FNP Womens Health Exam Flashcards by stephanie Cox

The progestin component of hormone therapy is given to:

Counteract the negative lipid-effects of estrogen

Minimize endometrial hyperplasia

Help with vaginal atrophy symptoms

Prolong ovarian activity

Minimize endometrial hyperplasia

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Postmenopausal hormone therapy can result in:

A reduction in the rate of cardiovascular disease

An increase in the rate of rheumatoid arthritis

A reduction in the frequency and severity of vasomotor symptoms

A disturbance in sleep patterns

A reduction in the frequency and severity of vasomotor symptoms

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A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

“It is probably just a cyst because that is the most common breast mass.”

“We will order a mammogram and ultrasound to help establish a diagnosis.”

“We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”

“Because your lump is painful, it is most likely not cancer.”

“We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”

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A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

Pregnancy test

Pelvic ultrasound

Endometrial biopsy

Pregnancy test

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A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

Conjugated estrogen, 0.625 mg/day oral

Estradiol, 7.5 mcg/24 hr. vaginal ring

Medroxyprogesterone, 10 mg/day oral

Conjugated estrogen, 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Estradiol, 7.5 mcg/24 hr. vaginal ring

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Polycystic ovary syndrome can result in:

Infertility

Increased risk of uterine (endometrial) cancer

Hirsutism

All of the above

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Most breast cancer cases are in women with a family history of breast cancer.

True

False

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A 65-year-old female asks if she can stop her pap exams. She heard that you can stop having screenings at age 65. You review her chart and see that she had CIN2 5 years ago. You respond:

Yes, you are 65 so you can stop pap screenings now.

No, you should continue pap screenings until the age of 70.

No, you should continue to have routine screening for at least 20 years after the CIN2 was diagnosed.

If you have a complete hysterectomy you could stop screenings.

No, you should continue to have routine screening for at least 20 years after the CIN2 was diagnosed.

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Increased FSH levels and lower estrogen levels are associated with which of the following?

Decreased bone turnover

Hot flashes

Lower levels of interleukins

Chest pain

Hot flashes

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When educating midlife women on health promotion, all the following should be recommended EXCEPT:

To maintain a BMI between 18.5 and 24.9

Limit alcohol consumption to no more than one drink per day

To obtain depression screening

To maintain waist circumference less than 37 inches

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How much Vitamin D is recommended for a 55-year-old woman?

200 IU/day

400 IU/day

600 IU/day

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It is recommended that older women (age 65 and older) be screened for falls at which of the following intervals?

Every 3 months

Every 6 months

Yearly

Every 2 years

Yearly

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According to the American College of Obstetricians, the most common medications associated with female sexual dysfunction are which of the following?

SSRI’s

SNRI’s

Ace inhibitors

Statins

SSRI’s

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Which of the following statements is FALSE regarding vaginal cancer?

They are rare

The most common form is squamous cell carcinoma

They are associated with HPV infections

Basal cell carcinoma is the most common form

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Which of the following statements is TRUE regarding vulvar lichen sclerosis?

It often causes pruritus

It causes the vulvar epithelium to become pale

It is associated with autoimmune disorders

All the above is true

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Chronic heavy menstrual bleeding (HMB), formerly termed menorrhagia is the most common complaint of abnormal uterine bleeding (AUB):

True

False

True

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A 45-year-old woman presents with abnormal uterine bleeding. You discuss your recommendation for endometrial sampling to rule out endometrial hyperplasia and carcinoma. What is the most common cause of endometrial cancer?

Human papilloma virus

Unopposed estrogen

HNPPC

Past use of fertility medications

Unopposed estrogen

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According to the American College of Obstetrics and Gynecology, which of the following statements is incorrect regarding breast cancer screenings?

Begin discussing annual or biannual mammography starting at age 40 and older

Begin offering clinical breast exams to patients ages 20-39 every 1-3 years and then annual starting at age 40.

All women should be informed to perform monthly self-breast exams.

Self-breast examinations are not recommended for screening in the general population.

All women should be informed to perform monthly self-breast exams.

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A 30-year-old develops menorrhagia and iron deficiency anemia. She also reports increased pelvic pressure and dysmenorrhea. You palpate a large, mobile pelvic mass at the midline on pelvic exam and suspect a uterine leiomyoma. Which of the following is the initial test to confirm this diagnosis?

