Module 10: Reproductive
What do high levels of Prostaglandin F do to cause primary dysmenorrhea? (3)
-Uterine hyper-contractility -Decreased uterine blood flow -increased nerve sensitivity
What are 3 risk factors for developing Chlamydia?
1. Age <26 years 2. New sexual partner 3. Drug use
What 3 organisms are responsible for BV?
1. Gardnerella Vaginalis 2. Mobiluncus 3. Mycoplasma hominis
What are 3 risk factors for the development of pelvic organ prolapse? (6 listed)
1. Menopause 2. Aging 3. Low estrogen 4. Chronically increased intraabdominal pressure (pregnancy, coughing, lung disease, constipation, obesity, prolonged sitting/standing) 5. Pelvic floor trauma (vaginal birth, hysterectomy) 6. Genetic factors (connective tissue disorders, spina bifida)
What are 3 clinical manifestations of Bartholinitis? (6 listed)
1. Most asymptomatic and require no treatment in women <40 years 2. 1-8 cm cyst located in posterior-lateral portion of the vulva 3. fever 4. Malaise 5. cyst may be reddened/painful 6. pus may be visible at opening of duct
What are 2 risk factors for developing HPV?
1. Multiple sex partners 2. early onset of sexual activity 3. alcohol use, smoking, HIV infection are strongly correlated with persistent HPV infection
What are 3 risk factors for the development of leiomyomoas? (7 listed)
1. Nulliparity 2. Obesity 3. PCOS 4. Black 5. Asian 6. Post-menopausal hormone use 7. HTN
Name 3 clinical manifestations/complications of PCOS. (10 listed)
1. Obesity 2. Oligomenorrhea (infrequent menstrual periods) 3. Amenorrhea 4. Hyperandrogenism 5. Infertility 6. Insulin resistance 7. Hirsutism 8. Acanthosis nigricans 9. Acne 10. Sleep Apnea
What are 3 clinical manifestations of endometriosis? (9 listed)
1. Pain 2. Infertility 3. Progressive dysmenorrhea 4. Dysuria 5. Pain on defecation 6. Constipation 7. Abnormal vaginal bleeding 8. Dyspareunia 9. Asymptomatic pelvic mass with movable nodules and a fixed retroverted uterus (if implants are within the pelvis)
What can cause Bartholinitis? (3)
1. Streptococci 2. Staphyloccocci 3. STD's
What are 3 clinical manifestations of leiomymoas? (7 listed)
1. abnormal bleeding 2. pelvic pain 3. pelvic pressure 4. urinary symptoms (d/t pressure on bladder) - frequency - urgency - dysuria - bladder distention (d/t pressure on ureter) 5. constipation (d/t rectosigmoid pressure) 6. Abdominal/uterine heaviness 7. infertility/sub-fertility
What are 3 features of NORMAL vaginal discharge? (6 listed)
1. clear 2. milky/cloudy 3. slippery/clumpy texture 4. Non-irritating 5. Mild smell 6. May yellow after drying
Name 3 risk factors for the development of breast cancer in a woman <45 years old.
1. close relative who was diagnosed with breast cancer at <45 years old 2. >1 MALE relative diagnosed with breast cancer 3. Alterations in BRCA1 and BRCA2 genes 4. Ashkenazi Jewish heritage 5. Treatment with radiation to breast or chest during childhood or early adulthood
What are 3 risk factors for the development of ovarian cancer? (5 listed)
1. early menarche 2. late menopause 3. nulliparity (above are conditions associated with increased ovulation over the lifetime) 4. history of endometriosis 5. Genetics (BRCA1, BRCA2)
What are the two common causes of benign ovarian enlargement in ovulating women?
1. follicular cysts 2. corpus luteum cysts
What are 3 symptoms of syphilis in a newborn?
