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Women's health > Health Maintenance > Flashcards

Health Maintenance Flashcards

1
Q

initial menstrual cycle

A

menarche

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2
Q

FDLMP?

A

first day of last menstrual period

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3
Q

PMDD

A

premenstrual dysphoric disorder

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4
Q

ceasing of menstrual cycles - day after the patient’s last menstrual flow stops

A

menopause

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5
Q

few years leading up to menopause - may already have erratic hormones, menses typically regular

A

premenopause

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6
Q

“the menopausal transition” - menses often irregular and hormones are erratic, but menstruation has not completely ceased

A

perimenopause

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7
Q

no menstrual flow for +12 mo

A

postmenopause

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8
Q

menstrual flow
AKA menstruation, menses

A

menorrhea

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9
Q

painful menstrual flow

A

dysmenorrhea

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10
Q

heavy or prolonged menstrual flow

A

menorrhagia

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11
Q

unusually light menstrual flow or spotting only

A

hypomenorrhea
aka cryptomenorrhea

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12
Q

menstrual bleeding that occurs at any time between cycles
AKA intermenstrual bleeding

A

Metrorrhagia

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13
Q

periods that occur too frequently
cycle is 20 days or less

A

Polymenorrhea

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14
Q

bleeding at irregular intervals
amount and duration may also vary (often heavy)

A

Menometrorrhagia

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15
Q

periods that occur too rarely
cycle is over 35 days apart

A

Oligomenorrhea

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16
Q

what is amenorrhea?

A

no period for over 6 months

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17
Q

what is contact bleeding?
can be a sign for what?

A

bleeding following intercourse
Also called postcoital bleeding
Can be a sign of cervical cancer

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18
Q

CBE?

A

clinical breast exam

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19
Q

SBE?

A

self breast exam

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20
Q

difference between subtotal vs radical hysterectomy

A
  • Subtotal hysterectomy - uterine corpus only (not cervix)
  • Radical hysterectomy - uterus, cervix, pericervical tissue, upper vagina
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21
Q

Oophorectomy?

A

surgical removal of one or both ovaries

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22
Q

Salpingectomy?

A

surgical removal of one or both oviducts

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23
Q

Salpingo-oophorectomy ?

A

removal of one or both ovaries, oviducts
BSO - bilateral salpingo-oophorectomy

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24
Q

surgical gynecologic hx terms

A
  1. TAH - total abdominal hysterectomy
    - Removed through an incision in the abdomen
  2. TVH - total vaginal hysterectomy
    - Removed through the vagina
  3. Laparoscopic hysterectomy
    - Removed through the vagina OR
    - Morcellated and removed through incisions
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25
Q

Obstetric History Terms

Term, preterm, abortion, etc

A
  1. Term - 37 wks - 42 wks
  2. Preterm - 20-36 wks
  3. Abortion - < 20 wks
  4. Post-term - >42 weeks
  5. Puerperium - birth - 6 weeks postpartum
  6. Trimesters
    - 1st trimester - 0-14 wks
    - 2nd trimester - 15-28 wks
    - 3rd trimester - 29-42 wks
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26
Q

loss of a pregnancy before the fetus is viable outside of the womb
Typically 20 weeks’ gestation or earlier
Induced or spontaneous

A

abortion (AB)

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27
Q

abortion (usually prior to 20 weeks of pregnancy) - due to natural causes

A

Spont AB (SAB)

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28
Q

abortion induced for medical reasons

A

Therapeutic abortion (TAB)

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29
Q

abortion induced for non-medical reasons

A

Elective abortion (EAB)

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30
Q

the birth of an infant who has died in the womb
Typically used later in pregnancy (after 20 weeks’ gestation)

A

stillbirth

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31
Q

Obstetric hx procedural abbreviations

A
  1. CS - Cesarean section - Also abbreviated C-section
  2. D&C - Dilation and curettage
  3. BTL - Bilateral tubal ligation
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32
Q

