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Sasha: Module 8 Repro/GU > CA Bates > Flashcards

CA Bates Flashcards

1
Q

how many quadrants is the breast broken up into for documentatio

A

4 horizanl vertical line crossing the nipple
and a 5th area (axillary tail of breast tissue sometimes called tail of spense) and it extends laterally across the anterior axillary fold

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2
Q

how are findings locaalized

A

as the time on the face of a clock
and
distance in cm from nipple

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3
Q

what are the three most common kinds of breast masses

A

fibroadenoma (benign tumor)
cysts
breast cancer

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4
Q

commonly palpable as nodular, rope-like densities in women ages 25-50. may be tender or painful. considered benign and are not viewed as a risk factor for breast cancer

” nodular and ropelike”

A

fibrocystic changes

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5
Q 
fibroadenoma 
age 
number
shape
consistency
delimitation
mobility
tenderness
retraction signs
A

age : 15-25
usually puberty and young adults, but up to age 55

number: usually single, may be multiple

shape: round disclike or lobular
consistency: may be soft usually firm

delimitation: well delineated
mobility: very mobile
tenderness: non tender

retraction signs: absent

“smooth, rubbery, round mobile, nontender”

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6
Q 
Cysts
age 
number
shape
consistency
delimitation
mobility
tenderness
retraction signs
A

age : 30-50, regress after menopause except with estrogen therapy

number: single or multi
shape: round
consistency: soft to firm, elastic
delimitation: well delineated
mobility: mobile
tenderness: tender

retraction signs: absent

“soft to firm, round, mobile, tender”

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7
Q 
cancer
age 
number
shape
consistency
delimitation
mobility
tenderness
retraction signs
A

age : 30-90 most common OVER 50

number: single but can coexist with other nodules
shape: irregular or stellate
consistency: firm or hard
delimitation: no clearly delineated from surrounding tissue
mobility: fixed to skin or underlying tissue
tenderness: non tender

retraction signs: maybe

“irregular firm may be mobile or fixed to surrounding tissue

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8
Q

breast masses should be carefully evaluated and usually warrants further investigation like….. (4)

A

ultrasound, aspiration, mammo, or biopsy

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9
Q

what are three retraction signs

A
  1. abnormal contours
  2. skin dimpling
  3. nipple retraction and deviation
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10
Q

as breast CA advances it causes fibrosis (scar tissue). shortening of the tissue produces dimpling, changes in contour and retraction of deviation of the nipple. other causes of ____________ are fat necrosis and mammary duct ectasia…. what am i referring to?

A

retraction signs

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11
Q

variation in the normal convexity of each breast, and compare one side to the other. special positioning may again be useful. marked flattening of the lower outer quadrant of the left breast is an example of what you may see in this type of retraction sign

A

abnormal contours

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12
Q

seen when pts arms are at rest, during special positioning and on moving or compressing the breast

A

skin dimpling

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13
Q

nipple is flattened or pulled inward. can be broadened and feels thickened. when involvement is radially asymmetric the nipple may point in a different direction from its normal counterpart, typically toward the underlying cancer

A

nipple retraction and deviation

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14
Q

produced by lymphatic blockade. appears as thickened skin with enlarged pores
also called peau d’orange (orange peel) sign
seen first in the lower portion of the breast or areola

A

edema of the skin

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15
Q

uncommon form of breast cancer usually starts as a scaly eczema like lesions that may weep, crust, or erode.
breast mass may be present.
suspect this is any persisting dermatitis of the nipple and areola occur.
can present with invasive breast cancer or ductal carcinoma in situ

A

Paget’s Disease of the Nipple

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16
Q

inappropriate discharge of milk containing fluid, and is abnormal if it occurs 6 or more months after childbirth or cessation of breast feeding

A

galactorrhea

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17
Q

milky discharge unrelated to prior pregnancy and lactation. causes include hypothyroidism, pituitary prolactinoma, and drugs that are dopamine agonists, including many psychotropic agents and phenothiazines

A

nonpuerperal glactorrhea

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18
Q

spontaneous unilateral bloody discharge fro one or two ducts warrants further evaluation for ____________

A

intraductal papiloma

ductal carcinoma in situ or Pagets disease of the breast

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19
Q

clear serous, green, black, non bloody discharge that are multiductal are

A

usually benign

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20
Q

masses nodularity and change in color or inflammation especially in the incision line suggest

A

recurrence of breast cancer

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21
Q

deeply pigmented velvety axillary skin suggests

A

acanthosis nigricans

associated with internal malignancy

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22
Q

thickening of the nipple and loss of elasticity suggests

A

underlying cancer

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23
Q

tender cords

benign but sometimes painful conditon of dilated ducts with surrounding inflammation, sometimes associated masses

A

mammary duct ectasia

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24
Q

hard irregular poorly circumscribed nodules fixed to the skin or underlying tissue

A

cancer

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25
Q

if you are above the age of _____ it is cancer until proven otherwise

A

50

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26
Q

what is the most common type of cancer in women worldwide

and the second leading cause of death in women

A

breast cancer

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27
Q

breast cancer accounts for more than _____% of cancers in women

A

10%

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28
Q

in the US. a women born now has a ___% or ___ in ____ lifetime risk of developing breast cancer

A

12%

1 in 8

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29
Q

95% of new breast cancers occur above the age of ____

A

40

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30
Q

factors which increase relative risk of breast cancer:
(this card is a lot but it is an LO so here I go)

page 412 in bates

A 
>40 Relative Risk: factors are: 
female
age
inherited genetic mutations
2 or more first degree relatives with breast cancer diagnoses at an early age
personal history of breast cancer
high breast tissue density
biopsy confirmed atypical hyperplasia

2.1-4.0 RR: factors are:
one 1st degree relative with breast cancer
high dose radiation to chest
high bone density (postmenopausal)

1.1-2.0 RR: factors are:
late age at first full term pregnancy >30
early menarche (55)
no full term pregnancies
never breast fed a child
recent oral contraceptive use
recent and longterm use of hormone replacement therapy
obesity
other factors:
personal history of endometrium ovary or colon cancer
alcohol consumption
height
high socioeconomic status
jewish heritage
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31
Q

estimate absolute lifetime risk of breast cancer and are the most commonly used. they assess risk based on large population Data sets, BUT hey do not predict disease in a single individual.

A

Gail and CLaus models

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32
Q

used for predicting BRCA1 or BRCA2

A

BRCAPRO model

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33
Q

there is no single model that addresses all the known risk factors or includes all of the genetic details of personal and daily history, so devising data bases personalized management strategies is an on going focus for reseach

A

true

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34
Q

Breast cancer risk assessment tool often called the _____________ provides 5 year and first degree relatives with breast cancer previous breast biopsies and presence of hyperplasia, age at menarche, and age at first delivery. it is the best used for individuals over the age of 50 who have either no family history of breast cancer or one affected first degree relative and who have annual screening mammos. should not be used for women with a past history of breast cancer or radiation exposure, or those who are 35 or younger. does not determine risk for noninvasive breast cancer and does not take paternal history or disease in second degree relatives into account or age of onset of disease
this model was recently updated to include breast density but depends on the use of digital mammo and special software making it more difficult to use

A

GAIL MODEL

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35
Q

assess risk for high risk women and incorporates family history for both female And male 1st and 2nd degree relatives, including age of onset.
based on the woman’s current age
it is best used for individuals with no more than two first or second degree relatives with breast cancer.
expanded version includes family members with ovarian cancer,
model does not include personal, lifestyle or reproductive risk factors
discrepancies in risk assessment between published tables and the computerized program have been reported

A

CLAUS MODEL

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36
Q

used for high risk women to assess risk of BRACA1 and BRACA 2 mutations frequencies, cancer penetration i affected carriers and age of onset in first and second degree female and male relatives.
DOES NOT include on hereditary risk factors

A

BRCAPRO model

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37
Q

when do we begin evaluating a womans breast cancer risk?

