Exam 4: NSG3280/ NSG 3280 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Guide| Questions & Answers| Grade A| 100% Correct - Galen

1 Exam 4: NSG3280/ NSG 3280 (NEW 2026/ 2027 Update) Pathophysiology for Nurses I Guide| Questions & Answers| Grade A| 100% Correct - Galen Q. patho of syphillis ANSWER Destroys vascular system Terminal, arterioles and small arteries are destroyed Q. Main organism that causes PID ANSWER gonorrhea Q. Does HPV cause sores in the vagina and the penis ANSWER no Q. How do we diagnose epididymitis ANSWER urine culture Q. What is a possible etiology for fournier's gangrene ANSWER alcoholism Q. what are symptoms of BPH ANSWER Urinary retention which leads to UTI/bladder infection Slow stream Takes longer to void incomplete bladder emptying frequency, urgency 2 Q. what age is at highest risk for developing testicular cancer ANSWER 18-26 Q. What diagnostic tool do we use to diagnose urethral stricture ANSWER Can use retrograde urethrogram Q. What is a secondary cause of erectile dysfunction Antidepressants ANSWER Secondary = something other than your body causing it Q. Who is at high risk for penile cancer ANSWER Uncircumcised males Phimosis and then cancer Q. what is patho of rectocele ANSWER rectum can be torn or stretched Q. PID symptoms ANSWER Is an infection Look for WBC count Normal WBC is 15000 is high Fever of 100.4 or more Purulent discharge 3 Q. How do we diagnose cervical cancer ANSWER Pap smear Q. If my sister had ovarian cancer what am I at increased risk for ANSWER breast cancer Q. What is an advanced symptom of breast cancer ANSWER bloody discharge Q. What will cause an increased in blood pressure in elderly patient ANSWER Decreased artery elasticity Atherosclerosis Q. Turner's syndrome characteristics ANSWER Neck webbing Female Short Q. Which are three autosomal recessive disorders ANSWER PKU Cystic fibrosis Albinism Q. Huntington's disease affects which system ANSWER neuro 4 Q. Klinefelter manifestation ANSWER Males Hypogonadism Q. Does BPH increase risk of cancer ANSWER no Q. How do we diagnose urethral strictures ANSWER urethrogram Q. What infection causes ophthalmia neonatorum ANSWER Chlamydia Q. Who is at highest risk of developing testicular cancer ANSWER patient with cryptorchidism (testes do not drop) Q. Is endometriosis cancerous ANSWER no 5 Q. Three different ways endometriosis presents ANSWER Transportation - backward flow of tissue during menstruation Metaplasia - inflammation, hormones change non-endometrial tissue to endometrial tissue (metaplasia) Induction - regurgitated endometrial tissue causes chemical reaction converting non-endo tissue to endometrial tissue Q. What is a bartholin cyst ANSWER abcess that causes exudate at ductal orifice Q. Most common cause of/increases risk of vulvovaginitis ANSWER candida albicans If cause is Candida, it is d/t things that influence overgrowth of yeast (birth control/estrogen therapy, abx, DM, etc.) Q. What are uterine leiomyoma ANSWER fibroids (not cancerous) Q. What increases risk of breast cancer ANSWER sister who has breast cancer, early menarche Q. What does not increase risk of breast cancer ANSWER fibrocystic breast disease, breastfeeding 6 Q. What does autosomal dominant mean ANSWER Aa and Aa causes 75% of chance of passing on to children Q. What is thalidomide ANSWER teratogen = crosses placenta given in the 1950s for morning sickness, which led to malformations of the limbs ("flipper arms") - now used for leprosy & cancer pts Q. What is phenytoin ANSWER prevents seizures teratogen = crosses placenta Q. What respiratory changes do we expect to see with aging ANSWER Residual volume (increased in aging adult) = left over air in lungs after exhalation; "dead space" Will have increased CO2 and decreased O2 = increased respiration rate and depth cilia are less effective (not as many and not as sensitive) Vital capacity = how much capacity your lungs have to hold the air, when you have increased residual volume then your vital lung capacity decreases Q. What do we expect to happen to older person's circulatory function ANSWER increased BP, decreased elasticity, decreased baroreceptor function, decreased cardiac function, left ventricle wall thickens which decreases cardiac output Q. What do we expect to see in patient with PKU ANSWER in baby with PKU they will have increased phenylalanine because they don't have enzyme necessary to break it down 7 What is father's role in passing on hemophilia gene Affected father transmits defective gene to none of his sons but to all his daughters How is hearing affected in old age pitch discrimination Hear better in quiet places Presbycusis Cannot hear high frequency Can only hear low pitched What does aberrant mean odd What does cri du chat syndrome cause laryngeal malformation resembling a cat crying what are two autosomal dominant disorders marfan and huntington what is marfan syndrome connective tissue disorder that causes cardiovascular lesions what is cystic fibrosis Abnormally thick secretions from chloride transporter defect what do multiple pregnancies do to cardinal ligaments constant stretching of cardinal ligament = more prone to having issues with support structures Stretched ligaments do not go back to the shape they were in before what are the supporting structures that keep the uterus in place uterosacral ligaments and cardinal ligaments Descent of the uterus occurs when supporting structures relax and we have prolapse what are the manifestations of uterine prolapse sensation of bearing down d/t uterus pushing on rectum & ulceration/ bleeding from friction vaginal discomfort and discomfort walking or sitting difficulty urinating etiology of cystocele 8 Post childbirth or surgery that causes injury to vaginal wall manifestation of cystocele it causes incontinence when the bladder prolapses etiology of rectocele Multiparous women (multiple births), multiparous stretches the ligaments Obesity Postmenopause imbalance of hormones weakens cardinal ligaments manifestation of rectocele Dyspareunia = painful sex PID and fertility association associate with infertility where is PID pain