Womens health Flashcards
(156 cards)
1
Q
What T score reflects a patient who has osteopenia?
A
Between -1.0 and -2.5
2
Q
What T-score reflects a patient with osteoporosis?
A
-2.5 or less
3
Q
When and what test screens for osteoporosis?
A
Age 65, DXA scan and if negative, repeat in 2-5 years. If positive, then repeat in 1-2 years.
4
Q
What tanner stage does breast development (breast buds) start?
A
Tanner stage II
It ends at stage V
5
Q
At what age do you start Pap smear?
A
21 years old and repeat every 3 years
6
Q
When is Pap smear and HPV co testing started?
A
Age 30 through 65 and repeat every 5 years.
7
Q
What is normal vaginal pH?
A
4.0-4.5
8
Q
What medication treats BV?
A
Metronidazole (Flagyl) BID for 7 days
9
Q
Strawberry cervix is indicative of?
A
Trichomonas
10
Q
What medication treats trichomonas?
A
Metronidazole (Flagyl) 2g POx 1 dose or 500mg BID for 7 days
11
Q
What is dyspareunia?
A
Pain during intercourse
12
Q
A disease of the skin in which white spots appear on the skin and change over time. This is usually found in the vaginal area.
A
Linchen sclerosis
13
Q
Sexually active female who has not had a period in 6 to 7 weeks complains of lower abdominal/pelvic pain or cramping. Pain worsens when supine or with jarring. If ruptured, pain worsens and can be referred to the right shoulder. Medical history of pelvic inflammatory disease, tubal ligation, or previous a topic pregnancy. Leading cause of death for women in the US in the first trimester of pregnancy.
A
Ectopic pregnancy
14
Q
Middle aged to older female with a dominant mass on one breast that feels hard and is irregular in shape. The mass is attached to the skin, surrounding breast tissue or is immobile. Among the most common locations are the upper outer quadrant of the breast i.e. the tail of Spence. Skin changes maybe seen such as Peau d’orange, dimpling, and retraction. Mass is painless or maybe accompanied by serous or bloody discharge. The nipple may be displaced or become fixed.
A
Dominant breast mass/breast cancer
15
Q
Older female reports a history of chronic scaly red colored rash resembling eczema on the nipple that does not heal. Some women complaining of itching. The skin lesion slowly enlarges and evolves to include crusting, alteration, and or bleeding on the nipple.
A
Paget’s Disease of the breast (ductal carcinoma in situ)
16
Q
Recent or acute onset of red, swollen, and warm area in the breast of a younger woman. Can mimic mastitis. Often there is no distinct lump on the affected breast. Symptoms develop quickly. The skin maybe pitted or appear bruised. More common and African-Americans. A rare but very aggressive form of breast cancer.
A
Inflammatory breast cancer
17
Q
Older woman with complaints of vague symptoms such as abdominal bloating and discomfort, low back pain, pelvic pain, urinary frequency, and constipation. By the time it is diagnosed, the cancer has already metastasized. If metastasis, symptoms depend on area affected. Symptoms maybe bone pain, abdominal pain, headache, blurred vision, others.
A
Ovarian cancer
18
Q
In what Tanner are stage does breast development start
A
Tanner stage two and ends at stage five
19
Q
Where is the majority of breast cancer located
A
The upper outer quadrant of the breasts called the tail of Spence
20
Q
What is the diagnostic test for breast cancer
A
Tissue biopsy
21
Q
Is a cervical ectropion benign
A
Yes. Adolescence have a large ectropion which is an immature cervix
22
Q
Patients with what condition have high androgen levels and multiple cysts on their ovaries which causes acne, hirsutism, and ogliomenorrhea
A
PCOS
23
Q
What is the diagnostic test for cervical cancer
A
Biopsy of the cervix
24
Q
When is the best time to perform a Pap test
A
Between 10 and 20 days after the last Menses
25
What should the patient avoid about two days before the pap test
Douching and vaginal foams/medication
26
When should a baseline Pap smear be done
Age 21 and repeat every three years
27
If a patient age to 20 or younger had an abnormal Pap smear of undetermined significance when should the pap be repeated
12 months
28
If the patient has an abnormal Pap of undetermined significance that is 21 years or older what should be done next
Order Pap smear with reflex HPVDNA testing. If Pap is abnormal, HPV strain testing is done automatically by the lab.
