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NURS 522 final exam > Final exam questions > Flashcards

Final exam questions Flashcards

1
Q

Describe the role of FSH and LH in male fertility

A

FSH and testosterone is required for spermatogenesis. LH is required for testosterone secretion

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2
Q

Describe the role of FSH and LH is female fertility

A

FSH is required to grow the follicle, LH is required for ovulation. estrogen is released from the ovary during follicular stage whereas LH is required for progesterone release from the corpus luteum

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3
Q

Describe the steps of PSA follow up based on the lab results

A

PSA <1 = 4 years repeat
PSA 1-3 = 2 years repeat
PSA >3 = More frequent testing

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4
Q

When do you stop PSA testing

A

6o yrs and a PSA of < 1
70yrs old
within 10 years of life expec

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5
Q

Define primary amenorrhea

A

no menarch by 16 years
no secondary sexual characteristics by 14 years
no menarch after 1 year of tanner stage 5

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6
Q

pneumoic for tanner stages in girls

A

No body elevates 2 mountains in adulthood
Breast: none, bud, elevated, 2 mounds, adult
Shes not a small cat
Pubic Hair: none, small, course and curley, adult, thighhs

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7
Q

What are the causes of gynecomastia

A
  1. Homrmone imbalance - resolution in 3 years
  2. If occurs before puberty refer to pediatrican
  3. Can be causes by anabolic steroids, kelienfelter syndrome, MJ
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8
Q

Differential for male infertility

A

Pre testicular:

Post testicular:

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9
Q

What is primary dysmenorrhea

A

Pain in the absence of pathology

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10
Q

What is secondary dysmenorrhea

A

Pain secondary to pathology such as endometriosis etc

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11
Q

Mifegymiso use

A

7-9 weeks - currently 63 days (looking to stretch to 70 days)
u/s for dates
Combination of mifepristone and misoprostol

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12
Q

Most common cause of urinary incontinence in men

A

BPH
Followed by neurogenic
Medication

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13
Q

Name 3 PDE5 medications and their dose and schedule

A

Sidinafil - 1hr before sex, 50-100mg lasts 4 hrs
Vardinafil same as sidniafil, 10-20mg, same as sidinafil
Tadinafil - long duration, take 60mins prior, 10-20mg. or daily 2.5-5mg

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14
Q

What medications can cause urinary concerns in men

A

Allergy, seditives, antichologenics, cardiology, psych meds

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15
Q

PDe5 ihhibitor side effects

A

Most common is headache. Contraindicates in nitrate use (must wait 24-48hrs), with unstable hypertension, cardiac, may cause hypertension with alpha antagonists (BPH)
Side effects, blue vision, hearing loss

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16
Q

Treatments for primary dysmenorrhea

A

NSAIDs - 2-3 days prior to onset of pain and first couple of days of menses
Combined OC or progesterone IUD

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17
Q

Symptoms for endometriosis

A

Deep pain, lower back pain, chronic pelvic pain

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18
Q

What investigations can be used for suspected endometriosis

A

Use U/S to rule out ovairian cysts and fibroids

GOld standard is laproscopty

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19
Q

Endometrial medical management

A

1st line is OCC or progestine (5-20mg OD 50% get break through bleeding or depo provera
2nd line is mirena

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20
Q

What investigations can be used for suspected endometriosis

A

Use U/S to rule out ovarian cysts and fibroids

GOld standard is laproscopty

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21
Q

Endometrial medical management

A

1st line is OCC or progestin (5-20mg OD 50% get break through bleeding or depo Provera
2nd line is mirena

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22
Q

Fibroid medical management

A
  • IUD
  • GnRh agonist - shrinks but will grow back within 12 months
  • Selective progesterone eg ulipristal acetate
  • Oral contraceptive
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23
Q

Differential for Female infertility

A

CUP - O
Cervical, strictures
Ovulatory - PCOS, POF, prolactinoma, thyroid, cusihings
peritoneal - endometriosis
Uterine/tubal - PID, adhesions, previous etcopic, fibroids

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24
Q

Differential for male infertility

A

Testicular - Varicoseal (most common), post infections lesions, post infection reduction infertility (mumps), Klienfelter, previous

