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Primary Care II > Module 3 > Flashcards

Module 3 Flashcards

1
Q

The rate of unintended pregnancy in the United States is around

A

45% of all pregnancies

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2
Q

age 21-29 well woman

A

Every 3 years using cervical cytology (papanicolaou [Pap] test). The use of human papillomavirus (HPV) testing in women younger than 30 years is not currently recommended.

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3
Q

age 30-65 well woman

A

A Pap test and cervical HPV testing should be done every 5 years in women or Pap test alone every 3 years.

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4
Q

> 65 yrs well woman

A

who have had three consecutive negative Pap test results: No screening

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5
Q

IUD efficacy

A

99%, reversible

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6
Q

postpartum wait for IUD insertion

A

6-8 weeks

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7
Q

if a levonorgestrel-releasing IUD is inserted within 7 days of the start of the menstrual period,

A

no backup contraceptive method is needed

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8
Q

for IUD insertions after day 7 of the start of menses,

A

a backup method should be used for a minimum of 7 days.

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9
Q

the copper IUD requires

A

no form of backup contraception

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10
Q

Adverse effects of the copper IUD include

A

heavier menstrual periods, bleeding between periods, and increased menstrual pain. These side effects often lessen or go away completely within 1 year

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11
Q

% of patients with mirena/kyleena who have amenorrhea

A

1/3

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12
Q

absolute contraindications for the use of an IUD.

A

They include pregnancy, a distorted uterine cavity, unexplained vaginal bleeding, pelvic tuberculosis, cervical or endometrial cancer, malignant trophoblastic disease, acute pelvic inflammatory disease (PID), post septic abortion, postpartum sepsis, and purulent cervicitis. In addition, women with breast cancer should not use a levonorgestrel-releasing IUD

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13
Q

progestin-only etonogestrel (ENG) implant (Implanon)

A

highly effective (greater than 99%), flexible, 4-cm single rod inserted subdermally in the upper arm. The implant releases 60 to 70 mcg per day in weeks 5 to 6 postimplantation and gradually decreases to approximately 25 to 30 mcg per day at the end of the third year.

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14
Q

eng implant backup contraception

A

Backup contraception should be used if insertion occurs after day 5 of the start of mense

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15
Q

most popular OCPs are the

A

4-week cycle combination pills. Combination OCPs have a failure rate of 0.3% when used correctly, while the failure rate is 8% typical use

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16
Q

Estrogen in the pill inhibits

A

implantation of the egg by altering normal maturation of the uterine lining,

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17
Q

progestins in the pill

A

slow ovum transport and uterine motility. Progestins also cause the cervical mucus to become thick and scanty, slowing sperm transport and capacitation

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18
Q

preferred ocp for women with hirsutism and acne

A

third gen progestins (desogestrel, drospirenone, norgestimate)

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19
Q

estrogen content in ocp

A

Estrogen content is usually 20 to 35 mcg of EE per tablet, with no more than 50 mcg in formulations available in the United States

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20
Q

progestin content in ocp

A

progestin content ranges from 0.1 to 3 mg

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21
Q

contra for ocp

A

current breast cancer, being less than 21 days postpartum, severe cirrhosis of the liver, current or past history of deep vein thrombosis (DVT), major surgery with prolonged immobilization, vascular disease, having diabetes mellitus for more than 20 years, diabetic retinopathy, and a history of migraine with aura

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22
Q

OCPs should be started either with

A

the onset of menses (same-day start) or on the first Sunday of the week in which menses starts (Sunday start).

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23
Q

with sunday start for ocp

A

a backup contraceptive method (e.g., condom or abstinence) should be used for at least 7 days, unless Sunday is the first day of menses.

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24
Q

one late ocp dose or one missed dose recommendations

A

One dose late (less than 24 hours) or one missed (24 to 48 hours): Take the missed dose as soon as remembered and then the next dose at the usual time. No additional contraception is needed.

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25
Q

2 or more ocp missed doses

A

Take the missed dose as soon as possible and discard any other missed pills and continue taking the remaining pills at the regular time. Use a backup form of birth control or avoid sexual intercourse until the remaining pills have been taken for 7 consecutive days. If the OCP was missed in the last week of the hormone containing pills (days 15 to 21), then omit the hormone-free interval and begin the next new cycle. If unable to start a new pack, then backup contraception should be used until the new pack has been taken for 7 consecutive days. Emergency contraception should be considered if the dose was missed in the first week of the cycle and unprotected sex occurred in the 5 days prior.

