Purple Book - Women's Health

Risk factors associated with Bacterial Vaginosis?

-sexual activity -New or multiple sex partners -douching

atypical squamous cells of undetermined significance

- Ages 20 years or younger: Repeat cytology/Pap test in 12 months. -Ages 21 to 24 years: Preferred is repeat Pap test in 12 months (acceptable is reflex HPV test). -Ages 25 to 29 years: Preferred is reflex HPV test. Acceptable is repeat Pap test in 12 months. -Ages 30 years or older: If oncogenic HPV positive (subtypes 16 and 18), refer for colposcopy. If HPV negative, repeat co-testing in 3 years (ACOG, 2016).

What to do with Low-Grade Squamous Intraepithelial Lesions (LSIL)

- Ages 21 to 24 years: Repeat Pap test in 12 months. -Ages 25 to 29 years: Refer for colposcopy with cervical biopsy. -Ages 30 years or older: If HPV negative, repeat Pap test in 12 months (or colposcopy). If HPV positive, refer for colposcopy with cervical biopsy. Treatment ranges from cryotherapy or laser therapy (ablative therapy; ACOG, 2016).

What are Low-Grade Squamous Intraepithelial Lesions (LSIL)?

- Cervical cells show changes that are mildly abnormal. They are usually caused by an HPV infection.

What are considered very high risk factors for developing breast cancer?

-BRCA1 or BRCA2 gene -History of radiation therapy of the chest between the age 10-30

What can fibroids in the uterus (Uterin leiomyoma/myoma) cause?

-Can cause heavy menstrual bleeding and cramping, pelvic pain, and urgency (due to fibroid pressing on the bladder).

What should be ruled out if the cervix bleeds easily when the brush is inserted for a sample during a pap smear?

-Cervicitis bleeding may be a sign of inflammation

Why would adolescents and adult women taking birth control pills, and pregnant women, have large ecropions?

-Due to high estrogen

What is the spacing for pap test with co-testing (HPV testing) and what is the spacing for just a pap test?

-Every 3 years for co-testing -Every 5 years if there is no co-testing.

What are some risk factors associated with BRCA (breast cancer susceptibility gene)?

-Family hx of breast CA before age 50 -male breast cancer -breast cancer that is triple negative before age 60 -ovarian and other types of gynecological cancers

What are signs/symptoms associated with Bacterial Vaginosis?

-Fish like vaginal odor -Vaginal discharge is copious -Milk like vaginal discharge

What is menstruation?

-If not pregnant, both estrogen and progesterone fall drastically, inducing menses. Low hormone levels stimulate the hypothalamus, then the anterior pituitary (FSH), and the cycle starts again.

What are some signs/symptoms of Paget's disease of the breast?

-Itching -pain -burning senseation -skin lesion slowly enlarges and evolves to include crusting, ulceration, and/or bleeding of the nipple

When does puberty begin for a girl?

-Puberty in girls starts with breast buds

According to Tanner's stage, at what stage is it considered the start of puberty?

-Tanner stage 2 and ends at stage 5

Where is the majority of breast cancer located?

-The upper outer quadrant of the breasts (called the "tail of Spence")

What is the fertile time period?

-This time period is characterized by copious amounts of clear mucus that feels thin and elastic in the vagina. This sign is used in the cervical-mucus method of birth con- trol to indicate the fertile period of the cycle.

What are signs/symptoms of atrophic vaginitis?

-Vaginal dryness -itching -pain with sexual intercourse

What are signs/symptoms associated with candidal vaginitis?

-White cheese like vaginal discharge -severe vulvovaginal pruritus, swelling, and redness

What does a cervical ectropion look like?

-bright-red bumpy tissue with an irregular surface on the cervical surface around the os

What are the sign/symptoms associated with ovarian cancer?

-middle-aged or older woman with vague symptoms -abdominal bloating and discomfort -low-back pain -pelvic pain -changes in bowel habits

What are signs/symptoms associated with an ectopic pregnancy?

-sexually active female who has not had a period -lower abdominal/pelvic pain -cramping -pain worsens when supine or with jarring -If ruptured pelvic pain is worsen and can refer to the right shoulder

Menopause is defined as ......?

12 consecutive months without menses

What is the ovulatory phase?

