1
Q
at what age in males does puberty end and brown growth stops
A
age 21
2
Q
if testes have not started to enlarge by age ___ then further investigation is needed
A
14
3
Q
what is the first visible sign of puberty and the hallmark of Tanner stage 2 in males
A
testicular enlargement followed by penile growth
4
Q
when does spermarche usually occur
A
usually 12-18 months after testes start to enlarge
5
Q
what does the acronym FISTS stand for and what does it screen for
A
screens for IPV
Stnads for fighting, injuries, sex, threats, self defense
6
Q
true of false: chlamydia in men is often asymptomatic
A
true
7
Q
what age group of men have the highest rates of chlamydia
A
15-24
8
Q
when should HIV testing be done in males
A
at least once between age 16-18 or sooner if sexually active
9
Q
true or false: breast hypertrophy in males during puberty may be normal
A
true, up to 65% of males will develop some degree of breast hypertrophy during puberty
10
Q
a 15 year old male presents with breast hypertrophy that is less than 4cm and symmetrical. What would your advice be
A
will likely resolve within 3 years, no further workup needed
11
Q
when does breast hypertrophy in males going through puberty require workup
A
more than 4cm
occurring before puberty or in the absence of other male puberty development
grows larger than tanner stage 2-3 for females
12
Q
what workup is required for abnormal gynecomastia in puberty aged males
A
investigate for use of steroids, marijuana and other drugs
thyroid disease
testicular failure
klinefelders syndrome
testicular tumor
refer to peds
13
Q
a mother is concerned about white cheesy lumps noted under her infant sons foreskin and is unable to fully retract the foreskin. There is no signs of infection or inflammation. what is your advice
A
the foreskin will naturally detach over time and should not be forced as this may cause adhesions
white cheesy lumps, or smegma, are shed dead skins cells and can be wiped away once they come out
14
Q
true of false: CPS recommends routine circumision
A
false, the benefits are in line with the risks so there is not routine recommendation
15
Q
what are the benefits of circumcision
A
less likely to develop penile cancer in life but this is extremley rare to begin with
less likely to get HIV and HPV
less likely to get UTI in childhood
female partners less likely to get cervical cancer
16
Q
what are the risks of circumcision
A
painful
make cause rare but serious complications: too much bleeding, too much skin removed, S/E from analgesic medications, unsatisfactory appearance
17
Q
what is the standard care after circumcision
A
takes 7-10 days to heal and may be red with some yellow discharge
18
Q
what is the most common type of hernia
A
inguinal
19
Q
what is a strangulated hernia and why is it dangerous
A
ischemic from physical constriction of the blood supply.
can cause bowel infarction, perforation or peritonitis
20
Q
why is a sports hernia not a true hernia
A
because there is no abdo wall defect for the contents to protude out of
21
Q
what is another, more accurate, term for sports hernia?
A
athletic pubalgia
22
Q
why is rectus diastasis not a true hernia
A
separating of abdo muscles along the linea alba with a defect in the fascia
23
Q
what are some causes of secondary hernias
A
chronic cough
obesity
pregnancy
ascites
heavy lifting
prostatic enlargement
peritoneal dialysis
24
Q
what are signs of a strangulated hernia
A
steady and gradually increasing pain, n/v, tenderness, skin may be erythematous, may develop peritonitis
25
what might you ask the patient to do to assess a possible hernia if none is seen or palpated both supine and standing
valsalva
26
if a hernia cannot be reduced, it is ____
incarcerated
27
when there is a possible hernia bulge, when is US indicated
recurrent hernias, suspected hydrocele, or if diagnosis is unclear
28
what is the differential for a groin mass that is solid and non reducible
incarcerated hernia
adenopathy from infection
malignancy
ectopic testis
lipoma
29
what are red flag symptoms for hernia
severe pain
irreducibility
redness, swelling, warmth
n/v
fever
abscense of bowel movements
rapid increase in size
30
what type of hernia should always be repaired and why
groin hernias due to increased risk of strangulation
31
what is hesselbacks triangle
Anatomic inguinal triangle
inguinal ligament, inferior epigastric vessels, rectus abdominis muscle
32
what is the difference between an indirect and direct inguinal hernia
indirect is pushed down into the scrotum and protrudes at the deep inguinal ring. Direct does not go down into the scrotum and does not go through the deep inguinal ring
33
true of false: having a hiatal hernia increases risk of developing inguinal hernia
true
34
while trying to reduce an incarcerated inguinal hernia in office with gentle persistent pressure, the patient has sudden intense pain. What has happened and what is next step
likely has become strangulated, surgical emergency, send to emerg
35
what are the most common causes for scrotal pain
testicular torison
torsion of testicular appendage
epididymitis
36
what are signs of testicular torsion
sudden onset pain
exquisite tenderness
high riding and horizontally displaces teste
37
inguinal or scrotal mass that is nonreducible with severe pain, vomiting and constipation, is likely what?
incarcerated inguinal hernia
38
men presenting with scrotal pain, scrotal or perineal erythema, necrotising or blistered skin lesions and a toxic appearance is likely what?
fournier gangrene
39
men presenting with sudden onset scrotal pain, hypotension, weak pulse, pallor, dizziness or confusion should have what red flag diagnosis ruled out?
