Well Woman Care -Foster

Question 1

What structures does the vulva include? What innervates these?

Answer 1

Includes mons veneris, labia minora, labia majora, clitoris, Bartholin’s glands, fourchette, perineum

Mostly innervated by branches of pudendal nerve

Question 2

What is the blood supply to/from the ovaries? How does this differ from left to right?

Answer 2

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

Question 3

What is the passage of the ureters?

Answer 3

Crosses under ovarian vessels just anterior to bifurcation of internal iliac artery

closely attached to the peritoneum

Question 4

What is the lymphatic drainage for the various parts of the female reproductive tract?

Answer 4

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

Question 5

What arteries of the lower abdominal wall should be looked out for in laproscopic surgeries?

Answer 5

interior epigastric arteries

Question 6

What is primary prevention? Secondary prevention? Tertiary prevention?

Answer 6

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

Question 7

Who do we screen for disease?

Answer 7

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

Question 8

What are among the top 5 causes of death in adolescents?

Answer 8

accidents, cancer, homicide, suicide and congenital anomalies

screen for suicidal/homicidal thought

Question 9

What immunizations should be given to adolescents? (5)

Answer 9

diphtheria-tetanus-pertussis

Hep B

HPV

Meningococcal conjugate (if not already done)

varicella

Question 10

At what age should a patient’s first pap smear be done? What should be done with it?

Answer 10

21

pelvic exam and GC/Chlamydia (urine testing), HIV testing if sexually active

Question 11

What is included in a routine STD screening? Should you screen women with developmental disabilities?

Answer 11

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

Question 12

At what age should the first reproductive health visit be scheduled? What should be done at this visit?

Answer 12

13-15

establish rapport, discuss important issues (contraception, sexuality and STDs)

*does NOT have to include a pelvic exam

Question 13

What immunizations should be given between the ages of 19-39?

Answer 13

HPV (up to 26 if not previously given)

TdaP

Influenza

Question 14

What are some important considerations in preconception care?

Answer 14

Substance use

Nutritional counseling: weight, folic acid (0.4 mg/day)

Environmental factors, toxic exposures, work environment

Exercise habits

Question 15

What are the 5 A’s that should be used when addressing smoking?

Answer 15

ASK about tobacco use

ADVISE to quit

ASSESS willingness to make an attempt to quit

ASSIST in quit attempt if ready

ARRANGE follow-up

Question 16

Who should be screened for domestic violence? What should be asked?

Answer 16

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

Question 17

What is the RADAR pneumonic?

Answer 17

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

Question 18

What are important screening tests for the 40-64 age group?

Answer 18

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

Question 19

What are 2 common problems that the age group 40-64 experiences?

Answer 19

incontinence

sexual dysfunction

Question 20

What immunizations should be given for patients > 65? (4)

Answer 20

TdaP every 10 years

Influenza (yearly)

Pneumococcal vaccine (once)

Varicella (if no evidence of immunity)

Question 21

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?

Answer 21

age 65

Question 22

What should be addressed in the 65+ population?

Answer 22

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

Question 23

What are the main health concerns in the 65+ population?

Answer 23

Fractures a major health hazard (Osetoporosis prevention, fall prevention)

Effects of multiple medications

Changes in metabolism and nutrient requirements.

Exercise.