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Womens Health > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Three locations of UTIs

A

urethra- urethritis
bladder- cystitis
upper urinary tract- pyelonephritis

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2
Q

Symptoms of an acute simple cystitis lack what symptoms?

A

fever >99.9
systemic symptoms- chills or body aches
flank pain
costovertebral angle tenderness (CVA)

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3
Q

Microbiology of UTIs

A

75-95% of cases are E.Coli
Other organisms: enterobacteriaceae, klebsiella pneumoniae, proteus mirabilis, and staphlococcus saprophytcus

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4
Q

Clinical manifestations of UTI

A

urinary frequency, urgency, hesitancy, dysuria, suprapubic pain, hematuria

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5
Q

Specific manifestation of UTI in older adults

A

new onset nocturia, incontinence, forgetfulness, new or worsening urinary symptoms

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6
Q

Physical exam for UTI

A

not necessary but if performed should include CVAT, abdominal, fever assessment
Pelvic exam if vaginal complaints

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7
Q

Lab results positive for UTI

A

leukocytosis >10 microL
nitrates and + leaks on dipstick or UA
Urine culture if resistant organisms or all cases of upper UTI

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8
Q

What do you do for a negative urine dipstick test?

A

urine culture and/or UA due to high rate of false negatives

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9
Q

Multiple organisms on urine culture indicates…

A

suspected contamination

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10
Q

Treatment of UTI

A

first line: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin

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11
Q

OTC treatment for urinary discomfort

A

phenazopyridine

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12
Q

When should you expect symptom relief for a properly treated UTI

A

48-72 hours

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13
Q

Nonpharmacological treatment of UTI

A

liberal fluid intake (2-3L per day)
behavior modification- contraception modification, postcoital voiding, good hygiene
cranberry juice/pills (limited studies)

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14
Q

Etiologies for volvovaginitis

A

infection
reactions to allergens or irritants
estrogen deficiency
systemic disease (RARE)

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15
Q

Normal vaginal discharge physiology

A

white or transparent, thick, mostly odorless
formed by mucoid endocervical secretions with sloughing epithelial cells, normal bacteria, and vaginal transudate

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16
Q

Normal pH of vaginal secretions

A

4.0-4.5 (acidic)
In premenarchal and postmenopausal women: 4.7 or greater

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17
Q

Normal isolates of vagina

A

most abundant is lactobacillus

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18
Q

Bacterial Vaginosis (BV) findings

A

thin, off white discharge with fishy odor
no vaginal inflammation
pH >4.5
clue cells present
positive whiff test

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19
Q

Candidiasis findings

A

itching, soreness, change in discharge, “cottage cheese” discharge
vaginal inflammation
normal pH
pseudohyphae
budding yeast
negative whiff test

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20
Q

Trichomoniasis findings

A

malodorous, thin, yellow-green, frothy purulent discharge
vaginal inflammation
pH >4.5 motile trichomonads
often positive whiff test

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21
Q

Symptoms of vaginitis

A

change in volume, color, or odor of vaginal discharge
pruritus
irritation
burning
soreness
erythema
dyspareunia
spotting
dysuria (less common)

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22
Q

Rare findings of vaginitis

A

abdominal pain (think PID)
suprapubic pain (think cystitis)

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23
Q

Common diagnosis based on menses cycle

A

candida vulvovaginitis often in premenstrual period
trichomoniasis and BV often during or immediately after menstrual period

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24
Q

Pelvic exam should include…

A

degree of vulvovaginal inflammation
characteristics of vaginal discharge
presence of cervical inflammation
abdominal or cervical motion tenderness

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25
Q

Can appearance of vaginal discharge be used for diagnosis

A

NO.. extremely unreliable

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26
Q

What is the most important finding for diagnostic process of vulvovaginitis

A

pH… should always be determined

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27
Q

Cervical inflammation is suggestive of…

A

cervicitis

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28
Q

In cervicitis the cervix will be

A

erythematous and friable with a mucopurulent discharge

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29
Q

Ectropion

A

represents normal physiologic presence of endocervical glandular tissue in the exocervix. not friable

