All starred slides

Question 2

List the 5 stages of development

Answer 2

1) Newborn/Neonate (first 28 days after birth)
2) Infancy (0-12 months)
3) Early childhood (1-4 years)
4) Middle childhood (5-10 years)
5) Adolescence (11-20 years)
-Early, middle, late

Question 3

Expectation of milestones is adjusted for ______________.

Answer 3

prematurity

Question 4

What temp is most accurate for infants?

Answer 4

Rectal

Question 5

1) What is avg HR at birth?
2) What abt at 1-6 months?
3) 6-12 months?

Answer 5

1) 140
2) 130
3) 115

Question 6

Any fever lasting more than _______ days needs complete workup

Answer 6

5

Question 7

List 3 potential causes of acute limp in kids

Answer 7

1) Trauma
2) Injury
3) Slipped Capital Femoral Epiphysis (SCFE)

Question 8

Slipped Capital Femoral Epiphysis (SCFE) is most common in what group of children? What does this cause?

Answer 8

Obese; growth plate damaged, femoral head slips

Question 9

List and define 5 potential causes of chronic limp

Answer 9

1) Blount disease: Growth disease of the tibia
2) Avascular necrosis of the hip: Blood flow to the bone is interrupted
3) Leg length discrepancy
4) Spinal disorder: Scoliosis
5) Leukemia: Build up of cells in the bone and joints of the legs and hip.

Question 10

1) Define inspiratory stridor
2) What can it be caused by?
3) Give examples

Answer 10

1) Audible breath sound; high-pitched, inspiratory noise
2) Serious conditions
3) Laryngotracheobronchitis (croup), Epiglottitis, Foreign body
-Not as important to know: Bacterial tracheitis, hemangioma (subglottic), vascular ring, tracheomalacia

Question 11

Give the Coarctation of the aorta brief definition

Answer 11

Congenital narrowing of a section of the aorta

Question 12

1) What is the Ortolani test for?
2) Is the hip abducted or adducted?

Answer 12

1) The presence of a posteriorly dislocated hip that is reducible
2) Abducted

Question 13

The combination of what two maneuvers has a high specificity for DDH in infants <3 months?

Answer 13

Barlow and Ortolani

Question 14

1) What happens w a Barlow test when the hip is dislocatable? What abt if its subluxatable?
2) What does a positive Barlow test indicate?

Answer 14

1) If hip is dislocatable, posterior movement and palpable clunk may be detected as femoral head exits acetabulum (“jerk of exit”)
2) If the hip is subluxatable, there is subtle sliding movement or feeling of looseness (“tennis ball moving in a soup bowl”)
-A reduced hip that is subluxatable or dislocatable

Question 15

1) What does Barlow test test for?
2) What is done?

Answer 15

1) Ability to sublux or dislocate an intact but unstable hip
2) Hip is gently adducted with pronation of examiner’s hand (downward pressure no longer recommended)

Question 16

Describe the positive Ortolani Sign for DDH

Answer 16

1) “Clunk” felt as the femoral head, which lies posterior to the acetabulum, enters the acetabulum (reduced to normal position).
2) Palpable movement of the femoral head back into place

Question 17

1) How is an ortolani test done?
2) What should you avoid?

Answer 17

1) From an adducted position and hip flexed to 90°, the hip is gently abducted with supination of the examiner’s hand while lifting the greater trochanter anteriorly
Avoid extreme abduction

Question 18

1) Define hip dysplasia. Does it need to be Dxd early?
2) What is the Ortolani Test for?

Answer 18

1) Instability or dislocation of the hip in a newborn or infant.
Needs to be detected early to intervene
2) Test for the presence of a posteriorly dislocated hip that is reducible

Question 19

Give 4 examples of benign heart murmurs pre-school aged children

Answer 19

1) Still’s murmurs
2) Pulmonary flow murmur
3) Systemic flow murmurs / Supraclavicular systemic bruits
4) Venous hum

Question 20

Absence of red reflex in young children should lead to a high level of suspicion for __________________

Answer 20

retinoblastoma

Question 21

1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?

Answer 21

1) Newborn
2) 2 months

Question 22

1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?

Answer 22

1) 3 months
2) 6 months
3) 5 months

Question 23

1) At what age begins “mama and dada specific”?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?

Answer 23

1) 8 months
2) 9 months
3) 9 months

Question 24

At what age should an infant be able to walk and use a spoon?

Answer 24

11 months

Question 25

Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

Answer 25

1) 3 years
2) 4 years

Question 26

Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

Answer 26

1) 3 years
2) 4 years

Question 27

Cognitive/ language:
1) At what age should a child be able to say 1-3 single words?
2) What abt 2-3 word phrases?
3) What abt having 100% understandable speech and talking in paragraphs?

Answer 27

1) 1 years
2) 2 years
3) 4 years

Question 28

Cognitive/ language development:
1) What age should a child be able to know sentences, colors, and ask “why?”?
2) What age should a child be able to say ABCs, copy figures, and define words?
Social emotional development:
1) What age should a child know themself in a mirror?
2) What age should a child display imagination?

Answer 28

1) 3 years
2) 5 years
Social emotional:
1) 3 years
2) 4 years

Question 29

1) When does the height spurt peak in males? What is the age range?
2) What about the age range of growth spurts of the penis?
3) What abt testicular growth spurts?
4) What abt pubic hair development?

Answer 29

1) 14; 10.5-16 and 13.5-17.5
2) 10.5-14.4 or 12.5-16.5
3) 9-13.5 or 13.5-17
4) 10.7-14.5 for PH3

Question 30

1) When does the height spurt peak in females? What is the age range?
2) What is the age range of menarche?
3) What abt of breast development?
4) What abt of pubic hair?

Answer 30

1) 11.5; 9.5-14.5
2) 11-14.1
3) 8.2-21.1 for B2
4) 9.3-13.9 for PH3

Question 31

1) Define hepatomegaly
2) How far does a normal liver edge extend?
3) Liver disease can lead to what?

Answer 31

1) liver extends >3 cm below the right costal margin
2) Normal liver edge extends 1-3 cm.
3) Decreased protein production and other complications

Question 32

List 4 potential causes of hepatomegaly

Answer 32

1) Heart failure
2) Hepatitis
3) Epstein Barr Virus (EBV) infection
4) Biliary congestion

Question 33

1) Define splenomegaly
2) Describe a normal spleen

Answer 33

1) Spleen extends >2 cm below the left costal margin
2) Moveable; rarely extends >1-2 cm.

Question 34

List 5 potential causes of splenomegaly

Answer 34

1) Mononucleosis (e.g., EBV)
2) Hemolytic anemia
3) Leukemia
4) Autoimmune or inflammatory diseases
5) Portal hypertension

Question 35

1) Define pyloric stenosis
2) What causes it?
3) When does it usually present?

Answer 35

1) Narrowing due to thickening at the opening (pylorus muscle) from the stomach into the small intestine
2) Cause unknown
3) ~3-5 weeks of age.

Question 36

What are two PE findings that require follow up for suspected pyloric stenosis?

Answer 36

1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen
2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.

Question 37

What are two PE findings that require follow up for suspected pyloric stenosis?

Answer 37

1) Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen
2) Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry.

