4.5 Flashcards
1
Q
is estrogen high or low in someone with atrophic vaginitis
A
low
2
Q
why is cervix friable in atrophic vaginitis
A
hypoestrogenic state
3
Q
why is someone with atrophic vaginitis at increased risk of infections
A
decreased lactobacilli –> increased pH
4
Q
therapy for atrophic vaginitis
A
intravaginal estrogen products
5
Q
can lichen sclerosis be spread through sexual contact
A
yes
6
Q
what is a precursor to osteoporosis
A
osteopenia
7
Q
what pathologic fractures are most common in osteoporosis
A
vertebral fractures
8
Q
best diagnostic test for osteoporosis
A
DEXA scan
9
Q
osteoporosis T score
A
T score -2.5 or less
10
Q
Initial lifestyle modifications for osteoporosis
A
Vitamin D + calcium supplementation
11
Q
how much vitamin D is advised
A
800 mg
12
Q
how much calcium is advised
A
1500 mg
13
Q
first line MEDICAL management and prevention of osteoporosis
A
bisphosphonates
14
Q
Osteopenia T score
A
-1 to -2.5
15
Q
USPSTF advice for screening men for osteoporosis
A
insufficient evidence to screen men
16
Q
best tool for diagnosis of osteoporosis
A
DEXA
17
Q
USPSTF recommendations for DEXA scan
A
women 65 and older
younger women at risk
-a personal history of fractures
-low body weight
-smoking
-glucocorticoids
-and early menopause
18
Q
classification used based on vertebral height lost
A
Genant classification
19
Q
fractures above what level are suggestive of a malignancy
A
T4
20
Q
types of compression fractures
A
wedge
crush
burst
21
Q
what is the most common type of compression fracture
A
wedge
22
Q
menorrhagia
A
heavy menstrual bleeding that lasts longer than 7 days
23
Q
women who take estrogen alone and risk of breast cancer
A
lower risk of breast cancer
24
Q
women who take estrogen + progesterone and risk of breast cancer
A
higher risk of breast cancer
25
two types of breast implants
saline
silicone
26
which breast implant is safer
silicone
27
when do patients with breast implants need an MRI
5 years later
and then every 2-3 years
28
do breast implants affect a woman's ability to breastfeed
no
29
ALP tends to be higher in
bone disease
30
if ALP + GGT are high this indicates
hepatobiliary issue
31
BAP
bone alkaline phosphatase
measures metabolic status of osteoblasts
32
should BAP be used for screening of osteoporosis
NO -- can be used to monitor meds
33
what is necessary for activation of vitamin D
magnesium
34
functional cells in parathyroid
chief cells
35
blood supply to parathyroid
same as for thyroid
inferior thyroid arteries
36
congenital parathyroid aplasia
DiGeorge syndrome - a type of hypoparathyroidism
37
vitamin D levels at what level indicate risk for osteomalacia
< 12
38
preferred vitamin D supplementation
D3 (cholecalciferol)
39
after starting vitamin D supplementation, when should you recheck serum levels
3 months
40
cancer associated with proliferation of a single clone of immunoglobulin-producing plasma cells leading to increased production of ineffective monoclonal antibodies
multiple myeloma
41
what are the main ineffective monoclonal antibodies in multiple myeloma
IgG (60%) and IgA (20%)
42
most common primary bone malignancy in adults
multiple myeloma
43
risk factors for multiple myeloma
older adults (median age 65)
african americans
men
44
bones BREAK in multiple myeloma
Bone pain
Recurrent infections
Elevated calcium
Anemia
Kidney injury
45
most common symptom of multiple myeloma
bone pain; vertebral involvement most common
46
bone pain in multiple myeloma is due to what type of lesions
osteolytic lesions
47
what will you see on CBC for multiple myeloma
Rouleaux formation "stack of coins"
48
calcium levels in multiple myeloma
hypercalcemia!!!!
