womens' and mens Health Flashcards
(35 cards)
Risk factors of HPV
Early onset of sexual intercourse, multiple sexual partners, HPV infection, tobacco use.
Most cases of cervical CA have occurred with women who have not not been screened in over 5 years.
Prevention of HPV infection
HPV vaccines, using condoms all the time, Cervical cancer screening (pap smears), not smoking or quitting reduces the risk
Risk factors for acquiring cervical CA
Almost all cervical CA is caused by HPV.
Having HIV because it makes you immunocompromised.
Smoking.
Using birth control pills for more than 5 yrs
Having multiple partners.
When should pap smears be performed
Start at age 21
Screen every 3 years age 21 to 30
Use cytology only, do not test for HPV
Screen more frequently if high risk, includes women who:
have HIV, (at dx test q 6 months x 2, then annually if wnl)
are immunosuppressed,
were exposed to diethylstilbestrol (DES) in utero, or
have been treated for high grade precancerous cervical lesion or cervical cancer
Follow up of normal pap or ASCUS based on results of HPV testing
High Risk HPV has increased rate progression to cancer in women 30 and over even with normal cytology- recommend test for HPV genotype at age 30 and over*
High Risk HPV = 16 and 18 genotypes
HPV High Risk and NILM (negative for intraepithelial lesion) – refer colposcopy
HPV not High risk – repeat pap & HPV in 12 months
*If unable to do genotyping can repeat in 12 months, if still HPV positive or with ASC or higher refer for colposcopy
Terms of abnormal paps according to the Bethesda system
ASC- US Atypical squamous cells of undetermined significance
ASC–H cannot exclude high-grade squamous intraepithelial lesion
LGSIL – low grade
HGSIL – high grade
HGSIL – colposcopy and may need endocervical curetage (ECC) or loop electrosurgical excision (LEEP)
AGC Abnormal or Atypical Glandular Cells
ECC and may need endometrial biopsy and do HPV testing
Preconception counseling
Medications, OTC meds, herbal remedies
Educate re teratogenic agents: environmental exposures/etoh/drugs
Decrease caffeine to less than 200 mg day
Seafood recommendations …… Shark, king mackerel, tile fish, swordfish (these fish are high in mercury)
Folic acid -400 mcg/day supplements to prevent neural tube defects–
Vitamin D
Weight management – Ideal BMI 19.8 -26.0, exercise
Both under and overweight is concerning
Medical Issues DM, PKU, Asthma, Thyroid, Seizures, SLE, Depression
Labs – rubella/ varicella titres, Hep bSag,, CBC, HIV, STD’s
Detailed 3 generation (or more) Family History
Heritable Disease– refer genetic counseling
Indications for Genetic Counseling
Hereditary Disease in family Maternal age 35 or older Teratogen exposure Ethnic background associated with higher risk heritable disease (25 % of genetic background) Family history of birth defects Recurrent pregnancy loss
Screening only if…..
The disorder is very debilitating or lethal.
A reliable screening test is available.
The fetus can be treated, or reproductive options (abortion / elective sterilization) are available and acceptable to the parents.
Examples: Hemoglobin electrophoresis to test for sickle cell anemia & the thalassemias, DNA testing for Tay-Sachs disease and cystic fibrosis
Family History basics
Diseases that occur at an earlier age then expected (10-20 years before most people get the diseases)
Diseases in more than one close relative
Disease that does not usually affect a certain gender (e. g. Breast cancer in male)
Certain combination of diseases within a family (breast and ovarian cancer, or heart disease and diabetes)
Prevention of Osteoporosis
Non Pharmacological treatments
Adequate Calcium, Vitamin D and regular exercise (weight bearing and muscle strengthening)
Eating foods rich in CA at least 1200mg per day
Vit D 400 to 800 IU per day
Low-fat dairy products
Dark green leafy vegetables
Canned salmon or sardines with bones
Soy products, such as tofu
Calcium-fortified cereals and orange juice
Breast Cancer recommendations
USPSTF
Age 50 to 74: Biennial mammograms
Age 40 to 49: Individualized decision re: biennial mammograms
Age 75 and older: Insufficient evidence to make a recommendation re: mammograms
Do not recommend monthly self breast exams (SBE)
Insufficient evidence to recommend clinical breast exams (CBE)
Any risk breast cancer? Start annual mammogram at age 40
Breast cancer screening
Using guidelines individualize discussion
Any risks: start screening age 35 to 40
Age 40 discuss screening options
Continue to offer mammogram screening at age 40, advise re possibility of false positives
Teach SBE and breast awareness???
