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Primary care > Well women > Flashcards

Well women Flashcards

1
Q

Bartholin’s glands

Skene’s glands

A

Bartholins: right and left of vaginal opening (5 and 7 oclock position)
Skenes- lower urethral meatus

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2
Q 
Bimanual exam 
Vaginal tone 
Cervix 
Uterus 
Ovaries 
Rectal/vaginal 
Hemacult
A

Vaginal tone
Cervix: 4 cm
Uterus: 5-8 cm
Ovaries: 2-4 cm

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3
Q

Position of uterus most common
Tipped backward
Fundus tipped backward
Fundus tipped forward

A

anteverted: tipped forward toward bladder
retroverted
retroflexed
anteflexed

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4
Q

Cervical cancer
___ most common
Rates are ____

A

5th

declining (Gardasil, targeting high risk)

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5
Q

Risk factors for abnormal paps

A
  • Adolescents and age 30-40
  • coitarche >18 (sexual activity)
  • Lifetime sexual partners >3
  • Hx STD, HIV or abnormal pap (95%of abnormal paps r/t HPV)
  • HPV high risk types (serial abnormal paps)
  • smoker (nicotine travels here) 2-4 fold increase
  • contraceptive history (hormones increase risk)
  • gynecologic history (DES: synthetic hormone late 60s/70s to prevent miscarriage; women whos MOTHERS took DES are at increased risk)
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6
Q 
HPV 
\_\_\_\_\_\_common STI 
Stats:
Risk factors: 
Types and associated disease
Prevention
A

the most common STI

stats: 79 million americans; 14 million new each year; 3/4 sexually active 15-49 are infected
risk: sex at early age, multiple partners, weakened immune system
types: 6/11= genital warts, 16/18- cervical cancer
prevention: gardasil (two one with 4 strain protection and one with 9) or cervarix (16/18) vaccine for boys and girls prior to sexual activity age 9

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7
Q 
Gardasil 9 vaccine
Prevents:
Doses: 
girls ages: 
boys ages: 
stains covered: 
# shots and timing: 
contraindications and considerations:
A

prevents: cervical, vaginal, vulvar, anal cancer and genital warts
doses: 3
girls 9-26
boys 9-15
strain 6/11/16/18+31/33/45/52/58
3 shots (0,2 and 6 months)
contraindications: allergy to yeast or previous injection, syncope: wait 15 mins

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8
Q 
Current screening guidelines for PAPs 
Begin at 
21-29 
30-65 
>65 
Women with benign hysterectomy 
Women with history of CIN2, CIS, or cervical cancer
DES, HIV, immunocompromised
A

begin at 21
21-29 every 3 years, HPV reflex if abnormal
30-65 q 3 with pap alone or co testing HPV/pap q 5
>65 no paps if negative history
benign hysterectomy: no paps
Hx CIN2/3, CIS, CxCa: pap ever year 20 years after diagnosis
DES, HIV, immunocompromised: every year

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9
Q

Transformation zone
Area most susceptible to _____
This is where you obtain_____
Consists of:

A 
HPV 
pap smear 
Squamous cells: cervix 
Columnar/Glandular cells: inside cervical canal 
Columnar transform to squamous cells
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10
Q

-

A

satisfactory

unsatisfactory (typically glandular not obtained) cervix 2-4 cm difficult to get up there

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11
Q

-

A

negative for intraeptihelial lesion: repeat routine
epithelial cell abnormality
squamous (outside)
glandular (inside)- more worrisome

if negative for lesion but benign variation retest in one year??? 80% resolve on own- don’t think so

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12
Q 
Abnormal pap results 
ASC
    ASCUS 
    LSIL 
    HSIL
A

ASC- atypical squamous cells
ASCUS: uncertain significance: reflex HPV and wait for result
LSIL: low grade often associated with HPV: colposcopy, HPV testing or repeat pap (21-24 dont do colposcopy repeat pap in 1yr) mild dysplasia
HSIL: high grade usually precancerous, needs colposcopy usually back in one month- mod-sev dysplasia

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13
Q

Reflex HPV DNA
# of strains tested
2 samples pap/HPV or reflex

HPV testing:

A

15

HPV testing: not in 30

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14
Q

AGS

A

always colposcopy and endocervical scraping (if + will get cone biopsy)
after childbearing years: hysterectomy recommended

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15
Q

Carcinoma in situ

A

CIS: non-invasive cervical cancer

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16
Q

Management SIL
Low grade:
High grade:

A

low grade: test q 6 months
high grade: remove it (ablative was done in past and included cryotherapy and laser ablation)
now: excisional procedures
LEEP (choice)- squamous cells- whole top of cervix removed
Laser cone excision- glandular cells (AGUS)- cervix + into canal