Fetal Descriptor abbreviations

A
  • FHT - fetal heart tones
  • EFW - estimated fetal weight
  • LGA - large for gestational age
  • SGA - small for gestational age
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33
Q

Rupture of Membrane abbreviations

A
  • ROM - rupture of membranes - “water breaking”
  • AROM - artificial rupture of membranes
  • PROM - preterm rupture of membranes (< 37 wks)
  • SROM - spontaneous rupture of membranes
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34
Q

has been pregnant 5+ times

A

Grand multigravida

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35
Q

a pregnant woman or the number of pregnancies a woman has had

A

Gravida

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36
Q

number of times a woman has given birth

A

Para/Parous

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37
Q

has given birth more than once

A

Multiparous

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38
Q

difference between Grand multipara vs Great grand multipara

A
  • Grand multipara - has delivered 5+ infants of 24+ wks gestational age
  • Great grand multipara - delivered 7 + infants of 24+ wks gestational age
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39
Q

3 Descriptors of Gravidity/Parity

A
  • GP System - Gravida, Para - total of pregnancies, total of live births
  • GPA System - Gravida, Parus, Abortus - less common
  • GTPAL - Describes outcomes of pregnancies

May also write out - OB history: 6 pregnancies, 2 term infants, 2 premature infants, 2 abortions (one SAB, one TAB), 4 living children

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40
Q

frequency of screening for First reproductive health visit

at what age?

A

age 13-15

  • Age-appropriate reproductive health info
  • No pelvic exam unless symptomatic or STD screen needed
  • Frequency of subsequent visits - varies depending on sexual activity, symptoms
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41
Q

freq of screening for pelvic exam and pap smear?

at what age?

A

begin age 21 in healthy pts

  1. Do not need Pap in asx pt < 21 y/o, even if sexually active
  2. Pelvic exam frequency - depends on s/s, high-risk hx, or part of Pap/HPV
    - Many recommend against routine pelvic exams (unless Pap/HPV needs done)
  3. Pap smear frequency - varies depending on findings, history
    - Usually every 3-5 yrs
  4. Do not need to do pelvic before prescribing BC
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42
Q

freq of screening for CBE

A

controversial

  • If done, every 1-3 years for women 20-39 years old
  • Yearly CBE and mammograms for women 40+
  • Does not take the place of a mammogram
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43
Q

Consider general screening lab tests during well woman exam:

A
  1. CBC (+/- differential)
  2. Glucose screening
  3. Lipid profile
  4. Thyroid function tests
  5. Urinalysis (+/- Urine culture)
  6. STD screening if high-risk behavior or suggestive s/s
  7. Other labs as indicated by history
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44
Q

menstrual hx for well woman exam

A
  1. Age at menarche and menopause
  2. Length and regularity of cycles
  3. Intermenstrual or contact bleeding
  4. Amount of flow
  5. Pain with menses
  6. Presence of PMS
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45
Q

contraceptive/sexual history well woman exam

A
  1. Current birth control method
  2. Patient’s satisfaction with that method
  3. Current sexual activity status
  4. Number and gender/sex of partners
  5. New partner in last 3 months
  6. Condom use
  7. History of abuse
46
Q

MHx and SHx for well woman exam

A
  1. Medical History - allergies, medications, infectious diseases, medical conditions, immunizations, transfusions, hospitalizations
    - Include in particular history of blood clots or excessive bleeding/bruising
  2. Surgical History - inpatient procedures, outpatient procedures, outcomes of surgeries
47
Q

FHx for well woman exam

A

any major illnesses, any OB/GYN illnesses or complications, age of female relatives at menopause
Include familial heart disease, HTN, renal disease, vascular disease, hematologic disease, osteoporosis, vascular accidents

48
Q

OB + GYN + Breast hx for well woman exam

A
  • GYN History - infertility, maternal DES use, date of last Pap, history of abnormal Paps, history of STDs
  • OB History - all pregnancies, outcomes, and complications
  • Breast History - history of breast disease, breastfeeding, last mammogram, use of SBE, date of last CBE
49
Q

For ROS, be sure to hit ___, but include general major systems
example?