Pelvic ultrasound

Pelvic MRI

Pelvic CT

Hysteroscopy

Pelvic ultrasound

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Hormone replacement therapy (HRT) increases risk of which of the following?

Osteoporosis

Vasomotor symptoms

Stroke

Thyroid cancer

Stroke

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A 25-year-old female presents for her well woman visit. Her last pap was at age 22; normal results. She is sexually active with three partners within the last year. She should have the following:

Pap smear, Pelvic exam, STI screening

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A 23-year-old woman returns after an abnormal pap smear result. Her results show low-grade squamous intraepithelial lesion (LSIL) with a positive human papillomavirus (HPV) test. She has had 3 male sexual partners in her life and has been in an exclusive relationship with the same man for the last three years. She denies consistent use of barrier protection during intercourse. Her periods are regular. She denies menorrhagia, vaginal discharge, abnormal bleeding, dysuria, or past history of sexually transmitted infection. She had her first pap smear two years ago with her regular doctor in another state; she is uncertain of the result. What is the appropriate step in management of this patient?

Obtain past medical records of previous pap smear results and repeat pap in 12 months

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The preferred colorectal cancer screening test is a colonoscopy and should be recommended starting at what age?

50 (age 45 for African American women)

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According to the American Congress of Obstetricians and Gynecologists, bone mineral density screening should routinely begin at what age? (Risk factors may warrant earlier screening)

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Bone density should be screened in postmenopausal women < 65 years with high risk factors. All of the following are high risk factors except:

Hypertension

According to the American College of Obstetricians and Gynecologists, mammogram screenings should start at what age?

If a woman has never had CIN 2 or higher, and she has had three consecutive negative cytology results within the past 10 years, with the last cytology being within the past five years, at what age can cervical cytology be discontinued?

The human papillomavirus vaccine series is recommended for boys and girls age 9-26 years, with the target age of vaccination of:

11-12

BRCA 1 and BRCA 2 genetic mutations are associated with:

Breast

A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? Ceftriaxone and Azithromycin Ceftriaxone and Cefixime Acyclovir Metronidazole and Azithromycin

Ceftriaxone and Azithromycin

A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? Trichomoniasis Bacterial vaginosis HPV Herpes simplex virus

Bacterial vaginosis

Oral contraceptive pills can cause endometrial cancer. | True or False

False

A 40-year-old woman is seen for her yearly examination. She is single and in a monogamous relationship, no history of STIs. Her social history includes smoking cigarettes "occasionally" and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best for this patient? Intrauterine device Oral contraceptive Etonogestrel/ethinyl estradiol vaginal ring Vaginal contraceptive sponge

Intrauterine device

A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? Fluconazole Estrogen vaginal cream Metronidazole Doxycycline

Fluconazole

Which of the following is likely NOT among the proposed mechanisms of action of all form of oral emergency contraception? Inhibits ovulation Slows sperm transport Slows ovum transport Acts as an abortifacient

Acts as an abortifacient

A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? Blood pressure measurement Complete blood cell count Thyroid-stimulating hormone Urine dip for protein

Blood pressure measurement

According to the U.S. Medical Eligibility Criteria for Contraceptive Use, all of the following are category 1 or category 2 for taking combined oral contraceptives EXCEPT? A 22-year-old woman who smokes 1 ppd A 29-year-old woman with history of PID A 32-year-old woman with history of migraine with aura A 30-year-old woman breastfeeding a 6 month old infant

A 32-year-old woman with history of migraine with aura

A woman with frequent vaginal candidiasis asks you what she can do to prevent this from reoccurring. You are correct when you tell her all of the following EXCEPT: Avoid soaps with fragrance Wear polyester underwear Do not douche Avoid intercourse until end of treatment

Wear polyester underwear

Which of the following agents is most active against Trichomoniasis: Ceftriaxone Diflucan Doxycycline Metronidazole

Metronidazole

During an office visit with an 18-year-old client named Kimberly, the nurse asks whether she is using any form of birth control. Kimberly responds that she is currently breastfeeding her 6-month-old, so she doesn't need to be on birth control. The nurse recognizes that Kimberly is relying on which type contraception? Abstinence Tubal ligation Symptothermal Lactational amenorrhea

Lactational amenorrhea

April is a 24-year-old client who has recently become sexually active with multiple partners. She knows she has been taking too many risks in her sexual encounters and would like to begin using contraception. She is also concerned about acquiring a sexually transmitted infection. Which method of contraception should the nurse recommend to April? ``` Male condoms and etonogestrel implant (Nexplanon) Injectable depot medroxyprogesterone acetate (DMPA) Female condoms and progestin-only contraceptive pills Intrauterine device (IUD) ```

