SIU School of Medicine

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Department of Internal Medicine

Women's Health

Knowledge

Students should be able to define, describe and discuss:

  • The pathophysiology, clinical findings and diagnosis of menopause
  • Treatment options for menopausal symptoms
    • Risks and benefits of hormonal and alternative therapies
      • SSRIs, gabapentin, catapres, black cohosh, soy products
  • The pathophysiology, risk factors, causes and diagnosis of osteoporosis
  • Treatment options for osteoporosis
    • Calcium, vitamin D, estrogen, raloxifen, alendronate, calcitonin
  • Differences in clinical presentation, diagnosis and treatment of heart disease in women compared to men
  • Differential diagnosis and diagnostic evaluation of a breast mass
  • Risk factors and screening guidelines for breast cancer
  • Pathophysiology of and screening guidelines for cervical cancer
  • Management of abnormal pap smears
  • Physiology of bladder control
  • The pathophysiology, clinical findings, types and diagnosis of urinary incontinence
  • Treatment options for urinary incontinence
    • Pharmacologic – estrogen, alpha agonists and antagonists, cholinergics, anti-cholinergics, anti-spasmodics, calcium channel blockers
    • Physiotherapy – Kegel exercises, biofeedback, timed voiding
    • Surgery

Skills

Students should demonstrate specific skills, including:

  • History-Taking Skills:
    • Students should be able to obtain, document, and present a medical history for an annual health maintenance examination on a woman and determine appropriate evaluation and therapy for a woman with
      • Menopausal symptoms
      • Osteoporosis
      • Suspected coronary artery disease
      • A breast mass
      • Urinary incontinence

  • Physical Exam Skills:
    • Students should be able to perform a breast exam
    • Students should be able to perform a pelvic exam, including a pap smear and be familiar with special maneuvers indicated for a patient with incontinence (cough test; bulbocavernosis reflex, clitoral-sacral reflex)

  • Differential Diagnosis:
    • Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings on a woman with
      • menopausal symptoms
        • Irregular menstrual cycles
        • mood swings, anxiety, irritability
        • insomnia
        • hot flashes
        • vaginal mucosal atrophy and irritation
      • potential osteopenia/osteoporosis
        • age
        • thin body habitus
        • tobacco or alcohol use
        • Caucasian or Asian race
        • Sedentary life style
        • Lack of sun exposure
        • Family history
      • Symptoms suggestive of coronary artery disease
        • Chest pain (classic or atypical)
        • Epigastric pain
        • Dyspnea
        • fatigue
      • A breast mass
      • Urinary incontinence
        • Loss of urine with increased intra-abdominal pressure -- exercise, cough, laughter
        • Loss of urine preceded by a strong urge to void, whether bladder is full or not – ‘Overactive bladder”
        • Urine loss associated with over distention of the bladder – diabetic neuropathy, spinal cord injury, multiple sclerosis
        • Incontinence associated with delirium, infection, atrophic vaginitis, drugs, stool impaction, or psychiatric illness
        • Incontinence associated with recurrent UTIs, pelvic prolapse, previous pelvic surgery or radiation

  • Laboratory Interpretation:
    • Students should know the indications for, limitations of and understand the results of
      • An FSH (follicle stimulating hormone) level
      • A bone mineral density test
      • Exercise stress testing including nuclear stress imaging
      • Mammography and breast ultrasonography
      • A pap smear

  • Basic and Advanced Procedure Skills:
    • Students should be able to perform a pap smear
  • Management Skills:
    • Students should be able to outline an appropriate, cost-effective evaluation and treatment plan for patients experiencing menopausal symptoms that includes consideration of symptom severity, co-morbid conditions such as hypertension, coronary artery disease, osteoporosis, clotting disorders, family history, and patient preferences.
    • Students should be able to recommend an appropriate cost-effective evaluation and treatment plan for patients with osteoporosis that includes consideration of co-morbid conditions such as GERD, peptic ulcer disease, breast cancer, thrombophilias, family history, patient preferences, and indications for endocrinology consultation.
    • Students should be able to develop an appropriate cost-effective evaluation and treatment plan for patients with cardiac symptoms that includes consideration of cardiovascular risk factors, likelihood of gastrointestinal, musculoskeletal, psychiatric or pulmonary pathology as etiologic cause of symptoms, patient preferences, and need for consultation from a cardiologist
    • Students should be able to develop an appropriate evaluation and treatment plan for patients with a breast mass that includes consideration of patient risk factors and indications for referral to a surgeon
    • Students should be able to determine when to obtain consultation from a gynecologist for a patient with an abnormal pap smear
    • Students should be able to outline an appropriate evaluation and treatment plan for patients with symptoms of urinary incontinence that considers the type of incontinence, severity of symptoms, and indications for referral to a urologist or urogynecologist.

Attitudes and Professional Behaviors

Students should be able to:

  • recognize the importance of patient preferences when selecting among diagnostic and therapeutic options
  • appreciate the impact the patients illness and symptoms have on a patient’s quality of life and well-being

Resources

  • Clerkship Seminar, “Women’s Health”, S. Hingle, MD
  • Internal Medicine Clerkship Guide, Paauw, et al, Mosby 2003, pp. 499-520
  • Articles
    • Postmenopausal Hormone Replacement Therapy for Primary Prevention of Chronic Conditions: Recommendations and Rationale, US Preventive Services Task Force Guidelines from Guide to Clinical Preventive Services, August 1, 2002
    • Nonhormonal Pharmacologic and Complementary Treatment of Menopause, Thiedke, Clinics in Family Practice, Volume 4, Number 1, March 2002
      National Institutes of Health Consensus Development Conference Statement: Osteoporosis Prevention, Diagnosis and Therapy, Volume 17, Number 1, 2001
    • Screening for Cervical Cancer: Recommendations and Rationale, US Preventive Services Task Force Guidelines from Guide to Clinical Preventive Services, January 2003
    • Cardiovascular Disease in Postmenopausal Women: Myths and Reality, Lewis et al, American Journal of Cardiology, June 20, 2002
  • Books
    • Breast Health and Common Breast Problems: A Practical Approach, 2004,
      Pamela Ganschaw, editor, ACP Women’s Health Series
    • Coronary Artery Disease in Women, 1999, Pamela Charney, editor, ACP Women’s Health Series
    • Osteoporosis An Evidence Based Guide to Prevention and Management, 2002, Cummings et al., ACP Women’s Health Series
  • Presentations

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