2nd phase of ovarian cycle -Luteinizing hormone is secreted - Begins when estrogen peaks - Ends w/ release of the oocyte (egg) -- (ovulation)

A 35-year-old smoker is being evaluated for birth control choices. The patient has a history of pelvic inflammatory disease (PID) along with an embolic episode after her last pregnancy. Which of the following methods of birth control would you recommend? A) Condoms and the vaginal sponge (Today Sponge) B) Estrogen patches C) Intrauterine device D) Depo-Provera (depot medroxyprogesterone)

A Condoms and the vaginal sponge (Today Sponge) Contraindications for hormonal contraception include migraine headaches; cigarette smoking or obesity in women older than 35 years; history of thromboembolic disease; hypertension or vascular disease if older than 35 years of age; systemic lupus erythematosus with vascular disease, nephri- tis, or antiphospholipid antibodies; breastfeeding (may use progestin-only pills); hyper- triglyceridemia; coronary artery disease; congestive heart failure; and strokes.

Risks for neural tube defects include: a) folic acid deficiency, poor prenatal care, and previous sibling with a neural tube defect b) folic acid deficiency accompanied by a sibling with a history of seizures c) folic acid deficiency, vitamin C deficiency and maternal history of seizures d) folic acid deficiency, vitamin C deficiency and paternal history of seizures

A Process of elimination and because no correlation between seizures and neural tube defect, and potential genetic component with sibling history

Minnie is pregnant. She has hypothyroidism and has been on the same levothyroxine medication for years. What might you expect to do with her levothyroxine medication? a) Increase the dosage b) maintain her established dose c) decrease her dosage d) increase the dose during the first trimester then decrease it during the second and third trimester

A Because there is an increased metabolic demand

What causes osteoporosis in women?

A gradual loss of bone density secondary to estrogen deficiency and other metabolic disorders.

What is ectopic pregnancy?

A pregnancy in which the fertilized egg implants outside the uterus.

What can polycystic ovary syndrome (PCOS) cause?

causes acne, hirsutism (excessive facial and body hair), oligomenorrhea (amenorrhea or infrequent periods), insulin resistance

What hormones related to the menstrual cycle come from the ovaries:

Estrogen and Progesterone

An 18-year-old college freshman comes to your clinic, complaining of severe left-sided lower abdominal pain and a foul yellow discharge. The pain began last night while she was having intercourse with her boyfriend. Afterward the pain became more severe and the discharge started. By this morning she had a fever of 101 degrees and walking was making the pain worse. Only lying very still makes the pain better. She has tried ibuprofen and acetaminophen without any improvement. She denies any nausea, vomiting, diarrhea, or constipation. Her past medical history is unremarkable. She has had two past sexual partners. She uses the birth control patch instead of condoms. She smokes a half pack of cigarettes a day and drinks four to five beers per weekend night. She denies any illegal drug use. Her parents are both healthy. On examination you find a young woman who appears ill. Her temperature is 102 degrees and her pulse is elevated at 110. She is tender in the left lower quadrant but has no guarding or rebound. Speculum examination reveals yellow purulent drainage from the os. On palpation there is cervical motion tenderness and the left adnexa is swollen and tender. A urine analysis is unremarkable and the urine pregnancy test is pending. What is the best choice of diagnosis for this adnexal swelling? A) Ovarian cyst B) Tubal pregnancy C) Pelvic inflammatory disease

Ans: C Feedback: PID is common in young sexually active woman and is usually caused by bacteria that have been sexually transmitted. It is often associated with fever, pelvic pain, and a purulent cervical discharge. On examination there is often cervical motion tenderness and adnexal swelling and pain. A purulent discharge is often seen in the cervical os. Causes of cervical infection are gonorrhea, Chlamydia, and sometimes herpes. This woman should be made aware that barrier methods of contraception may prevent transmission of these diseases, whereas the contraceptive patch or pill will not. It would be prudent to consider further history and screening for HIV in this patient.

Mrs. Jaeger is a 67ñyear-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered? A) Endometrial cancer B) Hormone replacement therapy C) Uterine or cervical polyps D) All of the above

Ans: D Feedback: Bleeding after menopause can have serious as well as benign causes. It is important to consider endometrial cancer as a cause of postmenopausal bleeding.

