nr 602 final exam
ASCCP recommended management for an ASCUS pap result with high risk hpv 16 cotest in 26
year old no abnormal paps - ANScolposcopy
What is included in the well women of an adolescent? - ANShealth history
menses
gynecologic and pregnancy issues
psychosocial
abuse drugs alcohol use
physical exam
screening tests
immunizations
When does ACOG pap smear start - ANS21 years old done every three years
ACOG pap for over 30 yrs old - ANSevery five years with HPV test completed
ACOG when can you stop pap smear - ANScan stop at 65 if negative history for 10 years or if
they had a hysterectomy with no history of cervical cancer
Bethesda pap smear report reads LSIL is what classification? - ANSCIN 1
A single Pap smear reading of ASCUS in a patient negative for HPV infection should have what
as follow-up? - ANSroutine screening
a female patient is 35 years old. she has never had an abnormal PAP smear has regular
screening since age 18. If she has a normal PAP smear with HPV testing today, when should
she have the next cervical cancer screening? - ANS5 years
A young sexually active is having her first pap smear what would you explain? - ANSpap smear
detects cervical cancer
26 year old pap smear shows negative and positive HPV what do you do? - ANSrepeat HPV
and pap
what is not part of criteria for older women to cease pap smears? - ANSover 55 year old
no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus -
ANSprimary amenorrhea
No menses for at least 6 months - ANSsecondary amenorrhea
,female athlete triad - ANSdisordered eating, amenorrhea, osteoporosis
labs for female athlete triad - ANSHCG
serum prolactin
serum TSH,FSH, LH
if amenorhea lasts longer than 6 months do what? - ANSbone density test
treatment plan for female athlete triad - ANSincrease caloric intake, decrease exercise
prescribe ca and vit d 1200/1500 daily and vitamin e 400 iu daily
complications of female athlete triad - ANSosteopenia/osteoporosis (stress fracture)
myocardial atrophy, arrhythmia, hypotension, brady
hypoglycemia, dehydration, electrolytes
lanugo, telogen effluvium hair loss zerosis dry skin, infertility, low body mass, cachexia,
respiratory failure
purpose of progesterone challenge - ANSendogenous estrogen
primary and secondary amenorrhea originates in hypothalamus - ANSsheehans syndrome
symptoms of breast cancer ( early) - ANSNone
Non-painful mass (occasionally pain)
Eczematous nipple (Paget's)
Serosanguinous (bloody) nipple discharge
late symptoms of breast cancer - ANSskin or nipple retraction
axilary lymhadenpathy
breast enlargement
redness, edema, brawny induration
peau d' orange
pain
fixation of the mass to the skin or chest wall
very late findings of breast cancer - ANSulceration
supraclavicular lymphadenopathy
edema of the arm, bone, lung, liver, brain or other distant metstases
Follow up for breast cancer patients - ANS1. Bilateral mammogram 6 months after complete
radiation post-lumpectomy; Mammogram yearly after
2. Contralateral mammogram annually post-mastectomy (entire breast + pectoralis major fascia)
PE every 3-6 months for 3 years then annually
, fibrocystic breast disease - ANSthe presence of single or multiple benign cysts in the breasts
signs and symptoms of fibrocystic breast disease - ANSoccurs 2 weeks before the onset of
mensus and worst right before the menstrual cycle. resolves after menses starts often in women
in their 30's. breast lumps are rubbery and mobile to touch
Tx for fibrocystic breast disease - ANSOnce a benign diagnosis or normal findings have been
established by biopsy or on clinical or imaging findings, simple reassurance will provide many
patients with adequate relief.
For those patients who still seek treatment, symptomatic relief by avoiding trauma and by
wearing a bra with adequate support can be very helpful. The role of caffeine consumption in
the development and treatment of fibrocystic change has never been proven; however, many
patients report relief of symptoms after abstinence from coffee, tea, and chocolate. Similarly,
observational studies have suggested that low-fat diets can provide some relief. The data
regarding the utility of vitamin E supplementation and evening primrose oil are controversial.
Mild analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can
be used to relieve breast pain. For more symptomatic women, danazol and tamoxifen have
been found to be effective, although their significant side effects have limited their acceptability
and utility.