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26
Q

ocps not recommended for

A

lactating women
estrogen decreases amount and quality of breast milk

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27
Q

adverse effects of ocps

A

nausea, abdominal bloating, hair changes, weight gain, leg pain, cramps, swelling

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28
Q

risk with ocp

A

There is an increased risk of cardiovascular disease and thromboembolic disease in women who are older than 35 years and who smoke more than 15 cigarettes a day while taking OCPs. Women older than 40 years who are nonsmokers may safely continue low-dose OCPs. The use of OCPs is safest throughout the menstrual lifetime of women who are of normal weight, are nonsmokers, have normal blood pressure and cholesterol levels, do not have diabetes mellitus, and have no family history of heart disease.

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29
Q

The risk of developing hypertension in OCP users

A

increases with the duration of use and in older women.

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30
Q

When combination OCPs are discontinued,

A

90% of women resume ovulation and menses within 3 months

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31
Q

transdermal contraceptive patch

A

Because the transdermal delivery bypasses the liver, there is no first-pass hepatic metabolism and lower doses of hormones are possible. With the patch, hormone levels are constant without peakes and troughs. In addition, because the patch is applied once every 7 days, compliance is enhanced

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32
Q

patch hormone numbers

A

The patch contains EE and norelgestromin and is applied weekly. About 20 to 35 mcg of EE and 150 mcg of norelgestromin are released from the patch on a daily basis.

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33
Q

application of contraceptive patch

A

The patient should be instructed to apply the patch to the buttock, abdomen, upper arm, or upper torso, but avoiding the breast. The patch should be changed in 7 days and at the same time and the old patch removed and the new patch applied to a different site. It is important to inform the patient that lotions should not be used at the site of the patch and an occlusive dressing cannot be used at the patch site. The patch is changed every 7 days for 3 weeks and then is followed by a patch-free week.

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34
Q

If there is a delay in removing and replacing the patch during the second or third patch cycle,

A

the woman should apply a new patch as soon as possible. If the new patch is applied within 48 hours of the patch day, there is an adequate release of hormones and the patch change day can remain the same. If it is after this 48-hour time period, the day that she remembers and applies a new patch becomes the new patch day, and either avoid intercourse or use a backup contraceptive method for 7 days following the application.

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35
Q

if a patch becomes detached for less than 24 hours, it can

A

be reapplied to the same location

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36
Q

If the patch is detached for longer than 24 hours

A

, then a new patch should be applied and this then becomes the new patch change day and an additional form of contraception should be used for the next 7 days

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37
Q

side effect of patch

A

may be breakthrough bleeding in the first two cycles after initiating the patch. This is very common. The most commonly reported side effects were breast tenderness, headache, application site reactions, nausea, and dysmenorrhea

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38
Q

contraceptive vaginal ring

A

Like the patch, it also has the advantage of consistent hormone release without peaks and troughs but rather peaks immediately after insertion and has a slow decrease over the 3-week cycle. Also, there is not first-pass loss in the liver because it is absorbed vaginally so the EE concentration is lower than with OCPs

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39
Q

vaginal ring hormone levels

A

The ring releases 15 mcg of EE and 120 mcg of ENG per day. The mechanism of action is the same as the other combined hormonal contraceptives with the addition of thickening the cervical mucus and preventing the penetration of sperm. The ring has the same effectiveness rating at the patch, 99%

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40
Q

instruction for insertion of vaginal ring

A

Insertion of the ring is similar to insertion of a diaphragm. The woman should be in a comfortable position and have the sides of the ring pressed together and insert it into the vagina as high as possible. The higher the insertion, the less likely of discomfort or the ring falling out. The ring is left in position for 3 weeks and then removed. During the 3 weeks, the woman should be instructed to periodically check to be sure the ring is still in place. After one ring-free week, a new ring is inserted on the same day of the week and time that the old ring was removed. If the ring is left in place for more than 3 weeks but less than 5 weeks, it should be removed and a new one inserted after a week ring-free interval to allow for withdrawal bleeding. If the ring is left in place for longer than 5 weeks, then backup contraception should be used until the new ring has been in place for 7 days.