A 24-year-old travel agent comes to your clinic, complaining of pain and swelling in her vulvar area. She states that 2 days earlier she could feel a small tender spot on the left side of her vagina but now it is larger and extremely tender. Her last period was 1 year ago and she is sexually active. She uses the Depo-Provera shot for contraception. She denies any nausea, vomiting, constipation, diarrhea, pain with urination, or fever. Her past medical history is significant for ankle surgery. Her mother is healthy and her father has type 2 diabetes. On examination she appears her stated age and is standing up. She states she cannot sit down without excruciating pain. Her blood pressure, temperature, and pulse are unremarkable. On visualization of her perineum, a large, red, tense swelling is seen to the left of her introitus. Palpation of the mass causes a great deal of pain. What disorder of the vulva is most likely causing her problems? A) Bartholin's gland infection B) Vulvar carcinoma C) Secondary syphilis D) Condylomata acuminata

Ans: A Feedback: Bartholin's gland infections cause a red-hot tender abscess at the duct opening to the Bartholin's glands. Gonococci, Chlamydia, and other organisms often cause them. Size is variable; if chronic, the infection can present as a nontender cyst.

A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative. Which disorder of the vulva is most likely in this case? A) Genital herpes B) Condylomata acuminata C) Syphilitic chancre D) Epidermoid cyst

Ans: A Feedback: Genital herpes consists of small, shallow, painful ulcers. Primary infections are often associated with fever, malaise, and regional lymphadenopathy. The outbreak occurs generally between 1 and 3 weeks after exposure. Herpes is contagious and the majority of transmission occurs without the presence of obvious lesions. Transmission during passage through the birth canal can cause serious illness in affected newborns.

A 23-year-old waitress comes to your clinic complaining of severe pelvic pain radiating to her right side. The pain began yesterday and is getting much worse. She has had no burning with urination and denies any recent sexual activity. She has no nausea, vomiting, constipation, diarrhea, fever, or vaginal discharge. Her last period was 3 to 4 weeks ago. Her past medical history consists of severe acne, depression, and mild obesity. She has had no surgeries. She broke up with her boyfriend 6 months ago and denies dating anyone else. She smokes one pack of cigarettes a day, drinks three to four beers two to three times a week, and denies any illegal drug use. Her mother is diabetic and her father has coronary artery disease. On examination you see a mildly obese female in moderate distress. Her blood pressure is 130/80 and her pulse is 90. She is afebrile. On auscultation she has active bowel sounds. She has no rebound or guarding in any abdominal quadrant. Speculum examination shows no lesions on the cervix and no discharge or bleeding from the os. During the bimanual examination she has no cervical motion tenderness, but her right adnexal area is swollen and tender. A urine analysis is normal and the urine pregnancy test is pending. What disorder of the adnexa is most likely the diagnosis? A) Ovarian cyst B) Tubal pregnancy C) Pelvic inflammatory disease

Ans: A Feedback: Ovarian cysts often occur just before the onset of menses. They are also common in a disease known as polycystic ovarian syndrome. Other symptoms of this disorder are acne, hirsutism (increased hair growth), irregular periods, obesity. This disorder runs in families and later manifestations include diabetes, high blood pressure, and coronary artery disease. Single cysts on the right side can mimic the symptoms of appendicitis.

Which of the following represents metrorrhagia? A) Fewer than 21 days between menses B) Excessive flow C) Infrequent bleeding D) Bleeding between periods

Ans: D Feedback: Metrorrhagia is bleeding between periods. Menorrhagia is excessive bleeding with menses, while oligomenorrhea is infrequent menses. Polymenorrhea is menstruation with fewer than 21 days between periods.

Which of the following is true of the HPV vaccine? A) Ideally it should be administered within 3 years of first intercourse. B) It covers against almost every HPV type. C) It can be used as adjuvant therapy in cervical cancer. D) It can protect against anogenital lesions.

Ans: D Feedback: The HPV vaccine confers the greatest protection if given before exposure to the HPV. Currently, HPV types 6, 11, 16, and 18 are targeted because these are among the most common types causing cervical cancer. There are many other types, some of which are associated with cervical cancer. It is not recommended for treatment of preexisting cervical cancer but is protective against anogenital lesions.

A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 130/80 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have? A) Trichomonas vaginitis B) Candida vaginitis C) Bacterial vaginosis D) Atrophic vaginitis

Ans: B Feedback: Candida is associated with a thick, white, curd-like discharge that causes severe pruritus. The pH will be normal (£4.5) and the KOH whiff test will be normal. The wet prep often shows yeast spores and budding hyphae. Candida is very common in diabetics and after recent use of antibiotics. It is not thought to be sexually transmitted.

Which of the following is true of human papilloma virus (HPV) infection? A) Pap smear is a relatively ineffective screening method. B) It commonly resolves spontaneously in 1-2 years. C) It is the second most common STI in the United States. D) HPV infections cause a small but important number of cervical cancers.

