Reproductive System Women's Health Overview

Question 1

what general history is important to get from a patient on their visit?

Answer 1

1. menstrual cycle
2. conception
3. STDs
4. self breast exams
5. last gene exam
6. screenings: pap/mammogram/BMD
7. immunizations : HPV/Tdap
8. medications: calcium intake/folic acid supplmentation
9. screen for abuse
10. fam history of : breast, uterine/ovarian, colon, diabetes, CHD, HTN, hyperlipidemia, osteoporosis

Question 2

what OB/GYN history should you ask?

Answer 2

1. age at menarche
2. age of 1st pregnancy
3. age of first sexual encounter
4. number of sexaul partners
5. history of STIs
6. sexually active?
7. GTPAL
8. methods of contraception
9. most recent pap smear

Question 3

Describe GPAL

Answer 3

g= gravida : total number of pregnancies
p= parity: birth of infants >24 weeks
a= abortion : pregnancies terminated <24 weeks
l= living chidlren: number of living children

Question 4

What should you use the breast exam to do?

Answer 4

as a teaching opportunity

Question 5

What lab marker is used for ovarian cancer. is a good screen

Answer 5

CA-125. no it is not a good screen

Question 6

What screen is used to help prevent cervical cancer?

Answer 6

pap smear

Question 7

what age for first screening be for cervical cancer?

Answer 7

first screening at age 21

Question 8

How often should screening take place in women age 21-35?

Answer 8

every 3 years

Question 9

What special guidelines should be considered for those women who are over 30 in regards to getting pap smears?

Answer 9

if they have 3 consecutive negative annual paps, no history of CIN 2 (HGSIL/moderate dysplasia) or CIN3 (severe dysplasia), not immunocompromised, not exposed to DES in utero then, they can get paps ever 2-3 years

Question 10

pap smear guidelines for post-hysterectomy?

Answer 10

• if procedure done for BENIGN REASONS and NO history of abnormal cells, then they can DISCONTINUE TESTING
• if underwent procedure and had ANY HISTORY OF CIN 2 OR CIN 3 then they need annual screening until 3 consecutive negatives and then testing may be discontinued.

Question 11

When do you stop pap smears?

Answer 11

there are several guidelines…

ACS: d/c in non-risk patients at age 70
USPSTF: d/c at 65
ACOG: determine on individual basis

Question 12

even if you do not do cervical screenings on your gyne exam, what should ALWAYS be included during exam?

Answer 12

PELVIC!!!

Question 13

Where do you collect cells from for the pap smear?

Answer 13

squamocolumnar junction (transition zone)

Question 14

should you lubricate the speculum?

Answer 14

no, just warm it with water. make sure the size fits the patient!!

Question 15

What can be used now for pap smear collection?

Answer 15

liquid based (thin-prep)

Question 16

what two HPV viruses cause >80% of cervical abnormalities?

Answer 16

HPV 16 and HPV 18.
to screen for these in a non-high risk patient, you will have to order separately. If high risk, this is done reflexively with pap smear.

Question 17

Describe Bethesda II reporting

Answer 17

1. Specimen Type (conventional, liquid based)
2. Adequacy of Specimen (satisfactory, unsatisfactory)
3. Interpretation:
   a. Negative
   b. ASCUS
   c. ASC-H
   d. ASGUS
   e. LGSIL
   f. HGSIL
4. Other organisms may be reported such as
   - trich
   - fungal
   - shift if flora suggesting bacterial vaginosis

Question 18

What is a colposcopy?

Answer 18

Diagnostic test usually done secondary to abnormal pap.
(allows visualization of cervix and transition zone).

1. add acetic acid to cervix
2. abnormal cells appear white
3. biopsy abnormal cells
4. also get endocervical sample

Question 19

What should you do in regards to certain abnormal cytology?

Answer 19

1. reactive: may indicate a previous or current infection (treat and repeat in 6 months)
2. ASCUS: repeat 3 months, colposcopy, or HPV testing
3. ASGUS: endometrial biopsy and colposcopy
4. ASC-H, LGSIL, HGSIL-colposcopy

Question 20

What are mammogram guidelines

Answer 20

USPSTF: start routine screening average risk at 50, high risk at 40. every 2 years.

ACS recommends mammograms yearly at 40, and high risk starting earlier.

Question 21

Describe a mammorgram for screening vs diagnostic purposes?

Answer 21

screening= just checking
diagnostic= abnormality has been felt.

Question 22

When should a SBE be done?

Answer 22

1 week after start of menses. start in early 20s and do monthly. this is optional.

Question 23

When should a clinical breast exam be done?

Answer 23

every 3 years starting in 20s then early after 40

Question 24

what are the options with the HPV vaccine?

Answer 24

1. gardisil: protects against 6,11,16,18
2. cervarix: protects against 16/18
3. starts at age 9-26 (also males)
4. will not cure infection but can help prevent infection

Question 25

What is a bone mineral density measurement?

Answer 25

helps screen for osteoporosis
several types:

DEXA scan
US (calcaneal)
QCT

Question 26

who should get a BMD scan?

Answer 26

all women aged 65 and older, caucasian and asian women at higher risk or younger/post-menopausual women with 1 or more risk factors.

Question 27

What are some osteoporosis risk factors?

Answer 27

family history
frail health
recurrent fails
fracture as adult
cig smoking
low body weight
low calcium intake
medications (steroid/thyroid)
heavy caffeine use 
excessive ETOH
celiac disease
chemo
amenorrhea
hyperparathyroid