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Well woman and contraception
Terms in this set (52)
Indications for pelvic examinations for well-woman exams include
abnormal vaginal bleeding
Cervical cytology that is recommended for women between the ages of 19-29 years includes
Age 21-29: screen every 3 years with cytology alone
Age 30 years and over: Co-test with cytology and HPV testing every 5 years (option to screen cytology alone every 3 years)
What screening options (cytology and/or HPV) are appropriate for a woman between ages 30 and 65 during a well-woman's exam?
She can choose to be screened every 5 years with an HPV co-test (Pap and HPV tests) or every 3 years with cytology (Pap test).
Chlamydia & gonorrhea screening
Sexually active women <24 and older women who are at increased risk for infection.
Breast exams are recommended for woman in physicians office setting how often?
Offer every 1-3 years for women aged 25-39
May be offered annually for women 40 years and over
Colorectal cancer screening is done in what age group?
Start screening at 50 years and continue until the age of 75 years
Breast CA risk factors
-nulliparity and longer intervals between menarche and age at first birth
-older age at first birth, older age at menopause, and younger age at menarche
-Family history of breast cancer, ovarian cancer (including fallopian tube cancer and primary peritoneal cancer), and other types of germline mutation-associated cancer (eg, prostate and pancreatic) are associated with an increased risk of breast cancer.
Breast cancer screening guidelines
The USPSTF recommends screening mammography for women, with or without clinical breast examination, every 1 to 2 (biennial) years for women age 40 years and older.
Beginning at age 50
1. Yearly FOBT
2. FIT yearly (fecal immunochemical test)
3. FIT DNA every 1-3 years
4. Colonoscopy every 10 years
5. CT colonography every 5 years
6. Flex sig every 5 years
7. Flex sig with FIT (flex sig every 10 years PLUS FIT every year)
Diabetes screening recommendations. What about women with risk factors or gestational diabetes?
beginning at age 45 years (If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable.)
Women with gestational diabetes-every 3 years for at least 10 years.
Screen 40-70 year old women who are obese or overweight
Hepatitis C screening recommendations
one-time testing for persons born from 1945 through 1965 and unaware of their infection status
HPV vaccine recommendations for <15 years of age
Two doses of HPV vaccine are recommended for most persons starting the series before their 15th birthday.
-The second dose of HPV vaccine should be given 6 to 12 months after the first dose
-Adolescents who receive 2 doses less than 5 months apart will require a third dose of HPV vaccine.
HPV vaccine recommendations for teens and young adults who start the series at ages 15-26 years of age
Three doses of HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years, and for immunocompromised persons.
-The recommended 3-dose schedule is 0, 1-2 and 6 months.
-Three doses are recommended for immunocompromised persons (including those with HIV infection) aged 9-26 years.
DTaP/Td/Tdap vaccine recommendations
Give infants and children 5 doses of DTaP. Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
Give pregnant women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36.
Give adults a single dose of Td every 10 years. For adults who have never received Tdap, a dose of Tdap can replace one of the 10-year Td booster doses.
What to include in the history for a woman who is 45 years old during a well-woman's exam?
Family history (thalassemias, sickle cell anemias)
Sexual practices: number of partners; exchange drugs or money for sex
Problems with intercourse
Lipid profile should be screened when?
Every 5 years beginning at 45 years of age
Important considerations for nutrition and fitness during well-woman's exam are
Folic acid supplementation
physical activity level
Psychosocial considerations for well-woman's exam are
intimate partner violence
acquaintance rape prevention
Cardiovascular risk factors
Personal history of preeclampsia/gestational diabetes, or pregnancy induced hypertension
CPG for alcohol misuse screening
USPSTF recommends >13 years of age screened annually
USPSTF recommends Low-dosed ASA for individuals aged 50-59 years with ASCVD risk 10% or greater
Blood pressure screening recommendations
USPSTF recommends adults aged 18-39 with normal BP (<130/85) with no other risk factors (obesity, DM, CKD) be screened every 3 years
Depression screening. What are risk factors for depression in pregnancy and older adults?
