question

Cryptorchidism?

answer

Undescended testicles--ONE or BOTH Fetal testes are in the abdominal cavity for maturation-Descend in 8th or 9th month of gestation

question

Why don't they descend?

answer

1)Hormonal imbalance 2)Testicular spermatic cord defect (cord to short) 3)Low birthweight and early gestational age-common with preterm infants. (in pre term infants, these usually descend on own with time)

question

Complications and treatment of cryptorchidism?

answer

Undescended testicles may have a defect-->increased risk of 1) infertility and 2) testicular cancer Tx: Hormone replacement or surgery to find and descend the testicle

question

Testicular torsion?

answer

Twisting of the spermatic cord that suspends testicle. Absent posterior attachments of the testicle-Bilateral common. Seen in pre adolescent males

question

S/S of TT ?

answer

Severe distress! Severe pain in testicle with swelling of the scrotum-->ischemia of the testicle REPRODUCTIVE EMERGENCY-->Testicular death (surgery in 12 hours or testicle begins to die)

question

Tx of TT?

answer

Testicle is secured to scrotal wall--usually both are done even if only one is twisted

question

Neoplasm of the Testis (testicular cancer)?

answer

Affects men ages 15-34. More common in white men than black Risk factors? Increased risk with undescended testicles and family history

question

S/S of testicular cancer?

answer

Slight painless enlargement of testicles-->groin ache/heaviness-->hard painless mass on testicle (spreads easily, late diagnosis if there is NO pain). Spreads to lung and lymph nodes.

question

Dx and Tx of testicular cancer?

answer

Dx=Self-testicular exam once per month. Biopsy is NOT done because poking this cancer with a needle would allow metastasis. Tx=Removal of entire testicle-silicone implant. Radiation-->95% survival after treatment if caught early

question

Benign prostatic hyperplasia (benign prostatic hypertrophy)?

answer

Prostatic growth in men over 50 (not related to prostate cancer). 80% of men over age 60 have some hyperplasia. Risk factors are Age and decreased hormone levels

question

Patho of BPH?

answer

Prostate grows around urethra-->obstruction of urine flow. Affects the ANTERIOR lobes of the prostate most (tricky because can only feel posterior lobes on rectal exam).

question

S/S of BPH?

answer

Difficulty voiding (especially starting a stream or not having much force) Bladder distention/urinary retention Overflow incontinence (pressure builds up high enough to push out) Constant desire to empty bladder (urge) Causes cystitis

question

Tx of BPH?

answer

Classic treatment: Transurethral resection of the prostate (TURP) PLUS newer treatments (medication to shrink prostate, lasers, balloon dilation etc). Possibility of impotence after surgery (10% chance)

question

Prostate cancer?

answer

2nd most common cancer in men. (skin cancer is # 1 most common, not killing)(#1 cancer killer=lung) (#2 cancer killer=prostate)

question

Risk factors of prostate cancer?

answer

1) Increased risk over age 50 2) Especially common in african american men 3)Increased risk with high fat diet 4) Family hx Bonus: Decreased incidence in vegetarians AND rarely found in asian and latino men

question

S/S of prostate cancer?

answer

No symptoms early-->difficulty stopping and starting stream of urine. Dysuria, frequency, hematuria PAIN is a very late sign Prostate nodular and non-moveable on palpation. Mostly found in posterior lobe.

question

DX of prostate cancer?

answer

Rectal exam, biopsy and PSA (prostate specific antigen) (less than 4 =normal) PSA is not very accurate--not used for wide spread screening as much.

question

Tx of prostate cancer?

answer

Metastasis is common, but we're catching it much earlier. "Watchful waiting" vs "aggressive treatment" Decision based on age: Aggressive for younger men, watchful waiting for older men Aggressive tx: Surgery=Radical prostatectomy (70-90% impotence) Less aggressive option: radiation/proton accelerator, chemo, hormone therapy (estrogen) Good rate of cure if confined to prostate.

question

Hypospadius?

answer

Urethral meatus located on the ventral surface (under) the penis. Varying degrees of severity, can also have some curvature of the penis. -Cannot control direction of the stream of urine and sexual functioning can be altered. Tx=Surgery

question

Epispadius?

answer

Urethral opening on the dorsal surface (top) of the penis. Less common than hypospadius. -Commonly causes incontinence, direction of stream and sexual functioning Tx=Surgical treatment is difficult

question

Epididymitis?

