43: Nonhormonal and Preventative Health

Question 1

Reproductive Tract overview

Question 2

Menstrual Cycle phases

Answer 2

-follicular (menses -> ovulation)
-luteal (ovulation –> menses)

Question 3

Follicular phase

Answer 3

-menses to ovulation

Question 4

luteal phase

Answer 4

ovulation to menses

Question 5

ovulation mech

Answer 5

-drop in estrogen
-LH surge
-release of matured follicle

Question 6

Preventative Health

Answer 6

-annual exam (vital, breast, pelvic screening)

Question 7

breast exam for avg risk women

Answer 7

-self/clinical exam
-mammogram (start at 40-50 until 75 every 1-2 years)

Question 8

breast exam for HIGH risk women

Answer 8

-BRCA1/2 mutations
-breast MRI and mammogram ANNUALLY (start at age 30)

Question 9

Pelvic Exam screens for

Answer 9

-STI
-gyno cancers
-pelvic inflammatory disease
-ovarian cysts, polyps, fibroids

Question 10

Pelvic exam components

Answer 10

-assess external genitalia
-internal speculum exam or recto vaginal exam

Question 11

Pelvic exam recommendations

Answer 11

-not really for asymptomatic patients
-performed when indicated by medical history or symptoms

Question 12

Cervical Screening (PAP smear)

Answer 12

-swab inserted into vagina to collect cells

Question 13

Cervical Screening recommendations

Question 14

What groups don’t really need cervical screening?

Answer 14

-under 21 years
-over 65 years w normal prior screenings
-hysterectomy w cervix removal

Question 15

Cervical Screening recommendations age 21-29

Answer 15

-Pap smear every 3 years

Question 16

Cervical screening recommendations for 30-65 years

Answer 16

-choose one:

-pap every 3 years
-HPV test every 3 years
-PAP and HPV every 5 years

Question 17

big takeaway of cervical screenings

Answer 17

-age 21-29 start
-every 3 years

Question 18

most common STI in US

Answer 18

-HPV

Question 19

HPV (human papillomavirus)

Answer 19

->150 viruses
-42.5% of adults 18-59
-warts (papilloma) but also asymptomatic

Question 20

HPV genital warts may lead to

Answer 20

-inc risk of multiple cancers

Question 21

HPV transmission

Answer 21

-skin-to-skin contaact
-vaginal, anal, oral sex

Question 22

HPV-associated cancers in women

Answer 22

-Cervix (most)
-Vagina
-Vulva
-Anus (most)
-Oropharynx

Question 23

HPV-associated cancers in men

Answer 23

-penis
-anus (most)
-oropharynx

Question 24

HPV prevention

Answer 24

-barrier protection
-mutual monogamy
-male circumcision
-HPV screening
-vax

Question 25

HPV screening for pts w cervix

Answer 25

-follow recommended cervical screening guidelines

Question 26

HPV screening for pts w penis

Answer 26

-no recommended routine screening -high risk pt may benefit from anal PAP smear

Question 27

patients w penis at higher risk of HPV include

Answer 27

-men who have sex w men -HIV+ men

Question 28

HPV vax

Answer 28

-Gardasil 9 -Cervarix and Gardasil discontinued

Question 29

Gardasil 9 indication

Answer 29

-HPV vax against 9 strains -males and females age 9-45 -recommended to start. 9-11 years old

Question 30

Gardasil 9 admin schedule

Answer 30

-if UNDER 15: 2 doses -if OVER 15: 3 doses

Question 31

Gardasil 9 admin in <15yo

Answer 31

-2 doses -0 months -6-12 months

Question 32

Gardasil 9 admin in >15yo

Answer 32

-3 doses -0 month -2 month -6 month

Question 33

Gardasil 9 vax efficacy in ages 19-26

Answer 33

-98-100% prevention of HPV-cancers in females ~75% in males

Question 34

Gardasil 9 vax efficacy in ages 27-45

Answer 34

-88-95% -slightly less effective -provides less benefit after exposure!

Question 35

Gardasil 9 side effects

Answer 35

-injection site reactions -dizzy/fatigue -headache -syncope -vomitting -myalgia

Question 36

Patient Case: -19 y/o F -only received one dose of Gardasil at age 16 How many additional doses should she receive to complete series

Answer 36

-2 more doses -3 dose series bc she started after age 15

Question 37

Role of provider

Answer 37

-educate about HPV risk -give recs -utilize standing orders -process and monitor for follow up

Question 38

Non-hormonal contraception

Answer 38

-

Question 39

Stats of contraception

Answer 39

-65% of women aged 15-49 are on contraception

Question 40

Reasons for non-hormonal contraception

Answer 40

-back up hormonal method -side effects/contraindications -no need for ongoing contraceptives -no alteration to body's natural cycle

Question 41

Behavioral Contraceptive methods

Answer 41

-Coitus interuptus (withdrawal) -Lactation Amenorrhea Method (LAM) -Fertility Awareness Methods (FAM) -Natural Family Planning (NFP)

Question 42

FAM + NFP methods

Answer 42

-Basal Body Temp (BBT) -Billings Ovulation Method -Calander/Rhythym method -standard days method -two-day method

Question 43

Basal Body Temp (BBT)

Answer 43

-predict ovulation -regular cycles -take temp every morning -record in chart

Question 44

BBT change that signifies ovulation

Answer 44

-slight drop in temp followed by large inc in temp (1 degree)

Question 45

Billing Ovulation method

Answer 45

-monitor cervical mucus -clearer,thinner mucus is fertile -irregular cycles

Question 46

cervical mucus during fertility

Answer 46

-clearer -thinner

Question 47

Calander/rhythym method

Answer 47

-based on past cycles -Fertile days = shortest cycle -18 days and longest cycle - 11 days

Question 48

Standard days method

Answer 48

-26-32 day cycle -move rubber band around colored beads like a calander

Question 49

2-day method

Answer 49

-cervical secretions -pregnancy UNLIKELY if no secretions for 2 days

Question 50

FAM + NFP monitoring

Answer 50

-sympothermal -electronic (detect LH) -marquette

Question 51

Natural Cycles App

Answer 51

-first app approved by FDA for contraception -based on BBT and cycle data -App will prompt use to use protection on fertility days -1-7% failure rate

Question 52

Advantages to FAM and NFP

Answer 52

-no effect on hormones/cycle -no side effects -inexpensive/free -culturally acceptable

Question 53

Disadvantages to FAM +NFP

Answer 53

-no STI protection -hard for irregular cycles -consistent montioring -requires abstinence/back up contraception

Question 54

Barrier methods

Answer 54

-prevent sperm from entering uterus -fewer side effects but less efficacy

Question 55

Barrier devices

Answer 55

-condoms -vaginal sponge -diaphragm -cervical cap -gel/spermicide

Question 56

Long-term non-hormonal birth control

Answer 56

-Copper IUD -sterilization

Question 57

Copper IUD

Answer 57

-up to 10 years -can be used as emergency -inserted and removed by HCP -copper is spermicide -no STI prevention

Question 58

IUD side effects

Answer 58

-heavy bleeding -spotting

Question 59

Sterilization

Answer 59

-male vasectomy -tubal ligation

Question 60

Contraception efficacy

Answer 60

1. implant, IUD, sterilization 2. injection, pill, patch, ring, diaphragm 3. condom, sponge 4. FAM and spermicide

Question 61

pt case wants to try effective non-hormonal but wants children later

Answer 61

-copper IUD