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NR -602 MIDTERM STUDY EXAM NEWEST ACTUAL EXAM WITH COMPLETE QUESTIONS AND DETAILED ANSWERS GRADED A | BRAND NEW!!! Phyllodes tumor - WWW Correct Answer > Low grade malignant tumor of the stroma Discrete, firm, round, mobile, findings similar to a fibroadenoma, but mass is usually larger; may observe stretching of skin due to rapid tumor growth Hamartoma ! VY Correct Answer > Discrete, nontender, nonmobile; may be nonpalpable with incidental diagnosis on imaging studies Galactocele ! VA Correct Answer > Discrete, firm, sometimes tender Ultrasound - V/V Correct Answer > Woman is younger than age 30 with concerning breast mass Diagnostic Mammogram w/wo Ultrasound - VW Correct Answer > Woman is 30 years or older with concerning breast mass FNA biopsy - WAV Correct Answer > Tissue for cytologic evaluation aspirated with a small needleDifferentiates solid and cystic masses Palpable breast mass or thickening Stereotactic-guided core-needle biopsy - WW Correct Answer > Large-bore needle used to obtain cores of tissue for histologic examination Stereo-tactic mammography used for localization and targeting. Calcification seen on mammogram, masses or other abnormalities visible only by mammography (i.e. not visible with ultrasound) Ultrasound-guided core-needle biopsy - WWW Correct Answer > Large-bore needle used to obtain cores of tissue for histologic examination Ultrasound used for localization and targeting solid or indeterminate lesion (most commonly a mass) seen on ultrasound Personal history of invasive breast cancer, especially in first- degree relatives Inherited detrimental genetic mutations Biopsy-confirmed proliferative breast lesions with atypia Dense breast tissue on mammogram High-dose radiation to chest, especially during puberty or young adulthood Menarche before age 12 years Menopause at age 55 years or older Nulliparity First full-term pregnancy after age 30 years Current use of combined oral contraceptives (likely due to detection bias of regular screening) Use of combined estrogen-progestogen hormone therapy after menopause Weight gain leading to overweight or obese status after age 18 years Physical inactivity Consumption of one or more alcoholic beverages per day Jewish ancestry (Ashkenazi) Place of birth (North America and Northern Europe versus Asia and Africa) Hematological changes in pregnancy - WWW Correct Answer > Blood volume increases by 30% to 50%, or 1,100 to 1,600 mL and peaks at 30 to 34 weeks' gestation Cardiac output increases by 30% to 50% over that in women who are not pregnant which peaks in the early third trimester and is maintained until birth. *Women with cardiac disease may become symptomatic during the first trimester. Stroke volume is also increased during pregnancy by 20% to 30%. These increases in cardiac output and stroke volume allow for the 30% increase in oxygen consumption observed during pregnancy. Recommended Vaccines in Pregnancy - VWWV Correct Answer > Influenza (flu) Tetanus, diphtheria, pertussis (Tdap) Third trimester (ideally 27-36 weeks' gestation) Advised Vaccines in Pregnancy (at risk) - VWWV Correct Answer > Hepatitis B 3 injections beginning at any point in gestation characteristic odor is associated with VVC, sometimes a yeasty or musty smell occurs. Vulvovaginal Candidiasis Diagnosis - WWW Correct Answer > Speculum exam w/ microscopic eval of vaginal secretions with saline and KOH. Normal vaginal pH. pseudohyphae may be seen on a wet smear PMS (premenstrual syndrome) - WAV Correct Answer > Occurs in the majority of premenopausal women, whereby one or more affective or somatic symptoms occur. only occurring during the luteal phase of the menstrual cycle PMDD (premenstrual dysphoric disorder) - VWWV Correct Answer > Group of symptoms similar to but more severe than PMS, including severe mood disturbances. Disrupt daily functioning. only occurring during the luteal phase of the menstrual cycle Dysmenorrhea ! V// Correct Answer > Painful uterine contractions which occur during menstruation (most common causes of chronic pelvic pain in women of