Well Woman Exam LECT [Slides 1-50] Flashcards
When recording a pt’s obstetric hx, what information must be recorded?
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
What weeks are considered full term?
37-42
What weeks are considered preterm?
20-36 weeks+6 days
What is the difference between primapara and primagravida?
Primapara - has given birth to one child
Primagravida - woman who is in or has experienced her 1st pregnancy
What is the difference between nullipara and nulligravida?
Nullipara - has never given birth or has never had a pregnancy progress beyond the gestational age of an abortion
Nulligravida - never been pregnant
Most common causes of amenorrhea (2)
Pregnancy
Menopause
Averate age of menarche
12-13
When would a pt be considered to have primary amenorrhea?
If pt has not cycled at 16 yo
What should you be concerned about if a pt has post-coital bleeding?
Cervical CA
What should you be concerned about if a pt has post-menopausal bleeding?
Endometrial/uterine CA
What should you be concerned about if a pt has heavy vaginal bleeding, passing clots?
Structural abnormality
Pt complaining of midcycle ovulatory pain/cramps most likely has what syndrome?
Mittelschmerz syndrome
What does Naegel’s rule calculate?
Estimated date of confinement (delifery)
Subtract 3 months and add 7 days to LMP
What kind of gynecologic hx do you want to obtain in preconception planning/counseling?
PNV, folic acid
Have they had chicken pox?
Do they have cats?
Will tehre be risk with their job? (daycare workers CMV)
When does ACOG recommend getting a clinical breast exam?
Every 1-3 years for women age 20-39
Every year w/ annual mammogram for women >40
When does ACOG recommend beginning annual pelvic exams?
Age 21
What STD screening should be periodically obtained in female pts aged 13-18 yo?
Chlamydia/Gonorrhea (if sexually active)
HIV
In female pts aged 13-18 yo, what counseling must you do to address sexuality?
Address high risk sexual behaviors (# of partners)
Contraception options
STD prevention (barrier protection)
In female pts aged 13-18, what psychosocial evaluation/counseling must be done?
Suicide, depressive sx, bullying, school experiences
sexual abuse by family or partner
When should pts receive the Tdap vaccine booster?
Once b/w 11-18 yo
When should pts receive the HPV vaccine?
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*
How often should pts get cervical cytology?
21-29: q3 years with cytology alone
>30: q3 years with cytology alone, cotest with HPV q5 years
When should pts get GC screening?
25 yo or younger and sexually active
26 and older who are at high risk
What kind of psychosocial evaluation must be done for female pts aged 19-39?
Intimate partner violence
Acquaintance rape prevention
How often should a lipid profile assessment be done for female pts 40-64 yo?
Q 5 years beginning at 45
What must be addressed in health risk assessment of female pts 40-64 yo?
Aspirin prophylaxis to reduce risk of stroke (55-79 yo)
Breast self awareness
Chemoprophylaxis for breast CA (high risk women 35 or older)
What 4 aspects of hx must be obtained for pts 65 years and older?
FMH
Tobacco, alcohol, other drugs
Pelvic prolapse
Menopausal sx
What is the ACOG recommendation for African American screening of colorectal CA?
Begin at 45 yo
How often should bone mineral density screening be done in female aged 65 or older?
Do not screen more frequently than q 2 years?
How should sexuality and reproductive planning be approached in pts 65 years and older?
Sexual fxn
STD prevention
How should psychosocial evaluation be addressed in pts 65 years and older?
Intimate partner violence
Advanced directives
When should the pneumococcal vaccine be administered?
once at 65 years or older
High risk factors that may require bone mineral density screen in pts younger than 65
Hx of fractures
Body weight <127 pounds
Medical causes of bone loss (meds or disease, current smoker, alcoholic or rheumatoid arthritis)
High risk factors that may require mammography younger than 40 yo
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
