Exam (elaborations) NURSING 633 (NURSING633) NURSING 633 Week 7 – Gynecology (GYN) and Sexually Transmitted Infections (STI) (Answered)

Week 7 – Gynecology (GYN) and Sexually Transmitted Infections (STI) When seen on a wet mount like the following, clue cells would indicate the treatment by which of the following? Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1 Flagyl (Metronidazole) 500mg PO BID x 7 days No treatment needed Diflucan (Fluconazole) 150mg PO x 1 The uterus should sound to ______ cm when measuring for Mirena IUD insertion to allow for the arms to open and proper alignment to occur. 6-9 cm; measured and forgotten about. 6-10 cm; measured and documented in the chart. 1-3 cm; measured and forgotten about. 3-5 cm; measured and documented in the chart. If cervical stenosis is met when performing IUD insertions, which of the following should be used to overcome resistance? 6 - 9 cm 12 - 15 cm 9 - 12 cm 3 - 6 cm A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulvall itching and discharge. He is asymptomatic. How should they be treated? They both should receive metronidazole A 40 year old female patient returns to your clinic to review her pap smear results from the previous week. You tell her the test is abnormal with “atypical squamous cells of undetermined significance and HPV positive”. What is the appropriate next step of the following? Repeat cytology in 1 year Repeat cytology immediately Perform or refer out for colposcopy Repeat cytology in 2-4 months After an IUD is placed, the threads should be cut so approximately ______ are visible. This should then be _________. 3 cm; measured and documented in the chart. 3 cm; measured and forgotten about. 6 cm; measured and documented in the chart. 6 cm; measured and forgotten about. You suspect that the patient you are seeing has HIV. which of the following is a sensitive screening test for human immunodeficiency virus? Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen HIV antibody test ELISA test Western blot test A 35 year old female presents for her well-woman exam with no complaints and no significant medical history. She admits to occasional unprotected intercourse with her partner, which is an unstable, but safe relationship. Upon exam, you note a green, frothy and malodorous discharge she states she has noticed on occasion, but thought it was normal. Wet mount shows the following image with a positive “Whiff Test”. What is your likely diagnosis?: Bacterial Vaginosis Vaginal candidiasis Trichomonas vaginalis Atrophic vulvovaginitis Clue cells are found in patients who have: Bacterial vaginosis [Clue cells are hallmark sign of bacterial vaginosis and can be seen in a microscopic exam.] A 21-year-old college student has recently been informed that he has HPV infection on the shaft of his penis. With the following methods can be used to visualize subclinical HPV lesions on the penile skin? Apply acetic acid to the penile shaft to look for acetowhite changes Lesions of HPV infection will turn white with application of acetic acid. Routine use of this procedure to detect mucosal changes due to HPV is not recommended because results do not influence clinical management (per CDC). An initial pharmacological approach to the patient was diagnosed with primary dysmenorrhea could be: Acetaminophen NSAIDs prior to the onset of menses Combination of acetaminophen and NSAIDs NSAIDs at the time symptoms begin or onset of menses Pain associated with dysmenorrhea is likely due to prostaglandins. NSAIDs are prostaglandin synthesis inhibitors. They are usually started at the onset of menses or onset of symptoms and continued for 2-3 days depending on symptom pattern. There is no demonstrated increase in efficacy when acetaminophen is added or given alone. A 45 year old diabetic female presents with c/o vaginal itching and discharge that began after douching post-menstruation approximately one week ago. Upon exam, you find thick, white discharge with a curdlike consistency and erythema generally in the vuvlvogavinal region. Under a wet mount you see the following below. Which of the following is an appropriate treatment for this patient? Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1 Flagyl (Metronidazole) 500mg PO BID x 7 days Diflucan (Fluconazole) 150mg PO x 1 No treatment needed A male patient presents with dysuria and penile discharge. He states that his female partner has been diagnosed with an STD, but he is not sure which one. Which of these should be part of the differential? Syphilis and Chlamydia HIV and herpes Chlamydia and gonorrhea Bacterial vaginosis and Trichomonas A 65 year old female presents with c/o vaginal soreness and dysuria that has been intermittent for several years. She notes the pain is worse after intercourse with her husband of 30 years, with whom is in a monogamous relationship. She denies vaginal discharge and has not had a pap smear since her total hysterectomy ten years ago. She currently only takes a multivitamin. Your wet mount reveals few