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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 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).
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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). Seizures: Subtle movements like lip smacking, pedaling, or eye deviation may indicate seizures.
8. Abnormal growth and development: Cardiovascular: Murmurs: Cyanosis with murmur (congenital heart defects like Tetralogy of
Fallot). Weak/absent femoral pulses (coarctation of the aorta).
9. Abnormal growth and development: Gastrointestinal: 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).
4 / 19 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) 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
5 / 19 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
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
7 / 19 Lifts head/chest when on stomach Holds 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
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
8 / 19 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 6-7 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.
37. Testicular Torsion: Clinical manifestation: Acute pain High-riding testis
Absence of systemic symptoms 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.
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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, medica- tions
52. Erectile dysfunction: Treatment: Phosphodiesterase (PDE-5) Inhibitors Slidenfil(Viagra) and
Vardenafil last 4 hours. Tadalafil and Avanafil can last up to 36 hours
53. Epididymitis - etiology: Men <35 - commonly caused by STD (chlamydia or gonorrhoeae) Men >35 - usually bacterial
associated with UTI
54. Epididymitis: Clinical Manifestation: Pain, scrotal edema, POSITIVE PREHN SIGN (pain reduced with testicles elevated), normal
creamasteric reflex (testicle rise with thigh stroked), flu-like symptoms
55. Epididymitis: Diagnostics: UA w/ c/s, STD testing if high risk, ultrasound if torsion suspected,
56. Epididymitis: Treatment: 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
57. PSA level normal ranges: PSA >4 is abnormal
Ranges may vary:
- 40-49: <2.
- 50-59: <3.
- 60-69: <4.
- 70-79: <6.
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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)
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.
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- 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
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
14 / 19 termination Placental abruption
NURS 5432 Midterm Study
Guide
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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
83. PCOS (polycystic ovarian syndrome) management: *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
84. 21 yo female patient has irregular periods, hirsutism, and weight gain. Indications of......: PCOS
85. Gonorrhea symptoms: dysuria, greenish-yellow discharge
86. Gonorrhea treatment: 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
NURS 5432 Midterm Study
Guide
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87. Chlamydia treatment: Doxycicline 100mg BID for 7 days or Azithromycin 1gm x single dose or Lev- ofloxacin 500mg PO x 7 days
88. Trichomonas treatment: 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)
89. Genital Herpes Suppressive Treatment: ***valacyclovir 500-1000mg QD
***acyclovir 400mg BID ***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 5-7 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
NURS 5432 Midterm Study
Guide
19 / 19 **Educational management **Medication to manage mental status and behavior (ADHD, anxiety, aggression)
