Well Woman Exam Overview

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Questions and Answers

What is the purpose of a well woman exam?

To determine a woman's sexual activity.

To provide hormonal therapy.

To only perform a Pap smear.

To conduct a head-to-toe examination of a woman. (correct)

At what age should women start receiving Pap smears?

There is no specific age requirement.

At age 21, regardless of sexual activity. (correct)

As soon as they become sexually active.

At age 18, regardless of activity.

Which component is always included in a well woman exam?

Pelvic exam.

Pap smear.

Clinical Breast Exam (CBE). (correct)

Cholesterol screening.

Why might women not need to visit a healthcare provider yearly for a well woman exam?

Most women do not require yearly screenings. Signup and view all the answers

What should be assessed during a clinical breast exam?

Temperature, tenderness, and size. Signup and view all the answers

What should you do if a 21-year-old woman declines a Pap smear during her well woman exam?

Discuss the importance, but respect her decision. Signup and view all the answers

What is a common misconception regarding the frequency of well woman exams?

Every woman needs to come in yearly. Signup and view all the answers

What is the recommended position for a patient during a Clinical Breast Exam?

Lying flat with arms above head. Signup and view all the answers

What is considered a common abnormal finding in a PAP test?

Atypical squamous cells of unknown significance (ASC-US) Signup and view all the answers

What is a typical sign of low-grade squamous intraepithelial lesion (LSIL)?

Usually resolves without treatment Signup and view all the answers

Which treatment is commonly used for amenorrhea when PCOS is the cause?

Oral Contraceptive Pills (OCPs) Signup and view all the answers

What does a breast lump most commonly indicate?

Fibrocystic changes Signup and view all the answers

What is a primary symptom of dysmenorrhea?

Painful cramping Signup and view all the answers

Which condition is commonly linked with premature menopause?

Increased risk for osteoporosis Signup and view all the answers

What is a common treatment for vulvodynia?

Pelvic floor therapy Signup and view all the answers

How is a yeast infection typically diagnosed?

KOH-prep examination Signup and view all the answers

What symptom is associated with vaginal atrophy?

Painful sex Signup and view all the answers

What should be avoided in breast care for discomfort?

Consuming caffeine Signup and view all the answers

What does cervical motion tenderness usually indicate?

Inflammation or infection Signup and view all the answers

What condition can often be misdiagnosed as a yeast infection?

Lichen sclerosus Signup and view all the answers

What is a treatment option for managing uterine bleeding due to hormonal imbalance?

Levonorgestrel Releasing System (LUS) Signup and view all the answers

Which of the following statements about primary amenorrhea is true?

It can be seen in teenagers with no underlying reason. Signup and view all the answers

What should be assessed for during a bimanual exam in relation to the uterus?

Tenderness or enlargement Signup and view all the answers

Which finding during a clinical breast exam might indicate an abnormal condition?

Skin dimples or divots Signup and view all the answers

In a speculum exam, which condition is NOT typically assessed?

Pelvic floor strength Signup and view all the answers

What does cervical motion tenderness usually signify during a pelvic examination?

Possible infection or inflammation Signup and view all the answers

Which observation might indicate an abnormal condition during the assessment of the bladder?

Prolapse Signup and view all the answers

What factors should be considered while performing a Clinical Breast Exam?

Assessing breast size and tenderness Signup and view all the answers

Which resources mentioned are free applications for well woman exam information?

US Prevention Task Force App Signup and view all the answers

What can be observed during the Clinical Breast Exam regarding temperature?

Temperature differences can indicate issues Signup and view all the answers

Why might a 21-year-old patient decline testing during a well woman exam?

She is not sexually active and feels testing is unnecessary Signup and view all the answers

What is a common reason insurance companies cover annual well woman exams?

Preventive healthcare to reduce long-term costs Signup and view all the answers

What is the relationship between a Pap smear and a well woman exam?

A Pap smear may be included in a well woman exam, but is not mandatory. Signup and view all the answers

At what point should a woman start having Pap smears according to current guidelines?

At age 21, regardless of sexual history. Signup and view all the answers

Which of the following statements about Pap smear frequency is false?

Most women require yearly Pap smears throughout their lives. Signup and view all the answers

What is a common misconception regarding the initiation of Pap smear testing?

Women should start Pap tests within the first year of sexual activity. Signup and view all the answers

How often is it generally accepted that women should have well woman exams?

