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AANP FNP: Adult > GYN/Men's health > Flashcards

GYN/Men's health Flashcards

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1
Q

Secondary amenorrhea

A
  • cessation of menstrual flow after establishment of normal cycle
  • pregnancy test, refer for other studies
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2
Q

What grade of abnormal Pap must you refer?

A

CIN 2 on the Bethesda Classification

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3
Q

Cervical cancer screening guidelines

A
  • Start screening at 21 years old
  • Screen every 3 years with cytology, and starting age 30, may start screening every 5 years with cytology and HPV co-test
  • Stop screening at age 65
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4
Q

Causes of vulvovaginitis

A
  • trichomonas
  • bacterial vaginosis
  • candidiasis
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5
Q

Trichomonas: sx, dx, tx

A

Sx: discharge, pruritis, erythema, “strawberry patches” on cervix and vagina, dyspareunia, dysuria
Dx: microscopy on saline slide
Tx: metronidazole 2gm po x1, or 500mg PO BID x7 days

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6
Q

Bacterial vaginosis: sx, dx, tx

A

Sx: watery gray discharge, fishy smell, spotting
Dx: microscopy on saline slide shows clue cells, Whiff test (KOH slide)
Tx: metronidazole 2gm PO x1, or 500mg PO BID x7 days, or gel BID x5 days

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7
Q

Candidiasis: sx, dx, tx

A

Sx: thick, white, curd-like discharge, erythema and pruritis
Dx: microscopy on KOH slide shows pseudo-hyphae (spag&mb)
Tx: topical or oral antifungal

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8
Q

Some common pathogens for pelvic inflammatory disease

A

Chlamydia trachomatis, Neisseria gonorrhea, E. coli

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9
Q

Symptoms of pelvic inflammatory disease

A

fever/chills, nausea/vomiting, vaginal discharge, dysuria, dyspareunia, pelvic pain, infertility, positive for cervical motion tenderness, adnexal tenderness, abdominal tenderness

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10
Q

Pelvic inflammatory disease: dx, tx

A

Dx: STI testing, elevated ESR/CRP, ultrasound
Tx: empiric, broad-spectrum antibiotic coverage recommended
- Regimen A: Ofloxacin, OR Levofloxacin +/- metronidazole
- Regimen B: Cefoxitin + Probenecid + Doxy +/- metronidazole OR
Ceftriaxone + Doxy +/- metronidazole

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11
Q

Primary dysmenorrhea

A

Occurs in adolescents shortly after onset of menses and no pelvic pathology is identified.

Result of high levels of prostaglandin.

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12
Q

Secondary dysmenorrhea

A

Occurs in women > age 20. More likely associated with some form of pelvic disease.

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13
Q

How to treat primary dysmenorrhea

A

Prostaglandin inhibitors (ibuprofen, naproxen, indomethicin), oral contraceptive pills, exercise, high fiber diet and reduction of sugar/caffeine/salt

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14
Q

Oligomenorrhea

A

infrequent, irregular bleeding

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15
Q

Polymenorrhea

A

Frequent, irregular bleeding

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16
Q

Menorrhagia

A

Excessive, prolonged bleeding with regular frequency

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17
Q

Metrorraghia

A

bleeding between cycles

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18
Q

Menometrorrhagia

A

prolonged, frequent, excessive, irregular bleeding

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19
Q

Intermenstrual bleeding

A

Variable quantity between cycles

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20
Q

Diagnostic tests for abnormal uterine bleeding

A

hCG (r/o ectopic pregnancy), prolactin, TSH, CBC, PAP, STI screen, UA

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21
Q

What is the most common cause of serosanguinous nipple discharge?

A

Intraductal papilloma (usually benign, requires excisional biopsy)

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22
Q

Fibrocystic breast disease: symptoms, management

A

Sx: tenderness related to cycle, mobile, nipple discharge usually not present
Tx: warm soaks, low sodium diet

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23
Q

Breast cancer: symptoms

A

family hx, firm, immobile, painless mass, may have dimpling, nipple retractions, bloody discharge, lymphadenopathy

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24
Q

Normal age span where menopause occurs?

