Well woman exam

Question 1

patient has not had menarche by age 16

Answer 1

primary amenorrhea

Question 2

Concern with post coital bleeding

Answer 2

cervical cancer

Question 3

concern with post menopausal bleeding

Answer 3

endometrial/uterine cancer

Question 4

Midcycle ovulatory pain

Answer 4

Mittelschmerz syndrome

Question 5

when does Naegeles Rule not work?

Answer 5

if they have irregular cycles

Question 6

what is a pregnancy risk associated with daycare workers

Answer 6

CMV infection

Question 7

Breast exam recommendation from ACOG and ACS

Answer 7

• every 1-3 years for women 20-39

- Every year with annual mammograms for women age 40 and over

Question 8

Pelvic exam recommendation from ACOG

Answer 8

-beginning annual at age 21 if not indicated earlier by history

Question 9

when does ACOG recommend an initial visit to OB/GYN for screening and provision of preventative health care services and guidance to take place?

Answer 9

b/t ages of 13-15

Question 10

What immunizations should be given ages 13-18?

Answer 10

• Diptheria and reduced tetanus toxoids & acellular pertussis (Tdap) vaccine booster
• Hep B
• HPV
• Influenza
• MMR-if not previously
• Varicella

Question 11

What do you add to the screening history when patient is 19-39?

Answer 11

urinary and fecal incontinence

Question 12

What Labs do you get in ages 19-39?

Answer 12

• CERVICAL CYTOLOGY: 21-29 q 3 years w/ cytology alone; >30 q 3 years w cytology alone, co test with HPV q 5 years
• HIV

Question 13

What vaccine for ages 19-39?

Answer 13

• diphtheria and Tdap (Tdap booster q 10 years)

- HPV if not previously and only ages 9-26

Question 14

what is added to screening history for ages 40-64?

Answer 14

• pelvic prolapse

- menopausal symptoms

Question 15

what labs will be order from ages 40-64?

Answer 15

• colorectal cancer . . .45 for AAs . . conoloscopy q 10 years
• lipid profile assessment q 5 years
• mammography yearly after 40
• TSH
• Diabetes

Question 16

what vaccine is added when you are 40-64 years old?

Answer 16

-varicella Zoster vaccine at 60 and older

Question 17

pelvic exam 65 and older?

Answer 17

can discontinue if choose to

Question 18

Cervical cytology in 65 and older

Answer 18

• Cervical cytology: Can discontinue if no hx of CIN 2 or higher–> 3 consecutive negative prior cytology or 2 consecutive negative co test within previous 10 years
• If hx of CIN2 or 3: need to continue pap x 20 years after even if extends to over 65

Question 19

what lab tests are added in 65 and older

Answer 19

bone mineral density screening: in absence of new risk factors do NOT screen more frequently than q 2 years

Question 20

what vaccine in added at 65 and older

Answer 20

Pneumococcal vaccine

Question 21

what is Chloasma?

Answer 21

pigmentation over the bridge of the nose and under eyes that may be a sign of pregnancy

Question 22

Breast cancer clinical signs?

Answer 22

skin dimpling and flattening of nipple

Question 23

how long do you stick a swab for Gonorrhea/chlamydia into cervical os

Answer 23

45 sec

Question 24

what is hegar’s sign

Answer 24

when cervix become softer during pregnancy and you are able to palpate the uterus b/t the cervix and fundus on bimanual exam