AAA
40
testicular torsion vs torsion of the testicular appendage: which presents with sudden onset pain and which presents with gradual onset pain
gradual onset - torsion of testicular appendage
sudden onset - testicular torsion
41
true or false: flank pain that radiates into the scrotum is not a red flag symptom
false, this may be a presentation of AAA in older men
42
epididymitis is often not distinguishable from testicular torsion with acute swelling and painful. What test can help distinguish?
the cremasteric reflex is absent in testicular torsion
43
what is the cremasteric reflex
stroking the inner thigh causes the ipsilateral testicle to pull upward
44
If testicular torsion is suspected, what testing is suggested
If high suspicion then immediate surgical exploration instead of testing. If just ruling out, color doppler US
45
what is the treatment for testicular torsion
emergency surgery, within 12 hours, if manual detorsion is unsuccesful
46
what is the difference between epididymitis and epididimyo-orchitis
epididymitis is inflammation of the epididymis
epididymyo-orchitis also includes inflammation of the testis
47
epididymitis is usual bilateral or unilateral
unilateral
48
what is the more common cause of Epididymitis, bacterial or viral?
bacterial
49
chlamydia may cause what painful scrotal condition, usually in men under 35
Epididymitis
50
true or false: indwelling catheter do not increase risk for men to develop Epididymitis
false
51
why might heavy lifting cause Epididymitis?
chemical irritation from retrograde urine flow due to valsalva associated with heavy lifting
52
what are S&S of Epididymitis
severe scrotal pain, sometimes referred to abdo, often gradual onset
may have fever, n/v, urinary symptoms
may have urethral discharge
swelling, induration, marked tenderness, may have erythema
Tenderness on palp to the epididymis (posterior superior aspect of testis)
53
true or false: Epididymitis may cause sepsis
true
54
true or false: unless finding are clearly isolated to the Epididymitis, testicular torsion must be considered in a differential
true
55
what is treatment for Epididymitis
scrotal elevation
anti inflammatory
broad spectrum abx (levoflox, doxy)
IM ceftriaxone if hx of anal intercourse
56
orchitis is usually viral or bacterial
viral
57
what virus most commonly causes orchitis
mumps
58
orchitis is usually bilateral or unilateral
Usually starts as unilateral and progresses to bilateral
59
what are the consequences of untreated orchitis
may cause testicular atrophy or infertility
60
what are the S&S of orchitis
symptoms 4-7 days after parotid swelling from mumps
usually starts as unilateral but may become bilateral
swelling of testes with mild to severe pain
systemic symptoms
tested are tender, enlarged, indurated, edematous and erythematous
61
what is treatment for orchitis
supportive with analgesics, hot packs or cold packs
abx only if confirmed bacterial
refer to urology for follow up
62
true or false: testicular torsion is uncommon in men after the age of 30
true
63
testicular torsion is more common on the right or left side
left
64
what can be attempted first before sending for emergent surgery for testicular torsion
manual detorsion - rotate teste in outward direction, more than one rotation may be needed to resolve pain, pain relief guides the procedure
65
what are the 4 classifications of prostatitis
type 1 = acute bacterial
type 2 = chronic bacterial
type 3 = chronic prostatitis/chronic pevlic pain syndrome
type 4 = asymptomatic inflammatory
66
what are symptoms of prostatitis
urinary irritation or obstruction
frequency, urgency, incomplete emptying
pain usually in perineum
67
an exquisitely tender prostate that is swollen and boggy with systemic symptoms indicated what class of prostatitis
type 1 - acute bacterial
68
In men, what causes perineal/penile pain including during ejaculation that interfere with QOL, urinary symptoms and a prostate that is tender but not boggy or swollen
Type 3 prostatitis - chronic prostatitis/chronic pelvic pain syndrome
69
true or false: patients presenting with fever and typical S&S of prostatitis should have a prostate massage before collecting urine
false, this is potentially dangerous as it may induce bacteremia
70
if a pt with suspected bacterial prostatitis is not responding to abx, what is next step
may need transrectal US or cystoscopy to r/o abscess or involvement of seminal vesicles
71
what DI should be considered with hematuria in Type 2, 3, and 4 prostatitis
cystoscopy
72
what is treatment for type 1 prostatitis
if non toxic, outpatient with abx, bed rest, analgesics, stool softener and hydration (usually fluroquinolone) and continue for 30 days