49
serum protein electrophoresis for multiple myeloma
monoclonal spike protein - IgG most common
50
urine protein electrophoresis in multiple myeloma
Bence-Jones proteins composed of kappa or lambda light chains
51
what causes kidney injury in multiple myeloma
light chain antibody deposition in kidneys
52
radiographs for multiple myeloma
"punched out" lytic lesions
53
definitive diagnosis of multiple myeloma
bone marrow aspiration --> plasmacytosis (clonal plasma cells) >/= 10%
54
most effective therapy in multiple myeloma
autologous stem cell transplant
55
low bone turnover + decreased bone mineralization and/or cartilage at the epiphyseal plates
vitamin D deficiency
56
decreased bone (osteoid) mineralization)
osteomalacia
57
decreased cartilage at the epiphyseal plates
Rickets
58
if we have demineralization of the bone osteoid, what do we see in our bones
soft bones
59
malabsorption from what diseases can cause vitamin D deficiency
chronic liver or kidney disease
gastric bypass
celiac
60
most common form of vitamin D deficiency in kids
Rickets
61
most common form of vitamin D deficiency in adults
osteomalacia
62
clinical manifestations of vitamin D deficiency
diffuse bone pain and tenderness
proximal muscular weakness
hip pain
bowing of long bones --> antalgic/waddling gait
hypocalcemia
63
what clinical symptoms are associated with hypocalcemia
muscle spasms
cramps
positive Chvostek's sign
tingling, numbness
64
Diagnosis of vitamin D deficiency
decreased calcium, phosphate, and 25-hydroxyvitamin D levels
Increased alkaline phosphatase
increased parathyroid hormones
65
what will you see on radiographs for vitamin D deficiency
looser lines (zones) -- transverse pseudo-fracture lines
often bilateral and symmetrical
66
management for vitamin D deficiency
vitamin D supplementation
67
when do we commonly see vitamin D deficiency in Rickets in kids
between 3 most - 3 years when growth needs are high and decreased sun exposure
68
common causes of rickets
calcipenic - calcium or vitamin D deficiency
phosphopenic - due to renal phosphate wasting
69
initial clinical manifestations of rickets
bowing of forearm bone, knee, costochondral junction
70
other clinical manifestations in rickets
delayed fontanel closure
craniotabes (soft skull bones)
genu varum (bowing of the femur and tibia)
growth delays
delayed dentition
parietal and frontal bossing
71
Diagnosis for rickets
decreased calcium
decreased phosphate
decreased 25-hydroxyvitamin D
72
what will you see on radiographs for rickets
costochondral junction enlargement
long bones have a "fuzzy" cortex
widening of epiphyseal plate
73
management for rickets
vitamin D supplementation
74
screening with mammogram
biennial screening (every other year) for women 50-74
75
category 1 mammogram
negative
76
category 2 mammogram
benign findings noted
77
category 3 mammogram
probably benign findings, short term follow up suggested
78
category 4 mammogram
suspicious findings; further evaluation noted
79
category 5 mammogram
cancer is highly suspected
80
category 6 mammogram
known breast cancer
81
category 0 mammogram
abnormality noted for which more imaging is recommended
82
fine needle breast aspiration
collects sample of cells
83
core needle breast biopsy
collects core of tissue
US or MRI guides process
84
open (surgical) breast biopsy
removes all or part of abnormality
85
what is the preferred breast biopsy
core needle biopsy
86
abnormal bone remodeling in aging bone due to increased osteoclastic and osteoblastic activity
Paget's disease of the bone
87
increased osteoclastic and osteoblastic activity leads to
larger and weaker bones
88
clinical manifestations of Paget's disease of the bone
most are asymptomatic
bone pain (MC)
skull enlargement
deafness
89
labs for Paget's disease of the bone
markedly elevated alkaline phosphatase
90
initial test for Paget's disease of the bone
radiograph
91
what will radiographs show for Paget disease of the bone
lytic phase: blade of grass or flame shaped
sclerotic phase: increased trabecular markings
92