A

early 20s by asking about family history

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38
Q

pattern of breast or ovarian in maternal or paternal family member is suspicious for

A

autosomal dominant genetic mutations

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39
Q

what do you loook specifically for in a positive family history

A
  1. age 50 or younger for diagnosis
  2. breast cancer in two or more indiv. in the same lineage (paternal or maternal)
  3. multiple primary or ovarian tumors in one person
  4. breast cancer in a male relative
  5. Ashkenazi Jewish ancestry
  6. family member with a known predisposing gene
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40
Q

what mutation represent roughly half of the familial breast cancers

A

BRCA1 and 2

account for 5% of breast cancers

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41
Q

if family history is suspect the next steps for clinical include

A

using the BRCAPRO calculator, conducting genetic testing, considering MRI for sceening in addition to mammo and making appropriate specialty referals

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42
Q

mammo women 40 to 50

A

controversial: why?
1. due to lower sensitivity and specificity
2. maybe related to heterogenous estrogen exposure in women still premenopausal
3. high number of false positives (9 out of 100 women)
4. high rate of resulting invasive procedures

having mammo 40-50 is based on individual patient

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43
Q

screening mammo age 50-74

A

biennial screening for women. changed it from annual to biennial.
reduced the harm of ammo screening. decreased false positives

however American cancer society and world health organization recommend annual mammo. world health organization says every 1 to 2 years.

digital mammo appears to perform better in younger women and women with higher breast density

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44
Q

screening mammos for over 75 yo

A

individualized decisions about continuing screening, depending on coexisting conditions and anticipated 5 year survival

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45
Q

Clinicial Breast Examination (CBE) guideleines

A

USPSTF and World Health Organization: determined evidence supporting insufficiency of CBE for establishing balance of benefits and harms
American Cancer Society recommends the CBE every 3 years for women ages 20-39 and annually preferably before mammo, beginning age 40. CBE provides pt education but cautions that a thorough CBE may take up to 10 min.

CBE is heavily influenced by the technique of the examiner.

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46
Q

Breast self exam contraversy

A

evidence that is does not reduce mortality and may lead to higher rate of benign biopsies

but some say it promotes health awareness and advises clinicians to teach and review the patient techniques.

monthly BSE 5 to 7 days after onset of menses (when hormonal stimulation of breast tissue is low) can be taught to women as early as their 20s

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47
Q

BSE instructions on how to perform. page 427 in bates

again this is long. but it is an LO so i would read it over :)

you can do it!

A

lying supine:

  1. lie down with a pillow under your right shoulder. lace right arm behind your head.
  2. use finger pads of the three middl fingers on your left hand to feel for lumps in the right breast. finger pads are the top third of each finger
  3. firmly press enough to know how your breast feels, using firmer pressure for tissue closest to the chest and ribs. firm ridge in the lower curve of each breast is normal. if you’re not sure how hard to press talk with provider. or try to cop the at they do it
  4. press firm on he breast in an up and down or strip patient. also can us a circular or wedge pattern but be sure to use the same pattern every time. check the entire breast area form the underarm tot he sternum and the collarbone to the ribs below the breast. remember how your breast feels from month to month
  5. repeat exam on your left breast
  6. if you fin a mass or lump or skin change go see your doctor DUH

Standing:

  1. while standing in front of a mirror with your hands pressing firmly down on your hips , look at your breasts and say…. I am beautiful hahaha!…. but for real look at your breasts for changes in size shape contour or dimpling or redness or scaliness of nipple or breast skin.
  2. examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. raising arm straight up tightens he tissue in this area and makes it hard to examine.
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48
Q

breast MRI screening criteria

A

annual screening with MRI and mammo for women at high lifetime risk of breast cancer, above 20%. woen at moderate lifetime risk (15% to 20%)urged to discuss MRI screening with their provider.

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49
Q

high risk (20% -25%) criteria and factors for breast cancer and therefore indicated to get a breast MRI include

(5)

A
  1. lifetime risk 20-25% using assessment tools
  2. BRCA1 or 2 mutation
  3. 1st degree relative (father, brother, with BRCA1 or 2 mutation but woman not tested)
  4. history of chest radiation between ages of 10-30
  5. high risk genetic syndrome in 1st degree relative with high risk syndrome
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50
Q

moderate risk (15-20%)

3

A
  1. lifetime risk of 15-20% using risk assessment tools
  2. history of breast cancer, ductal or lobular carcinoma in situ, atypical ductal or lobular hyperplasia
  3. extremely dense breasts or unevenly dense breasts on mammograms
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51
Q

tunnel for the vas deferens as if passes through the abdominal mucles

A

inguinal canal

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52
Q

triangular, slitlike structure palpable just above and lateral to the pubic tubercle.

A

external inguinal ring

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53
Q

aprrox 1 cm above the midpoint of the inguinal ligament.

A

internal inguinal ring

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54
Q

what is not palpable through the abdominal wall relating to anatomy of the groin

A

canal nor internal ring

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55
Q

how are inguinal hernias formed

A

loops of bowel force their way through weak areas of the inguinal canal and produce inguinal hernias.

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56
Q

what is another route for a hernia mass

A

femoral canal

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57
Q

develop at the internal inguinal ring, where the spermatic cord exits the abdomen

A

indirect inguinal herniea

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58
Q

arise more medially from weakness in the floor of the inguinal canal and are associated with straining and heavy lifting

A

direct inguinal hernias

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59
Q

more present as emergencies with bowel incarceration or strangulation

A

femoral hernias

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60
Q 
INGIRECT HERNIA
frequency, age, sex
point of origin
course
examination during straining
A

frequency, age, sex: all ages, both sexes. often children, may be adults

point of origin: above inguinal ligament, near its midpoint (internal inguinal ring)

course: often into the scrotum

examination during straining: the hernia comes down the inguinal canal and touches the finertips

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61
Q 
DIRECT HERNIA
frequency, age, sex
point of origin
course
examination during straining
A

frequency, age, sex: less common, men older than 40; rare in women

point of origin: above inguinal ligament, close to the pubic tubercule (near the external inguinal ring)

course: rarely into the scrotum

examination during straining: the hernia bulges anteriorly and pushes the side of the finger forward

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62
Q 
FEMORAL HERNIAS
frequency, age, sex
point of origin
course
examination during straining
A

frequency, age, sex: least common, more common in women

point of origin: below the inguinal ligament, appears more lateral than an inguinal hernia. can be hard to differentiate from lymph nodes

course: never into scrotum

examination during straining: inguinal canal is empty

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63
Q

may be from psychogenic causes, especially if early morning erection is reserved; it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, and diabetes

A

erectile dysfunction

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64
Q

common in young men. possible causes are medications, surgery, neurologic deficits, lack of androgen.

A

premature ejaculation

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65
Q

lack or orgasm with ejaculation is usually

A

psychogenic

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66
Q

reduced or absent ejaculation affects

A

middle aged or older men

less common

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67
Q

yellow penile discharge

A

gonorrhea

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68
Q

white penile discharge

A

non gonococcal urethritis from chlamydia

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69
Q

rash, tenosynovitis, monoarticular arthritis, even meningitis, not always with urogenital symptoms

A

disseminated gonorrhea

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70
Q

what are the 4 infections from oral-penile transmission

A
  1. gonorrhea
  2. chlamydia
  3. syphilis
  4. herpes
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71
Q

tight prepuce that cannot be retracted over the glans.