29
What types of HPV are oncogenic
Types 16 and 18. Referral for colposcopy and cervical biopsy
30
If A patient Pap smear had atypical glandular cells of undetermined significance what should be done next
Refer for endometrial biopsy
31
If a patient’s Pap results was a low-grade squamous intraepithelial lesion and high grade squamous epithelium lesion what should be done next
HPV Testing and refer for Colposcopy and biopsy
32
What are the two FDA approved vaccines that are very effective in preventing persistent infection with the oncogenic HPV strain
Gardasil and Cervarix
33
What is used to help with a diagnosis of fungal infection of the hair skin and nails
Potassium hydroxide slide
34
A test for BV. A positive result occurs when a strong fishlike owner is released after 1 to 2 drops of KOH are added to the slide
Whiff test
35
Used as an adjunct for evaluating herpatic infections i.e. oral, genital, skin. A positive smear will show large amounts of abnormal nuclei in the squamous epithelium cells not commonly used
Tzanck smear
36
What type of birth control pills are used for acne
Triphasic pills such as ortho Tri-Cyclen
37
Does a patient that takes an oral contraceptive need to follow up
Yes within 2 to 3 months to check blood pressure and for side effects and patients questions
38
How do you treat menstrual cramps
NSAIDs such as Alleve, naprosyn
39
What are possible causes of secondary dysmenorrhea
Endometriosis, PID, fibroids
40
What constitutes primary amenorrhea
Absence of menses by age 15, often secondary to dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. Refer to reproductive endocrinology.
41
What are the variables of secondary dysmenorrhea
Onset usually after age 25, abnormal uterine bleeding and, variable symptoms such as nausea, Vomiting, diarrhea, and back pain. Dyspareunia (pain during intercourse), symptoms often worsen over time. Causes are endometriosis, fibroids, PID or infection, adenomyosis
42
How do you manage dysmenorrhea
Get a good history both medical and menstrual. Physical exam to identify a cause. Pelvic exam may differ if young, not sexually active adolescents with mild symptoms. Consider a pelvic ultrasound to look for adnexal masses, fibroids, other pelvic pathology. If secondary, address underlying cause
43
How do you define a post menopausal woman
A woman that did not have her period for more than one year
44
What is the mnuemonic for abnormal uterine bleeding
```
P: polyps greater than 30 years
A: adenomyosis greater than 30 years
L: leiomyoma/fibroids greater than 30 years
M: malignancy/hyperplasia greater than 40 years, obesity, DM, PCOS greater than 50 years
C: coagulopathy any age
O: ovulatory dysfunction any age
E: endometrial disorders any age
I: iatrogenic medications any age
N: not classified
```
45
What drugs interact with oral contraceptives and will cause the patient to use an alternative form of birth control such as condoms when taking these drugs and for one pill cycle afterwards
Anticonvulsants such as phenobarbital and phenytoin, antifungal, certain antibiotics such as ampicillin, tetracycline, and rifampin. Saint Johns wort which may cause a breakthrough bleeding
46
Monthly hormonal cycle induces breast tissue to become engorged and painful. Symptoms occur two weeks before the onset of menses and are at their worst right before the menstrual cycle. Resolves after menses start. Commonly starts in women in their 30s.
