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NURS 5432 Midterm Study Guide
1. Abnormal growth and development: skin: Jaundice within the first 24 hours (pathologic, possible
hemolysis or infection). Petechiae, purpura (suggests clotting disorders or sepsis). Birthmarks: Café-au-lait spots (>6 or >0.5 cm in size may indicate neurofibromatosis). Port-wine stain (may indicate Sturge- Weber syndrome).
2. Abnormal growth and development: Head: Bulging fontanel (increased intracranial pressure,
hydrocephalus). Sunken fontanel (dehydration). Craniosynostosis (premature suture closure, abnormal head shape). Large anterior fontanel (hypothyroidism, Down syndrome).
3. Abnormal growth and development: Eyes: Absent red reflex (retinoblastoma, congential
cataracts). Hypertelorism (widely spaced eyes may indicate genetic syndromes like Down or Noonan syndrome). Purulent eye drainage is not normal usually indicative of infection gonorrhea,chlamydia, or herpes Persistent strabismus after 6
2 / 21 months.
4. Abnormal growth and development: Ears: Low-set ears (associated with renal or genetic
abnormality like Turner's or trisomy 21). Ear pits or tags (linked to renal anomalies).
5. Abnormal growth and development: Mouth: Cleft palate/lip (requires surgical evaluation).
Absent suck reflex (neurological impairment or prematurity). Macroglossia (associated with hypothyroidism, Beckwith-Wiedemann syndrome).
6. Abnormal growth and development: Neck: Webbing excessive amounts of skin Turner's or
Noonan's syndrome
7. Abnormal growth and development: Neurological: Tone abnormalities:
Hypotonia ("floppy baby syndrome" may indicate CNS abnormalities or genetic conditions). Hypertonia (cerebral palsy, neonatal abstinence syndrome). Reflexes: Absent Moro reflex (brachial plexus injury, neurologic abnormality). Persistent primitive reflexes beyond expected age (suggests developmental delay).
4 / 21 HIP" B: Hep B D: DTaP (Diphtheria Tetanus acellular Pertussis) R: Rv (Rotovirus) H: HIB (Haemophilus Influenza Type B) I: IPV (Inactivated Polio Vaccine) P: PCV (Pneumococcal)
14. Childhood Immunization Schedule: 4 months: "4 DR HIP"
D: DTaP (Diphtheria Tetanus acellular Pertussis) R: Rv (Rotovirus) H: HIB (Haemophilus Influenza Type B) I: IPV (Inactivated Polio Vaccine) P: PCV (Pneumococcal)
15. Childhood Immunization Schedule: 6 months: "Be DR HIP IN 6 months"
B: Hep B D: DTaP (Diphtheria Tetanus acellular Pertussis) R: Rv (Rotovirus) H: HIB (Haemophilus Influenza Type B) I: IPV (Inactivated Polio Vaccine)
5 / 21 P: PCV (Pneumococcal) IN: Influenza
16. Childhood Immunization Schedule: Age 1 - 1.5 years: "1 Very MAD HIP-star"
V: Varicella Zoster M: MMR A: Hepatitis A D: DTaP (Diphtheria Tetanus acellular Pertussis) H: HIB (Haemophilus Influenza Type B) I: IPV (Inactivated Polio Vaccine) P: PCV (Pneumococcal)
17. Childhood Immunization Schedule: Age 4-6 years: "Very DIM between 4-6"
V: Varicella Zoster D: DTaP (Diphtheria Tetanus acellular Pertussis) I: IPV (Inactivated Polio Vaccine) M: MMR
18. Childhood Immunization Schedule: Age 11 - 12 years: "Tada!! Human Men"
T: TdaP H: Human papilloma Virus
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27. Tanner stage 3: girls: Age 12-
Breast enlargement without separate nipple contour. Pubic hair fills out but is straight
28. Tanner stage 4 female: Age 14
Secondary mound occurs in the breast at the areola; Pubic hair is adult like (dark, course curled)
29. Tanner stage 5 female: Age 15
sexually mature adult breast and adult quality pubic hair that can also be found on the inner thighs.
30. Tanner Stages Male: Stage 1: Preadolescent
Stage 2: growth of testes and scrotum. Skin of scrotum redden and becomes wrinkled. Sparse, long straight pubic hair. Stage 3: growth of penis and continued growth of testes and scrotum. Skin of scrotum darker and more wrinkled. Dark, course, curled pubic hair Stage 4: further growth in length and width. Darker course curls hair. Stage 5: penis, testes, and scrotum adult size. Pubic hair extends towards umbilicus.
