing is recommended q 1 to 2 years
DRE optional
Screening should stop at age 70 or when life expectancy drops below 10 yrs
Normal PSA
<4mg/mL
Risk Factors for Prostate CA
Age (rare before 40yrs - rates increase after age 50)
Ethnicity (Af. Amer. men highest incidence)
Family Hx (1st degree relative-risk increases 2-fold)
Other (Agent Orange expos., high fat diet, smoking)
BPH is not a risk factor for prostate CA
Milky nipple discharge unrelated to pregnancy or lactation
Galactorrhea
Nipple discharge that is bilateral, multi-ductal, prompted by stimulation and ranges in color from white to yellowish, green or black indicates what?
physiologic nipple discharge (normal)
Your 61 yo female patient presents with a chief complaint of spontaneous unilateral bloody nipple discharge. As her FNP, you know that warrants further evaluation for:
Intraductal papilloma
Current ACA (Amer. Cancer Society) recommendations for breast cancer screenings
Mammo
40y - 45y- optional annual screening
45y - 54y- annual screening
> /= 55 - biennial screening w/ option to continue annual screens - continue if health/life expectancy >/= 10 years
CBE Not recommended
A 40yo female presents with a single, round, soft, well-delineated, mobile, tender breast mass. What is the most likely diagnosis?
Breast Cyst
A 22 yo patient with a smooth, rubbery, round, mobile, non-tender breast mass. What is the most likely diagnosis?
Fibroadenoma
In a patient with pelvic pain, what are some life-threatening conditions that should be on your differential?
- ectopic pregnancy- including rupture
- ovarian torsion
- appendicitis
What can cause vaginal discharge in the pediatric patient?
Leukorrhea STI from consensual sexual activity or sexual abuse Bacterial vaginosis Foreign body External irritants
Most common cause of pelvic pain
PID (pelvic inflammatory disease) - must rule out life-threatening causes
A 30-year-old woman who is sexually active complains of a large amt of milk-like vaginal discharge for several weeks. A microscopy slide reveals a large number of cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is 6.0. What is most likely?
a) Trichomonas infection
b) Bacterial vaginosis
c) Candidal infection
d) Normal finding
b) Bacterial vaginosis
Your patient presents with profuse vaginal drainage that is yellow-green, frothy, and malodorous. She also complains of pain with urination. You suspect that your patient may have:
Trichomonal vaginitis
A 69 year old woman comes to the clinic with complaints of persistent vulvar itching. She has had the itching for several weeks. She has type 2 diabetes mellitus. Physical exam shows a erythematous and swollen vulva. There are pustules on the medial aspect of her thighs. A KOH preparation shows psuedohyphae and budding yeast under the microscope. What is the likely diagnosis?
Candida Vaginitis
Diagnosed after 12 months without a menstrual period
Menopause - Typically occurs between ages 48 and 55 years, peaking at a median age of 51 yrs Always ask about any bleeding or spotting after menopause as this may be an early sign of cancer
What is considered delayed puberty in females?
No breasts or pubic hair by age 12 years
What are some causes of delayed puberty in females?
Usually inadequate gonadotropin secretion from the anterior pituitary due to defective hypothalmic GnRH production
Also: anorexia nervosa and chronic disease
Hematochezia
Stool with red blood- usually originates in the colon, rectum, or anus, much less frequently from the jejunum or ileum
Important questions to ask when assessing for STIs
Have you been sexually active in the last year?
Do you have sex with men, women, or both?
How many sexual partners have you had?
Sexual orientation? Gender identity?
Have you had sex with someone you don’t know well or had just met?
Have you been coerced or pressured to have sex?
Have you ever had an STI?
STI screening in sexually active females over age 25
GC/Chlamydia - annually
Recommendations for HIV testing
At least once between age 13 and 64
Annually for unsafe sex practices or IVDU, gay, or bisexual men (q3-6mo)
Current cervical cancer screening recommendations
Begin at age 21 - end at age 65 assuming 3 consecutive negative cytology results
Age 21-65 cytology q 3 years OR
Age 21-29 cytology q 3 years then
Age 30-65 cytology + HPV testing (for high risk or oncogenic HPV types) q 5 years
Screening after hysterectomy with removal of cervix (for benign reasons) - not recommended
What is considered delayed puberty in the male?
Suspected in boys who have no signs of pubertal development by 14 years of age
What are some common causes of delayed puberty in the male?
Most common cause is constitutional delay, frequently a familial condition involving delayed bone and physical maturation, but normal hormone levels.
Less common causes: primary or secondary hypogonadism as well as congenital GnRH deficiency
Normal scrotal findings in a newborn
Scrotal edema may be present for several days following birth because of the effect of maternal estrogen.
Rugae (wrinkles) are present in NB at 40 wks gestation
NB testes should be about 10mm wide and 15mm long and should lie in the scrotal sacs most of the time
Exam findings with gonococcal urethritis
copious amount of purulent/yellow urethral discharge and dysuria
Exam findings with nongonococcal urethritis
less copious amount of clear or cloudy urethral discharge - urethral pruritus or dysuria - chlamydia
What are considered normal findings in the breasts of newborns?
Often enlarged, both in males and females from maternal estrogen effect - this may last several months Breasts may be engorged w/ a white liquid which may last 1 to 2 weeks
What is premature thelarche?
Breast development in a girl, most often between 6mo and 2yrs without other signs of puberty or hormone abnormalities
What exam findings are consistent with a hernia in the newborn infant?
Scrotal mass that is separate from the testes, usually reducible, and often does not transluminate. They do not resolve. Sometimes a thickened spermatic cord (silk sign) is noticed
Exam findings consistent with a hydrocele.
Non-tender, fluid filled mass within the tunica vaginalis of the scrotum - overlie the testes and the spermatic cord and are not reducible - transluminate and examining fingers can palpate above the mass within the scrotum - resolve by 18 months
Indirect inguinal hernia
Originates above the inguinal ligament near its midpoint and comes down the inguinal canal often into the scrotum - can occur in all ages and both sexes, often in children - may occur in adults
Direct inguinal hernia
Oriniates above the inguinal ligament close to the pubic tubercle (near the external inguinal ring) and bulges anteriorly - rarely into the scrotum
Less common - usually in men < 40 years old - rare in women
A 26yo male presents with yellow penile discharge, rash, tenosynovitis, and monoarticular arthritis. What is the most likely pathogen?
Gonorrhea
A hymen with two orificies is know as what?
a septate hyman
A hymen that surrounds the orifice circumferentially
an annular hymen
Possible cause of redundant labial tissue
estrogen effect
A hymen that does not encircle the vaginal orifice, but rather border the lower part of the vaginal orifice and extends to the posterior and lateral margins of the hymenal ring.
a crescentic hymen (crescent shaped)
Seven attributes of a symptom
1) Location (where is it? does it radiate?)
2) Quality (what is it like?)
3) Quantity (how bad is it?)
4) Timing (when did/does it start?)
5) Onset (setting in which symptom occurs)
6) Remitting/exacerbating (what makes it better or worse)
7) Associated manifestations (have you noticed anything else that accompanies it?)
What findings are consistent with Parkinson’s disease?
- Decreased facial mobility/mask-like faces, with decreased blinking and characteristic stare
- Low-frequency unilateral resting tremor, rigidity, and bradykinesia
