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Review > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Breast CA mass presentation

A
  • hard
  • irregular
  • attached to skin, immobile
  • most common in upper outer quadrants (tail of Spence)
  • Peau d’orange
  • dimpling
  • retraction
  • nipple discharge
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2
Q

Breast mass treatment plan

A
  • mammogram

- referral to breast surgeon

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3
Q

Paget’s disease of the breast presentation

A
  • history of chronic scaly red-colored rash like eczema
  • starts on nipple and spreads to areola
  • itching, burning
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4
Q

Paget’s disease aka

A

ductal carcinoma in situ

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5
Q

Higher risk for BRCA

A
  • fam hx breast CA before age 50
  • male breast CA
  • breast CA that is triple-negative (before age 60)
  • ovarian and other types of gynecological cancers
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6
Q

Treatment plan for any patient reporting positive BRCA mutation

A

-refer to breast specialists

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7
Q

What to do with family history of breast CA

A
  • Ask when the family member had it and screen 10 years earlier
  • Refer high risk for genetic counseling and testing
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8
Q

ovarian cancer presentation

A
  • middle aged or older
  • vague symptoms
  • abdominal bloating
  • discomfort
  • low-back pain
  • changes in bowel habits
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9
Q

Risk factors for ectopic pregnancy

A
  • PID
  • tubal ligation
  • previous ectopic pregnnacy
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10
Q

Estrogen exposure and menarche and breast CA risk

A
  • early menarche <12

- late menopause >55

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11
Q

Diagnostic study for breast CA in <30 year old

A

US

-assess identified mass with mammogram

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12
Q

Diagnostic study for breast CA in >30

A
  • any woman/man with breast complaint
  • mammogram
  • f/u with tomosynthesis if dense breasts on mammogram
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13
Q

Diagnostic test for any breast mass

A

biopsy

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14
Q

Cervical ectropion

A
  • normal finding

- bright-red bumpy tissue with irregular surface on cervical tissue

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15
Q

What can cervical ectropion be caused by

A
  • birth control
  • pregnancy
  • due to high levels of estrogen
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16
Q

Follicular phase days

A

1-14

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17
Q

Follicular phase aka

A

proliferative phase

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18
Q

FSH is released from where

A

anterior pituitary

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19
Q

Which hormone is dominant in follicular phase

A

-estrogen

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20
Q

Day for ovulatory phase

A

day 14

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21
Q

Which hormone induces ovulation

A

luteinizing hormone

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22
Q

Days for luteal phase

A

-14-28

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23
Q

Predominant hormone during luteal phase

A

progesterone

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24
Q

Where is progesterone produced

A

-corpus luteum

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25
Q

Purpose of progesteron

A

-stabilize endometrial lining

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26
Q

What happens to menstrual cycle of not pregnant

A
  • estrogen and progesterone levels fall
  • induce menses
  • low hormones stimulate hypothalamus, then anterior pituitary and release FSH
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27
Q

Fertile time period

A

-1-2 days before ovulation is best chance for pregnancy

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28
Q

Can you do a pap during menses

A

no

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29
Q

When is the best time to perform a pap

A

10-20 days after last menses

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30
Q

OTC ovulation tests detect what in urine

A

hCG

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31
Q

What age to stop pap smears

A

> 65

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32
Q

Do women with hysterectomy with cervix removal need pap smear

A

no

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33
Q

21-24 with LSIL

A

pap in 12 months

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34
Q

25-20 with LSIL

A

colposcopy and cervical biopsy

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35
Q

Plan if endometrial cells are seen in pap test

A

refer for endometrial biopsy

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36
Q

Which age group has large ectropion

A

girls and teenagers

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37
Q

Extended cycle pills

A

Seasonale
3 months consecutive
only 4 periods a year

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38
Q

Lab monitoring with ethinyl estradiol and drospirenone

A

High risk of DVT and hyperkalemia

-check K if on ACE, ARB, or K sparing diuretic

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39
Q

Who should Yaz be considered for

A
  • acne
  • PCOS
  • hirsutism
  • PMDD
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40
Q

