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?

    <p>Most women do not require yearly screenings.</p> Signup and view all the answers

    What should be assessed during a clinical breast exam?

    <p>Temperature, tenderness, and size.</p> 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?

    <p>Discuss the importance, but respect her decision.</p> Signup and view all the answers

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

    <p>Every woman needs to come in yearly.</p> Signup and view all the answers

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

    <p>Lying flat with arms above head.</p> Signup and view all the answers

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

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

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

    <p>Usually resolves without treatment</p> Signup and view all the answers

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

    <p>Oral Contraceptive Pills (OCPs)</p> Signup and view all the answers

    What does a breast lump most commonly indicate?

    <p>Fibrocystic changes</p> Signup and view all the answers

    What is a primary symptom of dysmenorrhea?

    <p>Painful cramping</p> Signup and view all the answers

    Which condition is commonly linked with premature menopause?

    <p>Increased risk for osteoporosis</p> Signup and view all the answers

    What is a common treatment for vulvodynia?

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

    How is a yeast infection typically diagnosed?

    <p>KOH-prep examination</p> Signup and view all the answers

    What symptom is associated with vaginal atrophy?

    <p>Painful sex</p> Signup and view all the answers

    What should be avoided in breast care for discomfort?

    <p>Consuming caffeine</p> Signup and view all the answers

    What does cervical motion tenderness usually indicate?

    <p>Inflammation or infection</p> Signup and view all the answers

    What condition can often be misdiagnosed as a yeast infection?

    <p>Lichen sclerosus</p> Signup and view all the answers

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

    <p>Levonorgestrel Releasing System (LUS)</p> Signup and view all the answers

    Which of the following statements about primary amenorrhea is true?

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

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

    <p>Tenderness or enlargement</p> Signup and view all the answers

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

    <p>Skin dimples or divots</p> Signup and view all the answers

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

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

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

    <p>Possible infection or inflammation</p> Signup and view all the answers

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

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

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

    <p>Assessing breast size and tenderness</p> Signup and view all the answers

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

    <p>US Prevention Task Force App</p> Signup and view all the answers

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

    <p>Temperature differences can indicate issues</p> Signup and view all the answers

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

    <p>She is not sexually active and feels testing is unnecessary</p> Signup and view all the answers

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

    <p>Preventive healthcare to reduce long-term costs</p> Signup and view all the answers

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

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

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

    <p>At age 21, regardless of sexual history.</p> Signup and view all the answers

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

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

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

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

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

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

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

    <p>Most often benign</p> Signup and view all the answers

    Which HPV strains are most commonly associated with cervical cancer?

    <p>HPV 16 and HPV 18</p> Signup and view all the answers

    What is the primary treatment for secondary dysmenorrhea?

    <p>Depends on underlying cause</p> Signup and view all the answers

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

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

    What is a common finding in women undergoing menopause?

    <p>Vaginal atrophy</p> Signup and view all the answers

    What is the most common cause of vaginal itching?

    <p>Yeast infection</p> Signup and view all the answers

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

    <p>HRT without progesterone</p> Signup and view all the answers

    What is a key feature of vulvodynia?

    <p>Vulvar pain for at least three months</p> Signup and view all the answers

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

    <p>Premature menopause</p> Signup and view all the answers

    How can a LS diagnosis be confirmed?

    <p>Punch biopsy</p> Signup and view all the answers

    During what life stage is primary amenorrhea most commonly identified?

    <p>Teenage years to 20s</p> Signup and view all the answers

    What is a potential symptom of amenorrhea caused by PCOS?

    <p>Excessive hair growth</p> Signup and view all the answers

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

    <p>Increase caffeine intake</p> Signup and view all the answers

    What characteristic is most commonly associated with LS?

    <p>Irretractable itching</p> 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.

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