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Advanced Health Assessment > Test 3: GU, GI > Flashcards

Test 3: GU, GI Flashcards

1
Q

Normal bleeding with menstrual interval < 21 days

A

polymenorrhea

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2
Q

infrequent bleeding; menstrual interval > 35 days

A

oligomenorrhea

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3
Q

excessive flow, saturating more than 1 pad an hr.

A

menorrhagia

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4
Q

decreased menstrual flow

A

hypomenorrhea

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5
Q

any female who presents with vaginal bleeding should have a

A

hCG

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6
Q

primary amenorrhea is the absence of ever initiating a period by

A

age 16

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7
Q

primary amenorrhea can be caused by

A

hypothalamic-pituitary-ovarian (HPO) disorders

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8
Q

causes of secondary amenorrhea

A

pregnancy, anorexia, stress, chronic illness, hypothyroidism, long distance runners, ballerinas

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9
Q

ectopic pregnancy is most common between ages

A

25-34 years

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10
Q

risk factors for ectopic pregnancy

A

hx of PID or tubal surgery, previous ectopic pregnancy, infertility, IUD use, smoking

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11
Q

S/S of ectopic pregnancy

A

low back or abd pain, adnexal or cervical motion tenderness

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12
Q

diagnosis of ectopic pregnancy is confirmed by

A

positive hCG test and US

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13
Q

difference in hCG levels with regular pregnancy and ectopic

A

in ectopic pregnancy, hCG levels increase up to 4-6 weeks then plateau or decrease.

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14
Q

discharge with bacterial vaginosis

A

white, thin, fishy smell

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15
Q

bacterial vaginosis on saline wet mount

A

epithelial cells with stippled borders

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16
Q

diagnosis of bacterial vaginosis

A

saline wet mount, KOH test, vaginal pH > 4.5

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17
Q

candida vulvovaginitis is not a

A

STD

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18
Q

bacterial vaginosis most commonly spread by

A

sex

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19
Q

vulvovaginitis is most commonly caused by

A

candidia albicans

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20
Q

risk factors for candida albicans

A

atbx therapy, corticosteroid, pregnancy, hypothyroidism, DM, anemia, oral contraceptives, wearing tight-fit clothing

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21
Q

discharge in candida vulvovaginitis

A

thick, white, curdy, malodorous

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22
Q

S/S of candida vulvovaginitis

A

itching, pain or urination, dyspareunia

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23
Q

when the mucosa can bleed when the white patches are scrapped off

A

candida vulvovaginitis

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24
Q

Diagnosis of candida vulvovaginitis

A

KOH

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25
Q

atrophic vaginitis is associated with

A

urinary incontinence.

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26
Q

atrophic vaginitis is usually caused by

A

estrogen deficiency

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27
Q

s/s of atrophic vaginitis

A

vaginal dryness, itching, blood-tinged discharge, bleeding after sex, pale vaginal walls.

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28
Q

wet prep in atrophic vaginitis shows

A

regular flora

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29
Q

trx for atrophic vaginitis

A

hormone replacement therapy

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30
Q

pain with menses

A

dysmenorrhea

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31
Q

results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.

A

primary dysmenorrhea

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32
Q

caused by congenital anomaly of uterus or vagina; include endometriosis, adenomyosis, PID, and endometrial polyps.

A

secondary dysmenorrhea

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33
Q

When pain occurs during first 2 days of menses with suprapubic pain, N/V

A

primary dysmenorrhea

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34
Q

In primary dysmenorrhea, the physical and pelvic exam should always be

A

normal.

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35
Q

a result of STI of the fallopian tubes and ovaries

A

pelvic inflammatory disease.

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36
Q

PID is most common in women

A

younger than 35 and sexually active.

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37
Q

S/S of PID

A

bleeding, abd pain, fever, cervical motion and adnexal tenderness

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38
Q

complication of PID

A

peritonitis

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39
Q

diagnostics of PID

A

elevated WBC and ESR

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40
Q

fibroadenomas are common in women ages

A

15-25

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41
Q

Single, nontender, round, rubbery, mobile, and firm mass.

A

fibroadenoma

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42
Q

diagnostic of fibroadenoma

A

mammogram, US

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43
Q

fibrocystic changes are common in women ages

A

25-50

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44
Q

bilaterally, round, nodular, ropelike masses with breast engorgement.

A

fibrocystic changes

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45
Q

the different between fibroadenoma and fibrocystic changes is that

A

fibrocystic changes fluctuate in size and transient; fibroadenomas do not vary in size.