1. growth abnormalities 2. rashes 3. hepatosplenomegaly 4. jaundice 5. CNS involvement - blindness, deafness 6. Late manifestation: notched incisors
Name 3 potential causes of primary amenorrhea. (5 listed)
1. hypothalamic disorders (hypothalamic-pituitary-ovarian access is dysfunctional) 2. Autoimmune disease (hyperprolactinemia) 3. Medications 4. Congenital absence of vagina, uterus 5. Disorders of anterior pituitary gland (e.g. tumors) - prevents the ovary from receiving the necessary signals and ovulation/menstruation do not occur 6. Genetic abnormalities (such as androgen insensitivity or Turner's Syndrome)
PCOS is defined as having at least 2 of the following...
1. irregular ovulation 2. elevated levels of androgens (testosterone) 3. appearance of polycystic ovaries on US
What are 2 conditions that would cause hypothalamic-pituitary-ovarian access dysfunction, resulting in primary amenorrhea? (4 listed)
1. malnutrition (anorexia nervosa) 2. stress 3. infection (meningitis, syphilis) 4. TBI
What are 3 risk factors for the development of cervical cancer? (5 listed)
1. multiple sex partners 2. smoking 3. many children 4. long history of oral contraceptive use 5. immunocompromised
Name 3 pelvic disorders that can cause secondary amenorrhea. (9 listed)
1. ovarian cysts 2. adenomyosis 3. endometriosis 4. endometritis (infection) 5. PID 6. Uterine fibroids 7. Polyps 8. Tumors 9. ParaGard IUD (non-hormonal)
What are the 4 most common sites of endometriosis?
1. ovaries 2. uterine ligaments 3. rectovaginal septum 4. pelvic peritoneum
What are 3 factors that can protect a woman against developing ovarian cancer? (3 listed)
1. pregnancies 2. prolonged lactation 3. use of hormonal contraceptives that limit ovulation (birth control, tubal ligation, hysterectomy)
What does cryptochordism put you at risk for? (2)
1. testicular cancer (risk is 35-50x times greater) 2. infertility
In what 2 situations does the fishy odor associated with BV increase?
1. when exposed to semen 2. during menstruation
Testicular cancer is the most common form of cancer in young men between what ages?
15-35
The diagnosis of secondary amenorrhea is made when there is an absence of regular menstrual periods for ______ months.
3 months
what is the lifetime risk percentage of developing uterine cancer?
3%
More than 2/3 of breast cancers in women are diagnosed at over ______ years.
55 years
90% of men older than ________ will experience BPH
70 years
A fibroadenoma is: a. a well-defined mobile breast mass, smooth and hard like a marble on physical examination. b. a "squishy" breast mass. c. a painful irregular breast mass. d. a painless irregular breast mass.
A
Pelvic inflammatory disease is often characterized by: a. Gradual onset of dull and steady low bilateral abdominal pain. b. Sudden onset of dull and steady low bilateral abdominal pain. c. Sudden unilateral sharp and stabbing abdominal pain. d. Gradual onset of dull pain that is located in the left lower quadrant Correct answer A
A
What is the most common microorganism that causes acute bacterial prostatitis? a. Escherichia coli b. Haemophilus influenza c. Treponema pallidum
A
There are 3 distinct syndromes associated with HSV infection; which occurs when individuals have no antibodies to HSV 1 and HSV 2? A. First episode primary HSV infection B. First episode non-primary HSV infection C. Recurrent infections
A. First episode primary HSV infection
PID is: A. multimicrobial B. primarily caused by Staphylococcus aureus C. associated with a hyperandrogenic state D. affects only the cervix
A. Multimicrobial there are multiple organisms that cause it, so generally it is because of chlamydia or gonorrhea, but 66% of women will also have BV
The APRN suspects prostate cancer because the patient is over 65 years old and has: A. symptoms of urinary obstruction that are progressive and are not relieved by treatment B. penile discharge C. painful erections D. fibrous plaques found on dorsum of penile shaft
A. symptoms of urinary obstruction that are progressive and not relieved by treatment
Chlamydial cervicitis is suspected. What will the APRN typically find on examination of the cervix? A. yellow mucopurulent discharge B. blisters and erythema C. thin grey malodorous discharge D. unexplained bleeding
A. yellow mucopurulent discharge
The presence of endometrial tissue within the uterine myometrium is called what?