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30
Q

Lab tests to diagnose vulvovaginitis

A

narrow range pH paper or broad range paper
saline microscopy- performed 10-20 minutes from obtaining sample

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31
Q

Technique of saline microscopy

A

vaginal discharge sampled with cotton-tipped swab
sample is mixed with one to two drops of 0.9% NS on a glass slide
cover slips placed on slides which are examined under a microscope at 10x and 40x

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32
Q

KOH preparation for microscopy

A

addition of 10% potassium hydroxide (KOH) destroys cellular elements and can be helpful in diagnosis (especially candida vaginitis)
whiff test is used with KOH
excessive WBCs without evidence of yeast, trichomonads, or clue cells suggests cervicitis

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33
Q

Most common cause of vaginitis in women of childbearing age

A

Bacterial vaginosis

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34
Q

Diagnosis of bacterial vaginosis is made when 3 of the following are present

A

abnormal grayish discharge
pH greater than 4.5
+whiff test
presence of clue cells

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35
Q

Treatment of Bacterial Vaginosis

A

Metronidazole oral x 7 days
metronidazole gel intravaginally x 5 days
clindamycin gel intravaginally x 7 days

Alternatives: clindamycin oral x 7 days
clindamycin ovules intravaginally x 3 days

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36
Q

Most common cause of vulvovaginal itching

A

candida vulvovaginitis
90% are Candida albicans

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37
Q

Diagnosis and treatment of uncomplicated candida vulvovaginitis

A

sporadic, infrequent episodes
mild to moderate signs/symptoms
probable infection with candida albicans
healthy, non pregnant women

variety of OTC oral and vaginal regimens
oral prescription fluconazole may be less expensive than OTC options

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38
Q

Diagnosis and treatment of complicated candida vulvovaginitis

A

poorly controlled diabetes, immunosuppression, debilitation
severe signs/symptoms
candida species other than C. albicans (c. glabrata)
pregnancy
history of recurrent vulvovaginal candidiasis

oral fluconazole (150mg orally) for two to three doses 72 hours apart
eliminate risk factors

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39
Q

Organism responsible for trichomonas vaginalis

A

flagellated protozoan trichomonas vaginalis

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40
Q

Signs/Symptoms of Trichomonas Vaginalis

A

always sexually transmitted
purulent, malodorous, thin, frothy discharge, with associated burning, pruritus, dysuria, frequency, and vaginal inflammation

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41
Q

Diagnosis of trichomonas

A

presence of motile trichomonads on wet mount is diagnostic but only occurs in 50-70% of culture-confirmed cases

CULTURE is diagnostic

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42
Q

Treatment of Trichomonas vaginalis

A

Metronidazole or Tinidazole BID x 7 days
Also treat sexual partners

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43
Q

Etiology of genital ulcers

A

herpes simplex virus (MOST COMMON)
treponema pallidum
haemophilus ducreyi
klebsiella granulomatis (Rare in US)
lymphogranuloma venererum (unknown in US)

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44
Q

Painful ulcers, multiple lesions

A

think HSV, chancroid

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45
Q

Painless, single lesions

A

think syphillis, LGV, and granuloma inguinale

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46
Q

S/S of genital ulcers

A

dysuria
fever
malaise
body aches
lymphadenopathy

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47
Q

Diagnosis of genital ulcers

A

evaluate for herpes, GC, CT, screen for symphilis and HIV
viral culture (HSV)
serologic screening (syphillis)

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48
Q

Follow up of initial syphillis serology is negative

A

repeat 1-3 months later

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49
Q

Primary HSV infection

A

patient HSV-seronegative for both HSV-1 and HSV-2 prior to this episode
associated with multiple constitutional S/S
dysuria
sx can last 2-4 weeks if untreated

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50
Q

Non-primary HSV infection

A

in an area not previously infected
ex: oral then genital infection

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51
Q

Recurrent HSV

A

over time recurrence generally decrease and recurrence lower in HSV-1 vs HSV-2
recurrence may be asymptomatic, shorter in duration

