Patho exam 4

Why is the scrotum located outside of the abdominal cavity?

so that temperature is 3 degrees below normal body temperature ideal for sperm production

A 27-year-old woman feels a lump in her right breast. She has normal menstrual cycles, she is G3, P3, and her last child was born 5 years ago. The physician palpates a 2-cm, irregular, firm area beneath the lateral edge of the areola. The mass is not painful and does not feel firm. There are no lesions of the overlying skin and no axillary lymphadenopathy. A biopsy specimen shows microscopic evidence of an increased number of ducts, which are compressed because of proliferation of fibrous connective tissue. Dilated ducts with apocrine metaplasia also are present. What is the most likely diagnosis? (A) Traumatic fat necrosis (B) Fibrocystic changes (C) Mammary duct ectasia (D) Fibroadenoma (E) Infiltrating ductal carcinoma (B) Fibrocystic changes

(B) Fibrocystic changes (explanation: Fibrocystic changes account for the largest category of breast lumps, statistically about 40% of all breast "lumps." These lesions are probably related to cyclic breast changes that occur during the menstrual cycle. In about 30% of cases of breast lumps, no specific pathologic diagnosis can be made. Fibrocystic changes include ductal proliferation, ductal dilation (sometimes with apocrine metaplasia), and fibrosis. Fat necrosis may produce a localized, firm lesion that mimics carcinoma, but histology shows macrophages and neutrophils surrounding necrotic adipocytes, and healing leaves a fibrous scar. Inspissated duct secretions may produce duct ectasia with a surrounding lymphoplasmacytic infiltrate. A fibroadenoma is a discrete mass formed by a proliferation of fibrous stroma with compressed ductules. Carcinomas have proliferations of atypical neoplastic cells that fill ducts and can invade stroma)

A 25-year-old woman sees her physician because she has noticed a lump in her right breast. The physician palpates a 2-cm, firm, circumscribed mass in the lower outer quadrant. The figure shows the excised mass and the mammogram. What is the most likely diagnosis? (A) Phyllodes tumor (B) Fibrocystic changes (C) Fibroadenoma (D) Fat necrosis (E) Infiltrating ductal carcinoma (F) Mastitis

(C) Fibroadenoma (explanation: Grossly and radiographically, this patient has a discrete mass that in a woman her age is most likely a fibroadenoma. Phyllodes tumors are typically much larger and are far less common. Fibrocystic changes are generally irregular lesions, not discrete masses. Fat necrosis and infiltrating cancers are masses with irregular outlines. Mastitis has a more diffuse involvement, without mass effect)

A 28-year-old woman in the third trimester of her third pregnancy discovered a lump in her left breast. The physician palpated a 2-cm, discrete, freely movable mass beneath the nipple. After the birth of a term infant, the mass appears to decrease slightly in size. The infant breastfeeds without difficulty. What is the most likely diagnosis? (A) Intraductal papilloma (B) Phyllodes tumor (C) Lobular carcinoma in situ (D) Fibroadenoma (E) Medullary carcinoma (D) Fibroadenoma

(D) Fibroadenoma (explanation: Fibroadenomas are common and may enlarge during pregnancy or late in each menstrual cycle. Most intraductal papillomas are smaller than 1 cm and are not influenced by hormonal changes. Phyllodes tumors are uncommon and tend to be larger than 4 cm. Lobular carcinoma in situ is typically an ill-defined lesion without a mass effect. Medullary carcinomas tend to be large; they account for only about 1% of all breast carcinomas)

A young couple is trying to conceive their first child. The woman speaks to her mother, who tells her that she should take her temperature to determine when she ovulates. The action of which of the following hormones is respon- sible for this change in body temperature? (A) Estrogen (B) Human chorionic gonadotropin (C) Luteinizing hormone (D) Progesterone (E) Prolactin

(D) Progesterone

What can cause gynecomastia in an adolescent male?

- Gynecomastia may be drug-induced. Testicular, adrenal, or pituitary tumors - Klinefelter syndrome, secondary hypogonadism, partial or complete androgen insensitivity syndrome, hyperthyroidism, or chronic diseases (eg, cystic fibrosis, ulcerative colitis, liver disease, renal failure, and AIDS) leading to malnutrition may be associated with gynecomastia - Breast cancer in the adolescent male is extraordinarily rare. - Long time anabolic steroid use

Common warning sign of Preeclampsia

- Hypertension - Protein in urine - Upper abdominal pain - Severe & constant headaches - Swelling, especially of face - Dizziness - Blurred vision - Sudden weight gain (1lb/day)

What does a semen analysis test for?

