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42 Cards in this Set
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- Back
Dysmenorrhea
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painful menstruation
Can be primary or secondary Dysmenorrhea * Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation * Secondary: pelvic disease present. Common causes: endometriosis, cervical os stenosis, fibroids, cancer |
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Menorrhagia
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abnormally heavy menstrual flow, greater than 80cc per menses
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Leukorrhea
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any vaginal discharge than blood- often a symptom of vaginal or cervical infection
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Endometrosis medical management
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mild analgesics, NSAIDS, OCPs
Comfort measures: heating pads, relaxation, biofeedback |
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Menstruation
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* Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days) * Average duration of flow is 2-7 days * Average blood loss is 30-80cc * Requires intact hypothalamus, pituitary gland, ovaries, and uterus |
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Amenorrhea
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* Defined absence of menstrual flow
* What is the most common cause???? * Other causes: anxiety, fatigue, chronic illness, extreme dieting, strenuous exercise |
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Metorrhagia
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bleeding between menstrual periods
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Endometriosis
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* Defined as abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow * Causes intense pain * Can lead to infertility * Can lead to painful intercourse * Treatment can be medical or surgical |
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Premenstrual Syndrome
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* Symptoms occur during the luteal phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels * Most common in 30-40 year olds * Severity increases with age until menopause |
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PMS Emotional symptoms
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irritability, easily induced crying spells, low self esteem, anxiety, and depression
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PMS Risk factors
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after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses
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PMS Physical symptoms
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breast tenderness, bloating, fluid retention, increased appetite and food cravings, insomnia, fatigue, hot flashes, headaches, and musculoskeletal discomfort
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PMS Cognitive symptoms
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short term memory problems, difficulty concentrating, and unclear thinking
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PMS treatment
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* Diet: eliminate caffeine; limit sodium intake
* Medications (most are controversial) mild K+ sparing diuretics, progesterone, Parlodel, OCPs, antidepressants, prostaglandin inhibitors, and NSAIDS |
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Menopause
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* Refers to the last menstrual period- the actual date cannot be determined until one year passes without menses
* FSH and LH levels increase * Decreased estrogen levels affect the reproductive system, CV system, and bone density |
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Effects of Menopause
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* Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis * During perimenopausal phase: hot flashes, emotional changes, and fatigue |
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Cervical Cancer
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* Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV * Classic symptom: painless vaginal bleeding (starts as spotting between menstrual periods or after sex as malignancy grows, the bleeding increases in frequency, duration, and amount) * Treatment varies on stage of cancer and includes many non-surgical and surgical techniques |
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Ovarian Cancer
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* Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates * Tumors grow and spread rapidly and are often bilateral |
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Ovarian Cancer Risk Factors
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* Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer * Nulliparity * Infertility * History of dysmenorrhea or heavy bleeding * Diets high in animal fat * Age older than 40- peaks at age 50-55 |
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Ovarian cancer symptoms
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* abdominal pain or swelling; dyspepsia, indigestion, gas
* Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding * The only sign may be an abdominal mass- may not be identifiable until size reaches 6 inches * Pap only abnormal in 20-30% * CA-125 may be elevated (not diagnostic- used to eval progress) * USG and CT can be diagnostic tools * Exploratory laparotomy used to dx and stage tumors |
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Treatment of Ovarian Cancer
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* Similar to cervical cancer
* Tx depends on stage of cancer * Chemotherapy * Radiation * Surgery |
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Breast Cancer
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* Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90% * When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25% Early detection methods * Self breast exam needs to be done monthly in women over 20 * Mammography- begin age 40, then annually * Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes |
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Assessment of Breast Cancer
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* Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau d orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration * Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment |
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Treatment of Breast Cancer
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* Nonsurgical (rarely done alone, except in inoperable cases): chemotherapy, radiation
* Surgical 1. Lumpectomy: local excision and resection 2. Partial mastectomy: removal of portion of breast that contains the tumor 3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact) |
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Benign Prostatic Hypertrophy
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* Occurs in almost all men with aging
* Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland * Leads to narrowing of prostatic urethral channel |
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Symptoms of BPH
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* Urinary frequency
* Nocturia * Urinary hesitancy * Hematuria * Diminished force of urinary stream * Post-void dribbling * Bladder distention * Possible renal insufficiency (edema, pallor, pruritis) * Uniform, elastic, nontender palpable prostate |
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BPH Laboratory assessment
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* CBC (infection or anemia)
* BUN & serum creatinine (eval renal function) * Prostate specific antigen (PSA) to rule out malignancy * Flowmetry- evaluates flow rate and residual urine |
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BPH Interventions
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* Pharmacologic
1. finasteride (Proscar) shrinks prostate gland and improves urine flow by decreasing the level of dihydrotestosterone (DHT), which is responsible for prostate growth 2. alpha-adrenergic agonists (Cardura & Flomax) cause constriction of prostate gland, which urethral pressure, improves urine flow, and decreases residual mass |
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BPH Interventions
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* Nonsurgical measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time * Avoid alcohol, caffeine, and diuretics * Void as soon as urge is felt ***Prevent overdistention of bladder, which leads to loss of tone ***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants Operative interventions * Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate |
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Prostate Cancer
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* Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50 * If at risk (prostate CA in 1st degree relative or African American), need screening earlier * DRE yields hard, irregular prostate |
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PSA
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* Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL * Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis * PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA) |
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Menarche
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First menstrual period
Average age of onset 12 to 13 years old Can range from 9-17 years old and still be within normal limits Often anovulatory |
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Prostate Cancer screening
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* Transrectal USG
* If malignancy suspected, need biopsy * After dx made, need CT of pelvis to assess nodes * Bone scan can determine metastasis * Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone |
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Prostate Cancer Interventions
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* Many similar to BPH
* Advanced cases require pelvic lymphadenectomy * Radical Prostatectomy- removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes |
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Radical Prostatectomy
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* Patient is sterile, but ability to have erection and orgasm shouldnt be permanently impaired
* May have erectile dysfunction if damage is done to pudendal nerve during surgery * Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley |
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Prostate Cancer treatments
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* Chemotherapy
* Radiation * Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, or Depo-Provera |
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Erectile Dysfunction
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* Inability to maintain an erection for sexual intercourse
* Can be organic or functional |
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Organic ED
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* Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; DM; thyroid dysfunction; smoking; ETOH; certain medications |
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Functional ED
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* Psychologic cause
* Have normal nocturnal and morning erections * Usually precipitated by stress |
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ED Pharmacologic Treatment
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Viagra can be used to treat both types of ED
-take the pill 1 hour before intercourse -need stimulation to achieve erection -must abstain from alcohol- can impair erectile ability -common SE: HA, facial flushing, diarrhea -men taking nitrates cannot take Viagra because of vasodilatation effects |
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Testicular Cancer
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* Most common malignancy in men ages 15-35
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection * Testicular CA rarely bilateral- if it is, usually metastatic * Early detection aided by self exam Diagnostic Assessment * Primary tumor markers are alpha-fetoprotein and hCG * Benign testicular tumors NEVER cause an increase in these markers Patient education * May wish to store sperm in sperm bank to preserve for future use * Insurance may cover these expenses * Also need counseling regarding anxiety and body image disturbances * May be candidate for silicone prosthesis * Need monthly TSE on remaining testicle |
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Estrogens inhibit the release of LH from the pituitary
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*
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