NU 545
Unit 3 Study Guide
Advanced Pathophysiology
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-minute
review. The guide is structured to help students
reinforce understanding, identify weak areas, and prepare
confidently for the assessment.
,UNIT 3: HORMONES and REPRODUCTION
Physio-Pathological Basis of Advanced Nursing (NU545)
Study Guide and Resources
Edited by: Jessica L. Santos
1
,SECTION 1: STUDY GUIDE
1. KNOW ALL STDS: PATHOPHYSIOLOGY, ETIOLOGY, CLINICAL MANIFESTATIONS,
DIAGNOSTIC TESTS, TREATMENTS, AND COMPLICATIONS. HOW IS EACH TRANSMITTED
DURING PREGNANCY TO THE FETUS? KNOW THE DIFFERENT STAGES OF SYPHILIS;
WHAT ORGANISM CAUSES EACH STD AND IS IT VIRAL, BACTERIAL, ETC.? DO YOU
TREAT BOTH PARTNERS AND WHY? WHAT AGE GROUP HAS THE GREATEST RISK OF
STDS AND WHY? WHAT CAUSES CERVICAL CANCER? (please see Excel spreadsheet,
“Unit 3 STD Chart” under the resources tab, please see below for page numbers)
Different Stages of Syphilis (pp. 923-tab & 924; key search term: “incubation period of syph”)
There are 4 stages of untreated syphilis: primary, secondary, latent, and tertiary.
1. Primary Syphilis (incubation period ranges from 12 days to 12 weeks average of three
weeks)
o Local invasion: multiplies in epithelium and produces a granulomatous tissue
reaction called a chancre at the site of treponemal entry. Consider syphilis with any
open lesion
o Chancre (eroded,painless, firm and indurated ulcer <2cm in
diameter)
o Some microorganisms drain with lymph into adjacent lymph nodes.
o Cell-mediated and humoral immune responses are stimulated within the
nodes and at the site of the chancre.
o If left untreated, heals in 2-8 weeks, disappears with no scar
2. Secondary Syphilis (usually 6 weeks after first appearance of chancre – may overlap with
primary stage)
o Systemic.
o Blood borne bacteria is spread to all major organ systems.
o Followed by a period during which the immune system is able to suppress infection.
o Even without treatment, spontaneous resolution of the skin lesions occurs and the
individual enters latent stage of infection. Relapses may occur for several years.
o Typically, this stage presents with low-grade fever, malaise, sore throat, hoarseness,
anorexia, generalized adenopathy, headache, joint paint, lymphadenopathy, pruritus,
and skin or mucous membrane lesions or rashes (e.g., condylomata lata).
o Women-appear in perineum, vulva, inner thigh, anal area&groin, Men-inner thigh and
anal area
3. Latent Syphilis (may be as short as 1 year or as long as a lifetime)
2
, o Subdivided into early and late stages even though no criteria to delineate one from
the other.
o Silent infection: medical history and serologic studies show that syphilis is present, but
the individual has no clinical manifestations.
o Transmission of infection is possible during both late and early latent stages.
4. Tertiary Syphilis-rare as antibiotics cure syphillis
o Most severe stage, involving significant morbidity and mortality.
o Noninfectious disease: significant morbidity and mortality occur
o Destructive skin, bone, and soft skin lesions called gummas develop, which result from
a severe hypersensitivity reaction to the microorganism.
o Cardiovascular complications include aneurysms, heart valve insufficiencies, and heart
failure.
o CNS: possible manifestations of neurosyphilis may develop (this may occur at any
stage of syphilis infection).
o Eval / Treatment (pg. 925)
o Early diagnosis depends on darkfield microcopy of specimen from infected site.
o If initial result negative, test is repeated on 2 successive days
o 2 categories of serologic testing exist: nontreponemal antigen & treponemal
antibody,
o See table 26-3 (pg. 927)
o Nontreponemal Antigen: Show presence of regain in serum,
o Provide indirect evidence of infection
o VDRL antigen / RPR test – Yield positive results in
o > 50% individuals with primary syphilis & 100% in secondary phase.
o These tests have a high rate of false positive
- Treponemal Antibody
- Serologic – specific tests – assess antibody response to T. pallidum
- FTA-AB test & TP-PA assay
- During latent phase – patients can have positive serologic evidence
but confirmation must include presence of treponemata in
cerebrospinal fluid to confirm.
Preferred treatment for all stages is parenteral injection of benzathine PCN G. – no resistance to
date
If <1 year infected – 1 IM dose is appropriate
If >1 year infected – treatment is 3 weekly injections
This treatment is appropriate for pregnant women
Non-pregnant women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN G since
tetracycline causes permanent, lifelong discoloration of fetus teeth.
Titers should decrease 4-fold if treatment is successful.
Sexual partners are examined and treated and use of condoms recommended until treatment
If infants require treatment, PCN is drug of choice.
Infants are given serologic tests for syphilis every 2-3 months until test becomes nonreactive or
titer has decreased 4-fold.
An individual has syphilis, secondary stage. What will the nurse typically find upon assessment?
Low grade fever, malaise, and sore throat. Typically this stage (secondary) presents with
variable systemic symptoms, including low-grade fever, malaise, sore throat, hoarseness,
anorexia, generalized adenopathy, headache, joint pain, and skin or mucous membrane lesions
or rashes.