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52
Q

Treatment of HSV (Primary infection)

A

Acyclovir
Famciclovir
Valacyclovir

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53
Q

Treatment of HSV (recurrent infection)

A

chronic suppressive therapy
episodic therapy
or nothing!
Acyclovir
Famciclovir
Valacyclovir

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54
Q

Organism responsible for syphilis

A

spirochete bacterium treponema pallidum
seen on dark field microscopy
corkscrew-shaped organism

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55
Q

Primary syphilis infection

A

chancre at site of entry approximately 10-60 days after infection
heals spontaneously in 3-6 weeks

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56
Q

Secondary syphilis infection

A

4-8 weeks after primary chancre appears, skin rash of rough red or brown lesions on trunk, palms, or soles
other symptoms: fever, lymphadenopathy, headache, weight loss, muscle aches, patchy hair loss
HIGHLY infective
if untreated resolves in 2-6 weeks and then enters latent phase (no symptoms but tests positive)

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57
Q

Tertiary stage of syphilis

A

1/3 of patients
transmission unlikely
mainly through transfusions or placental transfer
severe CNS and cardiovascular damage
ophthalmic and auditory abnormalities
gummas- 1-10 years

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58
Q

Diagnosis of Syphilis

A

Non-treponemal tests
VDRL
RPR
Treponemal tests
fluorescent treponema antibody absorption
microhemaglutination test for antibodies to T. pallidum
T. pallidum particle agglutination assay
T. pallidum enzyme immunoassay
Chemiluminescence immunoassay

USE of only ONE test is insufficient
Positive treponema test is positive for life

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59
Q

Treatment of syphilis

A

Early: benzathine Penicillin G IM once
Unknown duration: benzathine penicillin IM weekly for 3 weeks

Alternatives: Doxycycline 100mg PO BID for 4 weeks

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60
Q

Chancroid

A

starts as erythematous papule, evolves into pustule, erodes into a deep ulcer
almost always confined to genital area and draining lymph nodes
painful
base is usually covered with gray or yellow purulent exudate that bleeds when scraped

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61
Q

Diagnosis of Chancroid

A

definite- isolation of H.ducreyi bacteria from the lesion
probable- painful genital ulcer and tender suppurative inguinal adenopathy, plus negative dark field microscopic exam for T. pallidum, negative serum test for syphilis, negative culture for HSV, clinical presentation not typical for herpes

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62
Q

Treatment of chancroid

A

Azithromycin PO once OR ceftriaxone IM once
Alternatives: Ciprofloxacin or Erythromycin

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63
Q

Condyloma Acuminate

A

Genital warts
HPV manifestations
can be found on genitals, tongue, lips, oral cavity
spread through skin to skin contact

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64
Q

Patient applied treatments for condyloma acuminate

A

podofilox
imiquimod
sinecatechin

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65
Q

Healthcare applied treatments for condyloma acuminate

A

cryosurgery
trichloracetic acid
laser
intralesional interferon injections

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66
Q

Cervicitis

A

inflammation of uterine cervix

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67
Q

most common causes of Cervicitis

A

Chlamydia trachomatis and neisseria gonorrhoeae

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68
Q

Other causes of cervicitis

A

local trauma from foreign object
malignancy
radiation therapy
sensitivity to chemical irritation
systemic inflammatory disease

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69
Q

Clinical manifestations of cervicitis

A

may be asymptomatic
all sexually active women age 25 years or younger should be screened
cervix may be tender to motion
When present manifestations are:
purulent or mucopurulent discharge from the endocervix
intermenstrual or postcoital bleeding
dysuria, urinary frequency
dyspareunia
vulvovagnial irritation

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70
Q

Cardinal signs of cervicitis

A

purulent or mucopurulent discharge on the surface and/or exuding from the OS
friability (bleeding)
erythema and edema

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71
Q

Diagnosis of cervicitis

A

Nucleic acid amplification testing (NAAT) for N. gonorrhoeae and C. trachomatis
performed with endocervical sample
could use vaginal swab or urine sample

