Week 5 Flashcards
(99 cards)
1
Q
This is a designation based on one’s chromosomes and genitalia, biological.
A
Sex
2
Q
This is a social construct that assigns roles and attributes to people based on their natal sex.
A
Gender
3
Q
This refers to individuals inner understanding of themselves in regard to sexual orientation and the words they use to describe themselves as sexual beings.
A
Sexual identity
4
Q
The sex assigned to a person at birth based on their genitalia.
A
Natal sex
5
Q
An umbrella term used to describe those persons whose gender identity in some way is different from their natal sex assigned at birth.
A
Transgender
6
Q
Behavior or expression of the mismatch gender identity vs the assigned sex.
A
Gender non-conforming
7
Q
The way in which someone expresses their gender identity through their appearance, dress, and behavior.
A
Gender expression
8
Q
The medical, social, physical, and legal changes to the perceived sex.
A
Transition
9
Q
Male to female identifies as:
A
Transfemale
10
Q
Female at birth to male identifies as
A
Trans male
11
Q
The person identifies with the original/same sex as at birth.
A
Cis gendered
12
Q
Lesbian patients have lower risk of:
A
HIV and syphilis
13
Q
Lesbian patients are at high risk of:
A
Breast cancer
14
Q
AIDS is the ___ defined by the ___ count and HIV is the ___.
A
AIDS- Syndrome defined by the CD4 count
HIV- virus
15
Q
At risk populations for HIV and AIDS:
A
Primarily MSM
Women of color in heterosexual relationships
16
Q
Patients with HIV are treated with:
A
HAART (highly active antiretroviral therapy) prescribed by specialist
17
Q
Monitoring for HAART and considerations should include:
A
- High risk of drug-drug interactions
- Dyslipidemia
- Lipodystrophy- disfiguring distribution of fat
- Liver disease
- Check LFTs
18
Q
PEP is:
A
Post exposure prophylaxis of 3 meds taken for 28 days and within 72 hours of possible HIV exposure (72 hours is the absolute window for efficacy).
19
Q
PEP is only for:
A
HIV
20
Q
PrEP is:
A
Pre-exposure prophylaxis first HIV prevention consisting of 2 medications in 1 pill taken daily.
21
Q
PrEP is for:
A
Patients at repeated risk for exposure
22
Q
What is the MOA Of PrEP?
A
It prevents the HIV from replicating in the body should the virus enter the body.
23
Q
MTF aka trans women the goal of transition is:
A
To develop secondary female sex characteristics (feminization)
24
Q
MTF transition is done by:
A
- Giving medication to cause feminization- estrogen
- Block testosterone- (anti-androgen agents) spironolactone, 5-Alpha-reductase-inhibitors like propecia (finasteride), and GnRH agonists
25
What should be monitored with spironolactone?
It is a diuretic so BP and K levels
26
This reduces the formation of the potent androgen dihydrotestosterone (DHT) from its precursor testosterone in certain tissues in the body such as the prostate, skin, and hair follicles. Effective to prevent hair loss.
Propecia (finasteride)
27
This is used on label to treat precocious puberty and it shuts down the LH and FSH production in the pituitary, therefore blocking testosterone at a very early stage in the chain of hormonal events.
GnRH
28
What do you need to monitor with trans women?
Testosterone levels- want between 40-80
Prolactin- don’t want consistently in the 100s
CBC- lower H/H is anticipated
CMP- K
Monitor for risks associated with estrogen (VTE, DVT)
29
What changes between 0-3 months with the trans women after starting hormones and what is permanent?
Lower libido
Softening skin
Breast budding- permanent
Emotional changes
30
What changes between 4-10 months with the trans women after starting hormones and what is permanent?
Change in genitals
Softening hair
Decrease in muscle mass
Cessation of spermatogenesis-permanent
31
What changes between 10 months- 4 years with the trans women after starting hormones and what is permanent?
