Final Study Guide Exam 3 PHC PDF

Exam review from Dr. Hammond Must review! Herina inguinal, ventral, umbilical: indirect hernia How they present: An inguinal hernia typically presents as a bulge in the groin area, often noticeable when standing or straining, while a ventral hernia appears as a bulge anywhere on the abdominal wal...

Exam review from Dr. Hammond Must review! Herina inguinal, ventral, umbilical: indirect hernia How they present: An inguinal hernia typically presents as a bulge in the groin area, often noticeable when standing or straining, while a ventral hernia appears as a bulge anywhere on the abdominal wall, and an umbilical hernia shows as a visible swelling around the belly button; an indirect inguinal hernia specifically presents as a bulge in the groin that can sometimes extend into the scrotum in men, often feeling like a soft lump that worsens with activity and can be pushed back in when lying down. Key points about each type of hemia presentation: Inguinal hernia: Visible bulge in the groin area Feeling of pressure or weakness in the groin Discomfort or pain when bending, lifting, or coughing May extend into the scrotum in men Ventral hernia: Bulge on the abdomen, often along the midline May be visible or only palpable depending on the size and location Pain or discomfort that worsens with activity Umbilical hernia: Visible bulge at the belly button May be more prominent when straining or crying (in infants) Often painless, especially in infants Important considerations : Indirect inguinal hernia: This specific type of inguinal hemia occurs when the bowel protrudes through the inguinal ring, following the path of the spermatic cord in males, which is why it can extend into the scrotum. Symptoms that may indicate a complication (incarceration) Severe pain Nausea and vomiting Inability to reduce the bulge Redness and swelling at the hernia site Prehns Sign: Prehn's sign is a clinical finding that helps clinicians determine whether testicular pain is caused by eprdrdymi1ls or testicular torsion. A positive Prehn's sign, characteized by pain relief from the maneuver, is indicative of epididymitis, or the inflammation of the epididymis (i.e., duct running behind the testes). Conversely, a negative Prehn's sign is characteized by an exacerbation of pain and indicates testicular torsion, or the rotation of the testicles around the spermatic cord, resulting in the obstruction of blood flow to the testicle. Testicular torsion is considered a medical emergency and requires immediate medical attention. Cremasteric reflex: a superficial reflex when the inner thigh is stroked, causing the cremaster muscle to contract and pull the testicle up. Absent in testicular torsion. Scrotal mass and hydrocele when will you have the patient re assess if a baby we watch but how long will you re assess: A "scrotal mass" refers to any lump or bulge felt in the scrotum, while a "hydrocele" is a specific type of scrotal mass where fluid accumulates within the sac surrounding the testicle, causing painless swelling in the scrotum; essentially, a hydrocele is a fluid-filled collection within the scrotum, considered a benign scrotal mass. Key points to remember:. Scrotal mass: A general term for any lump or bulge in the scrotum, which can be caused by various conditions including a hydrocele, testicular cancer, varicocele, epididymitis, or a cyst. a Hydrocele A painless swelling in the scrotum due to fluid buildup within the tunica vaginalis, the sac surrounding the testicle. Important considerations : a Diagnosis: To determine the cause of a scrotal mass, a doctor will perform a physical examination, including palpating the scrotum, and may order further tests like an ultrasound to differentiate between a hydrocele and other potential causes. a Symptoms: A hydrocele typically presents as a smooth, fluid-filled swelling in the scrotum that may change size throughout the day, while other scrotal masses could be associated with pain or discomfort. a Treatment Most hydroceles in children resolve on their own, while larger or symptomatic hydroceles in adults may require surgical drainage of the fluid. A baby with a scrotal mass or hydrocele should be reassessed by a doctor if the swelling is large, firm, painful, or does not resolve on its own by the time the baby is around one year old; if you notice any significant worsening or new symptoms, contact your pediatrician immediatel Cryptorchidism and when to do an orchiopexy:: An orchiopexy for cryptorchidism (undescended testicles) is typically recommended when a child's testicle(s) haven't descended into the scrotum by around 6 months of age, with most experts suggesting surgery should be performed ideally before the child turns I year old to minimize the risk of future fertility issues and potential testicular cancer development;. Key points about cryptorchidism and orchiopexy: a What is it?: Cryptorchidism is a condition where one or both testicles haven't descended into the scrotum naturally. a Why surgery is needed: Early surgical intervention through an orchiopexy is recommended to reposition the undescended testicle(s) into the scrotum, reducing the risk of infertility and potential testicular cancer later in life. Ideal timing: Most medical professionals