Nrnp 6552 exam questions and answers
Nrnp 6552 exam questions
nrnp 6552 midterm exam
nrnp 6552 week 2 assignment
nrnp 6552 week 8 discussion
nrnp 6552 week 4 discussion
NRNP 6552 Final Exam
Question 1
WIC is a federally operated assistance program that also offers dietary counseling and provides vouchers for healthy foods for women living at or below 185% of the poverty level. WIC stands for:
A. Women in Care
B. Why I Care
C. Women, Infants, and Children
D. Wonderful Infants and Children
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Question 2
Ibandronate (Boniva, a medication for osteoporosis, can be administered: NRNP 6552 Final Exam
A. Orally
B. Through an IM injection
C. Intravenously
D. A and C
E. A, B, and C
Question 3
Osteoporosis is characterized by:
A. Low bone mass
B. Deterioration of bone tissue
C. Disruption of bone architecture
D. All of the above
Question 4
The three trisomies for which testing is offered during the second trimester are:
A. 13. 18, 21
B. 16, 19, 21
C. 3, 9, 19
D. 16, 21, 22
Question 5
The following are differential diagnoses for pelvic pain that are of gynecologic origin except: NRNP 6552 Final Exam
A. Interstitial cystitis
B. Mittelschmerz
C. Fibroids
D. Uterine prolapse
Question 6
Progestin-only methods are:
A. Likely to improve menstrual symptoms
B. Unlikely to ever cause breakthrough bleeding
C. A and B
D. None of the above
Question 7
Contractions that may occur in early pregnancy are called:
A. Souffle contractions
B. Chadwick contractions
C. Uteroplacental contractions
D. Braxton-Hicks contractions
Question 8
The following are foods to avoid during pregnancy except:
A. Soy products
B. Unpasteurized milk
C. Raw eggs
D. Raw alfalfa sprouts
Question 9
In a woman who is 20 weeks pregnant, the fundus is typically the same height as:
A. The symphysis pubis
B. The umbilicus
C. The xiphoid process
D. None of the above
Question 10
With prepackaged lunch meat, hot dogs, pate, and meat spreads there is an increased risk of:
A. Toxoplasmosis
B. Cytomegalovirus
C. Listeriosis
D. Coliform bacteria
Question 11
The HPV vaccine is contraindicated in:
A. Pregnancy
B. Breastfeeding
C. Males
D. A and B
E. A, B, and C
Question 12
When discussing contraception, LARC stands for:
A. Less aggressive reversible contraception
B. Long awaited reversible contraception
C. Long acting reversible contraception
D. None of the above
Question 13
Prior to giving semen for an analysis, a male should be abstinent for:
A. 24 hours prior to the test
B. 2-5 days prior to the test
C. 2 weeks prior to the test
D. None of the above
Question 14
As women age, adipose tissue is redistributed and begins to accumulate in the:
A. Hips and thighs
B. Breasts
C. Waist
D. Triceps area
Question 15
A generic prenatal vitamin supplement should be prescribed and should include:
A. Iron, folic acid, and vitamins
B. Mercury, folic acid, and vitamins
C. Vitamins only with no other supplements
D. Iron and Vitamins with no other supplements
Question 16
A complete male evaluation usually includes:
A. Two semen analyses, approximately one hour apart
B. Two semen analyses, approximately one month apart
C. One complete semen analysis
D. A fractionated semen analysis
Question 17
Physiologic methods of contraception include: NRNP 6552 Final Exam
A. Abstinence
B. Coitus interruptus
C. Lactational amenorrhea method
D. B and C
E. A, B, and C
Question 18
All of the following are barrier methods of contraception except
A. Male condom
B. Female condom
C. Diaphragm
D. Coitus interruptus
Question 19
A woman who is pregnant should never lift more than _ during pregnancy.
A. 10 pounds
B. 22 pounds
C. 28 pounds
D. 36 pounds
Question 20
Paula is 30 weeks pregnant and is in your office today. She is very concerned about her stretch marks. She wants to know if there is anything, she can put on them to make them go away. She has seen a few products on infomercials and wonders if they work. You tell her:
A. There are a few products on the market which have proven to be very helpful in making stretch marks disappear
B. Despite advertiser’s claims, there is no magic cream to prevent them or make them go away.
C. Watching weight gain and eating nutritiously can help decrease their number and severity
D. B and C
Question 21
Vulvovaginitis in the vulva and vagina can be caused by which of the following organisms? NRNP 6552 Final Exam
A. Bacteria
B. Fungi
C. Protozoa
D. All of the above
Question 22
It is believed that women acquire most of their bone mass
A. As infants
B. In early adolescence
C. In their 20’s
D. In their 50’s
Question 23
The progestin implant is __ inserted into the upper arm.
