Intro to Women's Health Flashcards
Overview of the GYN visit
tailor the visit to the pt. age, needs and health issues : discussing contraception v pregnancy etc.
- remember; these pt. may not see a primary care doctor: ensure to ask them about their health maitnence and other issues
GOAL = identify health issues early on and promote preventative medicine
- urinary and UTI health
- DM and HTN
- malnutrtion & obestiy
- thyroid helath
Get Through History
- GYN and OB history
GYN exam: breast and pelvic (& CV and pulm always)
Diagnosis testing
- pap smear
- STI
- mammogram
- biopsy
Important History Taking for the GYn visit
GYN v OB specific questions
age & CC with HPI and ROS (directed to the complaint)
- medications!
- socail history: dirnking, smoking, drug use
- allergies
GYN specifics for history
- PMHx: cancers, OP, etc.
- LMP: interval between, duration and amount of flow, discomfort
- age of menopasue
- STIs hx.
- sexucal history
- G&P:
- gravida: total number of pregnancies
- para: FPAL: Full term, Preterm, abortion/miscarrigae, living children
- contraception use
OB specifics
- LMP: age of menarche, interval between, duration and flow
- STI and sexual history
- bleeding/clotting disorders (recurrent miscarriage risk)
- HTN,SLE or DM (impact pregnancy)
- PShx. (abdominal surgery: scar tissue)
Hisotry taking at the GYN appt.
family and socail
Family
- heart disease, HTN, vascualr
- DM
- hematologic
- OP
- hirsituism
- cancers (any)
- migraines! auras = no OCP use
Socail
- smoking, drugs alcohol
- work and marriage
- sexual preference and educationsl background
Physical Exam of the GYN visit
general approach
Breast exam
general approach to the PE
- vitals always
- head to toe approach
- heart and lungs!
Breast Exam
- dicuss self breast exam and how to do
- perform clinical breast exam:
- discuss and perform starting at age 20 every 3 years
- at age 30/40: begin annually
Clinical Breast Exam
- pt: can be sitting or laying
- want to palpate under the areoli and aroung the edges for massess/lumps
- dont forget to palpate axillary tail
- MC location of lesions is axillary tail & upper right quadrant
- documnet location of lesion as direction and distance from nipple & clockwise fashion
Breast Cancer Screening Recommendations
Mammograms
- annually in those 40 years+
- USPSTF: says 50 biennially
Clinical Breast Exam
- every 1-3 years in those 20-39
Breast Self Exam
- consider for high risk persons/optional (to reduce false positive)
- do the week after their period
Physical Exam of the GYN visit
ABD.
gestaional age estimate via fundal height
Abdominal Exam
- always inspect first!
- palpate all four quadrants
- umbilicus/supraputbic regions: start at umbilicus and palpate downwards in logical fashion
Gestational Age Estimate
- fundal height : gestaional estaimte of age
- at umbilicus = 22 weeks
- mid-way between umbilicus and pubic bone = 12 weeks
Physical Exam of the GYN visit
Pelvic Exam
External Inspection (and internal)
- well light: exam perineal area with gloved hands
- hair distrubution, lesions, redness, scratch marks
- look for melanoma!!
