Unit 10: Assessment of Male and Female Genitourinary System: Assessment of Breasts

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Mons Pubis

1. subQ fatty tissue over anterior symphysis pubis.
2. protects pelvic bones during intercourse

Clitoris

1. erectile body about 2.5 cm long and 0.5 cm wide
2. primary organ of sexual stimulation

Labia Majora

1. 2 longitudinal folds of adipose an CT
2. extends from clitoris to posterior commissure of perineum
3. protects urethra and vagina from infection

Labia Minora

1. 2 thin skin folds
2. form prepuce of clitoris and fourchette
3. protects urethra and vagina from infection

Vaginal Orifice

opening of the vagina

Hymen

thin fold of CT surrounding vaginal opening in women who have not had intercourse.

Perineum

Space between fourchette and anus

Anus

opening at opposite end of GI tract from mouth

Bladder

holds and stores urine

Penis

1. male sex organ
2. exit for semen and urine

Scrotum

1. loosely hanging pouch behind penis
2. contains two sacs and testes

Testicle

1. contain tightly coiled seminiferous tubules
2. seminiferous tubules produce sperm
3. testes do secrete some testosterone

Urethral meatus

1. external opening of urethra

Urinary catheter

1. used to drain bladder
2. treat incontinence and urinary retention

Tail of spence

the upper outer tail of breast tissue that extends into the axilla

Areola

1. dark tissue surrounding nipple
2. occasional hair follicles and small glands to lubricate nipple during breast feeding

Nipple composition

composed of CT, smooth muscle, blood vessels, and nerve endings

Montgomery's glands

sebaceous glands

Breast self-exam

1. premenopausal women should perform 5-7 days after menstrual cycle begins or 3-5 days after it ends.
2. postmenopausal women should perform it same day each month
3. look in mirror with arms at sides. note dimpling, retraction, or breast flattening as she first elevates arms, presses hands against hips and bends forward
4. use pads of 3 middle fingers palpate entire breast systematically. Repeat lying down or with towel under arm
5. compress nipple and observe for any discharge
6. report any redness, inflammation, masses, flattening, puckering, dimpling, retraction, sunken areas, asymmetrical nipple direction, discharge, bleeding, lesions, or eczematous nipple changes

Pertinent Breast Hx questions

1. do you have a lump or thickening inn or near your breast or under your arm that persists through the menstrual cycle?
2. Is the skin on your breast or nipple red, dimpled, puckered, scaly, or inflamed?
3. do you have nipple changes?
4. has your breast changed in size, shape, or contour?

Pertinent female genitourinary Hx questions

1. when was last menstrual period
2. do you have any pain? where?
3. can you describe your menstrual cycle?
4. what was your age of menarche?
5. what was age of menopause?
6. do you have any abnormal vaginal bleeding
7. what are your sexual practices
8. how many partners have you had
9. what type of sexual activity: oral, genital, anal
10. sexual preference
11. do you practice safe sex, what do you use
12. do you use contraceptives? if yes what type
13. have you ever been pregnant? how many? any miscarriages? abortions? age of first full-term pregnancy
14. do you have any vaginal discharge? if yes describe it
15. do you have a Hx of GU surgery, STDs, or cancer
16. are you taking any meds, hormone replacement therapy, or birth control pills
17. do you have any urinary symptoms, such as burning, frequency, or dysuria

Pertinent male genitourinary questions

1. do you have penile pain, if yes describe
2. do you have any lesions, if yes describe
3. do you practice oral, anal, or genital sex
4. have many partners have you had
5. what is your sexual preference
6. do you practice safe sex, if yes what do you use
7. do you have any discharge
8. did you have a Hx of GU surgery, STDs, or cancer
9. are you taking any meds
10. do you have any medical problems like D.M., HTN, or peripheral vascular disease
11. do you have any problems with urination? burning, frequency, dysuria, hematuria

Mary Jane McCormick, age 40, has discovered a lump in her right breast. As you obtain her health Hx you identify risk factors for breast cancer. Which factor increases the risk for breast cancer?
a. Hx of fibrocystic breast disease
b. multiparity
c. breast fed her children
d. age

d. age

Mary Jane McCormick, age 40, has discovered a lump in her right breast. As you obtain her health Hx, you identify risk factors for breast cancer. Which diet would decrease the risk for breast cancer?
a. low-calorie
b. low-salt
c. low-fat
d. low-fiber

c. low-fat

Donna Penner, age 56, is postmenopausal. You are reviewing BSE with her. At what time of the month should she perform BSE?
a. first of every month
b. middle of the month
c. last day of the month
d. same time every month

d. same time every month

Which is the most common site for breast cancer in men?
a. upper outer quadrant in the tail of spence
b. areola
c. upper inner quadrant
d. lower outer quadrant

b. areola

Part of the assessment of the breast includes assessing the lymph nodes. Which area would be best for palpating the central lymph nodes?
a. high in the middle of the axilla
b. high in the axilla on the lateral aspect of the humerus
c. high in the axilla toward the posterior axillary line
d. high in the axilla toward the anterior axillary line

