Disease and Disorders Common in Midlife Women Flashcards

Question

thyroid nodule

Answer 1

-discrete lesion w/in thyroid -high prev in women & elderly; 5% palpable -further eval if seen on US or felt on PE

Answer 2

-dx'd more in women -incidence 40-50yo ->90% differentiated thyroid ca are papillary or follicular -tx management w endo -no screening in asymptomatic adults per USPSTF

Answer 3

-2x in women than in men -most asymptomatic -RFs: sex, increased parity, age, hormone use, obesity, rapid weight loss -highest incidence in 1) American Indians & 2) Mexican Americans

Answer 4

-exogenous estrogen alone or in combined hormone contraceptives risk developing cholesterol gallstones by increasing hepatic secretion of biliary cholesterol -incr risk cholelithiasis, -cystitis, -cystectomy -oral is worse than transdermal -admin HT w caution in women w hx of chole-

Answer 5

-incr risks (including HIV) with vaginal atrophy -older women need more info than younger; still at risk if sex active -HIV & hep C in certain populations; no routine screening for sexually active postmeno women, based on sex hx -consider expedited partner tx per state recs

Answer 6

-chlamydia trachomatis -neisseria gonorrhoeae -genital herpes (HSV) -human papillomavirus (HPV) -hepatitis B -hepatitis C - HIV -syphilis -vaginal trichomoniasis

Answer 7

-screening for defined populations of asymptomatic women based on age, pregnancy status, or geographic factors, irrespective of personal behaviors or risk factors

Answer 8

-women who have an increased risk of infection based on personal sexual behaviors (more than 1 sexual partner in the past year; new partner in the past 90 days -factors identified locally, including prevalence of infection in the community, are important

Answer 9

-woman's sexual partner is suspected or known to have chlamydia, gonorrhea, syphilis, HIV, or hep B or C

Answer 10

-performed after a woman is dx'd w one STI to find coincident infection with other pathogens -women dx'd w chlamydia, gonorrhea, syphilis, HIV, or primary herpes should be screened for other pathogens -not necessary for women dx'd w recurrent genital warts or recurrent genital herpes -bacterial vaginosis and vaginal candidiasis are not sexually transmitted and are not a reason to perform this test

Answer 11

-should be performed for any woman who, because of s/sxs of infection, is suspected of having an STI

Answer 12

-mostly women <25yo -sxs include purulent cervical or vaginal discharge, dysuria, deep dyspareunia, AUB -dx'd w nucleic acid amplification tests; urine testing is okay (picks up 10% less) -test of cure not necessary; rescreen in 3 mo

Answer 13

-single dose azithromycin 1g PO -doxycycline 100mg BID x7 days PO

Answer 14

-found in cervix, anus, urethra, pharynx, eyes -sxs include pain/burning w urination, vaginal discharge, postcoital, intermenstrual, or postmeno bleeding -dx w nucleic acid amplification tests w vaginal sample -quinolones no longer rec for tx d/t resistance

Answer 15

-ceftriaxone 250mg IM + azithromycin 1g PO -single dose cefixime 400mg PO + azithromycin 1g PO

Answer 16

-HSV 1 and HSV 2 transmitted by skin-to-skin genital contact; can be caused by asymptomatic shedding -sxs include prodromal burning, itching, & skin hypersensitivity, followed by vesicles or pustules on the vulva, perineum, or rectum, that break and leave tender ulcers -initial infection can take 2-3wks to heal with primary herpes and 7-10days with recurrent herpes -dx with a type-specific herpes culture or a polymerase chain reaction test from active lesion -routine serologic testing not recommended

Answer 17

-not for cure: antiviral medication during earliest phase of an outbreak can shorten duration, including acyclovir, famciclovir, valacyclovir for -7-10days (initial outbreak) -1-5days (recurrence)

Answer 18

-causes almost all cervical ca as well as ca of the vagina, vulva, penis, anus, rectum, & oropharynx -genotype 16/18 are high risk for cervical a -genotype 6 & 11 can cause genital warts and low-grade cervical lesions -by age 50yo, at least 80% of US women will have acquired genital HPV infection and most clear it on their own -9 valent vaccine (Gardasil 9) should e given to girls and women age 9-26yo; which has been expanded through 45yo

Answer 19

-concentrated in blood, semen, vaginal secretions, and wound exudates, and is transmitted primarily by percutaneous exposure to blood and sexual contact -10% of adults develop chronic hepatitis (risk for cirrhosis and liver ca) -national strategy for control is through vaccination -screen high-risk persons: HIV positive, injection, drug users, household contacts, or sex partners of positive persons, men who have sex w men, immigrants from geographic regions w prevalence of 2% or more -immunize adults w DM and chronic liver disease

Answer 20

-passed mainly by blood contact (sharing IV drug equipment) -most become chronic, incurring risk of cirrhosis and liver ca -asymptomatic, so anyone born between 1945 and 1965 should be screened -if positive, should be under brief etoh screen and intervention and referral to appropriate services (hepatology)

Answer 21

-16% of people infected w HIV don't know they are infected, so adults between 15-65yo should be screened at least once regardless of risk factors -targeted annual screening: past or present injection drug users, sex partners of HIV-infected persons, men who have sex w men, more than one sex partner -testing is done with 4th gen HIV ag-abcombo testing or 3rd gen ab immunoassay -guidance recommends antiretroviral therapy for all HIV-infected patients to reduce the risk of disease progression and transmission; best done by HIV experienced specialist (ID)

Answer 22

-caused by treponema pallidum & is considered the "great imitator" bc many of its s/sxs are indistinguishable from those of other diseases -includes: PRIMARY stage (single, painless chancre for 3-6wks); SECONDARY stage (multiple chancres, skin rashes, mucous membrane lesions); LATENT stage (untreated can cause death) -test w rapid plasma regain & confirm by treponemal serum ab test (risk of false positives) -tx: single injection of benzathine penicillin

Answer 23

-most curable STI; seen in all ages -caused by trichomonas vaginalis and can involve vagina, endocervix, urethra; 5% may be asymptomatic colonization -sxs include yellow-green or gray vaginal discharge, vulvovaginal irritation & itching, strong unpleasant odor, discomfort w intercourse or urination -dx: saline suspension, POCT, nucleic acid testing -tx: metronidazole or tinidazole single oral dose, tx partners

Answer 24

-not an STI -imbalance in vaginal bacterial flora in which normal lactobacilli are replaced by Gardnerella vaginalis and other anaerobic bacteria -sxs include thin, white, or gray vaginal discharge w a high pH and strong fishy odor -dx: 4 Amsel's criteria = a thin homogenous white vaginal discharge, clue cells accounting for at least 20% of vag epithelial cells on microscopy, pH higher than 4.5, and positive "whiff" test (w KOH or amine test), or POCT probe -tx: metronidazole or clindamycin vag cream, alternative regimens include oral tinidazole and or oral clindamycin