WH Dx 1 Flashcards
Contraindications for estrogen 9
- Age 35 or older who smoke 15 or more cigarettes a day
- CVD risk factors (obesity, DM)
- HTN
- VTE
- ischemic heart disease
- history of a stroke
- Lupus
- migraines with an aura
- valvular heart disease
bone mineral density test guidelines
3
-everyone 65 years and old
-women <65 years past menopause with risk of fracture
-repeat every two years
vaginal swab tests for what STDs
gonorrhea, chlamydia, trichomoniasis
blood test for what STDs
4
genital herpes,
HIV,
syphilis,
hep B
Pap smear guidelines 3
- 21-29 cytology every 3 years
- 30-65 cytology every 3 years or co testing every 5 years
- > 65 no screening once negative
clinical breast exam guidelines
2
- 25-39 every 1-3 years
- 40 years and older, annually
mammography guideline
1
40-75 annually
colon cancer screening guideline
2
45-75 q2 years cologuard and colonoscopy every 10 years
abnormal pap smear can be caused by
3
pregnancy, shortly after pregnancy, and changes in estrogen levels
abnormal pap smear - when to repeat HPV testing
at 1 year for patients with minor screening abnormalities
abnormal pap smear differentials
2
STI infection, menopause
abnormal pap smear education
3
- Not all abnormal pap smears indicate cancer.
- There are a number of changes that can cause an abnormal pap smear such as hormones.
- Reduce your risk of getting abnormal pap smears from getting vaccinated against certain disease, wear barrier protection every time, and keep up to date on your screenings.
abnormal pap smear meds
none - other interventions needed
abnormal pap smear tests
4
- Average risk HPV 16 or 18 positive should do a colposcopy. If HSIL then do a LEEP.
- HPV positive with unknown genotype or HPV 16/18 negative - NILM do HPV and cytology in one year. ASC-US or LSIL colposcopy. HSIL LEEP or colp
- HPV unknown - HSIL do LEEP or colp. LSIL do colp. ASC-US HPV testing with or without cytology in a year. NILM routine
- HPV negative - HGSIL LEEP or colp. LSIL HPV testing with or without cytology in one year. ASC-US HPV testing with or w/o cytology in three years. NILM routine
abnormal pap smear f/u
will depend on treatment
abnormal pap smear anticipatory guidance
- get vaccinated
- stay up to date on cytology screenings
abnormal pap smear red flags
4
- pain during intercourse
- bleeding between or following periods
- bleeding after intercourse
- increased vaginal discharge
atrophic vaginitis occurs when
there is a drop is estrogen levels and is often seen in menopausal patients
atrophic vaginitis sx
6
- vaginal dryness
- burning
- pruritis
- vaginal discharge
- bleeding or spotting
- dyspareunia
atrophic vaginitis dd
3
bacterial vaginosis
UTI
STI
atrophic vaginitis education
4
- This is an inflammatory process of the vaginal lining that affects vaginal wall thickness and moisture.
- Occurs in some pre-menopausal women bust most often in post menopausal women.
- This occurs from a drop is your estrogen levels.
- Over the counter moisturizers and lubricants may help the symptoms but won’t help with the tissue regrowth.
atrophic vaginitis medication
2
- first line is non-hormonal options moisturizer, lubricants
- persistent symptoms are vaginal estrogens
atrophic vaginitis test
clinical diagnosis, no test
atrophic vaginitis f/u
4 weeks to determine if interventions effective
atrophic vaginitis anticipatory guidance
4
- Get up to date on vaccines
- Get pap smear every 3-5 years depending on with or without HPV testing
- Get mammogram yearly starting at 40 y.o.
- Get colon cancer screening 45-75 y.o.
atrophic vaginitis red flags
5
symptoms worsen
increase vaginal bleeding
abnormal discharge
foul smelling odor
change in urinary or bowel habits
bacterial vaginitis
shift of vaginal microbes from Lactobacillus towards a different bacterial species
bacterial vaginitis sx
2
- vagina discharge is off-white, thin
- fishy odor
BV DD
2
trichomonas vaginalis
candidiasis
BV education
This is an infection of the vagina that causes bad-smelling vaginal discharge. You are more at risk if you are sexually active, have a new sex partner, or have more than 1 partner. If you partner doesn’t have a vagina then they don’t need to be treated but if they do they should be treated. It is possible for this infection to reoccur even if not sexually active.
Reduce risk by avoiding douching, don’t smoke, avoid sharing sex toys and clean toys between use.
BV medication
antibiotic
BV test
vaginal swab for a smear test
BV f/u
no f/u if symptoms resolve
BV red flags
worsening symptoms
pelvic pain
bleeding or spotting
Bartholin cyst
develops when mucus accumulates at the bartholin gland and blocks the gland
bartholin cyst is most common when
around menopause age
bartholin cyst s/sx
Usually painless and may be asymptomatic. Most are detected on routine pelvic exam. Large cysts may cause discomfort during sex, sitting, or ambulating.
1-3 cm in size, soft, nontender, unilateral
bartholin cyst DD
3
STD
fibroma
vaginal prolapse
bartholin cyst education
This lump develops when the gland becomes backed up with drainage that is supposed to be secreted into the vaginal canal. There are not a lot of known ways to prevent this from happening. Wear panty liners or pads if you have discharge from the cyst. Keep the area clean. Some patient experience reoccurrence of this cyst.
bartholin cyst med
None - treatment involves soaking small cysts in sitz bath or warm compress to help drainage; large cysts > 3 cm I & D
Bartholin cyst test
Dx made on physical exam. If drainage is present, you can send for culture in individuals at risk for STDs
Bartholin cyst f/u
One month to assess if drained
Bartholin cyst AG
3
- Get up to date on vaccines including HPV vaccine
- Get pap smear every 3-5 years
- Get STD counseling if sexually active
Bartholin cyst red flags
Be aware of infection of cysts which includes area becoming red, painful, or tender. Change in discharge. Foul smelling discharge. All of which could indicate infection and/or STD
Bladder or uterine prolapse risk factors
6
increase parity
increased age
menopause
obesity
constipation
hysterectomy
bladder or uterine prolapse s/sx
5
bulge or vaginal pressure
may have urinary symptoms
defecatory (constipation, incomplete emptying)
sexual dysfunction
low back or pelvic pain
bladder or uterine prolapse DD
3
urethral prolapse
gynecological mass/tumor, ovarian mass
bladder or uterine prolapse education
This prolapse occurs when the muscles that support the organs in the pelvis become weakened which causes them to drop down and press against or bulge into the vagina.
You can prevent further issues or exacerbation by losing weight,
managing constipation, and
avoiding activities that require heavy lifting.
bladder or uterine prolapse Meds
None - use conservative measures in pregnant and non pregnant individuals such as vaginal pessary and pelvic floor muscle training. Surgical treatment is saved for symptomatic prolapse or those who fail or decline conservative measures.
bladder or uterine prolapse test
pelvic exam
bladder or uterine prolapse f/u - pessary and surgery
return every 3 months to have pessary inspected to ensure it is not causing erosions; if getting surgery then return post-op
bladder or uterine prolapse red flags 4
worsening symptoms
pelvic or vaginal pain
symptoms of bladder or urinary infection
decreased urine stream
Pap smear guidelines
2
- 21-29 q3year cytology testing
- 30-65 every 3-5 years (5 years with HPV cotesting)