felt general pelvic region bartholinitis etiology Bacteria (Gonorrhea and Chlamydia) / abscess formation called Bartholin cyst bartholinitis manifestation bartholin gland malfunction causes dry gland & cause dyspareunia (painful intercourse) exudate at duct orifice etiology of uterine leiomyomas / fibroids Estrogen and human growth hormone influence tumor formation reliant on estrogen for growth Growth increases during pregnancy - high HGH and estrogen Usually shrink, disappear after menopause - less estrogen NOT cancerous manifestations of uterine leiomyomas / fibroids discharge, backache & constipation (can cause a sensation of bearing down as well) NOT cancerous ovarian cyst patho sacs on ovaries that produce fluid theca-lutein - know that is produces straw colored fluid & can cause peritonitis 9 ovarian cyst manifestations larger cysts can rupture and cause infection, hemorrhage, abdominal pain endometriosis complication Endometriomas are what cause peritonitis Endometrial tissue can rupture & cause peritonitis (biggest complication of peritonitis is sepsis) how does endometriosis pain present Dysmenorrhea abdominal pain is not cramp-like Pain radiates all over pelvic area, back, and legs Starts before cycle & lasts after end of cycle (typically week before & after) main cause of cervical cancer HPV Endometrial malignancy manifestations & related factors Bleeding post-menopause Bleeding between periods unopposed estrogen therapy- not given progesterone to balance estrogen age related changes in musculoskeletal system increased bone resorption and decreased bone formation what neuro changes do you expect to see in aging adult Myelin sheaths are decreased causing decrease in cognitive and motor function = slower response time epididymitis manifestations inflamed top of the teste, if this is chronic it makes it difficult for sperm to come out (trouble with fertility) what is most prevalent STI Chlamydia trachomatis Syphilis bacteria Treponema pallidum Urethritis, cervicitis, and salpingitis STDs Gonorrhea Nongonococcal urethritis Chlamydia 10 Pelvic inflammatory disease Ulcerative lesions with systemic involvement Syphilis Lymphogranuloma venereum Herpes simplex virus Ulcerative lesions only chancroid granuloma inguinale Nonulcerative lesions Genital warts Molluscum contagiosum Vulvovagintis Trichomoniasis Candidiasis Gardnerella vaginalis vaginitis Systemic infections Cytomegalovirus Hepatitis Acquired immunodeficiency syndrome (AIDS) Enteric infections Giardiasis Campylobacter enteritis Shigellosis Amebic dysentery What is usually asymptomatic in women? Gonorrhea purulent vaginal discharge, dysuria, and abnormal vaginal bleeding are symptoms of Gonorrhea in women urethritis, including dysuria and a purulent urethral discharge accompanied by redness and swelling at the site of infection, usually occur after a 3- to 6-day incubation period Gonorrhea in men 11 Gonorrhea is ________ transmitted directly Can gonorrhea spread via lymphatic system? Yes One of the first symptoms of gonorrhea can be ______ of the urethra, causing ________ retention scarring urinary The chancer from syphilis can act as a _________ for the infection Reservoir infection of the vascular system consisting of five distinct stages: incubation, primary and secondary stages, latency, and late syphilis Syphilis Etiology Treponema pallidum, an anaerobic spirochete formation of a chancre, a painless, ulcerative lesion that arises at the original spirochete portal of entry is the first phase of syphilis The initial syphilis chancer may be unnoticeable in ________ at first females Latent syphilis the third stage of syphilis, which may last for years, during which symptoms disappear although the person is still infected may still be infected for decades low-grade fever, malaise, sore throat, headache, lymphadenopathy, and mucosal or cutaneous rash and is spread through the lymphatic/blood systems is the second phase of syphilis aortic necrosis and subsequent aortic insufficiency; damage to the central nervous system may be progressively widespread, with degeneration of the cortical neurons and, eventually, paresis, blindness, and mental deterioration are the symptoms of 12 the tertiary phase of syphilis First choice of treatment for syphilis Benzathine penicillin G After invasion of the mucosa by Chlamydia during sexual contact, a painless lesion appears on the genitalia after a 1- to 3-week incubation period Lymphogranuloma Venereum Persistant HPV infection can lead to cervical cancer After 2 weeks from the sighting of the LVM lesion, what is predicted to happen? inguinal lymph nodes begin to swell, and the systemic symptoms of fever and malaise develop What forms in the lymphnodes, causing the swelling? polymorphonuclear leukocytes Infected lymph nodes become abscessed and may rupture through the skin and body cavities, causing _______ fistula formation Recurrence of HSV infections can be induced by ____, ________, and _________ Stress, immunosuppression, infectious disease In females, the _______ is the primary site of HSV-2 infection cervix In males, the ___________ is the primary site of HSV-2 infection glans penis, foreskin, or penile shaft The virus (HSV) may enter the lymphatic system, causing inguinal lymphnodes to become edematous and tender Chancroid is typically a cofactor in ______ HIV Chancroids are typically _______ and can spread into larger lesions, which can then spread and _________ organ Painful 13 destruct and erode surrounding initial sign of _________ may be a painless papule or nodule that subsequently ulcerates into an enlarging, granulomatous, red velvety ulcer Granuloma inguinale What organism is the most common cause of pelvic inflammatory disease? Neisseria gonorrhoeae ________ is self limiting and does not require therapy Molluscum contagiosum Transmission of Chlamydia during birth may result in ________ or infection of the eyes in the newborn ophthalmia neonatorum What is the initial incubation time for syphilis? 