Menstrual Pain Severity and Pathophysiology

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What is the recommended age to start Pap screening according to the American Cancer Society in 2020?

35 years

21 years

30 years

25 years (correct)

Which organization recommends primary HPV testing alone every five years for women aged 25 and above?

US Preventative Task Force

World Health Organization

American Cancer Society (correct)

ACOG

What does ACOG recommend for Pap screening for women aged 30-65?

Annual mammogram

Co-testing every three years (correct)

Cytology alone every three years

Primary HPV testing alone every five years

At what age does US Preventative Task Force recommend starting Pap screening with cytology alone every three years?

21 years (B) Signup and view all the answers

Which condition is NOT covered in the lecture on women's health part one?

Ovarian cancer (A) Signup and view all the answers

What type of testing does the American Cancer Society recommend for women ages 30-65?

Primary HPV testing alone every five years (C) Signup and view all the answers

What is the primary etiology and pathophysiology of dysmenorrhea?

Increased prostaglandin PGF2a production (C) Signup and view all the answers

Which condition can result in hypersensitization to type C pain nerve fibers in dysmenorrhea?

Uterine ischemia (B) Signup and view all the answers

What age range is associated with a higher risk of primary dysmenorrhea?

Under 30 years old (C) Signup and view all the answers

Which of the following is a risk factor for secondary dysmenorrhea?

Family history of endometriosis (D) Signup and view all the answers

What symptom is NOT typically associated with primary dysmenorrhea?

Fever (D) Signup and view all the answers

How can the diagnosis of dysmenorrhea be confirmed effectively?

Response to NSAIDs treatment (B) Signup and view all the answers

What diagnostic test is recommended for severe refractory cases of secondary dysmenorrhea?

Laparoscopy (B) Signup and view all the answers

At what age is it recommended to start the HPV vaccine?

11 to 12 years (C) Signup and view all the answers

What is the maximum age limit for receiving the Gardasil 9 vaccine in the United States?

45 (A) Signup and view all the answers

How many doses are recommended for the HPV vaccine if it's initiated before the 15th birthday?

2 doses (D) Signup and view all the answers

Which of the following symptoms is commonly associated with high-risk HPV infections?

Postcoital bleeding (B) Signup and view all the answers

What is considered the gold standard for cervical cancer screening according to the text?

ThinPrep (B) Signup and view all the answers

Which category of cells are characterized by atypical glandular cells (AGCs) according to cytologic grading?

Glandular cell (D) Signup and view all the answers

What is the recommended action if a patient is HPV positive but cytology negative and aged 30 years or older?

Proceed to HPV and DNA typing (C) Signup and view all the answers

What is the acronym used for cervical cancer precursors grading in the Bethesda system?

ASCUS (D) Signup and view all the answers

What is the recommended action if a patient has no endocervical cells present in their Pap smear?

Have the patient back for a repeat Pap smear (D) Signup and view all the answers

Which pharmacologic agents are first-line treatment for primary dysmenorrhea?

Ibuprofen, naproxen, celecoxib, and mefenamic acid (D) Signup and view all the answers

Which hormonal contraceptives are recommended for primary dysmenorrhea in women desiring contraception?

Levonorgestrel IUDs and combined oral contraceptives (C) Signup and view all the answers

Why are continuous dosing regimens preferred over cyclic dosing for pain control in dysmenorrhea?

To limit ovulation (B) Signup and view all the answers

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

Combined oral contraceptives (B) Signup and view all the answers

What is the comparative effectiveness of progestin-only contraceptives in reducing primary dysmenorrhea?

Less effective than combined options and IUDs (C) Signup and view all the answers

Which contraceptive method has been found to be just as effective as combined oral contraceptives for secondary dysmenorrhea?

Levonorgestrel IUDs (D) Signup and view all the answers

What is a common symptom of candidal vulvovaginitis?

Itching (B) Signup and view all the answers

How is candidiasis diagnosed using a 10% KOH prep?

Pseudohyphae visible under microscope (C) Signup and view all the answers

What is a recommended non-pharmacologic management strategy for candidiasis?

Refrain from intercourse until symptoms are gone (B) Signup and view all the answers

Which of the following is an over-the-counter option for treating candidiasis infections?

Tioconazole (A) Signup and view all the answers

What defines recurrent vulvovaginal candidiasis (RVVC)?

