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85 Cards in this Set
- Front
- Back
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Amenorrhea |
primary: absence of menarche by 16 secondary: cessation of menstrual flow after cycle has been established MOST COMMON IS PREGNANCY
Teens should be referred for chromosomal defects, anatomical anomalies, hormone imbalance, tumor, or trauma
Tests PRN pregnancy endocrinology referral |
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PAP Smear |
Normal findings no atypia no malignancy
If infection detected, repeat PAP 3-4 months after treatment
IF Cervical Intraepithelial Neoplasia is 2 or 3, refer
start at age 21 or 3 years after sexual intercourse begins
21-29 every 3 years 30-65 every 5 years stop >65 unless cause for screening (CIN2 or 3) total hysterectomy no PAP |
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Vuvlovaginitis |
Inflammation of the vulva and vagina commonly caused by bacteria
Trich, BV, and candida usually
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Trichomonas |
S/S: frothy yellow green discharge pruritis viral eyrthema "strawberry patches" on cervix dyspareunia dysuria
Diagnostic tests: normal saline shows motile trichomonads
Management: metronidazole (flagyl) PO |
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Bacterial vaginosis |
S/S: watery gray FISHY SMELL
Diagnostic tests: normal saline will show CLUE cells
Management: Flagyl PO Clindamycin (Cleocin) cream or PO |
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Candidiasis |
S/S: Thick white curd-like d/c vulvovaginal erythema pruritis
Diagnostic tests: KOH show hyphae
Management: Miconazole intravaginally at HS Terconazole suppository Butaconazole 3 applications |
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PID |
inflammation of the uterus, fallopian tubes, ovaries, and surrounding tissues that lead to infection
S/S: fever/chills n/v vaginal discharge dysuria dyspareunia lower abd pain infertility
PE: cervical motion tenderness adnexal tenderness fever >38 abd tenderness
Management: Outpatient Ofloxacin (Floxin) x 14 days levofloxacin with or without metronidazole x 14d
Cefoxitin (mefoxin) IM PLUS Benemid PO PLUS doxy x 14 days……..with or without metronidazole |
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Dysmenorrhea |
camping with menstruation
primary: adolescent women due to high levels of prostaglandin
secondary: over age 20 and typically associated with some type of pelvic disease |
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S/S Dysmenorrhea |
cramping that radiates to back and upper thighs HA diarrhea fatigue occasional n/v self-limiting to 72 hours
PE: normal pelvic pain with uterine tenderness during menses |
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Treatment of dysmenorrhea |
Prostaglandin synthetase inhibitors NSAIDS ibuprofen naproxen indomethacin
Oral contraceptives excercise high fiber diet reduce sugar reduce caffeine reduce salt |
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Oligonmenorrhea |
infrequent irregular frequency > 40 days |
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Polymenorrhea |
frequent irregular frequency < 18 days |
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Menorrhagia |
regular frequency excessive and prolonged bleeding |
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Metrorrhagia |
bleeding between cycles |
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Menometrorrhagia |
Prolonged frequent excessive irregular |
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Intermenstrual |
variable between cycles |
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Diagnostic tests for abnormal uterine bleeding |
hCG prolactin TSH CBC PAP STD screen UA
consult and refer |
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Premenstrual Syndrome (PMS)/Premature Dysphoric Disorder (PDD) |
Peaks during 30s Quickly decreases after 41
S/S: body aches breast tenderness feeling bloated headaches food cravings poor coordination hypersensitivity irritability mood swings depressive moods anxiety tension fear of loss control
Management: Palodel Xanax BuSpar Nortriptyline Pamelor Anafranil Tenormin
Restrict caffeine Restrict salt exercise Take vit E Take vit B6 |
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Fibrocystic Breast Disease |
Benign breast condition with increased growth and fibrosis of breast tissue |
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S/S Fibrocystic Breast Disease |
breast tenderness related to cycle modularity with cyst formation or enlargement breast discharge |
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PE Fibrocystic Breast Disease |
tenderness to area variable number of cysts mobile variable may be round, nodular, soft, firm usually no nipple d/c but if there its clear |
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Diagnostic tests for Fibrocystic Breast Disease |
mammography FNA cytology excision biopsy that allows staging |
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Management of Fibrocystic Breast Disease |
warm soaks TID low sodium diet vitamin supplements hormonal therapy surgical intervention |
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Breast cancer |
malignancy of breast tissue |
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S/S breast cancer |
non-tender painless mass asymptomatic late symptoms: pain erythema dimpling ulceration nipple retraction |
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PE Breast cancer |
non-tender with poorly defined borders fixed and firm (can't move) dimpling nipple retraction bloody d/c lymphadenopathy may have no nipple d/c |
