Midterm Lectures Flashcards
When performing an internal bimanual exam on a female, it is important to move the cervix gently side to side and observe the pt for any expression of pain or discomfort. What can cervical motion tenderness suggest?
PID
What is Tinea Cruris?
- fungal infection that affects the skin of your genitals, inner thighs, and buttocks
- Causes an itchy, red, often-ring shaped rash in warm, moist areas of your body
At 65yo, cervical cytology can typically be discontinued, when is this not the case?
if the pt has a history of CIN2 or CIN3, then they need to continue pap for 20yrs after even it it extends >65yo
What allergens are mandatory to be listed on a food label?
milk
eggs
peanuts
What is the classic presentation of genital herpes?
- single or clusters of vesicles on the genitalia
- may have burning, tingling and pain prior to vesicle appearance
What is the treatment for HSV-2?
Acyclovir
What immunizations should be given to women 19-39yo?
- Tdap booster every 10yr
- HPV -> one series for those who are not previously immunized between ages of 9-45
- influenza annually
- MMR and varicella if not previously immunized
What is Vernix?
- white cheesy stuff that babies have all over (esp inguinal/axillary), appears about 35wks and may be gone at 41 weeks
**Long nails, lack of vernix, peeling/dry skin = signs of post-maturity
What are Epstein pearls?
epithelial cysts made of collagen that are found in the mouth
____________ is a potential peripheral complication of IV therapy that presents with pain, increased skin temp and redness
Phlebitis
What routine lab tests should you run on women age 65yo and older?
- bone mineral density screening no more than every 2 yrs unless they have new risk factors
- lipid profile assessment every 5yrs starting at 45yo
- mammography annually
- TSH every 5yrs beginning at 50yo
- diabetes testing every 3 yrs after 45yo
What are the sources of niacin?
meats, poultry, fish
legumes
wheat
synthesized in body from tryptophan
What nutrients are affected by tetracyclines?
Ca
Mg
Fe
Vitamin B12
What gynecological labs should be done periodically for women 13-18yo?
- chlamydia and gonorrhea if sexually active -> urine based screening is an efficient method without a speculum exam
- HIV if sexually active
What is the classic presentation of Gonorrhea in men vs women?
- men = penile discharge and dysuria or can be asymptomatic
- female = pelvic pain or mucopurulent vaginal discharge
**Can cause in fiction of urogenital, anorectal or pharyngeal infections
What nutrients are affected by neomycin and kanamycin?
fat-soluble vitamins
Vitamin B12
Albumin <3.5 is considered to indicate a ___________________ response
Mild systemic inflammatory response
The ACOG recommends the initial visit to the OB/GYN for screening and the provision of preventative health care services and guidance to take place between the ages of ___-___
13-15 -> just gathering a hx, only do pelvic exam if indicated by hx (vaginal d/c, menstrual do, pelvic pain, STIs can be tested by urine)
**the major things you want to get from this appt are FH, tobacco, alcohol and other drug use, sexual abuse
What is Naegeles rule?
It establishes the estimated date of confinement (EDC) AKA the due date -> subtract 3mo and add 7 days to LMP or add 9mo and 7days
What is the treatment for syphilis?
Penicillin
What are the components of 0.9% NaCl and is considered isotonic, hypotonic or hypertonic?
- Na and Cl -> 154 mEq/L
- isotonic (osmolality 250-375) -> 308
Why vitamin K is injected and topical erythromycin ophthalmologic ointment is applied immediately after birth
a. Vitamin K = to prevent hemorrhagic disease of the newborn bc newborns are born with low levels of vitamin K
b. Topical erythromycin ophthalmologic ointment = prevention of gonococcal conjunctivitis; less against chlamydia
How long does it take for a vitamin B12 deficiency to develop?
may take 3-6yrs after GI abnormalities develop
____________ is a potential peripheral complication of IV therapy that is defined as leakage of IV solution or medication into the extravascular tissue
Infiltration
What is the most common solid tumor among males 15-34yo?
testicular cance r
What are the 2 specific questions you should ask to every pt in every office visit to assess for depression?
- During the past month, have you been bothered by feeling down, depressed or hopeless?
- during the past month, have you been bothered by little interest or pleasure in doing things?
**Yes to these questions prompts a more detailed questionnaire -> Patient Health Questionnaire-9 (PHQ-9)
What nutrients are affected by hypolipidemics such as cholestyramine or colestipol?
fat and fat-soluble vitamins
Differentiate between the presentations assoc with the various stages of syphilis
- primary = chancre
- secondary = joint pains, fatigue, LAD, maculopapular rash
- latent phase = may be asymptomatic
- tertiary = neurosyphilis (confusion, HA, stiff neck, vision loss)
What nutrients are affected by sulfa drugs?
