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AANP Study Cards > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What is the most common location for breast cancer

A

Upper outer quadrant

Tail of spence

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2
Q

What are symptoms of breast cancer

A
  • dominant painless breast mass
  • mass feels hard, irregular is non mobile
  • skin changes (peau d’orange, dimpling, retractions)
  • serous or bloody discharge from the nipple
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3
Q

What are the most common sites for metastatic disease

A
  • bone
  • liver
  • lungs
  • brain
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4
Q

What is the presentation of paget’s disease of the breast?

A
  • history of a red-colored rash that is scaly and starts on the nipple spreading to the areola of 1 breast
  • itching
  • pain
  • burning sensation
  • crusting
  • ulcer
  • bleeding of the nipple
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5
Q

What is the presentation of inflammatory breast cancer

A
  • acute onset of red, swollen warm area of the breast that is rapidly growing
  • pitting of breast tissues
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6
Q

Women who have a high lifetime risk of breast cancer should undergo

A
  • annual mammogram
  • annual breast MRI
  • Clinical breast exam q6-12 months

Beginning 10 years prior to age at which youngest affected family member was diagnosed

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7
Q

What is the typical sx of ovarian cancer

A
  • abdominal pain
  • low back pain
  • pelvic pain
  • dyspareunia
  • changes in bowel habits
  • unusual fatigue
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8
Q

Presentation of ectopic pregnancy

A
  • pelvic pain that may be diffuse or localized to 1 side
  • vaginal bleeding
  • reports amenorrhea or light menses in preceeding weeks
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9
Q

What are risk factors for ectopic pregnancy

A
  • IUD use
  • tubal ligation
  • in vitro
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10
Q

How is an ectopic pregnancy diagnosed?

A
  • Beta HCG

- Transvaginal ultrasound

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11
Q

Risk factors for breast cancer in men are

A
  • cryptochidism
  • positive family history
  • BRCA 1/2 gene
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12
Q

The diagnostic test for breast CA is

A

Tissue biopsy

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13
Q

A palpable ovary in a menopausal women is always

A

-abnormal

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14
Q

If you find a palpable ovary in a postmenopausal woman you should

A
  • order a pelvic ultrasound

- refer

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15
Q

For women 21-29 USPSTF recommends cervical cancer screening by ____ every ____ years

and recommends against _____ if <30

A
  • Liquid based cytology or pap test
  • every 3 years
  • HPV cotesting if <30
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16
Q

For women 30-65 USPSTF recommends cervical cancer screening by ____ every ____ years

A
  • Liquid based cytology or pap test or liquid based cytology plus cotesting
  • every 3 years or every 5 years if cotesting
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17
Q

For women 65+ USPSTF recommends cervical cancer screening

A

can be stopped if not otherwise high risk

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18
Q

If you have a result of atypical squamous cells of undetermined significance what is the recommendations

A
  • Age 21-24: Repeat pap in 12 months
  • 25-29: reflex HPV test, repeat pap in 12 months
  • 30+: Cotest for HPV if + refer to colposcopy
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19
Q

If you have a result of Atypical squamous cells and cannot exclude high grade squamous intraepithelial lesion (ASC-H)

A

Refer to colposcopy regardless of age

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20
Q

If you have a result of LSIL what is the recommendations

A
  • age 21-24: Repeat pap in 12 months
  • Age 25-29: Repeat for colposcopy
  • Age 30: Repeat pat in 12 months
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21
Q

If you have a result of HSIL what is the recommendations

A

Refer for colposcopy regardles of age

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22
Q

If a dose of Gardasil is given at age 15 or older how many doses are required

A

3

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23
Q

When is gardisil given?

A

between 11-12 years but can be given as young as 9 or as old as 26

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24
Q

What HPV strains are most likely to cause cervical cancer?