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41
Q

If the ring is removed or falls ouft

A

t, it can be rinsed in cool water and reinserted within 3 hours. If the ring is out of the vagina for more than 3 hours and it is during the first 2 weeks of the cycle, the ring can be reinserted as soon as possible, and backup contraception should be used until it has been in place for 7 days

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42
Q

progestin only pill

A

“mini pill”
increased rate of failure- 1-4%
he progestin inhibits ovulation inconsistently but causes thickening of the cervical mucus (creating a hostile environment for sperm), alters ovum transport (leading to a higher risk of ectopic pregnancy), and inhibits implantation.

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43
Q

progestin only pill advantage

A

s safe during lactation and may increase the flow of milk; it can be used in women older than 35 years; it can be used in women with sickle cell disease; and it can be used in women with myomas

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44
Q

depo-provera injection

A

given every 3months
initial injection is typically given on day 5 of menses but may be given at any time if the woman is not pregnant
150mg

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45
Q

depo provera- pregnancy after

A

may take an average of 9 to 10 months for fertility to return after stopping the injections.

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46
Q

black box warning depo-provera

A

long-term use of DMPA because of the possibility of loss of bone mineral density.

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47
Q

condom application

A

tip should extend one-half inch beyond the penis to collect the ejaculate. Care must be taken during withdrawal of the penis to prevent the condom from coming off and spilling the semen

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48
Q

diaphragm failure rate

A

6-12%

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49
Q

diaphragm instructions

A

largest size that covers the cervix comfortably is best
one teaspoon of spermicide is placed in the cup and a small amount is spread around the rim. The diaphragm must be left in place for 6 hours after intercourse; if additional intercourse is desired, additional spermicide must be inserted into the vagina. The diaphragm should not be left in place for more than 24 hours.

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50
Q

diaphragm care

A

diaphragm is washed with a mild soap, dried, and stored. Before the diaphragm is used again, it should be held up to the light to check for holes, tears, and breaks. The patient should be instructed to urinate before inserting and after removing the diaphragm to reduce the risk of urinary tract infections (UTIs)

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51
Q

vaginal contraceptive sponge

A

one-size-fits-all disposable sponge of polyurethane treated with a spermicide, which protects against pregnancy but not against STIs
horoughly wet with two tablespoons of water before being inserted into the vagina. The failure rate for the sponge is approximately 12% for nulliparous women and up to 24% for parous women
keep in place 6 h after intercourse, not more than 30 hours

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52
Q

calendar method birth control

A

calendar method is based on the assumptions that the ovum is viable for 24 hours after ovulation, spermatozoa are viable for 48 hours after coitus, and ovulation occurs 12 to 16 days before menses. The woman records the length of her cycle for several months and establishes her fertile period by deducting 18 days from her shortest cycle and 11 days from her previous longest cycle to determine the ovulation period of each cycle. During each subsequent menstrual cycle, abstinence should occur during this calculated fertile period. The patient must have regular menstrual cycles to use this method effectively.

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53
Q

basal body temperature method

A

, the patient measures basal body temperature daily. Abstinence is observed from menses to 3 days of elevated temperature. Although this method does not predict ovulation effectively, it can be used to learn the pattern of temperature changes over time. The lengthy abstinence period required plus abstinence in anovulatory cycles make this a less favorable method for many

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54
Q

cervical mucus method,

A

a woman learns to recognize and interpret changes in the amount and consistency of cervical that occur in response to changes in estrogen and progesterone levels associated with the menstrual cycle. Abstinence begins in menses (and every day thereafter to reduce the risk of confusing mucus with semen) until the first day of slippery, copious cervical mucus is detected. Abstinence is observed every day thereafter until 4 days after the last day mucus is present or the peak mucus day, since ovulation typically occurs within 2 days of the peak day of mucus production.

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55
Q

symptothermal method

A

, the fertile period is determined by calendar calculation and cervical mucus changes to predict the fertile period; changes in mucus and basal temperature are used to pinpoint the end of this period. This method is difficult to learn but is the most effective natural method to prevent pregnancy.

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56
Q

3 types of post coital birth control

A

withdrawal, postcoitus douche, and emergency contraception

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57
Q

simplest, most effective, and most practical method of preventing implantation after unprotected sex is

A

the administration of emergency contraception. Emergency contraception is available over-the-counter and is known as “Plan B One-Step.”

