Ch. 4

Question 1

Absence menstrual flow clin sign various disorders
Eval: absence both menarche and secondary characteristics by age 13; absence menses by 15 yrs; absence menstruation with 5 yrs breast development; 6 month+ cessation after secondary amenorrhea
Associated with weight and nutritional status
Sign of a diseasxe
Can be result of pregnancy, anatomic abnormalities,
Hypogonadtropic amenorrhea

Answer 1

Amenorrhea

Question 2

Prob in central hypothalamic-pit axis
Pit lesion or genetic inability produce LSH/FH
Often results from suppression as result of stress or sudden and severe weight loss
Loss of Ca can occur with this
Assessment: thorough H&P; specific components depend on age, prengnacy test, diagnostic tests, endocrine levels checked, CT scan

Answer 2

Hypogonadtropic amenorrhea

Question 3

Pain during or shortly after menstruation most common prob
Common in smokers and obese pts
Associated with early menarche, nulliparity, lack of exercise
Primary Dysmenorrhea
Secondary Dysmenorrhea

Answer 3

Dysmenorrhea

Question 4

Condition associated with ovulatory cycles
Biocmeical basis and arises with release prostaglandins with menses
During luteal phase and subsequent menstrual flow prostaglandin released increasing amplitude and frequency contractions and causing vasospasm of uterine arterioles - resulting in ischemia and lower abdominal cramps
Response: backache, weakness, sweats, anorexia, nausea, vomiting, diarrhea, dizziness, headache, syncope, poor concentration
Onset menstruation and last 12-72 hrs
Appears 6-12 months after menarche (ovulation establish)
Estrogen and progesterone necessary - experienced with ovulatory cycles

Answer 4

Primary Dysmenorrhea

Question 5

Menstrual pain that develops later than primary - typ after 25 yrs
Associated with pelvic patho
Have underlying symptom to suggest underlying cause
Dull lower-abdominal aching radiating to thigh and back
Bloating or pelvic fullness
Careful pelvic exam, US, D&C, biopsy, laparoscopy
Treatment to remove underlying cause

Answer 5

Secondary Dysmenorrhea

Question 6

Premenstrual dysphoric disorder (PMDD) - more severe variant - irritability, dysphoria, mood lability, anxiety, fatigue, appetite changes, sense feeling overwhelmed, mood distrubances
PMS - complex and poorly understood - 1+ large number physical and psychological symptom beginning in luteal phase of cycle then symptom-free period; symp:fluid retention, behavioral/emotional changes, cravings, headache, fatigue, backache; ovarian func required for this
Diagnosis PMDD

Answer 6

Premenstrual syndrome

Question 7

5+ affective and phys symp present before menses and begin improve follicular phase
1 symp marked affective lability, irritability or anger, depressed mood or feelings hopelessness or self-deprecating thoughts, or anxiety
1+ following with total 5: decreased interest usual activities, subj difficulty concentrating, letharge, change in appetite, hypersomnia/insomnia, feeling overwhelmed, breast tenderness, muscle pain, bloating, weight gain
Symp interfere with work or relationships
Symp not caused by another condition/disorder
Woman and HCP confirm symp occurring and evidence through daily rating
Symptom not caused by effects substance/treatment

Answer 7

Diagnosis PMDD

Question 8

Presence and growth endometrial tissue outside uterus
Contains uterine glands and stroma (CT) and responds to cyclic hormone stimulation in same way uterine endometrium does but often out of phase with it; grows during proliferative and secretory cycle; during or immediately after menstruation - tissue bleeds resulting in subsequent fibrosis and adhesions on adj organs
Symp: pelvic pain, dysmenorrhea, painful intercourse/dyspareunia, chronic noncyclic pelvic pain, pelvic heaviness, pain radiating into thighs, report bowel symptom: diarrhea, pain with defecation, constipation; abnormal bleeding and pain during exercise

Answer 8

Endometriosis

Question 9

Changes in amt, duration, interval, regularity menstrual bleeding
Infrequent (oligomenorrhea)
Scanty at norm intervals (hypomenorrhea)
Excessive (menorrhagia)
Occurs between periods (metorrhagia)

Answer 9

Alterations in cyclic bleeding

Question 10

30 organisms that cause infections/infectious disease syndromes primary through intimate contact
Causative organisms: wide spectrum
Direct cause of tremendous human suffering and heavy demands on healthcare sys
Common among young people
⅕ infected with STIs each year; untreated and rates underreported
If untreated - cause long-term consequences
Prevention

Answer 10

STIs

Question 11

Preventing infection most effective way to prevent adverse consequences
Prompt diagnosis and treatment prevent comps and transmission to others
Identification of risk prevention cousneling
Be motivated understand how serious risk infection is
Ways: abstinence, monogamous relationship
Reduction number of partners, low-risk sex, avoid exchange body fluids, vaccines
Examine partner
Education on influence on drugs and alcohol