Adenomyosis
what is the number one risk factor for BPH?
Age
Early menarche, late menopause, and nulliparity are risk factors for: a. Cervical cancer b. Ovarian cancer c. Vaginal cancer
B
What type of ovarian cyst causes more symptoms, especially if it ruptures? A. follicular cyst B. corpus luteum cyst C. dermoid cyst
B. Corpus luteum cyst (less common than follicular cysts)
The APRN palpates a 1.5 cm firm, non-tender, mobile mass in the upper outer quadrant of a 34-year-old woman's breast. There is no family history of breast cancer. The APRN suspects this mass is a: A. Breast Cyst B. Fibroadenoma C. Cancerous lesion D. Usual ductal hyperplasia
B. Fibroadenoma It is a fibroadenoma because it is MOBILE, cysts are not usually FIRM (usually squishy), Fibroadenomas are also NON-TENDER and SMOOTH
There are 3 distinct syndromes associated with HSV infection; which occurs when individuals have pre-existing antibodies? A. First episode primary HSV infection B. First episode non-primary HSV infection C. Recurrent infections
B. first episode non-primary HSV infection
An individual has secondary stage syphilis. what will the APRN typically find? A. Hard chancre and firm enlarged lymph nodes B. low-grade fever, malaise, and sore throat C. Gummas, cardiovascular lesions, and neurosyphilis D. Nothing except antibodies present on lab results
B. low-grade fever, malaise, and sore throat Chancre - primary (1) Gummas - tertiary (3) Nothing - latent
The following are symptoms of what disorder? § Urge to urinate often § Delay in starting urination § Decreased force of urinary stream § As the obstruction progresses, the bladder cannot empty all the urine and the increasing volume then can lead to long-term urine retention § The volume of urine retained may be great enough to produce an uncontrolled overflow incontinence with any increase in intraabdominal pressure
BPH
The following are clinical manifestations for what disease? § Elevated vaginal pH (5-5.5) § Vaginal discharge · Strong fishy odor o Especially after intercourse and during menses o Odor is intensified with alkaline secretions (semen, menstrual discharge) · Thin · Gray · Homogeneous · Adheres to vaginal walls and can drain from vagina · Frothy
BV
what condition is a sexually associated condition, but not considered an STI?
BV
____________ __________ is present in up to 66% of women with PID.
Bacterial Vaginosis
Whey are young women at greater risk of acquiring an STI when compared with older women?
Because of the position of the susceptible cells on the surface of their cervix
Newborns born to mothers infected with gonorrhea who have prolonged rupture of membranes must be treated to prevent what?
Blindness
Aside from skin cancer, what is the most common cancer in American women?
Breast cancer
A 45 year old female is being evaluated by the APRN for abnormal uterine bleeding, pain, and pelvic pressure. The APRN suspects the diagnosis will be: a. Endometriosis b. Adenomyosis c. Leiomyomas d. Uterine polyps
C
Most abnormal uterine bleeding is a result of: a. leiomyomas b. Adenomyosis c. anovulation d. endometriosis
C
Ovarian Cancer: A. has a hereditary (genetic) cause B. is the rarest of the female genital cancers C. has often metastasized prior to diagnosis D. Is easily detected with pap smears
C
BPH: A. Is caused by cellular hypertrophy B. Produces compression of the spermatic cord C. Produces obstructive and annoying symptoms D. Is associated with stress incontinence
C. Produces obstructive and annoying symptoms A - hyperplasia is a better term, and is caused by enlargement of the gland
Dysmenorrhea is most likely the result of the release of the following? A. Progesterone B. Prolactin C. Prostaglandin D. Estrogen
C. Prostaglandin
There have been recent ads on TV promoting a medication that treats a penile condition in which there are fibrous plaques found on the dorsum of the penile shaft. This condition is: a. Paraphimosis b. Phimosis c. Peyronie disease d. Priapism
C. peyronie disease
Use of antibiotics contributes to the development of what type of vaginitis?