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58
Q

Plan B One-Step is

A

levonorgestrel 1.5 mg and is a one-tablet regimen to be taken as soon as possible after unprotected sex but must be within 72 hours

59
Q

Ulipristal (Ella)

A

. The emergency contraceptive contains 30 mg of ulipristal and prevents pregnancy by blocking progesterone receptor sites. It should be taken as soon as possible but can be taken up to 5 days after unprotected intercourse.

60
Q

The primary method used for elective abortion in the first trimester is

A

vacuum aspiration under local anesthesia and involves dilation of the cervix and vacuum aspiration of the products of conception.

61
Q

Second-trimester abortion (after 13 weeks) can be done with

A

dilation of the cervix and evacuation of the pregnancy (D&E) or with medication (medical abortion)

62
Q

A D&E is a

A

surgical procedure that can be performed either under local or general anesthesia. Because the fetus may be too large to remove by suction alone, forceps are inserted through the cervix, and the fetus is removed.

63
Q

Complications from abortions increase as

A

gestational age increases and include retained products of conception and unrecognized ectopic pregnancy.

64
Q

% of pt that have breast ca that present with lump in breast

A

70%, 90% found by woman herself

65
Q

fibrocystic changes or fibrocystic disease

A

and are the most common breast lesions. Fibrocystic changes are extremely common and are considered a normal variant of breast tissue.

66
Q

in benign breast disorders,

A

the breast masses or lumps are tender and usually bilateral. There may be a rapid fluctuation in the size of benign masses compared with breast malignancies, which slowly increase in size. In premenopausal women, masses should be reassessed in 2 to 3 weeks during a different phase of the monthly cycle. Typically, the tenderness and size of the mass may increase before menses. Fibrocystic breast disease is most common in women aged 30 to 50 years or in postmenopausal women on hormone replacement therapy

67
Q

Treatment of fibrocystic breast disease

A

consists of avoiding trauma, wearing a firm bra throughout the day and night, eliminating coffee, tea, and chocolate from the diet, and taking 400 IU of vitamin E daily. Patients may be prescribed diuretics, oral contraceptives, NSAIDs, and supplemental progestin.
For patients with severe pain, danazol (Danocrine) 100 to 200 mg twice daily is helpful

68
Q

% of women who experience abnormal uterine bleeding

A

in reproductive years, 10-20%

69
Q

Acute AUB is defined as

A

an episode of bleeding in a nonpregnant woman of reproductive age that, in the opinion of the provider, requires immediate intervention to prevent further blood loss.

70
Q

Chronic AUB is

A

uterine bleeding that is abnormal in duration, volume, and/or frequency and has been present for the majority of the past 6 months. Chronic AUB is associated with a reduction in work productivity by approximately 30%

71
Q

The normal frequency of menses is

A

24 to 38 days, with an average duration of 4.5 to 8 days and approximately 5 to 80 mL of blood loss per month.

72
Q

anovulatory bleeding is the cause of AUB in

A

approximately 95% of women younger than 20 years and in 90% of perimenopausal women who experience AUB for 2 to 3 years before the onset of menopause

73
Q

Any woman who presents with AUB and is 35 years of age or older should be evaluated for

A

cervical and uterine cancer.

74
Q

Dyspareunia is

A

painful sexual intercourse that can occur as a result of either introduction of the penis (natural or artificial) into the vagina or deep penile penetration.

75
Q

Vaginismus

A

, the involuntary contraction of perineal muscles

76
Q

Nocturia is currently defined by the International Continence Society as

A

having to wake at night one or more times to void, each time being preceded and followed by sleep.

77
Q

As men age, nocturia is usually a sign of a

A

prostatic problem, most often benign prostatic hyperplasia (BPH)

78
Q

prostatodynia is

A

often used as a designation for unexplained chronic pelvic pain in men, which may be mistaken for inflammatory prostatitis

79
Q

chronic pelvic pain syndrome (CPPS)

A

cPPS affects mostly young and middle-aged men and is characterized by pain in the groin that may extend to the genitalia and perineum

80
Q

The patient with CPPS is usually treated with

A

alpha blocker medications to reduce bladder neck and urethral spasms

81
Q

Testicular pain is often directly related to

A

anatomical causes

82
Q

Testosterone levels peak during adolescence and early adulthood and then gradually decline

A

about 1% per year after age 30 years.

83
Q

Normal testosterone levels are

A

300 to 1100 ng/dL in men aged 18 to 69 years and are best assessed in the morning between 7:00 and 10:00am.

