Well Woman Care -Foster Flashcards
What structures does the vulva include? What innervates these?
Includes mons veneris, labia minora, labia majora, clitoris, Bartholin’s glands, fourchette, perineum
Mostly innervated by branches of pudendal nerve
What is the blood supply to/from the ovaries? How does this differ from left to right?
Blood from ovarian arteries arising from aorta immediately below renal arteries.
Arteries cross the ureter at the level of the pelvic brim.
Also get blood supply from uterine arteries
Venous drainage of right ovary is into IVC
left ovary drains into renal vein
What is the passage of the ureters?
Crosses under ovarian vessels just anterior to bifurcation of internal iliac artery
closely attached to the peritoneum
What is the lymphatic drainage for the various parts of the female reproductive tract?
Lower vagina and vulva drain to inguinofemoral and external iliac nodes
Cervix drains through parametria to pelvic nodes (hypogastric, obturator, external iliac)
Endometrium drains to pelvic and para-aortic nodes
Ovaries drain to pelvic and para-aortic nodes
What arteries of the lower abdominal wall should be looked out for in laproscopic surgeries?
interior epigastric arteries
What is primary prevention? Secondary prevention? Tertiary prevention?
Primary: remove risk factors (prevent from getting disease)
Secondary: early detection and treatment (in people who are preclinical or not with the disease being clinically apparent)
Tertiary: reduce complications of an established disease
Who do we screen for disease?
asymptomatic patients
ONLY screen for things that have effective treatments of asymptomatic phase and where “lead time” (between diagnosis and disease progression) is important
must have a minimal risk and cost and a high sensitivity and specificity
What are among the top 5 causes of death in adolescents?
accidents, cancer, homicide, suicide and congenital anomalies
screen for suicidal/homicidal thought
What immunizations should be given to adolescents? (5)
diphtheria-tetanus-pertussis
Hep B
HPV
Meningococcal conjugate (if not already done)
varicella
At what age should a patient’s first pap smear be done? What should be done with it?
21
pelvic exam and GC/Chlamydia (urine testing), HIV testing if sexually active
What is included in a routine STD screening? Should you screen women with developmental disabilities?
Chlamydia: sexually active women < 25
gonorrhea: sexually active adolescents
HIV: sexually active adolescents and women age 19-64
YES! these women can be at high risk for sexual abuse
At what age should the first reproductive health visit be scheduled? What should be done at this visit?
13-15
establish rapport, discuss important issues (contraception, sexuality and STDs)
*does NOT have to include a pelvic exam
What immunizations should be given between the ages of 19-39?
HPV (up to 26 if not previously given)
TdaP
Influenza
What are some important considerations in preconception care?
Substance use
Nutritional counseling: weight, folic acid (0.4 mg/day)
Environmental factors, toxic exposures, work environment
Exercise habits
What are the 5 A’s that should be used when addressing smoking?
ASK about tobacco use
ADVISE to quit
ASSESS willingness to make an attempt to quit
ASSIST in quit attempt if ready
ARRANGE follow-up
Who should be screened for domestic violence? What should be asked?
Everyone!
Has anyone close to you ever threatened to hurt you?
Has anyone ever hit, slapped, kicked or hurt you physically?
Has anyone, including partner or family member, pressured or forced you to do something sexually that you did not want to do?
Are you ever afraid of your partner or someone at home?
ask about injuries
What is the RADAR pneumonic?
REMEMBER to ask routinely
ASK DIRECTLY about violence; interview in private
DOCUMENT suspected violence in chart; file reports when required by law
ASSESS your patient’s safety
REVIEW options with your patient; know about referrals in your community
What are important screening tests for the 40-64 age group?
Mammogram
Lipid profile every 5 years
Colorectal cancer:
colonoscopy every 10 years.
FOBT yearly, stool DNA.
Sigmoidoscopy ,double contrast BE, CT colonography every 5 years
starting age 50, age 45 if African American
Diabetes testing every 3 years starting age 45
TSH every 5 years starting age 50
HIV
Hep C if born 1945-65 and unaware of status
What are 2 common problems that the age group 40-64 experiences?
incontinence
sexual dysfunction
What immunizations should be given for patients > 65? (4)
TdaP every 10 years
Influenza (yearly)
Pneumococcal vaccine (once)
Varicella (if no evidence of immunity)
At what age should Paps be discontinued if there was no history of high grade lesions on biopsy and negative test for the past 10 years?
age 65
What should be addressed in the 65+ population?
Chronic health problems, long-term disability
Screen for depression, changes in cognitive function; alcoholism and sexual dysfunction underdiagnosed.
Ask about bladder function.
Physical or emotional abuse or neglect
What are the main health concerns in the 65+ population?
Fractures a major health hazard (Osetoporosis prevention, fall prevention)
Effects of multiple medications
Changes in metabolism and nutrient requirements.
Exercise.