A. A single rod
B. Two rods
C. 6 rods
D. None of the above
Question 24
Annabelle is a 17-year-old who came in to see you because she is concerned about a “lump” in her right breast. She first noticed it about a month ago and it has not changed in size since then. On exam you note the mass to be about 2 cm in diameter at about 7:00 on her breast. It feels well-delineated and is freely mobile. There is no nipple discharge. You decide to proceed with imaging. The best diagnostic imaging test for this patient would be: NRNP 6552 Final Exam
A. MRI
B. Diagnostic mammography
C. Ultrasound
D. CT scan
Question 25
When assessing fetal heart tones with the doppler, the normal range is:
A. 60-80 BPM
B. 100-120 BPM
C. 120-160 BPM
D. 160-200 BPM
Question 26
The copper IUD is a T shaped device and
A. Is made entirely of copper
B. Is made of polyethylene with copper wire around the stem and arms
C. Releases hormones from the copper to help prevent pregnancy
D. Does not really have copper; it is just called the copper IUD
Question 27
Your patient, Autumn, is 9 weeks pregnant and is asking you if she should have a flu shot this year as it is flu season. You tell her:
A. She should wait until the second trimester and then have the flu shot.
B. She can have the flu shot anytime during the pregnancy
C. Flu shots are contraindicated during pregnancy
D. The flu shot should be administered in the delivery room as soon as the baby is delivered NRNP 6552 Final Exam
Question 28
The bluish hue that the cervix takes on during pregnancy is called:
A. Goodell’s sign
B. Baby Blues sign
C. Cervical ripening sign
D. Chadwick’s sign
Question 29
Blood serum pregnancy tests can detect the presence of HCG __ days after fertilization.
A. 24 hours
B. 1-3 days
C. 3-5 days
D. 8-10 days
Question 30
How long is the vaginal ring left in place?
A. 1 week
B. 2 week
C. 3 week
D. 3 month
Question 54
What factors can cause premature menopause?
A. Smoking
B. Autoimmune disorders
C. A women’s mother had early menopause
D. All of the above
Question 55
The following are warning signs of pregnancy except:
A. Bleeding more than light spotting
B. Severe abdominal pain
C. Extreme nausea and vomiting
D. Braxton-Hicks contractions
Question 56
When a woman is pregnant and calculating the last menstrual period (LMP), it should be counted from:
A. The first day of the last period
B. The last day of the last period
C. The middle of the last period
D. None of the above NRNP 6552 Final Exam
Question 57
To reduce risk of illness during pregnancy, fish and shellfish should be:
A. Served raw
B. Cooked thoroughly
C. Served at every meal
D. Encouraged as often as possible
Question 58
The vaginal ring (Nuva ring) is:
A. Replaced on a weekly basis
B. Left in place for 21 days and then removed for a week
C. Replaced on a monthly basis
D. Placed in the vagina at least 2 hours prior to intercourse and removed at least 6 hours after intercourse
Question 59
All of the following are risk factors for fetal genetic or development abnormalities in maternal, paternal, and family history except:
A. Maternal age equal or greater than 30 years
B. Mother and father related by blood
C. Maternal exposure to toxins
D. Congenital blindness or deafness
Question 60
A woman with a normal BMI of 18.5-24.9 should ideally gain __ pounds during pregnancy.
A. 11-20
B. 15-25
C. 25-35
D. 28-40
Question 61
The following are LARC methods of contraception except: NRNP 6552 Final Exam
A. Mirena
B. Nexplanon
C. Liletta
D. Oral contraceptives
Question 62
A blood test can help confirm if a woman is beginning menopause. The test measures the level of which of these?
A. Follicle-stimulating hormone
B. Estrogen
C. Progesterone
D. Cholesterol
Question 63
The current FDA approval limit for the copper IUD is:
A. 3 years
B. 5 years
C. 7 years
D. 10 years
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Question 64
The following are risk factors for breast cancer except:
A. Menarche after the age of 12
B. Nulliparity
C. Menopause at age 55 years or older
D. First full-term pregnancy after age 30
Question 65
While there is no conclusive data on safe doses, caffeine intake during pregnancy should be limited to approximately __ mg daily.
