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What does ASCCP/ACS/ASC P 2020 recommend for cervical cancer screening in individuals younger than 21?

  • Screening is not recommended for this age group (correct)
  • Screening should begin at age 16
  • Screening should occur every year
  • Regular screening should begin at age 18

    • Which organization recommends against cervical cancer screening in individuals younger than 21 years?

  • CDC
  • ASCCP/ACS/ASC P 2020 (correct)
  • ACOG 2016
  • USPSTF 2018

    • What is a key limitation of the cervical cancer screening test mentioned?

  • High specificity and sensitivity
  • Low specificity and sensitivity (correct)
  • High cost and low availability
  • Requires frequent retesting

    • Which guideline explicitly states that screening should not occur in individuals younger than 21?

    <p>ASCCP/ACS/ASC P 2020</p> Signup and view all the answers

    Why is the cervical cancer screening test not recommended by the CDC?

    <p>It has low specificity and sensitivity</p> Signup and view all the answers

    What role does prolactin play in lactation?

    <p>Regulates volume and production of breast milk</p> Signup and view all the answers

    What characteristic distinguishes colostrum from mature milk?

    <p>Thicker and stickier consistency</p> Signup and view all the answers

    When does the production of colostrum typically begin during pregnancy?

    <p>Midpregnancy</p> Signup and view all the answers

    What is a primary benefit of the laxative effect of colostrum on newborns?

    <p>To assist in expelling meconium</p> Signup and view all the answers

    What change occurs in transitional milk compared to colostrum?

    <p>Thinner consistency with more calories</p> Signup and view all the answers

    At what age should women begin routine HPV-based testing?

    <p>25 years</p> Signup and view all the answers

    Women who have had a supracervical hysterectomy should continue with screening because they still have a risk for what?

    <p>Cervical cancer</p> Signup and view all the answers

    How often should women with a history of CIN2 or higher continue cervical cancer screening?

    <p>Every 3 years</p> Signup and view all the answers

    For how long should patients with a limited life expectancy continue cervical cancer screening?

    <p>Not recommended</p> Signup and view all the answers

    What constitutes adequate negative screening in the last 25 years for women over age 65?

    <p>3 negative Pap tests</p> Signup and view all the answers

    What HPV type is responsible for the largest percentage of cervical cancers?

    <p>HPV type 16</p> Signup and view all the answers

    Which HPV type is specifically associated with glandular cancers such as adenocarcinoma?

    <p>HPV type 18</p> Signup and view all the answers

    How many hrHPV assays have been cleared by the FDA?

    <p>5</p> Signup and view all the answers

    Which of the following is a common type of cervical cancer caused by HPV?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Women over the age of 65 with no history of CIN2 should stop screening if they have what?

    <p>Adequate negative prior screening</p> Signup and view all the answers

    Which hrHPV type accounts for 10-15% of cervical cancers?

    <p>HPV type 18</p> Signup and view all the answers

    What is the recommended action for those with inadequate documentation of screening history?

    <p>Continue routine screening for 25 years</p> Signup and view all the answers

    What percentage of cervical cancers is attributed to hrHPV subtypes other than 16 and 18?

    <p>25-35%</p> Signup and view all the answers

    Which two tests are FDA-cleared for primary HPV screening in women 25 years and older?

    <p>cobas HPV test and Onclarity HPV assay</p> Signup and view all the answers

    What management approach should be considered when histology or cytology results are inconclusive?

    <p>Manage according to the highest-grade abnormality found</p> Signup and view all the answers

    What is the recommended daily dosage of elemental calcium for women according to the guidelines?

    <p>1,200 mg</p> Signup and view all the answers

    Which of the following is considered a first-line drug therapy for osteoporosis?

    <p>Bisphosphonates</p> Signup and view all the answers

    What does the term 'urge incontinence' primarily relate to?

    <p>Detrusor instability leading to involuntary leakage</p> Signup and view all the answers

    What condition does the acronym 'DIAPPERS' help to identify in relation to urinary incontinence?

    <p>Causes of urge incontinence</p> Signup and view all the answers

    Which of the following factors is associated with stress incontinence?

    <p>Pelvic floor muscle weakness</p> Signup and view all the answers

    What is the recommended daily dose of Vitamin D supplementation?

    <p>800 to 1000 IU/day</p> Signup and view all the answers

    Which term is not widely used but describes urinary leakage from an overdistended bladder?

    <p>Overflow incontinence</p> Signup and view all the answers

    What health issue is primarily addressed by pharmacologic therapy guidelines mentioned?

