Womens health Flashcards
What T score reflects a patient who has osteopenia?
Between -1.0 and -2.5
What T-score reflects a patient with osteoporosis?
-2.5 or less
When and what test screens for osteoporosis?
Age 65, DXA scan and if negative, repeat in 2-5 years. If positive, then repeat in 1-2 years.
What tanner stage does breast development (breast buds) start?
Tanner stage II
It ends at stage V
At what age do you start Pap smear?
21 years old and repeat every 3 years
When is Pap smear and HPV co testing started?
Age 30 through 65 and repeat every 5 years.
What is normal vaginal pH?
4.0-4.5
What medication treats BV?
Metronidazole (Flagyl) BID for 7 days
Strawberry cervix is indicative of?
Trichomonas
What medication treats trichomonas?
Metronidazole (Flagyl) 2g POx 1 dose or 500mg BID for 7 days
What is dyspareunia?
Pain during intercourse
A disease of the skin in which white spots appear on the skin and change over time. This is usually found in the vaginal area.
Linchen sclerosis
Sexually active female who has not had a period in 6 to 7 weeks complains of lower abdominal/pelvic pain or cramping. Pain worsens when supine or with jarring. If ruptured, pain worsens and can be referred to the right shoulder. Medical history of pelvic inflammatory disease, tubal ligation, or previous a topic pregnancy. Leading cause of death for women in the US in the first trimester of pregnancy.
Ectopic pregnancy
Middle aged to older female with a dominant mass on one breast that feels hard and is irregular in shape. The mass is attached to the skin, surrounding breast tissue or is immobile. Among the most common locations are the upper outer quadrant of the breast i.e. the tail of Spence. Skin changes maybe seen such as Peau d’orange, dimpling, and retraction. Mass is painless or maybe accompanied by serous or bloody discharge. The nipple may be displaced or become fixed.
Dominant breast mass/breast cancer
Older female reports a history of chronic scaly red colored rash resembling eczema on the nipple that does not heal. Some women complaining of itching. The skin lesion slowly enlarges and evolves to include crusting, alteration, and or bleeding on the nipple.
Paget’s Disease of the breast (ductal carcinoma in situ)
Recent or acute onset of red, swollen, and warm area in the breast of a younger woman. Can mimic mastitis. Often there is no distinct lump on the affected breast. Symptoms develop quickly. The skin maybe pitted or appear bruised. More common and African-Americans. A rare but very aggressive form of breast cancer.
Inflammatory breast cancer
Older woman with complaints of vague symptoms such as abdominal bloating and discomfort, low back pain, pelvic pain, urinary frequency, and constipation. By the time it is diagnosed, the cancer has already metastasized. If metastasis, symptoms depend on area affected. Symptoms maybe bone pain, abdominal pain, headache, blurred vision, others.
Ovarian cancer
In what Tanner are stage does breast development start
Tanner stage two and ends at stage five
Where is the majority of breast cancer located
The upper outer quadrant of the breasts called the tail of Spence
What is the diagnostic test for breast cancer
Tissue biopsy
Is a cervical ectropion benign
Yes. Adolescence have a large ectropion which is an immature cervix
Patients with what condition have high androgen levels and multiple cysts on their ovaries which causes acne, hirsutism, and ogliomenorrhea
PCOS
What is the diagnostic test for cervical cancer
Biopsy of the cervix
When is the best time to perform a Pap test
Between 10 and 20 days after the last Menses
What should the patient avoid about two days before the pap test
Douching and vaginal foams/medication
When should a baseline Pap smear be done
Age 21 and repeat every three years
If a patient age to 20 or younger had an abnormal Pap smear of undetermined significance when should the pap be repeated
12 months
If the patient has an abnormal Pap of undetermined significance that is 21 years or older what should be done next
Order Pap smear with reflex HPVDNA testing. If Pap is abnormal, HPV strain testing is done automatically by the lab.
What types of HPV are oncogenic
Types 16 and 18. Referral for colposcopy and cervical biopsy
If A patient Pap smear had atypical glandular cells of undetermined significance what should be done next
Refer for endometrial biopsy
If a patient’s Pap results was a low-grade squamous intraepithelial lesion and high grade squamous epithelium lesion what should be done next
HPV Testing and refer for Colposcopy and biopsy
What are the two FDA approved vaccines that are very effective in preventing persistent infection with the oncogenic HPV strain
Gardasil & Cervarix
What is used to help with a diagnosis of fungal infection of the hair skin and nails
Potassium hydroxide slide
A test for BV. A positive result occurs when a strong fishlike owner is released after 1 to 2 drops of KOH are added to the slide
Whiff test
Used as an adjunct for evaluating herpatic infections i.e. oral, genital, skin. A positive smear will show large amounts of abnormal nuclei in the squamous epithelium cells not commonly used
Tzanck smear
What type of birth control pills are used for acne
Triphasic pills such as ortho Tri-Cyclen
What type of birth control pill is safe for breast-feeding women
Progesterone only pills. Use on day one of menstrual cycle.