A. 50
B. 100
C. 200
D. 400
Question 66
All women should be offered testing for cystic fibrosis carrier status during pregnancy. This test should be done: NRNP 6552 Final Exam
A. Only once in a lifetime, as the status will not change
B. With every pregnancy that results in a live birth
C. With every pregnancy, including those that do not result in a live birth
D. Every five years
Question 67
Progestin-only contraceptives are generally considered safer for women who:
A. Have a diagnosis of Diabetes
B. Experience Migraines with aura
C. Are 15 or younger
D. Overweight
Question 68
Advantages off the Lactational Amenorrhea method include all of the following except:
A. It is readily available
B. It can be used immediately postpartum
C. It is free
D. It is the most effective method of birth control
Question 69
When taking alendronate (Fosamax) for postmenopausal osteoporosis,
A. It should always be taken with food
B. It should be taken first think in the morning on an empty stomach
C. It should be taken with an 8 oz glass of water
D. B and C
Question 70
When the cervix softens in pregnancy, this is called:
A. Goodell’s sign
B. Cervical lip sign
C. Mucus plug sign
D. Vulvar sign
Question 71
When presenting the laboratory tests that should be performed during the pregnancy it is important to let the woman know: NRNP 6552 Final Exam
A. She must have all the recommended tests done or it can be considered child abuse
B. She is required to have all tests done, except for the HIV test
C. She can “opt out” of any test
D. She should make sure that her partner signs the consent for all the tests done.
Question 72
Nonlatex condoms:
A. Fit tighter on the penis than latex condoms
B. Come in a variety of colors
C. Have an increased risk of breakage or slippage during intercourse than latex condom
D. Lead to a greater incidence of allergies than latex condoms
Question 73
In a patient with irritable bowel syndrome, a diet that eliminates _ is recommended.
A. Fat
B. Carbohydrates
C. Protein
D. Purine
Question 74
When using the TNM system for staging cancers, the letters stand for:
A. Tumor, nodes, melanoma
B. Tumor, nodes, metastasis
C. Tension, number, metastasis
D. Tumor, number, metastasis
Question 75
Paula also asks you about the dark line that starts at her sternal notch and goes down toward the genitalia vertically. You tell her that is called _ and that is normal in pregnancy and may appear due to increasing levels of melanocyte-stimulating hormone. NRNP 6552 Final Exam
A. Linea alba
B. Striae gravidarum
C. Linea nigra
D. Melanin
Question 76
The following routines can help with sleep patterns:
A. Taking a warm bath
B. Exercising
C. Changing into sleepwear
D. A and C only
E. All of the above
Question 77
When performing a semen analysis, the following is/are measured:
A. Semen volume
B. Total motility
C. pH
D. A and B
E. A, B, and C
Question 78
HPV can be spread through:
A. Skin-to-skin genital contact
B. Only through actual intercourse
C. The air as it is an airborne virus
D. Dirty needles
Question 79
The following are presumptive signs of pregnancy except:
A. Urinary frequency
B. Nausea and vomiting
C. Fatigue
D. Nipple lightening
Question 94
Sometime in the last month of pregnancy, the fundal height drops slightly. This is called: NRNP 6552 Final Exam
A. Lightening
B. Flexing
C. Pubic cradling
D. Hegar’s sign
Question 95
The first-line medication for ovulation induction in women who do not have PCOS is:
A. Clomiphene citrate
B. Letrozole
C. Pergonal
D. Follistim
Question 96
Pelvic adhesions can be caused by:
A. Previous surgeries
B. Infection
C. Endometriosis
D. All of the above
D
Question 97
Urine pregnancy tests are considered to be:
A. Reliable
B. Unreliable
C. Expensive
D. Invasive
Question 98
The following are preventive factors for the development of ovarian cancer:
A. Pregnancy resulting in at least one full-term birth
B. Factors that inhibit ovulation
C. Breastfeeding
D. A and C
E. A, B, and C
Question 99
When using the Bethesda system to categorize epithelial cell abnormalities on pap smear, the term used when squamous cells do not appear completely normal, but it is not possible to determine the cause of the abnormal cells is; NRNP 6552 Final Exam
A. ASC-H
B. ASC-US
C. HSIL
D. LSIL
A
Question 100
The Tanner scale divides sexual physical maturity into __ stages
A. Three
B. Five
C. Seven
D. Nine
NRNP 6552 Final Exam
feminist perspective
A perspective that acknowledges the oppression of women within a patriarchal society that also struggles toward the elimination of sexist oppression and the domination of all human beings.
Alcohol Consumption and Women
Recommended daily intake limit? Possible Risks?