A

phimosis

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72
Q

tight prepuce that once retracted cannot be returned edema ensues

A

paraphimosis

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73
Q

inflammation of the glans

A

blanitis

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74
Q

inflammation of the glans and prepuce

A

balanoposthitits

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75
Q

congenital, ventral displacement of the meatus on the penis

A

hypospadias

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76
Q

profuse yellow discharge

A

gonococcal urethritis

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77
Q

scanty white or clear discharge

A

nongonococcal urthritis

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78
Q

what is the definitive diagnosis required for gonococcal urthiritis and nongonococcal urthrititis

A

gram stain and culture

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79
Q

induration along the ventral surface of penis suggests

and tenderness in the indurated area suggest

A

urethral stricture or possibly carcinoma

periurethral inflammation secondary to urrthral structure

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80
Q

4 things that a tender, painful scrotal swelling could be

A
  1. acute epididymitis
  2. acute orchitis
  3. torsion of the spermatic cord
  4. strangulated inguinal hernia
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81
Q

multiple tortuous veins in this area, usually on the left, may be palpable and even visable

A

varicocele

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82
Q

vas deferens if infected may feel thickened or beaded. cystic structure in the spermatic cord suggests

A

hydrocele of the cord

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83
Q

bulge that appears with straining

A

hernia

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84
Q

how does bowel sounds help differentiate between a hernia and a hydrocele

A

bowel sounds may be heard over a hernia

bowel sounds are NOT heard over a hydrocele

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85
Q

when a hernias contents cannot be returned to the abdominal cavity

A

incarcerated

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86
Q

when a hernias blood supply to the entrapped contents is compromised

A

stangulated

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87
Q

hernia with tenderness, nausea, vomiting and consider surgical intervention

a. strangulation OR
b. incarcerated

A

A. STRAGULATION

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88
Q

what is the most common form of cancer for men between ages 15-34

A

testicular carcinoma

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89
Q

what are three conditions that have to do with penile discharge or lesions
p.535

A

i. Peyronie’s disease
ii. Hypospadias
iii. Carcinoma of the penis

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90
Q

palpable, non tender hard plaques are found just beneath the skin, usually along the dorsum of the penis. the pt complains of a rooked, painful erection

A

Peyronie’s disease

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91
Q

an indurated module or ulcer that is usually non tender. limited almost completely to me who re not circumcised, it may be masked by the prepuce. any persistent penile sore is suspicious

A

Carcinoma of the penis

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92
Q

congenital displacement of the urethral meatus to the inferior surface of the penis. a groove extends from the actual urethral meatus to its normal location on the top of the glans

A

Hypospadias

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93
Q

may make the scrotal skin taut, seen in heart failure or nephrotic syndrome

A

scrotal edema

pitting edema

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94
Q

non tender, fluid filed mass within the tunica vaginalis. it transilluminates and the examining fingers can get above the mass within the scrotum

A

hydrocele

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95
Q

usually an indirect inguinal hernia, that comes through the external inguinal ring, so the examining fingers cannot get above it within the scrotum

A

scrotal hernia

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96
Q

testis is atrophied and may lie in the inguinal canal or the abdomen, resulting in an unfilled scrotum. no palpable testis or epididymis on the affected side. raises the risk for testicular cancer

A

cryptorchidism

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97
Q

testicular length usually

A

small testis

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98
Q

testis is acutely inflamed, painful, tender, and swollen
may be difficult to distinguish from epididymis
scrotum may be reddened
seen in mumps an other viral infections usually unilateral

A

acute orchitis

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99
Q

usually appears as a painless nodule

any nodule within the testis warrants investigation for malignancy

A

EARLY tumor or the testis

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100
Q

painless nodule spreads, may seem to replace the entire organ. the testicle characteristically feels heavier than normal

A

LATE tumor of the testis

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101
Q

a painless, movable cystic mass just above the testis suggest a _____________ or _____________. both transilluminate.

which contains sperm
and then which dose not,

are they clinically indistinguishable.

A

Spermatocele or cysts of the epididymis

which contains sperm: spermatocele

which does not contain sperm: cysts of epididymis

YES they are clinically indistinguishable.

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102
Q

an acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testis. the scrotum may be reddened and the vas deferens inflamed. it occurs chiefly in adults, most commonly with chlamydia infection. coexisting urinary tract infection or prostatitis supports the diagnosis.

A

acute epididymitis

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103
Q

refers to varicose veins of the spermatic cord, usually found on the left. it feels like a soft :bag of worms” separate from the testis, and slowly collapses when the scrotum is elevated in the supine patient. infertility may be associated.

A

varicocele of the spermatic cord

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104
Q

twisting of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. the scrotum becomes red and edematous. there is no associated urinary infection. most common in adolescents, is a surgical emergency because of obstructed ciruclation

A

torsion of the spermatic cord

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105
Q

the chronic inflammation produces a firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens

A

tuberculous epididymitits

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106
Q

Appearance: single or multiple papules or plaques of variable shapes; may be round, acuminate (or pointed), or thin and slender. may be raised, flat or cauliflower-like
causative organism: human papillomavirus (HPV), usually subtypes 6 and 11, carcinogenic subtypes rare
incubation: weeks to months, infected contact may have no visible warts.
can arise on penis, scrotum, groin, thighs, anus, usually asymptomatic, occasional itching and pain
may disappear without treatment

A

genital warts (condylomata aciminatata)

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107
Q

appearance: small scattered or grouped vesicles, 1 to 3 mm in size, on glans or shaft of penis. appear as erosions if vesicular membrane breaks.
Causative organism: usually herpes simplex virus 2 (Double stranded DNA virus)
incubation: 2 to 7 days after exposure
primary episode may be asymptomatic; recurrence usually less painful of shorter duration.
associated with fever, malaise, HA, arthraligias, local pain and edema, lymphadenopathy

what do you need to distinguish this from (2)

A

genital herpes simplex

need to distinguish from genital herpes zoster (usually in older patients with dermatomal distribution); candidiasis.

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108
Q

appearance: small red papule hat becomes chancre, or painless erosion up to 2 cm in diameter. base of chancre is clean, red, smooth and glistening; borders are raised and indurated. chancre heals within 3 to 8 weeks.
causative organism: Treponema pallidium (spirochete
incubation: 9 to 90dyas after exposure
may develop inguinal lymphendopathy within 7 days; lymph nodes are rubbery, non-tender, mobile
20-30% of pt develop secondary syphilis while chancre still present (suggest co-infection with HIV)

what do you need to distinguish from (3)

A

primary syphilis

distinguish from:

  1. genital herpes simplex
  2. chancroid
  3. granuloma inguinale from Klebsiiella granulomatis (rare in US; 4 variants, so difficult to identify)
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109
Q

Appearance: red papule or pustule initially, then forms a painful deep ulcer with ragged non indurated margins; contains necrotic exudate has a friable base
causative organism: Haemophilus ducreyi, an anaerobic bacillus
Incubation: 3 to 7 days after exposure
painful inguinal adenopathy; suppurative buboes in 25% of pts

what do you need to distinguish from? (4)

A

chancroid

need to distinguish from:

  1. primary sphyilis
  2. genital herpes simplex
  3. lymphoomogranuloma venereum
  4. granuloma inguinale from Kelbsiella granulomatis (both rare in the US).
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110
Q

its incidence is low (4 per 100,000 men) BUT it is the most common cancer of young men between ages 15-34

A

testicular cancer

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111
Q

when detected early how is the prognosis of testicular cancer

A

GREAT!

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112
Q

what are risk factors for testicular cancer (5)

A
  1. cryptorchidism (which confers a high risk for testicular carcinoma in the undescended testicle)
  2. history of carcinoma in contralateral testicle
  3. mumps orchitis
  4. inguinal hernia
  5. hydrocele in childhood
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113
Q

Instructions for testicular self exam…

just read it over
p.531

A

best performed after a warm bath or shower. the heat relaxes the scrotum and makes it easier to find anything unusual

  1. standing in front of a mirror, check for any swelling on the skin of the scrotum
  2. with the penis out of the way, examine each testicle separately
  3. cup the testicle between your thumb and fingers with both hands and roll it gently between fingers. one testicle may be larger than the other; that is normal, but be concerned about any lump or area of pain.
  4. find the epididymis, this is a soft, tubelike structure at the back of the testicle that collects and carries sperm, and is not an abnormal lump.
  5. if you find any lump, dont wait. see a doctor. the lump may just be an infection, but if it is cancer, it will spread unless stopped by treatment
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114
Q

who is at highest risk of HIV/AIDS

A

african american men and men having sex with men.

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115
Q

testing for HIV (what age)

people at high risk: how often?

A

universal testing from ages 18-64, regardless of risk

groups at high risk: annually

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116
Q

presence of any STI (hep B chancroid etc) warrants testing for

A

coinfection of HIV

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117
Q

what type of approach is beneficial in adopting for take a sexual history

A

client centered counseling!