31. Developmental Milestones by age: 2-5 months: Smiles and
coos Watches a person's face intently Follows people and objects with eyes Laughs aloud Lifts head/chest when on stomach Holds
8 / 21 head steady when pulled to sit Grasps rattle placed in hand Startles to loud noise
32. Developmental Milestones by age: 6-9 months: Turns to
sound Babbles and combines vowel/consonant sounds Responds to name Rolls over Sits independently Transfers objects Supports weight on feet Uses thumb and fingers to pick up objects Crawls
33. Developmental Milestones by age: 10-12 months: Takes simple action on request
Purposefully says "mama" or "dada" Sits independently and plays Pulls to standing/cruise furniture Communicates by reaching and pointing Moves purposefully to get desired object Has increasing curiosity Recognizes people Uses both hands well
34. Developmental Milestones by age: 13-18 months: Scribbles with large crayon
10 / 21 Prehn sign absent Absent creamastric reflex
38. benign prostatic hyperplasia (BPH): enlargement of the prostate gland, common in older men
>50, causes urinary obstruction
39. benign prostatic hyperplasia (BPH) clinical manifestation: -Bladder distention,
smooth/rubbery nodules, enlarged prostate, urinary symptoms (frequency, nocturia, dribbling, retention), diflculty urinating -infection caused by retention
40. benign prostatic hyperplasia (BPH): Diagnostic: UA (r/o UTI), PSA (>
abnormal), uroflowmetry, normal BUN/Cr
41. benign prostatic hyperplasia (BPH): Treatment: Drug: alpha blockers ("-osin" :
Alfuzosin, doxazosin, Tamsulosin), 5-Alpha Reductase inhibitors (finasteride and dutasteride) for reducing prostate size. Surgical option: transurethral resection of the prostate (TURP)
42. Side effect of alpha-adrenergic antagonist agents: (Alfuzosin, doxazosin,
Tamsulosin): SE: orthostatic hypotension, dizziness
43. BP Management in Elderly Males: Ace inhibitors (-
prils) ARBs (-sartan)
44. BP Management in Elderly Males with BPH: • Alpha-blockers (Tamsulosin, Alfuzosin, Tera-
zosin) ’Relax bladder neck, lower BP.
- Low-dose diuretics (HCTZ) ’Manage fluid retention.
45. Prostatitis: Acute or chronic inflammation of the prostate
11 / 21 (Usually Gram (-) like E. Coli)
46. Prostatitis Treatment: 1st line ABX: Fluoroquinolones (Cipro/Levo) x 4-6 weeks
*(Ciprofloxacin 500mg PO BID or Levofloxacin 500-750mg QD) 2nd line ABX: Sulfamethoxazole/trimethoprim 160 mg BID (check local resistance) **PLUS- NSAIDs and Alpha 1 Blockers for lower urinary tract symptoms ("-osin" : Alfuzosin, doxazosin, Tamsulosin)
47. Prostate Cancer: malignant neoplasm of the prostate gland; second most common cancer in men.
High-fat diet increase risk.
48. Prostate Cancer: Clinical manifestation: S/S: Bladder distention, hard prostate w/ nodules.
*early: mimic BPH; late: bone pain, uremia
49. Prostate Cancer: Diagnostics: Needle biopsy w/ ultrasound
50. Prostate Cancer: Managment: Refer to urologist for treatment to include surgery, radiation, and/or
hormonal therapy.
51. Erectile dysfunction: Etiology: Psychological (stress/anxiety), medical conditions, drug use, med-
ications
52. Erectile dysfunction: Treatment: Phosphodiesterase (PDE-5)
Inhibitors Slidenfil(Viagra) and Vardenafil last 4 hours. Tadalafil and Avanafil can last up to 36 hours
13 / 21 3 negative cytology 2 negative HPV + cytology (one in the last five years)
60. PAP Guidelines Pregnancy Considerations: Squamous lesions may progress during
preg-nancy but regress after Colposcopy ONLY to exclusive invasive cancer in high-risk women Unless cancer is identified, treatment of CIN is contraindicated
61. CIN I (Bethesda Classification): mild dysplasia: neoplastic cells confined to lower 1/3 of epithelium
62. CIN III (Bethesda Classification): severe dysplasia (Carcinoma in situ): involvement up to the
basement membrane of epithelium
63. CIN II (Bethesda Classification): moderate dysplasia: involvement of 2/3 of epithelium
64. American Cancer Society (ACS) Pap Smear Guidelines: • Start at 25: Preferred
HPV testing alone every 5 years OR
- Co-testing (Pap + HPV) every 5 years
- Cytology (Pap) alone every 3 years
- Ages 30-65: Same options as above.
65. American College of Obstetricians and Gynecologists (ACOG) Pap Smears
Guidelines: • Start at 21: Cytology (Pap) alone every 3 years.
- Ages 30-65: Choose one:
- HPV testing alone every 5 years
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- Co-testing every 5 years
- Cytology alone every 3 years
66. United States Preventive Services Task Force ( USPSTF) & American
Acade-my of Family Physicians(AAFP) Pap Smear Guidelines: • Start at 21: Cytology (Pap) alone every 3 years.
