AHA Final Exam Final Study Guide PDF

Health Assessment Exam #1 Blueprint Unit 1-3 (Hx and Interviewing, Physical Overview, HEENOT) Know the difference between hypertropia, exotropia, esotropia, and hypotropia.. (Bickley et al. , 2021, pg 368)  Esotropia (inward deviation)  Exotropia (Outward deviation)  Hypertr...

Health Assessment Exam #1 Blueprint Unit 1-3 (Hx and Interviewing, Physical Overview, HEENOT) Know the difference between hypertropia, exotropia, esotropia, and hypotropia.. (Bickley et al. , 2021, pg 368)  Esotropia (inward deviation)  Exotropia (Outward deviation)  Hypertropia (Upward deviation)  Hypotropia (Downward deviation) Know the difference between Lacrimal gland enlargement, Dryness of the eyes, Nasolacrimal duct obstruction, and Thyroid eye disease. Lacrimal gland enlargement, also known as dacryoadenitis, can be caused by a number of conditions, including infections, inflammation, or autoimmune diseases:  Acute dacryoadenitis Most common in children and young adults, this is usually caused by a viral or bacterial infection, such as mumps, Epstein-Barr virus, staphylococcus, or gonococcus. Symptoms include tenderness, redness, and swelling of the gland, which can cause the eyelid to droop and form an S-shape.  Chronic dacryoadenitis Can be caused by non-infectious inflammatory disorders, such as thyroid eye disease, sarcoidosis, or orbital pseudotumor.  Lacrimal gland tumors These can include pleomorphic adenomas, which can cause diplopia and limited ocular motility. Lacrimal gland lymphomas are more common in patients over 60, but can also occur in children.  Sjögren Syndrome An autoimmune disorder that causes the progressive degeneration of the lacrimal glands. Symptoms of lacrimal gland swelling include: Pressure on the eye and Distorted vision. Treatment for lacrimal gland swelling depends on the cause. For example, viral conditions like mumps can be treated with rest and warm compresses. You should see an eye care specialist or healthcare provider as soon as you notice any swelling, pain, or discoloration near your eye (Bickley et al. , 2021, pg 369) Dryness of the eye – red eye with gritty sensation. Dryness from impaired secretion is seen in Sjogren Syndrome. Nasolacrimal duct obstruction – leads to impaired drainage, can be caused by ectropion Thyroid eye disease or Exophthalmos. Protrusion of the eyeball, a common feature of thyroid eye disease, is triggered by autoreactive T lymphocytes. In this disorder, there is a spectrum of eye changes, ranging from lid retraction to extraocular muscle dysfunction, dry eyes, ocular pain, and lacrimation. Changes do not always progress. In unilateral exophthalmos, consider thyroid eye disease (though usually bilateral), trauma, orbital tumor, and granulomatous disorders. What is therapeutic communication and special consideration for blind patients and patients hard of hearing? Blind-/Low-Vision: Shake hands to establish contact and explain your name/role. Present anyone else in the room. Verbally orient to room. Encourage glasses if they wear them. Explain things verbally sing gestures wont be received by patient. (Bickley et al. , 2021, pg 66) Hearing impairment: Find out the pt preferred method. Might need ASL interpreter. Encourage use of hearing aids. (Bickley et al. , 2021, pg 65) How do we establish an effective patient encounter? Step 1 Initiating the encounter ▪ Setting the stage/preparation ▪ Greeting the patient and establishing initial rapport Step 2 Gathering information ▪ Initiating information gathering ▪ Exploring patient's perspective of illness ▪ Exploring biomedical perspective of disease including relevant background and context Step 3 Performing the physical examination Step 4 Explaining and planning ▪ Provide correct amount and type of information ▪ Negotiate plan of action ▪ Shared decision making Step 5 Closing the Encounter How do you establish rapport with patients with disabilities? Make eye contact, engage in simple conversations. Avoid talking down to patient or been condescending. (Bickley et al. , 2021, pg 66) Clues to the Patient’s Perspective on Illness (Bickley et al. , 2021, pg 13) What information is gathered in a clinical assessment? Physical Exam o Vitals o General – Orientation, mood, memory odors, grooming, etc o Eye -Pupils size, accommodation, conjunctiva, sclera, otoscope. Acuity. o HENT- Scalp, hair, face, Ear Canal-otoscope, nose, Mouth (Symmetry, color, moisture, lesions, mucosa, teeth, palate, tongue). Weber test/Rinhe Test.  Nerve I- Olfactory- Not tested.  Nerve II- Optic -Snellen chart  Nerve III- oculomotor– Extra ocular movement- Follow fingers  Nerve IV -trochlear - Extra ocular movement - Follow fingers  Nerve VI -abducens- Extra ocular movement - Follow fingers  Nerve V -Trigeminal- Motor, sensory and corneal reflex. Clench jaw. Touch skin.  Nerve VII facial – Raise eyebrows, puff cheeks, smile.  Nerve VIII -vestibulocochlear – whispering something  Nerve IX glossopharyngeal – say “Aaaa”. Quality of voice. Hoarse? Gag reflex with tongue depressor.  Nerve X -Vagus.  Nerve XI spinal accessory – trapezius muscles (Shrug shoulders, turn neck side to side).  Nerve XII – Hypoglossal - Stick out tongue. Symmetry? o Neck- palpate lymph nodes, masses, neck pulsations, trachea midline? Swallow. Check thyroid. Back, Posterior Thorax and Lungs. Observed muscles of back. Percuss chest and lungs. o Respiratory. Rate, rhythm depth, Auscultate lungs, under the axilla. Upper extremities. ROM. Strength Squeeze two fingers. BUE resistance. Point-to-point movement. Coordination. Examine female breast tissue. Arms raised, axillary nodes. Nodules? Palpate percuss the thorax. Listen to breath sounds.  o Cardiovascular. Thorax observation of Jugular vein, carotid pulse, listen bruit. Apex with bell. Heart listen x 6 spots. o Gastrointestinal. Listen to Bowel sounds. Palpate light then harder. Percuss the liver. Don’t forget the femoral and popliteal pulses. Inguinal lymph nodes. BLE for discoloration, skin issues, edema. Pedal pulses. Varicose veins? ROM/Strength of BUE/BLE. Reflexes knee, Babinski feet. o Musculoskeletal – Gait. Knee bends. o Integumentary- moist, ulcers, pallor, discolorations, molds. o Neurologic/Psychiatric- Mental, status, cranial nerves, motor system, reflexes. BUE, BLE reflexes. o Genitourinary. General genitalia. Females: Pap smear and bimanual palpation uterus, anorectal fistula. Explain the Mnemonic FIFE ▪The patient's Feelings, including fears or concerns about the problem ▪The patient's Ideas about the nature and the cause of the problem ▪The effect of the problem on the patient's life and Function ▪The patient's Expectations of the disease, of the clinician, or of the health care, often based on prior personal or family experiences. (Bickley et al. , 2021, pg 13) Understanding Racism and Bias and Social Determinants of Health Racism and Bias Implicit bias is a set of unconscious beliefs or associations that lead to a negative evaluation of a person on the basis of their perceived group or identity. Social Determinants of Health The conditions in which people are born, grow, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces include economic policies and systems, development agendas, social norms, social policies, and political systems. How to improve patient health and reduce inequities.  How to address health disparities. At pt level: Ask patient about social challenges, guide to resources to access benefits/support services (MCD, health clinics, etc) At practice level: offer culturally safe care, use patient care navigators, “ensure that care is accessible to those most in need” At community level: Partening with local organizations/public health agencies. (Bickley et al. , 2021, pg 19) Purpose of inspection, palpation, auscultation, and percussion. (Bickley et al. , 2021, pg 124) Causes of fatigue Fatigue is a common symptom of depression and anxiety. Fatigue es normal response to hard work, sustained stress, grief. Investigate further if fatigue is unrelated to those situations (Bickley et al. , 2021, pg 212) Assessment of fatigue Fatigue is a common symptom of depression and anxiety, but consider infectious, endocrine, adrenal, heart failure, COPD/CKD, anemia, electrolyte imbalance, malignancy, nutritional deficits and medications side effects. (Bickley et al. , 2021, pg 212) Know the difference between hypothyroidism and hyperthyroidism. S/S (Bickley et al. , 2021, pg 351) Alzheimer's disease characteristics, diagnostic tests, and treatment plans. Consists of evidence of a causative genetic mutation from family history or genetic testing, or the presence of cognitive decline in TWO or MORE cognitive domains, with ALL THREE of the following features: clear evidence of decline in memory and learning and at least one other cognitive domain, steady progressive decline in cognition without extended plateaus, and no evidence of mixed etiology from other neurodegenerative, cerebrovascular, mental, or systemic disease. Alertness and attention are preserved Other Dementias are unlikely Memory difficulties take the form of repeating questions, losing objects, or confusion when performing tasks such as shopping. LATE STAGES: impaired judgement and disorientation progressing to aphasia, apraxia, left-right confusion, and dependence of instrumental activities of daily living, Psychosis and agitation can also occur NO CURE – treatments can include:  Cholinesterase inhibitors These drugs increase levels of acetylcholine, a brain chemical that helps nerve cells communicate. They are often the first medicines tried and can help with memory and behavioral symptoms. Examples include donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).  