3
Unit 3 Study Guide
Advanced Pathophysiology
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-minute
review. The guide is structured to help students
reinforce understanding, identify weak areas, and prepare
confidently for the assessment.
,UNIT 3: HORMONES and REPRODUCTION
Physio-Pathological Basis of Advanced Nursing (NU545)
Study Guide and Resources
Edited by: Jessica L. Santos
1
,SECTION 1: STUDY GUIDE
1. KNOW ALL STDS: PATHOPHYSIOLOGY, ETIOLOGY, CLINICAL MANIFESTATIONS,
DIAGNOSTIC TESTS, TREATMENTS, AND COMPLICATIONS. HOW IS EACH TRANSMITTED
DURING PREGNANCY TO THE FETUS? KNOW THE DIFFERENT STAGES OF SYPHILIS;
WHAT ORGANISM CAUSES EACH STD AND IS IT VIRAL, BACTERIAL, ETC.? DO YOU
TREAT BOTH PARTNERS AND WHY? WHAT AGE GROUP HAS THE GREATEST RISK OF
STDS AND WHY? WHAT CAUSES CERVICAL CANCER? (please see Excel spreadsheet,
“Unit 3 STD Chart” under the resources tab, please see below for page numbers)
Different Stages of Syphilis (pp. 923-tab & 924; key search term: “incubation period of syph”)
There are 4 stages of untreated syphilis: primary, secondary, latent, and tertiary.
1. Primary Syphilis (incubation period ranges from 12 days to 12 weeks average of three
weeks)
o Local invasion: multiplies in epithelium and produces a granulomatous tissue
reaction called a chancre at the site of treponemal entry. Consider syphilis with any
open lesion
o Chancre (eroded,painless, firm and indurated ulcer <2cm in
diameter)
o Some microorganisms drain with lymph into adjacent lymph nodes.
o Cell-mediated and humoral immune responses are stimulated within the
nodes and at the site of the chancre.
o If left untreated, heals in 2-8 weeks, disappears with no scar
2. Secondary Syphilis (usually 6 weeks after first appearance of chancre – may overlap with
primary stage)
o Systemic.
o Blood borne bacteria is spread to all major organ systems.
o Followed by a period during which the immune system is able to suppress infection.
o Even without treatment, spontaneous resolution of the skin lesions occurs and the
individual enters latent stage of infection. Relapses may occur for several years.
o Typically, this stage presents with low-grade fever, malaise, sore throat, hoarseness,
anorexia, generalized adenopathy, headache, joint paint, lymphadenopathy, pruritus,
and skin or mucous membrane lesions or rashes (e.g., condylomata lata).
o Women-appear in perineum, vulva, inner thigh, anal area&groin, Men-inner thigh and
anal area
3. Latent Syphilis (may be as short as 1 year or as long as a lifetime)
2
, o Subdivided into early and late stages even though no criteria to delineate one from
the other.
o Silent infection: medical history and serologic studies show that syphilis is present, but
the individual has no clinical manifestations.
o Transmission of infection is possible during both late and early latent stages.
4. Tertiary Syphilis-rare as antibiotics cure syphillis
o Most severe stage, involving significant morbidity and mortality.
o Noninfectious disease: significant morbidity and mortality occur
o Destructive skin, bone, and soft skin lesions called gummas develop, which result from
a severe hypersensitivity reaction to the microorganism.
o Cardiovascular complications include aneurysms, heart valve insufficiencies, and heart
failure.
o CNS: possible manifestations of neurosyphilis may develop (this may occur at any
stage of syphilis infection).
o Eval / Treatment (pg. 925)
o Early diagnosis depends on darkfield microcopy of specimen from infected site.
o If initial result negative, test is repeated on 2 successive days
o 2 categories of serologic testing exist: nontreponemal antigen & treponemal
antibody,
o See table 26-3 (pg. 927)
o Nontreponemal Antigen: Show presence of regain in serum,
o Provide indirect evidence of infection
o VDRL antigen / RPR test – Yield positive results in
o > 50% individuals with primary syphilis & 100% in secondary phase.
o These tests have a high rate of false positive
- Treponemal Antibody
- Serologic – specific tests – assess antibody response to T. pallidum
- FTA-AB test & TP-PA assay
- During latent phase – patients can have positive serologic evidence
but confirmation must include presence of treponemata in
cerebrospinal fluid to confirm.
Preferred treatment for all stages is parenteral injection of benzathine PCN G. – no resistance to
date
If <1 year infected – 1 IM dose is appropriate
If >1 year infected – treatment is 3 weekly injections
This treatment is appropriate for pregnant women
Non-pregnant women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN G since
tetracycline causes permanent, lifelong discoloration of fetus teeth.
Titers should decrease 4-fold if treatment is successful.
Sexual partners are examined and treated and use of condoms recommended until treatment
If infants require treatment, PCN is drug of choice.
Infants are given serologic tests for syphilis every 2-3 months until test becomes nonreactive or
titer has decreased 4-fold.
An individual has syphilis, secondary stage. What will the nurse typically find upon assessment?
Low grade fever, malaise, and sore throat. Typically this stage (secondary) presents with
variable systemic symptoms, including low-grade fever, malaise, sore throat, hoarseness,
anorexia, generalized adenopathy, headache, joint pain, and skin or mucous membrane lesions
or rashes.
3
