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Women's health trigger > Lecture 6: Health Maintenance > Flashcards

Lecture 6: Health Maintenance Flashcards

1
Q

What qualifies as postmenopause?

A

No menstrual flow for 12+ months

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2
Q

What is metrorrhagia?

A

Menstrual bleeding between cycles

aka intermenstrual bleeding

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3
Q

What is considered polymenorrhea?

A

20 days or less

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4
Q

What is menometrorrhagia?

A

Completely irregular bleeding

metrorrhagia is between cycles

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5
Q

What is considered oligomenorrhea?

A

35 days or more

poly is 20

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6
Q

What time period qualifies as amenorrhea?

A

No menstrual period in over 6 months

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7
Q

What is cryptomenorrhea and what is it AKA

A

unusually light menstrual flow or spotting only

“hypomenorrhea”

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8
Q

What might contact bleeding suggest?

A

Cervical cancer

Postcoital, contact cervical

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9
Q

What does a radical hysterectomy remove?

what about a subtotal hysterectomy?

A
  • Uterus
  • Cervix
  • Pericervical tissue
  • Upper vagina

subtotal = uterine corpus only (not cervix)

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10
Q

what is removed during the following propcedures:
1. oophorectomy
2. Salpingectomy
3. salpingo-oophorectomy

A
  1. one or both ovaries
  2. one or both oviducts
  3. one or both ovaries and oviducts
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11
Q

What is a BSO?

A

Bilateral salpingo-oophorectomy

Removal of ovaries and tubes

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12
Q

TAH and TVH

A
  • TAH: total abdominal hysterectomy
  • TVH: total vaginal hysterectomy
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13
Q

what is the timing of preterm infants vs abortion considered

A

preterm - 20-36 wks
abortion - <20 wks

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14
Q

what is the difference between a spontaneous, therapeutic and elective abortion

A
  • spontaneous - due to natural causes
  • therapeutic - induced for medical reasons
  • elective - induced for non-medical reasons
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15
Q

what is stillborn

A

birth of an infant who has died in the womb typically after 20 weeks gestation:(

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16
Q

what is:
grand multigravida
grand multipara
great grand multipara

A
  • grand multigravida: a woman who has been pregnant 5+ times
  • grand multipara - a woman who has delivered 5+ infants 24+ weeks gestation
  • great grand muulti para - same but 7+ infants delivered
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17
Q

When does the first reproductive health visit tend to occur?

A

13-15

start of puberty?

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18
Q

What occurs at the first reproductive health visit?

A
  • Health info
  • If symptomatic: pelvic or STD screen may be needed
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19
Q

When do we start pap smears and pelvic exams?

A
  • Pap smears: 21 unless symptomatic, even if active
  • Pelvic exams: 21, but depends on s/s and hx.
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20
Q

do you need a pelvic exam prior to starting birth control

A

NO

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21
Q

How often are pap smears?

A

Every 3-5 yrs

Usually start at age 21.

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22
Q

When are CBE indicated?

A
  • controversial
  • if done, do every 1-3 yrs for 20-39 y/o
  • yearly CBE and mammogram for 40+ y/o
  • does NOT replace mammogram

no longer routinely recommended if no s/s

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23
Q

Ideal setup for a well woman exam

A
  • Cloth gowns
  • Calming + aesthetic environment
  • One breast at a time (cover the other)
  • Allow companion if no issues
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24
Q

Although SBE is no longer recommended, what should a woman keep in mind if she still intends to examine her breasts?

A
  • Visual exam for changes/dimpling
  • Palpate all quadrants
  • Examine same time every month
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25
Q

What test needs to be done prior to the bimanual exam?

A

Pap smear

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26
Q

PANCE-wise, what do you lubricate the speculum with?

A

Warm water

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27
Q

Describe a traditional pap smear

A
  1. Cervical scraping around external os via SPATULA
  2. BRUSH in endocervical canal. 360deg rotation. apply on same slide as step one.

brOOm Outside, brush inside

for newer method: use ThinPrep test

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28
Q

What structures are palpated during a bimanual exam? what are normal findings?

