A&P2 Final Exam Flashcards
What condition is characterized by unilateral localized pain that is sharp or burning and occurs frequently in women 40 years and older?
Noncyclic mastalgia
Is noncyclic mastalgia a sign of breast cancer?
Rarely
Define mastalgia
Breast pain
When during a woman’s cycle is mastalgia common?
Premenstrual
What is a common breast change in women with mastalgia?
Fibrocystic
What is the first line treatment for mastalgia?
Reassurance
What are 5 treatments for mastalgia?
Supportive bra, modify dose or route of hormone therapy, different contraceptive method or delivery system, topical use of NSAID, herbal products
Give 3 examples of nipple discharge
Normal lactation
Galactorrhea unrelated to child bearing
Non milky discharge
Describe non milky nipple discharge
spontaneous
unilateral
from single duct
clear or bloody in color
likely associated with cancer
What are common causes of benign non milky nipple discharge
Intraductal papilloma/mammary duct ectasia
Is Galactorrhea caused by breast pathology?
No
If your patient presents with nipple discharge what other medical condition would you ask about?
Hypothyroidism
Are STI’s in women more frequently asymptomatic or symptomatic?
Asymptomatic
Which age group has the highest prevalence rates of STI’s?
Adolescence
What age group are more susceptible to cervical infections
Female adolescence and young women
What is the most common STI in the US?
HPV
What causes genital warts and cervical cancer?
HPV
What are 5 symptoms of HPV?
Perfuse irritating vaginal discharge
Itching
Dyspareunia (painful intercourse)
Post coital bleeding (after sexual intercourse)
Bumps (warts)
What prevents HPV?
Vaccination
What STI is characterized by a painful vesicular eruption of skin and mucosa of genitals?
Genital Herpes
What is the cure for genital herpes?
There is no cure however systemic antiviral drugs partially control symptoms
What are the 2 types of genital herpes and how are they transmitted?
HSV 1 - non-sexually or oral to genital contact
HSV 2 - transmitted sexually
What is a bacterial infection of the GU tract caused by gram negative bacteria?
Chancroid
What is a parasitic infection caused by lice?
pediculosis pubis
What STI is caused by anaerobic one-celled protozoan and is found in the vagina in women and urethra in men?
Trichomoniasis
What is the most commonly reported Bacterial STI?
Chlamydia
What are 2 risk factors of chlamydia?
Multiple sex partners
Failure to use barrier methods of contraception
What is a serious complication of chlamydia and gonorrhea?
PID (pelvic inflammatory disease)
What STI is caused by aerobic gram negative diplococcus?
Gonorrhea
What are 2 risk factors of gonorrhea?
Early onset of sexual activity
Multiple sex partners
What female conditions are included in PID (pelvic inflammatory disease) either alone or a combination of?
Endometritis
Salpingitis
Tubo-ovarian abscess
Pelvic peritonitis
What is a common condition seen with PID (pelvic inflammatory disease)
Bacterial Vaginosis
What are 6 major medical complications with PID (pelvic inflammatory disease)
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome
Chronic pelvic and abdominal pain
Increased risk of ectopic pregnancy
Infertility
Recurring PID
What is the cause of the systemic disease Syphilis?
Motile spirochete
Is syphilis only seen in the genital area?
No, it can effect any tissue or organ in the body.
Name the 3 periods of syphilis and describe each one
Primary - presence of chancre
Secondary - rash on palms of hands and soles of feet (can also be across the knees)
Latent - if untreated is asymptomatic and may develop tertiary syphilis
A blood born pathogen transmitted by percutaneous or mucosal exposure to infectious blood or body fluids.
Hepatitis B (HBV)
How long can hepatitis B survive outside the body?
7 days
What is the most common chronic blood born infection in the US?
Hepatitis C
Which form of hepatitis has a higher rate among IV drug users?
Hepatitis C
Which type of Hepatits is the leading cause of liver transplant in the US?
Hepatitis C
In HIV how does the virus effect the CD4 cells?
The number of cells are depleted
Function of remaining cells are impaired
Gradual loss of immune function
What are the 6 classifications of antiretroviral therapy (ART) to treat HIV?
Nucleoside reverse transcriptase inhibitors (NRTIs)
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
Protease Inhibitors (PIs)
Fusion Inhibitors (FIs)
CCR5 Antagonists
Integrase Strand Transfer Inhibitors (INSTIs)
What 4 STIs should all women be screened for at the first prenatal visit?