Based on individual health recommendations rather than a set frequency. Signup and view all the answers

What is a major characteristic of ASC-US in Pap test results?

Most often benign Signup and view all the answers

Which HPV strains are most commonly associated with cervical cancer?

HPV 16 and HPV 18 Signup and view all the answers

What is the primary treatment for secondary dysmenorrhea?

Depends on underlying cause Signup and view all the answers

Which condition is characterized by hyperandrogenism and requires two out of three diagnostic criteria for confirmation?

PCOS Signup and view all the answers

What is a common finding in women undergoing menopause?

Vaginal atrophy Signup and view all the answers

What is the most common cause of vaginal itching?

Yeast infection Signup and view all the answers

Which of the following treatments is NOT typically suggested for menopause symptoms?

HRT without progesterone Signup and view all the answers

What is a key feature of vulvodynia?

Vulvar pain for at least three months Signup and view all the answers

Which condition can lead to an increased risk of osteoporosis during menopause?

Premature menopause Signup and view all the answers

How can a LS diagnosis be confirmed?

Punch biopsy Signup and view all the answers

During what life stage is primary amenorrhea most commonly identified?

Teenage years to 20s Signup and view all the answers

What is a potential symptom of amenorrhea caused by PCOS?

Excessive hair growth Signup and view all the answers

Which strategy is NOT recommended for alleviating symptoms of breast discomfort?

Increase caffeine intake Signup and view all the answers

What characteristic is most commonly associated with LS?

Irretractable itching Signup and view all the answers

Study Notes

Well Woman Exams

Pap smear: collection of cervical cells during a speculum exam
Well woman exam: head-to-toe exam of a woman, may include a clinical breast exam (CBE) and Pap smear

Pap Smear Myths and Facts

Most women fall into routine screening categories for their age group
Pap smears do not begin until age 21, regardless of sexual activity
Most insurance companies cover an annual well woman exam

ASCCP & US Preventative Task Force Apps

ASCCP mobile app free for iOS and Google devices
US Preventative Task Force app available for free for iOS and Google devices

Patient Example: Annie

21-year-old female presenting for a well woman exam
Declines need for testing and birth control
Blood pressure 120/80, pulse 82, temperature 98.2
Weight 120lb, height 5’5”

Clinical Breast Exam (CBE)

Patient should lay flat with arms above head
Palpate both breasts and axillary area using one of three patterns: wedge, vertical, circular or clockwise
Note: Any unusual warmth or coldness, tenderness, size, shape, surface abnormalities (rashes, wounds, open areas, peeling or cracking skin, dimples, divots, unusual color changes)

Genital Urinary (GU) Exam

Bimanual exam:
- Ovaries & Fallopian tubes: tenderness or enlargement
- Uterus: tenderness, enlargement and position
- Bladder: tenderness or prolapse
- Cervix: cervical motion tenderness
Speculum exam:
- Exterior: any rashes, lesions, atrophy
- Vagina: foreign body, redness, irritation, excessive discharge, tenderness, prolapse
- Cervix: discharge, redness, friability, bleeding, IUD strings
Rectal exam: note lesions, bleeding, irritation

Pap Smear Results

ASC-US (Atypical Squamous Cells of Unknown Significance): Most common abnormal finding. Can be a sign of infection such as HPV or a vaginal infection, inflammation, or low hormones in postmenopausal women. Most often benign.
LSIL (Low Grade Squamous Intraepithelial Lesion): Can also be called mild dysplasia. Usually caused by HPV. May go away without treatment but can sometimes lead to cancer.
ASC-H (Abnormal Squamous Cells Cannot Rule Out High Grade): May be a sign of high-grade lesions. Can become cervical cancer if left untreated.

HPV

HPV 16, 18, and high-risk HPV strains (at least 12) are linked to cervical cancer

Patient Management

Complete a pregnancy test
Uterine Bleeding (AUB):
- Regular cycle: NSAIDS
- LUS (Levonorgestrel releasing system): Mirena
- OCPs
- Surgery: Hysterectomy; Ablation

Amenorrhea (Absence of Menstruation)

Most common reason: PCOS (Polycystic Ovarian Syndrome)
Treatment depends on the underlying cause
May include OCPs or medication such as Clomid for pregnancy

Breast Concerns

Most common is a lump in the breast
Can be found in women on HRT or OCPs
May be noted during certain points in their menstrual cycle
Most often benign in nature (fibrocystic or mammary dysplasia)

