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IPAP Senior OB Test 3 > Benign D/O of Breast & Genital tract > Flashcards

Benign D/O of Breast & Genital tract Flashcards

1
Q

What is a fibroadenoma composed of

A

glandular / cystic epithelial structures surrounded by cellular stroma

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2
Q

Most common breasr mass ID’d in adolescent female

A

Fibroadenoma

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3
Q

what is considered “Fibrocystic changes” to breast tissue

A

palpably nodular breast tissue

histologic pattern dilated ducts / acini invested w/ dense collagenous stroma

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4
Q

Are “Fibrocystic changes” to breast tissue by themselves considered a cancer risk?

A

No

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5
Q

How is fibrocystic breast disease characterized by

A

Hyperplasia; multi bilat cysts w/pain & tenderness (greater Sx in premenstrual)

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6
Q

how to decrease Sx in fibrocystic breast disease

A

decrease chocolate
+/- caffine
wear support bra
avoid breast trauma

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7
Q

what is a green breast discharge r/t

A

content of cholesterol dieposides

not infx / malignancy

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8
Q

What type of breast discharge must be evaluated

A

spontaneous discharge

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9
Q

How do Pt’s present with mastitis in the Puerperal setting (during child birth/ immediately after)

A

warm / tender / diffuse breast erythema

+/- fever / malaise /myalgias / leukocytosis

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10
Q

MC organism of mastitis

A

staphylococcus

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11
Q

those breast feeding w/ mastitis, can they continue to breast feed?

A

yes

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12
Q

If mastitis does not improve after ABX what should be done?

A

US to r/o abcess

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13
Q

what should be done w/ those that develop mastitis in Nonpuerperal setting (not during child birth/ immediately after)

A

Image / biopsy to exclude inflammatory breast cancer;

Uncommon

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14
Q

If a Nonpuerperal Pt has a peripheral breast abscess what are the usual causes

A

infx from folliculitis / EIC / Montgomery gland

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15
Q

Tx of peripheral breast abscess

A

I&D & ABX

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16
Q

If a Nonpuerperal Pt has a Subareolar breast abscess what are the usual causes

A

keratin-plugged mild ducts

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17
Q

Tx of subareolar breast abscess

A

duct excision & removal of sinus tracts

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18
Q

Mastalagia is ___, and seen more in women ____

A

breast pain; women nearing menopause

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19
Q

breast pain that is bilat, diffuse, most severe during late luteal phase is ____, and requires ____

A

Cyclic;

no specific eval needed, Tx Sx

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20
Q

Breasr pain that is focal & no relation to menstral cycle is ____, & could be ____or ___

A

Noncyclic, frequently simple cyst, could be Cancer

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21
Q

this vulvar Dx presents classically in post-menopausal women w/inflamed dermis

A

Lichen Sclerosis

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22
Q

What are the Sx’s of Lichen Sclerosis

A

Early: pruritus, irritation, vulvar thickening
Late: burning & dyspareunia, introital stenosis

