CA random facts from lecture Flashcards
Palpable Mass in 12-25 year old….what could it be?
fibroadenoma
nontender
MOBILE
palpable mass in a 25-50 year old…what could it be? 3
breast cyst (well circumscribed, sometimes tender)
fibrocystic changes
cancer ( FIXED MASS)
if there is a palpable mass in over 50 year old….what could it be?
cancer until proven otherwise!
what is the lifetime risk for breast cancer?
1 in 8
what is the most important RF for breast cancer?
AGE!!!!
suspect BRCA1 or 2 if before 50!!
what is the screening test of choice for breast cancer?
MAMMOGRAPHY
screening for breast cancer should be….
individualized!
when should you start screening for breast cancer?
40-50s depending on reccomendations
40 is the earliest you would screen
when should you stop screening mammograms for breast cancer?
if life expectancy is less than 10 years!
when should you suspect BRCA1 or 2 gene mutations?
3
- 1st degree relative w/breast cancer before 50
- greater than two individuals in same lineage with breast cancer
- 1st degree relative with ovarian cancer
clinical breast exam
when do they start?
how often should they be done?
start at 20
20-40: every 2-3 years
40+: annually
what are the four positions you have the pt put their arms in for clinical breast exam?
- arms at side
- arms overhead
- hands on hips
- leaning forward
how should you palpate the breast?
supine position, one breast at a time
vertical strip pattern with concentric circles
what are the quandrants of the breast? how do you describe the location of a lump/bump?
upper outer quadrant
upper inner quadrant
lower outer quadrant
lower inner quadrant
describe with clock numbers THEN cm from nipple
male breast cancer accounts for what percent of all breast cancer?
1%
if you see a nipple with what looks like eczema on it or dry skin, what should you always suspect?
pagets disease
what are the names of the lymph nodes in the axillary region? 4
two others to consider? 2
- lateral
- central
- subscapular
- pectoral
two others:
- infraclavicular
- supraclavicular
what are 5 tests you can do to dx breast cancer?
- breast bx
- US
- mammogram
- contrast enhanced MRI
- cytology of nipple discharge
what are 4 common/concerning male genital sxs?
- sexual response
- penile discharge/lesions
- scrotal pain, swelling, lesions
- STIs
what is the most important thing to remember about STIS?
PREVENTION!!
what are 3 ways to prevent STIs?
- condoms
- HPV vaccine
- universal testing
when preforming male and female exams, what must you always have?
a chaparone!
how should you inspect the penis?
standing or supine
what 2 fingers do you use to palpate the scrotom?
first two
what position is the patient in to inspect for hernias? what must you ask the patient to do?
standing
ask them to bear down
what percent of women with CA have not family hx or reproductive RF?
50%
where are indirect hernias?
near internal ring, often enter the scrotum
where are direct hernias? what are they associated with?
near external inguinal ring
associated with lifting or straining
where does femoral hernial occur? what is it associated with?
below femoral ligament
more associated with bowel incarceration/strangulation
what finge should you use to examine the right inguinal canal for hernia?
right hand
testicular torsion
3 defining characteristics!
cremasteric reflex absent
1 high riding testes with bell clapper deformity and profound swelling
EMERGENCY!!!!
epididymitis
2 defining characterstics
- cremaster reflex present
- epididymis tenderness and induration
what are 7 test you could do if you found abnormal findings on a male during a genital exam?
- scrotal US
- UA/UC
- gram stain of urethral discharge
- STI testing
- semen analysis
- aspiration
- tumor markers for alpha fetoprotein/HCG
testicular torsion is an…
EMERGENCY
who do you refer someone with a testicular mass to?
urology
who do you refer somone with a hernia to?
general surgery
incarcerated/strangulated is an EMERGENCY!!
post menopausal bleeding is a red flag because you need to rule out?
endometrial cancer
gravida para notation
explain this notation
G=total # of pregnancies
Para=# of successful pregnancies
then TPAL
term
preterm
abortion
living children
EX: G4P2113
when does cervical cancer screening start and stop?
start: 21
stop: 65
how often do you screen for cervical cancer for women 21-29?
every 3 years!
how often to you screen for cervical cancer in women 30-65? what do you screen with?
every 5 years, PAP+ HPV cotest!
what position is a women in to have a pap done? what to make sure you do?
lithotomy position
keep downward pressure
what two fingers do you insert to do a bimanual exam?
index and middle
what are the 5 things you are palpating for on bimanual exam?
- cervix
- uterus
- ovaries
- access pelvic floor muscles
- rectovaginal exam
what is pathonewmonic for trichomoniasis?
strawberry cervix
is urine HCG qual or quant?
qual
is serume HCG quant or qual?
BOTH
what are the 3 things you could look for on a wet prep?
clue cells
yeast
trichomonas
clue cells bacterial vaginosis
HYPHAE
YEAST INFECTION
trich
flagella present!
how much does HcG rise by every 48 hours?
increases by 50%
what is indicated by:
- HCG rising too fast
- HCG rising too slow
RISES TOO FAST:
1. multiple gestations
RISES TOO SLOW:
1. nonviable IUP
2. ectopic pregnancy
polycystic ovarian syndrome
what is this?
3 things your at increased risk for?
4 PE findings
OVULATORY DYSFUNCTION and HYPERANDROGENISM
puts at risk for:
1. metabolic syndrome
2. T2DM
3. CVD
4. endometrial cancer
PE FINDINGS:
acne
hirsuitism
menstrual irregularities
obesity
DX VIA transvaginal US and testosterone
what are 3 RF for prostate cancer?