HIV
Syphilis
Hepatitis B surface antigen
Chlamydia (C. trachomatis)
What bacteria is responsible for 50% of UTIs in women.
E. coli
Name 3 reasons why a woman’s anatomy is susceptible to UTI’s?
A short urethra
Short distance between the urethra and anus
A perineal environment is moist which encourages migration of bacteria from rectum to urethra
What are three types of UTIs?
Asymptomatic Bacteriuria
Cystitis
Pyelonephritis
Which type of UTI presents w/o symptoms but culture shows bacteria in urine?
Asymptomatic Bacteriuria
In cystitis what parts of the GU system are involved?
Bladder and urethra
Name 3 negative findings in a patient with cystitis
No fever
No CVA tenderness
No flank pain
What are patient complaints with cystitis?
Dysuria with urinary frequency and urgency
What are 4 patient populations that are classified as complicated bacterial cystitis
Pregnant women
Recent antibiotics
Previous UTI within the last 6 months pr
Or decrease immunity
What part of the GU system is affected in pyelonephritis?
It involves one or both kidneys
Name the 5 symptoms of pyelonephritis
Fever
Chills
Back pain
CVA tenderness
Flank pain
What type of patient symptoms were classified as a complicated pyelonephritis?
Pregnancy
Vomiting
hypertensive
immunodeficient
True or false hospitalization should be considered for a patient being treated for complicated polynephritis.
True
Follicular phase (or proliferative phase)
Days 1 - 14
Each month, follicle-stimulating hormone (FSH) is produced by the anterior pituitary. FSH stimulates the maturation of the follicles in a woman’s ovary. Estrogen is produced by the developing follicles (or the “eggs”). Estrogen is the predominant hormone during the first 2 weeks of the menstrual cycle. It stimulates the development and growth of the endometrial lining.
Ovulatory phase
Day 14 (of a 28 day cycle)
Luteinizing hormone (LH) is secreted by the anterior pituitary gland, which induces ovulation and the maturation of the dominant follicle on day 14 (of a 28-day cycle). The follicle migrates to the fimbriae of the fallopian tube. It takes about 5 days for the egg to move through the fallopian tube, where conception can take place.
Luteal phase
Days 14 - 28
Progesterone is the predominant hormone during the last 2 weeks of the cycle. It is produced by the corpus luteum and helps to stabilize the endometrial lining
Menstruation
If not pregnant, both estrogen and progesterone fall drastically, inducing menses. Low hormone levels stimulate the hypothalamus and then the anterior pituitary (FSH), and the cycle starts again.
Best time to perform a Pap test
at least 5 days after period stops
What 4 things should the patient avoid for 3 - 5 days before a Pap test?
Douching, vaginal foams/medicines, tampon use, and vaginal intercourse
US Preventative Task Force Cervical Cancer Screening Guidelines for ages 21 - 29
Liquid-based cytology or conventional Pap test every 3 years
US Preventative Task Force Cervical Cancer Screening Guidelines for ages 30 - 65
Liquid-based cytolog
or
Conventional Pap smear
or
Liquid-based cytology plus cotesting (for high-risk HPV)
every 3 years or every 5 if cotesting (if not cotesting, needs Pap every 3 years)
*cotesting = also testing for HPV
US Preventative Task Force Cervical Cancer Screening Guidelines for those over 65 or for those with history of hysterectomy with cervical removal (not due to cancer)
Can stop screening if not otherwise at high risk for cervical cancer
Pap/cytology and HPV testing are NOT recommended before age 21 years, even if sexually active, or if the person has an STD or sexually transmitted infection (STI) or has multiple sex partners. (True or False?)
True
Should you be able to palpate an ovary?
Being able to palpate an ovary would be considered abnormal. Next, you would want to rule out ovarian cancer and order an intravaginal ultrasound.
What is the treatment for BV?
Flagyl 500mg PO BID x 7 days or Flagyl vaginal cream 0.75% 1 applicator vaginally nightly for 5-7 days
Or
Clindamycin cream 2% nightly 5-7 days
Last resort would be clindamycin 300 mg po BID x 7 days.
What is the pH in BV, trich or atrophic vaginitis?
> 4.5
In diagnosing BV, what is seen on microscopy?
Clue Cells
How does atrophic vaginitis present?
Thin, dry, pale mucosa
What is the treatment of the female UTI?
