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NR509 Final Exam Questions With Accurate Answers
Risk factors for breast cancer - accurate answers-1) age 2) BRCA status 3) breast density on mammo 4) Hx of breast CA 5) Family Hx 6) reproductive factors affecting duration of uninterrupted estrogen exposure Best time to do self breast exam - accurate answers-5-7 days after menses Mammary duct ectasia - accurate answers-tendor cords- dilated ducts with surrounding inflammation and masses. Benign Documenting breast nodules - accurate answers-1) location 2) size-cm 3) shape- round, cystic, disclike, irregular contour 4) consistency 5) delimitation- well circumscribed or not 6) tenderness 7) mobility in relation to skin, fascia, chest wall (check by moving breast near the mass and watch for dimpling) A mobile breast mass that becomes fixed when the arm relaxes is attached to what? - accurate answers-ribs and intercostal muscles hard, irregular, poorly circumscribed nodules fixed to the skin or underlying tissues suggests what? - accurate answers-Breast Cancer when hand is pressed against hip and mass becomes fixed it is attatched to what?
- accurate answers-pectoral fascia nonpuerperal galactorrhea - accurate answers-milky discharge unrelated to a prior pregnancy and lactation. Causes include hypothyroidism, pituitary prolactinoma, and drugs that are dopamine agonists, including many psychotropic agents and phenothiazines unilateral bloody nipple discharge from 1-2 ducts indicate - accurate answers- intraductal papilloma, ductal CA in situ, Paget's Disease Benign ductal discharge include - accurate answers-clear, serous, black, or nonbloody discharge multiductal Hidradenitis suppurativa - accurate answers-sweat gland infection from follicular occlusion
ancanthosis nigricans - accurate answers-deeply pigmented and velvety axilla d/t obesity, DM, PCOS, malignant paraneoplastic disorder (rare) enlarged lymph nodes indicate - accurate answers-infection of the hand/arm, recent immunizations/skin test, generalized lymphadenopathy Check epitrochlear nodes medial to the elbow and other groups of nodes Nodes that suggest malignancy - accurate answers-larger than 1-2cm firm and hard, matted or fixed to the skin pectoral nodes- palpate inside the border of the pectoral muscle lateral nodes- high in axilla, upper humerus subscapular- stand behind pt and feel inside the muscle of the post axillary fold infra/supraclavicular visible signs of breast cancer - accurate answers--Retraction signs: abnormal contours, skin dimpling, nipple retraction and deviation -Skin edema (Peau d'orange sign) -Paget's Disease of the Nipple (eczema-like lesion on nipple causes of female incontinence - accurate answers-weak pelvic floor muscle- cystocele, rectocele, enterocele, DM, MS, Parkinson's Meds (anticholenergic, alpha adrenergic blockers), Increased intra-abdominal pressure from COPD, chronic constipation, or obesity loss of urethral support- stress incontinence weakness of perineal body from childbirth- predisposes rectocele and enterocele retention cyst - accurate answers-a round translucent nodule that may be very small or up to 1-2 cm cervical polyp - accurate answers-arises from endocervical canal visible when protrudes through cervical os bright red, soft, fragile benign but may bleed
how to obtain pap smear on pregnant women - accurate answers-use a cotton tip applicator with saline moistened risk factors for cervical cancer - accurate answers-persistent infection with high HPV subtypes (HPV16/18) multiple sex partners smoking, immunosuppressants, HIV, oral contraceptives, coinfection with chlamydia, parity, prior cervical cancer, genetic polymorphisms affecting entry of HPV DNA into cervical cell Cervical Screening Guidelines - accurate answers-screening should begin at age 21 21-65 it should be every 3 years. 21-29 every 3 yrs. 30-65 - every 5 + HPV.