if septic, hospitalize with IV abx and then will need oral abx for 4 weeks after
73
how long is the course of abx for type 1 and for type 2 prostatitis
type 1 - 4 weeks
type 2 - 6 weeks
74
what medications, other than abx, may be used in the treatment of type 2 prostatitis
NSAIDs, muscle relaxants, alpha adrenergic blockers
75
true or false: type 4 prostatitis does not require treatment
true
76
what are the most common causes of painless scrotal masses
hydrocele, non-incarcerated inguinal hernia, varicocele
77
painless scrotal mass associated with dyspnea and leg swelling may be what chronic condition
RHF
78
what is a red flag for a painless scrotal mass
mass that is part of or attached to testis and does not transilluminate
79
a painless scrotal mass that transilluminates is likely what
hydrocele or spermatocele
80
a painless scrotal mass that dissappears or becomes smaller when in recumbent may be what
hernia
varicocele
81
what is a variocele
veins enlarged inside scrotum
82
what is the most commonly identified cause of infertility in men
varicocele
83
a painless scrotal mass that feels like a "bag of worms" and is palpable during valsalva is most likely what
varicocele
84
what are red flags for varicoceles
isolated on right side
sudden onset of varicocele
varicocele that is not reducible
85
what is treatment for varicocele
usually none unless fertility problems
treated with surgery or embolization
86
What is a hydrocele
collection of peritoneal fluid in scrotum
87
what is the difference between primary and secondary hydrocele
primary is congenital
secondary is from underlying condition such as infection, injury or malignancy
88
what are risk factors for developing primary hydrocele
breech presentation
low birth rate
gestational progestin use
living in warmer climates
89
how can you differentiate a hydrocele from a hernia
a hernia will not transilluminate or be fluctuant and hydroceles tend to surround both testes and epididymis
90
when is an US warranted when diagnosing hydrocele
if there is pain or cannot reliably palpate the testicular structuresw
91
what is treatment for hydrocele
surgery if primary
can aspirate if surgery not an option but will almost always reaccumulate within a week or so and high risk of infection
92
when is a "watch and wait" approach taken for hydroceles
in infants as they tend to resolve spontaneously but should consult surgeon if persists past age 2
93
Genital warts are usually caused by what form of HPV
HPV 6 and 11
94
what appearance features are indicative of gential warts
soft, moist, minute pink or grey polyps
rough surface
occur in clusters
usually asymptomatic but may be burning or itchy
usually under foreskin or on penile shaft but may also be in anus and rectum
95
true or false: no genital wart treamtent is completely satisfactory and relapses are frequent
true
96
what are some topical treatment options for genital warts
antimitotics
caustics
interferon inducers
sinecatechins
97
when should males and females receive the HPV vaccine. How late in life can the HPV vaccine be given
should receive at age 11-12 but can be given up to age 26
98
which HPVs are most likely to cause cervical and other cancers
16 and 18
99
What are fordyce spots
small visible sebaceous glands along shaft of penis
100
what are characteristics of fordyce spots
1-2mm
flat to elevated
palpable
white/yellowing
confluent papules
transilluminate
usually bilat and symmetrical
asymptomatic
101
what are characteristics of most normal variants of penile lumps
symmetrical
smooth surface
well circumscribed border
asymptomatic
102
tiny lumps in neat rows aroudn the corona of the glans of the penis that are uniform, symmetrical and asymptomatic are likely what
pearly penile papules
103
what is a lymphocele
palpable cord like structure at shaft of penis
104
what causes lymphoceles
friction
increased sexual activity
thrombosed vessel
sclerosing lymphangitis
105
true or false: since lymphoceles are usually causes by sclerosing lymphangitis, no STI testing is needed
false, sclerosing lymphangitis may be occuring due to an STI so should test to see if treatment is needed
106
what is treatment for lymphocele
if not STI, none as it will likely spontaneously resolve
107
when penile warts are smooth, they may be difficult to differentiate from skin tags. What is one way to differentiate them
bright light will show fine dots or cobblestone pattern to warts
108
small penile papules with a central depression or ubilication or likely what
molluscum contagiosium
109
when testing for prostatitis, what classes would you use the 4 glass test for
category 1 (ABP) and category 3 (CPPS)
110
what is first line treatment for class 3 CPPS prostatitis? what are other treatment options?