A

16 and 18

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25
Q

What can interfere with pap tests results and how long before a pap should you refrain from the activities

A
  • sex
  • douching
  • tampon use
  • lubricants
  • vaginal foams/medications

Refrain for approximately 2-3 days before

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26
Q

If gardisil schedule is interrupted does the dose have to repeated

A

No

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27
Q

A _______ is used to evaluate herpetic infections and a positive smear will show large abnormal nuclei in squamous epithelial cells

A

Tzanck

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28
Q

A _____ test is for BV. How is the result +

A

Whiff test

- when a strong fish like odor is released after 1-2 drops of KOH

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29
Q

Postmenopausal breast will feel

A

softer with less volume and may be pendulous

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30
Q

According to the CDC you can be reasonably certain a woman is not pregnant if she has no symptoms or signs of pregnancy and meets the following:

A
  • at least 7 days or less after start of normal menses
  • has had no sexual intercourse since the start of last normal menses
  • has been correctly and consistently using a reliable method of contraception
  • is 4 days postpartum
  • exclusively breastfeeding and is <6 months postpartum
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31
Q

Combined hormonal contraception work by

A

-stopping ovulation and thickening the cervical mucus plug

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32
Q

What are absolute contraindications to hormonal contraceptive use

A
  • any condition (past or present) that increases risk of blood clotting (hx of thrombophlebitis or thromboembolitic event)
  • smoker >35, >15 cigs/day
  • conditions that increase risk for stroke (migraine with aura, or migraine without aura >35, hx of TIA/CVA, HTN >160/100)
  • inflammation +/- acute infection of the liver
  • known or suspected cardiovascular disease
  • known or suspected pregnancy
  • undiagnosed vaginal bleeding
  • breast/endometrial or ovarial cancer
  • <21 days post partum
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33
Q

What are contraindications for dropirenon (Yaz, Yasmin, Synd)

A
  • Hyperkalemia
  • Kidney disease
  • Renal failure
  • Adrenal insufficiency
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34
Q

My CUPLETS (mnemonic for absolute CI to hormonal birth control)

A 
My- Migraines with focal neurological aura
C- CAD or CVA
U- Undiagnosed bleeding
P- Pregnancy
L- Liver disease
E- estrogen dependent tumor
T- Thrombus or emboli
S- Smoker >35
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35
Q

What are relative CI to hormonal birth control

A
  • Migraines
  • Smoker <35
  • Fracture or cast on lower extremity
  • adequate controlled HTN
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36
Q

What are advantages of hormonal birth control after 5+ years of use

A
  • Decreases risk of endometrial and ovarian cancer

- decreased incidence of dysmenorrhea, pelvic pain, acne, hirstutism, ovarian cysts, heavy or irregular periods

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37
Q

What is required to be done in order to rx contraception

A

-health history, rule out pregnancy, check BP

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38
Q

All patients starting a new method of contraception should be instructed to use a back up option for ___ days

A

7

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39
Q

It is normal to experience spotting for ____ months after initiation and therefore patients should be discouraged from switching in this time frame because it should resolve

A

3 months

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40
Q

Patients on lower doses of estrogen have _____ rates of spotting

A

Increased

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41
Q

If your pt misses 1 day for an OCP what should you tell the pt

A

take 2 now and continue as normal

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42
Q

If your pt misses 2 consecutive days (or >48 hrs since last pill was taken)

A
  • take most recent pill ASAP

- use back up contraception until 7 days of consecutive hormonal pills

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43
Q

Drugs that interact with OCP

A
  • Anticonvulsants
  • Antifungals
  • Antibiotcs: Ampicillin, tetracyclines, rifampin, clarithromycin
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44
Q

The patch has ____ rate of estrogen which ____ risk for DVT

A

higher; increases

45
Q

Do not recommend Depo provera to women who may want to become pregnant within ___ months as it can take up to ____ year for ovulation to occur

A

12 months; 1 year

46
Q

What disease process would you want to avoid the use of depo-provera and why

A
  • anorexia nervosa/bulimeia

- increased risk of osteoprosis

47
Q

When using the progestin only pills if a dose is >3hours late you should advise that the patient

A

uses a back up method of birth control

48
Q

The emergency contraception pill works best if taken within ____ hours of intercourse

A

72

49
Q

What are contraindications to IUD

A
  • Active or history of PID within the past year
  • Suspected or confirmed pregnancy or STI
  • Uterine or cervical abnormality
  • Undiagnosed vaginal bleeding
  • uterine or cervical cancer
  • hx of ectopic pregnancy
50
Q

After intercourse if using a diaphragm it must be left in for at least ______ and up to _____ days