Question 38

1) A Firm 2 cm “olive-like” mass of the RUQ or midline of the abdomen is suspicious for what?
2) What condition is described?: “Parent may report visible peristaltic waves across the abdomen and projectile vomiting (usually nonbilious) immediately after feeding, while infant remains hungry”

Answer 38

1) Pyloric stenosis
2) Pyloric stenosis

Question 39

1) What is the most common heart murmur?
2) Where is it? What is it related to and can it move?
3) What are the common ages?

Answer 39

1) Still’s murmur
2) Left lower sternal border; related to flow, can change with position/Valsalva
3) 3 years to adolescence

Question 40

1) What murmur is prominent in high-flow situations? (anemia, fever)
2) Where is this murmur?
3) What demographic is it seen in?

Answer 40

1) Pulmonary flow murmur
2) Upper left sternal border
3) Older children, adolescence and older.

Question 41

1) Are systemic flow murmurs / Supraclavicular systemic bruits true “carotid bruits”?
2) What causes them?

Answer 41

1) Heard over carotids, but no, they’re not.
2) Normal blood flow into aorta and head/neck vessels

Question 42

1) What causes venous hum?
2) What is it sensitive to?

Answer 42

1) Blood returning from great veins to heart
2) Posture and head/neck position

Question 43

1) What should you inspect about the head in an infancy PE?
2) Should you observe or palpate the two fontanelles? What are these and when does each close?

Answer 43

1) Inspect for symmetry
2) Palpate:
Anterior fontanelle: closes between 4 - 26 months of age
Posterior fontanelle: closes by 2 months of age

Question 44

True or false: you should test for red light reflex in infants

Answer 44

True

Question 45

Infancy male genital PE: what should you inspect and palpate for?

Answer 45

Inspect and palpate for descent of testes into scrotal sac

Question 46

Infancy female genital PE; what should you do? (very general q)

Answer 46

Inspect genitals

Question 47

1) At what age should a baby respond to sounds?
2) At what age should a baby coo and gain head control?

Answer 47

1) Newborn
2) 2 months

Question 48

1) At what age should a baby roll over?
2) At what age should they babble?
3) At what age should they sit?

Answer 48

1) 3 months
2) 6 months
3) 5 months

Question 49

1) At what age begins “mama and dada specific”?
2) What age should a baby pull to stand, crawl, and actively manipulate reachable objects?
3) At what age may an infant recognize strangers?

Answer 49

1) 8 months
2) 9 months
3) 9 months

Question 50

At what age should an infant be able to walk and use a spoon?

Answer 50

11 months

Question 51

Physical/ motor development:
1) At what age should a child be able to pedal a tricycle, jump in place, and feed themselves with utensils?
2) At what age should a child be able to cut with scissors, hop, and balance on 1 foot?

Answer 51

1) 3 years
2) 4 years

Question 52

Cognitive/ language:
1) At what age should a child be able to say 1-3 single words?
2) What abt 2-3 word phrases?
3) What abt having 100% understandable speech and talking in paragraphs?

Answer 52

1) 1 years
2) 2 years
3) 4 years

Question 53

Cognitive/ language development:
1) What age should a child be able to know sentences, colors, and ask “why?”?
2) What age should a child be able to say ABCs, copy figures, and define words?
Social emotional development:
1) What age should a child know themself in a mirror?
2) What age should a child display imagination?

Answer 53

1) 3 years
2) 5 years
Social emotional:
1) 3 years
2) 4 years

Question 54

1) When does the height spurt peak in males? What is the age range?
2) What about the age range of growth spurts of the penis?
3) What abt testicular growth spurts?
4) What abt pubic hair development?

Answer 54

1) 14; 10.5-16 and 13.5-17.5
2) 10.5-14.4 or 12.5-16.5
3) 9-13.5 or 13.5-17
4) 10.7-14.5 for PH3

Question 55

1) When does the height spurt peak in females? What is the age range?
2) What is the age range of menarche?
3) What abt of breast development?
4) What abt of pubic hair?

Answer 55

1) 11.5; 9.5-14.5
2) 11-14.1
3) 8.2-21.1 for B2
4) 9.3-13.9 for PH3

Question 56

List 3 potential pediatric PE findings of the throat

Answer 56

1) Streptococcal pharyngitis
2) Peritonsillar abscess
3) Retropharyngeal abscess

Question 57

1) Define Streptococcal pharyngitis
2) What does it cause do to the tongue?
3) How doe it affect the tonsils/ post pharynx?
4) How doe it affect the uvula and palate?

Answer 57

1) Bacterial infection of the pharynx (aka “strep”)
2) “Strawberry” tongue
3) White or yellow exudates on the tonsils or posterior pharynx.
4) Beefy red uvula
5) Palatal petechiae

Question 58

What are 3 symptoms of peritonsillar abscess?

Answer 58

1) Erythema of one tonsil
2) Asymmetric enlargement of one tonsil
3) Lateral displacement of uvula

Question 59

1) What are the symptoms of retropharyngeal abscesses?
2) What swelling may occur?

Answer 59

1) Fever, stiff neck, pain with neck extension, dysphagia, etc.
2) Midline or unilateral of posterior pharyngeal wall (visualization may not be possible and should not be attempted if significant airway compromise)

Question 60

Koplik spots are pathognomonic for what? Describe these spots

Answer 60

Measles; bluish white dots about 1 mm in diameter surrounded by a rose-red areola

Question 61

1) What severity does asthma present with?
2) What does it do to the inspiratory: expiratory ratio? Define this ratio as well

Answer 61

1) Varying severity
2) Prolonged expiratory phase; proportion of time spent on inspiration versus expiration

Question 62

What are 3 childhood resp diseases?

Answer 62

1) Asthma
2) Pneumonia
3) Respiratory foreign body

Question 63

What are 3 symptoms of pneumonia?

Answer 63

1) Fever
2) Tachypnea
3) Dyspnea

Question 64

List 2 symptoms of respiratory foreign body

Answer 64

1) Inspiratory stridor
2) Prolonged inspiratory phase

Question 65

1) Do benign heart murmurs come w associated findings? (breathing difficulties, color changes, growth/activity restriction, feeding difficulty, CP/SOB/palpitations, etc.)
2) True or false: Most, if not all children, will have one or more functional or benign murmurs before reaching adulthood.

Answer 65

1) As a rule of thumb, usually no
2) True

Question 66

Should you identify murmurs by their quality or intensity? Give examples

Answer 66

By their quality, not intensity
-Ex: Systolic vs. diastolic, crescendo vs. decrescendo, high or low pitch, etc.

Question 67

What 8 vital signs should you get during development? At what ages should you measure each?

Answer 67

1) Height: every visit
2) Weight: every visit
3) BMI (body mass index): at every visit
4) Head circumference: birth to 36 months
5) BP: start measuring at age 2
6) Pulse: higher in infancy; slows down with aging
7) RR: higher in infancy; slows down with aging
8) Temp: <2 months of age: rectal temp
≥2 months of age: tympanic temp

Question 68

What vital signs should be measured at every visit throughout development?

Answer 68

Height, weight, BMI, BP (at age 2+)

Question 69

What vital signs are higher in infancy and slow down with aging?

Answer 69

Pulse and RR

Question 70

What does an APGAR score consist of?

