APEA FNP review Flashcards
• MRSA
+
ABX
…..
• MSSA
+
• DRSP
+
• Neisseria gonorrhoeae
-
• Neisseria meningitides
-
• E. coli
-
• Shigella, Campylobacter, Salmonella
-
• Mycoplasma, H. flu, M. cat, Proteus, Pseudomonas, Legionella, others
-
• Atypical pathogens (Mycoplasma, Legionella, others)
-
_______ give a cephalosporin if PCN reaction was anaphylaxis
Never
______ give a cephalosporin if PCN reaction was hives
Never
_________give a cephalosporin if PCN reaction was morbilliform rash
Give
Name the 3 gram positive bugs
Staph, Strep, Enterococcus
Common skin gram positive organisms
Staphylcoccus aureus, MRSA, Staph epidermis
_______is one of the few staph organisms that grows below the belt vagina/UTI
Staph saprophyticus
_________ causes group A strep throat
Streptococcus pyogenes
________ grows in the lungs and causes a nasty pneumonia
Streptococcus pneumonia
_______ is a common dental abscess and can cause endocarditis
Streptococcues viridans
________ is called group B strep and is commonly treated in pregnancy before delivery
Strept agalactiae
_______ is a gram positive common causes of UTI
Enterococcus faecalis/Enterococcus faecium (of note the most common causes of UTI is E. coli and then Klebsiella pneumonia)
Can amoxicillin really kill DRSP? Adult dose? Peds dose?
Yes. Adult = 2 g BID. Peds=90mcg/kg/day
How would you know if a bug produced beta-lactamase?
Always suspect that a bug produces beta-lactamase when a pt had an infection and an antibiotic tx in the last 90 days.
What abx treat community acquired MRSA skin/soft tissue infections?
Sulfonamides, tetracyclines, Linezolid ….Clindamycin depending on the regions)
Pregnancy
…..
_____= first trimester
conception to 14 weeks
_______=second trimester
14 to 28 weeks
_______=third trimester
28 weeks to 40 weeks/birth
How to calculate delivery date
Subtract 3 months from last menstrual period then add 7 days and one year. Naegel’s Rule: Pregnancy lasts 281-282 days
LMP = 07/20/2014. What is the delivery date?
04/27/2015
A FNP has just diagnosed pregnancy in a patient at 8 weeks gestation. The patient will be followed for pregnancy by another provider. What must be done today? (Select all that apply)1. Make a referral to a midwife or OB-GYN. 2. Prescribe a daily prenatal vitamin. 3. Establish a due date. 4. Initiate routine lab tests.
Daily prenatal vitamin/Establish due date (#2 & #3)
ACOG recommends that prenatal care be initiated by what time frame? 6 weeks, 8 weeks, 10 weeks, or 12 weeks
10 weeks
Pregnancy patient history includes:
Past OB history (# of miscarries), Personal and family medical history (esp current/past med list), Past surgical history, Genetic history, Menstrual and gynecological history (menarche), Current pregnancy history, Psychosocial information (esp domestic violence risk).
ACOG and AMA guidelines on domestic violence recommend “routine assessment of ___ pregnant women for domestic violence”
all
_________ of pregnant women are physically abused and 3 times _________rate of abuse if pregnancy is unintended
7-20% of pregnant women are physically abused; 3X higher rate if pregnancy is unplanned
Domestic violence risk factors are
Age < 35 years, Single, divorced, or separated, Use alcohol or drugs; or have partners who do, Smoke cigarettes, Physically or sexually abused as a child
Domestic Violence Clues
Bruising, Improbable injury, Depression, Late prenatal care (after first trimester), Missed prenatal visits, Cancellation of appointment - short notice
hCG ________ every 48-60 hours in 1st trimester
doubles
A pregnant patient has a MCV < 80 fL. There is no iron deficiency anemia. What is a likely cause?1. This is normal in pregnant women 2. This is occult iron deficiency anemia 3. This is likely thalassemia 4. This is a lab error.
Thalassemia (#3)
Pregnancy creates dilution anemia which makes underlying anemias even _____?
Worse
A pregnant patient has been found to have asymptomatic bacteriuria. How should this be handled? Select all that apply. 1. Consider urine screening monthly until delivery 2. Treat with an antibiotic 3. Treat when symptomatic 4. Treat in the third trimester only.
Consider urine screen monthly until delivery and treat with antibiotic (#1 & #2)
Standard diagnostic studies at first visit
The most important diagnostic test on very visit is a pregnancy test and the second is a CBC to r/o anemia. Other important tests include Urinalysis with screen for bacteria, protein and glucose, routine urine culture (high risk of pyelonephritis in pregnant women with asymptomatic bacteriuria), Blood type and Rh, antibody screening (screen for hemolytic disease of the newborn), Rubella Immunity (Repeat testing not necessary if immune; if not immune, immunization AFTER delivery and avoidance of contact with infected individuals!!!), STI testing: chlamydia (NAAT-nucleic acid amplification test - endocervical specimen), syphilis, universal screening via HIV (opt-out), Hep B (even if immunized), TSH in pregnant patients being treated for hypothyroidism (their needs increase in pregnancy; untreated can result in delayed neurologic development) TSH if symptoms of disease, personal or family history, other risk factors
When is a patient with an ectopic pregnancy most likely to present for evaluation?
6-8 weeks after LMP
Symptoms of ectopic pregnancy
Symptoms: abdominal pain, vaginal bleeding, amenorrhea, Low grade fever, Symptoms 6-8 weeks after LMP
Risk factors for ectopic pregnancies
Previous ectopic, Tubal pathology, tubal surgery, Current IUD use, Previous cervicitis (Gonorrhea or Chalmydia), History of PID
Normal BMI (18.5-24.9) has an appropriate weight gain of _________ during pregnancy?
25-35lbs
Underweight BMI <18.5 has an appropriate weight gain of______ during pregnancy?
28-40lbs
Over weight BMI (25.0-29.9) has appropriate weight gain of_______ during pregnancy?
15-25lbs
Obese BMI (>30.0) has appropriate weight gain of ________ during pregnancy?
11-20lbs
Birth weight does influence neonatal morbidity and mortality and may influence child’s future risk of __________?
DM, HTN, and CV disease
At least _______ minutes of moderate exercise on most days is a reasonable activity level for most pregnant women. Avoid activities that put them at risk for____________?
30; falls or abdominal injuries.
Uterine cramping due to hormonal changes or growing uterus is normal.Cramping that becomes worse with time or is associated with bleeding may indicate________?
ectopic pregnancy or threatened abortion
Immunizations given with every pregnancy
Flu (give at any time); TDAP (give in third trimester)
Pregnant patient should immediate contact provider if_______ occurs?
