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NM701 Gynecological Health > Breast Changes + Cervical Cancer > Flashcards

Breast Changes + Cervical Cancer Flashcards

1
Q

x-ray, best for detecting calcifications, masses and architectural distortion in the breast

  • cannot show if mass is solid or cystic
  • low sensitivity in women w/ dense breast tissue
A

Mammogram

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2
Q

sound waves, best for differentiating solid and cystic masses in the breast
*typically cannot show calcifications

A

Ultrasound

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3
Q

magnetic fields that have to be enhanced with contrast; best for seeing tissue with increased blood flow such as tumors in the breast

  • **high sensitivity and high negative predictive value
  • **high false positive rate
A

MRI

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4
Q

with bilateral milky discharge (galactorrhea) and pregnancy test negative, order:

A

serum prolactin + TSH

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5
Q

with bilateral milky discharge (galactorrhea) and hyperprolactinemia, order:

A

MRI of sella turcica to rule out prolactin-secreting tumor

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6
Q

test done for dark/black nipple discharge to evaluate for bleeding

A

Guaiac testing

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7
Q

small needle inserted to aspirate cells for cytology; commonly used to differentiate solid and cystic masses and targets breast mass/thickening

A

Fine-needle aspiration biopsy

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8
Q

large bore needle used to obtain cores of tissue for histologic examination, stereotactic mammography used for localization and targeting of tissue to be biopsied
* targets calcification seen on mammogram, masses or other abnormalities visible only by mammography (i.e. not visible with ultrasound)

A

Stereotactic core needle biopsy

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9
Q

large bore needle used to obtain cores of tissue for histologic examination, US used for localization and targeting of tissue to be biopsied
*targets lesions visible only with MRI

A

Ultrasound-guided core needle biopsy

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10
Q

uses wire or radioactive seed to localize an occult mammographic, sonographic or MRI detected abnormality prior to excisional biopsy
*targets mass or calcification seen on imaging in a location that cannot be effectively assessed with core biopsy

A

Needle-localized breast biopsy

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11
Q

surgical procedure that requires skin excision, mass removed with the surrounding margin of tissue

  • targets palpable breast mass/thickening or skin changes
  • used for initial diagnosis only when needle biopsy is not feasible
A

Excisional breast biopsy

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12
Q 
Type of Nipple Discharge:
usually in women >50 yo
Dilation of ducts/inflammation
BILATERAL	
MULTIDUCTAL
Green/black nipple discharge; sticky green brown or black
A

Mammary duct ectasia

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13
Q 
Type of Nipple Discharge:
Lesion in duct
Spontaneous (without stimulation)
UNIDUCTAL
UNILATERAL
Bloody nipple discharge
A

Intraductal papilloma

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14
Q

Type of Nipple Discharge:
Milky discharge in someone who is not pregnant/lactating in the last 12 months
BILATERAL
MULTIDUCTAL
May occur spontaneously OR with nipple stimulation

A

Galactorrhea

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15
Q 
Factors that make nipple discharge \_\_\_\_\_\_\_\_\_\_:
Spontaneous 
Unilateral
From a single duct
Clear, bloody, or serosanguinous
Associated with a mass
Occurs in older women
A

worrisome

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16
Q 
Factors that make nipple discharge \_\_\_\_\_\_\_\_\_\_:
Occurs with manipulation or stimulation
Bilateral
Multiductal
Milky
Yellow, green, brown, or black
Mass present
A

less worrisome

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17
Q 
Subjective Info for c/o \_\_\_\_\_\_\_\_\_\_:
Duration and color
Spontaneous or only with stimulation
Unilateral or bilateral
One duct/hole or multiple
Medications
Associated symptoms - pain, mastalgia, breast mass
History of breast dx or surgery
ROS: hypo/hyperthyroid, pituitary tumor, hyperprolactinemia, menstrual, pregnancy, lactation general medical, family hx esp breast and ovarian cancer
A

nipple discharge

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18
Q

Objective Info for c/o ___________:
Comprehensive breast exam - inspect and palpate in upright and supine positions, include lymph nodes
If discharge can be reproduced or seen - note color, consistency, laterality, location, number of ducts using the clock method
Skin changes
Masses
Tenderness
Addition based on ROS: thyroid palpation if s/p thyroid surgery, visual field for galactorrhea in women not pregnant or breastfeeding