Answer 70

Appearance (skin color)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration

Question 71

1) Define acrocyanosis (a 1 on the color pt of APGAR)
2) Describe the scale APGAR is measured on

Answer 71

1) Pink trunk, blue extremities
2) 7 to 10 is reassuring
-4 to 6 is moderately abnormal
-0 to 3 is low

Question 72

1) Is HR >100 a good thing on APGAR?
2) Is “grimace” or “cry or active withdrawal” a more positive expression of reflex irritability on APGAR?

Answer 72

1) Yes
3) Cry or active withdrawal is more positive

Question 73

1) What should you inspect about the head in an infancy PE?
2) Should you observe or palpate the two fontanelles? What are these and when does each close?

Answer 73

1) Inspect for symmetry
2) Palpate:
Anterior fontanelle: closes between 4 - 26 months of age
Posterior fontanelle: closes by 2 months of age

Question 74

Infancy PE:
1) What should you inspect abt eyes?
2) What abt ears?
3) What reflex should you test w the ears?
4) What should you inspect abt the neck

Answer 74

1) Sclerae, pupils, irises, extraocular movements, and presence of red reflex
2) Position, shape, landmarks, patency of ear canal
3) Acoustic blink reflex
4) For masses

Question 75

1) Do infants breathe through the nose or mouth?
2) What sinuses are present at birth?
3) What should you inspect abt the nose in an infancy PE?

Answer 75

1) Obligate nasal breathers for first the 2 months of life
2) Only ethmoid sinuses
3) Position of nasal septum

Question 76

Infancy oral PE:
1) What should you inspect abt the mouth?
2) What should you palpate?
3) How do you know how many teeth a child should have?
4) Which teeth erupt first?

Answer 76

1) Mucosa, tongue, gums, palate, tonsils, and posterior pharynx
2) Gums and teeth
3) 6-26 months of age, 1 tooth per month
4) Central + lat. incisors first, molars last

Question 77

Infancy neck PE:
1) What should you inspect for on the neck?
2) What should you palpate for?
3) What should you assess for?

Answer 77

1) Masses
2) Presence of adenopathy: unusual in infancy
3) Mobility of neck

Question 78

Absence of red reflex in young children should lead to a high level of suspicion for __________________

Answer 78

retinoblastoma

Question 79

1) Why should you inspect an infant’s breasts?
2) What should you palpate for?

Answer 79

1) Enlarged in newborns secondary to maternal estrogen
2) Masses

Question 80

Infancy male genital PE: what should you inspect and palpate for?

Answer 80

Inspect and palpate for descent of testes into scrotal sac

Question 81

Infancy female genital PE; what should you do?

Answer 81

Inspect genitals

Question 82

Infant abd. PE:
1) What should you inspect abt the abdomen/ what should be gone by 2 weeks old?
2) What should you auscultate?

Answer 82

1) Umbilical cord remnant is gone by 2 weeks of age
2) Bowel sounds

Question 83

Infancy abd PE:
1) What should you palpate?
2) Are infant rectal exams generally done

Answer 83

1) Liver edge 1-2 cm below costal margin is normal; palpable spleen tip is normal
2) Generally not done

Question 84

1) Testes undescended in scrotal sac by age _____ is abnormal and need to refer
2) From 18 months to 4 years of age what is seen in the knees?
3) Inspect spine for scoliosis in what children?

Answer 84

1) 1 year old
2) Knock-knees
3) Any child who can stand

Question 85

1) What are Tanner stages?
2) While the age of puberty is highly variable, generally starts around age _________.
3) What age does puberty typically start in females? And in males?

Answer 85

1) Sexual maturity rating, to determine stage of puberty based on primary and secondary sex characteristics
2) 10-11
3) Females ~age 11; males ~age 12

Question 86

1) What determine stage of puberty in both males and females?
2) What are stage 1 and stage 5 in both males and females?

Answer 86

1) Tanner stages
2) Stage 1: “Pre-puberty”; Stage 5: Full development

Question 87

What is the first sign of puberty in females?

Answer 87

Breast budding

Question 89

List 6 barriers to good geriatric care

Answer 89

1) Communication
2) Underreporting symptoms.
3) Multiple complaints that may interact; “somatization” of emotions
4) Lack of time- be patient; probe relatives or other caregivers, screening tools
5) Measure function, be alert to change, esp. rapid change
6) Track data, treat diagnoses instead of sxs, have pt. familiarity, multiple visits instead of few marathons

Question 90

[barriers to good geriatric care]:
1) What type of change should you be particularly alert for?
2) What tools are important?
3) What may pts do to emotions?

Answer 90

1) Rapid change
2) Screening tools
3) somatization

Question 91

1) How often is breast cancer screening with Mammography recommended for 40-75 y/o?
2) What abt over 75?

Answer 91

1) Screen yearly or biennially
2) Shared decision-making process about whether to continue screening (dependent on health/life expectancy)

Question 92

1) What age range should be screened for cervical cancer?
2) What age range should be screened every 3 years with cervical cytology alone?
3) What age range should you screen every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with both tests together (cotesting)?

Answer 92

1) Women aged 21-65 years
2) 21-29 yo
3) 30-65 yo

Question 93

How often should cervical cancer screening be done >65y/o?

Answer 93

If adequate recent screening with normal Pap smears, and not otherwise at high risk for cervical cancer, routine screening is not recommended

Question 94

1) What age should screening for colorectal cancer and premalignant polyps/lesions (USPSTF) for all adults of average risk? (both males and females).
2) When should this screening occur selectively?
3) What is the preferred test option and how often?

Answer 94

1) 45 y/o
2) In pts 76-85 years
3) Colonoscopy every 10 years (other testing options exist if pt is not amenable to colonoscopy)

Question 95

What condition relevant to older adults has screening recommendations that vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial?

Answer 95

Prostate cancer

Question 96

1) Screening for what condition may offer a small potential benefit, but have risks of harm (false positives, etc.)? What should you engage in bc of this?
2) When should discussion of screening for this condition begin for avg risk men? What abt higher risk?

Answer 96

1) Prostate cancer; shared decision making
2) 50 years; as early as age 40

Question 97

1) What is the prostate cancer screening method?
2) How often and up to what age? What do these vary depending on?

Answer 97

1) Prostate-specific Antigen (PSA) testing
2) Every 1-2 years up to age 69-75 depending on the source (UpToDate recommendations are given above)
-USPSTF: men aged 55-69, individual decision of whether to screen with PSA

Question 98

Who should be screened for lung cancer (USPSTF)?

Answer 98

Adults age 50-80 yo with:
1) 20 pack-year smoking history AND
2) Currently smoke or have quit within the past 15 years

Question 99

1) What is the lung cancer screening (USPSTF) recommendation for those who need them?
2) When should screening be discontinued?

Answer 99

1) Annual screening with low dose computed tomography (LDCT) of the chest.
2) Once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Question 100

What is the recommendation for skin cancer screening (USPSTF) for asymptom. adolescents and adults (do not have signs/ symptoms of skin cancer)?

Answer 100

“The current evidence is insufficient to assess the balance of benefits and harms of visual skin examination [whole-body screening skin exam] by a clinician to screen for skin cancer.”