Vaginal bleeding, Escape of fluid from vagina, Decreased fetal activity, Signs of preterm labor
Uncomplicated visit schedule: _________ weeks until 28 weeks, _______ until 36 weeks,_______ every week after 36 weeks.
4 weeks until 28 weeks (7 months aka end of 2nd trimester), 2 weeks until 36 weeks (9 months), and every weeks after 36 weeks
2nd trimester assessment/monitoring includes:
Blood pressure, weight, fundal height, fetal heart auscultation, CBC for anemia, Urinalysis as indicated (glucosuria, proteinuria, ketonuria), Dysuria (asymptomatic bacteriuria →pyelonephritis)
When do you screen all pregnant women for gestational diabetes
24-28 weeks
Diabetes diagnosed at initial pre-natal visit is “_______diabetes.” Diabetes diagnosed during pregnancy is “gestational”
Overt
Overt diabetes is identified at FIRST prenatal visit is diagnosed by:
Fasting glucose > 126, or A1C > 6.5%, or random > 200 mg/dL
ACOG recommends two step test = 50g Glucose load without regard to meals. Measure one hour later: Positive screen (> 130-140 mg/dL) requires?
3 hr 100g test.
How to treat gestational diabetes
referral to dietician, insulin, oral meds (glyburide & metformin are ok for 2nd and 3rd trimester).
McDonald’s rule estimates gestational age by:
uterine fundal height measured in cm from symphysis pubis to top of uterus. Between 18-34 weeks there is good correlation between fundal height and gestational age of the fetus. Bladder must be empty
Maternal Quad Screen (AFP, estriol (uE3), HCG, inhibin A) is measured at _____ weeks?
15-22 weeks
Abnormal maternal quad screens require follow-up_______?
US and/or amniocentesis
Fetal movements aka ________ are first felt at ________ weeks?
Quickening;Primpara =17-20 weeks, subsequent pregnancies = 15-16 weeks
A pregnant mother is Rh negative. When should she receive RhoGam (generic name =anti D immune globulin)?
During the second trimester (28 weeks)
During 2nd and 3rd trimester, pregnant patient should contact provider if ______?
Vaginal bleeding, Leakage of fluid per vagina, Uterine contractions, Decreased fetal activity, Signs of preterm labor: low, dull backache, increased uterine activity, menstrual like cramps, diarrhea, spotting, bleeding
What are kick counts?
Patient lies on her left side 30 minutes after eating and records the time she starts the test and notes each time the baby moves or kicks.
A healthy fetus should move ___ times within one hour (most move a lot more than this!)
3-5 times
At 35-37 weeks, __________ screen is performed via vaginal and rectal swabs.
Group B Strept (Strept agalactiae). Common cause of neonatal sepsis → morbidity and mortality
A pregnant patient (first trimester) with mild persistent asthma has used inhaled budesonide (Pulmicort) BID prior to pregnancy with good results. What should be done with this medication during pregnancy? 1. Discontinue it. Use albuterol instead. 2. Discontinue and try Singulair (LTRA).3. Continue at the same dose BID.4. Continue once daily.
Cont at the same dose BID (#3)
Which antibiotic is considered Category B for a patient in her third trimester of pregnancy?1. Amoxicillin-clavulanate 2. Levofloxacin 3. Trimethoprim sulfamethoxaxole 4. Doxycycline
- Amoxicillin-clavulanate (Category B - correct answer)2. Levofloxacin (Category C b/c it impairs bone/cartilage in fetus)3. Trimethoprim sulfamethoxaxole (Never use in 1st or 3rd trimester b/c it impair folic acid and decreases amniotic fluid) 4. Doxycycline (Category D - skeletal deformities)
A pregnant patient has taken sertraline for the past 10 years with excellent results. She asks if this is safe to take while she is pregnant. How should this be answered?1. It is safe; Category A. 2. It is safe; Category B. 3. It might be safe; Category C. 4. It is not safe; Category D.
Category C - it might be safe
When concerned for preterm premature rupture of membranes (PPROM), Nitrazine testing: pH of _____________ indicates amniotic fluid and a pH of 3.8-4.2 indicates vaginal secretions.
7.0-7.7
Amniotic fluid from posterior vaginal fornix swabbed on a slide will show a fern pattern is call the ¬¬¬¬¬¬-_____?
Fern Test
Placenta Previa is improper implantation of the placenta into the lower uterine segment. A _________should NOT be performed if placenta previa is suspected.
vaginal examination
What is characteristic of abruptio placenta? Select all that apply.1. Abrupt onset of vaginal bleeding 2. Abdominal and/or back pain 3. Scant bloody vaginal discharge 4. May occur in second or third trimester
All 4 are characteristics of abruption placenta.
Pre-eclampsia definition (ACOG, 2013) = “New development of HTN and either proteinuria or end organ dysfunction after 20 weeks of gestation is usually due to preeclampsia.”__________ were removed as essential criterion
Proteinuria and edema. BUT: edema of the face and hands, and edema associated with more than a 2 kg weight gain in one week…WORRY!!!! End organ= heart failure, pulmonary edema, decreased GFR, thrombocytopenia
Most effective pre-eclampsia treatment
Delivery of infant by 40 weeks or earlier
Pharm/life style treatment for pre-eclampsia
Bed rest left lateral recumbent position to decrease pressure on vena cava. Well-balanced diet with moderate protein intake. Excessive salt intake should be avoided, but sodium restriction not recommended. Hospitalization recommended if BP 160/110 consistently with bed rest. HTN tx = Methyldopa (Aldomet®) is drug of choice, Hydralazine (Apresoline®), CCBs (nifedipine, verapamil, diltiazem)
Folic acid is recommended prior to and during the first 2-3 months of pregnancy to prevent neural tube defects. Select the examples of neural tube defects. 1. Myelomeningocele 2. Spina bifida 3. Anencephaly 4. Encephalocele
All 4 are examples of neural tube defects
A patient has a fundal height measurement of 24 cm at 24 weeks. This gives a good estimate of:
The gestational age of the fetus.
A patient is suspected of having diabetes during her initial prenatal visit (first trimester). What test(s) could be used to screen her for this? Select all that apply. 1. Fasting blood glucose 2. A1C 3. Random blood glucose 4. 3 hour glucose tolerance test
Fasting blood glucose, A1C, and random blood glucose. 3 hr glucose tolerance test is not a screening test
According to McDonald’s rule, the uterine fundus should be palpable at 12 weeks:
just above the level of the symphysis pubis.