answer

Inflammation of the testicles. Causes: 1) Bacterial infection (sexually transmitted and non-sexually transmitted) Most common. 2) Trauma 3)Reflux of urine up the vas deferens

question

S/S of epididymitis?

answer

Scrotum appears large, red, tender Pain radiates into the groin Fever, cloudy urine, urethral discharge

question

Tx of epididymitis?

answer

Antibiotics (if infection) Also bedrest w/scrotal support (very painful to move)

question

Varicocele?

answer

Enlargement of veins in the scrotum--like a varicose vein. Cause is unknown. Often occurs during puberty

question

S/S of varicocele?

answer

Often no symptoms, but can make the scrotum feel "heavy". May be some swelling in the area. When palpated, feels like a "bag of worms" Usually goes away when lays down

question

Tx and Complication of varicocele?

answer

Tx: None if there are not symptoms tha toothier the patient. Surgical repair can be done if necessary. Complication: Low sperm count or infertility. Extra blood in the area, increases the temperature in the scrotum. Sperm need cooler temperatures to live. Surgical repair may be necessary to restore sperm count

question

Pelvic Inflammatory Disease (PID)?

answer

Inflammation of the upper reproductive tract (internal organs=cervix, uterus, fallopian tubes and ovaries) Cause=Any infection can spread. Commonly chlamydia and gonorrhea-sexually transmitted infections. Occurs after 1) childbirth 2)abortion 3)use of IUD with multiple sex partners

question

S/S of PID?

answer

Cervical discharge, fever, lower abdominal pain (dull and steady worse with movement) Irregular bleeding. Increased WBC --> Septic Shock (possibly) OR may be Asymptomatic

question

Tx of PID?

answer

Antibiotics, Treat the sex partners too. NO SEX Bedrest in semi fowler's position. May require hospitalization for IV antibiotics

question

Uterine Leiomyomas?

answer

Uterine fibroid. Benign tumors inside, within the wall or on outside of the uterus. Grows from smooth muscle cells. Occur during reproductive years and shrink with menopause. Growth is enhanced by estrogen.

question

Cause of uterine leiomyomas?

answer

Unknown-Strong family history. Black women have 3x more often than white women. Related to reproductive hormones

question

S/S of uterine leiomyomas?

answer

Vaginal bleeding, feeling of heaviness, pressure on the bladder and bowel--lead to difficulty urinating and constipation True PAIN is a LATE sign

question

Dx and Tx of uterine leiomyomas?

answer

Dx-Bimanual exam Tx-Medications to shrink Surgery to remove tumors Hysterectomy in older women

question

Endometriosis?

answer

Spread of endometrial tissue to place other than lining of uterus. Usually in the abdomen, intestines, ovaries, fallopian tubes, but can be further away. Endometrial tissue follows the menstrual cycle-grows, sloughs and bleeds every 28 days-->scarring and inflammation of surrounding structures

question

Patho of endometriosis?

answer

Theory: Retrograde menstruation Metaplasia-one type of tissue becomes another Combination of these

question

S/S of endometriosis?

answer

Dysmenorrhea (pain before, during and after mensturation) Abnormal bleeding Infertility-due to scarring and inflammation

question

Tx of endometriosis?

answer

-Hormones (BCP) or stronger to suppress menstruation -Surgery to remove (may be too much scar tissue to remove) (laser) -Get pregnant if you can (may cause tissue to atrophy)-delays problems only -Hysterectomy and remove ovaries

question

Cervical cancer?

answer

About the 5th most common cancer in American women 1)Can be found at any age 2)Easily detected with pap smear--good cure rate 3)Should have pap smear regularly once sexually active Cause: Human papilloma virus, transmitted sexual contact

question

Risks of cervical cancer?

answer

1) HPV infection 2)Multiple sex partners 3)Early intercourse-before age 16 4)Multiple pregnancies 5)Herpes-Type II infection 6)Male partner with many sexual contacts Long latent period-10 years because invasive cancer develops

question

S/S and Dx of cervical cancer?

answer

S/S-Asymptomatic Dx-Pap smear: Screening recommendations have changed. Old: Pap smear every year New:Start pap smear screening when sexually active or 21-whichever comes first After 3 negative tests, then have every 2-3 years Stop screening after age 70

question

Possible pap-smear results?

