womens' and mens Health Flashcards
Risk factors of HPV
Early onset of sexual intercourse, multiple sexual partners, HPV infection, tobacco use.
Most cases of cervical CA have occurred with women who have not not been screened in over 5 years.
Prevention of HPV infection
HPV vaccines, using condoms all the time, Cervical cancer screening (pap smears), not smoking or quitting reduces the risk
Risk factors for acquiring cervical CA
Almost all cervical CA is caused by HPV.
Having HIV because it makes you immunocompromised.
Smoking.
Using birth control pills for more than 5 yrs
Having multiple partners.
When should pap smears be performed
Start at age 21
Screen every 3 years age 21 to 30
Use cytology only, do not test for HPV
Screen more frequently if high risk, includes women who:
have HIV, (at dx test q 6 months x 2, then annually if wnl)
are immunosuppressed,
were exposed to diethylstilbestrol (DES) in utero, or
have been treated for high grade precancerous cervical lesion or cervical cancer
Follow up of normal pap or ASCUS based on results of HPV testing
High Risk HPV has increased rate progression to cancer in women 30 and over even with normal cytology- recommend test for HPV genotype at age 30 and over*
High Risk HPV = 16 and 18 genotypes
HPV High Risk and NILM (negative for intraepithelial lesion) – refer colposcopy
HPV not High risk – repeat pap & HPV in 12 months
*If unable to do genotyping can repeat in 12 months, if still HPV positive or with ASC or higher refer for colposcopy
Terms of abnormal paps according to the Bethesda system
ASC- US Atypical squamous cells of undetermined significance
ASC–H cannot exclude high-grade squamous intraepithelial lesion
LGSIL – low grade
HGSIL – high grade
HGSIL – colposcopy and may need endocervical curetage (ECC) or loop electrosurgical excision (LEEP)
AGC Abnormal or Atypical Glandular Cells
ECC and may need endometrial biopsy and do HPV testing
Preconception counseling
Medications, OTC meds, herbal remedies
Educate re teratogenic agents: environmental exposures/etoh/drugs
Decrease caffeine to less than 200 mg day
Seafood recommendations …… Shark, king mackerel, tile fish, swordfish (these fish are high in mercury)
Folic acid -400 mcg/day supplements to prevent neural tube defects–
Vitamin D
Weight management – Ideal BMI 19.8 -26.0, exercise
Both under and overweight is concerning
Medical Issues DM, PKU, Asthma, Thyroid, Seizures, SLE, Depression
Labs – rubella/ varicella titres, Hep bSag,, CBC, HIV, STD’s
Detailed 3 generation (or more) Family History
Heritable Disease– refer genetic counseling
Indications for Genetic Counseling
Hereditary Disease in family Maternal age 35 or older Teratogen exposure Ethnic background associated with higher risk heritable disease (25 % of genetic background) Family history of birth defects Recurrent pregnancy loss
Screening only if…..
The disorder is very debilitating or lethal.
A reliable screening test is available.
The fetus can be treated, or reproductive options (abortion / elective sterilization) are available and acceptable to the parents.
Examples: Hemoglobin electrophoresis to test for sickle cell anemia & the thalassemias, DNA testing for Tay-Sachs disease and cystic fibrosis
Family History basics
Diseases that occur at an earlier age then expected (10-20 years before most people get the diseases)
Diseases in more than one close relative
Disease that does not usually affect a certain gender (e. g. Breast cancer in male)
Certain combination of diseases within a family (breast and ovarian cancer, or heart disease and diabetes)
Prevention of Osteoporosis
Non Pharmacological treatments
Adequate Calcium, Vitamin D and regular exercise (weight bearing and muscle strengthening)
Eating foods rich in CA at least 1200mg per day
Vit D 400 to 800 IU per day
Low-fat dairy products
Dark green leafy vegetables
Canned salmon or sardines with bones
Soy products, such as tofu
Calcium-fortified cereals and orange juice
Breast Cancer recommendations
USPSTF
Age 50 to 74: Biennial mammograms
Age 40 to 49: Individualized decision re: biennial mammograms
Age 75 and older: Insufficient evidence to make a recommendation re: mammograms
Do not recommend monthly self breast exams (SBE)
Insufficient evidence to recommend clinical breast exams (CBE)
Any risk breast cancer? Start annual mammogram at age 40
Breast cancer screening
Using guidelines individualize discussion
Any risks: start screening age 35 to 40
Age 40 discuss screening options
Continue to offer mammogram screening at age 40, advise re possibility of false positives
Teach SBE and breast awareness???
Do CBE annually?????
High Risk – use guidelines, consider referral
Ovarian Cancer screening
No effective screening exists – screening not recommended
Screening has not proven to decrease the death rate from the disease
Use pelvic U/S for adnexal masses
Use CA-125, a tumor marker, for postmenopausal women with an adnexal mass or for detecting relapse
Consider annual trans-vaginal pelvic ultrasound with CA-125 in high risk post menopausal women
Signs and symptoms of depression
Rarely is the chief complaint
Often associated with vague somatic complaints and with anxiety
May present with irritability and anger
Feelings of helplessness and hopelessness, Loss of interest in daily activities, Appetite or wt changes
Sleep changes, self loathing, reckless behavior, concentration problems, unexplained aches and pains
No universal screening for depression, but PHQ2 and PHQ9 are useful