Breast Concern Symptoms

Tenderness
Rapid changes in size
Redness, dimpling, peeling

Breast Concern Testing

Mammogram
Ultrasound
Breast biopsy

Breast Concern Treatment and Self Care

Avoid trauma
Wear well-fitting bras
Eliminate caffeine, HRT, OCPs, progesterone supplements
Stress importance of breast self-awareness and CBE

Dysmenorrhea (Painful Menstruation)

Painful cramping associated with sweating, headaches, nausea/vomiting/diarrhea, leg or back pain
Can affect up to 90% of women in their lifetime
Primary: Teenagers to 20s, no underlying reason
Secondary: 20s to 30s, usually a pathology

Dysmenorrhea Treatment

Primary: NSAIDS, OCPs, heating pad, TENS unit, reassurance
Secondary: Treatment depends on cause, refer to a specialist

Menopause

Spontaneous: No period for 12 months
Perimenopause: Abnormal menstrual cycle, may have symptoms
Premature menopause: Risk for osteoporosis
Primary Ovarian Insufficiency: Risk for osteoporosis

Menopause Treatment

Calcium and vitamin D supplementation
SSRIs
HRT: Caution, must use progesterone if the patient has a uterus
- Cannot be used with current, past, or suspected breast cancer
- Estrogen-sensitive malignancy
- Undiagnosed vaginal bleeding
MenoPro Mobile App (Free)

Genitourinary Syndrome of Menopause (GSM)

Common findings:
- Vaginal/Vulvar changes: Dryness, irritation, painful sex, spotting or bleeding after sex
- Vaginal Atrophy: Thin, pale, decreased elasticity
- Bladder Issues: Increase in frequency and urgency, common to experience UTIs, incontinence
Treatment:
- Nonhormonal treatments
- Hormonal treatments: Local estrogen

Patient Example: Deloris

53-year-old female, last menstrual period 8 months ago
Blood pressure 138/80, weight 145 lb
No significant family history
History of lipid disorder
Follow up to menopausal signs and symptoms

PCOS (Polycystic Ovary Syndrome)

Etiology is unknown
Common feature is hypersecretion of androgens
Diagnosis in adult women requires 2 of the 3 following:
- Hyperandrogenism
- Oligo-ovulation or anovulation
- Polycystic ovaries on ultrasound
Treatment depends on if pregnancy is desired
Can be a lifelong disease

Lichen Sclerosis (LS)

Irretractable itching
Unknown cause
Often mistaken for yeast infection or genital herpes
Exam: White wrinkle-appearing plaques or patches, tissue is usually red around it.
Testing: Punch biopsy, rule out coexisting vaginal infection
Treatment: Use ointment over cream

Vulvodynia & Dyspareunia

Vulvodynia: Vulvar pain for 3 months with no identifiable cause
Dyspareunia: Painful intercourse
Etiology is unknown
Diagnosis is based on exam and history, rule out any coexisting conditions
Treatment: Pelvic floor therapy and referral to a gynecologist

Yeast Infection

Most common cause of vaginal itching
Exam: Thick discharge, thick white patches in vaginal mucosa, usually no odor
Testing: KOH prep
Treatment: Topical is available OTC, oral and topical may be prescribed

Well Woman Exam

Pap smear and well-woman exam may be used interchangeably
Pap smear is a cervical cell collection during a speculum exam
Well-woman exam is a head-to-toe exam that may or may not include a pap smear, and includes a CBE
Most insurance companies cover an annual well-woman exam

Pap Smear Myths and Facts

Pap smears should not be done yearly on every woman
Women do not need to come in yearly for a pap smear
Women should start pap smears at age 21, regardless of sexual activity

Resources

ASCCP and US Preventative Task Force Apps are available for free
Hollier and Dunphy are useful texts for well woman exam information

Patient Encounter

Annie is a 21- year old patient presenting for a well woman exam
Annie declines testing and birth control since she is not sexually active

Clinical Breast Exam

Patient should lay flat with arms above head
During the exam, it is important to observe temperature, tenderness, size, shape, and surface of the breasts
When charting abnormalities, consider a clock-face model for the location

Bimanual Exam

Bimanual exams are done to evaluate:
- Ovaries and fallopian tubes
- Uterus
- Bladder
- Cervix

