HIPAA

HIPAA US Medical PG Question 1: A 42-year-old woman presents to the physician with symptoms of vague abdominal pain and bloating for several months. Test results indicate that she has ovarian cancer. Her physician attempts to reach her by phone multiple times but cannot reach her. Next of kin numbers are in her chart. According to HIPAA regulations, who should be the primary person the doctor discusses this information with?

• A. The patient's brother
• B. The patient's husband
• C. The patient's daughter
• D. All of the options
• E. The patient (Correct Answer)

HIPAA Explanation: ***The patient*** - Under **HIPAA**, the patient has the **right to privacy** regarding their protected health information (PHI). Therefore, the physician must make all reasonable attempts to contact the patient directly to convey their diagnosis. - Sharing sensitive medical information like a cancer diagnosis with anyone other than the patient, without their explicit consent, would be a **violation of HIPAA regulations**. *The patient's brother* - The patient's brother is not automatically authorized to receive her medical information, even if listed as **next of kin**, without the patient's explicit consent or a documented **healthcare power of attorney**. - Discussing the diagnosis with the brother without the patient's direct consent would be a **breach of patient confidentiality**. *The patient's husband* - Even a spouse does not automatically have the right to access a patient's **PHI** without the patient's express permission, according to **HIPAA**. - While often a trusted contact, without explicit consent, revealing the diagnosis to the husband would still violate the patient's **privacy rights**. *The patient's daughter* - Similar to other family members, the patient's daughter is not legally entitled to receive her mother's confidential medical information without explicit authorization or a medical **power of attorney**. - The physician's primary responsibility is to the patient herself, ensuring her **privacy** is maintained. *All of the options* - According to **HIPAA**, sharing the patient's diagnosis with any family member without her explicit consent would be a **breach of confidentiality**. - This option incorrectly assumes that **next of kin** automatically have the right to receive sensitive medical information.

HIPAA US Medical PG Question 2: A 19-year-old man presents to an orthopedic surgeon to discuss repair of his torn anterior cruciate ligament. He suffered the injury during a college basketball game 1 week ago and has been using a knee immobilizer since the accident. His past medical history is significant for an emergency appendectomy when he was 12 years of age. At that time, he said that he never wanted to have surgery again. At this visit, the physician explains the procedure to him in detail including potential risks and complications. The patient acknowledges and communicates his understanding of both the diagnosis as well as the surgery and decides to proceed with the surgery in 3 weeks. Afterward, he signs a form giving consent for the operation. Which of the following statements is true about this patient?

• A. He cannot provide consent because he lacks capacity
• B. He has the right to revoke his consent at any time (Correct Answer)
• C. His parents also need to give consent to this operation
• D. He did not need to provide consent for this procedure since it is obviously beneficial
• E. His consent is invalid because his decision is not stable over time

HIPAA Explanation: ***He has the right to revoke his consent at any time*** - **Informed consent** for medical procedures is an ongoing process, and a patient retains the right to **withdraw consent** at any point, even after initially signing the consent form. - This right is a fundamental aspect of patient autonomy and ensures that medical interventions are only performed with a patient's current and willing agreement. *He cannot provide consent because he lacks capacity* - The patient is 19 years old, which in most jurisdictions (including the US where the age of majority is typically 18) means he is considered an **adult** and legally capable of providing his own consent. - The scenario explicitly states he "communicates his understanding of both the diagnosis as well as the surgery," indicating he possesses the **mental capacity** to make an informed decision. *His parents also need to give consent to this operation* - As a 19-year-old, the patient has reached the **age of majority** and is legally entitled to make his own medical decisions, including consenting to surgery. - Parental consent is generally required for minors (individuals under the age of majority), but not for adults like this patient. *He did not need to provide consent for this procedure since it is obviously beneficial* - Even for procedures that are clearly **beneficial**, informed consent is ethically and legally mandatory to uphold **patient autonomy** and ensure respect for individual rights. - The concept of "obviously beneficial" does not negate the requirement for a patient's explicit agreement to a medical intervention. *His consent is invalid because his decision is not stable over time* - While the patient might have initially hated surgery at age 12, his current decision at age 19 to proceed with the ACL repair is based on current information and his mature understanding. - The fact that his previous aversion to surgery has changed does not invalidate his current, well-informed decision; it simply indicates a change in perspective based on new circumstances and greater maturity.

