Exam 2 Flashcards

Question

Acute head injury: meningitis - clinical manifestations and causes Signs?

Answer 1

- fever - headache - stiff neck - altered mental status - brudzinski and kernig's signs Causes: - inflammation of the membranes surrounding the brain and spinal cord, usually caused by infection

Answer 2

Manifestations: - headaches - seizures - cognitive or personality changes Causes: - benign or malignant tumor, affecting brain function by causing pressure or invading brain tissue

Answer 3

tension, migraines, underlying conditions

Answer 4

Clinical manifestations: focal or generalized, vary based on seizure type Causes: uncontrolled electrical activity in the brain leading to seizures

Answer 5

Clinical manifestations: - tremors - stiffness - slowness of movement Causes: progressive neurological disorder that affects movement

Answer 6

Manifestations: - fatigue - muscle weakness - coordination problems Chronic illness that affects the brain and spinal cord

Answer 7

Manifestations: - cognitive decline - mood swings - involuntary movements; chorea - hallucinations - speech difficulties - behavioral and personality changes Hereditary disorder leading to the progressive breakdown of nerve cells in the brain

Answer 8

Rapidly affecting the ability to move, speak, eat and breath Fatal motor neuron disease causing muscle weakness and atrophy

Answer 9

Delirium is an acute fluctuating state of confusion - Dementia is a gradual decline in cognitive function due to disease or injury

Answer 10

- muscle weakness and fatigue - drooping in eyelids - altered speaking - limited facial expressions - double vision which improves with one eye closed

Answer 11

autoimmune neuromuscular disease affecting various parts of the skeletal body; requires medication potential surgery

Answer 12

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia but without acute infarction of brain - symptoms typically last less than 1 hours

Answer 13

Greater risk of having a stroke in future Caused by a partial blockage caused by focal brain, spinal cord, or retinal ischemia - without acute infarction of the brain

Answer 14

There is no way to predict outcome; history of TIA is associated with increased risk of stroke: - 1/3 do not have another event - 1/3 have more TIAs - 1/3 progress to stroke

Answer 15

- related to location of stroke; neural tissue destruction is basis for neurologic dysfunction - affects many body functions (r/t artery involved, area of brain supplies, time of onset/length of ischemia)

Answer 16

- most obvious effect of stroke - impairment of: -- mobility -- respiratory function -- swallowing and speech -- gag reflex (worry about aspiration) -- self-care abilities characteristic motor deficits: - loss of skilled voluntary movement (akinesia) - impairment of integration of movements - changes in muscle tone - altered reflexes (changes from hyporeflexia to hyperreflexia) - can have initial period of flaccidity - spasticity of muscles follows flaccid stage

Answer 17

Aphasia: occurs when stroke damages the dominant hemisphere of brain and affects language - receptive (wernicke's): loss of comprehension - expressive (Broca's): loss of production of language - global: total inability to communicate Dysphasia: refers to impaired ability to communicate - used interchangeably with aphasia - nonfluent: minimal speech activity with slow speech - fluent: speech is present but has little meaningful communication dysarthria: problem with muscular control of speech - troubles with pronunciation, articulation, phonation - does not affect meaning of communication or language comprehension

Answer 18

- may have a hard time controlling their emotions - emotional responses may be exaggerate or unpredictable - magnified by: -- depression -- changes in body image -- loss of function -- mobility and communication problems

Answer 19

- both memory and judgment may be impaired because of stroke

Answer 20

- stroke on right side of brain is more likely to cause problems in spatial-perceptual orientation - incorrect perception of self and illness - unilateral neglect of affected side: homonymous hemianopsia - agnosia: don't recognize an object - apraxia: ability to carry out learned movement on commands

Answer 21

results from inadequate blood flow to brain from partial or complete occlusion of an artery classified as thrombotic or embolic

Answer 22

ischemic stroke classification - occurs from injury to a blood vessel wall and formation of a blood clot - results in narrowing of blood vessel; most common cause of stroke - often associated with HTN or DM Extent of stroke depends on: - rapidity of onset - size of damaged area - presence of collateral circulation

Answer 23

ischemic stroke - occurs when an embolus lodges in and occludes a cerebral artery - result in infarction and edema of area supplied by involved vessel - second most common cause of stroke Manifestations: - sudden onset with severe clinical manifestations - warning signs are less common - patient usually conscious - prognosis related to amount of brain tissue deprived of blood supply - recurrence is common

