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GYN > prevention > Flashcards

prevention Flashcards

1
Q

top 5 causes of death in women

A

i. 1. Heart Disease
ii. 2. Cancer
iii. 3. Cerebrovascular events
iv. 4. COPD
v. 5. Pneumonia, Influenza

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2
Q

• Ages 15-34 years MCC of mortality

A

 1. Accidents
 2. Cancer (blood cancers)
 3. Homicide/Suicide

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3
Q

• Ages 35-54 years MCC of mortality

A

 1. Cancer (breast primarily)
 2. Heart Disease (menopause >50)
 3. Accidents

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4
Q

• Ages 55-74 years MCC of mortality

A

 Cancer
 2. Heart Disease
 3. COPD

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5
Q

• Age 75 years and over

A

 Heart Disease
 2. Cancer (colon, GI, endometrial)
 3. Cerebrovascular events

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6
Q

i. Cervical Cancer prevention

A

Pap smear, HPV vaccine

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7
Q

iv. Colorectal Cancer prevention screening .

A

→ Hemoccult testing, Colonoscopy starting at 50

1. Decrease risk by changing diet

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8
Q

anemia prevention screenin g

A

Hemoglobin, Hemoglobin electrophoresis

1. Very common in women of child bearing age

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9
Q

vi. Coronary Artery Disease prevention screening

A

→ lipid profile, BP screening, smoking cessation, ASA

  1. # 1 killer of women of all ages
  2. Counsel on diet and exercise, look at family hx
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10
Q

Thyroid disease prevention (more common in women)

A

screen with TSH (not in asymptomatic pts)

1. Especially in postpartum (thyroiditis)

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11
Q

Sexually Transmitted Infections screening

A

HPV vaccine, screening for chlamydia, gonorrhea

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12
Q

diabetes screening

A

→ FBS, Hgb A1c, diet/exercise

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13
Q

osteoporosis screening

A

bone density (DXA) scan, wt bearing exercise, Ca/vit D supplements after age 50

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14
Q

Well women exam hx (4 main areas)

A

menstual hx
OB
GYN
Sex and contraception

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15
Q

what 5 things should fall under menarche Hx

A

menarche, LMP, menopause, abnormal bleeding, symptoms

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16
Q

OB hx

A

GaPbcde, OB complications

G = pregnancies
P = outcomes of pregnancies (b=term deliveries
 c=premature deliveries
d=abortions
e=living children)
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17
Q

GYN Hx

A

especially if they have irregular bleeding: PID disease, polyps, etc

gynecologic diseases
 surgeries
 STI history
 breast disease
 urinary complaints
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18
Q

every pregnant woman should be vaccinated with

A

TDAP including pertussis in the third trimester

helps to protect the baby so pregnant women need it even if they just got one

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19
Q

when do you normally get TDAP

A

every 10 yeaars

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20
Q

HPV vaccine

A

2 dose series given 6-12 months apart 11-12

not covered past 26 yrs of age and can cost 400 dollars

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21
Q

most common strains of HPV that cause cervical cancer

A

16 and 18

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22
Q

don’t give live vaccines to

A

babies under 6 months

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23
Q
  1. Pneumococcal are for
A

All adults age 65 and older should get vaccinated with PCV13 and PPSV23, 1 year apart

Adults at high risk should be vaccinated once with each vaccine

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24
Q

MMR vaccine

A

Everyone should have 2 doses by the age of 6 years

Required for school entrance

All women of childbearing age unable to show proof of Rubella immunity with titers

Live virus not indicated during pregnancy

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25
Q

for women getting ready to get pregnant should have MMR titers because

A

can get vaccinated for fetal protections if titers aren’t great

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26
Q

HEP B vaccine

A

IVDA, health care workers, current recipients of blood products, Hepatitis C, prostitutes

3 dose series, given at 0, 4 weeks and 8 weeks

Now required for school entrance in most areas

At postpartum visit if not immune

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27
Q

HEP A

A

not required

except in border areas of travlers

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28
Q

Varicella/Zoster vaccine

A

Recommended for anyone not previously exposed to chicken pox

2 doses given 4-8 weeks apart

Live virus not indicated during pregnancy
just don’t be around any patient with a rash if you can’t prove immunity with a tier

Zostavax available for adults >50 years of age, given routinely at age 60

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29
Q

PPD (TB skin testing)

A

Every 2 years for high-risk individuals

Should be considered in any patient with a cough lasting >4 weeks

Should be placed at the first prenatal visit

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30
Q

Cervarix

A

HPV vaccine types 16 & 18 only

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31
Q

Gardasil

A

HPV vaccine types 6, 11, 16, 18

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32
Q

Gardasil 9

A

HPV vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58

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33
Q

PCV13

A

= Pneumococcal Conjugate Vaccine (Prevnar

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34
Q

PPSV23

A

Pneumococcal Polysaccharide Vaccine (Pneumovax)