Candida Albicans (yeast)
What diagnosis? men - clear mucus penile discharge - mild burning with urination - unilaterally painful scrotum women -90% asymptomatic -yellow mucopurulent discharge from cervical os -hypertrophic edematous and friable area of cervical ectopy -intermenstrual or post-coital spotting -erythematous, raw, friable cervix
Chlamydia
What disease pathogenesis involves an elementary body?
Chlamydia
What is the leading cause of preventable infertility and ectopic pregnancy?
Chlamydia
What is the most common bacterial STI reported in the U.S.?
Chlamydia
What maternal infection can cause an eye infection and pneumonia during childbirth?
Chlamydia
What bacteria causes Chlamydia?
Chlamydia trachomatis
A 43 year old female is experiencing abnormal periods. In order to for the midwife to make a diagnosis, the abnormal periods must be present the majority of the past______months. a. 2 b. 3 c. 4 d. 6
D. 6 months
What type of ovarian cyst are ovarian teratomas that contain elements of all 3 germ layers and may contain mature tissues, including skin, hair, sebaceous and sweat glands, muscle fibers, teeth, and bone?
Dermoid cyst
What type of ovarian cyst is usually asymptomatic, found incidentally on pelvic exam, and has malignant potential?
Dermoid cyst
What is the most common microorganism that causes acute bacterial prostatitis?
E. Coli
Men who practice unprotected anal intercourse may acquire sexually transmitted epididymitis because of what 3 pathogens?
E. coli haemophilis influenzae, tuberculosis cryptococcus
The presence of functioning endometrial tissue outside the lining of the womb is called what?
Endometriosis
what is the diagnosis? 1. severe acute pain 2. scrotal/inguinal pain 3. flank pain 4. pyuria 5. bacteriuria 6. scrotum on involved side is red and erythematous
Epididymitis
What duration is considered NORMAL uterine bleeding?
Every 28 days, with variations up to 7 days
T/F: The endometrial tissue in adenomyosis responds to cyclic hormonal changes.
FALSE The endometrial tissue in adenomyosis does NOT respond to cyclic changes (unlike endometriosis)
T/F: The majority of ovarian cancers are associated with a known pattern of inheritance.
FALSE The majority of ovarian cancers are SPORADIC and not associated with a known pattern of inheritance
T/F: The uterus is enlarged and tender with leiomyomas.
FALSE. Uterus is enlarged and irregular, but NON-TENDER and nodularity is appreciated upon pelvic exam
T/F: The urinary symptoms related to prostate cancer are the same as those for BPH.
False. § Unlike urinary symptoms of BPH, the symptoms of an obstruction caused by prostatic cancer and are progressive and do not relent
What is the diagnosis? · Sudden onset of painful urination or purulent penile discharge (or both) within 1 week of infection · Some men will only have a little discharge or sometimes just urethral itching · If left untreated, can cause penile abscesses, fistula and strictures
Gonorrhea
What are the 3 bacterial STI's discussed in our module?
Gonorrhea Chlamydia Syphilis
What is the diagnosis and what gender? · Dysuria · Increased vaginal discharge · Abnormal menses · Dyspareunia · Lower abdominal/pelvic pain · Fever · Friable cervix · Mucopurulent discharge from cervical os · Discharge from the Skene or Bartholin glands may be asymptomatic until infection has spread
Gonorrhea Women
what are the 2 main pathogens for Pelvic Inflammatory Disease?
Gonorrhea and Chlamydia
What do these uterine prolapse grades mean? Grade 0 Grade 1 Grade 2 Grade 3
Grade 0: normal Grade 1: halfway to the hymenal ring Grade 2: reaches the hymen Grade 3: passes the hymen
What grade of uterine prolapse rarely requires correction?
Grade 1 (minimal)
If the uterus descends into the vaginal space and reaches to the hymen, what grade is this?
Grade 2
what grade of uterine prolapse? uterus is so low that the cervix protrudes from the vagina.
Grade 3 (Severe)
what is the first sign of ascending infection in PID?
Gradual onset of dull, steady, aching bilateral lower abdominal pain
What is the most common symptomatic viral STI in the U.S.?