a. high in the middle of the axilla

Part of the assessment of the breast includes assessing the lymph nodes. Which area would be best for palpating the lateral lymph nodes?
a. high in the middle of the axilla
b. high in the axilla on the inner aspect of the humerus
c. high in the axilla toward the posterior axillary line
d. high in the axilla toward the anterior axillary line

b. high in the axilla on the inner aspect of the humerus

Part of the assessment of the breast includes assessing the lymph nodes. Which area would be best for palpating the epitrochlear lymph nodes?
a. one inch above the olecran process
b. high in the axilla on the lateral aspect of the humerus
c. high in the axilla toward the posterior axillary line
d. high in the axilla toward the anterior axillary line

a. one inch above the olecran process

Bill Brown, age 55, has a Hx of cardiac disease and is taking digoxin. How might digoxin affect his breast?
a. gynecomastia
b. galactorrhea
c. mastalgia
d. cystic breast

a. gynecomastia

Mary Smith, age 20, has a benign fibrocystic cyst of the left breast. Which characteristic is associated with a fibrocystic breast disease?
a. immobile
b. hard consistency
c. tender
d. irregular shape

c. tender

When inspecting the breast, which position is best for accentuating dimpling or retraction of breast tissue?
a. sitting, hands at side
b. sitting, hands over head
c. sitting, leaning forward
d. sitting, hands pressed on hips

d. sitting, hands pressed on hips

Mary Johnson, age 25, has come to the ER with the chief complaint of lower abdominal pain. Considering her age, which question would be most appropriate to identify a gynecological problem?
a. when was your last menstrual period
b. what was your age of menarche
c. are your period flows heavy
d. when did you last move your bowels

a. when was your last menstrual period

As you obtain a gynecological history, Mary states that she is a marathon runner. What effect might strenuous exercise have on her menstrual cycle?
a. dysmenorrhea
b. menorrhagea
c. amenorrhea
d. no effect

c. amenorrhea

Ms. Johnson also reports that she has white, cheesy vaginal discharge. This type of vaginal discharge is often associated with
a. gonorrhea
b. trichomonas
c. HPV
d. candidiasis

d. candidiasis

Sharon Stewart, age 30, is scheduled for her annual gynecological exam. Part of the exam includes a pap test. The pap test is a screening test for:
a. cervical cancer
b. gonorrhea
c. syphilis
d. HPV

a. cervical cancer

On examination of Ms. Stewart's external genitalia you note a painless, white, wartlike lesion. The lesion described is most likely:
a. gonorrhea
b. syphilis
c. condylomata acuuminatum
d. herpes simplex

c. condylomata acuuminatum

When performing a gynecological examination including a pap test, what lubricant should be used for the speculum?
a. no lubricant
b. water
c. water-soluble jelly
d. vaseline

b. water

You are performing a pelvic examination of Joan Kelly, age 33. She is 10 weeks pregnant. You examine the color of the cervix. Considering that Mrs. Kelly is pregnant, what color change might you see in her cervix?
a. pink
b. pale pink
c. red
d. blue

d. blue

You examine the color of the cervix. What would be the normal color of the cervix of a premenopausal nonpregnant woman?
a. pink
b. pale pink
c. red
d. blue

a. pink

What is the normal pubic hair distribution of a 25-year-old female patient?
a. triangle shape
b. circular shape
c. inverse triangle shape
d. diamond shape

c. inverse triangle shape

You are obtaining a vaginal pool specimen to perform a KOH prep test. The KOH prep test is best for assessing:
a. candida albicans
b. HPV
c. gonorrhea
d. chlamydia

a. candida albicans

Mathew Wall, age 25, discovered a lump in his left testicle while performing a TSE. Which finding describes the normal consistency of the testes?
a. soft
b. rubbery
c. nodular
d. hard

b. rubbery

The health Hx is helpful in identifying risk factors for testicular cancer. Which childhood medical problem increases the risk for testicular cancer?
a. mumps
b. undescended testicles
c. umbilical hernia
d. chickenpox

b. undescended testicles

Which family Hx factor increases the risk for testicular cancer?
a. maternal use of birth control pills
b. maternal Hx of smoking
c. maternal Hx of alcohol use
d. maternal use of DES

d. maternal use of DES

The PSA test is a screening fest for:
a. BPH
b. prostatitis
c. prostatic cancer
d. epididymitis

c. prostatic cancer

Bill Brown, age 20, comes to the student health center c/o thick, yellow penile discharge. This type of penile discharge is often associated with:
a. gonorrhea
b. syphilis
c. HPV
d. candidiasis

a. gonorrhea

On examination of the external genitalia, you note a painless, white, wartlike lesion. The lesion described is most likely:
a. gonorrhea
b. syphilis
c. condylomata acuminatum
d. herpes simplex