84
Q

Normal Levels of free testosterone

A

(the active, non-protein-bound form) in men of this age group are between 46–224 ng/dL.

85
Q

Vulvovaginitis is defined as the

A

simultaneous inflammation of the vulva and vagina. The patient typically complains of vaginal itching, burning, and discharge, which comprise the triad of vulvovaginitis symptoms and account for some of the most common reasons women seek health care from primary-care practitioners

86
Q

the most common cause of abnormal vaginal discharge, itching, and burning is

A

infection from bacteria, yeast, parasites, or vulvovaginal atrophy.

87
Q

Mastitis is a general term that refers to

A

inflammation of the breast

88
Q

3 categories of mastitis

A

hree general categories: puerperal mastitis, nonpuerperal mastitis, and periductal mastitis

89
Q

Puerperal mastitis is a

A

cellulitis that develops in the lactating or nonlactating breast after childbirth. Epidemic puerperal mastitis was a hospital-acquired infection most commonly seen in the preantibiotic era. The most common contagion for epidemic puerperal mastitis is Staphylococcus aureus. S. aureus is spread by cross-transmission from neonate to mother, as well as cross-transmission in the nursery. There is multiple duct involvement, which results in inflammation of several nonadjacent lobes of the breast.

90
Q

Sporadic puerperal mastitis is an

A

acute process that is far more common in women who breastfeed rather than in those who bottle-feed their children. It usually occurs in the second to sixth week postpartum;

91
Q

Nonpuerperal mastitis is a

A

rare disease found in patients who are immunocompromised, have undergone radiation therapy, or have had an autoimmune disorder. It can also occur in neonates. It is common in late adolescence or early adulthood. Nonpuerperal mastitis is a ductal abnormality or a local manifestation of a systemic problem. Several pathological pathways may be involved, including squamous metaplasia of the lactational ducts (the most common cause in nonpuerperal mastitis), periareolar abscesses, and cellulitis. Mastitis can also be caused by several obscure pathogens or by a substance in the breast such as silicone. This disease usually presents as a palpable mass and a known infectious process such as tuberculosis (TB) or syphilis. Nonpuerperal mastitis must always be evaluated for the presence of underlying carcinoma.

92
Q

Periductal mastitis has been referred to

A

and cross-referenced under several other names, such as mammary duct ectasia, mastitis obliterans, plasma cell mastitis, comedomastitis, and secretory disease of the breast. Duct ectasia is a condition in which dilated lactiferous ducts of the breast are filled with keratin and secretions. Periductal mastitis is the inflammatory process that occurs around these ducts. Some degree of duct dilation normally occurs with aging

93
Q

factors that contribute to puerperal mastitis

A

Cracked, abraded, or otherwise damaged nipples provide a portal of entry for infecting microorganisms. Patients who are having latch-on and positioning difficulty during feeding also increase their risk for both nipple skin disruption and milk stasis, which can lead to mastitis. A slow milk ejection reflex, breast engorgement, failure to empty the breast adequately, waiting too long between feedings, supplemental feedings, the use of pacifiers, wearing a tight and restrictive bra, sleeping positions that constrict the breast, and weaning also contribute to a woman’s risk of developing mastitis.

94
Q

Periductal mastitis/mammary duct ectasia is seen primarily in

A

perimenopausal and postmenopausal women. The peak incidence is between 40 and 49 years of age, but it can occur at any time after menarche

95
Q

mastitis subjective presentation

A

first complaint is fatigue followed by the onset of flu-like symptoms and breast tenderness. The involved breast segments may be red and warm. Patients describe the affected area as being tender to painful. A fever of at least 100.0°F (37.8°C) can be expected with myalgia, malaise, and chills. Nausea and vomiting can accompany these symptoms.

96
Q

Many patients with periductal mastitis are

A

asymptomatic.

97
Q

mastitis objective

A

varying degrees of erythema and edema of the affected breast may be noted. The erythema is most commonly in a V-shaped distribution and may or may not feel hard. Sometimes there is purulent nipple discharge. There may or may not be a palpable blocked duct.

98
Q

Breast engorgement is often mistaken for

A

mastitis but does not have the accompanying systemic symptoms of infection (e.g., fever, erythema, myalgia)

99
Q

Flu-like symptoms should always be treated as

A

mastitis in postpartum patients unless proven otherwise.

