NUR 353 FINAL EXAM: EXAMS 2, 3, 4 2026/2027 | NUR 353
FINAL EXAM REVIEW
Breast cancer - ANS✔✔ ● Black women have a higher incidence before age 45 and are more
likely to die from BC
● Black women are significantly more likely to be diagnosed with regional or distant BC
● Racial differences may be related to insufficient screening and lack of access to
healthcare.
● Men are also at risk due to increased estrogen levels, family history, BRCA2 gene, liver issues
(cirrhosis and klinefelter), and genetic disorders. Radon exposure and carcinogenic chemicals.
Estrogen receptor + is most common in males.chemicals. Estrogen receptor + is most common
in males.
Normal Breast Changes for Women - ANS✔✔ ● Breasts in non-pregnant women change with
hormonal fluctuations during the menstrual cycle.
● 3-4 days before menstruation: breasts feel full, tight, heavy, and occasionally sore.
● Breast volume is smallest on days 4-7 of the cycle.
● NORMAL if they change!
Rheumatoid Arthritis (RA) - ANS✔✔ ● Autoimmune inflammatory disease attacking synovial
membrane.
● Cytokine-driven inflammation (TNF, IL-1, IL-6) → cartilage + bone destruction.
● Synovium thickens into pannus, which erodes bone, ligaments, tendons.
● Systemic disease: can affect lungs, heart, skin, eyes.
S/S:
○ Symmetric joint pain, swelling, warmth.
○ Morning stiffness > 1 hr, not relieved by rest.
○ Fatigue, fever, malaise.
,○ Joint deformity, contractures.
○ Extra-articular: nodules, dry eyes, pleuritis, pericarditis, vasculitis.
First line RA treatment - ANS✔✔ ● Medication: Methotrexate
● Recommended as the first-line disease modifying Antirheumatic drug
● Should be started early—within 3 months of diagnosis—to delay joint degeneration.
● Takes 3-6 weeks to reach therapeutic levels.
● NSAIDs and glucocorticoids are used until methotrexate becomes therapeutic.
● Used for pain and discomfort until methotrexate takes effect.
● Expensive with toxic side effects. Oral ulcers and liver/renal impairment
● Consider risks vs. benefits; associated with decreased life expectancy.
Leflunomide (Arava) - ANS✔✔ ● A DMARD used for RA.
● Contraindicated in pregnancy.
● Pregnancy protocol:
○ Stop the medication.
○ Take cholestyramine (drug-clearing agent).
○ Confirm plasma levels < 20 mcg/L before attempting pregnancy.
● Teratogenic; plasma levels may take up to 2 years to drop without protocol.
Ankylosing Spondylitis (AS) - ANS✔✔ ● Chronic inflammatory disease.
● Characterized by stiffness and fusion (ankylosis) of the spine and sacroiliac joints
● Primary site = enthesis
● Excessive bone formation → fibrosis, ossification, fusion
● More common in men
● Onset: late adolescence / young adulthood (~20 years)
,● Secondary AS associated with IBD, psoriatic arthropathy, Reiter syndrome
Common S/S:
● Low back pain & stiffness
● Worse after rest
● Better with activity
● Early morning stiffness
● Restricted flexion, rotation
● Progressive kyphosis, stooped posture
Osteoarthritis (OA) - ANS✔✔ ● Degenerative disease caused by loss of articular cartilage.→
exposed/sclerotic subchondral bone.
● Osteophyte (bone spur) formation.
● Mild synovitis and thickened joint capsule.
● Caused by mechanical wear, obesity, trauma; worsens in load-bearing joints.
S/S:
● Pain with activity, relieved by rest.
● Stiffness improves with movement.
● Joint enlargement, tenderness, ↓ ROM.
● Crepitus when cartilage is gone.
● Heberden's (DIP) & Bouchard's (PIP) nodes.
● Risk factors: obesity and trauma. Research about microRNA affect gene expression of
chondrocytes
Rhabdomyolysis - ANS✔✔ ● Rapid breakdown of damaged skeletal muscle.
● Causes include prolonged immobilization (e.g., lying on floor for hours).
, ● Muscle cell contents (myoglobin, protein pigment) enter bloodstream.
● Leads to hyperkalemia → risk of cardiac arrhythmias.
● S/S: muscle pain, weakness, elevated CKs, dark urine.
Cryptorchidism - ANS✔✔ Group of abnormalities where the testes fail to fully descend.
Extravaginal Torsion - ANS✔✔ ○ Occurs only in neonates
○ Less common.
○ Tunica vaginalis adheres to scrotal wall.
○ S/S: red scrotal skin, edema.
○ Surgery may be used (controversial).
Intravaginal Torsion - ANS✔✔ ○ More common in pediatric and young populations.
○ Testis rotates within the tunica vaginalis
○ EMERGENCY!
○ Presents with severe pain; risk of testicular loss.
○ Treatment: immediate surgery or manual detorsion.
Gouty Arthritis - ANS✔✔ ● Caused by deposition of monosodium urate crystals in joints and
tissues.
● Result of impaired purine metabolism → uric acid buildup.
● Triggers a strong inflammatory response.
Follicular cyst - ANS✔✔ fluid-filled; arise from follicles.
Dermoid cyst - ANS✔✔ congenital; may contain hair, teeth, skin, glands. Slow-growing, non-
tender.