advise performing an orchiopexy between 6 months and 1 year of age. a Reasons for early surgery: a Fertility concems: The longer an undescended testicle remains outside the scrotum, the higher the potential for impaired sperm production. a Cancer risk: Some studies suggest a slightly increased risk of testicular cancer associated with undescended testicles, which can be lowered by early surgical correction Erectile Dysfunction, what medication is used, when is it contraindicated, what is common cause of ED? Erectile dysfunction (ED) can have many causes, including physical and psychological factors: a Medical conditions High blood pressure, high cholesterol, diabetes, cardiovascular disease, prostate problems, multiple sclerosis, spinal cord injuries, and nerve damage a Medications Antidepressants, antihistamines, and medications for high blood pressure, pain, or prostate conditions Substance use Tobacco use, drug use, and heavy drinking a Psychological conditions Depression, anxiety, performance anxiety, stress, relationship problems, lack of sexual knowledge, past sexual problems, and past sexual abuse Other factors Being overweight, chronic sleep disorders, and injuries that damage nerves or arteries. Aging Although you are more likely to develop ED as you age, aging does not cause ED ED is defined as having trouble getting or keeping an erection that's firm enough for sex. Occasional ED is usually caused by stress, tiredness, or drinking too much alcohol, and it's nothing to worry about Medications for ED and contraindications: There are several oral medications that can treat erectile dysfunction (ED), including: a Sildenafil (Viagra): The first FDA-approved ED medication in 1998. It's effective for 69% ofpeople. a Tadalafil (Cialis): Approved by the FDA in 2003. a Vardenafil (Levitra, Staxyn): Approved by the FDA in 2003 a Avanafil (Stendra): Approved by the FDA in 2012 These medications are all phosphodiesterase type 5 (PDE5) inhibitors, which work by relaxing the penile erectile tissues during sexual stimulation. Oral medications for ED might not be safe for everyone. They can be dangerous or ineffective if you're also taking: a Nitrate medicines, which are often prescribed for chest pain a Alpha-blocker medicines, which are commonly prescribed for an enlarged prostate a Medicines that affect the CYP3A4 enzym BPH s/s how it present and what is the tx 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  a Leaking or dribbling of urine a Diffi culty starting urination a Pain after ejaculating or while urinating a Pee changes color or smells Symptoms usually begin after age 45,btt some men have no symptoms. Treatment is only necessary if symptoms become bothersome. Treatment options include: a Lifestyle changes Limit fluids before bedtime or going out, and reduce consumption of caffeine and alcohol. You can also try pelvic floor muscle training. a Medications Options include alpha blockers, 5-a$ha-reductase inhibitors, and phosphodiesterase-S 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 Scrotal pain and swelling Dx test : To diagnose scrotal pain and swelling, the primary diagnostic test is a scrotal ultrasound with Doppler imaging which can effectively identify the cause, particularly differentiating between testicular torsion (decreased blood flow) and epididymitis (increased blood flow) by assessing blood flow in the affected arca; aphysical exam is also crucial, and depending on the situation, a urine test may be needed to check for infection. Key points about diagnosing scrotal pain and swelling Physical exam: A doctor will perform a thorough physical examination of the scrotum, checking for tenderness, lumps, and swelling. Ultrasound with Doppler: This imaging test is considered the gold standard for diagnosing the cause of scrotal pain and swelling, as it can visualize the internal structures of the scrotum and assess blood flow. Urine analysis: A urine test can be helpful to check for signs of infection, which could be related to epididymitis. Blood tests In some cases, blood tests may be ordered to look for signs of inflammation or infection. Conditions that can cause scrotal pain and swelling: Testicular torsion: A medical emergency where the spermatic cord twists, cutting off blood supply to the testicle. Epididymitis: Inflammation of the epididymis, often caused by a bacterial infection. Orchitis: Inflammation of the testicle itself, usually due to infection. Hydrocele: Fluid collection around the testicle Spermatocele: A benign cyst filled with sperm fluid Varicocele: Enlarged veins in the scrofum Squamous ceII ca of the penis which patient is at risk Penile squamous cell carcinoma (SCC) is the most common tlpe of penile cancer, accounting for about 95Yo of cases. It's relatively rare in the United States, but more coflrmon in developing countries:  a Symptoms Early tumors can be small and look like abrasions or callused skin. They can also appear as a raised, reddened maculopapule, ulcer, or exophyic papillary tumor. a Diagnosis A biopsy is required to diagnose penile SCC, and should include normal skin for comparison. A doctor may also feel the lymph nodes in the groin for swelling.. Treatment Early-stage penile SCC is usually curable. Treatments include:. Mohs micrographic