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Women's Health > Midterm > Flashcards

Midterm Flashcards

1
Q

Feminism

A

Perspecive that acknowledges oppression of women within patriarchal society
Oppression: not having a choice

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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.

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3
Q

Intersectionality

A

Combination of multiple identities to explain disparities in health outcomes
Low socio-economic status most powerful factor

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4
Q

Tanner stage 2

A

Female: breast bud forms, small amount of downy hair

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5
Q

Tanner stage 3

A

Breasts elevate and extend beyond borders of areola

Coarse and curly hair and extends bilaterally

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6
Q

Tanner stage 4

A

Areola + Papila=secondary mound, increased size and elevation
Adult like hair that spares thighs

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7
Q

Tanner stage 5

A

Final adult size

Thighs not spared

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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

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9
Q

Early adulthood

A 
18-(30-50 perimenopause)
Reproductive years 
Cardiac disease biggest killer 
Intimacy vs isolation
Generative vs stagnation
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10
Q

Midlife

A

35-50 perimenopausal to 50-60 menopause

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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
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12
Q

Preventative services under ACA

A

Well women exams
Contraceptive and related services
Breastfeeding support including breast pumps
Maternity and newborn care

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13
Q

Primary prevention

A

Preventing disease in susceptible populations

-Health education and counseling, targeted immunization

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14
Q

secondary prevention

A

Early detection of disease states and subsequent prompt treatment
-Routine lab screening

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15
Q

Tertiary prevention

A

Limit disability and promote rehabilitation from clinical disease states

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16
Q

Counseling recommendations for all women

A 
Alcohol misuse
Breastfeeding 
Diet and exercise
Fall prevention
STI
Skin CA
Tobacco use
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17
Q

Bones of pelvis

A

2 hip bones: innominate bones–consist of pubis, ischium, ilium fused together at the acetabukum
Sacrum + Coccyx

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18
Q

Platypelloid pelvis

A

Squished and round

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19
Q

Anthropoid pelvis

A

Elongated

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20
Q

Gynecoid pelvis

A

Normal

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21
Q

Android pelvis

A

Similar to gynecoid but sacrum is longer

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22
Q

Structures that make up external female genitalia

A

Vulva, clitoris, periurethral glands, skenes glands, bartholin glands

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23
Q

Vulva

A

Mons pubis, labia minora, labia majora, clitoris, urinary meatus, vaginal opening, corpus spongiosum erectile tissue

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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

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25
Q

Bartholin’s glands

A

Located on vulvovaginal area
Stimulated during sexual arousal
If ducts are blocked, infection can occur resulting in cyst formation

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26
Q

Structures that make up the internal female genitalia

A

Urethra, ovaries, fallopian tubes, uterus, vagina

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27
Q

Anatomy of ovaries

A

3 parts: outer cortical region, medullar region, hilum

Produce gametes and sex hormones

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28
Q

Anatomy of fallopian tubes

A

Inner surface covered by cilia
4 segments: interstitialis, isthmus, ampulla, infundibulum
Wall composed of 3 layers: mucosa, muscularis, serosa

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29
Q

Anatomy of uterus

A

Fundus, body, cervix

Uterine wall: endometrium, myometrium, serosa

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30
Q

Hypothalamus hormones

A

Initially releases GnRH in pulsatile manner

Stimulates pituitary gland to produce FSH and LH

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31
Q

Pituitary gland hormones

A

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

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32
Q

Ovarian cycle

A

Follicular phase: day 1-14
ovulation: 10-12 hours after LH peak
luteal phase: increased estrogen and progesterone prevents further ovulation

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33
Q

Endometrial cycle

A

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

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34
Q

2 different types of speculum for pelvic exam

A

Pederson + Graves

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35
Q

Pederson speculum

A

For pre-coitarche, nuliparas, postmenopausal, transgender men on testosterone, transgender women with neovaginas
Bladers are narrower and flat, no curve

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36
Q

Graves speculum

A

For most parous women

Bladers have a curve

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37
Q

When should large graves speculum be used

A

Significant pelvic or genital adipose tissue, lax vaginal walls, grand multiparity

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38
Q

Montogomery tubercles

A

Common findings on breast exam

Benign

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39
Q

Newly inverted nipple

A

Suggests pathology

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40
Q

Normal breast tissue in adult woman

A

Feels dense, firm and elastic, prior to and during menstruation may have cyclical tenderness, swelling and nodularity

41
Q

Tail of spence

A

Breast tissue that extends from the upper outer quadrant toward the axilla
Have woman raise her arm above her head to palpate

42
Q

Sequence of exam

A

Breast exam, pelvic exam–inspection and palpation, speculum, bimanual, rectovaginal if necessary

43
Q

Normal cervical os

A

Pink, midline, 2-3cm diameter
Nulliparous women: small and round
Multiparous women: horizontal slit
Trauma of delivery: stellate os

44
Q

Mission of USPSTF

A

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
Q

Cervical cancer screening

A

Pap test every 3 years age 21-65 or every 5 years if HPV testing age 30-65
Not recommended if hysterectomy

