NR 602 Final Exam Questions &
Answers Rated A+)
Colposcopy exam- - ANSWERprocedure that visualizes vaginal, vulvar, or cervical epithelium w/
magnification to id abnormal area to be bx
Dysmenorrhea - ANSWERpainful menstruation that prevents normal activity and requires medication
3 types: primary (no organic cause), secondary (pathologic cause) and membranous - causes intense
cramping pain due to passage of a cast of endometrium through undilated cervix
Dysmenorrhea treatment - ANSWERTx- NSAIDs/tyelnol, heat, antiprostaglandins, OCP w/ increased
estrogen- pain relief r/t absence of ovulation, decreased prostaglandin production; surgery
Dysmenorrhea mechanism - ANSWERprostaglandin activity
Cystocele - ANSWER-vaginal wall weakens and stretches and allows the bladder to bulge into the
vagina
Cystocele sx - ANSWERSx-felling of fullness or pressure in vagina, increased discomfort when you
strain/cough/bear down, feeling of incomplete empty, repeated bladder infection, pain or urinary
leak during sex, bulge of tissue into vaginal opening
Cystocele prevention - ANSWERkegels, prevent constipation, avoid heavy lifting, avoid wt gain
Rectocele - ANSWER-When thin tissue of vagina separates the vaginal and rectum allowing vaginal
wall to bulge
Rectocele sx - ANSWERSx- soft bulge of tissue in vaginal, difficult BM, sensation of rectal pressure,
incomplete emptying after BM, sexual concerns
Causes of rectocele - ANSWERCauses- constipation/strain, chronic cough, heavy lifting, overweight,
childbirth, age
Retocele prevention - ANSWERPrevention- kegels, prevent constipation, avoid heavy lifting, cough,
avoid wt gain
Uterine prolapse - ANSWER-pelvic floor muscles and ligaments stretch and weaken and no longer
provide support for uterus and protrude into vagina.
Uterine Prolapse causes - ANSWERCauses- pregnancy, large baby delivery, lower estrogen level after
menopause, obesity Common in postmenopausal and one or more childbirth
Uterine Prolapse symptom - ANSWERSx- heaviness or pulling into pelvis, tissue protruding from
vagina, urinary probs (leakage, retention), trouble having BM, feeling of sitting on small ball, sexual
concerns
Uterine Prolapse prevention - ANSWERPrevention- kegels, treat constipation, correct lifting, avoid wt
gain
uterine prolapse treatment - ANSWERTx- pessary
,Herpes simplex - ANSWERchronic viral infection caused by HSV1 or HSV2, relapsing
Herpes Simplex prevention - ANSWERPrevention: consistent condom use b/c viral shedding can occur
in asymptomatic periods and can lead to transmission. W/ symptoms- Valacyclovir 500 mg daily
Herpes Simplex sign and symptoms - ANSWERSx-multiple painful vesicular or ulcerative lesion on
genitals, can be absent. Virus lays dormant and can be reactivated
Herpes Simplex diagnosis - ANSWERlays dormant and can be reactivated
Dx-cell culture and PCR
Herpes Simplex treatment - ANSWERTx- systemic antiviral. Acyclovir 7-10 days for 1st episode,
suppressive 200 mg daily BID
Chancroid - ANSWER-Transmitted via sexual contact or on hands that have touched lesion. Caused by
Haemophillus ducreyi
-Reportable disease
Chancroid symptoms - ANSWER-Sx- erythematous papule that evolves into pustule and degenerates
into saucer shaped ragged ulcer that is circumscribed by inflammatory wheal. Tender, heavy foul
discharge that is contagious
Chancroid diagnosis - ANSWERDx-culture that grows H ducreyi
Chancroid treatment - ANSWERTx- Abx azithromycin 1 g PO one time, ceftriaxone 250 mg IM 1 x,
cipro 500 mg PO BID x3 days erythromycin 500 mg PO TID x7 days. Personal hygiene, clean w/ soap
and water, sitz bath
Syphilis - ANSWER-chronic, systemic disease caused by a sphirochete transmitted via contact with
infectious moist lesion. Sexually acquired or vertically transmitted from infected mom. Reportable
disease
Syphilis transmitted - ANSWER-Transmitted in primary and secondary stages
Primary-mucus mem 10-90 days later. Secondary- 2 wks-6mo after primary lesion then generalized
cutaneous eruption of secondary may appear. Latent- may last a lifetime
Syphilis prevention - ANSWERPrevention- condom, wash w/ soap and water after sex, screen ppl @
high risk (men that have sex with men, drug trafficers, correctional facilities)
Syphilis symptoms - ANSWERSx- [Primary]- Chancre- indurated firm painless papule or ulcer w/
raised borders, women can have cervical or vaginal lesion....on any mucus mem. [Secondary}-viral
syndrome w/ diffuse lymphadenopathy AEB dermatitis, papulosquamous lesion on palms and soles.
Lesions on trunk will be macular or maculopapular popular or pustular other systemic include patchy
alopecia, hepatitis, nephritis. [Latent]- resolution of lesion of primary and secondary or finding of
serologic test w/o therapy
Syphilis Diagnosis - ANSWERDx- T pallidum sphirochetes on dark field exam of cutaneous lesion,
serologic testsing antibody titers
Syphilis treatment - ANSWERPenicillin G
Chlamydia trachomatis gold standard test - ANSWER. Gold standard test is NAT, not culture
,Chlamydia trachomatis - ANSWERnegative whiff w/ mucupurulent d/c and + clue
cells.
Chlamydia trachomatis symtoms - ANSWERSx- dyspuria, intramenstrural spotting, postcoital
bleeding, pain w/ sex, vag d/c purulent d/c reddened congested cervix or can be asymptomatic.
