Well Woman Exam LECT [Slides 1-50]

Question 1

When recording a pt’s obstetric hx, what information must be recorded?

Answer 1

Date of delivery/termination

Hospital

Gestational age, sex, birth weight (gravity and parity)

Type of delivery

Duration of labor

Type of anesthesia

Maternal complications

Fetal complications

Question 2

What weeks are considered full term?

Answer 2

37-42

Question 3

What weeks are considered preterm?

Answer 3

20-36 weeks+6 days

Question 4

What is the difference between primapara and primagravida?

Answer 4

Primapara - has given birth to one child

Primagravida - woman who is in or has experienced her 1st pregnancy

Question 5

What is the difference between nullipara and nulligravida?

Answer 5

Nullipara - has never given birth or has never had a pregnancy progress beyond the gestational age of an abortion

Nulligravida - never been pregnant

Question 6

Most common causes of amenorrhea (2)

Answer 6

Pregnancy

Menopause

Question 7

Averate age of menarche

Answer 7

12-13

Question 8

When would a pt be considered to have primary amenorrhea?

Answer 8

If pt has not cycled at 16 yo

Question 9

What should you be concerned about if a pt has post-coital bleeding?

Answer 9

Cervical CA

Question 10

What should you be concerned about if a pt has post-menopausal bleeding?

Answer 10

Endometrial/uterine CA

Question 11

What should you be concerned about if a pt has heavy vaginal bleeding, passing clots?

Answer 11

Structural abnormality

Question 12

Pt complaining of midcycle ovulatory pain/cramps most likely has what syndrome?

Answer 12

Mittelschmerz syndrome

Question 13

What does Naegel’s rule calculate?

Answer 13

Estimated date of confinement (delifery)

Subtract 3 months and add 7 days to LMP

Question 14

What kind of gynecologic hx do you want to obtain in preconception planning/counseling?

Answer 14

PNV, folic acid

Have they had chicken pox?

Do they have cats?

Will tehre be risk with their job? (daycare workers CMV)

Question 15

When does ACOG recommend getting a clinical breast exam?

Answer 15

Every 1-3 years for women age 20-39

Every year w/ annual mammogram for women >40

Question 16

When does ACOG recommend beginning annual pelvic exams?

Answer 16

Age 21

Question 17

What STD screening should be periodically obtained in female pts aged 13-18 yo?

Answer 17

Chlamydia/Gonorrhea (if sexually active)

HIV

Question 18

In female pts aged 13-18 yo, what counseling must you do to address sexuality?

Answer 18

Address high risk sexual behaviors (# of partners)

Contraception options

STD prevention (barrier protection)

Question 19

In female pts aged 13-18, what psychosocial evaluation/counseling must be done?

Answer 19

Suicide, depressive sx, bullying, school experiences

sexual abuse by family or partner

Question 20

When should pts receive the Tdap vaccine booster?

Answer 20

Once b/w 11-18 yo

Question 21

When should pts receive the HPV vaccine?

Answer 21

One series for those who are not previously immunized b/w 9 and 45

• Cervarix - 16 and 18*
• Gardasil HPV - 6, 11, 16, 18*
• Gardasil 9 - everything basically*

Question 22

How often should pts get cervical cytology?

Answer 22

21-29: q3 years with cytology alone

>30: q3 years with cytology alone, cotest with HPV q5 years

Question 23

When should pts get GC screening?

Answer 23

25 yo or younger and sexually active

26 and older who are at high risk

Question 24

What kind of psychosocial evaluation must be done for female pts aged 19-39?

Answer 24

Intimate partner violence

Acquaintance rape prevention

Question 25

How often should a lipid profile assessment be done for female pts 40-64 yo?

Answer 25

Q 5 years beginning at 45

Question 26

What must be addressed in health risk assessment of female pts 40-64 yo?

Answer 26

Aspirin prophylaxis to reduce risk of stroke (55-79 yo)

Breast self awareness

Chemoprophylaxis for breast CA (high risk women 35 or older)

Question 27

What 4 aspects of hx must be obtained for pts 65 years and older?

Answer 27

FMH

Tobacco, alcohol, other drugs

Pelvic prolapse

Menopausal sx

Question 28

What is the ACOG recommendation for African American screening of colorectal CA?

Answer 28

Begin at 45 yo

Question 29

How often should bone mineral density screening be done in female aged 65 or older?

Answer 29

Do not screen more frequently than q 2 years?

Question 30

How should sexuality and reproductive planning be approached in pts 65 years and older?

Answer 30

Sexual fxn

STD prevention

Question 31

How should psychosocial evaluation be addressed in pts 65 years and older?

Answer 31

Intimate partner violence

Advanced directives

Question 32

When should the pneumococcal vaccine be administered?

Answer 32

once at 65 years or older

Question 33

High risk factors that may require bone mineral density screen in pts younger than 65

Answer 33

Hx of fractures

Body weight <127 pounds

Medical causes of bone loss (meds or disease, current smoker, alcoholic or rheumatoid arthritis)

Question 34

High risk factors that may require mammography younger than 40 yo

Answer 34

Hx of breast CA or family hx of relatives with premenopausal breast or ovarian CA

+ test for BRCA1 or BRCA2 mutations

+ hx of high risk breast biopsy results