Memantine (Namenda) This drug works by blocking the effects of glutamate, a chemical in the brain. It can help slow the progression of symptoms in moderate to severe Alzheimer's disease.  Immunotherapy drugs These drugs target the protein beta-amyloid to help reduce amyloid plaques, a hallmark of Alzheimer's. Examples include lecanemab and donanemab.  Antidepressants, antipsychotics, and anti-anxiety drugs These drugs may help with behavioral and psychological symptoms like depression, anxiety, and agitation. However, they should only be used after other strategies have been tried.  Person-centered care This involves tailoring a person's care to their interests, abilities, history, and personality. It can be effective in managing some symptom Suicide. Who has the highest incidence? 2nd leading cause of death among 15 to 24 yo. Man are 4x more likely than women to die of suicide. Man more likely use firearm, women to use poison. 90% of all suicides are non-Hispanic whites. (Bickley et al. , 2021, pg 263-264) What screening test will be performed for dementia? The Montreal Cognitive Assessment (MoCa) (Bickley et al. , 2021, pg 277) What are common illicit drugs? ¼ USA Americans reported binge drinking. SUD – Marijuana, cocaine, psychotherapeutic drugs. (Bickley et al. , 2021, pg 267) What are common drugs that are overdosed? Opioids, Fentanyl (Bickley et al. , 2021, pg 267) What foods reduce cardiovascular risks? Following a healthy diet. Vegetables such as leafy greens (spinach, collard greens, kale, cabbage), broccoli, and carrots Fruits such as apples, bananas, oranges, pears, grapes, and prunes Whole grains such as plain oatmeal, brown rice, and whole-grain bread or tortillas Fat-free or low-fat dairy foods such as milk, cheese, or yogurt Protein-rich foods: Fish high in omega-3 fatty acids (salmon, tuna, and trout) Lean meats such as 95% lean ground beef or pork tenderloin or skinless chicken or turkey Eggs Nuts, seeds, and soy products (tofu) Legumes such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans Oils and foods high in monounsaturated and polyunsaturated fats: Canola, corn, olive, safflower, sesame, sunflower, and soybean oils (not coconut or palm oil) Nuts such as walnuts, almonds, and pine nuts Nut and seed butters Salmon and trout Seeds (sesame, sunflower, pumpkin, or flax) Avocados Tofu Common causes of breath odor (Halitosis) Poor oral hygiene, tobacco smoking, plaque retention on teeth, dentures and periodontal disease (Bickley et al. , 2021, pg 267). Diagnostic tests performed for bacterial throat infection? Rapid Antigen testing for streptococcal and fusobacterium. (Bickley et al. , 2021, pg 422). Risk factors for carcinoma of the lip.  Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others  Fair skin  Excessive sun exposure to your lips  A weakened immune system What causes angioedema? Localized subq or submucosal swelling cause by leakage of the intravascular fluid into the interstitial tissue.. Triggered by mast cells. Associates S/S urticaria and pruritus. Usually resolves within 24-48 hrs. Can be LIFE THREATNING if it involves larynx, tongue, upper airway and develops into anaphylaxis (Bickley et al. , 2021, pg 430) Primary syphilis characteristics, diagnostic tests, and treatment plan. Characteristics: Small red papule becomes a chancre – painless erosion up to 2cm in diameter, base is smooth, red and glistening, boarders are raised and indurated. Chancre heals within 2-3 weeks Causative organism: Treponera pallidiium which is a spirochete. Incubation period is 9- 90 days after exposure. May develop inguinal lymphadenophathy within 7 days – lymph nodes are rubbery, non- tender, mobile 20-30% of patients develop secondary syphilis while chancre are still present -this suggests HIV infection  Blood tests A doctor will order a blood test to check for syphilis. If the test is positive, a second test will be performed to confirm the diagnosis.  Medical exam A doctor will review your exam and ask questions to determine the stage of infection.  Antibiotics The preferred treatment for syphilis is penicillin, which is given as a single shot in the early stages. If you're allergic to penicillin, your doctor may suggest an alternative antibiotic or a process to help your body get used to penicillin Exudative tonsillitis characteristics, diagnostic tests, and treatment plan. Streptococcal pharyngitis typically produces white/yellow exudates on the tonsils or posterior pharynx, with red beefy uvula, palatal petechia(Bickley et al. , 2021, pg 430) Test: Rapid antigen strep test. To detect group A streptococcus. Tx Strept throat. (Dynamed) Foods high in potassium Here are some examples – there are a ton more  Avocados, bananas, melons, oranges, prunes and raisins  Artichokes, winter squash, plantains, spinach, potatoes and tomatoes  Bran products and granola  Beans (baked, black, pinto, etc.)  Brown or wild rice  Certain fishes  Chicken   Beef AHA EXAM 2 STUDY GUIDE Bronchitis characteristics, diagnostic tests, and treatment plan: Inflammation of the trachea, bronchi, and bronchioles. Transient infection lasting anywhere from 3-6 weeks. Cigarette smoking can increase the severity and frequency of acute bronchitis. Subjective findings of bronchitis – persistent cough lasting longer than 10-14 days, could be the only symptom. Cough is initially dry but may progress to productive with sputum that is yellow, green, or clear Other symptoms: low grade fever less than 101, fatigue, malaise, occasional dyspnea or wheezing, headache, substernal chest discomfort or burning pain Objective findings of bronchitis: lungs clear and resonant, afebrile, occasional wheezing, crackles that clear with cough Diagnosis of bronchitis: based on clinical presentation, mainly viral, chest x-ray will be NORMAL if patient has acute bronchitis. Treatment of bronchitis : rest, drink plenty of fluids, loosen mucous, sooth cough with cough suppressant, inhaled medications such as albuterol Emphysema characteristics, diagnostic tests, and treatment plan. Progressive airflow limitations, gas exchange abnormalities, and hypersecretion of mucous usually induced by significant exposure to noxious particles or gases. Symptoms may not be fully reversible post treatment. PERMANENT abnormal enlargement destruction of air spaces distal to the terminal bronchioles, including alveolar ducts, alveolar sac, and alveoli. Chronic and progressive dyspnea, cough, wheezing, chest tightness, recurrent lower respiratory tract infections *Physiologic changes incurred with airflow remodeling typically do NOT emerge as physical signs until PROFOUND impairment of lung function occurs Physical signs include - increased AP diameter, weight loss, accessory muscle use, tachypnea SPIROMETRY is the most reliable and objective mechanism for measurement of airflow limitation Diagnosis of COPD: FEV1/FVC 4 is a medical emergency. Treatment: Non-pharmacological management: Immediate surgical intervention (orchiopexy) within 6 hours. Manual detortion if surgery is not performed within six hours. Bilateral orchiopexy. Surgical exploration and detorsion with orchiopexy or orchiectomy for non- viable testis. Pharmacological management: pain medication antiemetic Varicocele characteristics, diagnostic tests, and treatment plan. A varicocele is a condition in which the veins within the scrotum become enlarged and swollen, similar to varicose veins in the leg. Varicoceles are caused by faulty valves that prevent blood from flowing properly, causing it to pool and widen the veins. Varicoceles are usually harmless and don't require treatment unless they cause problems. Symptoms include:  A dull ache or discomfort in the scrotum  A painless lump in the testicle  Swelling in the scrotum  A smaller testicle on the side with the varicocele Varicoceles are more common on the left side of the scrotum and usually develop during puberty. They can grow larger over time and become more noticeable. Varicoceles can be treated with:  Supportive underwear: Wearing supportive underpants instead of boxer shorts can help with mild discomfort.  