women Flashcards
The typical patient is a middle-aged or older woman with vague symptoms of abdominal bloating or abdominal discomfort, early satiety, gastrointestinal reflux disease-type symptoms, low-back pain, pelvic pain, dyspareunia, and changes in bowel habits. Other symptoms are unusual lower abdominal or lower back pain and/or unusual tiredness or fatigue
ovarian cancer
Older female reports a history of a red-colored rash that is scaly (resembling eczema) and starts on the nipple and spreads to the areola of one breast. Some women complain of itching, pain, or burning sensation. The skin lesion slowly enlarges and evolves to include crusting, ulceration, and/or bleeding on the nipple. Up to half of women will have a breast mass.
Pagets disease of the breast
Puberty in girls starts at tanner stage
2 with breast buds
most breast cancer is located in the
tail of spence - upper outer quadrant of the breast
most common type of solid breast tumor. They consist of fibrous tissue that can range from a few millimeters to 2.5 centimeters in size. A
fibroadenomas
sexual intercourse – to – days before ovulation offers the highest chance of pregnancy
1 - 2 days
Amitriptyline (elavil) helps with what
IBS
age 21-29 screen cervical cytology
alone can be done every 3 years
age 30-65 screen cervical cytology
pap and cotest with HPV
pap test every 5 yrs if cotesting and normal
Atypical Squamous Cells of Undetermined Significance
Age 21 to 24 years: Preferred is repeat Pap test in 12 months (acceptable is reflex HPV test).
Age 25 to 29 years: Preferred is reflex HPV test. Acceptable is repeat Pap test in 12 months.
Age 30 years or older: Cotesting for high-risk HPV. If HPV positive, refer for colposcopy.
HPV types what are causes of cervical cancer
16-18
whiff test used to detect
bacterial vaginosis
KOH test used to detect
Fungal infection
Desogen, Ortho-TriCyclen, and Yaz/Yasmin are all indicated for
acne
Women taking Seasonale (84 days hormones/7 days placebo pill) will have only
4 periods a year
NuvaRing is a plastic cervical ring that contains etonogestrel and ethinyl estradiol (EE). It is left inside the vagina for
3 weeks and then removed for one week
Missing Consecutive Days of Oral Contraceptive Pills
Missed 1 day: Take two pills now and continue with same pill pack (“doubling up”). Continue taking remaining pills at the usual time.
Missed 2 consecutive days (or >48 hours since last pill should have been taken): Take the most recent missed pill as soon as possible (even if it means taking two pills the same day). Discard any leftover missed pills. Continue taking remaining pills at the usual time.
Use backup contraception (e.g., condoms) or avoid sex until hormonal pills have been taken for 7 consecutive days.
Low-dose birth control pills contain
20 mcg to 35 mcg of EE.
progesterone only pills are safe for women who are also known as the mini pill
breastfeeding
Cu-IUD lasts
10-12 years
Mirena lastts
5 years
probably has the broadest indication for use as a contraceptive for women with medical conditions (e.g., diabetics, smoker for more than 35 years, on anticonvulsant or antiretroviral therapy, ovarian cancer, ischemic heart disease, liver tumors).
Cu- IUD
Yaz or Yasmin contains estrogen and drospirenone. Has a higher risk of
blood clots, stroke, heart attacks and hyperkalemia
primary amenorrhea is the absence of menarche by age of
15
most common cuse of primary amenorrhea is
turners syndrome
Secondary amenorrhea is the absence of menses for more than
3 months in girls/women who previously had regular menstrual cycles, or, if irregular cycles, it is missing menses for 6 months. The most common cause of secondary amenorrhea is pregnancy.
Breast Cancer Screening
USPSTF: Biennial screening mammography for women aged 50 to 74 years. There is insufficient evidence for digital breast tomosynthesis (DBT) as the screening method for breast cancer.