A

nipple discharge

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19
Q

dilation of ducts w/ surrounding inflammation and fibrosis that usually occurs in women > 50 yo,

A

Mammary duct ectasia

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20
Q

Diagnostics for __________:
*depends on masses presence and discharge characteristics
If discharge black–>guaiac test for blood
If age>40 and hasn’t had a mammogram in last 6 months–>mammogram

A

Mammary duct ectasia

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21
Q

Treatment for __________:

  • Advise to avoid nipple stimulation and follow up in 3-4 months
  • Expectant management due to benign process
  • Surgically treated with removal of the subareolar duct system if imaging shows focal thickening of the duct wall or if symptoms are severe
A

Mammary duct ectasia

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22
Q

small benign growth in the duct usually occurs in women 40-50 years of age

A

Intraductal papilloma

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23
Q

Diagnostics for ____________:
*depends on if mass present and characteristics of discharge
Spontaneous, unilateral and uniductal and reproducible on exam:
-Age >30 = mammogram and US
-Age <30 = US and if indicated, mammogram

A

Intraductal papilloma

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24
Q

Treatment for __________:
Without atypia, single papilloma and < 1 cm: Do not remove
Multiple papillomas or single papilloma > 1 cm: duct excision

A

Intraductal papilloma

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25
Q

milky discharge in a woman who has not been pregnant or lactating in the last 12 months

A

galactorrhea

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26
Q 
Diagnostics for \_\_\_\_\_\_\_\_\_\_\_\_:
Pregnancy test
If negative → serum prolactin and TSH
If hyperprolactinemia present - imaging of sella turcica with MRI to rule out pituitary prolactin-secreting tumor
Pregnant → normal
A

galactorrhea

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27
Q

Treatment for __________:
-Decrease breast/nipple stimulation to decrease discharge
-Outside of pregnancy/lactation:
Pituitary tumors → expectant management, medication, and/or surgery
Meds: bromocriptine and cabergoline
Discontinuation of meds → recurrence of galactorrhea, therefore lifelong therapy required
Discontinuing medication causing galactorrhea

A

galactorrhea

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28
Q 
Subjective Data for \_\_\_\_\_\_\_\_\_\_\_:
Menstrual cycle → luteal phase through first few days of menstruation
**possible pregnancy!**
Caffeine intake
Hormone use
Cyclic, noncyclic or chest wall pain
Focal or diffuse
Medication
Family history of breast and ovarian cancer
ROS to eliminate non-breast causes
A

Mastalgia

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29
Q 
Likely cause of \_\_\_\_\_\_\_\_\_\_\_:
hormonal changes (cyclic)
increased estroge
deficient progesterone
hyperprolactinemia
Many meds - just look it up
pregnancy
possibly caffeine especially recent big increase in amount
A

Mastalgia

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30
Q

Diagnostics for _______:

  • Pregnancy test
  • Imaging: only if mass with abnormality occurs with CBE
    • Age > 30: mammogram and US
    • Age < 30: US and if indicated, mammogram
A

Mastalgia

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31
Q

Subjective Date for ___________:
When noticed, any changes patient made
Other symptoms - mastalgia, discharge
History of breast disease or surgery
Menstrual, pregnancy, lactation, and general med history
Family history of breast or ovarian cancer

A

Breast Masses

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32
Q 
Objective Data for \_\_\_\_\_\_\_\_\_\_\_:
CBE
Palpable mass -- size, shape, consistency, or texture - discrete or poorly differentiated borders; tender, mobile or fixed
Skin changes, nipple discharge 
Location in relation to a clock
A

Breast Masses

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33
Q

Diagnostics for ____________:
Palpable area of concern?
-Age < 30: US
-Age >/= 30: mammogram with or without US
(dependent on suspicion for malignancy)
Biopsy is done for definitive diagnosis (usually fine needle but more invasive if needed)

