19-8 Clinical Care OBGYN Flashcards
what is the second most common cancer in women
female breast carcinoma
what is the second leading cause of cancer deaths
female breast carcinoma
what is the most significant risk factor for female breast carcinoma
age
what is the most reliable means of detecting breast cancer before a mass can be palpated
mammography
mammography can identify most slow growing cancers within how many years before they are palpable
2 years
what is the diagnostic procedure of choice in both palpable and image detected abnormalities
core needle biopsy
local and distant recurrences for female breast carcinoma occur most frequently within what time frame
within the first 2-5 years
how often should a female with breast carcinoma be examined during the first 2 years
every 6 months and then annually thereafter
what disease condition in males increase their risk of male breast carcinoma
men with prostate cancer
which condition has the worse prognosis, male breast carcinoma or female breast carcinoma
male breast carcinoma
what is described as a painless, hard, ill defined, non tender mass beneath the nipple or areola
male breast carcinoma
what is described as a painful bilateral, breast mass that worsens during premenstrual phase cycle
fibrocystic changes
what is the most frequent lesion of the breast
fibrocystic changes
what is described as a round, rubbery, discrete, mobile, nontender mass of the breast
fibroadenoma
what is a common benign neoplasm (of the breast) that occurs most frequently in young women
fibroadenoma
what is the cause of fat necrosis
- trauma (MVA or assault)
- segmental resection
- radiation therapy
- flap reconstruction after mastectomy
what are risk factors for female breast carcinoma
- age
- FMH of breast cancer or ovarian cancer
- BRCA1/BRCA2 mutation
- nulliparous
- early menarche
- late menopause
- PMH of endometrial cancer or cancer in the other breast
what is considered early menstrual cycle
under 12
what is considered late menopause
after 55
what is described as a single nontender, firm to hard breast mass, with ill defined borders
female breast carcinoma
what is the treatment for fibrocystic changes
- NSAIDs
- avoid trauma
- wear supportive bra
- decrease dietary fat intake
- eliminate caffeine
- vitamin E, 400IU daily
- BSE
what causes milky discharge in non lactating women
hyperprolactinemia
what type of medications can cause lactation in men and women
antipsychotic drugs
what is the normal range for menstrual bleeding
2 to 7 days
what is the average number of days for normal menstrual bleeding
5 days
what is the mean blood loss per menstrual cycle
40ml
blood loss over 80ml
menorrhagia
bleeding between periods
metrorrhagia
bleeding that occurs more often than every 21 days
polymenorrhea
bleeding that occurs less frequently than every 35 days
oligomenorrhea
what are structural causes of abnormal uterine bleeding
- polyp
- adenomyosis
- leiomyoma
- malignancy (hyperplasia)
what is the most common anovulation cause of abnormal uterine bleeding
ovulatory dysfunction
what are the common sequalae of sexual violence
- anxiety disorders
- PTSD
- rape trauma syndrome
what are the two principle phases of rape trauma syndrome
- immediate or acute
- late or chronic
what is “quickening”
perception of first movement noted
at how many weeks can “quickening” be felt
18th week
at how many weeks does softening of the cervix occur
around 7 weeks
what is chadwick sign
bluish to purple color of the cervix
at how many weeks is the uterine fundus palpable above the pubic symphysis
12-15 weeks from the last menstrual period
at how many weeks can fetal heart tones be heard
8-10 weeks
at how many weeks will the uterine fundus be palpable at the umbilicus
20-22 weeks
how long can pregnant women remain on the ship
up until 20th week
what is a threatened abortions
- bleeding or cramping occurs
- pregnancy continues
- the cervix is not dilated
what type of abortion has a dilated cervix
incomplete abortion
what type of abortion is it when the cervix is not dilated
threatened abortions
what causes functional amenorrhea
hypothalamic pituitary
what are the complications of premature menopause
increased risk of coronary disease, stroke, and mortality
what is the most common cause of secondary amenorrhea in premenopausal women
pregnancy
any female with vaginal bleeding, a positive hCG, and abdominal pain is experiencing what condition
ectopic pregnancy
what trimester does ectopic pregnancies usually occur
first trimester 2% of the time
what are the risk factors for ectopic pregnancy
- infertility
- PID
- ruptured appendix
- prior tubal ligation
what is the most common cause of maternal death during the first trimester
ectopic pregnancy
what condition does the patient have:
- unilateral pelvic pain
- vaginal bleeding
- adnexal tenderness
- positive hCG
ectopic pregnancy
treatment for ectopic pregnancy
- laparoscopy
- methotrexate 50mg/mm IM
what are complications of ectopic pregnancy
- shock
- anemia
- repeat tubal pregnancy
how often does repeat tubal pregnancies occur
10%
what is the procedure of choice to confirm and remove ectopic pregnancy
laparoscopy
what causes mastitis
staph aureus
what condition must be considered if mastitis occurs in nonlactating breast