A

Age 45-55

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25
Q

Definition of menopause/perimenopause

A

one year after last bleeding episode=menopause

when irregular bleeding/symptoms start=perimenopause

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26
Q

Some body changes that occur with menopause

A

skin dryness
increased risk CAD
mood changes, depression
vulvovaginal dryness/atrophy

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27
Q

What three factors help make the decision of whether or not to use hormone therapy for menopause symptoms?

A

Family or personal history of breast cancer?
Family or personal history of MI/CAD? Hyperlipidemia?
Family or personal history of uterine cancer?

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28
Q

Osteoporosis: risk factors

A 
Female, white, Asian, petite frame, elderly
Early menopause or estrogen deficiency
Family history
Smoking or alcohol abuse
Sedentary lifestyle
Certain meds/disease: steroids, thyroid
29
Q

Female athlete triad

A
  • Risk for osteoporosis at young age
    1. Eating disorder and/or excessive exercise
    2. Amenorrhea
    3. Decreased estrogen, resulting in bone loss
30
Q

Results of the DEXA scan (bone density)

A

T scores
> -1.0 SD is normal
-1.0 to -2.5 is osteopenia (consider calc w/vit D, wt bearing exercise)

31
Q

Bone density testing recommendations

A

All women ≥ 65 years old

All postmenopausal women

32
Q

Treatment for osteoporosis

A

Prevention is key: avoid risk factors
weight bearing exercise
Calcium supplementation or increase calcium in diet
Drug therapy: ERT, bisphosphonates

33
Q

Calcium supplement recommendations

A

11-24yo: 1200-1500mg/day
25-49yo: 1000mg/day
50-64yo- 1500mg/day (if not on ERT, or 1000mg/day on ERT)
≥65yo: 1500mg/day

34
Q

Dietary sources of calcium

A

Dairy products
Sardines, fish with bones
Green leafy vegetables
Vitamin D supplements to increase absorption

35
Q

Definition of SLE

A

multisystem, inflammatory disorder that affects primarily women of childbearing age

36
Q

S/sx of SLE

A

Fever, anorexia, malaise, weight loss, butterfly rash, alopecia, Raynaud’s, joint symptoms, vasculitis, nephritis, abdominal pains

37
Q

SLE: dx, tx

A

Dx: ANA positive in about 95 percent of patients
Tx: bed rest, naps, avoid fatigue, sun protection, NSAID, steroids

38
Q

UA: presence of nitrate

A

> Specificity,

39
Q

UA: presence of esterase

A

> Sensitivity,

40
Q

Commonly used antibiotics for lower UTI

A

Bactrim, Cipro, Augmentin
Other options: amoxicillin, levofloxacin, nitrofurantoin
3 day course is optimal for uncomplicated

41
Q

Treatment of acute pylenonephritis

A

14 day course
Bactrim, Cipro, other quinolone, Augmentin, Aminoglycosides (Gentamycin, Tobramycin)
Severe cases or those with nausea/vomiting should be hospitalized

42
Q

Stress incontinence

A

urine leakage from activities with increased pressure on bladder (lifting, coughing, sneezing, exercise, laughing)

43
Q

Urge incontinence

A

Caused by strokes, infections, stones, neoplasms
urgency, involuntary urinary loss, nocturia, frequency, large amounts
frequently referred to as “Overactive bladder”

44
Q

Primary amenorrhea

A
  • absence of menarche by age 16

- consider pregnancy test, refer to endocrinology

45
Q

Management of incontinence

A

Stress- timed voids, pessary, surgery, “squeeze before you sneeze”
Urge- Kegels, medication, “freeze and squeeze”
Patient teaching: weight loss, fluid management, avoid caffeine

46
Q

Medications for incontinence

A

Oxybutynin (Ditropan)