Example of ethinyl estradiol and drospirenone

A

Yaz

Yasmin

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41
Q

Which pill is safe for breastfeeding women

A

progestin only

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42
Q

Contraindications to oral contraceptives

A
  • increased risk of blood clotting
  • > 35 with smoking
  • any increased risk of stroke
  • inflammation or acute conditions of liver
  • CVD; uncontrolled HTN
  • some reproductive conditions
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43
Q

Mneumonic for absolute contraindications for OCP

A 
My CUPLETS
My: migraines with focal aura
C: CAD or CVD
U: undiagnosed genital bleeding
P: pregnancy
L: liver tumor or active liver disease
E: Estrogen-dependent tumor
T: thrombus or emboli
S: smoker >35
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44
Q

Advantage of using pill >5 years

A
  • decreased ovarian and endometrial CA risk
  • decreased dysmenorrhea
  • decreased endometriosis symptoms
  • decreased acne and hirsutism
  • decreased ovarian cysts
  • decreased irregularity
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45
Q

When to follow up with new start of OCP

A

within 2-3 months

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46
Q

NSAIDS for menstrual cramps

A
  • mefenamic acid (Ponstel)
  • Naproxen (Aleve)
  • Ibuprofen (Advil)
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47
Q

missed 1 day

A

take two pills now and continue

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48
Q

missed 2 days

A

take two pills the next 2 days to catch up
continue
-use condoms

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49
Q

Drug interactions with OCP

A
  • anticonvulsants
  • antifungals
  • ampicillin, tetracyclines, rifampin
  • St.John’s wort
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50
Q

Pill danger signs mneumonic

A

ACHES

  • abdominal pain
  • chest pain
  • headaches
  • eye problems
  • severe leg pain
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51
Q

Which BC products contain both estrogen and progesterone

A
  • COC
  • patch
  • NuvaRing
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52
Q

What can be elevated with COC

A

Blood pressure

-check in 3-4 weeks

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53
Q

Paragaurd effectiveness

A

copper IUD

10 years

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54
Q

Mirena effectiveness

A

5 years

contains levonorgestrel

55
Q

IUD patient education

A
  • check occasionally for string

- if not felt, order pelvic US

56
Q

Depo-Provera lasts…

A

3 months per injection

57
Q

Depo-Provera should not be recommended to..

A
  • women who want to become pregnant in 12 months
  • avoid long-term use >2 years
  • risk of osteoporosis
58
Q

Anorexia and Depo-Provera

A
  • test for osteoporosis with DXA
  • avoid Depo-provera –> increase risk of osteoporosis
  • Recommend calcium and vitamin D
59
Q

How long to leave diaphragm inside vagina after sex

A

6-8 hours

60
Q

Diapghram must be used with what

A

spermicide

61
Q

How long can cervical cap be worn

A

up to 72 hours –> may cause abnormal cervical cell change

62
Q

Cervical ring usage

A
  • place in for 3 weeks
  • remove for 1 week
  • should fit around cervix
63
Q

Which contraceptive has a higher risk of VTE than OCP

A

ortho evra transdermal contraceptive patch

64
Q

When is the morning after pill most effective

A

within 72 hours

65
Q

If patient does not have period within ___ of taking EC, they return to rule out pregnancy.

A

3 weeks.

