[01.05] CMD - Approach to the Female Patient V2.pdf

Correct diagnosis

What does correct evidence-based treatment come from?

Build trust with the patient

What is a critical need when a patient is sensitive to disrespect regarding their culture?

Transmen

What specific patient group might obstetricians treat who require cultural awareness and sensitivity?

Artificial Intelligence and social media

What two modern tools allow patients to read about their symptoms before visiting a doctor?

Help patients properly understand collected content

What is one of the current doctor’s roles regarding information patients find online?

Patient will not return for future treatment

What happens if a patient does not trust their doctor?

Consent and data privacy

What two things should a doctor always ask for and emphasize to maintain trust?

Primary physician

What role should a physician practicing obstetrics and gynecology assume for her patient?

Nine to ten months

How long is the consistent relationship an OB typically has with a pregnant patient?

Medicolegal and psychosocial

Besides medical health, what two other types of issues might an OB be involved in for their patient?

Healthy lifestyle and minimizing health risk

What are the two focuses of the annual well-woman visit?

Preventive health practices

What does the annual well-woman visit promote?

Alcohol drinking, smoking, and vaping

What are three practices mentioned that put a woman’s health at risk?

Proper dieting

What intervention can specifically help women with PCOS and those in their 30s trying to get pregnant?

Preventable cancers

Screening is especially important for which type of deadly diseases?

Pap smear and mammogram

What two tools allow for the prevention and detection of cervical and breast cancers?

Three doses

How many doses are required for the HPV vaccine?

Three doses

How many doses are in the initial tetanus vaccine series?

Five doses

How many doses are required for lifetime tetanus immunity?

Body Mass Index

What specific measurement is important to check during a comprehensive history?

Specific indication or patient request

Under what two conditions should physical exams like internal or speculum exams be performed during a well-woman visit?

Shared decision-making

What process involves the doctor and patient discussing which specific physical exam procedures are needed?

Determine the context in which symptoms occurred

What is a key goal when investigating symptoms like vaginal discharge?

Observation, Chief Complaint, Pertinent Gynecological History, PMH, Family History, Social History, Safety, Nutrition, and ROS

What are the components of a complete gynecological history?

Non-verbal cues

What should a clinician observe to decide how to approach different cases?

Comfort, Acceptance, Responsiveness, Empathy

What does the CARE mnemonic for communication skills stand for?

Gender and culture sensitivity

What is included under the Acceptance component of the CARE mnemonic?

Culturally sensitive and respectful

The case of the Middle Eastern patient emphasized that a doctor must be what?

Her own words

How should the patient’s chief complaint be expressed in the documentation?

Chief complaint and Review of Systems

Which two sections are used to filter through possible differential diagnoses?

Review of Systems

If a patient mentions heavy bleeding but comes in for dysuria, where is the bleeding documented?

First day of last menses

How is the Last Menstrual Period (LMP) defined?

PCOS

What is the most common cause of menstrual irregularity?

Menarche, Interval, Duration, Amount, Symptoms

What does the MIDAS mnemonic for menstrual history stand for?

21 to 35 days

What is the normal interval range for a menstrual cycle?

Four to seven days

What is the normal duration of menstrual flow?

Bright red with cramping before and during the first day

What are the characteristics of an ovulatory cycle?

Irregular, dark colored, painless, and very short or very long

What are four characteristics of an anovulatory cycle?

OB Score

What must every female patient have recorded regarding their reproductive history?

Number of pregnancies

What does Gravidity refer to?

Pregnancies that went beyond 20 weeks

What does Parity refer to?

37 weeks or after

At what week is a baby considered Term?

20 to 36 weeks

What is the week range for a Preterm birth?

Number of miscarriages

What does the Abortions component of the OB score represent?

Living offspring today

What does the Live component of the OB score represent?

G4 T1 P1 A1 L3

A woman is 10 weeks pregnant, had twins at 36 weeks, a term delivery, and one miscarriage. What is her OB score?

Dictates type of screening

Why is it important to determine if a patient is sexually active?

Transvaginal ultrasound

What imaging is preferred for a sexually active woman?

Transrectal ultrasound

What imaging is an option for a patient who has not had sexual contact?