Bactrim DS 1 tab PO BID x 3 days or Macrobid 100mg PO BID x 5 days.
After how many UTIs would you refer your patient to the urologist?
3 infections in a 6 month period
What is the most common pathogen in female UTIs?
E. coli
First line treatment for Chlamydia is?
Doxycycline 100 mg BID x 7 days
In women the most common pathogen that causes Bartholin gland abscess is?
Chlamydia
What is the recommended treatment for Chancroid?
Zithromax 1 gram x 1 dose or
Ceftriaxone 250 mg IM in a single dose
What is the recommended treatment for genital herpes?
1st outbreak - Acyclovir 400 mg TID x 7-10 days
2nd. outbreak - Acyclovir 400 mg TID x 5 days
3rd. outbreak - Suppressive therapy Acyclovir 400 mg BID x 1 year
What is the recommended treatment for gonorrhea?
Ceftriaxone 500 mg IM x 1 dose
What is the recommended treatment for pelvic inflammatory disease (PID)?
Ceftriaxone 500 mg IM x 1 plus
Doxycycline 100 mg PO BID x 14 days with
Flagyl 500 mg PO BID x 14 days
What is the recommended treatment for primary, secondary, and early latent syphilis?
Benzathine penicillin G 2.4 million units IM x 1
What is the recommended treatment for late latent and tertiary syphilis?
Benzathine penicillin G 2.4 million units IM x 3 doses q week
What is the recommended treatment for Cystitis (uncomplicated UTI)?
Bactrim DS 160/80 BID x 3 days or
Macrobid 100 mg BID x 5 days
What is the recommended treatment for Pyelonephritis?
Ciprofloxacin 500 mg PO BID x 7 days or
Levaquin 750 mg PO once a day x 7 days
Fibrocystic breast changes (previously called fibrocystic breast disease) is/are a very common condition found in reproductive-aged women between the ages of 30 and 50 (True or False)
True
Nonmalignant breast lesions- nonproliferative are…
benign
Nonmalignant breast lesions- proliferative (examples)..
fibroadenomas, fibrosis, papillomas, mild-to-moderate hyperplasia, etc.
What should a treatment plan include for a 30 - 50 year old woman experiencing cyclic onset of bilateral breast tenderness and breast lumps that start from a few days (up to 2 weeks) before her period for many years. Once menstruation starts, the tenderness disappears, and the size of breast lumps decreases. May report that the lesion or mass has grown in size. During breast examination, the breast may feel lumpy, nodular, or cystic. If mass present, it is mobile with discrete edge, not attached to the skin, and feels rubbery to firm texture (not hard). Nipples and/or breast may feel tender.
Objective Findings;
Multiple mobile and rubbery to firm (not hard) masses on one or both breasts.
-Stop caffeine intake. Take vitamin E and evening primrose capsules daily.
-Wear bras with good support.
-Referral needed if dominant mass, skin changes, fixed mass
Noncontrollable risk factors for breast cancer include
-Older age (50 years or older)
-Genetic mutations (BRCA 1/2)
-Early menarche (before age 12)
-Late menopause (after age 55)
-Dense breast
-Personal or family history of breast cancer
-Radiation therapy to the chest/breast before age 30 (treated for Hodgkin’s lymphoma)
-Mother took diethylstilbestrol (DES; 1940–1971)
Controllable risk factors for breast cancer include
-Not being physically active
-Overweight or obese after menopause
-Hormones (estrogen and progesterone) taken during menopause for >5 years
-Pregnancy at age 30 or older
-Not breastfeeding
-Nulliparity
-Moderate-to-high alcohol intake
8 breast cancer types
-Ductal carcinoma in situ (DCIS)
-Infiltrating lobar carcinoma (CA)
-Infiltrating ductal CA
-Mixed lobar and ductal CA
-PDB
-Inflammatory breast CA
-Phyllodes tumor
-Breast sarcoma (rare)
3 breast cancer receptors
-Estrogen receptor (ER)
-Progesterone receptor (PR)
-HER2 (human epidermal growth factor receptor)
*Most breast cancers (80%) are hormone-receptor positive (ER and/or PR)
What is the treatment plan for someone who is 30 years or older with a dominant breast mass?
Order diagnostic mammogram and breast ultrasound (to determine if cystic or solid). If abnormal mammogram, refer to breast specialist.
What is the treatment plan for someone 30 years or younger?