According to McDonald’s rule, the uterine fundus should be palpable at 16 weeks:
b/t the umbilicus and symphysis pubis
According to McDonald’s rule, the uterine fundus should be palpable at 20 weeks:
level of the umbilicus
A 3 week post-partal patient has a positive screen for depression. What is this patient’s most likely diagnosis?
Postpartum depression
Peds
…….
What vaccine is given at birth for most patients > 2grams?
Hep B….Amelie says that the Hep B schedule will probably be the only one on the test
What vaccines are given at 2,4,6 months?
Hep B(birth, 2 and 6 months), PCV13, DTAP, HIB, Rotavirus, IPV……Here is a mnemonic to remember the vaccines…… “Hippster, (Hep B), Please (PCV) Don’t (DTAP) Hurt (HIB) ouR (Rotavirus) Immunity (IPV)”
First influenza vaccine can be given at _____ months. First dose requires 2 doses separated by 4 weeks.
6
What vaccines are given at the 12-15 month visits?
Hib, PCV 13, MMR, Varicella, Hep A (first dose of MMR, Varicella and Hep A. fourth dose of Hib and PCV).
What vaccines are given at 4-6 year old appointment?
DTAP, IPV, MMR, Varicella
The second dose of MMR may be given at ________time, provided at least 1 month has elapsed since the first dose, and both doses are given at or after age 12 months.
Any
______ is administer to all children age 11-12 years. BOOSTER at age 16. Consider other adolescents, esp college freshmen living in dorms
Meningococcal Conjugate Vaccine (MCV4)
A vaccine given 4 days prior to the scheduled time to receive is considered a valid dose. A vaccine given 5 days prior to the scheduled time to receive is considered?
an INVALID dose and should be repeated
What is the most important reason to administer Tdap to a pregnant mother (in US) with every pregnancy? 1. It protects mother from tetanus. 2. It protects mother from pertussis. 3. It protects infant from tetanus. 4. It protects infant from pertussis.
It protects the mother and the infant from pertussis (#2 & #4)
What is CDC’s recommendation for length of time to monitor a child after receiving an immunization? 15 minutes, 30 minutes, 45 minutes, or 60 minutes? Why is this?
15 mins. This is time that they are most likely to have a reaction. Don’t let teenagers get vaccine and drive until you know that they will not have a reaction.
What is the recommended schedule for the hepatitis B immunization?
3 immunizations at 1, 2, and 6 months
What notable event occurs with regularity about one week after receiving the MMR immunization? 1. Cough 2. Rash 3. Fever 4. Chills
Rash
A mother reports that her 1 year old has an allergy to eggs that produces a non-pruritic rash. Which immunizations are contraindicated? 1. None 2. Influenza only 3. MMR only 4. MMR and influenza.
None
A mother reports that her 1 year old has an allergy to eggs that produces hives. Which immunization(s) are contraindicated? Select all that apply. 1. None 2. Influenza only 3. MMR only 4. MMR and influenza.
Influenza only (MMR is neomycin or gelatin allergies)
Which immunizations are live or attenuated?
Varicella, MMR, LAIV, zoster vaccine
A 12 month old received the MMR immunization 1 week ago. When can the varicella immunization be given?
In 3weeks (Must wait a total time of 4 weeks between live attenuated vaccines )
ADHD (Attention Deficit Hyperactivity Disorder) is characterized by 3 findings:
Hyperactivity, Impulsivity, Inattention
ADHD can be diagnosed if hyperactivity, impulsivity, and/or attention deficit occurs ¬¬¬_________ and affects _______
occurs in more than one setting and affects academic, social, emotional, etc.)
What are the target outcomes of ADHD therapy?
Improved relationships with parents, teachers, siblings, peers, improved academic performance, improved rule following
When should a PCP refer a ADHD patients?
Refer for lack of response to stimulant therapy, co-existing psyc disorders (oppositional defiant disorder, emotional problems, etc.), co-existing neurologic, medical disorders (tics, autism, spectrum disorder, sleep disorder)
________ are first line tx for ADHD.
Stimulants are first line.Consider methylphenidate in pre-schoolers, Atomoxetine (Strattera), Norepinephrine stimulants (SNRI)
In children who have asthma, what are the most important historical clues? Select all that apply. 1. Predictability of symptoms 2. Precipitating factors 3. Triggers 4. Family history
All 4 are important historical clues
What medications are used to manage symptoms of asthma in a young child? Select all that apply. 1. Short acting beta agonists 2. Inhaled steroids 3. Oral steroids 4. Leukotriene blockers
All 4 medications are used to manage syptoms
Principles of Asthma Treatment in young children are mostly the same as adults with 2 notable exceptions:
How drug is administered (peds = nebulizer and adults = inhaler) and LTRA are more efficient in peds population (1 in 3 kids have leukotriene driven asthma)
How many episodes of asthma should occur prior to initiating daily inhaled steroids in young children? 1. One in 3 months 2. Two in 3 months 3. Two times in 1 year 4. Four times in 1 year
Four times in one year
Most common bacterial pathogen in pneumonia for peds and adults
Streptococcus pneumoniae
Most common pathogen in pneumonia for 6 months to 5 years
viral origins
Non-specific findings include general appearance, fever but inconsistent sign, cough, malaise. ________ is the most sensitive sign of confirmed pneumonia
Increased respirations: most sensitive sign of confirmed pneumonia
In pneumonia , CBC with differential (left shift if bacterial); usually WBC ______ is bacterial
> 15,000
What antibiotic choice is first line treatment for pediatric patients who have bacterial pneumonia?
Amoxicillin 90 mg/kg/d (aka high dose PCN). Can use Augmentin or 3rd generation cephalosporin. For PCN allergy use macrolide or clindamycin
The most common cause of bronchiolitis is?
Respiratory syncytial virus (RSV)
Bronchiolitis is a lower respiratory tract infection that obstructs the small respiratory airways. Most common in what age group?
From infancy to 2 years; especially < 12 months of age.
How is bronchiolitis treated?
It is self-limiting. May prescribe albuterol treatments for severe symptoms of wheezing and elevated respiratory rate. Oral corticosteroid use is controversial.
A 3 year old child presents with croup. What indicates a need for urgent referral? 1. Respiratory rate 30/minute 2. Fever of 100°F 3. Stridor 4. Wheezing
Stridor (#3)
Which immunization has nearly eliminated epiglottitis in infants and children?
Hib
How is cystic fibrosis most commonly diagnosed in the US?