lactobacilli and increased parabasal cells. What is your likely diagnosis? Bacterial Vaginosis Atrophic vulvovaginitis Trichomonas vaginalis Vaginal candidiasis Syphilis may present as: Discharge Dysuria Painful lesions A rash Secondary syphilis can present as a rash, more commonly on the palms of the hands or soles of the feet. Lesions are usually painless. It usually does not produce significant dysuria or discharge. A 54-year-old female presents with small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. With diagnosis is least likely? Endometrial hyperplasia Ovarian cancer Uterine polyps Endometrial carcinoma Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding is an uncommon presentation of ovarian cancer, but can present this way. Other pathologies are usually evaluated before considering ovarian pathology. A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as pelvic inflammatory disease? Temperature greater than 101°F A nurse practitioner identifies filamentous structures and many uniform, oval-shaped structures during a microscopic exam of vaginal discharge. These are probably: Hyphae Typically filamentous structures, hyphae by the mechanism that allows fungal growth. Yeast may look like uniform oval shaped structures. Visualization of this should prompt immediate diagnosis of a fungal infection. Candida albicans is a specific fungus. Since many fungi can produce hyphae and yeast, it is not possible to diagnose Candida albicans specifically. A 31-year-old female patient presents with fatigue, fever, worsening unilateral low back pain for the past 5 days. Her pain is 5 out of 10 on the pain scale which has been unresponsive to ibuprofen. she denies abdominal pain, but is anorexic and nauseous. She denies vaginal discharge. Urinalysis demonstrates hematuria, the presence of WBC casts, leukocytes, nitrates. Which should be included in differential diagnosis? Pyelonephritis The patient's complaint of unilateral low back pain is likely secondary to pyelonephritis. The presence of WBC casts in the urine strongly suggest a renal origin for pyuria. A patient who presents with this scenario has to be considered to have pyelonephritis until proven otherwise. Most women with PID have bilateral abdominal tenderness, usually in the lower quadrants. Purulent vaginal discharge and fever also common. A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what tests should be performed? Lymph node biopsy RPR Comprehensive metabolic panel HIV test Asymptomatic HIV infections often have persistent generalized lymphadenopathy. The uterus should sound to ______ cm when measuring for Mirena IUD insertion to allow for the arms to open and proper alignment to occur. 3 cm; measured and documented in the chart. 6 cm; measured and forgotten about. 3 cm; measured and forgotten about. 6 cm; measured and documented in the chart. What is your treatment for Atrophic Vulvovaginitis? Diflucan (Fluconazole) 150mg PO x 1 Clindamycin 2% 5g applicator PV x 7 days Premarin cream 0.5g PV 1-3 x wk Flagyl (Metronidazole) 2g PO x 1 Chancroid considered a cofactor for transmission of: HIV Chlamydia Trichomonas Gonorrhea Chancroid is an STD. It is spread by sexual contact or by contacting pus from an infected lesion. The ulcers usually. Painful and then, but usually not painful in women. It is a cofactor in the transmission of HIV. In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the public health department. The patient asks the NP not to report it because her husband works in the public health department. How show this be managed by the NP? Tell the patient that it will not be reported, but report it anyways Respect the patient's right to privacy and not report it Report it to the public health department but don't divulge all the de Report it to the public health department as required by law [If state law requires it, it should be reported. Patient names or other identifying data are not part of the reporting process, so the patient should not worry about being identified and associated with this finding.] A 26-year-old female patient has been diagnosed with gonorrhea. However should she be managed? Ceftriaxone only Ceftriaxone and azithromycin Cefixime and azithromycin Penicillin G Usual treatment for gonorrhea/Chlamydia includes ceftriaxone 250 mg IM in conjunction with 1 g azithromycin by mouth. A sexually active adolescent male has a warty growth on the shaft of his penis. It is painless. This is likely: Herpes Syphilis HPV Trichomonas This is not a clinical presentation of trichomonas because this produces a discharge. Syphilis produces a painless lesion that presents as an ulceration with a hard edge and clean yellow base. Herpes produces lesions but are usually painful. HPV produces warty growths as described above. A 19-year-old student who is on prescription combined oral contraceptive pills is being seen for lower GI pain. The nurse practitioner has obtained a Pap smear and is about to perform the bimanual exam. She gently remove the plastic speculum from