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What does ASCCP/ACS/ASC P 2020 recommend for cervical cancer screening in individuals younger than 21?
Which organization recommends against cervical cancer screening in individuals younger than 21 years?
What is a key limitation of the cervical cancer screening test mentioned?
Which guideline explicitly states that screening should not occur in individuals younger than 21?
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Why is the cervical cancer screening test not recommended by the CDC?
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What role does prolactin play in lactation?
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What characteristic distinguishes colostrum from mature milk?
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When does the production of colostrum typically begin during pregnancy?
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What is a primary benefit of the laxative effect of colostrum on newborns?
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What change occurs in transitional milk compared to colostrum?
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At what age should women begin routine HPV-based testing?
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Women who have had a supracervical hysterectomy should continue with screening because they still have a risk for what?
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How often should women with a history of CIN2 or higher continue cervical cancer screening?
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For how long should patients with a limited life expectancy continue cervical cancer screening?
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What constitutes adequate negative screening in the last 25 years for women over age 65?
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What HPV type is responsible for the largest percentage of cervical cancers?
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Which HPV type is specifically associated with glandular cancers such as adenocarcinoma?
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How many hrHPV assays have been cleared by the FDA?
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Which of the following is a common type of cervical cancer caused by HPV?
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Women over the age of 65 with no history of CIN2 should stop screening if they have what?
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Which hrHPV type accounts for 10-15% of cervical cancers?
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What is the recommended action for those with inadequate documentation of screening history?
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What percentage of cervical cancers is attributed to hrHPV subtypes other than 16 and 18?
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Which two tests are FDA-cleared for primary HPV screening in women 25 years and older?
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What management approach should be considered when histology or cytology results are inconclusive?
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What is the recommended daily dosage of elemental calcium for women according to the guidelines?
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Which of the following is considered a first-line drug therapy for osteoporosis?
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What does the term 'urge incontinence' primarily relate to?
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What condition does the acronym 'DIAPPERS' help to identify in relation to urinary incontinence?
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Which of the following factors is associated with stress incontinence?
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What is the recommended daily dose of Vitamin D supplementation?
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Which term is not widely used but describes urinary leakage from an overdistended bladder?
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What health issue is primarily addressed by pharmacologic therapy guidelines mentioned?
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Which of the following causes of abnormal uterine bleeding is categorized as structural?
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Which laboratory test is considered the first-line for individuals where pregnancy is possible in cases of abnormal uterine bleeding?
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What is the definition of primary amenorrhea?
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Which of these is NOT a recommended treatment for vasomotor symptoms associated with menopause?
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Which of the following represents a contraindication to hormone therapy?
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What is required for the diagnosis of polycystic ovarian syndrome (PCOS) in adults?
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Which of the following is a characteristic of secondary amenorrhea?
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Which imaging technique is advised as first-line when further evaluation is needed for abnormal uterine bleeding?
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During lactation, which hormone plays a major role in milk ejection?
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In the context of midlife women's health, which treatment is preferred for vulvovaginal atrophy?
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Which condition is most commonly associated with secondary amenorrhea?
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What does the diagnosis of primary amenorrhea indicate about an individual?
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Which statement best describes 'Genitourinary Syndrome of Menopause'?
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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).
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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.
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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.
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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
-
Risk Factors for HT use:
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
- Evidence of 2 out of 3 of the following must be present:
-
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
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Diagnosis in Adults: Rotterdam Consensus Criteria
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.
-
General Population
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
- Causes:
-
Stress Incontinence (sphincter incompetence):
- Causes:
- Aging
- Pelvic floor muscle weakness
- Estrogen deficiency
- Perineal trauma
- Prostatic/pelvic surgery
- Sneezing
- Coughing
- Laughing
- Exertion or effort
- Causes:
-
Overflow Incontinence (term not widely used):
- Causes:
- Leaking from overdistended bladder
- Incomplete emptying
- Impaired detrusor contractility
- Bladder outlet obstruction
- Prostatic enlargement
- Causes:
-
Functional Incontinence:
- Causes:
- Severe mental illness
- Sedating medications
- Physical or mental disability
- Causes:
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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.