Newborn screening
What symptoms might be present in a child with suspected cystic fibrosis? 1. Excessive sweating 2. Frequent episodes of diarrhea 3. Recurrent upper respiratory infections 4. Recurrent pulmonary infections
Recurrent pulmonary infections (recurrent URI is more common in asthma)
In children, _____ is the most common bone cancer and peaks at age _____?
ALL (acute lymphocytic leukemia) & age 4 (but leukemia can occur at any age)
Presenting signs of _________ include fever, bleeding (50% ) decreased platelet count (<100,000), bone pain (21-38%), and lymphadenopathy.
Leukemia
For most nodes > _____ is considered an abnormally enlarged node
10mm
For the epitrochlear node > ______ is considered an abnormally enlarged node
5mm
For the inguinal node > _____ is considered an abnormally enlarged node
15mm
For the cervical node >_____ is considered an abnormally enlarged node
20mm
Lymph nodes that are non-tender, firm, rubbery, matted and fixed are more likely to be ¬¬¬¬¬______?
Malignant
Findings associated with Leukemia include Bruising, bleeding, frequent nosebleeds, Bone pain (long bones), Recurrent infections, fever, Swollen lymph nodes, Fatigue, Poor appetite and ________
Hepatosplenomegaly
Which characteristic must be present for a diagnosis of febrile seizures?1. It occurs nocturnally 2. It can be precipitated after ingestion of an herbal substance 3. It occurs in the setting of illness 4. It occurs after a cerebral insult.
It occurs in the setting of illness (#3)
Which findings warrant further evaluation for seizure? Select all that apply. 1. Bulging fontanel 2. Ongoing seizures 3. Post-ictal drowsiness > 10 minutes 4. Ill appearing child
All four findings warrant further evaluation for seizure
Does the American Academy of Pediatrics recommend switching b/t Tylenol and Ibuprofen for fever management?
No, increased risk of medication error and and toxicity in non-medically trained individuals
Pyloric stenosis is the hypertrophy of the pyloric muscle. It is more common in _______? Frequently presenting at age 3-6 weeks w/ ______?
First born males/projectile vomiting
A 4 week old has suspected pyloric stenosis. What diagnostic test is most commonly used to diagnose this?
Ultrasound
When would you make an emergency surgery referral for pyloric stenosis?
If the child was not passing any stools
When does the lower esophageal sphincter (LES) mature?
9-12 months. GER symptoms should decrease at this age
What are the red flags symptoms of GER?
Choking with eating, Coughing with eating, Forceful vomiting, GI bleeding, Poor weight gain, Refusal to feed, Constipation or diarrhea, Abdominal tenderness, Fever
_______ is a common pediatric emergency which 3-11 month kids will present with a sausage shape mass.
Intussusception
Tell-tale sign of intussusception include: colickly abdominal pain, vomiting, and ______ stools
red currant jelly
Symptoms of colic and intussusception are very similar. Colic usually presents in _____ months?
1-3 months. Intussusception is common in kids a little older (3-11 months)
_______ is involuntary stooling in a child > 4yo?
Encopresis
_________ is usually the underlying problem in encopresis?
Constipation
Encopresis treatment includes:
Use of laxatives (miralax), behavior changes (sit on commode for 5 minutes BID or TID after meals), dietary changes. Tx goal = one soft stool a day
How is oral rehydration for a child with diarrhea usually accomplished?
Commercially prepared electrolyte solution (aka Pedialyte)
Undescended testes are more commonly found in?
Premature males (30% vs 2-5% in full term males)
An undescended testicle, even after repair, increases the risk of what cancer?
Testicular
Refer to urology if testicle(s) has not descended in ____ months?
Six
_______ is a collection of fluid in the scrotum?
Hydrocele
In a communicating hydrocele the fluid is from the_____?
Peritoneal
When does a hydrocele usually resolve in a male infant?
1yo
A 1 year old has a persistent hydrocele, what might be the underlying problem?
Inguinal Hernia
______________ retrograde passage of urine from bladder to upper urinary tract.
Vesicoureteral reflux (VER
In Ped UTI, treatment should be initiated within _______ hours to prevent renal scarring
72
Treatment of Ped UTI
3rd generation cephalosporin
AAP recommends a _________ for all infants 2 -24 months for first febrile UTI
renal and bladder ultrasound (RBUS)
What is the value of renal and bladder US in a patient with first UTI? 1. Demonstrate size and shape of kidneys 2. Demonstrate dilation of ureters 3. Indicate gross anatomic abnormalities 4. Absence of radiation
All four are valuable in pt with first UTI
What disease might manifest itself with a “strawberry tongue”? Select all that apply. 1. Kawasaki disease 2. URI 3. Leukemia 4. Strept throat
Kawasaki disease and strept throat (#1 and #4)
Kawasaki disease is the acute generalized ___________ of the medium sized vessels like the coronary, liver and kidney arteries
systemic vasculitis
Kawasaki disease is diagnosed with the following : fever for 5 days plus ________criteria or coronary vessel involvement.
4 out of 5 criteria (1. Bilateral conjunctival injection without exudate 2. Polymorphous, macular rash urticarial or pruritic 3. Inflammatory changes of lips and oral cavity 4. Changes in extremities (edema, or desquamation of hands and feet) 5. Cervical lymphadenopathy (unilateral, anterior cervical)
If Kawasaki disease is suspected, then immediately refer to ED for?
IV immune globulin and aspirin therapy
Infant clues of congenital heart disease include:
Prematurity, poor feeding, failure to thrive, respiratory symptoms, growth problems
Maternal clues of congenital heart disease include:
DM, obesity, TORCH infections (Toxoplasmosis, Other (syphilis/coxsackie), Rubella, CMV, Herpes), use of lithium, Etoh, family hx
Lower peripheral arterial pulses are always compared to upper peripheral arterial pulses to r/o
Coarctation of the aorta
________ is a common “pull injury” where the annular ligament slips over the radial head
Nursemaid elbow
Which child is most likely to exhibit Osgood Schlatter disease? 5 year old, 10 year old, 15 year old, 20 year old
15 yo - more common in adolescents
What assessment finding is evident in a patient who exhibits Osgood Schlatter disease? Select all that apply. 1. Limp 2. Knee pain 3. Swelling of the tibial tuberosity 4. Swelling of the patellas bilaterally
Knee pain and swelling of the tibial tuberosity (#2 and #3)
___________ is osteochondritis of the tibial tubercle. More common in athletes especially if they recently completed a growth spurt
Osgood schlatter disease
How is Osgood schlatter disease managed?
Continuation of activity as pain tolerates ,Ice, Analgesics 3-4 days, Protective pad over tubercle
Hip pain in children can come from a number of sources such as ______?