Tolterodine (Detrol)

47
Q

Tanner staging for girls: breast development

A
  1. Preadolescent breasts
  2. Breast buds with areolar enlargement
  3. Breast enlargement without separate nipple contour
  4. Areola and nipple project as secondary mound
  5. Areola recedes, nipple retracts, adult breast
48
Q

Tanner staging for boys: Penis

A
  1. Preadolescent
  2. Enlargement and roughen/reddening of scrotum
  3. Penis enlongates
  4. Penis enlarges in width and glans develops, rugae appear
  5. Adult shape and appearance
49
Q

Epididymitis: causative organisms

A

35yo, bacteria from bladder

50
Q

Epididymitis: Sx

A

symptoms like UTI + scrotal edema (grapefruit)
enlarged, tender epididymis
Positive Prehn’s sign (pain relieved with lifting scrotum)

51
Q

Epididymitis: Dx, Tx

A

Dx: STI testing, urine culture, scrotal US
Tx 35yo: Bactrim PO BID x10 days OR
Cipro 250mg PO BID x10days

52
Q

Acute bacterial prostatitis: causative organisms

A

Gram negative bacteria (especially E. coli)

In younger men: Chlamydia

53
Q

Acute bacterial prostatitis: Sx

A

UTI symptoms + prostate swollen, warm, tender/boggy

54
Q

Acute bacterial prostatitis: Dx, Tx

A

Dx: Urine culture
Tx: refer if urinary retention evident; no sex until resolves
Bactrim, Levaquin, Ofloxacin

55
Q

BPH incidence

A

By age of 50, 50 percent of men will have

By age of 80, 80 percent of men will have

56
Q

BPH sx

A

urgency/frequency, nocturia, dribbling, retention
May have bladder distention
Prostate nontender with enlargement, smooth, rubbery consistency with possible nodules

57
Q

BPH dx/tx

A 
Dx: UA, PSA, DRE
Tx: Refer as needed
Alpha blockers (Terazosin, tamsulonsin)
5-alpha-reductase inhibitors (Finasteride, dutaseride) to shrink prostate
Saw palmetto effective for some patients
58
Q

When to start routine DRE

A

Age 40

59
Q

When to start routine PSA

A

Age 50

60
Q

Prostate cancer sx

A

Usually asymptomatic, BPH symtpoms, adenopathy, bladder distention, prostate palpates HARDER THAN NORMAL with OBSCURE BOUNDARIES and nodules may be present

61
Q

Prostate cancer dx/tx

A

Dx: PSA values >4 is suspicious (watch trend and for spikes) although about 40 percent with prostate cancer present with normal PSA; prostate ultrasound (to check for solid nodules), biopsy
Tx: Refer

62
Q

Normal PSA values

A

age 40-49:

63
Q

Risk factors for prostate cancer

A

African American

high fat diet may contribute

64
Q

Top 4 killers of adults in US

A
  1. Heart disease
  2. Cancer (F: Lung, Ovarian; M: Lung, Prostate); M+F: Lung, Colorectal)
  3. Lower respiratory disease (asthma, COPD, pneumonia)
  4. CVA
65
Q

Erectile dysfunction: possible causes

A 
Stress/psychosocial
atherosclerosis
diabetes
recreational drugs/smoking
medications (thiazide, beta blocker, H2 blocker, antidepressant, NSAID, antihistamine, antiepileptics, muscle relaxers)
66
Q

Treatment of ED with PDE

A

sildanefil (Viagra)- onset 30min, lasts 4hrs, without food
vardenafil (Levitra)- like sildanefil
tadalafil (Cialis)- onset 15min, lasts 36hrs, with/without food

67
Q

Normal creatitine clearance values in adults

A

Males

68
Q

Normal BUN and Creat and BUN/Cr ratio

A

BUN: 10-20
Creat: 0.5-1.5
BUN/Cr ratio: 10 to 1

AANP FNP: Adult (14 decks)

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