Exam 3

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BPH- Benign Prostatic Hyperplasia

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BPH- Benign Prostatic Hyperplasia

Characterized by excessive cell growth of the prostate gland . A physiologic change of aging

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BPH- Benign Prostatic Hyperplasia risk factors

• Aging

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BPH- Benign Prostatic Hyperplasia S / S

Frequency ( urinating ) Dribbling of urine ( small amounts of urine with each episode ) Incomplete bladder emptying Straining to urinate Weak urinary stream Sudden urges to urinate .

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BPH- surgical tx

Transurethral needle ablation ( TUNA ) ( slower recovery ) Transurethral resection of the prostate ( TURP ) ( faster recovery ) Transurethral incision of prostate ( TUIP )

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BPH- tests done to dx

Digital Rectal Exam ( DRE ) PSA test ( Rules out prostate cancer but cannot diagnose prostate cancer ) Urine flow studies Ultrasound Cystoscopy

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Prostate cancer-S/S

. Early stages- asymptomatic Advanced stage- Trouble urinating, Erectile dysfunction, Blood in semen, bone pain

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Prostate cancer - risk factors

Age, AA men- (at greater risk), Obesity, Diet, Fx

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Prostate cancer- dx test

DRE & PSA

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Testicular torsion- S / S

-Sudden onset of severe unilateral scrotal pain—(Occurs during activity or rest Scrotal )

-swelling

-Erythema

-Abdominal pain

-Nausea

-Vomiting

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Testicular torsion- dx test

scrotal pain Lab tests and imaging studies usually are not necessary

IF THERE IS UNCERTAINTY C / diagnosis

-Radionuclide scan of the testicles -Ultrasonography

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Testicular torsion- surgical tx

Detorsion

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Testicular torsion- Risk factors

Age- male under 25

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Orchitis-

inflammation of the testes

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Orchitis-

testes Bilateral or unilateral

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Orchitis causes

-Bacterial infection

-Mumps virus

-STD- chlamydia and gonorrhea

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Orchitis-Risk factors

Older than 45 y / o

Long-term use of folly catheter

Lack of mumps vaccine

Freq UTIs

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Orchitis S/S

Blood in semen Discharge from penis Fever

Groin pain

Pain w / intercourse or ejaculation

Pain w / urination ( Dysuria )

Testicle pain

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Dx test of orchitis

Testicular ultrasound

Urinalysis

Urine culrure

NAAT-( tests to screen for gono and chlamydia)

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epididymitis

inflammation of the epididymis

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Epididymitis causes

E.coli

Infection( UTI, Gono, Chlamydia)

Medications

Injury/irritation

Obstruction of urine flow

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epididymitis risk factors

uncircumcised males

unprotected sex

recent groin injury

use a catheter

athletes

repetitive activities

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epididymitis s/s

acute scrotal/inguinal pain

urethral discharge

dysuria

Fever

Urinary- urgency, frequency

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Dx test of epididymitis

Urinalysis

Urine culture

CBC

NAAT( Chlamydia and gonorrhea)

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epididymitis complications

abscesses, fistulas, infertility, testicular necrosis, and chronic epididymitis

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varicocele

enlarged veins of the spermatic cord and lack of blood drainage of the testes

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hydrocele

sac of clear fluid in the scrotum

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Varicocele and Hydrocele s/s

Heaviness of scrotum Swelling in scrotum

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Varicocele and Hydrocele complications

Infertility

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Syphilis-

bacteria ( T. pallidum )

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Syphilis risk factors

Engaged in high-risk sexual behavior

Dxed with other STDS Exchanged sex for drugs IV drug abusers Incarcerated adults

Fetus can be infected transplacental in pregnant women

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Syphilis stage 1

Primary- painless Chancre( skin lesions)

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Secondary Syphilis

Rash develops all over the body

Fever

Headache

Malaise

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Latent syphilis

Disease dominant ( May "heal")

Gummas form

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Tertiary syphilis

Neurosyphilis- meningitis, stroke, paresis, dementia

CV complications- aortic arthritis

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Syphilis Dx test

-Rapid plasma reagin(RPR)

