Blueprint Test 4

Question 1

Current recommendations for prostate cancer screening

Answer 1

PSA (prostate specific antigen) testing is recommended q 1 to 2 years
DRE optional
Screening should stop at age 70 or when life expectancy drops below 10 yrs

Question 2

Normal PSA

Answer 2

<4mg/mL

Question 3

Risk Factors for Prostate CA

Answer 3

Age (rare before 40yrs - rates increase after age 50)
Ethnicity (Af. Amer. men highest incidence)
Family Hx (1st degree relative-risk increases 2-fold)
Other (Agent Orange expos., high fat diet, smoking)
BPH is not a risk factor for prostate CA

Question 4

Milky nipple discharge unrelated to pregnancy or lactation

Answer 4

Galactorrhea

Question 5

Nipple discharge that is bilateral, multi-ductal, prompted by stimulation and ranges in color from white to yellowish, green or black indicates what?

Answer 5

physiologic nipple discharge (normal)

Question 6

Your 61 yo female patient presents with a chief complaint of spontaneous unilateral bloody nipple discharge. As her FNP, you know that warrants further evaluation for:

Answer 6

Intraductal papilloma

Question 7

Current ACA (Amer. Cancer Society) recommendations for breast cancer screenings

Answer 7

Mammo

40y - 45y- optional annual screening

45y - 54y- annual screening

> /= 55 - biennial screening w/ option to continue annual screens - continue if health/life expectancy >/= 10 years

CBE Not recommended

Question 8

A 40yo female presents with a single, round, soft, well-delineated, mobile, tender breast mass. What is the most likely diagnosis?

Answer 8

Breast Cyst

Question 9

A 22 yo patient with a smooth, rubbery, round, mobile, non-tender breast mass. What is the most likely diagnosis?

Answer 9

Fibroadenoma

Question 10

In a patient with pelvic pain, what are some life-threatening conditions that should be on your differential?

Answer 10

• ectopic pregnancy- including rupture
• ovarian torsion
• appendicitis

Question 11

What can cause vaginal discharge in the pediatric patient?

Answer 11

Leukorrhea
STI from consensual sexual activity or sexual abuse
Bacterial vaginosis
Foreign body
External irritants

Question 12

Most common cause of pelvic pain

Answer 12

PID (pelvic inflammatory disease) - must rule out life-threatening causes

Question 13

A 30-year-old woman who is sexually active complains of a large amt of milk-like vaginal discharge for several weeks. A microscopy slide reveals a large number of cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is 6.0. What is most likely?

a) Trichomonas infection
b) Bacterial vaginosis
c) Candidal infection
d) Normal finding

Answer 13

b) Bacterial vaginosis

Question 14

Your patient presents with profuse vaginal drainage that is yellow-green, frothy, and malodorous. She also complains of pain with urination. You suspect that your patient may have:

Answer 14

Trichomonal vaginitis

Question 15

A 69 year old woman comes to the clinic with complaints of persistent vulvar itching. She has had the itching for several weeks. She has type 2 diabetes mellitus. Physical exam shows a erythematous and swollen vulva. There are pustules on the medial aspect of her thighs. A KOH preparation shows psuedohyphae and budding yeast under the microscope. What is the likely diagnosis?

Answer 15

Candida Vaginitis

Question 16

Diagnosed after 12 months without a menstrual period

Answer 16

Menopause - Typically occurs between ages 48 and 55 years, peaking at a median age of 51 yrs Always ask about any bleeding or spotting after menopause as this may be an early sign of cancer

Question 17

What is considered delayed puberty in females?

Answer 17

No breasts or pubic hair by age 12 years

Question 18

What are some causes of delayed puberty in females?

Answer 18

Usually inadequate gonadotropin secretion from the anterior pituitary due to defective hypothalmic GnRH production
Also: anorexia nervosa and chronic disease

Question 19

Hematochezia

Answer 19

Stool with red blood- usually originates in the colon, rectum, or anus, much less frequently from the jejunum or ileum

Question 20

Important questions to ask when assessing for STIs

Answer 20

Have you been sexually active in the last year?
Do you have sex with men, women, or both?
How many sexual partners have you had?
Sexual orientation? Gender identity?
Have you had sex with someone you don’t know well or had just met?
Have you been coerced or pressured to have sex?
Have you ever had an STI?