Ans: B Feedback: HPV is the most common STI in the United States and is by far the most common cause of cervical cancers. The sensitivity of the liquid-based cytology is between 61% and 95% and specificity is from 78% to 82%. While HPV affects almost 50% of the population at some point, many of these infections resolve spontaneously.

Jean has just given birth 6 months ago and is breast-feeding her child. She has not had a period since giving birth. What does this most likely represent? A) Primary amenorrhea B) Secondary amenorrhea C) Oligomenorrhea D) Dysmenorrhea

Ans: B Feedback: Periods will normally stop after menarche for several reasons, including pregnancy, lactation, and menopause. Failure to start periods usually indicates an endocrine problem and is referred to as primary amenorrhea. Oligomenorrhea represents infrequent menses and dysmenorrhea is pain with menstruation.

A 34-year-old married daycare worker comes to your office, complaining of severe pelvic pain for the last 6 hours. She states that the pain was at first cramp-like but is now sharp. Nothing makes the pain better or worse. She has had no vaginal bleeding or discharge. She has had no pain with urination. She has had some nausea for the last few days but denies vomiting, constipation, or diarrhea. She states she feels so bad that when she stands up she has fainted. Her past medical history consists of two prior cesarean sections and an appendectomy. She is married and has two children. She denies any tobacco, alcohol, or drug use. Her parents are both healthy. On examination you find a pale young woman who is obviously in a great deal of pain. She is lying on her right side with her eyes closed. Her blood pressure is 90/60 and her pulse is 110. She is afebrile. She has bowel sounds and her abdomen is soft. The speculum examination reveals a bluish cervix but no blood or purulent discharge at the os. There is a mild amount of tenderness with palpation of the cervix. The uterus is nongravid but the right adnexal area is swollen and very tender. Urine analysis is normal and the urine pregnancy test is pending. What type of adnexal disorder is causing her pain? A) Ovarian cysts B) Tubal pregnancy C) Pelvic inflammatory disease

Ans: B Feedback: Tubal pregnancies start to cause pain as the fetus grows too large to be contained in the tube. Eventually the tube begins to rupture and bleeding ensues, leading to hypotension, tachycardia, and syncope. On visualization of the cervix, the purple to bluish color of pregnancy may be seen.

A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings? A) Trichomonas vaginitis B) Candida vaginitis C) Bacterial vaginosis D) Atrophic vaginitis

Ans: C Feedback: Bacterial vaginosis generally has a homogenous, grayish-white, thin discharge. The pH will be over 4.5 and the KOH wet prep releases a strong fishy odor, known as a ìpositive whiff test.î Any basic pH fluid (semen or blood) will cause the fish-like odor to occur, often after intercourse, as with this patient. The wet prep will show clue cells, which are epithelial cells with borders stippled by bacteria.

A 28-year-old married clothing sales clerk comes to your clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal deliveries. Her past six Pap smears have all been normal. She is married and has two children. Her mother is in good health and her father has high blood pressure. On examination you see a young woman appearing healthy and relaxed. Her vital signs are unremarkable and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness and both ovaries are palpated and nontender. What is the most likely diagnosis for the abnormality of her cervix? A) Carcinoma of the cervix B) Mucopurulent cervicitis C) Cervical polyp D) Retention cyst

Ans: C Feedback: Cervical polyps are polyps of endometrial cells arising from either the uterus or the cervix. They are benign and usually painless but can bleed during intercourse.

A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over 2 years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer and her father has coronary artery disease, high blood pressure, and Alzheimer's disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep. What form of vaginitis is this patient most likely to have? A) Trichomonas vaginitis B) Candida vaginitis C) Bacterial vaginosis D) Atrophic vaginitis

Ans: D Feedback: The itching and pain with intercourse in atrophic vaginitis are due to the decreased amount of estrogen after menopause. There is generally scant discharge and the wet prep and KOH whiff test are unremarkable. Use of vaginal lubricants or hormonal replacement in selected patients often corrects the problem.