Breast maturation- permanent
Body fat redistribution
Thickening of hair on head
32
Female to male transition aka trans males only need to take:
Testosterone
33
What needs to be monitored in trans males?
CBC- H/H will be normal values for males
| Testosterone levels- 400-1000 (cis males range 300-1200)
34
Increase testosterone risk factors include:
High BP
Diabetes
Heart attack
Stroke
35
What changes at the 0-3 month mark with trans males with the start of testosterone and what is permanent?
Increase in libido
Increase in appetite (watch for weight gain)
Increase in body hair- permanent
36
What changes at the 3-6 month mark with trans males with the start of testosterone and what is permanent?
Genital changes- clitoral enlargement- permanent
Cessation of menses
Increase in muscle mass/strength
Change in vocal quality
37
What changes between 6month- 5 years with trans males after the start of testosterone and what is permanent?
Development of terminal facial hair- permanent
Body fat redistribution
Hair loss- permanent
38
Puberty delaying options for transgender children should be initiated at:
Tanner stage 2
39
Three things experts agree to look for in children with regard to gender identity:
1. insistence on their gender identity
2. Persistence- has been talking about for long time
3. Consistency with regard to expression of the gender identity
40
This is a slow growing DNA virus that causes one of the most common STIs in the US?
HPV
41
Low-risk HPV types are what and cause what?
6 and 11
| Genital warts aka condyloma acuminata
42
High-risk HPV types are what and can cause what?
16 and 18
| Cause 70% of all cervical cancers
43
When should men transitioning to women (trans women) consider sperm banking?
Before giving supplemental hormones
44
This is the complete lack of or significant reduction in sexual interest or sexual arousal, associated with 3 or more of the following six symptoms:
1. Absence or reduction of interest in sex
2. An absence or reduction in fantasies or erotic thoughts
3. Absent or decreased desire to initial sexual encounters
4. Absent or reduced sense of excitement/pleasure during sex
5. Absent or reduced response to sexual cues
6. Absent or reduced sensations in the genital or elsewhere during sex
Female sexual interest/ arousal disorder
45
What are the 2 categories of female sexual interest/ arousal disorder?
Primary: lifelong
Secondary: emerged after a period of normal sexual function
46
What HPV vaccines can be used for female and male?
Gardasil and gardasil 9
47
What HPV vaccine is only for women and what is the age range?
Cervarix
| 9-25
48
When is a 3-dose HPV vaccine given?
After the age of 15 (15-26)
| Immunocompromised
49
When is the 2-dose HPV vaccine given?
Ages 9-14
50
Who should be vaccinated for HPV?
High-risk patients
Starting at age 9 and above
Ideally, before patient is sexually active
Patients with existing, or previous history of HPV CAN still be vaccinated
Lactating women
51
Who should not be vaccinated against HPV?
Pregnant women
| Yeast hypersensitivity
52
Side effects of HPV vaccine?
Pain at the site
| Syncope- monitor does 15 minutes following vaccination
53
Differential diagnosis for genital warts?
1. Molluscum contagiosum- have an indurated center (white center) and go away on it’s own (pox virus)
2. Condyloma lata- syphilis lesion
54
What are the patient applied treatment options for genital warts?
1. Imiquimod (Aldara) 5% or Zyclara cream 3.75%
2. Podofilox (condylox) 0.5% solution or gel -costly
3. Sinecatechins (Veregen) 15% ointment
55
Should patient applied therapies for genital warts be used during pregnancy?
No- safety unknown
56
What provider administered options for therapy of genital warts are there?
1. TCA or BCA
2. Surgical removal
3. Cryotherapy
57
What are the 2 types of cervical cancer?
1. SCC (squamous cell carcinoma)- most common
| 2. Adenocarcinoma
58
SCC is associated with what type of HPV?
HPV 16
59
Adenocarcinoma is associated with what type of HPV?