Fibrocystic breast
47
Adults to middle aged woman complains of the cyclic onset of bilateral breast tenderness and breast lumps that start from a few days before her period For many years. Once menstruation starts, the tenderness disappears and the size of the breast lumps decrease. During breast examination, the breast lumps are tender and feel rubbery, and are mobile to touch. Denies dominant mass, skin changes, nipple discharge, or enlarged nodes
Fibrocystic breast
48
What is the treatment plan for fibrocystic breast
Stop caffeine intake. Vitamin E and evening prime rose capsules daily. Wear bras with good support. Must refer if the patient has a dominant mass, skin changes, or fixed mass
49
What are some risks and complications of PCOS
Endometrial cancer, infertility, diabetes, metabolic syndrome, obesity, cardiovascular disease, and hyperlipidemia.
50
Signs and symptoms include ogliomenorrhea, amenorrhea, hyperandrogenism i.e. acne, hirsutism, cystic ovaries, infertility, mental health issues. Patient Can skip months of period. It takes two years to have a solid, healthy menstrual period established. These patients need to have babies earlier in life.
PCOS
51
Insulin resistance is the pathophysiology of
PCOS
52
How do you diagnose polycystic ovarian syndrome
Rotterdam criteria which is two of three:
Oligomenorrhea
Hyperandrogenism
Cystic ovaries
53
Complications associated with PCOS include
Uterine/endometrial cancer, diabetes, cardiovascular disease, infertility
54
Acne, hirsutism, alopecia, acanthosis nigricans, amenorrhea, oligomenorrhea, infertility, hyperinsulinemia and mood disorders in adults are all symptoms of
PCOS
55
What is the PCOS diagnostic work up and differential
Bodyweight, BMI greater than 30, waste greater than 35 inches, blood pressure, ultrasound of ovaries/uterus hyperplasia greater than 10 mm, CBC, lipid’s low HDL, high trigs/LDL, LFTs, TSH, oral glucose tolerance hemoglobin A-1 C DM=>6.4 at risk => or equal to 5.6-6.4, total testosterone for PCOS =>60, tumor > 200, free T for PCOS = 2-3, pregnancy 🤰 test hcg, prolactin 3-27ng/ml consider DHEA-S, LH/FSH ratio >3, but may be normal in PCOS
56
How do you manage a patient with PCOS
Discuss fertility planning, FastTrack fertility, letrozole preferred, not clomid,
57
What are problems associated with PCOS
Infertility and 40% of females, spontaneous abortion, gestational diabetes, preeclampsia/hypertension
58
What are lifestyle modifications for PCOS patients
Weight loss greater than 5%, exercise and stress reduction
59
If a patient with PCOS does not desire pregnancy how are they managed
Combination hormonal contraceptives, low androgen progestins are safer i.e. Levonorgestrel, Norethindrone, Norgestimate which helps androgen symptoms and prevents uterine cancer. Metformin
60
How is cervical cancer develops
Persistent HPV infection over many years
61
When should HPV vaccination be given
Give prior to onset of sexual activity i.e. coitarche. This is the age of first penile vaginal sex. Give routinely at 9 to 12 years for boys and girls in three injections spaced out at the first month, then second month, then six months.If Series is incomplete, finished with new vaccine. May benefit if greater than 26 years old but no recommendations yet
62
What are the screening guidelines for cervical cancer screening age greater than 30
Pap and HPV is the primary screening. Repeat every five years if both negative. Pap only every three years.
63
What is the cervical cancer screening guidelines for age 65 and over
May stop if negative history times 10 years
64
What are the cervical cancer screening guidelines after a hysterectomy
For benign disease it can be discontinued. If not benign, three annual negative tests then discontinue ACS. Ongoing screening for 20 years even if older than 65
65
What are the guidelines for ASC (atypical squamous cells) for ages 21-24
Watch and wait. Repeat pap at 12 mos. if negative, routine screening. If positive then refer for colposcopy.