what will skull radiographs for Paget disease of the bone show
cotton wool appearance
93
first line for treating Paget's disease of the bone
bisphosphonates - Zoledronate has greater efficacy
calcium and vitamin D supplementation recommended
94
is Paget disease of the breast a type of breast cancer
yes
95
what will you see on PE for Paget disease of the breast
chronic eczematous itchy scaly rash on the nipples and areola (may ooze)
96
most accurate biopsy for breast cancer
open biopsy
97
most common carcinoma for vaginal cancer
squamous cell carcinoma
98
risk factor for vaginal cancer
HPV types 16 and 18
99
most common symptom of vaginal cancer
abnormal vaginal bleeding
100
most common site for vaginal cancer
posterior wall of the upper 1/3 of the vagina
101
definitive diagnosis of vaginal cancer
biopsy
102
most common type of cancer of the vulva
squamous cell carcinoma
103
risk factor for cancer of the vulva
HPV types 16 and 18
104
most common site for cancer of the vulva
labia majora
105
what will you see on PE for cancer of the vulva
red or white ulcerative or raised crusted lesion
106
most common skin cancer
basal cell carcinoma
107
squamous cell carcinoma in situ (has not invaded the dermis)
Bowen's disease
108
major risk factor for squamous cell carcinoma
sun exposure
109
squamous cell carcinoma is often preceded by
actinic keratosis
110
clinical manifestations of squamous cell carcinoma
erythematous, elevated thickened nodule with white scaly or crusted, bloody margins
may present as a non healing ulceration
111
most common cause of skin cancer related death
melanoma
112
major risk factor for melanoma
UV radiation
113
most common type of melanoma
superficial spreading
114
where is superficial spreading melanoma most commonly found
trunk in men
legs in women
115
melanoma that most commonly arises in chronically sun-damaged or sun-exposed areas the skin in older individuals such as the face
lentigo maligna
116
most common melanoma found in darker-pigmented individuals
acral lentiginous
117
clinical manifestations of basal cell carcinoma
small raised (dome shaped) papule that are pink, white or flesh colored
Translucent, waxy, or pearly quality with raised "rolled" borders
central depression
with overlying telangiectatic present on head and face
118
describe inheritance of osteogenesis imperfecta
autosomal dominant
119
what is abnormal in osteogenesis imperfecta
type 1 collagen
120
clinical manifestations of osteogenesis imperfecta
severe premature osteoporosis --> multiple recurrent spontaneous fractures
Presenile deafness
121
what might you see on PE in osteogenesis imperfecta
blue tinted sclera
brown teeth
122
management for osteogenesis imperfecta
bisphosphonates
PT
surgery
123
most common primary bone malignancy in children and young adults
osteosarcoma
124
what bone is most commonly affected on osteosarcoma
distal femur
125
where does osteosarcoma most commonly metastasize
lungs
126
clinical manifestations of osteosarcoma
bone pain that is worse at night
127
radiographs for osteosarcoma
hair on end or sunburst appearance
128
definitive diagnosis for osteosarcoma
biopsy
129
labs for osteosarcoma
increased alkaline phosphatase
130
second most common primary bone malignancy in adolescents and young adults (after osteosarcoma)
Ewing sarcoma
131
peak incidence of Ewing sarcoma
10-15 years
132
Ewing sarcoma is due to translocation between what chromosomes
11 & 22
133
Ewing sarcoma originates from what cells
mesenchymal progenitor cells
134
most common location for Ewing sarcoma
diaphysis of long bones -- femur most common then pelvis
135
common sites for metastasis for Ewing sarcoma
bone
bone marrow
lung
136
common cause of death for Ewing sarcoma
METs to lungs
137
clinical manifestations of Ewing sarcoma
localized bone pain and swelling
138
PE for Ewing sarcoma
palpable soft tissue mass
local tenderness
joint swelling
139
what will radiographs show for Ewing sarcoma
multilayered periosteal reaction with an "onion skin/peel" appearance
destructive lytic lesions have a "moth-eaten" appearance