72
Q

treatment of cervicitis

A

empiric antibiotic therapy
treatment of sex partners
ceftriaxone IM once (gonorrhea)
add azithromycin for concerns about resistance
Doxycycline (100mg PO BID 7 days) (chlamydia)
Alternatives for chlamydia azithromycin, ofloxacin, levofloxacin

73
Q

Test of cure for gonorrhea

A

not recommended if received treatment for uncomplicated infection

recommended for oropharyngeal infections

74
Q

Treatment of chlamydia

A

Doxycycline (100mg PO BID 7 days)
Alternatives for chlamydia azithromycin, ofloxacin, levofloxacin

75
Q

Treatment of gonorrhea

A

ceftriaxone IM once
add azithromycin for concerns about resistance

76
Q

Test of Cure for chlamydia

A

retesting: done on all patients 3 months after treatment
Test of cure:
for persistant symptoms
suspected compliance issues with regimen
pregnant females
treatment with erythromycin and amoxicillin

77
Q

Pelvic Inflammatory Disease (PID)

A

most serious form of STD
involves upper genital tract- endometrium, Fallopian tubes, ovaries, and pelvic peritoneum
caused by chlamydia trachomatis or neisseria gonorrhea

78
Q

Greatest risk for PID is…

A

previous PID

79
Q

Other risks for PID

A

adolescents
multiple sex partners
not using condoms
GC or CT infection

80
Q

Why is it important to diagnose PID early?

A

to prevent infertility and/or ectopic pregnancy
infertility occurs in 15% after one episode of PID and up to 75% after 3 episodes

81
Q

S/S of PID

A

lower abdominal pain
guarding
CMT, uterine tenderness
rebound tenderness
purulent cervical discharge
tender/painful adnexa, palpable
fever
serum WBCs elevated
abnormal uterine bleeding

82
Q

Tubovarian abscess

A

in severe cases of PID
acutely ill with high fever, tachycardia, severe pelvic/abdominal pain, nausea vomiting

83
Q

Diagnostic labs for PID

A

pregnancy test
microscopic exam of vaginal discharge
CBC
NAAT
Urinalysis
C-reactive protein
HIV
Hep B
Syphilis testing

84
Q

Treatment for PID

A

empiric treatment essential for sexually active women ill appearing with CMT, cervical or ovarian tenderness on pelvic exam
Severe cases or pregnant = hospitlization
Outpatient oral therapy- ceftriaxone IM + doxycycline 100mg PO BID + metronidazole 500mg PO BID x14 days

85
Q

Follow up for PID

A

in 48-72 hours to ensure clinical improvement
consider hospitalization and further eval if no improvement in 72 hours
male partners should be evaluated if sexual contact with patient within 60 days of symptom onset

86
Q

Cardiovascular Risk of combined oral contraceptives

A

Hypertension- frequently cause mild elevation, but can cause overt hypertension as well (not common)
These users are at increased risk of myocardial infarction and stroke compared to nonusers

87
Q

Strokes with hormonal contraceptives

A

rare due to population who take the medication but still a risk
if pt experiences a stroke pill should be discontinued and not resumed

88
Q

VTE risk of hormonal contraception

A

increase risk in both high and low dose estrogen OC but also may exist with progestin
smoking increases the risk
obesity further increases risk

89
Q

Who are good candidates for POPs?

A

older women
breast feeding women
post-delivery
over 35 and smoker
severe breast tenderness or other estrogen related symptoms
sickle-cell anemia
epileptics

90
Q

Down sides of POPs

A

associated with more breakthrough bleeding and slightly higher failure rates than combined OCs

91
Q

Main progestin formulation

A

Norethindrone 0.35mg tablets
28 active pills taken continuously

92
Q

Do POPs have to be taken at the same time every day?