Infection, inflammation, malignancy, diseases (Legg-Calve-Perthes, slipped capital femoral epiphysis) or systemic illness
Legg-calve-perthes disease is ________ of the capital femoral epiphysis due to interrupted vascular supply
osteonecrosis
Trendelenburg’s test is positive in?
slipped capital femoral epiphysis, legg-calve-perthes and developmental dysplasia.
How is the Trendelenburg test performed?
Positive Trendelenburg’s sign: asking child to stand on affected side causes a pelvic tilt (the unaffected side is lower)
Legg-Calves-Perthers is common in _____yo and slipped capital femoral epiphysis is more common in ______ yo?
LCP = 3-12yo. SCFE=Adolescent age
____________ will have a negative trendelburg’s test and the pt will have a history of recent URI
transient synovitis of the hip
Tx for transient synovitis of the hip?
None - self limiting in 7 -14 days
Roseola, Fifth Disease, Rubella (German measles), Rubeola, Chicken Pox, Herpangina, and Hand foot and mouth disease commonly cause ________?
Viral exanthem
Roseola etiology
Human Herpesvirus 6
Fifth Disease etiology
Parvovirus B19
Rubella etiology
Rubella virus
Rubeola (measles) etiology
Rubeola virus
Chicken pox (Varicella zoster virus) etiology
Herpes virus
Herpangina etiology
Coxsackie A Virus
Hand foot mouth etiology
Coxsackie virus A16
________ is the only rash that has to go completely away before they can return to school or daycare?
Chickenpox
Maculopapular “brick red” rash; starts on head and neck, spreads to trunk and extremities
Measles (Rubeola)
“Slapped cheek” rash; lacy, macular rash
Fifth Disease (Erythema infectiosum)
Maculopapular rash, looks like measles rash; remarkable lymphadenopathy, macules on soft palate
Rubella aka German measles
High fever for 2-4 days, then abrupt cessation of fever with appearance of maculopapular rash but not on face
Roseola (Exanthem subitum)
Vesicular lesions on erythematous base appearing in crops
Chickenpox
What symptoms most typically characterize a patient who has herpangina? 1. Mild symptoms 2. Pharyngitis with tonsillar exudate 3. Painful vesicles on the soft palate and mouth 4. High fever, rosy red cheeks
Painful vesicles on the soft palate and mouth
A 4 year old presents with a lacy, macular rash and fever. What might this be? 1. Herpangina 2. Hand, foot, and mouth disease 3. Fifth’s Disease4. Measles
Fifth’s disease
A 3 year old is diagnosed with Fifth’s disease. Her mother is pregnant and has had significant exposure to the sick child. She just learned that she is pregnant. If she is not immune, what is the risk? 1. Intrauterine fetal death 2. Significant fetal neurologic delay 3. Congenital heart defects4. Significant orthopedic anomalies
Intrauterine fetal death
What is the usual age at which roseola is diagnosed? 7-13 months , 2-4 years old, 3-6 years old, 6-12 years old
7-13 months
Measles is characterized by what clinical findings? Select all that apply. 1. Cough 2. Coryza 3. Conjunctivitis 4. Anemia
Cough, coryza (irritation/swelling of nasal mucousa), conjunctivitis
Koplik’s spots: 1-3 mm whitish, bluish or gray elevations on the buccal mucosa, hard and soft palate are pathognomonic for_________?
Measles
_______ vaccine has decreased the incidence of AOM since 2000?
Pneumococcal conjugate vaccine 7 (PCV 7)
What is the most common pathogen in AOM?
Viral (RSV and influenza)
What are the most common bacterial pathogens in AOM?
Steptococcus pneumoniae, Heamophilus influenza, and Moraxella catarrhalis
Management of AOM is age driven, in < _____ months antibiotics should be given if diagnosis of AOM is certain or uncertain
six
Management of AOM is age driven, _________, antibiotics should be given if diagnosis of AOM is certain or uncertain in severe illness only
in 6 months to 2 years
Management of AOM is age driven,> _______ years, antibiotics should be given if diagnosis of AOM is certain and severe illness is present.
2
A 2 year old is diagnosed with otitis media and an antibiotic is prescribed. When should her fever resolve after starting the antibiotic?
48-72 hours
A healthy 2 year old is diagnosed with otitis media. How much amoxicillin should be prescribed for her?
Amoxicillin 90 mcg/kg/day
Growth and Development
……
At the first visit 2-3 days postpartum ______ will be checked. Lab values >______ will require phototherapy
bilirubin will be checked and levels >15-17 in 48-72 hr infants will require phototherapy (phototherapy may be initiated in values higher or lower - depends on the reference)
From birth weight, the infant may lose ____ % over the first few days of life
10%
At first week postpartum visit, NP should assess weight gain, elimination patterns, breastfeeding, hearing test, congenital/metabolic screening test results from hospital and ________?
Assess mom for postpartum depression and pyschosis
Fetal nutrition is best determined by assessing?
Sub-q fat on the anterior thighs and gluteal region
White papules on nose and cheeks
Milia
Congenital with indefinite borders; buttocks and base of spine; predominantly in AA and Asian infants
Mongolian spots
“stork bite”, pink red capillary on face or neck
Nevus simplex:
Port wine stain anywhere on malformation body
Nevus flammeus:
Fontanelles are normally described as?
Soft and flat
Anterior fontanelle closes by?
9-18 months
Posterior fontanelle closes by?
2 months
_________ are eyes that are far apart and may indicate a number of underlying syndromes
hypertelorism
Enlarged corneas suggest____?
Glaucoma
_________ reflex refers to the reddish-orange reflection of light from the eye’s retina that is observed when using an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot
red
Abnormal red reflex may show leukocoria which suggests _______?
Cataracts (most likely from maternal infection like rubella) or retinoblastoma
Low set ears or ear deformities may inidicate _______ agenesis/dysfunction
renal (remember that ears and kidney develop along the same embryogenic timeline)
Neonate teeth can be a choking hazard and NP should _____?
Refer to remove the teeth ASAP
_______ results from a short sternocleodmastoid muscle
torticollis
A webbed neck may be associated with?
Turner’s syndrome
In coarctation of the aorta, _______ pulses will be ______ in comparison to the brachial arteries
femoral arteries will be weak or non- palpable in comparison to the brachial arteries
Transillumination of the scrotum can:
differentiate a hernia from hydrocele
Deep sacral dimples may suggest?
Neural tube defects
The ______ and ________ test are performed at every neonatal/infant wellness visit to assess for hip dysplasia
The Ortolani and Barlow Test
How do you perform Ortolani’s test?
It relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver. It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner’s index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant’s legs using the examiner’s thumbs. A positive sign is a distinctive ‘clunk’ which can be heard and felt as the femoral head relocates anteriorly into the acetabulum
How do you perfom the Barlow Maneuver?
performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. (Femur is being pushed toward the Butt. B= butt and Barlow)
Breast milk is ideal for sole source of nutrition up to ______ months and may reduce risk of atopic dermatitis and atopic sensitization.
Six
Delay baby foods until _______?
4 to 6 months
________ foods should be the first foods introduced to an infant.
Single ingredient foods
Fruit juice should not exceedd _____oz/day
4-6
Cow’s milk should be introduced at?
One year
The pinsor grasp starts around 6 months so finger foods can be started at ______ months?
8-10
Risk for iron deficiency starts around 1 year, so iron intake from food sources should be _______?
1/mg/kg/day
Start fluoride supplementation at _____ months
six
Vitamin ____ and ______ may be needed in baby who exclusively breastfeed or have moms who are strict vegetarians
D and B12
At 3- 6 months, a baby should ______ and _______ with their eyes
fix and follow
The corneal light test (aka Hirschburg’s test) check for _____?
Strabismus (ocular malignment). Strabismus is normal until 6 weeks of age. Persistent strabismus after 3-4 months should be referred for correction
A what age should eye alignment occur?
2-4 months
________ is the most common cause of vision problems in children
Amblyopia: When the two eyes don’t focus on the same object, the brain ignores information from one of the eyes. If this is not corrected, it can result in loss of vision, amblyopia.
The corneal light reflex and cover/uncover tests are used to assess:
strabismus. Start cover/uncover test at 6 months
20/20 vision is usually not developed until___?
6 years
How do you assess for hearing in newborn to 3 month?
Startle the child and watch for response
What would you expect for a 3-6 month to perform on a hearing test?
Stops and listens to new sounds, stops crying with parent’s voice
What would you expect for a 6-12 month to perform on a hearing test?
Responds to own name when called
What would you expect for 12-18 month to perform on a hearing test?
Follows directions without cues
What would you expect for a 18-24 month to perform on a hearing test?
50% of speech intelligible to strangers
Pediatric hearing loss is associated with what abnormality?
Speech delay
What is the purpose of pneumatic otoscopy?
To assess TM mobility
By 3 years, _________% of speech should be intelligible to a stranger
90%
Primary teeth start appearing at _______ months and should finish around ____ years
six months to 2 years
Dentist visit should start at _____ months?
Six
The best way to examine the oral cavity of a small child is?
to lie the child on his back on an exam table.
Normal heart rate at birth is?
120-160bpm with sinus arrhythmia
Normal heart rate at 3 yo?
80-120bpm
Normal heart rate at 6 yo?
70-110bpm (pretty close to adult normal range)
What is the purpose of measuring blood pressures in all 4 extremities in the newborn period?
To assess for coarctation
Up to 10 years old, the heart rate should be assessed with _______?
Stethoscope
When should routine blood pressure screening begin for children?
3 years old
Dyslipidemia risk assessment (i.e. watch increased BMI and poor nutrition habits) at age 2,4,6,8,10 and then annually. A fasting lipid panel should be drawn at age?
18-21yo
> _________ mg/dL is termed hyperbilirubinemia
> 5mg/dL is hyperbilirubinemia
Total bilirubin >______mg/dL is associated with increased risk of neurologic dysfunction such as, _____?
> 25-32mg/dL is associated with kernicterus (bilirubin deposits in the brain)
Bilirubin usually peaks in full-term neonates on _______ day
3rd-4th day of life
Bilirubin usually peaks in premature neonates on __________ day
5-7th day of life
A 3 day old term-infant who is being breastfed has hyperbilirubinemia (16 mg/dL). This is most often treated by:
phototherapy.
Genu varum (aka ________) is normal at _______?
Bowlegged; Normal until age 3 yo. With ankles together, measure distance between knees, if > 4-5 inches - refer
Genu valgum (aka __________) is normal at ________?
Knockknees; Normal until age 3 yo. measure ankle distance with knees together, if > 4-5 inches - refer
Metatarsus adductus (aka_____) is usually benign if feet can generally be moved into anatomic position. Caused by tight muscles and ligaments in utero. Most cases resolve when the child ________?
Pigeon toe; ambulates
Talipes Equinovarus (aka _________) is a rigid deformity that is corrected surgically by casting involving the foot and ankle
“Club foot” - urgent orthopedic referral is needed
Where should the examiner’s 2nd-5th fingers be placed to perform Ortolani’s test?
On the greater trochanter
A 2 month old patient has suspected hip dysplasia. What might be present on assessment?
Positive Galeazzi test (flexing an infant’s knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks. If the knees are not level then the test is positive)
Rigid vs flexible metatarsus adductus treatments
With flexible metatarsus toes/feet can be shifted back to midline. Parent should stretch feet to midline with every diaper change. Rigid metatarsus adductus can not be returned to midline. Refer to ped-ortho
Scoliosis is defined as a ≥ ______degree curvature. Risk is greatest during pubertal growth spurt.
> 10 degree
Which scoliosis patient should cause the greatest concern for the NP?1. A 13 y/o female with a 20˚ curve 2. A 17 y/o female with a 20˚ curve 3. A 12 y/o male with a 15˚ curve 4. A 18 y/o male with a 15˚ curve
13 yo female with 20 degree curve (b/c it is already 20 degrees before her growth spurt - it will most likely get worse during growth spurt
Tanner stage 2 (8-13yo) for females
Breast bud forms small mound
Tanner stage 3 for females
Breast and areola enlarge but no separation in contour
Tanner stage 4 for females
Secondary mound formed by areola and papilla about the level of the breast
Tanner stage 2 for boys
Slight enlargement of testes (2-3 cm), scrotum becomes reddened and textured (10-13.5 yrs.)
Tanner stage 3 for boys
Further testicular growth (3-4 cm) slight enlargement of penis
Tanner stage 4 for boys
Penis increases in length and diameter, testes enlarge (4-5 cm)
Tanner stage 2 for pubic hair
Sparse, lightly pigmented, straight along border or labia/base of penis
Tanner stage 3 for pubic hair
Hair becomes more pigmented, coarse, curled, and more abundant
Tanner stage 4 for pubic hair
Pubic hair abundant but covers smaller area than found in adult
Pubertal growth occurs at Tanner Stage II - III in _______
girls
Pubertal growth occurs at Tanner Stage III - IV in_______
boys
The correct order of maturation in males is:
pubic, axillary, and then facial hair.