- age
- african
- family hx
what age do you start prostate screening? remember?
50 years old
BUT INDIVIDUALIZED
what lab can you check if suspected prostate cancer?
PSA every 2-4 years
what is important to know about digital rectal exams and prostate cancer?
early detection has not been show to reduce mortality and may leave for over dx and over tx
what finger should you use for digital rectal exam?
index finger
what are 5 tests you could do for followup to an abnormal digital rectal exam?
- PSA
- guiac
- transrectal US guided prostate bx
- post-prostatic massage urine culture
- colonoscopy
what percent of pregnancies are unitended?
50%
when is the best time to take a home pregnancy test?
1 week after missed period
what are the urine requirements for HCG for a positive test?
20-50 units
what are the unit requirements of HCG for a serum test to be positive?
5-10 units
what is the scheduling for OBGYN visits once a woman finds out she is pregnant?
4 rules
1. 1st vist: 8 weeks after gestation
2. every 4 weeks until 28 weeks pregancy (1/month)
3. every 2 weeks until 36 weeks gestation
4. weekly 36-42 weeks
what is your biggester concern from 36 weeks to delivery that makes for weekly visits?
preclampsia
what is the best way to gage estimated due date? and then confirmatory?
last menstrual period
confirm with US where they measure from crown to rump to determine due date
what are the 3 most common sxs of pregnancy?
- morning sickness
- breast tenderness and fullness
- urninary frequency and fatigue
first prenatal visit key points:
3
3 others
1. beasts: fuller due to increased vascularity and glandular hyperplasia
2. pelvic:
1. chadwicks sign: blueish discoloration of the cervix due to increased blood flow
2. uterus soft
- venous hum
- lower extremity edema and varicose veins
- hemmorids
explain the size of the uterus during these phases:
- 6-8 weeks
- 8-10 weeks
- 10-12 weeks
- 6-8 weeks=plum
- 8-10 weeks=orange
- 10-12 weeks=grapefruit
explain how the pts weight might influence how much weight they will gain in the pregnancy?
- low BMI: 25-30 pounds
- obese: possibly none
what should a prego woman take for supplement?
multivitamin with folic acid!
what are five foods a prego lady should avoid?
- fish
- cheese (esp soft)
- raw milk
- large fish! or uncooked
- deli meat!!
what do you need to remind a woman not to do when in 3rd trimester?
lay supine on back! don’t lay flat!!
what do you need to screen for in a prego lady?
abuse! rates increase in this population!
what are the 3 most important immunizations a prego lady can get?
- influenza (not nasal)
- Tdap (for whooping cough)
- RhoGAM (if Rhnegative!)
what are the 5 most common genetic screening to test the a fetus for?
- down syndrome trisomy 21
- hemoglobinpaties
- cystic fibrosis
- fragile X
- ashkenazi jewish population
explain the pattern of BP in a prego woman?
cardiac output increase, vascular resistance decreases
this means the BP dips in the middle of the pregnancy between weeks 16-24 so know this so can accuary analyze health
what are 3 things you might wnat to check on a urine dip stick of a prego woman?
- protein
- glucose (nephrons get leakier so helps check for gestation diabetes)
- ketones (indicates hydration)
when do you start to hear the fetal HR? rate? if abnormal?
10 weeks! !!
120-160
if abnormal hr do NST which alllows you to monitor the HR for longer time ~20 mins and monitor fetal contractions
Rh postive babies in Rh negative mom are at risk for developing…
hemolytic anemia
who and when do you give RhoGAM to?
Rh negative mothers
26-28 weeks gestation
second trimester:
quickened growth starts___
external palpations start___
quickened growth (visible): 18-22 weeks
external palpations: 24 weeks
second trimester key points:
5 milestones for H&P
monitor:
- uterine contractions
- fundal height starting at 20 weeks
- 1-hr GDM screen 24-28 weeks
- Rhogram if RH- @ 28 weeks
- US to check anatomy
third trimester H&P:
6 milestones
2 labs
- fetal movement
a. can check baby size on the outside
b. check baby position via leopold maneuver can confirm with US
2. vaginal leaking
a. want to know if amniotic fluid since prevents against infection with the baby
3. preclampsia
4. fetal presentation
5. cervix exam
6. labs
a. check group B step at 36 weeks
b. HgB at 36 weeks
what does fetal presentation refer to?
1. vertex position
2. complete breech
3. incomplete breech
4. frank breech
what are the leopld maneuvers?
used to determine the position of the fetus in uterus and determine if baby is breeched and a cessarian section is needed
best accuarcy if after 36 weeks
what are the 5 desciptions you use for the cervix during the 3rd trimester?
- dilation
- effacement
- fetal station
- consistency
- position of the cervix
how much does cervix dilate?
0-10 cm
how is effacement of the cervix measured?
thinning of the cervix
fetal station scale
-3 to +2
what is the consistency and position of the cervix described as in pregnancy?
CONSISTENCY
firm
medium
soft
POSTION OF CERVIX
posterior
middle
anterior
just some fun random complaints in pregnancy?
heartburn
urinary frequency
vaginal discharge
constipation
hemorrhoids
backache
nausea
breast tenderness
fatigue
lower abdominal pain
abdominal striae
loss of mucous plug
edema
post-natal visit occurs when?
6 weeks post partum
what are some things you should offer at the postnatal visit?
menses resumes
family planning
screen for post partum depression
breastfeeding return to work
sexual activity
weight loss guide
stress management