Alcohol is hazardous for a woman who has either more than 7 drinks per week or more than 3 drinks per day. This amount put’s women at risk for developing AUD (Alcohol Dependance Disorder). #Alcoholism
Tanner Stages
A scale used to assess the sexual maturity and puberty in both sexes. This scale involves 5 stages that involve development of breast and public hair growth and divides sexual physical maturity that extend from adolescence into adult hood.
Tanner Scale Stage One
Stage one: small nipples no breast, no pubic hair, no signs of puberty scrotum, testes, and penis are the same as in childhood
Tanner Scale Stage Two
Stage two: Breasts and nipples have just started to grow, the areola has become larger, breast tissue bud feels firm behind the nipple, initial growth of pubic hair that is light in color and not curled.
Initial growth of scrotum and testes. The skin on the scrotum has become redder, thinner, and more wrinkled. The penis may have grown a little in length. Few hairs around the root of the penis. the hairs are straight without curls, and light in color.
Tanner Scale Stage Three
Stage Three: breasts and nipples have grown additionally. The aureola is darker and the breasts tissue buds have gotten larger. The public hair is more widespread. The hair is darker, and curls may have appeared.
the penis has now grown into length. Scrotum and testes have grown. The skin of the scrotum has become darker and more wrinkled.
Tanner Scale Stage Four
Nipples and aerolas are elevated and form an edge towards the breast. The breast has also grown a little larger. More dense pubic hair growth with curls and dark hair. Still not entirely as an adult womens.
the penis has grown in both length and width. The head of the penis has become larger. The scrotum and testes have grown more dense curly and dark hair. the hair growth is reaching the inner thighs.
Tanner Scale Stage Five
Fully developed breasts. Nipples are protruding. the edge between aerola and breast has disappeared. Adult hair growth.. Dense curly hair extending towards the inner thighs.
Penis and scrotum as an adult. Public hair extends upwards up to the umbilicus. It is dense and curly.
Primary prevention vs. Secondary Prevention vs Tertiary prevention
Primary prevention: Includes preventative measures that come BEFORE THE ONSET of a disease, illness, or injury, and BEFORE the disease process begins. Examples are, HPV vaccination, Safe sex practices, immunizations, health education, and counseling.
Secondary Prevention: Includes those preventive measures that lead to early diagnosis and prompt treatment of disease, illness, or injury. Examples are, Pap smears, HIV testing, HPV testing, syphilis testing. routine lab screening for early detection of disease.
Tertiary Prevention : Limits the ability and promotes rehab from clinical disease states. (Disease and illness is already here).
U.S. Preventive Task Force
Who are they? What do they do? what do they recommend?
They are an independent volunteer panel or national experts in disease prevention and evidence-based medicine.
They work to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.
American College of Obstetrics and Gynecologists recommendations
Membership organization dedicated to the advancement of women’s health care and the professional and socioeconomic interests of its members through continuing medical education , practice, research, and advocacy.
Preventable causes of death for women
The leading causes of death in women in the U.S. are related to modifiable, behavioral risk factors.
Smoking
Obesity
High Blood Pressure
Women’s Health Statistics
What is the leading cause of death in females of all races and all origins?
Heart disease (21.8%), Cancer (20.7%), and Chronic Lower Respiratory Disease (6.2%).
Women Health Statistics-What is the most common gynecological cancer in the U.S.?
Uterine cancer
Women’s Health Statistics
What gynecologic cancer in women causes the most deaths?
Ovarian Cancer
Women’s Health Statistics
What gynecological cancer is the MOST preventable?
Cervical cancer used to be the leading cause of cancer in women however due to regular pap testing cervical cancer has decreased significantly. Cervical cancer is also the MOST PREVENTABLE and the ONLY gynecological cancer with a screening test and a vaccine
List all of the possible gynecological cancers for women?
Uterine, Ovarian, Cervical, Vaginal and Vulvar.
The HPV vaccination protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers. Recommended for pre teens ages 11-12 but can be given as early as 9 until age 26 ( this range will likely be on test but as of 2020 that range has been extended until the age of 40).
What are the advantages of taking an oral contraceptive for more than five years?
Ovarian and endometrial cancers decrease by 40-50%
What are the disadvantages of taking an oral contraceptive for more than five years?
Increases risk of breast and cervical cancers, even tho it lowers risk of ovarian and endometrial.
Unintended pregnancy Statistics
Unintended pregnancy rates per 1,000 women were highest among women who are
- 18-24 years old
- Low income, < 100% of federal poverty level
- Had never completed high school
- Were Non-hispanic black or african american
- Were cohabiting but never married.
