Male & Female Repro Flashcards
Which lymph node is high up in the middle of the axilla, over the ribs and serratus anterior muscle.
Central axillary nodes
Which lymph nodes are along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold.
Pectoral
Which lymph nodes are along the lateral edge of the scapula, deep in the posterior axillary fold.
Subscapular
Which lymph nodes are along the humerus, inside the upper arm.
Lateral
These receive lymph from the other three groups of nodes.
Central axillary nodes
In this breast stage development in preadolescent consist of what?
There is only a small elevated nipple.
Only the nipple protrudes & the areola is flush with the breast contour in what stage of breast development?
Mature breast
In pregnant women, the white color of breast milk is from?
emulsified fat and calcium caseinate.
In pregnant women, the thick yellow fluid is
precursor for milk, containing the same amount of protein and lactose but practically no fat.
Mastalgia occurs with?
trauma, inflammation, infection, and benign breast disease.
Cyclic pain is common with?
normal breasts, oral contraceptives, and benign breast disease.
Any pain or tenderness in the breasts?Is the painful spot sore to touch? Do you feel a burning or pulling sensation?
These questions are referring to what?
Mastalgia
It is common to have a slight asymmetry in size; often the left breast is slightly larger than the right. What does a sudden increase in the breast signify?
inflammation or new growth.
What describes a loose protective sac, which is a continuation of the abdominal wall
scrotum
This has a solid oval shape, which is compressed laterally and measures 4 to 5 cm long by 3 cm wide in the adult male
testis
Why is the left testis lower than the right?
The left testis is lower than the right because the left spermatic cord is longer.
What is the subjective data for a patient with prostatitis?
Fever, chills, malaise, urinary frequency and urgency, dysuria, urethral discharge; dull, aching pain in perineal and rectal area.
What is the objective data for a patient with prostatitis?
tender enlargement
describe absent testis
temporary migration or true cryptorchidism
describe atrophied testis
Small and soft, fixed, nodules on testes or epididymides warrant ultrasound imaging. Marked tenderness
What is a supernumerary nipple?
An extra nipple along the embryonic “milk line” on the thorax or abdomen is a congenital finding.
What is the hormonal change with gynecomastia?
aging male that may result into testosterone deficiency.
gynecomastia is common during?
adolescence
*common for the breast tissue to enlarge temporarily
Ever noticed a lump or thickening in the breast? Where? When did you first notice it? Changed at all since then? Does the lump have any relation to your menstrual period? Noticed any change in the overlying skin: redness, warmth, dimpling, swelling?
These questions are referring to what?
Lump; Approach any recent change or new lump with suspicion.
Any discharge from the nipple? When did you first notice this? What color is the discharge? Consistency—thick or runny? Odor?
These questions are referring to?
Galactorrhea.
Bloody or blood-tinged discharge always is significant. Any discharge with a lump is significant.
Types of medications that may cause clear nipple discharge include?
oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, calcium channel blockers.
Any rash on the breast? When did you first notice this? Where did it start? On the nipple, areola, or surrounding skin?
These questions are referring to what?
Paget disease; starts with a small crust on the nipple apex and spreads to areola.
Eczema or other dermatitis; usually starts on the areola or surrounding skin and then spreads to the nipple.
Any trauma or injury to the breasts? Did it result in any swelling, lump, or break in skin?
caused by local hematoma or edema and resolves shortly.
Any history of breast disease yourself? What type? How was it diagnosed? When did it occur? How is it being treated?
Past breast cancer increases the risk for recurrent CA
The presence of benign breast disease makes the breasts harder to examine; the general lumpiness conceals a new lump.
Any breast cancer in your family? Who? Sister, mother, maternal grandmother, maternal aunts, daughter? How about your father’s side? At what age did this relative have breast cancer?
Breast CA occurring before menopause in certain family members increases risk for this woman
Ever had surgery on the breasts? Was it a biopsy? What were the biopsy results? Mastectomy? Mammoplasty—augmentation or reduction? Ever had radiation to chest? What was it for? At what age?
Biopsy-confirmed atypical hyperplasia increases breast cancer risk.
Female lymphoma survivors treated with chest or axillary radiation between 10 and 30 years of age are at high risk of breast CA; screen with mammography and imaging annually beginning 8 to 10 years after diagnosis.
Oral contraceptives are effective for?
birth control and may benefit dysmenorrhea or menorrhagia.
Tenderness, lump, or swelling. Any tenderness or lump in the underarm area? Where? When did you first notice it?
Breast tissue extends up into the axilla. The axilla also contains many lymph nodes.
Early detection is enhanced if the male is familiar with his normal consistency. Points to include during health teaching for TSE are:
T = timing, once a month S = shower, warm water relaxes scrotal sac E = examine, check for changes, report changes immediately
A fungal infection in the crural fold, not extending to scrotum, occurring in postpubertal males (“jock itch”) after sweating or wearing layers of occlusive clothing. It forms a red-brown half-moon shape with well-defined borders.