Answer 24

Results from bleeding into: - brain tissue itself -- intracerebral or intraparenchymal hemorrhage - subarachnoid space or ventricles

Answer 25

Bleeding within brain caused by rupture of a vessel - sudden onset of symptoms - progression over minutes to hours; prognosis is poor - hemorrhage occurs usually during activity Hypertension is most common cause - other causes: vascular malformation, coagulation disorders, anticoagulant drugs, trauma, brain tumors, ruptured aneurysms - extent of symptoms varied and depends on amount, location, and duration of bleeding Manifestations: because of increased ICP - neurologic deficits - headache - nausea, vomiting - decreased levels of consciousness - HTN

Answer 26

Balance Eyes Face Arms Speech Time

Answer 27

Nonmodifiable risk factors: - age: risk doubles each decade after 55 - gender: more common in men but more women die - ethnicity/race - heredity/family history Modifiable risk factors: - HTN - heart disease - DM - serum cholesterol - smoking - obesity - sleep apnea - metabolic syndrome - lack of physical exercise - poor diet - drug and alcohol use

Answer 28

MRI or noncontrast CT scan: show size and location of lesion - distinguish between ischemic and hemorrhagic stroke other studies: - CTA or MRA - CT/MRI - cerebral angiography - digital subtraction angiography - transcranial doppler ultrasonography - lumbar puncture - LICOX system

Answer 29

primary assessment focuses on: - cardiac status - respiratory status - neurologic assessment if patient stable, obtain history secondary assessment includes a comprehensive neurologic examination: - level of consciousness - NIH stroke scale - cognition - motor abilities Comprehensive neurologic examination: - cranial nerve function - sensation - proprioception - cerebellar function - DTRs

Answer 30

Goals: manage airway, breathing, circulation, intracranial pressure stroke can affect all systems - need to assess all, prevention of skin breakdown, nutrition communication, sensory-perceptual problems, sensory-perceptual alterations, coping

Answer 31

- Control fluid and electrolyte balance - manage ICP - recombinant tissue plasminogen activator (tPA): dissolves clot, must be started within 3-4.5 hours of onset of clinical signs of ischemic stroke -- patients are carefully screened -- blood tests for coagulation disorders; hx of GI bleeding, stroke, head trauma, internal bleeding

Answer 32

after stroke patient has stabilized for 12-24 hours: care goals shift from preserving life to lessening disability and reaching optimal function - evaluated by physiatrist - some aspects begin as soon as patient is stable interprofessional care including SLP, PT, OT, dietary, neuro

Answer 33

Goals include that patient will: - maintain stable or improved level of consciousness - attain maximum physical functioning - attain maximum self-care abilities and skills - maintain stable body functions - maximize communication abilities - maintain adequate nutrition - avoid complications of stroke - maintain effective personal and family coping

Answer 34

health promotion: - reduce incidence of stroke - focus on stroke prevention - teach how to reduce modifiable risk factors BP screening and antihypertensive therapy Anticoagulation therapy for AFib Teach early symptoms of stroke and TIA

Answer 35

Preventative drug therapy: - antiplatelets - ASA 81 mg/day - warfarin - direct factor Xa inhibitors Drug therapy for hemorrhagic stroke: - anticoags and platelet inhibitors contra - manage HTN: oral and IV agents - seizure prophylaxis is situation specific Surgical interventions for patient with TIAs due to carotid disease: CEA, transluminal angioplasty, stenting Endovascular: stent retrievers Surgical therapy for hemorrhagic stroke: - evacuation of hematomas - AVM resection and/or radiosurgery - catheter embolization - clipping or coiling of an aneurysm

Answer 36

Patient interview: occurs in advance or day of surgery - obtain info regarding food and drug allergies - identify the reason the patient is having surgery and any comorbidities - identify potential risks and complications of the surgical procedure - preop: jewelry must come off, denture can go (pt sticker to identify), hearing aids kept during preop

Answer 37

Preoperative teaching: patient has right to know what to expect and how to participate several days before surgery; know care expected after surgery - increases patient satisfaction - reduce fear, anxiety, stress - may decrease complications such as pain and vomiting - include info focused on safety, highest priority teaching points, written material - do teaching several days before surgery, priority to patient concerns - teach deep breathing, coughing, early ambulation - inform if tubes/drains/monitoring devices will be used post-op - what they are to expect with surgery-specific information