Question 101

1) Osteoporosis screening to prevent osteoporotic fractures (USPSTF) is recommended in women >______.
2) How should you screen them? What does frequency of screening depend on?
3) Screening may begin earlier if woman is _______________ and at increased risk of osteoporosis

Answer 101

1) 65
2) Screen with bone measurement testing (e.g., DEXA scan to measure bone mineral density [BMD]); a number of factors
3) postmenopausal

Question 102

What is the current recommendation for osteoporosis screening to prevent osteoporotic fractures (USPSTF) in men?

Answer 102

“Insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”

Question 103

Define dementia

Answer 103

An acquired condition that is characterized by a decline in at least two cognitive domains:
1) Loss of memory
2) Attention
3) Language
4) Visuospatial
5) Executive functioning

Question 104

1) List types of dementia diagnoses
2) Which is most common?
starred

Answer 104

1) Alzheimer disease (AD), vascular dementia, dementia with Lewy bodies, and Parkinson disease with dementia, and dementia of mixed etiology.
2) AD

Question 105

Define delirium

Answer 105

Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surroundings

Question 106

What are 4 non-underlying disease related causes for delirium?

Answer 106

1) Intoxication
2) Sleep deprivation
3) Medications
4) Illegal drugs

Question 107

Elder abuse:
1) What should screening include looking for?
2) What is the prevalence of elder abuse? What group is it higher in?
3) Why may abuse not be detected?

Answer 107

1) Screening should include looking for abuse, neglect, exploitation, and abandonment.
2) Prevalence ranges from 5-10%
Higher in elders with dementia and depression
3) Elders less likely to report, therefore abuse may not be detected

Question 108

Why are elders less likely to report, therefore abuse may not be detected? (4 reasons)

Answer 108

1) Fear of retaliation
2) Physical or cognitive inability to report.
3) Unwillingness to expose the abuser
4) 90% are family members

Question 109

1) The great heterogeneity in older pts health contributes to the difficulty in distinguishing between __________ aging verses ____________ conditions.
2) This makes it harder to answer what question?

Answer 109

1) intrinsic; pathologic
2) “When to treat?”

Question 110

1) If undecided on whether to treat, then evaluate what abt a pt’s function?
2) What should determine your decision after that?

Answer 110

1) Whether function is sufficiently impaired
2) If so, then treat; if not very impaired, then watch, wait, reevaluate

Question 111

List 6 ADLs (activities of daily living)

Answer 111

Bathing
Dressing
Toileting
Transferring
Continence
Feeding

Question 112

1) What main thing should you ask abt ADLs?
2) In general, what are ADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 112

1) Ask how well the patient performs the ADLs
2) Basic self-care abilities
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for ADLs?

Question 113

1) What main thing should you ask abt Instrumental Activities of Daily Living (IADLs)?
2) In general, what are IADLs?
3) What 3 questions should you ask to help answer the main question?

Answer 113

1) Ask how well the patient performs the IADLs
2) Activities which are higher level functions
3) -Can the patient perform these activities independently?
-Does the patient need help?
-Is the patient completely dependent on others for IADLs?

Question 114

Blood pressure:
1) With aging, ______ and __________________ increase, whereas __________ decreases (widening pulse pressure)
2) Isolated systolic hypertension (SBP ≥140 mmHg with DBP <90 mmHg) after age 50 and widened pulse pressure >60 increases risk for what 3 things?

Answer 114

1) SBP and peripheral vascular resistance; DBP
2) Stroke, renal failure, and heart disease

Question 115

1) Define orthostatic hypotension
2) What % of older adults does it occur in?
3) List 4 symptoms

Answer 115

1) Drop in SBP of >20 mmHg or DBP of >10 mm Hg, increase of HR of 20 BPM, or dizziness within 3 minutes of standing
2) 20%
3) Lightheadedness, weakness, unsteadiness, and visual blurring

Question 116

Heart rate and rhythm:
1) Resting HR is unchanged, but ___________________ declines, affecting response to exercise and physiologic stress.
2) Why?
3) What abt heart rhythm can change w age?

Answer 116

1) maximal heart rate
-Due to slowing of pacemaker cells in SA node and blunted β-adrenergic response (Beta blockers may also do this)
3) More likely to have abnormal heart rhythms

Question 117

1) Does RR change w age?
2) What do age-related changes in temp. regulation lead to?

Answer 117

1) No; respiratory rate unchanged
2) Susceptibility to hypothermia

Question 118

What is the “5th vital sign” in older adults?

Answer 118

Functional Status

Question 119

1) Assessment of older adults places special emphasis on maintaining what 2 things?
2) Maintaining what is the primary focus?

Answer 119

1) Independence and optimal level of function
2) Functional status

Question 120

1) A number of performance-based assessment instruments for functional status are available, such as what? What does this screening assess?
2) Patients should also undergo risk factor assessment for _______

Answer 120

1) 10-Minute Geriatric Screen; physical, cognitive, and psychosocial factors
2) falls

Question 121

List the 2 types of macular degeneration.
Which is more common and less severe? Which is neovascular?

Answer 121

Two types:
1) Dry atrophic: more common, less severe
2) Wet exudative: neovascular

Question 122

List 2 symptoms of macular degeneration

Answer 122

1) Poor central vision
2) Blindness

Question 123

What is the leading cause of visual impairment?

Answer 123

Cataracts

Question 124

List some of the multiple risk factors for cataracts

Answer 124

1) Cigarette smoking
2) High alcohol intake
3) Diabetes mellitus (DM)
4) Medications (e.g., steroids)
5) Trauma

Question 125

1) Define glaucoma
2) What does it lead to?

Answer 125

1) Increased intraocular pressure
2) Optic nerve damage

Question 126

In older adults:
1) Systolic bruits heard in middle or upper portions of carotid arteries suggest what? From what?
2) What does having an S3 strongly suggest after age 40?

Answer 126

1) Partial arterial obstruction; atherosclerosis
2) Heart failure and dilatation of the left ventricle from CHF

Question 127

1) S4 can be heard in healthy older people, but often suggests decreased ____________ and impaired _______________.
2) What may occur as a result?

Answer 127

1) ventricular compliance and impaired ventricular filling
2) LVH (left ventricular hypertrophy)

Question 128

1) Menstrual periods typically cease between what ages? What is the median?
2) Women often experience hot flashes for up to how many years? What are 3 other symptoms they may have?
3) Within how long are the ovaries usually no longer palpable?

Answer 128

1) 48-55; median 51 years
2) Five year; vaginal dryness, urge incontinence, or dyspareunia
3) 10 years

Question 129

1) Proliferation of prostate epithelial and stromal tissue (aka benign prostatic hyperplasia (BPH)) begins in what decade?
2) What decade does it continue to and what happens then?
3) How many men w BPH have symptoms?

Answer 129

1) Third decade
2) Until the seventh, then plateaus
3) Only half

Question 130

True or false: Signs and symptoms of alcohol abuse/ use disorder may be subtler in older adults

Answer 130

True

Question 131

True or false: Signs and symptoms of alcohol abuse/ use disorder may be more obvious in older adults

Answer 131

False; may be more subtle

Question 132

List the 4 CAGE questions

Answer 132

1) Have you ever felt you shouldCut downon your drinking?
2) Have peopleAnnoyedyou by criticizing your drinking?
3) Have you ever felt bad orGuiltyabout your drinking?
4) Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?