Most unintended pregnancies result from not using contraception consistently or correctly or at al.
Cultural Perspective of Women
To create a culture in health care settings where providers must educate themselves about the health needs and concerns of the population and create environments that are welcoming, nonthreatening, and normalized to people of ALL gender, identities, and sexual orientations.
World Health Organization (WHO): Who are they and what do they do?
They are a world health org that plays an essential role in the global governance of health and disease. They establish, monitor, and enforce international norms and standards.
They define health as a ” state of complete physical, mental, and social well-being and not just the absence of disease or infirmity”. * Definition of Infirmity means physical or mental weakness***
HIV Screening Recommendations
The CDC recommends HIV screening as a routine part of clinical care for patients ages 13-64 in ALL health care settings. Patients who present for STI treatments should be screen for HIV at each visit.
Screening Guidelines for IPV (Intimate Partner Violence).
All women of childbearing ages 14-46 should be screened for IPV.
Factors that put women at risk for IPV
Pregnancy, history of depression, low self-esteem, poverty, unemployment, controlling partner, and community or family with male dominant forms.
Definition of rape
There is still no clinical definition of sexual assault or rape that has gained acceptance. clinicians should become familiar with their states definitions and corresponding laws.
The revised UCR definition of rape is: Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.
Genital Trauma and Rape Statistics
1 in 5 women have been raped at one point in there life.
Victims of rape are less likely to report their perpetrator if they know the person
80% of assaults are either a former partner, friend, family, member or acquaintance
Evidentiary Examination of a Rape Victim
A evidentiary collection kit should be used and instructions on how to collect, preserve, seal, and store samples should be followed. Collection should be done AFTER inspection of the area and prior to palpitation or physical manipulation of the area. STD possibility should be treated prophylactically even if tested negative, pregnancy test should be given and emergency contraception may be given up to 120 HOURS OF THE ASSAULT (A SINGLE DOSE OF LEVONORGESTREL (PLAN B) 1.5 MG.
What does the Pneumonic EMPOWER stand for?
It is used for intimate partner violence and stands for…
Empathetic listening
Making time to properly document findings
Provide information about domestic violence
Offering options and choices
Working with a domestic abuse specialist
Encouraging the planning for safety and support
Referring to local services
Gravida Para Abortus system GTPAL
Gravidity= the number of pregnancies
Para= deliveries aka same thing as term; Ex. G2P1 1 abortion LC 1 vaginal birth
Term: Term deliveries (38 weeks or more)
Preterm: deliveries up to 37 weeks
Abortus/Miscarriages : Abortion (surgical or miscarriage)
LC=Living Children
P: Para= number of births of viable offspring
Healthy People 2020 who they are and why they are important
Devised using a framework that focuses on determinants of health with an extra focus on social determinants (Personal, social, economic). Healthy people focus areas include…
- Cancer
- HIV
- LBGQT health
second definition from the CDC’s website on healthy people 2020 objectives
provides science-based, 10-year national objectives for improving the health of all Americans. Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors; empower individuals toward making informed health decisions; measure impact of prevention activities.
American College of Nurse-Midwives (who can they treat?) definition of scope of practice
primary care providers throughout the lifespan with a special emphasis on pregnancy, childbirth, and gynecological reproductive health.
Hyperandrogenism
An endocrin disorder that results in excessive levels of androgens ( male sex hormones such as testosterone) in the female body. S/S muscular male like body, deepening voice, clitoromegaly, increased iibido, menstrual irregularity, HTN, Hyperlipidemia, glucose intolerance, hirsutism (aka dark course hair in male like matters on face, chest, back). , alopecia, acanthosis nigricans (discolored dark velvety patches in skin folds and creases (armpits, groin, and neck (underlying obesity, tumor, or cancer causes A.N) oily skin, and acne.
Quick Patho: POS –> inc testosterone levels (causes hirsutism (aka facial hair), insulin resistance and hyperinsulemia, –>Inc LH (luteinizing hormone)
Causes: Usually POS (polycystic ovarian syndrome causes 80-90% of cases
Diagnosis includes
Serum Testosterone (normal 20-80)
Serum 17a-hydroxyprogesterone (normal <2)
dehydroepiandrosterone (normal 250-300)
Dexmethasone supression Test,LH, lipid profile
BMI Formula what is considered overweight and underweight
Weight (Lbs) x 703/height (in) squared
BMI
19-24=Normal
25-29 =overwight
30-39= obese
40 extreme obese
Screening for Thyroid Dysfunction
TSH screening in all adults ages 35 and repeated tests every 5 years thereafter. If s/s of thyroid problems screened again and if abnormal screenings should be done yearly.
