NSG 554 - Nurse Practitioners in Primary Care I
Exam 4
Question:
Hyperthyroid examination findings
Answer:
-Diffusely enlarged thyroid -Frequent asymmetric and often with bruit
-Subacute: moderately enlarged/tender, dysphagia, jaw/ear pain
-toxic multi nodular goiter: palpable nodules
-Silent thyroiditis: small nontender goiter
Question:
PALM-COEIN
Answer:
-Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia -Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, Not yet classified 1 / 4
Question:
Abnormal premenstrual bleeding: Laboratory studies
Answer:
-CBC, pregnancy test, thyroid tests.-Vaginal and urine samples for PCR or culture to r/o chlamydia
Question:
Vaginitis
Answer:
-inflammation and infection of the vagina -caused by a variety of pathogens, allergic reactions to contraceptives or other products, vaginal atrophy, friction during coitus -normal pH is 4.5 or less
Question:
Vaginitis: Clinical findings
Answer:
-vaginal irritation, pain, unusual or malodorous discharge -Hx including LMP, recent sexual activity, use of contraceptives, tampons, douches, recent changes in meds or use of abx, presence of burning, pain, pruritus, profuse discharge
- / 4
Question:
Vaginitis: PE
Answer:
-inspection of vulva -speculum exam of vagina, cervix -vaginal/cervical/urine sample for detection of chlamydia -discharge inspected under microscope in a drop of 0.9% saline solution to look for trichomonads or clue cells and in a drop of 10% potassium hydroxide to look for candida
-pH should be tested: if >4.5 infections d/t trichomonads or bacterial
vaginosis -bimanual exam to look for evidence of pelvic infection ** cervical motion tenderness
Question:
Vulvovaginal candidiasis
Answer:
-R/F include pregnancy, DM, use of broad spectrum abx or corticosteroids -Heat, moisture, occlusive clothing increase risk
- / 4
Question:
Vulvovaginal candidiasis: S&S
Answer:
-pruritus -vulvovaginal erythema -white, curd like discharge not malodorous -Microscopic exam with 10% potassium hydroxide= hyphae and spores -culture swab with Nickerson medium or for PCR testing if candida is suspected but not demonstrated
Question:
Trichomonas vaginalis vaginitis
Answer:
-STI protozoal flagellate infects vaginal, skene ducts, lower urinary tract in women; lower genitourinary tract in men
Question:
Trichomonas vaginalis vaginitis: S&S
Answer:
-pruritus -malodorous, frothy, yellow/green discharge -diffuse vaginal erythema and red macular lesions on cervix in severe cases (strawberry cervix)
- / 4