Exam 4 Flashcards
A 23 year old, sexually active presents for her first pap smear. Her history includes no pregnancies. Her first intercourse was at age 14 and has had at least 10 sexual partners if not 12 since. Which condition do you want to be alert for during her exam?-
HPV
A 20 year old, sexually active female seen in the clinic because her boyfriend was diagnosed with gonorrhea. What is the treatment of choice for gonorrhea?
Ceftriaxone
A 24 year old female with complaints of dysuria, pain with sex and mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What STIs has she most likely been exposed to?
Chlamydia
45 year old woman with complaints of vaginal discharge. You identify clue cells on the vaginal smear. What is the diagnosis?
Bacterial Vaginosis
Which of the following medications is the treatment of choice for Trich?
Flagyl
A 26 year old woman presents with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority
Pregnancy test
A 36 year old woman with complaints of vaginal itching, burning, and discharge. On wet mount, you notice hyphae. Which treatment would be appropriate?
Fluconazole for candida vaginitis
21 yo woman requesting birth control. Which of the following tests would be essential before prescribing oral contraceptives?-
Urine pregnancy/HCG
A 40 year old woman who sees you yearly for exams. She is single, not in a monogamous relationship. She smokes occasionally and drinks 2 beers a day. Her BMI is 25. She is requesting birth control. Which is appropriate for her?
IUD
What is the most common cause of secondary amenorrhea?-
Pregnancy
A 22 year old woman is dx with PMS. Which of the following lifestyles changes to minimize symptoms?-
Regular exercise
A 25 yo woman complaining of painful menstruation. Which pelvic pathology is the most common cause of dysmenorrhea?
Endometriosis
A male patient comes in with complaints of painful penile lesions. Small fluid filled vesicles that are painful to touch. Which treatment would you give?
Acyclovir
What is the most common serious gyencological complication in women
Pelvic inflammatory disease
When providing education to a woman about the use of plan b, the NP knows to tell the patient that the latest it can be used after intercourse and be effective is
72 hours
Male pt presents with painful lesions on the penis. They are small-fluid fulled vesicles clustered to the shaft of the penis. What is the dx?-
Herpes
What medication would an NP prescribe for a patient diagnosed with primary syphilis who has no known drug allergies?
PCN G
What age should women receive their first pap smear regardless of sexual activity?-
21 years
A 24 year old female comes in with complaints of dysuria, pain with sex, and mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What medication would you treat her with?
Azithromycin (for Chlamydia)
A 36 yo woman with vaginal itching, burning, and discharge. On wet mount you see hyphae. Based on clinical symptoms and findings, what would your dx be?
Candida
27-year-old female with complaints of no menstrual cycle for 6 months. What would be the most appropriate test to order?
Prolactin
Which of the following is contraindicated to estrogen containing contraceptive methods?
Factor 5 Leiden
You are counseling a patient on oral combination contraceptive treatment. She wants to know what to do if she misses a pill.
Take the last missed pill along with today’s pill
In providing contraceptive counseling to a patient on dilantin for a seizure disorder, which would you recommend?
Depoprovera
Which of the following is a common side effect reported after one use of depo?
Weight gain
With a hormonal IUD, which of the following is commonly reported by patients?
Reduction in menstrual flow
A patient wants to become pregnant and wants to stop oral combination contraceptives. When is it safe for her to try and conceive?-
Immediately
Perimenopause in women usually starts between
40-45 years
When checking hormone levels in 42 year old woman who reports hot flashes and no menstrual cycle for 6 months, what would you expect to find?
Increased LH
A patient has 101.5 fever, abdominal pain and vaginal discharge for 3 days. What medications would you prescribe?
Clindamycin and azithromycin
IV drug user presents for routine blood tests, her HIV is negative today. What would you advise her to do?
Repeat in 1 year
A nurse presents after an accidental needle stick. Her HIV test in negative today. What would you counsel her to do?
Repeat in 2 months
A 33 year old woman who had a negative pap last week, with two negative paps prior. When would you have her return for a pap?
5 years
A woman presents to discuss contraceptive options. She is breast feeding on demand. She wishes to continue. What is the most appropriate contraceptive for her to use?
Progesterone only oral contraception
What is the recommended treatment for chlamydia?
Azithromycin 100 mg once or doxycycline BID for 7 days
What are some of the consequences of chlamydia?
PID, infertility, ectopic pregnancy
Most common STI reported in the U.S.
Chlamydia
A patient is being treated with Metronidazole for Bacterial Vaginosis, why should you counsel them to avoid alcohol?
Mixing the two can cause, headache, nausea/vomiting, chest pain, and or hypertension.
Most common cause of vaginal odor and discharge
Bacterial vaginosis
One of the most common reasons for amenorrhea?
Pregnancy
Patient who use depo contraception should be counseled about what?-
Taking calcium supplements at least 1200 mg daily due to risk of bone loss
20-year-old woman with allergy to azithromycin- How would you treat for chlamydia?