First line is phytotherapy (quecetin and cernilton)
can use abx and alpha blockers if pt is newly diagnosed and niave
can trye pregabalin and 5 alpha reductase inhibitors
111
true or false: hematospermia is usually benign
true
112
what is shistosmiasis and when might you consider it
a parasitic infection, consider only in men with hematospermia who have spent time in areas like Africa or parts of the Middle East
113
what are red flags for hematospermia
symptoms that last longer than a month with no recent prostate biopsy
palpable lesions along epididymis or in prostate
travel to region with schistosomiasis
systemic symptoms
114
a man comes to the clinic 1 month after prostate biopsy with hematospermia. There are not other symptoms or red flags. Whats the next step
reassure that this is normal and can take several months to resolve after prostate biopsy
115
what testing is required for hematospermia in a young and healthy male with a normal physical exam and no red flags
urinalysis
C&S
STI workup
116
what are causes of urethral strictures
trauma (most common)
STI
idiopathy
lichen sclerosus
urethritis
malignancy
117
a new onsent double urine stream in men with increased frequency may be a sign of what
urethral stricture
118
how does cryptorchidism affect testicular cancer risk
double risk of testicular cancer but this is eliminated if orchiopexy done before age 10
119
what testing is required for diagnosing testicular cancer
US for scrotal mass and possible exploration
staging with a abdo/pelvic/chest CT
serum tumor markers
CXR
120
when is the best time in the menstrual cycle to have intercourse for couples struggling to get pregnant
during the 6 days, and particularly 3 days, before ovulation which usually occurs about 12 days before onset of next menses
121
what is clomiphene and what is it used for
for infertility in men
antiestrogen taken fro 3-4 months to help stimulate sperm production
122
what are S&S of andropause
weight gain
loss of muscle mass
apathy
depression
small testicles
loss of vertical height
gynecomastia
123
how is andropause diagnosed
symptoms of low testosterone confirmed with lab testing
124
true or false: a patient with andropause who has been treated for prostate CA in the past should have testosterone replacement managed by a specialist
true
125
what is the proper way to collect a total testosterone
measures in the morning or within 3 hours of waking
126
what hormone deficiency should be ruled out in men with undetermined anemia
testosterone deficiency
127
true or false: if only symptom is ED, testosterone should be tested before starting treatment
false, only test if failed tx if no other symptoms
128
what is the difference between primary and secondary hypogonadism
primary is testicular and has high LH/FSH
Secondary is pituitary and has normal LH/FSH
129
a man has symptoms of hypogonadism. Labs show low testosterone and high LH/FSH. What is the diagnosis
primary hypogonadism
130
what is the first line treatment for andropause
testosterone
131
what are contraindications to testosterone therapy in men
hx of prostate cancer, hx of breast cancer, wishing to maintain fertility
132
true or false, if a male pt has low normal testosterone levels with symptoms of andropause, no treatment should be given
false, if low normal but symptomatic, can trail testosterone therapy
133
true or false: cardiovascular disease is a contraindication for testosterone therapy
false
134
what is the monitoring required for testosterone therapy
reassess and redraw testosterone, crit, PSA and DRE at first 3 and 6 months
retest testosterone annually once stable
135
what baseline investigations should be done before starting testosterone therapy
total testosterone
hematocrit
PSA
DRE
136
true or false: men may experience a weaker urinary stream, nocturia and hesitancy as a normal part of aging
true
137
what are LUTS
lower urinary tract symptoms, constellation of symptoms often associated with BPH
138
why should straining be avoiding in men with LUTS/BPH
may cause hematuria, acute syncope, hemorrhoids or inguinal hernias
139
what are some risk factors for sudden complete urinary retention in BPH
prolonged attempts to postpone voiding
immobilization
exposure to cold
use of anesthetics, anticholinergics, sympathomimetics, opiods, alcohol
140
what would you expect the findings of the DRE to be in BPH
enlarged, non tender and rubbery prostate that may have lost the median furrow
141
true or false: a DRE can reliably rule our BPH
false, even a seemingly small prostate may still cause symptoms
142
what is needed to diagnose BPH
DRE
urinalysis and culture
PSA
sometimes bladder US
143
in regards to PSA testing, at what level might you consider additional testing to r/o prostate cancer
>4 if no risk factors but may be lower such as >2.5 if risk factors present
144
what is the differential diagnosis for BPH
infection
prostate CA
overactive bladder
145
what medications should be avoided in BPH
anticholinergics, sympathomimetics, opiods
146
what medications are used in the treatment of BPH
alpha adrenergic blockers ("zosins")
5 alpha reductase inhibitors ("asterides")
PDE5 inhibitors (tadalafil)
147
true or false: significant urinary retention in men with possible BPH should be treated immediately with catheterization
true
148
true or false: the herbal saw palmetto helps BPH
false, no herbals have been proven to help with BPH
149
what are indications for surgical management in BPH
not responding to medical tx
recurrent UTI, renal calculi, severe bladder dysfunction, upper tract dilation
150
what are possible complications of a TURP
ED, retrograde ejaculation, incontinence
151
True or false: when assessing a patient for BPH, you must do a urinalysis and DRE
true, to rule out other diagnoses
152
when assessing a patient for BPH, when would you do a PSA? when would you not
should offer to patients with a description of risks and benefits as long as they have at least a 10 year life expectancy and the knowledge of prostate cancer would change the management or the result would be helpful in monitoring BPH progression
153
should men presenting with traditional LUTS symptoms in the evaluation of BPH undergo prostate biopsy or ultrasound
no, not unless there is concern and need to r/o prostate CA or other differentials
