ANP Certification GU contraception puberty Flash Cards.txt

  1. Normal size of Prostate on DRE palpation
  2. Grade 1 Prostate on DRE palpation
  3. Grade 2 Prostate on DRE palpation
  4. Grade 3 Prostate on DRE palpation
  5. Grade 4 Prostate on DRE palpation
  6. What is the normal pH of the vagina?
  7. What vaginal pH is best for bacterial vaginosis to grow?
  8. When should you stop flying in pregnancy?
    >35 weeks gestation
  9. When is Oxygen needed during flight if pregnant?
    If Hgb is <8.5
  10. What fish should be avoided during pregnancy?
    Those high in mercury: swordfish, mackerel, albacore tuna, tile fish
  11. When is the onset of puberty for girls?
    Between 8 and 13
  12. When is the onset of puberty for boys?
    Between 9-14 years
  13. What is precocious puberty ages for boys and girls?
    Boys if younger than 9 years old, CNS tumor is often implicated. If girls younger than 8, most are just idiopathic and not pathologic.
  14. What is thelarch?
    Breast buds
  15. When are breasts fully developed?
    By age 16
  16. How soon does menses start once breasts bud?
    2 years
  17. When would a female need an endocrine consult for late puberty and what might be the causes?
    If no breasts by age 13 and no period by age 16. Multiple factors can cause, including nutrition, hormonal, genetic, Turner syndrome,
  18. When would a male need an endocrine consult for late puberty and what might be the causes?
    If no puberty start by age 14. Multiple risk factors, nutritional, hormonal, genetic, syndrome
  19. What are the characteristics of Turner syndrome?
    XO female Short stature, no ovaries, infertile, no estrogen, wide webbed neck, broad chest, learning differences
  20. What are the characteristics of Kleinfelter syndrome?
    XXY male. Long and Lanky, hypogonadism, no sperm, low muscle bulk, gynecomastia, minimal hair, rounded hips, learning differences, infertility
  21. When is full height reached for girls?
    Three years after onset of Tanner 2.
  22. When does menses start after Tanner 2?
    Menses start within 2 years after start puberty
  23. When do nocturnal emissions start for boys?
    Around age 14
  24. How long does it take for boys to complete puberty?
    3 years
  25. What is precocious puberty?
    Puberty that starts before 9.5
  26. What BMI indicates obesity in kids?
    Being above the 95th percentile in BMI
  27. Tanner Stage 3, what goes on?
    Onset of growth spurt
  28. When does growth spurt peak?
    Growth peaks at Stage 4
  29. What happens in Tanner 1 for girls and for boys?
    Nothing. This is prepuberty
  30. What happens in Tanner 2 for girls and for boys?
    Both get downy pigmented pubic hair. Girls get breast buds. Boys get scrotal skin reddening and testicular enlargement
  31. What happens in Tanner 3 for girls and for boys?
    Both get onset of growth spurt and darker, courser pubic hair. Girls get breast mound enlargement. Boys get pencil penis stage, gets longer but not wider.
  32. What happens in Tanner 4 for girls and for boys?
    Growth Spurt hits its peak and adult type pubic hair on mons pubis. Girls get second elevated areola mound above breast and MENARCHE. Boys get longer and wider penis.
  33. What tanner stage might gynecomastia be normally noted in boys?
    Tanner 3 stage
  34. What happens in Tanner 5 for girls and for boys?
    Full adult genitalia and hair. Areola mound recesses back into breast.