10-90 days Is gonorrhea spread through the circulatory system? NO In gonorrhea infections, the bacteria penetrate the ________ , causing ________ columnar epithelium inflammation _____ and ______ destroys terminal arterioles and small arteries Inflammation and endothelial swelling (syphilis) Nongonococcal Infection infection caused by pathogens other than gonorrhea Is ophthalmia neonatorum congenital? NO cuz its not present at birth 14 Can chlamydia cause epididymitis? YES _____ is still communicable even after the warts or lesions are removed HPV ________ ligament supports the uterus and upper part of vagina Cardinal Descent of the uterus occurs when supporting structures relax uterine prolapse What ligaments tear or stretching during a uterine prolapse Cardinal/uterosacral Sensation of bearing down, discomfort while walking or sitting down, difficulty urinating are S/S of Uterine prolapse where the body of the uterus moved to a position in the posterior of pelvis. Could cause infertility Retroplacement Protrusion of the bladder into the vagina through a deficient in the vaginal wall Cystocele Anterior rectal wall into posterior vagina Rectocele Inflammation of the cervix, uterus, oviducts, and ovaries Caused by IUD, pelvic surgery, abortion, infection PID Inflammation of the broad ligaments and connective tissues Parametritis Inflammation of the vulva or vagina Vulvovaginitis 15 Can be caused by candida albicans, trichomonad vaginalis, Haemophilus vaginalis, N. Gonorrhea, HPV, HSV2 Vulvovaginitis Candida albicans requires ________ to grow, which during the menstrual cycle, the body increases glycogen levels in the vaginal environment Inflammation to the bartholin gland that provide vaginal lubrication Bartholinitis Caused by Gonorrhea or chlamydia or abscess formation Bartholinitis Fibroid/ myopia tissue growth in the uterus that happens to about 50% of premenopausal women Uterine Leiomyomas Uterine leiomyomas are reliant on ____________ and usually shrink after _____________ estrogen for growth menopause Sacs on the ovaries that contain fluid or semisolid material on the ovaries Can occur between puberty to menopause Ovarian cysts Ovarian cysts that rupture can cause infection, hemorrhage, or abdominal pain Endometriosis endometrial tissue located outside the uterus ________ are filled with brown blood debris that can rupture and spill onto the perineum, causing _______ Endometriomas peritonitis Cancer in the cervix due to PHV, multiple pregnancies, and HSV2 Cervical cancer Cancer of the endometrium 16 - cancer of the uterus S/S: postmenopausal bleeding, abdominal pressure, pelvic fullness Tx: total abdominal hysterectomy w/ bilateral sapling-oophorectomy (TAH-BSO), radiation, chemo - risk factor is estrogen - dx: with endometrial biopsy cancer of the ovary -ovarian tumors -nonspecific symptoms -no effective screening test -most are advanced when diagnosed vulvar cancer -Usually squamous cell carcinoma -Associated with HPV, increasing age, previous cancer, autoimmune conditions, and immunosuppression Cancer of the vagina -primary cancers are rare, 80-90% squamous cell carcinomas and 5-10% adenocarcinomas -HPV infection or irritation from extended use of a pessary are risk factors -manifestations include abnormal bleeding, abnormal vaginal discharge, a palpable mass or dyspareunia -diagnosis via the PAP smear -treatment depends on the stage of the cancer from local surgery to radical surgery and radiation benign (fibrocystic) breast disease caused by hormonal imbalance during reproductive years Multiple tender masses that occur with numerous symptoms and physical findings -Swelling and tenderness -Mastalgia - Nodularity - Dominant Lumps - Nipple Discharge - Infections and inflammations Specific Benign Neoplasms - Fibroadenomas, adenomas, papillomas - Freely moveable encapsulated masses that are sharply delineated from the surrounding breast tissue - Usually just one mass breast cancer risk factors - Age over 50 - Family history, mother, grandmother, sister - Personal history - First pregnancy after the age of 30 - Radiation exposure 17 hypospadias congenital abnormality in which the male urethral opening is on the undersurface of the penis, instead of at its tip epispadias congenital defect in which the urinary meatus is located on the upper surface of the penis priapism a painful erection that lasts 4 hours or more but is not accompanied by sexual excitement Typically idopathic phimosis narrowing of the opening of the prepuce over the glans penis Paraphimposis foreskin that has been retracted over the glans up onto the shaft of the penis cannot be replaced in its normal position urethral stricture fibrotic narrowing of the urethra and are usually composed of scar tissue Mostly acquired by trauma or gonorrhea penile cancer This is a RARE cancer in men. Mostly in uncircumcised & not very hygienic male. Bacteria harbors in prepuse & are irritants causing carcigenic cancer. Presents with no pain, fatigue & nodular growths. Surgery is usually a Penectomy and client with have a urethrostomy in place after surgery. Phimosis is common in patients with penile cancer due to the constant inflammation hydrocele scrotal swelling caused by a collection of fluid When should a hydrocele be removed? Only if the patient finds it completely unbearable ________ is the inflammation of the testies typically as a response to ________ such as ____________ Epididymititis bacterial infections 18 gonorrhea or chlamydia testis located in a position other than the scrotum Cryptorchidism Risk for testicular malignancy inflammation of the prostate gland prostatitis ___________ is a blood test used to indicate if there is a alteration in prostate function PSA PSA range less than 4 ng/ml is normal PSA Range indicative of prostate cancer: over 10 ng/mL When do uterine leiomyomas occur most frequently in women? During reproductive years The etiology of endometriosis Transportation Metaplasia Induction Endometrial tissue flows backward through the oviducts during a normal menstrual period. After this retrograde flow, endometrial fragments implant on the ovary, peritoneal surfaces, and other areas. Transportation endometriosis Inflammation or a hormonal change triggers metaplasia (conversion of one kind of tissue to a form that is not normal for that tissue). Thus coelomic epithelium at certain sites converts to endometrial epithelium. Metaplasia endometriosis In this theory, a combination of transportation and metaplasia takes place, and regurgitated endometrium chemically induces mesenchyma to form endometrial epithelium. (Currently, this theory is thought to be the most likely explanation for endometriosis.) Induction endometriosis 19 Ovarian cyst may change in size during the __________ Menstrual cycle bleeding between menstrual periods or postmenopausal bleeding is the most common inital symptom of endometrial cancer What test can detect cervical cancer? Mudda fuggin PAP smear Palpable breast masses fluctuates with the menstrual cycle and may be associated with pain or tenderness Fibrocystic breast changes Low parity and having your first child at after the age of 35 will increase your risk of ________ malignant breast cancer cellular aging -Progressive decline in proliferation and reparative capacity of cells -Exposure to environmental factors theories of cellular aging Programmed senescence theory Free radical theory As people age, skin will thin, making blood vessels and bruises for visible produce fewer melanocytes increase age/liver spots that appear on the back of hands and face produce seborrheic keratoses How much of the dermis is lost as you age? 20% There is a loss of stretch and resilience in the dermis, causing a sagging appearance Hypodermis layer will _________ as you age, causing a higher sensitivity to the __________ decrease cold 20 Hair on older people will thin increases in ears, nose, and eyebrows loses pigmentation women will develop chin hair, leg hair, and axillary hair but pubic hair will decrease Nails on older people will become harder, thicker, dull, and more brittle vertical ridges appear growth slows Ligaments, tendons, and joints become dry, hardened, and less flexible Muscle mass will ______ as you age decrease The left ventricle in the heart as you age will thicken (hypertrophy) Cardiac output, stroke volume, and coronary artery blood flow will _______ as you age decrease Vascular elasticity will _______ as you age decrease Respiratory changes in the elderly include recoil loss chest wall stiffens gas exchange is less efficient resistance to airflow increases effectiveness of cough response is reduced cilia are less effective Renal changes in the elderly patients include kidney blood flow decreases size and function decreases urine creatinine clearance decreases the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment. phenotype 21 homozygous dominant (AA), homosygous recessive (aa), heterozygous (Aa) genotype Different forms of the same gene, of the two types of a gene allele One cell divides into two mitosis one cell divides twice to produce sex cells with half the genetic information meiosis chromosomes exchanged to mix mom and dad genes to form new combination crossing over recombinant chromosomes Chromosomes that carry genes from each parent. Radiation, chemicals, or viruses that can alter DNA Mutagens Severe Combined Immunodeficiency (SCID) Both limbs of lymphocyte system are missing or defective; no adaptive immune response only affects males having extra or missing whole chromosomes aneuploidy The failure of chromosomes to separate during meiosis is called nondisjunction Most common chromosomal disorder older maternal age can increase the risk Trisomy 21 (Down Syndrome) Trisomy 18 (Edwards Syndrome) 22 MR Rocker bottom feet Prominent occiput Clenched fists w/overlapping fingers Congenital heart disease Horseshoe kidneys IUGR/FTT 90% die by age 1 Trisomy 13 (Patau Syndrome) severe cleft lip and/or palate, microphthlamia, severe mental retardation, microcephaly, holoprosencephaly, NTDs, polydactyly, rocker-bottom feet, Cri du chat syndrome A deletion of the short arm of chromosome 5 associated with an array of congenital malformations, the most characteristic of which is an infant cry that resembles a meowing cat. Klinefelter Syndrome (XXY) underdeveloped sex organs, breast development, large hands, and long arms and legs Tunrer's Syndrome only one normal X chromosome and an abnormal X chromosome autosomal dominant disorders Marfans syndrome and huntingtons disease males and females affected equally autosomal recessive disorders both parent are carriers of a mutant recessive gene 1 in 4 chance of producing affected offspring 2 in 4 chance of producing who carries disease Lack of pigmentation in the hair, skin, and eyes risk for skin cancer and burn impaired vision, nystagmus, photosensitivity Albinism Inability to metabolize amino acid phenylalanine slowly developing mental retardation Phenylketonuria 23 1 in 20 Caucasian Americans carry defective gene and 1 in 2500 live births Abnormally thick secretions from chloride transporter defect progressive destruction of lung bronchioles and pancreatic ducts Cystic Fibrosis (CF) sex-linked disorders dieseases that are determined by genes found on the sex chromosomes. particularly the X chromosome Hemophilia A Always affects males Affected father transmits defective gene to none of his sons but to all of his daughters Deficiency of factor VIII Hemophilia A Agents that cause congenital malformations Teratogens TORCH infections T - toxoplasmosis O - other (syphilis) R - rubella C - cytomegalovirus H - herpes all of these can cause genetic mutations - Avoid __________ during pregnancy radiation A patient diagnosed with a micro-penis must be evaluated for endocrine disorders Cryptorchidism is associated with testicular cancer Is PKU a chromosome abnormality? No It is a single gene abnormality Thalidomide is a 24 teratogen agent The creation of a deformed child teratogenesis long thin arms and legs, tall and slender, thin fingers, cardiovascular lesions/ hearty valve disorders, aorta is weak Connective tissue disorder autosomal dominant disorder Marfans syndrome Mental deterioration, involuntary movements, symptoms onset at age 40, passed to offspring before parents know about disease Autosomal dominant disorder Huntington