What does this indicate?
Tinea cruris
Clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans, foreskin, or anus. These rupture to form superficial ulcers. May have mild tingling before outbreak or shooting pain in buttock or leg. An STI, the initial infection lasts 7 to 10 days and is treated with oral antivirals. The virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.
What does this indicate?
Genital herpes – HSV-2 Infection
Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower-like patch. Color may be gray, pale yellow, or pink in white males and black or translucent gray-black in black males. They occur on shaft of penis, behind corona, or around the anus where they may grow into large, grapelike clusters.
What does this indicate?
Genital warts
Begins within 2 to 4 weeks of infection as a small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge.
What does this indicate?
Syphilitic chancre
Begins as red, raised, warty growth or as an ulcer with watery discharge. As it grows, may necrose and slough. Usually painless. Almost always on glans or inner lip of foreskin and following chronic inflammation.
What does this indicate?
Carcinoma
Palpation reveals a nontender, indurated base that can be lifted like a button between the thumb and the finger. Lymph nodes enlarge early but are nontender.
What does this indicate?
Syphilitic chancre
What does syphiltic chancre treated with and what happens when its left untreated?
This is an STI easily treated with penicillin G; but untreated it leads to cardiac and neurologic problems and blindness.
What is the treatment for genital warts?
The vaccine Gardasil is indicated for prevention of genital warts
Clinical symptoms and signs include: pain with straining; soft swelling that increases with increased intra-abdominal pressure; may decrease when lying down
What type of hernia does this indicate?
indirect inguinal hernia
Clinical symptoms and signs include: usually painless; round swelling close to the pubis in area of internal inguinal ring; easily reduced when supine
What type of hernia does this indicate?
Direct inguinal hernia
What is the cause of indirect inguinal hernia?
Cause- congenital or acquired
What is the cause of direct inguinal hernia?
Cause- Acquired weakness; brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites
What instrument is used to examine the sigmoid colon?
colonoscope
describe tarry black stools:
may be tarry due to occult blood (melena) from upper GI bleeding
describe non-tarry stools:
ingestion of iron medications
describe red blood stools:
occurs with lower GI bleeding, local bleeding around the anus, with colon and rectal cancer.
Clay color indicates:
biliary cirrhosis, gallstones, alcoholic or viral hepatitis.
Frothy stool is referring to?
Steatorrhea is excessive fat in stool: malabsorption as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn disease.
What foods are best to prevent constipation?
High-fiber foods of the soluble type (beans, prunes, barley, carrots, broccoli, cabbage)
Lower cholesterol levels, whereas insoluble fiber foods (cereals, wheat germ) reduce risk for colon cancer.
What is the position for male when doing a perianal examination?
left lateral decubitus, standing, or lithotomy position.
What is the position for female when doing a perianal examination?
lithotomy position if examining genitalia as well; use the left lateral decubitus position for the rectal area alone.
Subjective data includes: frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination; continuous pain in lower back, pelvis, thighs
What does this indicate?
Carcinoma
Subjective data includes: Urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia.
What does this indicate?
Benign Prostatic Hypertrophy (BPH)
Objective data includes: A symmetric nontender enlargement; commonly occurs in males beginning in the middle years. The prostate surface feels smooth, rubbery, or firm (like the consistency of the nose), with the median sulcus obliterated.
What does this indicate?
Benign Prostatic Hypertrophy (BPH)
Subjective data includes: Fever, chills, malaise, urinary frequency and urgency, dysuria, urethral discharge; dull, aching pain in perineal and rectal area.
What does this indicate?
Prostatitis
Objective data includes: A malignant neoplasm often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone-hard and fixed. The median sulcus is obliterated.
What does this indicate?
Carcinoma
Objective data includes: An exquisitely tender enlargement is acute inflammation, yielding a swollen, slightly asymmetric gland.
What does this indicate?
Prostatitis
What are the significance factors in aging elderly women?
The uterus shrinks in size because of decreased myometrium; vagina becomes shorter, narrower, and less elastic.
Dark gray colored urine contains?
melanin, melanuria
Tea color urine indicates?
liver disease, especially with pale stools, jaundice
Myoglobinuria
Some medications or food dyes
Blood in urine
Pink color urine indicates?
menses;
Some foods like beets, berries, food dyes
Some laxatives
Kidney stones
Urinary tract infection
Red color urine indicates?
blood in the urine
Orange color urine indicates?
medication side effect: rifampin for meningitis, pyridium, warfarin (coumadin)
- Some foods, food dyes, laxatives
- Dehydration
- Jaundice (bilirubinemia)
Amber color urine indicates?
gold or concentrated with dehydration;
- Some laxatives
- Food or supplements with B-complex vitamins
Yellow color urine indicates?
natural yellow is urochrome excretion, a pigment in blood;
-Bright neon yellow with vitamin supplements
Pale yellow color urine indicates?
clear, watery with excess liquids
Acute viral hepatitis or cirrhosis
Cloudy urine indicates?