reproductive ages). Cyclical pain that results from an excessive amount of endometrial prostaglandin production. primary dysmenorrhea ! VW Correct Answer > Associated with ovulatory cycles so it usually does not occur immediately at menarche, but rather within the first 6 months. Progressive. Dx of exclusion. Tx with NSAIDs or herbals and vitamin supplements (particularly Vitamin E). Combined Oral Contraceptives (COCs), implants, vaginal rings, patches and Levonorgestrel-Releasing Intrauterine System (LNG-IUS) devices. secondary dysmenorrhea - WWW Correct Answer > Due to an underlying pelvic pathology which may include, but is not limited to: pelvic inflammatory disease, endometriosis, uterine fibroids and adenomyosis. Dx by laparoscopic biopsy and histology. Tx with onservative surgical management (excision or destruction of lesions/laser or heat and lysis of adhesions if indicated) Hysterectomy amenorhea ! V/V Correct Answer > Absence of menstruation commonly caused by pregnancy, hypothalamic amenorrhea, and PCOS. AUB - Structural Causes !YA/ Correct Answer > PALM; Polyps, Adenomyosis, Leiomyoma, Malignancy and hyperplasia AUB - Non structural Causes ! V/V Correct Answer > COEIN; Coagulopathy, Ovulatory dysfunction, Endometrial, latrogenic, Not yet classified AUB: Management - WW Correct Answer > 0 Normalize bleeding, correct any anemia, and restore quality of life o Keep in consideration age, desire for future fertility, women's preference o Estrogen Therapy o COC o Progesterone Therapy o NSAIDs o D&C o Endometrial ablation o Uterine arterial embolization o Hysterectomy Pelvic Pain DDX - WWW Correct Answer > Bladder pain syndromes, irritable bowel syndrome, pelvic-floor muscle myalgias, and other gynecologic anatomic abnormalities (e.g., uterine fibroids, ovarian cysts, hydrosalpinx) sensorimotor stage - W/V Correct Answer > in Piaget's theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities preoperational stage - VWW~ Correct Answer > in Piaget's theory, the stage (from about 2 to 6 or 7 years of age) during which a child learns to use language but does not yet comprehend the mental operations of concrete logic concrete operational stage - W/V Correct Answer > in Piaget's theory, the stage of cognitive development (from about 6 or 7 to 11 or 12 years of age) during which children gain the mental operations that enable them to think logically about concrete events formal operational stage - WWW Correct Answer > in Piaget's theory, the stage of cognitive development (normally beginning Famciclovir 250 mg orally three times a day for 7-10 days Suppressive HSV Treatment YA Correct Answer > Acyclovir 400 mg orally twice a day OR Valacyclovir 500 mg orally once a day OR Valacyclovir 1 g orally once a day OR Famiciclovir 250 mg orally twice a day Presumptive Signs of Pregnancy - VV Correct Answer > Amenorrhea, N&V, breast tenderness or changes, deepening pigmentation, urinary frequency, fatigue, increased basal body temperature, and quickening (at 16 weeks). Probable Signs of Pregnancy ! VA/ Correct Answer > Goodell's sign (cervical softening at 4wk), Chadwick's sign (blue color of vagina & cervix at 6-8 wk), enlarged uterus, (+) urine or blood pregnancy test. Positive Signs of Pregnancy ! WW Correct Answer > Palpation of fetus, ultrasound visualization of fetus, and fetal heart tones. 12 week Fundal Height - WWW Correct Answer > The fundus should be at the level of the symphysis pubis 16 week Fundal Height - WWW Correct Answer > The fundus should be between the symphysis pubis and umbilicus 20 week Fundal Height - WWW Correct Answer > The fundus should be at the level of the umbillicus 25-35 week Fundal Height - WWW Correct Answer > The fundus should measure from the symphysis pubis and correlate with with gestational week (+/- 2 cm) Naegele's Rule - WW Correct Answer > Add 7 days to LMP, subtract 3 months, add 1 year; Used to calculate due date Tier 1 Birth Control - WWW Correct Answer > Fail rate <1%; IUD, DMPA (Depo), Progestin implant, sterilization Tier 2 Birth Control - WW Correct Answer > Fail rate 2-3%; OCP, COC's, transdermals, cervical