disease When both parents are Aa- there is a 75% chance of an offspring inheriting _________ Autosomal dominant disease Breakdown of nerves can cause slower reaction time Pitch discrimination is decreased because of the deterioration of hair cells Medications for ED PDE-5 inhibitors -Sildenafil -Vardenafil -Todalafilpatho of syphillis Destroys vascular system Terminal, arterioles and small arteries are destroyed Main organism that causes PID gonorrhea Does HPV cause sores in the vagina and the penis no 25 How do we diagnose epididymitis urine culture What is a possible etiology for fournier's gangrene alcoholism what are symptoms of BPH Urinary retention which leads to UTI/bladder infection Slow stream Takes longer to void incomplete bladder emptying frequency, urgency what age is at highest risk for developing testicular cancer 18-26 What diagnostic tool do we use to diagnose urethral stricture Can use retrograde urethrogram What is a secondary cause of erectile dysfunction Antidepressants Secondary = something other than your body causing it Who is at high risk for penile cancer Uncircumcised males Phimosis and then cancer what is patho of rectocele rectum can be torn or stretched PID symptoms Is an infection Look for WBC count Normal WBC is 15000 is high Fever of 100.4 or more Purulent discharge How do we diagnose cervical cancer Pap smear 26 If my sister had ovarian cancer what am I at increased risk for breast cancer What is an advanced symptom of breast cancer bloody discharge What will cause an increased in blood pressure in elderly patient Decreased artery elasticity Atherosclerosis Turner's syndrome characteristics Neck webbing Female Short Which are three autosomal recessive disorders PKU Cystic fibrosis Albinism Huntington's disease affects which system neuro Klinefelter manifestation Males Hypogonadism does BPH increase risk of cancer no how do we diagnose urethral strictures urethrogram What infection causes ophthalmia neonatorum Chlamydia who is at highest risk of developing testicular cancer patient with cryptorchidism (testes do not drop) is endometriosis cancerous 27 no three different ways endometriosis presents Transportation - backward flow of tissue during menstruation Metaplasia - inflammation, hormones change non-endometrial tissue to endometrial tissue (metaplasia) Induction - regurgitated endometrial tissue causes chemical reaction converting non-endo tissue to endometrial tissue what is a bartholin cyst abcess that causes exudate at ductal orifice most common cause of/increases risk of vulvovaginitis candida albicans If cause is Candida, it is d/t things that influence overgrowth of yeast (birth control/estrogen therapy, abx, DM, etc.) what are uterine leiomyoma fibroids (not cancerous) what increases risk of breast cancer sister who has breast cancer, early menarche what does not increase risk of breast cancer fibrocystic breast disease, breastfeeding what does autosomal dominant mean Aa and Aa causes 75% of chance of passing on to children what is thalidomide teratogen = crosses placenta given in the 1950s for morning sickness, which led to malformations of the limbs ("flipper arms") - now used for leprosy & cancer pts what is phenytoin prevents seizures teratogen = crosses placenta what respiratory changes do we expect to see with aging Residual volume (increased in aging adult) = left over air in lungs after exhalation; "dead space" 28 Will have increased CO2 and decreased O2 = increased respiration rate and depth cilia are less effective (not as many and not as sensitive) Vital capacity = how much capacity your lungs have to hold the air, when you have increased residual volume then your vital lung capacity decreases what do we expect to happen to older person's circulatory function increased BP, decreased elasticity, decreased baroreceptor function, decreased cardiac function, left ventricle wall thickens which decreases cardiac output what do we expect to see in patient with PKU in baby with PKU they will have increased phenylalanine because they don't have enzyme necessary to break it down what is father's role in passing on hemophilia gene Affected father transmits defective gene to none of his sons but to all his daughters how is hearing affected in old age pitch discrimination Hear better in quiet places Presbycusis Cannot hear high frequency Can only hear low pitched what does aberrant mean odd what does cri du chat syndrome cause laryngeal malformation resembling a cat crying what are two autosomal dominant disorders marfan and huntington what is marfan syndrome connective tissue disorder that causes cardiovascular lesions what is cystic fibrosis Abnormally thick secretions from chloride transporter defect what do multiple pregnancies do to cardinal ligaments constant stretching of cardinal ligament = more prone to having issues with support structures Stretched ligaments do not go back to the shape they were in before 29 what are the supporting structures that keep the uterus in place uterosacral ligaments and cardinal ligaments Descent of the uterus occurs when supporting structures relax and we have prolapse what are the manifestations of uterine prolapse sensation of bearing down d/t uterus pushing on rectum & ulceration/ bleeding from friction vaginal discomfort and discomfort walking or sitting difficulty urinating etiology of cystocele Post childbirth or surgery that causes injury to vaginal wall manifestation of cystocele it causes incontinence when the bladder prolapses etiology of rectocele Multiparous women (multiple births), multiparous stretches the ligaments Obesity Postmenopause imbalance of hormones weakens cardinal ligaments manifestation of rectocele Dyspareunia = painful sex PID and fertility association associate with infertility where is PID pain felt general pelvic region bartholinitis etiology Bacteria (Gonorrhea and Chlamydia) / abscess formation called Bartholin cyst bartholinitis manifestation bartholin gland malfunction causes dry gland & cause dyspareunia (painful intercourse) exudate at duct orifice etiology of uterine leiomyomas / fibroids Estrogen and human