NR 509 Final Exam
Suspicious breast mass - ANS--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 - ANS---*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 - ANS-Soft to firm, round, mobile, often tender.
The best way to examine the lateral portion of the breast - ANS--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) - ANS--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 - ANS--Cause: Candida albicans, a yeast (normal overgrowth of
vaginal flora); many factors predispose, including antibiotic therapy
-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 - ANS--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 - ANS-This 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 - ANS-Acute: 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.
Suspicious breast mass - ANS--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 - ANS---*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 - ANS-Soft to firm, round, mobile, often tender.
The best way to examine the lateral portion of the breast - ANS--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) - ANS--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 - ANS--Cause: Candida albicans, a yeast (normal overgrowth of
vaginal flora); many factors predispose, including antibiotic therapy
-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 - ANS--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 - ANS-This 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 - ANS-Acute: 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.