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Diagnostic test for Breast Cancer |
mammography FNA cytology excision biopsy that allows staging |
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Management for Breast Cancer |
refer for surgery, chemo, radiation, HRT |
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Breast Cancer Screening |
begins at age 40
annually 40-70
continue
SBE |
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Menopause |
cessation of ovarian production whether from aging, chemo, surgical removal, or radiation
starts between 45-55 and lasts one year median age is 51
S/S: dry skin, loss of elasticity, changes in pigment CV decreased breast size and tone mood changes, depression, sleep disturbance osteoporosis
atrophy and thing of vulva tissue, loss of hair thin vagina, vaginitis, dyspareunia, decreased stimulation prolapsed uterus, decreased tone, reduced size
Management: HRT estrogen (Premarin, Estrace, Estraderm, Climara) progestin (cyclic or continuous, NOT if HYSTERECTOMY) exercise Ca
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Osteoporosis |
change in bone structure due to reduction in quantity rather than composition
results in abnormally low bone mass |
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What does osteoporosis in menopause result from? |
loss of estrogen |
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Risk factors for Osteoporosis |
female white asian elderly early menopause estrogen deficient small frame or underweight family hx high consumption caffeine, phosphates, NA, protein smoking low Ca intake alcoholosim thyroid hormones corticosteroids
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Testing for Osteoporosis |
DEXA scan
Tscores: > -1.0 normla -1.0 to -2.5 is osteopenia (low bone mass) Below -2.5 osteoporosis
Bone density recommended: all women > or equal to 65 all postmenopausal women <65 with one or more additional risk: family hx smoking excessive exercise excessive alcohol use corticosteroid use hyperthyroidism slender body size
postmenopausal women with fractures HRT for extended periods of time
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PREVENTION for Osteoporosis |
Estrogen replacent
weight bearing exercise 30 min. mod. exercise 3-5 x week walking, jogging, dancing, climbing stairs, aerobics, strength training
Increase Ca intake or supplementation 11-24 = 1200-1500 mg 25-49 = 1000 mg 50-64 = 1500 mg if not taking ERT 50-64 = 1000 mg if taking ERT Over 65 = 1500 mg
dairy salmon sardines green leafy veggies tofu calcium fortified foods Vit D 800-1000 IU/day
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Drug therapies for Osteoporosis |
BIphoshonates
Actonel Fosomax Boniva
take with full glass H2O NPO 30 minutes to one hour after taking Sit upright for 30 minutes to 1 hour after |
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UTI |
usually E. coli
Lower: cystitis, urethritis/dysuria frequency syndrome
Upper: pyelonephritis, renal abscess |
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S/S lower UTI |
DYSURIA IS KEY SYMPTOM Frequency Nocturia Urgency Hematuria (40-60% of patients) |
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Lab/Diagnostics for Lower UTI |
UA: generally shows pyuria
Presence of nitrate by dipstick is very specific but not sensitive for bacteria
Esterase detection by dipstick is very sensitive but not specific |
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Management of Lower UTIs |
3 days maximizes benefits and minimizes drawbacks of tx
Bactrim Cipro Augmentin
Others considered: Amoxicillin Levaquin Macrobid Macrodantin |
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What med to use if lower UTI in pregnancy |
Amoxicillin Macrobid Keflex
With pregnancy will not increase dose, but can increase length of treatement
Treatment will be 7-10 days |
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S/S Acute Pyelonephritis |
flank pain low back pain abdominal pain FEVER AND CHILLS USUALLY INDICATE UPPER UTI n/v mental status changes in elderly |
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Lab/Diagnostics for Acute Pyleonephritis |
WBC casts on UA ESR elevated |
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Management of Upper UTIs |
14 day course vs. 6 week course
Bactrim Cipro Augmentin Gentamicin Tobramycin
severe cases or those with n/v should be hospitalized |
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Urinary Incontinence |
Types:
Stress
Urge
Mixed
Other |
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Stress Incontinence |
caused by muscle impairing urethral support
Urine leakage from activities such as lifting, coughing, exercise, sneezing, laughing, climbing stairs |
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Urge Incontinence |
caused by: destructor hyperactivity by CNS abnormalities such as stroke Infections of GU tract Urinary stones Neoplasms
Urgency involuntary urinary loss nocturia frequency
Often referred to as overactive bladder |
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Management of Stress Incontenence |
diary of recent urinary activities (fluids, voids, incontenence events)
timed voids to prevent full bladder
pessary
surgery |
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Management of Urge Incontenence |
Urge suppression/distraction
Quick pelvic contractions
Medication |
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Patient teaching for incontenence |
weight loss fluid management (drink for thirst only and use lozenges for dry mouth) avoid caffeine kegals |
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Bladder control strategy for urge control |
freeze and squeeze |
