Intro

Question 1

Women of childbearing age are always assumed to be what? What should be done? What else should be assumed if pt prevents with any kind of abdominal pain?

Answer 1

• always assumed to be pregnant, do pregnancy test until confirmed negative
• always assume ectopic pregnancy until proven otherwise

Question 2

Reproductive hx questions to ask?

Answer 2

• LMP, regular?
• contraceptive hx
• sexual hx: # of partners, hx of STIs, use of condoms
• obstetric hx:
  if currently pregnant need to get LMP, and due date
  current gestational age
  hx of any problems during pregnancy
  prior preg. hx - each preg: length, delivery, wt of baby, gender, any complications?
  current complaint

Question 3

Leading cause of death in women? RFs for this?

Answer 3

• CVD
• RFs:
  personal hx of CHD
  over 55
  HTN
  hyperlipidemia
  family hx (1st degree male under 55, 1st degree female under 65)
  DM
  PVD

Question 4

CVD Preventative recommendations?

Answer 4

• moderate exercise/wt maintenance (BMI 18.4-24.9)
• control hyperlipidemia
• control HTN
• control DM
• smoking cessation and avoid exposure to 2nd hand smoke
• aspirin
• heart health diet w/ omega 3 fatty acids
• refer for eval/tx of depression

Question 5

How is menstrual cycle regulated? What happens to lining of uterus b/c of this?

Answer 5

• regulated by gonadotropins from hypothalamus
• feedback loop from ovaries
• affects lining of uterus when fxning correctly:
  builds up, then is shed during menses unless woman becomes pregnant

Question 6

S/Sxs of cervical cancer? RFs? Screening?

Answer 6

• usually asx, may cause spotting
• RFs: early age of sexual activity and mult sexual partners, sex with high risk partners, hx of STI’s, immunosuppression
• pap smear: procedure to detect abnormalities to prevent the development and detect cervical cancer
• gardisil: protects against oncogenic strains of HPV that are linked to cervical cancer

Question 7

S/Sxs of breast cancer? RFs? Screening?

Answer 7

• mass may be detected, there may be skin or nipple changes, an abnormality may be found on mammogram or US
• RFs:
  increasing age, female
  caucasian
  postmenopasual obesity (premenopausal obesity is protective)
  tall stature
  high endogenous estrogen levels
  screening:
• breast exam
• mammography

Question 8

RFs of vulvar cancer? Sx? Inspection?

Answer 8

• fairly rare
• RFs:
  cigarette smoking
  vulvar dystrophy
  HPV
  immunodefiency
• disease in older women
• need to do careful inspection of outer labia and perineum
• a common sx is itching

Question 9

Presentation of endometrial cancer? RFs?

Tx?

Answer 9

• usually presents with irregular or postmenopausal bleeding- always need to be investigated and cancer needs to be ruled out in older women
• RFs:
  excess estrogen w/o opposing progesterone
  tamoxifen therapy
  obesity
  nulliparity
• usually if found early an hysterectomy will be curative

Question 10

S/Sxs of ovarian cancer?
RFs?
PE?

Answer 10

• silent cancer, presents late
• usually already advanced and presents with ascites, mets
• RFs:
  genetic
  increasing age
  infertility (Hormone tx)
  endometriosis
  perimenopausal or postmenopausal hormone therapy
• PE:
  pelvic exam, if a adnexal mass is felt esp on post-menopausal women it is ovarian cancer until proven otherwise
• dx testing: CT