CNM Exit Exam Questions And Correct Answers
G's and P's order
GTPAL
Gravida, term, preterm, abortion, living children
-twin delivery only counts as 1 under either term or preterm. only count multiple for
twins for the living portion of number of children
leopolds
The first Leopold's maneuver palpates for the fetal lie, followed by the presentation,
position, and attitude.
ROS
subjective part of pts complaints for each body system. ex) loss of urine when coughing
infertility
infertility inability to conceive within 1 yr of unprotected sex < age 35yo or within 6
months of trying if > 35 yo or inability to carry pregnancy to live birth
cholecystitis
Murphy sign: sudden sharp increase in tenderness and sudden arrest of inspiration
when the RUQ is palpated. Maneuver done with upward pressure under right costal
margin while the pt takes a deep breath
pain begins in the epigastrium and radiates to the RUQ, N/V
hypospadias
Congenital displacement of urethral meatus to inferior surface of penis
,phimosis
-tight foreskin that cannot be retracted
-may be congenital or the result of recurrent infections of the glans penis and prepuce
-may contribute to male infertility
variocele
Varicose veins of spermatic cord
Feels like "bag of worms" separate from testes, may be assoc with infertility
acute epididymitis
Acutely inflamed, tender, swollen
Scrotum may be reddened, most common cause is chlamydia infection
diabetes dx
Hyperglycemia s/s with random glucose >200
Fasting >126
2hr ggt >200
HA1C >6.5%
Rpt test another day to confirm
2hr ggt norm less than 140, dx diabetes >200
vag wet prep slide
-Saline with discharge to see cells, motile trich wbcs
-KOH with discharge to see hyphae, yeast buds
norm vag
Ph: 3.8-4.5,
KOH whiff test neg
epith cells present
,lactobacilli present
squamous metaplasia
-occurs when columnar cells of the endocervix are replaced by mature squamous
epithelium
-occurs at zone of transformation
BV
pH >4.5,
+ Whiff,
>20% epith cells are clue cells,
lactobacilli few/absent
Tx: flagyl 500mg BID q 7days, metrogel, tinidazole, clindamycin
Trich
pH >4.5,
whiff neg or positive
motile trich seen
>1wbc per epith,
lacto reduced/absent
-frothy d/c, strawberry cervix, mal odor yellow/green d/c
-tx: flagyl, tinidazole
(flagyl ok in pregnancy)
Yeast infection
pH <4.5
whiff neg,
hyphae/spores seen after KOH applied
lacto present
Yeast culture if wet prep is norm, pt s/s
-tx with fluconazole, but in pregnanzy use topical agents, avoid oral anti-fungals
, chlamydia
-can cause pneumonia and conjunctivitis in neonates
-can turn into PID, ectopics,, infertility, etc
-asymptomatic
-vag d/c pain, irreg bleeding
-tx: azithromycin 1g (single dose) or doxycycline for 7 days. wait 7 days after tx to have
sex(AVOID DOXY IN PREGNANCY- causes teeth staining in children)
Test of cure
-not rec to do TOC for non-pregnant women who were tx with CDC approved tx
-BUT is rec to re test for re-infection 3 months after tx
gonorrhea
-same s/s as chlamydia and riks for PID, etc.
-tx: ceftriaxone IM injection and azithromycin single dose (safe in preg)
abx contraindicated in pregnancy
-erythromycin- hepatotoxicity
-quinolones ("floxacins")
-doxyxycline - stains childrens teeth. cipro- can cause fetal cartilage damage. tmp-smz
can cause fetal risks. macrobid ok in first trimester, avoid in the third.
HPV vaccine schedule
-9-26yo girls should receive 3 doses at 0,2,6 month intervals
-ok in breastfeeding
-ok to stop during pregnancy and continue schedule PP
HPV strains that cause warts
G's and P's order
GTPAL
Gravida, term, preterm, abortion, living children
-twin delivery only counts as 1 under either term or preterm. only count multiple for
twins for the living portion of number of children
leopolds
The first Leopold's maneuver palpates for the fetal lie, followed by the presentation,
position, and attitude.
ROS
subjective part of pts complaints for each body system. ex) loss of urine when coughing
infertility
infertility inability to conceive within 1 yr of unprotected sex < age 35yo or within 6
months of trying if > 35 yo or inability to carry pregnancy to live birth
cholecystitis
Murphy sign: sudden sharp increase in tenderness and sudden arrest of inspiration
when the RUQ is palpated. Maneuver done with upward pressure under right costal
margin while the pt takes a deep breath
pain begins in the epigastrium and radiates to the RUQ, N/V
hypospadias
Congenital displacement of urethral meatus to inferior surface of penis
,phimosis
-tight foreskin that cannot be retracted
-may be congenital or the result of recurrent infections of the glans penis and prepuce
-may contribute to male infertility
variocele
Varicose veins of spermatic cord
Feels like "bag of worms" separate from testes, may be assoc with infertility
acute epididymitis
Acutely inflamed, tender, swollen
Scrotum may be reddened, most common cause is chlamydia infection
diabetes dx
Hyperglycemia s/s with random glucose >200
Fasting >126
2hr ggt >200
HA1C >6.5%
Rpt test another day to confirm
2hr ggt norm less than 140, dx diabetes >200
vag wet prep slide
-Saline with discharge to see cells, motile trich wbcs
-KOH with discharge to see hyphae, yeast buds
norm vag
Ph: 3.8-4.5,
KOH whiff test neg
epith cells present
,lactobacilli present
squamous metaplasia
-occurs when columnar cells of the endocervix are replaced by mature squamous
epithelium
-occurs at zone of transformation
BV
pH >4.5,
+ Whiff,
>20% epith cells are clue cells,
lactobacilli few/absent
Tx: flagyl 500mg BID q 7days, metrogel, tinidazole, clindamycin
Trich
pH >4.5,
whiff neg or positive
motile trich seen
>1wbc per epith,
lacto reduced/absent
-frothy d/c, strawberry cervix, mal odor yellow/green d/c
-tx: flagyl, tinidazole
(flagyl ok in pregnancy)
Yeast infection
pH <4.5
whiff neg,
hyphae/spores seen after KOH applied
lacto present
Yeast culture if wet prep is norm, pt s/s
-tx with fluconazole, but in pregnanzy use topical agents, avoid oral anti-fungals
, chlamydia
-can cause pneumonia and conjunctivitis in neonates
-can turn into PID, ectopics,, infertility, etc
-asymptomatic
-vag d/c pain, irreg bleeding
-tx: azithromycin 1g (single dose) or doxycycline for 7 days. wait 7 days after tx to have
sex(AVOID DOXY IN PREGNANCY- causes teeth staining in children)
Test of cure
-not rec to do TOC for non-pregnant women who were tx with CDC approved tx
-BUT is rec to re test for re-infection 3 months after tx
gonorrhea
-same s/s as chlamydia and riks for PID, etc.
-tx: ceftriaxone IM injection and azithromycin single dose (safe in preg)
abx contraindicated in pregnancy
-erythromycin- hepatotoxicity
-quinolones ("floxacins")
-doxyxycline - stains childrens teeth. cipro- can cause fetal cartilage damage. tmp-smz
can cause fetal risks. macrobid ok in first trimester, avoid in the third.
HPV vaccine schedule
-9-26yo girls should receive 3 doses at 0,2,6 month intervals
-ok in breastfeeding
-ok to stop during pregnancy and continue schedule PP
HPV strains that cause warts