Question 133

1) What test is preferred over CAGE?
2) What does this test identify?
3) How many questions and what’s the scoring?

Answer 133

1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C)
2) Not just harmful drinkers detected by CAGE, but also hazardous drinkers who have not yet reached that level of harm (early intervention to reduce consumption)
3) 3 Questions, scored from 0-12

Question 134

What are the 3 questions for the Alcohol Use Disorders Identification Test-Concise (AUDIT-C)?

Answer 134

1) How often did you have a drink containing alcohol in the past year?
2) How many drinks did you have on a typical day when you were drinking in the past year?
3) How often did you have 6 or more drinks on one occasion in the past year?

Question 136

1) Define gravidity
2) Define parity

Answer 136

1) # of pregnancies, current and past, regardless of outcome (multiple gestation only counts once)
2) # of times a woman has given birth to an infant ≥20 weeks of gestation regardless of outcome
multiple gestation only counts once (except for living children)

Question 137

How do you document OB history?

Answer 137

GTPAL (ex, G2P1001): gravidity, term, preterm, abortion/(miscarriage), living

Question 138

1) Define term
2) Define preterm
3) Define abortion
4) Define living

Answer 138

1) Number of times a woman has given birth to an infant ≥37 weeks gestation
2) Number of times a woman has given birth to an infant between 20-36 6/7 weeks gestation
3) Number of losses before 20 weeks
4) Number of living children

Question 139

1) Define gravida
2) Define primigravida and multigravida
3) Define nulligravida

Answer 139

1) Is or has been pregnant
2) Is in or has had one pregnancy; has been pregnant more than once
3) Has never been pregnant

Question 140

1) Define primipara
2) Define multipara
3) Define nullipara

Answer 140

1) Has only birthed one child or is pregnant for the 1st time
2) Has given birth 2+ times
3) Has never given birth or had pregnancy go past gestational abortion age

Question 141

What does GTPAL stand for?

Answer 141

G = total pregnancies
T = # born ≥37 weeks (= term)
P = preterm
A = miscarriages/abortions
L = living children

Question 142

1) Define “breast self-examination”
2) Is it generally currently recommended for average-risk women? Why or why not?

Answer 142

1) Self-inspection in a systematic way on a regular, repetitive basis (e.g., monthly) for detection of breast cancer.
2) No longer recommended for average-risk women, lack of evidence for benefits (beyond mammography) and potential harm from false-positives.

Question 143

Pt education on “Breast Self-Awareness” is recommended; what does this include?

Answer 143

1) Being aware of normal appearance and feel of one’s breasts
2) Be educated on signs/symptoms of breast cancer and notify health care provider if any changes (pain, mass, new nipple discharge, redness).

Question 144

1) True or false: Breast cancers are not frequently self-detected
2) True or false: Breast cancer is the most common female malignancy

Answer 144

1) False; they are frequently self-detected
2) True

Question 145

When should clinical breast exams (CBE) be recommended to each of the two age groups?

Answer 145

1) 25-39 yo: may be offered every 1-3 yrs based on shared decision-making*
2) ≥40 yo: may be offered annually based on shared decision-making*
*Uncertainty if CBE offers additional benefits beyond screening mammography, and there is possibility of false positives/harm.

Question 146

When should mammography be recommended to each of the two age groups?

Answer 146

1) 40-75 years old: screen every 1-2 yrs
2) Older than 75 years: shared decision-making process about whether to continue screening (dependent on health/life expectancy)

Question 147

1) What should you do first in a breast exam?
2) Is asymmetry of breasts common?
3) What should you further evaluate for?
4) What should you describe about any masses?
5) What is normal for large breasts?

Answer 147

1) Visual inspection first; have pt lean forward for large and/or pendulous breasts
2) Yes, some asymmetry is common
3) Marked differences or recent changes
4) Size, shape, consistency, position, & mobility
5) Normal firm transverse inframammary ridge with large breasts

Question 148

1) When should you palpate the breast?
2) In what 2 positions should you inspect?
3) In what positions should you palpate? How should you palpate?

Answer 148

1) After visual inspection
2) With pt seated with arms at sides, then with pt supine and ipsilateral arm above head*
Palpation with pt supine, ipsilateral arm above head; use pads of fingers for palpation (not tips/no nails)

Question 149

1) What should you thoroughly palpate during a breast exam?
2) What technique is best validated?
3) What should you squeeze?

Answer 149

1) Rectangular area extending from clavicle to inframammary fold and from midsternal line to posterior axillary line and well into axilla (tail of breast)
2) Vertical strip
3) Not nipple, but rather tissue surrounding

Question 150

What are 8 symptoms concerning for malignancy?

Answer 150

1) Rapid change in the appearance of one breast
2) Thickness, heaviness or visible enlargement of one breast
3) Discoloration, giving the breast a red, purple, pink or bruised appearance
4) Unusual warmth of the affected breast
5) Dimpling or ridges on the skin of the affected breast, similar to an orange peel
6) Itching
7) Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
8) Flattening or nipple inversion

Question 151

1) What does redness of the breast suggest?
2) What is it often due to?
3) In women who have not recently nursed a baby it is worrisome for what?

Answer 151

1) Infection or inflammation
2) Mastitis in postpartum patient.
3) Inflammatory breast cancer (IBC)

Question 152

1) What is dimpling often a sign of?
2) In what positions should you assess it?

Answer 152

1) A tumor beneath.
2) With pt supine, sitting, and standing

Question 153

1) Is it suspicious if there’s asymmetry of the breast?
2) What is nipple retraction a sign of if new?

Answer 153

1) Yes
2) A tumor beneath. Carefully palpate around and under the nipple

Question 154

List 5 abnormal nipple findings

Answer 154

1) Discoloration or ulceration
2) Clear or milky discharge (galactorrhea)
3) Nipple discharge may be sent for culture & sensitivity and cytopathology
4) Bloody discharge (usually unilateral)
5) Pus/purulent discharge

Question 155

1) What is galactorrhea and what may it be due to? Bilateral or unilateral usually?
2) Is bloody discharge of the nipple usually bilateral or unilateral? What is it associated with?
3) What does pus usually indicate?

Answer 155

1) Clear or milky discharge may be due to stimulation (normal) or elevated prolactin levels (abnormal).
-Bilateral (usually)
2) Usually unilateral, associated w. inflammation (usually intraductal papilloma).
-Evaluation to rule out malignancy is required.
3) Infection but may be due to underlying tumor.

Question 156

1) Is nipple discharge usually cancer? Explain.
2) What can be a sign of ductal ectasia or fibrocystic changes?

Answer 156

1) Usually benign but may be an early sign of endocrine dysfunction or cancer
2) Non-bloody, bilateral discharge with nipple stimulation (“nonspontaneous”)
*spontaneous = occurring without nipple stimulation

Question 157

1) When is milky discharge of the nipple common? What else is it associated with?
2) What is bloody unilateral nipple discharge concerning for?
What does it usually require?

Answer 157

1) Common during childbearing; associated with hyperprolactinemia or hypothyroidism, OCPs, tricyclic antidepressants
2) Invasive ductal carcinoma, intraductal papilloma, or intraductal carcinoma (e.g., be concerned for cancer)
-Ductography and ductal excision

Question 158

1) If you clearly identify a discrete mass, consider it to be _________ until proven otherwise.
2) In general, determination of final diagnosis requires a what?