    <p>Osteoporosis</p> Signup and view all the answers

    Which of the following causes of abnormal uterine bleeding is categorized as structural?

    <p>Endometrial polyps</p> Signup and view all the answers

    Which laboratory test is considered the first-line for individuals where pregnancy is possible in cases of abnormal uterine bleeding?

    <p>Beta hCG</p> Signup and view all the answers

    What is the definition of primary amenorrhea?

    <p>Absence of menses by age 15 regardless of secondary sex characteristics</p> Signup and view all the answers

    Which of these is NOT a recommended treatment for vasomotor symptoms associated with menopause?

    <p>Nonsteroidal anti-inflammatory drugs</p> Signup and view all the answers

    Which of the following represents a contraindication to hormone therapy?

    <p>Unexplained vaginal bleeding</p> Signup and view all the answers

    What is required for the diagnosis of polycystic ovarian syndrome (PCOS) in adults?

    <p>Evidence of two of three criteria from the Rotterdam consensus</p> Signup and view all the answers

    Which of the following is a characteristic of secondary amenorrhea?

    <p>Cessation of menstruation for three normal cycles</p> Signup and view all the answers

    Which imaging technique is advised as first-line when further evaluation is needed for abnormal uterine bleeding?

    <p>Ultrasound</p> Signup and view all the answers

    During lactation, which hormone plays a major role in milk ejection?

    <p>Oxytocin</p> Signup and view all the answers

    In the context of midlife women's health, which treatment is preferred for vulvovaginal atrophy?

    <p>Low-dose vaginal estrogen preparations</p> Signup and view all the answers

    Which condition is most commonly associated with secondary amenorrhea?

    <p>Polycystic ovarian syndrome (PCOS)</p> Signup and view all the answers

    What does the diagnosis of primary amenorrhea indicate about an individual?

    <p>No menstruation by age 13</p> Signup and view all the answers

    Which statement best describes 'Genitourinary Syndrome of Menopause'?

    <p>It includes vulvovaginal atrophy but does not require hormone therapy.</p> Signup and view all the answers

    Study Notes

    Cardiovascular Disorders

    • Congenital heart disease in children and heart murmurs are discussed in Chapter 1 of the text.

    Dermatologic Disorders

    • Acne vulgaris is discussed in Chapter 3.
    • Fifth disease, hand foot and mouth disease, herpes zoster, impetigo, rubeola, rubella and varicella are also discussed in Chapter 3.

    Endocrine Disorders

    • Gynecomastia and hypothyroidism are discussed in Chapter 4.

    Abnormal Uterine Bleeding

    • 14%-40% of childbearing women experience abnormal uterine bleeding.
    • Potential causes include structural uterine abnormalities, early pregnancy complications, coagulopathies, ovulatory dysfunction, smoking, iatrogenic sources, sexually transmitted infections, and sexual trauma.
    • A table is provided with categories of AUB (Abnormal Uterine Bleeding) including Polyps (AUB-P), Adenomyosis (AUB-A), Leiomyoma (AUB-L), Malignancy (AUB-M), Coagulopathy (AUB-C), Ovulatory Disorders (AUB-O), Iatrogenic (AUB-I), and Not Classified (AUB-N).
    • Laboratory testing for AUB includes:
      • Beta hCG
      • CBC with platelets, iron studies
      • Coagulation studies
      • STD testing
      • Cervical cytology
      • Other considerations as clinically indicated (TSH, LFTs, renal panel, screening for PCOS)
      • Prolactin, estrogen, testosterone, FSH, LH
      • Endometrial biopsy (first-line test for women over 45)
    • Imaging for AUB includes:
      • TV-USS (transvaginal sonography)
      • Saline infusion sonohysterography
      • Hysteroscopy
      • MRI

    Amenorrhea

    • Always rule out pregnancy before diagnosing amenorrhea.
    • Primary amenorrhea is defined as no menses by age 13 in the absence of secondary sex characteristics or absence of menses by age 15 regardless of secondary sex characteristics.
    • Secondary amenorrhea is defined as cessation of menstruation for three normal cycles or for 6 months in a woman who previously experienced menstrual bleeding.
    • Primary amenorrhea can be caused by:
      • Chromosome mutations
      • Outflow tract disorders
      • Ovarian disorders
      • Hypopituitarism
      • CNS disorders
      • Extreme weight loss/anorexia nervosa
    • Secondary amenorrhea can be caused by:
      • Pregnancy
      • PCOS (accounts for 90% of oligomenorrhea)
      • Endocrine disorder
      • Anatomical causes
      • Premature ovarian failure
      • Stress
      • Malnutrition