Pain medication: Taking pain medication can help with discomfort.  Surgery: This involves tying off or clipping the enlarged veins.  Embolization: This minimally invasive procedure involves using a catheter to inject tiny coils or foam into the veins to block them off. Larger varicoceles can increase the risk of other health problems, such as low testosterone or azoospermia (a lack of sperm in semen Hydrocele characteristics, diagnostic tests, and treatment plan. A hydrocele is a condition where fluid builds up in the scrotum, causing swelling in the pouch that holds the testicles: Hydroceles are common in newborns, especially premature babies, and most go away on their own by the time the baby is one year old. They can also occur in older boys and adults due to injury, inflammation, or other health problems. Symptoms include:  A painless, swollen testicle on one or both sides  The scrotum feels like a water-filled balloon  Discomfort in the groin area when sitting  Pain in the scrotum  Swelling that changes in size throughout the day Hydroceles are usually not dangerous and only treated when they cause discomfort, embarrassment, or threaten the blood supply of the testicle. Treatment options include:  Surgery: A surgical procedure called a hydrocelectomy removes the sac lining. This is often necessary for hydroceles that don't go away on their own after a few months.  Needle drainage: This is an option, but the fluid will come back Epididymitis characteristics, diagnostic tests, and treatment plan: Epididymitis is a condition that causes inflammation of the epididymis, a coiled tube in the back of the testicle that stores and carries sperm. Symptoms include:  Pain in the scrotum  Redness  Tenderness  Firmness  Warmth  Fluid swelling in the scrotum  Aching or discomfort in the testicles that does not go away Epididymitis can be acute (sudden) or chronic (long-term). It's most common in young men ages 19 to 35, and is usually caused by a bacterial infection. Common causes include:  Gonorrhea and chlamydia infections  E coli and similar bacteria  Mycobacterium tuberculosis (TB)  Ureaplasma  Amiodarone, a medicine that prevents abnormal heart rhythms Epididymitis is treated with antibiotics. It's important to take all of the prescribed antibiotics, even if symptoms improve, to ensure the infection is gone. If the infection was caused by a sexually transmitted infection (STI), any sex partners should also be treated. Epididymitis is relatively common and is easily confused with testicular torsion, which is a surgical emergency  Physical exam: A healthcare provider will examine the scrotum for a tender area or lump. + Prehns sign  Urinalysis: A urine sample is tested for bacteria under a microscope. Urine cultures are not recommended for chlamydial and gonococcal epididymitis.  Blood test: A blood sample is examined for signs of infection.  Urethral swab: A swab of fluid from the urethra is tested for a bacterial infection or STD.  Ultrasound: An ultrasound uses sound waves to create an image of the scrotum. It can measure blood flow in the epididymis and examine the inside of the testicle.  Uroflow: This test measures urine flow rate and how long it takes to empty the bladder. It may be used with an ultrasound to check if urine is left in the bladder.  Rectal exam: A rectal exam checks for prostate problems.  Technetium-99m (99m Tc) scanning: This scan can help determine if the condition is epididymitis or torsion Hemangioma characteristics, diagnostic tests, and treatment plan: A hemangioma is a non-cancerous tumor that's made up of an abnormal cluster of blood vessels in the skin or internal organs. The most common type of hemangioma in infants is called an infantile hemangioma, also known as a strawberry mark. Here are some facts about hemangiomas:  Appearance Hemangiomas appear as a flat mark or birthmark on the skin that brightens and grows in size over the first few months of a baby's life. They can appear on or under the skin.  Prevalence Hemangiomas are very common in children, affecting about 5% of all children. They are more common in girls, premature babies, and babies with low birth weight.  Treatment Most hemangiomas go away on their own by the time a child is 3 to 5 years old. Treatment may be needed if the hemangioma:  Breaks open and becomes an open sore  Gets infected  Is large or in a visible area   Causes problems with vision, eating, hearing, breathing, or diaper changes  Internal organs Hemangiomas can also occur inside the body, affecting organs like the liver or gastrointestinal tract. Symptoms include nausea, vomiting, abdominal discomfort, loss of appetite, or a feeling of fullness in the abdomen Wood’s lamp: What is a Wood’s lamp examination? A Wood’s lamp examination is a simple test that can identify certain conditions on your skin, scalp and hair. It’s often used to help diagnose fungal, bacterial and parasitic infections. The lamp uses long-wave ultraviolet (UV) light to make certain cells show color or appear fluorescent. The tool, developed by American physicist Robert Wood, is also called:  Blacklight test.  Ultraviolet light test.  Wood’s light test. What can a Wood’s lamp diagnose? Wood’s lamp examination can help healthcare providers diagnose several disorders, including:  Abnormal pigmentation, such as melasma and vitiligo.  Bacterial infection, including Pseudomonas and Corynebacterium.  Corneal abrasion.  Porphyria.  Scabies and head lice.  Skin fungus infections, including ringworm, tinea capitis (scalp ringworm) or tinea versicolor (yeast infection on the skin).  Skin imperfections such as acne, aging skin and milia Carpal tunnel syndrome and testing Carpal tunnel syndrome (CTS) is a common condition that occurs when the median nerve in the wrist is compressed  Numbness, tingling, or burning in the thumb, index, middle, and ring fingers  Pain or tingling that travels up the forearm toward the shoulder  Weakness and clumsiness in the hand  Dropping things  Shock-like sensations in the fingers  Wrist splint A splint can help relieve symptoms by keeping the wrist from moving and reducing compression on the nerves. Wearing a splint at night can help with tingling and numbness, and may also help prevent daytime symptoms.  Anti-inflammatory medication Oral or injected anti-inflammatory medications can help reduce swelling and relieve pain.  Corticosteroid injections A steroid injection into the carpal tunnel can help relieve pressure on the median nerve and reduce swelling. Injections can provide symptom relief for about three months, but should only be administered once every six months.  Surgery Surgery can help ease compression on the nerves in the carpal tunnel. Endoscopic repair is usually faster than open repair, with patients returning to work about eight days earlier. CTS can be treated with surgery, which involves cutting a ligament in the wrist to relieve pressure on the median nerve. There are two types of surgery: open release surgery and endoscopic surgery  Exercise Stretching and strengthening exercises can help, especially if symptoms have improved. A physical or occupational therapist can supervise these exercises.  Ergonomic changes Changing the position of your keyboard or making other ergonomic changes can help ease symptoms.  Extracorporeal Shock Wave Therapy (ESWT) This non-invasive treatment uses high-energy shock waves to stimulate healing. Other things you can try include:  Resting your hands periodically  Minimizing repetitive movements  Taking short breaks when doing repetitive tasks with your hands  Using ergonomically designed tools and furniture  Keeping your hands warm  Elevating your wrists and hands  Improving your postur McMurray test: The McMurray test is a physical exam that helps diagnose a torn meniscus in the knee. It's often performed when a patient has knee pain or has recently been injured. During the McMurray test, a healthcare provider will: Have the patient lie on their back with their knee bent to 90 degrees Hold the patient's knee with one hand and the sole of their foot with the other Rotate the tibia internally and externally while extending the knee Palpate the joint line A positive McMurray test result indicates a compromised meniscus and may include: pain, snapping, audible clicking, and lockin Drawer test A drawer test is a physical exam that can help diagnose a torn ligament in the knee or ankle:  Anterior drawer test Assesses the anterior cruciate ligament (ACL) in the knee: 1. The patient lies on their back with their knee bent to 90 degrees. 2. The examiner sits on the patient's foot and holds their lower leg in place. 3. The examiner pulls the patient's lower leg toward them. 4. If the tibia moves more than normal, or if the ligament feels loose, the test is positive.  