- Venereal disease research lab( VDRL)

-PCR testing and Darkfield microscope

-ICE syphilis recombinant antigen test

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Syphilis possible complications

Brain, CV, and organ damage

Stillbirth

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Chlamydia s/s

Often asymptomatic in both males and females

Females: pos vaginal bleeding/discharge

- friable cervix and discharge

Male: possible urethritis

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Chlamydia pos complication

-Nongonococcal urethritis

PID

Epididymitis

Fitz-Huge Curtis syndrome( fibroids develop around the liver)

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Gonorrhea s/s

Men- dysuria (2-5 days after exposure)

Purulent discharge

Women- purulent discharge

Dysuria

Genital pruritus

Vag spotting

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Gonorrhea pos complications

Arthritis

Meningitis

Myocarditis

Penile balanitis

Urethritis

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Gonorrhea n Chlamydia pt education

Safe sex is the best sex . Resistant to many of the body's defenses

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Trichomoniasis-

MOST COMMON ( NONVIRAL ) STI

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Trichomoniasis- S / S

Almost all are asymptomatic .

Testicular pain-Epididymitis

- Most females are asymptomatic

-Vaginal discharge Bloody Purulent Green Yellow

-Abnormal vaginal odor. Musty May smell " Fishy "—Dyspareunia ( painful sex and postcoital after sex ) bleeding -Vulvovaginal irritation and burning Vulvovaginal itching

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Trich pos complications

Infertility

Pregnancy issues Cervical neoplasia

Post op issues

Increased risk of STIS ( HIV )

PID

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Trich pt edu

Treat all partners .

No sex a week after treatment and until partners finish treatment

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HSV1- HSV2-

HSV1- commonly cause oral " cold sores . " HSV2- Most commonly causes genital infection transmitted through sexual activity .

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HsV s/s

May be asymptomatic Painful recurrent blisters ( in pelvic area ) Burning Local tenderness Erythema

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HSV transmission

Maternal transmission Sexual transmission

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Hsv pt edu

Latex condoms One person or monogamous Get checked for STIs

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HPV Human papilloma virus

some strands lead to genital warts or cervical cancer

-different types

70 distinct genetic types

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Complications of HPV

Anal , vulvar , vaginal , rectal , oropharyngeal , Laryngeal cancers

HIV

Hep C

HVS

Chlamydia

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HPV preventive measures

HPV vaccine

No cure

Pap smear test

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STD knows the different types

Chlamydia

Gonorrhea

Syphilis Herpes simplex Virus

HPV

PID

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PID

sexually transmitted bacteria spread from vagina to fallopian tubes , uterus or ovaries

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. PID S / S -

asymptomatic

Low abdominal pain Pelvic pain

Menstrual irregularities

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which ones are mandatory reportable ?

Chlamydia

Gonorrhea

Syphilis

HIV(pt does not have to be identified or treated)

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Std pt edu

Abstinence during treatment

Partner notification and treatment

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Std pt edu #2

Safe sex practices

Re screen- 3 months .

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Cervical cancer s/s

-No signs in early stages -Unusual vaginal bleeding

-Watery bloody vaginal discharge

-Pelvic pain during intercourse

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Cervical cancer risk factors

HPV Weakened immune systems . Smoking

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Cervical cancer - diagnostic test

Biopsy

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Cervical cancer- screening test

HPV DNA test Pap smear

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Ovarian cancer s/s

-Swollen tummy

-feeling bloated

-Urgency& Persistent painful urinating

-tender tummy

-No appetite or feeling full quickly .

