Midterm Flashcards
1
Q
Feminism
A
Perspecive that acknowledges oppression of women within patriarchal society
Oppression: not having a choice
2
Q
Feminist health care
A
How women live their lives collectively and as individuals within a patriarchal society
Intersection of sexism, racism, class, nation, gender
Works with women, etc.
3
Q
Intersectionality
A
Combination of multiple identities to explain disparities in health outcomes
Low socio-economic status most powerful factor
4
Q
Tanner stage 2
A
Female: breast bud forms, small amount of downy hair
5
Q
Tanner stage 3
A
Breasts elevate and extend beyond borders of areola
Coarse and curly hair and extends bilaterally
6
Q
Tanner stage 4
A
Areola + Papila=secondary mound, increased size and elevation
Adult like hair that spares thighs
7
Q
Tanner stage 5
A
Final adult size
Thighs not spared
8
Q
Adolescence development
A
11-14, 15-17, 18-21
Adult height and weight obtained
Puberty, bone mass acquired
Thelarche, adrenarche (6 mons post), peak height (2 years post), menarche (2-3 years post)
Identity + autonomy
Morbidity: pregnancy, STI, running away, suicide
9
Q
Early adulthood
A
18-(30-50 perimenopause) Reproductive years Cardiac disease biggest killer Intimacy vs isolation Generative vs stagnation
10
Q
Midlife
A
35-50 perimenopausal to 50-60 menopause
11
Q
Women’s health initiatives under healthy people 2020
A
- Osteoporosis: reduce hip fractures among older women >65
- Increase proportion of providers who refer women with symptoms of inherited bleeding disorders, such as von Willebrand disease
- Reduce breast cancer, uterine cancer, cervical cancer
- Increase cervical and breast cancer screening
- Decrease unintended pregnancy
- Increase access to contraception
- Increase aspirin use for adults with no history of CV disease
- Reduce number of STD/HIV/AIDS
- Increase routine vaccination of adolescents—HPV, influenza for pregnant women
- Reduce incidence of IPV
- Reduce rate of maternal mortality
- Reduce C sections
- Increase access to early prenatal care
- Increase abstinence from alcohol, smoking, illicit drugs among pregnant women
- Decrease iron deficiency among pregnant women
12
Q
Preventative services under ACA
A
Well women exams
Contraceptive and related services
Breastfeeding support including breast pumps
Maternity and newborn care
13
Q
Primary prevention
A
Preventing disease in susceptible populations
-Health education and counseling, targeted immunization
14
Q
secondary prevention
A
Early detection of disease states and subsequent prompt treatment
-Routine lab screening
15
Q
Tertiary prevention
A
Limit disability and promote rehabilitation from clinical disease states
16
Q
Counseling recommendations for all women
A
Alcohol misuse Breastfeeding Diet and exercise Fall prevention STI Skin CA Tobacco use
17
Q
Bones of pelvis
A
2 hip bones: innominate bones–consist of pubis, ischium, ilium fused together at the acetabukum
Sacrum + Coccyx
18
Q
Platypelloid pelvis
A
Squished and round
19
Q
Anthropoid pelvis
A
Elongated
20
Q
Gynecoid pelvis
A
Normal
21
Q
Android pelvis
A
Similar to gynecoid but sacrum is longer
22
Q
Structures that make up external female genitalia
A
Vulva, clitoris, periurethral glands, skenes glands, bartholin glands
23
Q
Vulva
A
Mons pubis, labia minora, labia majora, clitoris, urinary meatus, vaginal opening, corpus spongiosum erectile tissue
24
Q
Periurethral glands
A
Open directly into the vulva and are adjacent to the distal urethra
Also called skenes glands
Release mucus and form a triangular area of mucus membrane surrounding the urethral meatur
25
Bartholin's glands
Located on vulvovaginal area
Stimulated during sexual arousal
If ducts are blocked, infection can occur resulting in cyst formation
26
Structures that make up the internal female genitalia
Urethra, ovaries, fallopian tubes, uterus, vagina
27
Anatomy of ovaries
3 parts: outer cortical region, medullar region, hilum
| Produce gametes and sex hormones
28
Anatomy of fallopian tubes
Inner surface covered by cilia
4 segments: interstitialis, isthmus, ampulla, infundibulum
Wall composed of 3 layers: mucosa, muscularis, serosa
29
Anatomy of uterus
Fundus, body, cervix
| Uterine wall: endometrium, myometrium, serosa
30
Hypothalamus hormones
Initially releases GnRH in pulsatile manner
| Stimulates pituitary gland to produce FSH and LH
31
Pituitary gland hormones
Anterior: FSH, PRL, LH
FSH targets ovaries--stimulates growth an development of primary follicles and results in production of estrogen and progesterone
LH targets developing follicle within the ovary--responsible for ovulation, corpus luteum formation and hormone production
32
Ovarian cycle
Follicular phase: day 1-14
ovulation: 10-12 hours after LH peak