answer

-Negative: This is a negative smear with no abnormal or unusual cells seen, -Atypical: There are some cells that look strange. It could be atypical squamous cells of uncertain significance or regeneration of cells on the cervix or changes in the cells related to infections or the trauma of childbirth. Depending on other descriptions the pathologies uses, some type of follow up is needed (could just be a yeast infection). -Low-grade squamous intraepithelial lesion: There are some cells that may be considered mild dysplasia or with mild premalignant potential. This could be a HPV wart. Dysplasia is a precancerous change, and this finding requires further evaluation -High-grade squamous intraepithelial lesion: Signs of a high degree of precancerous change. This result is severe enough to warrant very prompt and complete evaluation -Cancer-Distinct signs of cancer and warrants prompt and complete evaluation

question

Tx of Cervical cancer?

answer

Removal of lesion, laser therapy, cryosurgery, electrocautery. Good recovery if caught early

question

Px of Cervical cancer?

answer

Vaccine-GARDASIL-only works on the 4 most common strains of HPV (3 injections over 6 months) HPV Types 16 and 18 cause 70% of cervical cancer cases and HPV types 6 and 11 cause 90% of genital warts cases. Now recommended for both boys and girls

question

Endometrial cancer?

answer

Cancer of uterus lining. Most common in post-menopausal women. Risk factors: infertility (no ovulation), late menopause (after age 55), obesity, diabetes, HTN, unopposed estrogen therapy (estrogen stimulation without progesterone opposition-PROLONGED) (BCP and estrogen replacement therapy decreases risk by 1/2)

question

S/S of endometrial cancer?

answer

#1 =Painless post-menopausal bleeding (might ask self am I getting my period back)?

question

Tx of endometrial cancer?

answer

Dilatation and curretage (uterine scraping) Surgery (total abdominal hysterectomy) Followed by radiation or radiation implants in some cases Good prognosis if caught early

question

Ovarian cancer?

answer

Most common in women 60-80 years. 4th most common cancer in women (most common genital cancer in women) Hard to diagnose (poor ways to screen and no early detection method) Plus very vague s/s

question

Risk factors of ovarian cancer?

answer

1)Family hx (close relatives) 2)Personal hx of breast cancer 3)Nulliparity (no births) 4)High fat diet 5)Excessive ovulation 6)Infertility BCP cuts risk in 1/2 Key seems to be to use your ovaries some, but not too much

question

S/S of ovarian cancer?

answer

Bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly. Urinary symptoms (urgency or frequency). No symptoms until late in the disease A pap smear is NOT a test for ovarian cancer; it detects cervical cancer.

question

Dx of ovarian cancer?

answer

Difficult-some chemical/blood tests under research

question

Tx of ovarian cancer?

answer

Surgery, radiation, chemo. Poor prognosis, hard to catch early-no screening tool or reliable tumor market YET. (CA-125 tumor marker) , but not very accurate only about 50% accurate. Better for post-diagnosis follow up

question

Breast cancer?

answer

# 1 cancer in women (lung cancer is #1 for deaths but #2 for prevalence). 1:8 women who live past 85 will have in lifetime. 90% are found by women themselves

question

Risk factors of breast cancer?

answer

A. Hormonal factors-extended length of time breast exposed to estrogen/progesterone. -Early menstruation (55 years)(40+ menstrual years-->twice as much risk of BC than 30 years) - Post menopausal hormone replacement B. Reproductive Factors-childbirth -1st baby after age 35 -Few pregnancies (many pregnancies are protective) - breast-feeding decreases risk -decreased risk if 1st baby born before age 18 C. Dietary factors-high fat diet and obesity increase risk D.Family history-very strong risk (mother/sister/daughter with cancer=primary female relatives) E. Ethnicity-Black women more at risk F. Age-Increased risk with age

question

S/S of breast cancer?

answer

Single lump-painless, hard, not moveable-1/2 are located in the UOQ. Advanced signs=puckering of the skin, nipple retraction (when not there before), change in breast shape, bloody discharge from nipple

question

Dx of breast cancer?

answer

Do SBE (Do 1 week after menstruation) Mammogram (early detection is best defense)-start at age 40 Ultrasound

question

Tx of breast cancer?

answer

Lumpectomy-->radical mastectomy Hormones, chemo, radiation

question

Uterine prolapse?

answer

A pelvic relaxation disorder Bulging of the uterus and cervix into the vagina (SINKING) S/S: irritation of the cervix and vaginal membranes Protruding mass and pressure

question

Cystocele?