inflammatory carcinoma
what antibiotics are used for mastitis caused by MSSA
- cephalexin (keflex)
- clindamycin
what antibiotics are used for mastitis caused by MRSA
- trimethroprim/sulfamethoxazole (bactrim)
what are the complications of mastitis
- abscess formation
- sepsis
within how many hours should a patient with mastitis be referred to supervising physician if no improvement
72 hours
what is primary amenorrhea
- failure of menarche to appear
what age does menarche ordinarily occur
11-15 years
what is secondary menarche
absence of menses for 3 consecutive months in women who have began menses
what is the terminal episode of naturally occurring menses
menopause
when can a diagnosis of menopause be made
after 6 months of amenorrhea
nearly 70% of adnexal torsions occur on what side
right
What type of abortion is it when:
- products of conception are completely expelled
- pain stops
- cervical os is closed
- blood in vaginal vault
- spotting may persist
complete abortion
What type of abortion is it when:
- the cervix is dilated
- some products of conception remains in the uterus
- mild cramps
- bleeding is excessive
incomplete abortion
what type of abortion has
- brownish vaginal discharge but no active bleeding
- pain stops
- cervix is semi firm and slightly patulous
- adnexal are normal
- uterus is smaller
- products of conception has not been expelled
missed abortion
what are the complications of pregnancy loss
- hemorrhage
- anemia
- recurrent abortion
what instruction governs pregnancy
opnavinst 6000.1
what is the instruction that governs sexual assault patient
SECNAVINST 1752.4
when is uterine catherization contraindicated
- high riding/ free floating prostate
- blood at urethral meatus
- perineal hematoma
where is the urethral meatus located
lies in the superior fornix of the vulva above the vaginal opening and below the clitoris
how many times do you clean the area before inserting a foley in a female
4-5 times
how many times do you clean the area before inserting a foley into a male
3-4 times
under what conditions are pregnant service women allowed to stay on the ship
- up til 20th week of pregnancy
- while in port
- during short underway
(if MEDEVAC is within hours)
what type of nipple discharge is more likely benign fibrocystic changes
serous (clear)
what type of discharge is more likely neoplastic papilloma or carcinoma
bloody
bilateral nipple discharge is likely associated with what
non neoplastic ENDOCRINE etiology
what causes inflammation of the vagina
- pathogens
- allergic reactions to contraceptives
- vaginal atrophy
- friction
what condition has
- vaginal irritation
- pain
- unusual or malodorous discharge
- pelvic inflammation
- cervical motion tenderness
- adnexal tenderness
vaginitis
what are things that predispose patients to vulvovaginal candidiasis
- broad spectrum antibiotics
- pregnancy
- diabetes
- corticosteroids
- heat
- moisture
- occlusive clothing
what condition is:
- pruritis
- vulvovaginal erythema
- white curd like discharge
- NOT malodorous
vulvovaginal candidiasis
what condition is:
- sexually transmitted protozoal
- infects vagina, skene ducts, and lower urinary tract
- pruritis
- malodorous frothy, yellow-green, discharge with diffuse vaginal erythema
- strawberry cervix
trichomonas vaginalis
which vaginitis is caused considered to be a polymicrobial disease that is not sexually transmitted and chronic in nature
bacterial vaginosis
what is caused by an overgrowth of gardnerella and other anerobes
bacterial vaginosis
what is increased malodorous discharge without obvious signs of vulvitis or vaginitis
bacterial vaginosis
what is the treatment for vulvovaginal candidiasis
antifungals (fluconazole)
what is the treatment for trichomonas
metronidazole (antibiotic)
- treat both partners
what is the treatment for bacterial vaginosis
metronidazole
clindamycin vaginal cream
what patient education should be given to someone with vaginits
- avoid nonabsorbent undergarments
- avoid douching
- delay sexual intercourse until tx is complete
what age should cervical cancer screening begin
21
how many years is cervical screening and PAP requirements for age 21-65
every 3 years
at what age is HPV testing conducted
at age 30
how often are PAP and cervical screenings required in women aged 30-65 with negative HPV risk factors
every 5 years
in what 2 ways can PAP be described
- ASC-US (Atypical Squamous Cell of Unknown Significance)
- SIL (Squamous intraepithelial Lesions)
what system is used to report PAP smear
bethesda system
when is the follow up for women with ASC-US and negative HPV screening
1 year
What is indicated if a woman have ASC-US and a positive HPV screen
colposcopy
what vaccination is recommended for the prevention of HPV
gardasil
what age is gardasil recommended
age 9 and older
what is the treatment for cervical dysplasia
- cryosurgery
- CO2 laser
- LEEP
- Conization
most common benign neoplasm of the female genital tract
leiomyoma
what condition is described as a discrete, round, firm, often multiple uterine tumor
leiomyoma
where are lesions from endometriosis typically located
- pelvis
- bowel or diaphragm
when is early menopause
before age 45
when is premature menopause
before age 40