Folate
What is urge incontinence?
- detrusor muscle overactivity, leading to uninhibited (involuntary) detrusor muscle contractions during bladder filling
- detrusor muscle under activity or bladder outlet obstruction
5 clinical components of the APGAR score (all get a score of 0-2, w/7-10 being normal)
a. HR
b. Respiratory Effort
c. Muscle Tone
d. Reflex Irritability
e. Color
What is Central Cyanosis?
- bluish discoloration of tongue/mucus membranes
- Persisting after the first 10 mins of life is always abnormal -> think cardiac dz/pulmonary dz
What are the risk factors for osteoporosis?
- white females
- older white males
- postmenopausal females
- certain chronic medical conditions
- certain medications
- vitamin D deficiency
What is a Omphalocele?
abdominal wall defect where the gut comes through the umbilical cord and is covered with amnion and peritoneum
_______ is the term used for a woman who is or has been pregnant
Gravid
What are the 2 maneuvers used to examine the hips in a newborn baby?
Ortolani and Barlow
**Assess for dysplasia of the hip which is more common in females, if there are CNS abnormalities, or with breech presentation
Name the one common hypotonic solution
0.45% normal saline
What is the treatment for epididymitis?
- single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the tx of choice for sexually active males 14-35
- ceftriaxone with 10 days of oral levofloxacin or ofloxacin is recommended for men who practice insertive anal intercourse
What is the Hegar’s sign?
in pregnancy the uterine consistency becomes softer and you may be able to palpate between the cervix and fundus -> this is the Hegar’s sign
What are the high risk factors for osteoporosis that would require a woman to get diabetes testing prior to 45yo?
- BMI >25
- First degree relative with DM
- High risk race (native american, Latuba)
- prior birth > 9lbs
- history of gestational DM, PCOS
What nutrient deficiencies cause pallor?
Fe
Vitamin B12
Folate
**these also cause conjunctiva pallor
What are the sx of protein deficiency?
- dry and scaly, cellophane appearance of skin
- interosseous muscle atrophy, squaring off of shoulders, poor hand grip and leg strength
- parotid enlargement
Small, shallow, painless, genital or rectal papule or ulcer with no induration and unilateral tender inguinal or femoral LAD is indicative of what STI?
LGV
What are the sx of Vitamin A deficiency?
- follicular hyperkeratosis of the skin
- night blindness
- Xerosis, keratomalacia, bitot spots -> all of the eyes
Explain Milia
1-2mm white, firm papules on the face and bridge of the nose that appear at 36 wks gestation and resolve spontaneously by a few months
How do you calculate the percent weight change of someone?
Their usual weight - current weight then divided by their usual weight x 100
Explain the sizing and usage of IV needles
- *The smaller the number, the bigger the needle/tubing**
- 22 gauge = children and older adults; slow infusions
- 20 gauge = crystalloid infusion for maintenance
- 18 gauge = fluid resuscitation or blood transfusion
- 16 gauge = fluid resuscitation or blood transfusion
St. Johns wart should not be combined with what type of antipsychotic?
SSRI’s -> serotonin syndrome
T/F: the acute phase reactants transferring and prealbumin are reliable tools in the assessment of nutritional status
FALSE! Transferring and prealbumin have not been found to be reliable tools int he assessment of nutritional status!
What are the components of a discharge summary?
- onsultants
- procedures w/dates
- pertinent H&P details
- Course -> brief summary of hospital course, tax and progress during stay
- discharge condition
- disposition -> home, skilled nursin, rehab center, etc
- meds
- follow-up -> who, when and why
How often should women 40-64 get clinical breast exams?
Yearly
Who needs a geriatric assessment?
> 65yo along with..
- chronic comorbid conditions
- cognitive changes
- high health care utilization
- change in living situation, risk of fall or functional status change
- polypharmacy
- change in health like weight loss, etc
Normal number of arteries and veins in an umbilical cord
2 arteries and 1 vein
When does the ACOG and ACS recommend clinical breast exams for women?
- every 1-3yrs for women 20-39yo
- every year with annual mammograms for women >/= 40yo
When can chemoprophylaxis for breast cancer be done?