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46
Q

s/s of fibrocystic breast changes

A

benign cysts, nipple discharge, and breast tenderness.

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47
Q

nonpharm trx for fibrocystic breast changes

A

wear bra 24 hours a day, cold compress

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48
Q

galactorrhea

A

nipple discharge

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49
Q

nipple discharge is more commonly caused by

A

benign lesions

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50
Q

causes of nipple discharge

A

herpes zoster, pituitary disorders, phenothiazines, methyldopa, antidepressants

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51
Q

unilateral bloody nipple discharge may be

A

intraductal papilloma

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52
Q

mastitis is usually caused by

A

staph aureus

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53
Q

s/s of mastitis

A

painful, hot, red breast; fever, purulent discharge

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54
Q

complication of mastitis if not treated

A

abscess

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55
Q

mastitis most often affects

A

primigravidas

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56
Q

important education about mastitis

A

don’t stop breastfeeding unless abscess forms.

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57
Q

s/s of breast cancer

A

single unilateral lump that is hard, nontender, and immobile.

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58
Q

cancerous breast lumps occur mostly in the

A

RUQ

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59
Q

signs a breast tumor has become malignant

A

attaches to chest wall causing retractions, increases in size, dimpling of breast, nipple discharge, axillary lymphadenopathy.

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60
Q

caused by sudden obstruction of a ureter

A

renal colic

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61
Q

when increased abdominal pressure cause bladder pressure to exceed urethral sphincter tone or poor support of bladder neck.

A

stress incontinence

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62
Q

Momentary leakage of small amounts of urine with coughing, laughing, and sneezing while the person is in an upright position.

A

stress incontinence

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63
Q

not associated with pure stress incontinence

A

desire to urinate

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64
Q

strong, uncontrolled detrusor contractions that causes urgency following involuntary leakage

A

urge incontinence

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65
Q

large-volume incontinence

A

urge incontinence

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66
Q

causes of urge incontinence

A

stroke, brain tumor, dementia

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67
Q

when PVR is normal

A

urge incontinence

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68
Q

when PVR is > 100 ml

A

overflow incontinence

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69
Q

when neurologic disorder or anatomic obstruction limits bladder emptying until the bladder is overdistended. Detrusor contractions are insufficient to overcome urethral resistance.

A

overflow incontinence

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70
Q

A continuous dripping or dribbling with decreased force of stream.

A

overflow incontinence

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71
Q

causes of overflow incontinence

A

BPH, peripheral nerve disease, diabetic neuropathy

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72
Q

In men, painful urination without frequency or urgency suggests

A

urethritis

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73
Q

meds that can cause incontinence

A

sedatives, hypnotics, diuretics, anticholinergic agents, alpha-adrenergic agonists, CCB

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74
Q

reversible risk factors that can cause incontinence

A 
o	Delirium, dementia, depression
o	Infection
o	Atrophic vaginitis/urethritis
o	Pharmaceuticals
o	Endocrine/excess urine production
o	Restricted mobility
o	Stool impaction
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75
Q

when hernia sac protrudes directly through the abd wall

A

direct inguinal hernia

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76
Q

This type of hernia bulges anteriorly and pushes the side of the finger forward.

A

direct inguinal hernia

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77
Q

This type of hernia comes down the inguinal canal and touches the fingertip.

A

indirect inguinal hernia

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78
Q

this hernia descends down into the scrotum

A

indirect inguinal hernia

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79
Q

s/s of strangulated hernia

A

colicky abd pain, N/V, and abd distention.

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80
Q

hernia most common in females

A

femoral hernia

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81
Q

common cause of pyelonephritis

A

E. coli

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82
Q

risk factors for pyelonephritis

A

UTI, catheter, DM, eldelry, BPH, pregnancy

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83
Q

S/S of pyelonephritis

A

fever, chills, N/V, flank pain, hematuria, dysuria, +CVA tenderness

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84
Q

diagnostics for pyelonephritis

A

CBC shows leukocytosis, white cell casts in urine

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85
Q

most common cause of urethritis in men

A

gonorrhea

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86
Q

s/s of urethritis in females

A

asymptomatic

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87
Q

s/s of urethritis in men

A

dysuria, fever, discharge, suprapubic discomfort.