  35. What is noted in normal vagina pathogens?
    Lactobacillus. Gives vagina its acidic environment
  36. What is noted in Candida vulvovaginitis pH? Discharge?
    pH less than 4.5. White, curdy, cottage cheese
  37. What is noted in Candida vulvovaginitis KOH test? And microscopic?
    Absent KOH whiff test. Microscopic will see budding yeast, PSEUDO-HYPHAE with KOH prep
  38. What is noted in Candida vulvovaginitis patient symptoms and treatment?
    Itching or burning. Treat with antifungal, the -azole cream or oral
  39. What is noted in Bacterial vaginosis pH? Discharge?
    pH more base at greater than 4.5. Thin, white gray, increased adherent discharge
  40. What is noted in Bacterial vaginosis KOH test? And microscopic?
    Positive KOH whiff test, fishy smell. Microscopic will see CLUE CELLS.
  41. What is noted in Bacterial vaginosis patient symptoms and treatment?
    Foul odor with occasional Itching. Treat with Metronidazole topically or orally or Cleocin
  42. What is noted in atrophic vaginitis pH? Discharge?
    pH more base at greater than 5. Scant, clear
  43. What is noted in atrophic vaginitis KOH test? And microscopic?
    Absent. Microscopic will see less than normal amount of lactobacilli due to low estrogen level
  44. What is noted in atrophic vaginitis patient symptoms and treatment?
    Itching or burning, or may be asymptomatic. Treat with topical vaginal estrogen.
  45. What causes genital herpes? What is clinical findings? Treatment?
    HHV2, HHV1. Painful ulcerated lesions, lymphadenopathy with initial infection. TX Acyclovir, etc
  46. What causes nongonococcal urethritis and cervicitis? What is clinical findings? Treatment?
    C. trachomatis, ureaplasma urealyticum, mycoplasma genitalium. Irritative voiding. abundant WBCs Occasional discharge women have more than men. Commonly to be asymptomatic. TX Azithromycin x1 dose. Or Doxycycline x1 week
  47. What causes gonococcal urethritis and vaginitis ? What is clinical findings? Treatment?
    N. gonorrhoeae. abundant WBCs Voiding irritation or asymptomatic. Gonococcal more likely to give men a penile discharge. TX Cefixime, Rocephin
  48. What causes trichomoniasis ? What is clinical findings? Treatment?
    Trichomonas vaginalis. Parasitic infection, abundant WBCs. Dysuria, itching, dyspareunia, Frothy YELLOW GREEN discharge, Cervical Petechial Hemorrhages (Strawberry Spots). Or asymptomatic. Microscopically reveals motile organisms. Alkaline pH. TX ORAL Metronidazole only
  49. What causes Genital Wart (condyloma)? What is clinical findings? Treatment?
    HPV 6, 11. Verrucaform lesions. TX liquid nitrogen, podofilox. Keep on for 1-2 hours then wash off
  50. Which HPV has highest cancer risk?
    HPV 16, 18, 31, 33, 35, 39, 45 (teens and 30s)
  51. What causes PID? What is clinical findings? Treatment?
    N. gonorrhoeae, C. trachomatis, bacteroides, streptococcus. Irritative voiding. But will have Abdominal pain, CERVICAL MOTION TENDERNESS, vaginal discharge. TX Rocephin 250mg IM X1 Plus Doxycycline 100mg BID x14 days Plus Metronidazole 500mg BID. To cover ALL the organisms.
  52. UTI, acute uncomplicated UTI in non-pregnant women, what is the usual pathogen and what is treatment options?
    E Coli, S. Saprophyticus, and Enterococci. TX Bactrim DS BID x 3 days. If E coli resistance Nitrofurantoin x7 days.
  53. What antibiotic is given in UTI nonpregnant woman if local rate of E coli resistance is high, or if person has Sulfa Allergy?
    Cipro 250 mg PO BID x3 days, Cipro 500 PO QD x3 days, or Levofloxacin 250 qd x3 days
  54. Acute uncomplicated pyelonephritis in outpatient in non-pregnant women, what is the usual pathogen and what is treatment options?
    E. coli, enterococcus. Cipro 500 BID x7 days or Cipro 1 gram QD x7 days, or Levofloxacin 250 mg QD x7 days. Or Augmentin, Cephalosporin or Bactrim DS x 14 days
  55. What causes positive Nitrites in Urine?
    Gram NEGATIVE will cause Nitrites.
