Patient

Question 1

What is indicated for all abnormal Pap smear results including atypical squamous cells of undetermined significance (ASCUS) when HPV is positive?

Answer 1

Colposcopy

Reflex HPV testing for high-risk DNA types should be performed in patients with ASCUS. If negative, then co-testing with cytology and HPV can be repeated in three years. Repeat cytology in one year is also an acceptable option for ASCUS if HPV testing cannot be done.

Question 2

What age does one start getting Pap tests done?

Answer 2

Start at Age 21

Question 3

When are Pap test not indicated?

Answer 3

Pap test screening is not indicated in patients who have had a HYSTERECTOMY , unless it was done for cervical cancer or a high-grade cervical dysplasia.
Patients with a uterus can discontinue cervical cancer screening between the ages of 65–70 if they have had three consecutive negative smears or two negative consecutive cotesting in the last 10 years and no history of high-grade cervical intraepithelial neoplasia or cancer

Question 4

What age group and When should women get Co-testing (cytology and HPV)?

Cytology alone?

Hpv alone?

Answer 4

women ages 30 to 65 years should be screened with cytology and HPV testing (‘‘co-testing’’) every five years (preferred) or cytology alone every three years (acceptable). Screening by HPV testing alone is not recommended for most clinical settings.

Question 5

Pap test shows high grade squamous intraepithelial lesion. Next step?

Answer 5

recommend immediate LEEP (loop electrosurgical excision procedure — removes abnormal tissue by cutting it away using a thin wire loop that carries an electrical current.) or colposcopy ( magnifying device to look at your vulva, vagina , and cervix and a biopsy is taken from cervix) for women with HSIL cytology test results; for women not managed with immediate excision, colposcopy is recommended regardless of HPV result obtained at co-testing.

Question 6

Culture is the gold standard in the diagnosis of herpes. They are highly specific, yet sensitivity is limited.

Answer 6

10-20% false negative rate

Question 7

Informed consent

Answer 7

Emergency situation with patient health/life in danger, don’t need surgical consent

Consent should not be taken after a procedure or after given drugs (ex morphine)

Question 8

Elective c section: best time to do so?

Answer 8

Elective delivery should not be scheduled prior to 39 weeks due to risks associated with prematurity.

Elective c section due to not wanting to experience the pain of vaginal delivery is acceptable

Question 9

Patient privacy

Answer 9

Patient privacy is the responsibility of physicians. Physicians may be fined and/or assessed criminal penalties for violating the privacy of a patient’s protected health information

Question 10

Non maleficence vs beneficence

Answer 10

The non-maleficence principle expresses the concept that professionals have a duty to protect the patient from harm. Since an anencephalic infant will not survive, performing a Cesarean section on this patient will cause her harm. Beneficence principle expresses the concept that professionals have a duty to act for the benefit of others, and, in this case, performing a Cesarean section will not benefit the fetus.

Question 11

power of attorney

Answer 11

power of attorney should make decisions based on what the patient would have wanted for herself, regardless of what they think her best interests might be.

Question 12

Justice

Answer 12

Justice requires that we treat like cases alike. It is the physician’s duty to educate the patient about all her treatment options in a non-judgmental way regardless of the nature of the treatment and her socioeconomic status.

Question 13

Conflict of interest

Answer 13

It is acceptable for pharmaceutical companies to support conferences in which physicians receive CME credit. Physician participation in those activities should not be contingent upon physician use or advocacy of the product. An investigator may own stock in a company if he/she does research for that company, as long as he/she declares the conflict of interest and the conflict of interest is addressed.

Question 14

Want an abortion, but no insurance

Answer 14

Patients requesting abortion should be counseled appropriately regardless of their insurance status and do not have to obtain the consent of their partner to undergo the procedure.

Clinical guidelines from the Society of Family Planning state that surgical abortion can be performed successfully and safely as early as three weeks from the onset of last menses if a protocol exists that includes sensitive pregnancy testing, immediate and meticulous examination of the aspirate, and assiduous follow-up of questionable specimens to rule out ectopic pregnancy or continuing gestation.

Question 15

What age to start getting colonoscopy?

Answer 15

Women should be offered colorectal cancer screening starting at age 50. Options include yearly hemoccult testing, flexible sigmoidoscopy every five years, or colonoscopy every 10 years. U

Question 16

Breast health/screening

Answer 16

ACOG recommends that women aged 40 years and older be offered screening mammography annually. Ultrasonography is an established adjunct to mammography. It is useful in evaluating inconclusive mammographic findings, in evaluating young patients and other women with dense breast tissue, and in differentiating a cyst from a solid mass. Breast ultrasound is not recommended as a primary screening modality for women at average risk of developing breast cancer. A combination of first and second-degree relatives on the same side of the family diagnosed with breast and ovarian cancer (one cancer type per person) increases the risk of BRCA mutation.

Question 17

First degree relative with colon cancer

Answer 17

If there is a history of a first degree relative with colon cancer before age 60, then begin screening with colonoscopy at age 40, or 10 years before the youngest relative diagnosis, and repeat every five years. Although a sigmoidoscopy can be an acceptable screening procedure, it would still begin at age 50 and repeat every five years, if normal.

Question 18

Contraceptions best to worst for pregnancy prevention

Answer 18

Contraceptive methods iud, implant, depo, combo oral

Question 19

Osteoporosis

Answer 19

Bone density screening (dexa) is recommended for women beginning at age 65 unless they have pre-existing risk factors which warrant earlier screening. Risk factors for osteoporosis are early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease. These factors would institute early screening in a patient for osteoporosis.

Question 20

Vaccinations contraindicated in pregnancy

Answer 20

Pregnancy, or the possibility of pregnancy, within four weeks is a contraindication to the MMR and varicella vaccinations.

Question 21

Heart disease concerns

Answer 21

Heart disease is the number one killer of women. Studies show an inverse relationship between the level of physical activity and incidence of death from coronary disease

Question 22

Obese and velvety, hyperpigmented skin on the back of a neck and under arms

Answer 22

Obese and the skin changes are consistent with acanthosis nigricans, which is closely associated with insulin resistance. Given these risk factors, pt should be tested for diabetes.

Question 23

Folate recommendations

Answer 23

Folate lowers homocysteine levels. The Nurses Health Study showed fewer nonfatal MIs and fatal coronary events in women with adequate intake doses of folate and vitamin B6. Folate can also help prevent neural tube defects. Studies have shown that diet alone is not effective in achieving adequate levels, and routine folate supplementation is therefore recommended. Women of reproductive age should take a daily 400-microgram supplement. Adequate levels are especially important prior to pregnancy and during the first four weeks of fetal development. Folic acid levels may be used to diagnose B12 or folate deficiency and are not routinely check to guide folic acid supplementation prior to pregnancy unless a patient is suspected to have a deficiency.