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35
Q

UA would be done as a well check for

A

pregnant women

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36
Q

PE for well women check should include

A
  1. Height, Weight, BMI; BP, pulse; LMP (should be part of your vitals)
  2. Urinalysis, UPT if indicated
  3. FBS or Hgb if indicated
  4. Laboratory tests: TSH, lipid profile, CBC, Chemistry panel as indicated
  5. Breast exam and lymph nodes
  6. Chest (CV and Respiratory)
  7. Pelvic exam, including exam of abdomen and lymph nodes
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37
Q

when would you do a rectovaginal exam

A

screening women over 50

or retroflexed uterus

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38
Q

6 topics for counseling in a well woman exam

A
  1. Diet and exercise
  2. STI prevention
  3. Contraception use, hormone therapy
  4. (Self breast exam) à 2016 guidelines don’t mention self breast exams
    a. Now there are no recommendations for or against
  5. Skin self exam (1qyr) and SPF use
  6. Smoking cessation, EtOH use
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39
Q

M&M in women

A

Remember that the #1 or #2 cause of M&M in women of any age group is cancer. We will focus here on Gynecologic cancers.

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40
Q

common and uncommon cancers in women

A

breast
cervical

endometrial- pretty common

ovarian will kill you but less than 2% of the population gets this
vuvlar:4th most common gynecologic cancer
vaginal

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41
Q

RF for vulvar neoplasim

A

smoking, vulvar dystrophy (eg, lichen sclerosus),
vulvar or cervical intraepithelial neoplasia

MCC: HPV infection (60%), immunodeficiency syndromes
a prior history of cervical cancer
and northern European ancestry

42
Q

types of HPV that causes vulvar

A

HPV 16 and 33 are the predominant subtypes accounting for 55.5% of all HPV-related vulvar cancers

43
Q

majority of vulvar cancers are

A

90% squamous cell carcinomas

Melanoma is the second most common type of vulvar cancer. Lesions typically arise de novo on the clitoris or labia minora, but can also develop within preexisting junctional or compound nevi

slow growing and superficial
kind of like squamous cell carcinoma of the skin

44
Q

classification of vuvlar cancers

A

VIN-I, mild dysplasia

VIN-II, moderate dysplasia

VIN-III, severe dysplasia or carcinoma in situ

lesions do tend to be superficial and isolated

45
Q

classifications of vulvar cancers that will progress

A

VIN-I and VIN-II are likely to progress to CIS or carcinoma

46
Q

DDX of vulvar cancer

A

Epidermal inclusion cysts

lentigos- liver spots with age

disorders of Bartholin gland can cause hyperpigmentation

acrochordons-tree bark

hidradenomas

seborrheic keratosis

lichen sclerosus

other dermatoses

condyloma acuminate

47
Q

Flesh colored lesions of vulvar

A

sebaceous glands, inclusion cysts, vestibular papillae, skin tags, cysts, and infections (warts, molluscum contagiosum)

vulvar malignancies are usually flesh colored can be white or red

48
Q

White lesions

A

lichen sclerosus, lichen simplex chronicus, and vitiligo

MC sx is itching of neoplasm
maybe common sx of lichen too

49
Q

Brown, black, or red vulvar lesions

A

Brown, black, or red vulvar lesions can be due to a wide variety of benign, infectious, inflammatory, and malignant conditions

50
Q

Pustules, vesicles, and erosions of the vulva are usually

A

Pustules, vesicles, and erosions are usually related to infection or inflammation

51
Q

Ulcers and fissures of the vulva can be caused by

A

Ulcers and fissures can be caused by infection, malignancy or systemic disease with vulvar involvement

52
Q

Ulcers and fissures can be caused by

A

Vulvar pruritus is the most common symptom of vulvar cancer and a unifocal vulvar nodule, plaque, ulcer, or mass (fleshy, nodular, or warty) on the labia majora is the most common physical finding

53
Q

when should you biopsy the vulva

A

Any suspicious lesion, chronic pruritis, lesion that does not resolve with standard treatment should be biopsied

may use colposcopy for better visualization if you have a mass on the inside

54
Q

prognosis of vulvar cancers

A

5-year survival 70% - 90% for localized diseas

20% if deep pelvic nodes are involved but that take forever

55
Q

paget disease of the vulva

A
  1. Extensive intraepithelial disease
  2. Not common (<1%)
  3. May be associated with carcinoma of the skin and pts with pagets disease of the skin anywhere else –>