Mefenamic acid (Ponstel) is an NSAID that is very effective
menstrual pain
Become familiar with BV. “Clue cells” are
squamous epithelial cells that have blurred edges due to the large number of bacteria on the cell’s surface
Trichomonal vaginitis (trichomoniasis)
Strawberry cervix”
Bubbly discharge
Vulvovagina red/irritated
what contraceptive puts patient at highest risk for blood clots
ortho patch
patient do if missed two pills
take missed pill and get rid of rest
age start pap smears
21 years old pap, cytology alone every 3 years
HPV testing added in starting at age
30
Gardasil vaccine started at
11 but can get at age 9
Gardasil helps prevent
HPV 16 - 18
Genital warts treatment
TCA acid
what ssri helps with hot flashes or nightsweats in menopause
Paxil
what are herbs used for menopause
black cohosh, ginko,
what antisphycotic drug can cause galactorreha
zyprexa
A young adult who is sexually active presents with dysuria, frequency, and urgency of urination. She also reports a yellowish vaginal discharge and lower abdominal pain. A cervical swab reveals the presence of intracellular gram-negative bacteria. Based on the symptoms and lab findings, what is the appropriate treatment for this patient?
A.Azithromycin 500 mg orally once a day for 7 days
B.Ceftriaxone 500 mg intramuscularly in a single dose
C.Metronidazole 2 g orally in a single dose
D.Doxycycline 100 mg orally twice a day for 7 days
Doxycycline 100 mg orally twice a day for 7 days
The patient’s symptoms of dysuria, frequency, urgency of urination, yellowish vaginal discharge, and lower abdominal pain, along with the lab finding of intracellular gram-negative bacteria, are consistent with chlamydia caused by Chlamydia trachomatis. Recommended treatment for adults and adolescents is doxycycline 100 mg orally twice a day for 7 days. Alternative regimens include azithromycin 1 g orally in a single dose or levofloxacin 500 mg orally once a day for 7 days. Patients diagnosed with chlamydia should also be tested for gonorrhea; treatment with ceftriaxone 500 mg intramuscularly is common if results are positive. A single dose of metronidazole 2 g orally would be appropriate for Trichomonas vaginalis.
The nurse practitioner is preparing to create a plan of care to vaccinate a 16-year-old patient who has never had a human papillomavirus (HPV) vaccination. Which vaccination plan will the nurse practitioner recommend to the patient?
A.Administer 2 doses over the course of 12 months
B.Administer 2 doses over the course of 3 months
C.Administer 3 doses over the course of 6 months
D.Administer 3 doses over the course of 3 months
Answer: C. Administer 3 doses over the course of 6 months
Patients older than 15 years of age who have never received the HPV vaccine will receive 3 doses of the vaccine over 6 months. The second dose should be given 1 to 2 months after the first dose, and third dose 6 months after the first dose. Patients aged 9 to 14 years should receive a two-dose series, 6 to 12 months apart.
most common side effects of copper IUD is
heavy menstraul bleeding and pain
copper IUD can be placed in ____ hours after birth
48
A 30-year-old patient presents to the clinic for her annual physical examination. She reports she read online that birth control pills reduce the risk of cancer. The nurse practitioner should advise the patient there is a decreased risk of which of the following cancers in patients who take combined oral contraceptives?
endometrial and ovarian
are preferred for patients who are breastfeeding. for contracetpion
Hormone-free or progesterone-only contraception, such as the progestin-only pill (mini-pill) (D), progestin-releasing or copper-containing IUDs, or medroxyprogesterone acetate (Depo-Provera)
Nucleic acid amplification testing is recommended screening for
chlamydia, gonorrhea and trichomoniasis
amenorrha is a what sign of pregnanccy
presumptive
patients who way over 200 lbs should not use
transdermal contaception
Magnesium sulfate is used in pregnancy for which of the following?
A.Severe constipation
B.Neuroprotection for hypertensive disorders
C.As an antihypertensive
D.Preterm labor
Answer: B. Neuroprotection for hypertensive disorders
Magnesium sulfate is used when patients are admitted to labor and delivery with a hypertensive disorder in order to help prevent eclampsia. It is not an antihypertensive, and it is not effective for preterm labor. Constipation in pregnancy is often treated with diet and lifestyle changes. Stool softeners can be used as well.
The nurse practitioner is preparing to discuss the recommendations of reproductive screening for a 65-year-old female patient with a history of human papillomavirus (HPV) and moderate cervical dysplasia. Which plan for screening will the nurse practitioner include?
