Week 5 Flashcards

1
Q

This is a designation based on one’s chromosomes and genitalia, biological.

A

Sex

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2
Q

This is a social construct that assigns roles and attributes to people based on their natal sex.

A

Gender

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3
Q

This refers to individuals inner understanding of themselves in regard to sexual orientation and the words they use to describe themselves as sexual beings.

A

Sexual identity

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4
Q

The sex assigned to a person at birth based on their genitalia.

A

Natal sex

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5
Q

An umbrella term used to describe those persons whose gender identity in some way is different from their natal sex assigned at birth.

A

Transgender

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6
Q

Behavior or expression of the mismatch gender identity vs the assigned sex.

A

Gender non-conforming

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7
Q

The way in which someone expresses their gender identity through their appearance, dress, and behavior.

A

Gender expression

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8
Q

The medical, social, physical, and legal changes to the perceived sex.

A

Transition

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9
Q

Male to female identifies as:

A

Transfemale

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10
Q

Female at birth to male identifies as

A

Trans male

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11
Q

The person identifies with the original/same sex as at birth.

A

Cis gendered

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12
Q

Lesbian patients have lower risk of:

A

HIV and syphilis

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13
Q

Lesbian patients are at high risk of:

A

Breast cancer

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14
Q

AIDS is the ___ defined by the ___ count and HIV is the ___.

A

AIDS- Syndrome defined by the CD4 count

HIV- virus

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15
Q

At risk populations for HIV and AIDS:

A

Primarily MSM

Women of color in heterosexual relationships

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16
Q

Patients with HIV are treated with:

A

HAART (highly active antiretroviral therapy) prescribed by specialist

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17
Q

Monitoring for HAART and considerations should include:

A
  1. High risk of drug-drug interactions
  2. Dyslipidemia
  3. Lipodystrophy- disfiguring distribution of fat
  4. Liver disease
  5. Check LFTs
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18
Q

PEP is:

A

Post exposure prophylaxis of 3 meds taken for 28 days and within 72 hours of possible HIV exposure (72 hours is the absolute window for efficacy).

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19
Q

PEP is only for:

A

HIV

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20
Q

PrEP is:

A

Pre-exposure prophylaxis first HIV prevention consisting of 2 medications in 1 pill taken daily.

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21
Q

PrEP is for:

A

Patients at repeated risk for exposure

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22
Q

What is the MOA Of PrEP?

A

It prevents the HIV from replicating in the body should the virus enter the body.

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23
Q

MTF aka trans women the goal of transition is:

A

To develop secondary female sex characteristics (feminization)

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24
Q

MTF transition is done by:

A
  1. Giving medication to cause feminization- estrogen
  2. Block testosterone- (anti-androgen agents) spironolactone, 5-Alpha-reductase-inhibitors like propecia (finasteride), and GnRH agonists
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25
Q

What should be monitored with spironolactone?

A

It is a diuretic so BP and K levels

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26
Q

This reduces the formation of the potent androgen dihydrotestosterone (DHT) from its precursor testosterone in certain tissues in the body such as the prostate, skin, and hair follicles. Effective to prevent hair loss.

A

Propecia (finasteride)

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27
Q

This is used on label to treat precocious puberty and it shuts down the LH and FSH production in the pituitary, therefore blocking testosterone at a very early stage in the chain of hormonal events.

A

GnRH

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28
Q

What do you need to monitor with trans women?

A

Testosterone levels- want between 40-80
Prolactin- don’t want consistently in the 100s
CBC- lower H/H is anticipated
CMP- K
Monitor for risks associated with estrogen (VTE, DVT)

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29
Q

What changes between 0-3 months with the trans women after starting hormones and what is permanent?

A

Lower libido
Softening skin
Breast budding- permanent
Emotional changes

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30
Q

What changes between 4-10 months with the trans women after starting hormones and what is permanent?

A

Change in genitals
Softening hair
Decrease in muscle mass
Cessation of spermatogenesis-permanent

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31
Q

What changes between 10 months- 4 years with the trans women after starting hormones and what is permanent?

A

Breast maturation- permanent
Body fat redistribution
Thickening of hair on head

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32
Q

Female to male transition aka trans males only need to take:

A

Testosterone

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33
Q

What needs to be monitored in trans males?