46
Q

Breast CA screening

A

Mammogram every 2 years age 50-74

Age 40-49 individual basis

47
Q

Cholesterol screening

A

> 45 yes

20-45 if increased risk

48
Q

Osteoporosis screening

A

> 65 DEXA scan

49
Q

Colon CA screening

A

50-75 FOBT, sigmoidoscopy, colonoscopy

76-85 individual basis

50
Q

Ovarian CA screening

A

Not recommended

51
Q

IPV screening

A

all women

52
Q

Types of bariatric surgery

A

Malabsorptive: bypass parts of the digestive system and some reduction of stomach pouch
Restrictive bariatric surgeries : produce small stomach pouch

53
Q

Contraception after bariatric surgery

A

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
Q

Pregnancy after bariatric surgery

A

Wait at least 12-24 months

May have nutrient deficiencies, N/V may disrupt adjustable gastric band

55
Q

Incidence of obesity in US

A

34.9% adults and 17% children

56
Q

Sexual health

A

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
Q

Sexual agency

A

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
Q

Efficacy

A

Method failure rate
The likelihood that an unintended pregnancy will occur even when the method is used consistently and exactly as prescribed

59
Q

Effectiveness

A

User failure rate

All unintended pregnancies that occur if a method is not used properly

60
Q

Physical methods of contraception

A

Abstinence, coitus interruptus, lactational amenorrhea (prolactin production inhibits ovulation), fertility awareness

61
Q

Barrier methods of contraception

A

Male condoms, spermicides, diaphragms

62
Q

Female sterilization

A

Permanently blocking fallopian tubes

If pregnancy does occur after, ectopic pregnancy rate is high

63
Q

Male sterilization

A

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
Q

Combination hormonal contraception

A

COC pills, patch, vaginal ring

65
Q

Progestin only methods

A

Pills, depo medroxyprogesterone injection, subdermal implant, IUD

66
Q

Effect of progestin

A

Prevents LH surge and therby inhibits ovulation; thickens cervical mucus, changes motility of fallopian tubes and causes endometrium atrophy

67
Q

Effect of estrogen

A

Suppresses FSH to prevent ovulation

68
Q

Benefits of combined hormonal methods

A

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
Q

Meds that can reduce effectiveness of COC pills

A

Antiretrovirals, rifampin, griseofulvin, some anticonvulsants, st johns wort

70
Q

SE COC pills

A

Libido changes, increase risk of VTE, nausea, cervical ectopy, leukorrhea, chloasma, growth of breast tissue, increased cholesterol in bile, benign hepatocellular adenomas

71
Q

Combined patch

A

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
Q

Combined ring

A

Leave in place for 21 days and then remove for 1 week

May remove up to 6 hours for sexual intercourse

73
Q

Progestin only pill

A

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
Q

Depot injection

A

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
Q

Noncontraceptive benefits of depot

A

Decreased number of seizures, decrease in sickle cell crises

76
Q

Progestin implant

A

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
Q

Copper IUD

A

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
Q

Hormonal IUD

A

Produces thickening of cervical mucus, endometrial atrophy

Ovulation suppressed in some women

79
Q

Natural menopause

A

Cessation of menstruation for at least 12 consecutive months
Estrogen and progesterone levels decrease and FSH/LH remain high

80
Q

Sx of menopause

A

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
Q

Increased risk of early menopause

A

irregular cycles, cycles less than 21 days, changed hormone levels, age, smoking, underweight women, vegetarians

82
Q

Most effective tx for vulvar and vaginal atrophy

A

Estrogen therapy

83
Q

EPT should be limited to

A

3-5 years

84
Q

Other causes of menopause

A

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
Q

Differentials for menopause

A

DM, HTN, arrhythmias, thyroid, anemia, depression, tumors, carcinoma, hyperprolactinemia, pregnancy
Labs: CBC, fasting glucose, TSH, prolactin, FSH, LH, estriol

86
Q

Midlife health issues to be aware of

A

Obesity, CVD, DM, CA, osteoporosis, thyroid disease, depression

87
Q

Absolute CI to estrogen therapy

A

Breast CA, uterine or ovarian CA, hx of stroke, hx of biliary tract disorder, undiagnosed abnormal genital bleeding, hx of active thrombophlebitis

88
Q

Absolute CI to progesterone therapy

A

Active thrombophlebitis, liver dysfunction, breast CA, undiagnosed abnormal vaginal bleeding, pregnancy

89
Q

Drug approved for hypoactive sexual desire disorder

A

Flibanserin

May cause sedation

90
Q

Scope of unintended pregnancies

A

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
Q

Questions to ask someone after unintended pregnancy

A

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
Q

Scope of infertility in US

A

6-15% of women
Inability to achieve pregnancy for 12 months
if >35 can evaluate after 6 months
if >40 can evaluate immediately

93
Q

Etiology of infertility

A

55% due to female factors

35% due to male factors

94
Q

Spermatogenesis

A

Takes about 72 days, after which the sperm mature in the epididymis and travel out of the vas deferens during ejaculation

95
Q

Majority of female infertility is due to

A

Ovulatory dysfunction and tubal peritoneal pathology

96
Q

Short duration of __ may contribute to infertility

A

Luteal phase

97
Q

BBT

A

Consistently lower temperature during follicular phase and consistently higher temperature during luteal phase

98
Q

Hysterosalpingogram

A

Assesses for patency of fallopian tubes and if the inside of the uterine cavity is normal

Women's Health (2 decks)

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