A.HPV testing in 1 year
B.Cervical cytology in 3 years
C.Cervical cytology and HPV testing in 5 years
D.Future screening is not recommended
Solution: C
Cervical cytology and HPV testing in 5 years.
The recommended screening for a 65-year-old female patient with a history of human papillomavirus (HPV) and moderate cervical dysplasia is cervical cytology (pap test) with HPV testing every 5 years. Screening more frequently than every 5 years is of little benefit and not indicated unless there is a significant change in the clinical presentation. Cervical cancer screening should be stopped after age 65 once the patient has had adequate prior screenings (that were negative) and is not at a high risk for cervical cancer.
A G2P1 patient presents for an initial prenatal visit at 12 weeks’ gestation. The patient’s blood type is O negative. Which of the following is the best course of action for this patient?
A.Plan delivery via cesarean section
B.Check an antibody screen and, if positive, administer RhoGAM
C.Check an antibody screen and, if negative, recheck at 28 weeks
D.Plan on administering RhoGAM when the patient is 72 hours post partum
Answer: C. Check an antibody screen and, if negative, recheck at 28 weeks
If the patient is Rh negative, the most appropriate course of action is to check an antibody screen. If the screen is negative, it means there has been no alloimmunization, and RhoGAM can be given in the third trimester. If the antibody screen is positive, alloimmunization has occurred and the patient needs to be referred to maternal–fetal medicine. RhoGAM is given post partum if the neonate is found to be Rh positive.
A 35-year-old woman smokes approximately 10 cigarettes per day. She started smoking at age 18 years. She has a new male sexual partner and is interested in contraception. She was recently treated for gonorrhea and chlamydia. She is using condoms inconsistently. The urine pregnancy test is negative. She denies a history of hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual period was 5 days ago. Which of the following contraceptive methods is recommended?
A.Oral contraceptive pills
B.Copper intrauterine device (IUD)
C.Etonogestrel implant (Nexplanon)
D.Vaginal ring (NuvaRing)
Answer: C. Etonogestrel implant (Nexplanon)
An etonogestrel implant (Nexplanon) is the best option for this patient. It is a progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral contraceptives, which contain estrogen/progesterone. An IUD is contraindicated until the patient is retested (4-6 weeks after treatment) to ensure that her gonorrhea and chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and progestin; it is contraindicated for this patient.
A patient who recently started norethindrone (Micronor) calls to report that they are on the last row of the pill packet but forgot today’s dose. It is now 5 hours late. The nurse practitioner advises the patient to:
A.Skip the late pill and resume the normal schedule; no back-up method is needed
B.Discard the remainder of the current pill packet and start a new packet on the first day of menstrual cycle
C.Take the pill now, resume the normal schedule, and abstain from sex for 2 days
D.Take the pill now, resume the normal schedule, and use a back-up method for 7 days
Take the pill now, resume the normal schedule, and abstain from sex for 2 days.
Progesterone-only birth control pills should be taken at the same time every day. If a dose is more than 3 hours late, the patient should take the dose as soon as possible and use a back-up method or abstain from sex for 2 days. All pills in a progesterone pill packet (1 month) are active pills, so the fact that it is the last week of the packet is irrelevant. The patient should not be advised to discard any of the pills.
Tanner stages girls
Stage 1 – Absent development
Stage 2 – Breast bud
Stage 3 – Common Contour (not separated)
Stage 4 – Double mound (contour separated)
Stage 5 – End stage development (Adult type)
Tanner stages boys
Stage 1 – Absent development
Stage 2 – Bulky testes and scrotum
Stage 3 – Cock lengthens
Stage 4 – Darkening of scrotum
Stage 5 – End stage development (Adult type)
To properly treat vulvovaginal candidiasis in a female patient with a history of lupus and diabetes, the nurse practitioner will prescribe:
A.Fluconazole (Diflucan) PO daily × 3 days
B.Clotrimazole (Gyne-Lotrimin) intravaginally × 7 days
C.Fluconazole (Diflucan) PO every 72 hours × 2 doses
D.Terconazole (Terazol) vaginal cream × 5 days
Fluconazole (Diflucan) PO every 72 hours × 2 doses.