- Infertility - types of semen analysis: male infertility check, post-vasetomy check (hospital do routine), forensic studies - A typical semen analysis measures: - Volume of semen - Viscosity—consistency or thickness of the semen - Sperm count—total number of sperm - Sperm concentration (density)—number of sperm per volume of semen - Sperm motility—percent able to move as well as how vigorously and straight the sperm move - Number or percent of normal and abnormal (defective) sperm in terms of size and shape (morphology) - Coagulation and liquefaction—how quickly the semen turns from thick consistency to liquid - Fructose—a sugar in semen that gives energy to sperm - pH—measures acidity - Number of immature sperm - Number of white blood cells (cells that indicate infection)

What are some breast changes that would increase the risk of developing breast cancer?

- Usually there is a dominant nontender mass in the breast. - Clinical findings; depends of the site of the involvement - Suspensory ligaments involved, results in retraction, revealed by: - Dimpling - Deviation of the nipples - Fixation to the pectoral muscles. - Lactiferous tubules involved results in: Flattening of the nipple - Bloody or clear discharge. - Lymphatic obstruction produces peau d'orange or a pig's skin: Edema of the skin: skin with indented deeply with holes Holes are accentuated orifices of the sweat glands - Lymphatic spread is marked by regional lymphadenopathy

A patient with benign prostatic hyperplasia (BHP) is being considered for a transurethral resection of the prostate (TURP). What complications can occur as a result of this procedure?

-Hyponatremia -Fluid overload -Water intoxication

Select the correct statement about testosterone control. A) GnRh from the hypothalamus causes FSH and LH release from the anterior pituitary. B) FSH stimulates testicular production of testosterone. C) Inhibin and testosterone exert positive feedback on the hypothalamus and pituitary. D) The pineal gland is believed to be the gland that exerts the most influence in testosterone control.

A) GnRh from the hypothalamus causes FSH and LH release from the anterior pituitary.

A boy who has not passed through puberty sustains an injury to his anterior pituitary such that FSH is no longer released, but LH is normal. After he grows to maturity, one would expect that he would ________. A) be sterile B) not develop secondary sex characteristics C) be impotent (unable to have an erection) D) have impaired function of interstitial cells

A) be sterile

A low secretion of luteinizing hormone (LH) in the normal male adult would cause ________. A) decreased testosterone secretion B) excessive beard growth C) increased spermatogenesis D) shrinkage of the anterior pituitary gland

A) decreased testosterone secretion

Which fact in the patient's history could be related to the presence of testicular cancer? A. Epispadias B. Cryptorchidism C. Hernia repair D. Uncircumcised penis

B. Cryptorchidism

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? A. A 30-year-old white male with a history of cryptorchidism B. A 48-year-old African American male with erectile dysfunction C. A 19-year-old Asian male who had surgery for testicular torsion D. A 28-year-old Hispanic male with infertility caused by a varicocele

A. A 30-year-old white male with a history of cryptorchidism (explanation: The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.)

The nurse is caring for a 62-year-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? A. Avoid straining during defecation. B. Restrict fluids to prevent incontinence. C. Sexual functioning will not be affected. D. Prostate exams are not needed after surgery.

A. Avoid straining during defecation. (explanation: Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.)

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test? A. Ultrasound B. Cremasteric reflex C. Doppler ultrasound D. Transillumination with a flashlight

A. Ultrasound (explanation: When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele)

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? A. diminished reflexes B. elevated liver enzymes C. seizures D. serum magnesium level of 6.5 mEq/L

A. diminished reflexes

During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition? A. mild preeclampsia B. gestational hypertension C. severe preeclampsia D. eclampsia

A. mild preeclampsia

Tumor impinging the supraoptic nucleus of hypothalamus would affect secretion of what hormone?

ADH

Common cause of abnormal vaginal bleeding during reproductive years

Abnormal uterine bleeding in reproductive age: top differential dx (4) 1. Pregnancy 2. Premature ovarian failure 3. Thyroid dysfunction 4. Hyperprolactinemia (#2 - Hypothyroidism causes anovulation in females of reproductive age and is frequently associated with menorrhagia and intermenstrual bleeding)

A 73-year-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse would give the patient anticipatory guidance that which of the following conditions is likely to be developing? A) A tumor of the prostate B) Benign prostatic hyperplasia C) Bladder atony because of age D) Age-related altered innervation of the bladder

