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Flashcards in GYN health Deck (70):
1

Tanner 1 for girls

Preadolescent breasts

2

Tanner 2 for girls

Breast buds with areolar enlargement

3

Tanner 3 for girls

Breast enlargement without separate nipple contour

4

Tanner 4 for girls

areola and nipple projection as secondary mound

5

Tanner 5 for girls

adult breasts; areola recedes, nipple retracts

6

% of false negative results of PAP tests

1/3

7

What are the bethesda classification categories

Squamous cell abnormality
ASCUS- atypical squamous cell of undetermined significance
Low grade SIL- CIN 1 (HPV or mild dysplasia)
High grade SIL- CIN 2 (moderate dysplasia)
CIN 3 (severe dysplasia)
CIS (carcinoma in situ)
squamous cell carcinoma

8

When do you refer an abnormal PAP

at CIN 2, 3, or CIS

9

Management of infection on a PAP

treat based on causative agent, repeat PAP in 3-4 months after treatment

10

What age do you start cervical cancer screening?

21!

11

Frequency of conventional or liquid based cytology

21-29: EVERY 3 YEARS
30-65: EVERY 3 YEARS

12

When can you do the HPV co-test for PAPs

NOT UNDER 30 YEARS OLD!
30-65- Can opt to do the cytology + HPV coyest every 5 years

13

When to stop cervical cancer screening

>65 if 3 consecutive normal cytology

14

cervical CA screening post-hysterectomy

stop screening for women who had a hysterectomy with removal of cervix and do not have a hx of high grade precancerous lesion (CIN2 or 3) or cereal CA

15

ACOG recommendations for bimanual pelvic exams for screening

Annual may be appropriate

16

Who should be screened more regularly for cervical CA?

hx of high grade pre CA lesions (CIN 2 or 3) or cervical CA, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised or are HIV positive

17

s/sx of trichomonas

Malodorous, frothy, yellowish, green discharge, parities, vaginal erythema, "STRAWBERRY PATCHES" on the cervix and vagina, DYSPARUNIA, dysuria

18

s/sx of BV

Watery, gray, fishy smelling discharge, vaginal spotting

19

s/sx candidiasis

Thick, white, curd-like discharge; vulvovaginal erythema with puritis

20

Trich on a micro wet prep

NS mixture shows motile TRICHOMONADS

21

BV on a wet prep

NS shows clue cells

22

What are clue cells

squamous epithelial cells with poorly defined borders

23

Candidiasis on a wet-prep

KOH shows pseudo hyphae cells

24

TX trich

metronidazole 2 grams by mouth single dose or 500mg BID for 7 days

25

TX of BV

Metro 500mg PO BID x 7days or 2 grams x1 or gel 0.75% 5 grams intravaginally BID x5 days
OR
clindamycin (cleocin) vaginal cream 2% 5 grams intravaginally at HS x7days or 300mg PO BID x 7days

26

tx of candidiasis

miconazole (monostat) or clotrimazole (Gyne-lotrmin) (1%) 5 grams intravaginally at HS x 7 days
Terconazole (terazole) 80mg sup at HS x 3days
butaconazole 3 applications

27

What is the treatment of PID?

Regimen A:
Ofloxacin 400mg PO BID x14days OR
Levofloxacin 500mg PO x14days with or without metro 500mg BID x14 days

Regiman B:
Cefoxitin 2gm IM +
Probenecid 1 gram PO x1+
doxy 100mg PO BID x14 days with or without metro 500mg x14days

OR

Ceftriaxone 250IM x1 +
doxy 100mg po BID x14days with or without metro 500mg BID x14day

28

What does probenecid do?

Slows down the renal excretion rate

29

Primary vs secondary dysmenorrhea

primary- adolescent women as a result of high levels of PROSTAGLANDINs, pain begins with onset of menses and pelvic pathology is identified
secondary- women older than 20 and associated with pelvic disease

30

Management of primary dysmenorrhea

Prostaglandin synthetase inhibitors (PGSIs) / NSAIDS
Ibuprofen
naproxen
indomethacin

oral contraceptives
exercise
high fiber diet
reduction of sugar, caffeine and salt

31

What are some causes of abnormal uterine bleeding?

endocrine dysfunction
Polycystic ovarian disease
immature hypothalamis-pituitary-ovarian axis (adolescents)
resistant follicular stimulation

32

Oligomenorrhea

infrequent, irregular. frequency >40days

33

Polymenorrhea

frequent, irregular, frequency

34

Menorrhagia

Regular frequency but bleeding excessive and prolonged

35

Metrorrhagia

bleeding between cycles

36

Menometrorrhagia

prolonged, frequent, excessive, irregular bleeding

37

intermenstrual

variable quantity between cycles

38

tests for abnormal uterine bleeding

HCG
prolactin
thyroid functions
CBC
PAP
STD screening
urinalysis

39

define PMS

somatic (body aches, breast tenderness, bloating..) and affective symptoms which occur 7-10 days prior to menstruation and ends with the onset of menses

40

Medications/ interventions that may help with PMS

Bromocriptine (Parlodel)
Alprazolam (xanax)
Buspirone (BuSpar)
tricyclic antidepressants (nortriptline)
clomipramine
SSRIS
Atenolol
oral contraceptives
progesterone
caffeine restriction
Vitamin E
salt restriction
Vitamin b6
exercise

