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NURS 5432 Midterm Study Guide Review
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).
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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 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
4 / 26 Cryptorchidism: Undescended testicles beyond 6 months. Hydrocele: Persistent beyond 1 year or associated with inguinal hernia.
11. Abnormal growth and development: Musculoskeletal: Developmental dysplasia of the hip (DDH):
Positive Ortolani/Barlow tests or asymmetric gluteal folds. Clavicular fracture: Crepitus, decreased arm movement on the attected side.
12. Childhood Immunization Schedule: Birth: Hep B
13. Childhood Immunization Schedule: 2 months: "2 Be DR HIP" B:
Hep B
5 / 26 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
7 / 26 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 M: Meningococcal
19. Childhood Immunization Schedule: Age 16-18: "Men"
M: Meningococcal Booster (need for college)
20. CDC MMR recommendations: 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
21. Vaccinations in pregnancy (okay to give): Flu, Tdap (EVERY pregnancy), RSV, and COVID- 19
8 / 26 vaccination
22. Vaccinations in pregnancy (contraindication): No live vaccines
Avoid Varicella,MMR, Zoster during pregnancy
23. Tanner stages: A widely used system that describes the 5 stages of pubertal development
24. Thelarche: onset of breast development
25. Tanner stage 1: girls: Age 8-
preadolescent, no breast, no pubic hair
26. Tanner stage 2: girls: Age 11-
Breast bud stage with elevation of breast and papilla; enlargement of areola. Pubic hair sparse, long, and straight.
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
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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
11 / 26 Walks alone Feeds self with fingers and begins using a spoon 4-10 word vocabulary Follows simple directions Coordinates use of both hands Responds to name Points to 2 pictures upon request Long jabbering sentences Throw ball overhead
35. Developmental Milestones by age: 19-24 months: Walks up/down stairs Jumps with
both feet Completes simple puzzles, circle shapes first Stacks 6- blocks Uses 2-word sentences 30- word vocabulary
36. Complications of testicular torsion: testicular infarction, necrosis (loss of testis)
Treat within 6 hours. As time progresses chance of loss increases.
13 / 26 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 (>4 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)
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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
(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
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- 50-59: <3.
- 60-69: <4.
- 70-79: <6.
58. Elevated PSA indication: More likelihood for dx of cancer
59. PAP Guidelines Age Specific Considerations: Pediatrics - screening under 21 not recommend- ed
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)
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60. PAP Guidelines Pregnancy Considerations: Squamous lesions may progress during pregnan- cy 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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- Ages 40-44: Optional yearly mammograms.
- Ages 45-54: Yearly mammograms recommended.
- Ages 55+: Mammograms every 1-2 years, Screening continues with life expectancy of at least 10 more years. ***High risk add MRI to mammogram
70. hormone replacement therapy (HRT): replacement of hormones (estrogen and/or proges- terone) to treat
symptoms associated with menopause. Given to females with intact uterus
71. Medroxyprogesterone acetate (MPA) or natural progesterone given with estrogen:
hormone replacement therapy (HRT) Improves sleep disorders, urogenital atrophy, lowers risk of osteoporotic fractures, may improve mood
72. hormone replacement therapy (HRT) contraindications: *estrogen-dependent malig- nancies
*unexplained uterine bleeding *history of thromboembolism or stroke *coronary artery disease *active liver disease
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73. ERT (estrogen replacement therapy): Given to females without a uterus (otherwise increases the risk of endometrial
cancer without opposing progesterone)
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