A 42-year-old realtor comes to your clinic, complaining of growths in her vulvar area. She is currently undergoing a divorce and is convinced she has a sexually transmitted disease. She denies any vaginal discharge or pain with urination. She has had no fever, malaise, or night sweats. Her past medical history consists of depression and hypothyroidism. She has had two spontaneous vaginal deliveries and one cesarean section. She has had no other surgeries. She denies smoking or drug use. She has two to three drinks weekly. Her mother also has hypothyroidism and her father has high blood pressure and hypercholesterolemia. On examination you see a woman who is anxious but appears otherwise healthy. Her blood pressure, pulse, and temperature are unremarkable. On visualization of the perineum you see two 2- to 3-mm, round, yellow nodules on the left labia. On palpation they are nontender and quite firm. What diagnosis best fits this description of her examination? A) Genital herpes B) Condylomata acuminata C) Syphilitic chancre D) Epidermoid cyst

Ans: D Feedback: These cysts are small, firm, round cystic nodules in the labia that are nonpainful. These do not represent a sexually transmitted infection, but rather a blocked sebaceous gland.

Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true? A) This is most likely due to lack of lubrication. B) This is most likely due to atrophic vaginitis. C) This is most likely due to pressure on an ovary. D) Psychosocial reasons may cause this condition.

Ans: D Feedback: Vaginismus is an involuntary contraction of the muscles around the vaginal opening. While all of the above may contribute to vaginismus, the psychosocial history must be obtained and frequently is helpful in finding the underlying cause.

What is the diagnostic test for breast CA? A) Tissue Biopsy B) MRI C) CT scan D) Ultra Sound

Answer: A Rational: A biopsy is the only diagnostic procedure that can definitely determine if the suspicious area is cancerous

Women with polycystic ovary syndrome (PCOS) are at higher risk for the following: A) Heart disease and endometrial cancer B) Uterine fibroids and ovarian cancer C) Premature menopause D) Pelvic inflammatory disease (PID)

Answer: A Rational: Chronic anovulation results in high levels of estrogen and androgens in the body. The risk of heart attack is four to seven times higher in women with polycystic ovary syndrome (PCOS) than women of the same age without PCOS. Women with PCOS are at greater risk of having high blood pres- sure and have high levels of low-density lipoprotein (LDL) and low levels of high- density lipoprotein (HDL) cholesterol. Lack of ovulation is usually the reason for fertility problems in women with PCOS. More than 50% of women with PCOS have diabetes or prediabetes (impaired glucose tolerance) before the age of 40. Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not progesterone. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia and cancer.

At what age can you perform pap test with co-testing (HPV testing)?

At the age of 30 years, can perform Pap test with co-testing (HPV testing).

A woman who is in the third trimester of pregnancy presents to the nurse practitioner for a physical exam. During the physical exam, the nurse practitioner finds all of the following cardiac changes associated with pregnancy except: A) Systolic ejection murmur B) Diastolic murmur C) Displaced apical impulse D) Louder S1 and S2

B

The two small mucous glands situated on either side of the posterior wall of the vaginal opening are the: a. Nabothian cysy b. Bartholin's gland c. Skeen glands d. Prepuce

B

Besides the uterus what other organs have estrogen receptors?

Brain, Bones, Liver, Skin, Vascular bed

A new mother who is on her fourth day of breastfeeding complains to the nurse practi- tioner of sore breasts. The nurse practitioner would: A) Recommend a decrease in the number of times she breastfeeds her infant per day B) Recommend that she stop breastfeeding and use infant formula for the next 48 hours C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away D) Recommend that she purchase plastic nipple pads for her nursing bra and use them daily

C

Small red masses just visible on urethral meatus in postmenopausal women are a) skene's glands b) procidentia c) urethral caruncles d) cystocele

C

Specifically what structures produce progesterone?

Corpus luteum and placenta after implantation

During pregnancy, many women develop which cardiovascular change? a) Diastolic murmur b) Hypertension c) Bradycardia d) Systolic murmur

D

Jenny is 19 weeks pregnant. Her titer for measles is negative; she has never had the disease nor the immunization. What is your best course of action? a) Give MMR 1 today and MMR 2 in one month b) Give MMR 1 today but wait until the pregnancy is over before giving MMR 2 c) Wait until third trimester and give MMR 1 and MMR 2 at the appropriate intervals d) Do not give MMR during pregnancy

D Because it is live vaccine and potential development

What is Paget's disease of the breast?

Chronic scaly red-colored rash resembling eczema that starts on the nipple and spreads to the areola of one breast.

What is atrophic vaginitis?

Chronic lack of estrogen in estrogen-dependent tissue of the urogenital tract; results in atro- phic changes in the vulva and vagina of menopausal women.