HIPAA US Medical PG Question 3: A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?

• A. Duty, breach, causation, and damages (Correct Answer)
• B. Only duty and breach
• C. Only breach and causation
• D. Duty, breach, and damages

HIPAA Explanation: ***Duty, breach, causation, and damages*** - In a medical malpractice lawsuit, all four elements—**duty, breach, causation, and damages**—must be proven for a successful claim. - The healthcare provider had a **duty** to provide competent care, they **breached** that duty by administering the wrong blood type, this breach **caused** the patient's death and renal failure, and these injuries constitute **damages**. *Only duty and breach* - While **duty** and **breach** are necessary components, proving only these two is insufficient for a malpractice claim. - It must also be demonstrated that the breach directly led to the patient's harm and resulted in legally recognized damages. *Only breach and causation* - This option omits the crucial elements of professional **duty** owed to the patient and the resulting **damages**. - A claim cannot succeed without establishing that a duty existed and that quantifiable harm occurred. *Duty, breach, and damages* - This option misses the critical element of **causation**, which links the provider's breach of duty to the patient's injuries. - Without proving that the breach *caused* the damages, even if a duty was owed and breached, and damages occurred, the claim would fail.

HIPAA US Medical PG Question 4: A 75-year-old nursing home resident presents with multiple unexplained bruises in various stages of healing on the upper arms and inner thighs. The patient appears withdrawn and anxious when staff members enter the room. Which of the following is the most appropriate next step?

• A. Request psychiatric consultation
• B. Prescribe anti-anxiety medication
• C. Schedule follow-up in one week
• D. Report suspected abuse to adult protective services (Correct Answer)

HIPAA Explanation: ***Report suspected abuse to adult protective services*** - Multiple unexplained bruises in various stages of healing, particularly on the **upper arms and inner thighs**, are highly suspicious for **physical abuse**, especially in an elderly, vulnerable patient. - The patient's withdrawn and anxious behavior around staff further supports a suspicion of abuse, necessitating immediate reporting to Adult Protective Services as a **mandated reporter**. *Request psychiatric consultation* - While the patient's anxiety and withdrawal might warrant psychiatric evaluation, addressing the potential **physical abuse** takes immediate precedence due to safety concerns. - A psychiatric consultation alone would not address the root cause of potential harm or ensure the patient's safety. *Prescribe anti-anxiety medication* - Administering anti-anxiety medication would only mask the symptoms (anxiety) without investigating or resolving the underlying cause of distress, which appears to be related to **potential abuse**. - This approach could delay identification of a serious safety issue, potentially putting the patient at further risk. *Schedule follow-up in one week* - Delaying action for a week is inappropriate given the strong suspicion of ongoing **abuse** and the patient's vulnerability. - Waiting could allow further harm to occur and does not fulfill the ethical and legal obligations of a healthcare professional in cases of suspected abuse.

HIPAA US Medical PG Question 5: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

HIPAA Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

HIPAA US Medical PG Question 6: A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?

• A. Your lab reports show that you have an acute myeloid leukemia
• B. What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies? (Correct Answer)
• C. You must be curious and maybe even anxious about the results of your tests.
• D. I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.
• E. Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?

HIPAA Explanation: ***"What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?"*** - This **open-ended question** allows the patient to express their current knowledge and perceptions, which helps the physician tailor the discussion. - It establishes a **patient-centered approach**, respecting the patient's existing understanding and preparing them for further information. *"You must be curious and maybe even anxious about the results of your tests."* - While empathic, this statement makes an **assumption about the patient's feelings** rather than inviting them to share their own. - It is often better to ask directly or use more open-ended questions that allow the patient to express their true emotions, especially given their **relaxed demeanor**. *"I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.”"* - This statement immediately introduces **overwhelming and potentially alarming information** (referral, chemotherapy, radiotherapy) without first establishing the diagnosis or assessing the patient's readiness to receive it. - It prematurely jumps to treatment and logistics, potentially causing **unnecessary distress** before the patient has processed the core diagnosis. *"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?""* - While it attempts to assess the patient's preference for information, this question is a **closed-ended "either/or" choice** that might limit the patient's ability to express nuanced needs. - It also prematurely introduces the idea of "options" without first explaining the diagnosis in an understandable context. *"Your lab reports show that you have an acute myeloid leukemia"* - This is a **direct and blunt delivery of a serious diagnosis** without any preparatory context or assessment of the patient's existing knowledge or emotional state. - Delivering such news abruptly can be shocking and overwhelming, potentially **hindering effective communication** and rapport building.

