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Women's Health > Well Women Visit - Exam 2 > Flashcards

Well Women Visit - Exam 2 Flashcards

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1
Q

What does FDLMP stand for? PMS? PMDD?

A

FDLMP - first day of last
menstrual period

PMS - Premenstrual Syndrome

PMDD - Premenstrual
Dysphoric Disorder

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2
Q

_______ few years leading up to menopause - may already have erratic hormones, menses typically regular

A

premenopause

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3
Q

______menses often irregular and hormones are erratic, but menstruation has not completely ceased

A

Perimenopause

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4
Q

What is the technical definition for postmenopause? What is dysmenorrhea?

A

no menstrual flow for 12+ months

painful menstrual flow

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5
Q

What is cryptomenorrhea? Metrorrhagia?

A

light menstrual flow or spotting only, same thing as hypomenorrhea

menstrual bleeding occurring between cycles, same thing as intermenstrual bleeding

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6
Q

What is considered polymenorrhea? Menometrorrhagia?

A

periods that occur too frequently , a cycle that is 20 days or less

bleeding at irregular intervals
amount and duration may also vary (often heavy)

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7
Q

What is Oligomenorrhea? Amenorrhea?

A

periods that occur too rarely, cycle is over 35 days apart

no menstrual period for over 6 months

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8
Q

postcoital bleeding can be a sign of _______. What is another name for it?

A

cervical cancer

contact bleeding

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9
Q

What is the difference between a subtotal hysterectomy and radial hysterectomy?

A

Subtotal hysterectomy : uterine corpus only (not cervix)

Radical hysterectomy: uterus, cervix, pericervical tissue, upper vagina

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10
Q

What is a BSO? TAH? TVH?

A

bilateral salpingo-oophorectomy

TAH - total abdominal hysterectomy

TVH - total vaginal hysterectomy

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11
Q

When should you NOT recommend a laparoscopic hysterectomy for your pt?

A

if cancerous because they chop up the uterus into little tiny pieces and remove them via the vagina

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12
Q

What does a subtotal hysterectomy remove? Total hysterectomy? Radical?

A

subtotal: just the body of the uterus but leaves the cervix

total: takes the uterus and the cervix

radical: takes the uterus, cervix and top portion of the vagina PLUS the right and left parametrium

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13
Q

What are the weeks related to term, preterm, abortion, post-term, puerperium. Give the weeks of trimesters

A
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14
Q

What are the differences between spontaneous, therapeutic and elective abortions?

A
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15
Q

What is considered a still birth?

A

Stillbirth - the birth of an infant who has died in the womb

Typically used later in pregnancy (after 20 weeks’ gestation)

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16
Q

What does BTL mean? FHT? EFW? PROM? EGA?

A

BTL - Bilateral tubal ligation

FHT - fetal heart tones

EFW - estimated fetal weight

PROM - preterm ROM (< 37 wks)

EGA - estimated gestational age

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17
Q

What is considered grand multigravida? Great grand multipara?

A

pt who has been pregnant 5+ times

delivered 7 + infants of 24+ wks gestational age

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18
Q

What is the GTPAL system

A

G - Gravida
T - Term
P - Preterm
A - Abortions
L - Living children (30 days)

G4P4-0-0-4 (G4P4)

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19
Q

When is the recommended first reproductive health visit? Do you have to do a pelvic exam? What is the purpose?

A

between 13 and 15

No pelvic exam unless symptomatic or STI screen needed

to provide age-appropriate reproductive health info

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20
Q

What determines the frequency of subsequent GYN visits in the 13-21 age window?

A

varies depending on sexual activity, symptoms, patient needs

or if the pt gets pregnant

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21
Q

**What is the recommended age for the pts first pap smear? Do you need a pelvic exam before prescribing birth control?

A

begin age 21 in healthy pts regardless of sexual activity

NO!! do not need pelvic exam before prescribing birth control

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22
Q

How often should you preform a clinical breast exam on an average risk women?