  56. What is the side effects of epididymitis?
    Infertility is a potential post infection side effect
  57. What is the symptoms of epididymitis?
    Irritative voiding, epididymal painful swelling and scrotal swelling
  58. If man younger than 35 gets epididymitis or prostatitis, what is it typically from?
    Gonorrhea or chlamydia. Tx with Rocephin plus Doxycycline
  59. If man older than 35 gets epididymitis or prostatitis, what is it typically from?
    Enterobacaters. Tx with Cipro
  60. What is the most common cause of prostatitis of any age?
    Non bacterial. Viruses, inflammation, auto immune disorders
  61. What is the Phren's test?
    Positive test will provide relief of pain with scrotal elevation above pubis
  62. Acute Bacterial prostatitis has what symptoms?
    Irritative voiding, suprapubic and perineal pain, fever, leukocytosis and a tender BOGGY prostate.
  63. Chronic Prostatitis needs to be treated for how long?
    Treat for 4 to 6 weeks if chronic.
  64. What is the risk factors for bladder cancer?
    Tobacco use plays a big role. Also textile worker.
  65. What is the most common finding with bladder cancer?
    Painless gross hematuria
  66. What is a hydrocele?
    Collection of serous fluid that causes painless scrotal swelling. Easily transilluminated
  67. What is a Varicocele?
    Palpable nest of worms scrotal mass that is only evident in the STANDING position
  68. Testicular torsion exam finding?
    Scrotal pain and loss of cremasteric reflex. Entire testicle swells and twists and occludes blood blow
  69. What is a Blue Dot Sign?
    Tender blue colored mass at undersurface of scrotum. Position of torsion of testicular appendage
  70. What is priapism?
    Erection longer than 4 hours
  71. What is the most common cancer in males ages 15 to 30?
    Testicular cancer. HX of white, Scandinavian, cryptorchidism
  72. What is Phimosis?
    Foreskin cannot be pulled back to expose glans
  73. What is paraphimosis?
    Cannot get foreskin back over the glans
  74. What is cryptorchidism?
    Testicle located in inguinal canal or abdomen. An undescended testicle.
  75. When is antiretrovirals started in HIV infection?
    If History of AIDS defining illness or condition including opportunistic infection, or with CD4 T cell is less than 350
  76. What additional people should start on antiretrovirals regardless of CD4 counts?
    Pregnancy, HIV associated nephropathy, HIV with HBV
  77. What is a KOH slide test for?
    Used to detect fungal infection anywhere on body. Will see Hyphae and spores.
  78. Tzank smear is used for?
    Diagnosis of herpes infections
  79. What is puerperal mastitis?
    Cellulitis in a lactation or non lactating breasts after delivery
  80. What are the hormones in Combined oral Contraceptive and what is MOA?
    Progestin and Estrogen. Progestin inhibits ovulation by suppressing LH and also inhibits implantation by thickening mucus. Estrogen inhibits ovulation by suppressing FSH and L and inhibits implantation by altering endometrial structure
  81. Benefits of Combined oral Contraceptives?
    Decrease incidence of: benign breast tumors, dysmenorrhea, IDA, ovarian cancer, ovarian cysts and PID.
  82. How does combined oral contraceptives protect against PID?
    Due to its properties that thicken the cervical mucus
  83. What is the major drug interaction of BCPs?
    BCPs with anti epeliptic drugs have interaction. Causes sub therapeutic level of seizure medications: dilantin, Phenobarbital, Carbamazepine
  84. What is approved birth control for person with seizure disorder?
    Depo Provera injection
  85. Who is the progesterone only pill good for?
    Lactating women. But has side effect of bleeding irregularity
  86. Contraindications to BCPs?
    Do not use if clot chance, structural heart problems, lactating less than 6 weeks post partum, headache with focal neuro symptoms, older than 35 and smoking more than 1 PPD.