Posterior drawer test Assesses the posterior cruciate ligament (PCL) in the knee:  A positive test is indicated by a soft or mushy feeling, or increased posterior translation of the tested knee compared to the other knee.   Ankle drawer test Assesses the ankle lateral ligament:  This test can help identify ankle instability Scoliosis characteristics, diagnostic tests, and treatment plan: Scoliosis is a sideways curve of the spine. Everyone has normal curves in the spine, and when looked at from behind, the spine appears straight. However, children and teens with scoliosis have an abnormal S-shaped or C-shaped curve of the spine. The curve can happen on either side of the spine and in different places in the spine. In most people, the cause of scoliosis is unknown. For most children and teens, the cause of scoliosis is idiopathic. This means researchers and doctors do not know the cause. However, they think that a combination of factors plays a role in the development of the disease. Doctors diagnose scoliosis by examining your child or teen and taking x-rays. This helps doctors develop a treatment plan, which depends on the location and severity of the curve. Children and teens with milder curves may just need to visit their doctor for regular check-ups. Others may require bracing or surgery. Chadwick sign Chadwick's sign is a common pregnancy symptom that appears as a bluish or purplish discoloration of the vulva, vaginal tissue, or cervix. It's caused by increased blood flow to the pelvis during early pregnancy and is usually not painful. When it appears As early as 6 weeks after conception What it looks Dark bluish or purplish discoloration of the vulva, vaginal tissue, or like cervix What causes it Increased blood flow to the pelvis Pain Usually not painful Typically lasts until after delivery Rosving sign: A sign of appendicitis. If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis. Osteoarthritis characteristics, diagnostic tests, and treatment plan: Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention. Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility. OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it. There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile. Causes Factors that may contribute to the development of OA include  Age. The risk of developing OA increases with age and symptoms generally, but not always, appear in people over 50.  Joint injury. A bone fracture or cartilage or ligament tear can lead to OA, sometimes more quickly than in cases where there is not an obvious injury.  Overuse. Using the same joints over and over in a job or sport can result in OA.  Obesity. Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.  Musculoskeletal abnormalities. Malalignment of bone or joint structures can contribute to faster development of OA.  Weak muscles. If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA.  Genetics. People with family members who have OA are more likely to develop it.  Gender. Women are more likely to develop OA than men.  Environmental Factors. Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density. Symptoms Symptoms tend to build over time rather than show up suddenly. They include  Pain or aching in a joint during activity, after long activity or at the end of the day.  Joint stiffness usually occurs first thing in the morning or after resting.  Limited range of motion that may go away after movement.  Clicking or popping sound when a joint bends.  Swelling around a joint.  Muscle weakness around the joint.  Joint instability or buckling (as when a knee gives out). OA may affect different parts of the body in different ways.  Hips. Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.  Knees. A “grating” or “scraping” feeling when moving the knee.  Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.  Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes. Treatment:  Pain relievers Over-the-counter or prescription pain relievers can help with pain and inflammation.  Injections Steroid injections into the joint can help with pain in the short to medium term. Hyaluronic acid injections can help lubricate joints and increase mobility.  Supportive devices Canes, walkers, shoe inserts, or braces can help with stability and reduce pain.  Heat and cold therapies Applying heat or ice can help with pain and stiffness.  Exercise Low-impact activities like swimming, water aerobics, and weight training can help relieve stiffness and strengthen muscles.  Lifestyle changes Maintaining a healthy weight, stopping smoking, and reducing stress can help.  Complementary therapies Massage and acupuncture may help some people.  Surgery Joint replacement surgery is an option if other treatments don't help enoug Rheumatoid arthritis characteristics, diagnostic tests, and treatment plan: heumatoid arthritis (RA) is a chronic (long-lasting) autoimmune disease that mostly affects joints. RA occurs when the immune system, which normally helps protect the body from infection and disease, attacks its own tissues. The disease causes pain, swelling, stiffness, and loss of function in joints. Additional features of rheumatoid arthritis can include the following:  It affects the lining of the joints, which damages the tissue that covers the ends of the bones in a joint.  RA often occurs in a symmetrical pattern, meaning that if one knee or hand has the condition, the other hand or knee is often also affected.  It can affect the joints in the wrists, hands, elbows, shoulders, feet, spine, knees, and jaw.  RA may cause fatigue, occasional fevers, and a loss of appetite.  RA may cause medical problems outside of the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin. Fortunately, current treatments can help people with the disease to lead productive lives. What happens in rheumatoid arthritis? Doctors do not know why the immune system attacks joint tissues. However, they do know that when a series of events occurs, rheumatoid arthritis can develop. This series of events includes:  A combination of genes and exposure to environmental factors starts the development of RA.   The immune system may be activated years before symptoms appear.  The start of the autoimmune process may happen in other areas of the body, but the impact of the immune malfunction typically settles in the joints.  Immune cells cause inflammation in the inner lining of the joint, called the synovium.  This inflammation becomes chronic, and the synovium thickens due to an increase of cells, production of proteins, and other factors in the joint, which can lead to pain, redness, and warmth.  As RA progresses, the thickened and inflamed synovium pushes further into the joint and destroys the cartilage and bone within the joint.  As the joint capsule stretches, the forces cause changes within the joint structure.  The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak over time and do not work as well. This can lead to more pain and joint damage, and problems using the affected joint. Who Gets Rheumatoid Arthritis? You are more likely to get rheumatoid arthritis if you have certain risk factors. These include:  Age. The disease can happen at any age; however, the risk for developing rheumatoid arthritis increases with older age. Children and younger teenagers may be diagnosed with juvenile idiopathic arthritis, a condition related to rheumatoid arthritis.  Sex. Rheumatoid arthritis is more common among women than men. About two to three times as many women as men have the disease. Researchers think that reproductive and hormonal factors may play a role in the development of the disease for some women.  Family history and genetics. If a family member has RA, you may be more likely to develop the disease. There are several genetic factors that slightly increase the risk of getting RA.  Smoking. Research shows that people who smoke over a long period of time are at an increased risk of getting rheumatoid arthritis. For people who continue to smoke, the disease may be more severe.  Obesity. Some research shows that being obese may increase your risk for the disease as well as limit how much the disease can be improved.  Periodontitis. Gum disease may be associated with developing RA.  Lung diseases. Diseases of the lungs and airways may also be associated with developing RA. Symptoms of Rheumatoid Arthritis Common symptoms of rheumatoid arthritis include: RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen and affect more joints. This can lead to more damage and disability. At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause. The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease. Rheumatoid arthritis can cause other medical problems, such as:  Joint pain at rest and when moving, along with tenderness, swelling, and warmth of the joint.  Joint stiffness that lasts longer than 30 minutes, typically after waking in the morning or after resting for a long period of time.  