Answer 38

- signs of infection after surgery - anesthesia depresses the respiratory system - DVT, risk for PE -- s/s: sudden SOB, tachypneic perfusion - increased risk for bleeding: anticoags, antiplatelets, st. johns wort, garlic, ginkgo biloba, ginseng - incentive spirometer to prevent pneumonia - allergies: latex allergy (bananas and avocados), shellfish allergy (contrast dye) - anaphylactic reaction: angioedema, hives, rash, contact anesthesia - malignant hyperthermia - dehiscence

Answer 39

- letting the patient know that pain or lack of mobility is to be expected - 6 hours is recommended for food before surgery; minimum 2 hours for fluids, few sips of water - check that all required forms are signed and in chart - contact person, not driving yourself - insulin given even if NPO to T1DM

Answer 40

main office, dressing rooms, main desk, areas where street clothes are permitted; receiving area for supplies and equipment

Answer 41

areas where hat, scrubs, and designated shoe covers are worn; hallways leading into the OR suites; sterile storage areas (depending on policy) not mask or gloves

Answer 42

area where there are opened sterile supplies; sterile storage areas (depending on policy)

Answer 43

- ID of patient, DOB, what procedure they are having, ask the patient - mark surgical site - stop if patient doesn't understand - happens before anesthesia given and while patient is still awake Complications that may occur: - Malignant hypertension(trending vital signs in higher range to hypertensive crisis) - Malignant hypothermia(use bear hugger or warming blanket) - Anaphylaxis

Answer 44

- obtain and provide baseline data, preoperative assessments - provide comfort - we must: -- identify the reason the patient is having surgery -- assess patients response to stress of surgery -- insulin to NPO DM -- think about any OTC meds - review results of pre-op diagnostic tests - identify potential risks and complications of surgical procedure -- bleeding, pneumonia -- DVT that can become PE

Answer 45

- Begins immediately after surgery... - PACU-post anesthesia care unit, limits transportation and gives readily access - Option respiratory assessment or vital signs taking respiratory assessment - Nursing focus is to maintain pt safety and identify actual or potential problems

Answer 46

Prevent complication, orient pt, support emotional status, tissue perfusion, output and intake(oliguria<400mL), pain control, adequate temperature(malignant hyper/hypothermia), respiratory function, encourage coughing/deep breathing(don't for certain parts of body bc inc. ICP), through HTT, infection control, vitals, elimination evaluation - A(patent airway) B(RR, breath sounds, Sp02) C(capillary refill, ECG) - TURP(do expect pink or bloody urine during surgery, compared to other surgeries) - Dehiscence: wound reopens fix with wet sterile gloves - Assess bowel sounds/flatulence to see if they are returning - Cough and breathing - Fluids stool softeners, eat a regular meal to have urge - 4-6 hrs if havent peed after removing cath pt needs to pee - Surgery inc. metabolic needs, needs glucose - Insulin IV can be used for hyperkalemia - May be giving or holding insulin during or after surgery - Problems with anesthesia really constipated or gas pains need to get it moving - Assistive devices used and pain meds if needing to wound care, PT will be hepful - Only Dr. is supposed to remove initial dressing if surgical site is soaked call the doctor Is it bleeding, is there infection(warmth/redness/purulent discharge) want bed of wound cool to touch to look clean dry and intact pink color to wound bed...same w dressing - If pt has fever and heart rate is elevated could be indicative of infection - If extremity or bone surgery assess C(circulation)M(motor)S(sensory)

Answer 47

- decreased kidney function, drugs may be lingering - can develop confusion - assess LOC: hypoglycemia, hypoxia, infection

Answer 48

Refraction: eye's ability to bend light rays so they fall on retina; create sharp image - myopia: nearsighted - hyperopia: farsighted - presbyopia: loss of accommodation - astigmatism: visual distortion - aphakia: absence of lens Corrections: corrective glasses, contacts, laser surgical therapy, implant surgical therapy

Answer 49

- sub; obj data - focused assessment: subjective and objective (inspections and assessing vision) - initial observation: -- color combinations; head position; covering eyes; depth perception; face and appearance - assessing functional status -- visual acuity: right eye first then left -- Snellen eye chart (legal blindness is 20/200 with correction) -- near vision difficulty or age greater than 40: Jaegar chart - extraocular muscle function (corneal light reflex, six cardinal positions for eye movement) - pupil function and intraocular pressure (PERRLA) - physical examination of structures, conjunctiva and sclera