HPV
What virus is most commonly implicated in causing cervical cancer?
HPV strains 16 and 18 (cause 70% of cervical cancers)
JY is a 46-year-old woman who has detected a thickening in the upper outer quadrant of her LT breast. She is examined by her APRN who finds a single non-mobile, painless lump. JY is referred to a surgeon and a biopsy of the lump reveals lobular carcinoma in situ. She has a 15-year-old daughter and she is concerned about her daughter's risk for breast cancer. What would you tell her about that?
Her daughter has an increased risk because JY is young and pre-menopausal. She should be referred for Genetic testing for BRCA1 and BRCA2.
A collection of fluid within the tunica vaginalis is known as what?
Hydrocele
What is the most common benign tumor of the uterus?
Leiomyoma (fibroid)
Primary amenorrhea is a failure of ____________ by age ______ with no secondary sex characteristics or age _______ regardless of development of sex characteristics.
Menarche 13 - no secondary sex characteristics 15 - regardless of development of sex characteristics
What bacteria causes Gonorrhea?
Neisseria gonorrhoeae
When are leiomyomas most common?
Not seen before menarche Incidence increases in women ages 30-50 years incidence decreases with menopause (because leiomyomas occur at times of estrogen exposure)
What kind of female reproductive cancer is often termed the 'silent killer'?
Ovarian Cancer it is commonly diagnosed after metastasis has occurred
What type of incontinence would you see with BPH?
Overflow incontinence
AUB is classified by the CAUSE of the uterine bleeding, using what system?
PALM-COEIN System
What disorder is the most common cause of anovulation and ovulatory dysfunction in women?
PCOS
What is the leading cause of infertility in the U.S.?
PCOS
what female disorder is associated with metabolic dysfunction, including dyslipidemia, insulin resistance, and obesity?
PCOS
What is the main symptoms of epididymitis?
Pain (acute/severe)
Which is a medical emergency: A. Paraphimosis B. Phimosis
Paraphimosis - because it will cut off blood supply and cause necrosis
what is a fibrotic condition of the tunica albuginea of the penis that results in varying degrees of curvature and sexual dysfunction?
Peyronie Disease
AUB is classified by the CAUSE of the uterine bleeding, using the PALM-COEIN System. What does PALM-COEIN stand for?
Polyp Adenomyosis Leiomyoma Malignancy Hyperplasia Coagulopathy Ovulatory dysfunction Iatrogenic Not yet classified
Painful, persistent erection that lasts >4 hours without sexual stimulation is known as what?
Priapism
In what stage of syphilis does a chancre develop?
Primary syphilis
What hormone increases milk production and suppresses ovulation?
Prolactin
Women with painful periods produce 10x more what?
Prostaglandin F
What is the most commonly diagnosed non-skin cancer in men in the U.S.?
Prostate CA
An adult male has severe rectal pressure and pain, fever x2 days, worsening pain that radiates to the back, inability to sit, urinary frequency, urgency and dysuria. What is your diagnostic hypothesis? What is the usual causative agent?
Prostatitis E. Coli
Testicular cancer tumors are most often on what testicle?
RT
what is the greatest risk factor for contracting an STI?
Risky Behaviors (those with unprotected intercourse or genital/oral contact with multiple partners are at the greatest risk)
what is the usual cause of epididymitis?
STI's (Neisseria Gonnorrhea or Chlamydia Trichomonas)
What type of dysmenorrhea results from pelvic disorders (ovarian cysts, adenomyosis, endometriosis, etc.)?
Secondary dysmenorrhea
Pathologic studies have found endometriosis on all organs of the body except for where?
Spleen
T/F: In premenopausal and postmenopausal women, any bleeding is considered abnormal
TRUE
T/F: Persistent corpus luteum is a normal finding in the 1st trimester of pregnancy.
TRUE § Corpus luteum produces progesterone to support the pregnancy until the placenta is established
Janice is concerned because the NP said there were fibrocystic changes in the breasts. What does this mean?
The breast tissue responds to hormonal changes of the menstrual cycle and is usually benign.