Higher incidence of internal carcinoma, particularly of the colon and breast

56
Q

tx of vulvular pagets

A

Treatment is wide local excision or simple vulvectomy and wide margins to prevent recurrence

57
Q

Vulvar Melanoma

A
  1. Raised, irritated, pruritic, pigmented lesion
  2. 5% of all vulvar malignancies
  3. Wide local excision is required for diagnosis and staging
  4. Melanoma likes “hidy” places
58
Q
  1. Rarest of all gynecologic cancers
A

Vaginal cancer

59
Q

MCC with vaginal cancer

and what is the most common site

A

Most common c/o is vaginal bleeding

Posterior wall of the upper 1/3 of the vagina is most common site of the tumor**; red ulcerated or white hyperplastic lesions

60
Q

most common type of vaginal cancer

and Tx

A

Colposcopy with directed biopsy for definitive diagnosis

Squamous cell carcinoma in 95% of cases

Treatment includes surgical excision; chemoradiation for invasive disease

61
Q

prognosis of vaginal cancer

A

5-year survival is 50% - 80% with local disease

62
Q

Most common gynecological cancer in US

A

Endometrial (Uterine) Cancer

63
Q

most common type of endometrium cancer

A

Adenocarcinoma of the endometrium is the most common type of uterine cancer

more aggresive than squamous cell carcinoma

64
Q

genetic syndrome associated with high risk of uterine cancer as well as other types of cancer

A

Lynch syndrome

65
Q

average age of diagnosis for endometrial (uterine) cancer

A

Average age at diagnosis is 61 yrs, most women are early stage at diagnosis

usually presents with symptoms

66
Q

RF for vaginal cancer

A 
increased risks for HPV infection
Early sexual activity
High lifetime number of sexual partners
Infection with HIV
Smoking 
Long-term use of oral contraceptives (>5 years)
Low socio-economic status
67
Q

RF for endometrial cancer

A

Use of unopposed estrogen after menopause
Overweight women (high BMI)
Nulliparity
Tamoxifen therapy

68
Q

protective factors for endometrial cancer

A

Childbearing, esp if last pg at older age
Combination oral contraceptives
Combination hormone replacement

69
Q

screening tools for endometrial cancer

A

none

no real screening and a lot of women think that pap smears are screening for endometrial cancers bUT survival rates are really good

70
Q

MC SX of endometrial cancer

A

Cardinal symptom is abnormal uterine bleeding but this is also the cardinal symptom of vaginal bleeding despite endometrial being more common you need to consider vaginal too

any pt over 40 with bleeding this needs to be on the ddx

71
Q

when would you need further evaluation in women over 40 following a pap

A

Endometrial cells on Pap smear in women ≥40 years of age need further evaluation

if they finished their period over a week ago

72
Q

best way to test for endometrial cancer ( in a pt over 40 with bleeding)

(GOLD STANDARD )

A

Endometrial sampling

Endometrial biopsy is gold standard for diagnosis
tissue is the issue and dx has to be histological

73
Q

for women under 40 how would you test for endometrial cancer

A

Transvaginal US

you would do this before a biopsy in these younger populations

74
Q

what would you see on transvaginal US in a pt with endometrial cancer

A

Thickened endometrium or endometrial stripe (>4-5mm) worrisome
20mm is the mean endometrial thickness for pts with cancer

anything over 5–> get biopsy
most OB practices will have ULS

75
Q

Sonohysterography would be used to evaluate for endometrial cancer

A

Filling endometrial cavity with fluid to visualize focal lesions for biopsy

Sonography is not a valid alternative to endometrial sampling in premenopausal women. Evaluation for a nonendometrial source of bleeding, such as cervical, fallopian tube or ovarian cancer, should also be pursued.

76
Q

Evaluation of the endometrium for malignant and premalignant disease indicated if

A

Abnormal uterine bleeding
Postmenopausal bleeding
Abnormal PAP with atypical cells favoring endometrial origin

77
Q

D&C

A

refers to dilation, opening the cervical canal, and curettage, scraping the endometrium with a sharp instrument called a curette

78
Q

recommendation for endometrial cancer

A

Total extrafascial hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) for staging

taking out the tubes and the ovaries

CT scan for mets to lymph

79
Q

2nd most common GYN cancer in US

A

ovarian cancer
Lifetime risk 1.4%
Higher risk in hereditary cancer syndromes (BRCA)

80
Q

ovarian cancer average age

A

v. Average age at diagnosis is 63 yrs
vi. 95% of ovarian cancers are epithelial cell origin
vii. BRCA mutations affect ovarian tissue as well

81
Q

Risk Factors for ovarian cancers (4)

A

 Age >60 years
 Family history of ovarian or other gynecologic cancer
 Hereditary cancer syndrome
 Smoking

