Women's Preventative Health

Question 1

One liquid cytology sample can be used to assess which three important preventative health screenings?

Answer 1

1. Pap smear
2. HPV DNA probe
3. STI (gonorrhea, chlamydia)

Question 2

Although culture samples for gonorrhea and chlamydia can be taken from a liquid cytology sample, the first-line diagnostic technique for these organisms is. . .

Answer 2

. . . nucleic acid amplification testing (NAAT)

This has the advantage of being able to be performed on a first catch urine sample (NOT a clean catch sample), making uncomfortable pelvic sampling unnecessary

Question 3

Age-stratified recommendations for pap smears and HPV testing

Answer 3

• Below age 21: No screening (regardless of sexual activity)
• Age 21-29: Pap smear every 3 years
• Age 30-64: Pap smear every 3 years OR Pap smear + HPV test every 5 years
• Age 65+: If no history of abnormal smears or HPV, testing may be ceased.

Question 4

Current recommendations for breast cancer screening

Answer 4

Every 1-2 years starting at age 40

USPSTF says start at age 50

Go until age 74

Question 5

Recommendations for HPV vaccine

Answer 5

At least bivalent vaccine in females age 9-26

Question 6

__% of women over the age of 80 who suffer a hip facture will be not able to walk again for at least 1 year

Answer 6

56% of women over the age of 80 who suffer a hip facture will be not able to walk again for at least 1 year

Question 7

Risk factors for osteoporosis

Answer 7

• Inactivity
• Poor nutrition
• Smoking
• Age
• Hypoestrogenemic states

Question 8

DEXA scan screening guidelines

Answer 8

• Begins at age 65 for women in the general population (70 for men)
  
  • <65 if <127 lb, Hx of fragility fracture, current smoking, FHx hip fracture, alcoholism, rheumatoid arthritis
• Diagnose w/ t score

Question 9

Cholesterol screening in women

Answer 9

• For general population:
  
  • Begin at age 45
  • Every 5 years
  • Cholesterol assessment (LDL, HDL, total chol, triglycerides)

Question 10

Special age 21-24 population with regards to cervical cancer screening

Answer 10

Women in this category are screened by Pap, but if their resultant Pap is consistent with ASCUS (atypical squamous cells of undetermined significance), they will be re-Pap smeared in 1 year rather than progressing to colposcopy.

Question 11

Specific rules regarding discontinuance of Pap smear schedule

Answer 11

• Age > 65 AND. . .
  
  • No Hx of HSIL or cancer ever
  • OR 3 negative cytologies (Paps) in a row
  • OR 2 negative co-tests (Pap + HPV) in a row
    
    • (so basically, 10 years-worth of testing with no evidence of disease)

Question 12

Mammogram screening guidelines

Answer 12

Question 13

What is the most effective form of contraception?

Answer 13

Depo-Provera, aka depot medroxyprogesterone acetate, the injectable progestin

Takes user error totally out of the equation.

Comparably effective forms: Nexplanon (etonogestrel arm implant), IUD, and sterilization.

Question 14

Important osteoporosis risk factors

Answer 14

• Age > 50
• Family history
• Menopausal status and early menopause
• Small stature and low BMI
• Heavy alcohol consumption

Question 15

Single best intervention for preventing osteoporosis

Answer 15

Regular weight bearing exercise

Note, this is even more important than calcium and vitamin D

Question 16

Recommendations for chlamydia screening

Answer 16

All women who are sexually active below the age of 25 (irrespective of whether or not they have symptoms)

Question 17

Any women with irregular menstrual bleeding over the age of 45, even if there is another etiology like fibroids, should receive . . .

Answer 17

. . . an endometrial biopsy

Question 18

Rules about Pap smears following hysterectomy

Answer 18

Supracervical: Paps needed (patient still has a full cervix)

Infracervical for benign indication: No Paps

Infracervical for malignant indication: Paps needed (malignant cells may have migrated onto vaginal stump)