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118
Q

key instructions for using a condom correctly and therefore reducing the risk of STI and HIV (4)

A
  1. using a new condom with each sex act
  2. applying the condom before any sexual contact occur
  3. adding only water based lubricants
  4. holding the condom during withdrawal to keep it from slipping off.
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119
Q

what age is HPV vaccination for boys and men recommended.. and what does it prevent

A

GARDASIL for boys and men ages 9-26 for prevention of genital warts

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120
Q

what are you looking for when you retract the prepuce (foreskin)?

A

chancres and carcinomas.

can see smegma: cheesy, whitish material may accumulate normally under foreskin

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121
Q

dome-shaped white or yellow papules or nodules formed by occluded follicles filed with keratin debris of desquamated follicular epithelium

A

epidermoid cysts

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122
Q

change in bowel pattern, especially stools of thin pencil-like shape, may warn of

A

colon cancer

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123
Q

blood in the stool may be from

4

A

polyps or cancer or from gastrointestinal bleeding or local hemroids

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124
Q

mucus may accompany

A

villous adenoma

125
Q

positive answers to person or family history of colonic polyps or colorectal cancer and history of inflammatory bowel disease indicates

A

increased risk for colorectal cancer and a need for further testing and surveillance

126
Q

may be indicated by itching, anorectal pain, tenesmus, or discharge or bleeding from infection or rectal abscess
causes include gonorrhea, chlamydia, lymphogranuloma veereum, receptive intercourse, ulcerations of herpes simplex, chancre or primary syphilis.

A

proctitis

127
Q

itching in younger pts may be from

A

pinworms

128
Q

genital warts may occur from (2)

A

HPV

condylomata lata in secondary syphilis

129
Q

anal fissures can be found in (2)

A

proctitis

crohn’s disease

130
Q

difficulty starting or holing back urine stream. flow is weak. frequent urination especially at night. pain and burning when urine is passes. blood in urine or semen or pain with ejaculation. frequent pain or stiffness in the lower back, hips, or upper thighs

A

symptoms suggest urethral obstruction as in benign prostatic hyperplasia (BPH) or prostate cancer, especially in men older than 70 years

131
Q

AUA symptom index helps quantify

A

BPH severity and need for referral.

132
Q

men feeling discomfort or heaviness in the prostate area at the base of the penis. malaise fever and chills

A

prostatitis

133
Q

leading cancer diagnosed in US men and the second leading cause of death in men after lung cancer

A

prostate cancer

134
Q

what are primary risk factors of prostate cancer

A
  1. age
  2. ethnicity
  3. family history
135
Q

after age ____, the risk of prostate cancer increases sharply with each advancing decade

A

50

136
Q

incidence rates for prostate cancer are higher in which ethinicity

A

african american men.

prostate cancer occurs at an earlier age and more advanced stage in african american men.

137
Q

what is a strong risk factor to remember as you interview the patients.

A

family history

men with on affecte first degree relative namely a father or brother, are 2 or 3 more likely to have prostate cancer.

138
Q

what is their a correlation between concerning prostate cancer and diet

A

maybe a higher risk if you have a high intake of saturated fat from diary and animal sources

139
Q

what is the most common methods for screening for prostate cancer

A

prostate specific antigen (PSA)
and
digital rectal exam (DRE)

140
Q

glycoprotein produced by prostate epithelial cells. it is a biomarker for early detection of prostate cancer, bit it has a number of limitations as a screening test.

A

PSA

141
Q

PSA can be elevated in a number of benign conditions such as: (4)

A
  1. hyperplasia
  2. prostatitis
  3. ejaculation
  4. urinary retention

causing false positives

142
Q

the common cutpoint for proceeding to biopsy is

A

4.0 ng.mL

143
Q

PSA does not distinguish small volume indolent cancers from aggressive life-threatening disease

true/false

A

TRUE

144
Q

low sensitivity of 59% with a specificity of 94%. detects tumors on the posterior and lateral aspects of the gland but misses the 25 to 35% of tumors arising in other areas.

A

DRE

145
Q

prostate PSA testing should begin at age

A

50 average risk
45 high risk (single affected first degree relative)
40 at very high risk from two or more affected relatives

146
Q

swollen, thickened, fissured perianal skin with excoriations

A

pruritus ani

147
Q

tender, purulent, reddened mass with fever or chills accompanies an

A

anal abcess

148
Q

sphincter tightness may occur with

A

anxiety
inflammation
scarring

149
Q

sphincter laxity may occur with

A

neurologic diseases such as S2-4 cord lesions

150
Q

fairly common
congenital
abnormality located in the midline superficial to the coccyx or the lower sacrum.
look for opening of sinus tract
opening may exhibit a small tuft of hair surrounded by a halo of erythema
generally asymptomatic except perhaps for slight drainage, abscess formation and secondary sinus tracts may complicate the picture

A

pilonidal cyst and sinus

151
Q

dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. seldom produce symptoms unless thrombosis occurs. causes acute local pain that increases with defecation and sitting. tender swollen bluish ovoid mass is visible at the anal margin

A

external hemorrhoids (thrombosed)

152
Q

enlargements of the normal vascular cushions located above the pectinate line. they are not usually palpable. sometimes, especially during defecation may cause bright red bleeding. may also prolapse through anal canal and appear as reddish, moist protruding masses

A

internal hemorrhoids (prolapsed)

153
Q

happens when someone is straining for a bowel movement. this may happen to the rectal mucosa with or without the muscular wall.
it appears as a donut or rosette of red tissue.
involving only mucosa is relatively small and shows radiating folds. when the entire bowel wall is involved, it is larger and covered by concentrically circular folds

A

prolapse of the rectum

154
Q

painful oval ulceration of the anal canal, found most commonly in the midline posteriorly, less commonly in the midline anteriorly. its long axis lies longitudinally. there may be a swollen sentinel skin tag just below it. gentle seperation of the anal margins may reveal the lower edge of the fissure. the sphincter is spastic; the examination is painful. local anesthesia may be required

A

anal fissure

155
Q

inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus. usually an abscess before it. look for these at opening or openings anywhere in the skin around anus

A

anorectal fistula

156
Q

common.
variable in size and number
can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile)
soft and may be difficult or impossible to feel even when in reach of the examining finger.
proctoscopy and biopsy are needed for differentiation of benign form malignant lesions

A

polyps of the rectum

157
Q

asymptomatic
routine rectal examination is important for this reason!
firm, nodular rolled edges of an ulcerated cancer

A

cancer of the rectum

158
Q

widespread peritoneal metastases from any sources may develop in the are of peritoneal reflection anterior to the rectum

firm to hard nodular

may be just palpable with the tip of the examining finger.

in women this metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus

A

rectal shelf

159
Q

palpated through the anterior rectal wall
rounded
heart shaped structure approx 2.5 cm long
median sulcus can be felt between the two lateral lobes
only the posterior surface is palpable
anterior lesions including those that may obstruct the urthetha are not detectable by PE

A

normal prostate gland

160
Q

presents with fever and urinary tract symptoms such as frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain. the gland feels tender, swollen “boggy” and warm.
examine gently.
more than 80% infections are causes by E.coli, Enterococcus, and Proteus.
in men younger then 35 consider sexual transmission of Neisseria gonorrhea and chlamydia trachonatis

A

acute bacterial prostatitis

161
Q

associated with recurrent urinary tract infections, usually from the same organism.
men may be asymptomatic or have symptoms of dysuria or mild pelvic pain.
prostate gland may feel normal, without tenderness or swelling
cultures of prostatic fluid show infection of E.coli usually

A

Chronic bacterial prostatitis

162
Q

seen in 80% of symptomatic men who report obstructive or irritative symptoms on voiding but show no evidence of prostate or UTI.
PE findings are not predictable, but examination is needed to assess any prostate induration or asymmetry suggestive of carcinoma.