Pregnant women should have TSH measured immediately after becoming pregnant goal TSH levels 2.5-3.5. (Women who are pregnant should only use levothyroxine alone and not combined with any other medications for the thyroid especially liothyronin (triostat).
Screening for Rubella Immunity
A rubella blood test looks for IgG antibodies made by the immune system and will stay in the blood stream for years. The IgG antibodies are produced by the immune system in response to a recent infection, a past infection, or that you have received the vaccine. Women who do contract rubella when they are pregnant are at risk for miscarriage, still birth, and fetal defects with the most common birth defect being DEAFNESS
Osteoporosis screening, risk factors, how to measure risk, the name of the screening test
The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. Those at risk should be screened at age 60
Risk Factors include…
- postmenopausal women younger than the age of 65 with atleast one risk factor
- parental history of hip fracture
- smoking
- excess alcohol consumption
- low body weight.
Best way to measure risk is to use a clinical risk assessment tool. Several tools are available to assess osteoporosis risk, such as OST, ORAI, OSIRIS, SCORE, and FRAX.
SCREENING
The most commonly used test is central DXA of the hip and lumbar spine this provides measurement of bone mineral density, and most treatment guidelines use central DXA to define osteoporosis and the treatment threshold to prevent osteoporotic fractures. Other screening tests include peripheral DXA and quantitative ultrasound.
The U.S. Food and Drug Administration has approved multiple drug therapies to reduce osteoporotic fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen. The choice of therapy should be an individual one based on the patient’s clinical situation and the trade-off between benefits and harms.
Other relevant USPSTF recommendations
The USPSTF has made recommendations on interventions to prevent falls in community-dwelling older adults and the use of vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults.
Screening for Cardiovascular Disease
Blood pressure screening at each health care visit and once a year if low bp.
Cholesterol checked every 4-6 years for normal risk if elevated than yearly
BMI yearly at annual well visit
Smoking and physical activity at each visit
If abnormals, EKG and stress tests. EKG yearly if HTN.
Risk factors
older age, male sex, high blood pressure, current smoking, abnormal lipid levels, diabetes, obesity, and physical inactivity. Several calculators and models are available to quantify a person’s 10-year risk of CVD events; the USPSTF recommends that clinicians use the Pooled Cohort Equations to assess CVD risk.
Treatments
Asymptomatic adults at increased risk of CVD events are usually treated with a combination of diet and exercise modifications, lipid-lowering medications, aspirin, hypertension management, and interventions to encourage tobacco cessation.
Other relevant USPSTF recommendations
The USPSTF has made recommendations on many factors related to CVD prevention, including screening for high blood pressure, use of statins, counseling on smoking cessation, and counseling to promote healthful diet and physical activity. In addition, the USPSTF recommends low-dose aspirin use in certain persons at increased risk of CVD events.
Why do we screen for TYPE 2 DIABETES but not TYPE 1?
TYPE 1 DIABETES
Screening for type 1 diabetes is not recommended for the following reasons: patients typically present with an acute onset of symptoms, no established cutoff value is available for antibody tests, no accepted treatment exists for patients who are asymptomatic, and no medication is available to prevent the disease in persons genetically predisposed to type 1 diabetes
TYPE 2 DIABETES
Screening is recommended for type 2 diabetes because reliable tests are available, and lifestyle changes and medications reduce progression and adverse sequelae of the disease, even in persons who are initially asymptomatic.
Diabetes in women (pregnant and nonpregnant)
(USPSTF) recently updated recommendations and suggests screening individuals 40 to 70 years of age who are overweight or obese. Persons with abnormal results should be referred for intensive behavioral counseling interventions focusing on physical activity and a healthy diet. Clinicians should consider screening certain individuals at higher risk. repeat screening every 3 years and a fasting blood glucose yearly.
PREGNANT WOMEN-Glucose test is done between 24-28 weeks. The test may be performed earlier if high glucose levels are in the urine or if they had Gestational DM in previous pregnancies.
CERVICAL CANCER AND SCREENING
Pap-test 21-65 (cervical cancer screen)
New screening interval was recently updated from annually to once every three years if normal
Co-testing with HPV via PAP every 5 years for ages 30-65.
Colorectal Cancer Screening
USPSTF recommends screening all adults ages 5-75 years old. Early screening in women if a first degree relative had colorectal cancer at a young age. If they have inflammatory bowel disease, or rare genetics such as familial adenomatous polyposis or nonpolypous
Use of the Rectovaginal examination
perform with the patient laying in a supine lithotomy position (lithotomy means with legs up in stirrups). Used in a person who has a retroflexed or retroverted uterus. allows palpitation to depth of 2.5 cm’s more than transvaginal ultrasound. This is very uncomfortablly and usually omitted unless very necessary.