Order breast ultrasound with/without diagnostic mammogram/breast biopsy. If low clinical suspicion, may observe for one or two menstrual cycles.
What is the treatment plan if there are any skin changes (peau de orange, dimpling)?
Order diagnostic mammogram with biopsy of underlying mass.
What is the average age of menopause for women in the US?
51 years old
Bacterial vaginosis signs/symptoms
“Fish-like” vaginal odor; profuse milk-like discharge that coats the vaginal vault
Not itchy/vulva not red; overgrowth of anaerobes
Bacterial vaginosis lab results
Clue cells; no WBCs
Whiff test: positive pH >4.5
Candidal vaginosis signs/symptoms
Cheesy or curd-like white discharge
Vulvovagina red/irritated
Candidal vaginosis lab results
Pseudohyphae, spores, numerous WBCs
Trichomonal vaginitis (trichomoniasis) 3 objective findings
“Strawberry cervix”
Bubbly discharge
Vulvovagina red/irritated
Trichomonal vaginitis (trichomoniasis) lab results
Mobile protozoa with flagella
Numerous WBCs
Atrophic vaginitis signs/symptoms
Scant to no discharge
Fewer rugae, vaginal color pale; dyspareunia (painful intercourse); may bleed slightly during speculum examination (if not on hormones)
Atrophic vaginitis lab results
Atrophic changes on Pap test
Elevated FSH and LH
Risk factors for breast cancer
-obesity (BMI of 30 or higher)
-older age
-moderate-to-high intake of alcohol
-first pregnancy at age 30 years or older
-early menarche (before age 12 years)
-late menopause (age 55 or older)
-history of breast mass with atypical hyperplasia
-positive family history
-genetic mutations, such as BRCA 1/2
What are the 4 components of the AMSEL criteria and what is it used to diagnose?
Thin, gray/white discharge
Malodorous “fishy” discharge upon adding 10 % potassium hydroxide
High vaginal pH (>4.5)
Identification of clue cells
Bacterial Vaginosis
How many of the AMSEL criteria must be met for diagnosis of BV?
3 of 4
Name 6 medications that may cause breast pain.
Oral contraceptives with estrogen and progesterone
SSRI’s
Tricyclics
Digoxin
Spironolactone
Methyldopa
What could unilateral and bloody nipple drainage be indicative of?
Cancer
What labs would you order in a non-lactating patient with milky discharge?
TSH
Prolactin
When is the best time to do a breast exam?
2 weeks between cycles
What is the normal pH of the vagina?
3.5-4.5 to keep normal flora in check
What is the bacteria that causes BV?
Gardnerella
What do clue cells look like?
Fuzzy edges
Pepper sprinkled on edges
What are 9 risk factors for vulvovaginal candidiasis (yeast vaginitis)?
Diabetes
Pregnancy
Obesity
Repeated antibiotic therapy
Diet high in refined sugars or artificial sweeteners
Use of corticosteroids
Exogenous hormones
Immunosuppressed states
Local allergic or hypersensitivity reactions
Post menopausal therapy
What does the discharge look like in yeast vaginitis?
Thick clumpy curd like adherent (sticks to the vaginal wall).
What is the treatment of yeast vaginitis?
Diflucan 150 mg PO once or may repeat in 5-10 days OR Monistat OTC and start probiotics
How does yeast vaginitis present on microscopy?
Hyphae
Budding/branching (spaghetti and meatballs)
What is the treatment for atrophic vaginitis?
Esterase cream 0.5% 2 grams nightly for 2 weeks then 2-3 times per week or
Vagifem 10 mcg tab vaginally
The treatment for Bartholin gland abscess is?
Incision and drainage (I&D)
What is the treatment for pediculosis pubis?
Permethrin 1% cream rinse apply for 10 minutes then rinse off, may repeat.
What is the treatment for Trichomoniasis?
Flagyl 500 mg po BID x 7 days
Describe the discharge seen with Trichomoniasis.
Frothy grayish white and copious
What is a classic symptom see on pelvic exam seen in a person with pelvic inflammatory disease (PID)?
Cervical motion tenderness (CMT)
How is pelvic inflammatory disease (PID) diagnosed?
There is no definitive dx test however when suspicious test for all STI’s and perform a pelvic exam to assess for CMT
What is the treatment for Hepatitis B?
There is no know treatment so vaccinate to prevent.
What are 3 symptoms of uncomplicated cystitis?