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bladder control strategy for stress control |
squeeze before you sneeze (or lift, etc) |
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Immediate release meds for incontinence |
ditropan detrol sanctura |
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Extended release meds for incontinence |
enablex toviax ditropan XL vesicare detrol LA oxytrol gelnique |
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Epididiymitis |
acute inflammation or infection of the scrotum secondary to an inflamed epididymis
Generally <35 yrs old
If >35, likely a bacterial infection from bladder or from surgery |
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S/S Epididimytis |
pain dysuria urgency/frequency low back/perineal pain fever/chills malaise scrotal edema |
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PE Epididymitis |
enlarged, tender epididymis urethral discharge may be evident positive prehn's sign |
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Prehn's sign |
if you lift the testicle, the pain goes away |
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Diagnostic tests for Epididymitis |
STD testing Culture of the urine Scrotal Ultrasound |
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Management of Epidiymis |
Refer if septicemia is suspected
<35: Ceftriaxone PLUS Doxy Azithromycin one gram orally
>35: TMP/SMZ-DS Cipro
Support/elevate scrotum Analgesics NSAIDS ice (early on) heat (late) bed rest |
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Acute Bacterial Prostatitis |
Inflammation of prostate
Usually gram-negative like E.Coli
Nonbacterial (most likely in young men): chlamydia, mycoplasma, gardnerella |
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S/S Acute Bacterial Prostatitis |
fever chills low back pain dysuria urgency/frequency nocturia |
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PE Acute Bacterial Prostatitis |
edematous prostate may be warm and tender/boggy to palpation and pain |
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Diagnostic test for Acute Bacterial Prostatitis |
UA positive for causative agent |
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Management of Acute Bacterial Prostatitis |
Consult or refer if septicemia or urinary retention evident
Bactrim Levaquin Noroxin Floxin
Sitz baths TID for 30 min each time
No sexual intercourse until acute phase resolves |
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Benign Prostatic Hypertrophy (BPH) |
progressive hyperplasia of the prostate
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S/S BPH |
urgency/frequency nocturia dribbling retention |
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PE BPH |
bladder distention prostate is non-tender with asymmetry of prostate or symmetrical enlargement smooth, rubbery consistency with possible nodules |
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Lab/Diagnostic for BPH |
UA to rule out UTI NO hematuria with UTI Abd ultrasound to r/o upper tract patho BUN/Cr are normal PSA > 4 indicates disease DRE |
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Management of BPH |
observe and consult/refer to urology PRN
Alpha-Blocers: to relax muscles of bladder & prostate Hytrin Minipress Flomax
5-alpha reductase inhibitors: shrink large prostates Proscar Avodart
Saw palmetto can be effective for some |
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Prostate cancer |
malignant neoplasm of prostate |
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S/S Prostate cancer |
usually asymptomatic
may appear to be BPH in early stages (frequency, crippling, nocturia)
advanced stages: bone pain from metastasis |
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PE Prostate cancer |
adenopathy bladder distention prostate palpates harder than normal obscure boundaries of prostate nodules may be present |
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Lab/Diagnostics Prostate Cancer |
PSA > 4
Abnormal age specific ranges : 40-49 < 2.5 50-59 <3.5 60-69 <4.5 70-79 <6.5
THE HIGHER THE PSA, THE MORE LIKELY CANCER
~ 40% OF PROSTATE CA SHOWS UP PSA WNL
Needle biopsy of prostate
ultrasound to identify solid nodules |
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Management of Prostate Cancer |
refer for surgery, radiation, HRT |
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Stress causes of erectile dysfunction |
psychosocial anxiety (performance)
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Recreational drug causes of erectile dysf |
alcohol amphetamines barbiturates cocaine marijuana methadone nicotine opiates |
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What diseases can cause erectile dysf |
atherosclerosis diabetes |
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Medications that can cause erectile dysf |
diuretics antihypertensives H2 blockers antidepressants anti-anxiety agents anti-epileptics antihistamines NSAIDs muscle relaxants Parkinson's disease meds |
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Management for erectile dysf |
check testosterone level
Phoshodiesterase Inhibitors: viagra levitra cialis avanafil |
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Viagra |
works: 30 min lasts: 4 hours take: with food
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Levitra |
works: 60 min lasts: 4 hours take: without food |
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Cialis |
works: 15 min lasts: up to 36 hours take: with or without food
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Avanafil |
works: 15 min lasts: up to 36 hours take: with or without food |
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Gerentology considerations |
LOOK AT PGS 266-267 |