ring. Ovarian Cycle - WWW Correct Answer > The 28 days of the menstrual cycle as they apply to events in the ovary. The ovarian cycle has three subphases: the follicular phase, ovulation, and the luteal phase. Follicular Phase - WW Correct Answer > The first phase of the ovarian cycle, during which a follicle (an oocyte and its surroudning cells) enlarges and matures. This phase is under the control of FSH from the anterior pituitary, and typically lasts from day 1 to day 14 of the menstrual cycle. The follicle secretes estrogen during this time period. Ovulatory Phase - WWW Correct Answer > The second stage of the general menstrual cycle, when the mature ovum is released. Approximately 10 to 12 hours after the LH peak Luteal Phase - WAV Correct Answer > The third phase of the ovarian cycle, during which a corpus luteum is formed from the remnants of the follicle that has ovulated its oocyte. The corpus luteum secretes progestrone and estrogen during this time period, which typically lasts from day 15 to day 28 of the menstrual cycle. Formation of the corpul luteum is triggered by the same LH surge that triggers ovulation, however in the absence of LH (levels quickly decline after the surge) the corpus luteum begins to degenerate. Endometrial Cycle - W/V Correct Answer > The 28 days of the menstrual cycle as they apply to the events in the uterus. The endometrial cycle is also known as the uterine cycle, and has the three subphases: menstruation, the proliferative phase, and the secretory phase. Menstruation phase !Y/A/ Correct Answer > Decline in progesterone levels causes functional layer of endometrium to discharge resulting in vaginal bleeding called menstruation. This marks the end of one cycle and the beginning of the next cycle. Begins with the initiation of menses and lasts 4 to 6 days Proliferative phase - WAV Correct Answer > The second phase of the uterine (endometrial) cycle, during which the endometrium is "rebuilt". This phase of the cycle is under the control of estrogen, secreted from the follicle developing in the ovary during this time period. Typically lasts from day 6 to day 14 of the menstrual cycle. A Rating + V/A Correct Answer > Recommendation to screening all women aged 21 to 65. for cervical cancer w/ PAP test every 3 years For women aged 30 to 65 who would like to lengthen the screening interval recommendation to co-testing with a combination of Pap test and human papillomavirus (HPV) testing every 5 years. D Rating - WW Correct Answer > Harms or potential harms outweigh the benefits and therefore recommends against Screening women younger than age 21 Screening women older than 65 years who have been screened adequately and who are not at increased risk for cervical cancer Screening women who have had a hysterectomy with removal of the cervix and have no history of high-grade precancerous lesions or cervical cancer Screening women younger than age 30 with HPV testing either with Pap test or alone ( B Rating - /// Correct Answer > Recommendation to screening all sexually active women age 24 years and younger, and women older than 24 who are at an increased risk for a sexually transmitted infection (STI), for chlamydia and gonorrhea. The most significant risk factor for infection is age. Adolescents and women through 24 years of age are at highest risk for developing these STIs. USPSTF recommends using nucleic acid amplification tests (NAATs) to diagnose chlamydia and gonorrhea infections, both of which can be tested using the same specimen. B Rating - /// Correct Answer > Screening mammography every 2 years for women age 50 to 74 years B Rating - /// Correct Answer > Screening for BRCA-related cancer, but only for women with a family history associated with an increased risk for BRCA gene mutations. Risk factors include a family history of any of the following: Breast cancer diagnosed before age 50 Bilateral breast cancer Breast and ovarian cancer Breast cancer in one or more male family members Multiple cases of breast cancer in the family One or more family members with two types of BRCA-related cancer Ashkenazi Jewish ethnicity 