A

CBC- H/H will be normal values for males

Testosterone levels- 400-1000 (cis males range 300-1200)

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34
Q

Increase testosterone risk factors include:

A

High BP
Diabetes
Heart attack
Stroke

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35
Q

What changes at the 0-3 month mark with trans males with the start of testosterone and what is permanent?

A

Increase in libido
Increase in appetite (watch for weight gain)
Increase in body hair- permanent

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36
Q

What changes at the 3-6 month mark with trans males with the start of testosterone and what is permanent?

A

Genital changes- clitoral enlargement- permanent
Cessation of menses
Increase in muscle mass/strength
Change in vocal quality

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37
Q

What changes between 6month- 5 years with trans males after the start of testosterone and what is permanent?

A

Development of terminal facial hair- permanent
Body fat redistribution
Hair loss- permanent

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38
Q

Puberty delaying options for transgender children should be initiated at:

A

Tanner stage 2

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39
Q

Three things experts agree to look for in children with regard to gender identity:

A
  1. insistence on their gender identity
  2. Persistence- has been talking about for long time
  3. Consistency with regard to expression of the gender identity
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40
Q

This is a slow growing DNA virus that causes one of the most common STIs in the US?

A

HPV

41
Q

Low-risk HPV types are what and cause what?

A

6 and 11

Genital warts aka condyloma acuminata

42
Q

High-risk HPV types are what and can cause what?

A

16 and 18

Cause 70% of all cervical cancers

43
Q

When should men transitioning to women (trans women) consider sperm banking?

A

Before giving supplemental hormones

44
Q

This is the complete lack of or significant reduction in sexual interest or sexual arousal, associated with 3 or more of the following six symptoms:

  1. Absence or reduction of interest in sex
  2. An absence or reduction in fantasies or erotic thoughts
  3. Absent or decreased desire to initial sexual encounters
  4. Absent or reduced sense of excitement/pleasure during sex
  5. Absent or reduced response to sexual cues
  6. Absent or reduced sensations in the genital or elsewhere during sex
A

Female sexual interest/ arousal disorder

45
Q

What are the 2 categories of female sexual interest/ arousal disorder?

A

Primary: lifelong
Secondary: emerged after a period of normal sexual function

46
Q

What HPV vaccines can be used for female and male?

A

Gardasil and gardasil 9

47
Q

What HPV vaccine is only for women and what is the age range?

A

Cervarix

9-25

48
Q

When is a 3-dose HPV vaccine given?

A

After the age of 15 (15-26)

Immunocompromised

49
Q

When is the 2-dose HPV vaccine given?

A

Ages 9-14

50
Q

Who should be vaccinated for HPV?

A

High-risk patients
Starting at age 9 and above
Ideally, before patient is sexually active
Patients with existing, or previous history of HPV CAN still be vaccinated
Lactating women

51
Q

Who should not be vaccinated against HPV?

A

Pregnant women

Yeast hypersensitivity

52
Q

Side effects of HPV vaccine?

A

Pain at the site

Syncope- monitor does 15 minutes following vaccination

53
Q

Differential diagnosis for genital warts?

A
  1. Molluscum contagiosum- have an indurated center (white center) and go away on it’s own (pox virus)
  2. Condyloma lata- syphilis lesion
54
Q

What are the patient applied treatment options for genital warts?

A
  1. Imiquimod (Aldara) 5% or Zyclara cream 3.75%
  2. Podofilox (condylox) 0.5% solution or gel -costly
  3. Sinecatechins (Veregen) 15% ointment
55
Q

Should patient applied therapies for genital warts be used during pregnancy?

A

No- safety unknown

56
Q

What provider administered options for therapy of genital warts are there?

A
  1. TCA or BCA
  2. Surgical removal
  3. Cryotherapy
57
Q

What are the 2 types of cervical cancer?

A
  1. SCC (squamous cell carcinoma)- most common

2. Adenocarcinoma

58
Q

SCC is associated with what type of HPV?

A

HPV 16

59
Q

Adenocarcinoma is associated with what type of HPV?

A

HPV 18

60
Q

A cytology is a:

A

PAP

61
Q

Co-testing is a:

A

High risk HPV screen

62
Q

A repeat cytology for an inconclusive test means:

A

That you are basically repeating the pap

63
Q

At what age do you stop doing the PAP alone and start co-testing?

