WOMEN'S HEALTH EXAM REVIEW QUESTIONS AND ANSWERS 2022

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WOMEN'S HEALTH EXAM REVIEW QUESTIONS AND ANSWERS 2022 What differentiates pelvic pain from abdominal pain? 1. Pain below the umbilicus is pelvic pain 2. Duration of pain 3. Gender specific 4. A... ge of the patient - ANS-1. Pain below the umbilicus is pelvic pain Primary amenorrhea may be diagnosed by age 15 years. What should be present for this diagnosis? Select all that apply. 1. Normal growth 2. Presence of secondary sexual characteristics 3. Elevated testosterone level 4. Hyperprolactinemia - ANS-1. Normal growth 2. Presence of secondary sexual characteristics Primary Amenorrhea - ANS-Absence of menses by age 15 years (could consider earlier if abnormalities present) • Often secondary to dysfunction in the hypothalamus, pituitary, ovaries, uterus, or vagina • Many causes • Refer for dx, tx DYSMENORRHEA - ANS-Painful cramping associated with menstruation secondary to excessive uterine muscle contraction • Most common GYN problem in adolescents and many adult females • Get a good HISTORY!!! • Primary vs. Secondary Primary Dysmenorrhea - ANS-Absence of pelvic pathology but likely have a lot of prostaglandins being produced • Usually starts in adolescence • Pain starts 1-2 days prior to onset of menses, then resolves over the next 12- 72 hours • May present with nausea, diarrhea, fatigue, dizziness, HA, back pain • Improves with NSAIDs, hormonal contraceptives • Improves with age and parity Secondary Dysmenorrhea - ANS-Get a good history (medical and menstrual) • Physical exam Purpose: Rule out a secondary cause (pelvic pathology-endometriosis, adhesions, fibroids, PID) • Pelvic exam (consider deferral for young, non-sexually active adolescents with mild symptoms) • Consider pelvic US to look for adnexal masses, fibroids, other pelvic pathology Once Primary Dysmenorrhea is established... - ANS-Non-Pharm Management • Exercise improves symptoms • Heat to the lower abdomen is as effective as oral analgesics for relief Pharm Management - ANS-NSAIDs: 80-86% response rate (Start at onset of menses for 1-2 days or for duration of pain) •Hormonal contraceptive therapy (OK for first line tx) •If treatment with NSAIDs or hormonal contraceptives fails, try the other •Consider treatment with both •Consider secondary cause for failure of first and second line tx Polycystic Ovarian Syndrome (PCOS) - ANS-Chronic, complex endocrine disorder associated with oligo-ovulation and/or anovulation •Characterized by formation of cysts in the ovaries (hence, "polycystic") •Common endocrinopathy; affects 6.5 -8% of females •Endocrine Society has a diagnostic algorhythm; Rotterdam Criteria for diagnosis Polycystic Ovarian Syndrome (PCOS) - ANS-Cutaneous symptoms: acne, hirsutism, alopecia, acanthosis nigricans •Anovulatory symptoms: amenorrhea, oligomenorrhea, dysfunctional uterine bleeding,and infertility (typically begins in teenage years) •Hyperinsulinemia: Increased insulin level increase artherosclerosis •Mood disorders especially in adolescents Differential Diagnosis - ANS-Pregnancy! •Congenital adrenal hyperplasia •Thyroid dysfunction •Cushing's syndrome •Androgen secreting tumors • Others Diagnostic Studies - ANS-Testosterone: increased (but < 150 ng/dL), most sensitive measure of hyperandrogenemia •Pregnancy test •Lipid studies (decreased HDL s;elevated trigs, LDLs) •OGTT (oral glucose tolerance test) (more sensitive /specific than FBG/A1C) •Doppler ultrasound of ovaries (string of pearls) Management for PCOS - ANS-Weight loss(may restore ovulation) , exercise, stress management If pregnancy not desired - ANS-To Treat Androgen Exces: Estrogen/progestin contraceptive (first line treatment) treats acne, hirsutism and protects the endometrium OR drospirenone ( analogue of spironolactone) OR Both •Metformin if needed for glucose regulation, reduces insulin secretion (BUT no longer routinely recommended -not supported by the data If pregnancy desired - ANS-Weight loss should always be attempted initially; this may restore ovulation •REFER -Clomiphene first line (Clomid®) OR Letrozole (more effective in obese women) Possible complications with PCOS - ANS-Endometrial cancer (due to d eficient progesterone secretion) •Postmenopausal breast cancer •Ovarian cancer •Hyperlipidemia •Hyperinsulinemia and insulin resistance •Diabetes mellitus ; metabolic syndrome •Cardiovascular disease •Infertility (due to infrequent ovulation) 1. A 4 year-old female is brought in to the clinic by her mother who reports that she is constantly scratching "her private part". The patient states that it itches. On exam, the vagina is red and irritated. How should the NP proceed? A) Call child protection for suspected sexual abuse B) Prescribe a cortisone cream C) Collect a vaginal swab of the external vagina for microscopic evaluation D) Prescribe a topical antifungal - ANS-C) Collect a vaginal swab of the external vagina for microscopic evaluation Explanation: This child has a vaginitis. There are many diagnoses in the differential including pinworms, yeast, contact irritants from soap or bubble bath, etc. Since the diagnosis is not clear, some evaluation must occur in order to determine the diagnosis so proper treatment can be initiated. Since the description of the problem does not indicate what the diagnosis is, it is inappropriate to treat with a cortisone cream or topical antifungal. Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually transmitted disease (STD)? CONTINUES... [Show More]

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