NR 509 Final Exam - arm relaxes is attached to the ribs and interco...

NR 509 Final Exam Suspicious breast mass - correct answer-A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia.-Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer Risk for Breast cancer - correct answer--*Age* -family history of breast/ovarian CA

• inherited genetic mutations,

-personal history of breast cancer

• high levels of endogenous hormones
• breast tissue density
• proliferative lesions with atypia on breast biopsy, - duration of unopposed estrogen

exposure related to early menarche -age of first full-term pregnancy

• late menopause.
• breastfeeding for less than 1 year,
• postmenopausal obesity

-cigarette smoking, alcohol ingestion,

• physical inactivity, and type of contraception.

Characteristics of a breast cyst - correct answerSoft to firm, round, mobile, often tender.The best way to examine the lateral portion of the breast - correct answer-Have pt roll onto the opposite hip -place her hand on her forehead.

• keep shoulders pressed against the bed

-palpate in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple Bacterial Vaginosis (BV) - correct answer-Caused by overgrowth of anaerobic bacteria (often from sex)

• Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls,

usually not profuse, may be minimal

• Fishy/musty genital odor

-Normal vulva and vaginal mucosa -Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH ("whiff test"); test the vaginal secretions for pH > 4.5

Candidal Vaginitis - correct answer-Cause: Candida albicans, a yeast (normal

overgrowth of vaginal flora); many factors predispose, including antibiotic therapy 1 / 2

-Discharge: white and curdy, may be thin but usually thick, not as profuse as

trichomonal infection, not malodorous

• vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse)

-The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these patches are scraped off; in mild cases, the mucosa looks normal -Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candida Trichomonal Vaginitis - correct answer-Trichomonas vaginalis, a protozoan; often but not always acquired sexually

• Discharge:Yellowish green or gray, possibly frothy; often profuse and pooled in the

vaginal fornix; may be malodorous -Pruritus (though not usually as severe as with Candida infection); pain on urination (from skin inflammation or possibly urethritis); dyspareunia -Vestibule and labia minora may be erythematous; the vaginal mucosa may be diffusely reddened, with small red granular spots or petechiae in the posterior fornix; in mild cases, the mucosa looks normal

• Scan saline wet mount for trichomonads

Syphillis - correct answerThis ulcerated papule with an indurated edge usually appears after 3 to 6 weeks of incubating infection from the spirochete Treponema pallidum.These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks. Wear gloves during palpation since these chancres are infectious.s/s of epididymitis - correct answerAcute: swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed.Chronic: firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens.Genital Warts (Condylomata Acuminata) - correct answer-Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender.May be raised, flat, or cauliflower-like (verrucous).

-Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare,

approximately 5-10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.-Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain.-May disappear without treatment.Risk for prostate CA - correct answerAge, ethnicity, and family history are the strongest risk factors for prostate cancer.

• / 2