module 16 abnormalities in children, pregnancy, and older adults

Question 1

ambiguous genitalia patho

Answer 1

newborns genitalia are not clearly either male or female

- presence or absence of male hormone controls the development of sex organs

Question 2

ambiguous genitalia subjective

Answer 2

FMH:

• genital abnormailites
• congenital adrenal hyperplasia
• unexplained deaths in early infancy
• infertility in close relatives
• abnormal development during puberty

Question 3

ambiguous genitalia objective

Answer 3

in genetic female:
- enlarged clitoris that has the appearance of a small penis
- urethral opening anywhere along, above, or below the clitoris
- fused labia resemble a scrotum
- lump of tissue felt within the fused labia
In genetic male:
- small penis that resembles an enlarged clitoris
- urethral opening anywhere along, above, or below the penis; or as low as on the peritoneum
- small scrotum with any degree of separation
- undescended testicles

Question 4

hydrocolpos patho

Answer 4

distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction
- imperforate hymen, transverse vaginal septum

Question 5

hydrocolpos subjective

Answer 5

none

Question 6

hydrocolpos objective

Answer 6

• small midline lower abd. mass or a small cystic mass between the labia
• may resolve spontaneously or may require surgical intervention
• abd. sonography: large midline translucent mass displacing the bladder forward.

Question 7

vulvovaginitis patho

Answer 7

inflammation of the vulvar and vaginal tissues

Question 8

vulvovaginitis subjective

Answer 8

vaginal discharge
discomfort, pian, pruritus
vulvar irritation
burning with urination 
infants/children: 
- discharge on the diaper or panties
- abnormal vaginal order
- redness of the vulva 
wiping the anus from posterior to anterior, wearing tight-fitting synthetic undergarments, and using vaginal irritants such as bubble bath

Question 9

vulvovaginitis objective

Answer 9

warm, erythematous, and swollen vulvar tissue
vaginal pruritus, especially at night -> pinworms
itching, soreness, bleeding, and vaginal discharge; bloody and foul-smelling discharge may suggest vaginal foreign body

Question 10

premature rupture of membranes patho

Answer 10

spontaneous premature rupture of membranes in a preterm pregnancy carries a high risk of perinatal morbidity and mortality, as well as maternal morbidity and mortality

Question 11

premature rupture of membranes subjective

Answer 11

during pregnancy before term, premature passage of fluid form the vagina

Question 12

premature rupture of membranes objective

Answer 12

PROM should be verified with a sterile speculum examination to collect fluid for testing with nitrazine paper
amniotic fluid pH of 7.15 and will turn nitrazine paper blue-green
amniotic fluid on a slide with have a fern pattern
Us will reveal dec. or absent amniotic fluid

Question 13

vaginal bleeding during pregnancy patho

Answer 13

vaginal bleeding that can occur early or late in pregnancy

Question 14

vaginal bleeding during pregnancy subjective

Answer 14

vaginal bleeding

may or may not have pain

Question 15

vaginal bleeding during pregnancy objective

Answer 15

dx based on gestational age and the character of bleeding

pts with vaginal bleeding in labor or who have a suspected placenta previa: prepare for c-section

Question 16

atrophic vaginitis patho

Answer 16

inflammation of the vagina due to the thinning and shrinking of the tissues, as well as decreased lubrication
- lack of estrogen during perimenopause and menopause

Question 17

atrophic vaginitis subjective

Answer 17

vaginal soreness or itching

discomfort or bleeding with sex

Question 18

atrophic vaginitis objective

Answer 18

vaginal mucosa is dry and pale
- may become red and develop petechiae and superficial erosions
accompanying vaginal discharge may be white, gray, yellow, green, or blood-tinged
can be thick or watery

Question 19

stress incontinence subjective

Answer 19

small volume incontinence with coughing, sneezing, laughing, running
hx prior pelvic surgery

Question 20

stress incontinence objective

Answer 20

pelvic floor relaxation
cystocele
rectocele
lax urethral sphincter
loss of urine with provocative testing 
atrophic vaginitis 
postvoid residual less than 100

Question 21

urge incontinence subjective

Answer 21

uncontrolled urge to void
large volume incontinence
hx: CNS disorders; stroke, MS, parkinsonism

Question 22

urge incontinence objective

Answer 22

unexpected findings only as related to CNS disorder

- postvoid residual less than 100

Question 23

overflow incontinence subjective

Answer 23

small volume incontinence
dribbling, hesitancy
in men: s/s of enlarged prostate, nocturia, dribbling, hesitance, dec. force of stream

Question 24

overflow incontinence objective

Answer 24

distended bladder
prostate hypertrophy
stool in rectum
fecal impaction 
postvoid residual greater than 100

Question 25

functional incontinence subjective

Answer 25

change in mental status, impaired mobility, new environment

meds: hypnotics, diurentics, anticholinergics, alpha-adrenergic agents, CCB

Question 26

functional incontinence objective

Answer 26

impaired mental status or unexpected finding only as related to other physical condition