Chlamydia trachomatis diagnoses - ANSWERDx-Urine or endocervix/vaginal swab
Chlamydia trachomatis tx - ANSWERTx- 1 gm Azithromycin OR doxy, erythro PLUS rocephin 250 or
cefixime Complications- salpingitis and PID, perihepatitis,
Gonorrhea - ANSWERSTI, first causes cervical infection and ascend to endometrium and fallopian
tube. Reportable
Gonorrhea prevention - ANSWERPrevention: Screen all high risk ppl sexually active women age 25 or
less. Use condoms. Sex partner w/ in 60 days evaluate to tx that sex partner, > 60 days tx most recent
sex partner, NB receive erythro ointment after delivery
Gonorrhea symptoms - ANSWERSx-many are asymptomatic. inflamed and edematous cervix with d/c
coming from cervical os. Vag d/c urinary frequency, dysuria, unilateral swelling of intoitus, anal
itching, pain, pharyngitis, conjunctivitis, systematic triad (polyarthalgia, tenosynovitis, and
dermatitis)
Gonorrhea diagnosis - ANSWERDx- endocervical vaginal or urine specimens Complications-
salpingitis- tubal scarring, infertility
Gonorrhea treatment - ANSWERTx- Rocephin 125 mg, cefixime OR azithromycin
No sex 7 days after therapy. Tx for chlamydia as well.
HSV-type 1 or 2. - ANSWERType 2 most common cause of genital herpes. Produces cervical lesion,
first vesicular then ulcers. After initial infection, virus continues to reside in nerve cells for life.
HPV- spread - ANSWERspread via skin to skin (genital warts)
Prevention- abstinence, condom use, treating affected partner @ same time
Trich - ANSWERCaused by flagellated protozoan, mobile
Trich prevention - ANSWERPrevention: condoms, decrease # of sex partners, vulvular hygiene
Trich symptoms - ANSWERSx- purulent malodorous d/c w/ burning itching, dysuria, frequency, and
painful sexl. Postcoital bleeding may occur foamy white green d/c, strawberry appearing cervix
trich diagnosis - ANSWERDx- motile flagellated organisms on saline wet smear, Affirm
Trich treatment - ANSWERTx-Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose
Candida - ANSWERwhite curd like d/c
Candida diagnosis - ANSWERDx- potassium hydroxide prep---distinct presence of hyphae
Candida treatment - ANSWERTx- topical azole drugs or PO fluconazole
bacterial vaginosis - ANSWERmost prevalent vaginal infection. * Loss of lactobacilii and increase in
vaginal pH fishy odor
, bacterial vaginosis risk factor - ANSWERRisk factors: multiple sex partner, douching, lack of condom
use, lack of vag lactobacilli
Bacterial vaginosis prevention - ANSWERcondom use, no douching
bacterial vaginosis treatment - ANSWERTx- metronidazole 500 mg PO x7 days, metronidazole gel 0.75
%x5 days, clinda cream 2% x3 nights OR tinidazole PO x2 days
Bacterial vaginosis symtoms - ANSWERSx-3 of 4 Amsel criteria
Bacterial vaginosis diagnosis - ANSWERDx- Gram stain is gold standard, saline wet mount with "clue
cells", Amsel criteria: thin homogenous white/yellow d/c, "clue cells on microscopy, fishy odor w/ k
hydroxide solution, pH of 4.5 or >-----need 3 of 4 to be dx.
PID - ANSWER-inflamm of upper femal genital tract w/ combo of endometritis, salpingitis, tubo-
ovarian abscess, and pelvic peritonitis.
PID prevention - ANSWERPrevention- screening and tx sexually active women and sex partners for
gonorrhea and chlamydia
PID symptoms - ANSWERSx- insidious or acute lower abd/pelvic pain usually bilateral. Pelvic
pressure/back pain ass w/ purulent vag d/c. N, HA, fever is NOT necessary. Abd tenderness, may be
distended bowel sounds hypo or absent. Bimanual= extreme tenderness or cervix ****CDC says
empiric tx should be initiated in sex active young women and those @ risk for STD and if 1 or more of
following criteria- cervix motion tenderness, uterine tenderness, and adnexal tenderness.
PID diagnosis - ANSWERDX-+endocervical swabs...but all may be normal.
PID treatment - ANSWERTx- empirically with presumptive dx. Rocephin 250 IM +doxycycline 100 mg
BID x14 + metronidazole 500 mg BID x14
HEP B - ANSWER-caused by Hep B virus, transmitted via blood with other concentration in wound
exudate, semen vag secretions, and saliva. Transmitted via percutaneous or mucous mem
w/exposure to blood or body fluid. Reportable disease. Can cause liver failure and death
Risk factors- unprotected sex w/ infected partner, hx of STD, illegal injection drug use.
Hep B prevention - ANSWERPrevention: Hep B immune globulin-provides 3-6 mo protection and
used post exposure prophylaxis in adjunct to vaccine or in unvaccinated person and Hep B vaccine.
Hep B Vaccine- contains HBsAg provides protection from pre and post exposure, require series.
Routinely screen ALL preg women. Unvaccinated or those ho do not respond to Hep b vaccine series
should be given HBIG and vaccine if exposed.
Hep B diagnosis - ANSWERDx-presence of igM antibody is dx
Hep B symptoms - ANSWERSx- asymptomatic. Constitutional @ first- anorexia, N, jaundice, RUQ pain
HEP TX - ANSWERTx- supportive care. No effective antiviral drugs
Hep C - ANSWER-Caused by Hep C virus through parenteral exposure of contaminated blood
Hep C prevention - ANSWERPrevention-no vaccine, reducing transmission and chronic liver disease. +
pt do not donate blood, , don't use razors or toothbrushes
Hep C symptoms - ANSWERSx- asymptomatic or mild illness.