A

YES; has a dose of progestin that is close to the threshold of efficacy, so needs to be taken at the same time every day
variation of only a few hours in administration can reduce effectiveness
However, highly effective when taken as directed

93
Q

Side effects of POPs

A

menstrual changes
unscheduled bleeding, spotting, amenorrhea
follicular cysts
acne flare-up
weight gain or loss
headache

94
Q

When is a pregnancy test appropriate in POP users

A

if experiencing nausea, breast tenderness, a change in menstrual pattern or lower abdominal pain.

95
Q

POP effects on cardiovascular system

A

little effect on coagulation factors, blood pressure, or lipid levels

96
Q

Cancer risks vs benefits of POPs

A

protects against the development of endometrial cancer
breast cancer risk not significantly different

97
Q

Missed POP pills

A

back. up contraception needed for at least two days if pill is taken more than 3 hours late on any given day
or started more than five days from the onset of menses

98
Q

Only injectable contraceptive available in US

A

depot medroxyprogesterone acetate (DMPA)
highly effective, reversible, avoids the need for compliance daily or near the time of sexual intercourse
reduces risk of endometrial cancer and volume of menstrual bleeding

99
Q

Route of DMPA

A

deep IM injection
lower dose can be administered subQ every 3 months as well

100
Q

effectiveness of DMPA

A

99.7%
effective for 3 months

101
Q

Migraines with injectable contraceptive

A

women who have migraines with combination OC typically do not have a problem with injectable contraceptives

102
Q

Who can safely use DMPA (injectable contraceptives)

A

women taking enzyme inducing anticonvulsant drugs can use DMPA
also those with sickle cell anemia, fibroids, and older women who smoke

103
Q

Decreased risk of PID in those using injectable or oral contraceptives

A

due to changes in cervical mucus, decreased menstrual blood flow, and a reduction in retrograde menstruation

104
Q

Efficacy of injectable contraceptives

A

probability of pregnancy is only 0.2%
failure rate is 5/100 in first year (possibly due to users not returning for injections as scheduled)

105
Q

Initial injection of DMPA

A

within 7 days of the onset of menses
ensures that patient is not pregnant and that it prevents ovulation during the first month
back-up contraception is unnecessary
can be initiated any day if pregnancy is ruled out (back up contraception should be used for 7 days)

106
Q

Accidental administration of DMPA during pregnancy

A

no increased risk of congenital anomalies

107
Q

Repeat injections of DMPA

A

every 12 weeks; but no one turned away based on time
two week “grace period” is appropriate

108
Q

Switching from injectable contraceptives to another method

A

should be started no later than 15 weeks after previous injection

109
Q

With long term use of DMPA, most users become __________

A

amenorrheic

110
Q

Side effects injectable contraceptives

A

menstrual irregularities (most common)
weight changes (possibly 3-6 kg)
headache
abdominal pain or discomfort
nervousness & depression (in those with PMS or mood disorders)- not contraindication to use of DMPA

111
Q

Menstrual irregularities with injectable contraceptives

A

if spotting or unscheduled bleeding persists after several injections of DMPA evaluate for other causes such as uterine fibroids, adenomyosis, or endometrial polyps

111
Q

Menstrual irregularities with injectable contraceptives

A

if spotting or unscheduled bleeding persists after several injections of DMPA evaluate for other causes such as uterine fibroids, adenomyosis, or endometrial polyps

112
Q

Major benefit of DMPA

A

causes amenorrhea- appropriate contraceptive choice for women with prolonged, heavy menstrual bleeding, dysmenorrhea, or iron-deficiency anemia

113
Q

Other benefits of DMPA

A

protects against the development of endometrial hyperplasia
decreased risk of PID
low risk of conceiving ectopic and intrauterine pregnancies
inhibit pituitary gonadotropin secretion and ovarian estrogen production
treatment of pain associated with endometriosis
fewer painful crises in women with sickle cell disease
great for those with special needs (cognitive impairment, military personnel)

114
Q

Cardiovascular risk of DMPA

A

may be a good option for those with history of blood clots

115
Q

Bone mineral density of injectable contraceptives

A

primary concern in long-term safety of DMPA
due to suppression of ovarian estradiol production
BMD of hip and spine decreases 0.5-3.5% after one year and 5.7% to 7.5% after two years of use