B) Benign prostatic hyperplasia

A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? A. E. coli bacteria in his urine B. A very tender prostate gland C. Complaints of chills and rectal pain D. Complaints of urgency and frequency (explanation: A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatis)

B. A very tender prostate gland (explanation: A tender and swollen prostate is indicative of prostatis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatis)

Which diagnostic evaluation is used for a patient with a suspected testicular cancer? A. Prostate-specific antigen (PSA) B. α-Fetoprotein (AFP) C. Complete blood cell count D. Urine and semen analyses

B. α-Fetoprotein (AFP) (explanation: Palpation of the scrotal contents is the first step in diagnosing testicular cancer. A cancerous mass is firm and does not transilluminate. Ultrasound of the testes is indicated when testicular cancer (e.g., palpable mass) is suspected or when persistent or painful testicular swelling is present. If testicular cancer is suspected, blood is obtained to determine the serum levels of AFP, lactate dehydrogenase (LDH), and human chorionic gonadotropin (hCG).)

Tests to confirm breast cancer.

Biopsy

A pituitary adenoma impinging on the optic chiasm can cause what?

Bitemporal hemianopsia

The most important risk for testicular cancer in young males is ________. A) smoking B) a diet high in fat C) nondescent of the testes D) sexually transmitted diseases

C) nondescent of the testes (cryptorchidism)

Development of male reproductive structures depends on which of the following events? A) that the female hormones are suppressed during pregnancy B) the suppression of inhibin C) secretion of male hormones prenatally and lasting into the first few months after birth D) that human gonadotropin be synthesized in the first week of the pregnancy

C) secretion of male hormones prenatally and lasting into the first few months after birth

The nurse teaches a patient about testicular self-examination. Which statement would be appropriate for the nurse to include? A "Testicular cancer usually affects men after 50 years of age." B. "Avoid self-examination because lesions are difficult to detect." C. "The cure rate of testicular cancer is almost 100% when detected early." D. "There is no need to worry if any hard lumps on the testicles are painless."

C. "The cure rate of testicular cancer is almost 100% when detected early." (explanation: The cure rate of testicular cancer is almost 100% if the treatment begins before metastasis. The nurse should instruct the patient to report any painless hard lumps on the testicles, because some tumors are painless. The nurse should teach testicular self-examination to the patient, because the patient can detect any lumps and report immediately. Testicular cancer usually occurs in males between 15 and 35 years of age.)

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A. A systolic blood pressure increase of 10 mm Hg B. Weight gain of 1.2 lb (0.54 kg) during the past 1 week C. A dipstick value of 2+ for protein D. Pedal edema

C. A dipstick value of 2+ for protein

______________ may be a cause of vaginal bleeding in a patient who states that she is NOT pregnant. Select one: A. Bacterial vaginosis B. Hypotension C. Ectopic pregnancy D. Menopause

C. Ectopic pregnancy

A 17-year-old primigravida has gained 4 pounds since her last prenatal visit. Her blood pressure is 140/92 mm Hg. The most important nursing action is to: A. advise her to cut down on fast foods that are high in fat. B. caution her to avoid salty foods and to return in 2 weeks. C. assess weight gain, location of edema, and urine for protein. D. recommend she stay home from school for a few days to reduce stress.

C. assess weight gain, location of edema, and urine for protein.

35-year-old multigravida with hypertension of 150/100 mmHg before 20 weeks gestation. This would be classified as:

Chronic HTN (preeclampsia after 20 weeks)

A 25-year-old woman has noted breast secretions for the past month. She is not breastfeeding and has never been pregnant. She has not menstruated for the past 5 months. Physical examination yields no abnormal findings. MRI of the brain shows a 0.7-cm mass within the sella turcica. Which of the following additional complications is she most likely to have? A Acromegaly B Cushing disease C Hyperthyroidism D Infertility E Neurologic dysfunction

D. Infertility (explanation: D Prolactinomas are more common than other hormone secreting pituitary adenomas. In addition to her galactorrhea and infertility, this patient also may have decreased libido, and her amenorrhea is secondary to the excessive prolactin secretion. Microadenomas might not have pressure effects on surrounding structures such as optic , but they can be discovered because of their hormonal effects. Acromegaly results from a growth hormone-secreting pituitary adenoma in an adult. Cushing disease occurs when there is an ACTH secreting pituitary adenoma. A thyroid-stimulating hormone (TSH)−secreting pituitary adenoma is uncommon, but it could account for elevated levels of T4 and TSH in a hyperthyroid patient. Neurologic dysfunction with hyponatremia from the syndrome of inappropriate diuretic hormone leading to neurologic dysfunction is most often a paraneoplastic syndrome caused by a small cell anaplastic lung carcinoma, but may also be due to head trauma that damages the nerve tracts and neurohypophysis with uncontrolled release of vasopressin (antidiuretic hormone, ADH))