Vulvovaginal candidiasis is an overgrowth of Candida albicans yeast in the vulva/vagina. The condition can be treated topically with miconazole, clotrimazole, and terconazole or orally with fluconazole. If the episode is severe, or if the patient is at high risk/immunocompromised, fluconazole should be given in two sequential doses that are 3 days a part, as opposed to the typical one-dose regimen. A history of diabetes and lupus necessitates a two-dose treatment.
Which of the following is most strongly associated with inflammatory breast cancer?
A.Dominant mass in the tail of Spence
B.History of recent mastitis
C.Peau d’orange appearance of the skin
D.Galactorrhea
Answer: C. Peau d’orange appearance of the skin
Peau d’orange is a classic finding of inflammatory breast cancer. Mastitis is not a precursor for inflammatory breast cancer but can be a misdiagnosis. Galactorrhea is almost always a benign finding.
PMS occurs more in what phase
late luteal phase
FSH do what
stimulate the maturation of ovarian follicles
in the ovarian cycle what phase begins with ovulation and ends with the onset of menses
luteal phase
Hellp (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome
Serious but rare complication of preeclampsia/eclampsia (15% of cases develop HELLP). Classic patient is a multipara woman older than 25 years of age who is in the third trimester of pregnancy. Presents with the signs and symptoms of preeclampsia accompanied by right upper quadrant (or midepigastric) abdominal pain with nausea/vomiting and malaise (may be mistaken for viral illness). Symptoms can present suddenly. Lab abnormalities are elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (>1.2 mg/dL), and lactate dehydrogenase (LDH) with decreased number of platelets (<100,000 cells/mcL), which may progress to disseminated intravascular coagulation (DIC) in 15% to 38% of patients, peripheral smear with schistocytes and burr cells, and hemoglobin and hematocrit. If severe, right upper quadrant/epigastric pain may have hepatic bleed or swelling, which may be signs of impending hepatic rupture.
amniocentesis is done at what weeks
15-18
chorionic villus sampling can be done at
10-12 weeks
Patients who are European Jewish should be screened for
Tay sachs
Low Alpha-Fetoprotein indicates what
down syndrome
high alpha Fetoprotein indicates what
multiple births or neural tube defects
Group B Streptococcus (GBS) is treatment
penicillin G 5 million units IV, followed by 2.5 to 3 million units IV every 4 hours until delivery.
If penicillin allergy, use clindamycin or erythromycin instead.
Group B Streptococcus (GBS) is tested for at
35-37 weeks
weight gain in pregnancy
Best weight gain is a total gain of 25 to 35 lb (11.3–15.9 kg) if healthy weight before pregnancy (body mass index [BMI] of 18.5–24.9) is ideal.
Underweight patients (BMI <18.5) to gain a total of 28 to 40 lb (12.7–18.1 kg).
Obese patients (BMI >30) to gain a total of up to 11 to 20 lb (4.98–9.07 kg).
probable signs of pregnancy
goodell, chadwick , hegar and HCG
positive signs of pregnancy are
fetal heart tones, anything the dr can feel, hear , see
quickening is considered a what sign of preganncy
presumptive sign
Fundus at 12 weeks is
above the symphis pubis
16 weeks is
between the symphis pubis and umbilicus
20 weeks is
at the umbilicus
Preferred medications for hypertension in pregnancy are
methyldopa (Aldomet), labetalol (beta-blocker), hydralazine, and long-acting nifedipine.
methyldopa, check
LFTs at baseline and periodically (contraindicated if active hepatic disease). Discontinue if jaundice, abnormal LFTs, or unexplained fever occur.
Chloasma/melasma is due to
high estrogen
first line treatment for chlamydia in pregnant pt is
azithromycin 1 gram
alt amoxicillin
nitrofurantoin (macrobid) in pregnancy do not us in what trimester
3rd
presumptive signs
what pt reports
nausea
probable
HCG
hegar
chadwick
goodell
positive
these are objective, what MD sees
12 weeks fundal hgt is located at
symphisis pubis
20 week gestation
level of umbilicus
rhogram given
28 week and 72 hours after pregnancy
UTI in pregnancy
CAMP
Cepahlosporin
amoxicillin
macrolid
pcn
do not use what in pregancy
cipro
AFP done when
weeks 16-20
mastitis med
dixlocin
Keflex if allergic to PCN
