-
What are the axillary lymph nodes and how are they positioned?
-
When is the best time to do a clinical Breast exam?
5-7 days post menstruation
-
What are UPSTF and ACS position on BSE?
- UPSTF: Providers SHOULD NOT teach BSE
- ACS: women's choice
-
Mammogram screening ACS vs UPSTF?
- UPSTF:
- - 50 and > q 1-2 years
- -Against clinicians teaching women how to perform BSE
- ACS:
- After age 40
- - Annual CBE
- - Monthly BSE – optional
- - Women at high risk – MRI and mammogram every year
- - Women at moderate risk – Mammogram and possible MRI every year
- - Women at low risk – Mammogram every year
- -Ages 20 to 39
- CBE every 3 years
- Monthly BSE – optional
-
RF of BC?
- 50 or older
- Family hx - 1st degree relative = positive family hx
- early menarche, delayed menopause
- 1st live birth after 35 or no pregnancy at all.
-
What are the 4 views to examine the breast? ( esp dimplig and retraction)
- arms at side
- arms over head
- arms pressed against hips
- leaning forward
-
How is menopause define?
12 months without period - usually between the ages of 45-52
-
What does post-menopausal bleeding indicate?
- bleeding that occurs
- after 6 months w/o periods and warrants further investigation. (possible
- endometrial cancer)
-
What are some general considerations that the patient should keep in mine before doing the vaginal exam?
( vaginal interactions, bladder? gowning/drapping, gloves, etc )
avoid intercourse, douching or use of vaginal suppositories for 24-48 hrs before examination.
- -The patient must have an empty bladder.
- -The patient must be appropriately gowned
- and draped.
- - Use non-sterile gloves on both hands. You may want to double-glove your dominant hand
- -Properly dispose of soiled equipment and
- supplies.
- -Both male and female examiners should be
- chaperoned by a female assistant.
- - Always tell the patient what you are
- about to do before you do it.
-
What are the 2 most basic shapes of speculum and how are they different from eachother?
- Medium Pedersen: usually most comfortable for sexually active women
- Narrow bladed Pedersen: best
- for pts w/ small introitus, such as a virgin or an elderly woman.
- Graves: for parous women with vaginal prolapse
-
How do you perform a vaginal exam when the vaginal orifice is smaller?
- When vaginal orifice is even smaller, a fairly good bimanual exam can be performed
- by placing 1 finger in the rectum rather than in the vagina.
-
Sign and Symptoms of PID
pain with adnexal tenderness, and mvt of cervix
-
In what type of women is it expected to not feel or difficult to palpate ovaries?
- - post menopausal women
- - obese women
- - women difficult to relax
-
- ovaries are palpable in ½ women in
- reproductive years.
- Fallopian tubes cannot be felt.
-
How do you perform a vaginal exam with hands or with speculum?
see notes for elaborate answer
-
What are some RF for cervical cancer?
- HPV infection ( RF to that: Immunosuppresion,
- High parity, Cigarette smoking, Long-term use of oral contraceptives, Nutritional
- factors)
- women who begin to have sex early
- multiple sexual partners
-
SS of cervical cancer?
- - Abnormal vaginal bleeding
- Between menses.
- After sexual intercourse, douching, or a pelvic exam.
- Menstrual bleeding may last longer and be heavier than usual.
- Bleeding after menopause
- Increased vaginal discharge
-
How to prevent CC?
What is the difference between the 2 types of HPV vaccines?
When can boys and girls get them?
- Monogamy, Condoms
- HPV Vaccine
- - Gardasil
- * Prevents 4 HPV types (6, ll, 16, 18)
- * Shown to also protect against cancers of the anus, vagina, and vulva.
- *Licensed to use in males
-
- Cervarix
- Prevents 2 HPV types (16, 18)
- Both vaccines are administered as a 3-dose series
Routinely recommended for 11 and 12 year old girls (can be started as early as age 9)
Also recommended for ages 13-26 in females, and 13 through 21 in males
-
Explain the physiology of the cervix?
Cells?
 - Columnar --> endocervix
- Squamous --> ectocervix
- SJC
- - Original- border where original squamous cells meet columnar cells
- - Present- innermost border where maturing squamous cells meet native columnar cells.
-
What is the transformation zone?
- Area of actively maturing epithelium between present SCJ and original SCJ -->
- 90% of neoplasias occur in this area
- sample area for papsmear
-
Pap smear - when to start?
Even of pregnant?
When to stop?
- 21
- Pregnant and < 21 = NO!
- Stop: > 65, after total hyterectomy
-
-
Population not appropriate for a pap?
-HIV positive women
- Women who are immunosuppressed
- -Women who were exposed to
- diethylstillbestrol (DES) in utero
- - Women previously treated for CIN2, CIN 3
- or cancer ( These women remain at risk for persistent or recurrent disease for
- 20 years after treatment)
-
Guidelines for obtaining speciment to test for pap smear?
- - Obtain one specimen from the endocervix
- and another from the ectocervix, OR
- a combination specimen using the cervical brush
- Cervical scrape/ Endocervical brush --> Place longer end of scraper in cervical os, press, turn and scrape in a full circle ( 360 degrees) making sure to include the transformation zone and SJC --> Smear the specimen on a glass slide. Set slide on safe spot that is easy to reach
- For pregnant women:
- cotton tip applicator, moistened with saline is best instead of the endocervical brush.
- Cervical Broom --> plastic brush tipped with a broomlike fringe for collection of a single specimen containing both squamous and columnar epithelial cells.
- - Yellowing d/c on cervical swab =
- mucoprurulent cervicitis ( caused by Chlamidia, gonorrhea, herpes simplex)
-
How are Pap smear reported?
- The Bethesda System of
- Reporting Pap smear results
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