For high risk women aged 35yo or older
____________ is a potential peripheral complication of IV therapy that is defined as inflammation of a vein
Phlebitis
What nutrient deficiencies cause glossitis?
riboflavin niacin B vitamins Fe Folate
Low-fat means ___g of fat or less per serving
3g
___________ is a painless cystic mass separate from the testis located superior and posterior to the testis
spermatocele
What immunizations should be given to women age 65yo and older?
- herpes zoster if not already
- Tdap booster every 10yrs
- influenza annually
- pneumococcal vaccine once at 65yo or older
- varicella vaccine if no immunity
What nutrients are affected by laxatives such as mineral oil?
water
electrolytes
fat
fat-soluble vitamines
Isotonic solutions are the best choice with normal saline preferred. However, during high volume resuscitation with NaCl, its possible to overload the Cl and induce a _____________________ metabolic state
Hyperchloremic metabolic acidosis (NAGMA)
What is overflow incontinence?
continuous urine leakage due to incomplete bladder emptying
Is the cremaster reflex present or absent with testicular torsion?
typically absent
How do you calculate BMI?
weight (kg)/height (meters)
What are the components of D10W and is considered isotonic, hypotonic or hypertonic?
- glucose (double the amount of D5W) -> 100g/L
- hypertonic (osmolality >375) -> 505
What are the sx of Zn deficiency?
- Flaking dermatitis
what is the classic presentation of acute orchitis?
- sudden onset of testicular pain and high fever
- nausea and vomiting are common
What nutrients are affected by diuretics such as thiazides and furosemide?
K
Mg
Ca
Zn
How does the treatment differ between phlebitis, infiltration and extravasation?
- D/C IV line for all
- use moist warm compress for phlebitis and infiltration but a cool compress for extravasation
- elevate extremity for filtration
- administer antidote if one exists for extravasation
Expected daily weight gain after the first week of birth
15-30g/day**
Age at which the majority of newborns regain their birth weight
10-14 days
What are the high risk factors for osteoporosis that would require a woman to get mammograms prior to 40yo?
- hx of breast cancer or FH of relatives who have hx of premenopausal breast or breast and ovarian cancers
- positive for BRCA 1 or 2 mutations
- hx of high-risk breast biopsy results (atypical hyperplasia and lobular carcinoma in situ)
What immunizations should be given to women 13-18yo?
- Tdap vaccine booster once between ages of 11-18
- HPV -> one series for those who are not previously immunized between ages of 9-45 (Gardasil 9 is the newest most broad coverage one)
- MMR and varicella if not previously immunized
- Influenza annually
What nutrients are affected by lithium and amiodarone?
Iodine
List sources for vitamin A
milk fish oil liver eggs carrots squash greens
What are the sources of vitamin B12?
eggs
dairy products
meats, liver
NONE in plants
What is the cause of presbycusis?
- loss of cochlear hair cells and ganglion cells in the vestibulocochlear nerve.
**Consider reviewing med list for ototoxicity
What labs should be routinely done on women 40-64yo?
- HIV
- Lipid profile assessment every 5 yrs starting at 45yo
- mammography yearly after 40yo
- TSH every 5yrs starting at 50yo
- diabetes testing every 3yrs starting at 45yo
What are the components of 3% NaCl and is considered isotonic, hypotonic or hypertonic?
- Na and Cl -> 513 mEq/L
- hypertonic (osmolality >375) -> 1026
Name the 4 common hypertonic solutions
3% saline
D5NS
D5LR
D10W
What immunizations should be given to women 40-64yo?
- Tdap booster every 10yrs
- influenza annually
- HPV between 9-45 if not already
- MMR and varicella alone if not already
- varicella zoster if 60yo or older**
What are the complications of untreated gonorrhea?
- PID
- fertility issues due to scarring of the fallopian tubes
It is Important to examine the lumbosacral spine in every infant. What can a dimple indicate?
a. possible “spinal dysraphism” (tethered cord); should US by 3 mos
What 2 STI’s most commonly cause painless genital ulcers and how can you tell them apart?
Syphilis and LGV -> LGV is assoc with inguinal or femoral LAD (groove sign)
What is the treatment for urge incontinence?
- fluid restriction
- kegels
- pessary
- beta-agonist
What are the only vitamins required by law to be listed on a food label?
Vitamin A
Vitamin C
Calcium
Fe
What are the sources of saturated fats and trans fats?
- animal fats: meat, butter, whole milk, etc
- solid fats: margarine
- coconut & palm kernel oils
Trans fat free means the food has less than ____g trans fat per serving.
0.5
**This can still add up!
What should you be concerned for with post-coital versus post-menopausal bleeding?