The earliest secondary sexual characteristic in girls is:
the onset of breast development (thelarche).
The earliest stage of male maturation is:
testicular volume.
A 4 month old has an ankle bracelet made of tiny flowers. The baby’s mother states that this prevents colic. How should the NP respond? 1. Leave it on and encourage its use 2. Tell the mother that it will not help and that she should remove it 3. Recognize that this is a harmless cultural practice 4. Ask if this has helped other siblings.
Recognize that this is a harmless cultural practice
An NP has filed a report of suspected child abuse for a child she has just examined. Which statement is correct? 1. NPs are mandatory reporters in some states 2. Suspected child abuse requires concrete evidence of abuse 3. Child neglect does not constitute child abuse 4. The parents should be informed that the report is being made.
The parents should be informed that the report is being made
An 8 y/o female is brought to your clinic with a spiral fracture of the arm. The NP suspects abuse because the mother’s story doesn’t match the child’s story. How should the NP proceed? 1. Confront the mother about possible abuse 2. Ask the child what happened 3. Separate the child from the mother 4. Tell the parent that you are concerned about the child’s safety.
Tell the parent that you are concerned about the child’s safety
Early adolescents (11-14yo) are more prone to be egocentric, moody, have eating disorders, focus on present and concrete facts, engage in risky behaviors and die secondary to _____?
Motor vehicle accidents so encourage seat belt use
Middle adolescents (15-17yo) are influenced by peers, seek privacy at home, transition their thoughts from concrete to operational (start thinking about the future) and _____ behaviors escalate?
Risky
Late adolescents (18-21yo) are focused on achieving task, emotional intimacy, risky behaviors peak, seek independence and mobility, deaths are secondary to _____?
Motor vehicle accidents, suicide and homicide
What anticipatory guidance is needed for the adolescent group?
Healthy diet, exercise, avoid risky sexual behaviors, don’t use drugs/Etoh
A 12 year old female visits the NP because she has asymmetry of her breasts. She is in Tanner Stage 3. The NP knows that this:
will probably resolve by Tanner Stage 5.
A 2 week old infant has white pinpoint papules on his face and cheeks. What is this?
Milia
Which finding is abnormal in a 2 month old child? 1. A closed anterior fontanel 2. A palpable posterior fontanel 3. Presence of the stepping reflex 4. Red reflex
Closed anterior fontanel
In most children, the primary teeth have completely erupted by:
24 months.
Normal vision in a child is expected by:
6 years of age.
By 2 months, a child should _____ a face, ______ a toy if placed in their hand, smile/coos, and lifts ________?
Focus on a face, grasp a toy, and lift head 45 degrees
By 4 months, a child should ________ head when held upright, ________ when pulled upright, _______ body when on hands, rolls _________, and follows light ______
Hold and control head when held upright, no head lag when pulled upright, raises body when on hands, rolls prone to supine, and follows light 180 degress
By 6 months, a child should be able to place object in ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬____________, sits with support/maybe unassisted, rolls ______________, bears weight, recognizes parents, ____________, babbles, smiles, squeals, laughs, imitates sounds
Able to place object in opposite hand and in mouth, sits with support/maybe unassisted, rolls supine to prone, bears weight,recognizes parents, says “dada” or “baba”, Babbles, Smiles, squeals, laughs, imitates sounds
By 9 months, a child should be able __________, bangs, shakes, drops, and throws objects, _________ self with finger foods, responds to _________ and understands a few words, _________ anxiety, crawls, creeps, and scoots
pulls to stand, bangs, shakes, drops, and throws objects, able to feed self with finger foods, responds to own name and understands a few words, stranger anxiety, crawls, creeps, and scoots
By 12 months, a child should be able pull to stand, may take a few steps,_________ grasp and able to point, says_______ words, looks for dropped or hidden objects, responds to own name and understands a few words, _____ self and drinks from cup, ______ and says “bye-bye”, “dada”, “mama” and imitates vocalizations
pull to stand, may take a few steps, uses pincer grasp and able to point, says 2-4 words, looks for dropped or hidden objects, responds to own name and understands a few words, feeds self and drinks from cup, waves and says “bye-bye”, “dada”, “mama” and imitates vocalizations
By 15 months, a child should be able to walk well and is able to stoop, Can point to a ________, says _______ words, stacks_______ blocks, follows simple commands, points, grunts, pulls to show what he wants, listens to a story
walk well and is able to stoop, Can point to a body part, says 3-6 words, stacks two blocks, follows simple commands, points, grunts, pulls to show what he wants, listens to a story
By 18 months, a child should be able to walk ¬¬¬¬¬¬¬¬¬¬______, throw a ball, says _________ words, imitates words, uses ________phrases, points to_____body parts
walk backwards, throw a ball, says 15-20 words, imitates words, uses two word phrases, points to multiple body parts
By 2 yo, a child should be able to walk up and down ________ one step at a time, can kick _____,says at least ______ words, imitates adults, follows _______ commands, stacks ____ blocks
walk up and down stairs one step at a time, can kick a ball,says at least 20 words, imitates adults, follows two step commands, stacks 5 blocks
By 3 yo, a child should be able to _______, can stand on ________, able to ride a tricycle, says name, age, and gender, knows _______ of others, able to copy a circle, able to recognize ________
to jump, can stand on one foot, able to ride a tricycle, says name, age, and gender, knows gender of others, able to copy a circle, able to recognize colors
By 4 yo, a child should be able to sing _______, can hop on one foot, able to ________ overhand, able to draw a person with ______, able to cut and paste, able to build a tower with ____blocks, counts to five, able to copy a ______, able to dress self with supervision
able to sing a song, can hop on one foot, able to throw a ball overhand, able to draw a person with three parts, able to cut and paste, able to build a tower with 10 blocks, counts to five, able to copy a square, able to dress self with supervision
By 5yo, a child should be able to draw a person with body, head, arms, legs, able to recognize most _______ and can print some, plays ________, learns address and phone number, can define at least one word
to draw a person with body, head, arms, legs, able to recognize most letters and can print some, plays make believe, learns address and phone number, can define at least one word
Infant will feed every ______ hours. Awaken to feed if ____ hours have elapsed without feeding.
Infant will feed every 2-3 hr, awaken to feed if 4 hours have elapsed.
Supplementation with Vitamin D is only needed if____?
If breastfeeding mother’s diet lacking in Vitamin D OR formula is not fortified with Vitamin D and infant does not have adequate exposure to sunlight
Place infant on_______ for sleeping and do not put a bottle in the crib for sleep
back
Do not use ______
baby powder
Avoid foods which are choking hazards such as:
nuts, hotdogs, whole grapes, hardcandy
Begin potty training at ______?