A

GU

  • Example GU: abnormal vaginal discharge or bleeding, dyspareunia, abdominopelvic pain, dysuria, urinary hesitancy or urgency, incontinence, hematuria
  • Menopause S/S - if peri/post menopausal, around age 45-55, or on MHT
50
Q

how to prepare for PE of well woman exam

A
  1. Conduct in a calm, aesthetically pleasing environment with adequate gowning and draping
    - Chaperone - at discretion of provider
    - Pt companion unless it may interfere
    with exam or history
  2. Explain steps of exam that will be taken
  3. Have patient empty bladder before exam
  4. Will need to expose patients’ breasts
    - Preferably one at a time to reduce embarrassment and keep patient warm
  5. When doing pelvic exam, try to “press down” drape between patient’s knees
    - Help maintain eye contact and monitor patient’s face
    - Allows patient to see what is going on if she so desires
51
Q

general PE of well woman exam

A
  1. Vital Signs (including height)
  2. Thyroid
  3. Lungs
  4. Heart
  5. Abdomen
  6. Extremities
  7. Other exam (as needed)
52
Q

T/F: breast exam is no longer routinely recommended during the well woman exam if there are no s/s

A

T

53
Q

How to perform breast exam?

A
  1. Inspect in four positions
  2. Palpate all quadrants, including tail of Spence
  3. Palpate for regional lymphadenopathy
54
Q

SBE method

A
  1. Visual examination for skin changes/dimpling
  2. Palpate all quadrants of the breast
  3. Examine at the same time period each month

Most major organizations (including USPSTF and WHO) no longer recommend SBE

55
Q

general considerations during pelvic exam

A
  1. Attempt to alleviate fear and inspire cooperation and confidence
  2. Relaxing surroundings
  3. Chaperone (if needed)
  4. Warm instruments
  5. Gentle and unhurried manner
  6. Continuous explanation
56
Q

external pelvic exam of well woman exam

A
  1. Pubic hair - pattern, lice nits, folliculitis
  2. Skin - vulva, mons pubis, perineum
  3. Clitoris
  4. Urethral meatus - just below clitoris
    - Same color as surrounding tissue
    - No protuberances
  5. Labia Majora and Minora
  6. Vestibular glands
    - Usually cannot see or palpate these
57
Q

What is perineal support?
indicative of?

A
  • Have patient “bear down”
  • Cystocele, urethrocele, rectocele, uterine prolapse
  • Urethral “stripping” - pressure from proximal to distal urethra to express discharge
58
Q

Traditional Method for Pap smear?
What is the newer method?

A
  1. Obtain cervical scraping from complete squamocolumnar junction by rotating 360 degrees around the external os.
  2. Smear material from one end of the slide to the other.
  3. Place a saline-soaked cotton swab or small endocervical brush into the endocervical canal and rotate 360 degrees.
  4. Place this specimen on the same slide and apply fixative solution.

Newer Method - ThinPrep Test with spatula/brush or broom (see PDF)

59
Q

how to perform bimanual exam?
findings of cervix/uterus/adnexa?

A
  1. Place one hand on lower abdominal wall, two lubricated fingers
    of other hand in vagina
  2. Compress uterus and adnexa between abdominal hand and fingers
  3. Position, size, shape, mobility, consistency, and tenderness of pelvic organs
  • Cervix - 3-4 cm diameter and moderately firm, moderately mobile w/o undue discomfort
  • Uterus - Half the size of pts’ fist, smooth and regular outline, not tender, mobile
  • Adnexa - fallopian tubes and ovaries - usually nontender; Cannot be felt in many overweight women or postmenopausal women; Usually palpable in very slender women
60
Q

how to perform rectovaginal examination

A
  1. Insert well-lubricated middle finger of examining hand gently into the rectum and examine
  2. Insert index finger of examining hand into vagina
  3. Raise cervix toward anterior abdominal wall and palpate uterosacral ligaments
  4. May also do fecal occult blood testing
61
Q

recommendations for comprehensive skin exam? (USPSTF, ACS)

A
  1. USPSTF - no recommendation for or against
  2. ACS - periodic (q 3 yrs) for pts 20-40 and yearly 40+
    - Annually or more often for higher risk patients
    - Encourage monthly self-examinations
  3. Encourage UV ray protection - SPF 30 or higher
62
Q

Risk Factors mandating increased skin screening:

A
  1. Suspicious moles or lesions
  2. History of skin cancer - personal or family
  3. Atypical moles
  4. History of extensive sun exposure
  5. 50+ total moles
63
Q

recommendations for pap smear screening?

