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NURS 5432 MIDTERM STUDY GUIDE
Abnormal growth and development: skin - Answers - 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). Abnormal growth and development: Head - Answers - Bulging fontanel (increased intracranial pressure, hydrocephalus). Sunken fontanel (dehydration). Craniosynostosis (premature suture closure, abnormal head shape). Large anterior fontanel (hypothyroidism, Down syndrome). Abnormal growth and development: Eyes - Answers - 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 months. Abnormal growth and development: Ears - Answers - Low-set ears (associated with renal or genetic abnormality like Turner's or trisomy 21). Ear pits or tags (linked to renal anomalies). Abnormal growth and development: Mouth - Answers - Cleft palate/lip (requires surgical evaluation). Absent suck reflex (neurological impairment or prematurity). Macroglossia (associated with hypothyroidism, Beckwith-Wiedemann syndrome).
Abnormal growth and development: Neck - Answers - Webbing excessive amounts of skin Turner's or Noonan's syndrome Abnormal growth and development: Neurological - Answers - 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). Seizures: Subtle movements like lip smacking, pedaling, or eye deviation may indicate seizures. Abnormal growth and development: Cardiovascular - Answers - Murmurs: Cyanosis with murmur (congenital heart defects like Tetralogy of Fallot). Weak/absent femoral pulses (coarctation of the aorta). Abnormal growth and development: Gastrointestinal - Answers - Absent or delayed meconium (>48 hours): Failure to pass meconium in 24-48 hours is abnormal Think Hirschsprung disease or cystic fibrosis. Omphalocele or gastroschisis: Abdominal wall defects requiring surgical intervention. Projectile vomiting: Pyloric stenosis (non-bilious), intestinal obstruction (bilious). Abnormal growth and development: Geintourinary - Answers - Ambiguous genitalia: Requires genetic and endocrinology evaluation. Cryptorchidism: Undescended testicles beyond 6 months. Hydrocele: Persistent beyond 1 year or associated with inguinal hernia. Abnormal growth and development: Musculoskeletal - Answers - Developmental dysplasia of the hip (DDH): Positive Ortolani/Barlow tests or asymmetric gluteal folds. Clavicular fracture: Crepitus, decreased arm movement on the affected side. Childhood Immunization Schedule: Birth - Answers - Hep B Childhood Immunization Schedule: 2 months - Answers - "2 Be DR HIP" B: Hep B D: DTaP (Diphtheria Tetanus acellular Pertussis)
Childhood Immunization Schedule: Age 16- 18 - Answers - "Men" M: Meningococcal Booster (need for college) CDC MMR recommendations - Answers - MMR Series of 2 (1 year and by 12 years) If exposed can give as early as 6 months May be given simultaneously with TB testing with PPD, but prefer to postpone PPD for 4 - 6 weeks to avoid possible suppressive response to PPD Vaccinations in pregnancy (okay to give) - Answers - Flu, Tdap (EVERY pregnancy), RSV, and COVID-19 vaccination Vaccinations in pregnancy (contraindication) - Answers - No live vaccines Avoid Varicella,MMR, Zoster during pregnancy Tanner stages - Answers - A widely used system that describes the 5 stages of pubertal development Thelarche - Answers - onset of breast development Tanner stage 1: girls - Answers - Age 8- 10 preadolescent, no breast, no pubic hair Tanner stage 2: girls - Answers - Age 11- 12 Breast bud stage with elevation of breast and papilla; enlargement of areola. Pubic hair sparse, long, and straight. Tanner stage 3: girls - Answers - Age 12- 13 Breast enlargement without separate nipple contour. Pubic hair fills out but is straight Tanner stage 4 female - Answers - Age 14 Secondary mound occurs in the breast at the areola; Pubic hair is adult like (dark, course curled) Tanner stage 5 female - Answers - Age 15 sexually mature adult breast and adult quality pubic hair that can also be found on the inner thighs.
Tanner Stages Male - Answers - 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. Developmental Milestones by age: 2-5 months - Answers - Smiles and coos Watches a person's face intently Follows people and objects with eyes Laughs aloud Lifts head/chest when on stomach Holds head steady when pulled to sit Grasps rattle placed in hand Startles to loud noise Developmental Milestones by age: 6-9 months - Answers - 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 Developmental Milestones by age: 10-12 months - Answers - 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 Developmental Milestones by age: 13-18 months - Answers - Scribbles with large crayon Walks alone Feeds self with fingers and begins using a spoon 4 - 10 word vocabulary Follows simple directions Coordinates use of both hands
BP Management in Elderly Males with BPH - Answers - • Alpha-blockers (Tamsulosin, Alfuzosin, Terazosin) → Relax bladder neck, lower BP.
