CMN 572 UNIT 2 EXAM. QUESTIONS WITH 100% CORRECT ANSWERS.

Contraceptive standard follow up regimens: -Re-check placement of IUDs in 4-6 weeks, then follow yearly -Follow-up with pills, patches and rings in 3 months, then every year -Depo injections, follow-up for injection q 12 wk 2 types of Pap tests: Conventional: cervical cells are collected using a wooden spatula and/or brush and placed on glass slide. Least expensive method. Liquid Prep: cervical cells are obtained with a "broom" and placed into a bottle containing liquid. Residual liquid can also be used for HPV testing on the same sample CIN (cervical intraepithelial neoplasia) An disordered growth and development of the epithelial lining of the cervix. Formerly termed "dysplasia". Divided into low and high grade lesions CIN 1: low grade lesions CIN 2 or 3: high grade lesions CIS: carcinoma in situ (localized) -These are diagnoses made after cervical biopsy (histology) Common report terminology on Pap smear lab Adequacy of sample: either satisfactory or unsatisfactory. Unsatisfactory may mean that there are not enough cells to evaluate AKA sample wasn't taken from cervix A normal pap is reported as "negative for intraepithelial lesion or malignancy" NILM EC/TZ absent or insufficient: no or insufficient number of endocervical cells (EC). This is the area where the squamous cells meet the glandular cells. This is called the transformation zone (TZ)and is where cancer is more likely to develop (inside cervical canal) Abnormal PAP results: Unsatisfactory insufficient sample HPV status unknown=repeat Pap 2-4mos 30yo & HPV-= repeat 2-4 mos 30yo & HPV+= colposcopy or repeat 2-4mos @2-4 mos: abnormal: manager per guidelines NILM/- =routine screening Unsatisfactory=colposcopy Abnormal PAP results: NILM but EC/TZ insufficient/absent 21-29yo: continue routine screening 30yo & HPV- =routine screen or HPV unknown= HPV test (pref) or repeat pap q3 years 30 & HPV+ =PAP/HPV @ 1 yr or genotype Abnormal PAP results: 30yo with -PAP & HPV+ repeat contesting in 1 yr: both results - = repeat contest in 3 years OR HPV genotyping: HPV 16/18+= colposcopy HPV 16/18- = repeat cotest 1 yr Abnormal PAP results: 21-24yo with ASC-US or LSIL repeat Pap in 1 yr: - again= repeat 1 yr until negative x2 (if ASC again or high grade=colposcopy) OR HPV reflex testing += repeat in 1 yr - =continue routine screen Abnormal PAP results: ACS-US 24 yo HPV test (pref): + =colopscopy - = cotest in 3 years OR repeat Pap 1 year: - = continue routine screening ACS= colposcopy Reportable STDs chlamydia, gonorrhea, syphillis-all states Genital warts, PID-certain states/local Partner management chlamydia & gonorrhea: treat contacts within 60 days of sx's 60 days of symptom onset=treat most recent partner Partner management of HSV partners with sx's=treat test those without symptoms Partner management of PID male sex partners of women within 60 days = tx empirically for chlamydia/gonorrhea Partner management of syphilis treat contacts within 90 days presumptively even if negative 90 days=tx presumptively (unless sero test negative) Menstrual flow types & suggested OCP cramping associated with heavier flows: COCs. estrogen needed Irregular menses + PCOS or insulin resistance: high progestin, low androgen Irregular menses other than above: low estrogen/progestin Role of estrogen and progesterone Estrogen (estradiol) is responsible for the development of breast enlargement & other secondary sexual characteristics, decreases FSH progesterone (progestin= NORethindone, LevonorGESTREL, etc) is responsible for stimulating the uterine lining for fertilization and maintaining pregnancy. secreted by corpus lutem & placenta Missed OCP/patch/ring instructions POP: sensitive (2-3 hours) to continued routine administration. May need emergency contraception if pt having sex COC: only 1 pill missed/ 24-48 hours from last scheduled dose: take yesterdays & todays pill ASAP. Set reminders to stay on schedule 2 pills or 48 hours missed dose: Take the most recent missed pill as soon as possible Continue taking the remaining pills at the usual time(even if it means taking two pills on the same day). Use back-up contraception for 7 days. -If pills were missed in the last week of hormonal pills (prior to hormone free week): skip hormone free interval and begin new pack/use backup contraception until new pack can be obtained