NR 602 FINAL EXAM GUIDE QUESTIONS AND CORRECT DETAILED ANSWERS WITH EXPERT FEEDBACK UPDATED ALREADY 2025

Colposcopy exam- - -procedure that visualizes vaginal, vulvar, or cervical epithelium w/ magnification to id abnormal area to be bx painful menstruation that prevents normal activity and requires medication 3 types: primary (no organic cause), secondary (pathologic cause) and membranous - causes intense cramping pain due to passage of a cast of endometrium through undiluted cervix - -Dysmenorrhea Dysmenorrhea treatment - -Tx- NSAIDs/tyelnol, heat, antiprostaglandins, OCP w/ increased estrogen- pain relief r/t absence of ovulation, decreased prostaglandin production; surgery Dysmenorrhea mechanism - -prostaglandin activity -vaginal wall weakens and stretches and allows the bladder to bulge into the vagina - Cystocele Sx-felling of fullness or pressure in vagina, increased discomfort when you strain/cough/bear down, feeling of incomplete empty, repeated bladder infection, pain or urinary leak during sex, bulge of tissue into vaginal opening - -Cystocele Cystocele prevention - -kegels, prevent constipation, avoid heavy lifting, avoid wt gain Rectocele - --When thin tissue of vagina separates the vaginal and rectum allowing vaginal wall to bulge Sx- soft bulge of tissue in vaginal, difficult BM, sensation of rectal pressure, incomplete emptying after BM, sexual concerns - -Rectocele Causes of rectocele - -Causes- constipation/strain, chronic cough, heavy lifting, overweight, childbirth, age Retocele prevention - -Prevention- kegels, prevent constipation, avoid heavy lifting, cough, avoid wt gain NR 602 NR 602 -pelvic floor muscles and ligaments stretch and weaken and no longer provide support for uterus and protrude into vagina. - -Uterine Prolapse Uterine Prolapse causes - -Causes- pregnancy, large baby delivery, lower estrogen level after menopause, obesity Common in postmenopausal and one or more childbirth Uterine Prolapse symptom - -Sx- heaviness or pulling into pelvis, tissue protruding from vagina, urinary probs (leakage, retention), trouble having BM, feeling of sitting on small ball, sexual concerns Uterine Prolapse prevention - -Prevention- kegels, treat constipation, correct lifting, avoid wt gain uterine prolapse treatment - -Tx- pessary chronic viral infection caused by HSV1 or HSV2, relapsing - -Herpes Simplex Herpes Simplex prevention - -Prevention: consistent condom use b/c viral shedding can occur in asymptomatic periods and can lead to transmission. W/ symptoms- Valacyclovir 500 mg daily Herpes Simplex sign and symptoms - -Sx-multiple painful vesicular or ulcerative lesion on genitals, can be absent. Virus lays dormant and can be reactivated Herpes Simplex diagnosis - -lays dormant and can be reactivated Dx-cell culture and PCR Herpes Simplex treatment - -Tx- systemic antiviral. Acyclovir 7-10 days for 1st episode, suppressive 200 mg daily BID Chancroid - --Transmitted via sexual contact or on hands that have touched lesion. Caused by Haemophillus ducreyi -Reportable disease Chancroid symptoms - --Sx- erythematous papule that evolves into pustule and degenerates into saucer shaped ragged ulcer that is circumscribed by inflammatory wheal. Tender, heavy foul discharge that is contagious Chancroid diagnosis - -Dx-culture that grows H ducreyi Chancroid treatment - -Tx- Abx azithromycin 1 g PO one time, ceftriaxone 250 mg IM 1 x, cipro 500 mg PO BID x3 days erythromycin 500 mg PO TID x7 days. Personal hygiene, clean w/ soap and water, sitz bath NR 602 NR 602 Syphilis - --chronic, systemic disease caused by a sphirochete transmitted via contact with infectious moist lesion. Sexually acquired or vertically transmitted from infected mom. Reportable disease Syphilis transmitted - --Transmitted in primary and secondary stages Primary-mucus mem 10-90 days later. Secondary- 2 wks-6mo after primary lesion then generalized cutaneous eruption of secondary may appear. Latent- may last a lifetime Syphilis prevention - -Prevention- condom, wash w/ soap and water after sex, screen ppl @ high risk (men that have sex with men, drug trafficers, correctional facilities) Syphilis symptoms - -Sx- [Primary]- Chancre- indurated firm painless papule or ulcer w/ raised borders, women can have cervical or vaginal lesion....on any mucus mem. [Secondary}-viral syndrome w/ diffuse lymphadenopathy AEB dermatitis, papulosquamous lesion on palms and soles. Lesions