A

6-8 hours and up to 2 days

51
Q

The diaphragm must be used with _____ before each intercourse

A

Spermacide

52
Q

Woman taking seasonale (84/7) will have ___ cycles/year

A

4

53
Q

Copper IUD lasts ____ years; Mirena lasts ___ years

A

10-12 years; 5

54
Q

Desogen, Ortho-tricyclen and Yaz are all indicated for what skin condition

A

Acne

55
Q

What is primary dysmenorrhea

A

crampy pelvic pain caused by menstruation not by a disease process

56
Q

Secondary dysmenorrhea is

A

crampy pelvic pain caused by a secondary disease process such as endometriosis

57
Q

What are treatment options for dysmenorrhea

A
  • Mefeamic acid
  • NSAIDs
  • Tylenol
  • Extended cycle OCPs
58
Q

Primary amenorrhea is the absence of menarche by ____ years or older

A

15

59
Q

Secondary amenorrhea is the absence of menses for more than ____ months in a pt that has had regular menstrual cycles or if irregular it has been missing for ____ months

A

3; 6

60
Q

What are fibrocystic breast changes?

A
  • non-malignant breast lesions which are either non proliferative or proliferative
  • proliferative type increases risk for breast cancer
61
Q

What is classic presentation of fibrocystic breast changes

A
  • bilateral breast tenderness
  • breast lumps that start from a few days up to 2 weeks pre menstrual cycle for many years
  • once cycle ends then the lumps decrease and no tenderness
62
Q

_____ is the most common cancer in women

A

Breast

63
Q

What are non modifiable risk factors for breast cancer

A
  • age >50
  • BRCA 1/2
  • early menarche (<12 years)
  • Late menopause (>55)
  • dense breasts
  • personal or family hx of breast ca
  • radiation to chest or breast before age 30
  • mother took diethylstillbestrol
64
Q

Modifiable risk factors for breast cancer

A
  • Sedentary lifestule
  • overweight/obese postmenopausal
  • hormones post menopause >5 years
  • pregnancy at age 30 or greater
  • no breastfeeding
  • nulliparity
  • moderate ETOH intake
65
Q

USPSTF recommends biennial screening mammography for women (every 2 years)

A

50-74

66
Q

What are females with PCOS at increased risk for?

A
  • T2DM
  • Dyslipidemia
  • Metabolic syndrome
  • Endometrial hyperplasia
  • Breast cancer
  • Obesity
  • NAFLD
  • Depression
  • OSA
  • infertility
67
Q

What is a classic presentation of PCOS

A
  • excessive facial and body hair (hirsutism)
  • acne
  • amenorrhea or irregular menstruation
68
Q

What diagnostic imaging test is indicated in PCOS

A

-Transvaginal ultrasound (enlarged ovaries with multiple small follicles)

69
Q

What labs are indicated in PCOS

A

Serum testosterone, DHEA, androgen levels, FSH, LH, TSH, FBG, 2hr OGTT

70
Q

What are first line treatment for PCOS

A

OCP

71
Q

This medication can help induce ovulation in PCOS

A

Metformin

72
Q

USPSTF recommends Osteoporosis screening in women ____ years and older

A

65

73
Q

At risk groups for osteoprosis include

A
  • older woment
  • thin or small body frames
  • postmenopausal
  • chronic steroid use
  • anorexia or bulimia
  • Long term PPI use
  • Gastric bypass
  • celiac
  • ankylosing spondylitis
  • RA
  • Hyperthyroid
  • Female Athlete triad
  • low calcium intake
  • low physical activity
  • high caffeine, high ETOH
74
Q

What do you use to measure the bone mineral density and what is the testing interval

A

DEXA scan; baseline then q2 years

75
Q

When do you treat for osteoprosis

A
  • T score (-2.5) or less

- postmenopausal with hx of hip or vertebral fracture

76
Q

Osteopenia is defined as a T score between

A

-1.5 and -2.4

77
Q

What is indicated to minimize risk of osteoporosis

A
  • weight bearing exercise 3x/week >30 minutes
  • calcium with vitamin D 1,2000mg/day and vit D 800 IU
  • smoking cessation
78
Q

What is the 1st treatment pharmacotherapy for osteoporosis?