- postcoital = cervical cancer
- postmenopausal = endometrial/uterine cancer
When can cervical cytology be discontinued in women?
In women age 65yo or older who have no history of CIN 2 or higher, 3 consecutive negative prior cytology results, or 2 consecutive negative co-tests pithing the previous 10yrs
____________ is a potential peripheral complication of IV therapy that occurs when the IV catheter becomes dislodged and medication infuses into the tissues
Extravasation
What nutrient deficiencies cause tetany?
Ca
Mg
Vitamin A is worse with what types of conditions?
those that have fat malabsorption
Explain a Caput Succedaneum
- blood that gets between the scalp and the periosteum so it can flow ACROSS suture lines
- Looks like a boggy area of edema and/or bruising
- present at birth and gone in days
- generally DOESN’t enlarge
What does G4P2113 mean?
She has been pregnant 4 times, has had 2 term births, 1 preterm birth, 1 abortion, 3 living kids
A single, painless, well-demarcated ulcer (chancre) is indicative of what STI?
Syphilis (primary)
T/F: the cremasteric reflex is present with scrotal abscesses
True
What is considered “significant” weight loss?
Unintentional weight loss of 5% over 6mo or 10% over one year
Who should be screened for osteoporosis and how should this be done?
- DEXA scan for women 65yo or older
- screening women <65yo whose 10yr fracture risk is high -> use FRAX fracture risk assessment tool
What are the components of D5W and is considered isotonic, hypotonic or hypertonic?
- glucose
- isotonic (osmolality of 250-375) -> D5W is 278
List the classes of medications to be cautious of in geriatric pts
- opioids
- benzos
- antidepressants
- hypnotics
- antipsychotics
- antihistamines
- glaucoma agents
- NSAIDS
- Muscle Relaxants
What are the components of 0.45% NaCl and is considered isotonic, hypotonic or hypertonic?
- Na and Cl -> 77mEq/L
- hypotonic (osmolality <275) -> 154
What are the components of Lactated ringers and is considered isotonic, hypotonic or hypertonic?
- Na, Cl, K, Ca
- isotonic (osmolality 250-375) -> 274
What is a chloasma?
pigmentation over the bridge of the nose and under the eyes that may be a sign of pregnancy
What is Acrocyanosis?
- blue discoloration of the perioral area, feet and hands
- Normal for the first 24hrs, closely assoc w/cold surroundings, perioral changes seen w/sucking/feedings
Explain Erythema toxicum
- AKA flea-bite syndrome
- Benign rash of the newborn that usually appears on day 2-3
- Erythematous base with 1-2mm pustules or papules; spares palms & soles
- Pustule/vesicles contain debris and eosinophils
Fat free means the food has less than ____g of fat per serving
0.5g
How do you calculate caloric need?
- 3 components of total energy expenditure = basal energy expenditure, thermal effect of feeding, and activity energy expenditure
- in a sedentary hospitalized pt, 30-35 kcal/kg of body weight will maintain weight
- acutely or severely ill pts (trauma, burn pt, etc) may require 35-40Kcal/kg
If a solid intra-testicular mass is discovered, __________ is both diagnostic and therapeutic
orchiectomy
What does the vaginal discharge from a yeast infection look like?
white adherent discharge
What does the vaginal discharge from a Bacterial vaginosis infection look like?
foul smelling thin grey homogenous discharge
Most common type of vaginal infection
________ disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections
Peyronies disease
**sx may appear suddenly or develop gradually typically due to trauma
Explain when cervical cytology should be done on women and when co-testing of HPV should be done
- 21-29yo = screen every 3yrs w/cytology alone
- >/= 30yo = screen every 3yrs w/cytology alone & co-test with cytology and HPV every 5yrs
What are the STOPP and START criteria for elderly medications?
- STOPP = Screening Tool of Older Person’s Prescriptions -> similar to Beers criteria but also includes drug-drug interaction and duplication of drugs within class
- START = screening tool to alert doctors to the right treatment -> consists of 22 evidence based prescribing indicators in older persons
What is the classic presentation of chlamydia in men vs. women?
- men = penile discharge, pruritus, dysuria
- female = vaginal discharge, vaginal bleeding or pain during intercourse (dyspareunia), dysuria
**Can cause infection of urogenital, anorectal, conjunctival (neonatal), or pharyngeal infections
Fluid resuscitation includes dehydration, hypovolemia or shock (any type). During fluid resuscitation, the goal is to keep fluids within the intravascular space. ____________ solutions are the best choice, with ____________ being the preferred one
Isotonic solutions are the best choice with normal saline preferred
Albumin <2.4 represents a _________________ response
severe systemic inflammatory response, reflecting systemic inflammation that produces anorexia and increases protein catabolism and thus accelerates the development of protein-calorie malnutrition
____________ is a potential peripheral complication of IV therapy that presents with pain, stinging, burning, swelling, and redness at the injection site
Extravasation
What are the components of a hospital progress note?
