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Adv Practice Women’s Health 6032 Test 1 > Module 2 (a) > Flashcards

Module 2 (a) Flashcards

1
Q

Reasons for Health Promotion?

A
  1. Modifiable, behavioral risk factors are the leading causes of death for women
    - Smoking-related illness
    - Overweight or obesity
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2
Q

Preventive Health Services for women Under the AÇA?

A
  1. Well-woman physical exam (W/ recommended counseling, screening, and immunizations
  2. Contraceptives
  3. Breastfeeding support (including breast pumps)
  4. Maternity and newborn care
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3
Q

Heart Disease, Cancer and Women

A
  1. Heart disease is the leading cause of death in women in the US
    Risk Factors
    -Obesity
    -Smoking/Tobacco Use
    -At-risk drinking (greater than 3 drinks per day or 7 drinks per day)
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4
Q

Immunization Considerations

A
  1. HPV - Males and females ages 9-26 — Shared Decision making is utilized above age 26 to weigh risks and benefits
  2. Influenza - given yearly to all women, including pregnant women
  3. Hep B - Given at birth or age 11-18 — Booster required if woman is not immune or is high risk (IV drug use, healthcare)
  4. Tdap booster every 10 years and during pregnancy (Given between 27-33 weeks)
  5. Pneumococcal — Given to women >65 yrs old (Younger if they have chronic diseases
  6. Covid — Given to pregnant and breast feeding women
  7. Varicella and MMR are Contraindicated in pregnancy because they are LIVE vaccines
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5
Q

Self Breast Exams

A
  1. NO requirement for clinicians to teach women how to perform BSE. (Risk for false positive test results
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6
Q

Clinical Breast Exam

A
  1. Every 1-3 years starting at age 20
  2. Every year starting at age 40
  3. Recommended more frequently with a strong family hx
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7
Q

Mammograms

A
  1. USFSTF recommends biennial screening mammography for women aged 50-74.
  2. For women 40-49, the decision to start screening should be made through shared-decision making
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8
Q

Cervical Cancer

A
  1. Begin screening at age 21
  2. Screening Tests include
    - PAP test every 3 years
    - 30-65 yrs = PAP + HPV DNA “co-test” every 5 years
  3. End screening age 65 or after hysterectomy for benign indications
  4. Any patient w/ a cervix should undergo routine cervical cancer screening
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9
Q

Chlamydia and Gonorrhea Infection

A
  1. ALL sexually active patients aged 24 yrs or younger AND individuals 24+ who are at risk for STIs
  2. Test: Nucleic Acid Amplification Tests (NAATs)
  3. Risk factors: Age, hx of STIs, new or multiple sexual partners, exchanging sex for money or drugs, no monogamous relationships who do not use condoms consistently, and specific communities
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10
Q

HIV Infection Screening

A
  1. All adults aged 15-65 yrs old
  2. Screen all pregnant women
  3. Screen younger adolescents and older adults who are at increased risk for infection
  4. One-time screen for all patients aged 15-65 to ID existing disease w/ follow up testing based on risk factors
  5. Pregnancy: Screen at New OB visit and consider repeat screening in 3rd trimester (Risk factors vs. state mandated screenings)
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11
Q

Sexual Health Hx

A
  1. Partners — How many Partners and are they men, women, or both
  2. Practices — What type of sex do they have — be descriptive
  3. Past Hx of STDs
  4. Protection from STDs
  5. Pregnancy Plans
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12
Q

General Physical Exam

A
  1. Patient is in control of the Exam — TRAUMA informed care — Treat each patient as if they have trauma
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13
Q

GYN Exam Ages 19-39

A
  1. FOCUS on reproductive life plan, contraception, pre-conception plan, and exercise
  2. HPV and Influenza Vaccination
  3. Screen for STI, and Cervical Cancer
  4. Physical Exam:
    - Initiate speculum exam w/ PAP at 21
    - 30-39 co-test PAP + HPV q5 years
    - Clinical breast exam (q1-2 years)
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14
Q