Four or more episodes within a year (C) Signup and view all the answers

What is a common recommendation for maintenance therapy in patients with RVVC?

Take oral fluconazole weekly for six months (D) Signup and view all the answers

What is a potential treatment option for non-albicans VVC if persistent after other therapies?

Refer the patient out for further evaluation (B) Signup and view all the answers

What is a key difference between albicans and non-albicans species in terms of treatment response?

Non-albicans VVC may be less responsive to some antifungal treatments (B) Signup and view all the answers

What type of vaginal pH is typically found in candidiasis infections?

Less than 4.5 (A) Signup and view all the answers

What is one of the recommendations for patients with recurrent yeast infections to help maintain stable vaginal flora?

Avoid panty liners (A) Signup and view all the answers

What is the recommended treatment duration for vulvovaginal candidiasis (VVC) in HIV-infected women?

7-14 days (D) Signup and view all the answers

What is the main reason fluconazole is not recommended for routine prophylaxis in HIV women?

Absence of recurrent VVC (C) Signup and view all the answers

Why is topical azole therapy preferred over systemic treatment during pregnancy for VVC?

Reduced systemic absorption (D) Signup and view all the answers

What is the key reason that fluconazole should be avoided during lactation?

Found in breast milk (B) Signup and view all the answers

Which age group is most commonly affected by Bartholin gland cysts?

Over 60 years old (C) Signup and view all the answers

What is a common cause of Bartholin gland cysts related to mechanical irritation?

Tight fitting undergarments (B) Signup and view all the answers

What is the recommended initial treatment for asymptomatic Bartholin gland cysts in patients over 40 years old?

Local moist heat application (B) Signup and view all the answers

What diagnostic test is indicated if an infection is suspected in a Bartholin gland cyst?

Culture and sensitivity of cyst contents (C) Signup and view all the answers

What is the most common causative organism for Bartholin gland cyst infections?

Escherichia coli (E. coli) (A) Signup and view all the answers

What concurrent treatment should be considered for high-risk recurrent Bartholin gland cyst infections?

Antibiotics targeting E. coli and staph infections (D) Signup and view all the answers

What is the recommended management for a woman aged 25 with ASCUS and a positive HPV test?

Proceed to colposcopy (B) Signup and view all the answers

What is the next step if a woman aged over 24 presents with ASC-H on the cytology report?

Colposcopy is required (D) Signup and view all the answers

What would be the management for a woman with LSIL, negative HPV test, and aged over 24?

Repeat in one year (A) Signup and view all the answers

What is the recommended approach if a woman with LSIL presents during pregnancy?

Defer to postpartum for colposcopy (C) Signup and view all the answers

What is the recommended management for women with AGCs who are 35 years or older?

Colposcopy with endocervical sampling (A) Signup and view all the answers

Inadequate colposcopy for CIN II or III or recurrent CIN II or III may necessitate which procedure?

Diagnostic excisional procedure (A) Signup and view all the answers

When can a woman reenter routine screening after excision or ablation of CIN II or III?

Between 12 and 40 minutes if both HPV and cytology are negative (A) Signup and view all the answers

What is the preferred treatment for AIS (adenocarcinoma in situ)?

Hysterectomy (C) Signup and view all the answers

What intervention is recommended for women with Atypical endometrial cells if the initial test results are negative?

Colposcopy (D) Signup and view all the answers

What should be done for women with no lesion on colposcopy or CIN I preceded by lesser abnormalities in the follow-up?

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

What defines adequate prior screening for women over 65 years old according to the guidelines mentioned?

Three consecutive negative cytology results and two consecutive negative HPV-positive cytology results within 10 years (C) Signup and view all the answers

Which age group sees a very low occurrence of cervical cancer, making screening unnecessary according to the text?

Under 21 (A) Signup and view all the answers

What is the key characteristic of CIN III?

High-grade lesion involving the full thickness of the squamous epithelium (A) Signup and view all the answers

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

HPV 16 and 18 (A) Signup and view all the answers

What is contraindicated for treatment during pregnancy according to the text?

Endocervical curettage (A) Signup and view all the answers

What is the primary method of prevention mentioned for HPV infections?

Using condoms (A) Signup and view all the answers

What do low-risk types of HPV, such as HPV 6 and 11, commonly cause?