luteal phase: increased estrogen and progesterone prevents further ovulation
33
Endometrial cycle
Proliferative phase: influenced by estrogen; regrowth of endometrium after menstrual bleed; lasts 10 days, ending with ovulation
secretory phase: begins at ovulation; days 15-28; endometrium becomes thick, cushiony and nutritive
menstruation: lasts 4-6 days; prostaglandins initiate contractions of uterine smooth muscle leading to menstruation
34
2 different types of speculum for pelvic exam
Pederson + Graves
35
Pederson speculum
For pre-coitarche, nuliparas, postmenopausal, transgender men on testosterone, transgender women with neovaginas
Bladers are narrower and flat, no curve
36
Graves speculum
For most parous women
| Bladers have a curve
37
When should large graves speculum be used
Significant pelvic or genital adipose tissue, lax vaginal walls, grand multiparity
38
Montogomery tubercles
Common findings on breast exam
| Benign
39
Newly inverted nipple
Suggests pathology
40
Normal breast tissue in adult woman
Feels dense, firm and elastic, prior to and during menstruation may have cyclical tenderness, swelling and nodularity
41
Tail of spence
Breast tissue that extends from the upper outer quadrant toward the axilla
Have woman raise her arm above her head to palpate
42
Sequence of exam
Breast exam, pelvic exam--inspection and palpation, speculum, bimanual, rectovaginal if necessary
43
Normal cervical os
Pink, midline, 2-3cm diameter
Nulliparous women: small and round
Multiparous women: horizontal slit
Trauma of delivery: stellate os
44
Mission of USPSTF
Intent is to provide clinicians with a framework for decision making about the provision of preventive health services that is based on an extensive review of existing evidence
Grades A-D
45
Cervical cancer screening
Pap test every 3 years age 21-65 or every 5 years if HPV testing age 30-65
Not recommended if hysterectomy
46
Breast CA screening
Mammogram every 2 years age 50-74
| Age 40-49 individual basis
47
Cholesterol screening
>45 yes
| 20-45 if increased risk
48
Osteoporosis screening
>65 DEXA scan
49
Colon CA screening
50-75 FOBT, sigmoidoscopy, colonoscopy
| 76-85 individual basis
50
Ovarian CA screening
Not recommended
51
IPV screening
all women
52
Types of bariatric surgery
Malabsorptive: bypass parts of the digestive system and some reduction of stomach pouch
Restrictive bariatric surgeries : produce small stomach pouch
53
Contraception after bariatric surgery
If malabsorptive, nonoral administration of contraception is considered
Estrogen containing pills increase incidence of gallstones
Depo may cause weight gain
Vaginal ring provides contraception while bypassing digestive system
54
Pregnancy after bariatric surgery
Wait at least 12-24 months
| May have nutrient deficiencies, N/V may disrupt adjustable gastric band
55
Incidence of obesity in US
34.9% adults and 17% children
56
Sexual health
Physical, emotional, mental and social well-being in relation to sexuality
Not the absence of disease, dysfunction or infirmity
Ability to understand the benefits, risks and responsibilities of sexual behavior
57
Sexual agency
Individuals have control over their own sexuality
Woman's ability to say yes to wanted sexual activity
Awareness of nonsexual need to be sexual-->deliberate choice to experience stimulation-->some sexual arousal-->awareness of desire to continue experience for sexual reasons-->more arousal and orgasms-->spin offs (emotional bonding, love, etc)-->physical well being
58
Efficacy
Method failure rate
The likelihood that an unintended pregnancy will occur even when the method is used consistently and exactly as prescribed
59
Effectiveness
User failure rate
| All unintended pregnancies that occur if a method is not used properly
60
Physical methods of contraception
Abstinence, coitus interruptus, lactational amenorrhea (prolactin production inhibits ovulation), fertility awareness
61
Barrier methods of contraception
Male condoms, spermicides, diaphragms
62
Female sterilization
Permanently blocking fallopian tubes
| If pregnancy does occur after, ectopic pregnancy rate is high
63
Male sterilization
Cuts or blocks both right and left vas deferns
No effect on sex drive or male hormone production or sexual function
Wait 3 months before relying on this
64
Combination hormonal contraception
COC pills, patch, vaginal ring
65
Progestin only methods
Pills, depo medroxyprogesterone injection, subdermal implant, IUD
66
Effect of progestin
Prevents LH surge and therby inhibits ovulation; thickens cervical mucus, changes motility of fallopian tubes and causes endometrium atrophy
67
Effect of estrogen
Suppresses FSH to prevent ovulation
68
Benefits of combined hormonal methods
