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Clin Medicine > Endo Repro Wooten > Flashcards

Endo Repro Wooten Flashcards

1
Q

Pap smears, cervical dysplasia and such

A

Ok

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2
Q

Incidence cervical cancer

A

Decreased 50%

13000 new cases each year and 4000 deaths

4th most common cancer

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3
Q

Cervical area vulnerable

A

Squamocolumnar junction

Between columnar and start nonkeratinized squamous epithelial

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4
Q

Colposcopy

A

Look with microscope

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5
Q

Little

A

Inside cervis

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6
Q

Nullpaous

A

Outside

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7
Q

Multiparous

A

More toward outside

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8
Q

Postmenopausal

A

Inside cervix

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9
Q

Transformation zone

A

Changes

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10
Q

How many high risk HPV

A

15

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11
Q

What are high risk

A

16, 18, 31, and 45

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12
Q

Risk factors HPV progress

A 
Multiple sexual partners with multiple sex partner
Yong age first intercourse preg
Smoking**
Organ transplant
DES
High parity
HIV
STD-alter transformation zone
Lower socioeconomic status 
NO PAP TEST_people with bad paps. Had last baby and get busy —ppl with long periods of time between screening
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13
Q

If abnormal pap and smoke

A

Stop! Will help

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14
Q

Who needs pap and when

A

21 start
21-29 cytology every three years (if abnormal look for virus)

30-65pap every three yards or HPV and pap every five years
65 older stop unless risk if negative prior screening

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15
Q

19 yo maternal grandma cervical (NOT HEREEDITARY) smokes . What risk factor. Does she need pap

A

Smoking stop.

No doesn’t need one she’s not 21

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16
Q

40 yo african American female no complaints . No prob. Hemochromatosis from dad. Normal pap and negative HPV last year. When does she need next one ? If HPV status unknown when do next one (just had cytology)

A

5 years from then

Three years

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17
Q

Bethesda system

A

Tells specimen type or specimen adequacy (unsatisfactory if not enough cells or satisfactory) then general categorization (negative, epithelial cell abnormality, other-see interpretation result like endometrial cells ina woman older than 40-if endometrial cells have period or can be cancer)

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18
Q

Colposcopy

A

Gold standard for treatment and diagnosis

Use microscope

Cervix is washed with acetic acid cells turn bright white when looking at them

Looking for white cells to see changes with 3% acetic acid

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19
Q

Adequate colposcopy

A

Have to see entire squamocolumnar junction

Aceto white changes (just a bt abnormal)

Punctuations-little blood vessels coming out

Mosaicism-little tiles white tiles

Abnormal vessels-MORE WORRIES

MASS-cancer end point

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20
Q

Then what

A

Directed biopsy

Always take sample from inside cervix too caus cant see in there

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21
Q

What get from path with thess

A

Pathology CIN123 CIS and cancer

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22
Q

Negative

A

Normal to maybe inflammatory

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23
Q

CIN1 and 2 low grade see LSIL HSIL

A

High grade CIN2-3 see HSIL

for cancer see squamous cell carcinoma

This secondary biopsy test good to see what do

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24
Q

34 Asian female abnormal pap positive high risk HPV what is next step. She is inquiring about HPV vaccine. What advise her

A

Colposcopy this age group

HPV vaccine up to 46, the 9 valentine cover 9 most common types so if have two can protect from other 7 the more strains you have more activity of cervix

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25
Q

Treatment

A

Ablative(not common now dont know what cells are not)-destroy cervical tissue, cryotherapy, laser ablation

Excisional take tissue now do it
-cold knife cone, loop electrode excisional procedure , curretage

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26
Q

Risk of excisional procedure

A

Cervical incompetence-preg so get second trimester loss

Increased risk preterm premature rupture of membranes
Cervical stenosis

Bleeding infection

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27
Q

Cervical carcinoma

A

4% death rate

47 diagnosis

90% from HPV

  • 80% squamous cell carcinoma
  • 15% adenocarcinoma/adenosquamous
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28
Q

Symptoms cervical cancer

A

Posit cordial bleeding

Watery vaginal bleeding, spotting

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29
Q

How cervical cancer spreads

A

Lymphatic and direct invasion

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30
Q

Staged cervical carcinoma

A

Clinically

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31
Q

Manage cervical cancer

A

Microinvasive-cone , hysterectomy

Invasive-radical hysterectomy with lymph node dissection

Bulky disease-radical hysterectomy with lymph node direction or radiation therapy and cisplastin based chemotherapy