82
Q

Protective Factors for ovarian cancer

A 
	Childbearing
	Combination oral contraceptives
	Breastfeeding 
	Tubal ligation
	Hysterectomy
83
Q

Screening Tools for ovarian cancer

what is the serum maker and is it specific

A

Pelvic exam can detect ovarian cancer = bad prognostic indicator

b/c Cancer usually advanced by the time it can be palpated

CA-125 serum marker –> not specific tumor marker (can be elevated in colon cancer as well) but useful in following the cancer

TVUS may be useful but a lot of pts don’t want a ULS

USPSTF recommends against routine screening (2012)

Tana says she would start with just genetic screening in a high risk pt
family hx of ovarian cancer does not cover TVUS

have you ever had irregular bleeding?

84
Q

prognosis of ovarian cancer

A

5-year survival rate is 89% for localized disease
but most time it’s not found localized

36% for women with regional metastases

17% for women with distant metastases

85
Q

average age of ovarian cancer

A

Most women aged 40-65 years at diagnosis

86
Q

Serum CA-125 sensitivity for ovarian cancer

A

Serum CA-125 marker elevated in >80% of patients

87
Q

CC sxs of ovarian cnacer

A

bloating
pelvic or abdominal pain
early satiety

ovaries drain to the retroperitoneal lymph nodes and you don’t feel this

88
Q

ddx of adnexal mass

A

Ovarian malignancy (uncommon under 40)

Ovarian cyst–> soft and tender w/o other sxs

Ectopic pregnancy–>UPT

PID with TOA–> fever or vomiting

Pelvic kidney

GI etiology–> (L) diverticula, (R) appendicitis?

Crohn’s disease

Diverticulitis

GI neoplasm

89
Q

central pelvic mass

A

Intrauterine pregnancy

Leiomyomata (fibroids)

Uterine malignancy

Bladder malignancy

Ovarian malignancy (if they get big and push everything over)

90
Q

premenopausal ovarian mass

A

(post meno ULS and CT)

get an ULS

simple cyst less than 6cm and normal CA-125

–> observe
BC pills to regulate cycles
recheck ULS

in pts with solid or complex cyst over 6cm
–> surgical evaluation

91
Q

what is FIGO

A

ternational Federation of Gynecology and Obstetrics

ternational Federation of Gynecology and Obstetrics

92
Q

RF for vaginal cancers

A 
increased risks for HPV infection
Early sexual activity
High lifetime number of sexual partners
Infection with HIV
Smoking 
Long-term use of oral contraceptives (>5 years)
Low socio-economic status
93
Q

what % of postmenopausal women with abnormal bleeding have endometrial cancer

A

5-20% postmenopausal women with abnormal uterine bleeding have endometrial cancer

94
Q

when would sonography be used for irregular bleeding

A

Filling endometrial cavity with fluid to visualize focal lesions for biopsy

if you think that pt has a polyp or a fibroid based on the ULS findings you can repeat an ULS with this

Sonography is not a valid alternative to endometrial sampling in premenopausal women. Evaluation for a nonendometrial source of bleeding, such as cervical, fallopian tube or ovarian cancer, should also be pursued.

95
Q

Hysteroscopy

A

is a procedure in which a telescope with a camera is used to evaluate or treat pathology of the endometrial cavity, tubal ostia, or endocervical canal.

During hysteroscopy, the uterus is distended with a gas or fluid medium. Most diagnostic and brief or minor operative procedures can be performed without anesthetic or with a local anesthetic. In women undergoing hysteroscopy under local anesthetic, we suggest a paracervical block over other methods of administering local anesthesia.

96
Q

simple cyst less than 6cm and normal CA-125

A

–> observe 6-8 weeks

BC pills to regulate cycles

recheck ULS and see if it goes away

97
Q

solid or comple over 6 cm or other worrisome signs workup

A

surgical evaluation

98
Q

Leading cause of cancer death in women worldwide

A

breast cancer

Main cause of death in women 20-59 yo

99
Q

Majority of breast cancers diagnosed by

A

Majority of breast cancers diagnosed by abnormal mammogram

100
Q

RF breast cancer

A

Age >40 years and increases with age
Family h/o breast cancer (BRCA genes)
Menarche <12 yrs of age or >40 menstrual yrs
Oral contraceptive use >5 years
Nulliparity or first delivery >35 yrs of age
Obesity
Other types of cancer, including contralateral breast, uterus, ovary, salivary gland, colon

101
Q

For women who are at average risk for breast cancer, most of the benefit of mammography results from

A

from biennial screening during ages 50 to 74 years

While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s.

102
Q

Who benefits from early breast cancer screening

A

Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

GYN (13 decks)

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