Answer 50

- every structure of visual system changes - changes may be benign or result in severely compromised visual acuity Increased risk for vision loss: - alters ability to function, may have other deficits - societal devaluation - inadequate finances - increased fall risk - concerns with independence - dexterity and administration of eye drops or other medications

Answer 51

Emergency! separation of retina and underlying epithelium; fluid accumulation between layers Manifestations: - flashes of light - floaters - cobweb/hairnet or ring in field of vision Need surgical therapy

Answer 52

Group of disorders characterized by increased IOP and subsequent optic nerve atrophy and peripheral visual field loss - 2nd leading cause of permanent blindness Patho: - Aqueous production (inflow) and aqueous reabsorption (outflow) must be balanced to maintain IOP - Outflow occurs at angle where iris meets cornea - Inflow > outflow --> increased IOP -- Increased IOP --> permanent loss of vision

Answer 53

Primary open-angle glaucoma (POAG) Angle-closure glaucoma (ACG) Acute angle-closure glaucoma (AACG)

Answer 54

POAG: - initially asymptomatic - gradual loss of peripheral vision: optic nerve damage - late or untreated: tunnel vision AACG: ocular emergency - severe, sudden pain in or around eye - N/V - colored halos, blurred vision, ocular redness

Answer 55

10-21 mmHg POAG: IOP 22-32 AACG: IOP > 50

Answer 56

Opacity in the lens; can be in one or both eyes - altered metabolic processes in lens cause water accumulation and changes in lens fiber structure, altering transparency resulting in vision changes Manifestations: - decreased vision - abnormal color perception - glare Dx: ophthalmoscope or slit lamp No cure other than surgical removal - can have temporary nonsurgical: prescription eyewear, visual aids, increase light and change lifestyle

Answer 57

Leading cause of irreversible central vision loss Two forms: - Dry (nonexudative): atrophy of macular cells -- more common; slow, progressive, painless loss of vision - Wet (exudative) -- more severe; abnormal blood vessels develop in or near macula -- rapid onset of vision loss; AMD-related blindness

Answer 58

Risk factors: - fam hx - obesity - HTN - being white - smoking Clinical manifestations: - blurred and darkened vision - scotomas (blind spots) - metamorphopsia (vision distortion) - acute vision loss

Answer 59

Microvascular damage to the retina; blurred vision; progressive loss of vision - most common with HTN or DM Diabetic retinopathy: - nonproliferative: loss of central vision - proliferative: advanced disease; severe vision loss - treatment: laser photocoagulation Hypertensive retinopathy: - treatment: lower BP to restore vision

Answer 60

Most common outpatient infection - classified by location: upper and lower -- pyelonephritis: renal parenchyma and collecting system -- cystitis: bladder -- urethritis: urethra - can be complicated or uncomplicated (underlying compromise or structural issue)

Answer 61

- emptying symptoms: hesitancy, intermittency, post-void dribbling, urinary retention or incomplete emptying, dysuria - storage symptoms: urinary frequency, urgency, incontinence, nocturia, nocturnal enuresis - hematuria and/or cloudy appearance many problems produce LUTS; often confused with UTI

Answer 62

- flank pain, chills, fever Other: fatigue, anorexia, or asymptomatic

Answer 63

classic manifestations absent - nonlocalized abdominal discomfort - cognitive impairment/confusion - generalized deterioration - often afebrile

Answer 64

- initial: dipstick for nitrates, WBCs, and leukocyte esterase - urine culture/sensitivity (clean catch urine sample) - take history (recurring UTIs, complicated UTIs, CAUTIs or HAI UTI, UTI unresponsive to empiric therapy) - imaging: ultrasound or CT scan

Answer 65

Uncomplicated or initial UTI: - Bactrim - nitrofurantoin cephalexin - ampicillin, amoxicillin, cephalosporins Complicated: fluoroquinolones Fungal: fluconazole Urinary analgesic: phenazopyridine

Answer 66

Nephrolithiasis: kidney stone disease Risk factors: - metabolic - climate - diet - genetic - lifestyle Concentration of supersaturated crystals precipitate and form stone - can reduce risk by keeping urine diluted and free flowing (drink fluids)

Answer 67

- calcium oxalate - calcium phosphate - cystine - struvite - uric acid calcium stones are most common can be mixed and in various locations

