Women's Health

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Krsmart
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150031
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Women's Health
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2012-04-25 11:40:36
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  1. Pain is present in fewer than _________% of patients with breast cancer
    10%
  2. What are some dietary changes that can be implemented to help with fibrocystic changes of the breasts?
    Eliminate caffeine; vitamin E supplementation, evening primrose oil
  3. Infertility is defined as lack of conception despite unprotected intercourse for at least________months
    12
  4. The absence of menses by age 14 in girls with no secondary sex characteristics or failure to menstruate by age 16 years in girls who may or may not have developed secondary sexual characteristics is defined as (primary or secondary) amenorrhea?
    Primary
  5. The first diagnostic test done in a woman with amenorrhea is a__________?
    Pregnancy test
  6. Exercise, a diet low in salt, sugar, alcohol, and caffeine, increased calcium, vitamins, and SSRIs have been shown to be help in the treatment of______________?
    Premenstrual syndrome
  7. What is the most common cause of normo-gonadotropic amenorrhea?
    PCOS
  8. What is the most commonly reported gynecologic symptom that causes significant disruption in quality of life and is the leading cause of short-term school absenteeism in adolescents and a common cause of missed work for adult women?
    Dysmenorrhea
  9. Define menorrhagia.
    Heavy menses > 80 mL of blood or > 7 days
  10. Define metrorrhagia.
    Variable menses at irregular but frequent intervals
  11. Define menometrorrhagia
    Increased blood loss or duration at irregular intervals
  12. Define oliogomenorrhea
    Menses > 35 days
  13. Define polymenorrhea
    Menses length < 21 days at regular interval
  14. Midcycle pain that is caused by the release of an egg from the surface of an ovary is known as ___________?
    Mittelschmerz
  15. A normal Pap smear can always ensure that a patient’s endometrium is normal. True or False?
    False
  16. The proliferation of abnormally placed endometrial tissue that responds to hormone changes and causes pain is called____________?
    Endometriosis
  17. What is the treatment for endometriosis?
    OCs, NSAIDs and laparoscopy can be helpful.
  18. Leiomyomas or fibroids are (benign or malignant) tumors of the uterus?
    Benign
  19. Postmenopausal bleeding can be a sign of_____________?
    Endometrial cancer
  20. Endometrial hyperplasia (precursor of endometrial cancer) occurs when estrogen does not have ____________ as a counterbalance?
    Progesterone
  21. Any postmenopausal patient with abnormal uterine bleeding should be referred for_________________?
    Endometrial biopsy
  22. What are some contraindications to having an endometrial biopsy?
    Pregnancy, acute infection, PID, or known bleeding disorder (including warfarin use)
  23. What is the average age of menopause?
    51.5 years
  24. Menopause is defined as the lack of menses for a period of___________?
    One year
  25. How is premature menopause defined?
    As ovarian failure and menopause cessation before age 35.
  26. The first test that should be done in a woman whose menses has ceased is:
    A pregnancy test
  27. What positive effect do estrogens have on the bones?
    They block bone resorption. Loss of estrogen leads to bone loss.
  28. What are the expected changes in the lipid profile of post menopausal women?
    LDLs often rise and HDLs can decrease after menopause
  29. Why is progesterone added to HRT for women with a uterus?
    It reverses the endometrial hyperplasia that can lead to uterine cancer.
  30. Would HRT for a women without a uterus include progesterone?
    No
  31. The relief of vasomotor symptoms, management of urogenital atrophy,and the prevention of osteoporosis and colorectal cancer are the benefits of __________?
    Hormone Replacement Therapy (HRT)
  32. Endometrial hyperplasia and carcinoma, breast cancer, ovarian cancer, cardiovascular events, nausea and gallbladder disease are the adverse effects of ______?
    Estrogen therapy
  33. Give an example of a selective estrogen receptor modulator (SERM) used in the prevention and treatment of osteoporosis?
    Raloxifene (Evista)
  34. What are the adverse effects of raloxifene (Evista)?
    Thromboembolism and hot flashes
  35. In menopause, serum FSH and LH levels are (increased or decreased)?
    Increased
  36. What are some indications for estrogen replacement therapy?
    Moderate to severe vasomotor instability or genital atrophy and diminished quality of life secondary to menopausal symptoms.
  37. What publications revealed that synthetic estrogen/progesterone replacement therapy places women at greater risk for illness, which resulted in the reversal of the wide spread use of hormone replacement therapy?
    Woman’s Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) trials
  38. Why is a combination of hormones used for menopausal symptoms in a woman with an intact uterus?
    Unopposed estrogen can cause endometrial hyperplasia and must be counter balanced with progesterone.