A
  • Cervix - 3/4 cm in diameter and moderately firm/mobile w/o discomfort
  • Uterus - half size of pts fist. smooth, regular outline, nontender, mobile.
  • Adnexa: fallopian tubes and ovaries - usually only palpable in sim women. not in overwieght/postmenopausal women!
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29
Q

describe a rectovaginal examination

which finger goes where, what are you palpating?

A
  • insert well-lubricated middle finger of examining hand into rectum.
  • insert index finger of examining hand into vagina
  • raise cervix towards anterior abdominal wall and palpate uterosacral ligaments
30
Q

According to ACS guidelines, when are comprehensive skin exams indicated?

A
  • For 20-40, Q3y
  • For 40+, Q1y

encourage UV ray SPF 30 or higher

31
Q

Pap smear frequencies

A
  1. 21-29: every 3 years
  2. 30-65: every 3 years OR HPV +/- pap every 5
  3. 65+: can stop if no hx of dysplasia/cx + 3 negative paps or 2 negative paps/HPVs in past 10y
  4. Guidelines do not apply to cervical cx, HIV+, immuno, or DES exposure
32
Q

What STDs should all pregnant women be screened for regardless of risky behavior?

A
  1. Hep B
  2. HIV
  3. Syphilis

HHS

33
Q

What age should pregnant women be screened for gonorrhea/chlamydia?

A

< 25y

or anyone w high risk sexual behavior. also Hep c if high risk.

34
Q

For non-pregnant women, what are the STD screenings?

A
  • HIV once if low risk
  • Gonorrhea/Chlamydia annually if < 25
  • If high risk: HIV/syph/trich/hepB/C/Gonorrhea/Chlamydia/(+/- HSV)
35
Q

what is considered high risk sexual behavior

A

non-intuitive ones (in my head at least):
* young age
* African american race
* unmarried
* living in low Socioeconomic area
* new partner in last 60 days

Intuitive ones (in my head):
* illicit drug use
* admission to correctional facility
* multiple sexual partners
* hx of prior STI
* contact w sex workers
* meeting partners on internet.

36
Q

Generally, when do you start mammograms?

A
  • ACS/ACOG/ACR: annually at 40-45 (can change to biennial esp at age 55)
  • USPSTF/WHO/ACP/AAFP: Biennial starting at 50

USPSTF -“insufficient evidence to continue past age 74”

many providers do it as long as woman is in good health and expects to live 10+ more years

37
Q

When do you stop mammograms?

A
  • Life expectancy < 10y and in poor health
  • After age 74 on average
38
Q

Generally, when do you start colonoscopy screening?

A

45

USPSTF - no screening after 75

39
Q

When is DEXA scan recommended?

A
  • women 65+
  • woman < 65 but you have the fx risk of a 65+ white female with no other RFs
  • No recommendations for men

You do it about every 2 years, no set frequency

40
Q

What does a 65y white woman with no other RFs have for their osteoporotic risk?

A

9.3% 10 year risk

FRAX?

41
Q

How are pap smears graded?

A

Bethesda system

42
Q

What are the two types of atypical squamous cells in the besthesda system?

A
  • ASC-US (undetermined significance)
  • ASC-H (cannot exclude high-grade lesion)
43
Q

What does LGSIL/LSIL (low-grade squamous intraepithelial lesion) correspond to? (CIN ranking)

A

CIN-I

CIN = cervical dysplasia (gogle says Cervical intraepithelial neoplasia)

CIN 1 = lower 1/3 of epithelial lining of cervix
CIN 2 = lower 2/3^^
CIN 3 = over 2/3 ^^

44
Q

What does high-grade squamous intraepithelial lesion (HGLSIL/HSIL) correspond to? (CIN ranking)

A

CIN-II or CIN-III

45
Q

What are atypical grandular cells/AGC associated with?

A

Adenocarcinoma of the endocervix or endometrium

46
Q

Describe CIN 1/2/3

A
  1. CIN-I = disordered growth of lower 1/3
  2. CIN-II = disordered growth of lower 2/3
  3. CIN-III = disordered growth of over 2/3; considered full thickness
47
Q

When do you always treat CIN?

A

CIN-2/3 always treated unless pregnant or CIN 2 in adolescents.

adolescent = high chance of spontaneous regression and lower risk of cancer

48
Q

Top 2 highest risk HPV strains

A
  1. HPV 16: 50-70% of all cervical cancers
  2. HPV-18: 7-20% of all cervical cancers

HPV is in 80% of all CIN lesions + 99.7% of all invasive cervical cx.