A

chronic pelvic pain syndrome

163
Q

non-malignant enlargement of the prostate gland that increases with age, present in more tan 50% of men by 50 years.
symptoms arise both from smooth muscle contraction in the prostate and bladder neck and from compression of the urethra.
they may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both and are seen in more than one third of the men by 65 years.
affected gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm through slightly elastic
there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen

A

benign prostatic hyperplasia

164
Q

suggested by an area of hardness in the gland.
a distinct hard nodule that alters the contours of the gland may or may not be palpable.
as it enlarges, it feels irregular and may extend beyond the confines of the gland.
the median sulcus may be obscured
hard areas in the prostate are not always malignant
may also result form prostatic stones, chronic inflammation and other conditions

A

cancer of the prostate

165
Q

age of onset of menses

A

menarche

166
Q

absence of menses for 12 consecutive months usually occurring between 48 and 55 years

A

menopause

167
Q

bleeding ocurring 6 months or more after cessation of menses

A

postmenopausal bleeding

168
Q

absence of menses

A

amenorrhea

169
Q

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

A

dysmenorrhea

170
Q

a cluster of emotional behavior and physical symptoms occurring 5 days before menses for 3 consecutive cycles
cessation of symptoms and signs within 4 days after onset of menses, and interference with daily activity

A

premenstrual syndrome (PMS)

171
Q

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

A

abnormal uterine bleeding

172
Q

when do girls usually begin to menstruate

A

between ages of 9 and 16

173
Q

how long does it take for periods to get into a regular pattern

A

up to 1 year

174
Q

how long does a flow usually last

A

3-7 days

175
Q

vocab work for last menstrual cycle and then the term for the one before that

A

last menstrual period (LMP)

prior menstrual period (PMP)

176
Q

results from prostaglandins production during the luteal phase of the menstrual cycle, when estrogen an progesterone levels decline

A

primary dysmenorrhea

177
Q

causes of this are:

endometriosis, adenomyosis, pelvic inflammatory disease, endometrial polyps

A

causes of secondary dysmenorrhea

178
Q

causes of this are:
low body weight (from malnutrition and anorexia nervosa, stress, chronic illness, hypothalamic-pituitary-ovarian dysfunction)

A

casues of secondary amenorrhea

179
Q

_________ suggests cervical polyps or cancer, or in an older women, atrophic vaginitis

A

postcoital bleesing

180
Q

what is the issue with giving estrogen to women in menopasue

A

helps with symptoms BUT increases other heath hazards

181
Q

absence of EVER initiating periods

A

primary amenorrhea

182
Q

cessation of periods after they have been established

pregnancy, lactation, menopause: physiologic forms

A

secondary amenorrhea

183
Q

less than 21-day interval between menses

A

polymenorrhea

184
Q

infrequent bleeding

A

oligomenorrhea

185
Q

excessive flow

A

menorrhagia

186
Q

intermenstrual bleeding

A

metorrhagia

187
Q

occurs between ages of 48-55/
peaks at about 51
cessation of menses for 12 months
ovaries stop producing estriadol or progesterone and estrogen levels drop significantly
pituitary secretion of LH and FSH elevted

A

menopause

188
Q

causes of postmenopausal bleeding

A

endometrial cancer
hormone replacement therapy
uterine and cervical polyps

189
Q

The Gravida Para Notation

G stands for?
P stands for?

A

G: gravida, or total # of pregnancies
P: para, or outcomes of pregnancies. after P, you will often see the notations F (full term, P (premature, A (abortion), and L (living child)

190
Q

pap screening ages

A

21-65

191
Q

several screening guidelines

A

first screen: 21 yo

women ages 21-29: every 3 years with cytology

women ages 30-65: screen every 3 years with cytology if three consecutive negative screening tests, no history of invasive carcinoma from CIN 2 or CIN 3, and no risk factors such as HIV infection, immunocompromised, or exposure in utero to diethylstilbestrol or with cytology and HPV testing every 5 years.

women with hysterectomy: discontinue screening if hysterectomy for benign indictions and no prior history of high grade CIN.
if hysterectomy for CIN2, CIN3 or cancer and cervix removed, continue annual screening for 20 years after postsurveillance period.

women greater than 65: discontinue

192
Q

when does the CDC recommend gardicil for routine vaccination in girls?

A

before their first sexual contact , usually ages 11 or 12 but possibly starting at age 9

193
Q

how many dose series is gardacil

A

three dose series

194
Q

what HPV does gardicil target

A

16, 18, 6, 11
and prevents most cervical cancer
vaccine also reduces risk of anogenital warts, invasive anogenital cancers, and vulvar and vaginal cancer

195
Q

this is recommended for girls and women ages 13-26 if they have not had all three doses

A

catch up vaccination

196
Q

what are the men recommendation for gardicil

A

boys and men ages 9 through 26, ideally before their first sexual contact, since it prevents genital warts.

197
Q

which vaccine is NOT recommended for boys and men

A

bivalent vaccine which targets HPV 16 and 18

198
Q

in women three symptoms merit special attention for ovarian cancer what are they?

A
  1. abdominal distension
  2. abdominal bloating
  3. urinary frequency
199
Q

family history
presence of the BRCA1 and BRCA 2 have a lifetime risk of 39% to 46% and 12 to 20%
over 90% of ovarian cancers appear to be random
risk is decreased by use of oral contraceptives, pregnancy, and history of breast feeding

A

risk factors for ovarian cancers

200
Q

what about CA-125 testing

A

this is neither sensitive nor specific

201
Q 
mons pubis
labia majora and minora
urethral meatus, clitoris
vaginal introitus
perineum
A

external examination areas

202
Q 
vagina, vaginal walls
cervix
uterus, ovaries
pelvic muscles
rectovaginal walls
A

internal examination areas

203
Q

avoids intercourse, douching, or use of vaginal suppositories for 24 to 48 hours before exam

empties bladder before exam

lies supine, with head and shoulders elevated, arms at sides or folded across chest to enhance eye contact and reduce tightening of abdominal muscles

A

tips for successful exam for the patient

204
Q

obtains permission, selects chaperone

explains each step of exam in advance

drapes pt from midabdomen to knees , depresses drape between knees to provide eye contact with pt

avoids unexpected or sudden movements

chooses a speculum of correct size

warm speculum tap water

monitors comfort of examination by watching pt

uses excellent gentle technique, especially when inserting the speculum

A

tips for successful pelvic exam for examiner

205
Q

which speculum is usually most common for a sexually active women

A

medium pedersen speculum

206
Q

pt with small introitus should have which speculum

A

narrow bladed pedersen speculum

207
Q

the graves specula are best suited for which type of women

A

parous women with vaginal prolapse

208
Q

excoriations or itchy, small, red maculopapules

look for nits or lice at bases of pubic hairs

A

pediculosis pubis (lice or crabs)

209
Q

check for this when menarche seems unduly late in relation to development of a girls breasts and pubic hair

A

imperforate hymen

210
Q

plastic brush tipped with a broom-like fringe for collection of single specimen containing both squamous and columnar epithelial cells. rotate the tip of the brush in the cervical os, in a full clockwise direction, then place the sample directly into preservatives so that the laboratory can prepare the slide (liquid based cytology)

used to test for chlamydia and gonorrhea

A

cervical broom

211
Q

place longer end of the scraper in the cervical os. press turn and scraping in a full circle, making sure to include transformation zone and squamocolumnar junction. smear on glass slide.

A

cervical scrape

212
Q

roll it between your thumb and index finger, clockwise and counterclockwise. remove the brush and to pick up the slide you have set aside. smear slide with a brush using gentle painting motion to avoid destroying any cells.