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Ovarian cancer- risk factors

Jewish descent

Age

Fx

Obesity

Smoking

infection

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DX test

Pelvic exam

CT

MRI

ultrasound Biopsy

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Menopause s/s

Hot flashes

Night sweats

Irritability

Anxiety

Insomnia

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Menopause pt edu

Low estrogen High FSH

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COPD- Chronic obstructive pulmonary disorder-

a combination of chronic bronchitis emphysema and hyperreactive airway disease . Causes chronic obstruction of airflow from the lungs Pt does not have the ability to fully exhale . Air pockets develop overtime Irreversible

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COPD- cause

Smoking

IV drug abuse ( emphysema )

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COPD- S/S

Dyspnea

Cough or wheezing Hypoxia

Respiratory distress ( clubbing of the fingers ) Ankle edema

Right ventricle heart failure

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COPD- Dx

PFTS ( spirometers ) Chest x - ray

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COPD- complications

RVF

-Pulmonary hypertension

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chronic bronchitis " blue bloater"

productive cough and bronchial inflammation Productive cough • At least 3 months out of the year for at least 2 years

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chronic bronchitis risk factor

Smoking

Air pollutants

Dust & silica

Fx

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Chronic bronchitis s/s

BLUE

B- Big & Blue skin "cyanosis" (hypoxia)

L- Long term "chronic" COUGH & sputum

U- Unusual lung sounds. (Crackles & Wheezes)

E- Edema peripherally

JVD

Weight gain

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CB pathophysiology

Hypersecretion of mucus and chronic productive cough for 3 months in 2 consecutive years. Chronic irritants = chronic inflammation leads to vasodilation of local arterioles, congestion, airway mucous membrane edema or swelling and bronchospasm.

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CB pos complications

-pulmonary hypertension

-cor pulmonale

RHF

-respiratory failure

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Emphysema

• A serious disease that destroys lung tissue and causes breathing difficulties.

Enlargement of air space

• Well perfused

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Emphysema s/s

Pink

P- Pink skin& pursed-lip breathing (huffing and puffing)

I- Increased chest "Barrel chest"

N- No chronic cough (minimal)

K- Keep tripoding.

o Clubbing fingers

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Emphysema causes

smoking, air pollution, genetics, untreated pulmonary disease

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Pt education for emphysema

o Smoking cessation

o Oxygen therapy

o Pulmonary rehabilitation

o Pneumococcal and influenza vaccine

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pathophysiological changes in the lungs- emphysema

o The alveoli are injured. Excess air in the alveoli. The alveolar walls are weakened, distended, and cannot recoil. (Accumulate excessive carbon dioxide)

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Oxygen levels copd

88%-92%

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Use of oxygen contraindicated

Supplemental O2 removes a COPD pt's hypoxic( low level of oxygen) repistaroy drive causing hypoventilation which causes higher carbon dioxide levels, apnea( puases in breathing) and respiratory failure.

Too much oxygen can be dangerous

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Asthma

chronic inflammatory disorder that causes reversible airway constriction because of bronchial hyperreactivity

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Asthma causes

genetic, exercise, cold air, allergens, NSAIDs

Viral infection- rhinovirus

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types of asthma

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

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mild intermittent

symptoms occur less than twice a week

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mild persistent asthma

Symptoms occur >2x/wk, but not daily

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moderate persistent asthma

Daily symptoms occur w/ exacerbations 2x/wk

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severe persistent asthma

Symptoms occur continually, along w/ frequent exacerbations that limit physical activity & QOL

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Risk factors or asthma

FHx of asthma, obesity, allergic rhinitis

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dx tests asthma

PFTs:

Compare with normal pts adjusted for age, sex, height, ethnicity

SPIROMETRY

↓ FEV1 and FEV1/FVC

Check for reversibility pre and post bronchodilator

>12% or 200mL ↑ FEV1 or 15% or 200mL ↑ FVC is (+)

+/- allergy testing - high rate of atopy

CXR - usually normal

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Pos complications of Asthma

status asthmaticus( severe asthma attacks)

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S/S of asthma

--wheezing

--chest tightness

--SOB

--coughing fits

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Asthma pt education

proper inhaler use and technique, the role of medication, and avoidance of environmental precipitants. periodic self-monitoring with a peak flow meter, asthma action plan

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pneumonia

Bacterial infection of the lungs

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pneumonia s/s

Coughing, CRACKLES, sputum production, pleuritic chest pain, shaking, chills, fever, dyspnea, tachypnea, malaise, decreased breath sounds

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Pneumonia causes

bacterial, viral, parasitic

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pneumonia risk factors

- Advanced age

- Lung diease

- Smoking

- Immuno suppressed

- Bed riddin

- Post- Op

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