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FNP Licensure Review > Womens/ STI > Flashcards

Womens/ STI Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

FSH stimulates eggs into producing estrogen
* ↑ Estrogen, stimulates growth of endometrium
* Around day 14 the woman most fertile

A

Follicular phase (days 1-14)

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2
Q

LH induces ovulation

A

Midcycle (day 14): Ovulatory Phase

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3
Q

Helps stabilize endometrial lining

A

Luteal Phase (days 14-28)

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4
Q
  • Estrogen ↓, Progesterone ↓
A

Menstruation

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5
Q

Safe for breast feeding.
* Should be taken at the same Ame every day.
* Late dose (>3hr) or missed day, use condom.

A

Proges1n-Only Pills: 9% failure rate “mini pill”

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6
Q

Contraindications for COC

A

Smoker >35 years old (>15 cigarettes per day)
* History of
* ↑ risk of blood clotting.
* Thromboembolic disorders (DVT): thrombus,
emboli.
* Genetic coagulation defects (factor V Leiden
Disease).
* Prolonged immobility (surgery).
* Inflammation or acute infections of the liver with ↑ LFTs.
* Cardiovascular disease.
* Conditions that increase risk of stroke.
* Migraines, CVAs, TIAs, HTN.

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7
Q

Beneifts of COC (5+ years)

A
  • Decreases risk of ovarian and endometrial
    cancers by 40-50%.
  • ↓ acne, hirsutism.
  • Regulates heavy menses, dysmenorrhea,
    cramps, ↓ pain with endometriosis.
  • ↓ risk of ovarian cysts.
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8
Q

What to do if missed 2 days of BC pills?

A

Missed 2 days of pill: Take 2 pills the next 2 days, use condom.

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9
Q

3-month IM injection.
* Must check for pregnancy before use.
* To be used at least 1 yr. (Not recommended if planning to get pregnant within 12 months)
* Black/Box WARNING: not to be used for more than 3 yrs due to risk bone demineralization
(osteopenia/osteoporosis) .
* Do not use with hx. Anorexia (order DEXA).
* Recommend Vitamin D and Ca, weight bearing exercises.

A

Depo-Provera

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10
Q

Cause: anaerobe bacterial infec1on in the vagina.
* Risk factors: sexual ac1vity, mul1ple sex partners, douching.
* NOT an STI. Sexual partner does not need to be treated.
* Whiff test: fishy odor.
* Treatment: metronidazole (Flagyl)
* Flagyl educaAon: avoid alcohol.
* Lab findings:
* + Clue cells.
* + Whiff test

A

Bacterial Vaginosis

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11
Q

Cause: Overgrowth of Candida albicans yeast.
Risk factors: DM, HIV (or any immunosuppression), on abx.
Findings: white cheese-like curd vaginal discharge, severe vulvovaginal
itching, swelling, redness.
Treatment: Miconazole (Monistat), clotrimazole.
Lab findings: Wet Smear Microscopy
* pseudo hyphae and spores w/WBC

A

Candida Vaginitis

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12
Q

Cause: unicellular protozoan parasite w/ a flagella. Affects male and female. Symptoms include
itching, burning, irritation of vagina/urethra.
Risk factors: multiple sex partners, hx of STI, previous trich, no condom use.
Findings: “strawberry cervix” (punctate hemorrhages), swollen and erythematous vaginal area,
dysuria.
Treatment: Metronidazole (flagyl). Treat sexual partner.
Lab findings: Mobile unicellular organism with flagella, ↑ WBC.

A

Trichomonas Vaginitis

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13
Q

Cause: chronic lack of estrogen in urogenital tract = atrophic changes in vulva and vagina.
Risk factors: menopause.
Findings: atrophic labia, decreased rugae, fissures, dry, pale vagina.
Treatment: estrogen.

A

Atrophic Vaginitis

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14
Q

Cause: hormonal changes due to menses, causes painful cysts to enlargein breasts. Cyclical, cysts change size and symptoms vary. Benign.
Risk factors: Common around age 30s. Worst 2 weeks before menses.
Findings: painful/tender mass like growths on one or both breasts that change in size depending on menses cycle.
Treatment: Wear good bra support. Reduce caffeine. Primrose capsules or oil, vitamin E. If cyst continues to bother, may remove fluid to relieve symptoms.