HIPAA US Medical PG Question 7: A 23-year-old woman presents to the emergency department with acute alcohol intoxication. Her blood alcohol level is 280 mg/dL. She becomes increasingly agitated and attempts to leave against medical advice. Which of the following determines her capacity to refuse treatment?

• A. Age of the patient
• B. Family's wishes
• C. Blood alcohol level
• D. Understanding of risks and benefits (Correct Answer)

HIPAA Explanation: ***Understanding of risks and benefits*** - A patient's capacity to refuse treatment is primarily determined by their **ability to understand the nature of their condition**, the proposed treatment, and the **potential risks and benefits** of both accepting and refusing treatment. - Even with intoxication, if a patient can demonstrate this understanding, they technically have the capacity to make decisions, though the intoxication itself often impairs this ability. - Capacity assessment includes four key elements: understanding information, appreciating how it applies to their situation, reasoning through options, and communicating a choice. *Age of the patient* - While age is a factor in pediatric care (requiring parental consent for minors), for adults, it does not solely determine capacity; an adult of any age can be deemed to lack capacity for various reasons. - The patient's age (23 years old) indicates she is legally an adult, but it does not automatically confer or deny treatment capacity, which is assessed based on mental status. *Family's wishes* - Family wishes are important for patients who **lack decision-making capacity** and have no advance directives, but they do not override the decisions of a fully capacitated patient. - In situations where capacity is questionable, family input might be considered, but the direct assessment of the patient's understanding remains paramount. *Blood alcohol level* - A high blood alcohol level strongly suggests impaired judgment and cognitive function, making it a red flag for potential lack of capacity, but it is not a direct measure of capacity itself. - Some individuals may maintain a degree of understanding even with high levels, so a direct assessment of their comprehension is still necessary, not just assuming based on the level alone.

HIPAA US Medical PG Question 8: A 34-year-old man presents to the local clinic with a 2 month history of midsternal chest pain following meals. He has a past medical history of hypertension. The patient takes lisinopril daily. He drinks 4–5 cans of 12 ounce beer daily, and chews 2 tins of smokeless tobacco every day. The vital signs are currently stable. Physical examination shows a patient who is alert and oriented to person, place, and time. Palpation of the epigastric region elicits mild tenderness. Percussion is normoresonant in all 4 quadrants. Murphy’s sign is negative. Electrocardiogram shows sinus rhythm with no acute ST segment or T wave changes. The physician decides to initiate a trial of omeprazole to treat the patient’s gastroesophageal reflux disease. How can the physician most effectively assure that this patient will adhere to the medication regimen?

• A. Instruct the patient to purchase a weekly pill organizer
• B. Have the patient repeat back to the physician the name of the medication, dosage, and frequency (Correct Answer)
• C. Provide the patient with details of the medication on a print-out
• D. Contact the pharmacist because they can explain the details more thoroughly
• E. Tell the patient to write the medication name, dosage, and frequency on their calendar at home

HIPAA Explanation: ***Have the patient repeat back to the physician the name of the medication, dosage, and frequency*** - The **"teach-back" method** is an effective way to confirm patient understanding and improve adherence by having the patient restate information in their own words. - This method allows the physician to identify and clarify any misunderstandings immediately, ensuring the patient comprehends the **medication regimen**. *Instruct the patient to purchase a weekly pill organizer* - While a **pill organizer** can be helpful for medication organization, simply telling the patient to buy one does not guarantee they will understand or consistently use it. - It does not address the fundamental issue of ensuring the patient fully comprehends the **medication instructions** and its importance. *Provide the patient with details of the medication on a print-out* - A print-out provides information, but merely giving a patient a **document** does not confirm they have read, understood, or retained the information. - Many patients may not read or fully comprehend written materials, making it less effective than active engagement methods like **teach-back**. *Contact the pharmacist because they can explain the details more thoroughly* - Pharmacists play a crucial role in medication education, but delegating the primary explanation entirely removes the physician's opportunity to assess the patient's immediate understanding and address concerns directly. - The **physician-patient interaction** is a key moment for establishing a shared understanding of the treatment plan. *Tell the patient to write the medication name, dosage, and frequency on their calendar at home* - This method relies on the patient's ability and willingness to *independently* record and recall information, which may not be sufficient for comprehensive understanding or adherence. - It does not provide an immediate feedback loop for the physician to assess the patient's comprehension of the **treatment plan**.