HPV 18
60
A cytology is a:
PAP
61
Co-testing is a:
High risk HPV screen
62
A repeat cytology for an inconclusive test means:
That you are basically repeating the pap
63
At what age do you stop doing the PAP alone and start co-testing?
30
64
If a patient had a hysterectomy for cancer do you need to PAP test them?
Yes- continue to look for cancer
65
If patient had a hysterectomy for a benign reason and have a low risk of cancer do you need to continue PAPs?
No
66
What is ASC-US?
Atypical squamous cells of undetermined significance
67
What is ASC-H?
Atypical squamous cells, can not exclude high-grade
| *more concerning, treat as a high-grade test result
68
What is LSIL?
Low grade squamous intraepithelial neoplasia
| -also called CIN 1- mild dysplasia
69
What do you do for LSIL women age 21-24?
You watch for 2 years, if they persist and don’t resolve after the 2 years l, then you treat
70
What is HSIL?
High grade squamous epithelial neoplasia
| - CIN 2 or 3
71
What do you do for CIN 2?
25 and older- treat bc of risk of progression (LEEP/loop)
| 24 and younger- follow up at 6 months to see if regressing. If not, treat.
72
What do you do for a CIN 3?
25 and older- treat bc of risk of progression (LEEP/loop)
| 24 and younger- follow up at 6 months and if not regressing, treat.
73
These are the cells collected when doing the PAP with the cytobrush, collected from a little higher up into the opening of the cervix.
Glandular cells
74
Are atypical glandular cells more or less concerning than atypical squamous cells?
More concerning
75
What is AGC?
Atypical glandular cells
76
What is AIS?
Endocervical adenocarcinoma in situ
77
What should be done with an unsatisfactory cytology?
Repeat in 2-4 months
| HPV positive in women over 30- refer for colposcopy
78
What should you do for negative pap but positive HPV in women over 30?
Repeat the cytology in 1 year or HPV genotype gets- HPV 16/18 Do a colposcopy; not HPV 16-18 repeat co-testing in 1 year
79
For ASC-H:
Treat as if it’s high grade and send for colposcopy, regardless of age
80
If HSIL positive and older than 25:
They can go to immediate LEEP/loop treatment
81
HSIL positive and 21-24:
Do colposcopy first
| *dont do immediate treatment on cervix in order to preserve healthy tissue and preserve fertility
82
This is a visualization of the lesion by putting liquid on the lesion that makes it appear white in color. A biopsy can then be done on that white area.
Colposcopy
83
A ___ is like a sweeping, then you take the sample of that whole sweeping.
Pap smear
84
A ___ is a little biopsy of the site that is question.
Colposcopy
85
This is the outside, visible portion of the cervix, seen on speculum exam?
Ectocervix
86
This is the inner portion that marks the transition of the cervix to the endometrium of uterus?
Endocervix
87
If you had a 19 year old come in that was sexually active, would you PAP?
No
88
Is cervical cancer a disease of socioeconomic disparity?
Yes
89
At what age does a women get her first PAP?
21
90
When would you bring a 21 year old with a normal PAP back for another PAP?
3 years
91
When would a woman come in for an annual PAP?
Immunocompromised or have HIV
92
Does smoking have a high association with HPV?
Yes
93
If a patient is vaccinated for HPV, do they still need routine PAPs?
Yes
94
If a patient is 21-24 and has a low-grade pap result what do you do?
Follow up in a year (can monitor up to 24 months)
95
What do you do if patient has a PAP with a high-grade change?
Colposcopy
96
What are some things that can cause ASC-US
Could be from time of cycle
Yeast infection
Inflammation of the cervix
HPV
97
If woman is HPV negative but has ASC-US, when do you repeat PAP?
3 years
98
If patient has HPV and ASCUS when do you repeat PAP?
1 year
99
What is the area that you collect a sample from for a PAP that has the highest cell activity?
The squamocolumnar junction or transformation zone
