Well women exam Flashcards
FH high risk factors that may warrant early screening
breast, ovarian, uterine/endometrial, colorectal cancers
diabetes
thyroid disease
familial hyperlipidemia
Ages 13-18 screening
recommended that initial OB/GYN appt occurs during these years
- ask about menstrual history
- FH
Ages 13-18 PE
-Tanner staging
-Pelvic exam–only when indicated by history (vaginal d/c, –menstrual disorder, pelvic pain)
abd exam
Ages 13-18 labs
- Chlamydia & gonorrhea (if sexually active)–can do urine test instead of pelvic exam
- HIV (if sexually active)
Ages 13-18 eval & counseling
- sexuality: address high risk behaviors, contraception, and STD prevention aka condoms*
- fitness & nutrition
- psychosocial: suicide, depression, Sexual abuse*
- tobacco, alcohol, drugs*
Ages 13-18 immunizations
- 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
Ages 19-39 screening
- ask FH
- tobacco, alcohol, other drugs
- sexual practices–vaginal, oral, anal, orientation & partners
Ages 19-39 PE
-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
Ages 19-39 labs
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
Ages 19-39 eval & counseling
- 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
Ages 19-39 immunizations
- Tdap booster every 10 yrs*
- HPV for those not immunized*
- influenze vaccine annually
- MMR is not already given
- varicella if not already given
Ages 40-64 screeening
- FH
- tobacco, alcohol, drugs
- pelvic prolapse
- menopausal symptoms
Ages 40-64 PE
- breasts: yearly clinical exam*
- pelvic
Ages 40-64 labs
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
Ages 40-64 eval & counseling
- sexuality & reproductive: genetic testing, STD prevention (condoms)
- psychosocial eval: IPV (intimate partner violence), advance directives
- tobacco, alcohol, drugs
- breast self-awareness
Ages 40-64 immunizations
- 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
Ages 65+ screening
- FH
- Tobacco, alcohol, drugs
- pelvic prolapse
- menopausal symptoms
Ages 65+ PE
- breasts: yearly
- pelvic: can be reasonable to stop this, based on women’s health if she would choose not to intervene on conditions detected
Ages 65+ labs
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
Ages 65+ eval & counseling
- sexual function
- STDs & barrier protection
- IPV, advanced directives
- breast self-awareness
- tobacco, alcohol, & drugs
Ages 65+ immunizations
- Herpes zoster if not previously immunized
- Tdap (every 10 yrs)
- pneumococcal: once at 65 or older**
- influenze & varicella
Chloasma
pigmentation over the bridge of the nose and under the eyes may be a sign of pregnancy
Breast exam
- -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
High risk factors that require earlier bone mineral density testing
postmenopausal women less than 65 with
- -history of fractures
- -body weight less than 127 lbs
- -current smoker, alcoholic, rheumatoid arthritis (causes of bone loss)
Mammography in younger than 40 with
- -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
Lipid profile assessment younger than 45 yo if
- -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)
Colorectal screening earlier if
- -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
Screen for diabetes before 45yo if
- -BMI>25
- -first degree relative with DM
- -native american or latina
- -prior birth > 9 lbs
- -history of gestational DM, PCOS
Screen for thyroid dz before 50 yo if
strong FH of thyroid dz
Give meningococcal vaccine if
- -adults with functional or anatomic asplenia
- -college students living in dorms, military recruits
- -pt traveling to hyperendemic or epidemic areas