UTI or kidney stones
Blue color urine indicates?
medication side effect like amitriptyline, indocin
- Foods: asparagus
- Dye after prostate surgery
Objective data includes: warty growth appears as abnormal thickened white epithelium. Visibility of lesion is enhanced by acetic acid (vinegar) wash, which dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein.
What does this indicate?
HPV
What will HPV progress towards if left untreated?
Must be treated or will progress to cervical cancer
Subjective data includes: sudden fever >38° C or 100.4° F, suprapubic pain and tenderness.
What does this indicate?
Acute Salpingitis
Objective data includes: acute—rigid, boardlike lower abdominal musculature. May have purulent discharge from cervix. Movement of uterus and cervix causes intense pain.
What does this indicate?
Acute Salpingitis
Subjective data includes: sharp, stabbing abdominal or pelvic pain, vaginal spotting or new-onset bleeding, although < half of women have these classic symptoms; positive urine pregnancy test.
What does this indicate?
Ectopic Pregnancy
Objective data includes: softening of cervix and fundus; movement of cervix and uterus cause pain; palpable tender, round, mobile swelling, lateral to uterus. Late signs may indicate rupture: decreased BP, tachycardia, diaphoresis, shock; regard as emergency.
What does this indicate?
Ectopic Pregnancy
S: Usually asymptomatic; when cyst is large, can be painful; may have dyspareunia.
What does this disorder?
Ovarian Cyst
O: Bimanual palpation shows smooth, round, fluctuant, mobile, nontender mass on ovary. Ultrasound image shows location of cyst.
What does this disorder?
Ovarian Cyst
S: Vague symptoms; may have abdominal pain, pelvic pain, increased abdominal size, bloating, difficulty eating, red spotting, or may be asymptomatic.
What does this disorder?
Ovarian Cancer
O: May or may not palpate solid tumor on ovary. Heavy, solid, fixed, poorly defined mass suggests malignancy; benign mass may feel mobile and solid. Biopsy necessary to distinguish.
What does this disorder?
Ovarian Cancer
S: Amenorrhea for 3 months or infrequent menses, infertility, hyperandrogenism (acne, hirsutism, hair loss), weight gain.
What does this disorder?
Polycystic Ovary Syndrome (PCOS)
O: Bimanual palpation may reveal enlarged ovary with multiple fluctuant balloonlike masses. MRI image shows patient’s right ovary with multiple cysts, also unrelated benign teratoma in left ovary.
What does this disorder?
Polycystic Ovary Syndrome (PCOS)
Is the discharge associated with vaginal itching, rash, pain with intercourse?
These questions are referring to?
Rash is result of irritation from discharge. Dyspareunia occurs with vaginitis of any cause
Any unusual vaginal discharge? Increased amount?
Normal discharge is small, clear or cloudy, and always nonirritating
Family history of diabetes? What is the purpose of asking this from a patient?
Diabetes increases glycogen content.
Use a vaginal douche? How often? What does it affect?
Frequent douching alters pH.
What breast stage development?
A small mound of breast and nipple develops; the areola widens.
breast bud stage
What are the normal findings of the prostate gland?
Size- 2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum
Shape- heart shape, with palpable central groove
Surface- smooth
Consistency- elastic, rubbery
Mobility- slightly movable
Sensitivity- nontender to palpation
What are the normal findings associated with breasts of aging women?
- After menopause: ovarian secretion of estrogen and progesterone decreases, which causes the breast glandular tissue to atrophy. This is replaced with fibrous connective tissue.
- decrease breast size and elasticity so the breasts droop and sag, looking flattened and flabby.
The testes is capped by what?
epididymis
What are the maneuvers to screen for retraction?
- First ask her to lift her arms slowly over her head. Both breasts should move up symmetrically.
- Next ask her to push her hands onto her hips and to push her two palms together. These maneuvers contract the pectoralis major muscle. A slight lifting of both breasts occurs.
- Ask the woman with large, pendulous breasts to lean forward while you support her forearms; note the symmetric free-forward movement of both breasts
Patient education about BSE includes?
- Lie down. Press the 3 middle fingers in a circular motion and use 3 levels of pressure. Follow an up and down pattern.
- Sit up. Examine underarm with arm slightly raised.
- Note surface changes with hands pushed on hips, shoulders hunched.
**The best time to perform BSE is right after the menstrual period
What are the appropriate questions to ask regarding menopause?
- Have your periods slowed down or stopped?
- Any associated symptoms of menopause (ex: hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, itching)?
- If hormone replacement therapy (HRT), how much? How is it working? Any side effects?
- How do you feel about going through menopause?
Please See HeR First
- P- periods
- S- symptoms/side effects
- Hr- hormone replacement
- F- feel