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25
Q

What is Klinefelter syndrome

A

Primary hypogonadism, often associated with gynecomastia, being tall, more adipose, reduced fertility

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26
Q

what is the difference between primary and secondary hypogonadism

A 
Primary = testicular failure (disease of the testies)
Secondary = Disease of the hypothalamus or pituitary
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27
Q

what do the lab results for primary vs secondary look like

A 
Primary = high FSH/LH &amp; low testosterone and sperm count
Secondary = Low/norm fsh/lh and low testosterone and sperm
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28
Q

Labs for fertility in women

A

Day 3 LH/FSH, prolactin, TSH, estrodiol, DHE

Day 21 progesterone

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29
Q

Definitions of menopause

A

Sterilisity if <50 and no period x 2 year or >50 and no period x 1 year.
Premature if < 40 yrs
Cessation of menstruation x 1 year

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30
Q

How soon before menopause does perimenopause start

A

About 4 years prior with irregular periods

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31
Q

When do vasomotor symptoms occur

A

increase as stages of menopause progress and should decrease within 4 years of final period

32
Q

Labs are not recommended but if drawn what would indicate menopause

A

Low estrodiol <20

33
Q

Can oral contraceptive be used in perimenopause?

A

Yes if no contraindications eg smoking, HTN, liver., migraine with aura, VTE, hx of breast ca. Use lowe dose for vasomotor symptoms. However postmenopausal use is not advised as it is much higher than HT

34
Q

Differential for AUB in premenopausal women

A

Polyps, Adymisosis, Leiomyomas, coagulaopathies, ovarian dysfunction, endometrial, inatorpic, nyd

35
Q

Medical tx of AUB in premenopausal women

A

NSAIDS = reduce heavy bleeding
COC = continuous use
Depot or LNG-IUS

36
Q

what is the minimum number of days that progesterone should be used as HT

A

minimum is 16 days but best if estrogen is continuously aposed

37
Q

what is the name of a progestrone only noethidrone pill

A

micronor

38
Q

name one oral and one transdermal combined HT

A 
Transdermal = Climera
Oral = premplus
39
Q

Can an LNG-IUD be used in menopause

A

Yes with oral estrogen. It has been shown to be more effective than cyclical administration of E and P.

40
Q

what are the sideeffects of estrogen

A

Nausa, breast pain

41
Q

what are the estrogen side effects

A

breast pain, moodiness, fatigue, fluid retention. Micronized progesterone has less side effects

42
Q

what women should be offered transdermal vs oral therapy

A
  1. malabsorption
  2. increased vte risk
  3. hypertriglycerimia
  4. obese or with metobolic syndrome
43
Q

can progesterone be used to combat vms

A

yes, megstorl (20mg) or micronized (300mg) a day is better than a placebo. No defined link between breast ca and progesterone but possible….

44
Q

who cannot use HRT

A
  1. Undiagnosed AUB
  2. Liver dysfunction
  3. CHD
  4. Stroke
  5. Active VTE
  6. Hormone dependant ca
45
Q

what would you expect to see in LH/FSH for POF

A

high LH as not being inhibited by oocyles (inhibin b)

46
Q

what drugs can be uses for osteoporosis

A

Biophonbhates
RANKL inhibitors
SERMS
PTH Analogs

47
Q

What are the sideeffects of biophosphates

A

GI, abdo pain, msk pain, rare esphophigitis. Must take with fluid and not lie down 30 mins after. Watch Ca

48
Q

What are the Side effects of denosumab (RANKL inhibitor)

A

Necrotic jaw, nausia, limb pain, rash, watch Ca

49
Q

SERM side effects (Tamoxifen)

A

vasodilation, vaginal attrophy, bone denisty stops with medication cesation, incrased risk of DVT

50
Q

Balanitis xerotica obliterans:

A

lichen sclerosis et atrophicus in men,
White blanching can be constrictive
secondary to chronic inflamation

51
Q

Lichen Sclerosis

A 
white, symetrical to anus
Often itchy, shiney and thin skin
Vaginal atrophy evident
Common post menopausal - probably autoimmune
tx: Steroids x 6 weeks then maintenence
52
Q

Lichen simplex chronicus

A 
Leathery
Persistant itchy - often at night
Can follow an infection or atopy
tx: High dose steroid
Sleep managment
53
Q

Lichen Planus

A

Mild to severe itching but can be errosive
Can present oral, nasal, anal, scalp, nails, skin
Systemic and immune modulated
Focus on mucosa during exam

54
Q

What can chaseberry be used for?