A

30

64
Q

If a patient had a hysterectomy for cancer do you need to PAP test them?

A

Yes- continue to look for cancer

65
Q

If patient had a hysterectomy for a benign reason and have a low risk of cancer do you need to continue PAPs?

A

No

66
Q

What is ASC-US?

A

Atypical squamous cells of undetermined significance

67
Q

What is ASC-H?

A

Atypical squamous cells, can not exclude high-grade

*more concerning, treat as a high-grade test result

68
Q

What is LSIL?

A

Low grade squamous intraepithelial neoplasia

-also called CIN 1- mild dysplasia

69
Q

What do you do for LSIL women age 21-24?

A

You watch for 2 years, if they persist and don’t resolve after the 2 years l, then you treat

70
Q

What is HSIL?

A

High grade squamous epithelial neoplasia

- CIN 2 or 3

71
Q

What do you do for CIN 2?

A

25 and older- treat bc of risk of progression (LEEP/loop)

24 and younger- follow up at 6 months to see if regressing. If not, treat.

72
Q

What do you do for a CIN 3?

A

25 and older- treat bc of risk of progression (LEEP/loop)

24 and younger- follow up at 6 months and if not regressing, treat.

73
Q

These are the cells collected when doing the PAP with the cytobrush, collected from a little higher up into the opening of the cervix.

A

Glandular cells

74
Q

Are atypical glandular cells more or less concerning than atypical squamous cells?

A

More concerning

75
Q

What is AGC?

A

Atypical glandular cells

76
Q

What is AIS?

A

Endocervical adenocarcinoma in situ

77
Q

What should be done with an unsatisfactory cytology?

A

Repeat in 2-4 months

HPV positive in women over 30- refer for colposcopy

78
Q

What should you do for negative pap but positive HPV in women over 30?

A

Repeat the cytology in 1 year or HPV genotype gets- HPV 16/18 Do a colposcopy; not HPV 16-18 repeat co-testing in 1 year

79
Q

For ASC-H:

A

Treat as if it’s high grade and send for colposcopy, regardless of age

80
Q

If HSIL positive and older than 25:

A

They can go to immediate LEEP/loop treatment

81
Q

HSIL positive and 21-24:

A

Do colposcopy first

*dont do immediate treatment on cervix in order to preserve healthy tissue and preserve fertility

82
Q

This is a visualization of the lesion by putting liquid on the lesion that makes it appear white in color. A biopsy can then be done on that white area.

A

Colposcopy

83
Q

A ___ is like a sweeping, then you take the sample of that whole sweeping.

A

Pap smear

84
Q

A ___ is a little biopsy of the site that is question.

A

Colposcopy

85
Q

This is the outside, visible portion of the cervix, seen on speculum exam?

A

Ectocervix

86
Q

This is the inner portion that marks the transition of the cervix to the endometrium of uterus?

A

Endocervix

87
Q

If you had a 19 year old come in that was sexually active, would you PAP?

A

No

88
Q

Is cervical cancer a disease of socioeconomic disparity?

A

Yes

89
Q

At what age does a women get her first PAP?

A

21

90
Q

When would you bring a 21 year old with a normal PAP back for another PAP?

A

3 years

91
Q

When would a woman come in for an annual PAP?

A

Immunocompromised or have HIV

92
Q

Does smoking have a high association with HPV?

A

Yes

93
Q

If a patient is vaccinated for HPV, do they still need routine PAPs?

A

Yes

94
Q

If a patient is 21-24 and has a low-grade pap result what do you do?

A

Follow up in a year (can monitor up to 24 months)

95
Q

What do you do if patient has a PAP with a high-grade change?

A

Colposcopy

96
Q

What are some things that can cause ASC-US

A

Could be from time of cycle
Yeast infection
Inflammation of the cervix
HPV

97
Q

If woman is HPV negative but has ASC-US, when do you repeat PAP?

A

3 years

98
Q

If patient has HPV and ASCUS when do you repeat PAP?

A

1 year

99
Q

What is the area that you collect a sample from for a PAP that has the highest cell activity?

A

The squamocolumnar junction or transformation zone