    Menopause

    • Menopause is defined as 1 year without a cycle.
    • Vasomotor Symptoms
      • Hormone therapy is the gold standard for vasomotor symptoms (VMS).
      • Estrogen-alone therapy is used for symptomatic women after hysterectomy.
      • Combination therapy (progestogen or conjugated equine estrogen plus bazedoxifene) protects against endometrial neoplasia in symptomatic women with a uterus.
      • Prescribe the lowest dose of hormone therapy that provides symptom relief for the shortest period of time. Periodically assess dosing and need for therapy.
      • Micronized progesterone 300 mg HS decreases VMS.
      • Hormone therapy improves sleep by reducing nighttime awakenings.
      • Paroxetine (Brisdelle) is the only nonhormonal medication with an FDA-approved indication for VMS.
      • Off-label nonhormonal treatments for VMS include SSRIs, SNRIs, clonidine (Catapres) and gabapentin (Neurontin).
    • Genitourinary Syndrome of Menopause
      • Low-dose vaginal estrogen preparations are effective and safe for vulvovaginal atrophy (VVA) and preferred over systemic therapies.
      • Vaginal ET lacks data for use > 1 year; evaluate any bleeding; progesterone therapy is not required.
      • Ospemifene is the only nonhormonal therapy with an FDA indication for VVA (intravaginal DHEA used off label).
      • OTC vaginal moisturizers are effective for mild vaginal dryness and dyspareunia.
    • Urinary Tract Systems and Pelvic Floor Disorders
      • Low-dose vaginal ET may provide benefit for the urinary system, prevention of recurrent UTI, overactive bladder and urge incontinence.
      • HT does not have FDA indications for any urinary health indication.
      • Systemic HT does not improve urinary incontinence and may increase stress urinary incontinence.
    • Sexual Function
      • Systemic HT and low-dose vaginal estrogen increase lubrication, blood flow and sensation in vaginal tissues.
      • Low-dose vaginal ET improves sexual function in postmenopausal women with VVA.
      • Systemic HT does not improve sexual function, sexual interest, arousal or orgasmic response in women without menopause symptoms.
      • Non-estrogen alternatives with FDA indications for dyspareunia: ospemifene and intravaginal DHEA.
    • Hormone Therapy
      • Risk Factors for HT use:
        • Age > 60 years or > 10 years past menopause
        • BMI > 30
        • Insulin resistance
        • Hypertension
        • Smoking
        • Dyslipidemia
        • Venous thromboembolism: personal or familial
      • Contradictions to HT:
        • Unexplained vaginal bleeding
        • Known or suspected breast cancer
        • Acute liver disease
        • Active thromboembolic diagnosis
        • Acute cardiovascular disease
        • Recent cerebrovascular accident
        • Pregnancy

    PCOS

    • Diagnostic Criteria
      • Diagnosis in Adults: Rotterdam Consensus Criteria
        • Evidence of 2 out of 3 of the following must be present:
          • Hyperandrogenism
          • Oligo-ovulation or anovulation
          • Polycystic ovaries on ultrasound
        • Exclusion of alternative etiologies
      • Diagnosis in Adolescents: All 3 of the following (Rotterdam Criteria):
        • Oligomenorrhea or amenorrhea present 2 years after menarche
        • Polycystic ovaries with increased ovarian size (ultrasound)
        • Hyperandrogenemia diagnosed via laboratory analysis

    Lactation

    • Lactogenesis is initiated by the decline of estrogen and progesterone after delivery of the placenta.
    • Oxytocin and prolactin are released by the pituitary gland in response to labor and stimulation of the nerve endings in the breasts.
      • Oxytocin plays a major role in milk ejection/release of milk. Stimulates uterine contractions during labor and postpartum, preventing hemorrhage. Release is stimulated by visual, olfactory and auditory stimulation. Oxytocin creates a warming effect via vasodilation, enhancing skin-to-skin contact. It calms, reduces stress and promotes bonding for mother and infant.
      • Prolactin plays a major role in milk synthesis. Peaks 45 minutes after breastfeeding. Infant suckling (hand expression or using a breast pump) can release prolactin. Promotes appetite and stress reduction during pregnancy. Regulates volume and production of breast milk and fosters maternal adaptation.
    • The mammary gland uses 30% of total energy expended by the mother.
    • Colostrum is the thick, sticky, fluid discharged from the breasts after delivery. Rich in immunoglobulins, vitamin E, and leukocytes.
      • Production begins midpregnancy; secretion occurs within the first 5 days after birth.
      • Higher protein than mature milk and lower in fat and lactose.
      • Low volume matches small gastric capacity of newborn (about 5-7 mL).
      • Has a laxative effect on newborns to assist in expelling meconium.
    • Transitional milk is produced between 2-5 days after delivery and 10-14 days after delivery. It is thinner, more plentiful breast milk with increased lactose, fat, calories, and water-soluble vitamin content.
    • Mature milk contains the highest caloric content, fat content, lactose and protein.