on trunk will be macular or maculopapular popular or pustular other systemic include patchy alopecia, hepatitis, nephritis. [Latent]- resolution of lesion of primary and secondary or finding of serologic test w/o therapy Syphilis Diagnosis - -Dx- T pallidum sphirochetes on dark field exam of cutaneous lesion, serologic testsing antibody titers Syphilis treatment - -Penicillin G Chlamydia trachomatis gold standard test - -. Gold standard test is NAT, not culture Chlamydia trachomatis - -negative whiff w/ mucupurulent d/c and + clue cells. Chlamydia trachomatis symtoms - -Sx- dyspuria, intramenstrural spotting, postcoital bleeding, pain w/ sex, vag d/c purulent d/c reddened congested cervix or can be asymptomatic. Chlamydia trachomatis diagnoses - -Dx-Urine or endocervix/vaginal swab Chlamydia trachomatis tx - -Tx- 1 gm Azithromycin OR doxy, erythro PLUS rocephin 250 or cefixime Complications- salpingitis and PID, perihepatitis, Gonorrhea - -STI, first causes cervical infection and ascend to endometrium and fallopian tube. Reportable Gonorrhea prevention - -Prevention: Screen all high risk people sexually active women age 25 or less. Use condoms. Sex partner w/ in 60 days evaluate to tx that sex partner, 60 days tx most recent sex partner, NB receive erythro ointment after delivery NR 602 NR 602 Gonorrhea symptoms - -Sx-many are asymptomatic. inflamed and edematous cervix with d/c coming from cervical os. Vag d/c urinary frequency, dysuria, unilateral swelling of intoitus, anal itching, pain, pharyngitis, conjunctivitis, systematic triad (polyarthalgia, tenosynovitis, and dermatitis) Gonorrhea diagnosis - -Dx- endocervical vaginal or urine specimens Complications- salpingitis- tubal scarring, infertility Gonorrhea treatment - -Tx- Rocephin 125 mg, cefixime OR azithromycin No sex 7 days after therapy. Tx for chlamydia as well. HSV-type 1 or 2. - -Type 2 most common cause of genital herpes. Produces cervical lesion, first vesicular then ulcers. After initial infection, virus continues to reside in nerve cells for life. HPV- spread - -spread via skin to skin (genital warts) Prevention- abstinence, condom use, treating affected partner @ same time Trich - -Caused by flagellated protozoan, mobile Trich prevention - -Prevention: condoms, decrease # of sex partners, vulvular hygiene Trich symptoms - -Sx- purulent malodorous d/c w/ burning itching, dysuria, frequency, and painful sexl. Postcoital bleeding may occur foamy white green d/c, strawberry appearing cervix trich diagnosis - -Dx- motile flagellated organisms on saline wet smear, Affirm Trich treatment - -Tx-Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose Candida - -white curd like d/c Candida diagnosis - -Dx- potassium hydroxide prep---distinct presence of hyphae Candida treatment - -Tx- topical azole drugs or PO fluconazole bacterial vaginosis - -most prevalent vaginal infection. * Loss of lactobacilii and increase in vaginal pH fishy odor bacterial vaginosis risk factor - -Risk factors: multiple sex partner, douching, lack of condom use, lack of vag lactobacilli Bacterial vaginosis prevention - -condom use, no douching NR 602 NR 602 bacterial vaginosis treatment - -Tx- metronidazole 500 mg PO x7 days, metronidazole gel 0.75 %x5 days, clinda cream 2% x3 nights OR tinidazole PO x2 days Bacterial vaginosis symtoms - -Sx-3 of 4 Amsel criteria Bacterial vaginosis diagnosis - -Dx- Gram stain is gold standard, saline wet mount with "clue cells", Amsel criteria: thin homogenous white/yellow d/c, "clue cells on microscopy, fishy odor w/ k hydroxide solution, pH of 4.5 or -----need 3 of 4 to be dx. PID - --inflamm of upper femal genital tract w/ combo of endometritis, salpingitis, tubo- ovarian abscess, and pelvic peritonitis. PID prevention - -Prevention- screening and tx sexually active women and sex partners for gonorrhea and chlamydia PID symptoms - -Sx- insidious or acute lower abd/pelvic pain usually bilateral. Pelvic pressure/back pain ass w/ purulent vag d/c. N, HA, fever is NOT necessary. Abd tenderness, may be distended bowel sounds hypo or absent. Bimanual= extreme tenderness or cervix ****CDC says empiric tx should be initiated in sex active young women and those @ risk for STD and if 1 or more of following criteria- cervix motion tenderness, uterine tenderness, and adnexal tenderness. PID diagnosis - -DX-+endocervical swabs...but all may be normal. PID treatment - -Tx- empirica