Reproductive System Women's Health Overview Flashcards
what general history is important to get from a patient on their visit?
- menstrual cycle
- conception
- STDs
- self breast exams
- last gene exam
- screenings: pap/mammogram/BMD
- immunizations : HPV/Tdap
- medications: calcium intake/folic acid supplmentation
- screen for abuse
- fam history of : breast, uterine/ovarian, colon, diabetes, CHD, HTN, hyperlipidemia, osteoporosis
what OB/GYN history should you ask?
- age at menarche
- age of 1st pregnancy
- age of first sexual encounter
- number of sexaul partners
- history of STIs
- sexually active?
- GTPAL
- methods of contraception
- most recent pap smear
Describe GPAL
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
What should you use the breast exam to do?
as a teaching opportunity
What lab marker is used for ovarian cancer. is a good screen
CA-125. no it is not a good screen
What screen is used to help prevent cervical cancer?
pap smear
what age for first screening be for cervical cancer?
first screening at age 21
How often should screening take place in women age 21-35?
every 3 years
What special guidelines should be considered for those women who are over 30 in regards to getting pap smears?
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
pap smear guidelines for post-hysterectomy?
- 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.
When do you stop pap smears?
there are several guidelines…
ACS: d/c in non-risk patients at age 70
USPSTF: d/c at 65
ACOG: determine on individual basis
even if you do not do cervical screenings on your gyne exam, what should ALWAYS be included during exam?
PELVIC!!!
Where do you collect cells from for the pap smear?
squamocolumnar junction (transition zone)
should you lubricate the speculum?
no, just warm it with water. make sure the size fits the patient!!
What can be used now for pap smear collection?
liquid based (thin-prep)
what two HPV viruses cause >80% of cervical abnormalities?
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.
Describe Bethesda II reporting
- Specimen Type (conventional, liquid based)
- Adequacy of Specimen (satisfactory, unsatisfactory)
- Interpretation:
a. Negative
b. ASCUS
c. ASC-H
d. ASGUS
e. LGSIL
f. HGSIL - Other organisms may be reported such as
- trich
- fungal
- shift if flora suggesting bacterial vaginosis
What is a colposcopy?
Diagnostic test usually done secondary to abnormal pap.
(allows visualization of cervix and transition zone).
- add acetic acid to cervix
- abnormal cells appear white
- biopsy abnormal cells
- also get endocervical sample
What should you do in regards to certain abnormal cytology?
- reactive: may indicate a previous or current infection (treat and repeat in 6 months)
- ASCUS: repeat 3 months, colposcopy, or HPV testing
- ASGUS: endometrial biopsy and colposcopy
- ASC-H, LGSIL, HGSIL-colposcopy
What are mammogram guidelines
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.
Describe a mammorgram for screening vs diagnostic purposes?
screening= just checking diagnostic= abnormality has been felt.
When should a SBE be done?
1 week after start of menses. start in early 20s and do monthly. this is optional.
When should a clinical breast exam be done?
every 3 years starting in 20s then early after 40
what are the options with the HPV vaccine?
- gardisil: protects against 6,11,16,18
- cervarix: protects against 16/18
- starts at age 9-26 (also males)
- will not cure infection but can help prevent infection