Dysuria
Frequency
Urgency
Do patients with simple cystitis have fevers?
No
What are 4 patient populations that would be classified an a complicated cytitis?
Pregnancy
Recent antibiotics
UTI within the last 6 months
Immunocompromised
Asymptomatic bacteriuria presents as?
No symptoms but culture is positive for bacteria
What patient population would you treat for Asymptomatic bacteriuria?
Pregnancy or having a urilogical procedure
When interpreting a urinalysis what are 2 lab values indicative of a UTI and what would your next step be?
Positive for nitrites or leucocyte esterase
Send culture if either are positive
Definition of menopause
Permanent cessation of menstrual periods for 12 full months (most common cause is due to aging, average age is 51)
Menopausal signs & symptoms
Classic symptoms:
-Change in menstrual cycle pattern (early)
-Vasomotor symptoms (includes night sweats)
-Vulvovaginal symptoms, dyspareunia
Other symptoms sometimes associated with menopause:
-Sleep disturbances besides night sweats
-Cognitive concerns (memory, concentration)
-Psychological symptoms (depression, anxiety, moodiness)
Osteoporosis T-score
less than or equal to -2.5
Osteopenia (low bone mass) T-score
T-score between –1.0 and –2.5
What is a normal T-score?
Greater than or equal to -1.0
Osteoporosis risk factors
-Advanced age (ages 50-90)
-Parental history of fragility fracture
-Female sex
-Current tobacco smoking
-Weight
-Long-term use of glucocorticoids
-Height
-Rheumatoid arthritis
-Low femoral neck BMD
-Prior fragility fracture
-Alcohol intake >3 units daily*
-Other causes of secondary osteoporosis
What supplement is recommended for a woman in menopause?
1200 mg Calcium w Vit D 800 mg
Can you give unopposed estrogen to someone who has a uterus?
NEVER
When is hormone therapy recommended for women?
Early menopause (ppl who are under 60 or are 10 years within menopause)
FSH > 30 mIU/mL
Indicative of decreased ovarian function (which is associated w perimenopause)
Subjective signs that would make you suspect ovarian cancer
Patient complaints of abdominal pain/back ache, fatigue, or changes in bowel movement
Which of the following would you expect to find on a wet-mount slide of a patient diagnosed with bacterial vaginosis?
A large number of squamous epithelial cells whose surfaces and edges are coated with large numbers of bacteria along with a few leukocytes.
Diagnosis of bacterial vaginosis includes three of four Amsel criteria:
(1) white, thick adherent discharge
(2) pH >4.5
(3) positive whiff test (amineodor mixed with 10% potassium hydroxide [KOH])
(4) clue cells >20% on a wet mount (epithelial cells dotted with large numbers of bacteria that obscure cell borders).
Define urinary incontinence.
Involuntary leakage of urine primarily due to pelvic floor dysfunction.
What are 8 non-pharmacologic treatments for UI?
Lifestyle interventions
Avoiding caffeine, artificial sweeteners, and alcohol
Bladder training
Reverse bladder re-training
The Knack skill
Pelvic muscle exercise
Weight management
Incontinence pessary
Name 5 symptoms of dermatoses
Itching
Pain
Burning
Rashes
Lesions
What part of the female genitalia are dermatoses found.
Vulva
What is Hidradenitis Suppurativa?
A chronic relapsing inflammatory disorder of hair follicles.
What are benign growths found on the smooth muscle of the uterus?
Uterine Fibroids
What are 3 symptoms of uterine fibroids?
Dysmenorrhea
Pelvic pain or pressure
Dyspareunia
What medication class would be prescribed for the treatment of fibroids?
Gonadotropin-releasing Hormone Agonists
What are 2 surgical options for fibroids?
Myomectomy
Hysterectomy
A disease in which tissue similar to the lining of the uterus grows outside the uterus.
Endometriosis
Name 8 sites for endometrial implants
Ovaries
Anterior and posterior cul-de-sac
Posterior broad ligaments
Uterosacral ligaments
Fallopian tubes
Sigmoid colon
Appendix
Round ligaments
Name 5 symptoms of endometriosis
Dysmenorrhea
Dyspareunia
Dyschezia
Chronic or intermittent dull throbbing or sharp pelvic, abdominal, or back pain.
Dysuria
How is a dx made for endometriosis
Through surgical bx
Which area of the breast is the most common site for female breast cancer?
Tail of Spence (upper outer quadrant)