Why is it common for malignant tumors of the female reproductive system to grow large before causing pain, leading to late diagnosis?
The female pelvis and abdomen are poorly innervated because it's designed to accommodate a growing fetus
What area of the cervix is very vulnerable to the oncogenic effects of HPV and, therefore, where carcinoma in situ is most likely to develop?
Transformation zone (where the squamous epithelium cells and columnar epithelial cells meet)
What bacteria causes syphilis?
Treponema pallidum
The following are clinical manifestations for what STI? § Range from none to severe § Vaginal discharge and internal pruritis most common manifestations § Vaginal discharge · Copious · Frothy · Malodorous · Yellow green to gray-green § Internal pruritis § Dyspareunia § Dysuria § Vaginal walls appear erythematous, sore with small punctate red marks (strawberry marks) on vaginal walls and cervix § Women report an increase in symptoms after menses § Most men are asymptomatic but have scant intermittent d/c, slight pruritis and mild dysuria
Trichomoniasis (Trich)
T/F: As long as the blood supply is sufficient, the ectopic endometrium proliferates, breaks down, and bleeds with the normal menstrual cycle
True
T/F: Most ovarian cancers are sporadic and have no known pattern of inheritance.
True
Is testicular torsion a surgical emergency?
Yes - torsion twists the arteries and veins and spermatic cord, thereby reducing/stopping circulation to the testes
What is Prostaglandin F (associated with primary dysmenorrhea)?
a potent myometrial stimulant and vasoconstrictor
What is the main symptom of endometrial cancer?
abnormal uterine bleeding, especially if post menopausal
Define amenorrhea
absence or suppression of menstruation
The following are symptoms of what disorder? § Sudden onset of malaise § Low back and perineal pain § High fever (up to 104 F) § Chills § Dysuria § Symptoms of lower urinary tract obstruction · Slow/small/narrowed urinary stream, which may be a medical emergency · Edema can compress the urethra, causing urinary obstruction § Symptoms of UTI or pyelonephritis
acute bacterial prostatitis
Abnormal uterine bleeding is most commonly caused by what?
anovulation
With a cystocele, you will see a bulge in the ________ wall of the vagina.
anterior (top)
Why can obesity cause abnormal uterine bleeding?
because adipose tissue secretes estrogen
Why would someone who isn't having a Herpes outbreak still be able to transmit the virus to a partner?
because the virus can shed even if they are asymptomatic
Enlargement of the prostate gland is known as what?
benign prostatic hyperplasia
what is the first manifestation of prostate cancer?
bladder outlet obstruction symptoms (slow urinary stream, hesitancy, incomplete emptying, nocturia, dysuria, frequency)
Define ectropion.
cells from the inside of the cervical canal (granular cells) are present on the outside of the vaginal portion of the cervix
After ovulation, the _________ ____________ secretes ________________, which limits growth and changes the vasculature of the endometrium, thus limiting the bleeding that occurs during endometrial shedding.
corpus luteum progesterone
What type of cyst is normally formed by the granulosa cells left behind after ovulation?
corpus luteum cyst
Testicular maldescent is AKA as what?
cryptorchidism
testicular cancer is most often associated with what?
cryptorchordism
the descent of the portion of the posterior bladder wall into the vaginal canal is called what?
cystocele
If a patient has adenomyosis, what will their uterus be like on clinical exam?
diffusely enlarged (2-3x expected size) globular most tender before/after menstruation
the congenital adhesions that cause phimosis in infancy are separated naturally by what?
during the first 3 years of life, they separate naturally with penile erections
When is secondary amenorrhea common? (3 life periods listed)
early adolescence peri-menopausal period pregnancy/lactation
What are some risk factors for developing breast cancer?
early menarche late menopause nulliparity The longer the exposure to estrogen, the higher the risk.