Answer 158

1) malignant
2) Biopsy

Question 159

1) Should a dominant breast mass that does not have a corresponding abnormality on Mammogram still be considered malignant until proven otherwise?
2) Mammograms miss up to ____% of cancers

Answer 159

1) Yes
2) 30%

Question 160

True or false: While uncommon, breast cancer can occur in men

Answer 160

True
(Thus, discrete masses should be appropriately evaluated).

Question 161

1) Breast cancer can occur in young women (20s and 30s) so what should be appropriately evaluated?
2) What is more difficult about evaluating young patients for breast cancer?

Answer 161

1) Thus worrisome masses in this population should be appropriately evaluated.
2) Mammograms more likely to be false-negative

Question 162

1) True or false: you should pay very careful attention to any mass that the patient brings to your attention.
2) True or false: Women who are very self-aware can often detect subtle/early changes concerning for malignancy that an examiner may have difficulty identifying.

Answer 162

1) True
2) True

Question 163

1) Define mastalgia (breast pain)
2) What percent of women does it affect during lifetime?

Answer 163

1) Breast pain
2) 70% of women

Question 164

1) What is the most common type of mastalgia? What is it associated with? Bilateral or unilateral?
2) What is noncyclical mastalgia not associated with? What is it associated with?
3) What is extramammary (non-breast, pain referred from other locations) mastalgia associated with?

Answer 164

1) Bilateral and benign, begins during luteal phase, resolves with menses
2) Not associated with menstrual cycle; assoc with duct ectasia, mastitis, large breast size, meds, pregnancy, etc.
3) Chest wall trauma, rib fxs, shingles (varicella-zoster virus), heart, gallbladder, etc.

Question 165

1) What is required to determine the cause of mastalgia?
2) What should be done if there’s concerning findings? Why? Give examples

Answer 165

1) Careful physical exam to determine cause.
2) Imaging to rule out malignancy/serious pathology (unilateral, noncyclical, localized pain, breast mass, skin changes, etc.)

Question 166

1) Define fibrocystic breast changes
2) How common is it?
3) What are the symptoms?

Answer 166

1) Benign changes in breast epithelium producing a nodular, sensitive breast
2) Common; ½ of all women experience
3) Lumpiness, swelling, pain/tenderness; nodular, rope-like densities

Question 167

What are the essentials of fibrocystic breast change diagnosis? What is the most common age?

Answer 167

1) Painful, often multiple, usually bilateral mobile masses in the breast.
2) Rapid fluctuation in size of masses is common. *Frequently worsens just before menses (increase in pain and size of cysts).
3) Affected by hormone levels
-Most common age is 30–50 years (premenopausal); occurrence is rare in postmenopausal women.

Question 168

1) How are fibrocystic breast changes diagnosed
2) How are they treated?

Answer 168

1) Diagnosed with CBE and sx history; mammogram, ultrasound may be used. Aspirate palpable cysts
2) Observation (Decrease caffeine intake), vitamin E supplementation

Question 169

1) Define mastitis
2) What are the symptoms?

Answer 169

1) Inflammation of breast tissue that may be accompanied by infection (e.g., bacteria):
2) Erythema, warmth, swelling, tenderness/pain; fatigue, malaise, fever

Question 170

1) When does mastitis generally occur? What is it particularly associated with?
2) How is lactational mastitis treated?

Answer 170

1) I lactating or recently lactating women; incomplete emptying of the breast (engorgement) or plugged duct(s)
2) NSAIDs, cold compresses, ongoing breastfeeding and/or hand expression to help empty breast, antibiotics if associated infection

Question 171

3 most common breast masses are what?

Answer 171

Fibroadenoma (benign tumor), cysts, and breast cancer

Question 172

1) With fibroadenoma (benign tumor) what is the typical age?
2) How many are there usually?
3) Shape and size?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?

Answer 172

1) 15-25 years, usually puberty and young adulthood, but up to 55
2) Usually single, may be multiple
3) Round, disc like, or lobular; typically small (1-2cm)
4) Usually firm (but may be soft)
5) Well delineated
6) Very mobile
7) Usually nontender
8) Absent

Question 173

1) In cysts of the breast, what is the typical age?
2) How many are there usually?
3) Shape?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?

Answer 173

1) 30-50 yrs, regress after menopause
2) Single or multiple
3) Round
4) Soft to firm, usually elastic
5) Well delineated
6) Mobile
7) Often tender
8) Absent

Question 174

1) In breast cancer, what is the typical age?
2) How many are there usually?
3) Shape?
4) Consistency?
5) Delineation?
6) Mobility?
7) Tenderness?
8) Retraction signs?

Answer 174

1) 30-90, most common >50
2) Usually single, although may coexist w other nodules
3) Irregular or stellate
4) Firm or hard
5) Not clearly delineated
6) May be fixed to skin or underlying tissues
7) Usually nontender
8) May be present

Question 175

1) What age is a pelvic exam recommended in?
2) Describe how to perform a pelvic exam

Answer 175

1) ACOG recommends annual pelvic exam in women 21 yrs & older
2) -Empty bladder to ensure comfort & assist your exam
-“Clean catch” urine specimen from mid-stream if needed
(A full bladder will push the uterus and cervix higher in the pelvis and make the exam more difficult and uncomfortable.)
-Muscle relaxation needed
-Explain every part of exam before performing (“Talk before you touch”)
-Avoid being abrupt or stern
-Rehearse what you will say and how you will say it.

Question 176

What should you evaluate about the cervix?

Answer 176

1) Nulliparous vs multiparous
2) Normal vaginal discharge?
3) Ectropion (when inside of cervical canal everts), retention (Nabothian) cysts, small polyps (benign)
4) Inflammation, masses, dysplasia (further eval)

Question 177

List the 5 early Sx of Adnexal Neoplasm. Specify which is most common

Answer 177

1) Abdominal bloating or distention- most common
2) Abdominal or pelvic pain
3) Decreased energy or lethargy
4) Early satiety
5) Urinary urgency

Question 178

What should you physically examine for Adnexal Neoplasm?

Answer 178

1) Assess for any signs of infection or cancer
2) The breast examination is especially important because the ovary is a common site of metastatic breast carcinoma (abdomen, too)
3) Bimanual exam assessing each side and comparing sides
-keep in mind age-parameters for ovarian size

Question 179

Give the vague symptomatology of ovarian cancer

Answer 179

Abdominal bloating or distention
Abdominal or pelvic pain
Decreased energy
Early satiety
Urinary urgency
Abnormal menstrual cycles
Unexplained back pain that worsens over time
Non-specific gastrointestinal symptoms

Question 180

1) What are functional ovarian cysts?
2) What type of cyst occurs when an ovarian follicle fails to rupture during follicular maturation and ovulation does not occur?

Answer 180

1) Not neoplasms, but anatomic variations that arise due to normal ovarian function
2) Follicular cyst

Question 181

1) When does a follicular cyst become medically significant?
2) How are they diagnosed?