Decreased risk of PID and ectopic pregnancy, decreased risk of colon, ovarian and endometrial CA, decreased risk of endometriosis, RA, and asthma, preservation of bone density
69
Meds that can reduce effectiveness of COC pills
Antiretrovirals, rifampin, griseofulvin, some anticonvulsants, st johns wort
70
SE COC pills
Libido changes, increase risk of VTE, nausea, cervical ectopy, leukorrhea, chloasma, growth of breast tissue, increased cholesterol in bile, benign hepatocellular adenomas
71
Combined patch
Avoids first pass metabolism so allows for lower dose administration
20mcg per day of ethinyl estradiol and 150mcg per day of progestin
Wear 1 week at a time for 3 weeks and then no patch for 1 week
72
Combined ring
Leave in place for 21 days and then remove for 1 week
| May remove up to 6 hours for sexual intercourse
73
Progestin only pill
Must be taken at exactly the same time every day
Does not suppress ovulation reliably
Thickening cervical mucus is primary MOA--persists for 22 hours after each dose
74
Depot injection
150mcg IM injection every 13 weeks
Risks: osteoporosis if long term use
SE: change in bleeding patterns, weight gain, depression, HA, decreased libido, dizziness
Ovulation delayed 15-49 months after last injection
75
Noncontraceptive benefits of depot
Decreased number of seizures, decrease in sickle cell crises
76
Progestin implant
ACOG recommends as first line method
Etonogestrel released slowly over 3 years
Ovulation returns in 6 weeks after removal
Unscheduled bleeding most reported SE
77
Copper IUD
Primary effect: reaction to having a foreign body in the tract creates a sterile inflammatory response that has spermicidal effects
Main SE: bleeding and dysmenorrhea
Can be used as emergency contraception
78
Hormonal IUD
Produces thickening of cervical mucus, endometrial atrophy
| Ovulation suppressed in some women
79
Natural menopause
Cessation of menstruation for at least 12 consecutive months
Estrogen and progesterone levels decrease and FSH/LH remain high
80
Sx of menopause
Acne, arthralgia, asthenia, decreased libido, decreased vaginal lubrication, depression, dizziness, dry eyes, dry or thinning hair, dyspareunia, dysuria, fatigue, forgetfulness, formication, headache, hirsutism, hot flashes, irregular menses, irritability, mastalgia, myalgia, nervousness, night sweats, nocturia, etc.
81
Increased risk of early menopause
irregular cycles, cycles less than 21 days, changed hormone levels, age, smoking, underweight women, vegetarians
82
Most effective tx for vulvar and vaginal atrophy
Estrogen therapy
83
EPT should be limited to
3-5 years
84
Other causes of menopause
Surgical excision of both ovaries or ovarian function ablation caused by medications, chemotherapy or radiation
Women usually have more severe sx and greater risk for developing CVD, osteoporosis, cognitive impairment
85
Differentials for menopause
DM, HTN, arrhythmias, thyroid, anemia, depression, tumors, carcinoma, hyperprolactinemia, pregnancy
Labs: CBC, fasting glucose, TSH, prolactin, FSH, LH, estriol
86
Midlife health issues to be aware of
Obesity, CVD, DM, CA, osteoporosis, thyroid disease, depression
87
Absolute CI to estrogen therapy
Breast CA, uterine or ovarian CA, hx of stroke, hx of biliary tract disorder, undiagnosed abnormal genital bleeding, hx of active thrombophlebitis
88
Absolute CI to progesterone therapy
Active thrombophlebitis, liver dysfunction, breast CA, undiagnosed abnormal vaginal bleeding, pregnancy
89
Drug approved for hypoactive sexual desire disorder
Flibanserin
| May cause sedation
90
Scope of unintended pregnancies
51% of US pregnancies
Most frequent between 18 and 24 in unmarried, low income, minority groups who have not finished high schools
40% end in abortion
Associated with later entry into prenatal care, low birth weight, decreased likelihood of breastfeeding
91
Questions to ask someone after unintended pregnancy
How do you feel about being pregnant?
Do you know what your choices are?
What are your thoughts about becoming a parent? About adoption? About abortion?
92
Scope of infertility in US
6-15% of women
Inability to achieve pregnancy for 12 months
if >35 can evaluate after 6 months
if >40 can evaluate immediately
93
Etiology of infertility
55% due to female factors
| 35% due to male factors
94
Spermatogenesis
Takes about 72 days, after which the sperm mature in the epididymis and travel out of the vas deferens during ejaculation
95
Majority of female infertility is due to
Ovulatory dysfunction and tubal peritoneal pathology
96
Short duration of __ may contribute to infertility
Luteal phase
97
BBT
Consistently lower temperature during follicular phase and consistently higher temperature during luteal phase
98
Hysterosalpingogram
Assesses for patency of fallopian tubes and if the inside of the uterine cavity is normal