Stage IIb and greater-external beam radiation and concurrent cisplastin based chemotherapy

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32
Q

Prevent cervical cancer

A

Sex no

Use of barrier protection

Regular exams and paps

HPV vaccine

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33
Q

HPV vaccine

A

3 doses
1 2 months 2nd third dose 6 months

Routine 2 dose if less than 15

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34
Q

Mean and women

A

27-45

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35
Q

Can get HPV if have abnormal pap

A

Yup

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36
Q

Pregnant and HPV vaccine

A

No but breast feeding fine

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37
Q

Gardasil

A

6, 11, 16, 18

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38
Q

9 strain

A

6, 11, 16, 18, 31, 33, 45, 52, 58

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39
Q

Side effects HPV vaccine

A

Syncope

HA, N, fever, injection site pain

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40
Q

52 yo gp3p 6 month daily vaginal bleeding worse after intercourse . Smokes,

A

Cervical cancer

Do biopsy

Risk factors-smoking, hasn’t been screened in long time, multiparous,

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41
Q

What percent of pregnancies are unplanned

A

50%

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42
Q

Methods of birth control

A

Inhibit formation and release of egg

Barrier between sperm and egg

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43
Q

Typical failure rate

A

Rate when the methods is actually used by patient

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44
Q

Method failure

A

Rate of failure if used correctly

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45
Q

Most effective reversible contraception

A

Hormonal

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46
Q

Kinds of hormonal

A

Oral contraceptive

Injectable-depo

Implantable-etonogestrel rod implant

Hormone contain IUS

Contraceptive patches (orthoevra)

Contraceptive ring (nova ring)

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47
Q

Oral contraception

A

Suppress HPA GnRH and LH and FSH
Stop feedback

Progesterone-suppresses LH and ovulation, thickens cervical mucus , creates hostile uterine env

Estrogen-improve cycle control

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48
Q

Monophonic triphasic

A

Triphasic-change amount every week
Monophonic pills-same , less side effects

21 days active hormone7 days placebo, but now 24 days and 4 days for lighter period

Continuous regimens every 3 month or 6 month cycle of never
-get nice constant state , safe not harming

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49
Q

Progestin only

A

Cervical mucous thick mainly

Ovulation in 40% continue

Mainly for breastfeeding or contraindication for estrogen -if give estrogen can decrease supply

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50
Q

Note about progestin

A

Same time every day starting on first day of menses (if more than 3 hours late should use backup)

Not the msot efficacious

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51
Q

Benefits of hormonal

A

Men’s trail cycle regularity

Improve dysmenorrhea

Crease risk of iron defiency anemia

Lower incidence of endometrial and ovarian cancers, benign breast and ovarian disease

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52
Q

AE

A

Breakthrough bleeding at beginning

Amenorrhea

Bloating, weight gain, breast tenderness, n, fatigue, HA

Venous thrombosis, pulmonary embolism, cholestatic and gallbladder, stroke MI, hepatic tumros—-have you or family ever had blood clot, MI, stroke, family history self history, migraine with aura greater risk for stroke contraindication

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53
Q

Transdermal patch

A

E and p

Weekly for 3 weeks and 1 week without patch

Caution in fat girl no over 198

Same ae as oral contraception, except GREATER RISK OF THROMBOSIS

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54
Q

Vaginal ring

A

E and p

Insert into vagina for 3 weeks-people forget

Can be removed for up to 3 hours without affecting efficacy

Better tolerated since not going through GI tract and less breakthrough bleeding

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55
Q

Who cant use combination birth control pills

A

Women over 35 who smoke

History of thromboembolic event (personal-if have family history need to be checked for inherited thrombophlebitis)

Women with history of CAD, cerebral vascular disease, CHF or migraine with aura, uncontrolled HTN

DM, chronic HTN, systemic lupus erythematous is…individualized prescribing

Women with moderate to severe liver * disease or liver tumors

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56
Q

Injectable hormonal

A

Depo

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57
Q

How do it

A

IM injection 11-13 weeks

Maintains contraceptive level of progestin for 14 weeks

Give 1st day of period if not back up method for 2 weeks

Thickens cervical mucus, endometrium decidualization, blocks LH surge and ovulation

Efficacy is gooooood!!!!