growth hormone influence tumor formation reliant on estrogen for growth Growth increases during pregnancy - high HGH and estrogen Usually shrink, disappear after menopause - less 30 estrogen NOT cancerous manifestations of uterine leiomyomas / fibroids discharge, backache & constipation (can cause a sensation of bearing down as well) NOT cancerous ovarian cyst patho sacs on ovaries that produce fluid theca-lutein - know that is produces straw colored fluid & can cause peritonitis ovarian cyst manifestations larger cysts can rupture and cause infection, hemorrhage, abdominal pain endometriosis complication Endometriomas are what cause peritonitis Endometrial tissue can rupture & cause peritonitis (biggest complication of peritonitis is sepsis) how does endometriosis pain present Dysmenorrhea abdominal pain is not cramp-like Pain radiates all over pelvic area, back, and legs Starts before cycle & lasts after end of cycle (typically week before & after) main cause of cervical cancer HPV Endometrial malignancy manifestations & related factors Bleeding post-menopause Bleeding between periods unopposed estrogen therapy- not given progesterone to balance estrogen age related changes in musculoskeletal system increased bone resorption and decreased bone formation what neuro changes do you expect to see in aging adult Myelin sheaths are decreased causing decrease in cognitive and motor function = slower response time epididymitis manifestations inflamed top of the teste, if this is chronic it makes it difficult for sperm to come out (trouble with fertility) 31 what is most prevalent STI Chlamydia trachomatis Syphilis bacteria Treponema pallidum Urethritis, cervicitis, and salpingitis STDs Gonorrhea Nongonococcal urethritis Chlamydia Pelvic inflammatory disease Ulcerative lesions with systemic involvement Syphilis Lymphogranuloma venereum Herpes simplex virus Ulcerative lesions only chancroid granuloma inguinale Nonulcerative lesions Genital warts Molluscum contagiosum Vulvovagintis Trichomoniasis Candidiasis Gardnerella vaginalis vaginitis Systemic infections Cytomegalovirus Hepatitis Acquired immunodeficiency syndrome (AIDS) Enteric infections Giardiasis Campylobacter enteritis Shigellosis Amebic dysentery 32 What is usually asymptomatic in women? Gonorrhea purulent vaginal discharge, dysuria, and abnormal vaginal bleeding are symptoms of Gonorrhea in women urethritis, including dysuria and a purulent urethral discharge accompanied by redness and swelling at the site of infection, usually occur after a 3- to 6-day incubation period Gonorrhea in men Gonorrhea is ________ transmitted directly Can gonorrhea spread via lymphatic system? Yes One of the first symptoms of gonorrhea can be ______ of the urethra, causing ________ retention scarring urinary The chancer from syphilis can act as a _________ for the infection Reservoir infection of the vascular system consisting of five distinct stages: incubation, primary and secondary stages, latency, and late syphilis Syphilis Etiology Treponema pallidum, an anaerobic spirochete formation of a chancre, a painless, ulcerative lesion that arises at the original spirochete portal of entry is the first phase of syphilis The initial syphilis chancer may be unnoticeable in ________ at first females Latent syphilis 33 the third stage of syphilis, which may last for years, during which symptoms disappear although the person is still infected may still be infected for decades low-grade fever, malaise, sore throat, headache, lymphadenopathy, and mucosal or cutaneous rash and is spread through the lymphatic/blood systems is the second phase of syphilis aortic necrosis and subsequent aortic insufficiency; damage to the central nervous system may be progressively widespread, with degeneration of the cortical neurons and, eventually, paresis, blindness, and mental deterioration are the symptoms of the tertiary phase of syphilis First choice of treatment for syphilis Benzathine penicillin G After invasion of the mucosa by Chlamydia during sexual contact, a painless lesion appears on the genitalia after a 1- to 3-week incubation period Lymphogranuloma Venereum Persistant HPV infection can lead to cervical cancer After 2 weeks from the sighting of the LVM lesion, what is predicted to happen? inguinal lymph nodes begin to swell, and the systemic symptoms of fever and malaise develop What forms in the lymphnodes, causing the swelling? polymorphonuclear leukocytes Infected lymph nodes become abscessed and may rupture through the skin and body cavities, causing _______ fistula formation Recurrence of HSV infections can be induced by ____, ________, and _________ Stress, immunosuppression, infectious disease In females, the _______ is the primary site of HSV-2 infection cervix In males, the ___________ is the primary site of HSV-2 infection 34 glans penis, foreskin, or penile shaft The virus (HSV) may enter the lymphatic system, causing inguinal lymphnodes to become edematous and tender Chancroid is typically a cofactor in ______ HIV Chancroids are typically _______ and can spread into larger lesions, which can then spread and _________ organ Painful destruct and erode surrounding initial sign of _________ may be a painless papule or nodule that subsequently ulcerates into an enlarging, granulomatous, red velvety ulcer Granuloma inguinale What organism is the most common cause of pelvic inflammatory disease? Neisseria gonorrhoeae ________ is self limiting and does not require therapy Molluscum contagiosum Transmission of Chlamydia during birth may result in ________ or infection of the eyes in the newborn ophthalmia neonatorum What is the initial incubation time for syphilis? 