A

Fibrocystic Breasts

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15
Q

Cause: endocrine disorder in women of reproductive age. Primary
characteristics: hyperandrogenism, anovulation, insulin resistance and
neuroendocrine disruption.
Findings:
* Obesity, facial hair, hyperlipidemia, obstructive sleep apnea, acne,
amenorrhea, infrequent periods. Infertility.
* On transvaginal US: enlarged ovaries with multiple small follicles.
* Elevated hormones: testosterone, dehydroepiandrosterone,
androstenedione.
Treatment: contraceptives, spironolactone, metformin, weight loss.

A

PCOS

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16
Q

Cause: bone demineralization due to estrogen deficiency from menopause.
Risk factors: menopause, anorexia/bulimia, chronic steroid use, long term use PPIs, gastric bypass, celiac
disease, hyperthyroidism, ankylosis spondylitis, RA, low Ca intake, vitamin D deficiency, inadequate physical
activity, alcoholism, high caffeine intake, smoking.
Findings: older female (>50), being thin, small body frame, family history. White or Asian descent.

A

Osteoporosis

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17
Q

Tx options for osteoporsosis

A

Weight bearing exercises, Ca and Vitamin D.
* Bisphosphonates: patient education to drink with full glass of water, don’t lay down. May erode esophagus

18
Q

Painless breast mass that is hard and irregular. Mass not easily
movable, may have changes to the skin. Nipple retraction, discharge,
bleeding.
* Skin changes: dimpling, rash, redness, “peau d’orange”, swelling, lumps, vascularization.
Risk factors: female, obesity, lack of physical activity, alcoholism, hormone replacement therapy (birth control), early menarche, having children late, nulliparity, older age, family history (5-10%)

A

Breast Cancer

19
Q

Intraductal (milk ducts) pre-cancerous or non-invasive abnormal cells arising from the breast.
Stage 0. Rarely produces symptoms, usually found on routine imaging. If left untreated, may develop
into invasive cancer.
* In situ: ”in place”, abnormal cells have not moved out of the mammary ducts into the surrounding tissues.
* Screening: mammogram, biopsy, cytopathology.
* Treatment: lumpectomy.

A

Ductal Carcinoma In Situ

20
Q

chronic scaly erythematous rash that looks like eczema, starts on the nipple and
spreads to the areola. It is a type of cancer. Rash may be itchy, inflamed, nipple may be
inverted. If left untreated, develops into a larger affected area with crusting, ulceration and or
bleeding nipple.
* Nipple discharge: straw-colored or bloody.
* Sensation: burning, tingling, pain, may feel a lump/bump underneath
affected area.
* Screening: mammogram, biopsy, cytopathology.
* Treatment: lumpectomy, mastectomy, chemo, radiation…

A

Paget’s Disease

21
Q

A mutation in either genes, which are tumor suppressor
genes. These can be harmful and produce hereditary breast-ovarian cancers.
* 5-10% breast cancers are attributed to BRCA mutations.
* 5x’s higher risk of breast cancer, 1—30x higher risk of ovarian cancer.
* Risk factors: family history before age 50, male breast cancer, triple negative breast cancer
before age 60, ovarian and other types of GYN cancers. Ashkenazi Jews.
* Referral: breast specialist, genetic counseling.
* Tests: genetics, MRI, mammograms…

A

BRCA 1 or BRCA 2

22
Q

Aggressive, fast occurring form of breast cancer.
* Findings: acute onset (weeks to months) of erythematous, breast
swelling, warm area in the breast, peau d’orange, nipple retraction,
itching. Can happen at any age. Don’t confuse with mastitis. Often no
mass (may not be detected in mammography or US).
* Test: biopsy, MRI, mammo/US.
* Treatment: lumpectomy, mastectomy, radiation, chemo

A

Inflammatory Breast Cancer

23
Q

Prevalence: middle age to older woman
* Findings: asymptomatic in early stage. Vague symptoms of abdominal bloating and
discomfort, low back pain, abdominal fullness, pelvic pain, changes in bowel habits, loss of
appetite/weight loss.
* ⚠ a palpable ovary is abnormal, r/o ovarian cancer. Order intravaginal US.
* Risk factors: family history, BRCA mutation, Ashkenazi Jewish, nulliparity.
* Birth control lowers risk of ovarian cancer.
* Treatment: surgery, chemotherapy.