- Ages 30-65: Choose one:
- HPV testing alone every 5 years
- Co-testing every 5 years
- Cytology alone every 3 years
67. Similarities between ACS, ACOG, and USPSTF & AAFP Pap smear
guidelines- : Less than 21 years of age testing not recommended Greater than 65 years of age is not recommended Hysterectomy with no history of cervical cancer or high-grade cancerous lesion testing is Not recommended
68. Next step following an abnormal Pap smear findings: HPV
testing Repeat PSP smear Colposcopy Refer if CIN 2, 3, or CIS
69. ACA Mammogram Guidelines: Start at 40
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74. Conjugated Estrogens (Premarin): estrogen hormone; comes from pregnant mare urine
75. Estradiol: synthetic, comes in lower dosages
Formulations: Estrace (vaginal cream), Estring (vaginal ring), Vagifem (vaginal tablet), Vivelle-Dot, Alora, Climara (patch)
76. Differentials for vaginal bleeding: Ectopic pregnancy
Pregnancy termination Placental abruption Placenta previa Uterine Rupture Postpartum hemorrhage Menses Genitourinary Trauma Ovarian torsion or cyst rupture Endometrial carcinoma / cancers
77. Combined Oral Contraception Contradictions: Thrombophlebitis
History of clot Current breast cancer unexplained vaginal bleeding Endometrial carcinoma Hepatic adenoma Smoking after 35 Migraine with aura
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78. PCOS (polycystic ovarian syndrome): An endocrine disorder associated with chronic anovula-
tion, most common in young women (teens to twenties). High LH/FSH ratio in blood; A hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
79. PCOS (polycystic ovarian syndrome) etiology: multiple eggs develop, but none ovulate;
amount of estrogen production not normal;
80. PCOS (polycystic ovarian syndrome) symptoms: *infertility
*irregular menstrual cycle *hirsutism *acne *mental health problems
81. PCOS diagnostic criteria: Must have 2 of the following 3:
- oligo and/or anovulation
- hyperandrogenism (hirsutism, acne, elevated testosterone)
- polycystic ovaries on sonographic exam Have greater degree of insulin resistance --> acanthosis nigricans.
82. PCOS lab findings: ***Elevated LH/FSH ratio due to elevated estrogen -> decreased FSH with increased
LH
***Elevated testosterone
19 / 21 ***Famciclovir 250mg BID
90. Syphilis treatment: penicillin G IM single dose (benzathine penicillin)
91. Bacterial Vaginosis (BV) treatment: Metronidazole 500mg BID for 7 days -
or-Metronidazole gel 0.75% 5gm intravaginally for 5 days -or- Clindamycin 2% 5gm intravaginally QHS for 7 days
92. Your patient has syphilis and has a PCN or cephalosporin allergy. What
antibiotics would you prescribe?: Doxycycline 100mg PO BID for 14 days (for primary/secondary syphilis) Doxycycline 100mg PO BID for 28 days (for latent syphilis) Ceftriaxone 1-2g IM/IV daily for 10-14 days (use cautiously in cephalosporin allergy) For pregnant pts: desensitization is required
93. UTI treatment in pregnancy: Primary options: Cephalexin 250 mg-500mg QID for 5-
days Fosfomycin 3 grams orally in a single dose
94. UTI treatment in pregnancy: Secondary options: ***Nitrofurantoin 100mg BID for
5-7 days ( Not recommended for last trimester due to risk of hemolytic anemia) ***Amoxicillin/Clavulanate (Augmentin) 500mg TID for 5-7 days or 875mg BID for 5-7 days ***Sulfamethoxazole/trimethoprim (Bactrim) 160/800mg BID for 5-7 days (Not recommended during first trimester folic acid anatagonist properties)
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95. Alternatives for pregnant woman with a UTI is allergic to PCN: Cefpodoxime
100mg BID for 5-7 days Cephalexin 250-500mg q6hr for 5-7 days Macrolides (azithromycin, erythromycin) can be used.
96. General Considerations for UTI Treatment in Pregnancy: **Screening: screen
for asymptomatic bacteriuria and treat appropriately ***Antibiotic Selection: guided by safety profiles in pregnancy and local resistance patterns.
97. Complications of untreated UTI in pregnancy: pyelonephritis, preterm birth, and low birth
weight.
98. Which antibiotics should be avoided in pregnant patients with UTI?: Avoid
Fluoroquinolones and tetracyclines due to potential adverse ettects on fetal development.
99. Fragile X Syndrome: Mutation of FMR1 gene on X
chromosome Most common cause of autism in either gender
100. Fragile X clinical manifestations:
Male: Large testicles Large body habitus Learning and behavioral issues Large forehead and ears Prominent jaw Avoids eye contact