- Date and time
- Subjective -> update all info that has occurred since last evaluation including overnight events, new or different concerns
- Objective -> VS, focused PE, new labs or imaging results
- Assessment -> update of current problems, new problems
- Plan -> to changes, radiographic or labs needed, discharge plan
What does testosterone supplementation cause and increased risk for in men?
prostate adenocarcinoma -> testosterone supplementation in men with hypogonadism improves ED and libido but requires interval monitoring of hemoglobin, serum transaminases and PSA levels
What is the tx for tinea cruris?
topical anti fungal for up to 4 weeks
What is the classic presentation of prostatitis?
- painful ejaculation, hematospermia, and painful defecation
- acute onset of irritative or obstructive voiding sx
- pt may report suprpubic, rectal or perineal pain
What are sx of niacin deficiency?
- pigmentation changes of the skin
- glossitis
- angular stomatitis
- Cheilosis
Routine delivery room care of a healthy, term infant
Warming, Drying, Clearing of airways
Explain a Cephalohematoma
- blood under the periosteum between the periosteum and bone; DOESN’T cross suture lines
- May be b/l
- inc in size after delivery; may be tense or fluctuant; can mimic fracture on X-ray
- resolves in wks to mos
what is the classic presentation of epididymitis?
gradual onset of scrotal pain with fever, urethral discharge, and urinary sx
At what age is it appropriate to start asking women about a history of pelvic prolapse?
65yo
What nutritional deficiencies can be determined from a CBC?
Fe
B12
Folate
What does Ginkgo Biloba supplementation increase the risk of?
bleeding
What are the high risk factors for osteoporosis that would require a woman to get bone mineral density scans younger than 65yo?
- hx of fractures
- body weight less than 127lbs
- medical causes of bone loss such as meds or diseases (RA)
- current smoker or alcoholic
Multiple vesicular lesions that rupture and become painful, shallow genital ulcers are indicative of what STI?
HSV
What is the tx for stress incontinence?
- fluid restriction
- pelvic floor exercise (kugels)
- anticholinergic meds
_______ is the term used for a woman who is in or who has experienced her first pregnancy
Primagravida
**Multigravida is used for women who have been pregnant more than once
What tests should be run for dx of genital ulcers?
- serologic tests (VDRL or RPR) for syphilis and darkfield microscopy or direct fluorescent Ab testing for Treponema pallidum
- culture or PCR test for HSV
- culture for H. Ducreyi in settings with a high prevalence of chancroid
Define free water
Water not bound by macromolecules. When applied to IV fluids, will cause a shift of fluids into the cells (ICF) from the vascular space (ECF)
What is the average age of menarche and what is considered primary amenorrhea?
- 12-13yo
- primary amenorrhea = if pt hasn’t cycled at 16yo
What is the daily salt recommendation?
less than 2,300mg/day
**A diet that sticks to this recommendation = dash diet
What is the management for osteoporosis?
- lifestyle change: fall prevention, smoking cessation, moderation of alcohol intake
- bisphosphonate therapy
- hormone therapy
What are the 2 tools for assessment of balance problems in geriatric pts to be able to intervene to prevent falls and fall related injuries?
- Tinetti Balance and Gait Evaluation
- Get Up and Go Test
What certain screenings can be stopped in a geriatric pt unless the pt has 10 or more yrs life expectancy left?
- colonoscopy stopped after 75yo
- pap smear after 65yo
- mammogram after 65yo
How do you calculate body water deficit?
(0.6 x weight (kg) x (pt Na - 140))/ 140 -> answer will be in L
What type of paresthesias are common with niacin deficiency?
burning paresthesias
Choanal atresia is associated with __________________
CHARGE syndrome
What nutrient deficiencies cause spooning of the nails?
Fe
What factors put you at risk for HPV infection?