65 after 3 normal paps - and negative HPV 10years. NO NEED FOR ANNUAL SCREENING FOR AVERAGE RISK WOMEN AT ANY AGE. WOMEN WITH HYSTERECTOMY - NO SCREENING. Tanner stages of breast development - accurate answers-Tanner I: no glandular tissue; areola follows skin contours of the chest (prepubertal) Tanner II: breast bud forms with small area of surrounding glandular tissue; areola beings to widen - 8-13yrs Tanner III: breast begins to become more elevated and extends beyond borders of areola; remains in contour with surrounding breast Tanner IV: increased breast size and elevation; areola and papilla form a
secondary mound projecting from the contour of the surrounding breast Tanner V: adult size; areola returns to contour of the surrounding breast, with projecting central papilla (nipple) - 12.5-18.5yrs Menstruation - accurate answers-begins between ages of 9-16 years takes >1 year to settle into regular pattern Interval ranges 24-32 days and lasts 3-7 days Ask about LMP- last start date PMP- prior menstrual period
Helps to establish regular pattern, heavy, color, smell, number of pads, bleeding between cycles after sex EXCESSIVE BLOOD FLOW BRIGHT RED WITH CLOTS dysmenorrhea - accurate answers-painful menstruation Primary- without organic cause- caused by increased prostaglandin production in luteal phase Secondary- with an organic cause- caused by endometriosis, adenomyosis, PID, endometrial polyps PMS - accurate answers-bloating, weight gain, swelling of hands/feet, aches/pains, Diagnosed by s/s starting 5 days before menses and lasting for at least 3 cycles with cessation of symptoms within 4 days after onset of menses Amenorrhea - accurate answers-Primary- never initiating periods Secondary- cessation after they were established due to pregnancy, lactation, menopause (physiologic) or low body weight d/t malnutrition, anorexia), stress, chronic illness, hypothalmic pituitary ovarian dysfunction abnormal menstrual bleeding - accurate answers-poly/olig- <21 days or infrequent Men/Met- excessive or intermenstrual Postcoital- suggest polyps or CA of cervix or if older suggests atrophic vaginitis caused by pregnancy, cervical/vag infection/CA, cervical endometrial polyps, hyperplasia, fibroids, bleeding disorder, hormonal contraceptive/replacement therapy Chlamydia - accurate answers-A bacterial infection that affects the reproductive organs of both males and females Caused by urethritis, cervicitis, PID, ectopic pregnancy, infertility, chronic pelvic pain risk factors <26, multiple partners, prior hx of STI
Both transilluminate. The former contains sperm, and the latter does not, but they are clinically indistinguishable. Varicocele of the spermatic cord - accurate answers-What is the following presentation suggestive of: varicose veins of this structure, usually found on the left; feels like a soft "bag of worms" separate from the testis, and slowly collapses when the scrotum is elevated in the supine pt; infertility may be a/w this? Torsion of spermatic cord - accurate answers-common in neonates and teens acutely painful, tender, swollen, retracted upward in scrotum cremasteric reflex absent in affected side if tx delayed scrotum red and edematous no UTI Surgical emergency acute epididymitis - accurate answers-indurated, swollen, tender, epididymis scrotum reddened, vas defrens inflamed caused by N. gonorrhea, chlamydia, e.coli, pseudomonas (elderly), trauma, autoimmune urinalysis negative Tuberculous epididymitis - accurate answers-The chronic inflammation of tuberculosis produces a firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens. Indirect inguinal hernia - accurate answers-develop at the internal inguinal ring where the spermatic cord exits the abdomen if peritoneal lining remains an open channel to the scrotum it can allow hernia to develop Direct inguinal hernia - accurate answers-arise more medially d/t weakness in the floor of the inguinal canal Associated with straining and heavy lifting Femoral hernia - accurate answers-A type of hernia that causes a bulge in the upper part of the thigh near the groin more likely an emergency with bowel incarceration or strangulation