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88
Q

pt comes in with s/s of urethritis, you should

A

test for gonorrhea and chlamydia

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89
Q

yellow-green urethral discharge indicates

A

gonococcal infection

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90
Q

mucoid-like urethral discharge indicates

A

chlamydia

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91
Q

pyuria is

A

> 5 WBC per HPF in urine

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92
Q

testing to diagnose gonorrhea and chlamydia in urethritis

A

DNA testing and gram stain/culture

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93
Q

any patient with STD needs to have all partners tested who have had sexual contact in the past

A

60 days

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94
Q

common causes of cystitis (UTI):

A

E. coli, Proteus mirabilis, Klebsiella pna, Enterobacter, or staph

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95
Q

this symptom is usually absent in adults with cystitus

A

fever

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96
Q

diagnosis of cystitus

A

UA positive for leukocytes and nitrites.

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97
Q

risk factors of urolithiasis

A

alkaline pH of urine, calcium supplementation, thiazide diuretic, gout, high animal protein diet

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98
Q

S/S of urolithiasis

A

back/flank pain, hematuria, dysuria, N/V, + CVA tenderness

99
Q

gold standard for dx urolithiasis

A

spiral CT

100
Q

if urine pH < 5.5, stone is mostly

A

uric acid

101
Q

if urine pH > 5.5, stone is likely

A

struvite

102
Q

How long does glomerulonephritis occur after staph group A beta infection?

A

1-3 weeks

103
Q

s/s of glomerulonephritis

A

previous strep infection, hematura, proteinuria, edema, HTN, abd/flank pain

104
Q

diagnosis for glomerulonephritis

A

antistreptolysin O (ASO) is increased,

105
Q

recurrence of glomerulonephritis

A

rare because immunity develops after first episode.

106
Q

glomerulonephritis trx

A

self-limited: low salt and fluids, loop diuretics, antihypertensives.

107
Q

common causes of acute prosatitis

A

E coli, pseudomonas, Klebsiella, Proteus, chlamydia, and gonorrhea

108
Q

risk factor for acute prostatitis

A

sexual activity

109
Q

s/s of acute prostatits

A

fever, dysuria, low back pain.

110
Q

prostate in acute prostatits

A

tender, swollen, “boggy”, and warm.

111
Q

Important with acute prostatits

A

do not massage as it can cause septicemia

112
Q

diagnostic for acute prostatitis

A

UA shows wbc, bacteria, and hematuria

113
Q

trx for acute prostatitis

A

use condoms until resolved, good hydration

114
Q

causes of chronic prostatis

A

recurrent UTIs.

115
Q

s/s of chronic prostatitis

A

asymptomatic, no tenderness of pain to prostate.

116
Q

risk factors for prostate cs

A

family hx, african american

117
Q

screen those high risk for prostate cancer at

A

45

118
Q

s/s of prostate cancer

A

mostly asymptomatic

119
Q

prostate in prostate cancer

A

hard, asymmetrical nodule.

120
Q

diagnostic for prostate cancer

A

US, PSA level

121
Q

testicular cancer most commonly occurs in

A

men 15-34.

122
Q

risk factors for testicular cancer

A

crytorchidism, inguinal hernia, HIV positive, hydrocele as child

123
Q

S/S of testicular cx

A

solid, firm, nontender testicular mass, gynecomastia, mass does not transilluminate.

124
Q

gold standard for diagnosing testicular cx

A

scrotal ultrasound

125
Q

trx for testicular cx

A

radiation/chemo, radical orchiectomy

126
Q

avoid these meds with BPH

A

sympathomimetic or anticholinergic meds

127
Q

gold standard trx for BPH

A

TURP

128
Q

Twisting of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum.

A

testicular torsion

129
Q

s/s of testicular torsion

A

unilateral scrotal pain, scrotal edema and redness, lower abd pain, n/v

130
Q

cremasteric reflex in testicular torsion

A

absent

131
Q

diagnostic for testicular torsion

A

doppler US shows reduced blood flow.

132
Q

testicular torsion trx

A

surgical emergency

133
Q

epididymitis in men < 35

A

chlamydia or gonorrhea

134
Q

epididymitis in men > 35

A

bacterial UTI or prostatitis

135
Q

s/s of epididymitis

A

gradual scrotal pain, urehtral discharge, dysuria, epididymitis is tender and enlarged, scrotal edema.

136
Q

cremasteric reflex in epididymitis

A

present

137
Q

diagnostic for epididymitis

A

normal blood flow

138
Q

trx for epididymitis

A

elevate scrotum may relieve pain, cold compress

139
Q

inflammation of the glans penis

A

balanitis

140
Q

cause of balanitis

A

uncircumcised, poor hygeine

141
Q

most common complication of balanitis

A

phimosis

142
Q

when foreskin cannot be retracted over penis

A

phimosis

143
Q

when phimosis is present at birth

A

resolves spontaneously by 3 years old.