Answer 11

Prevention

Question 12

Chlamydia
Gonorrhea
Syphilis
Pelvic inflammatory disease

Answer 12

Bacterial STIs

Question 13

Most frequent
Asymptomatic and highly destructive
Increased risk ectopic pregnancy and tubal factor infertility
Causes inflammation on cervix - causes ulcartions increasing risk getting HIV infection
<25 yrs most common
Risky behaviors
Screening and diagnosis

Answer 13

Chlamydia

Question 14

Obtaining info regarding risk factors
Symptoms - spotting, postcoital bleeding, mucoid or purulent cervical discharge, dysuria
Lab diagnosis - culture, DNA probe, ezyme immunoassay, nucleic acid amplification tests of urine specimens or from endocervix/vagina

Answer 14

Screening and diagnosis - Chlamydia

Question 15

Oldest communicable disease
Drug-resistant more common
Aerobic, gram-negative
Sexual contact transmission - genital to genital
Teenagers and young adults more common engaging in multiple partners
Asymptomatic - if symptoms: greenish-yellow purulent endocervical discharge or experience menstrual irregularities; pain - pelvic or lower abdominal pain or menses that last longer or more painful than normal
Perinatal comps can occur
Screening and diagnosis

Answer 15

Gonorrhea

Question 16

Screen pregnant women first prenatal visit
classic/vague/no symp
Cultures from endocervix, rectum and pharynx
Also have test for syphilis

Answer 16

Screening and diagnosis - Gonorrhea

Question 17

Microscopic abrasions in SQ tissue - occurring during sex - thru kissing, biting, oral-genital sex; trans-placental transmission
Untreated in pregnancy: congenital syphilis
Serious systemic disease and death if not treated
Primary: 5-90 days after infection; painless papule at site inoculation
Secondary: 6wks-6months; widespread, symmetric, maculopapular rash on palms, soles, generalized lymphadenopathy
Fever, headache, malaise
Untreated - enter latent phase - go to tertiary - neurologic, CV, MS, multiorgan sys comps develop
Screening and diagnosis

Answer 17

Syphilis

Question 18

Diagnosed with another STI/HIV screened for this
All high-risk pregnant women screen in first prenatal visit, again in late third trimester and at time of giving birth
Microscopic exam and serology during latency and late infection
Test for antibodies - not during active infection
False positives not unusual
HIV testing offered

Answer 18

Screening and diagnosis - Syphilis

Question 19

Infectious process that most commonly involves uterine tubes, uterus, rarely ovaries and peritoneal surfaces
Multiple causative organisms - anaerobic and aerobic
Ascending spread from vagina and endocervix to upper tract
End of or just after menses
Also after miscarriage, induced abortion, pelvic surgery, birth
Risk factors: young age, multiple partners, high rate new partners, hx STIs, IUDs more than 1 sexual partner
Increased risk ectopic pregnancy, infertility, chronic pelvic pain
Symp: vary, pain: dull, cramping, intermittent, severe; report: fever, chills, N&V, increased vaginal discharge, symp of UTI, irregular bleeding, abd pain
Screening and diagnosis

Answer 19

Pelvic inflammatory disease

Question 20

Diff due to diagnose because variety symp
Recommend treatment for PID in all sexually active women and others at risk STIs and no other causes found: lower abdominal tenderness, bilateral adnexal tenderness, cervical motion tenderness; high temp above 100, abnormal discharge, elevated ESR, elevated CRP (not super reliable), lab doc of cervical infection of gonorrhea

Answer 20

Screening and diagnosis - Pelvic inflammatory disease

Question 21

HPV
HSV
Hepatitis A
Hep B
Hep C
HIV

Answer 21

Viral

Question 22

Most common
Variety types
Highest risk of causing cancer of cervix, vagina, vulva, penis, oropharyngeal area
Small lesions
Moist areas - may have fine fingerlike projections
Flat-topped papules most often on cervix - only seen via magnification
Flesh-colored or darker colored
Painless but uncomfy when large, inflamed, or ulcerated
More common in prengnat first-trimester women
Screening and diagnosis

Answer 22

HPV

Question 23

Symps: profuse, irritating vaginal discharge; itching; dyspareunia; postcoital bleeding; bumps on vulva or labia; hx known exposure imp
Phys inspection vulva, perineum, anus, vagina, cervix
Rotate speculum to see all lesions
Hx, eval s&s, pap test, phys exam used make diagnosis
HPV lesions differentiated
Serologic test for secondary syphilis