surgery Sentinel lynph node biopsy, which involves removing the first lymph node to receive lymphatic drainage from the tumor RISK FACTORS: Human papillomavirus (HPV): A virus that's passed through sexual contact, including oral sex. Uncircumcision: Circumcision may help prevent HPV infection. However, there's little evidence that adult circumcision reduces the risk of penile cancer. Phimosis: A condition where the foreskin can't be pulled back over the glans. Smoking: Current cigarette smokers have an increased risk of penile cancer. Poor hygiene: Not washing the penis frequently or thoroughly can increase the risk of smegma, a buildup of fluids that can collect under the foreskin. Age: Being 60 years or older increases the risk of penile cancer. Other penile conditions: Rash, teaing, and inflammation of the penis may be risk factors Testicular torsion DX test and how to treat A diagnosis of testicular torsion is typically made through a physical examination by a doctor, often accompanied by a Doppler ultrasound to con-firm blood flow issues in the affected testicle; the primary treatment is immediate surgery to untwist the spermatic cord and secure the testicle in place, as testicular torsion is considered a medical emergency requiring prompt action to maximize the chance of saving the affected testicle. Key points about testicular torsion diagnosis and treatment: A negative Prehn's sign is a key indicator of testicular torsion, a medical emergency that requires immediate diagnosis and treatment: a Prehn's sign: A test that involves lifting the scrotum to assess pain changes. A negative Prehn's sign indicates that lifting the scrotum makes the pain worse, which is a sign of testicular torsion. A positive Prehn's sign indicates that lifting the scrotum relieves pain, which is a sign of epididymitis. a Symptoms: Sudden, severe pain in the scrotum, swelling, nausea, vomiting, and sometimes the testicle appearing higher than normal or at an unusual angle. a Physical examination: The doctor willcarefully examine the scrotum, checking for tenderness, swelling, and the position of the affected testicle. a Doppler ultrasound: This imaging test is used to assess blood flow to the testicle, which can be significantly reduced in cases of torsion. a Treatment: a Immediate surgery: The primary treatment is surgical intervention to untwist the spermatic cord and usually fix the testicle to the scrotum to prevent future torsion (orchiopexy). Time is critical: The best chance of saving the testicle is within 4-6 hours of the onset of symptoms. a Potential complications: If left untreated for too long, the affected testicle may need to be removed (orchiectomy Pyrones disease presentation and pathological content how it will present : Peyronie's disease is a chronic condition that causes a significant bend in the penis during an erection, sometimes along with pain. It can make it difficult to get or maintain an erection, and can prevent vaginal intercourse For men with stable, mild curyature (S30 degrees) who have satisfactory erectile function, observation is an acceptable option. ln cases of worsening curvature or sexual dysfunction medical andlor surgical management (removal of plaque) Click to edit Master title style.For men with stable, mild curvature(S30 degrees)who have satisfactory erectile function,observation is an acceptable option.In cases of worsening curvature or sexual dysfunction medical andlor surgical management (removal of plaque).Oral pentoxifylline(vasodilator and anti-inflammatory) best initial treatment within three months of onset.In men who are bothered by penile deformity of>3 months' duration may use intra lesional injection with collagenase.Surgical management is indicated for patients whose Peyronie's disease has persisted for rrnore thanl2 months, is refractory to medical treatment, and is associated with a penile deformity compromising sexual function. Symptoms of bladder cancer: Bladder cancer signs and symptoms may include: Blood in urine (hematuria), which may cause urine to appear bright red or cola colored, though sometimes the urine appears normal and blood is detected on a lab test a Frequent urination a Painful urination a Back pain When to see a doctor If you notice that you have discolored urine and are concerned it may contain blood, make an appointment with your doctor to get it checked. Also make an appointment with your doctor if you have other signs or symptoms that worry you. Bladder Cancer causes and treatment: Bladder cancer begins when cells in the bladder develop changes (mutations) in their DNA. A cell's DNA contains instructions that tell the cell what to do. The changes tell the cell to multiply rapidly and to go on living when healthy cells would die. The abnormal cells form a tumor that can invade and destroy normal body tissue. In time, the abnormal cells can break away and spread (metastasize) through the body. Types of bladder cancer Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Doctors use this information to determine which treatments may work best for you. Types of bladder cancer include a Urothelial carcinoma. Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well. Urothelial carcinoma is the most common type of bladder cancer in the United States. a Squamous ceII carcinoma. Squamous cell carcinoma is associated with chronic irritation of the bladder for instance, from an infection or from long-term use of a urinary - catheter. Squamous cell bladder cancer is rare in the United States. It's more common in parts of the world where a certain parasitic infection (schistosomiasis) is a common cause of bladder infections. a Adenocarcinoma. Adenocarcinoma begins in celis that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is very rare. Some bladder cancers include more than one type of cell. Risk factors Factors that may increase bladder cancer risk include Smoking. Smoking cigarettes, cigars or pipes may increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk ofcancer. a Increasing age. Bladder cancer risk increases as you age. Though it can occur atany age, most people diagnosed with bladder cancer are older than 55. a Being male. Men are more likely to develop bladder cancer than women are  a Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it's thought that being around certain chemicals may increase the risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products. a Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have a higher risk of developing bladder cancer. a Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-tefln use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis. a Personal or family history of cancer. If you've had bladder cancer, you're more likely to get it again. If one of your blood relatives a parent, sibling or child has a history of bladder cancer, you - - may have an increased risk of the disease, although it's rare for bladder cancer to run in families. A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organ Chronic bacterial prostatitis : Chronic prostatitis is treated with fluoroquinolones or Bactrim x 6- 12 weeks Placenta abruptae presentation : Placental abruption is a serious condition that occurs when the placenta separates from the uterine wall before birth. Symptoms include: Vaginal bleeding, which can vary in amount and may not be visible a Abdominal pain, which can begin suddenly a Back pain a Uterine tenderness or rigidity a Uterine contractions that are frequent and don't relax  a Decreased fetal movement a Blood in amniotic fluid a Nausea and thirst a Faint feeling Placental abruption can occur at any time after 20 weeks of pregnancy, but it's most common in the last trimester. It can be a significant cause of matemal and neonatal morbidity and mortality. A healthcare provider can diagnose placental abruption based on symptoms and an ultrasound. Other tests that can confirm placental abruption include: a Complete blood count a Fetal monitoring a Measuring fibrinogen levels a Pelvic exam a Platelet count a Vaginal ultrasoun Placenta previa presentation The main sign of placenta previa is bright red vaginal bleeding, usually without pain, after 20 weeks of pregnancy. Sometimes, spotting happens before an event with more blood loss. The bleeding may occur with prelabor contractions of the uterus that cause pain A patient presenting with vaginal bleeding in the second or third trimester should receive a transabdominal sonogram before a digital examination. If there is a concern for placenta previa, then a transvaginal sonogram should be performed to confirm the location of the placenta. Transvaginal sonogram has been shown to be superior to a transabdominal sonogram and is Low lying and marginal placentas are identified with sonography and are determined by measuring the distance of the edge of the placenta to the internal os. With the diagnosis of placenta previa, the patient is scheduled for elective delivery at36 to 37 weeks via cesarean section.However, some patients with placenta previa present with complications and require urgent cesarean sections at an earlier gestational ag Symptoms of pre-eclampsia: High blood pressure: A sudden rise in blood pressure or a blood pressure of 160/110 mm Hg or higher in more than one reading Protein in urine: Protein in the urine, also known as proteinuria Swelling: Swelling of the hands, face, ankles, neck, or feet, especially if it's sudden or getting worse quickly Headache:A severe headache that doesn't go away or becomes worse, especially if it's accompanied by sensitivity to light Vision changes: Vision changes such as blurred or double vision, flashing lights, or spots Pain: Pain in the upper part of the tummy, particularly on the right-hand side Nausea and vomiting: Nausea or vomiting that shows up suddenly after the midpoint of pregnancy Weight gain: Sudden weight gain over I to 2 days or more than 2 pounds (0.9 kg) a week Shortness of breath: Trouble breathing Feeling lightheaded or faint: Feeling lightheaded or faint Increased fetal movement Stage for amniocentesis: An amniocentesis is typically performed between 15 and 20 weeks of gestation during the second trimester of pregnancy; this is considered the standard stage for this procedure. Key points about amniocentesis:. Reasoning for timing: This timeframe allows for sufficient amniotic fluid to be present for sampling while minimizing potential risks associated with performing the procedure too early in pregnancy.. Procedure: A thin needle is inserted through the abdomen, guided by ultrasound, to