Question 21

STI screening in sexually active females over age 25

Answer 21

GC/Chlamydia - annually

Question 22

Recommendations for HIV testing

Answer 22

At least once between age 13 and 64

Annually for unsafe sex practices or IVDU, gay, or bisexual men (q3-6mo)

Question 23

Current cervical cancer screening recommendations

Answer 23

Begin at age 21 - end at age 65 assuming 3 consecutive negative cytology results

Age 21-65 cytology q 3 years OR
Age 21-29 cytology q 3 years then
Age 30-65 cytology + HPV testing (for high risk or oncogenic HPV types) q 5 years
Screening after hysterectomy with removal of cervix (for benign reasons) - not recommended

Question 24

What is considered delayed puberty in the male?

Answer 24

Suspected in boys who have no signs of pubertal development by 14 years of age

Question 25

What are some common causes of delayed puberty in the male?

Answer 25

Most common cause is constitutional delay, frequently a familial condition involving delayed bone and physical maturation, but normal hormone levels.
Less common causes: primary or secondary hypogonadism as well as congenital GnRH deficiency

Question 26

Normal scrotal findings in a newborn

Answer 26

Scrotal edema may be present for several days following birth because of the effect of maternal estrogen.
Rugae (wrinkles) are present in NB at 40 wks gestation
NB testes should be about 10mm wide and 15mm long and should lie in the scrotal sacs most of the time

Question 27

Exam findings with gonococcal urethritis

Answer 27

copious amount of purulent/yellow urethral discharge and dysuria

Question 28

Exam findings with nongonococcal urethritis

Answer 28

less copious amount of clear or cloudy urethral discharge - urethral pruritus or dysuria - chlamydia

Question 29

What are considered normal findings in the breasts of newborns?

Answer 29

Often enlarged, both in males and females from maternal estrogen effect - this may last several months Breasts may be engorged w/ a white liquid which may last 1 to 2 weeks

Question 30

What is premature thelarche?

Answer 30

Breast development in a girl, most often between 6mo and 2yrs without other signs of puberty or hormone abnormalities

Question 31

What exam findings are consistent with a hernia in the newborn infant?

Answer 31

Scrotal mass that is separate from the testes, usually reducible, and often does not transluminate. They do not resolve. Sometimes a thickened spermatic cord (silk sign) is noticed

Question 32

Exam findings consistent with a hydrocele.

Answer 32

Non-tender, fluid filled mass within the tunica vaginalis of the scrotum - overlie the testes and the spermatic cord and are not reducible - transluminate and examining fingers can palpate above the mass within the scrotum - resolve by 18 months

Question 33

Indirect inguinal hernia

Answer 33

Originates above the inguinal ligament near its midpoint and comes down the inguinal canal often into the scrotum - can occur in all ages and both sexes, often in children - may occur in adults

Question 34

Direct inguinal hernia

Answer 34

Oriniates above the inguinal ligament close to the pubic tubercle (near the external inguinal ring) and bulges anteriorly - rarely into the scrotum

Less common - usually in men < 40 years old - rare in women

Question 35

A 26yo male presents with yellow penile discharge, rash, tenosynovitis, and monoarticular arthritis. What is the most likely pathogen?

Answer 35

Gonorrhea

Question 36

A hymen with two orificies is know as what?

Answer 36

a septate hyman

Question 37

A hymen that surrounds the orifice circumferentially

Answer 37

an annular hymen

Question 38

Possible cause of redundant labial tissue

Answer 38

estrogen effect

Question 39

A hymen that does not encircle the vaginal orifice, but rather border the lower part of the vaginal orifice and extends to the posterior and lateral margins of the hymenal ring.

Answer 39

a crescentic hymen (crescent shaped)

Question 40

Seven attributes of a symptom

Answer 40

1) Location (where is it? does it radiate?)
2) Quality (what is it like?)
3) Quantity (how bad is it?)
4) Timing (when did/does it start?)
5) Onset (setting in which symptom occurs)
6) Remitting/exacerbating (what makes it better or worse)
7) Associated manifestations (have you noticed anything else that accompanies it?)

Question 41

What findings are consistent with Parkinson’s disease?

Answer 41

• Decreased facial mobility/mask-like faces, with decreased blinking and characteristic stare
• Low-frequency unilateral resting tremor, rigidity, and bradykinesia