Speculum Exam

During the speculum exam, evaluate:
- Exterior: Rashes, lesions, atrophy
- Vagina: Foreign objects; redness, irritation; excessive discharge; tenderness; prolapse
- Cervix: Discharge; redness; friability; bleeding; IUD strings
- Rectal: Lesions; bleeding; irritation

Abnormal Pap Smear Results

ASC-US: Most common abnormal finding; most often benign
LSIL: Low-grade squamous intraepithelial lesion; usually caused by HPV
ASC-H: Abnormal squamous cells that cannot rule out high grade; can become cervical cancer if left untreated

HPV

Several strains of HPV are linked to cervical cancer, including:
- HPV 16
- HPV 18
- HPV HR

Patient Management

Complete a pregnancy test
Manage uterine bleeding with:
- Regular cycle: NSAIDs
- LUS
- OCPS
- Surgery

Amenorrhea

Most common reason is PCOS
Treatment depends on cause
May include:
- OCPS
- Medications such as clomiphene for pregnancy

Breast Concerns

Most common is a lump in the breast
Can be found in women on HRT or OCPs
Most are benign
Women and families can be highly anxious about breast concerns

Breast Concerns Symptoms and Testing

Symptoms include:
- Tenderness
- Rapid changes in size
- Redness, dimpling, peeling
Testing includes:
- Mammograms
- Ultrasounds
- Breast Biopsy

Breast Awareness

Advocate for breast self-awareness and regular CBEs
Encourage a healthy lifestyle including:
- Avoiding trauma to the breast
- Wearing well-fitting bras
- Eliminating substances such as caffeine, HRT, OCPs, and progesterone supplements

Dysmenorrhea

Painful cramping associated with at least one of the following:
- Sweating
- Headaches
- Nausea, vomiting, diarrhea
- Leg or back pain
Affects up to 90% of women
Primary: Common in teens and 20s
Secondary: Common in 20s and 30s, usually a pathology
Treatment:
- Primary: NSAIDs, OCPs, heat, TENS unit, reassurance
- Secondary: Treatment depends on the cause, referral to specialist

Menopause

Spontaneous- No period for 12 months
Perimenopause- Abnormal menses with symptoms
Premature menopause- Risk for osteoporosis
Primary ovarian insufficiency- Risk for osteoporosis
Treatment:
- Calcium and Vitamin D supplementation
- SSRIs
- HRT with progesterone if patient has a uterus
- MenoPro Mobile app

GSM

Common findings:
- Vaginal or vulvar changes: dryness, irritation, painful sex, spotting or bleeding
- Vaginal atrophy: Thin, pale, decreased elasticity
- Bladder issues: Increased frequency and urgency, UTIs, incontinence
Treatment:
- Non-hormonal and hormonal treatment options
- Local estrogen

Deloris Patient Encounter

Deloris is a 53-year-old patient with an LMP 8 months ago
She has a history of a lipid disorder, BP of 138/80, and a weight of 145 lbs
She presents for follow-up for menopausal signs and symptoms

PCOS

Etiology is unknown
2 of the 3 criteria must be present for diagnosis:
- Hyperandrogenism
- Oligo-ovulation or anovulation
- Polycystic ovaries on ultrasound
Treatment depends on if pregnancy is desired

LS (Lichen Sclerosus)

Irretractable itching
Unknown cause
Often misdiagnosed for yeast infections and genital herpes
Exam Findings:
- White wrinkle-appearing plaques or patches
- Tissue is usually red around it
Testing: Punch biopsy; rule out coexisting vaginal infections
Treatment: Use ointment over cream

Vulvodynia and Dyspareunia

Vulvodynia is vulvar pain for 3 months with no cause
Etiology is unknown
Many women have pain with sexual intercourse
Diagnosis is based on exam and history
Rule out any coexisting conditions
Treatment: Pelvic floor therapy and referral to a gynecologist

Yeast Infection

Most common cause of vaginal itching
Exam Findings:
- Thick discharge
- Thick white patches in vaginal mucosa
- Usually no odor
Testing: KOH-prep
Treatment: Topical OTC; oral and topical prescription medications

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Description

This quiz covers essential information about well woman exams, including procedures such as Pap smears and clinical breast exams. Additionally, it discusses common myths and facts regarding Pap smear screenings and the availability of related mobile apps. Perfect for those seeking a better understanding of women's health assessments.