Micronor
What are absolute contraindications to birth-control pills
Any condition that increases the risk of blood clotting such as history of thrombophlebitis or thromboembolic disorders such as DVT, genetic coagulation defects such as factor V Leiden disease, major surgery with prolonged immobilization, smoker over the age of 35. Any condition that increases the risk of strokes such as headaches with focal neurological symptoms, history of CVA and TIA, hypertension, migraine headache with aura. Inflammation and or acute infections of the liver with elevated liver function test, and hepatic adenomas or carcinoma, cholestatic jaundice of pregnancy. Known or suspected cardiovascular disease such as coronary artery disease, diabetes with vascular component. Some reproductive condition or cancers, known or suspected pregnancy, undiagnosed genital bleeding, breast, real, or ovarian cancer.
Mnuemonic for absolute contraindications for oral contraceptives
My CUPLETS My: migraines with aura C: CAD or CVA U: undiagnosed genital bleeding P: pregnant or suspect pregnancy 🤰 L: liver tumor or active liver disease E: estrogen dependent tumor T: thrombus or emboli S: smoker age 35 or older
Advantages of oral contraceptives and after five or more years of use
Decreased incidence of dysmenorrhea and cramps, PID, iron deficiency anemia, acne and hirsutism, ovarian cyst, heavy and or
Irregular period.
Before starting oral contraceptives what must be ruled out
Pregnancy
All patients must be instructed to use what during the first two weeks after starting the pill
Back up condoms
Does a patient that takes an oral contraceptive need to follow up
Yes within 2 to 3 months to check blood pressure and for side effects and patients questions
How do you treat menstrual cramps
NSAIDs such as Alleve, naprosyn
What are possible causes of secondary dysmenorrhea
Endometriosis, PID, fibroids
What constitutes primary amenorrhea
Absence of menses by age 15, often secondary to dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. Refer to reproductive endocrinology.
What are the variables of secondary dysmenorrhea
Onset usually after age 25, abnormal uterine bleeding and, variable symptoms such as nausea, Vomiting, diarrhea, and back pain. Dyspareunia (pain during intercourse), symptoms often worsen over time. Causes are endometriosis, fibroids, PID or infection, adenomyosis
How do you manage dysmenorrhea
Get a good history both medical and menstrual. Physical exam to identify a cause. Pelvic exam may differ if young, not sexually active adolescents with mild symptoms. Consider a pelvic ultrasound to look for adnexal masses, fibroids, other pelvic pathology. If secondary, address underlying cause
Can intrauterine contraception help with dysmenorrhea symptoms
Yes
How long does Mirena last
Five years
How long does Skyla last
3 years because skyla=smaller
If a patient comes in with abnormal uterine bleeding and how is this constituted
Any bleeding beyond 12 months since last menstrual period in a post menopausal woman. Even one drop of blood is concerning. Referred to OB/GYN to rule out cancer
How do you define a post menopausal woman
A woman that did not have her period for more than one year
What is the mnuemonic for abnormal uterine bleeding
P: polyps greater than 30 years A: adenomyosis greater than 30 years L: leiomyoma/fibroids greater than 30 years M: malignancy/hyperplasia greater than 40 years, obesity, DM, PCOS greater than 50 years C: coagulopathy any age O: ovulatory dysfunction any age E: endometrial disorders any age I: iatrogenic medications any age N: not classified
If a patient misses one day of birth control what must They do next
Take two pills for the next two days to catch up and finish the birth control pill pack. Use condoms for the current pill cycle.
What should a patient do if they miss two consecutive days of birth control
Take two pills the next two days to catch up and finish the birth control pill pack. Use condoms for the current pill cycle.