What is the most common cause of secondary dysmenorrhea?
endometriosis
As an ovarian follicle grows, it produces _____________, which causes proliferation of the ____________________.
estrogen endometrium
T/F: Genital herpes is a reportable disease
false
What breast changes will a client notice right before they are due for the period, characterized by an increased breast tenderness/lumpiness?
fibrocystic changes
what kind of cyst forms when the dominant follicle fails to rupture or one or more of the nondominant follicles fail to regress?
follicular cyst
Follicular cysts and corpus luteum cysts are called _______________ cysts because they are caused by variations of normal physiologic events.
functional
Condylomata acuminata is AKA what and associated with what virus?
genital warts HPV
what is the cardinal characteristic of PCOS?
hyperandrogenic state
How does a hypothalamic disorder cause primary amenorrhea?
hypothalamic-pituitary-ovarian (HPO) access is dysfunctional and the hypothalamus is unable to synthesize the gonadotropin-releasing hormone (GNRH). The pituitary then fails to secrete LH and FSH - and the ovary does not receive the hormonal signals required to stimulate estrogen production, therefore ovulation and menstruation do not occur
What is the most likely theory regarding the etiology of endometriosis?
impaired cellular and humoral immunity
What is the most plausible theory of endometriosis?
impaired cellular and humoral immunity
Phimosis is normal in _______ and caused by congenital _________.
infancy adhesions
in what stage of syphilis is the patient asymptomatic?
latent
What duration is considered ABNORMAL uterine bleeding?
menstrual cycle <21 days or >35 days, lasting longer then 7 days
When is a fetus most at risk when the mother has a primary herpes outbreak?
near birth/delivery if they have an active lesion during birth, they will generally have a cesarean
does adenomyosis respond to estrogen/hormones?
no
What increases the risk of developing cervical cancer? (5 listed)
numerous sexual partners smoking HPV exposure chronic stress poor nutrition
What criteria must be met before diagnosing abnormal uterine bleeding?
o Vaginal bleeding that is abnormal in duration, volume, frequency, or regularity and has been present for the majority of the previous 6 months
inflammation of the ovaries is called?
oophoritis
What type of cancer causes more deaths than any other female reproductive cancer?
ovarian cancer
The uterine endometrium has an overactive response to ___________ and an underactive response to ________.
overactive response to ESTROGEN underactive response to PROGESTERONE This impairs the endometrial receptivity to blastocyst implantation and decreases the chance of a successful pregnancy.
What is the pH of the vagina with a BV infection?
pH is increased (alkaline) 5-5.5
Define dyspareunia
painful intercourse
What is the first sign of breast cancer?
painless lump
What is usually the first sign of testicular cancer?
painless testicular enlargement
what is it called when the foreskin is retracted band cannot be moved forward (reduced) to cover the glans?
paraphimosis
Who is most commonly affected by abnormal uterine bleeding?
peri-menopausal women
what is it called when the foreskin cannot be retracted back over the glans?
phimosis
Phimosis is most commonly caused by what?
poor hygiene
with a rectocele, you will see a bulge in the ______ wall of the vagina.
posterior (bottom)
What condition must be ruled out before diagnosing secondary amenorrhea?
pregnancy
what is the most common cause of secondary amenorrhea?
pregnancy
Name the 4 stages of syphilis.
primary, secondary, latent, tertiary
Abnormal uterine bleeding can be attributed to the lack of corpus luteum that produces what hormone?
progesterone
There is ________________ resistance of endometrial cells.
progesterone
Women who fail to ovulate experience irregularities in their menstrual cycle, which is related to the lack of _________.
progesterone
What is often associated with the initial development of idiopathic priapism?
prolonged sexual stimulation
what is the primary risk factor for the development of endometrial cancer?
prolonged unopposed estrogen Exposure to unopposed estrogen includes: estrogen-only hormone replacement therapy, Tamoxifen use, early menarche, late menopause, nulliparity, PCOS
Primary dysmenorrhea is associated with the release of what?
prostaglandins in ovulatory cycles
If a woman states that she needs to splint her posterior vaginal wall to accomplish defecation, what do you suspect she has?
rectocele
the bulging of the rectum and posterior vaginal wall into the vaginal canal is called what?
rectocele
inflammation of the fallopian tubes is called?
salpingitis
In what stage of syphilis does a condylomata lata form?
secondary
Secondary amenorrhea is the absence of menses for ___ months or irregular menses for ___ months in women who have ____________ _______________.
secondary amenorrhea is the absence of menses for 3 MONTHS or irregular menses of 6 MONTHS in women who have PREVIOUSLY MENSTRUATED.