  87. Who long can someone stay on Depo Shots?
    Only for 2 years. Takes 6 to 12 months to become pregnant after last dose.
  88. Who should not have a copper IUD?
    Current or recent PID, unexplained vaginal bleeding, cervical cancer or fibroids that distorted uterine cavity.
  89. How long should a diaphragm stay in after sex?
    For minimum of 6 hours
  90. How does one get a Spermicide induced UTI?
    Spermicide Nanoxynol 9 kills lactobacilli normal flora
  91. Emergency Contraception needs to be taken before how many hours?
    Within 72 hours
  92. How does emergency contraception work?
    Stops ovulation, impairs ovum and sperm transport, interferes with fertilization
  93. When should menses return after using emergency contraception?
    3-4 weeks
  94. When is average age of onset of menopause?
    Age 51
  95. What lifestyle habit can cause earlier onset of menopause?
  96. What needs to be taken into consideration when giving oral HRT?
    If have a uterus still, will need to give progestin also, otherwise, unopposed estrogen supplement will cause increase in endometrial lining and cancer
  97. When is HRT contraindicated?
    HX of Breast cancer, uterine cancer, CVD, DVT or liver disease
  98. What can be given for hot flashes?
    SSRI and Gabapentin
  99. Signs of ectopic pregnancy are?
    Missed period for 6-7 weeks, or light spotting. Lower abdominal or pelvic pain. PMH of PID, tubal surgery, older age
  100. What is Polycystic Ovarian Syndrome and what are the sequelae?
    Hormonal abnormality that leads to infertility due to anovulation, excessive androgen production, insulin resistance, hyperinsulinemia, and hyperandrogenism. Increased risk of CAD, Breast Cancer, Uterine Cancer, T2DM, obesity, hirsutism, acne, amenorrhea
  101. What is found on Ultrasound of PCOS?
    Enlarged ovaries with multiple follicular cysts
  102. What consists of treatments for PCOS?
    Low dose BCP to suppress ovaries, Spironolactone to control hirsutism, Metformin is given to decrease insulin resistance and to induce ovulation.
  103. Dietary recommendation for PMS?
    Try a high CHO diet to decrease irritability. Irritability is main complaint of PMS, then followed by fatigue.
  104. What murmur is normal in pregnancy?
    Physiologic systolic ejection murmur and also S1 gets louder
  105. How does medications cross placenta?
    Via passive diffusion. Preferentially allow highly lipophilic drugs to cross
  106. What molecular weight readily crosses placenta?
    Less than 500 grams. ETOH and Cocaine are 100 gm, and cross easily. Heparin is 5000 grams and does not cross
  107. When is asthma worse in pregnancy?
    During weeks 29 to 36, when bronchospasm chance is increased due to GERD irritation. And may improve after 36 when baby goes into birth canal
  108. How is Nausea and Vomiting managed in pregnancy?
    Calcium antacids are OK. B6 helps. Zofran is schedule B
  109. When can AZT be started in pregnancy?
    After 14th week
  110. Pregnancy and asymptomatic bacteriuria?
    If left untreated can progress to acute pyelonephritis quickly. Must test and treat all pregnant women for bacteriuria.
  111. what is the treatment for pregnant patient with UTI?
    3-7 day course of Beta lactam or Nitrofurantoin, (cannot use Nitrofurantoin after 36 th week of pregnancy)
  112. What is scale for Lactation drug category risk?
    L1 is safest. L5 is contraindicated.
  113. HTN and pregnancy, safe drugs to treat with?
    Methyldopa is OK. BB are OK late in pregnancy. NO ACE
  114. What is the classic ectopic pregnancy Triad?
    Abdominal pain, vaginal bleeding and adnexal mass. But only seen in half of all ectopics.
