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PCM Final > Well women exam > Flashcards

Well women exam Flashcards

1
Q

FH high risk factors that may warrant early screening

A

breast, ovarian, uterine/endometrial, colorectal cancers
diabetes
thyroid disease
familial hyperlipidemia

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2
Q

Ages 13-18 screening

A

recommended that initial OB/GYN appt occurs during these years

  • ask about menstrual history
  • FH
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3
Q

Ages 13-18 PE

A

-Tanner staging
-Pelvic exam–only when indicated by history (vaginal d/c, –menstrual disorder, pelvic pain)
abd exam

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4
Q

Ages 13-18 labs

A
  • Chlamydia & gonorrhea (if sexually active)–can do urine test instead of pelvic exam
  • HIV (if sexually active)
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5
Q

Ages 13-18 eval & counseling

A
  • sexuality: address high risk behaviors, contraception, and STD prevention aka condoms*
  • fitness & nutrition
  • psychosocial: suicide, depression, Sexual abuse*
  • tobacco, alcohol, drugs*
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6
Q

Ages 13-18 immunizations

A
  • Tdap (diptheria, tetanus, & pertusis) booster 11-18 yrs*
  • hep B if not already given
  • HPV* can be given between ages of 9-45, gardasil 9 covers the most genotypes
  • influenza annually
  • MMR if not given already
  • varicella 1 series for those without previous immunity
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7
Q

Ages 19-39 screening

A
  • ask FH
  • tobacco, alcohol, other drugs
  • sexual practices–vaginal, oral, anal, orientation & partners
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8
Q

Ages 19-39 PE

A

-breast exam every 1-3 yrs beginning at age 20*
-pelvic: 19-20 yrs when indicated by medical history
ages 21 & older should get one

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9
Q

Ages 19-39 labs

A

Cervical cytology:
–ages 21-29 every 3 yrs cytology alone
–ages 30 & older every 3 yrs cytology alone OR co-test every 5 yrs
Chlamydia & gonorrhea testing:
–if 25 or younger & sexually active
–26+ who are at high risk should be screened routinely
HIV

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10
Q

Ages 19-39 eval & counseling

A
  • sexuality & reproductive planning: reproductive health plan, preconception & genetic counseling, STDs & barrier protection
  • psychosocial: intimate partner violence & rape prevention
  • health risk: breast self-awareness
  • tobacco, alcohol, & drugs
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11
Q

Ages 19-39 immunizations

A
  • Tdap booster every 10 yrs*
  • HPV for those not immunized*
  • influenze vaccine annually
  • MMR is not already given
  • varicella if not already given
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12
Q

Ages 40-64 screeening

A
  • FH
  • tobacco, alcohol, drugs
  • pelvic prolapse
  • menopausal symptoms
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13
Q

Ages 40-64 PE

A
  • breasts: yearly clinical exam*

- pelvic

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14
Q

Ages 40-64 labs

A 
Cervical cytology:*
--screen every 3 yrs with cytology alone OR
--co-test every 5 years
Colorectal cancer screening:*
--begins ages 45-50 (AA recommended at 45)
--colonoscopy every 10 yrs
HIV*
Lipid profile assessment:*
--every 5 yrs beginning at 45
Mammography:*
--yearly after 40 
TSH:
--every 5 yrs beginning at 50
Diabetes:
--every 3 yrs beginning at 45
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15
Q

Ages 40-64 eval & counseling

A
  • sexuality & reproductive: genetic testing, STD prevention (condoms)
  • psychosocial eval: IPV (intimate partner violence), advance directives
  • tobacco, alcohol, drugs
  • breast self-awareness
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16
Q

Ages 40-64 immunizations

A
  • Tdap booster every 10 yrs*
  • Varicella zoster: 60+**
  • influenza annually
  • MMR for those not previously immunized for those 40-54 yrs
  • varicella
  • HPV: can be given to 9-45 yo
17
Q

Ages 65+ screening

A
  • FH
  • Tobacco, alcohol, drugs
  • pelvic prolapse
  • menopausal symptoms
18
Q

Ages 65+ PE

A
  • breasts: yearly
  • pelvic: can be reasonable to stop this, based on women’s health if she would choose not to intervene on conditions detected
19
Q

Ages 65+ labs

A

Cervical cytology:*
–can discontinue in those with no history of CIN2 or higher: with 3 consecutive - prior cytology OR 2 consecutive - co-test within last 10 yrs
–if history of CIN 2 or CIN 3: need to continue pap x20 yrs after even if pt is 65+
Colorectal cancer screening:*
–start between 45-50, every 10 yrs get colonoscopy
Bone mineral density:*
–if no new risk factors do NOT screen more frequently than 2 yrs
Lipid profile assessment:*
–every 5 yrs beginning at 45
Mammography:*
–yearly
TSH
diabetes
urinalysis

20
Q

Ages 65+ eval & counseling

A
  • sexual function
  • STDs & barrier protection
  • IPV, advanced directives
  • breast self-awareness
  • tobacco, alcohol, & drugs
21
Q

Ages 65+ immunizations

A
  • Herpes zoster if not previously immunized
  • Tdap (every 10 yrs)
  • pneumococcal: once at 65 or older**
  • influenze & varicella
22
Q

Chloasma

A

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

23
Q

Breast exam

A
  • -can have pt sitting or laying down (with arm above head)
  • -palpate all quadrants of breast pushing gently towards chest
  • -compare both breasts: size, symmetry, contour, etc
  • -compress nipple between thumb & index finger, inspect for discharge
  • -review how & when to perform self breast exams
24
Q

High risk factors that require earlier bone mineral density testing

A

postmenopausal women less than 65 with

  • -history of fractures
  • -body weight less than 127 lbs
  • -current smoker, alcoholic, rheumatoid arthritis (causes of bone loss)
25
Q

Mammography in younger than 40 with

A
  • -history of breast cancer or FH of premenopausal breast or ovarian cancers
  • -positive test for BRCA1 or BRCA2
  • -history of high risk breast biopsy results
26
Q

Lipid profile assessment younger than 45 yo if

A
  • -personal history of CAD (AAA or peripheral artery dz)
  • -BMI > 30
  • -personal or FH of DM, PVD
  • -mult coronary heart dz risk factors (HTN, tobacco)
  • -FH of hyperlipidemia
  • -FH of premature cardiovascular dz (<50 for men, <60 for women)
27
Q

Colorectal screening earlier if

A
  • -FH colorectal cancer or adenomatous polyps younger than 60
  • -FH of adenomatous polyposis, HNPCC
  • -history of colon cancer, etc, etc I hate this, oh also UC or crohns, IBD
28
Q

Screen for diabetes before 45yo if

A
  • -BMI>25
  • -first degree relative with DM
  • -native american or latina
  • -prior birth > 9 lbs
  • -history of gestational DM, PCOS
29
Q

Screen for thyroid dz before 50 yo if

A

strong FH of thyroid dz

30
Q

Give meningococcal vaccine if

A
  • -adults with functional or anatomic asplenia
  • -college students living in dorms, military recruits
  • -pt traveling to hyperendemic or epidemic areas

PCM Final (3 decks)

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