GYN Exam Ages 40-65

A
  1. FOCUS on perimenopause Sx’s, age-related metabolic changes, physical changes and Exercise
  2. Immunizations:
    - Shingles Vaccine Ages >50 yrs and compromised immune system
    - Pneumococcal for those w/ asthma and COPD ; COVID and annual influenza offered as well
  3. Screening for — STIs, cervical cancer, mammograms offered w/ shared decision making
  4. Physical Exam
    - 40-65 yrs Co-test PAP + HPV q5 years
    - Clinical breast exam (q1-2)
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15
Q

NEXT SLIDES ON GYN CANCERS

A

NEXT SLIDES ON GYN CANCERS

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16
Q

Cervical Cancer

A
  1. 4th most common cancer in women worldwide — Caused by HPV
  2. Risk Factors — Multiple sex partners, immunosuppression, cigarette smoking, HPV or STI infection, inadequate screening/Gyn care
  3. Sx’s include — Abnormal DC, watery DC, abnormal vaginal bleeding, post-coital bleeding
  4. Many women w/ early cervical CA are asymptomatic
17
Q

Updated Cervical Cancer Screening 2018

A 
1. Cervical cytology alone q3 years 
OR
2. hrHPV testing alone q5 years. 
OR
3. Co-testing (hrHPV testing and cervical cytology every 5 years)

Guidelines are changing as the evidence is updated

18
Q

ASCCP RISK-Based MGMT for Cervical Cancer

A
  1. Risk based rather than results based
  2. More individualized
  3. Estimates patients immediate risk of pre-cancer based on type and duration of HPV infection
19
Q

Breast Cancer

A
  1. 1/8 women will be diagnosed with breast cancer in their lifetime
  2. High Risk Women (Fam hx or familial cancer hx) OFFER genetic counseling and genetic testing
  3. Sx’s
    - Breast mass, swelling, skin changes (dimpling, thickening), pain, nipple retraction or discharge
  4. Screening — Clinical breast exams (q1-3 years), mammography, breast self awareness — ALL should be SHARED-DECISION MAKING
    - Begin 40-50 yrs
    - Frequency - 1-2 years
    - DC at age 75 or life expectancy <10 yrs
20
Q

Endometrial Cancer

A
  1. Cancer of the lining of the Uterus
  2. Most Common in POST-MENOPAUSAL Women — Uncommon <45 yrs of age
  3. Sx’s —Persistent abnormal Vaginal Bleeding **
  4. Risk Factors — Obesity, PCOS, estrogen replacement therapy, pelvic radiation
  5. NO recommendation to screen low risk women
  6. Ask ALL post-menopausal women about abnormal bleeding
  7. Refer to GYN for endometrial biopsy
21
Q

Ovarian Cancer

A
  1. Responsible for MORE deaths than any other GYN cancer
  2. Risk Factors
    - Age, BRCA 1/2, Fam hx (familial cancer syndromes), infertility treatment, Nulliparity, breast cancer
  3. Sx’s — Vague, bloating, pelvic pain, urinary urgency/frequency, abdominal pain or mass in later disease
  4. REFERRAL when Adnexa mass is palpated on bimanual exam
22
Q

Vulvar Cancer

A
  1. 4% of all GYN cancers.
  2. Risks include: Post-menopausal, HPV infection
  3. Sx’s — Mass or lump on vulva, prolonged/persistent vulvar pruritus
  4. Screening — Careful exam of the vulva, vagina, perineum, inguinal lymph node assessment
  5. Treatment/Referral: Lesions or persistent Sx’s should be biopsies, refer to Gyn for colposcopy, imaging and treatment
23
Q

NEXT SLIDES: CERVICAL CA SCREENING

A

NEXT SLIDES: CERVICAL CA SCREENING

24
Q

HPV

A
  1. Spread through sexual contact
  2. Associated w/ anogenital cancer (Including vaginal, anal, vulvar
  3. 150 HPV subtypes —13 known to cause cervical cancer
  4. HPV 16/18 are MOST frequent and account for 80% of cervical cancers
  5. 90% of Genital warts are caused by HPV subtypes 6 & 11
25
Q