c. condylomata acuminatum

While obtaining a health Hx of Jack Madison, age 27, you note that he has a positive Hx of sickle cell anemia. Sickle cell anemia increases his risk for developing:
a. priapism
b. phimosis
c. hydrocele
d. chordee

a. priapism

While performing a newborn assessment on Baby Boy Kelly, you note that the urethral meatus opens on the dorsal side of the penis. This condition is referred to as:
a. epispadias
b. hypospadias
c. varicocele
d. hydrocele

a. epispadias

While performing a newborn assessment on Baby Boy Kelly, you note that there is scrotal swelling. What is the most likely cause of this condition?
a. epispadias
b. hypospadias
c. varicocele
d. hydrocele

d. hydrocele

You are working at a health fair, performing cancer risk assessments and promoting cancer screenings. Joe Devlin, age 50, has never been screened for prostate cancer. What is the recommended age for prostate screening for this patient?
a. 20
b. 30
c. 40
d. 50

d. 50

If both testicles are not descended

that is a concern

Where should urethral meatus be

tip of glans penis

what male abnormalities do you want to note

1. drainange
2. excoriation
3. lesions
4. lumps
5. moles
6. pubic lice
7. redness
8. swelling
9. warts (HPV)

How often should TSE be done

monthly

Common age of testicular cancer

16-36 (20-40)

How many people over age of 60 have BPH

50%

How many people over age of 80 have s/s of BPH

90%

How does BPH begin

small nodules in transition zone next to urethra

What is the most common cancer in men

prostatic cancer

What type of cancer is the second leading cause of death in men

prostatic cancer

What is good about prostatic cancer

1. slow growing
2. predictable pattern

When are most men diagnosed with prostatic cancer

older than 65

What race has a higher death rate with cancer

african americans

If cancer is confined to prostate at diagnosis what is the survival rate

100%

If cancer has spread regionally upon diagnosis what is the survival rate

94%

PSA levels

<4 ng/mL = normal
>/= 10 ng/mL = cancer

When should prostate screenings be done under age of 50

risk factors or strong family history

Abnormalities that should be noted when examining the female repro

1. drainange
2. excoriation
3. lesions
4. lumps
5. moles
6. pubic lice
7. redness
8. swelling
9. warts (HPV)

When does menarche occur

1. between 8-16
2. average = 12

Earlier menarch usually means

earlier menopause, but some sources say later menopause

When does menopause usually occur

46-55
average = 50

Menopause definition

no menstrual period for over one year, some sources say 6 months

Decreased estrogen due to menopause increases womens risk for what diseases

1. cardiovascular disease
2. osteoporosis

Physical results of menopause

1. atrophy of sexual organs
2. painful intercourse d/t vaginal dryness

Vaginal bleeding after menopause is a sign of what

cancer

If sexually active how often do women need a pap smear? If negative?

1. annually
2. every 2 years

Why would you need to know what type of birth control pt is taking?

1. meds that interfere
2. pt. education
3. side effects

Urgency

almost uncontrolable need to void

Frequency

>4-6x/day

polyuria

>3000mL/day

Urinary retention

incomplete emptying of bladder

When can blood be seen in urine

when ther is alot

Foul smelling urine can be a sign of

UTI

What can affect urination

1. incontinence (elderly, young children, paralysis)
2. kidney stones
3. meds (anesthesia)
4. prostate problems

Is incontinence a normal change with aging

no

CBE for low risk 20-39

every 3 years

CBE and mammogram for >40

anually

Women at higher risks may

1. have CBE, mammograms, and MRI's before age of 40
2. depends on risk level

Does a change in breast always mean there is cancer?

No

Why should premenopausal women do BSE 5-7 days after menstruation starts or 3-5 days after it ends

so breasts are not tender or swollen

Can women with breast implants to BSE? How?

yes, have surgeon point out edges of implant

What is the best position for feeling all breast tissue

lying down

When do women need to start having mammograms? High risk?

1. yearly after age 40
2. earlier if they are at significant risk

What does American Cancer Society believe to be the best chance of reducing womens risk from dying of breast cancer

do combination of CBE, mammograms, MRI's, and reporting breast changes early

Why would you a mammogram

mammogram would help you to see things that are too small to feel

How common is breast cancer in women

second most common in women

What is the most frequently diagnosed cancer in women

non-melanoma skin cancer

What is the first and second highest causes of death in women

1. lung cancer
2. breast cancer

Risk factors for breast cancer

1. 2 or more first line relatives
2. age
3. unopposed estrogen supplements
4. never nursing
5. first pregnancy after 30
6. menarche <12
7. late menopause
8. genetics
9. high fat diet
10. sedentary lifestyle
11. increased alcohol

S/S of brest cancer

1. lump or thickening near breast or under arm
2. skin on breast or nipple is red, dimpled, puckered, scaley, or inflamed
3. nipple changes
4. change in brest size, shape, or contour
5. unexplained weight loss
6. enlarged surrounding lymph nodes

Why does early menarche or late menopause increase risk for breast cancer?

breasts are under hormonal influence for a longer period of time

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