What drugs interact with oral contraceptives and will cause the patient to use an alternative form of birth control such as condoms when taking these drugs and for one pill cycle afterwards
Anticonvulsants such as phenobarbital and phenytoin, antifungal, certain antibiotics such as ampicillin, tetracycline, and rifampin. Saint Johns wort which may cause a breakthrough bleeding
When should emergency contraception such as the morning after pill be taken
Most effective if taken within the first 24 hours. Rule out pre-existing pregnancy first. Effective up to 72 hours after unprotected sex.
what is the mnuemonic for pill danger signs
ACHES A: abdominal pain C: chest pain H: headache E: eye problems change in vision S: severe leg pain
What type of contraception results in higher levels of estrogen which increases the risk of blood clots and DVT
Contraceptive patch i.e. Ortho Evra
What are contraindications for intrauterine device
Active PID or history of PID within the last year, suspected or with STD or pregnant, uterine or cervical abnormality, undiagnosed vaginal bleeding or uterine/cervical cancer, history of ectopic pregnancy
How long does a dose of Depo-Provera last
Each dose by injection lasts three months. Check for pregnancy before starting dose. Start in first five days of cycle because females are less likely to ovulate at these times. Women on Depo-Provera for at least one year or longer will have amenorrhea because of severe uterine atrophy from lack of estrogen. Do not recommend to women who want to become pregnant within 12 to 18 months. Causes the late return to fertility. It takes up to one year from most women to start ovulating.
What is the black box warning for Depo-Provera
Avoid long term use i.e. more than two years. Increases risk of osteopenia/osteoporosis that may not be fully reversible. Using Depo-Provera for more than two years is discouraged.
What contraceptive should be avoided in anorexia nervosa patients
Avoid using Depo-Provera in this population because it will further increase their risk of osteopenia/osteoporosis. Recommend calcium with vitamin D and weight-bearing exercises for patients on this medication. Consider testing for osteopenia/osteoporosis using a DXA scan
What are the rules for using a diaphragm with contraceptive gel and cervical cap
The diaphragm must be used with spermicidal gel. After intercourse leave diaphragm inside vagina for at least 6 to 8 hours. Can remain inside vagina for up to 24 hours. Need additional spermicide before every act of intercourse.
Patients that use diaphragm are at Increased risk of
UTIs and toxic shock syndrome
Monthly hormonal cycle induces breast tissue to become engorged and painful. Symptoms occur two weeks before the onset of menses and are at their worst right before the menstrual cycle. Resolves after menses start. Commonly starts in women in their 30s.
Fibrocystic breast
Adults to middle aged woman complains of the cyclic onset of bilateral breast tenderness and breast lumps that start from a few days before her period For many years. Once menstruation starts, the tenderness disappears and the size of the breast lumps decrease. During breast examination, the breast lumps are tender and feel rubbery, and are mobile to touch. Denies dominant mass, skin changes, nipple discharge, or enlarged nodes
Fibrocystic breast
What is the treatment plan for fibrocystic breast
Stop caffeine intake. Vitamin E and evening prime rose capsules daily. Wear bras with good support. Must refer if the patient has a dominant mass, skin changes, or fixed mass
What are some risks and complications of PCOS
Endometrial cancer, infertility, diabetes, metabolic syndrome, obesity, cardiovascular disease, and hyperlipidemia.
Signs and symptoms include ogliomenorrhea, amenorrhea, hyperandrogenism i.e. acne, hirsutism, cystic ovaries, infertility, mental health issues. Patient Can skip months of period. It takes two years to have a solid, healthy menstrual period established. These patients need to have babies earlier in life.
PCOS
Insulin resistance is the pathophysiology of
PCOS
How do you diagnose polycystic ovarian syndrome
Rotterdam criteria which is two of three:
Oligomenorrhea
Hyperandrogenism
Cystic ovaries
Complications associated with PCOS include
Uterine/endometrial cancer, diabetes, cardiovascular disease, infertility
Acne, hirsutism, alopecia, acanthosis nigricans, amenorrhea, oligomenorrhea, infertility, hyperinsulinemia and mood disorders in adults are all symptoms of
PCOS
What is the PCOS diagnostic work up and differential
Bodyweight, BMI greater than 30, waste greater than 35 inches, blood pressure, ultrasound of ovaries/uterus hyperplasia greater than 10 mm, CBC, lipid’s low HDL, high trigs/LDL, LFTs, TSH, oral glucose tolerance hemoglobin A-1 C DM=>6.4 at risk => or equal to 5.6-6.4, total testosterone for PCOS =>60, tumor > 200, free T for PCOS = 2-3, pregnancy 🤰 test hcg, prolactin 3-27ng/ml consider DHEA-S, LH/FSH ratio >3, but may be normal in PCOS