HPV Vaccination

A
  1. Ideally given ages 11-12
  2. Ages <15 — 2 doses 6-12 months apart
  3. Ages >15 — 3 dose series given over 6 months
26
Q

HPV Prevention Through Vaccination

A
  1. Risk factors
    - Male partner w/ HR HPV
    - Parter who is a sex worker
    - Cigarette smoking
    - HIV Co-infection
    - STI co-infection
  2. Decreased Risk
    - HPV vaccination
    - Evidence based screening
    - Monogamy
    - Healthy diet
27
Q

Cervical CA is the 4th most common cancer in women worldwide

A
  1. Peak incidence - 45-55 years old
  2. Increasing incidence in young women
  3. Cervical Intraepitherlial Neoplasia (CIN)
    - Cervical pre-cancers
    - rates of CIN are more common than invasive cervical cancer
    - Incidence rates — #1 latina, #2 African Americans, #3 Caucasian
28
Q

PAP Sample Collection

-Patient Education

A
  1. Avoid intercourse x 48 hrs prior
  2. Do not use vaginal meds/lubricant, creams, douches x 48 hrs prior
  3. Avoid collection during menstruation
  4. Use lubricant sparingly
29
Q

What does Screening Identify?

A
  1. Cervical cell changes (Precancerous or cancerous)
  2. High Risk HPV infection
  3. Abnormal growth on the surface of the cervix or endocervical canal
  4. Cervical intraepitherial neoplasia (CIN) aka displasia
30
Q

Cervical Intraepithelial Neoplasia (CIN)

A
  1. CIN 1 = Low-grade lesion — typically regresses back to normal
  2. CIN 2 = equivocal — often regress like CIN 1
  3. CIN 3 = High grade lesion — Immediate cancer precursor — 10 -20% progress to cancer WITHOUT TREATMENT
    - CIN 3 TO Cancer time averages 8.1 -12 years
31
Q

Updated Cervical Cancer Screening TEST and QUIZ

A
  1. Women age <21 yrs — NO Screening
  2. Women age 21- 29 years — Cervical cytology along every 3 years
3. Women aged 30-65 years 
—Cervical Cytology alone every 3 years 
OR
—hr HPV testing along every 5 years 
OR
—Co-testing (hrHPV testing and cervical cytology every 5 years
  1. Women aged >65 years w/ adequate prior screening — NO screening
32
Q

Screening Options

A
  1. Cytology alone — High specificity but lower sensitivity and lower predictive value than hrHPV testing
  2. PREFERRED Method for women age 30-65 years (Co-testing w/ Cytology + HPV DNA)
  3. Primary HPV Testing
    - Tests for 14 types of high risk HPV and Specifically test for types 14 & 18
  4. Start screening at age 21**
  5. Age 21-29 — Cytology alone every 3 years
  6. Age 30-65
    - Cytology alone every 3 years
    - FDA approved Primary HR HPV testing every 5 yrs
    - Co-testing (Cytology +hrHPV) every 5 yrs
    - Cytology alone acceptable every 3 yrs only if co-testing or primary HPV screening are NOT AVAILABLE
33
Q

Immunocompromised Individuals

A
  1. HIV Positive <30 y/o
    - Begin screening w/in 1 year of sexual activity or age 21
    - 3 annual, negative tests followed by q3 year screening
    - HPV not recommended
    - Cytology only with +HIV, then annually
  2. HIV positive >30 y/o
    - Co-test q3 years for life**
34
Q

Strategies for Mgmt of Abnormal PAP results (ASCCCP 2019)

A
  1. RISK-based mgmt vs result based mgmt
  2. Algorithms are no longer useful
  3. Use the PAP APP***
  4. Follow up is based on the individual probability of having CIN 3 or greater based on current results and past hx
    - Tx options include — Colposcopy, treatment, or surveillance

Adv Practice Women’s Health 6032 Test 1 (6 decks)

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