Menstrual Pain and Pathophysiology Quiz

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At what age does the American Cancer Society recommend starting primary HPV testing alone for Pap screening?

30 years

21 years

25 years (correct)

35 years

What does the United States Preventative Task Force recommend for Pap screening in the age group 30-65?

Co-testing every five years

Primary HPV testing alone every five years

Cytology alone every three years (correct)

All of the above

According to ACOG, what Pap screening method is recommended for women aged 21?

Co-testing every five years

Primary HPV testing alone every five years

Cytology alone every three years (correct)

No screening is recommended

What update did the American Cancer Society make in their Pap screening guidelines in 2020?

Increased the age to start screening Signup and view all the answers

What is the recommended age for ceasing cervical cancer screening if a woman has had adequate prior screening and no history of CIN II in the last 20 years?

Greater than 65 years Signup and view all the answers

What does CIN III refer to?

Severe dysplasia, a high-grade lesion Signup and view all the answers

What percentage of cervical cancers occur before the age of 20?

1% Signup and view all the answers

Which HPV types are associated with about 70% of all cancers?

HPV 16 and 18 Signup and view all the answers

What is contraindicated during pregnancy unless cancer is identified or suspected?

Endocervical curettage Signup and view all the answers

Which factor places women at significant risk for developing precancerous lesions?

Early age intercourse Signup and view all the answers

What are the high-risk HPV types?

HPV 16, 18, and 58 Signup and view all the answers

What is recommended for the prevention of HPV?

Immunization Signup and view all the answers

"Abnormal PAPs" are associated with which condition?

"Cervical intraepithelial neoplasia" Signup and view all the answers

"Most HPV infections are transient and become undetectable within one to two years". What do persistent infections place women at significant risk for developing?

"Precancerous lesions" Signup and view all the answers

What is CIN II?

High-grade lesion, cellular changes in the lower two-thirds of the squamous epithelium Signup and view all the answers

At what age should routine screening continue for at least 20 years after spontaneous regression or appropriate management of a high-grade precancerous lesion?

Until age 70 Signup and view all the answers

What is the recommended duration of therapy for immunocompromised hosts with vaginal candidiasis?

7-14 days Signup and view all the answers

What is the recommended prophylactic therapy for HIV women in the absence of recurrent VVC?

Fluconazole 200 milligrams weekly Signup and view all the answers

Why should fluconazole be avoided during lactation?

It is found in breast milk Signup and view all the answers

What is the main cause of Bartholin gland cysts?

Sexually transmitted diseases Signup and view all the answers

What is the most common causative organism of Bartholin gland cysts?

Escherichia coli Signup and view all the answers

What non-pharmacologic treatment is recommended for Bartholin gland cysts if the patient is older than 40?

Application of local moist heat and warm sitz baths Signup and view all the answers

What is the initial treatment for Bartholin gland cysts that are refractory to non-pharmacologic interventions?

Insertion of Word catheter Signup and view all the answers

What is primary dysmenorrhea?

Pelvic pain without pathologic cause Signup and view all the answers

How is secondary dysmenorrhea different from primary dysmenorrhea?

It results from pelvic pathology and is more severe than primary dysmenorrhea Signup and view all the answers

What is the recommended pH level in the vaginal area for a patient with candidiasis?

Less than 4.5 Signup and view all the answers

Which of the following is NOT recommended for non-pharmacologic management of candidiasis infections?

Using scented products Signup and view all the answers

What diagnostic test is used to confirm candidiasis by visualizing pseudohyphae?

10% KOH prep Signup and view all the answers

For recurrent VVC, what type of therapy is effective in reducing the infection?

Short duration of topical azole therapy Signup and view all the answers

Which option is a prescription intravaginal regimen for treating candidiasis infections?

Butoconazole 2% cream Signup and view all the answers

What is a risk factor for candidiasis infections?

Wearing tight fitting synthetic clothing Signup and view all the answers

Which pharmacologic management option is an over-the-counter regimen for treating candidiasis infections?

Miconazole Signup and view all the answers

What additional treatment may be considered if the oral fluconazole regimen for recurrent VVC isn't feasible?

Topical boric acid in gelatin capsules Signup and view all the answers

What is a symptom commonly associated with candidiasis?

Extreme itching Signup and view all the answers

What treatment can be recommended for symptomatic women who remain culture-positive despite maintenance regimen?

Consultation with a specialist Signup and view all the answers

What type of therapy is recommended to attempt mycologic remission for recurrent VVC?

Longer duration of antifungal therapy Signup and view all the answers

What may need to be considered if persistent VVC occurs despite other treatments?

Referring out for specialized care Signup and view all the answers

Which type of contraceptives is recommended first-line for secondary dysmenorrhea due to endometriosis?

Combined oral contraceptives Signup and view all the answers

Which type of dosing has been found to be superior for pain control with dysmenorrhea?