154
what diagnostic imaging should be done prior to prostate surgery and why
cystoscopy to evaluate prostate size and look for medial lobe and bladder calculi and to determine prostate volume
155
what medications are used for treatment of BPH
alpha blockers for LUTS
5-ARI to shrink prostate
(combo of alpha blockers and 5-ARI is good option)
antimuscarinics or beta 3 agonists for stoage symptoms
PDE5I if also ED
156
when might you consider desmopressin therapy in treatment of BPH and what monitoring is needed
if all other therapies are ineffective and patient wanting to continue with medical therapy and main concern is nocturnal polyuria
need monitoring of serum sodium
157
what are lifestyle changes to suggest helping with BPH
fluid restrict especially before bed
avoid caffeine, alcohol, spicy food
avoid drugs like diuretics, decongestants, antihistamines, antidepressants
timed bladder training
weight loss
avoid constipation
pelvic floor physical therapy
158
what non modifiable risk factors are for prostate cancer
black men
BRCA 1/2 gene
lynch syndrome
family hx of breast or ovarian CA
159
what are common presenting symptoms of prostate CA
bladder obstruction
hematuria
bone pain
spinal cord compression
pathologic fractures
160
Screening for prostate CA with PSA is conterversial but may be helpful in men over 50. What are some other causes of increased PSA other than prostate CA
BPH
smokers
after prostatitis or prostate manipulation
sexual activity
extreme bicycle riding
161
for men electing to undergo PSA screening for prostate cancer, at what age should screening begin
50 for low risk men, 45 for high risk men
162
why is PSA screening not recommended for men under 45
even with very high PSA levels at this age, the cancer of prostate cancer is extremely low
163
for men electing PSA screening, what is the recommended follow up testing for the following levels:
<1
1-3
>3
<1 repeat every 4 years
1-2 repeat every 2 years
>3 consider more frequent
164
when should elective PSA testing be discontinued
age 60 is PSA <1
at age 70 for all other men
if life expectancy is <10 years
165
when does menarche typically occur
2-3 years after breast bud development
166
what is precocious puberty for females
reaching puberty before age 8 for females
167
what is delayed puberty for females
lack of breast budding by age 13
168
what is the difference between mild discomfort from menses and true dysmenorrhea
true dysmenorrhea is cyclic pain that prevents normal ADLs and required medication, starting just before menses and lasting 2-3 days
169
which prostaglandin is implicated in primary dysmenorrhea
PGF2 alpha
170
what are some risk factors for primary dysmenorrhea
early age at menarche
high BMI
extreme ands of reproductive years
nulliparity
family hx of same
smoking
ETOH
copper IUD
171
True or false: n/v/d, fatigue and insomnia are symptoms associated with primary dysmenorrhea
true
172
true or false: if a women has generalized pelvic tenderness more focused in the area of the uterus but no palpable or visual abnormalities and remainder of physical is unremarkable, she cannot be diagnosed with primary dysmenorrhea
false
173
what testing may be done when diagnosing dysmenorrhea
preg test (always in women of reproductive age)
cervical culture if PID suspected
Pelvic US is masses or gyne abnormality
174
what are non pharmacological options for treatment of primary dysmenorrhea
magnesium
vitamin B1 and E
rosewater tea
exercise
TENS
acupuncture
175
what are pharmacological treatments for primary dysmenorrhea
Acetaminophen
NSAIDs started 1-2 days before onset of pain
COX 2 inhibitors (not used often due to risk of cardio and GI effects and not more effective than NSAIDs)
COCs
176
a women diagnosed with primary dysmenorrhea is taking OTC NSAIDs and COC and is not having any relief. What is next step
reevaluate for possible secondary cause
review dosing for NSAIDs (starting 1-2 days before with high dose)
177
what treatment will you use for a 55 year old woman in menopause with vaginal symptoms
vaginal estrogen
May also require systemic estrogen therapy
178
true or false: starting HRT earlier in menopausal women helps to reduce the likelyhood of adverse effects like blood clots, osteoporsis, mood swings
true
179
what usually causes urinary incontinence in men
BPH
180
which medication is MOST likely to cause ED
Beta blockers
181
what kind of medications can cause ED
beta blockers
antihypertensices
SSRIs
opiods
182
what are some complications of vasectomy
infection
bleeding/hematoma
pain
ED
pregnancy from unsuccessful surgery
183
vasectomy is not proven successful until ___
post sperm count
184
what is the most common cause of abnormal vagina bleeding after menopause
vaginal atrophy
185
what is the most common cause of heavy bleeding in perimenopause
uterine fibroids
186
true or false: abnormal bleeding after menopause should be considered endometrial cancer until proven otherwise
true
187
how can you treat urinary incontinence in menopausal femalse
pelvic floor physio
estrogen
treating secondary causes such as UTI
HRT
weight loss
188
when must you include progesterone with your estrogen therapy in treating menopausal women
if they have a uterus, you must include progesterone
189
what monitoring should be done for women with breast implants
infection
contracture
need for revision
encapsulation
leakage
190
when does male puberty usually start
age 14
191
how is menopause diagnosed
clinical history and presentation - 12 months without a period in a women in the appropriate age group who is not pregnancy and symptoms such as hot flashes
192
why is blood work not used to diagnose menopause
FSH, LH and estradiol is unreliable and can change throughout time of day
193
true of false: you required serume FSH, LH and estradiol before starting HRT for menopause
false, you can start based on a clinical diagnosis and adjust based on symptoms and response
194
can herbal remedies be used for menopausal symptoms if a patient is on antihypertensives
no as the herbals may interfere with the antihypertensives
195
what are primary prevention strategies for breast cancer
diet
exercise
weight loss
quitting smoking
having babies early
ETOH
196
Can urethral stricture in males cause post micturition dribble?