66
Q

Estrogen dose of low-dose BC

A

20-25 mcg

67
Q

Yaz or Yasmin has higher risk for what

A
  • blood clots
  • stroke
  • heart attacks
  • hyperkalemia
68
Q

Which contraceptive has broadest usage

A

copper IUD

69
Q

Safe progestin with less BTB

A

Levonorgestrel

70
Q

Safe progestin with more BTB

A

norethindrone

71
Q

Estrogen dose for heavy periods

A

30-35 mcg

72
Q

Estrogen dose for normal periods

A

20-25 mcg

73
Q

How does cervical cancer occur

A

from persistent HPV infection over many eyars

74
Q

When should Gardasil be given

A

PRIOR to sexual activity, more effective

75
Q

21-29 pap frequency

A

pap every 3 years

76
Q

ASC-US in >24 year old plan

A

Reflex HPV

-colposcopy if positive

77
Q

ASCUS in 21-24 plan

A

repeat pap in 12 months

  • if negative, continue routine
  • if positive, colposcopy
78
Q

ASC-H plan

A

colposcopy and endocervical sampling

79
Q

LSIL 21-24 plan

A

observe, repeat in 1 year

80
Q

LSIL in >25

A

colposcopy

81
Q

HSIL for any age

A

colposcopy

82
Q

AGC for any age

A

colposcopy

83
Q

Treatment for fibrocystic breasts

A
  • stop caffeine intake
  • take vitamin E and evening primrose capsules daily
  • wear bra with good support
84
Q

Fibrocystic breast presentation

A
  • bilateral breast pain around menses

- rubbery, tender, mobile nodes

85
Q

What is PCOS

A
  • anovulation
  • infertility
  • excessive androgen production
  • insulin resistance
86
Q

PCOS presentation

A
  • hirsutism
  • acne
  • amenorrhea
  • infrequent periods
  • terminal hair on face
  • usually obese
87
Q

PCOS treatment plan

A
  • transvaginal US
  • serum testosterone, DHEA, androstenedione elevated
  • FSH levels normal or low
  • fasting blood glucose abnormal
88
Q

PCOS medications

A
  • low dose oral contraceptives to suppress ovaries
  • Spironolactone to decrease and control hirsutism
  • Metformin if pregnancy is desired
  • weight loss reduces androgen and insulin levels
89
Q

PCOS complications

A
  • CHD
  • T2DM
  • Metabolic syndrome
  • Breast and endometrial cancer
  • central obesity
  • infertility
90
Q

Rotterdam criteria

A
  • for PCOS
  • need 2/3
  • irregular cycles
  • hyperandrogenism (acne, hair growth)
  • cystic ovaries
91
Q

Total testosterone in PCOS may be elevated at…

A

> 60

92
Q

How long after start of menses is AUB okay

A

2 years

93
Q

Classification of AUB

A

Polyps
Adenoids
Leiomyoma/fibroids
Malignancy

Coagulopathy
Ovulatory dysfunction
Endometrial disorders
Iatrogenic
Not classified
94
Q

Caus eof primary dysmenorrhea

A

excessive prostaglandins

95
Q

When to take NSAIDs for dysmenorrhea

A
  • start of onset for 1-2 days

- or 1-2 days before

96
Q

Who is osteoporosis common in

A

white or asian who are thin with small body frames

97
Q

Which osteoporosis patients to treat

A 
-postmenopausal women 
men >50
-history of hip or vertebral fracture 
-patients on chronic steroids
-anorexia and bulimia
-long term PPI use
-gastric bypass, celiac, hyperthyroidism, anklyosing spondylitis, RA, etc.
98
Q

Osteoporosis T-score

A
99
Q

Osteopenia t score

A

-1.5–2.4

100
Q

Osteoporosis treatment

A
  • weight bearing exercises
  • calcium with vitamin D2 and D3
  • Bisphosphonates
101
Q

Bisphosponate adverse effects

A
  • esophageal irritant

- osteonecrosis of jaw, more likely on IV or IM bisphosphonates

102
Q

Bisphosphonate examples

A
  • Fosamax (alendronate)
  • Actonel (risedronate)
  • Zoledronic acid
103
Q

Patient teaching with bisphosphonates

A
  • take upon awakening with full glass of water
  • sit up for at least 30 minutes
  • never take with anything other than water
104
Q

Repeat DXA how long after starting bisphosphonate

A

2 years

105
Q

Contraindications to bisphosphonates

A
  • inability to sit up right
  • esophageal motility disorders
  • history of PUD
  • history of GI bleed
106
Q

SERM is indicated for who

A
  • postemenopausal women with osteoporosis who also need breast CA prophylaxis
  • not to treat menopausal symptoms
  • does not stimulate endometrium or breast tissue
107
Q