  39. What type of hormone replacement therapy is prescribed to a woman with a hysterectomy?
    Estrogen only
  40. What test can be done to diagnosis ovarian cancer?
    Transvaginal ultrasound is helpful.
  41. What is the problem with doing Pap smears on women under the age of 21?
    Younger women have increased incidence of atypical cells that usually clear by the time they are 21 years of age without having unnecessary procedures
  42. Women younger than age 21 regardless of their sexual activity should not be screened for cervical cancer with Pap smears. True or False?
    True
  43. Screening women for cervical cancer earlier than age_________leads to more harms than benefits.
    21
  44. Women ages 21-65 can be screened with cytology (Pap smear) every______years?
    3
  45. The cytologic examination of exfoliated cervical and endocervical cells that is currently used as a screening tool for cervical neoplasia and carcinoma is known as________________?
    Pap smear
  46. What is the Bethesda System?
    A system for describing abnormal cells obtained with Pap smear.
  47. What are the cervical/vaginal abnormalities that can be detected by the Pap smear?
    Atypical Squamous Cells (ASC), Atypical Glandular Cells (AGC), Low/High Grade Squamous Intraepithelial Lesions (LSIL) (HSIL), frank cervical carcinomas, bacteria, fungi, or protozoa
  48. Which cervical/vaginal abnormalities are usually asymptomatic?
    ASC, AGC, LSIL, HSIL, carcinomas, infections
  49. What is the most common cause of cervical cancer?
    HPV
  50. If the Pap smear is abnormal, what is the next appropriate action?
    Check for HPV

    Repeat Pap Smears at 4-6 month intervals until 2 consecutive negative smears are obtained.
  51. Is it acceptable to do the liquid Pap if the woman is menstruating?
    Yes
  52. Does a woman with a hysterectomy need a Pap?
    No unless she has a previous history of cancer.
  53. What is a colposcopy?
    Diagnostic procedure to examine an illuminated, magnified view of the cervix, vagina and vulva allowing for biopsies of abnormal appearing tissue.
  54. A woman with ASCUS requires
    HPV testing
  55. A woman with CN2 needs:
    LEEP
  56. When should a colposcopy be performed?
    If a repeat smear shows ASC-US or a higher-grade abnormality
  57. Why is it important to check for STIs if a woman complains of intermittent bleeding?
    STIs can be a cause of bleeding
  58. Are minors able to get treatment for STIs without parental consent?
    Yes
  59. What are the 5 P’s that are used to elicit a sexual history?
    • Partner
    • prevention of pregnancy
    • protection from STD’s
    • practices (anal, oral, vaginal)
    • past history of STDs
  60. Why do women need to have not urinated for 1 hour for a chlamydia test
    The result is not accurate unless there has been no void for 1 hour.
  61. Who should get tested for GC and Chlamydia?
    All sexually active women
  62. Why do you suspect sexual abuse in a child with genital molluscum?
    In the genital area, it may have been contracted from an adult as an STI
  63. Is BV an STD?
    No
  64. Can you get molluscum more than once?
    No because the body builds up immunity
  65. What percentages of pregnancies are unintended?
    49%
  66. Name the “barrier” methods of birth control.
    Male condom, female condom, diaphragm and the cervical cap.
  67. The diaphragm is used with a spermicide and should remain in the vagina for no less than___________hours following coitus.
    6
  68. Should women with frequent UTIs use the diaphragm with spermicides?
    Not recommended
  69. How do estrogen-progestin oral contraceptives prevent pregnancy?
    Inhibition of FSH and LH thereby preventing ovulation
  70. How does the estrogen component of OC contribute to prevent pregnancy?
    Estrogen inhibits implantation by changing normal uterine lining maturation
  71. How does the progestin component of the OC contribute to prevent pregnancy?
    Progestins slow ovum transport and uterine motility and make cervical mucus thick and scanty, slowing sperm transport
  72. If a woman misses a dose of her OC, what should she do?
    Take it as soon as she remembers. Be sure to read the package insert.
  73. If more than 3 doses of OCs are missed, what should be done?
    Begin a new pack of OCs and use back up.
  74. What types of drugs can decrease the efficacy of oral contraceptives?
    Antiepileptic drugs (AEDs), rifampin, St. Johns Wart and possibly some antibiotics.
  75. Why is it important to take the progesterone only pills on time?
    A 3 hour window of tardiness can lead to pregnancy
  76. What form of oral contraception is recommended for lactating women?
    Progesterone only is recommended. OCs containing estrogen can decrease the milk supply.
  77. What percentage of women that are not using birth control will become pregnant in one year?
    85%
  78. Should a woman with breast cancer be prescribed oral contraceptives?
    No, because estrogen can stimulate estrogen dependent tumors.