17
Q

After LEEP repeat pap in

A

4-6 months

18
Q

Breast cancer

women have ___ in ____ chance of developing

A

1 in 8

second most deadly cancer

19
Q

Breast cancer screening recommendations
ACS
USPSTF

A

ACS*** after 40 on q year
CBE q 3 years for women 20-30, yearly >40
SBE q month after 20
MRI for high risk starting at 25 followed by after 6 months mammo/us

USPSTF: q 2 years 50-75 insufficient evidence CBE, mri, recommend against BSE

20
Q

Risk factors breast mass/lump

A
  • female
  • over 50
  • genetic
  • FMH
  • previous cancer in breast
  • ethnicity (caucasian increased, AA more aggressive)
  • breast abnormalities (density, hyperplasia)
  • menstruation (early onset, late menopause)
  • childbearing (more children, breast fed- less risk)
  • DES (women who took it themselves)
  • HRT>5 years use
  • Lifestyle: overweight, physical inactivity alcohol use
21
Q

Genetic risk

  • BRCA risk
  • autosomal recessive/dominant
  • men with gene
  • higher in which groups
  • treatment
A

BRCA1 BRCA 2 85% risk BRCA and 44% risk ovarian: early age dx, multiple primary cancers in same individual ie breast/ovarian, male breast ca, multiple generations

  • autosomal dominant (only need one parent gene to get it)
  • men carry pass on gene (higher risk prostate, breast and other CA)
  • E. european Jewish Ashkenazi
  • prophylactic mastectomy 91% risk reduction
22
Q

Screening for women at high risk

>20% liftetime risk or BRCA1/2 or first degee relative with proven mutation

A

annual screening by age 30, but not before 25

23
Q

Ultrasound best for

A

women 35

24
Q

BIRADS category

A

0- nothing additional imaging/comparison want films sent
1- negative
2- benign noncancerous (scarring, prev. biopsy)
3- probably benign- short interval f/u
4- suspicious- biopsy
5- high probability malignancy- biopsy
6- known malignancy

25
Q

Breast discharge
Physiologic causes:
Pharmacologic causes:
Pathologic causes:

A

physiologic: stress, pregnancy, sex stimulation, surgery to chest
pharmacologic: phenothiazines, cimetidine, methyldopa, opiates, OCP, E2, EOTH, marijuana, antiemetic
pathologic: breast tumor, pituitary tumor (visual changes, amenorrhea: need MRI presses on optic nerve), hypothalmic tumor, infections, hypothyroidism, PCOS

26
Q

Breast discharge diagnostics

A 
Culture 
Pap 
Mammogram/US 
Prolactin/thryoird/HCG 
2nd opinion
27
Q 
Fibrocystic breast changes 
Bilateral/uni 
Cyclic
Menses 
Quantity 
PE findings
A 
bilateral 
cyclic in nature 
resolve with menses 
few to many small lumps 
PE: thick, lumps, bilaterally, outer quadrants
28
Q

Fibrocystic diagnosis/treatment
Diagnostic tests.
Medication managment.
Nonpharmacologic management.

A

Mammo/U/S if not sure
FNA or surgical excision- generally not
OTC pain relievers
OCPS decrease circulating E2
vitamin E 150-600 mg, and B6 50-100 mg qd
danazol 100-400 mg qd in divided doses (SE: facial hair, menstrual changes, wt gain and voice change- its an androgen)
decrease caffeine, chocolate, low fat, support bra, heating bad

29
Q

Mastalgia
interventions
Non pharmacological
Pharmacological

A 
painful breast tissue 
firm supportive bra and decrease caffeine 
vitamin E 200-600 mg 
Vitamin B6 100 mg daily 
OCPs 
danazol 
2nd opinion 
Tamoxifen can be used but feel menopausal
30
Q 
Fibroadenoma
Bilateral/unilateral 
Mobile/immobile 
Tender/nontender 
Cyclic/noncylic 
PE findings
A 
unilateral 
mobile 
nontender 
noncyclic 
PE: fatty globular lump, solid, firm, rubbery, well delineated mobile mass
31
Q

Fibroadenoma dx and treatment

A

Mammo/us
biopsy for dx- moving away from this
no pharmacologic interventions

32
Q

Mastitis

PE findings and treatment

A

unilateral, erythemic, painful, hot, soft or abscess
Nurse frequently, hot soaks
Dicloxacillin 250-500 mg QID x 10d
Emycin 250 mg QID x 10-14 d

33
Q

Birth control pills

ACHES

A 
Abdominal pain 
Chest pain 
Headaches 
Eye problems 
Swelling or aching in legs
34
Q

Case:

What to do if ASCUS

A

wait for reflex
HPV+ do colposcopy and repeat in one year
HPV- cotest in 3 years

35
Q

Case:

Pap normal HPV positive

A

Repeat pap in one year

36
Q

Prolactin normal level

if elevated

A

8-29 if elevated order MRI then endocrinology if +

Primary care (16 decks)

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