A

PMS and PDD. Its a hormone modulator effecting FSH

55
Q

What is the cause of migrane with aura

A

Inability to metabolize estrogens or polymorphism in genes to encode sex hormones or metabolites of hormonal pathways

56
Q

Well circumsized, red velverty penile lesion

A

either bowens disease or erthroplasia of queyrt

Carcinoma in situ: tx 5fu

57
Q

Perly papules

A

Look like HPV
Dome, skin coured
Often on head

58
Q

Penile lichen planus

A

topical corticosteroids

often occurs in mucus memebranes as systemic

59
Q

Contact dermatitis

A

red puritis often condoms

Mild OTC corticosteroid

60
Q

Fordyce spots

A

little yellowish bumps often found in mouth but also genitils

61
Q

Bowenoid papulosis

A

smaller, often multiple papules on

the shaft of the penis biopsy as can be carcinoma

62
Q

Peyronie’s disease treatment

A

Oral vitamin E and K para-aminobenzoate
• Surgical replacement of fibrosis with patch graft
• Local injections of verapamil, high-potency
corticosteroids, or collagenase clostridium histolyticum
• Ultrasound or radiation therapy or a prosthesis

63
Q

hematospermia

A

normally bening or secondary to prostate biopsy
low risk in men <50
Worry if lasts longer than 1 month, constitutional symptoms, palpable mass, urinary obstructive symptoms

64
Q

How is low testosterone/hypogonadism diagnosed?

A

Measure
testosterone in the morning (7am-11am) or within 3 hours of
waking if low then order (FSH, LH, Prolactin, SHBG, cFT or
cBAT, TSH, ferritin, CBC and PSA.
Primary (testicular) = Low test and high LH/FSH
Secondary (pituitary/hypothalamic) = Low test and normal
LH/FSH

65
Q

what is the purpose of serum testosterone total testing

A

single most important test in diagnosing hypogondism
Low value indicates hypogondism
It measures total testosterone accuratly reflecting secretion

66
Q

when is free testosterone measurment used?

A

rarley

67
Q

how many times should total serum testosteone be measured

A

at least a couple of times, between 8-10am

68
Q

Differential for obstructive azoospermia

A 
Iatrogentic= tubal ligation
Infection = STI
retrograde ejaculation - prostate sx
congential absence of the vas
2/3rds of cases are obstructive
69
Q

non obstructive azoospermia

A

mumps
chemo/radiation
cripytochorism
torsion/trauma
Klienfelter - lacks seminiferus tubules and germ cells
Hypogonadotropic hypogonadism - usually primary no secondary sex characteristics, otherwise due to a tumor

70
Q

define hypogonadotropic

A

Overaies or testies do not produce sex hormones

71
Q

define Hypogonadotropic hypogonadism

A

it is where hypogonadotropic is caused by the pituitary or hypothalamus

72
Q

what kinds of cancer can be found in the vagina and which is the most common

A 
Squamous cell is the most common
Vulva from HPV 16 - 33
Cervical from HP 16-18
Adenocarcinoma - rises from barthalon gland (post meno) or from DES exposure - very rare
Pagets, sarcoma, basal cell
73
Q

what is an abnormal prolactin level

A

> 20

74
Q

screening a young woman with 1st degree relative with breast CA

A

1+ first degree relatives with invasive breast CA – annual

mammo 5-10 yrs younger than youngest case, no earlier than 25, no later than 40. CBE at 25

75
Q

Breast CA screening for women with hx of chest wall radiation

A

Hx of chest wall radiation <30 yo – Annual mammo +
screening breast MRI starting 5-10 yrs after radiation, no
earlier than 25, no later than 40

76
Q

what age for breast ca screening

A

50-74 every 2 years

can start at 40 yrs but womans preference only

77
Q

tanner stages boys

A 
no exams in preschool
new big exam in 2nd school
bigger and longer exams in highschool
Bigger, longer and wider exams to get into univerity
University has adult exams

NURS 522 final exam (3 decks)

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