Joint swelling that may interfere with daily activities, such as difficulty making a fist, combing hair, buttoning clothes, or bending knees.  Fatigue – feeling unusually tired or having low energy.  Occasional low-grade fever.  Loss of appetite. Rheumatoid arthritis can happen in any joint; however, it is more common in the wrists, hands, and feet. The symptoms often happen on both sides of the body, in a symmetrical pattern. For example, if you have RA in the right hand, you may also have it in the left hand. RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen and affect more joints. This can lead to more damage and disability. At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause. The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease. Rheumatoid arthritis can cause other medical problems, such as:  Rheumatoid nodules that are firm lumps just below the skin, typically on the hands and elbows.  Anemia due to low red blood cell counts.  Neck pain.  Dry eyes and mouth.  Inflammation of the blood vessels, the lung tissue, airways, the lining of the lungs, or the sac enclosing the heart.   Lung disease, characterized by scarring and inflammation of the lungs that can be severe in some people with RA. Causes of Rheumatoid Arthritis Researchers do not know what causes the immune system to turn against the body’s joints and other tissues. Studies show that a combination of the following factors may lead to the disease:  Genes. Certain genes that affect how the immune system works may lead to rheumatoid arthritis. However, some people who have these genes never develop the disease. This suggests that genes are not the only factor in the development of RA. In addition, more than one gene may determine who gets the disease and how severe it will become.  Environment. Researchers continue to study how environmental factors such as cigarette smoke may trigger rheumatoid arthritis in people who have specific genes that also increase their risk. In addition, some factors such as inhalants, bacteria, viruses, gum disease, and lung disease may play a role in the development of RA.  Sex hormones. Researchers think that sex hormones may play a role in the development of rheumatoid arthritis when genetic and environmental factors also are involved. Studies show: o Women are more likely than men to develop rheumatoid arthritis. o The disease may improve during pregnancy and flare after pregnancy. Treatments for rheumatoid arthritis (RA) include medications, physical therapy, and self- help strategies:  Medications Doctors often prescribe a combination of medications to treat RA:  Anti-inflammatory medications: Such as ibuprofen, to reduce inflammation and pain  Corticosteroids: Such as prednisone, hydrocortisone, or methylprednisolone, to quickly reduce inflammation and pain  Disease-modifying anti-rheumatic drugs (DMARDs): Such as methotrexate, leflunomide, hydroxychloroquine, or sulfasalazine, to slow the progression of the disease  Biologic response modifiers: Also known as biologic DMARDs, these medications target specific immune messages to reduce inflammation  Janus kinase (JAK) inhibitors: Such as baricitinib (Olumiant), tofacitinib (Xeljanz), or upadacitinib (Rinvoq), to stop inflammation from inside the cell  Physical therapy Can help improve strength and flexibility, which can support joints and improve joint functio Gout arthritis characteristics, diagnostic tests, and treatment plan. - Characteristics - Diagnostic Tests - Treatments Bouchard nodes vs Heber Nodes Both are characteristic sign of osteoarthritis.  Heberden node describes a bony swelling of the distal interphalangeal finger joint.  Bouchard nodes describes as bony swelling of the proximal interphalangeal finger joint. Cullen’s sign  Periumbilical ecchymosis (Bruising around belly button)  Possible causes: Bleeding within or behind peritoneum, acute pancreatitis, ectopic pregnancy, spleen rupture, liver (trauma, cancer, abscess), ruptured aortic aneurysm, abdominal trauma. Herpes zoster: Herpes zoster, also known as shingles, is a painful rash caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox:  Cause After a person recovers from chickenpox, the VZV remains dormant in the body and can reactivate years later to cause shingles.  Symptoms A painful rash that usually appears on the trunk or face, and develops into clusters of blisters that scab over. Other symptoms include itching, tingling, or burning, redness, and mild to severe pain.  Treatment Antiviral drugs, such as acyclovir, famciclovir, or valacyclovir, are most effective when started within 72 hours of the first symptoms. Other treatments include corticosteroids to reduce swelling and pain, and antihistamines to reduce itching.  Prevention The shingles vaccine is recommended for healthy adults 50 and older, and for adults 19 and older with weakened immune systems.  Duration Shingles usually resolves within 3–5 weeks, but people who take antiviral medication early may recover in as little as 2 weeks.  Complications Permanent skin discoloration and scarring can occur. Other complications include difficulty moving facial muscles, drooping eyelid, hearing loss, vision problems, and taste problem Epstein-Barr virus: Epstein-Barr virus, or EBV, is one of the most common human viruses in the world. EBV is also known as human herpesvirus 4 and is a member of the herpes virus family. Most people will get infected with EBV in their lifetime, especially in childhood, and will not have symptoms. EBV infections in children usually do not cause symptoms, or the symptoms are not distinguishable from other mild, brief childhood illness After you get an EBV infection, the virus becomes latent (inactive) in your body. In some cases, the virus may reactivate. This does not always cause symptoms, but people with weakened immune systems are more likely to develop symptoms if EBV reactivates. How it spreads You can spread the virus for weeks! When you first get EBV, you can spread it for weeks and even before you have symptoms. Once EBV is in your body, it stays inactive. If it reactivates, you can potentially infect others no matter how much time has passed since the first infection. EBV is most commonly spread through saliva by:   Kissing  Sharing drinks and food  Sharing drinking cups, eating utensils, or toothbrushes  Having contact with toys that children have drooled on The virus probably survives on an object at least as long as the object remains moist. EBV can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations. Prevention There is no vaccine to protect against EBV infection. You can help protect yourself by reducing contact with people who have EBV infection. Make sure you avoid:  Kissing  Sharing drinks and food  Using the same personal items that an infected person recently used Testing and diagnosis Diagnosing EBV infection can be challenging because the symptoms are similar to other illnesses. EBV infection can be confirmed with a blood test that detects antibodies. About 9 out of 10 adults have antibodies that show that they have a current or past EBV infection. Keep Reading:Laboratory Testing for Epstein-Barr Virus (EBV) Treatment and recovery Most people get better in 2 to 4 weeks. There is no specific treatment for EBV. However, some things can be done to help relieve symptoms such as:  Drinking fluids to stay hydrated  Getting plenty of rest  Taking over-the-counter medications for pain and feve Assessing supraclavicular lymph nodes (normal and abnormal findings) Generally speaking, most neck masses in children are of infectious etiology. In adults, however, neck masses in patients who are greater than or equal to 18 years old should always be considered to be malignant until proven otherwise. (NIH, 2024) Supraclavicular lymph nodes are considered abnormal if they are larger than 1 cm in diameter, hard or matted, or fixed and not tender. Here are some other things to consider about supraclavicular lymph nodes:  Location The left supraclavicular lymph node, also known as Virchow's node, is often associated with abdominal malignancies. The right supraclavicular lymph node is more likely to be associated with thoracic malignancies, such as lung or esophageal cancer. Pyelonephritis characteristics, diagnostic tests, and treatment plan: A kidney infection is a type of urinary tract infection (UTI). A kidney infection may begin in the tube that carries urine from the body (urethra) or in the bladder. The infection can travel to one or both kidneys. A kidney infection is also called pyelonephritis. A kidney infection needs prompt medical treatment. If not treated properly, an infection can cause lasting damage to the kidneys. Or the bacteria can spread to the bloodstream and cause a dangerous infection. Kidney infection treatment often includes antibiotics, which might be given in the hospital. To check for a kidney infection, you may be asked to provide a urine sample to test for