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58
Q

Black box depo

A

Bone metabolism associated with decreased estrogen levels

Particular concern in adolescents

Reversible after discontinuation

After 2 years consider another optioN!!!!!!!!!!!!!!!!! Depo is low estrogen state

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59
Q

Side effects depo

A

Irregularly irregular bleeding

  • decrease with use and can be amenorrhea
  • short term estrogen add back can improve bleeding
  • menses can take a year to regulate

Weight gain (progesterone makes us hungry), exacerbation of depression

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60
Q

If psychotic or suicidal

A

Don’t give dep

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61
Q

Indications for depo

A 
Breast feeding 
Effective
When e contraindicated
Seizure disorder
SS anemia
Anemia secondary to menorrhagia
Endometriosis
Decrease risk of endometrial hyperplasia
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62
Q

Contraindication depo

A

Preg
Unevaluated vaginal bleeding
Malignancy breast-estrogen and progesterone positive breast c
Active thrombophlebitis, or current past history thromboembolic events or cerebral vascular disease

Liver dysfunction disease

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63
Q

Long acting reversible contraceptives (Larcs are great)

A

Implantable nexplanon

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64
Q

Implantable nexplanon

A

Single radiopaque, rod shaped implant containing 68 mg estpgestrel

Use for 3 years
-preferred to be inserted in first 5 days of menses and if not then use back up for 7 days after insertion

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65
Q

MOA nexplanon

A

Thickens cervical mucous

Inhibits ovulation

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66
Q

AE

A 
Irregularly irregular vaginal bleeding
HA
Vaginitis
Weight increase
Acne
Breast pain
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67
Q

Indications

A

Convient, efficacious can use in breast feeding

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68
Q

Contraindication

A

Preg
History thrombosis
Known suspected breast cancer

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69
Q

Complications

A

Infection, bruising, deep insertion, migration, persistent pain or paraesthesia at insertion sit

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70
Q

IUD

A

Copper T-non hormonal

Levonorgestrel releasing

  • Mirene/liletta 5 years
  • skyla/kyleena 3 years

Insert in office and 1-5% expulsion rate

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71
Q

Risk

A

Increased infection first 20 days (do test before to check(

Ectopic pregnancy

If pregnant remov eif strongs visible (decrease risk spontaneous abortion )

Risk of uterine perforation at time of insertion requiring laparoscopy for removal

Risk of malposition and necessitating hysteroscpy for removal

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72
Q

Contraindications IUD

A

Breast cancer-levonorgesterel containing only

Recent peurperal sepsis

Recent septic abortion

Active cervical infection

Wilson’s disease-copper T only

Uterine malformations (uterine septum’s/fibroids/significantly enlarged > 10cm)

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73
Q

Mirena/kyleena

A

5 years

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74
Q

Liletta

A

3 years

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75
Q

Skyla

A

3 years, designed originally for nulliparoid

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76
Q

Effectively IUD

A

Preg rate .2%

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77
Q

I want to get preg in three years

A

Let’s do liletta or skyla

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78
Q

I want a kid in ten years

A

Mirena/Kyla

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79
Q

Benefits leo

A

Keep watching

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80
Q

INTERLUDE PELVIC PAIN AND PROLAPSE THEN WE WILL GET BACK TO IT

A

Ok

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81
Q

Muscle

A

Lavator ani

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82
Q

Normal pelvic anatomy and pelvic support

A

Ok

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83
Q

Pelvic organ prolapse

A

Cystocele-anterior wall of vagina

Posterior wall of vagina-rectocele

Top of vagina -enterocele

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84
Q

50% parous or vaginal delivery

A

Have prolapse

85
Q

Symptoms pelvic prolapse

A

Vaginal pressure heaviness, LBP, vaginal perineal pain, mass sensation, incontinence, anxiety , embarrassment

86
Q

Prosendetia

A

Cervical prolapse

87
Q

Risk factors

A

Perous 1 or more vagina birth

Genetic predisposition, menopause, age, CT disorder, pelvic surgery, elevated pressure(straining)

88
Q

Anatomy

A

Levator ani, fascia , uterosacral and cardinal ligaments

89
Q

Pop-q measures 6 points

A

0-no prolapse
1-leading prolapse 1 cm above hymen
2-leading prolapse less than or equal 1 cm above or below
III-1 cm beyond hymen but less than vaginal length
IIII complete