Male condoms and etonogestrel implant (Nexplanon)

While performing a pelvic exam, the nurse encounters genital warts in the vagina. Which sexually transmitted disease (STD) should the nurse suspect most in this client? Genital herpes simplex virus Human papillomavirus (HPV) Hepatitis B HIV

Human papillomavirus (HPV)

Which diagnostic test assesses a woman's risk for developing cervical cancer? HPV test Gonococcal culture Hepatitis B panel Pregnancy test

HPV test

Which of the following is the chief predictor of a risk of heterosexual HIV transmission? Duration of sexual intercourse Viral load Number of sexual partners of the male The concentration of sperms in the semen

Viral load

The fertilized ovum is termed: Zygote Blastocyst Embryo Fetus

Zygote

In normal viable singleton pregnancies, the serum HCG levels Double every 24 hours Double every 48 hours Double weekly Triple every 23 hours

Double every 48 hours

Tests commonly completed during the 1st trimester include all the following except: Pap smear if PT is due Urinalysis Sexually transmitted infection testing Group beta strep rectal and vaginal swab

Group beta strep rectal and vaginal swab

A sign of pregnancy that softens the cervix causing it to bleed more easily and turn a bluish color is: Hegar sign Goodwell sign Chadwick's sign Symptom of sexually transmitted infection

Chadwick's sign

During pregnancy, a woman with a normal BMI should add approximately how many health calories to her normal caloric need (this number rises in later pregnancy.) 200 calories 300 calories 600 calories 800 calories

300 calories

Maternal serum screening for neural tube defects and trisomy 18 & 21 can include all of the following testing except: Alpha-fetoprotein (AFP) Human chorionic gonatropin (HCG) Progesterone level Inhibin A

Progesterone level

If a woman chooses to have neural tube screening test called the "quad screen", this should be done: 6-10 weeks 16-20 weeks 28 weeks At any point during pregnancy

16-20 weeks

The most common causative agent of UTI in pregnant woman: Escherichia coli Streptococcus Giardia Staphylococcus

Escherichia coli

The following clinical manifestations describe what type of miscarriage/spontaneous abortion: some contents of the uterus remain, no longer viable pregnancy, cervical os may be open, vaginal bleeding & abdominal pain often present Complete abortion Inevitable abortion Threatened abortion Incomplete abortion

Incomplete abortion

Signs of ectopic pregnancy include all the following except: HCG levels lower than expected Abdominal pain Uterus measuring large for dating Vaginal bleeding

Uterus measuring large for dating

A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to? a. Gonorrhea b. Human papillomavirus (HPV) c. Chlamydia d. Trichomonas

Chlamydia

A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the most likely cause for her dyspareunia? a. Menopause b. Dehydration c. Excess progesterone d. Sexual trauma as a child

Menopause

A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? a. Pregnancy test b. Complete blood cell (CBC) count c. Thyroid-stimulating hormone (TSH) d. Urine dip for protein

Pregnancy test

A 44-year-old patient with breast cancer is prescribed Tamoxifen by the surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate? a. "You must be having menopause." b. "The hot flashes are a result of the antiestrogenic effects of Tamoxifen." c. "Tamoxifen will impact your temperature regulation center." d. "The drug destroys your ovaries."

The hot flashes are a result of the antiestrogenic effects of Tamoxifen."

A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes of infertility? a. Pelvic inflammatory disease (PID) b. Oral contraceptive use for 15 years c. Early menarche d. Diet high in soy protein

a. Pelvic inflammatory disease (PID)

When assessing a woman for infertility, which of the following tests should be done first? a. Analysis of partner's sperm b. Magnetic resonance imaging (MRI) c. Hysterosalpingogram d. Estrogen level

Analysis of partner's sperm

A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause? a. "Are you sexually active?" b. "How long have you been underweight?" c. "Did your mother take diethylstilbestrol during her pregnancy?" d. "Have you noticed any changes in your moods lately?"

"How long have you been underweight?"