Types and Sizes of speculums
There are three main types of cervical speculum: pediatric, Pederson and Graves. They come in plastic and medal.
The Pediatric Speculum (smallest most narrow)
Shorter in length, the pediatric speculum is intended for use in patients who have never had sexual intercourse and therefore have narrower vaginal canals
The Pederson Speculum
Flat and narrow, the Pederson speculum is a vaginal speculum used during OB/GYN examinations when women have narrow vaginal canals. This condition can be caused by traumatic injuries and the resulting scar tissue, but is also found in elderly women and women who have never had sexual intercourse. Using this narrow speculum type can eliminate some of the discomfort of a pelvic exam. (also used in menopausal women, transgender men on testostrone, transgender women with neovagina.
The Graves Speculum (resembles a ducks mouth in appearance)
The Graves speculum is the most common variety used by OB/GYNs. This vaginal speculum is commonly available in multiple sizes: small, medium and large. Used in Sexually Active Women.
Normal vs Abnormal Pap smears
checks for cervical intraepithelial neoplasia. Normal results show negative for cell changes to cervix. Abnormal shows positive for cell changes to cervix
Abnormal Uterine Bleeding (Diagnostics and lab tests)
The Graves speculum is the most common variety used by OB/GYNs. This vaginalspeculum is commonly available in multiple sizes: small, medium and large. The bills of the Graves speculum, which resemble a duck’s mouth, are wider than the bills of the Pederson speculum, and the sides are also curved
Diagnostics
Pap smear
Vaginal culture
pelvic ultrasound
EMB-Endometrial biopsy
Lab Tests
qualitative/quantitative HcG, CBC with platelets, Pt and PTT, FHS, Progesterone, TSH, Iron, and Prolactin
(Lab Tests Explained)
Prolactin-High levels interfere with the normal production of other hormones such as estrogen and progesterone. This can result in irregular or missed periods, and prevent ovulation. Some women can have high levels and be completely asymptomatic
FHS-
History (EXTRA INFO TO KNOW)
- Pelvic pain? think….
Miscarriage, ectopic pregnancy, PID, trauma, sexual abuse or assault - Nausea, weight gain, urinary frequency, fatigue? think…
Pregnancy - Weight gain, cold intolerance, constipation, fatigue? think…..
Hypothyroidism
4.Weight loss, sweating, palpitations?…..
Hyperthyroidism
5.Easy bruising, tendency to bleed? think… Coagulopathy - Jaundice, history of hepatitis? Think…
Liver disease - Hirsutism, acne, acanthosis nigricans, obesity? Think
Polycystic ovary syndrome - Postcoital bleeding (spotting or bleeding after intercourse unrelated to menstrual cycle)? Think…
Cervical dysplasia, endocervical polyps
9.Galactorrhea, headache, visual-field disturbance?Think
Pituitary adenoma - Weight loss, excessive exercise, stress? Think
Hypothalamic suppression - Thyromegaly, weight gain, edema?
Hypothyroidism - Thyroid tenderness, tachycardia, weight loss, velvety skin? Think…
Hyperthyroidism - Bruising, jaundice, hepatomegaly? Think..
Liver disease - Enlarged uterus?
Pregnancy, leiomyoma, uterine cancer - Firm, fixed uterus? Think
Uterine cancer - Adnexal mass? Think..