  79. Should a woman with factor V Leiden mutation take OCs?
    No because of the increased risk of thrombosis
  80. In what cases would you not want to prescribe an estrogen-containing contraceptive?
    Smokers, HTN, migraines, migraines with aura.
  81. Why are OCs not recommended for women who smoke over the age of 35?
    There is an increased risk of blood clots with OCs.
  82. Nausea associated with OCs can be reduced by taking the pill at ___________?
    Night time or with meals
  83. What conditions would the “mini-pill” that contains progesterone only be prescribed?
    It is safe in women that are lactating, are older than 35, smoke, or have sickle cell disease.
  84. Is the progesterone only pill as effective as combined oral contraceptives?
    No
  85. Why should women discontinue OCs prior to surgery and use other forms of prevention?
    There is an increased risk of thrombosis with OCs.
  86. What are some of the adverse effects of OCs?
    Increased risk of thrombosis and hypertension are the most important.
  87. ______________OCs have the same dosage of hormones in each pill where as biphasic and triphasic OCs have 2 and 3 dosages of hormones throughout the month.
    Monophasic
  88. When does fertility usually return after discontinuation of OCs?
    Immediately
  89. Is prolonged use of OCs associated with future fertility or other health problems?
    No
  90. Women may discontinue OC use after the first 3 months. The major reason for discontinuation of OC is:
    Breakthrough bleeding
  91. How can breakthrough bleeding while on OCs be reduced?
    Take the OCs at the same time (within 3-4 hours) each day
  92. Does cigarette smoking increase the incidence of breakthrough bleeding?
    Yes
  93. What are the non-contraceptive benefits of OCs?
    Decreased risk of benign breast tumors, dysmenorrhea, anemia, endometrial, ovarian, and colon cancer rates
  94. Users of OCs have decreased rates of PID. What is the possible reason?
    OCs increase endocervical mucous
  95. When is emergency contraception most effective?
    Within 72 hours of unprotected coitus.
  96. Depo-Provera injectable is given every__________months to prevent pregnancy
    3
  97. Why are women on Depo-Provera encouraged to have an adequate calcium/vitamin D intake?
    Depo-Provera can decrease bone density
  98. Can Depo-Provera be used by women with seizure disorders?
    Yes, it does not interact with anti-epileptic drugs and seems to be protective against seizures
  99. How long does it take for fertility to be respond after discontinuation of Depo-Provera?
    6-12 months
  100. Drospirenone is an aldosterone antagonist and is the progestin component of OCs such as Yasmin and Yaz. What electrolyte abnormality can occur?
    Hyperkalemia
  101. Would ACE inhibitors and Yasmin be a good combination?
    No, because hyperkalemia can occur with both agents
  102. What is the most popular form of BC?
    Nuvaring
  103. How do you recommend inserting or removing the NuvaRing?
    One foot up on a chair
  104. How long is the NuvaRing kept in place?
    After 3 weeks it is removed, the menses begins, and it replaced in one week
  105. Does the NuvaRing need to be refrigerated?
    Yes
  106. Can you take the NuvaRing out for coitus?
    It can’t usually be felt by the male partner. Removal for less than three hours is acceptable.
  107. The Ortho Evra patch is replaced__________:
    Weekly
  108. What is the most effective form of BC?
    Female sterilization, IUD, and implants
  109. Which forms are the least effective?
    Regulated abstinence (rhythm method), withdrawal
  110. Rhythm method, calendar method, cervical mucus method, symptothermal method are all forms of “regulated____________”
    Abstinence
  111. Postcoital controls for birth control include:
    Withdrawal, postcoital douche, and emergency contraception
  112. Emergency contraception such as Plan B should be taken within________hours after intercourse
    72
  113. What is new about the implantable Nexplanon?
    Should it become non palpable, it will now show up on x-ray (barium sulfate was added)
  114. Is emergency contraception available to women under age 17 without a prescription?
    N0
  115. Can women who have never had a child have an IUD inserted?
    Yes
  116. What type of hormone is contained in the Mirena?
    Progesterone
  117. How long is the Mirena effective?
    5 years
  118. A woman with a small uterus of 5 cm would not be a candidate for the Mirena. True or False
    True. The uterus must measure between 6-9 cm.
  119. What are the risks of IUD?
    Uterine perforation, and infection
  120. When can you get pregnant after removing IUD?
    Immediately
  121. Does the ParaGard copper IUD contain hormones?
    No
  122. How long is the copper IUD effective?
    10 years
  123. Do you need to check for the threads monthly if you have an IUD?
    No
  124. Why are IUDs inserted while a woman is menstruating?
    The cervix is easier to enter at this time.
  125. Are birth control methods tested on woman over 200 lbs?
    No

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