10-90 days Is gonorrhea spread through the circulatory system? NO In gonorrhea infections, the bacteria penetrate the ________ , causing ________ columnar epithelium inflammation _____ and ______ destroys terminal arterioles and small arteries 35 Inflammation and endothelial swelling (syphilis) Nongonococcal Infection infection caused by pathogens other than gonorrhea Is ophthalmia neonatorum congenital? NO cuz its not present at birth Can chlamydia cause epididymitis? YES _____ is still communicable even after the warts or lesions are removed HPV ________ ligament supports the uterus and upper part of vagina Cardinal Descent of the uterus occurs when supporting structures relax uterine prolapse What ligaments tear or stretching during a uterine prolapse Cardinal/uterosacral Sensation of bearing down, discomfort while walking or sitting down, difficulty urinating are S/S of Uterine prolapse where the body of the uterus moved to a position in the posterior of pelvis. Could cause infertility Retroplacement Protrusion of the bladder into the vagina through a deficient in the vaginal wall Cystocele Anterior rectal wall into posterior vagina Rectocele 36 Inflammation of the cervix, uterus, oviducts, and ovaries Caused by IUD, pelvic surgery, abortion, infection PID Inflammation of the broad ligaments and connective tissues Parametritis Inflammation of the vulva or vagina Vulvovaginitis Can be caused by candida albicans, trichomonad vaginalis, Haemophilus vaginalis, N. Gonorrhea, HPV, HSV2 Vulvovaginitis Candida albicans requires ________ to grow, which during the menstrual cycle, the body increases glycogen levels in the vaginal environment Inflammation to the bartholin gland that provide vaginal lubrication Bartholinitis Caused by Gonorrhea or chlamydia or abscess formation Bartholinitis Fibroid/ myopia tissue growth in the uterus that happens to about 50% of premenopausal women Uterine Leiomyomas Uterine leiomyomas are reliant on ____________ and usually shrink after _____________ estrogen for growth menopause Sacs on the ovaries that contain fluid or semisolid material on the ovaries Can occur between puberty to menopause Ovarian cysts Ovarian cysts that rupture can cause infection, hemorrhage, or abdominal pain Endometriosis 37 endometrial tissue located outside the uterus ________ are filled with brown blood debris that can rupture and spill onto the perineum, causing _______ Endometriomas peritonitis Cancer in the cervix due to PHV, multiple pregnancies, and HSV2 Cervical cancer Cancer of the endometrium - cancer of the uterus S/S: postmenopausal bleeding, abdominal pressure, pelvic fullness Tx: total abdominal hysterectomy w/ bilateral sapling-oophorectomy (TAH-BSO), radiation, chemo - risk factor is estrogen - dx: with endometrial biopsy cancer of the ovary -ovarian tumors -nonspecific symptoms -no effective screening test -most are advanced when diagnosed vulvar cancer -Usually squamous cell carcinoma -Associated with HPV, increasing age, previous cancer, autoimmune conditions, and immunosuppression Cancer of the vagina -primary cancers are rare, 80-90% squamous cell carcinomas and 5-10% adenocarcinomas -HPV infection or irritation from extended use of a pessary are risk factors -manifestations include abnormal bleeding, abnormal vaginal discharge, a palpable mass or dyspareunia -diagnosis via the PAP smear -treatment depends on the stage of the cancer from local surgery to radical surgery and radiation benign (fibrocystic) breast disease caused by hormonal imbalance during reproductive years Multiple tender masses that occur with numerous symptoms and physical findings -Swelling and tenderness -Mastalgia - Nodularity - Dominant Lumps - Nipple Discharge - Infections and inflammations 38 Specific Benign Neoplasms - Fibroadenomas, adenomas, papillomas - Freely moveable encapsulated masses that are sharply delineated from the surrounding breast tissue - Usually just one mass breast cancer risk factors - Age over 50 - Family history, mother, grandmother, sister - Personal history - First pregnancy after the age of 30 - Radiation exposure hypospadias congenital abnormality in which the male urethral opening is on the undersurface of the penis, instead of at its tip epispadias congenital defect in which the urinary meatus is located on the upper surface of the penis priapism a painful erection that lasts 4 hours or more but is not accompanied by sexual excitement Typically idopathic phimosis narrowing of the opening of the prepuce over the glans penis Paraphimposis foreskin that has been retracted over the glans up onto the shaft of the penis cannot be replaced in its normal position urethral stricture fibrotic narrowing of the urethra and are usually composed of scar tissue Mostly acquired by trauma or gonorrhea penile cancer This is a RARE cancer in men. Mostly in uncircumcised & not very hygienic male. Bacteria harbors in prepuse & are irritants causing carcigenic cancer. Presents with no pain, fatigue & nodular growths. Surgery is usually a Penectomy and client with have a urethrostomy in place after surgery. Phimosis is common in patients with penile cancer due to the constant inflammation 39 hydrocele scrotal swelling caused by a collection of fluid When should a hydrocele be removed? Only if the patient finds it completely unbearable ________ is the inflammation of the testies typically as a response to ________ such as ____________ Epididymititis bacterial infections gonorrhea or chlamydia testis located in a position other than the scrotum Cryptorchidism Risk for testicular malignancy inflammation of the prostate gland prostatitis ___________ is a blood test used to indicate if there is a alteration in prostate function PSA PSA range less than 4 ng/ml is normal PSA Range indicative of prostate cancer: over 10 ng/mL When do uterine leiomyomas occur most frequently in women? During reproductive years The etiology of endometriosis Transportation Metaplasia Induction Endometrial tissue flows backward through the oviducts during a normal menstrual period. After this retrograde flow, endometrial fragments implant on the ovary, peritoneal surfaces, and other areas. 