116
Q

DMPA return to fertility

A

return to fertility may be delayed
within 10 months of last injection- 50% of women who discontinue DMPA will conceive
some women fertility is not reestablished until 18 months after the last injection

117
Q

Nexplanon

A

contraceptive implant
single-rod progestin
slow release of 68mg of progestin etonogestrel
good for 3 years
irregular bleeding primary reason for discontinuation

118
Q

Adverse effects of Nexplanon

A

Headache, weight gain, acne, breast tenderness, emotional lability, and abdominal pain
migration of implant
unpredictable bleeding

119
Q

Insertion of contraceptive implants

A

Office procedure with or without local anesthesia
takes less than two to three minutes
can only be distributed to clinicians who have received 3 hours of training in patient selection, counseling, insertion, and removal

120
Q

Contraindications of Nexplanon

A

known or suspected pregancy
current DVT or PE (suggest getting medical clearance)
SLE
severe liver cirrhosis
undiagnosed abnormal genital bleeding
breast cancer in the last 5 years
hypersensitivity to any components of Nexplanon

121
Q

Nexplanon timing

A

if no hormonal contraception in the past month- insert anytime during first 5 days of menstrual period
if using COC- insert 4 days before stopping the pill
Can be inserted post abortion, postpartum, or during breastfeeding
If insertion occurs at any other time, back-up contraception advised for first seven days after insertion

122
Q

Advantages of transdermal hormonal contraceptive systems

A

therapeutic effects are achieved at lower peak doses
plasma hormone levels remain constant
improved patient compliance due to infrequent self-administration- no swelling pills
immediate cessation of drug administration possible with removal of transdermal patch

123
Q

Side effects of transdermal contraceptive patch

A

breast symptoms
headache
application site reactions
nausea

124
Q

Contraindications to transdermal contraceptive patch

A

same as those for other estrogen-progestin contraceptives
history of thromboembolism
estrogen-dependent tumor
abnormal liver function
skin hypersensitivity to any component of transdermal system
obese women may have potential for reduced contraceptive efficacy

125
Q

Initiation of transdermal contraceptive patch

A

either first day of menses or Sunday following the start of menses
if >5 days from menses, back-up contraception should be used for the first 7 days of use
alternatively women can start patch at anytime if pregnancy is excluded

126
Q

Two types of transdermal contraceptive patch

A

Ethinyl estradiol-norelgestronmin (EE/N) (Tulane and zafemy)
Ethinyl estradiol-levonorgestrel (EE/LNG) (Twirla)

127
Q

Vaginal Contraceptive Ring

A

delivers 15mcg ethinyl estradiol and 120mcg of etonogestrel daily
worn intravaginally for three weeks of each four week cycle

128
Q

Advantages of NuvaRing

A

rapid return to ovulation after discontinuation
lower doses of hormones
ease and convenience
improved cycle control
comes in one size and does not need to be fitted

129
Q

Administration of vaginal ring

A

in recently pregnant women, the ring may be started within five days of a first pregnancy loss or four weeks after a second or third trimester delivery
not removed during intercourse
can be removed for 2-3 hours without altering effectiveness

130
Q

Intrauterine Contraceptives or Devices

A

Safe and effective method of contraception
currently available IUDs release either copper or synthetic progestin
One copper IUD remains effective for at least 10 years

131
Q

Intrauterine contraceptives

A

Skyla, Kyleena, Liletta, and Mirena
Progestin-releasing IUDs inhibit sperm transport and fertilization of ova, and partially inhibit ovulation
remain effective for at least 3-8 years
amenorrhea is common and relief of dysmenorrhea
membrane regulates release of progestin

132
Q

Adverse effects upon fertility with IUD

A

none after removal
decreased risk of ectopic pregnancy once removed but increased while in place