What to ask a patient with Pelvic Inflammatory Disease while obtaining her history?

sexual history

Which of the following clinical presentations is MOST consistent with pelvic inflammatory disease (PID)? A. Upper abdominal cramping, severe headache, and heavy vaginal bleeding B. Left lower quadrant pain, referred pain to the left shoulder, and fever C. Pain around the umbilicus, low-grade fever, and generalized weakness D. Lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

D. Lower abdominal pain, fever, general malaise, and foul-smelling vaginal discharge

Major types of breast cancer

Ductal Carcinoma In Situ DCIS Invasive Ductal Carcinoma IDC - most common Tubular Carcinoma of the Breast type of IDC Medullary carcinoma of the breast type of IDC Invasive Lobular Carcinoma - second most common Lobular carcinoma in situ Paget's disease of the nipple

Male patient with painful scrotal pain, edema, nausea, vomiting, chills, and fever. What might this patient have?

Epididymitis due to gonorrhea (#1 cause of it)

A hypersecretion of prolactin in a young man could eventually cause what in the future?

Erectile dysfunction or impotence

A growth hormone secreting adenoma can cause the development of what syndrome/finding?

Gigantism (child) or Acromegaly (adult)

Complications that can arise due to a Transurethral Resection of the Prostate (TURP)

Hemorrhage, hypotension, large blood clots, decreased urinary output

Elevated estrogen levels in Polycystic Ovary Syndrome (PCOS) can increase risk of what?

Infertility/anovulation

Type of breast cancer with high risk of contralateral malignancy

Lobular carcinoma in situ

Clinical findings on physical examination of peau d'orange (breast)

Lymphatic obstruction

What finding would make PCOS unlikely? (usual findings listed)

Manifested by: Hirsutism, large ovaries, infertility, amenorrhea, insulin resistance, obesity, dysmenorrhea, persistent anovulation

Female patient with abdominal pain, vaginal discharge, and low-grade fever. What might be her current condition?

PID

When teaching a male patient on proper testicular self-examination, what should you mention to patient about testicular cancer?

Painless lump, scrotal swelling, feeling of heaviness

24 year-old primigravida at 37 weeks with 8 lb increase; BP increased to 110/60 mmHg and has 1+ proteinuria. What is her current condition based on these clinical findings?

Preeclampsia

Clinical/tests findings of Preeclampsia-Eclampsia

Preeclampsia Eclampsia new HTN after 20 weeks of gestation presenting with proteinuria HTN, proteinuria, edema BP > 140/90 Eclampsia predisposition to DM convulsive (seizures) condition associated with preeclampsia HELLP - Hemolysis (CBC), Elevated Liver enzymes (AST/ALT), Low Platelets (PT/PTT/Fibrinogen) - Pts with gestational and pregestational DM are greater risk for preeclampsia-eclampsia - One of the most common causes of maternal death is US and developed world - Risk for the fetus = intrauterine growth restriction (IUGR) and fetal hypoxia

What processes are stimulated by secretion of progesterone?

Progesterone prepares the body for pregnancy by causing the uterine lining to thicken

Which testosterone level test is a less sensitive indicator of hypogonadism after age 50 due to aging and increased SHBG but is recommended by most guidelines?

Serum Total Testosterone (TT)

Findings usually seen in HELLP Syndrome

The three chief abnormalities found in HELLP syndrome are: - Hemolysis - Elevated Liver enzyme levels - Low Platelet count The hematocrit may be decreased or normal and is typically the last of the three abnormalities to appear.

Microadenoma of adenohypophysis in 25-year-old female patient. What complications may arise?

Tickles the pituitary so inappropriate secretion of hormones (ex: prolactin/prolactinoma)

Common causes of primary amenorrhea

Turner syndrome, ovarian insufficiency (only ones from ppt that specified primary amenorrhea) Most common complication in nonpregnant pt with amenorrhea is infertility

The best time to achieve pregnancy

You're most likely to get pregnant if you have sex within a day or so of ovulation (releasing an egg from the ovary). This is usually about 14 days after the first day of your last period, if your cycle is around 28 days placenta long. An egg lives for about 12-24 hours after being released.