A

ENDOCERVICAL BRUSH

213
Q

cervical motion tenderness and or adnexal tenderness suggest

A

pelvic inflamm disease
ectopic preg
appendicitis

214
Q

uterine enlargement suggests

A

pregnancy
uterine myomas (fibroids)
malignancy

215
Q

nodules on uterine surface suggest

A

myomas

216
Q

most common hernia in women

A

indirect inguinal hernia

and next being femoral hernia

217
Q

small, firm, round cystic nodule in the labia suggests an epidermoid cyst. these are yellowish in color. look for dark punctum marking that blocked opening of the gland

A

epidermoid cyst

218
Q

warty lesions on the labia and within the vestibule suggest condyloma acuminatum. these result from infection with human paillomavirus

A

venereal wart (condyloma acuminatum) genital warts

219
Q

shallow, small, painful ulcers on red bases . initial infection may be extensive, as shown. recurrent infections usually are confined to a small local patch

A

genital herpes

220
Q

a firm, painless ulcers

because most in women develop internally, they often go undetected

A

syphilitic chancre (syphilis chancre)

221
Q

ulcerated or raised red vulvar lesion in an elderly women may indicate this

A

carcinoma of the vulva

222
Q

slightly raised, round or oval, flat topped papules covered by a gray exudate suggest condylomata lata. these constitute one manifestation of secondary syphilis and are contagious

A

secondary syphilis (condyloma latum)

223
Q

causes of this include trauma, gonococci anaerobes like bacteroides and peptostreptococci, and chlamydia trachomatis.
acutely, it appears as a tense, hot, very tender abscess.
look for pus coming out of the duct or erythema around the duct opening.
chronically a nontender cyst is felt.
it may be large or small

A

bartholin’s gland infection

224
Q

cause: trichomonas vaginalis (protazoan) no always acquired sexually
discharge: yellowish green or gray, possibly frothy, often profuse and pooled in the vaginal fornix, may be malodorous

other symp: pruritius, pain on urination, dyspareunia

vulva and vaginal mucosa: vestibule and labia minora may be reddened. vaginal mucosa may be diffusively reddened, with small red granular spots or petechiae in the posterior fornix. in mild cases the mucosa looks normal

lab eval: scan saline wet mount for tichonmonads

A

trichomnoal vaginitis

225
Q

cause: Candida albicans (yeast) many factors predispose, including abx
discharge: white curdy, thin but usually thick, not as profuse as in trichomonal infection, no malodorous

other symptoms: pruruitus, vaginal soreness, pain on urination, dyspareunia

vulva and vaginal mucosa: the vulva and even the surrounding skin are inflamed and sometimes swollen. vaginal mucosa red, with white patches of discharge. mucosa may bleed when these patches are scraped off. mild cases: mucosa normal

lab eval: scan potassium hydroxide preparation for branching hyphae of candida

A

candidal vaginitis

226
Q

cause: bacterial overgrowth prob from anaerobic bacteria, may be transmitted sexually
discharge: white or gray, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal

other sym: unpleasant fishy or musty genital odor

vulva and vaginal mucosa: vulva usually normal. vaginal mucosa usually normal

Lab eval: scan saline wet mount for clue cells, sniff for fishy odor after apply KOH (“whiff test”) vaginal secretions with PH>4.5

A

bacterial vaginosis

227
Q

bulge of the upper two thirds of the anterior vaginal wall, together with the bladder above it. results from weakened supporting tissues

A

cystocele

228
Q

herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.

A

rectocele

229
Q

results from weakness of the supporting structures of the pelvic floor and is often associated with a cystocele and rectocele. in progressive stages the uterus becomes retroverted and descends down that vaginal canal to the outside

what are the 3 stages of this

A

prolapse of the uterus

first degree prolapse: the cervix is still well within the vagina

second degree: it is at the introitus

third degree: (procidentia) the cervix and vagina are outside the introitus

230
Q

with increasing estrogen stimulation during adolescence all or part of the columnar epithelium is transformed into squamous epithelium by a process termed: metaplasia. this change may block the secretions of columnar epithelium and causes ______.

A

nabothian cysts

231
Q

usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. it is bright red, soft, and rather fragile. when only the tip is seen, it cannot be differentiated clinically from a polyp originating in the endometrium. they are benign but may bleed.

A

cervical polyp

232
Q

precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix or endocervical canal, the opening between the uterus and the vagina. It is also called cervical intraepithelial neoplasia (CIN). Strongly associated with sexually transmitted human papillomavirus (HPV) infection, is most common in women under age 30 but can develop at any age.

usually causes no symptoms, and is most often discovered by a routine Pap test. The prognosis is excellent for women who receive appropriate follow-up and treatment. But women who go undiagnosed or who don’t receive appropriate care are at higher risk of developing cervical cancer.

A

dysplasia

233
Q

begins in an area of metaplasia. earliest stages it cannot be distinguished from a normal cervix. later stages: an extensive, irregular, cauliflowerlike growth may develop. early frequent intercourse, multiple partners, smoking, and infection with HPV increase the risk for this

A

carcinoma of the cervix

234
Q

produces purulent yellow drainage from the cervical os, usually from chlamydia trachomatis, neisseria gonorrhoeae or herpes infection. these infections are sexually transmitted and may occur without symptoms or signs

A

mucopurulent cervicitis

235
Q

very common benign uterine tumors. may be single or multiple and vary greatly in size, occasionally reaching massive proportions. they feel firm, irregular nodules in continuity with the uterine surface. occasionally, projecting laterally can be confused with an ovarian mass, a nodule projecting posterioly can be mistaken for a retroflexed uterus. project toward the endometiral cavity and are not palpable, although they may be suspected because of enlarged uterus

A

myomas of the uterus

FIBROIDS

236
Q

may be detected as adnexal masses on one or both sides. later, they may extend out of the pelvis. tend to be smooth and compressible, tumors more solid and often nodular. uncomplicated ones are not usually tender

A

ovarian cysts

237
Q

rests on exclusion of several endocrine disorders and 2 of the 3 features listed: absent or irregular menses; hyperandrogenism; and confirmation of polycystic ovaries on ultrasound. obesity and absence of lactation outside pregnancy or childbirth are addiotnal predictors

A

polycystic ovary syndrome

238
Q

relatively rare and usually presents at an advanced stage/ symptoms include: pelvic pain, bloating, increased abdominal size, and urinary tracy symptoms, often there is a palpable ovarian mass. currently there are no reliable screening tests. a strong family history is an important risk facto but occurs in only 5% of cases

A

ovarian cancer

239
Q

pregnancy spills blood into the periotoneal cavity, causing severe abdominal pain and tenderness. guarding and rebound tenderness are sometimes associated. a unilateral adnexal mass may be palpable, but tenderness often prevents its detection. faintness, syncope, nausea, vomiting, tachycardia, and shock may be present, reflecting the hemorrhage. there may be prior history of amenorrhea or other symptoms of pregnancy

A

ruptured tubal pregnancy

240
Q

most often a result of sexually transmitted infection of the fallopian tubes or the tubes and ovaries. it is caused by neisseria gonorrhoeae, chlamydia trachomatis and other organisms. acute disease is associated with very tender, bilateral adnexal masses, although pain and muscle spasm usually make it impossible to delineate them. movement of the cervix produces pain. if not treated, a tubo-overian abscess or infertility may ensue.
infection of the fallopian tubes and ovaries may also follow delivery of a baby or gynecologic surgery

A

pelvic inflammatory disease

241
Q

daughters of women who took this during pregnancy are at great increased risk for several abnormalities like:

  1. columnar epithelium that covers most or all of the cervix
  2. vaginal adenosis
  3. circular collar or ridge of tissue, varying shapes, between the cervix and vagina. much less common is an otherwise rare carcinoma of the upper vagina
A

fetal exposure to DIETHYLSTILBESTROL (DES)

242
Q

bilateral transverse cervical os

stellate cervical os

unilateral transverse cervical os

A

types of lacerations from delivery

p.572 in bates

243
Q

normal shapes to the cervical os

A
  1. oval

2. slitlike

244
Q

when the entire anterior vaginal wall, toegther with the bladder and urethra, is involved in the bulge
a groove sometimes defines the border between urethrocele and cystocele but not always present

A

cystourethrocele

245
Q

small, red benign tumor visible at the posterior part of the urethral meatus. occurs chiefly in postmenopausal women and usually causes no symptoms. sometimes a carcinoma of the urethra is mistaken for this. to check, palpate the uretha through the vagina for thickening, nodularity, or tenderness, and feel for inguinal lympadenopathy