66
What are the guidelines of ASC-US age over 24
Reflex HPV and if positive refer for colposcopy
67
What are the guidelines if a patient is found to have ASC-H
Colposcopy for all
68
What are risk factors for bacterial vaginosis
New sexual partner, not using condoms, douching, copper are you see which can throw off the vaginal flora
69
Itching, burning, dysuria, vaginal pH of 4.0 to 4.6, negative with test, and buds and pseudohyphae on KOH
VV Candidiasis
70
Malodorous discharge, pH of the vagina is greater than 4.6 with a positive whiff test
BV
71
Malodorous discharge, dysuria, vaginal pH of 5.0 to 6.0, positive or negative with test
Trich
72
If a patient has recurrent used infections what should they be screened for
Diabetes, pregnancy test, HIV
73
If a patient is on Diflucan or vaginal medication, what must they do for precaution
Delay sexual intercourse until symptoms improve
74
What treatment for Vulvovaginal candidiasis relieve symptoms most rapidly
Topical antifungal
75
What is a male yeast infection
Balanitis
76
If a patient is on an antibiotic and is prone to yeast infections what should be recommended
daily yogurt or lactobacillus pills
77
Does a sexual partner need to be treated for BV
No because it’s not a sexually transmitted disease
78
What population with BV are at a higher risk for injury uterine infection and premature labor
Pregnant women
79
If a what’s near shows clue cells and very few white blood cells what must be considered
BV
80
What is the normal vaginal pH
4.0 to 4.5
81
What is considered an alkaline vaginal pH
Greater than 4.5
82
How do you treat BV
Flagyl or metronidazole b.i.d. for seven days. Do not drink alcohol while on this medication. Abstain from sexual intercourse until treatment is done
83
Uni cellular protozoan parasite with flagella that infects genitourinary tissue in both males and females. Infection causes inflammation, itching, burning of the vagina/urethra
Trichomonas
84
Adult female complains of very pruitic, reddened Vulvovaginal vaginal area. May complain of dysuria. Copious grayish green and bubbly vaginal discharge. Most males and sex partners may have symptoms urethritis or maybe asymptomatic
Trichomonas
85
When strawberry cervix is found from small points of bleeding on cervical surface with a swollen and vulvar and vaginal area with a vaginal pH of greater than 5.0 what must be considered
Trichomonas
86
Microscopic shows mobile Uni cellular organisms with flagella and large amount of white blood cells
Trichomonas
87
How do you treat trichomonas
Flagyl or metronidazole to grams PO or 500 mg b.i.d. for seven days. Treat sexual partner. Avoid sex until both partners complete treatment.
88
This occurs in postmenopausal women and they show nonspecific signs and symptoms such as watery, yellow or white, malodorous vaginal discharge
Atrophic vaginitis
89
Vaginal irritation or burning, dyspareunia or pain with intercourse, urinary tract symptoms, thinning of vaginal epithelium, loss of elasticity, loss of Rugae, vaginal pH greater than or equal to five is consistent with
Atrophic vaginitis
90
What is the treatment for atrophic vaginitis
Estrogen PV, Osphena as an alternative to estrogen, DHEA PV
91
A 60-year-old woman has begun to have a small amount of blood escaping from the vagina. What is the most common cause of malignancy when is One found?
Endometrial cancer
92
Atrophic vaginitis occurs due to
Lack of estrogen and estrogen dependent tissue of the urogenital tract and results in atrophic changes in the vulva and vagina of menopausal women.
93
Disease of low bone mass with micro architectural disruption
Osteoporosis
94
What are risk factors for osteoporosis
Caucasian/Asian, family history, advanced age, previous fracture, long-term glucocorticoid therapy, low bodyweight less than 127 pounds, cigarette smoking, excess alcohol and
95
What is a T score reflects osteoporosis
-2.5 or less
96
What is a T score that reflects osteopenia
Between -1.0 & -2.5
97
How do you screen for osteoporosis and at what age
Screening starts at age 65 and the screening choice is a DEXA scan. Screening that recommended pre-menopause unless risk factors present
98
How do you manage osteoporosis
Weight bearing exercise, stop cigarette smoking, stop excess alcohol, avoid cortical steroids and anti-convulsant is one possible, take calcium daily at 1200 mg a day plus if vitamin D deficient replace with vitamin D3. The preferred calcium choice is food
99
What medications can be prescribed for osteoporosis
Oral by phosphonate’s are considered first line for most patients because they inhibit bone resolution and it remains active in the bone for weeks, months and maybe years. It also increases bone mass and reduces risk of fracture.