A

Breast Masses

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34
Q

dense epithelial and fibroblastic tissue, usually nontender, encapsulated, round or oval, movable, firm, rubbery, can be large

A

Fibroadenoma

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35
Q

incidence of this breast mass decreases with increased age- commonly benign usually singular mass in younger women

A

Fibroadenoma

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36
Q

treatment for Fibroadenoma

A

expectant management

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37
Q

breast mass that usually decreases in size postmenopausally and many completely resolve

A

Fibroadenoma

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38
Q

fluid-filled mass most common in 35-50 yo women

*Discrete, tender, mobile, size may fluctuate with menstrual cycle

A

Cyst

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39
Q

Treatment for Asymptomatic cysts

A

expectant management

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40
Q

Treatment for Large, painful cysts

A

aspiration

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41
Q

Treatment for Complicated cysts

A

biopsy of debris to r/o atypia or malignancy

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42
Q

area of fatty tissue may occur in the breast or other areas - usually in later reproductive years
Discrete, soft, nontender, may or may not be mobile

A

Lipoma

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43
Q

If there are suspicious findings at Lipoma site on mammography or US, treatment is:

A

excision of lipoma

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44
Q

If lipoma site on mammography or US is consistent with lipoma on examination and tissue sampling, treatment is:

A

no excision needed

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45
Q

Poorly defined, firm, nontender, nonmobile mass that is usually result of trauma or surgical manipulation of the tissue that resolves spontaneously

A

Fat necrosis

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46
Q

Glandular tissue, fat and fibrous connective tissue mass

  • Discrete, nontender, nonmobile, may be nonpalpable with incidental dx on imaging studies
  • Average age of diagnosis: 45 yo
A

Hamartoma

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47
Q

Breast mass that may require excision for diagnosis but otherwise can be managed expectantly

A

Hamartoma

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48
Q

Milk-filled cysts that usually occur during or after lactation

  • Discrete, firm, sometimes tender
  • Duct dilation often have an inflammatory component
A

Galactocele

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49
Q

breast mass that requires aspiration for diagnosis and appropriate treatment

A

Galactocele

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50
Q

not indicated by pain or lack of pain, although most don’t report pain

A

breast cancer

51
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_:
bone pain
arthralgias
cough
jaundice
abdominal pain
headache
visual disturbances
malaise
loss of appetite
weight loss
fever
fatigue
A

metastasis of breast cancer

52
Q 
Suspicious for \_\_\_\_\_\_\_\_\_:
skin changes
lesion is hard
painless
irregular borders
may be immobile and fixed to the skin or surrounding tissue
A

breast cancer

53
Q

Suspicious for _________:
skin changes
lesion is hard
painless
irregular borders
immobile mass fixed to the skin or surrounding tissue
enlarged axillary cervical and supraclavicular lymph nodes

A

breast cancer

54
Q

areas of examination in breast cancer patient

A

lungs, abdomen, neuro

55
Q 
Diagnostics for \_\_\_\_\_\_\_\_\_\_\_:
Mammogram
US
possibly MRI
tissue sampling
A

breast cancer

56
Q 
Treatment for \_\_\_\_\_\_\_\_\_:
Staged
May be graded
tumor markers assessed
lymph node involvement,
Surgery
chemo
radiation
hormones
bisphosphonates
monoclonal antibodies - combo and individualized
A

breast cancer

57
Q

most significant risk factor for breast cancer

A

Age

58
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_:
BRCA 1 or 2 mutation
smoking
age
female sex
personal hx 
family hx
genetic mutations
breast lesions with atypia
dense breast tissue
high-dose radiation to chest (esp during puberty)
menarch before age 12
menopause after age 55
nulliparity
first full-term pregnancy after age 30
current use of COC
use of COC after menopause
weight gain after age 18
physical inactivity
alcohol consumption
Jewish ancestry
Born in North America, North Europe, Asia, or Africa
A

breast cancer

59
Q

Protective for __________:
Breastfeeding (decreased risk by 4.3% per year)
Moderate to vigorous physical activity for at least 4 hours/week (decreased risk by 30-40%)
Maintaining a normal weight
Decreasing alcoholic drinks