Answer 68

First symptom: sudden, severe pain (renal colic) - flank area, back or lower abdomen - ureter stretches, dilates, and spasms - may see N/V, "kidney stone dance", dysuria, fever, chills, moist cool skin Common obstruction sites: - ureteropelvic junction (UPJ): CVA flank pain/renal colic - ureterovesical junction (UVJ): lower abd. pain; testicular or labial pain

Answer 69

- noncontrast helical (spiral) CT scan - ultrasound - UA - 24hr urine Retrieval and analysis of stones important to determine problem contributing to stone formation

Answer 70

- adequate hydration; high intake of water (3L/day to produce 2.5 L urine/day if no CV or renal compromise) - sodium restriction - diet changes - drugs: alter pH of urine, prevent excess urinary secretion of a substance or correct primary disease Tx: some can pass; some too large and need surgical removal or scopes or broken up - type of surgery depends on location of stone - struvite stones: abx and acetohydroxamic acid; surgery

Answer 71

Involuntary leakage of urine - more prevalent with older adults, esp women - Women: stress and urge incontinence - Men: common with BPH or prostate cancer; overflow incontinence from urinary retention

Answer 72

D: delirium, dehydration, depression R: restricted mobility, renal impaction I: infection, inflammation, impaction P: polyuria, polypharmacy

Answer 73

- stress - urge - overflow - reflex - incontinence after trauma or surgery - functional incontinence can have more than 1

Answer 74

UTIs are the most common HAI - catheter-associated UTI (CAUTI): E. coli or pseudomonas - increased length of stay, costs, mortality

Answer 75

Benign Prostatic Hyperplasia AUA uses tool to assess voiding symptoms: - not diagnostic but provides guidelines for treatment - high score = increased symptom severity

Answer 76

- aging - obesity: increased waist circumference - lack of physical activity - high intake of red meat and animal fat - alcohol use - ED - smoking - DM - family history: first-degree relative

Answer 77

- manifestations occur gradually -- early: bladder may initially compensate for small amounts of resistance to urine flow -- symptoms worsen as obstruction increases - Lower urinary tract symptoms (LUTS) -- irritative symptoms -- obstructive symptoms Irritative symptoms: inflammation or infection - nocturia: often first - urinary frequency - urgency - dysuria - bladder pain - incontinence Obstructive symptoms: caused by prostate enlargement, decreased diameter of urethra - decrease in caliber and force of urinary stream - difficulty initiating a stream - intermittency: starting and stopping stream several times - dribbling at end of urination

Answer 78

- relatively rare: -- acute urinary retention: sudden and painful inability to urinate -- need catheter insertion and surgery if severe -- bladder damage can occur - UTI - if severe: pyelonephritis, sepsis, bladder calculi - renal failure -- caused by hydronephrosis -- bladder damage

Answer 79

- Requires rapid blood flow and access to a large blood vessel - Obtaining vascular access is the most difficult problems - Complications: Hypotension (change in VS), Muscle cramps, Loss of blood, concerns for fluid volume issues, hyperkalemia(need dialysis quick), hepatitis - Fluid restrictions for this pt because of fluid retention - Surgically placed has fistulas healthy that vibrate upon palpation feel thrill d/t turbulent blood flow, should hear bruit - Limb alert on someone with fistula “life line”

Answer 80

- Peritoneal access is obtained by inserting a catheter through anterior abdominal wall, can be done at home, lower risk for infection - May start right away or be delayed until site healed - Aseptic technique is important to avoid peritonitis - Nutrition: need to INC protein and restrict fluids, sodium, potassium (risk of hyperkalemia)

Answer 81

Autoimmune disorder - body develops antibodies against insulin and/or pancreatic beta cells that produce insulin, resulting in not enough insulin to survive - can have idiopathic diabetes - LADA: slow progressive type 1 DM in adults Requires exogenous insulin

Answer 82

3 Ps weight loss weakness fatigue DKA

Answer 83

Most prevalent; many risk factors: overweight, obese, advanced age, family history - pancreas usually makes some endogenous insulin but not enough is produced and/or body does not use insulin effectively Major distinction: - presence of endogenous insulin - in type 1 DM: absence of endogenous insulin

Answer 84

- nonspecific symptoms - fatigue - recurrent infection - recurrent vaginal yeast or candida infection - prolonged wound healing - visual problems

Answer 85

- A1C level 6.5% or higher - Fasting plasma glucose (FPG) level > 126 mg/dL - 2-hour plasma glucose level during OGTT greater than 200 mg/dL (with glucose load of 75 g)