- under 30yo
- smokers
- weakened immune system
- hx of child abuse
- children of a mother who had the virus during childbirth
Who should be screened for prostate cancer?
men 55-69 who know the benefits and harms of measuring PSA levels -> individualized decision
____________ is a potential peripheral complication of IV therapy that has the common PE findings of skin blanched, tight/leaking, bruised, swollen, edema, pitting and pain
Infiltration and extravasation both have these PE findings
Older adults should be screened for nutritional status using the acronym __________
DETERMINE:
- Disease
- Eating poorly
- Tooth loss/mouth pain
- Economic hardship
- Reduced social contact
- Multiple medications
- Involuntary weight loss
- Need for assistance with self-care
- Elderly years = >80yo
____________ fluids such as ___________ increase mortality and are not recommended for volume resuscitation
Colloids such as HydroxylEthyl Starches (HES)
What are sx of vitamin C deficiency?
- petechiae and purpura
- bleeding gums
- corkscrew hairs
Reduced sodium diet is considered at least _____% sodium than in the original product
25% sodium
What strain of HSV causes genital warts?
HSV-2
What are isotonic solutions used for?
- maintenance fluids or resuscitation
Explain the T-score assoc with osteoporosis
- normal = spinal or hip BMD with 1SD below the young adult female -> T-score >/= 1
- low bone mass (osteopenia) = spinal or hip BMD between 1-2.5SD below the young adult female reference mean -> T-score -2.5
- osteoporosis = spinal or hip BMD >/= 2.5 SD’s below the young adult female reference mean -> T-score = -2.5
- severe/established osteoporosis = BMD >/= 2.5SD’s below the young adult female reference mean and the presence of one or more fragility fractures
T/F: A sudden collection of fluid in the scrotum can be a sign of cancer
True
When does the ACOG recommend beginning pelvic exams for women?
at 21yo
What populations are most at risk for malnutrition?
- older persons who live alone
- chronically ill pts (renal failure, CHF, COPD, celiacs)
- adolescents who eat and diet erratically
- cancer pts undergoing chemo or radiation
- drug interactions
- alcoholics
- homelessness, low socioeconomic status
What are the 2 useful scales for assessing the functional ability (ADL’s) of geriatric pts?
- Katz Index if Independence in Activities of Daily Living
- Lawton Instrumental Activities of Daily Living Scale
What are the three major categories of the beers criteria?
- medications to always avoid for older pts
- medications that are potentially inappropriate for older pts with certain medical conditions
- medications used with caution
What vaccinations should you make sure pts over 65 are up to date on?
- tetanus or tetanus w/pertussis vaccine
- influenza vaccine
- pneumococcal vaccine
- herpes zoster vaccine
How do you test cervical discharge for gonorrhea/chlamydia?
with a gee-probe which is a swab that is inserted into the cervical os for 45 sec (keep in for the full 45 sec)
What is a Gastroschisis?
abdominal wall defect where the gut comes out just to the right of the belly button usually and its just bare gut and bowel with nothing covering it
What complications are assoc with genital warts from HPV?
- most lesions are self-limited
- high risk strains can lead to cancer of the oropharyngeal region or lower genital tract
What is the treatment for overflow incontinence?
Indwelling urethral catheter
alpha-adrenergic antagonist
What complications are assoc with HSV-2?
meningitis
PID
hepatitis
inc risk of HIV infections (possible due to open sores)
When should women begin getting colorectal cancer screenings?
- beginning at age 50
- african americans begin screening at 45yo bc of inc incidence and earlier onset of colorectal cancer
**colonoscopy every 10yrs is the preferred method
_________ is a testicular mass most commonly on the left side that lays posterior to and above the testis. The classic description is a “bag of worms”
varicocele
Who should be screened for testicular cancer?
only symptomatic men
What are the sources of poly & mono-unsaturated fats?
- seafood: omega-3 fats
- sunflower, corn, olive, soybean and cottonseed oils
- Walnuts, pine nuts
- sesame, sunflower, pumpkin and flax seeds
________ is the term used for a woman who has given birth to one child
Primapara
**Multipara is used for a woman who has given birth multiple times
Define Molding
the shaping of the fetal head to allow it to pass through the birth canal during childbirth
What do the numbers after parity mean?
number of term births (37-42wks), preterm births (20-36+6 wks), abortions (before 20wks), living kids
____________ is a potential peripheral complication of IV therapy that presents with edema, pallor, decreased skin temperature and pain
Infiltration
What ethnicities are at particular risk for obesity?
Minority populations with African Americans and Mexican Americans being most at risk
________ and __________ are the primary pathogens identified in men with urethritis
C. trachomatis and N. gonorrhoeae
Explain the mediterranean diet
- plant based: fruits, veggies, nuts, grains, seeds, beans, and olive oil
- eggs, dairy, poultry, and fish are eaten several times/weeks but portions are small
- minimal intake of red meat, refined sugar, flour, butter and fats (except for olive oil)
- 1-2 glasses of red wine/day
salt/sodium free diet means less than ____mg of sodium per serving
5mg
Who falls under the level A recommendation for STI screening?