Do CBE annually?????
High Risk – use guidelines, consider referral
Ovarian Cancer screening
No effective screening exists – screening not recommended
Screening has not proven to decrease the death rate from the disease
Use pelvic U/S for adnexal masses
Use CA-125, a tumor marker, for postmenopausal women with an adnexal mass or for detecting relapse
Consider annual trans-vaginal pelvic ultrasound with CA-125 in high risk post menopausal women
Signs and symptoms of depression
Rarely is the chief complaint
Often associated with vague somatic complaints and with anxiety
May present with irritability and anger
Feelings of helplessness and hopelessness, Loss of interest in daily activities, Appetite or wt changes
Sleep changes, self loathing, reckless behavior, concentration problems, unexplained aches and pains
No universal screening for depression, but PHQ2 and PHQ9 are useful
Presentation of MI in women
About half of women with an MI present with chest pain.
More likely atypical symptoms: fatigue, sleep disturbance, shortness of breath, back pain, upper abdominal/epigastric pain, nausea with or without vomiting
Less likely to identify their signs and symptoms as those of a heart attack.
Nonchest-pain symptoms may be falsely identified as non-cardiac.
Average delay for treatment: 1 hour longer than men
after being educated about MI symptom presentation, women are more likely to be able to identify atypical MI symptoms.
Risk factors of COPD
Genes- alpha 1 antitrypsin deficiency
Exposures – tobacco (active and passive)occupational, pollution
Gender - mortality higher in men than women, but over past 20 years dramatic (185%) increase in women
Age
Respiratory infections
Socioeconomic status
Definition of COPD
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.
The more familiar terms ‘chronic bronchitis’ and ‘emphysema’ are no longer used, but are now included within the COPD diagnosis. COPD is not simply a “smoker’s cough” but an under-diagnosed, life-threatening lung disease
Diagnosis of COPD
A COPD diagnosis is confirmed by a simple test called spirometry, which measures how deeply a person can breathe and how fast air can move into and out of the lungs.
This diagnosis should be considered in any patient who has symptoms of cough, sputum production, or dyspnea (difficult or labored breathing), and/or a history of exposure to risk factors for the disease.
PFT finding of FEV1/FVC ratio less than 0.70 is diagnostic
Prevention of COPD
Stop smoking
Quitting smoking slows down the damage to the lungs
Avoid bad air……Air pollution , chemical fumes, dust
Get vaccines—– Flu vax, Pneumococcal, Pertussis
Stages of change
Pre-contemplation – raise doubts, increase perception of risks
Contemplation – evoke reasons to change, list risks of not changing
Preparation – help patient determine steps to take
Action – help patient take steps toward change
Maintenance – Help pt identify strategies to prevent relapse
Relapse – help pt avoid demoralization, discouragement, get back to action
Smoking Cessation, the use of The five “A’s”
Most smokers require multiple attempts before successfully quitting for good. Remind pts of this if they get discouraged in their efforts
Ask about tobacco use: Ask the pt at each visit about current tobacco use
Advise to quit through clear personalized messages
Assess willingness to quit: find out the pts thoughts about quitting and if pt is ready to proceed
Assist to quit: Including individual, group, telephone counseling and pharmacological treatment
Arrange follow-up and support
Definition and Risk factors for Alcohol Abuse
Maladaptive pattern of alcohol abuse, clinically significant impairment or distress with one or more of the following: in the past 12 months:
Failure to fulfill roles at work, school or home
Recurrent alcohol use in hazardous situations
Legal problems related to alcoholism EG DUI
Continued use despite alcohol-related social or interpersonal problems ( fights, relationship losses)
Male gender Younger age Single Lower income White or Native American Cumulative exposure to lifetime adverse events Military combat deployment Depression, anxiety, antisocial personality Smoking Substance abuse
Risk factors of ED
DM – 50% Metabolic syndrome CVD – htn, chd, lipidemia Lifestyle – alcohol, obesity, smoking, sedentary lifestyle (especially in men under 60) Depression Neurologic damage Pelvic or vascular surgery ?BPH Medications