FINAL EXAM REVIEW
Breast cancer - ANS✔✔ ● Black women have a higher incidence before age 45 and are more
likely to die from BC
● Black women are significantly more likely to be diagnosed with regional or distant BC
● Racial differences may be related to insufficient screening and lack of access to
healthcare.
● Men are also at risk due to increased estrogen levels, family history, BRCA2 gene, liver issues
(cirrhosis and klinefelter), and genetic disorders. Radon exposure and carcinogenic chemicals.
Estrogen receptor + is most common in males.chemicals. Estrogen receptor + is most common
in males.
Normal Breast Changes for Women - ANS✔✔ ● Breasts in non-pregnant women change with
hormonal fluctuations during the menstrual cycle.
● 3-4 days before menstruation: breasts feel full, tight, heavy, and occasionally sore.
● Breast volume is smallest on days 4-7 of the cycle.
● NORMAL if they change!
Rheumatoid Arthritis (RA) - ANS✔✔ ● Autoimmune inflammatory disease attacking synovial
membrane.
● Cytokine-driven inflammation (TNF, IL-1, IL-6) → cartilage + bone destruction.
● Synovium thickens into pannus, which erodes bone, ligaments, tendons.
● Systemic disease: can affect lungs, heart, skin, eyes.
S/S:
○ Symmetric joint pain, swelling, warmth.
○ Morning stiffness > 1 hr, not relieved by rest.
○ Fatigue, fever, malaise.
,○ Joint deformity, contractures.
○ Extra-articular: nodules, dry eyes, pleuritis, pericarditis, vasculitis.
First line RA treatment - ANS✔✔ ● Medication: Methotrexate
● Recommended as the first-line disease modifying Antirheumatic drug
● Should be started early—within 3 months of diagnosis—to delay joint degeneration.
● Takes 3-6 weeks to reach therapeutic levels.
● NSAIDs and glucocorticoids are used until methotrexate becomes therapeutic.
● Used for pain and discomfort until methotrexate takes effect.
● Expensive with toxic side effects. Oral ulcers and liver/renal impairment
● Consider risks vs. benefits; associated with decreased life expectancy.
Leflunomide (Arava) - ANS✔✔ ● A DMARD used for RA.
● Contraindicated in pregnancy.
● Pregnancy protocol:
○ Stop the medication.
○ Take cholestyramine (drug-clearing agent).
○ Confirm plasma levels < 20 mcg/L before attempting pregnancy.
● Teratogenic; plasma levels may take up to 2 years to drop without protocol.
Ankylosing Spondylitis (AS) - ANS✔✔ ● Chronic inflammatory disease.
● Characterized by stiffness and fusion (ankylosis) of the spine and sacroiliac joints
● Primary site = enthesis
● Excessive bone formation → fibrosis, ossification, fusion
● More common in men
● Onset: late adolescence / young adulthood (~20 years)
,● Secondary AS associated with IBD, psoriatic arthropathy, Reiter syndrome
Common S/S:
● Low back pain & stiffness
● Worse after rest
● Better with activity
● Early morning stiffness
● Restricted flexion, rotation
● Progressive kyphosis, stooped posture
Osteoarthritis (OA) - ANS✔✔ ● Degenerative disease caused by loss of articular cartilage.→
exposed/sclerotic subchondral bone.
● Osteophyte (bone spur) formation.
● Mild synovitis and thickened joint capsule.
● Caused by mechanical wear, obesity, trauma; worsens in load-bearing joints.
S/S:
● Pain with activity, relieved by rest.
● Stiffness improves with movement.
● Joint enlargement, tenderness, ↓ ROM.
● Crepitus when cartilage is gone.
● Heberden's (DIP) & Bouchard's (PIP) nodes.
● Risk factors: obesity and trauma. Research about microRNA affect gene expression of
chondrocytes
Rhabdomyolysis - ANS✔✔ ● Rapid breakdown of damaged skeletal muscle.
● Causes include prolonged immobilization (e.g., lying on floor for hours).
, ● Muscle cell contents (myoglobin, protein pigment) enter bloodstream.
● Leads to hyperkalemia → risk of cardiac arrhythmias.
● S/S: muscle pain, weakness, elevated CKs, dark urine.
Cryptorchidism - ANS✔✔ Group of abnormalities where the testes fail to fully descend.
Extravaginal Torsion - ANS✔✔ ○ Occurs only in neonates
○ Less common.
○ Tunica vaginalis adheres to scrotal wall.
○ S/S: red scrotal skin, edema.
○ Surgery may be used (controversial).
Intravaginal Torsion - ANS✔✔ ○ More common in pediatric and young populations.
○ Testis rotates within the tunica vaginalis
○ EMERGENCY!
○ Presents with severe pain; risk of testicular loss.
○ Treatment: immediate surgery or manual detorsion.
Gouty Arthritis - ANS✔✔ ● Caused by deposition of monosodium urate crystals in joints and
tissues.
● Result of impaired purine metabolism → uric acid buildup.
● Triggers a strong inflammatory response.
Follicular cyst - ANS✔✔ fluid-filled; arise from follicles.
Dermoid cyst - ANS✔✔ congenital; may contain hair, teeth, skin, glands. Slow-growing, non-
tender.