A

-Bisphosphonates (Fosamax- alendronate) or Actonel (risedronate)

79
Q

What education should you provide regarding the use of bisphosphonates

A
  • take upon awakening with full glass 6-8oz of plainw after
  • remain upright for 30 minutes after
  • don’t take with any other meds, juice, coffee, antacids or vitamins
80
Q

What are CI to bisphosphonates

A

-inability to sit upright, esophageal motility issues, history of PUD, hx of GI bleeds, CKD, certain bariatric surgeries

81
Q

Average age of menopause is

A

51

82
Q

If ovarian cancer screening is done for a high risk individual then a ____ is ordered with _____

A

Transvaginal US
CA-125

*starts at age 30 or 5-10 years before first relative was dx’d

83
Q

What are risk factors for BV

A
  • sex
  • new or multiple sex partners
  • douching
84
Q

Should you treat BV in pregnancy and why

A

Yes because they have higher risk of preterm labor or LBW baby

85
Q

What is the classic presenation of BV

A
  • unpleasant fishlike odor that is worse after intercourse
  • milk like grey discharge
  • no vulvar or vaginal redness or irritation
86
Q

What are the tests for BV and findings

A

Wet smear: Clue cells (squamous epithelial cells with large amount of bacteria coating the surface that obliterates the edges)
and very few WBCs

Whiff test: 1 drop of KOH produces a strong fishy smell

Vaginal PH >4.5

87
Q

What is the treatment for BV

A

Flagyl BID x 7 days

88
Q

What education should you provide a patient with BV

A
  • abstain from sex or use condoms until treatment is complete
  • partner does not need treatment as it is not an STI
89
Q

What are risk factors for vulvovaginal candidiasis

A
  • DM
  • HIV
  • Antibiotic use
  • Immunosupression
90
Q

What are symptoms of a yeast infection

A

-white cheese like vaginal discharge accompanied by pruritis, swelling, redness

91
Q

What Labs are used vulvovaginal candidiasis and what are the findings

A
  • wet smear microscopy

- findings: pseudohyphae and spores with large # of WBCs

92
Q

What is the treatment of vulvovaginal candidiasis

A

Miconazole, clotrimazole x 7 days or Rx Fluconazole 1 dose

93
Q

What is the presentation of trichomoniasis

A
  • Inflammation (pruritis, burning, irritation) of vagina/urethra
  • dysuria
  • grayish green frothy discharge
  • strawberry cervix
94
Q

What is the Dx test for trichomoniasis

A

NAAT for T- vaginalis

95
Q

What is the treatment for trichomoniasis

A

Flagyl 2g PO x 1 dose or 500mg BID x 7 days

96
Q

In a patient with trichomoniasis do you treat their partner?

A

Yes it is considered a STI

97
Q

What is the most effective treatment to moderate to severe vaginal atrophy

A

Estrogen (low dose topical because of decreased systemic absorption)

98
Q

What is the classic presentation of atrophic vaginitis

A
  • vaginal dryness
  • itching
  • pain with sex (dyspareunia)
  • vulvar or vaginal bleeding with intercourse
  • decreased rugae
  • dry pale pink color to vaginal
99
Q

What is the presentation of lichen sclerosis

A

-Flat topped slightly scaly hypopigmented, white or mildly red polygonal papules that may coalese to form larger plaques with peripheral erythema

100
Q

What is the classic case of endometriosis

A

-hx of mod to severe pelvic pain with menses heavy cramping, dyspareunia

101
Q

What is the management of endometriosis

A

Estrogen/progesterone contraceptives

  • NSAIDs
  • GnRH analogues
102
Q

Post-menopausal is defined as

A

-any bleeding beyond 12 months since LMP

103
Q

What are causes of abnormal uterine bleeding

A 
PALM-COEIN
Polys (>30)
Adenomyosis (>30)
Leiomyoma (>30)
Malignancy (>40; obesity PCOS, DM)
Coagulopathy
Ovulatory dysfunction
Endometrial Disorders
Iatrogenic; Meds
Not yet classified
104
Q

What are symptoms of PCOS

A
  • oligomenorrhea
  • amenorrhea
  • AUB
  • hyperandrogenism
  • cystic ovaries
  • infertility
  • mood/mental health problems
105
Q

The pathophysiology of PCOS is associated with

A

Insulin resistance

106
Q

The rotterdam criteria is diganostic for ____ ensuring 2 of 3 of the following

A

PCOS

  • Oligomenorrhea
  • Hyperandrogenism
  • Cystic ovaries
107
Q

2012 Cervical guidelines

A
  • ages: 21-29 Pap q3 years
  • ages >30: Pap and HPV; repeat q5 years; if only pap only q 3 years
  • age 65 may stop
108
Q

What are risk factors for bacterial vaginosis

A
  • new sexual partner
  • no condom us
  • douching
  • Copper IUD

AANP Study Cards (20 decks)

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