Women's Health

Question 1

Define menopause

Answer 1

Transition when ovaries stop releasing eggs, menstrual activity decreases and eventually ceases. Generally defined as 1 year without menstruation.

Question 2

Why would women with menopause experience dypareunia?

Answer 2

Vaginal walls become less elastic, thinner, and shorter. Also, secretions decrease and change consistency.

Question 3

For women, decrease in pelvic muscle tone can cause what?

Answer 3

Increase risk of prolapse: bladder, vaginal, and uterus

Increase risk of stress incontinence.

Question 4

Define endometriosis

Answer 4

Endometrial tissue becomes implanted outside the uterus.

Question 5

What is the pathogenesis of endometriosis?

Answer 5

Cause is unknown. Most common theory: menstrual blood containing endometrial cells is retrogradely flushed back through fallopian tubes into pelvic cavity.

Question 6

What are the key clinical signs of endometriosis?

Answer 6

1. Dysmenorrhea
2. Dyspareunia
3. Infertility

Question 7

What are your treatment options for Endometriosis?

Answer 7

There is no cure: medical goal is pain relief and preservation of fertility.

Pregnancy and menopause stop continued development but won’t stop current implants.

Question 8

Define endometrial cancer

Answer 8

Cancer of the uterine lining (endometrium)

Question 9

Name the risk factors for endometrial cancer.

Answer 9

1. Increasing age >60 y.o.
2. Obesity
3. Increased levels of estrogen
   * * 4. Inactivity! (women who exercise are less likley to develop than women who do not exercise)

Question 10

Define the clinical presentation for endometrial cancer

Answer 10

1. Abnormal bleeding: Vaginal bleeding 1 yr after menopause

2. Abdominal/ LE edema (lymphatic metastases)

Question 11

Define Cervical cancer

Answer 11

Cancer that forms in the cervix

Question 12

What is the primary cause of cervical cancer?

Answer 12

HPV (human papilloma virus)

Question 13

How does HPV affect cervical cancer?

Answer 13

HPV essentially turns off cells’ tumor-suppressing genes, allowing abnormal changes in cervical epithelium

Question 14

Describe the early stages and advanced stages of cervical cancer.

Answer 14

Early stages: Asymptomatic

Advanced stages: abnormal vaginal bleeding, bowel/ bladder problems

Question 15

Define ovarian cancer

Answer 15

Malignant neoplasm located on the ovaries

Question 16

What is the leading cause of death from gynecologic cancers and why?

Answer 16

Ovarian cancer, due to the fact that 60-70% of women have metastatic disease at the time of diagnosis

Question 17

How is ovarian cancer diagnosed?

Answer 17

There is no cost-effective screening test for ovarian cancer but pelvic examination may reveal ovarian or abdominal mass

Question 18

What are the risk factors for ovarian cancer?

Answer 18

1. Age > 40 yr
2. Nulliparity; women who never breast-feed
3. Family history of breast, ovarian, or colon CA
4. Personal history of breast or endometrial CA
5. Presence of mutation in BRCA1 or BRCA2 genes
6. Caucasian

Question 19

What should a PT note about ovarian cancer due to risk of recurrence?

Answer 19

PT should note any gait disturbances as that may be sign of paraneoplastic syndrome (PCD)

Question 20

Define Ectopic pregnancy

Answer 20

Implantation of a pregnancy in any location otehr than the uterus, often in a fallopian tube (tubal pregnancy)

Question 21

What are the risk factors for ectopic pregnancy?

Answer 21

1. STDs
2. Prior tubal surgery
3. Current use of intrauterine contraceptive device
4. Pelvic inflammatory disease
5. Previous ectopic pregnancy

Question 22

Describe the pathogenesis of ectopic pregnancy

Answer 22

It’s a delayed ovum transport due to decreased Fallopian tube motility. Fertilization and implantation occurs in the tube. Also, pregnancy outgrows blood supply. So pregnancy terminates with vaginal bleeding and possible rupture of Fallopian tube.

Question 23

How serious is a rupture of the Fallopian tube with an extopic pregnancy?

Answer 23

Rupture is a medical emergency due to rapid intra-abdominal hemorrhage. Women can go into shock with this.

Question 24

Describe the clinical presentation of ectopic pregnancy

Answer 24

1. Vaginal bleeding during menstrual period
2. Classic pain: sudden, sharp, stabbing
3. Pain may be gradual onset: low back, one or other hip and shoulder strap pain, especially with inspiration

Question 25

If the therapist suspects ectopic pregnancy, what type of referral is warranted?

Answer 25

An urgent referral is warranted because of this is a potentially life-threatening condition

Question 26

How is an ectopic pregnancy diagnosed?

Answer 26

1. A pelvic ultrasound: an empty uterus and presence of gestational sac in tube. 2. An elevated human chorionic gonadotropin (hCG) 3. Laparoscopy

Question 27

Define breast cancer

Answer 27

Malignant neoplasm of breast (in lobules or ducts)

Question 28

What is the most common cancer among women?

Answer 28

Breast cancer

Question 29

What are the risk factors for breast cancer?

Answer 29

1. Female sex & age >= 60 years 2. Young age at menarche ( < 12 years old = greatest risk) 3. Age at 1st live birth ( >35 years old = greatest risk) 4. First-degree relatives with breast CA increases risk 5. At least one abnormal biopsy 6. Mutation in BRCA1 or BRCA 2 genes 7. Being white 8. Long term use of BCPs or combined HRT 9. Physical inactivity 10. Weight gain later in life

Question 30

What is the most common site of metastases for breast cancer?

Answer 30

1. Bone 2. Lungs 3. Liver 4. Skin 5. Adrenal glands 6. Brain

Question 31

True or False? Estrogen likely initiates breast cancer disease, as well as promotes its progression.

Answer 31

False, it does not initiate the disease but rather promotes its progression.

Question 32

True or False? Estrogen does not initiate breast cancer disease, but promotes its progression.

Answer 32

True!

Question 33

What is the most common clinical presentation for breast cancer?

Answer 33

Palpable new lump or nodule in the breast.

Question 34

What areas are more common for lumps to appear in men and women with breast cancer?

Answer 34

In women: more likely in upper lateral quadrant In men: more likely behind areola

Question 35

Describe the clinical presentation for breast cancer

Answer 35

1. Palpable new lump or nodule 2. Breast changes: generalized swelling, skin irritation, nipple pain or retraction 3. Lymphadenopathy may be initial symptom 4. Later in course: UE edema, bone pain, weight loss, jaundice

Question 36

What is the difference in screening recommendations between the American Cancer Society and U.S. Preventative Services Task Force?

Answer 36

There's no recommendation of self-breast exam from the U.S. Preventative Services Task Force

Question 37

How frequent does metastases with breast cancer occur?

Answer 37

Most frequently within 2-3 years of initial diagnosis. | Hence, be ware of lump or NEW onset of edema in upper quadrant

Question 38

Why is exercise beneficial for individuals with breast cancer?

Answer 38

1. It has a protective effect against breast CA in pre- and post-menopausal women 2. It helps maintain functional ability and reduce fatigue in women with breast CA receiving chemotherapy 3. Moderate activity after diagnosis decreases risk of mortality due to breast CA 4. Prevents loss of ROM and adhesive capsulitis for women that experiences a chronic neuropathic syndrome called postmastectomy pain syndrome (PMPS)