In what stage of syphilis would you see systemic symptoms?
secondary syphilis
Epididymitis occurs more often in whom?
sexually active young males <35 years old
What is the most common benign breast lesion?
simple breast cyst
What is it? - solid lumps of masses composed of stromal and glandular tissue -well defined mobile solid mass on US -smooth/hard like a marble -common in ages 15-35 years - hormonal role (increase in size during pregnancy and during estrogen therapy and regress after menopause)
simple fibroadenoma
In what stage of syphilis do gummas develop?
tertiary syphilis
Rotation of the testis which twists blood vessels and the spermatic cord is known as what?
testicular torsion
where on the breast do the majority of breast carcinomas occur?
the upper outer quadrant (this is where most of the glandular tissue of the breast is located)
Why are women with polycystic ovary syndrome (PCOS) at risk for uterine cancer?
they tend to have more anovulatory cycles and produce less progesterone. Unopposed estrogen may lead to uterine cancer.
What increases the risk of developing endometrial cancer? (5 listed)
unopposed estrogen early menarche late menopause family history obesity
leiomyomas are also known as what?
uterine fibroids
decent of the cervix/entire uterus into the vaginal canal is called what?
uterine prolapse
What causes a cystocele?
weakening of the anterior vaginal wall
Do leiomyomas enlarge with exposure to estrogen?
yes
Does gonorrhea cross the placenta to the fetus in an infected mother?
yes
What are 2 normal cell types of the cervix?
§ Squamous epithelium cells § Columnar epithelial cells
The NP notes that the patient's cervix has descended half way past the hymen. This is a: a. Grade 1 prolapse b. Grade 2 prolapse c. Grade 3 prolapse d. Grade 4 prolapse
C - grade 3 prolapse
A 60 year-old female presents to the APRN's office because of vaginal bleeding. Until proven otherwise, what is the APRN's diagnosis? a. Vaginal infection b. Cervical cancer c. endometrial cancer d. endometrial polyps
C.
Breast lesions that are not clinically definitive because they encompass a heterogeneous are classified as: a. Breast cancer b. Breast cyst c. Fibrocystic changes d. Mastitis
C.
RR "Googled" symptoms of trichomoniasis before seeing the APRN and is sure they must be infected. The APRN would expect to see the following upon a vaginal exam: a. Thin, watery discharge b. Thick white discharge c. yellow-green frothy discharge d. no discharge, only odor
C.
Primary amenorrhea etiology is classified into several Compartment Disorders. Amenorrhea that involves the ovary and are often linked to genetic disorders such as Turner Syndrome and androgen insensitivity syndrome (AIS) is a: a. Compartment IV Disorder b. Compartment III Disorder c. Compartment II Disorder d. Compartment 1 Disorder
C. Compartment II
Dermoid cysts A. Are a function of ovulation B. Contain a yellowish fluid C. Contain all 3 embryo layers D. Contain clear fluid
C. Contain all 3 embryo layers
John is experiencing painful blisters on his penis. He also feels ill (like the flu). He has a fever and tender and enlarged lymph nodes in his groin. The APRN suspects he has: A. Syphilis B. Gonorrhea C. Herpes D. Condyloma acuminate
C. Herpes This is correct because: PAINFUL BLISTERS What makes this not syphilis? main symptom of syphilis is usually one chancer (one little sore) that is found
A 43-year old male presents with painless scrotal swelling one week after a motorcycle accident. He denies injury at the time of the accident. On exam, the APRN finds a painless swelling around the testicles and explains to the patient that this is: A. torsion of the testes B. A spermatocele C. A hydrocele D. Cryptorchidism
C. Hydrocele Not: -Torsion, because it's painful (medical emergency) -spermatocele is fluid around the epididymus