What is the most common cause of secondary amenorrhea? a. Pregnancy b. Pituitary dysfunction c. Inadequate estrogen levels d. Genetic disorders

Pregnancy

A 22-year-old woman is diagnosed with premenstrual syndrome (PMS). Which of the following lifestyle changes should the clinician suggest to help minimize the patient's symptoms? a. At least 4 cups of green tea daily b. Regular exercise c. Take vitamin A supplements d. Eat a diet high in iron

Regular exercise

A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of dysmenorrhea? a. Pelvic inflammatory disease b. Endometriosis c. Sexually transmitted infections d. Ovarian cyst

Endometriosis

A 26-year-old woman tells the clinician that she has endometriosis because she has frequent pelvic pain. The clinician should also consider which of these differential diagnoses? a. Diverticulitis b. Cholelithiasis c. Kidney stones d. Ovarian cysts

Ovarian cysts

Which of the following would be appropriate treatment for a woman with mild endometriosis? a. Oral contraceptives b. Leuprolide acetate injections c. Nafarelin nasal spray d. Hysterectomy

Oral contraceptives

A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses? a. Leiomyoma b. Pregnancy c. Ovarian cancer d. All of the above

All of the above

A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first? a. Transvaginal ultrasound b. Endometrial biopsy c. Magnetic resonance imaging (MRI) d. Abdominal computed tomography (CT) scan

Transvaginal ultrasound

A 45-year-old woman is seen because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response? a. "You are approaching menopause." b. "You have a hormone imbalance." c. "Your FSH is normal, but your pituitary is making too much LH." d. "There is an imbalance between your ovaries and pituitary."

"You are approaching menopause."

Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal? a. Pregnancy test b. Estrogen level c. Progesterone level d. Luteinizing hormone (LH) level

Pregnancy test

A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at the age of 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer? a. Her numerous pregnancies b. Her age at menopause c. Her father's history of lung cancer d. Her grandmother's history of colon cancer

Her grandmother's history of colon cancer

A woman taking estradiol is at risk for developing endometrial cancer True or False

True

Which is true regarding postpartum depression and breastfeeding? Although small amounts of medications might be secreted in breast milk, it is okay to breastfeed while taking certain antidepressants. A woman should not breastfeed while taking antidepressants.

Although small amounts of medications might be secreted in breast milk, it is okay to breastfeed while taking certain antidepressants

Which of the following is false regarding candida infection of maternal breasts? Topical medications such as clotrimazole or nystatin will be applied to nipples. Infants should be treated as well for thrush. Woman might also need fluconazole to eradicate. Infant should not nurse during this time.

Infant should not nurse during this time.

``` Frequently prescribed mastitis treatment options for a breastfeeding mother include all the following except: Cephalexin Clindamycin Amoxicillin/clavulanate Nitrofurantoin ```

Nitrofurantoin

``` A new mother calls office after being discharged 30 hours after delivery. She reports a fever of 102 degrees F, uterine tenderness, malodorous lochia; she reports she had a long labor. The NP suspects: endometritis hematoma UTI mastitis ```

endometritis

Risk factors for postpartum depression include all the following EXCEPT: Maternal history of depression Maternal history of seizure disorder Unplanned pregnancy Lack of support system

Maternal history of seizure disorder

``` A woman comes to the office for her postpartum visit. She shares her infant was diagnosed with thrush twice in the last two weeks. She reports noticing her nipples are shiny red and a bit itchy. The NP suspects? mastitis clogged breast duct breast abscess candidal infection ```

candidal infection

All the following are recommended to encourage successful breastfeeding EXCEPT: Initiation of breastfeeding within 1 hour of birth Continuous rooming in with breastfeeding on demand Restricting length of breastfeeding time Avoiding use of supplemental formula during the early stages of milk production

Restricting length of breastfeeding time

All the following are acceptable contraceptive options for a breastfeeding woman to start within 21 days postpartum except: Progesterone only pill Depot medroxyprogesterone acetate injections Combined hormonal pill IUD

Combined hormonal pill

``` Which of the following conditions is a contraindication to breastfeeding? Hepatitis B Breast enlargement Infant galactosemia Use of amoxicillin ```