the vagina. While the NP is performing the bimanual vaginal exam, the patient complaints of slight discomfort during palpation of the ovaries. Which with the following is a true statement? The uterus and ovaries are both sensitive to any Palpation The ovaries are sensitive to deep palpation but they should not be painful. The fallopian tubes and ovaries are not sensitive to light or deep palpation The uterus and ovaries are not important organs of reproduction Unilateral adnexal pain accompanied by cervical motion tenderness and purulent endocervical discharge suggestive of PID What is included in your treatment plan for #4? (Though not sure which question it’s actually referring to.) Flagyl (Metronidazole) 2g PO x 1 with partner treatment and report to the county Rocephin (Ceftriaxone) 250mg IM of patient only and no report to the county Flagyl (Metronidazole) 2g PO x 1 of patient only and no report to the county Rocephin (Ceftriaxone) 250mg IM with partner treatment and report to the county 50-year-old male comes to in see the nurse practitioner for evaluation. He complains of fever, chills, pelvic pain, dysuria. He should be diagnosed with: Nonbacterial prostatitis Acute bacterial prostatitis Urinary tract infection Chronic bacterial prostatitis Acute bacterial prostatitis should always be considered first in male patient to present with these symptoms. Chronic bacterial prostatitis presents with a more subtle presentation. UTIs far less common in men than women and is usually associated with anal intercourse or being uncircumcised. Nonbacterial prostatitis presents like chronic prostatitis except urine and prostate secretion cultures are negative. If cervical stenosis is met when performing IUD insertions, which of the following should be used to overcome resistance? 1. 3-6 cm 2. 9-12 cm 3. 12-15 cm 4. 6-9 cm A 35 year old female presents for her well-woman exam with no complaints and no significant medical history. She admits to occasional unprotected intercourse with her partner, which is an unstable, but safe relationship. Upon exam, you note a green, frothy and malodorous discharge she states she has noticed on occasion, but thought it was normal. Wet mount shows the following image with a positive “Whiff Test”. What is your likely diagnosis?: 1. Trichomonas vaginalis 2. Vaginal candidiasis 3. Atrophic vulvovaginitis 4. Bacteria Vaginosis What is your treatment for Atrophic Vulvovaginitis? 1. Diflucan 2. Clindamycin 3. Flagyl 4. Premarin cream A sexually active adolescent male has a warty growth on the shaft of his penis. It is painless. This is likely: 1. Trichomonas 2. Syphilis 3. HPV 4. Herpes A male patient presents with dysuria and penile discharge. He states that his female partner has been diagnosed with an STD, but he is not sure which one. Which of these should be part of the differential? 1. Chlamydia and gonorrhea 2. Syphilis and chlamydia 3. Bacterial vaginosis and Trichomonas 4. HIV and herpes A 65 year old female presents with c/o vaginal soreness and dysuria that has been intermittent for several years. She notes the pain is worse after intercourse with her husband of 30 years, with whom is in an monogamous relationship. She denies vaginal discharge and has not had a pap smear since her total hysterectomy ten years ago. She currently only takes a multivitamin. Your wet mount reveals few lactobacilli and increased parabasal cells. What is your likely diagnosis? 1. Trichomonas vaginalis 2. Bacterial vaginosis 3. Vaginal candidiasis 4. Atrophic vulvovaginitis A 40 year old female patient returns to your clinic to review her pap smear results from the previous week. You tell her the test is abnormal with “atypical squamous cells of undetermined significance and HPV positive”. What is the appropriate next step of the following? 1. Repeat cytology in 1 year 2. Repeat cytology immediately 3. Perform or refer out for colposcopy 4. Repeat cytology in 2-4 months A male patient presents with dysuria and penile discharge. He states that his female partner has been diagnosed with an STD, but he is not sure which one. Which of these should be part of the differential? 1. Bacterial vaginosis and trichomonas 2. Syphilis and chlamydia 3. Chlamydia and gonorrhea 4. HIV and herpes Syphilis may present as: 1. Discharge 2. Painful lesions 3. A rash 4. Dysuria In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the public health department. The patient asks the NP not to reported because her husband works in the public health department. How show this be managed by the NP? Report it to the public health department but don't divulge all the details Report it to the public health department as required by law Tell the patient that it will not be reported, but report it anyways Respect the patient's right privacy and not report it If state law requires it, it should be reported. Patient names or other identifying data are not part of the reporting process, so the patient should not worry about being identified and associated with this finding.