144
Q

Collection of abnormally large dilated “varicose” veins (usually the internal spermatic vein) in the scrotum, usually situated above the testes

A

varicocele

145
Q

varicocele most commonly occurs in

A

left scrotum

146
Q

s/s of varicocele

A

“bag of worms” separate from the testes

147
Q

varicocele increases in size with

A

standing and valsalva maneuver

148
Q

varicocele should prompt evaluation of

A

renal tumor

149
Q

a collection of peritoneal fluid within scrotum

A

hydrocele

150
Q

communicating hydrocele is common in

A

infancy and resolves within first year of life.

151
Q

closure of the processus vaginalis which traps peritoneal fluid

A

noncommunicating hydrocele

152
Q

hydrocele is associated with

A

indirect inguinal hernia

153
Q

s/s of hydrocele

A

painless, scrotal swelling, transilluminate

154
Q

trx for hydrocele

A

communicating- observation

noncommunicating- surgical drainage

155
Q

s/s of appendicitis

A

anorexia, abd pain, N/V, fever

156
Q

in appendicitis this occurs AFTER pain

A

N/V, constipation and diarrhea

157
Q

Abd tenderness and rigidity over the right rectus muscle.

A

Mcburney’s point

158
Q

pain in the RLQ during LLQ pressure

A

rovsing’s sign

159
Q

increased lower quadrant pain when you press down on leg while pt pushes up

A

psoas sign

160
Q

pain with internal rotation of flexed right thigh

A

obturator sign

161
Q

perform this with suspected appendicitis

A

rectal exam in men and pelvic exam in women

162
Q

when pain subsides temporarily with appendicitis, suspect

A

perforation

163
Q

gold standard for diagnosing appendicitis

A

CT

164
Q

refrain from doing this with appendicitis

A

heat to abd

165
Q

most common cause of cholecystitis

A

obstruction of cystic duct by gallstone

166
Q

s/s of cholecystitis

A

RUQ pain that may radiate to scapular area, anorexia, N/V, fever

167
Q

risk factors for cholecystitis

A

pregnancy, rapid weight loss, obesity, high fat meals, increasing age

168
Q

Abrupt cessation of inspiration on palpation of the gallbaladder

A

Murphy’s sign

169
Q

gold standard diagnostic for cholecystitis

A

US, HIDA scan if US negative

170
Q

epigastric pain that may radiate to the back or other parts of the abd

A

acute pancreatitis

171
Q

positions with acute pancreatitis

A

supine makes it worse, leaning forward helps

172
Q

s/s of acute pancreatitis

A

rebound tenderness, N/V, abd distention, fever

173
Q

s/s of chronic pancreatitis

A

epigastric pain, steatorrhea

174
Q

s/s of peritonitis

A

guarding, rigidity, rebound tenderness, percussion tenderness, N/V

175
Q

involuntary contraction of the abdominal wall, often accompanied by a grimace.

A

guarding

176
Q

an involuntary reflex contraction of the abdominal wall that persists over several examinations.

A

rigidity

177
Q

s/s of hepatitis

A

malaise, fever, jaundice, dark urine

178
Q

in all types of hepatitis, ____ are higher than ____

A

ALT; AST

179
Q

transmission of hep a

A

food and water, fecal-oral route

180
Q

transmission of hep b

A

blood/body fluids

181
Q

marker to detect hep b

A

HBsAg

182
Q

hepatitis vaccine given at birth

A

hep b

183
Q

transmission of hep c

A

blood borne

184
Q

there is no vaccine for hepatitis

A

c

185
Q

transmission of hep d

A

blood-body fluids

186
Q

only transmitted after infection with hep B

A

Hep D

187
Q

transmission of hep E

A

fecal-oral

188
Q

causes of intestinal obstruction

A

adhesions or hernias in small bowel; or cancer or diverticulosis in colon

189
Q

s/s of small bowel obstruction

A

cramping, periumbilical pain with vomiting of bile/fecal material

190
Q

s/s of large bowel obstruction

A

lower abd pain, constipation early, vomiting late

191
Q

An emergent condition in which one bowel segment becomes invaginated into another

A

intussusception

192
Q

intussusception is most common in

A

infants 6-12 months

193
Q

risk factors for intussuception

A

hypertrophy of Peyer patches, Meckel’s diverticulum, recent viral URI or GI infection.