Infant galactosemia

``` Average weight loss is______, and should not exceed _____ at 72 hours in term newborns? 2%; 5% 3%; 5% 7%; 10% 10%; 15% ```

7%; 10%

Up to 85% of postpartum women experience tearfulness, loneliness, crying that often resolves within 2 weeks postpartum; these symptoms indicate: Postpartum depression Postpartum blues Postpartum psychosis Hormone dysfunction

Postpartum blues

Breastfed newborns typically feed how many times every 24 hours? 3-4 times 4-8 times 8-12 times 12-20 times

8-12 times

HPV type______is most commonly associated with cervical adenocarcinoma. This type of cervical cancer is more difficult to detect on cytology because it occurs in the upper portion of the endocervical canal.

HPV type 18

The most common anogenital low-risk (nononcogenic) HPV types are type _____and_____ (which cause 90% of genital warts),

6 and 11

HPV type_____ is most commonly associated with high-grade CIN and invasive cancers. Although women infected with this type are at greater risk for developing high-grade cervical lesions, most of these HPV infections will not develop into abnormal cellular changes.

Genital warts may be cancerous. In order to avoid missing a rare diagnosis of verrucous carcinoma or squamous cell carcinoma, health care providers should

biopsy all atypical lesions and send for histological evaluation.

The overall goal of cervical cancer screening is to prevent morbidity and mortality by (a) identifying, treating, and surveilling high-grade cervical cancer precursors, thereby reducing a woman’s risk of developing invasive cancer, and (b) avoiding unnecessary or over treatment of benign and transient HPV infections and cancer precursor lesions that most likely will regress. This goal is accomplished by

Loop electrosurgical excision procedure (LEEP),

Current approaches to cervical cancer prevention include

(a) vaccination, (b) cervical cancer screening, (c) follow-up evaluation using colposcopy and cervical biopsy, and (d) treatment for biopsy-confirmed high-grade cervical cancer precursors.

HPV quadrivalent vaccine to protect against HPV genotypes

6, 11, 16, and 18

The ACIP recommends routine vaccination at age_____ and may begin as early as age 9 years. And up to age ______.

11 to 12,26

The _______________stage of HIV is when the virus establishes itself in the body; acute HIV syndrome (viral flu-like syndrome) occurs within 2–4 weeks of exposure to HIV. Characterized by fever, swollen glands, rash, muscle and joint aches and pains, and headaches. May last for several weeks. May become transiently immunocompromised. Takes 6–12 weeks for immune system to produce antibodies. Newly infected individual’s blood may not test positive; however, individual may be highly contagious.

Acute infection

The _______________stage of HIV is when the viral load stabilizes. Period of clinical latency with few or no symptoms; however, viral replication in lymphoid tissues continues. The individual is relatively symptom free but may have transient episodes of HIV-related infections. Women may be prone to aggressive cervical dysplasia.

Clinical latency

The ______________ stage is when the CD4+ count < 200. Immune system is badly damaged and individual is vulnerable to opportunistic infections such as PCP. Individuals can respond to aggressive ART. CD4+ count < 50. Individual is severely ill with extensive organ involvement, aggressive neoplasia (Karposi’s sarcoma), wasting disease syndromes, severe disseminated infections such as M. tuberculosis and extrapulmonary histoplasmosis. Death occurs with vascular collapse and organ failure.

HIV

Sexual transmission of HIV is ________ more efficient from male to female than from female to male because HIV in semen is in higher concentrations than in cervical and vaginal infections and because the vaginal area has a much larger mucosal area of exposure to HIV than does the penis.

two to four times

Both younger and postmenopausal women may be at greater risk for acquiring HIV because of a _________________ resulting in increased friability and risk of trauma during intercourse, thus providing direct access to the bloodstream.

thinner vaginal epithelium

Factors such as______, ________, ________, ________ indirectly increase the prevalence of HIV in at-risk populations.

poverty, lack of education, social inequity, and inadequate access to health care

The risk for perinatal transmission of HIV can be reduced with the use of antiretroviral treatment. Without treatment the risk of transmitting HIV to a neonate is approximately ________, but can be reduced to less than _____with antiretroviral treatment and obstetrical intervention, including cesarean section at 38 weeks gestation and not breastfeeding.

30%, 2%

Women who have had PID are________more likely to have an ectopic pregnancy compared with women who have not.

6 to 10 times

Some of the complications associated with an STD experienced by pregnant women can include: __________, _________, __________, and __________.

spontaneous abortion, stillbirth, premature rupture of membranes, and preterm delivery.

Treatment for PID

Ceftriaxone 250mg IM and Doxy 100mg BID x 14

Genital warts with verruciform lesions treatment

Gent 240mg IM x 1 and Azithro 2g PO

Treatment for syphilis is

PCN G x1 IM

Treatment for bacterial vaginosis

Metronidazole 500mg BID x 8 days