Female professional assistant or chaperone

What must a male doctor have in the room when examining a female patient?

STI screening and vaccination

The type of sexual relationship may indicate the need for what?

Menopausal women

For which group is it especially important to ask about sexual satisfaction and desire?

Disuse atrophy

What can happen to the vagina if a menopausal woman stops having sex, leading to dyspareunia?

Lubricant

What can be prescribed to menopausal women to ease sexual interaction?

Dysuria associated with a wound

How do patients with an HSV infection often report their symptoms?

Antivirals like Acyclovir

How should Herpes be treated instead of antibiotics?

Men having sex with men

The high increase in HIV cases in the Philippines is mostly attributed to which group?

21 years and above

At what age is a Pap smear typically offered?

Cytologic testing

What is the term for a regular Pap smear?

Liquid-based with HPV DNA

What type of primary HPV screening is more expensive but allows for strain identification?

Every five years

If a patient is HPV negative, how often should they have a follow-up check-up?

New sexual partner

What is an exception that would require testing before the five-year mark?

66 years old

At what age can screening stop if there is a history of adequate negative prior results?

Gardasil 9

Which nonavalent vaccine covers the most prevalent HPV strains?

HPV 52

What is the most prevalent HPV strain in the Philippines?

High risk and asymptomatic

For which patients should HIV, Gonorrhea, and Chlamydia tests be offered?

Clinical Breast Exam

What does CBE stand for?

Visual Inspection with Acetic Acid

What does VIA stand for?

Midwives

Which healthcare worker besides doctors can perform a VIA?

Every three years

What is the screening interval for VIA alone?

Every five years

What is the screening interval for VIA combined with HPV testing?

D&C, Biopsy, and Excision

What are three examples of minor gynecological procedures?

Total Abdominal Hysterectomy

What does TAH stand for?

Bilateral Salpingo-Oophorectomy

What does BISO stand for in TAHBISO?

Unilateral Salpingo-Oophorectomy

What does USO stand for?

Adhesions

What can positive surgical history indicate that might affect fertility?

Laterality

What must be assessed regarding removed organs to evaluate reproductive implications?

Place, Quality, Radiation, Severity, Timing

What does the PQRST framework stand for in pelvic pain?

Endometriosis or ovulatory pain

What are the two primary considerations for chronic cyclical pelvic pain?

Endometriosis

A bruise-like lesion near a C-section scar that changes with the menstrual cycle suggests what?

Dienogest

What medication might be used to try and shrink endometriosis lesions before considering surgery?

Anaphylactic shock

What is a severe risk of not disclosing drug allergies?

Heavy and prolonged menstruation

What condition in teenage girls can lead to anemia?

9 years old

How early can girls begin receiving the HPV vaccine?

Every 10 years

How often should healthy adults receive a tetanus toxoid-containing vaccine?

Tdap

Which tetanus vaccine should be given once to adults with unknown status before continuing the series?

Congenital malformations, mental retardation, or pregnancy loss

What three family history items are crucial if a patient wants to get pregnant?

Congenital anomaly scan

What should a patient with a family history of cleft palate undergo during pregnancy?

Anti-Phospholipid A Syndrome

Which immunological condition can cause the immune system to dispose of a fetus?

Chromosomal mosaicism

What genetic condition can be found through DNA analysis in cases of recurrent pregnancy loss?

Egg donor

What is a sourcing option for parents with genetic anomalies, though it may not be desired?

Strenuous contact sports or martial arts

What should pregnant patients discontinue to avoid physical trauma and miscarriage?

Chloroquine

What malarial prophylaxis is safe for pregnant mothers traveling to areas like Palawan?

Doxycycline

Which medication is not recommended for pregnant patients?

Intimate Partner Violence

What does IPV stand for?

Violence Against Women and Children

What does VAWC stand for?

Astride or standard way

How should a pregnant patient sit on a motorcycle?

Folic acid and calcium

What are two specific nutritional components mentioned for female health?

Patient Health Questionnaire

What does PHQ-2 or PHQ-9 stand for?

Gather information and teach the patient about her body

What are the two functions of the physical examination?