133
Q

Emergency Contraception- Plan B

A

Progestin only (levonorgestrel)
One 0.75mg tablet within 72 hours, other 0.75mg tablet in 12 hours OR one 1.5mg tablet once
Failure rate is approximately 1.1%
will not terminate existing pregnancy or harm fetus if woman is already pregnant
taken within 72 hours of UPI
no prescription or age required to purchase

134
Q

Ella Emergency Contraception

A

Ulipristal Acetate (UPA)- selective progestin receptor modulator (I.e. antiprogestin)
one 30mg tablet once as soon as possible
well not terminate existing pregnancy or harm fetus if woman is already pregnant
taken within 120 hours of UPI
do not use progestin containing contraceptives within 5 days of its use

135
Q

Emergency Contraception- IUD

A

Copper IUD or LNG 52mg can now be used as EC
insert within 5 days of UPI, some sources say up to 10 days

136
Q

Contraceptive choices during lactation

A

POPs, implants, and Depo appropraite
delayed COCs until at least 4 weeks postpartum and then only if lactation is well-established

137
Q

Permanent contraception

A

vasectomy as effective but less morbid and costly than tubal occlusion
hysteroscopic tubal occlusion does not require an incision and is usually performed using a local anesthetic

138
Q

Best options for long-term but reversible contraception

A

intrauterine contraception, DMPA injections, or nexplanon

139
Q

How to minimize discomfort during GYN procedure

A

reassure the woman
explain each step before doing it
avoid the use of a tenaculum when possible
gently dilate the cervical canal if needed
NSAID 30-60 minutes prior to the procedure to decrease cramping

140
Q

Indications for endometrial cramping include

A

abnormal uterine bleeding
pelvic pain
infertility
may be better to refer to OBGYN

141
Q

Major contraindication to endometrial sampling

A

viable and desired intrauterine pregnancy

142
Q

Endometrial suction curette

A

most popular method for sampling endometrial lining
flexibility of curette minimizes cramping

143
Q

Side effects and complications

A

cramping, subsides rapidly
vasovagal reactions
rare complications- excessive uterine bleeding, uterine perforation, pelvic infection, bacteremia

144
Q

Absolute contraindications to IUD insertion

A

possible or confirmed pregnancy
severe distortion of uterine cavity
acute, recent,, or recurrent uterine infection
untreated cervicitis
active genital actinomycoses

145
Q

contraindication to use of Cu T IUD

A

Wilson’s disease
known copper allergy
Relative contraindication- anemia

146
Q

Contraindications to use of the LNg 20 IUD

A

known allergy to levonorgestrel
acute liver disease or liver tumor
known or suspected carcinoma of the breast

147
Q

Relative contraindications for IUD insertion

A

Risk factors for STDs
history of a previous IUD problem
unresolved abnormal uterine bleeding
known immunocompromise
past history of severe vasovagal reactivity

148
Q

IUD counseling

A

counsel prior to visit
for patient dissatisfaction with heavy bleeding and cramping
give patient a copy of the manufacturers patient information brochure
get signature to declaration of understanding of materials and written IUD consent

149
Q

Timing of IUD insertion

A

any time during menstrual cycle if using reliable contraceptive method or has bene abstinent since last menses
documentation of a negative pregnancy test for others

150
Q

Routine antibiotic propylaxis is…

A

not recommended with IUD insertion

151
Q

Explanation for apparent failure of contraception

A

nonadherence
inappropriate use
failure to continue use of the method
failure of the method
cost and drug coverage issues

152
Q

Factors to consider with choosing a method of BC

A

efficacy
convenience
duration of action
reversibility and time to return to fertility
effect on uterine bleeding
frequency of side effects and adverse events

153
Q

Top 10 questions to ask

A

What are your contraceptive goals? Do you ever want to get pregnant? When?
Are you currently having sex with a male partner?
Have you tried any contraceptive methods? If so, which one?
What did you like/dislike about the method?
Are you a good pill taker?
How often did you forget to use the method?
Are there any methods you have heard about and would like to try?
How important is the spontaneity of use?
Is protection from STIs important considering your life situation?
Is cost an issue? Does your insurance cover any contraceptive method?