Answer 181

1) If large enough to cause pain or persists beyond one menstrual interval
2) Pelvic ultrasound (adjunct to PEx)

Question 182

1) How do most follicular cysts resolve?
2) What if the presumed functional cyst persists?

Answer 182

1) Most spontaneously resolve within 6 weeks
2) Another type of cyst or neoplasm should be suspected and further evaluated

Question 183

1) Placental growth is a cardiovascular change during pregnancy that involves what?
2) What two things does the body increase to compensate for these changes?
3) When does the placenta stop growing?

Answer 183

1) New vessels are added, increased blood flow to placenta
2) HR and cardiac output
3) At ~week 26

Question 184

What does more fluid being present during pregnancy lead to? (2 things)

Answer 184

1) Daytime pedal edema
2) Nocturia/frequent nighttime urination (bc of daytime edema)

Question 185

Why does nocturia/frequent nighttime urination occur in pregnancy?

Answer 185

Excess blood volume that was in her legs all day finally returns to more central circulation and acts like a fluid bolus

Question 186

1) Define physiologic hypotension
2) IVC compression can happen in pregnancy; what are the symptoms and what process in the body causes each?
3) How can IVC compression be relieved?

Answer 186

1) Normal dip in the BP during pregnancy
2) Less venous return > cardiac output is decreased > blood pressure falls > dizziness, presyncope > syncope
3) If she’s on her back or right side, move to left lateral decubitus

Question 187

1) What urinary change is common in pregnancy besides nocturia?
2) What are pregnant people at higher risk of?

Answer 187

1) Mild glucosuria
2) UTI

Question 188

Why are pregnant ppl at a higher risk of UTI?

Answer 188

Dilation of urinary tract (secondary to increased blood volume) = greater risk of ascending infection

Question 189

1) Define gestational diabetes
2) What factors put people at risk for this?

Answer 189

1) Elevated blood glucose that starts after 20 weeks gestation
2) Obesity, being Hispanic or Southeast Asian

Question 190

How is gestational diabetes diagnosed?

Answer 190

All women are screened weeks 24-28 with oral glucose tolerance test (OGTT)

Question 191

List 3 potential GI pregnancy side effects

Answer 191

1) Constipation
2) GERD
3) Gallbladder disease

Question 192

What 2 things should you counsel a pregnant pt with constipation on?

Answer 192

1) Dietary fiber
2) Stool softener vs. motility agent

Question 193

1) What causes GERD in pregnant people?
2) How is it treated? (2 things)

Answer 193

1) LES relaxation plus compression of stomach by gravid uterus = reflux
2) -Lifestyle changes: Avoid caffeine, spicy food, nicotine, mint, large meals, fatty meals
-TUMS (calcium carbonate) acceptable in pregnancy

Question 194

What can accompany gallbladder disease in pregnancy?

Answer 194

1) Formation of new stones
2) Worsening of stones
3) Cholecystitis

Question 195

What causes breast enlargement in pregnancy?
What are the 3 steps?

Answer 195

-Mammary glands
1) Proliferate in 1st trimester
2) Glands differentiate in 2nd trimester
3) Glands produce milk in 3rd trimester

Question 196

When is 1st trimester?
2nd?
3rd?

Answer 196

1st trimester: conception to 12 weeks
2nd trimester: 13-27 weeks
3rd trimester: 28-40 weeks

Question 197

What are 5 potential skin changes that can occur w pregnancy? Describe each

Answer 197

1) Hyperpigmentation: “mask of pregnancy” also called “melasma”
-Etiology unknown
2) Linea nigra: Darkening of skin over linea alba
3) Palmar erythema
4) Spider angiomata: telangiectasia

Question 198

1) What should be the causes of weight gain in pregnancy?
2) How much weight gain is normal in each pt of pregnancy?

Answer 198

1) Amniotic fluid, placenta, fetus, maternal adipose stores
2)
1 lb/month first trimester
1lb/week thereafter

Question 199

1) How does being underweight affect pregnancy weight gain recommendations?
2) What abt being overweight?

Answer 199

1) Gain more; build up adipose stores
2) Gain less: adipose stores are adequate, and weight gain should be due to fluid, placenta, fetus

Question 200

1) What assesses (grossly) the growth of the fetus?
2) What is this measurement equal to?

Answer 200

1) Fundal height measurement
2) Fundal height (in cm) ≈ gestation age (in weeks) between 16-36 weeks gestation

Question 201

A larger than expected fundal height measurement is concerning for what 4 things?

Answer 201

1) Molar pregnancy
2) Large for gestational age baby/Gestational diabetes
3) Polyhydramnios
4) Multiples

Question 202

A smaller than expected fundal height measurement is concerning for what 3 things?

Answer 202

1) Small for gestational age baby or IUGR
2) Fetal Death
3) Oligohydramnios

Question 203

1) What is the goal for kick counts/ # of movements?
2) Fetal movement decreases in response to fetal _______________.
3) If mom perceives decreased fetal movement, what should be instituted?

Answer 203

1) > 10 movements/2 hrs
2) hypoxemia
3) Further testing

Question 204

1) Auscultation of heart tones can usually be done by fetoscope by the _____th week and with doppler by the _____th week (though typically not done until ______th week).
2) After how many can weeks fetal heart rate be assessed with external fetal monitor?
3) What 2 fetal HR questions should you ask yourself?

Answer 204

1) 12th; 8th; 10th
2) Sixteen (16)
3) -Is the heart rate within normal range? (110-160 bpm)
-Do you hear/see any abnormalities?

Question 205

When should a pregnant woman go to the hospital? (4 reasons)
important

Answer 205

1) Contractions occur approximately every 5 minutes for at least 1 hour
2) A sudden gush of fluid or a constant leakage of vaginal fluid (suggesting rupture of membranes [ROM])
3) Any significant vaginal bleeding
4) Significant decrease in fetal movement

Question 206

At 20 weeks, fundus should be where?

Answer 206

At the umbilicus (20 cm fundal height)
important

Question 207

1) What is the most common cause of perinatal morbidity and mortality?
2) What is this defined as?

Answer 207

1) Preterm birth
2) Birth before 37 completed weeks of gestation

Question 208

What are the two types of preterm birth?

Answer 208

Spontaneous vs medically indicated (induced)

Question 209

List 4 maternal complications (medical or obstetric)
that may cause PTL

Answer 209

1) Activation of maternal/fetal HPA axis due to stress
2) Inflammation/infection (see next slide)
3) Hemorrhage (e.g., placental abruption)
4) Pathologic uterine distention (polyhydramnios, etc.)
-Preterm labor may be secondary to these pathogenic processes

Question 210

What are 7 S/Sx of preterm labor?

Answer 210

1) Menstrual-like cramps
2) Low, dull backache
3) Abdominal pressure
4) Pelvic pressure
5) Abdominal cramping (with or without diarrhea)
6) Increase or change in vaginal discharge (mucous, watery, light bloody discharge)
7) Uterine contractions, often painless

Question 211

1) Define post-term pregnancy
2) What two groups is it most common in?
3) What is the most common cause of it?