- Low-dose diuretics (HCTZ) → Manage fluid retention. Prostatitis - Answers - Acute or chronic inflammation of the prostate (Usually Gram (-) like E. Coli) Prostatitis Treatment - Answers - 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) Prostate Cancer - Answers - malignant neoplasm of the prostate gland; second most common cancer in men. High-fat diet increase risk. Prostate Cancer: Clinical manifestation - Answers - S/S: Bladder distention, hard prostate w/ nodules. *early: mimic BPH; late: bone pain, uremia Prostate Cancer: Diagnostics - Answers - Needle biopsy w/ ultrasound Prostate Cancer: Managment - Answers - Refer to urologist for treatment to include surgery, radiation, and/or hormonal therapy. Erectile dysfunction: Etiology - Answers - Psychological (stress/anxiety), medical conditions, drug use, medications Erectile dysfunction: Treatment - Answers - Phosphodiesterase (PDE-5) Inhibitors Slidenfil(Viagra) and Vardenafil last 4 hours. Tadalafil and Avanafil can last up to 36 hours Epididymitis - etiology - Answers - Men <35 - commonly caused by STD (chlamydia or gonorrhoeae) Men >35 - usually bacterial associated with UTI Epididymitis: Clinical Manifestation - Answers - Pain, scrotal edema, POSITIVE PREHN SIGN (pain reduced with testicles elevated), normal creamasteric reflex (testicle rise with thigh stroked), flu-like symptoms Epididymitis: Diagnostics - Answers - UA w/ c/s, STD testing if high risk, ultrasound if torsion suspected,
Epididymitis: Treatment - Answers - Levofloxacin 500mg PO QD X 10 days If STD suspect or confirmed, treat with Ceftriaxone 500mg IM x1 and Doxycycline 200 mg PO x10 days PSA level normal ranges - Answers - PSA >4 is abnormal Ranges may vary:
- 40-49: <2.
- 50-59: <3.
- 60-69: <4.
- 70-79: <6. Elevated PSA indication - Answers - More likelihood for dx of cancer PAP Guidelines Age Specific Considerations - Answers - Pediatrics - screening under 21 not recommended Geriatrics - with adequate hx of screening and no CIN II in the last 20 years should not be screened Negative results 3 negative cytology 2 negative HPV + cytology (one in the last five years) PAP Guidelines Pregnancy Considerations - Answers - Squamous lesions may progress during pregnancy but regress after Colposcopy ONLY to exclusive invasive cancer in high-risk women Unless cancer is identified, treatment of CIN is contraindicated CIN I (Bethesda Classification) - Answers - mild dysplasia: neoplastic cells confined to lower 1/3 of epithelium CIN III (Bethesda Classification) - Answers - severe dysplasia (Carcinoma in situ): involvement up to the basement membrane of epithelium CIN II (Bethesda Classification) - Answers - moderate dysplasia: involvement of 2/3 of epithelium American Cancer Society (ACS) Pap Smear Guidelines - Answers - • 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. American College of Obstetricians and Gynecologists (ACOG) Pap Smears Guidelines - Answers - • Start at 21: Cytology (Pap) alone every 3 years.
*unexplained uterine bleeding *history of thromboembolism or stroke *coronary artery disease *active liver disease ERT (estrogen replacement therapy) - Answers - Given to females without a uterus (otherwise increases the risk of endometrial cancer without opposing progesterone) Conjugated Estrogens (Premarin) - Answers - estrogen hormone; comes from pregnant mare urine Estradiol - Answers - synthetic, comes in lower dosages Formulations: Estrace (vaginal cream), Estring (vaginal ring), Vagifem (vaginal tablet), Vivelle-Dot, Alora, Climara (patch) Differentials for vaginal bleeding - Answers - Ectopic pregnancy Pregnancy termination Placental abruption Placenta previa Uterine Rupture Postpartum hemorrhage Menses Genitourinary Trauma Ovarian torsion or cyst rupture Endometrial carcinoma / cancers Combined Oral Contraception Contradictions - Answers - Thrombophlebitis History of clot Current breast cancer unexplained vaginal bleeding Endometrial carcinoma Hepatic adenoma Smoking after 35 Migraine with aura PCOS (polycystic ovarian syndrome) - Answers - An endocrine disorder associated with chronic anovulation, 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. PCOS (polycystic ovarian syndrome) etiology - Answers - multiple eggs develop, but none ovulate; amount of estrogen production not normal; PCOS (polycystic ovarian syndrome) symptoms - Answers - *infertility *irregular menstrual cycle *hirsutism
*acne *mental health problems PCOS diagnostic criteria - Answers - 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. PCOS lab findings - Answers - ***Elevated LH/FSH ratio due to elevated estrogen - > decreased FSH with increased LH ***Elevated testosterone PCOS (polycystic ovarian syndrome) management - Answers - *Weight loss and lifestyle modification are 1st-line treatment. Diet (improves insulin levels/resistance) & Exercise (improves ovarian function) *Metformin *Hormone therapy (combined oral contraceptives) for irregular periods and hyperandrogenism *Letrozole- first-line for ovulation 21 yo female patient has irregular periods, hirsutism, and weight gain. Indications of......
- Answers - PCOS Gonorrhea symptoms - Answers - dysuria, greenish-yellow discharge Gonorrhea treatment - Answers - Gonorrhea TX: Ceftrixaone 500mg IM single dose (<150kg) or Ceftriaxone 1GM IM Single dose (> 150kg) Cover Chlamydia with: doxycycline : 100 mg orally twice daily for 7 days Chlamydia treatment - Answers - Doxycicline 100mg BID for 7 days or Azithromycin 1gm x single dose or Levofloxacin 500mg PO x 7 days Trichomonas treatment - Answers - Metronidazole 500mg PO BID x 7 days in females OR 2g PO one time in males Tinidazole 2g PO one time dose (no alcohol within 24 hours) Genital Herpes Suppressive Treatment - Answers - ***valacyclovir 500-1000mg QD ***acyclovir 400mg BID ***Famciclovir 250mg BID Syphilis treatment - Answers - penicillin G IM single dose (benzathine penicillin)
Large testicles Large body habitus Learning and behavioral issues Large forehead and ears Prominent jaw Avoids eye contact Female: less common, fewer prominent findings Fragile X Syndrome Treatment - Answers - **Behavioral therapy **Educational management **Medication to manage mental status and behavior (ADHD, anxiety, aggression)