SERM BBW

A

increased risk of DVT and PE

increased risk of death from stroke

108
Q

Osteoporosis and SERMs

A

option for patients who cannot tolerate or have contraindications to bisphosphonates

109
Q

What is tamoxifen used for

A

-breast CA that is hormone-receptor positive

110
Q

Side effects of SERM

A
  • hot flashes
  • white or brown vaginal discharge
  • weight gain or loss
111
Q

WHI results

A
  • combined estrogen-progestin replacement therapy increased risk of stroke, heart disease, VTE, breast CA, PE
  • NOT recommended to prevent chronic conditions
  • Use less than 5 years if for menopausal symptoms
  • Safe for healthy women to use within 10 years of menopause
  • unopposed estrogen for women without uterus
  • estrogen/prog needed for women with uterus
112
Q

Ovarian cancer is often caught early

A

false

-symptoms arise typically with metastasis

113
Q

Serum tumor marker for ovarian CA

A

CA-125

114
Q

FRAX-calculator

A
  • estimates 10-year risk for fracture

- determine if treatment of osteoporosis is needed

115
Q

Vulvovaginal atrophy symptoms

A
  • vaginal irritation, dryness, or burning,
  • dyspareunia
  • UTI
  • loss of rugae
  • discharge
  • vaginal pH >5
116
Q

VVA treatment

A

-estrogen vaginal

117
Q

VV candidiasis differential

A
  • itching, burning, dysuria
  • pH 4-4.6
  • whiff test negative
  • buds and psudohyphae
118
Q

BV differential

A
  • malodorous discharge
  • pH >4.6
  • positive whiff test
  • clue cells
119
Q

Trich differential

A
  • malodorous discharge, dysuria
  • pH 5-6
  • /+ whiff test
  • trichomonads on vaginal microscopy
120
Q

VVC management

A
  • Fluconazole (Diflucan)
  • single dose has 72 hours duration
  • avoid in pregnancy
  • avoid sex until resolved
  • topical agents: Monistat, Gyne-Lotrimin, etc.
121
Q

BV treatment

A
  • Metronidazole x 7 days
  • Metronidazole vaginal gel alternative
  • watch for disulfuram like reaction with alcohol
  • no sex until resolved
122
Q

What kind of organism is trichomoniasis

A

-protozoan parasite with flagella

123
Q

Trichomoniasis presentation

A

-copious grayish green discharge
-bubbly vaginal discharge
-strawberry cervix
-swollen and reddened vulvar region
dysuria

124
Q

Trichomoniasis treatment

A
  • Metronidazole 2 g PO

- treat sexual partner

125
Q

Medroxyprogesterone

A

Depo-Provera

126
Q

Women with COPD are at highest risk for what diseases

A
  • heart disease
  • endometrial cancer
  • chronic anovulation results in high levels of estrogen and androgens
  • high risk for HTN, high LDL, low HDL
  • > 50% have diabetes
  • without progesterone, endometrium becomes thick and can cause heavy or irregular bleeding –> endometrial hyperplasia to cancer
127
Q

What to do if patient forgot to take BC 2 consecutive days

A
  • take two today and two tomorrow

- use condoms for rest of cycle

128
Q

Hormone responsible for dysmenorrhea

A

prostaglandins

-causes contractions for endometrial shedding

129
Q

Kegel exercise instruction

A
  • pelvic floor muscles are the muscles she holds/stops flow of urine
  • anal sphincter will also tighten
  • relax abdomen and thighs
  • tighten muscles for 10 seconds and relax for 10 seconds
  • perform 10 exercises each time three times a day
130
Q

Criteria for PID

A

at least one

  • cervical motion tenderness
  • adnexal tenderness
  • uterine tenderness
131
Q

What to do with women who are at risk for breast ca

A

refer to breast specialist
mammogram and MRI of breast
genetic counseling and BRCA testing

132
Q

What does KOH do to vaginal secretions

A

-kills epithelial cells to better visualize pseudohyphae

133
Q

Best test to visualize vaginal trichomonas

A

wet smear with microscopy

KOH will kill the organisms

Review (24 decks)

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