A

start age 21

  1. Ages 21-29 - Pap every 3 years
  2. Ages 30-65 - Pap every 3 years OR HPV +/- Pap every 5 years
  3. Age > 65 - Stop screening if…
    - no history of moderate/severe dysplasia or cancer AND…
    - 3 (-) Paps in a row or 2 (-) Pap+HPV results in a row in past 10 years (most recent result within last 5 years)
64
Q

when do pap smear screening guidelines not apply?

A
  • If hx of cervical cancer, HIV+, immunodeficient or DES exposure
  • May still need yearly Paps even after hysterectomy
65
Q

STD screening guidelines for pregnant women?

A
  • Hep B, HIV, Syphilis - All pregnant women should be screened
  • Gonorrhea / Chlamydia - < 25 years or high-risk sexual behavior
  • Hep C - if high-risk sexual behavior
66
Q

STD screening guidelines for nonpregnant women?

A
  1. All sexually active women:
    - HIV - if they consent; one time if low-risk
    - Gonorrhea/Chlamydia - if < 25 years, annually
  2. High-risk sexual behavior, annually:
    - HIV
    - Syphilis
    - Trichomoniasis
    - Hepatitis B and C
    - Gonorrhea/Chlamydia
    - +/- HSV, Hepatitis C
67
Q

RF for high-risk sexual behaviors for STD screening guidelines

A
  • Demographics: Young Age (15-24); AA; Unmarried status; Living in low socioeconomic status area
  • Criminal hx: Illicit drug use; Admission to correctional facility
  • Sexual hx: New sexual partner in past 60 days; Multiple sexual partners; h/o prior STI; Contact with sex workers; Meeting partners on the internet
68
Q

breast cancer screening guidelines?

A
  1. Mammogram +/CBE
  2. Varying guidelines between agencies
    - ACS, ACOG, ACR - yearly screens starting age 40-45; May transition to biennial, esp. at age 55
    - USPSTF, WHO, ACP, AAFP - biennial starting age 50
  3. D/C - USPSTF states “insufficient evidence” to continue after age 74
    - Many continue screening “as long as a woman is in good health and expected to live 10+ yrs”
69
Q

colon cancer screening guidelines?

A
  1. Varying guidelines between agencies
  2. Average risk pts - FOBT, FIT, CT colonography, or endoscopy (sigmoid/colon) age 45-75
  3. High risk pts - refer to specialist
  4. D/C - USPSTF recommends against routine screening after age 75
70
Q

USPSTF recommendations for bone density screening

A
  1. Initial Screening (usually DEXA scan)
    - All women 65+ years old
    - Any woman < 65 whose fracture risk ≥ that of a 65 year old white female without additional risk factors
    - No recommendations for men
  2. Frequency - not specified; many screen every 2 years
71
Q

65-yr-old white woman with no other risk factors - ?% 10-yr risk of osteoporotic fracture

A

9.3% - fracture risk assessment tool

72
Q

grading for pap smear results?

A

Bethesda System

  1. Atypical Squamous Cells (ASC)
    - Undetermined significance - ASC-US
    - Cannot exclude high-grade lesion - ASC-H
  2. Low-grade Squamous Intraepithelial Lesion - LGSIL or LSIL
    - Corresponds to CIN-I
  3. High-grade Squamous Intraepithelial Lesion - HGSIL or HSIL
    - Corresponds to CIN II and CIN III
  4. Atypical glandular cells - AGC
    - Glandular cells - nml components of the endocervix; secrete mucus
    - Atypical - do not match glandular cells but are not definitely cancer

Associated with adenocarcinoma of endocervix or of endometrium

73
Q

3 results of cervical bx?