194
Q

s/s of intussusception

A

colicky abd pain, vomiting, bloody stools resembling jelly

195
Q

physical exam with intussusception

A

sausage-shaped mass in the RUQ

196
Q

gold standard to diagnose intussusception

A

barium enema- shows “coiled spring” appearance

197
Q

trx for intussusception

A

surgical reduction

198
Q

risk factors for pyloric stenosis

A

family hx

199
Q

s/s of pyloric stenosis

A

olive mass in RUQ, visible peristaltic waves while feeding, projectile vomiting

200
Q

diagnostic for pyloric stenosis

A

US, upper GI series

201
Q

s/s of IBS

A

abd pain, bloating, cramping, changes in bowel habits, mucus in stools

202
Q

trx for IBS

A

lactose free diet, heat to abd, add bulk

203
Q

constipation is

A

< 3 BMs/week for at least 12 weeks.

204
Q

meds that can cause constipation

A

antidepressants, anticholinergics, CCBs, iron, diuretics, antacids, opiates

205
Q

Congential absence of ganglion cells in a section of the wall of the large intestine resulting in lack of motility in that region, accumulation of feces, and dilation of the colon.

A

hirshsprungs

206
Q

hirshsprungs is mostly associated with

A

trisomy 21 (down’s syndrome)

207
Q

s/s of hirschsprungs

A

failure to pass meconium in 48 hours, constipation, abd distention, vomiting, poor feeding

208
Q

diagnostics of hirschsprungs

A

CBC shows anemia and high WBCs, abd xray shows dilated loops of bowel, colonoscopy

209
Q

trx for hirschsprungs

A

resection of bowel with possible colostomy

210
Q

diagnostic criteria for GERD

A

endoscopy

211
Q

causes of GERD

A

fatty meals, alcohol, chocolate, theophylline, CCB

212
Q

atypical symptoms of GERD

A

cough, wheezing, hoarseness, laryngitis

213
Q

peptic ulcer disease is caused by

A

H. pylori, NSAIDs, smoking, alcohol, age > 60

214
Q

___ ulcer is more common than ___ ulcer

A

duodenal; gastric

215
Q

s/s of duodenal ulcer

A

pain relieved by food, pain causes awakening at night.

216
Q

s/s of gastric ulcer

A

N/V, pain worse with eating, weight loss

217
Q

diagnostic for H. pylori

A

urea breath test

218
Q

cullen’s sign

A

ecchymosis around umbilicus

219
Q

causes of cullen’s sign

A

pancreatitis or ruptured ectopic pregnancy.

220
Q

referred pain in epigastric upon pressure on McBurney’s point

A

Aaron’s sign

221
Q

contraindications for the use of hormone replacement therapy in menopausal women is

A

unexplained vaginal bleeding

222
Q

microscopic evaluation of candida vulvovaginitis reveals

A

hyphae

223
Q

the benefit of topical of local estrogen for post-menopausal women is

A

reduced risk for UTIs

224
Q

estrogen in a menopausal female increases risk for

A

endometrial cancer

225
Q

symptom of chronic prostatitis

A

low back pain

226
Q

a prostatectomy will result in a

A

low PSA level

227
Q

hemorrhagic cystitis is characterized by

A

irritative voiding symptoms

228
Q

most common sign of cholecystitis

A

vomiting

229
Q

common causes of postmenopausal bleeding

A

hormone therapy, endometrial cancer

230
Q

bleeding at irregular intervals or intermenstrual bleeding

A

metorrhagia

231
Q

an episode of acute bleeding in a woman with normal regular menstrual cycles suggest

A

uterine fibroids

232
Q

menorrhagia is common in women with

A

hypothyroidism

233
Q

spontaneous abortion is most common at

A

10-12 weeks gestation

234
Q

a patient with ectopic pregnancy usually reports to the clinic at

A

6-8 weeks gestation

235
Q

uterine fibroids size after menopause

A

decrease

236
Q

s/s of uterine fibroids

A

heavy menstrual flow, pain is not common.

237
Q

s/s of endometrial cancer

A

painless vaginal bleeding and rapidly enlarging uterus.

238
Q

bowel sounds over a scrotal mass is a

A

inguinal hernia

239
Q

good way to check for hernias

A

raise head and shoulder while remaining supine

240
Q

most common cause of infertility in men

A

varicocele

241
Q

bacterial vaginosis is not a

A

std

242
Q

common causes of gross (macroscopic) hematuria

A

pyelonephritis and urinary stones

243
Q

cardinal symptom of uncomplicated UTI

A

dysuria

Advanced Health Assessment (5 decks)

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