yes
197
true or false: urethral stricture in males may cause premature ejaculation and exercise incontinence
false
198
true or false: BPH may present with painful urination
false
199
true of false: MSM have increase risk for UTI
true
200
true or false: the following increase risk of UTI in men - hx of circumcision, hx of testicular torsion, inguinal hernia
false
201
which of the following is not associated with early menopause: high parity, smoking tobacco, use of hormonal contraceptives, low BMI
use of hormonal contraceptives
202
true or false: attunement is a key tenet of trauma informed care
true
203
what are some clinical considerations before starting a patient on PREP
kidney/liver function
must take pill daily
HIV status
204
how long after exposure can PEP be initiated
72 hours
205
what are mammogram screening recommendations for women with no risk factors and at what age
age 50-74 should have a mammogram every 2-3 years
206
true or false: 80-90% of abnormal mammogram results are from breast cancer
false, 80-90% of abnormal results are not breast cancer
207
when would calcifications seen on mammograms be concerning
small calcifications that are new or increased with clustered or branching pattern
208
if a woman has significant risk factors, when should first mammogram be
age 35
209
when might you order an US for evaluation of breast tissue
assess nodules seen on mammogram or for palpable masses even with a normal mammogram
210
does a negative FNA for a breast mass reliably rule out malignancy
no
211
when assessing breast lumps, what nodes should always also be assessed
axillae and supraclavicular
212
what are some etiologies for mastalgia or matodyna
hypothyroidism
oral contraceptives
pregnancy
costochondritis
trauma
213
what is the difference in females between premature telarche and precocious puberty
premature telarche is breast development before age 8 without other signs of puberty
precocious puberty is breast development with other signs of puberty before age 8
214
true or false: breast implants have been linked to connective tissue disease and breast cancer
false
215
what is mondors disease and how is it treated
superficial thrombophlebitis of the breast in women, usually from trauma/surgery or pregnancy with a palpable thrombosed vein
treated with analgesics and warm compresses
216
what medications may cause galactorrhea in females
estrogen
antihypertensives
antidepressants
antipsychotics
217
what testing should be done for females with galactorrhea
pregnancy
prolactin (>20 abnormal)
MRI or CT of brain if prolactin elevated
218
what is the most common cause for bloody or serous galactorrhea
single papilloma
219
a breast mass in a female adolescent that is smooth and rubbery is likely what? what should be next steps?
fibroadenomas
Imaging with US and refer to a specialist
220
although all breast masses in female adults are considered cancer until proven otherwise, what are some common causes that are not cancer
fibroadenomas
cysts
fibrocystic nodules
lipoma
221
true or false: palpable breast masses are more likely to be malignant in women who are post menopausal
true
222
when would you refer a female with nipple changes to rule out possible pagets disease
scaling
eczematous changes
redness
erythema
recurring scab
nonhealing area
223
lactating women who develop mastitis are usually infected with ___ and will likely respond well to ___
infected with staph and will respond well to cephalexin
224
should breast feeding women with mastitis be informed to stop breast feeding
no as it will make the infection worse and may lead to breast abscess
225
what should non lactating women with mastitis be treated with and what other pathologies should be considered in these women
treat with amox/clav
consider CA, new onset DM, or TB
226
a women with suspected mastitis is not responding rapidly to abx. What is next step
refer to specialist to rule out inflammatory breast cancer
227
what increases risk of candida mastitis
artificial nipples
large intake of dairy, sweet foods or artificial sweeteners
recent abx use
hx of recurrent yeast infection
228
a breast feeding woman has red sore nipples with stabbing type pain with breast feeding. What is the likely diagnosis
candida mastitis
229
what is the treatment for breastfeeding women with candidia mastitis
topical antifungals after every feeding for 14 days
nystatin suspension for infant
oral antifungals only if pain persists past 2 weeks
230
true or false: if a breast feeding mother is prescribed oral flucanozole for candidia mastitis, you do not need to treat the infant with nystatin suspension because they will be treated through the breast milk
false, no enough transfers to the breast milk so the infant must still be treated separately
231
true or false: breast feeding women should stop breast feeding with the affected breast if they have a breast abcess
true
232
what follow up should occur for non lactating women who get a breast abscess
breast CA screening
233
what DI should be used for diagnosing a breast abcess
US to differentiate from a cyst
234
true or false: breast abscess must be drained with I&D or FNA if less than 5 cm even with abx treatment
true
235
besides being female, what is the biggest risk factor for breast cancer
advancing age
236
what interventions are specific for lowering risk of breast cancer in high risk women
SERMS
aromatase inhibitors
prophylactic mastectomy and oophorectomy
237
is there an increased risk of breast cancer with single agent estrogen use?
