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1: Middle age F wellness exam (Screenings (Gender (cervical cancer (Pap…
1: Middle age F wellness exam
Screenings
Gender
breast cancer
Mammogram
40-44: optional; 45-54 annually; >55-74 every 2 years
Breast MRI if have >20% lifetime risk of BC
Breast exam
2cm, irregular mass
cystic --> FNA; solid --> mammogram
nipple discharge
ddx: prolactinoma, hormone imbalance
meds: antidepressants, antipsychotics, antihypertensives, opiates
breast cancer: intraductal papilloma, mammary duct ectasia, paget disease of breast, DCIS
clinical exam q3yrs in 20s-30s, yearly >40yo
cervical cancer
Pap smear
technique: spatula rotated several times at ectocervix, cytobrush inserted into os, rotated 180degrees making sure sample squamous-columnar junction. place sample into liquid medium.
atypical squamous cells - some abs cells seen
low grade intraepithelial lesion - may progress, most regress
high grade - precancerous lesion
squamous cell carcinoma
screening: 21-29: every 3yrs; 30-65 every 5 years if co-tested for HPV or every 3 years if cytology alone
can stop at 65yo if adequate negative screens in last 10yrs
risk factors: early onset sx, multiple sexual partners, cigs, immunosuppressed. diethylstilbestrol DES exposure in utero
menopause
12 straight months w/o periods
perimenopause - slowww down for 2-8yrs
sxs: hot flashes, vaginal dryness, mood swings
ovarian cancer - not recommended if asymptomatic
age
skin
not recommended
lung - low dose CT >55yo with 30+ pack yrs, quit <15yrs ago
colon cancer
osteoporosis
risk factor: SMOKING, early menopause, sedentary, previous fracture as adult, fam hx, white ppl
increase dairy intake and weight bearing exercises
screening: >65yo DEXA scan <65yo fracture risk assessment tool to eval for DEXA scan
Lifestyle
BMI/weight
nutrient-dense diet low fat/fat free dairy, proteins, oils, grains. reduce portion
exercise
150min mod-intensity, 75min vigorous intensity or combo every week
2days/week - strengthening exercise
smoking cessation
risk factors
non modifiable
sex
hormonal exposure
breast density
age
fam hx/genetics
environment
obesity
radiation exposure
alcohol/smoking
gender
hormone tx
nulliparity
adv. maternal age
protective factors
early pregnancy
late menarche
early menopause
high parity
NSAIDs, ASA, selective estrogen receptor modulators
immunizations
age
tetanus
every 10 years 19-64yo
influenza
pneumococcal
pneumovax for smokers
zoster
Gender
HPV
Gardasil - 6,11 [gen warts], 16, 18
cervarix - 16, 18, 31, 45
Gardasil 9 - 6, 11, 16, 18, 31, 33, 45, 52, 58