Physically ready b/t 18-24 months, stay dry for nap, be able to squat, show an interest, age which pleasing parent is important
Women’s health
……
What differentiates pelvic pain from abdominal pain?
Pain below the umbilicus is pelvic pain
Primary amenorrhea may be diagnosed by age 14/15 years if _____ are present?
Normal growth & presence of secondary sexual characteristics.
Primary amenorrhea may be diagnosed by age 16 years if ___ are present?
Absence of menses by age 16 regardless of appearance of secondary sexual characteristics
Primary amenorrhea is often secondary due to a dysfunction of ______?
hypothalamus, pituitary, ovaries, uterus, or vagina
Primary dysmenorrhea is _______ of a pelvic pathology but is likely to have a lot of prostaglandin production
absent
Primary dysmenorrhea usually starts in _______, pain starts ________ prior to onset of menses, then resolves over the next ________ hours. S/s= nausea, diarrhea, fatigue, dizziness, HA, back pain. Tx =____________. Improves with __________
starts in adolescence, pain starts 1-2 days prior to onset of menses, then resolves over the next 12-72 hours. S/s= nausea, diarrhea, fatigue, dizziness, HA, back pain. Tx =NSAIDs, hormonal contraceptives. Improves with age and parity
Secondary dysmenorrhea usually starts after age ___ years (most common in 4th and 5th decades)
25 years
Secondary dysmenorrhea is abnormal uterine bleeding and is usually _________ pain
non-midline pelvic
Secondary dysmenorrhea s/s=
dyspareunia, symptoms worsen over time, and the absences of nausea, vomiting, diarrhea, or back pain during menses,
When develop a work-up for dysmenorrhea, a NP must r/o a secondary cause (pelvic pathology) such as ___________?
endometriosis, adhesions, fibroids, PID
Treatment for primary dysmenorrhea includes life style modifications such as ________?
Exercise and heating pad to lower abdomen
Pharm treatment for primary dysmenorrhea include
NSAIDs started at onset of menses for 1-2 days or for duration of pain, hormonal contraceptive therapy (OK for first line tx too), If treatment with NSAIDs or hormonal contraceptives fails, try the other option. Tx w/ both NSAIDs and hormonal contraceptives is ok. Consider secondary cause for failure of first and second line tx
PCOS is a chronic, complex endocrine disorder associated with ___________ and the formation of _____ in the ovaries
oligo-ovulation and/or anovulation/ formation of cysts in the ovaries
PCOS in a common diagnosis which affects _____ of females
6.5-8%
Endocrine Society recommends using the _______ as a diagnostic algorithm for PCOS
Rotterdam Criteria for diagnosis
At what age is PCOS most likely to present?
Teenage years
Rotterdam criteria states that 2 of the 3 criteria must be present for the diagnosis for PCOS. What are the 3 eligible criteria?
1) oligo/anovulation 2) hyperandrogenism (hirsutism, male pattern alopecia, or raised free testosterone or FAI) 3) Polycystic ovaries on ultrasound.
Other etiologies such as ___________ may present with similar symptoms of PCOS and should be on the differential diagnosis list
PREGNANCY!!!, congenital adrenal hyperplasia, androgen secreting tumors, Cushing’s syndrome, thyroid dysfunction, and hyperprolactinemia
Cutaneous or dermatology S/S of PCOS include ___________?
Cutaneous symptoms: acne, hirsutism, alopecia, acanthosis nigricans
Pelvic or gyn s/s of PCOS include?
Anovulatory symptoms, amenorrhea, oligomenorrhea, dysfunctional uterine bleeding, and infertility (typically begins in teenage years)
Endocrine s/s of PCOS include?
Hyperinsulinemia, increased testosterone, and hyperlipidemia
Psych or mood s/s of PCOS include?
Mood disorders especially in adolescents
In PCOS ____ test should be used to diagnosis elevated blood sugars
OGTT (more sensitive/specific than FBG/A1C)
What diagnostic test should be ordered to diagnose PCOS?
Testosterone: increased (but < 150 ng/dL) is most sensitive measure of hyperandrogenemia, r/o pregnancy w/ hCG test, Lipid studies (decreased HDLs; elevated trigs, LDLs), OGTT (more sensitive/specific than FBG/A1C), Doppler ultrasound of ovaries (cysts look like string of pearls on ovaries)
What lifestyle managements should be initiated with PCOS?
Weight loss (may restore ovulation), exercise, stress management
Before initiating pharm tx for PCOS, desire for ________ must be determined.
Must determine if pt desires pregnancy.
If pt does not desire pregnancy than pharmalogical tx for PCOS include?
Estrogen/progestin contraceptive (first line treatment) treats acne, hirsutism and protects the endometrium OR drospirenone (analogue of spironolactone) OR Both. Metformin if needed for glucose regulation, reduces insulin secretion BUT no longer routinely recommended (not supported by the data)
If pregnancy is desired than pharmalogical tx for PCOS includes?
Weight loss should always be attempted initially and REFER for Clomiphene first line (Clomid®) OR Letrozole (more effective in obese women). Amelie says that Clomid makes humans have litters - haha!
PCOS is a system wide disease and the sequalae of the syndrome includes_____?
Endometrial cancer (due to deficient progesterone secretion),Postmenopausal breast cancer, Ovarian cancer (so basically all the estrogen derived cancers), Hyperlipidemia, Hyperinsulinemia/insulin resistance/ Diabetes mellitus/metabolic syndrome,Cardiovascular disease and infertility (due to infrequent ovulation)
Cervical cancer is the _______ most common CA in females, ___ most common GYN CA in US and ______ most common cancer in women worldwide
3rd most common CA in females, 2nd most common GYN CA in US and 2nd most common cancer in women worldwide so basically cervical CA happens a lot
Virtually all cervical cancer is due to ____ infection. _________are most virulent strands
HPV/ Types 16, 18, cause 70% of all cancerous/precancerous lesion. Types 45, 31, 33, 52, 58, and 35 also cause cancer.
The HPV 4 vaccine protects against ______?
6,11,16 and 18 (BTW HPV 9 vaccine was just approved by the FDA and it covers 6,11,16,18,31,33,45,52,58 - yea more coverage for future generations = )
The HPV vaccine should be administered to males and females beginning at age _______ to age 26 for females and 21 for males?
11-12 yo
Cervical cancer is has the highest rates in females who _______?
have never been screened, or sporadically screened, so don’t let those older women skip their pap because they have been “fine” for a long time