  115. What are the symptoms of acute renal failure?
    Peripheral edema, weight gain due to water retention, oliguria, anorexia, lethargy, elevated creatinine
  116. What is the function of the kidneys?
    To regulate electrolyte, Sodium Bicarbonate, and fluid regulation (by ADH and Aldosterone). Also produce hormone erythropoietin
  117. What does the prostate produce?
    PSA and prostatic fluid
  118. What are the risks of prostate cancer?
    Af Am, +FHx, age 50 or older
  119. What are the signs of prostate cancer?
    Lower back pain, rectal perineal discomfort, low flow, nocturia. Hard fixed nodule or indurated area on prostate. Painless. PSA often over 4.0
  120. What risk does prostate surgery cause?
  121. What drugs are given for prostate CA?
    Proscar for antiandrogen effect
  122. Who is at absolutely no increased risk for prostate adenocarcinoma?
    Boys who had total orchiectomy as a child with no testosterone ever formed
  123. What happens in BPH to cause urine problems?
    Enlargement of connective tissue and increase in the number of smooth muscle and epithelial cells in prostate. Causes outflow obstruction and bladder detrusor hypertrophy
  124. What are some complications of a TURP?
    Retrograde ejaculation, ED, incontinence
  125. What are medication treatment options in BPH?
    5 alpha reductase inhibitors are antiandrogens to block conversion of testosterone dutasteride (Avodart) and finasteride (Proscar). Alpha adrenergic agonists such as Terazosin (Hytrin) and Tamsulosin (Flomax) which allow for detrusor muscle bladder relaxation
  126. How does the 5 alpha reductase inhibitors are antiandrogens work for BPH treatment?
    block conversion of testosterone, dutasteride (Avodart) and finasteride (Proscar). Long term treatment will decrease symptoms and decease prostate size and increase urine flow rate, decrease urinary retention.
  127. How does Alpha adrenergic agonists work for BPH tx?
    Terazosin (Hytrin) and Tamsulosin (Flomax) block the receptor sites which allow for detrusor muscle bladder relaxation.
  128. Reasons for impotency or Erectile dysfunction?
    NOT a normal part of aging process. Due to vascular insufficiency, neuropathy, prostatectomy, SSRI, BB, smokers, ETOH, DM
  129. What are the PDE-5 inhibitor drugs and how do they work?
    Tadalafil (Cialis), Lavitra, Sildenafil (Viagra). They enhance nitric oxide effects and relax smooth muscle and allow increased blood flow
  130. How are the PDE5 inhibitor drugs taken?
    Viagra and Levitra has short half five and is taken 30 minutes to one hour before sex, has 4 hour half life. Cialis has longest half life, 17 hour half life
  131. How does erection occur when taking PDE5 drugs?
    Sexual stimulation must occur, no spontaneous erection
  132. Contraindications for PDE5 drugs?
    Cannot take with nitrates, no recent MI, CVA or major surgery
  133. What is peyronie's disease?
    Crooked penis due to palpable hard painful plaques under penile skin
  134. What is orchitis?
    Acute painful swelling of testicle. Complains of heaviness in scrotum. Can become bilaterally affected
  135. What are the symptoms of chlamydia infection in males?
    Lymphogranuloma venerum. Symptoms occur 1-4 weeks after contact. Vesicular or ulcerative lesion on genitalia. Can progress to inguinal lymphadenitis or sinus tracts
  136. What are the symptoms of gonorrhea in males?
    1 to 5 days incubation. Dysuria, milky penile discharge occasionally blood tinged. Can cause proctitis if anal sex
  137. What is the syphilis lesion?
    Traponema pallidum spirochete
  138. When is syphilis most contagious?
    In Secondary syphilis.