extract a small amount of amniotic fluid for analysis in a lab.  a Purpose: This test can detect potential genetic abnormalities like Down syndrome, cystic fibrosis, or neural tube defects in the fetus. a Risks: While considered a safe procedure, there is a small risk of miscaniage, which is why it's usually only recommended for women considered at higher risk for genetic issue Weight gain in pregnancy how much underweight normal overweight: Underweight: BMI < 18.5 28-40Lb Normal BMI: 18.5 - 24.9 25-35Lb Overweight: BMI 25- 29.9 15- 25 lb Obese: BMI >30 11- lb Naegels rule: -3 months + 7 days -| 1 year When to give Rhogam - is given to pregnant people with Rh D- blood at 28 weeks of gestation and protect for 12 weeks. Repeat dose at T2hottrs post-partum. If a dose is needed before 28 weeks give a second dose within 12 weeks of the first dose. Hegar sign: Hegar's sign is a physical change that occurs in the cervix and uterus during pregnancy, indicating that a woman is likely pregnant: The cervical isthmus, the part of the ceryix closest to the uterus, softens and becomes more compressible. The lower part of the uterus feels soft compared to the cervix and the rest of the uterus. Hegar's sign is usually noticeable between weeks four and 12 of pregnancy. A medical professional can perform a bimanual examination to check for Hegar's sign. The examiner places two fingers in the anterior fornix and two fingers below the uterus, and feels for the softening of the lower uterus. a Significance Hegar's sign was one of several methods used to detect pregnancy before reliable blood and urine tests were available. However, it's not a specific indicator of pregnancy, and its absence doesn't rule out pregnancy Chadwick's sign: Chadwick's sign is a common pregnancy symptom that appears as a bluish or purplish discoloration of the l.ulva, 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 like Dark bluish or purplish discoloration of the rulva, vaginal tissue, or cervix What causes it Increased blood flow to the pelvis Pain Usually not painful What it lasts until Typically lasts until after delivery Goodell's sign: a What it is: The cervix softens due to increased blood flow and engorgement of blood vessels below the growing uterus. The cervix may also appear larger. a When it occurs: Goodell's sign usually becomes noticeable between weeks 4 and 8 of pregnanc Important gestational developmental stages feel fundal at the umbilicus : Fundal height is the distance between the top of your uterus and your pubic bone. Healthcare providers use it to measure if fetal growth is on track. Your fundal height is measured beginning at about 20 weeks in pregnancy. If the fetus measures smaller or larger than average, an ultrasound may be needed to get a more accurate size Yorn fundal height in centimeters should be close to the number of weeks you are in pregnancy, plus or minus 2 centimeters. However, this is only the case from about weeks 20 to 36. Before 20 weeks of pregnancy, your fundus is not high enough. After 36 weeks of pregnancy, your fundus starts to go down. This is because the fetus has dropped into your pelvis to prepare for labor. If this drop doesn't happen, this can indicate the fetus is breech. For example, if you arc 32 weeks pregnant, a fundal height of 30 to 34 centimeters is an acceptable size Prenatal vitamins to prevent neural tube defect: 400 mcg Folic Acid Dx test to perform for pt who are infertile w/ varicocele: For a patient with infertility and a suspected varicocele, the primary diagnostic test to perform is a scrotal ultrasound, specifically with color Doppler imaging which allows for acctuate visualization and assessment of the affected veins, including blood flow pattems, to confirm the presence of a varicocele and determine its severity; alongside this, a semen analysis is crucial to evaluate spefln quality and identifu potential fertility issues related to the varicocele Varicocele: A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum. Varicoceles usually form during puberty and develop over time. They may cause some discomfort or pain, but they often result in no symptoms or complications. A varicocele may cause poor development of a testicle, low sperm production or other problems thatmay lead to infertility. Surgery to treat varicocele may be recofitmended to address these complication Diagnostics: A system of grading has been established to better define varicocele. Grade 1: varicocele is palpable only when the patient performs the Valsalva maneuver. Grade 2: Palpable when the patient is standing. Grade 3 varicocele may be assessed with the light palpation and visual inspection. Sperm count, and motility are significant decrease in patients with a varicoceleapproximately 65 to 7 5%o of the time there is evidence of a progressive decline in fertility. Scrotal ultrasound venography (showing testicular Venus reflux from a varicocele) and thermographic (showing an increase in temperature at the varicocele) help to confirm the diagnosis. For a patient with a varicocele and suspected infertility, the primary diagnostic test is a semen ffiytii to assess spenn quality, including count, motility, and morphology, as this is the most direct way to evaluate if the varicocele is impacting fertility