HIPAA US Medical PG Question 9: A 68-year-old man comes to the emergency department because of sudden onset abdominal pain for 6 hours. On a 10-point scale, he rates the pain as a 8 to 9. The abdominal pain is worst in the right upper quadrant. He has atrial fibrillation and hyperlipidemia. His temperature is 38.7° C (101.7°F), pulse is 110/min, and blood pressure is 146/86 mm Hg. The patient appears acutely ill. Physical examination shows a distended abdomen and tenderness to palpation in all quadrants with guarding, but no rebound. Murphy's sign is positive. Right upper quadrant ultrasound shows thickening of the gallbladder wall, sludging in the gallbladder, and pericolic fat stranding. He is admitted for acute cholecystitis and grants permission for cholecystectomy. His wife is his healthcare power of attorney (POA), but she is out of town on a business trip. He is accompanied today by his brother. After induction and anesthesia, the surgeon removes the gallbladder but also finds a portion of the small intestine is necrotic due to a large thromboembolism occluding a branch of the superior mesenteric artery. The treatment is additional surgery with small bowel resection and thromboendarterectomy. Which of the following is the most appropriate next step in management?

• A. Decrease the patient's sedation until he is able to give consent
• B. Contact the patient's healthcare POA to consent
• C. Proceed with additional surgery without obtaining consent (Correct Answer)
• D. Ask the patient's brother in the waiting room to consent
• E. Close the patient and obtain re-consent for a second operation

HIPAA Explanation: ***Proceed with additional surgery without obtaining consent*** - In an **emergency situation** where immediate intervention is required to save a patient's life or prevent serious harm, and the patient **lacks capacity** to consent, explicit consent for additional necessary procedures is not required. The surgeon can proceed based on the principle of **implied consent** in emergencies. - The discovery of **necrotic small bowel due to thromboembolism** is a life-threatening condition requiring urgent surgical intervention in an already sedated patient, making it an emergency. *Decrease the patient's sedation until he is able to give consent* - Decreasing sedation to obtain consent in this critical situation would cause a **dangerous delay** in treating a life-threatening condition (bowel necrosis) and could lead to worsening outcomes or death. - The patient is **acutely ill** and likely in a state where he cannot grasp information and make decisions, even with reduced sedation, thus true informed consent would be difficult to obtain quickly. *Contact the patient's healthcare POA to consent* - Contacting the POA who is out of town would introduce **significant and potentially fatal delays** in treating a rapidly progressing, life-threatening condition. - While POAs are crucial for non-emergent decision-making, the **principle of preserving life** takes precedence in an acute emergency when a delay would cause irreversible harm. *Ask the patient's brother in the waiting room to consent* - The brother is **not the designated healthcare POA** and there is no indication he has legal authority to make medical decisions for the patient. - Relying on a non-POA family member for consent in an emergency, when the patient's legally appointed surrogate is known, is generally **not the appropriate first step** unless no other option exists and the brother can confirm the patient's wishes from prior discussions, which is not stated. *Close the patient and obtain re-consent for a second operation* - Closing the patient and then re-opening for another surgery would expose the patient to **two separate anesthetic events and surgical procedures**, significantly increasing morbidity and mortality risks compared to continuous surgery. - This option would also introduce an **unacceptable delay** in addressing the acute bowel necrosis, which requires immediate intervention.

HIPAA US Medical PG Question 10: An 11-month-old girl presents to a pediatrician with her mother who is concerned about a red discoloration with a rectangular shape over the child’s left buttock presenting since the previous night. The mother also mentions that her daughter has been crying excessively. There is no history of decreased breast feeding, fever, joint swelling, vomiting, decreased urine output, or change in color of urine or stools. The mother denies any history of injury. However, she mentions that the infant had suffered from a self-limiting upper respiratory infection three weeks before. There is no history of bruising or bleeding in the past. The mother informs the doctor that she has a brother (the patient’s maternal uncle) with hemophilia A. On physical examination, the girl’s temperature is 37.0°C (98.6°F), pulse rate is 160/min, and respiratory rate is 38/min. The lesion presents over the left buttock and is tender on palpation. What is the most likely diagnosis?