bacteria, blood or pus in your urine. Your health care provider might also take a blood sample for a culture. A culture is a lab test that checks for bacteria or other organisms in your blood. Other tests might include an ultrasound, a CT scan or a type of X-ray called a voiding cystourethrogram. A voiding cystourethrogram involves injecting a contrast dye to take X-rays of the bladder when full and while urinating. Treatment Antibiotics for kidney infections Antibiotics are the first line of treatment for kidney infections. The drugs used and the length of time of the treatment depend on your health and the bacteria found in your urine tests. Symptoms of a kidney infection often begin to clear up within a few days of treatment. But you might need to continue antibiotics for a week or longer. Finish taking the full course of antibiotics even if you start feeling better. Your provider might want you to have a repeat urine culture test to make sure that the infection has cleared. If the infection is still present, you'll need to take another course of antibiotics. Hospitalization for severe kidney infections If your kidney infection is severe, you may need to go to the hospital. Treatment might include antibiotics and fluids through a vein in your arm. How long you'll stay in the hospital depends on how severe your infection is. Treatment for recurrent kidney infections An underlying medical problem such as a misshapen urinary tract can cause you to have repeated kidney infections. In that case, you might be referred to a kidney specialist (nephrologist) or urinary surgeon (urologist). You might need surgery to repair a structural problem. Lachman maneuver: The Lachman maneuver, also known as the Lachman test, is a physical exam that assesses the integrity of the anterior cruciate ligament (ACL) in the knee: Lachman maneuver Purpose Assesses the ACL Procedure With the patient supine, flex the knee to 20–30°, stabilize the thigh, and pull the tibia anteriorly Positive The tibia translates anteriorly more than 2 mm compared to the uninjured result knee, or there is a soft or mushy end point to the movement Normal No more than 6–8 mm of laxity result Fibroadenoma: A fibroadenoma is a non-cancerous breast tumor that feels like a solid, firm, rubbery lump in the breast:  Appearance Fibroadenomas are usually painless, round, and have a smooth, well-defined border. They can vary in size and move easily under the skin.  Cause Fibroadenomas develop from the lobules of the breast, where glandular tissue and ducts grow over the lobule to form a solid lump.  Prevalence Fibroadenomas are most common in women between the ages of 14 and 35, but can occur at any age. They are less common in post-menopausal women because they shrink after menopause.  Treatment Most fibroadenomas don't require treatment and will go away on their own. However, a doctor may recommend removing them if they keep growing, change the shape of the breast, or press on other breast tissue. Removal can be done with surgery or cryoablation, a procedure that freezes and destroys the fibroadenoma.  Diagnosis A medical professional can diagnose a fibroadenoma. Breast sonography is often used to help diagnose fibroadenoma Fibrocystic breast changes Fibrocystic breast changes are a common, benign condition that causes non-cancerous breast tissue changes. Symptoms include:  Lumps or cysts  Swelling or discomfort  Tenderness or pain  Itching  Sensitive nipples  Change in breast texture Symptoms are usually felt in both breasts and may be more bothersome before a period. They usually stop after menopause. Fibrocystic breast changes occur when breast tissue thickens (fibrosis) and fluid-filled cysts develop. Hormonal changes during menstruation are thought to trigger these changes. There is no known cure, but a medical professional can help manage symptoms. Treatments include:  Taking over-the-counter pain medication like acetaminophen or ibuprofen  Wearing a supportive bra  Taking low-dose birth control pills   Limiting caffeine  Reducing salt in your diet  Taking a diuretic A doctor can puncture and drain cysts to reduce pain and pressure. However, the fluid may come back and cysts sometimes go away on their ow Paget disease of the Breast: Paget disease of the breast is a rare form of breast cancer that causes skin changes on the nipple and areola: Eczema like lesions  Symptoms Itching, tingling, redness, flaking, crusting, thickened skin, or a flattened nipple. There may also be a discharge from the nipple that is bloody or yellowish.  Risk factors Age, personal or family history of breast cancer, genetic mutations, radiation exposure, and long-term use of hormone replacement therapy.  Diagnosis A doctor will perform a clinical breast exam, mammogram, ultrasound, and biopsy to confirm a diagnosis.  Prognosis If the disease is only in the nipple or ductal carcinoma in situ (stage 0), the prognosis is excellent. Most people who are treated early make a full recovery. Paget disease of the breast is usually a sign of breast cancer in the tissue behind the nipple. It's more common in women over 50 and accounts for 1 to 4% of all breast cancer cases. It can also affect men, but this is extremely rare Paget disease: Paget's disease is a chronic bone disorder that causes bones to grow abnormally, becoming larger and weaker than normal. It's also known as osteitis deformans. Symptoms Bone pain, deformities, fractures, headaches, hearing loss, balance problems, loss of bowel or bladder control Affected Most commonly the pelvis, skull, spine, femur, and tibia bones Risk factors Older age, northern European heritage, family history Complications Bone cancer, heart problems Paget's disease occurs when there's an abnormal breakdown and regrowth of bone. The bones regrow too quickly, making them bigger and softer than normal. They may also be misshapen and break more easily. The disease often has no symptoms, or symptoms are similar to arthritis. In some cases, Paget's disease can progress to a sarcoma, a type of bone cancer Treatment:  Bisphosphonates The most common treatment for Paget's disease, these osteoporosis drugs can help reduce bone pain and slow the disease's progression. They can be taken orally or injected into a vein.  Supportive therapies These can include physiotherapy, occupational therapy, and devices like shoe inserts or walking sticks.  Surgery May be necessary to correct complications like broken bones, severe joint damage, or deformities. For example, a hip or knee replacement may be needed if arthritis is severe.  Calcium and vitamin D A doctor may recommend taking supplements to ensure you're getting enough of these nutrients. Vitamin D can be obtained from sunlight, oily fish, or supplements like fish oil.  Calcitonin A hormone produced by the thyroid gland that helps regulate calcium and phosphate levels in the blood, and promotes new bone formatio Breast cancer: Ductal Carcinoma – arises from epithelial lining of the ducts Lobular Carcinoma – Originates in the glandular tissue of the lobes As breast cancer advances, it causes fibrosis (scar tissue) Shortening of the tissue produces dimpling, changes in contour, and retraction of deviation of nipple Bacterial vaginosis characteristics, diagnostic tests, and treatment plan. Most common is Gardnerella Vaginalis, vaginal fluid Ph>4.5 Gram Stain is the GOLD standard for diagnosis To be diagnosed, need at least three clinical criteria: Thin white discharge Clue cells  Ph>4.5 Fishy odor with the “whiff test” Treatment: Metronidazole 500mg orally BID for 7 days, OR metronidazole gel 0.75% one full applicator (5g) intravaginally QD 5 days OR Clindamycin cream 2% one fill applicator (5g) intravaginally at bedtime for 5 days Trichomonas characteristics, diagnostic tests, and treatment plan: Trichomoniasis, also known as "trich", is a common, curable sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis NAAT Test is gold standard  Symptoms Most infections are asymptomatic, but symptoms can include:  Women: Vaginal discharge that is yellow, frothy, or has an unpleasant odor, vaginal or vulvar itching, burning sensation, discomfort during intercourse, or swelling of the labia  Men: Itching or irritation inside the penis, burning after peeing or ejaculating, discharge from the penis, or slight discharge from urethra  Treatment A healthcare provider can treat trich with an oral antibiotic, such as metronidazole or tinidazole. It's important to take the entire course of antibiotics, even if you start to feel better. You should also avoid sex or use condoms until the infection has been treated.  Prevention The best way to prevent trichomoniasis is to use condoms consistently and correctly during sex. You should also cover sex toys with a condom and wash them after use.  