Erectile dysfunction - accurate answers-May be psychogenic- especially if early morning erection is preserved may be due to decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation and DM Lice/Scabies - accurate answers-pubis or genital excoriations in pubic hair Pnimosis - accurate answers-tight prepuce, cannot be retracted over glans Paraphimosis - accurate answers-right prepuce retracted, can't return, edema occurs balanitis - accurate answers-inflammation of the glans Balanoposthitis - accurate answers-inflammation of the glans and prepuce hypospadius - accurate answers-A condition in which the urethral meatus is located on the underside of the glans urethral stricture - accurate answers-induration along ventral surface of the penis tenderness suggest periurethral inflammation from the stricture Scrotal swellings - accurate answers-look for indirect inguinal hernia, hydrocele, scrotal edema, testicular carcinoma (rare) Fungal infection - accurate answers-Erythema and mild excoriation, common in moist area tender painful scrotal swelling - accurate answers-acute epididymitis, acute orchitis, torsion of the spermatic cord, strangulated inguinal hernia Testicular cancer - accurate answers-PAINLESS nodule peak incidence 15-34 years lymph drainage parallels retroperitoneal venous flow from renal and inferior vena cava varicocele - accurate answers-enlarged veins of the spermatic cord
Herpes simplex virus 2- genital herpes - accurate answers-small scattered or group of vesicles 1-3mm in size on the glans or shaft. Appears as erosions if vesicular membrane breaks primary episode asymptomatic. recurrence usually less painful or short duration Associated with fever, malaise, HA, arthralgia, local pain, edema, lymphadenopathy. May look similar to candidiasis Primary syphilis - accurate answers-Caused by Treponema pallidum (spirochetes). small red papule that becomes chancre (painless) erosion up to 2cm base of chancre is clean, red, smooth, glistening, borders raised indurated heal in 3-8 weeks incubation 9-90 days after exposure may develop inguinal adenopathy within 7 days- lymph rubbery, nontender, mobile May develop secondary syphilis (coinfection with HIV) Distinguish between genital herpes, chancroid granuloma, inguinale from k- granulomatis Confirmation test such as Dark-field microscopy, VDRL/RPR test, and FTA-ABS test are used to confirm diagnosis. Chancroid - accurate answers-Haemophilus ducreyi Incubation 3-7 days red papule/pustule then forms a PAINFUL deep ulcer with ragged margins, necrotic exudate, friable base distinguish from syphilis, herpes, granulomas
gonorrhea - accurate answers-yellow penile discharge rash tenosynovitis, monoarticular arthritis, meningitis indicates disseminated gonorrhea chlamydia - accurate answers-white penile discharge Herpes and chancroid - accurate answers-PAINFUL Syphilis, lymphogranuloma venereum - accurate answers-PAINLESS Paget's disease of the breast - accurate answers-redness, crusting, pruritus, and tenderness of the nipple eczematous change with rash, scaling, ulceration of nipple and areola self breast examination - accurate answers-best timed 5-7 days after mense lying supine with pillow under right shoulder, place right arm behind the head and use 3 fingers of left hand making overlapping dime sized circular motions apply 3 levels of pressure with firmer pressure toward the chest and ribs. examine in strip pattern remember how it feels from month to month standing in front of mirror with hands pressing firmly down on hips contract chest wall look for change in size, shape, contour, dimpling, redness, or scaliness exam underarm with arm slightly raised but not raised too high because it tightens the tissue breast development - accurate answers-Glandular tissue- milk secreting tubuloaveloar glands and ducts- form 15-20 separated lobes radiating around the nipple. drain into larger collecting ducts and lactiferous sinuses leading to 5- porous openings or the areola and nipple fibrous connective tissue-structural support copper ligaments connected to skin and fascia adipose tissue- superficial and peripheral areas areola- sebaceous glands, sweat, and axillary areolar glands. supplied with smooth muscle contracts to express breast milk. rich sensory innervation triggers "milk letdown" following neurohormonal stimulation