Alendronate (Fosamax) weekly
Risendronate (Actonel) weekly
Ibandronate (Bonita) monthly. Does not avoid hip fracture risk
These medications need to be taken for 5 years to prevent fracture.
100
What are the most common breast masses
Fibroadenomas and cysts. Benign complaints can mimic breast cancer. Refer to breast specialist
101
What are the diagnostic studies for breast masses
Ultrasound for any female/male less than 30 years, with focal mass or symptom. First line in pregnancy or less than 30 years. To assess mass identified on mammogram
102
What is a diagnostic test for any female or male greater than 30 with a breast complaint
Mammogram
103
What is the value of a breast ultrasound
Differentiates fluid filled cyst from solid mass
104
85% of breast cancer occurs in women that are what age
Greater than 50 years
105
What are risk factors for breast cancer
Gender and age especially greater than 65 years, genetic predisposition BRCA one, to genetic mutation, obesity, family history, reproductive history of low parity, estrogen exposure with early menarche less than 12 years, late menopause greater than 55 years, estrogen medications
106
What is screening for average risk patients for breast cancer
Mammogram start at age 45. May begin aged 40-44. Then yearly. At age 55+, screen every 2 years. Yearly screening may be offered. Clinical and self breast exam not recommended
107
What is a great option for contraception for all ages with fewer contra indications
Long acting reversible contraceptives such as ParaGard, Mirena, Skyla
108
Patients with gastric bypass, celiac disease, hyperthyroidism, ankylosing spondylitis, rheumatoid arthritis and others are at risk for
Osteoporosis
109
Low calcium intake, vitamin D deficiency, in adequate physical activity, alcoholic, high caffeine intake, and smoking are lifestyle risk factors for
Osteoporosis
110
When should a DEXA scan be repeated
You do a baseline scan and repeat in 1 to 2 years if on a treatment regimen in order to assess the efficacy of the medication. It’s not on treatment, repeat DEXA into 2-five years
111
What can biphosphonates cause as an adverse reaction
Esophagitis, esophageal perforation, gastric ulcers, reactivation/bleeding peptic ulcer disease. Patients need to report sore throat, dysphasia, or Midsternal pain immediately
112
When is the best time to take a biphosphonate
Take immediately upon awakening in the morning with a full glass of plain water. Take tablet sitting or standing and wait at least 30 minutes before laying down. Do not crash, split, or two tablets. Swallow the tablets whole. Never take these drugs with other medications such as juice, coffee, antacids, vitamins.