- persons at risk
- pregnant women
When should routine chlamydia and Gonorrhea testing be done?
- if aged 25yo or younger and sexually active
- 26yo and older who are at high risk should be screened routinely
**always screen for HIV
What should men presenting with urethral sx be examined for?
- inguinal LAD, ulcers or urethral discharge
- palpation of the scrotum for evidence of epididymitis or orchitis is advised
- DRE of the prostate may be considered esp in older pts or if rectal pain is reported
Where is vitamin B12 absorbed?
In the distal ileum after binding to gastric intrinsic factor
**Deficiency is more common with GI abnormalities like celiac disease, pancreatic disorder, atrophic gastritis
Currently, how is urethritis reported?
by at least one of the following
- presence of urethral discharge
- positive leukocyte esterase test result in first-void urine
- at least 10 WBC’s per high-power field in first void urine sediment
What is the classic presentation of HPV warts?
genital warts -> papules, cauliflower-like lesions or flat
What are crystalloids and what are the 3 common crystalloid solutions?
- solutions of salts and electrolytes used for volume expansion
- includes NS, LR, D5W
What is the BMI difference between obesity versus overweight?
- obesity = BMI >/= 30 or waist circumference >40 in men and >35 in women
- overweight = BMI 25-29
_________ is a birth defect in which the opening of the urethra is on the underside/ventral surface of the penis instead of at the tip
Hypospadias
What lab test is used to diagnose gonorrhea?
Nucleic acid amplification tests (NAAT)
What nutrient deficiencies cause bleeding gums?
vitamin C
riboflavin
Reduced fat or less fat means the food has at least ____5 less fat than the regular product
25%
What is the function of a spatula versus cytobrush used in a pap smear?
- spatula is used to gently scrape the ectocervix
- cytobrush is then used to obtain endocervical cells
**wipe spatula on half the microscope slide and the cytobrush on the other half then send to the lab for testing
What are the uses for a conventional slide versus liquid based prep for pap smear testing?
- conventional slide is used for specimen for cytology
- liquid based prep allows a single specimen to be used for cytology, HPV testing, evaluate ASCUS cytology and to test for gonorrhea and chlamydia
What STI’s are required to be reported?
syphilis
gonorrhea
chlamydia
HIV
**HPV is the most common STI overall but not required to be reported
If a male presents with scrotal pain, what condition is most likely?
Epididymitis
What are hypertonic solutions used for?
Used with caution in extreme cases of hyponatremia (Na ~115). Must be done slowly with frequent sodium monitoring. May induce osmotic demyelination syndrome (locked-in syndrome), iatrogenic hypernatremia, fluid overload
To what compartment do hypotonic solutions go?
They have an abundance of free water and do not stay in the vascular space. They will move into ICF causing them to reach a lower osmolality (cellular swelling)
Dermal Melanosis AKA Slate Grey Spots
- slate blue/grey or black macular to patch size benign spots formerly called “Mongolian Spots”
- More common in darker skinned races but can affect all races
- Those on the lower back/butt tend to resolve over several years
- May resemble bruises and should always be documented -> Recommend to parents that they show them to new daycares, baby sitters, etc
What is Fournier’s gangrene?
- genital, groin or perineal involvement
- polymicrobial cellulitis -> signs or sx of infection followed by suppuration and necrosis of overlying skin
- non-sexually transmitted but assoc with/secondary to epididymitis
What vitamin deficiency can cause impaired wound healing?
Vitamin C
What does G3P0121 mean?
she has been pregnant 3 times, has had 0 term births, 1 preterm birth, 2 abortions, 1 living kid
What are colloids and what solutions are common examples of this?
- solutions that contain large molecules and provide oncotic pressure in addition to volume expansion
- ex. Protein solutions such as albumin and non-protein solutions such as dextran and hydroxyethyl starch (HES)
Where is the epididymis in relation to the testis?
posterior
What is the classic presentation of testicular torsion?
young male with acute onset of unilateral scrotal pain
**Cremaster reflex is typically absent
Bifid uvula can be indicative of a ____________________
SOFT PALATE CLEFT
What on the abdomen during PE may be a sign of pregnancy?