BUT most HPV + women do not develop CIN or cervical cancer

48
Q

What is the major estrogen prior to menopause? After?

A
  • Estradiol/E2 is the major secretory product of the ovaries, and is far more MC than estrone/E1
  • After menopause: estrone/E1 is MC as long as you’re not on hormone replacement.

EstrONE = 1st, estraDIol = 2

49
Q

What secondary risk factor tends to synergistically increase risk of cervical cancer?

A

HPV with SMOKING

49
Q

What is the major estrogen during pregnancy?

A

Estriol/E3

prEgnancy

50
Q

Tx for ASC-US

A
  • Repeat cytology q6m until 2 normal.
  • Test for high-risk HPV (16/18)
  • Colposcopy

Any option viable. Colposcopy if top 2 are abnormal.

Make sure to tx hormones and infections prior to repeating smears.

50
Q

When are estrone levels ordered?

A
  • Monitoring antiestrogen therapy
  • Adjunct assessment in fx risk
  • Disorders of sex steroid metabolism
  • Delayed/precocious puberty

typically only doninant in menopause

51
Q

Next step in management for LSIL/HSIL/ASC-H/AGC

A

Colposcopy

51
Q

When is estriol ordered?

A
  • Quad screen in 2nd trimester
  • Screening for fetal pathologies
  • Marker for fetal demise
  • Assess preterm labor risk

primary estrogen in pregnancy

52
Q

When is estradiol ordered?

A
  • Monitoring antiestrogen therapy
  • Disorders of sex steroid metabolism
  • Evalulating ovarian function
  • Monitoring HRT
  • Elevated in hepatic cirrhosis or hyperthyroidism

primary estrogen prior to menopause

52
Q

what is a colposcopy

A

illuminated low-power magnification to inspect cervix, vagina, vulva, and anal epithelium

53
Q

What is done in colposcopy?

A
  • Biopsies
  • Endocervical samples via curette or brushing

Addition of acetic acid makes lesions turn white

no endocervical sampling done if pt is preggo

53
Q

Where can progesterone be secreted by?

A
  • Corpus luteum (post ovulation)
  • Adrenal glands (conversion to other steroids, no contribution unless tumor)
  • Placenta (primary by end of 1st trimester)
54
Q

Indications for colposcopy (5)

A
  1. Abnormal cervical cytology/HPV testing
  2. Clinically abnormal cervix
  3. Unexplained metrorrhagia or contact bleeding
  4. Vulvar/vaginal neoplasia
  5. History of in utero DES exposure
54
Q

What can interfere with progesterone readings? (2)

A
  • Adrenal tumors
  • Biotin > 5mg/dl
55
Q

Management of CIN-1 after colposcopy

A
  • 2 pap Q 6 months OR pap + HPV test at 6mo.
  • if cytology abnormal or HPV + then repeat colposcopy.
  • if 2 cytology smears normal and/or HPV neg then routine screening resumes

monitor because HIGH chance of spontaneous REGRESSION

55
Q

When are FSH/LH low?

A
  • Pituitary failure
  • Hypothalamic failure
  • Pregnancy
  • Anorexia/malnutrition
  • OCPs
56
Q

Management of CIN 2/3 & invasive cx or abnormal findings after colposcopy

56
Q

When are FSH/LH high?

A
  • Menopause
  • Castration
  • Precocious puberty (age-adjusted)

FSH/LH are high when estrogen and progesterone are low.

57
Q

Summary of pap smear/biopsy results and followup

A

Currettage for AGC and HSIL

57
Q

Main inihibitor of prolactin

58
Q

What drug classes can boost prolactin?

A
  • Antipsychotics
  • Antiemetics
  • Antidepressants
  • THC
  • Ergots
  • Opiates
  • Methyldopa
  • Verapamil

Meds tend to cause a 2-4x ULN rise.

Mainly psych meds

59
Q

S/S of hyperprolactinemia

A
  • Men: impotence
  • Women: oligomenorrhea/amenorrhea
  • MSK: decreased muscle mass and osteoporosis
60
Q

Pap smear result and treatment chart for abnormal findings/abbreviations

Women's health trigger (23 decks)

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