A

breast cancer

60
Q

American Cancer Society no longer recommends ___________for screening purposes at al

A

clinical breast exam (CBE)

61
Q

ACOG recommends annual mammography screening starting at age _______

A

40

62
Q

USPSTF recommends bi-annual mammography screening starting at age ______

A

50

63
Q 
Prevention measures for \_\_\_\_\_\_\_\_\_:
BRCA 1 and 2 testing
Chemoprevention Meds - SERMs, tamoxifen, raloxifene, (these two only FDA approved for this) aromatase inhibitors and others
Prophylactic mastectomy
Possibly salpingooophorectomy
A

breast cancer

64
Q

Squamous metaplasia on cervix is:

A

normal

65
Q

Normal physiological process that occurs at the squamocolumnar junction or transformation zone

A

squamous metaplasia

66
Q

Where more fragile columnar epithelial cells are replaced with harder squamous epithelial cells

A

transformation zone

67
Q

Process initiated by the eversion of the columnar epithelium onto the ectocervix - occurs under the influence of estrogen and its ensuing exposure to acidic vaginal pH

A

squamous metaplasia

68
Q

Squamous metaplasia may arise through reproductive years but is most active during:

A

adolescence and first pregnancy

69
Q

where columnar endocervical epithelium and squamous ectocervical epithelium meet and this is where most cervical cancers arise

A

transformation zone

70
Q

_____% of cervical cancer is from HPV

A

99.7%

71
Q

___ cervical cancer is not sexually transmitted

A

Clear cell adenoma

72
Q

most HPV infections are undetectable within ___-___ years

A

1-2

73
Q

high-rsk HPV infections are ___________ infections that cause cervical cancer

A

persistent

74
Q

woman contracting HPV in her ___s have higher chance of immune system unable to remove infection if they it is high-risk type

A

30s

75
Q

high risk types of HPV

A

Type 16 and 18

76
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_:
Early age at first intercourse (<18 yo)
**most importantly, how close to menarche/puberty (closer, the more risk)
Sexual Behavior
Multiple sex partners
Smoking- 2X risk
Immunosuppression
HIV/AIDS
Medications- COCs- 2X risk w/ > 5-year use
**Returns to normal after 10 years of d/c
High Parity- 3+ full-term pregnancies
Genetic disposition
Mother or sister with cervical CA
Diet Low in fruits and veggies
Diet Low in levels of Vitamin C, E, folate, and carotenoids
Poverty
DES (Diethylstilbestrol)
**Daughters of women who took DES are 40X higher risk (these women are >40 yo now)
Hx HSV-2
Hx Chlamydia
A

HPV

77
Q 
Prevention of \_\_\_\_\_\_\_\_:
Routine screenings!
Vaccine!
Decrease modifiable risk factors!
Safe sex
Smoking cessation (especially w/ abnormal pap)
A

HPV

78
Q

Girls aged 11 to 14 only need ___ doses of vaccine 6 months apart while…
Older teens and adults need all ___ doses

A

2 for younger vs 3 for older

79
Q

younger teens develop greater __________ from the HPV vaccine than do older teens and young adults.

A

immunity

80
Q

vaccine that has now been approved for women and men aged 27 - 45 who need a 3-dose series for full protection like older teens do.

A

Gardisil-9 56ine

81
Q

Pap tests screen for:

A

cellular changes in the cervix resulting from some types of HPV infections

82
Q

Pap rests DO NOT screen for:

A

genital warts or condyloma accuminata

83
Q

Pap test result that shows absence of endocervical/transformation zone component of endocervical or squamous metaplastic cells

A

Satisfactory

84
Q

Pap test result that shows absence of intraepithelial cells or malignancy

A

Negative

85
Q

Advantages of _______ Pap test:
More complete removal of cellular material
Sample can be used for HPV DNA, Chlamydia, Gonorrhea and Trich testing which eliminates need for 2nd visit for cytologic abnormality

A

Liquid-Based

86
Q

Disadvantages of _________ Pap test:
Neither more sensitive or specific
Higher cost
Not considered diagnostic for Trich (NAAT should follow to confirm)