40 Transportation endometriosis Inflammation or a hormonal change triggers metaplasia (conversion of one kind of tissue to a form that is not normal for that tissue). Thus coelomic epithelium at certain sites converts to endometrial epithelium. Metaplasia endometriosis In this theory, a combination of transportation and metaplasia takes place, and regurgitated endometrium chemically induces mesenchyma to form endometrial epithelium. (Currently, this theory is thought to be the most likely explanation for endometriosis.) Induction endometriosis Ovarian cyst may change in size during the __________ Menstrual cycle bleeding between menstrual periods or postmenopausal bleeding is the most common inital symptom of endometrial cancer What test can detect cervical cancer? Mudda fuggin PAP smear Palpable breast masses fluctuates with the menstrual cycle and may be associated with pain or tenderness Fibrocystic breast changes Low parity and having your first child at after the age of 35 will increase your risk of ________ malignant breast cancer cellular aging -Progressive decline in proliferation and reparative capacity of cells -Exposure to environmental factors theories of cellular aging Programmed senescence theory Free radical theory As people age, skin will thin, making blood vessels and bruises for visible produce fewer melanocytes increase age/liver spots that appear on the back of hands and face produce seborrheic keratoses 41 How much of the dermis is lost as you age? 20% There is a loss of stretch and resilience in the dermis, causing a sagging appearance Hypodermis layer will _________ as you age, causing a higher sensitivity to the __________ decrease cold Hair on older people will thin increases in ears, nose, and eyebrows loses pigmentation women will develop chin hair, leg hair, and axillary hair but pubic hair will decrease Nails on older people will become harder, thicker, dull, and more brittle vertical ridges appear growth slows Ligaments, tendons, and joints become dry, hardened, and less flexible Muscle mass will ______ as you age decrease The left ventricle in the heart as you age will thicken (hypertrophy) Cardiac output, stroke volume, and coronary artery blood flow will _______ as you age decrease Vascular elasticity will _______ as you age decrease Respiratory changes in the elderly include recoil loss chest wall stiffens gas exchange is less efficient 42 resistance to airflow increases effectiveness of cough response is reduced cilia are less effective Renal changes in the elderly patients include kidney blood flow decreases size and function decreases urine creatinine clearance decreases the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment. phenotype homozygous dominant (AA), homosygous recessive (aa), heterozygous (Aa) genotype Different forms of the same gene, of the two types of a gene allele One cell divides into two mitosis one cell divides twice to produce sex cells with half the genetic information meiosis chromosomes exchanged to mix mom and dad genes to form new combination crossing over recombinant chromosomes Chromosomes that carry genes from each parent. Radiation, chemicals, or viruses that can alter DNA Mutagens Severe Combined Immunodeficiency (SCID) Both limbs of lymphocyte system are missing or defective; no adaptive immune response only affects males having extra or missing whole chromosomes 43 aneuploidy The failure of chromosomes to separate during meiosis is called nondisjunction Most common chromosomal disorder older maternal age can increase the risk Trisomy 21 (Down Syndrome) Trisomy 18 (Edwards Syndrome) MR Rocker bottom feet Prominent occiput Clenched fists w/overlapping fingers Congenital heart disease Horseshoe kidneys IUGR/FTT 90% die by age 1 Trisomy 13 (Patau Syndrome) severe cleft lip and/or palate, microphthlamia, severe mental retardation, microcephaly, holoprosencephaly, NTDs, polydactyly, rocker-bottom feet, Cri du chat syndrome A deletion of the short arm of chromosome 5 associated with an array of congenital malformations, the most characteristic of which is an infant cry that resembles a meowing cat. Klinefelter Syndrome (XXY) underdeveloped sex organs, breast development, large hands, and long arms and legs Tunrer's Syndrome only one normal X chromosome and an abnormal X chromosome autosomal dominant disorders Marfans syndrome and huntingtons disease males and females affected equally autosomal recessive disorders both parent are carriers of a mutant recessive gene 1 in 4 chance of producing affected offspring 44 2 in 4 chance of producing who carries disease Lack of pigmentation in the hair, skin, and eyes risk for skin cancer and burn impaired vision, nystagmus, photosensitivity Albinism Inability to metabolize amino acid phenylalanine slowly developing mental retardation Phenylketonuria 1 in 20 Caucasian Americans carry defective gene and 1 in 2500 live births Abnormally thick secretions from chloride transporter defect progressive destruction of lung bronchioles and pancreatic ducts Cystic Fibrosis (CF) sex-linked disorders dieseases that are determined by genes found on the sex chromosomes. particularly the X chromosome Hemophilia A Always affects males Affected father transmits defective gene to none of his sons but to all of his daughters Deficiency of factor VIII Hemophilia A Agents that cause congenital malformations Teratogens TORCH infections T - toxoplasmosis O - other (syphilis) R - rubella C - cytomegalovirus H - herpes all of these can cause genetic mutations - Avoid __________ during pregnancy radiation A patient diagnosed with a micro-penis must be evaluated for 45 endocrine disorders Cryptorchidism is associated with testicular cancer Is PKU a chromosome abnormality? No It is a single gene abnormality Thalidomide is a teratogen agent The creation of a deformed child teratogenesis long thin arms and legs, tall and slender, thin fingers, cardiovascular lesions/ hearty valve disorders, aorta is weak Connective tissue disorder autosomal dominant disorder Marfans syndrome Mental deterioration, involuntary movements, symptoms onset at age 40, passed to offspring before parents know about disease Autosomal dominant disorder Huntington disease When both parents are Aa- there is a 75% chance of an offspring inheriting _________ Autosomal dominant disease Breakdown of nerves can cause slower reaction time Pitch discrimination is decreased because of the deterioration of hair cells Medications for ED PDE-5 inhibitors -Sildenafil 46 -Vardenafil -Todalafil