answer

A pelvic relaxation disorder. Herniation of the bladder into the vagina due to anterior wall weakness S/S: Bearing down sensation, unable to empty bladder, urgency and frequent cystitis

question

Rectocele?

answer

A pelvic relaxation disorder. Herniation of the rectum into the vagina space due to posterior wall weakness. S/S: discomfort, difficulty defecating

question

Cause of the three pelvic relaxation disorders?

answer

Weakened muscles from childbirth or congenital defect Treatment: Surgical repair (A&P repair) or hysterectomy (uterine prolapse). Pessary and exercises???

question

Vulvovaginitis?

answer

Inflammation/irritation of the vulva (labia) and vagina Health in this area depends on: 1) hormone levels 2)pH acidic 3) normal flora 4)glucose (don't want this)

question

Types of vulvovaginitis?

answer

Several types #1=Yeast infection (Candida albicans) Others=bacterial (STI), viral (herpes, HPV)

question

S/S of vulvovaginitis?

answer

Vaginal discharge (lg Amt), burning, itching, redness and swelling of vaginal tissues. Painful sex. Yeast-->white, thick curdy discharge (cottage cheese) Bacterial-->pus-like discharge (yellow, green smells bad)

question

Dx and Tx of vulvovaginitis?

answer

Culture the discharge Look at discharge under microscope--ferning with yeast. Tx: Good hygiene Antifungal-treat partner too Antibiotics-treat partner too Decrease sugar in diet (control diabetes) decreases food for the yeast Sitz baths and cool compresses feel good

question

Ovarian cysts?

answer

Sacs on the ovary full of fluid or semisolid material. Can occur at any time in a woman's life Etiology: Unknown S/S: No symptoms unless cyst ruptures->hemorrhage and abdominal pain Tx:Usually resolves and pain subsides. Sometimes requires surgery to control hemorrhage if a blood vessel tears during rupture

question

Fibrocystic breast disease?

answer

Benign palpable masses in breasts. Size of lump fluctuates with menstrual cycle. Common in women 30-50. S/S: Tender breasts immediately before menstrual cycle. Cysts firm, mobile and regular in shape. Most often in UOQ (near armpits) Tx: Avoid certain foods (tea, coffee, cola, chocolate)

question

Hiatal Hernia?

answer

Part of the stomach protrudes above diaphragm. Cause: Congenital or weakened diaphragm or trauma...often associated with obesity. Types. 1) Sliding (90%)- Poor connection where esophagus goes thru diaphragm. S/S: Heartburn with change in position or cough 2)Paraesophageal/rolling-secondary opening in diaphragm. S/S: non heartburn but can strangulate.

question

Tx of hiatal hernia?

answer

Not usually treated surgically unless strangulation occurs. Small meals, don't lie down after eating No tight clothes, lose weight Antacids

question

Peptic ulcer disease?

answer

Break in the protective mucosa of the stomach (any place exposed to HCl and pepsin) Types: gastric ulcers and duodenal ulcers

question

Predisposing factors of PUD?

answer

Anything that breaks mucosal lining 1) Increase in pepsin and acid production -Abnormal # of acid producing cells (heredity) -Alcohol, smoking, and caffeine -Excessive vagal stimulation (stimulates HCl production) -Impaired inhibition of HCl as food moves on down GI tract -Stress 2)Decreased resistance of mucosal barrier -Helicobacter pylori-bacteria that colonizes epithelia cells and disrupts barrier (65-75% of ulcer patients have this) -Poor blood flow to mucosa -Bile exposure-->irritation -NSAIDS, ASA (aspirin) and alcohol-->irritation -Stress, burns, trauma-->curlings ulcer

question

S/S of PUD?

answer

Epigastric burning pain relieved by food or antacids. Occurs 30 min - 2 hrs after eating (when stomach is empty)

question

Dx of PUD?

answer

H. Pylori test, upper GI barium swallow, endoscopic visualization

question

Complications of PUD?

answer

-Hemorrhage-erodes through a blood vessel--> + Guaiac test -Obstruction-edema, spasm, scar tissue -Perforation-erodes through layers-->acid in the abdominal cavity

question

Tx of PUD?

answer

Goals--decrease HCL (antacids, H2 receptors/proton pump inhibitors, decrease caffeine/alcohol, no smoking -Increase resistance of mucosa (antibiotics for H pylori, no NSAIDS, ASA or alcohol) -Promote healing to decrease stress.

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