Answer 23

Screening and diagnosis - HPV

Question 24

Painful, recurrent ulcers
Two diff antigen subtypes
Type 2 - sexually - genital lesions; type 1 - not sexual, oral lesions
Younger women more likely if have multiple partners
Recurrent infections more common
Ulcers: tender, itching, inguinal tenderness, lymphadenopathy, heavy watery to purulent vaginal discharge

Answer 24

HSV

Question 25

Fecal-oral route by ingestion of contaminated food Influenza-like symptom Serologic testing Does not result in chronic infection or chronic liver disease treatment usually supportive Vaccine and Ig for IM admin effective to prevent

Answer 25

Hepatitis A

Question 26

Most threatening to fetus and neonate Screen for active or chronic disease or disease immunity Blood or sexual contact at risk; found in other bodily fluids Disease of liver and silent infection Can be fatal Symp: arthralgias, arthritis, lassitude, anorexia, n&v, headache, fever, mild abdominal pain, clay-colored stools, dark urine, increased abd pain, jaundice

Answer 26

Hep B

Question 27

Bloodborn infection Responsible for 50% chronic viral hep Transmission to baby in birth process Risk: IV drug use, STIs, multiple sex partners, hx blood transfusions No vaccine Sev drugs treat hep C

Answer 27

Hep C

Question 28

More Black women Increasing in transgender people Severe depression cellular immune sys associated - leads to AIDS Antibiotics effective Once enters body, HIV positivity within 6-12 weeks; may be asymptomatic or have influenza-like response Lab studies: leukopenia, thrombocytopenia, anemia, elevated ESR Transmission to child in perinatal period Circ as early as first trimester, labor and delivery, breast milk Screening and diagnosis Counsling for HIV testing

Answer 28

HIV

Question 29

At risk: IV drug use, high risk sex partners, multiple partners, hx multiple STIs HIV used via antibody tests Reactive screening tests must be confirmed by an additional test - if confirmed is + Antibodies seen within 3 months after infection

Answer 29

Screening and diagnosis - HIV

Question 30

Counseling before and after testing standard Assess understanding of info Unless rapid, 1-3 week waiting period - anxious time Test results communicated in person and told is procedure ahead of time Explore feelings after result Emphasis placed in ways to remain HIV free Referr + woman to creect area

Answer 30

Counsling for HIV testing - HIV

Question 31

Discharge depends on infection presence Candiadiasis Trichomoniasis Group B streptococcus

Answer 31

Vaginal infections

Question 32

More common in healthy women than HIV women Most of yeast infections by albicans - increased steadily Predisposing: antibiotic therapy (broad spectrum), prengnacy, obesity, diets high in sugars, use corticosteroids, exogenous hormones, immunosuppressed dstate Tight-fitting clothes and underwear more likely occur Most common symp: vaginal puritis (mild or intense); feel dru, painful urination; discharge thick, white, lumpy, cottage cheese like; vulva red and swollen; may have yeasty or musty smell Screening and diagnosis Interprofessional care

Answer 32

Candiadiasis

Question 33

Onset and course symp Hx Phys exam Smear and vaginal pH

Answer 33

Screening and diagnosis - Candiadiasis

Question 34

Antifungal preps See HCP for first for diagnosis and treatment recommendation Extensive irriation, swelling, discomfort: sitz baths Colloidal oatmeal powder to bath Not wearing underpants to bed Complete full course treatment Not use tampons Avoid sex

Answer 34

Interprofessional care - Candiadiasis

Question 35

Usually an STI and common cause vaginal infection and discharge Anaerobic, one-celled protozoan with characteristic flagella Asymptomatic or yellowish to greenish, frothy, mucopurulent, copious, malodourous discharge; inflammation of vulva/vagina/both; complain of irritation and pruritus Dysuria and duspareunia common and worsen during and after menstruation Cervix vaginal walls - strawberry spots; cervix bleed on contact Screening and diagnosis Interprofessional care

Answer 35

Trichomoniasis

Question 36

Hx of current symp; hx sim symp and previous treatment Thorough sexual hx Speculum exam pH greater than 5.0

Answer 36

Screening and diagnosis - Trichomoniasis

Question 37

Class drugs: nitromidazoles - PO in single dose Male partner usually asymptomatic - harbers in urethra/prostate; discuss importance of partner treatment with patients; if not treated, infection will recur Understand sexual transmission of disease Present without symp for sev months and determining when become infected impossible

Answer 37

Interprofessional care - Trichomoniasis

Question 38

Normal vaginal flora in someone not pregnant Associated with poor pregnancy outcomes Imp fact in perinatal and neonatal morbidity and mortality, resulting in vertical transmission from birth canal of infected mother to infant during birth Risk factors: + culture; preterm birth less than 37 wks; prelabor rupture; maternal fever >100; + hx for early onset GBS Decrease risk: screened 35-37 weeks - rectovaginal culture and IV antibiotic prophylaxis for all who test +

Answer 38

Group B streptococcus