• A. Erythema multiforme minor
• B. Hemophilia
• C. Idiopathic thrombocytopenic purpura
• D. Diaper dermatitis
• E. Abusive bruise (Correct Answer)

HIPAA Explanation: ***Abusive bruise*** - The **rectangular shape** of the bruise is a **patterned injury**, highly suggestive of non-accidental trauma (child abuse). Patterned bruises reflect the shape of an object used to inflict injury (e.g., belt, hand, ruler). - **Location on the buttock** is a common site for abusive injuries, as opposed to accidental bruises which typically occur over bony prominences (shins, knees, forehead). - **Age of the child** (11 months, pre-ambulatory) makes accidental bruising less likely. Non-mobile infants rarely sustain bruises accidentally. - **Excessive crying** and **tenderness on palpation** are consistent with recent trauma. - **Mother's denial of injury** does not rule out abuse by another caregiver. - This is a **critical patient safety issue** requiring mandatory reporting to child protective services and further investigation. *Hemophilia* - While the family history of hemophilia A in a maternal uncle raises the possibility of the child being a carrier, **females with hemophilia A are extremely rare** (requiring extreme lyonization, Turner syndrome, or homozygous state). - The child has **no prior history of bleeding or bruising**, which would be expected if hemophilia were severe enough to cause spontaneous bruising. - The **specific rectangular pattern** of this bruise is not consistent with spontaneous bleeding from a coagulopathy, which typically causes diffuse ecchymoses. - If concerned, coagulation studies (PT, aPTT, factor VIII levels) could be obtained, but the patterned nature of the injury points to trauma. *Idiopathic thrombocytopenic purpura* - ITP typically presents with **petechiae and widespread purpura**, not a single discrete rectangular bruise. - While the recent URI could trigger ITP, the **pattern and location** of this lesion are inconsistent with thrombocytopenic bleeding. - ITP-related bleeding would not be tender on palpation and would not present in a rectangular shape. *Erythema multiforme minor* - Characterized by **target lesions** with concentric rings, typically on extremities and mucous membranes. - The described lesion is a **tender, rectangular bruise**, not an erythematous target lesion. - Erythema multiforme is not tender to palpation in the same way as traumatic bruising. *Diaper dermatitis* - Presents as **diffuse erythema and irritation** in areas of contact with urine and feces. - The lesion described is a **discrete, rectangular, tender bruise**, completely inconsistent with the appearance of diaper rash. - Diaper dermatitis is not typically described as having a specific geometric shape.

HIPAA Flashcard 1 of 10

Question: The Beers criteria are used to reduce potential inappropriate prescribing and harmful polypharmacy in the _____ population

Answer: geriatric

HIPAA Flashcard 2 of 10

Question: What type of disease prevention is identifying patients at risk of unnecessary treatment?_____

Answer: Quaternary

HIPAA Flashcard 3 of 10

Question: Examples of the beers criteria include drugs that increase the risk of _____ (benzodiazepines, opioids)

Answer: falls

HIPAA Flashcard 4 of 10

Question: Family member asks for information regarding patient's prognosis.

Answer: Avoid discussing patient information with relatives without permission of the patient.

HIPAA Flashcard 5 of 10

Question: Patients typically get exposed to _____ radiation via nuclear reactor accidents or radiotherapy

Answer: Ionizing

Extra Information:  https://onlinemeded.org?ref=anki 

HIPAA Flashcard 6 of 10

Question: In the hospital, patients with multi-drug resistant organisms, enteric organisms, and scabies require _____ precautions

Answer: contact

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HIPAA Flashcard 7 of 10

Question: What positioning may lower the risk of ventilator-acquired pneumonia? _____

Answer: Semirecumbent

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HIPAA Flashcard 8 of 10

Question: What position should patients with suspected arterial air embolism be placed? _____

Answer: Supine

Extra Information:  https://onlinemeded.org/spa/surgery?ref=anki 

HIPAA Flashcard 9 of 10

Question: What is the most likely complication to occur in a patient receiving total parenteral nutrition for one week? _____

Answer: Bloodstream infection (bacterial or fungal)

Extra Information:  https://onlinemeded.org?ref=anki 

HIPAA Flashcard 10 of 10

Question: What is the typical cause of zero urinary output after surgery? _____

Answer: Usually mechanical problem - look for plugged or kinked catheter

Extra Information:  https://onlinemeded.org/spa/pediatrics/urology/acquire?ref=anki