A

Clinical breast exam (CBE) - controversial, no longer recommended for average-risk women

If done, every 1-3 years for women 20-39 years old

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23
Q

What is the recommendation for mammograms for the average risk woman?

A

Yearly CBE and mammograms for women 40+

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24
Q

What are some menstrual history questions you should ask?

A

Age at menarche and menopause

Length and regularity of cycles

Intermenstrual or contact bleeding

Amount of flow

Pain with menses

Presence of PMS

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25
What are questions you should ask your pt regarding contraceptive/sexual history?
Current birth control method Patient’s satisfaction with that method Current sexual activity status Number and gender/sex of partners New partner in last 3 months Condom use History of abuse
26
_______ in the medical history would be especially important to realize in the GYN setting
Include in particular hx of blood clots or excessive bleeding/bruising aka bleeding disorders!!
27
What is dyspareunia? When should you start asking about perimenopausal symptoms?
pain with sex around age 45-55 or on MHT
28
Before performing a pelvic exam, have your patient ______. What should you do with the drape?
empty bladder before exam!! When doing pelvic exam, try to “press down” drape between patient’s knees to help maintain eye contact and monitor patient's face
29
What are the 5 different quadrants of the breast? Where is the tail of spence?
30
What are the 4 positions you should inspect in for a breast exam?
arms at sides arms over head arms pressed against hips leaning forward
31
What is the best technique for a breast exam?
Use the pads of the second, third, and fourth fingers, keeping the fingers slightly flexed. It is important to be systematic. Palpate in small, concentric circles applying light, medium, and deep pressure at each examining point.
32
What is the recommendation for self-breast exams?
no longer recommend!!
33
In order to check perineal support, what should you have your pt do? What are you checking for?
pt needs to "bear down" Cystocele, urethrocele, rectocele, uterine prolapse
34
What is urethral stripping?
applying pressure from proximal to distal urethra to express discharge
35
What is the traditional method for a pap smear?
Step 1: Obtain cervical scraping from complete squamocolumnar junction by rotating 360 degrees around the external os. Smear the material from one end of the slide to the other. Step 2: Place a saline-soaked cotton swab or small endocervical brush into the endocervical canal and rotate 360 degrees. Place this specimen on the same slide and apply fixative solution
36
What is the ThinPrep Test method of pap smear?
Insert spatula, brush combo into cervical os opening and rotate 360 degrees 5X then push combo to the bottom of the vial forcefully 10 times and swirl vigorously
37
What should a normal cervix feel like during a bimanual exam?
3-4 cm diameter and moderately firm, moderately mobile without undue discomfort
38
What should a normal uterus feel like during a bimanual exam?
Half the size of the patients’ fist, smooth and regular outline, not tender, mobile, symmetric
39
How do you preform a rectovaginal exam?
Insert well-lubricated middle finger of examining hand gently into the rectum and examine Insert index finger of examining hand into vagina Raise cervix toward anterior abdominal wall and palpate uterosacral ligaments May also do fecal occult blood testing
40
What are the ACS guidelines for a comprehensive skin exam?
periodic (q 3 yrs) for pts 20-40 and yearly 40+ Annually or more often for higher risk patients Encourage monthly self-examinations
41
What is the UV ray protection recommendation?
SPF 30 or higher
42
What are risk factors that would mandate a comprehensive skin exam?
Suspicious moles or lesions History of skin cancer - personal or family Atypical moles History of extensive sun exposure 50+ total moles
43
Cervical cancer screening should start _____. How often for pts 21-29? 30-65?
age 21 Pap every 3 years Pap every 3 years OR HPV +/- Pap every 5 years
44
When is the recommended age to stop doing pap smears? What are the factors?