A

Liquid-Based

87
Q

Factors that cause incorrect __________:
Not obtaining enough cells for evaluation
Leaving most of sample on collecting device
Obscured detection of abnormal cells d/t presence of blood, mucus, air drying, or other artifacts on slide

A

Pap test

88
Q

ASC-US and LSIL results are _____ worrisome

A

less

89
Q

ASC-H and HSIL results are _____ worrisome

A

more

90
Q

Nontender breast masses

A 
Fibroadenoma
Lipoma 
Phyllodes Tumor
Hamartoma 
Fat Necrosis
91
Q

Tender breast masses

A

Cyst

Sometimes Galactocele

92
Q

Mobile breast masses

A

Fibroadenoma
Cyst
Phyllodes Tumor
MAYBE Lipoma

93
Q

Nonmobile/Fixed breast masses

A

MAYBE Lipoma
Hamartoma
Fat Necrosis

94
Q

Discrete breast masses

A

All except Fat Necrosis

95
Q

I’ll defined breast mass

A

Fat Necrosis

96
Q

Firm breast masses

A

Galactocele
Fibroadenoma
Phyllodes Tumor
Fat Necrosis

97
Q

Soft breast masses

A

Lipoma

98
Q

May observe skin stretching due to rapid growth of this breast mass

A

Phyllodes Tumor

99
Q

Breast mass that may be nonpalpable and only diagnosed with imaging

A

Hamartoma

100
Q

Breast mass that occurs in adolescents and younger women

A

Fibroadenoma

101
Q

Breast mass that occurs during/after lactation

A

Galactocele

102
Q

Breast mass that occurs in late reproductive yeara

A

Lipoma

103
Q

Breast mass that occurs at age 35-50

A

Cyst

104
Q

Breast mass that occurs in ages 30-50

A

Phyllodes Tumor

105
Q

Breast mass in women average aged 45

A

Hamartoma

106
Q

Breast mass that can occur at any age

A

Fat necrosis

107
Q

Pap results that will probably resolve especially in young women showing mild dysplasia, cervical intraepithelial neoplasia CIN1

A

LSIL

108
Q

Pap result that means danger! Potentially CA already! - atypical squamous cells, cannot exclude high-grade lesions

A

ASC-H

109
Q

Pap results that are almost 100% are HPV, moderate to severe dysplasia, carcinoma in situ, CIN 2 and 3

A

HSIL

110
Q

Pap results that are considered OK

A

Negative

ASC-US

111
Q

GLANDULAR cells that are the red, beefy part of cervix and potentially uterine cells
**these are RARE so higher likelihood of being CA
Not related to HPV associated changes (HPV testing not helpful)

A

AGUS

112
Q

concerning type of discharge from breasts

A

clear
spontaneous
unilateral
bloody

113
Q

for c/o nipple discharge, what kind of exam do you perform?

A

CBE

114
Q

questions to ask for ___________:
cyclic?
unilateral/bilateral?
pregnancy?

A

mastaligia

115
Q

breast pain is concerning when it occurs post-___________

A

menopausal

116
Q

Effective reliefs for __________:
supportive, well-fitting bra
reassurance
caffeine and fat reduction

A

mastalgia

117
Q

________ Signs:
nipples pointing different directions
nipple retraction/flattening
palpable axillary lymph nodes

A

Worrisome

118
Q

sole risk factor present in the vast majority of breast cancer

A

older age

119
Q

pap result “don’t ask us, because we don’t know”

therefore, reflex test for HPV for most

A

ASC-US

120
Q

pap results “likely yes to HPV” but often low risk for type that causes cancer
Management type depends on age/other factors

A

LSIL

121
Q

pap results “yes to HPV” higher risk of cancer

A

HSIL

122
Q

pap results “may already be cancer but probably not”

A

ASC-H

123
Q

pap results glandular cells - rare result but often concerning

A

AGC

124
Q

Reasons to give Gardasil at ______ years old:
only need 2 doses instead of 3
better immune response

A

11-12

NM701 Gynecological Health (5 decks)

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