Vaginal Examination: vaginal walls anc cervix
- note presence of hymen, urethral opening
- bartholian glands: posterior: palpate for clogs
- skene glands: anterior
Cervical
- speculum: insert downwards; as cervix and uterus sit posterior to the bladder
- nulparais women: donut looking cervix
- multparis women: cervix will be slightly stretched open at the os
- Cervicitis: see redness and discharge at the cervic os
- pap smear: cells collected from the inside of the cervical os and the outside
Bimanual Exam: using two hands: one interal, one external
- palpating afte speculum exam : below pubic symphysis and to the sides
- feel uterus and ovaries
- help to note location of uterus if possible: retroverted (posterior), retroflexed (posterior and flopped) or anterverted (antrior)
STI Screening
wet moutn prep & KOH for what
STI Screen
- Wet mount prep and KOH can be used to determine trich, BV and candidiasis
- blood sample for HIV and syphilis
- send out vaginal discahrge for herpes, chalymida and gonrrhea
How Its Prepared
- sample of vaginal discahrge in saline solution: spread onto slide
- trich = see flagella
- BV: see clue cels
- add KOH
- get fishy smell for BV
- KOH helps see hyphae of yeast in candidiasis
-
Pap Smear
when is it done & what does it detect
Guidlines for testing and who to test/when
Pap Smear
- a smaple of cervical (external at os and internal) to test for HPV and screen for cerivical CA
- starting at age 21
Guidelines
age 21 = cytology test via pap smear every 3 years
Age 30-65 =
- pap smear cytology every 3 years
- HPV testing every 5 years
- combo: HPV and cytology test every 5 years
Age > 65 = no need
hysterectomy = no need
HPV Vax.
Colposcopy
HPV Vaccine
- given for kids 11-12 years of age
- catch up doses for 13-18 year olds
- after 18 = unknonw if vaccination will be benificial
- goal is to give vaccine prior to sexual intercourse
Colopscopy
- if abnormal cytology on pap smear: colposcopy can be done
- acetic acid is used and cells are sent off to test
Biopsys to be conducted
Vulvar
Cervical
Endometrial
Vulvar Biopsy
- condyloma
- dx. of differen leions
- cancer screen
- can be done as: punch, shave, etc. lidocine can be used for these and premed. with ibuprofen
Cervical
- a colposcopy: a cerivcal biopsy to assess for cervical cancer
- used acetic acid : a “bite” sample
- no use of lidocine
Endometrial
- indicated for those with abnormal bleeding > 40 or menopoasual abnormal bleeding
- a “suction like biopsy” because the endometrium is not fused to the muscle wall of the uterus
- for polyps, fibroids or cancer screening
Additional Screening to converse about at a GYN visit
Colon
- colonscopy at 50 (hemaccult at 50)
Lipids
- age 40
Thyroid
- any age, family hx. or symptoms
- chagne in mestrual cycle can be this!
Pelvic US
- age 40
Mamomgram
- age 40
Dexa Scans
- age 65 or earlier if RF
Cancer
- thyroid, ovaries, lymph, skin, oral
discuss sun expsoure, smoking, diet, nutrtion, sexual practices, environment/occupational startinga t 20
Womens Health and Alzheimers disease
biological difference in brain of women
2/3 of pt. with AD are women
- older age = increased risk factor
- women live longer = thus increase AD
- SES lower = increased risk & women ahve lower edu. level
Biology
- deviation in brain of men and women
- brain size is larger in men = slower to atrophy
- women have greater cortical thickness = protective
- women more prone to rapid degeneratiron because white matter atleterations
Psychosocial
- resilence
- stress
- depreesion
- sleep issues
- these all increase
women with estrogen = protective, drop in estrogen at menopause = increased risk
CVD and STroke & Womens Health
CVD = leading cause of death for women
Presentation of women with CVD
- different thatn men!! atypical
- less likely to have activity as the trigger
- N/V, back/should/jaw pain, SOB and anxiety
estrogen is preotective, drop at menopoause= increased risk
Psychosocial
- women put family over own health
- symptoms brushed off
Risk Facotrs
- early menarche and early menopause
- total hysterectoy
- young at at first child’s brither
- hx. of stillbirth/miscarriage
- gestaional DM and pre-eclampsia
- multiple births: stress/social related becuase this effects men too
Includes
- CVD
- stroke
- heart failure
- heart disease
Hyertension and Womens Health
Hypertension
- > in males for those under 65 BUT
- above 65 = females > males
- include in BP during 3rd decaade due to…
- hypertensive disorders of pregnant
- interactions of the RAS system
- psychosocial facotrs
Effects
- more likely to develop adverse outcomes
- increased inacitivtiy, obesity and age = increaser risk
control the HTN early on!!