Doxycycline 100 mg BID for 7 days
Hyphae on vaginal smear would indicate?
Yeast infection
How long without a period to be classified as secondary amenorrhea?
3 months
What are risk factors for PMS symptoms?
Caffeine, alcohol, nutrition, stress, smoking, family history
27-year old with painful menstruation. Most likely cause?
Endometriosis
Lesion on penis with no pain. Lesion is flat, indurated margins. What is the most likely diagnosis?
Syphilis
Treatment for syphilis if the patient has PCN allergy?
Doxycycline
Cervical caner screening and guidelines
<21: no screening
21-29: cytology every 3 years
30-65: cytology every 3 years or HPV testing every 5 years or both every 5 years
>65: no screening after adequate negative results
What would protozoa on vaginal smear indicate?
Trichomoniasis
25-year old with irregular periods, facial hair, obesity, elevated blood sugar. What is the most likely diagnosis?
Polycystic Ovarian Syndrome
What to avoid in patients seeking birth control with Factor V Leiden?
Estrogen
Treatment option for a menopausal woman with terrible hot flashes and hesistancy to be on hormone replacement therapy due to hx of breast cancer
Antidepressants (Effexor/Venlafaxine)
What is the average age for menopause in the US?
51-52 years
How long without a period till a woman will be considered in menopause?
1 year
What hormone increases in women that are perimenopausal?
FSH
Average age for girls to start menstrual cycle
11-14 years
When is primary amenorrhea considered?
If no menstruation by age 15 years
What are the four most common STIs?
Chlamydia, gonorrhea, syphilis, and trichomoniasis
Most common cause of urethritis in men?
Chlamydia
Use of spermicide can increase what?
Transmission of STIs, including HIV
How long should a patient use condoms for backup after missing a birth control dose?
7 days of no missed pills
Indication for progestin only birth control pills
-If estrogen in contraindicated
-If breastfeeding
Contraindications for nexplanon
pregnancy, DVTs, liver disease, breast CA, unexplained bleeding
Contraindications for IUD
Hx of PID, risk of STIs, pregnancy, undiagnosed bleeding
Difference in presentation between bacterial vaginosis, candidiasis, and trichomoniasis
-BV: Elevated pH, thin, white discharge with fishy odor, clue cells
-Candidiasis: Normal pH, pseudohyphae, thick, cottage-cheese discharge
-Trich: motile, pear-shaped, flagellated trichomonads, elevated pH, strawberry cervix, yellow-green, frothy discharge
What to be aware of when prescribing Ketoconazole for Tx of vaginal candidiasis?
The patient’s liver function
Causes of dysmenorrhea
Endometriosis (most common), ovarian cysts, ectopic pregnancy, PID, vaginitis
Absolute contraindications for combination estrogen/progestin BC
Clotting disorders or family hx, CV disease, stroke, cancer, liver disease, pregnancy, undiagnosed vaginal bleeding
What medications can decrease the effectiveness of birth control?
Anticonvulsants (dilantin) and antibiotics
What medication is good for BC in women who are breastfeeding?
Progestin- only pill
Treatment for bacterial vaginosis
Flagyl 500 mg BID for 7 days or Metrogel 0.75% for 5 nights
Tx for syphilis if PCN allergy
Doxycycline 100 mg BID for 14 days
Epithelial cell abnormality grading
ASC-US: atypical cells of undetermined significance
ASC-H: cannot exclude high-grade lesion
LSIL: low-grade, mild dysplasia, CIN 1
HSIL: high-grade, mod-severe dysplasia
CIS: carcinoma in situ
Diagnostics for amenorrhea
Urine pregnancy, CMP, thyroid, vaginal smear, FSH, LH, prolactin, androgen, progesterone challenge test
Tx for primary amenorrhea
estrogen therapy to develop secondary sex characteristics and prevent osteoporosis
Tx for secondary amenorrhea
oral contraceptives, periodic or cyclic progesterone 10 mg PO daily for 10 days
Tx of PCOS
Exercise, diet, weight control
Metformin can treat underlying metabolic disorder
Provera to start cycle and try for contraception
Contraceptives
Describe the climacteric phase of menopause
Occurs 10 years before menopause, ovulation becomes less frequent, shortening of the menstrual cycle and increased menstrual bleeding
Hormones during perimenopause
-Decreased estrogen
-Elevated FSH (above 40 mlu/ml = fast approaching menopause)/LH secretion
S&S of menopause
vasomotor symptoms: hot flashes, night sweats, insomnia, sleep distrubances, mood disorders, vaginal dryness or atrophy, decline in sexual desire, decreasing bone mass
Management of menopause
-Aerobic exercise (decreases hot flashes, insomnia)
-High complex carb and low fat diet
-Smoking cessation
-Stress reduction
-Herbal therapies: black cohosh
Pharmacological treatment for menopause
-Antidepressants- hot flashes and mood swings
-HRT (Estrogen therapy, Estrogen + progestin therapy)