Fibroadenoma - ANSbenign breast lesion 15-40 yrs old
risk factors for fibroadenoma - ANSmultiple fibroadenomas associated with rate cancer
syndromes like mafficci syndrome, Cowden syndrome, carney complex early ETOH
consumption
findings with fibroadenoma - ANSpainless, firm or rubbery mass with well defined borders, freely
mobile, changes with size may occur with pregnany or menstrual cycle, lesions under 5 cm,
considered to be giant fibrodenomas no nipple discharge
Dx of fibroadenoma - ANSmammo, us to differentiate fluid filled to solid mass, fine needle
aspiration biopsy, open biopsy
Intraductal papilloma - ANSbenign tumor within the ductal system of the breast, one of the
heterogeneous group of lesions encompassed by the term benign breast disease seen in
females 30-50
risk factors for intraductal papilloma - ANSmultiple papilloma's which increases the risk for
breast cancer
dx studies for intraductal papilloma - ANSmammo, us mri, galactography, fine needle or core
biopsy
ASCCP recommended management for an ASCUS pap result with high risk hpv 16 cotest in 26
year old no abnormal paps - ANScolposcopy
What is included in the well women of an adolescent? - ANShealth history
menses
gynecologic and pregnancy issues
psychosocial
abuse drugs alcohol use
physical exam
screening tests
immunizations
When does ACOG pap smear start - ANS21 years old done every three years
ACOG pap for over 30 yrs old - ANSevery five years with HPV test completed
ACOG when can you stop pap smear - ANScan stop at 65 if negative history for 10 years or if
they had a hysterectomy with no history of cervical cancer
Bethesda pap smear report reads LSIL is what classification? - ANSCIN 1
A single Pap smear reading of ASCUS in a patient negative for HPV infection should have what
as follow-up? - ANSroutine screening
a female patient is 35 years old. she has never had an abnormal PAP smear has regular
screening since age 18. If she has a normal PAP smear with HPV testing today, when should
she have the next cervical cancer screening? - ANS5 years
A young sexually active is having her first pap smear what would you explain? - ANSpap smear
detects cervical cancer
26 year old pap smear shows negative and positive HPV what do you do? - ANSrepeat HPV
and pap
what is not part of criteria for older women to cease pap smears? - ANSover 55 year old
no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus -
ANSprimary amenorrhea
No menses for at least 6 months - ANSsecondary amenorrhea
,female athlete triad - ANSdisordered eating, amenorrhea, osteoporosis
labs for female athlete triad - ANSHCG
serum prolactin
serum TSH,FSH, LH
if amenorhea lasts longer than 6 months do what? - ANSbone density test
treatment plan for female athlete triad - ANSincrease caloric intake, decrease exercise
prescribe ca and vit d 1200/1500 daily and vitamin e 400 iu daily
complications of female athlete triad - ANSosteopenia/osteoporosis (stress fracture)
myocardial atrophy, arrhythmia, hypotension, brady
hypoglycemia, dehydration, electrolytes
lanugo, telogen effluvium hair loss zerosis dry skin, infertility, low body mass, cachexia,
respiratory failure
purpose of progesterone challenge - ANSendogenous estrogen
primary and secondary amenorrhea originates in hypothalamus - ANSsheehans syndrome
symptoms of breast cancer ( early) - ANSNone
Non-painful mass (occasionally pain)
Eczematous nipple (Paget's)
Serosanguinous (bloody) nipple discharge
late symptoms of breast cancer - ANSskin or nipple retraction
axilary lymhadenpathy
breast enlargement
redness, edema, brawny induration
peau d' orange
pain
fixation of the mass to the skin or chest wall
very late findings of breast cancer - ANSulceration
supraclavicular lymphadenopathy
edema of the arm, bone, lung, liver, brain or other distant metstases
Follow up for breast cancer patients - ANS1. Bilateral mammogram 6 months after complete
radiation post-lumpectomy; Mammogram yearly after
2. Contralateral mammogram annually post-mastectomy (entire breast + pectoralis major fascia)
PE every 3-6 months for 3 years then annually
, fibrocystic breast disease - ANSthe presence of single or multiple benign cysts in the breasts
signs and symptoms of fibrocystic breast disease - ANSoccurs 2 weeks before the onset of
mensus and worst right before the menstrual cycle. resolves after menses starts often in women
in their 30's. breast lumps are rubbery and mobile to touch
Tx for fibrocystic breast disease - ANSOnce a benign diagnosis or normal findings have been
established by biopsy or on clinical or imaging findings, simple reassurance will provide many
patients with adequate relief.
For those patients who still seek treatment, symptomatic relief by avoiding trauma and by
wearing a bra with adequate support can be very helpful. The role of caffeine consumption in
the development and treatment of fibrocystic change has never been proven; however, many
patients report relief of symptoms after abstinence from coffee, tea, and chocolate. Similarly,
observational studies have suggested that low-fat diets can provide some relief. The data
regarding the utility of vitamin E supplementation and evening primrose oil are controversial.
Mild analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can
be used to relieve breast pain. For more symptomatic women, danazol and tamoxifen have
been found to be effective, although their significant side effects have limited their acceptability
and utility.
Fibroadenoma - ANSbenign breast lesion 15-40 yrs old
risk factors for fibroadenoma - ANSmultiple fibroadenomas associated with rate cancer
syndromes like mafficci syndrome, Cowden syndrome, carney complex early ETOH
consumption
findings with fibroadenoma - ANSpainless, firm or rubbery mass with well defined borders, freely
mobile, changes with size may occur with pregnany or menstrual cycle, lesions under 5 cm,
considered to be giant fibrodenomas no nipple discharge
Dx of fibroadenoma - ANSmammo, us to differentiate fluid filled to solid mass, fine needle
aspiration biopsy, open biopsy
Intraductal papilloma - ANSbenign tumor within the ductal system of the breast, one of the
heterogeneous group of lesions encompassed by the term benign breast disease seen in
females 30-50
risk factors for intraductal papilloma - ANSmultiple papilloma's which increases the risk for
breast cancer
dx studies for intraductal papilloma - ANSmammo, us mri, galactography, fine needle or core
biopsy