Which of these hormones blocks milk production during pregnancy? a. Progesterone b. Prolactin c. Chorionic somatomammotropin d. Thyroxine e. Insulin

a. Progesterone

Vaginal thinning seen in postmenopausal patients can increase risk of developing what?

atrophic vaginitis

What would be correct/crucial on evaluating the axillary lymph nodes in a patient with breast cancer?

axillary lymphadenopathy

A 43-year-old male develops a brain tumor that impinges on the supraoptic nucleus in the hypothalamus. As a result, the secretion of which of the following hormones is affected? a. Adrenocorticotropic hormone (ACTH) b. Antidiuretic hormone (ADH) c. Follicle-stimulating hormone (FSH) d. Growth hormone (GH) e. Prolactin

b. Antidiuretic hormone (ADH) (explanation: Antidiuretic hormone (ADH), also called arginine vasopressin (AVP), is secreted from the posterior lobe of the pituitary gland (neurohypophysis) into the general circulation from the endings of supraoptic neurons in the hypothalamus. ACTH, FSH, GH, and prolactin are all secreted by the anterior pituitary gland (adenohypophysis) into the portal hypophyseal circulation from the endings of arcuate and other hypothalamic neurons.)

A male student comes to the campus clinic complaining of painful scrotal edema, nausea, vomiting, chills, and fever. What should the nurse recognize these signs and symptoms as being associated with? a. Orchitis b. Epididymitis c. Urethritis d. Cystitis

b. Epididymitis

While obtaining a health history from a patient hospitalized with pelvic inflammatory disease (PID), the nurse recognizes that a risk factor related by the patient includes a. the use of oral contraceptives. b. sexual exposure to a partner with urethritis. c. use of superabsorbent tampons. d. history of long-term antibiotic treatment.

b. sexual exposure to a partner with urethritis. (Rationale: Exposure to a male partner with urethritis (which suggests infection with a sexually transmitted disease [STD]) introduces the bacteria into the vagina and cervix, allowing the organism to ascend to the other reproductive structures. Oral contraceptive use, use of superabsorbent tampons, and long-term antibiotic therapy do not increase risk for PID.)

A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? a. Requires two tablets of Tylenol #3 during the night b. Complains of fatigue and claims to have minimal appetite c. Continuous bladder irrigation (CBI) infusing, but output has decreased d. Expressed anxiety about his planned discharge home the following day

c. Continuous bladder irrigation (CBI) infusing, but output has decreased

Disease caused by inadequate secretion of ADH

diabetes insipidus (symptom = polyuria)

What cause would be life threatening in an adult woman with abnormal vaginal bleeding?

endometrial cancer, cervical cancer (HPV)

Female with pelvic pain during monthly period for many months. Tests are negative. She has been trying to conceive, but with no success. What might be her current condition?

endometriosis

Causes of secondary dysmenorrhea

endometriosis (most common)

34 year-old woman with a 2.5 cm lump, firm ovoid, movable, with very defined edges in outer quadrant of right breast. What would be associated with these clinical findings?

fibroadenoma

Transportation of hormones from hypothalamus to pituitary occurs how?

hypothalamic-pituitary-adrenal (HPA) axis or neuroendocrine axis

52 year-old man with hematospermia, hematuria, and weight loss. What study must be ordered to determine current condition.

identifiable bacteria recurrence tx 12-16wks uncommon type 50-80years no systemic illness slow onset of symptoms with outflow type symptoms: dribbling, hesitancy and loss of stream and forse hematuria, hematospermia, painful ejaculations presentation: febrile, lower abdominal pain, back pain, dysuria, pain with intercourse, bm, nocturia and hesitancy prostate enlarged and boggy --> chronic bacterial prostatitis

A 38-year-old male is upset about his low sperm count and visits a "practitioner" who commonly advertises his miracle cures of sterility. The practitioner is a quack who treats conditions of low sperm count with megadoses of testosterone. The patient experiences a huge surge in libido. Would this treatment result in a higher or lower sperm count, and why?

lower sperm count. high levels of testosterone inhibit the release of GnRH, inhibiting FSH release, resulting in direct inhibition of spermatogenesis

Clinical findings of Fibrocystic breast disease

multiple mobile bilateral small tender masses that vary in size during menstrual cycle

Medical term for abnormal placenta development covering the cervix.

placenta previa - associated with third trimester bleeding

Seen on urinalysis in-patient with Preeclampsia

proteinuria

Clinician notices tissue protruding from the vaginal opening at examination of a female patient. This could be what?

rectocele (posterior rectal prolapse)

Process of spermatogonia developing into spermatozoa

spermatogenesis