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23
Q

how does Lichen Sclerosis on the vulva appear as

A

cellophane paper
tissue paper
crinckled cigarette paper

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24
Q

Tx of Lichen Sclerosis

A 
Sx Tx;
min chem/mech irritation
topical steroid (Clobestasol)
Retinoids for severe/unremitting Sx
Phototherapy/5aminolevulinic acid for severe Sx
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25
This results from an intense itch/scratch cycle and has non-neoplastic morphologic alteration of vulvar skin
Lichen simplex chronicus
26
MC site and early findings of Lichen Simplex Chronicus
Labia Majora; excoriations w/background erythema
27
Tx of Lichen Simplex Chronicus
``` Eliminate Triggers Lube affected area Sitz baths oral antihistamines wear cotton gloves @ night Topical steroids ```
28
If Lichen Simplex Chronicus id not resolved in 1-3 wks?
biopsy
29
this is uncommon autoimmune d/o of T-cells/ Rx induced (NSAIDS, B-blockers) involves cutaneous & mucosal surfaces
Lichen Planus
30
Pts w/ lichen planus complain of
chronic vaginal discharge w/ intense vulvovaginal pruritis, burning pain, dyspareunia & postcoital bleeding
31
what are the 3 variants of lichen planus
Erosive (MC & most difficult) Papulosquamous Hypertrophic
32
description of lichen planus
``` purple pruritic polygonal papules plaques ```
33
Tx of Lichen Planus
Topical: Clobetasol Vaginal hydrocortisone supp.
34
this occurs in skin folds from friction between moist skin w/signs/Sx of burning / itching hyperpigmentation
Intertrigo
35
Tx of Intertrigo
``` Drying agents (corn starch, etc.) Inflammation: mild top steroids Infx: Tx cause weight loss light-weight loose clothing ```
36
what is the MCC of vaginal irritation after menopause
Atrophic Vaginitis
37
Signs/Sx of Atrophic Vaginitis
vulvar irritation clear/yellow/blood tinged discharge urinary Sx Dyspareunia
38
diagnosis of atrophic vaginitis
friable vaginal epithelium los of rugae pale mucosa pap smear changes
39
Tx of Atrophic Vaginitis
Topical estrogen | Tx concomitant Infx
40
This cyst occurs in duct w/ NO PAIN / common in reproductive age women
Bartholin Cyst
41
A Bartholin Cyst in a women > 40 is
concerning for Cancer; refer for Bx
42
Tx of Bartholin Cyst
None if Asymptomatic; I&D alone discouraged Word Cath for both cyst & abscess Marsupialization (if Failed Word)
43
A Bartholins Abscess is associated with what bug
polymicrobial but correlates w/ gonorrhea/chlamydia
44
Sx of Bartholins Abscess
Severe pain Difficulty walking / sitting dyspareunia
45
Tx of Bartholins Abscess
fluctuant I&D for relief & placement of Word Cath ABX if recurrent or High risk for complicated infection
46
WHo are at high risk of complicated infx with Bartholins abscess
Pregnant cellulitis systemic infection immunosuppressed
47
what ABX should be used for thoe at high risk of complicated infection w/ bartholins abscess
Augmentin 875mg 2x daily + Clindamycin 300mg 4x daily x 1 week
48
Cervical stenosis is characterized by
contraction of scar tissue / adhesions w/in endocervical canal blocks os
49
Sx of Cervical Stenosis
dysmenorrhea amenorrhea infertility
50
Tx of cervical stenosis
cervical dilators | vaginal estrogens x 4 wks in hypoestrogenic women (post-menopausal)
51
"trapped" Columnar cells beneath squamous cells during metaplasia continue to secrete mucus = descrete cyst (smooth clear white/yellow rounded elevations)
Nabothian Cyst
52
Nabothian Cysts are usually
asymptomatic w/ no Tx needed
53
these may have leucorrhea / postcoital spotting, arise in endocervical canal in reproductive yrs; typically < 3cm
Cervical Polyp
54
Tx of Cervical Polyp depends on
size (Tx large, symptomatic, or atypical)
55
Tx of small pedunculated cervical polyp
grasp @ base w/ forcep & twist
56
Tx of sessile cervical polyp
remove w/ Bx forceps, cauterize base
57
what are the estrogen dependent uterine D/O
Leiomyomata "Fibroids" Adenomyosis Endometrial hyperplasia
58
what is the MC pelvic tumor in women
Leiomyomata "Fibroids"
59
Types of Leiomyomata "Fibroids"
Intramural Submucosal Subserosal
60
Sx of Leiomyomata "Fibroids"
``` most asymptomatic bleeding mass effect; pressure, urinary freq, incontinence, constipation Pelvic Pain Infertility ```
61
Preferred method to diagnose Leiomyomata "Fibroids"
Ultrasound
62
Nests of endometrial glands & stroma embedded w/in muscular uterine wall
Adenomyosis
63
adenomyosis presents as
heavy abnormal uterine bleeding /dysmenorrhea in parous women ages 40-50
64
Tx of adenomyosis
Classic: hysterectomy Medical: GnRH agonist, Danazol Progestins (Mirena)
65
when is a ovarian cyst considered functional
>3cm
66
Premenopausal womanw/ =5cm simple/hemorrhagic ovarian cyst. what do you do to eval?
no additional Tx required
67
Premenopausal womanw/ >5cm but <7cm simple/hemorrhagic ovarian cyst. what do you do to eval?
TVS (TVUS?) repeat in 6-12wks; if persistent TVS yearly
68
Premenopausal womanw/ >7cm simple/hemorrhagic ovarian cyst. what do you do to eval?
MRI or surgical eval
69
Post-menopausal woman with =1cm simple ovarian cyst what is needed
nothing; normal finding
70
Post-menopausal woman with =5cm simple ovarian cyst what is needed
CA125 level --> normal --> TVS (TVUS?) repeated in 6-12wks--> if persistent TVS yearly
71
Post-menopausal woman with >7cm simple ovarian cyst what is needed
MRI or surgical consult
72
In premenopausal woman w/ indeterminate/probably benign cyst (hemorrhagic, matureteratoma, andometrioma) what should be done?
TVS repeated @ 6-12wks if persistent --> consider MRI / surgical consult
73
Ovarian cyst with qualities suggesting malignancy appear as and need?
Thick (>3mm) irregular septations Nodule w/blood flow consider surgical eval
74
50-80% of ovarian torsion cases have what?
ovarian mass
75
What increases the risk of ovarian torsion & what has the highest rates for torsion
1) ovaries >6cm | 2) adnexa 6-10cm
76
Which adnexa is more commonly affected by torsion
Right, b/c left mobility limited r/t sigmoid colon
77
Female Pt presents w/ sudden onset sharp lower ABD pain that is worse over several hours & radiates to flank / groin / thigh (may have low grade fever which suggest what is this
1) Ovarian Torsion | 2) Necrosis
78
Tx of ovarian torsion
Salvage as possible resect tumor/cyst possible oophoropexy w/ necrosis/rupture w/hemorrhage --> removal of adnexal structures

IPAP Senior OB Test 3 (6 decks)

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