Ovarian tumor, ectopic pregnancy, cyst
Uterine tenderness, cervical motion tenderness
PID, endometritis
Laboratory tests
Beta-subunit human chorionic gonadotropin
Pregnancy
Complete blood count with platelet count and coagulation studies
Coagulopathy
Liver function tests, prothrombin time
Liver disease
Thyroid-stimulating hormone
Hypothyroidism, hyperthyroidism
Prolactin
Pituitary adenoma
Blood glucose
Diabetes mellitus
DHEA-S, free testosterone, 173-hydroxyprogesterone if hyperandrogenic
Ovarian or adrenal tumor
Papanicolaou smear
Cervical dysplasia
Cervical testing for infection
Cervicitis, PID
Imaging and tissue sampling
Endometrial biopsy or dilatation and curettage
Hyperplasia, atypia, or adenocarcinoma
Transvaginal ultrasonography
Pregnancy, ovarian or uterine tumors
Saline-infusion sonohysterography
Intracavitary lesions, polyps, submucous fibroids
Hysteroscopy
Intracavitary lesions, polyps, submucous fibroids
Uterine Adenomyosis
endometerial glnds within the myometrium
–> suspect in a multiparous woman who is more than 40 years old presenting with menorrhagia (heavy bleeding) and dysmenorrhea (painful cramps), chronic pelvic pain. The uterus will be tender to palpation during pelvic exam and the uterus is usually enlarged. Definitive diagnosis requires histological analysis of a hysterectomy specimen, but can diagnose based on transvaginal ultrasound
TX: Hysterectomy or uterine artery embolization (if further children are not desired) or if a women desires childen she could benefit from hormonal medications for symptom relief such as LEVONORGESTREL-RELEASING IUD OR ORAL DIENOGEST
Uterine Fibroids
Most common pelvic tumor in women after age 50. 80% in AA women, 70% in white women). Fibroids are benign monoclonal tumors arising from the smooth muscle cells of the myometrium described by their location in the uterus (submucosal, intramural, subseroal, cervical).
Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. Somesubmucosal or subserosal fibroids may be pedunculated — hanging from a stalk inside or outside the uterus.
S/S: Abnormal uterine bleeding, pelvic pressure and pain, reproductive dysfunction
dx: Transvaginal ultrasound
Tx: Surgery is usually the preferred method if causing extensive pain and discomfort..
Menopause causes relief due to steriod hormones decreasing when the menstrual cycle stops. Postmenopausal hormone may cause the pain to resume or current fibroids to grow but will not cause new fibroid growths.
Lichen sclerosus
Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.
s/s thin, white, wrinkled skin localized in the labia minora and majora, but whitening could extend to perineum and around the anus in a keyhole pattern.
MOST COMMON SYMPTOMS: Painful defecations, rectal bleeding, dyspareunia, and dysuria.
fissuring or epithelia hyperplasia from rubbing is common. In end stages the vulva can become fused midline.
TREATMENT: Focused on symptom relief. topical corticosteriod ointment such as clobetasol propionate 0.05% QHS for 6-12 weeks followed by maintenace therapy 2-3x per week if symptoms improve.
Endometriosis
Pelvic endometriosis lesions are categorized as superficial peritoneal , ovarian, and deeply infiltrating. These lesions contain fibrous tissue, blood, cysts in addition to endometrial glands and stroma.
Patho-
S/S-pelvic pain, painful period cramps (dysmenorrhea), dyspareunia (painful sexual intercourse). (occurs typically during reproductive years).
LAB: Does not cause lab abnormalities. Imaging will show endometriomas deep nodules of the rectovaginal septum and bladder detrusor and is staged based on severity.
Definitive diagnosis is made by biopsy and tissue histology to establish a true diagnosis and rule out other causes
Asexual
person who experiences little to no sexual attraction or desire for sexual activity
Binary Gender
person who is attracted to people with both male and female gender identities
Cisgender
individuals whose gender identity matches his or her natal sex
Gay
person with male gender identity attracted to others with male gender identity, umbrella term for non-heterosexual people
Gender
social construction assigning roles and attributes to a person based on their natal sex
Gender Affirmation
process that strives to better align gender expression, social perception, or physical appearance with gender identity
gender expression
outward expression of gender or gender identiy
Gender identity
Internal understanding of oneself in regard to gender
Gender Nonconforming
person who identifies as somewhere in between male and female, both male and female, or having no gender
Intersex
people whose chromosomes are neither XX or XY, whose genitals are ambiguous or incongruent with chromosomal makeup
Lesbian
personal with female gender identity who is primarily attracted to others with female gender identity
Man
a person who identifies as male, regardless of natal sex
Natal female
assigned female at birth based on appearance of genitalia
Natal male
assigned male at birth based on appearance of genitalia
Natal sex
sex designation assigned at birth based on the appearance of genitalia
Nonbinary gender
concept of gender that recognizes gender as existing on a spectrum rather than as a dichotomy
Pansexual
person who is attracted to people of all gender identities, not limited to those with binary gender identities
Queer
umbrella term to describe all people with non-heterosexual gender identities, historically used as a derogatory slur by those outside the LGBTQ community,
Sex
designation based on chromosome and genitalia
Sexual orientation
concept describing one’s sexual attraction, identity, and behavior
Transgender
an umbrella term describing people whose gender identity or expression differs from their natal sex
Transgender woman
natal male who has a female gender identity
Transgender man
natal female who has a male gender identity
Woman
person who identifies as female, regardless of natal sex