90
Q

Symptomatic

A

Surgery or non

91
Q

Pessaries

A

Device fit in as first line

92
Q

Surgery

A

Hysterectomy cant just remove uterus need to do sacrospinal ligament suspension

Abdominal sacral colpopxey-complete obliteration of vaginal lumen

93
Q

Urinary incontinence

A

Leak urine social clinical well being,

94
Q

Stress

A

Increase intraabdominal pressure

Most common

25% 4-6 months after vaginal delivery

Urethral hypermobility -if loss of integrity of underling msucles, sphincter defiency

95
Q

Treat stress

A

Kegel

Surgery-tension free vaginal tape,

96
Q

Urge

A

Detrusor muscle overactivity

Volume increase but pressure in bladder low

Pressure rise and need to run to br frequently and urgently

97
Q

Treat urge

A

Behavioral bladder aiming

Anticholinergic agents

98
Q

Cystocele

A

Bladder form anterior wall

Cardinal ligament complex

Pubocervical fascia allow protrusion of the bladder , break speculum in half

99
Q

Rectocele

A

Rectum pushed up on posterior

-could also be sigmoidocele enterocele

100
Q

Enterocele

A

Bowel coming through

True hernia-only true hernia in vagina

101
Q

True hernia

A

Peritoneum and abdominal contents

102
Q

Apical prolapse

A

Level 1 defect can do down to opening

103
Q

Vaginalis vault prolapse

A

Post hysterectomy

Cervic everts like a sock comes down

104
Q

Urethrocele

A

Urethra lost support , usually birth trauma and comes in with tress incontinence …laugh cough sneeze, provocation

105
Q

POPq

A

For how much prolapse

106
Q

32 yo g4p4 pelvic pressure bulging sensation prolonged standing no urinary bowel complaints, no dysmenorrhea, sexually active husband BMI 46 , smoker, works in manufacturing .
What are risk factors.
One exam anterior bulging

A
  • four kids, one big, straining and lifting a lot, obese, smoking, Caucasian and Asian more likely , someon ein family with marfan or erlos danlos, separation of aorta
  • family history or personal history of stria or joint hypermobility? Must consider too.

Cystocele and urethrocele

107
Q

Treatment cystocele

A

Pelvic floor PT

Pessary-for support or space occupying-first line non surgical

Surgical correction-anterior colporrhaphy (pubocervical fascia is sutured int he midline and laterally to the Argus tendinous fascia) ANTERIOR REPAIN
=paravaginal is repairing lateral cystocele

108
Q

78 yo g2p2 Asian female presents with cancer something will fallout. She states that the symptoms have been present for years but a couple of months ago she noticed when using bathroom something different. Doesn’t empty bladder, poor control T2DM, HT, CHF, lung disease,
Firm-cervix soft-vaginal tissue,

What is the differential diagnosis

A

Asian risk, two kids, post menopausal, has had CT issues from umbilical repair,

Firm-cervix, soft-rectocele or cystocele,

Cervix coming out, uterine cervical prolapse

109
Q

78 yo african American same case.

A

Less risk prolapse but more risk fibroid

110
Q

Treat uterine prolapse

A

Pessary-conservative , she has health issues so lets try this first

Hysterectomy-

Colpocleisis-obliterate vaginal lumen, if dont want to have sex, not invading body cavity, not long procedure, use in 80s or 90s with severe prolapse

111
Q

62 yo african g3p3 urinary incontinence cough and sneeze , wears pads , denies dysuria or hematuria. Note waking up once a night to use the br. She denies bowel complaints. One large baby . Cough sneeze and cant make it to br

A
  • stress incontinence

- urge

112
Q

Additional tests

A

PE, Q tip test (urethral hypermobility-coat Cotten tip applicator put in urethra advance slowly know and pull back till meet resistance and ask to cough or strain + if go more than 30 degrees and urethral hypermobility contributing to incontinence)

Urodynamics-fill and have cough or strain if squirt urine , complex for others

Postvoid residual (less than 50 mL is Normal)

113
Q

Treat for stress incontinence

A

Topical estrogen
Pelvic floor PT/kegel

Pessary

Surgery-suburethral sling *(transvaginal tape or trasobturator tape for vaginal approach) abdominal approach with Marshall-marchetti-krantz or Burch procedure)

