NSG 6340 (2024/2025) FINAL EXAM
QUESTIONS WITH CORRECT DETAILED
ANSWERS || ALREADY GRADED A+
<LATEST VERSION>
Many clinicians rely on the HEEADSS (or the updated HEEADSS) acronym to
guide their psychosocial history. What is the HEEADSS stand for? - ANSWER ✔
Home
Education/Employment
Eating
Activities
Drugs
Sexuality
Suicide
Safety
What should be covered under (H)ome? - ANSWER ✔ Family configuration and
family members, living arrangements, relationships among the adolescent and
family members
What should be covered under (E)ducation/(E)mployment? - ANSWER ✔
Academic or vocational success, future plans, and safety at school or in the
workplace
What should be covered under (E)ating - ANSWER ✔ Brief nutrition history, risk
factor for obesity, concerns about weight or body image, disordered eating
behaviors
What should be covered under (A)ctivities? - ANSWER ✔ Friendships with peers
of the same and opposite sex, recreational activities, dating activity and
relationships, sexual activity
, What should be covered under (D)rugs? - ANSWER ✔ Personal use of tobacco,
alcohol, illicit drugs, anabolic steroids; peer substance use; family substance use;
driving while intoxicated
What should be covered under (S)exuality - ANSWER ✔ Sexual orientation,
sexual activity, sexual abuse
What should be covered under (S)uicide (Mental Health) - ANSWER ✔ Feelings
of sadness, loneliness, depression; pervasive boredom; inappropriately high levels
of anxiety; suicidal thoughts
What should be covered under (S)safety - ANSWER ✔ Risk of unintentional
injury, risk from violence, fighting or weapon carrying, abuse
What should be done before performing a teen breast exam? - ANSWER ✔
Before the exam, the teen should be informed of its components and given the
opportunity to be accompanied by a parent or friend. If he or she declines, a
chaperone should accompany the examiner, especially if the provider is of the
opposite gender.
What is the optimal timing for a breast exam? - ANSWER ✔ within a week of
completion of menses, when the breast is most quiescent and least tender
What should a breast exam include? - ANSWER ✔ (1) Inspection (arms
outstretched, overhead, and resting at the waist). Look for skin changes, distortion
and symmetry.
(2) Palpation: sitting and standing. Cover each breast from the clavicle to
inframammary fold and from the sternum to the midaxillary line. Include the
axillae and supraclavicular fossae.
(3) Notation of nipple discharge: color, which and how many ducts it involved and
palpation of which quadrant of the breast elicited it. Use the clock-face analogy to
describe its location.
(4) Notation of breast mass: mobility, texture, and location. Only dominant masses
with texture distinct from the surrounding tissue should be identified as masses;
areas of nodularity without discrete masses should be identified as such. A discrete
mass implies underlying pathology, while nodularity is often a variant of normal.
What is the diagnostic that is ideally suited to evaluating masses in the adolescent
population - ANSWER ✔ ULTRASOUND Ultrasound is ideally suited to
evaluating masses in the adolescent population. It is superior in characterizing
,masses and differentiating a cystic mass from a solid one. However, it cannot
distinguish a benign solid from malignant mass. Hallmarks of benign lesions in
adults, smooth regular borders, multiple masses, and homogeneous solid masses,
can also be seen in metastatic lesions to juvenile breasts. Abscesses carry the same
characteristics of malignant adult lesions: irregular borders and heterogeneous
contents.
Gynecomastia. - ANSWER ✔ Uni- or bilateral breast development in males. This
usually coincides with the onset of puberty and typically resolves within 2 years.
What are the differential DX for Gynecomastia. - ANSWER ✔ medications (e.g.,
tricyclic antidepressants, hormonal agents such as estrogens and testosterone,
insulin, anabolic steroids, alcohol, and illicit drugs, such as marijuana),
endocrinopathies (hypogonadism, Klinefelter syndrome, or congenital adrenal
hyperplasia), or underlying malignancy (pituitary, thyroid, adrenal gland, or
testes).
What workup is needed for Gynecomastia - ANSWER ✔ history (medications,
illicit drug or alcohol use, events of puberty) and physical exam, especially
focusing on sexual maturity ratings, as well as a testicular exam.
What management is needed for gynecomastia - ANSWER ✔ treating underlying
causes; surgery is reserved for severe disfigurement only.
Aberrant Breast Tissue. - ANSWER ✔ This is failure of regression of the
primordial milk crest and includes
(1) polythelia, or accessory nipple (the most common congenital breast anomaly),
(2) polymastia, or the presence of accessory breast tissue along the milk line, and
(3) supernumerary breast, or the presence of an accessory nipple and underlying
breast tissue.
Aberrant breast tissue prevelence - ANSWER ✔ The prevalence is about 2% to
6% of females. The condition usually presents with a soft tissue mass along the
primordial milk line.
What are possible conditions associated with Aberrant breast tissue - ANSWER ✔
It can be rarely associated with a carcinoma in the accessory breast tissue, and 10%
to 15% of patients with supernumerary breast tissue may have major structural
renal anomalies if two or more other phenotypic anomalies are present. The
evaluation in these women should include a physical examination, ultrasound,
, and/or biopsy as needed. Excision is necessary only if the mass is bothersome or
enlarging.
Amastia. - ANSWER ✔ Absence of breast tissue related to an iatrogenic cause
(removal of breast bud usually in evaluation of a pseudomass in a pediatric breast)
or congenital etiology (Poland syndrome). Poland syndrome typically presents
with unilateral amastia, ipsilateral rib anomalies, webbed fingers, and radial nerve
palsies. Treatment usually involves plastic surgery.
Breast Asymmetry. - ANSWER ✔ Normally, some adolescents and adults exhibit
moderate asymmetry of breast tissue. It is also normal for one breast to develop at
a different rate than the other. Extremes of these normal variants can present as
disorders. If the physical exam reveals breast asymmetry with normal breast tissue
and no dominant masses, the appropriate treatment is reassurance. If the adolescent
is pubertal, 75% of breast asymmetry will resolve completely by adulthood. If the
asymmetry is marked and causes psychological distress, plastic surgical
intervention may be an appropriate intervention. Breast asymmetry may also be
caused by a large mass that distorts normal breast tissue or by pseudoasymmetry
from deformities of the rib cage (e.g., pectus excavatum).
Nipple Inversion. - ANSWER ✔ This involves uni- or bilateral retraction of the
nipple that is not reversible. It is common in newborns. The condition generally
resolves within a few days of birth; if persistent from birth, patients can be
reassured that this is a normal variant. Treatment involves reassurance; surgeryis
needed only for chronic infections.
Macromastia. - ANSWER ✔ Another extreme of normal development includes
macromastia, its further extreme is gigantomastia, or virginal/juvenile hypertrophy.
Inpatients with juvenile hypertrophy, pendulous breasts can reach 30 to 50 pounds.
This disorder includes unilateral or bilateral excessive breast growth. While the
etiology is unknown, the condition may represent an abnormal response of breast
tissue to normal hormonal stimulation. There is a strong association with family
history and obesity. Adults usually present with complaints of back and shoulder
pain and limited activity, while adolescents tend to focus on the issues related to
self-image and social and athletic limitations. No definite therapeutic guidelines
have been developed. Although it is preferable to delay surgery until the breasts
have fully matured, this may not be practical in some adolescents if their breast
size is unbearable. Treatment options include surgery with reduction mastopexy.
Other approaches include hormonal treatment with medroxyprogesterone,
dydrogesterone, danazol, or a combination of medications and surgery.