Darkening of the linea nigra in the midline of the abdomen
__________ and ___________ are the most common pathogens in sexually active males 14-35yo
Neisseria gonorrhea and chlamydia trachomatis
What is the most common hearing condition in older pts?
presbycusis or age related sensorineural hearing loss
**Progressive symmetric loss of high frequency hearing
Who are considered high risk individuals for contracting meningococcal and should therefore be sure to get vaccinated?
- adults with anatomic or functional asplenia
- first year college students living in dorms, military recruits
- pts that are traveling to hyper endemic or epidemic areas
Maximum acceptable weight loss in the week following birth
up to 10% is acceptable in most situations but 7% loss or greater demands close follow-up
__________ is a collection of fluid in the testicle that presents as painless scrotal swelling that can be transilluminated. May worsen through the day
Hydrocele
**A new hydrocele or one that hemorrhages after minor trauma may signal cancer r
__________ is a condition in which one or both of the testes fail to descend from the abdomen into the scrotum and is the MOST common male birth defect
Cryptorchidism
**“5 day old infant with absence of 1 testicle”
What fungi cause tinea cruris?
Trichophyton rubrum or T. mentagrophytes
_________ is a “3 yr warning for heart problems” in men
erectile dysfunction
What does G3P1021 mean?
she has been pregnant 3 times, had 1 term birth, 0 preterm births, 2 abortions, 1 living kid
What does the vaginal discharge from a Trichomonas vaginalis infection look like?
- yellowish green discharge and punctate hemorrhages on ectocervix “strawberry cervix” are often noted
What are the complications assoc with untreated chlamydia?
- PID
- Fertility issues due to scarring of the fallopian tubes
What is Mittelschmerz syndrome?
midcycle ovulatory pain
light in sodium or lightly salted means at least _____% less sodium than the regular product
50% sodium
What does a tight vs lax vs absent anal sphincter palpated on rectovaginal exam tell you?
- tight sphincter = scarring, fissures, inflammation
- lax sphincter = neuro deficit
- absent sphincter = secondary to improper repair of 3rd/4th degree laceration from childbirth
What nutrients are affected by cytotoxic agents such as methotrexate?
Folate
How do you calculate the maintenance fluid?
80+ 1ml for each >30kg
Ex. 70kg person = 120ml/hr
What vitamin deficiencies cause angular stomatitis and cheilosis?
riboflavin
pyridoxine
niacin
Name the 3 common isotonic solutions
0.9% NS
D5W
Lactated ringers
What nutritional deficiencies can be determined from a TSH level?
Iodine
What should all men with erectile dysfunction be tested for?
cardiovascular risk factors -> ED sx present on average 3yr before CAD sx -> initial workup should be limited to glucose, lipids, TSH, and testosterone
**men with ED are at inc risk of coronary, cerebrovascular and peripheral vascular diseases
What is the clinical presentation of presbycusis?
- hearing loss along with tinnitus
- vertigo and feeling off balance
If a male presents with urethral discharge and no scrotal pain, what is most likely?
urethritis
What are the risk factors assoc with testicular cancer?
cryptorchidism personal or family hx of testicular cancer age ethnicity infertility
Differentiate between gravidity vs. parity
- gravidity = number of times a women has been pregnant
- parity = number of pregnancies that led to a birth at or beyond 20 weeks or of an infant weighing more than 500g
What lab test is used to diagnose chlamydia?
Nucleic acid amplification tests (NAAT’s)
____________ is a potential peripheral complication of IV therapy that has the common PE findings of erythema, pain, red streak along vein, palpable venouse cord, and purulent drainage
Phlebitis
Very low sodium diet means less than _____mg of sodium or less per serving
35mg
Explain Supernumery nipples
- inferior to true nipples and are more common in African Americans
- In white pts they are assoc with renal anomalies such as hydronephrosis, hypoplasia, etc
- Can occur anywhere along the mammary line
A nonindurated painful genital ulcer with serpiginous border and friable base and unilateral inguinal LAD is indicative of what STI?
Chancroid (H. Ducreyi)
What nutrients are affected by anticonvulsants such as phenobarbital or phenytoin?
Ca
Vitamin D
Folate
Niacin
Pierre-Robin Sequence is associated with ___________**
MICROGNATHIA**
Low sodium diet means _____mg of sodium or less per serving
140mg
Where can reliable nutrition information be found for pt education?
- academy of nutrition and dietetics
- office of disease prevention and health promotion
- health and human services
- american academy of pediatrics
- american heart association
- american diabetes association
What 3 things is vitamin C necessary for the biosynthesis of?
bile acids
collagen
norepinephrine