114
Q

45 yo g6p7, MS, needing to splint to have bowel movements, rectocele. What clues

A

Constipation and lots of kids, on interferon for MS

115
Q

Treat rectocele

A

Watch it, put is pessary

Surgical-posterior repair , pubocervical and rectovaginal fascia that overlies rectum and is under vagina we will do symmetric and altered closure

116
Q

38 no kids urinary urgency and frequency. Has to rush to br drinks a lot of diet soda, little water, smokes,
PE normal no prolapse , no blood in urine

A

Urge incontinence

-diet soda, smoker, job holds urine for long

117
Q

Treat urge incontinence

A
  • diet drink water
  • empty frequently every 90 min
  • no smoke
  • kegel PT (PT to overcome urge to make to bathroom safely)

If not work try anticholinergic meds

If not work Botox in bladder or nerve stimulators

118
Q

IUD benefit

A

Decrease menstrual blood loss

Less dysmenorrhea

Protection of the endometrial lining from unopposed estrogen

Convenient long term

119
Q

Copper T paragard

A

10 years

Copper interferes with sperm transport of fertilization and prevention of implantation

Same contraindications/insertion isssues as levorgestrel

120
Q

Barrier contraceptives

A

Condoms, diaphragms, cervical cap, sponge, spermicides

-less effective

121
Q

Condoms good for what

A

Only method with protection against sti

122
Q

Condoms

A

Res our tip decrease breakage

Female condom-vaginal liner and have to leave in 6-8 hours after intercourse and slips out

123
Q

Diaphragms

A

Must be used with spermicide

Inserted up to six hours before

May change fit after birth
Women who use as more likely to get urinary tract infections

More likely to get UTI

124
Q

Cervical cap

A

Smaller diaphragm, put on cervic with spermicide left in for 6 hours after intercourse no more than 48

125
Q

Sponge

A

Small pillow shaped sponge containing spermicide

Dimple in sponge fits over the cervic/opposite has an elastic loop for removal

One size

More effective in nullparous

Left in place for 6 hours but no more than 30 horus

126
Q

Calendar methods

A

Calculate fertile period and avoid sex during time

127
Q

Basal body temp method

A

,5-1 degree change at time of ovulation and avoid sex for 3 days

128
Q

Cervical mucus method

A

Woman assess and not change long and stringy for ov and avoid for 4 days

129
Q

Symptothermal method

A

Combines mucus and basal body temp

Awareness of ovulation signs, cramp, breast tenderness, changes in position or firmness or cervix

130
Q

Emergency contraceptive QID had unprotected sex.

Prevent ovulation and ertilization

A

Within 72 hours

No medical contraindication!!

131
Q

Plan B

A

OTC for over 17

Progestin only 2 pills taken 12 hours apart

Within 120 hours

Failure 1.1%

Cheaper

132
Q

Ella

A

Prescription

Ulipristal acetate

More effective

5 days after

Postpones follicular rupture/inhibit or delay ovulation

133
Q

Sterilization

A

Highly effective, most frequently used meyjod

Prevent sperm and egg from meeting

PERMANENT

134
Q

Counsel sterilization

A

Risk of regret

LARCS

Reasons for choosing

Discuss risk/benefits

Screen for indicator of regret (espicially with young age)

Possibility of failure and increase risk of ectopic if preg occur

Need to use condoms for STD

135
Q

Vasectomy

A

Occlusion vas deferens

Safer, more easy,

Postoperative complications: bleeding, hematoma, acute/chronic pain, local skin infections

Easier to reverse

Not immediately effective-10 weeks!!!!

136
Q

Female sterilization

A

Laparoscopy, mini laparotomy, hysteroscopy at time of c section

Safe, low cost, easy, permanent

137
Q

Laparoscopy

A

Camera in belly button

Small incision,

Occlude Fallopian tubes
-electrocautery, clips(hulks most reversible method, fishie lower failure rate bc large diameter), bands intermediate reversibility and less failure, higher incidence of postop pain, increased risk of bleeding

Salpingectomy-increasing in use due to recent literature regarding decrease in ovarian cancer risk

138
Q

High risk ovarian cancer

A

Salpingectomy

Completely non reversible

139
Q

Mini laparotomy

A

Most common

Post partum, use small infraumbilical incision in postpartum period or suprapubic incision

Can do same epidural in from labor

Cut cut

140
Q

Hysteroscopy

A

Not selling any more such complaints about post op pain from coils

Look in through cervix find tube and insert coil in and it scars…very effective so ok for obese or poor surgical patients, but complaints

141
Q

26 yo g3p3 female presents for contraceptive advice. Sexually active using basal body temp. Wants more reliable but not permanent. Have DVT< cholecystectomy, appendectomy, smokes marijuana. What recommend? What’s contraindication?

