NR 509 Final Exam GRADED A

NR 509 Final Exam GRADED A 1. Suspicious breast mass: -A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. -Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tis- sues, strongly suggest cancer 2. Risk for Breast cancer: --*Age* -family history of breast/ovarian CA - inherited genetic mutations, -personal history of breast cancer - high levels of endogenous hormones - breast tissue density - proliferative lesions with atypia on breast biopsy, - duration of unopposed estro- gen exposure related to early menarche -age of first full-term pregnancy - late menopause. - breastfeeding for less than 1 year, - postmenopausal obesity -cigarette smoking, alcohol ingestion, - physical inactivity, and type of contraception. 3. Characteristics of a breast cyst: Soft to firm, round, mobile, often tender. 4. The best way to examine the lateral portion of the breast: -Have pt roll onto the opposite hip -place her hand on her forehead. - keep shoulders pressed against the bed -palpate in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple 5. Bacterial Vaginosis (BV): -Caused by overgrowth of anaerobic bacteria (often from sex) - Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal - Fishy/musty genital odor -Normal vulva and vaginal mucosa -Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH ("whiff test"); test the vaginal secretions for pH 4.5 6. Candidal Vaginitis: -Cause: Candida albicans, a yeast (normal overgrowth of vaginal flora); many factors predispose, including antibiotic therapy -Discharge: white and curdy, may be thin but usually thick, not as profuse as trichomonal infection, not malodorous - vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse) -The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these patches are scraped off; in mild cases, the mucosa looks normal -Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candi- da 7. Trichomonal Vaginitis: -Trichomonas vaginalis, a protozoan; often but not al- ways acquired sexually - Discharge:Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous -Pruritus (though not usually as severe as with Candida infection); pain on urination (from skin inflammation or possibly urethritis); dyspare- unia -Vestibule and labia minora may be erythematous; the vaginal mucosa may be diffusely reddened, with small red granular spots or petechiae in the posterior fornix; in mild cases, the mucosa looks normal - Scan saline wet mount for trichomonads 8. Syphillis: This ulcerated papule with an indurated edge usually appears after 3 to 6 weeks of incubating infection from the spirochete Treponema pallidum. These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks. Wear gloves during palpation since these chancres are infectious. 9. s/s of epididymitis: Acute: swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Chronic: firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens. 10. Genital Warts (Condylomata Acuminata): -Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous). -Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts. -Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasion- ally cause itching and pain. -May disappear without treatment. 11. Risk for prostate CA: Age, ethnicity, and family history are the strongest risk factors for prostate cancer. 12. s/s prostatitis: -fever -frequency, urgency, dysuria, incomplete voiding, -sometimes low back pain - gland feels tender, swollen, "boggy," and warm 13. s/s BPH: - irritative (urgency, frequency, nocturia), -obstructive (decreased stream, incomplete emptying, straining), or both, - gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen. 14. Measuring a pregnant uterus: With a plastic or paper tape measure, locate the pubic symphysis and place the "zero" end of the tape measure where you can firmly feel that bone (Fig. 19-12). Then extend the tape measure to the very top of uterine fundus and note the number of centimeters measured. 15. s/s gestational HTN: systolic blood pressure (SBP) 140 mm Hg or diastolic blood pressure (DBP) 90 mm Hg first documented after 20 weeks, without proteinuria or preeclampsia, that resolves by 12 weeks postpartum. 16. s/s ectopic pregnancy: -Abdominal pain -adnexal tenderness -abnormal uterine bleeding 17. how a Bartholin gland infection presents: Causes of a Bartholin gland infection include trauma, gonococci, anaerobes like bacteroides and peptostrep- tococci, and C. trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small. 18. Bleeding between periods: Metrorrhagia 19. Vaccines safe in pregnancy: pneumococcal, meningococcal, and hepatitis B. Hepatitis A and B, meningococcal polysaccharide and conjugate, and pneumococ- cal polysaccharide vaccines can be given, if indicated. -inactivated influenza -Tdap 20. When to give the tetanus vaccine: All adults aged e19 years, including those aged e65 years: All adults aged e19 years who have not been vaccinated with Tdap should receive a single dose of Tdap regardless of the time interval since last receiving Td. After receiving Tdap, they should receive Td boosters at 10-year intervals. For adults aged e65 years, this will reduce the likelihood of transmission to infants aged 12 months. 21. HPV vaccine: -The quadrivalent vaccine prevents infection from HPV sub-types 16 and 18, as well as 6 and 11, which cause 90% of genital warts (prevents cervical ca also) -The bivalent vaccine prevents infection from subtypes 16 and 18. 22. Tanner staging of breast development: 1: preadolescent- elevation of nipple only 2: Breast bud stage: elevation of breast and nipple as a small mound; enlargement of areolar diameter 3: Further enlargement of elevation of breast and areola, with no separation of their contours 4: Projection of areola and nipple to form a secondary mound above the level of breast 5: Mature stage: projection of nipple only; areola has receded to general contour of the breast (although in some normal individuals the areola continues to form a secondary mound) 23. Breast masses: Most often found by women during self examination 24. Irregular rectal mass: Masses with irregular borders are suspicious for rectal cancer 25. s/s rectal prolapse: On straining for a bowel movement, the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red tissue. A prolapse involving only mucosa is relatively small and shows radiating folds, as illustrated. When the entire bowel wall is involved, the prolapse is larger and covered by concentrically circular folds. 26. Hemorrhoids vs polyps vs CA: -H-(internal-prolapsed)reddish, moist, pro- truding masses, (external) pain with defecation and sitting, tender, swollen, bluish, ovoid mass is visible at the anal margin. -P- on the stalk, or mucosal surface, soft, difficult to feel often -C- firm, nodular, rolled edge 27. Erectile dysfunction: In a 47 yo male, it is most often psychologic and not testosterone related.