no
238
what is the difference between primary and secondary amenorrhea
primary is no menarche by expected purberty age
secondary is menarche already started and then stopped for 6 months
239
what are some causes of secondary amenorrhea
PCOS, hypothalamic amenorrhea, hyperprolectinemia, primary ovarian insufficiency
240
what are some causes of primary amenorrhea
turner syndrome or anatomic abnormalities
241
what are the criteria for primary amenorrhea
no menarche by 14 with no secondary sex characteristics
no menarche by 16 with secondary sex characteristics
no menses for 1 year after reached sexual maturity
no menses in any female with features of turner syndrome
242
a female arrives to the clinic, 18 years old, with no menses for the past 6 months. She is not pregnant. She has recently lost a large amount of weight. Her FSH, LH, and estrogen are low, her prolactin in normal. what is the diagnosis
functional hypothalamic amenorrhea
243
what is the female athlete triad
disordered eating
amenorrhea
osteoporosis
244
when ruling out turner syndrome for amenorrhea, what signs would you look for
webbed neck
widely spaced nipple
short stature
245
what does the progesterone challenge test evaluate
evaluated the level of endogenous estrogen and assesses for outflow tract abnormalities
246
when is a progesterone challenge test done
as a diagnostic test for secondary amennorhea
247
what is a normal and abnormal result of a progesterone challenge test? what does an abnormal result indicate
normal is a withdrawal bleed in 2-7 days
no withdrawal bleeding means outflow tract abnormality or inadequate estrogen stimulation
248
what is the next step if there is no withdrawl bleed with a progesterone challenge test
second round of test if no withdrawal bleeding with the first round
249
what is the next step if there is no withdrawal bleeding on the second round of the progesterone challenge test
if no withdrawal bleeding with 2 rounds of progesterone challenge test, US indicated and MRI or laparoscopy may be needed
Test FHS and LH at least 2 weeks later
250
what does it mean if there is no withdrawal bleed on the first round of a progesterone challenge test but there is a withdrawal bleed on the second round
problem with HPO axis or the ovary (hypothalamic amenorrhea or POF)
251
a patient with amennorhea and no withdrawal bleeding on 2 rounds of progesterone challenge test has serum FHS and LH drawn 2 weeks later. The FHS and LH are elevated. Where is the problem? What is next step
ovarian dysfunction
Repeat the testing to make sure not a transient elevation
252
a patient with amennorhea and no withdrawal bleeding on 2 rounds of progesterone challenge test has serum FHS and LH drawn 2 weeks later. The FHS and LH are normal. Where is the problem?
pituitary or hypothalamic
253
although elevated gonadotropins may be from a menopausal state, what do they indicate if it happens before the age of 40
primary ovarian insufficiency (POF)
254
what is the treatment for primary ovarian insufficiency
hormone therapy
255
how long can it take for young women to develop a regular menses from time of starting menstruating
up to 24 months
256
when is heavy menstrual bleeding considered chronic
occurring for more than 6 months
257
what is the accronym PALM-COEIN and what is it used for
to assess causes of abnormal uterine bleeding
polyps, adenomyosis, leiomyoma, malignancy and hyperplasia
coagulopathy, ovulatory, endometrial, iatrogenic, not yet classified
258
how much blood loss per menstrual cycle is associated with anemia
more than 60-80ml
259
in patients presenting with excessive menstrual bleeding with no apparent cause on intial testing or not responding to treatment, especially adolescents, what testing should be done
von willebrand , PT, PTT, Factor VIII
260
what is the medical treatment for acute AUB
IV equine estrogen
261
what are first line treatment options for chronic AUB
COC
NSAIDs
progestin only methods
estrogen only
262
why should estrogen be combined with progesterone for long term use in women with a uterus
long term use of estrogen is assocaited with increased risk of ednoemtrial cancer, progesterone helps protect
263
when is COC contraindicated
over 35
smoker
history of thromboembolic disease<6 week postpartum
Migraines with focal neuro symptoms
Breast CA
Liver disease
264
what testing needs to be completed before starting hormone therapy for gender transitioning
hematocrit
lipid profile
bone mineral density if at risk for osteoporosis
prolactin and triglycerides
Referral letter from mental health or informed consent
265
what are some side effects of anabolic steroid use
in men - testicular and sperm dysfuction, ED, increased risk of prostate cancer, acne, stomache pain
in women - male hair growth, breast loss, deepend voice, hair loss, acne
for both - heart attack, liver or kidney problems, blood clots, fluid retention, mood swings/mental health, stunted growth
266
what are some S&S of ovarian cancer
abnormal bleeding
masses
vaginal discharge
bladder problems
constipation/diarrhea
bloating, early satiety, loss of appetitie
fatigue
pain in lower legs and abo
dyspareunia
weight loss
systemic edema
SOB
267
what are red flags for dysmenorrhea