  139. What is noted in Primary Syphilis? And Treatment?
    Just a lesion. Chancre occurs 2 to 4 weeks after contact. Minimal lymphadenopathy. Ulcer is painless with clean base and indurated margins. TX PCN IM 2.4 million X1, or Rocephin
  140. What is noted in Secondary Syphilis? And Treatment?
    Most Contagious Stage. Constitutional symptoms. Diffuse maculopapular rash of palms and soles. Generalized lymphadenopathy, fever, malaise, HA, myalgias, arthralgias. TX PCN IM 2.4 million x1 or Rocephin.
  141. What is noted in Tertiary Syphilis? And Treatment?
    Gumma lesions. In skin, mucous membranes and bones. Aortic heart problems, seizures, Argyll Robertson pupils, neurosyphilis. TX PCN IM x 3 doses
  142. When can return to sex after TURP?
    6 weeks
  143. What is detrusor hyperreflexia?
    Sudden urgency immediately followed by bladder contraction, results in immediate involuntary voiding
  144. What organs are most damaged by anabolic steroid use in men?
    Liver, can have cysts, tumors, hepatitis, hepatic cholestasis, HTN, fluid retention, suppressed gonadotropin, decreased testosterone, baldness, acne, gynecomastia, lower sperm count, aggressive behavior
  145. Precautions after vasectomy in regards to fertility?
    Check ejaculate for presence of sperm in 6 weeks
  146. What is a direct inguinal hernia?
    Middle aged men get. Acquired weakness
  147. What is an indirect inguinal hernia?
    The Indirect goes INto the scrotum. Often congenital, men 16 to 25.
  148. What does ELISA test check for with HIV?
    Tests for the presence of HIV antibodies. If positive, need to confirm with Western Blot test
  149. What are the age ranges for Early, middle and late adolescence?
    Early- 10-13 years, middle 14-17 years, Late- 18-21 years
  150. What is noted in Fragile X syndrome?
    Noted in males. Nothing Fragile about them! Large testicles, large body habitus, large forehead, ears, jaw, learning and behavior issues, hyperactivity. (not common in females)
  151. First line therapy for acne vulgaris with closed comedones includes?
    Benzoyl peroxide
  152. What acne vulgaris lesion best responds to topical antibiotics therapy?
    Inflammatory lesions
  153. How long does it take to see response to acne medications?
    6-8 weeks
  154. Best use in Accutane for what type of acne vulgaris lesion?
    Cystic lesions, especially those who have failed all other treatment
  155. What important side effect screening is important to assess when someone has been on Accutane?
    Mood changes. Depression has been noted.
  156. What are the forms of isotretinoin (Accutane) and tretinoin (Retin A)?
    Accutane is oral and highly teratogenic. Retin A is topical and skin photosensitizing.
  157. What is the leading cause of death in teens in USA?
    Accidental death is leading causes
  158. What is the Yuzpe regimen?
    Emergency contraception, taking two BCPs within 72 hours of sex and 2 BCPs 12 hours later
  159. Where are the Skenes glands?
    Anterior vaginal orifice, near urethra
  160. Where are the Bartholin's glands?
    Posterior vicinal orifice, by the back of the vagina, near Butt
  161. What is Procidentia?
    Third degree prolapse of the uterus. OUT OF VAGINA!
  162. Metrorrhagia?
    Irregular cycle with increase flow and increased duration
  163. Menorrhagia?
    Normal cycle, with increased flow
  164. Polymenorrhea?
    Period less than every 21 days
  165. Oligomenorrhea?
    Period more than every 35 days
  166. What is a Leiomyoma?
    A uterine fibroid
  167. What is the organism implicated in toxic shock syndrome?
    Staph aureus
  168. BCPs can decrease effect of what drugs?
    Anticoagulants, hypoglycemia agents
  169. BCPs can cause increased effect of some drugs such as?
    Beta Blocker, ETOH, Theodur, Valium, TCAs,
  170. Examples of drugs that may decrease BCP effect?
    Some antibiotics, antacids, anticonvulsants, barbiturates
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ANP Certification GU contraception puberty Flash Cards.txt
ANP Certification GU contraception puberty Flash Car