    Contraception

    • See the CDC PDF for information on contraception.

    Cancer

    • Refer to the text for information on cancer.

    Osteoporosis

    • Refer to the text for information on osteoporosis.

    Cervical Cytology Interpretation

    • Cervical Cancer Screening Recommendations
      • General Population
        • Age | ASCCP/ACS/ASCP 2020 | USPSTF 2018 | ACOG 2016
        • Younger than 21 | Recommends against screening this age. | Recommends against screening. | Recommends against screening.

    Cervical Cancer Screening

    • Women should get regular screening for cervical cancer.
    • Nearly 100% of cervical cancers test positive for high-risk human papillomavirus (hrHPV).
    • HPV 16 and 18 are most common types associated with cervical cancer.
    • HPV 16 accounts for 55-60% of all cervical cancers and causes a greater proportion of squamous cell carcinoma.
    • HPV 18 accounts for 10-15% of all cervical cancers and causes a greater proportion of glandular cancer, adenocarcinoma and adenosquamous carcinoma.
    • 12 other hrHPV subtypes account for 25-35% of cervical cancers.
    • Women aged 25 years and older should have HPV-based testing every 3 years.
    • Women with a supracervical hysterectomy should continue with routine screening.
    • Women with history of CIN2 or higher should continue screening every 3 years for 20 years after diagnosis.
    • Women aged 65 years or older with adequate negative prior screening and no history of CIN2 or higher should discontinue screening.
    • For women with history of CIN2, CIN3, adenocarcinoma in situ or cervical cancer, screening should continue every 3 years for 25 years after diagnosis even after age 65.
    • Women with inadequate screening history or lack of documentation of adequate screening should continue screening every 3 years for 20 years.
    • Discontinuation of screening is recommended for patients with a limited life expectancy.
    • A negative history should be based on:
      • Negative HPV test or co-test within 5 years
      • Colposcopic examination confirming CIN1 or less within 1 year
    • Two primary HPV tests are cleared by FDA for women 25 years and older:
      • cobas HPV test
      • Onclarity HPV assay
    • Both tests report initial genotyping for HPV types 16 and 18 on every test.

    Osteoporosis

    • Bisphosphonates are first-line drug therapy for osteoporosis.
    • Bisphosphonates decrease vertebral and hip fractures by 50% and can be given orally or intravenously.
    • Teriparatide is considered first-line therapy for patients with a very high risk of fracture.
    • Very high risk factors include T-score of -3.5 or below with no fractures, or T-score of -2.5 or below with a fragility fracture.
    • Nonpharmacologic therapy:
      • Adequate calorie intake
      • Avoid malnutrition
      • Supplemental elemental calcium (1,200 mg/day)
      • Vitamin D supplementation (800 to 1000 IU/day)
      • Exercise
      • Smoking cessation
      • Alcohol moderation

    Urinary Incontinence

    • Urge Incontinence (detrusor instability):
      • Causes:
        • Urinary tract infection
        • Chronic cystitis
        • Dementia
        • Parkinson's disease
        • Aging
        • Stroke
        • Irradiation of bladder
    • Stress Incontinence (sphincter incompetence):
      • Causes:
        • Aging
        • Pelvic floor muscle weakness
        • Estrogen deficiency
        • Perineal trauma
        • Prostatic/pelvic surgery
        • Sneezing
        • Coughing
        • Laughing
        • Exertion or effort
    • Overflow Incontinence (term not widely used):
      • Causes:
        • Leaking from overdistended bladder
        • Incomplete emptying
        • Impaired detrusor contractility
        • Bladder outlet obstruction
        • Prostatic enlargement
    • Functional Incontinence:
      • Causes:
        • Severe mental illness
        • Sedating medications
        • Physical or mental disability

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    Description

    This quiz covers essential topics in cardiovascular and dermatologic disorders, specifically focusing on congenital heart disease, heart murmurs, and acne vulgaris as discussed in Chapters 1 and 3. Gain insights into the common conditions affecting both children and adults along with the implications of various skin disorders. Test your knowledge on these critical medical subjects.

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