A

urethral caruncle

246
Q

forms a swollen red ring around the urethral meatus. usually occurs before menarche or after menopause. identify the urethral meatus at the center of the swelling to make this diagnosis

A

prolapse of the urethral mucosa

247
Q

important topics for health promotion and counseling (7)

A 
nutrition
weight gain
exercise
substance abuse
domestic violence
prenatal lab screenings
immunizations
248
Q

Nutrition

what types of things should you do?

idk this is a learning objective but so vague

A

pay attention to inadequate nutrition as well as obesity

take a diet history, review examination and lab findings (BMI, hematorcrit for anemia), recommend a multivitamin (0.4 to 0.8 folic acid, 30 mg of iron, and a variety of other routine vitamins), caution the patient about food to avoid (unpasteruized dairy products, soft cheeses, raw eggs, delicatessen meats due to listeria and salmonella and toxoplasmosis, large about of vit A can be toxic, large sea going fish), make nutritional plan (increase intake by only 300 cal per day)

249
Q

weight gain

again vague… idk just read the card hahaah

A

closely monitored during pregnancy

underweight: BMI 30

250
Q

how many minutes of exercise shoudl a pregnant women engage in for most days of the week

A

30 min

251
Q

should you initiate exercise in pregnancy

A

nahhh not really, do a special program if you do

aka get you buttttt to the gym and get into a routine so that when you do get pregnant you can just keep working out safely

252
Q

after first trimester what should women not due relating to exercise?

A

exercise in the supine position (compresses the inferior vena cava)

253
Q

substance abuse in pregnancy

again vague

A

universal screenings for this can help address these topics
try to stay judgement free with your approach

tobacco: low birth weights
alcohol: fetal alcohol syndrome: neurodevelopmental disorder
illicit drugs: dont use em
abuse of prescription drugs: ask about unusual narotics, stimulants, benzo, others

254
Q

domestic abuse

A

universal screening of all women for domestic violence without regard to socioeconomic status

255
Q

prenatal lab screenings in pregnancy

initial screening: what is part of it?

what about the timed screenings?

A

initial standard prenatal screening panal includes blood type and Rh, Ab screen, CBC, H and H, platelet count, rubella titer, syphilis test, hepatitis B surface Ag, HIV test, STI screen for gonorrhea and chlamydia, and UA with culture

timed screenings include: oral glucose tolerance test for gestational diabetes around 24 weeks, and a vaginal swab for group B streptococcus between 35 and 37 weeks

all other screening is independent on the patient

256
Q

immunizations in pregnancy

A

should be up to date on tetanus.

flu vaccine indicated in second or third trimester during flu season

these are safe for pregnancy: pneumococcal, menigococcal, Hep B

NOT safe during pregnancy: MMR, polio, varicella, but women should have rubella titers drawn during pregnancy and be immunized after birth if found to be non immune.

Rho (D) immunoglobulin or RhoGAM should be given to all Rh-negative women at 28 weeks gestation and agin within 3 days of delivery to prevent sensitization to an rH positive infant

257
Q

should take into consideration medical, nutritional, psychosocial, cultural and educational needs of patient and her family

A

plan of prenatal care

258
Q

secreted in to maternal circulation after implantation, which occurs 6-12 days after ovulation

A

hCG = human chorionic gonadotropin

259
Q

Best time to take Home pregnancy test?

A

1 week after missed period

260
Q

what will urine HCG show

A

Urine hCG 20-50 int units/L verses serum hCG 5-10 int units/L

261
Q

what do you factor in when choosing and at home pregnancy test

A

factor in duration of missed menses, need for accuracy, convenience and cost

262
Q

what is the schedule for prenatal visits: what gestation week

How many weeks though do they say normal pregnancy is?

A

1st visit – usually at ~8 weeks gestation

Every 4 weeks until 28 weeks gestation

Every 2 weeks until 36 weeks gestation

Weekly from 36 weeks gestation until delivery

40 weeks normally
38-42 weeks

263
Q

what is frequency of follow up determined by

A

Frequency of follow-up visits determined by individual needs of woman and her risks (more frequent visits – “high risk” due to medical and/or obstetric history, extremes of reproductive age, multiple gestation)

264
Q

Enable health care provider to:
Assess well-being of the woman and her fetus

Provide ongoing, timely and relevant prenatal education

Complete recommended health screening studies and review results

Detect medical and psychosocial complications and institute indicated interventions

Reassure the woman

A

all the goals of the prenatal visits

265
Q

if someone thinks they’re pregnant you get a hitory: what are the three things that are asked in this history

A
  1. LMP/amenorrhea
  2. Contraception/sexual history
  3. Symptoms of pregnancy
266
Q

what are some symptoms of pregnancy

A

morning sickness
breast tenderness/fullness urinary frequency
fatigue

267
Q 
Personal & demographic info (i.e., occupation)
Past obstetrical history
Personal and family medical history
Past surgical history
Genetic history
Menstrual and gynecological history 
Current pregnancy history 
Psychosocial information
A

more history taking….

i know you could recognize these on multiple choice!

268
Q

Calculating estimated due date

A

measuring crown to rump length

269
Q

Gravida para

A 
G = gravida (# total pregnancies)
P = para (# delivered pregnancies)
270
Q

what can parity further break down to

A 
T= term deliveries
P = preterm deliveries
A = abortions (spontaneous & therapeutic)
L = living children

“32-year-old G3P1102 at 18 weeks gestation determined by LMP presents…”

271
Q

Physical exam

Vital signs (weight, height, BMI, BP)

General

HEENT (including dentition)

Neck (including thyroid)

Breasts – fuller, tender due to ↑ vascularity & glandular hyperplasia, areola darkens, +/- colostrum

Heart

Lungs

Abdomen

Extremities

Skin

Lymph nodes

Pelvic (including speculum & bimanual exam)

Rectum

A

physical exam of the first prenatal visit

272
Q

PART OF PELVIC EXAM

chadwicks sign

A

bluish discoloration of cervix due to increased blood flow

273
Q

uterus soft, globular

plum: at how many weeks
orange: how many weeks
grapefruit: how many weeks

A

plum: 6-8 weeks gestation
orange: 8-10 weeks
grapefruit: 10-12 weeks

274
Q

pre-pregnancy weight related to what your weight gain should be!

A

underweight (BMI)

275
Q

where does the weight go?

how much in the:
breasts
baby
placenta
uterus
amniotic fluid

your blood
your protein and fat storage
your body fluids

total weight gain:

A

breasts: 1-2 lb
baby: 6-8 lbs
placenta: 1-2lbs
uterus: 1-2 lbs
amniotic fluid: 2-3 lbs

your blood: 3-4 lbs
your protein and fat storage: 8-10lbs
your body fluids: 3-4 lbs

total weight gain: 25-35 lbs

276
Q

nutrition counseling from the ppt and not bates like above

2 recommendations….

A

MVI once daily (w/ 0.4-0.8 mg of FOLIC ACID)

Avoid certain fish, cheese, raw milk & meat

277
Q

exercise counseling from the ppt and not bates like above

2 recommendations….

A

Avoid supine position in 3rd trimester (Supine position – puts pressure on inferior vena cava– this can lead to decreased floor to placenta to baby)

Avoid contact sports or risky activities

278
Q

substance abuse counseling from the ppt and not bates like above

what is goal

A

Abstinence is goal

279
Q

domestic violence

counseling from the ppt and not bates like above

A

Universal screening (abuse increased in pregnancy)

280
Q

immunizations counseling from the ppt and not bates like above

A

Flu shot (NOT NASAL), Tdap, RhoGAM

If rubella nonimmune, vaccinate AFTER pregnancy

281
Q

what do you always have to discuss with genetic screening

A

always dicuss informed consent

282
Q

most commongenetic disorder screened for ( 5)

A 
Down syndrome (trisomy 21)
Hemoglobinopathies
Cystic fibrosis
Fragile X
Ashkenazi Jewish population
283
Q

when is Fetal cfDNA in maternal blood drawn

and what id cfDNA?