Age > 65 - Stop screening if: no history of moderate/severe dysplasia or cancer AND... 3 negative Paps in a row or 2 negative Pap+HPV results in a row in past 10 years (most recent result within last 5 years)
44
______ is the alternative if a pt will not get a pap smear
self-HPV testing
45
**What are the 4 criteria that if you meet them the pap smear guidelines do NOT apply?
If hx of cervical cancer, HIV+, immunodeficient or DES exposure
46
T/F: Only women with a functioning uterus need pap smears
False! May still need yearly Paps even after hysterectomy they will just brush the cells out of the vaginal cuff instead of the cervix
47
What are the pregnant women STD screening guidelines?
Hep B, HIV, Syphilis - All pregnant women should be screened Gonorrhea / Chlamydia - < 25 years or high-risk sexual behavior Hep C - if high-risk sexual behavior
48
What are the non-pregnant ALL sexually active STD screening recommendations?
HIV - if they consent; one time if low-risk Gonorrhea/Chlamydia - if < 25 years, annually
49
What are the non-pregnant high-risk sexual behavior STD screening recommendations?
HIV Syphilis Trichomoniasis Hepatitis B and C Gonorrhea/Chlamydia +/- HSV, Hepatitis C every year
50
What is considered the high risk sexual behavior demographics and criminal hx?
Young Age (15-24 years old) African-American race Unmarried status Living in low socioeconomic status area illicit drug use admission to correctional facility
51
What 5 things in a women's sexual history qualifies them as high risk?
New sexual partner in past 60 days Multiple sexual partners History of prior STI Contact with sex workers Meeting partners on the internet
52
What is the conservative approach to breast cancer screenings? When should you stop screening?
yearly screens starting age 40-45 May transition to biennial, esp. at age 55 age 74 but many providers continue screening “as long as a woman is in good health and expected to live 10+ yrs”
53
What is the colon cancer screening recommendation for your average risk patient? High risk pt? When should you stop screening for colon cancer?
FOBT, FIT, CT colonography, or endoscopy (sigmoid/colon) age 45-75 refer to specialist 75
54
_____ is the initial screening for bone density. When should you start?
DEXA scan All women 65+ years old OR Any woman < 65 whose fracture risk ≥ that of a 65 year old white female without additional risk factors
55
**According to FRAX screening tool, a 65-yr-old white woman with no other risk factors has a ____ chance of 10-yr risk of osteoporotic fracture
9.3%
56
Under the Bethesda system; what are the different cell types results that could come back for a pap smear?
Atypical Squamous Cells Undetermined significance: ASC-US Atypical Squamous Cells Cannot exclude high-grade lesion : ASC-H Low-grade Squamous Intraepithelial Lesion: LGSIL or LSIL High-grade Squamous Intraepithelial Lesion: HGSIL or HSIL Atypical glandular cells: AGC Negative for intraepithelial lesion or malignancy: NILM
57
What results of a pap smear require no further work up?
Negative for intraepithelial lesion or malignancy: NILM
58
_______ cells are associated with adenocarcinoma of endocervix or of endometrium
Atypical glandular cells
59
What is CIN I considered?
mild cervical dysplasia disordered growth of lower ⅓ of epithelial lining
60
What is CIN II considered?
moderate cervical dysplasia disordered growth of lower ⅔ of epithelial linin
61
What is CIN III considered?
severe cervical dysplasia disordered growth of over ⅔ of epithelial lining considered full thickness
62
What CIN levels ALWAYS require treatment? What are the 2 exceptions?
CIN II and III Pregnant women (wait until postpartum period) CIN II in adolescents
63
Why do you NOT treat CIN II in adolescents?
there is a high chance of spontaneous regression and lower risk of cancer
64
T/F: Cervical cancer is not considered severe until it invades another nearby structure
FALSE!! once the cancer is seen to be TOUCHING the basement membrane it is considered severe do not need to wait until it reaches another structure
65
What are the sexual activity risk factors for cervical dysplasia?
Multiple sexual partners Early onset of sexual activity High-risk sexual partner
66
What are the infection factors for risk factors for cervical dysplasia?
HPV infection History of sexually transmitted infection Immunosuppression (including HIV/AIDS)