new or sudden onset pain
unremitting pain
fever
purulent cervical dishcarge
evidence of peritonitis
268
what are the S&S of toxic shock syndrome
sudden onset fever, HoTN, diffuse macular erythroderma, involvement of at least 2 other organ systems, renal impairment
269
what are the two most common chronic conditions that overlap with PMS symptoms and should be screened for seperatley
depression and anxiety
270
what are non pharmacological recommendations for PMS
complex carb diet
calcium supplement
B6 (max 100mg/day)
aerobic exercise
acupunture
chasteberry (cant take in pregnancy and lactation)
271
women with lynch syndrome are at increased risk of ovarian and endometrial cancer. What type of screening should they undergo
yearly pelvic exam and pelvic US and endometrial biopsy
272
how often should women with cervical dysplasia have pelvic exams
every 6 months for 1-2 years then yearly
273
post gynecological cancer, what other disorders should be monitored for and how often
yearly monitoring for hypothyroid, HTN and hyperlipidemia
274
what is vulvar vestibulitis syndrome and what is treatment
localized vulvar dysestheisa, can be worsened with tx for yeast/BV/HPV
topicals, refer to specialist
275
what is dysethetic vuvlodynia
generalized vulvar dysethesia
276
w omen has intense vulvar pruritis, relieved with itching. On assessment she has thick lichenified skin that is redenned. What is this and what is the treatment?
lichen simplex chornicus
sitz baths and clobestasole
277
a post menopausal women has vuvlar pruritis. the skin looks crinkly and waxy and has a keyhold appearance. What is this and what is the treatment
lichen sclerosus
topical clobetasol
278
what vulvuar skin condition causes pruritis with white lacy or fern like papules
lichen planus
279
true or false: chronic vulvar pruritis that is left untreated may increase risk of CA
true, as this may develop into lichen sclerosis which can further develop into vulvar CA
280
what should your next step be if you see white patches associated with vulvar pruritis
refer to derm as this may be lichen sclerosis which increases risk of CA
281
when should you biopsy an enlarged bortholin gland
in women over 40
282
what medication is available in canada to induce abortion and how late can you take it
mifegymsio can be used before 49 days gestation
283
what is the average age of menopause for smokers and non smokers
51 for non smokers
45 for smokers
284
what is the definition of mneopause
absence of menstruation for 1 year in appropriate age group without pregnancy
285
what is premature menopause and what usually causes is
before age 40
usually from premature ovarian insufficiency
286
when would menopausal hormonal therapy initiation increase risk of CVD instead of decreasing risk
if started late, >10 years after menopause
287
what are contraindications for menopausal hormonal therapy
undiagnosed AUB
known or suspected hx of metastatic breast CA
known or suspected estrogen dependent CA
coronary heart disease
active or hx of VTE
active or hx of stroke
known thrombophilia
active liver disease
known or suspected pregnancy
over age 60
288
true or false: a CT study involving 2 or 3 scans may increase the risk or developing cancer from radiation
true
289
what are ways to reduce the overall radiation dose from CT in the population
reduce CT related dose in individual patients
replace CT with other options, such as US or MRI, if reasonable
Decrease number of CT scans ordered
290
what are 3 unique considerations for CT in children
children are more sensitive to radiation
children have longer life expectancy and more window for excessive radiation
children may receive higher dose than needed if machine is not adjusted for their smaller bodies
291
true or false: pediatric CT scans usually need more than one scan
false, the vast majority can be done with a single scan
292
a patient with amennorhea is tested with the progesterone challenge test. She has withdrawl bleeding on the first round. Where is the problem?
Lack of ovulation
possibly anovulation or PCOS
293
what are some health benefits for men put on TRT
improves bone density
improved ED
improved mood and well being
maintains cardiovascular health
294
what should be monitored in patients taking alpha-adrenergic blockers? in patients taking 5ARI?
AAR - monitorBP, renal and liver
5ARI - monitor PSA and complete DRE
295
true or false: supplements like Vitamin E and selenium may improve prostate cancer symptoms and outcome
false, in some cases they may even be harmful especially when taken with hormone therapy
296
for men on hormone lowering therapy for prostate cancer, what supplements should they be put on and why
calcium and vitamin D because of increased risk of bone loss and fractures
297
what tumor markers in breast cancer are more aggressive: positve or negative
hormone negative tumors are usually more aggresive and grow faster
298
what baseline labs should be drawn before starting hormone therapy
CBC
ALT
Creatinine
Electrolytes
HBA1C
Lipids
Testosterone
Estradiol
Prolactin
Hep B and C
299
What liver serum marker may also be elevated with prostatic disease
GGT
NURS522
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