The USPSTF recommends > or = to 13 years of age annually, and in all pregnant and postpartum women. Risk factors for older women include poor health, disability, loneliness. Pregnant and postpartum risk factors include childcare, lower socioeconomic status, decreased social support
Screening for interpersonal and domestic violence should start at what age?
> or = to 13 years of age
Obesity screening should start at what age?
> or = to 13 years of age
Overweight- BMI 25-29
Obese- BMI >30
Osteoporosis screening recommendations
> or = to 65 years of age
postmenopausal women younger than 65 years
50-64 years of age with women with risk factors (parental history of hip fracture, smoking, white race, excessive alcohol consumption, and low body weight)
Lung cancer screening
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Skin cancer counseling recommendations
13-24 years of age annually
cervical cancer risk factors
-Human papilloma virus (HPV) infection
-Early age at first sexual intercourse.
-Multiple sexual partners and/or partners who have multiple partners.
-Multiple pregnancies (>3 full term pregnancies)
frequent cycle interval (<21 days)
infrequent cycle interval (>35 days)
What hormone causes maturation in the follicular phase of ovarian cycle? What happens?
FSH predominates during days 1-13, the ovarian follicles develop and estrogen secretion by follicles is stimulated
Phases of the ovarian cycle include (in order)
Follicular phase (day 1-14)
Ovulation (day 13-15)
Luteal phase (day 15-28)
Ovulation occurs approximately when?
14 days prior to menses
What is the dominant hormone of the follicular phase?
What is the dominant hormone of the luteal phase?
Variable menstrual cycle length is due to what?
varying lengths of the follicular phase (10-16 days)
LH surge happens how soon before ovulation?
34-36 hours before ovulation
What history is important in a well-woman's exam?
Menstrual history-LMP, age at start of menses, flow of menses, pain with menses, how often is the cycle?
Contraceptive method/which type and how long? Barrier method?
Sexually active? With men/women?
How many partners have you had in your lifetime? Last month? Last week?
Random hook-ups? sex for money? Sex while under the influence of drugs?
When was last screening for STIs
When was last PAP smear?
History of herpes?
Physical exam for a well-woman's exam?
mouth (HSV, HPV)
Chest-heart and lungs
Abdomen- liver palpation
PAP with or without HPV
-Inspect outside for lesions/trauma, discharge
-Inspect perineum and anus
-speculum-inspect walls of vagina
-inspect cervix looking at position (look for discharge, friability-easy bleeding, lesions
Ovulation occurs how many hours after the leutenizing hormone peak?
Prostaglandin synthetase inhibitors, like indocin, can cause what?
block prostaglandin production, which can block follicular rupture. Prostaglandins may stimulate ovum release by stimulation of smooth muscle inside the ovary.
Increasing estrogen levels cause the cervical mucus to what?
become clear, copious and elastic. Thus, treat vaginal dryness with estrogen.
During menstruation, prostiglandins cause what?
uterine contractions and sloughing of the degraded endometrial tissue
Average amount of blood loss during menstruation is what? How much is considered abnormal?
normal menstrual cycle (flow is) how long?
anywhere from 2- 8 days.
Corpus luteum function begins to decrease when?
When is contraception recommended after Ulipristol acetate (UPA) emergency contraceptive?
No sooner than 5 days- regular contraceptive may reduce the effectiveness of UPA
methods to ease IUD insertion?
paracervical block with lidocaine
According to the CDC, there is a low likelihood of pregnancy from days _____ of the menstrual cycle or after a spontaneous or induced abortion
Complications associated with IUDs and pregnancy include what?
spontaneous abortion, septic abortion, preterm delivery and chorioamnionitis
A healthcare provider can be reasonably certain that a woman is not pregnant if she has no signs and symptoms of pregnancy and meets what criteria?
-<7 days after start of her menstrual cycle
-has not had sexual intercourse since the start of her last menstrual cycle
-has been consistently and reliably using a reliable method of birth control
-is <7 days of a spontaneous or induced abortion
-is within 4 weeks postpartum
-is fully or nearly fully breastfeeding (>85% of feeds are breastfeeds), amenorrheic, and <6 months postpartum
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