100
Q

mastitis tx

A

continue breastfeeding, massage breast during feeding, rest, moist heat during feeding, cold compress between

101
Q

abx mastitis

A

best response is expected is when antibiotics are started within the first 24 hours of symptom onset. Broad-spectrum antibiotics such as dicloxacillin 500 mg or cephalexin (Keflex) 500 mg orally four times daily or amoxicillin-clavulanate (Augmentin) 500 gm orally three times daily is recommended for 10 to 14 days

102
Q

Cancer of the breast is the

A

most common cancer in American women and accounts for approximately 30% of all cancers in women in the United States.

103
Q

the lifetime risk of a woman getting breast cancer is

A

one in eight, and the lifetime risk of dying from breast cancer is 1 in 28

104
Q

two of the most widely publicized breast cancer susceptibility genes are

A

the tumor suppressor genes BRCA1 and BRCA2,

105
Q

Suspicious areas on a mammogram include

A

(1) asymmetry with definitive borders or discernible masses;
(2) architectural distortion (a “pulling in” of breast structures) not resulting from previous surgery;
(3) a nodule that is more radiodense, irregularly shaped, and has unclear margins;
(4) calcifications that are irregularly shaped, clustered, and of varying sizes;
(5) skin changes such as thickening or retraction;
(6) spiculations (needlelike); and
(7) axillary and/or intramammary lymph nodes more than 2 cm in diameter.

106
Q

invasive breast cancers are

A

mostly adenocarcinomas

107
Q

Patients who have potentially high recurrence rates and who would, therefore, greatly benefit from systemic therapy have the following features

A

: positive regional lymph node(s) or invasive tumors more than 2 cm in diameter even with negative lymph nodes.

108
Q

Fibroadenomas are

A

benign, solid masses of fibrous and glandular tissue that are often confused with breast cancer. These masses may be isolated or multiple and are typically firm, nodular, well-defined, freely mobile, and possibly tender. Growth of the tumor is hormonally stimulated; thus, it may grow rapidly during pregnancy, lactation, or hormonal manipulation. These are most common in younger patients and are not associated with an increased risk of breast cancer if in their simple form.

109
Q

Fat necrosis or panniculitis is

A

another benign condition and is typically trauma induced. The mass associated with panniculitis is firm and possibly tender, often with calcification seen on mammography.

110
Q

intraductal papilloma is a

A

benign condition with a small, usually solitary and nonpalpable mass in one mammary duct, with an associated spontaneous sanguineous or serosanguineous nipple discharge. If large enough to palpate, the mass is most often close to or beneath the areola, soft, mobile, 1 to 3 cm in size, poorly delineated, nontender, and sometimes associated with skin dimpling. It is most common in patients aged 35 to 55 years.

111
Q

Sclerosing adenosis,

A

most common in patients aged 35 to 45 years, is a benign proliferation of the breast epithelium with increased fibrous and glandular tissue, with hard, pea-sized nodules throughout the affected area. There is mild to moderate pain and swelling premenstrually. The presence of this condition has also been associated with an increased risk of breast cancer

112
Q

The survival rates for these two surgical treatment options, breast-conserving or radical mastectomy,

A

are equivalent.

113
Q

Breast-conserving surgery may not be an option if

A

there is a tumor beneath the nipple, a large tumor-size-to-breast-size ratio, multicentricity, extensive intraductal carcinoma, diffuse malignant-appearing calcifications on the mammogram, or contraindications to radiation therapy such as pregnancy, collagen-vascular disease, or prior radiation therapy to the breast or chest wall.

114
Q

chemo post breast cancer surgery

A

within 6 weeks

115
Q

A baseline mammogram should be done

A

3 to 9 months after tumor excision and at the completion of all treatment.

116
Q

The 5-year relative survival rate for patients with localized breast cancer is

A

98.4%, with regional spread it is 84.6%, and with distant metastases, it declines to 24.3%. The 10-year survival rate for localized breast cancer declines to 82% and 15-year survival declines to 75%

117
Q

The prostate gland, which starts enlarging in puberty and stops growing at around 20 years, begins to

A

enlarge again after 50 years.

118
Q

The normal prostate gland is

A

2 to 3 cm across; at its midpoint, it is typically twice the breadth of the examining finger and weighs approximately 20 g (i.e., walnut sized).