A

LARC, no oral bop bc clot, depo (weight gain), lets do LARC

142
Q

23 g2p2 want permanent contraception sure she doesn’t want more kids. BMI 58, mother breast cancer, denies alcohol tobacco

A

Permanent-salpingectomy,

Non permanent methods-risk of regret higher , depo

LARC

Biggest risk-risk of regret

143
Q

Breast tissue tenderness cycle

A

Hormone sensitive

144
Q

What causes growth of adipose tissue and lactiferous ducts

A

Stronger

145
Q

What causes lobular growth and alveolar budding

A

Progesterone

146
Q

Number one reason OBGY sued

A

Misssed Breast cancer

Need timely evaluation
=NEVER wait breaks complaint wait,

147
Q

Bump

A

How long been there, pain, has it lasted more than one cycle, nipple discharge, change in size, risk factors

148
Q

Risk factors breast cancer

A 
Age older
Personal history
History atypical hyperplasia
High breast tissue density
First degree relatives with breast tissue
Early menarche <12
Late cessation of menses>55
No term pregnancies
LONGER ESTROGEN EXPOSURE
Never breastfed
Recent and long term ocp
Post menopausal obesity
Endometrial or ovarian cancer
Alcohol
Tall ppl
High socioeconomic status
Jewish
149
Q

PE

A

Both breasts including axilla and chest wall

Mammogram, US, MRI, FNA, core biopsy

Palpable masses always get a biopsy from FNA/core excisional

150
Q

Mammography

A

Able to detect 2 yrs before palpable
Densities and calcifications <1 cm

Best over 40, saggies less density

Just do over 40

151
Q

Screening mammogram

A

4 images, 2 cariocaudal and 3 mediolateral

In and out

152
Q

Diagnostic mammogram

A

Done with complaint or palpable mass or abnormal screening

Both breasts

153
Q

When screen

A

Start at 40 annually

154
Q

US

A

For inconclusive mammogram findings
<40 better

Differentiate cystic or solid lesions can show solid tissue near cyst

Guidance for core needle biopsy

25 found bump..lets start with US

155
Q

MRI

A

Useful to adjunct mammography

Post cancer diagnosis for further evaluation

Used with implants

Women at high risk for breast cancer like BRCA

Screen if brca or implants, but used for adjunct for everyone else and used for staging

156
Q

FNA

A

Patient had abnormal mammogram or ultrasound. GET BIOPSY

Let’s start FNA to determine solid vs cystic

22-24 guage needle

Fluid clear, dont send it, if bloody send it ff and repeat mammogram and US

Cyst-return in 3 months if gone with expiration

If no resolve bigger biopsy

157
Q

FNA clear cyst completely

A

Return in 3 months

158
Q

If not cleared with FNA

A

Diagnostic mammogram /US and perform biopsy

159
Q

FNA useful for what

A

Cystic

160
Q

If return

A

Excision , get biopsy if doesn’t go away

161
Q

Core needle biopsy

A

For solid masses 14-16 guage
3-6 samples taken

Use US to watch needle go into mass

162
Q

Benign breast disease

A

Mastalgia

-cystic, noncyclic, extramammary

163
Q

Mastalgia cyclic

A

Start lateral phase of menstrual cycle and ends after onset of menses

164
Q

Noncyclic mastalgia

A

Not associated with menstrual cycle

Includes tumors, mastitis, cysts

Can be associated with some medications (antidepressants, antihypertensices, hormonal meds like OCP)

165
Q

Extramammary benign breast disease

A

Chest wall trauma, shingles, fibromyalgia

166
Q

Treat mastalgia

A

Danazol

-deepens voice, overweight, hair

167
Q

Symptoms relief benign breast disease

A

Properly fitting bra, weight reduction, exercise, decrease caffeine intake and vitamin E supplementation, evening of primrose oil