A

Ovarian cancer

24
Q
  • Cervical screening test.
  • Brush/spatula is inserted to collect cervical cells.
  • Do not preform if menstruating. Done every 3 years
    (21-29), 3-5 years (30-65) stop >65 years of age.
  • Not preformed <21 year of age.
A

Pap Smear

25
Q

What to do if Pap Shows Atypical Squamous Cells of Undetermined Significance +

A

: repeat in 12 months.

26
Q

What to do if Pap Shows Atypical Glandular Cells:

A

premalignancy or malignancy. + endometrial cells,
refer for biopsy.

27
Q

What to do if Pap Shows … High-Grade Squamous Intraepithelial Lesions:

A

higher risk of malignancy.
Colpo with biopsy, excision.

28
Q

What to do if Pap Shows Low-Grade Squamous Intraepithelial Lesions:

A

mildly abnormal cells. Usually caused by HPV. Repeat (21-24), colpo/biopsy (25-29).

29
Q

Microscope used to view the cervix. Diagnostic test for cervical ca. is biopsy.

A

Colposcopy

30
Q

Devise used like a scalpel to cut through the cervix to
treat cervical cancer.

A

Loop Electrosurgical Excision Procedure

31
Q

Bacterial Vaginosis test.Positive if strong fish like odor is released after two drops of KOH added to
a sample of BV discharge.

A

Whiff test

32
Q

To evaluate herpetic infection (oral, genital, skin).A positive smear will show large abnormal nuclei in squamous epithelial cells.

A

Tzanck Smear

33
Q

HPV DNA test

A

HPV types 16 & 18 cause 70% of all cases of cervical
cancers.Gardasil and Cervarix vaccination available for ages 9-26.

34
Q

Cause: bacterial infection caused by Chlamydia trachomatis. Infects both women and men.
Risk factors: < 25 years of age, multiple sex partners, not using a condom, history of STIs.
Findings/Symptoms: May be asymptomatic. Genital pain, discharge.
Treatment: Must treat sexual partner. Azithromycin or Doxy (for complicated).
Test: Nucleic acid amplification test (NAATs), vaginal swabs. Preferred for men is urine NAAT

A

Chlamydia

35
Q

Cause: Neisseria gonorrhoeae bacterium.
Risk factors: Multiple sexual partners, new partner <3 months, inconsistent condom use.
Findings: (dependent on site). Mucopurulent, pain, bleeding, dysuria, penile discharge, testicular
pain, pelvic pain, purulent discharge, PID, epididymitis, prostatitis…
Treatment: Always co-treat for chlamydia. Ceftriaxone and Azithromycin or Doxy.
Test: Nucleic acid amplification test (NAATs), vaginal swabs. Preferred for men is urine NAAT.

A

Gonorrhea

36
Q

Cause: Treponema pallidum bacterium.
Risk factors: Sexual activity, passed on mother to baby.
Findings:
* Primary: chancre (firm, painless, non-itchy ulceration that has a clean base with well
demarcated indurated margins).
* Secondary: condyloma lata (white papules look like warts), diffuse non-itchy rash,
usually hands and soles of feet.
* Tertiary: gumma (non-cancerous growths), neurological problems, heart symptoms.
Treatment: Penicillin G.
Test: RPR or VDRL for screening. If positive, confirm with FTA-ABS.

A

Syphillis

37
Q

Firm, painless, non-itchy ulceration that has a clean base with well

A

Primary Syphillis

38
Q

condyloma lata (white papules look like warts), diffuse non-itchy rash, usually hands and soles of feet.

A

Secondary Syphillis

39
Q

gumma (non-cancerous growths), neurological problems, heart symptoms

A

tertiary Syphilis

40
Q

How to tx Syphilis

A

PCN G

FNP Licensure Review (10 decks)

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