Answer 86

Impaired glucose tolerance (IGT) - OGTT—140 to 199 mg/dL Impaired fasting glucose (IFG) - Fasting glucose of 100 to 125 mg/dL May have both IGT and IFG Intermediate stage between normal glucose homeostasis and DM

Answer 87

Sliding scale used for rapid acting, give right before eating - Short acting/Intermediate acting is what can be mixed NRRN - NPH is cloudy, longer acting but not super long - Get lantus at night do the job of pancreas - Hypoglycemia(lethargy, cold, clammy)

Answer 88

Rapid Acting: onset 10-30 mins, peak 30 min-3 hrs, duration 3-5 hrs - Ex: lispro(Humalog), aspart(Novolog), glulisine(Apidra) Short Acting: onset 30 mins-1hr, peak 2-5 hrs, duration 5-8 hrs - Ex: Regular(Humulin R, Novolin R) Intermediate Acting: onset 1.5-4 hrs, peak 4-12 hrs, duration 12-18 hrs - Ex: NPH( Humulin N, Novolin N) Long Acting: onset 0.8- 4hrs, peak not present, duration 16-24 hrs - Ex: glargine(Lantus), detemir(Levemir), degludec(Tresiba) used for basal dosing typically Inhaled Insulin: onset 12-15 mins, peak 60 mins, duration 2.5-3 hrs - Ex: Afrezza

Answer 89

aspart, glulisine, lispro onset of action: 15 mins injected within 15 mins of meals

Answer 90

- onset of action 30-60 mins - injected 30-45 mins before meal

Answer 91

NPH - duration: 12-18 hours - peak: 4-12 hours - can mix with short and rapid acting - never give IV

Answer 92

basal rate - administered once or twice a day - released steadily and continuously with NO peak action - onset varies

Answer 93

need to make sure eating or watching blood glucose because sugar can be dropping

Answer 94

- results from overproduction of ADH which leads to increased reabsorption of water into the circulation Manifestations: - low urine output - increased body weight - dyspnea - fatigue - hyponatremia: muscle cramping and headache

Answer 95

- caused by deficient production or secretion of ADH which results in fluid and electrolyte imbalances; too little ADP - dumping out really dilute urine Manifestations: - increased urine output - increased serum osmolality (hypernatremia) - polydipsia - polyuria Hypernatremia can be caused by inadequate fluid intake or fluid loss; here it is fluid loss

Answer 96

Primary: - addison's disease - reduction of glucocorticoids, mineralcorticoids, androgens Secondary: - lack of pituitary ACTH - lack of glucocorticoids and androgens

Answer 97

- insidious onset: -- anorexia -- nausea -- progressive weakness -- fatigue -- weight loss - disease often advanced before diagnosed - abdominal pain - diarrhea - headache - orthostatic hypotension - salt craving - joint pain

Answer 98

- acute adrenal insufficiency - insufficient or sudden, sharp decrease in hormones - life-threatening emergency Various triggers: - stress, infections, surgery - sudden withdrawal of corticosteroids - adrenal surgery - sudden pituitary gland destruction

Answer 99

- hypotension, tachycardia - dehydration - decreased sodium, increased potassium, increased glucose - fever, weakness, confusion - severe vomiting, diarrhea, pain - shock may cause circulatory collapse

Answer 100

2nd most common cancer - hormonal regulation is related to breast cancer; genetic link in mutation of BRCA gene manifestations: - lump - thickening - mammography abnormality do not take BP on side of a mastectomy or lymph nodes taken out: limb alert

Answer 101

Patho: - most common cancer in males ages 15-34 - more common with cryptorchidism, fam hx, or anomalies - predisposing factors: orchitis, HIV, maternal exposure to exogenous estrogen, and testicular cancer of other testis Develops from 2 types of embryonic germ cells - seminoma: most common but least aggressive - nonseminomas: rare but very aggressive Non-germ cell tumors come from other testicular tissue: less than 10%

Answer 102

HPV vaccine ages (-) to help prevent types of cancer

Answer 103

- often asymptomatic Men: - pain with urination (dysuria) or urethral discharge - rare: testicular pain or swelling Women: - mucopurulent vaginal discharge, abnormal vaginal bleeding, dysuria, pain with intercourse Rectal: - anorectal pain, discharge or bleeding, anal pruritus, tenesmus, mucus-coated stools, painful BMs Throat: asymptomatic or sore throat