67
_____ and _____ also increase risk for cervical dysplasia.
Multiparity Long term oral contraceptive pill use
68
HPV strains ____ and _____ are associated with cervical cancer and ____ and ____ are associated with cervical warts
Cancer: 16 and 18 Warts: 9 and 11
69
Most HPV+ women do NOT develop _____ or _______. ______ have a synergistic effect with HPV
CIN cervical cancer cigarettes (increase risk of cervical dysplasia)
70
_____ is the ONLY cervical cell type that has treatment options. The rest of them (LSIL, HSIL, ASC-H, AGC) require ________
ASC-US Colposcopy
71
What are the 3 management options for ASC-US?
1. Repeat serial cytology - q 6 mo till 2 consecutive normal 2. Test for high-risk HPV (if +, then colposcopy) 3. Immediate referral to colposcopy
72
What do you do if the repeat pap for ASC-US is also abnormal? What should you do BEFORE you do the repeat pap?
then colposcopy Before repeat smear - treat underlying conditions: Hormones if atrophic vaginitis or Antimicrobials for infection
73
How do you perform a colposcopy? _____ is applied
3-5% aqueous acetic acid solution
74
What are the 5 indications for colposcopy?
Abnormal cervical cytology or HPV testing Clinically abnormal cervix Unexplained intermenstrual or postcoital bleeding Vulvar or vaginal neoplasia History of in utero DES exposure
75
What am I?
normal cervix
76
What am I?
cervical leukoplakia
77
What am I?
acetowhite lesion
78
What am I?
mosaicism on cervix
79
What am I?
atypical vessels on cervix
80
What is the CIN I expectant management?
81
What is the tx for CIN II/III?
surgical therapy
82
Consider looking at this slide again
83
Draw the summary table of all the different cell types
84
What are the 3 major estrogens produced by women?
Estrone (E1) Estradiol (E2) Estriol (E3)
85
**______ is the major secretory product of the ovary. What does it do during menses? menopause?
Estradiol (E2) Fluctuates widely during menses Drops significantly after menopause
86
How does estradiol (E2) compare to estrone (E1)?
Up to 4x as common and 5x as potent as estrone
87
______ is the main estrogen in postmenopausal women who are not on HRT/MHT
estrone (E1)
88
_____ is the major estrogen in pregnancy
estriol (E3)
89
______ is the estrogen of choice to check to see if you have any estrogen at all. Often effected in delayed or precocious puberty
estrone (E1)
90
_____ is used to check monitoring antiestrogen therapy or adjunct assessment of fracture risk
Estrone (E1)
91
_____ is part of the quad screen and screening for fetal pathology
Estriol (E3) aka all pregnancy related things
92
check _____ if concerned about ovarian function or monitoring HRT/MHT
Estradiol (E2)
93
When can estradiol be elevated?
Can be elevated in hepatic cirrhosis and hyperthyroidism
94
______ and _____ are used to monitor antiestrogen therapy and disorders of sex steroid metabolism
Estrone (E1) and Estradiol (E2)
95
Where are 3 places that produce progesterone? What can cause false progesterone readings?
Corpus luteum - significant production after ovulation Adrenal glands - progesterone converted to other steroids Placenta - primary secretor in pregnancy by end of 1st trimester high doses of biotin (>5 mg/d)
96
progesterone from the adrenal glands does not contribute to serum levels unless ______
a tumor is present
97
Of the following places, consider if FSH and LH would be high or low: Ovarian hypofunction/hypogonadism: Pituitary failure: Menopause: Hypothalamic failure: Castration: Precocious puberty: Pregnancy: Anorexia/malnutrition: Oral Contraceptives:
Ovarian hypofunction/hypogonadism - high Pituitary failure - low Menopause - high Hypothalamic failure - low Castration - high Precocious puberty - high Pregnancy - low Anorexia/malnutrition - low Oral Contraceptives- low
98
What is the main function of prolactin? What is it inhibited by?
initiation and maintenance of lactation Inhibited naturally by dopamine
99
**Most medication-induced rise in prolactin are modest, how do they compare to the ULN?
**2-4x ULN aka but NOT super super high
100
What are some s/s of hyperprolactinemia?
loss of libido, galactorrhea, infertility, decreased muscle mass, osteoporosis, impotence in men, oligomenorrhea or amenorrhea in women
101

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