Anogenital warts (A) Signup and view all the answers

Which group is less likely to clear a new HPV infection compared to younger women?

Women over the age of 30 (B) Signup and view all the answers

'Precancerous lesions' are associated with which type of HPV infections?

'High-risk' types like HPV 16 and 18 (A) Signup and view all the answers

'Abnormal PAPs' refer to which premalignant cervical disease?

'Cervical intraepithelial neoplasia (CIN)' (B) Signup and view all the answers

What is the average duration of menstruation considered normal?

4 days (D) Signup and view all the answers

How much blood loss is considered normal during a menstrual cycle?

35 to 50 cc (C) Signup and view all the answers

What is the range of variability in the duration of a normal menstrual cycle according to the lecture?

Plus or minus seven days (D) Signup and view all the answers

At what point is menstrual bleeding classified as abnormal and needing investigation?

8 days (D) Signup and view all the answers

How much blood loss during a menstrual cycle would be considered abnormal?

80 cc or more (D) Signup and view all the answers

What is the recommended method for patients to track their menstrual cycles according to the lecture?

Use a period tracking app on their phone (D) Signup and view all the answers

What defines menorrhagia?

Prolonged bleeding greater than seven days (B) Signup and view all the answers

What distinguishes metrorrhagia from menorrhagia?

Irregular and frequent bleeding (D) Signup and view all the answers

What is the characteristic feature of menometrorrhagia?

Prolonged bleeding occurring at regular intervals (C) Signup and view all the answers

Which condition involves the absence of menstruation for at least three to six months?

Amenorrhea (C) Signup and view all the answers

What defines secondary amenorrhea?

Absence of menstruation for at least three to six months after regular cycles established (B) Signup and view all the answers

What distinguishes primary amenorrhea from secondary amenorrhea?

Never having experienced menstruation (D) Signup and view all the answers

Which term describes uterine bleeding occurring at irregular but real frequent intervals?

Metrorrhagia (B) Signup and view all the answers

What is the key feature of oligomenorrhea?

Reduced frequency of menses in a predictable pattern (B) Signup and view all the answers

What is characteristic of secondary amenorrhea regarding the time frame?

Three to six months after regular cycles are established (A) Signup and view all the answers

How is primary amenorrhea different from secondary amenorrhea in terms of menstrual experience?

Having never had any menstrual bleeding at all. (C) Signup and view all the answers

What is the most common inherited bleeding disorder mentioned in the text?

Von Willebrand's disease (B) Signup and view all the answers

In pre-menarchal children, what is the most common cause of vaginal bleeding according to the text?

Foreign body insertion (C) Signup and view all the answers

Which disease can cause heavy periods and unpredictable bleeding, according to the text?

Hypothyroidism (B) Signup and view all the answers

What percentage of women with postmenopausal bleeding may have endometrial cancer?

10% (C) Signup and view all the answers

What causes abnormal uterine bleeding when a patient does not ovulate?

Lack of progesterone secretion (D) Signup and view all the answers

Which malignancy is less likely but still mentioned as a potential cause of abnormal vaginal bleeding?

Breast cancer (D) Signup and view all the answers

What can cause irregular vaginal bleeding or spotting due to its irritation?

Intrauterine device (IUD) (D) Signup and view all the answers

In which patients should pregnancy always be considered when presenting with unusual vaginal bleeding?

Reproductive age women (D) Signup and view all the answers

What is the predominant hormonal imbalance characteristic of anovulation leading to abnormal uterine bleeding?

Lack of progesterone secretion (C) Signup and view all the answers

What is the primary concern when a woman presents with post-menopausal bleeding?

Endometrial hyperplasia (C) Signup and view all the answers

What is the average age of menarche in America?

12.5 years old (C) Signup and view all the answers

What can be a reason for a patient with hypomenorrhea to come in for a visit?

Concern about pregnancy (B) Signup and view all the answers

What can cause contractions and expulsion bleeding during menstrual cycles?

NSAIDs (D) Signup and view all the answers

At what age does the average American woman experience menopause?

51 to 51.5 years old (A) Signup and view all the answers

What factor may contribute to the decreasing age of menarche according to the text?

Hormones in foods (A) Signup and view all the answers

'Prostaglandin can cause contractions and expulsion bleeding' - which condition is commonly treated with NSAIDs for this reason?