Answer 211

1) Pregnancy that has gone beyond 42 completed weeks
2) Primiparous (first birth/pregnancy), and hx of post-term delivery
3) Incorrect estimation of gestational age

Question 212

1) Who is a post-term pregnancy an increased risk to? What type of assessments must start if post-term?
2) Due to increased morbidity, most practices will not let pregnancy go beyond ___ wks

Answer 212

1) Incr. risk to baby; fetal assessment (kick counts, non-stress tests, ultrasound evaluation of amniotic fluid)
2) 42 wks

Question 213

List 5 conditions assoc. with post-term pregnancy

Answer 213

1) Macrosomia
2) Shoulder dystocia
3) Meconium aspiration syndrome (MAS)
4) Dysmaturity syndrome
5) Oligohydramnios

Question 214

1) Define macrosomia
2) Define shoulder dystocia
3) What can MAS cause?

Answer 214

1) Weigh of >4,500 g (~9.9 lbs)
2) Impaction of the anterior fetal shoulder behind the symphysis pubis during vaginal delivery causing a brachial plexus injury (emergency)
3) Severe respiratory distress/death

Question 215

1) Define dysmaturity syndrome
2) Define oligohydramnios. When is this an indication for delivery?

Answer 215

1) Infants with characteristics resembling chronic growth restriction
2) Decreased amniotic fluid; if >36 weeks

Question 217

Anatomical structures and their pathologies:
1) What is a pathology of the urethral meatus?
2) What is a pathology of the urethra?
3) What is a pathology of the glans?
4) What is a pathology of the corona/ prepuse?

Answer 217

1) Hypospadias
2) Cystitis
3) Balanitis
4) Paraphimosis

Question 218

1) What is the significance of the corpus cavernosum?
2) What structure do vasectomies involve?
3) What pathology can occur at the epididymis/testicle?
4) What very common pathology can occur involving the Tunica Vaginalis?

Answer 218

1) Erection
2) Vas deferens
3) Epididymitis/orchitis
4) Testicular torsion

Question 219

1) Hydroceles and varicoceles both involve what structure?
2) BPH can occur where?

Answer 219

1) Scrotum
2) Prostate

Question 220

1) Define paraphimosis
2) Is it an emergency? Why or why not?

Answer 220

1) Retracted fοreѕkiո in an uncircumcised mаlе that cannot be returned to normal position
2) Emergency; can cause ischemia to the glans/penis

Question 221

When loops of bowel force their way through weak areas of the inguinal canal, what type of groin hernia is this?

Answer 221

Inguinal

Question 222

1) What type of hernias arise at internal inguinal ring?
2) What type of hernias arise more medially through floor of inguinal canal (Hesselbach’s triangle)?

Answer 222

1) Indirect inguinal
2) Direct inguinal

Question 223

What are the boundaries of Hesselbach’s Triangle medially, laterally, and inferiorly?

Answer 223

1) Medially: Rectus abdominis m.
2) Laterally: Inferior epigastric vessels
3) Inferiorly: Inguinal ligament

Question 224

1) What is the most common malignancy in adult males 15-35 years old?
2) Is it curable? Explain.
3) How does it often present as?

Answer 224

1) Testicular cancer
2) Highly curable if detected early; do not delay evaluation
3) Painless testicular mass

Question 225

1) In any male with a solid, firm mass within the testis, __________________ must be the considered diagnosis until proven otherwise
2) How could it be proven otherwise?

Answer 225

1) testicular cancer
2) Scrotal ultrasound followed by other diagnostic work-up as necessary

Question 226

1) Who are indirect inguinal hernias most common in?
2) What abt direct hernias?
3) What abt femoral hernias?
Of these, which hernia is most common?

Answer 226

1) All ages, both sexes. Often in children, may be in adults. Most common.
2) Usually in men >40 and rare in women. Less common.
3) Least common. More common in women.
-Indirect inguinal most common

Question 227

What is the point of origin of:
1) Indirect inguinal hernias?
2) Direct inguinal hernias?
3) Femoral hernias?
-Of these, which can be hard to differentiate from lymph nodes?

Answer 227

1) Above inguinal ligament near midpoint (internal inguinal ring)
2) Above inguinal ligament close to pubic tubercle (near external inguinal ring)
3) Below inguinal ligament, more lateral than an inguinal hernia.
-Femoral hernias can be hard to differentiate from lymph nodes

Question 228

How do
1) Indirect inguinal hernias
2) Direct inguinal hernias
3) Femoral hernias
relate to the scrotum, and to examining w. a finger in the inguinal canal?

Answer 228

1) Often into scrotum; the hernia comes down inguinal canal & touches the fingertip.
2) Rarely in the scrotum; hernia bulges anteriorly and pushes the side of the finger forward.
3) Never in the scrotum; inguinal canal is empty
slide 29

Question 229

1) What demarcates the anal canal from the rectum?
2) What is the boundary between somatic (anal canal) and visceral (rectum) nerve supplies?

Answer 229

1) A serrated line
2) The anorectal junction (often called the pectinate or dentate line)

Question 230

1) In the male, the prostate gland lies against what?
2) What does a normal prostate gland feel and look like? important
3) True or false: You can only palpate part of the prostate (right and left lateral lobes) on DRE.

Answer 230

1) The anterior rectal wall
2) Rounded, heart-shaped, 2.5 cm long, smooth, rubbery, non-tender, not fixed to surrounding tissues
3) True

Question 231

What are 6 common or concerning Sx of the male anus, rectum, and prostate?

Answer 231

1) Change in bowel habits
2) Blood in the stool (hematochezia & melena)
3) Pain with defecation; rectal bleeding or tenderness
4) Anal warts or fissures
5) Weak stream of urine
6) Burning upon urination (dysuria)

Question 232

What men’s health Health Promotion and Counseling should be done? (3 things)

Answer 232

1) Discuss prostate cancer screening
2) Screen for colorectal cancer and premalignant polyps/lesions (USPSTF)
3) Provide counseling about sexually transmitted infections (STIs)

Question 233

1) Prostate cancer is the leading cancer diagnosed in men in the United States, and the ________ leading cause of death
2) What are the primary risk factors? What else may be a risk factor?
3) Are screening recommendations universal?

Answer 233

1) third
2) Advanced age, ethnicity (black), and family history
-intake of dietary fat
3) Screening recommendations vary depending on source (American Urological Association, American Cancer Society, USPSTF, etc.) and are controversial

Question 234

1) Why should you engage in shared decision making regarding prostate cancer screenings?
2) For average risk males, initiate discussion of screening at age ___ years (as early as age ____ for higher risk)

Answer 234

1) Screening may offer a small potential benefit, but there are risks of harm (false positives, etc.)
2) 50; 40

Question 235

1) What prostate cancer screening method is recommended? How often and in what age group?
2) Frequency of ________ testing and age to initiate and stop screening varies depending on the source

Answer 235

1) Prostate-specific Antigen (PSA) testing every 1-2 years up to age 69-75
2) PSA

Question 236

1) What type of GI cancer and polyps should you screen for in both males and females?
2) At what age should screening start for all adults of avg risk? (in both sexes)
3) What age group is there selective screening?
4) How often are colonoscopies done?

Answer 236

1) Colorectal cancer and premalignant polyps/lesions (USPSTF)
2) 45
3)76-85 years
4) Every 10 years (other testing options exist if pt is not amenable to colonoscopy)

Question 237

When you provide counseling about sexually transmitted infections (STIs), what else should you suggest?

Answer 237

Partners to be tested