NR 509 Final exam
2022/2023
1. Know that in a 47-year-old man ED is usually rather than
testosterone: psychologic
2. Erectile dysfunction may be from psychogenic causes, especially if: early
morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
3. When performing a breast exam, know what abnormal masses should do
when the arm: may be fixed to skin or underlying tissues (may cause dimpling of
skin or retraction when arms are lifted over head or hands are pressed against
hips)
4. Fibroadenoma and cysts mobility: very mobile/mobile
5. Know that a high proportion of breast masses are noted during -
: BSE
6. Breast stage 1: preadolescent- elevation of nipple only
7. Breast stage 2: breast bud stage- elevation of breast and nipple as a small
mound; enlargement of areolar diameter
8. breast stage 3: further enlargement of elevation of breast and areola, with no
separation of their contours
9. breast stage 4: projection of areola and nipple to form a secondary mound
above the level of breast
10. breast stage 5: mature stage- projection of nipple only; areola has receded to
general contour of the breast (although in some individuals the areola continues
to form a secondary mound)
11. Know where pain is located with pancreatitis: acute: epigastric, may radia-
tion straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
12. Know where pain is located with pancreatitis: chronic: epigastric, radiating
to back
13. Know how hepatitis A is transmitted: Transmitted through fecal-oral route.
Fecal shedding followed by poor handwashing contaminates water and foods
leading to infection of household and sexual contacts
14. Stress incontinence: the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that ex-
ceed urethral resistance. Causes include childbirth and surgery, postmenopausal
atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
, NR 509 Final exam
2022/2023
15. urge incontinence: detrusor contractions are stronger than normal and over-
come the normal urethral resistance. The bladder is typically small. Mechanisms:
Decreased cortical inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability
of sensory pathways ie: bladder infections, tumors, and fecal impaction. Decondi-
tioning of voiding reflexes ie: frequent voluntary voiding at low bladder volumes.
16. overflow incontinence: detrusor contractions are insufficient to overcome
urethral resistance, causing urinary retention. The bladder is typically flaccid and
large, even after an effort to void. Mechanisms: obstruction of the bladder outlet ie:
BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve
disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie:
diabetic neuropathy.
17. functional incontinence: the patient is functionally able to reach the toilet in
time because of impaired health or environmental conditions. Mechanism: prob-
lems in mobility resulting from weakness, arthritis, poor vision, or other conditions.
Also environmental factors such as an unfamiliar setting, distant bathroom facili-
ties, bed rails, or physical restraints.
18. Incontinence secondary to medications: drugs may contribute to any type
of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic
blockers, and potent diuretics
19. Know where lymph nodes should be with strep: · Strep throat àstreptococ-
cal pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the
posterior pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
20. What vaccines are safe during pregnancy: tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
21. Know what to be concerned about if you note an irregular rectal mass: ·
Any masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the anus or rectum may form a
clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider anoscopy or sigmoidoscopy for better visualization.
2022/2023
1. Know that in a 47-year-old man ED is usually rather than
testosterone: psychologic
2. Erectile dysfunction may be from psychogenic causes, especially if: early
morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
3. When performing a breast exam, know what abnormal masses should do
when the arm: may be fixed to skin or underlying tissues (may cause dimpling of
skin or retraction when arms are lifted over head or hands are pressed against
hips)
4. Fibroadenoma and cysts mobility: very mobile/mobile
5. Know that a high proportion of breast masses are noted during -
: BSE
6. Breast stage 1: preadolescent- elevation of nipple only
7. Breast stage 2: breast bud stage- elevation of breast and nipple as a small
mound; enlargement of areolar diameter
8. breast stage 3: further enlargement of elevation of breast and areola, with no
separation of their contours
9. breast stage 4: projection of areola and nipple to form a secondary mound
above the level of breast
10. breast stage 5: mature stage- projection of nipple only; areola has receded to
general contour of the breast (although in some individuals the areola continues
to form a secondary mound)
11. Know where pain is located with pancreatitis: acute: epigastric, may radia-
tion straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
12. Know where pain is located with pancreatitis: chronic: epigastric, radiating
to back
13. Know how hepatitis A is transmitted: Transmitted through fecal-oral route.
Fecal shedding followed by poor handwashing contaminates water and foods
leading to infection of household and sexual contacts
14. Stress incontinence: the urethral sphincter is weakened so that transient
increases in intra-abdominal pressure raise the bladder pressure to levels that ex-
ceed urethral resistance. Causes include childbirth and surgery, postmenopausal
atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
, NR 509 Final exam
2022/2023
15. urge incontinence: detrusor contractions are stronger than normal and over-
come the normal urethral resistance. The bladder is typically small. Mechanisms:
Decreased cortical inhibition of detrusor contractions from stroke, brain tumor,
dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability
of sensory pathways ie: bladder infections, tumors, and fecal impaction. Decondi-
tioning of voiding reflexes ie: frequent voluntary voiding at low bladder volumes.
16. overflow incontinence: detrusor contractions are insufficient to overcome
urethral resistance, causing urinary retention. The bladder is typically flaccid and
large, even after an effort to void. Mechanisms: obstruction of the bladder outlet ie:
BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve
disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie:
diabetic neuropathy.
17. functional incontinence: the patient is functionally able to reach the toilet in
time because of impaired health or environmental conditions. Mechanism: prob-
lems in mobility resulting from weakness, arthritis, poor vision, or other conditions.
Also environmental factors such as an unfamiliar setting, distant bathroom facili-
ties, bed rails, or physical restraints.
18. Incontinence secondary to medications: drugs may contribute to any type
of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic
blockers, and potent diuretics
19. Know where lymph nodes should be with strep: · Strep throat àstreptococ-
cal pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the
posterior pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
20. What vaccines are safe during pregnancy: tdap, flu, Pneumococcal,
meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
21. Know what to be concerned about if you note an irregular rectal mass: ·
Any masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the anus or rectum may form a
clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider anoscopy or sigmoidoscopy for better visualization.