Endometriosis (A) Signup and view all the answers

'Patients who develop leukemia' - how might leukemia first present in some patients according to the text?

With changes in menstrual cycles (C) Signup and view all the answers

'Women did not start menses till much later, usually 16 or even 17 back then' - why did women historically start menstruating later according to the text?

'Early and prolonged breastfeeding' (D) Signup and view all the answers

How much weight gain would make a patient 10 times more likely to develop endometrial cancer?

20 to 50 pounds (C) Signup and view all the answers

What is the role of obesity in the development of endometrial cancer?

Causes anovulation (D) Signup and view all the answers

How do progestins contribute to managing abnormal uterine bleeding?

Cause an organized slough of endometrial lining (C) Signup and view all the answers

Which medication is typically given to induce withdrawal bleeding in patients with amenorrhea?

Progesterone (D) Signup and view all the answers

When managing patients with excessive bleeding, which method can induce endometrial atrophy and improve bleeding control for up to five years?

Progestational IUD (B) Signup and view all the answers

Which situation would warrant a patient being sent to the emergency room for IV estrogen administration?

Unstable patient with continuous heavy vaginal bleeding (A) Signup and view all the answers

For patients with endometrial hyperplasia not suggestive of cancer, what medication is typically prescribed for management?

Provera (medroxyprogesterone) (C) Signup and view all the answers

'Mirena' is an example of what type of medical device used to control bleeding?

Progestin-containing IUD (D) Signup and view all the answers

'Premarin' and high-dose oral contraceptives are commonly used to manage what condition?

'Excessive menstrual bleeding' (B) Signup and view all the answers

What condition would warrant the use of IV estrogen for treatment?

Continuous heavy vaginal bleeding with unstable patient condition (D) Signup and view all the answers

What is one recommended action for managing abnormal uterine bleeding in a post-menopausal woman?

Perform an endometrial biopsy (D) Signup and view all the answers

Which factor puts a woman at a higher risk for endometrial cancer?

Being on combined hormone replacement therapy (C) Signup and view all the answers

What is the significance of high insulin levels in diabetic women regarding endometrial cancer risk?

Increases risk due to toxicity to ovaries (A) Signup and view all the answers

What is the expected endometrial stripe measurement in post-menopausal women on hormone replacement therapy?

Approximately 5 mm (B) Signup and view all the answers

Why is unopposed estrogen therapy considered a risk factor for endometrial cancer?

It stimulates endometrial proliferation (C) Signup and view all the answers

What action should be considered for women with abnormal uterine bleeding and a thickened endometrial lining?

Perform a transvaginal ultrasound (B) Signup and view all the answers

Which patient characteristic may prompt a clinician to consider an endometrial biopsy?

Post-menopausal status (D) Signup and view all the answers

What is the role of luteinizing hormone in assessing reproductive-age women with abnormal uterine bleeding?

Checking for hormonal imbalances (A) Signup and view all the answers

Why are pregnant patients with abnormal uterine bleeding advised to undergo a thorough history review?

To screen for eating disorders (C) Signup and view all the answers

What is a reason for considering an STD check in patients presenting with abnormal uterine bleeding?

To rule out infection as a cause (B) Signup and view all the answers

What is the recommended treatment for heavy bleeding in patients with a religious objection to using hormones?

NSAIDs (B) Signup and view all the answers

What is commonly recommended to control abnormal uterine bleeding in post-menopausal women?

Transvaginal ultrasound (B) Signup and view all the answers

What is the primary concern when prescribing oral contraceptives to control bleeding?

Nausea from taking all pills together (D) Signup and view all the answers

What is the most appropriate long-term treatment option for abnormal uterine bleeding?

Levonorgestrel-containing IUD (B) Signup and view all the answers

What is the common cause of abnormal uterine bleeding in post-menopausal women?

Vaginal atrophy (D) Signup and view all the answers

Which factor is NOT considered a risk factor for endometrial cancer according to the text?

Diabetes risk factor (D) Signup and view all the answers

What is the common screening method recommended for women aged 30-65 for cervical cancer?

Pap screening (A) Signup and view all the answers

What is the primary reason to avoid estrogen-containing products for controlling abnormal uterine bleeding?

Migraine with aura (B) Signup and view all the answers