A

drawn at ≥9 weeks of gestation

cfDNA = cell-free DNA, checks for trisomy 21, 18, 13 & sex chromosome aneuploidies

284
Q

when is Chorionic villus sampling (CVS) drawn

A

10-14 weeks gestation

285
Q

when do you do Amniocentesis

A

15-17 weeks gestation

286
Q

bp changes during pregnancy

A

MORE TO COME AFTER LECTURE….okay idk what she wants us to know from this slide…

SLIDE 16

287
Q

what does the urine dipstick find: 3 findings

A

Protein
Glucose
Ketones

288
Q

Physical exam:

Vital signs (weight, BP)

Urine dipstick, if indicated

Fundal height (cm)

Fetal presentation

FHR and fetal movement

Cervix exam (dilation, effacement, station)

LE edema

A

subsequent prenatal visits

289
Q

First trimester H&P
history

physical exam

labs/imaging

A

History:
Vaginal bleeding

Physical exam:
Vital signs
Head-to-toe exam including pelvic
FHR (start @ 10-12 wks)

Labs/Imaging : GET ALL OF THESE LABS AND ULTRASOUNDS AT THE FIRST PRENATAL VISIT!!!!
STI screening – gonorrhea, chlamydia, HIV, syphilis & hepatitis B

Pap, if indicated

Labs: genetic screening, CBC, blood type and Rh, antibody screen, rubella & varicella immunity, UC

At-risk:
TSH (if she has thyroid issue need to get this),
hgbA1c (gesttational diabetes around 26 weeks but if she is obese and she has risk factors for diabetes want to do this right at the first visit),
HCV (hoffman says she has a low threshold for when to get hep C testing) ,
HSV (if they have genital herpes needs to be put on suppressive therapy at 36 weeks so she can deliver vaginally!)

Ultrasound(transvaginal)

-heart beat at 10 week gestation

290
Q

this test checks for asymptomatic bacteriuria and treat if >100,000 CFU

A

UC

291
Q

Rh-negative mother who delivers a Rh-positive baby are at risk of developing

Rh-positive babies of these mothers are at risk of developing

A

antibodies (“sensitized”).

hemolytic anemia

292
Q

when do you screen for RH factor

A

first visit

293
Q

if mother is RH negative

A

check antibody screen & give RhoGAM (immune globin) at 26-28 weeks gestation & after delivery

294
Q

Second trimester H&P

history:
pE:
labs/imaging:

A 
History:
Fetal movement (“quickening” ~18-22 wks, external palpation ~24 wks+/28 )

Vaginal bleeding

Uterine contractions (PTL)

Physical exam:
Vital signs
Fundal height
FHR

Labs/Imaging:
1-hr GDM screen (24-28 wks)
–> 1 hour glucose test is screening
–> 3 hours glucose test is diagnostic for gestational diabetes

CBC (√ hgb & platelets)

Rhogam if Rh- (28 wks)

Ultrasound – √ anatomy

295
Q

how do you measure the fundal height?
from where to where?

when do you start doing this?

where do the lines start and stop on the belly

A

Measure length (cm) from pubic symphysis to fundus

Start @ 20 weeks gestation

start down by pubic symphasis at 12-14 weeks then 16 weeks then belly button is 20 weeks then 24 weeks then 28 weeks
then 32 weeks and 36 weeks is right under the breasts

slide 22

296
Q

what is a normal fetal HR?

A

Normal FHR = 120-160 beats per minute

297
Q

Third trimester H&P
history
PE
labs/imaging

A 
History:
Fetal movement
Vaginal bleeding
Uterine contractions (labor)
*****Leaking*****(could have risk for infection)
*****Preeclampsia s/s******
Physical exam:
Vital signs
Fundal height
FHR 
*****Fetal presentation******
******Cervix exam*********

Labs/Imaging:
Group B strep (36 wks)
Hgb (hemoglobin) (36 wks)

298
Q

three types of fetal breech presentation

wheat is the name of the maneuver

A

NOT RECOMMENDED TO DELIVER BREECH IF WE KNOW THIS!

complete breech: both legs curled up
incomplete breech: one leg up straight other leg curled
frank breech: both legs straight up

DEPENDING ON THE BREECH POSITION DEPENDS ON HOW WELL THE MANEUVER WILL WORK TO MOVE THEM AROUND
external cephalic version (ECV) is the name of the maneuver to move them out of breech position

299
Q

vertex presentation

A

head first

300
Q

leopold maneuvers

4

A

4 maneuvers used to determine fetal position, beginning in 2nd trimester, accuracy greatest after 36 weeks gestation

1st maneuver = determine what fetal part is located at the fundus or “upper fetal pole”

2nd maneuver = feel for fetal back while placing hands on sides of maternal abdomen

3rd maneuver = palpate presenting fetal part at the “lower fetal pole” distinguishing head from buttock

4th maneuver = check flexion/extension of the fetal head

301
Q

cervix exam: 5 different things you are examining

A
  1. Dilation (0-10cm)
  2. Effacement (0-100%)
  3. Fetal station (-3 to +2)
  4. Consistency (firm, medium, soft)
  5. Position (posterior, middle, anterior)
302
Q

What is cervical effacement?

steps of effacement and dilation… how they are related?

A

cervical effacement: length of the cervix: so when babies head pushes down the length of the cervix shortens… and this occurs at the same time as the dilation.

  1. cervix not effaced (long cervix) or dilated
  2. cervix is 50% effaced and not dilated
  3. cervix is 100% (compltly thinned out cervix) effaced and dilated 3cm
  4. cervix is fully dialted to 10 cm
303
Q

Fetal station

what is this?

A

on either side of cervix you can feel pelvic ring.. when you feel top of babies head and it is right at ring that is 0 station
if it is 3 cm above the ring it is at -3 station
if babies head is pushing through pelvic ring then going into positive cm.

-3 to +3

0 station midway between ischial spines

slide 31 has a good picture

304
Q 
Heartburn
Urinary frequency
Vaginal discharge
Constipation
Hemorrhoids
Backache
Nausea and/or vomiting
Breast tenderness/tingling
Fatigue
Lower abdominal pain
Abdominal striae
Uterine contractions
Loss of mucous plug
Edema
A

Common complaints in pregnancy

305
Q 
HEENT: 
facial edema in preeclampsia
conjunctival pallor in anemia
nasal congestion & nose bleeds 
gingival enlargement with bleeding 
dentition

Neck:
modest symmetric thyroid enlargement normal

Heart:
PMI – upward and leftward (4th intercostal space)
venous hum (due to ↑ blood flow thru normal vessels)

Lungs:
elevated diaphragm with percussion

Breasts:
marked venous pattern, darkened areolae, and prominent Montgomery’s glands
nodularity, possible colostrum

Abdomen:
striae and linea nigra
uterine contractility – PTL/labor vs BHC
fundal height, FHR
round ligament pain seen which normally tries to hold uterus in place

GU:
relaxation of introitus and enlargement of labia & clitoris
labial varicosities
cystoceles, rectoceles and uterine prolapse
speculum – cervix friable and leukorrhea may be normal
bimanual – uterus (contour, size)
anus – hemorrhoids

Extremities:
varicose veins
dependent vs non-dependent edema and symmetry

Skin/hair :
acne
hair changes
melasma and hirsutism (mild – on face, abdomen and extremities)

A

Physical exam findings in pregnancy

306
Q

when is the postnatal visit performed?
what is one of the exams you have done and why?
what do you offer to your patient and what are some examples of that?

A

Performed at ~6 weeks postpartum

Pelvic exam – confirm uterus is normal size

Offer support/counseling:
Menses resumes
Family planning
Screen for post partum depression
Breastfeeding/return to work
Sexual activity 
Weight loss guide 
Stress management – relationship, parenting, financial, job, body image
307
Q

if fundal weight is 4 cm more than expected consider

A

multiple gestations
large fetus
extra amniotic fluid
uterine leiomyoma

308
Q

cervix position is either

A

posterior, middle or anterior

309
Q

when do you start birth control again after pregnancy

A

6 weeks

Sasha: Module 8 Repro/GU (2 decks)

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