Answer 104

- all sexual contacts within 60 days should be evaluated and treated - abstain from sex for 7 days after treatment or until all partners have been treated and abstained for 7 days - high rate of recurrence of infection - must treat sexual partner(s) to avoid "ping-pong" effect: treatment, re-exposure, reinfection

Answer 105

Bacterial infection Doxycycline twice a day for 7 days Alternates: erythromycin, ofloxacin, levofloxacin

Answer 106

2nd most common reportable STI - incidence increasing - caused by gram-negative bacteria - transmitted by exposure to sexual fluids; ejaculation not necessary - incubation period 1-4 days - prior infection does not provide immunity to subsequent reinfection

Answer 107

Symptoms of rectal gonorrhea: - mucopurulent rectal discharge or bleeding - pain - pruritus - tenesmus - mucus-coated stools - painful BM Symptoms of oropharyngeal gonorrhea: - few, if any symptoms - some have a sore throat

Answer 108

- men often seek treatment early due to symptoms; are less likely to develop serious complications -- epididymitis can cause infertility - women often asymptomatic; serious complications from lack of care -- infection in Bartholin's or Skene's glands -- PID can cause ectopic pregnancy, infertility, chronic pelvic pain Neonates can develop gonococcal conjunctivitis - from exposure to infected mother during delivery - can result in permanent blindness - almost all states require prophylactic treatment for newborns

Answer 109

Bacterial infection - drug therapy often started before test results return - has developed resistance to many classes of antibiotics - first line treatment: high-dose IM ceftriaxone -- do sensitivity testing on patients who persistently test positive Patient education: - treat all sexual contacts within last 60 days; abstain from sexual contact for 7 days - return for repeat testing in 3 months

Answer 110

- syphilis, gonorrhea more common - more likely to have symptoms of genital infection - genital infection results in fewer complications - easier to diagnose; less complex anatomy - less likely to seek care unless symptomatic

Answer 111

- anatomy increases risk for STIs - less likely to show early signs of genital infection - trichomoniasis and herpes simplex type 2 more common - screen for, thus more likely to be diagnosed with HPV - have more frequent and serious complications related to STIs

Answer 112

Primary Episode: - incubation period 2-12 days - primarily asymptomatic; if symptoms occur - follow stages: Prodromal stage: - period before lesions appear - burning, itching, tingling may occur at site of inoculation Vesicular stage: - few to multiple small, painful vesicles appear on buttocks, inner thigh, penis, scrotum, vulva, perineum, perianal region, vagina, or cervix - contain large quantities of infectious particles Ulcerative Stage: - lesions rupture and form shallow, moist ulcerations Final stage: - spontaneous crusting and epithelialization of erosions occur

Answer 113

key complication from either of syph, chlamydia, or gonorrhea is that they can lead to PID - infections spread to uterus, ovaries, fallopian tubes and can lead to sepsis symptoms: lower abdominal pain, menstrual irregularities, fever treat: need to give antibiotics and analgesics

Answer 114

Primary: highly infectious; 3-6 week duration - single or multiple chancres - regional lymphadenopathy - exudate and blood from chancre are highly infectious Secondary: highly infectious; few wks after primary chancre heals - duration: 1-2 years - systemic flu-like symptoms - mucous patches in mouth, tongue, or cervix - symmetric, nonpruritic, maculopapular rash on palms and/or soles, and trunk or extremities Final stage: tertiary or late syphilis - no obvious symptoms - organ damage silently happening over years - gummas can lead to serious complications: inflammatory tumor-like response can be spread to fetus while pregnant

Answer 115

Bacterial infection need early treatment with drug therapy and to eradicate syphilitic organisms - penicillin G benzathine recommended for all stages - alternate: doxycycline or tetracycline - treat all sexual contacts from preceding 90 days - reexamination and follow-up testing every 6 months for up to 2 years; repeat HIV testing

Answer 116

Viral most common STI; can cause genital warts or lead to cancer - primary risk factor for cervical cancer - HPV typically asymptomatic; is preventable with vaccine Not curable but warts can be removed with prescription creams

Answer 117

clinical practice of treating the sexual partners of patients diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient to take to his/her partner without the healthcare provider first examining the partner

Answer 118

Rapid Plasma Reagin - is a syphilis screening test that measures antibodies present in the blood of individuals who have the disease

Answer 119

less than 400 mL/day

Answer 120

less than 100 mL/day