Continuous dosing Signup and view all the answers

Which NSAID is NOT mentioned as a possible treatment for primary dysmenorrhea?

Acetaminophen Signup and view all the answers

Which type of contraceptives are recommended for women desiring contraception and directly suppress ovulation?

Combined oral contraceptives Signup and view all the answers

What is the primary etiology and pathophysiology of dysmenorrhea?

Elevated prostaglandin PGF2a production through indirect hormonal control Signup and view all the answers

What is a risk factor for primary dysmenorrhea?

Alcohol use Signup and view all the answers

What condition should be ruled out through pelvic exam if the patient is sexually active and has dysmenorrhea?

Pelvic inflammatory disease Signup and view all the answers

Which symptom is considered secondary to prostaglandin disease in dysmenorrhea?

Headache Signup and view all the answers

What is a non-pharmacologic treatment option for dysmenorrhea?

Relaxation therapy Signup and view all the answers

What diagnostic testing should be considered for secondary dysmenorrhea?

MRI as second line non-invasive imaging Signup and view all the answers

At what age does the onset of ovulatory cycles usually occur in adolescents with primary dysmenorrhea?

6-12 months after menarche Signup and view all the answers

What is a risk factor for secondary dysmenorrhea?

Infertility Signup and view all the answers

What condition may need to be ruled out if a patient has pelvic pain between menstrual periods?

Endometriosis Signup and view all the answers

What should be considered if a patient with secondary dysmenorrhea has lack of response to NSAIDs or hormonal treatment?

Endometriosis Signup and view all the answers

When should pelvic exam be recommended for patients with dysmenorrhea?

If the patient is sexually active Signup and view all the answers

What should be ruled out through diagnostic testing for secondary dysmenorrhea?

Pelvic inflammatory disease Signup and view all the answers

At what age is the HPV vaccine recommended to be initiated?

11 to 12 years old Signup and view all the answers

How many doses of the Gardasil 9 vaccine are recommended if it's done before the 15th birthday?

Two doses six to 12 months apart Signup and view all the answers

Which vaccine is currently in use in the United States for HPV immunization?

Gardasil 9 Signup and view all the answers

What are the common symptoms that patients with HPV-related cervical pathology may present with?

Vaginal discharge and abnormal vaginal bleeding Signup and view all the answers

Which type of cells does the cytology report indicate the presence of for an adequate Pap smear sample?

Endocervical cells Signup and view all the answers

What is the gold standard for diagnosing HPV types in cervical cytology?

ThinPrep Signup and view all the answers

What does ASCCP stand for in the context of cervical cytologic grading?

American Society for Colposcopy and Cervical Pathology Signup and view all the answers

What does a cytologic grading of CIN III correspond to?

Moderate or severe dysplasia (CIS, CIN II, and CIN III) Signup and view all the answers

"Atypical glandular cells (AGCs)" are categorized as either not otherwise specified or that they favor neoplasia. What does "AIS" refer to in this context?

"Adenocarcinoma in situ" Signup and view all the answers

"Atypical squamous cells (ASC) of undetermined significance" are classified as a type of squamous cell categorization. What is another term used for this classification?

"Cannot exclude high-grade squamous intraepithelial lesion (HSIL)" Signup and view all the answers

What is recommended for women ages 30 years and older if they are HPV positive but cytology negative?

HPV and DNA typing Signup and view all the answers

What physical exam findings are associated with HPV-related cervical pathology?

Presence of external HPV lesions Signup and view all the answers

What is the recommended next step for a woman over 24 with ASCUS and a positive HPV test?

Proceed to colposcopy Signup and view all the answers

In the case of LSIL in pregnancy, what is the preferred management approach?

Defer to colposcopy postpartum Signup and view all the answers

What is the recommended procedure for high-grade SIL or HSIL?

Colposcopy with endocervical sampling Signup and view all the answers

What procedure is recommended for women with Atypical Endometrial Cells?

Colposcopy Signup and view all the answers

What is the management recommendation for women with no lesion on colposcopy or CIN I preceded by lesser abnormality?

Follow up without treatment and co-test at 12 months Signup and view all the answers

What should be the next step if both HPV and cytology are negative?

Refer for routine screening in three years Signup and view all the answers

What is the recommended management approach for recurrent CIN II or III?

Diagnostic excisional procedure Signup and view all the answers

What is the recommended approach for persistent CIN I for at least two years?

$\text{Diagnostic excisional procedure}$ Signup and view all the answers

After ablative or excisional treatment of CIN II or III, when can women reenter routine screening?

$\text{After negative co-testing between 12 and 40 minutes}$ Signup and view all the answers

Which organism is the most common cause of vulvovaginal candidiasis?

Candida albicans Signup and view all the answers

Which of the following is not a risk factor for vulvovaginal candidiasis?

Regular exercise Signup and view all the answers