154
Q

Strategies for enhancing compliance and continuation

A

provide ongoing support for contraceptive use based on regular assessment of clients sexual activity, relationships, attitudes about pregnancy, and life events
improve clients knowledge
anticipate and manage AEs
address cost and access barriers
provide clear information about ways to remember to take pills, what to do if one or more pills are missed, back-up contraception, and emergency contraception

155
Q

“most effective” contraceptive

A

intrauterine contraception (IUD)
contraceptive implants
sterilization

156
Q

“Lest effective” contraceptives

A

diaphragm
condoms
spermicides
withdrawal
periodic abstinence
various coital positions

157
Q

Tubal obstruction/ligation

A

any procedure that prevents pregnancy by occluding or disrupting tubal latency
often performed under local anesthesia
can undergo surgical sterilization shortly after birth
ligation of Fallopian tubes
laparoscopic is most common

158
Q

non contraceptive benefit of sterilizaiton

A

reduction of ovarian cancer

159
Q

Advantages of oral contraceptives

A

high effectiveness
does not increase risk of death among non-smoking, no birth defects
used through reproductive years
rapid reversibility (2 week delay)

160
Q

Menstrual related health benefits to hormonal contraceptives

A

decreased dysmenorrhea- reduction by 60%
decreased menstrual blood loss
regulation of menses
reduction in PMS symptoms
reduction of PMDD
decreased anovulatory bleeding
Mittelschmerz relief
reducted risk of post-ovulatory ovarian cysts
improvement of menstrual migraines

161
Q

General health benefits to hormonal contracepiton

A

endometrial cancer risk reduction
decreased risk of benign breast conditions
improvement of acne and hirsutism
reduced risk of hospitalization for gonorrheal PID
reduction of endometriosis symptoms
decreased risk of iron deficiency anemia
treatment of hot flashes
reduced risk of uterine fibroids

162
Q

Disadvantages to hormonal contraception

A

daily administraiton
expense and access
need for storage and ready access
no protection against STIs

163
Q

Lowest estrogen formulations

A

10mcg

164
Q

Most combined OCs contain

A

20-35mcg of ethinyl estradiol

165
Q

Contraindications to COCs

A

previous thromboembolic event or stroke
history of an estrogen-dependent tumor, breast CA
liver disease, severe cirrhosis
severe vascular headache- migraine with aura
pregnancy/postpartum <21 days
undiagnosed abnormal uterine bleeding
congenital hyperlipidemia
cerebral vascular or coronary artery disease
complicated valvular heart disease
women over 35 who smoke
DM with end organ failure
HTN
obese women over the age of 35

166
Q

MOA of hormonal contraception

A

estrogen inhibits FSH and LH seretion thereby inhibiting follicular maturation and ovulation and potentiates progesterone effects and thickens cervical mucus

167
Q

Progestin contraceptive effect

A

suppressing the release of GnRH and LH preventing ovulation
also thickens cervical mucus

168
Q

ACHES acronym

A

Abdominal pain
Chest pain
Headaches
Eye Problems
Severe leg pain

169
Q

Assessments required prior to hormonal contraception prescription

A

careful medical history and blood pressure measurement

170
Q

Assessments not required prior to hormonal contraception prescription

A

breast exams
cervical cancer screening
screening for STIs

171
Q

Instructions for missed COCs

A

If one missed pill- take as soon as possible, then take pills as scheduled (may take 2 at one time)
If two missed pills- take one pill as soon as possible, then take as scheduled
use back-up contraception until 7 days of active pills taken

172
Q

side effects of OCs

A

bloating
nausea
breast tenderness
mood changes
breakthrough bleeding
amenorrhea

173
Q

treatment of breakthrough bleeding

A

add extra estrogen for 1-2 cycles to stabilize endometrium

174
Q

assessment for post-pill amenorrhea

A

women who do not menstruate for 3 months after d/c an OC should undergo amenorrhea eval

175
Q

Only antibiotic that requires a back-up method

A

rifampin

Womens Health (2 decks)

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