119
Q

A slightly enlarged gland is documented as

A

+1 and is considered three finger-breadths across, with +2 being twice the normal breadth or four finger-breadths across. Occasionally a +3 or +4 classification will be noted,

120
Q

Prostatic cancer is known to have a propensity for the gland’s posterior and apical

A

peripheral zone (thus accounting for the ability to palpate many cases of prostatic cancer through the rectal wall), whereas BPH tends to affect the transition zone that surrounds the urethra.

121
Q

decreased urinary flow rates

A

(less than 15 mL/s)

122
Q

significant postvoid residual (PVR) bladder volumes

A

ignificant postvoid residual (PVR) bladder volumes (greater than 50 mL).

123
Q

Static constriction is caused by the

A

buildup of prostatic tissue, with direct obstruction of the bladder neck.

124
Q

Dynamic constriction is an

A

increase in prostatic muscle tone through adrenergic stimulation, leading to constriction of the bladder neck.

125
Q

Symptoms of obstructive BPH include

A

decreased force of stream, hesitancy, postvoid dribbling, sensation of incomplete bladder emptying, overflow incontinence, inability to voluntarily stop the urinary stream, urinary retention, double voiding (voiding a second time within 2 hours), and straining. Irritative symptoms of BPH include nocturia, urinary frequency, urgency, dysuria, and urge incontinence.

126
Q

The PSA in BPH is usually

A

less than 10 ng/mL

127
Q

BPH lifestyle recs

A

Avoidance of caffeine, alcohol, and highly seasoned foods, known to be bladder irritants,

128
Q

BPH tx

A

alpha 1 adrenergic antagonists, 5 alpha reductase inhibitors
surgery- transurethral resection of prostate

129
Q

Acute prostatitis occurs

A

predominantly in sexually active men aged 30 to 50 years, whereas chronic bacterial prostatitis is more common in patients older than 50 years.

130
Q

Acute bacterial prostatitis is always associated with

A

a UTI and has a characteristically abrupt onset.

131
Q

prostatitis subjective

A

nesmus (a spasmodic contraction of the anal sphincter), with pain and a persistent desire to empty the bowel or bladder, accompanied by involuntary and ineffective straining efforts

132
Q

The main principle of management for prostatitis is to

A

treat the patient on an outpatient basis if he does not have a fever.

133
Q

It is extremely important that the patient with acute bacterial prostatitis be kept

A

well hydrated, and percutaneous suprapubic catheterization may be required if urinary retention develops because urethral catheterization is contraindicated in patients with acute bacterial prostatitis to avoid trauma to the inflamed prostate and possible seeding of bacteria.

134
Q

acute bacterial prostatitis tx

A

levofloxacin (Levaquin) 750 mg by mouth (PO) daily or ciprofloxacin (Cipro) 750 mg PO every 12 hours.
or TMP/SMX

135
Q

most common cancer in men

A

prostate

136
Q

Most men diagnosed with prostate cancer

A

do not die from it

137
Q

In the United States, those at highest risk for prostate cancer are

A

African Americans, men with a family history of prostate cancer, and men with a diet high in fat, particularly animal fat

138
Q

prostate ca lobes most common ca

A

The left and right posterior lobes of the prostate are most predisposed to malignant transformation.

139
Q

later symptoms of prostate ca

A

Men with prostate cancer are usually asymptomatic early in the disease process and may even be asymptomatic in late stages of disease. Latent symptoms include bone pain, weight loss, anemia, shortness of breath, lymphedema, and lymphadenopathy. Neurologic symptoms (e.g., an inability to perceive touch, pain, and temperature in the perineal or scrotal areas and a lack of sensation of bladder distention)

140
Q

objective prostate ca

A

palpable hard prostate that may be localized or diffuse. Several hard areas may be noted or the nodules may be limited to one hardened area. Induration of the prostate may also be noted. Hematuria and hemospermia are signs that appear late in the course

141
Q

american cancer society prostate cancer screening recs if who are in relatively good health and can expect to live at least 10 more years,

A

start at age 50

142
Q

ACS recommends that African American men and men who have a father, brother, or son diagnosed with prostate cancer before the age of 65 years begin conversations about initiating prostate cancer screening at

A

age 45 years

143
Q

There is no PSA level below which prostate cancer can be definitively

A

ruled out; rather, the risk of prostate cancer increases as the PSA level increases

Primary Care II (4 decks)

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