A

CIN I - mild cervical dysplasia: disordered growth of lower ⅓ of epithelial lining
CIN II - moderate cervical dysplasia: disordered growth of lower ⅔ of epithelial lining
CIN III - severe cervical dysplasia: disordered growth of over ⅔ of epithelial lining; considered full thickness

74
Q

Always treat CIN II and III except:

A
  1. Pregnant women (wait until postpartum period)
  2. CIN II in adolescents (high chance of spontaneous regression and lower risk of cancer)
75
Q

RF for cervical dysplasia

A
  1. Sexual activity factors: Multiple sexual partners; Early onset of sexual activity; High-risk sexual partner
  2. Infection factors: HPV infection; History of sexually transmitted infection; Immunosuppression (including HIV/AIDS)
  3. Others: Multiparity; Long term oral contraceptive pill use
76
Q

What virus present in >80% of all CIN lesions and in 99.7% of all invasive cervical cancers?
Which strains are found in a majority of cervical cancers?

A

HPV

  • High-risk - 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68
  • HPV-16 - found in 50-70% of cervical cancers
  • HPV-18 - found in 7-20% of cervical cancers
77
Q

Most HPV+ women do not develop ___ or ____

A

CIN or cervical cancer

78
Q

what substances has a synergistic effect with HPV in causing cervical cancer

A

cigarettes

79
Q

3 options for mgmt for Minimally abnormal cervical cytology smears (ASC-US)

A
  1. Repeat serial cytology - q 6 mo till 2 consecutive normal
    - Second abnormal smear - colposcopy
  2. Test for high-risk HPV - Refer for colposcopy if positive
  3. Immediate referral to colposcopy

Before repeat smear: tx underlying conditions (atrophic vaginitis, infections)

80
Q

what atypical screening results are managed with colposcopy?

A

LSIL, HSIL, ASC-H, AGC

81
Q

Illuminated low-power magnification to inspect cervix, vagina, vulva, anal epithelium
3-5% aq acetic acid soln
Directed bx of abnml areas
Curette/brush of endocervical canal - No endocervical sampling done if pregnant

what is this?

A

Colposcopy

82
Q

5 indications for Colposcopy

A
  1. Abnormal cervical cytology or HPV testing
  2. Clinically abnormal cervix
  3. Unexplained intermenstrual or postcoital bleeding
  4. Vulvar or vaginal neoplasia
  5. History of in utero DES exposure
83
Q

mgmt for CIN I after colposcopy

A

Expectant management

  1. High chance of spontaneous regression
  2. 2 Pap q 6 mo OR Pap + HPV test at 6 months
    - Repeat colposcopy if cytology is abnormal or if the HPV +
    - If 2 cytology smears are normal and/or HPV negative, routine screening may resume

Surgery - CIN II/III, invasive cancer, abnml/satisfactory colposcopy

84
Q

Negative for intraepithelial lesion or malignancy

dx?
f/u & tx?

A

NILM
none

85
Q

Atypical Squamous Cells - undetermined significance

dx?
f/u? tx?

A

ASC-US

  • HPV Testing
  • Repeat Pap smear
  • Colposcopy and biopsy
  • Estrogen cream
86
Q

Atypical Squamous Cells - Cannot exclude HSIL

dx?

f/u? tx?

A

ASC-H

Colposcopy and biopsy

87
Q

Atypical Glandular Cells
Includes: AGC-NOS, AGC - favoring neoplasia, AIS (adenocarcinoma in situ)

dx?
f/u? Tx?

A

AGC

  • Colposcopy and biopsy
  • Endocervical curettage
88
Q

Low-grade squamous intraepithelial lesion

dx?
f/u? Tx?

A

LSIL

Colposcopy and biopsy

89
Q

High grade squamous intraepithelial lesion

dx?
f/u? tx?