Codman's triangle (can also be seen in osteosarcoma)
140
lab values in Ewing sarcoma
increased ESR, leukocytosis
*LDH carries prognostic significance*
141
when should kyphoplasty be performed (time period)
within 8 weeks of fracture
142
when should A1C be drawn in diabetic patients
twice per year for screening
143
goal of A1C levels in diabetic patients
<7%; 53 mmol/mol
144
what A1C level is diagnostic for diabetes
> 6.5%; 48 mmol/mol
145
screening A1C for nondiabetics
adults 35-70 who are overweight or obese every 3 years
146
what is A1C
glycated hemoglobin; average blood glucose concentration over the course of RBC lifespan (120 days)
147
ovaries stop functioning before 40 years old
primary ovarian insufficiency
148
young women with primary ovarian insufficiency are at an increased risk of developing
hypothyroidism; they should have TSH screen yearly
149
common causes of primary ovarian insufficiency
chemotherapy
radiation
Turner's syndrome
150
what testing should women with primary ovarian syndrome undergo
karyotype testing; to see if underlying genetic abnormality
151
excess parathyroid hormone
hyerparathyroidism
152
what is the most common cause of hypercalcemia
hyperparathyroidism
153
most common cause of hyperparathyroidism
parathyroid adenoma
154
What medication can cause hyperparathyroidism
lithium
155
clinical manifestations of hyperparathyroidism
usually asymptomatic
may have sign of hypercalcemia
156
clinical manifestations of hypercalcemia
bones - bone pain
stones - kidney stones
moans - abdominal pain
psychic undertones - psychosis, decreased DTR
157
triad for diagnosis of hyperparathyroidism
hypercalcemia + increased intact PTH + decreased phosphate
158
what else will you see for diagnosis for hyperparathyroidism
increased vitamin D; increased 24-hour urine calcium excretion
159
what may you see on bone scan for hyperparathyroidism
osteopenia
160
management for hyperparathyroidism
parathyroidectomy is definitive
calcium and vitamin D post parathyroidectomy to prevent hyperparathyroidism supplementation
Bisphosphonates
161
2 most common causes of hypoparathyroidism
post neck surgery (thyroidectomy, parathyroidectomy)
autoimmune destruction of parathyroid gland
162
clinical manifestations of hypoparathyroidism
most are aysmptomatic
may have signs of hypocalcemia
163
clinical manifestations of hypocalcemia
increased muscle contraction (Trousseau sign - carpopedal spasms when blood pressure cuff is inflated & Chvostek sign - tapping the cheek causes facial spasm)
164
triad for diagnosing hypoparathyoidism
decreased calcium + decreased PTH + increased phosphate
165
what may you see on EKG for hypoparathyroidism
prolonged QT interval (increased risk of arrhythmia)
166
management for hypoparathyroidism
calcium supplementation + activated vitamin D
if acute symptomatic -- IV calcium gluconate
167
gold standard testing for calcium levels
ionized calcium
168
when do you use corrected calcium to measure calcium levels
in patients with hypoalbuminemia
169
uterine herniation into the vagina
uterine prolapse
170
what causes uterine prolapse
weakness of pelvic support structures
171
when does uterine prolapse most commonly occur
after childbirth
172
posterior bladder herniating into the anterior vagina
cystocele
173
small bowel herniating into upper vagina
enterocele
174
distal sigmoid colon or rectum herniating into the posterior distal vagina
rectocele
175
what is removed in a total hysterectomy
cervix and uterus
176
what is removed in a partial hysterectomy
upper part of the uterus is removed but the cervix is left in place
177
what is ligated in hysterectomy due to blood supply
suspensory ligament (contains ovarian vessels)
178
procedure to remove tissue from the endometrium
endometrial ablasion
179
chronic, non-infectious inflammation of the bladder
interstitial cystitis
180
clinical manifestations of interstitial cystitis
suprapubic pain
urinary frequency
dysuria
hematuria
possible weight loss
181
treatment for interstitial cystitis
PT
bladder re-training
meds for pain or antidepressants
