Preventive Care and Health Maintenance

Question 1

72 yo woman in office for routine screening… what tests should you consider?

Answer 1

• Colonoscopy every 10 years
• Mammography every 1-2 years in all women 50 to 74 yo
• DEXA scan for postmenopausal women not on HRT and all women 65 years or older

Question 2

If a woman > 65 yo comes to office, which vaccines should you make sure she received?

… which types of testing should she undergo?

Answer 2

Vaccines:

• Tetanus-diphtheria booster every 10 years
• Influenza virus vaccine annually
• One-time pneumococcal vaccine

Testing:

• Cholesterol testing every 5 years
• Fasting glucose testing every 3 years
• Screening for thyroid disease with a TSH every 5 years
• Periodic urinalysis is recommended

Question 3

You are following up on the results of routine testing of a 68 yo G4P3 for her well-woman examination. Her physical exam was normal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram and lipid profile was normal, and the urinalysis shows hematuria. Which of the following is the most appropriate next step in the mgmt of this pt?

a. Colposcopy
b. Endometrial biopsy
c. Renal sonogram
d. Urine culture
e. No further tx or evaluation is necessary if the pt is asymptomatic

Answer 3

d. Urine culture

A urinalysis that is positive for blood should be followed up with a urine culture to evaluate for an asymptomatic UTI before further workup is done or referral to a urologist is made.

Parabasal cells on a Pap smear indicate lack of estrogen, and are a normal finding in postmenopausal women. It requires no further evaluation.

Question 4

A 74 yo woman presents to your office for a well-woman exam. Her last Pap smear and mammogram were 3 years ago. She has HTN, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and does not use alcohol. Based on this hx, which of the following medical conditions should be this patient’s biggest concern?

a. Alzheimer disease
b. Breast cancer
c. Cerebrovascular disease
d. Heart disease
e. Lung cancer

Answer 4

d. Heart disease

In order of decreasing incidence, the leading causes of death in women older than 65 years are the following: diseases of the heart, cancer, CVD, COPD, Alzheimer disease, diabetes, pneumonia and influenza, accidents, renal disease, and septicemia

Question 5

Leading causes of death in women between the ages of 20 and 24 years, in order of decreasing frequency:

Answer 5

Injuries/accidents

Suicide

Malignancy

Homicide

Heart disease

Pregnancy complications

Birth defects

Influenza and pneumonia

Stroke

Septicemia

Diabetes

Question 6

Routine screening for sexually active women younger than 25 years of age

Answer 6

Gonorrhea and chlamydia

No routine screening recommended for hep B or HSV

Question 7

Cervical cancer screening:

1. Age at initiation
2. Screening intervals for women with average risk
3. Age to d/c screening
4. Screening after hysterectomy

Answer 7

Cervical cancer screening:

1. Age at initiation: 21 years regardless of age of onset of sexual activity
2. Screening intervals for women with average risk:
   
   1. Age 21-29 years: cytology every 3 years
   2. >30 years: cytology and co-testing every 3-5 years if 3 consecutive negative Paps or negative high-risk HPV DNA test
3. Age to d/c screening:
   
   1. Age 65 if adequate negative prior screening results
   2. Women w/ hx of CIN 2 or CIN 3 or adenocarcinoma in situ should continue routine age-based screening for at least 20 years
4. Screening after hysterectomy:
   
   1. No screening is necessary if there is no hx of CIN 2, CIN 3, or adenocarcinoma in situ in the past 20 years
   2. Screening should be continued if hx of DES exposure or cervical cancer

Question 8

A 36 yo G2P2 presents for her well-woman exam. She has had two spontaneous vaginal deliveries without complications. Her largest child weighed 3500 g at birth. She uses OCPs and has never had an abnormal Pap smear.

After placement of the speculum, you note a clear cyst approximately 2.5 cm in size on the lateral wall of the vagina on the R side. The cyst is nontender and does not cause the patient any dyspareunia or discomfort. Which of the following is the most likely dx of this mass?

a. Bartholin duct cyst
b. Gartner duct cyst
c. Lipoma
d. Hematoma
e. Inclusion cyst

Answer 8

b. Gartner duct cyst

Gartner duct cysts arise from embryonic remnants of the mesonephric duct that course along the lateral vaginal wall. These are usually small and asymptomatic and are found incidentally during a pelvic exam. They can be followed conservatively unless the patient becomes symptomatic, at which time excision is recommended.

Inclusion cysts are usually seen on the posterior lower vaginal surface. Inclusion cysts are the most common vaginal cysts and result from birth trauma or previous gynecologic surgery.

Bartholin duct cysts are the most common large cysts of the vulva. Bartholin ducts open into a groove between the hymen and labia minora on the posterior lateral vaginal opening.

Lipomas are benign, encapsulated tumors of fat cells; they are most commonly discovered in the labia majora and are superficial in location.