A

HSIL

  • Colposcopy and biopsy
  • Endocervical curettage
90
Q

Cervical intraepithelial neoplasia - mild

dx?

f/u? tx?

A

CIN I

  • Repeat Pap smear
  • HPV Testing
91
Q

Cervical intraepithelial neoplasia - mod/severe

dx?
f/u?
tx?

A

CIN II-III

Surgery (LEEP, conization, cryotherapy, laser, hysterectomy)

92
Q

3 major estrogens produced by women:

A
  1. Estrone (E1) - main estrogen in postmenopausal women who are not on HRT
  2. Estradiol (E2) - major secretory product of ovary
    - Fluctuates widely during menses
    - Drops significantly after menopause
    - Up to 4x as common and 5x as potent as estrone
  3. Estriol (E3) - major estrogen in pregnancy
93
Q

characteristics of estrone (E1)

A
  1. Monitoring antiestrogen therapy
  2. Adjunct assessment of fracture risk
  3. Disorders of sex steroid metabolism
  4. Delayed or precocious puberty
94
Q

characteristics of estriol (E3)

A
  1. Part of Quad Screen in 2nd trimester
  2. Screening for fetal pathology
  3. Marker for fetal demise
  4. Assess preterm labor risk
95
Q

characteristics of Estradiol (E2)

A
  1. Monitoring antiestrogen therapy
  2. Disorders of sex steroid metabolism
  3. Evaluating ovarian function - Delayed or precocious puberty, menopausal status
  4. Monitoring HRT
  5. Can be elevated in hepatic cirrhosis and hyperthyroidism
96
Q

affects of progesterone to corpus luteum

A

significant production after ovulation
Can use to determine whether ovulation occurred
Can also help evaluate menopausal status

97
Q

progesterone effect on adrenal glands

A

progesterone converted to other steroids
Doesn’t contribute to serum levels unless a tumor is present
Can use in work-up of adrenal tumors

98
Q

progesterones effect on placenta

A

primary secretor in pregnancy by end of 1st trimester
Evaluation of placental function in pregnancy

99
Q

what can cause high false readings of progesterone?

A

high doses of biotin (>5 mg/d)

100
Q

Involved in M and F gametogenesis and ovarian cycle

what hormone?

A

FSH

101
Q

Involved in ovarian cycle and initial maintenance of luteal function for first 2 weeks of pregnancy
In males - promotes testosterone synthesis

what hormone?

A

LH

102
Q

initiation and maintenance of lactation

what hormone?

A

prolactin

103
Q

what hormone naturally inhibits prolactin?

A

dopamine

104
Q

what dopamine antagonists may increase prolactin

A

antipsychotics, antiemetics

105
Q

what Serotonergic drugs can increase prolactin

A

antidepressants, THC, ergots

106
Q

what Antihypertensive drugs with high CNS concentrations can increase prolactin

A

methyldopa, verapamil

107
Q

what Other common meds that can increase prolactin

A

opiates, high-dose estrogen or progesterone, valproic acid, cimetidine

108
Q

Most medication-induced rises are modest - increasing ?x ULN

A

2-4x ULN

109
Q

loss of libido, galactorrhea, infertility
MSK - decreased muscle mass, osteoporosis
In men - impotence
In women - oligomenorrhea or amenorrhea

dx?

A

hyperprolactinemia

110
Q

physiologic increases from hyperprolactinemia

A
  • Day-to-Day Activities: during sleep, exercise, nipple stimulation, sexual intercourse
  • Endocrine Changes: hypoglycemia
  • Recent Birth of Infant: postpartum period, lactation
111
Q

Pathologic Increases
that cause Hyperprolactinemia

A
  • Tumors / Lesions: pituitary adenoma; pituitary stalk compression; chest wall lesions
  • Endocrine / Chronic Disease: hypothalamic disease; primary; hypothyroidism; renal failure
  • Medications: Psych meds, THC; Opiates; Centrally-acting anti-HTN rx

Women's health (15 decks)

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