Complications Complications are rare, but pregnant women with trich may be at increased risk of premature delivery or low birthweigh Primary syphilis characteristics, diagnostic tests, and treatment plan. - Characteristics : Primary Causes by Treponema Pallidum Chancre* = primary lesions Painless local infection - Diagnostic Tests : NAAT sample direct swab from ulcer/lesion. - Treatments: Benzathine penicillin G 2.4 million units IM in a single dose If allergic to PNC alternative: - Doxycycline (100 mg orally 2 times/day for 14 days) and tetracycline (500 mg orally 4 times/day for 14 days) Primary stage During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. These sores usually occur in, on, or around the  Penis  Vagina  Anus  Rectum  Lips or in the mouth Sores are usually (but not always) firm, round, and painless. Because the sore is painless, you may not notice it. The sore usually lasts 3 to 6 weeks and heals regardless of whether you receive treatment. Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage. Treatment: Bicillin Chlamydia characteristics, diagnostic tests, and treatment plan. Chlamydia is the most common STI, highest rates under age 25, often asymptomatic, screen under age 25 annually, new sex partner, more than 1 partner, recent partner with STI If symptomatic: Burning upon urination, pain during sex, lower belly pain, abnormal, smelly discharge, bleeding between periods Treatment for Chlamydia: Doxycycline 100 mg orally 2 times/day for 7 days Alternative Regimens: Azithromycin 1 g orally in a single dose OR Levofloxacin 500 mg orally once daily for 7 day What testing is done for chlamydia? NAATS First urine of the day, vaginal/cervical swab Gonorrhea characteristics, diagnostic tests, and treatment plan. Gonorrhea is a common sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. It can affect the reproductive tract, throat, rectum, eyes, and joints. Symptoms include: Painful or burning when urinating, Increased vaginal discharge, Vaginal bleeding between periods, and Fever. However, up to 80% of women and 40% of men with gonorrhea don't have any obvious symptoms. Symptoms usually appear within 5 days for men and 10 days for women, but can take up to 30 days. Gonorrhea can lead to serious health problems, including infertility and pelvic inflammatory disease (PID). It can also cause infections in newborn NAAT test gold standard Treatment: monotherapy with a single intramuscular dose of ceftriaxone 500 mg. Candidiasis characteristics, diagnostic tests, and treatment plan. There are several tell-tale signs of a vaginal yeast infection. These symptoms can include:  An itchy or burning sensation in your vagina and vulva.  A thick, white vaginal discharge with the consistency of cottage cheese.  Redness and swelling of your vagina and vulva.  Small cuts or tiny cracks in the skin of your vulva because of fragile skin in the area.  A burning feeling when you pee. In some cases, another symptom of a vaginal yeast infection can be pain during sex. Antifungal medications work by fighting yeast overgrowth in your body. Medications are either oral (usually given in one dose of fluconazole by mouth) or topical (used daily for up to seven days). You may apply topical medications to your vaginal area or place them inside your vagina (suppository) using an applicator. Some common antifungal medications are miconazole (Monistat®) and terconazole Testicular cancer risk factors: Malignant tumor of the testicle. Two types of testicular cancer have been identified: Germ cell (90-95% of the cases: seminoma, teratoma, teratocarcinoma, and embryonal carcinoma). Nongerm cell - (5 – 10% of cases: Leydig cell, gonadoblastoma, adenocarcinoma). Screening: With early detection, testicular cancer is one of the most curable solid cancers in the United States. Controversy surrounds the initiation of monthly self-testicular examinations in adolescence. Boys with cryptorchidism are encouraged to undergo orchiopexy before age 13. Risk Factors: history of cryptorchidism (even if repaired), family history of testicular cancer, and previous history of testicular cancer, testicular atrophy. White race; rare in Black people, gonadal dysgenesis. Assessment Findings: Symptoms may include painless testicular mass, swelling, or discomfort. The affected testicle may feel harder than normal. Solid, firm, non-tender, unilateral testicular mass. Sensation of fullness, heaviness, or dull ache in scrotum, lower abdomen, or perennial area. Previous mole testicle and largest to size of normal testicle. Hydrocele. Gynecomastia in 5% of patients with germ cell tumors. Mass does not transilluminate. Erectile dysfunction and or loss of libido. Treatment: typically involves surgical removal of the affected testicle (orchiectomy), followed by chemotherapy or radiation if the cancer has spread. Non-pharmacologic management: Active surveillance, surgical intervention: radical orchiectomy in all testicular cancers, regardless of staging. Radiation therapy. Pharmacological management: chemotherapy: cryopreservation of sperm should be discussed prior to initiation of treatment; type of chemotherapy treatment depends on type of cancer: seminoma or non-seminoma. Who is at most risk for testicular cancer: prior cryptorchidism, white race, and family history Treatment for stage 1 testicular cancer: surgery radical orchiectomy and radiation. Referral and Follow-up: Referral to a urologist or oncologist for evaluation and treatment. Close monitoring of hCG, LDH an alpha-fetoprotein for indication of therapy response and recurrence. Periodic chest and abdominal CT for detection of metastasis. Follow up is largely dictated by the type of cancer and treatment. Typically, initial office visits are everyone 1-2 months after orchiectomy with adjuvant therapy. For patients with orchiectomy, and adjuvant therapy initial follow up is every 3-4 months. Frequency tapered, if no evidence of relapse. Regular follow-up with a urologist is necessary for surveillance of potential recurrence. Routine self-exams can be encouraged to catch early signs of recurrence (Dunphy et Al. 2022). Paraphimosis characteristics, diagnostic tests, and treatment plan: Paraphimosis is a urologic emergency that occurs when the foreskin of an uncircumcised or partially circumcised male becomes trapped behind the corona. It can be caused by:  Pulling the foreskin back too far or for too long   Forgetting to return the foreskin to its normal position after a medical procedure or urination  An infection  Physical trauma to the genital area  A foreskin that's tighter than normal If left untreated, paraphimosis can lead to serious consequences, including: Tissue damage (ischemia), Tissue death (necrosis), Permanent damage, Gangrene, and Amputation of the glans penis. Early intervention and prevention are key to managing paraphimosis. If you suspect paraphimosis, you should consult a urologist for prompt evaluation and treatment. Treatment options include: Reducing edema, Squeezing the tip of the penis, Using solutions to reduce swelling, Making a slit in the foreskin, and Circumcision surgery Priapism characteristics, diagnostic tests, and treatment plan: Priapism is a prolonged erection that occurs without sexual stimulation and requires immediate medical attention. It's characterized by a painful, persistent erection that lasts more than four hours. Priapism can occur due to a number of possible reasons, including:  Certain medications, such as antipsychotics, antidepressants, and drugs that reduce blood clotting  Recreational drugs, such as marijuana, cocaine, and alcohol  Underlying conditions, such as sickle cell disease There are two main types of priapism: ischemic and nonischemic. Ischemic priapism is the most common type and is considered a urologic emergency. Early intervention can help improve the chances of a functional recovery. Treatments for priapism include:  Corporal aspiration and injection: The initial treatment for ischemic priapism  Cavernosal shunt procedure: Used if medical management fails  Selective arterial embolization: A first-line intervention that uses embolization materials to achieve a 75% resolution rate  Androgen blockade: An alternative therapy that involves injections of leuprolide, bicalutamide, and ketoconazole Phimosis characteristics, diagnostic tests, and treatment plan: Phimosis is a condition where the foreskin is too tight to be fully retracted. It's usually not a problem unless it causes symptoms, such as:  Redness, soreness, or swelling  Difficulty urinating, or the foreskin balloons during urination  Painful erections  Blood in the urine  Frequent urinary tract infections (UTIs)  Bleeding or discharge from under the foreskin Phimosis can be treated with:  Gentle daily manual retraction  Topical corticosteroid ointment  Circumcision  A balloon made of medical silicone that can be worn for 30 minutes each day  Flesh tunnels that are inserted into the foreskin opening Long-standing phimosis can increase the risk of developing penile cancer Hypospadias characteristics, diagnostic tests, and treatment plan: Hypospadias is a birth defect that occurs when the urethral opening is located too close to the base of the penis. It's one of the most common birth defects in the male reproductive system, affecting about 1 in 150 to 300 male babies. Symptoms The urethral opening is located too close to the base of the penis Causes Thought to be multifactorial, with hormonal, environmental, and genetic factors Complications Difficulty urinating while standing, difficulty performing sexual intercourse, undescended testicles, inguinal hernia Treatment Surgical procedure performed by a pediatric urologic surgeon, ideally between 6 to 12 months old Success rate About 90 to 95% for most hypospadias surgery Hemorrhoids characteristics, diagnostic tests, and treatment plan: What are hemorrhoids? Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types:  External hemorrhoids, which form under the skin around your anus  Internal hemorrhoids, which form in the lining of your anus and lower rectum What causes hemorrhoids? Hemorrhoids happen when there is too much pressure on the veins around the anus. This can be caused by:  Straining during bowel movements.  Sitting on the toilet for long periods of time.  Chronic constipation or diarrhea.  A low-fiber diet.  Weakening of the supporting tissues in your anus and rectum. This can happen with aging and pregnancy.  Frequently lifting heavy objects. What are the symptoms of hemorrhoids? The symptoms of hemorrhoids depend on which type you have: With external hemorrhoids, you may have:  Anal itching  One or more hard, tender lumps near your anus  Anal pain, especially when sitting Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days. With internal hemorrhoids, you may have:  Bleeding from your rectum - you would see bright red blood in your stool, on toilet paper, or in the toilet bowl after a bowel movement  Prolapse, which is a hemorrhoid that has fallen through your anal opening Internal hemorrhoids are usually not painful unless they are prolapsed. Prolapsed internal hemorrhoids may cause pain and discomfort. How can I treat hemorrhoids at home? You can most often treat your hemorrhoids at home by:  Eating foods that are high in fiber.  Taking a stool softener or a fiber supplement.  Drinking enough fluids every day.  Not straining during bowel movements.  Not sitting on the toilet for long periods of time.  Taking over-the-counter pain relievers.  Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. With a sitz bath, you use a special plastic tub that allows you to sit in a few inches of warm water.   Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids. When do I need to see a health care provider for hemorrhoids? You should see your health care provider if you:  Still have symptoms after 1 week of at-home treatment.  Have bleeding from your rectum. Hemorrhoids are a common cause of bleeding, but other conditions can also cause bleeding. They include Crohn's disease, ulcerative colitis, colorectal cancer, and anal cancer. So it's important to see your provider to find the cause of the bleeding. How are hemorrhoids diagnosed? To find out if you have hemorrhoids, your health care provider:  Will ask about your medical history.  Will do a physical exam. Often providers can diagnose external hemorrhoids by looking at the area around your anus.  Will do a digital rectal exam to check for internal hemorrhoids. For this, the provider will insert a lubricated, gloved finger into the rectum to feel for anything that is abnormal.  May do procedures such as an anoscopy to check for internal hemorrhoids. What are the treatments for hemorrhoids? If at-home treatments for hemorrhoids don't help you, you may need a medical procedure. There are several different procedures that your provider can do in the office. These procedures use different techniques to cause scar tissue to form in the hemorrhoids. This cuts off the blood supply, which usually shrinks the hemorrhoids. In severe cases, you may need surgery. Can hemorrhoids be prevented? You can help prevent hemorrhoids by:  Eating foods that are high in fiber  Taking a stool softener or a fiber supplement  Drinking enough fluids every day  Not straining during bowel movements  Not sitting on the toilet for long periods of time BPH characteristics, diagnostic tests, and treatment plan: Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that can cause a variety of symptoms:  Frequent urination, especially at night  A weak urine stream  Leaking or dribbling of urine  Difficulty starting urination   Pain after ejaculating or while urinating  Pee changes color or smells Symptoms usually begin after age 45, but some men have no symptoms. Treatment is only necessary if symptoms become bothersome. Treatment options include:  Lifestyle changes Limit fluids before bedtime or going out, and reduce consumption of caffeine and alcohol. You can also try pelvic floor muscle training.  Medications Options include alpha blockers, 5-alpha-reductase inhibitors, and phosphodiesterase-5 inhibitors.  Surgery Options include greenlight laser surgery (PVP) and robotic waterjet treatment.  Watchful waiting This may be an option if symptoms are minor. You should contact your provider right away if you have:  Less urine than usual  Fever or chills  Back, side, or abdominal pain  Blood or pus in your urine Prostate cancer characteristics, diagnostic tests, and treatment plan Prostate cancer is a serious disease that can develop in the prostate, a gland in the male reproductive system. Symptoms Symptoms include difficulty getting or maintaining an erection, painful ejaculation, blood in semen, and decreased ejaculation volume. Causes The exact cause of prostate cancer is unknown, but it's thought to be caused by changes in the prostate's DNA. Some of these changes are inherited, while others can occur during a person's lifetime. Other factors that may increase the risk of prostate cancer include age, body chemistry, hormones, exposure to chemical toxins, poor diet, lack of exercise, and radiation. Screening Prostate cancer is usually detected through screening tests, such as blood tests that check for prostate-specific antigen levels.  Prostate-specific antigen (PSA) test A blood test that measures the level of PSA in the blood. PSA is a protein produced by the prostate, and higher levels can indicate prostate cancer. However, other conditions can also cause elevated PSA levels, such as an enlarged prostate, infection, or certain medications.   For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml.  For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.  An abnormal rise: A PSA score may also be considered abnormal if it rises a certain amount in a single year. For example, if your score rises more than 0.35 ng/ml in a single year, your doctor may recommend further testing.  Digital rectal exam (DRE) A prostate exam that can help detect prostate cancer. The average age for a prostate exam is 50, but some people may need to start screenings as early as age 45.  Ultrasound exam An exam that takes computer pictures of the prostate.  Biopsy A procedure that involves taking tissue samples from the prostate to examine for cancer cells. A pathologist will examine the samples under a microscope to determine if cancer is present.  Genomic testing A test that analyzes prostate cancer cells to identify gene mutations. This test can provide more information about a patient's prognosis, but it's not widely used. A Gleason score is a common way to determine the aggressiveness of prostate cancer. The score is based on two numbers and ranges from 2 to 10, with higher scores indicating more aggressive cance Treatment Treatment for prostate cancer depends on the stage of the disease. Treatment at an early stage can often eliminate the cancer. For prostate cancer that has spread to other parts of the body, or that doesn't respond to hormone therapy, chemotherapy may be an option. Surgery: A radical prostatectomy involves removing the entire prostate gland. Robotic surgery can reduce side effects like pain and blood loss. Radiation therapy: Uses high-energy waves to kill cancer cells. It can be used on its own or in combination with hormone therapy. Hormone therapy: Blocks or reduces the amount of testosterone in the body, which prostate cancer depends on for growth. Watchful waiting: Also known as active surveillance, this option involves monitoring the cancer without immediate treatment. Chemotherapy: A standard treatment option. Immunotherapy: A standard treatment option. Targeted therapy: A standard treatment option Prognosis Prostate cancer is the second leading cause of cancer death among men in the United States. However, most people with prostate cancer are diagnosed before the cancer spreads beyond the prostate gland