01 - 45 yo F annual exam Flashcards
at what age and how often should a clinical breast exam be performed?
part of a periodic health exam
- every 3 years for women in their 20s-30s
- every year for women 40 and over
what non-sexual factors are related to cervical cancer risk?
- diethylstilbesterol (DES) in utero
- cigarette smoking (strong correlation, 4x risk)
- immunosuppression
when should cervical cancer screening begin?
21
how often should cervical cancer screening be performed between age 21-29?
every 3 years
how often should cervical cancer screening be performed between age 30-65?
every 5 years if co-tested for HPV (preferred) or every 3 years with cytology alone (acceptable)
what are the cervical cancer screening guidelines for women over 65?
adequate screening is 3 consecutive normal pap tests with cytology alone or two normal pap tests if combined with HPV testing
what are the characteristics of a good screening test?
- accuracy
- able to detect disease in an asymptomatic phase
- minimal associated risk
- reasonable cost
- acceptable to patient
- have an available treatment
what are the USPSTF recommendations for lung cancer screening?
- annual screening with low dose CT in patients 55-80 who have smoked for 30 pack years
- must be currently smoking or have quit in the last 15 years
what are the ACS recommendations for breast cancer screening?
- women 40-44 have the choice for annual mammography if they wish
- women 45-54: annual mammogram
- women 55 and older: switch to mammogram every 2 years or choice to continue annual
what is the USPSTF recommendation for breast cancer screening?
biennial mammography 50-74 (grade B)
what are the breast cancer screening guidelines for women younger than 40?
not recommended unless high risk (eg BRCA)
what are the diagnostic tests for a breast lump?
- if it feels cystic: aspirate and cytology, FNA
- if it feels solid: mammography
- US to distinguish cystic vs solid
what are the menarche- and menopause-related risk factors for breast cancer?
menarche before age 12 or menopause after age 45
what are the hormonal risk factors for breast cancer?
- advanced age at first pregnancy
- exposure to DES
- hormone therapy
what are the Tdap recmomendations for adults?
Tdap should replace a single dose of Td for adults age 19-64 who have not received a dose of Tdap previously
when can menopause be confirmed?
only after a woman has not menstruated for 12 straight months
what is the hallmark of perimenopause?
menstrual irregularity
how much calcium do pre-menopausal women need? post-menopausal?
- pre-menopausal: 1000 mg daily
- post-menopausal: 1200 mg daily
what are the USPSTF recommendations for calcium and vitamin D supplementation in healthy pre- and post-menopausal women?
recommends AGAINST
what are the recommendations for osteoporosis screening in women younger and older than 65?
- under 65: use WHO risk assessment tool - screen with DEXA if risk of fracture is greater than or equal to that of a 65 year old white woman without additional risk factors (9.3% over 10 years)
- over 65: DEXA
what are the Bethesda system criteria for reporting cervical cytology?
- specimen adequacy: pap smear must contain over 5000 squamous cells and have sufficient endocervical cells
- general categorization of results: evidence of intraepithelial lesion or malignancy?
- interpretation: a) atypical squamous cell, b) low grade intraepithelial lesion (LSIL), c) high grade squamous intraepithelial lesion (HSIL), d) squamous cell carcinoma
what type of vaccine is Gardasil? what strains does it prevent against?
- quadrivalent recombinant DNA vaccine (HPV4)
- 6, 11, 16, 18
what type of vaccine is Cervarix? what strains does it prevent against?
- bivalent vaccine (HPV2)
- 16 and 18, 31, 45
what strains does Gardasil 9 prevent against?
6, 11, 16, 18, 31, 33, 45, 52, 58
what is the role of MRI in breast cancer screening?
- surveillance of women with more than 20% lifetime risk
- diagnostic tool to identify more completely the extent of disease in patients with a recent breast cancer diagnosis
- contrast enhanced MRI may be indicated in the evaluation of patients with breast augmentation
what is the role of US in breast cancer screening?
- not recommended for screening purposes
- used for evaluation of suspected abnormalities