113
what are contraindications for biphosphonates
Inability to sit upright, esophageal motility disorder’s, history of peptic ulcer disease or history of gastrointestinal bleeding
114
If I doses of biphosphonate are given what can happen
Osteonecrosis of the jaw more likely if on IM dose. Watch for complaints of Jaw heaviness, pain, swelling, and loose teeth
115
Squamous epithelium cells that have blurred edges due to the number of bacteria on the cell surface is consistent with what
Clue cells in BV
116
If a patient has a hard irregular mass that is not mobile on the breast what must be for what must be ruled out
Breast cancer
117
What type of medication can elevate total T4 levels and triglycerides/lipids
Birth control pills
118
In reproductive aged teens and women who present with acute pelvic pain or Lower abdominal pain what test must always be performed
Pregnancy test
119
A 28 year-old female presents with a slightly tender 1.5 cm lump in her right breast. She noticed it 2 today’s ago. She has no associated lymphadenopathy and there is no nipple discharge. How should she be managed
Re-examination after her next menses
120
A 22-year-old female has been diagnosed with PCOS. What is a common finding
Elevated insulin levels
121
A 22-year-old female states that she has multiple sexual partners and in consistently uses barrier protection. Which form of birth control should the nurse practitioner avoid prescribing in this patient
Intrauterine device because when a patient has multiple sexual partners they are at an increased risk for PID
122
What hormone increases during menopause
Follicle-stimulating hormone
123
A female should be told to take her oral contraceptive pill at bedtime if she experiences
Nausea
124
A patient who takes oral contraceptive pills is at an increased risk of
Gallbladder disease
125
Hot flashes that occurred during menopause are thought to be related to
Fluctuating estrogen levels
126
Does ovarian cancer present with postmenopausal bleeding
No
127
At what age are Pap smears discontinued in women
After the age of 65
128
What is the diagnostic test of choice to differentiate a solid from a fluid filled breast mass
Ultrasound
129
To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and
Palpate upward to just lateral to the pubic tubercle’s
130
The most common causes of sexual problems in females are related to
Psychosocial factors
131
When performing a vaginal exam with a speculum, the use of the upper blade as of a tractor could expose a
Rectocele
132
Upon examination of the cervix, and an irregular Cauliflower like growth was noted around the cervical os.This finding is most suggestive of
Carcinoma of the cervix
133
A female patient presents with a profuse, yellowish, green discharge that is malodorous. The vaginal discharge is most consistent with
Trichomonas
134
If urethritis or inflammation of the para urethral glands is expected in a female patient, the index finger should be inserted into the vagina and
Milk the urethra gently from the inside outward
135
Upon examination of the vagina, a small, red, benign tumor is noted at the posterior part of the urethral meatus. This finding is consistent with a
Urethral caruncle
136
Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a
Cystourethrocele
137
Chronic pelvic pain refers to pain that does not respond to therapy and lasts more than how many months
Six months
138
When examining the cervix, a translucent nodule is noted on the cervical surface. This finding is consistent with
A retention cyst
139
When performing a rectal exam on a female, a hard nodular rectal shelf is palpable at the tip of the examiners finger. This finding is suggestive of
Metastatic tissue in the rectouterine pouch
140
Examination of a female patients right breast reveals a retraction of the nipple and areola. This finding is consistent with
Breast cancer
141
If performed correctly and in a timely fashion, what is the most it definitive for the diagnosis of breast cancer. Diagnostic test
Breast tissue sample
142
The vaginal mucosa lies in transverse folds called the
Rugae
143
When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a
Cystocele
144
Can a female diagnosed with a 2nd° uterine prolapse, the cervix is located
In the introit us
145
Retraction of the nipple and areola suggest
An underlying breast mass
146
Postcoital bleeding suggests
Cervical cancer
147
The deep red area located around the cervical os is known as
The columnnar epithelium
148
Uterine enlargement may suggest
Pregnancy, uterine myoma’s or fibroids, or malignancy
149
The most common type of hernia in a woman is the
Indirect inguinal hernia
150
A 22-year-old patient has a single, nontender, freely movable lump in her right breast. She denies any nipple discharge. Which of the following diagnoses is the clinical presentation most consistent with
Fibroadenoma
151
In comparing sensitivity to specificity, sensitivity refers to a
True positive
152
Can a woman taking calcium take it with milk
No
153
Does weight loss reduce osteoporosis risk
No
154
Why is it important that a post menopausal woman with an intact uterus receive combined estrogen – progestin hormone replacement therapy rather than estrogen alone
Prolonged use of unopposed estrogen’s increases the risk of endometrial cancer
155
A 50-year-old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis
Endometrial cancer
156
Hormone replacement therapy is related to an increased risk of
Stroke