Ocp help if cyclic

168
Q

Nipple discharge

A

Hyperprolactinemia
Pituitary tumor or cancer

Unilateral-worse
Clear green-cyst
Milky-lactation
Bloody-yikes

Spontaneous or non

169
Q

Fibrocystic changes or ductal ecstasia

A

Non spontaneous, non bloody, and bl

170
Q

Bloody nipple discharge

A

Cancer till proven otherwise

171
Q

What do bloody nipple

A

Intraductal or invasive ductal carcinoma, benign intraductal papilloma

Breast ductogrpahy-excise duct

172
Q

Greater concern for malignancy

A 
Greater 2 cm
Immobility
Poorly defined margins
Firmness
Skin dimpling/retraction/color changes
Bloody discharge
Ipsilateral lymphadenopathy
173
Q

Benign categories

A

Non proliferative

Proliferative without atypia

Proliferative with atypia

174
Q

Number one non proliferative

A

Fibrocystic changes

Cyst from response to hormones, fibrosis from rupture and scar

175
Q

Number one lumpy

A

Fibrocystic changes

176
Q

Cysts

A

Lobulares dilate and form

177
Q

Fibrosis

A

Ares where cysts have ruptured and scarred

178
Q

Adenosis

A

Lobular growth with increased number of glands

179
Q

Lactational adenomas

A

Hormonal response

180
Q

Fibroadenoma

A

Most common benign tumor in females

Late teen early 20
Solid, rubbery, mobile and solitary

2-4 cm in size but can reach up to 15 cm in diameter with malignant potential when reach that size

181
Q

Galactocele

A

Cystic dilation of duct filled with Milky fluid

Occurs ear time of lactation

Secondary infection may produce acute mastitis

Typically can be needle aspirated

182
Q

Proliferative without atypia

A

Not cancerous

Epithelial hyperplasia, sclerosing adenosis, complex sclerosing lesions, papillomas

NOT PALPABLE see on imaging

183
Q

Epithelial hyperplasia

A

Overgrowth of he cells that line ducts

184
Q

Sclerosing adenosis

A

Extra growth of tissue within the breast lobules

185
Q

Complex sclerosing

A

Radial scar

Adenosis in which enlarged lobules are distorted by scar like fibrous tissue

186
Q

Papillomas

A

Intraductal growths
30-50
Cause serous or serosanginous discharge

187
Q

What do

A

Imagine and confirmed with biopsy

188
Q

Proliferative with atypia

A

LCIS, DCIS

When malignant cells replace the normal epithelial lining in the ducts or lobules-the BM is intact and cant metasticize

189
Q

LCIS

A

Not precursor

190
Q

DCIS

A

Ducts filled with atypical epithelial cells and women’s re increased risk for developing invasive disease or reoccurrence of DCIS

191
Q

Treat DCIS LCIS

A

Excision and followed with treatment with selective estrogen receptor modulators

192
Q

Most common malignancy in women

A

Breast cancer

193
Q

Second leading cause of cancer death

A

Bc

194
Q

Lifetime risk of getting it and dying

A

1/8

1/28

195
Q

Risk factor

A

Over 50

BRCA

196
Q

Brca1

A

Early ovarian

197
Q

BRCA2

A

Some early onset and lower risk ovarian

198
Q

Gail model

A

Put in stuff risk of developing cancer if 5 year risk is 1.7% or more talk about prophylaxis

199
Q

Most common histology

A

Ductal 50s

200
Q

Lobular

A

5015 more aggressive

201
Q

Nipple

A

Paget disease, bad 3%

202
Q

Inflammatory breast cncer

A

1-4% people get diagnosed as mastitis and its not noticed for a while

203
Q

Treat

A

Receptor status from lumpectomy

204
Q

er+

A

Respond better

205
Q

HER2/neu

A

Worst prognosis

206
Q

Surgery

A

Lumpectomy radiation

Mastectomy

Equal outcomes

207
Q

Meds

A

Hormonal, chemo, tamoxifen in pre menopausal, after get aromatase inhibits (decrease risk endometrial )

Trastuxumab hercepton-gives heart failure acts on HER2/neu but risk of heart failure

208
Q

First 2 years

A

3-6 months MRI mammography

Then every year after 2 years

209
Q

Most recur by when

A

5 years

Clin Medicine (28 decks)

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