18-year-old waitress is diagnosed with pelvic inflammatory disease (PID). The cervical Gen-Probe result is positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. All of the following statements are true regarding the management of this patient except: A) This patient should be treated for chlamydia even though the Gen-Probe for chlamydia is negative B) Ceftriaxone 250 mg IM and doxycycline 100 mg PO BID × 14 days are appropriate treatment for this patient C) Advise the patient to return to the clinic for a follow-up visit within 3 days after treatment D) Repeat the Gen-Probe test for Chlamydia trachomatis to ensure that the previous test was not a false-negative result

D Repeat the Gen-Probe test for Chlamydia trachomatis to ensure that the previ- ous test was not a false-negative result Treatment for both gonorrhea and chlamydia is recommended for the diagnosis of pelvic inflammatory disease (PID), regardless of whether the chlamydia test (or gonorrhea test) was negative. Repeating the Gen-Probe test (or another nucleic acid amplification test [NAAT]) for chlamydia is not recom- mended. Pelvic inflammatory disease (PID) is a clinical diagnosis. The Centers for Disease Control and Prevention (CDC) states that an internal vaginal swab specimen is equivalent to a cervical specimen when using the newer NAATs. Self-collected vaginal swabs are equivalent in sensitivity/specificity to those collected by a clinician. Treatment should be initiated as soon as the presumptive diagnosis has been made because preven- tion of long-term sequelae is dependent on early administration of appropriate antibiot- ics. All regimens used to treat PID should also be effective against N. gonorrhoeae and C. trachomatis because negative endocervical screening for these organisms does not rule out upper reproductive tract infection.

What is inflammatory breast cancer?

Highly aggressive, rapidly growing cancer that invades lymphatics and causes skin inflammation. Has poor prognosis.

What are risk factors for candidal vaginitis?

Diabetics, those who are HIV-positive, on antibiotics (i.e., amoxi- cillin), or have any type of immunosuppression are at higher risk.

What triggers the lining of the uterus to be shed?

Drop in estrogen and progesterone

What hormones related to the menstrual cycle come from the anterior pituitary gland?

Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH)

The ovaries are responsible for what phases of the menstrual cycle?

Follicular phase, ovulation, Luteal phase

What are s/sx of menopause (patient complaints)?

Hot flashes and noc sweats; sleep disturbances; vulvovaginal atrophy and dryness; urine leakage; PMS new or worsening; decreased libido; muscle and joint pain; wt gain

What is responsible for the decline in estrogen level?

Inability (or lack of) to mature any follicles

What are the phases of the menstrual cycle in the uterus:

Menstruation, Proliferation phase, Secretory phase

What is candidal vaginitis?

Overgrowth of Candida albicans yeast in the vulva/vagina.

What is Bacterial Vaginosis?

Overgrowth of anaerobic bacteria in the vagina

In a menopausal woman there is a palpable ovary, what do you do?

Rule out ovarian cancer. Order a pelvic/intravaginal ultrasound and refer to a gynecologist

What triggers ovulation?

Surge of LH stimulated by the rise in estrogen

What is the Bethesda system?

System of reporting cervical pathology results from cervical cytology (pap test) combined with HPV testing.

True/false: Ectopic pregnancy is the leading cause of death for women in the first trimester of pregnancy in the U.S.?

True

True/False: Cervical extropion is benign?

True It is a benign finding, made up of glandular cells (same cells that are inside the cervical os). It is more friable (bleeds easily) compared with the squamous epithelial cells on the surface of the cervix

True/false: It is not recommended to do Pap tests or human papillomavirus (HPV) testing before age 21 years.

True: Cervical cancer is rare before age 21 years. Therefore, the USPSTF (2012) does not recommend Pap tests or human papillomavirus (HPV) testing before age 21 years (do not co-test for HPV before age 21).

True/False: It is common for both girls and some boys to have tender and asymmetrical breasts?

True: It is common for both girls and some boys (45%) to have tender and asymmetrical breasts (gynecomastia). One breast may be larger than the other breast.

What are some risk factors for osteoporosis?

female white/asian increase age low body weight smoking inactivity certain medications (chronic steroids, PPIs) alcohol calcium/vitamin D deficiencies Hyperthyroidism RA Estrogen deficiency

What is the luteal phase?

period of corpus luteum activity (days 14-28) -Progesterone is the predominant hormone during the last 2 weeks of the cycle. It is produced by the corpus luteum and helps to stabilize the endometrial lining.

What is the follicular phase/proliferative phase?

period of follicle growth (days 1-14)

What hormones do the ovaries produce?

progesterone, estrogen, inhibin, relaxin