41

diagnostic tests for fibrocystic breast disease and beast CA

Mammography to identify calcifications (15% not visualized)
FNA cytology
excisional biopsy; most reliable, allows staging

42

Management of fibrocystic breast disease

Warm soaks TID
Low sodium diet
Vitamin supplements
hormonal therapy
surgical intervention

43

breast CA findings on physical exam

non-tender with poorly defined borders
fixed; firm
may also find dippling, nipple retractions, bloody discharge, lymphadenopathy, bloody discharge

44

Define fibrocystic breast disease

benign breast condition with an increased growth and fibrosis of breast tissue

45

When does breast cancer screening begin?

age 40/50. If family history of breast Ca, MRI in addition to a mammogram

46

Define menopause

cessation of ovarian function for 1 year through biological aging, surgical removal, chemotherapy, and/or radiation which marks the conclusion of the reproductive capability in women

47

What kind of hormonal therapy is available for menopause

Estrogen: Conjugated estrogen (Premarin), estradiol (estrace) estrone sulfate
Progestin: Cyclic or continuous (not necessary if hysterectomy)

48

Management to menopause if HT contraindicated

exercise, calcium supplementation, and diet

49

Concerns with starting HT

Family history of breast cancer, MI/ CAD, uterine CA, metabolic syndrome, lipid disorder

50

Risk factors for osteoporosis

female, white, asian
elderly
EARLY MENOPAUSE
estrogen deficiency
small frame or underweight
family history
high caffeine, phosphates, protein or sodium
smoking
low dietary calcium
sedentary lifestyle
ETOH
certain medications
certain diseases

51

medications that cause osteoporosis

thyroid hormones, corticosteroids, anticonvulsants

52

diseases that lead to osteoporosis

thyroid and parathyroid conditions, kidney disease, liver dysfunction, intestinal malabsorption, COPD

53

What does the DEXA measure?

measures amount of bone tissue in the hip, spine, wrist, ankle

54

What is the Tscore

its the number of standard deviations (SD) around the mean bone density for race and gender

55

Whats normal Tscore

T score>-1.0 SD normal

56

What Tscore becomes ostepenia?

between -1.0 and -2.5 is osteopenia (now called low bone mass)

57

What Tscore is considered osteoporosis

below -2.5 is osteoporosis

58

Bone density testing recommendations

all women 65 yo or older with one or more of the following risk factors:
family hx
smoking
excessive exercise
excessive alcohol use
corticosteroid use
hyperthyroidism
slender body size

postmenopausal women with fractures
PAtients considering treatment for osteoporosis for decision making
women on hormone replacement therapy for extended periods of time

59

Examples of weight bearing exercise

walking, jogging, dancing climbing stairs, aerobics, strength training

60

Daily calcium recommendations

11-24: 1200-1500mg
25-49: 1000mg
50-64: 1500 if not taking on ERT
50-64: 1000 if taking ERT
over 65: 1500mg

61

What are good dietary sources of calcium

dairy products, sardines, salmon with bnes
green leafy vegetables, tofu, calcium fortified foods
Vitmain D 800-1000 IU/day

62

MOst common calcium supplement and directions

calcium carbonate (has the greatest amount of elemental calcium), should not be taken with high fiber foods
avoid aluminum containing antacids (calcium binds with aluminum)

63

Drug therapies for osteoporosis

estrogens
bisphosphonates

64

examples of oral bisphosphanates

Risedronate (actonel)
Alendronate (Fosamax)
Ibandronate (BOniva)

65

Instructions for oral administration of bisphosphanates

full glass of water, NPO 30minutes-1hour, sit upright for 30minutes to an hour

66

Define SLE

Multisystem, inflammatory autoimmune disorder that affects primarily women of childbearing age

67

s/sx of systemic lupus erythematosus

fever
anorexia
malaise
weight loss
butterfly rash
fingertip leions
periungal erythema
splinter hemorrhages
alpopecia
raynauds phenomenon
joint symptoms often early manifestation
photosensitivity
vasculitis
nephritis
ocular manifestations
pericardial manifestations
pulmonary manifestations
abdominal pains, ileus, peritonitis

68

Labs/ diagnostics for SLE

ANA + in 95%
antiphospholipid antibodies
anemia, leukopenia, and thrombocytopenia are often present

69

Management of SLE

Mild symptoms: bed rest, mid afternoon naps, avoidance of fatigue
Sun protection
topical glucocorticoid for isolated skin lesions
NSAIDS, hydroxychloroquine, glucocorticoids, and therapies

70

Drugs implicated in Lupus like syndrome

think cardiovascular drugs
amiodarone
atenolol
bupropion
captopril
carbamazepine
chlorpromazine
diltiazem
gemfibrozil
glyburide
gold salt
griseofulvin
hydralazine
hydroxychloroquine
isoniazid
interferons
lithium
lovastatin
methyldopa
minocycline
nitrofurantoin
oral contraceptives
phenytoin
procainamide
PTU
quinidine
rifampin
simvastatin
tertracycline
ticlopidine
valproate