Female Repro Flashcards
1
Q
Vaginal infections DDx
A
- Bacterial vaginosis (Gardnerella)
- >4.5
- Discharge: thin, white/grey
- Odour: fishy
- Trichomonas
- pH>4.5
- Discharge: frothy, yellow/green
- Odour: fishy
- Candida vulvovaginitis
- pH<4.5
- white curdy “cottage cheese”
- CC: itching/burning
2
Q
Lymph Drainage of the Breast
A
- Majority of lymph drains into ipsilateral axillary nodes along a chain which starts at:
- ANTERIOR AXILLARY ( PECTORAL ) ->
- CENTRAL **most freq. palpable ->
- APICAL (Subclavian / Infraclavicular ) ->
- Supraclavicular ->
- Subscapular ( posterior axillary ) ->
- Interpectoral nodes ->
- MEDIAL BREAST drains into Internal Thoracic and Mediastinal ( Internal Mammary ) nodes
3
Q
Colostrum and Milk
A
- Colostrum : Secretory IgA (against Enteric infection).
- Human Milk : Starts 5 days post partum
- Protein, Lactose, Water, Fat
- Lacks vitamin K.
- Lower iron than cows milk.
- Has T & B lymphocytes.
4
Q
External Female Genitalia Lymph Drainage/blood supply/nerves
A
- Lymphatic Drainage : LOWER Vagina and Vulva (External Genitalia ) to Inguinal Lymph Nodes
- Blood Supply : Vaginal Arteries (from middle rectal and pudendal arteries )
- Nerve Supply: Pudendal Nerve (S2-4)
5
Q
Uterus & Ovaries Lymph drainage, blood supply, nerves
A
Blood supply to:
- Uterus: Uterine a. (br of hypogastric /internal iliac artery)
- Ovaries: Ovarian aa (br off aorta ; and anastomoses with the ovarian branch of the uterine artery
Lymphatic Drainage :
- Uterus ,ovaries, tubes and drain into internal iliac and paraortic lymphatics
- Middle and upper vagina drain into iliac lymph nodes
Nerve Supply:
- sympathetic: lower thoracic T10-12
- some parasympathetic (S2-S4)
6
Q
SYMPTOM : BREAST TENDERNESS/PAIN/Mastalgia DDx
A
- Cyclic Changes in Reproductive age females
- Increased tenderness premenstrual (increased Estrogen & Progesterone )
- Fibrocystic Change
- Pregnancy –usually diffuse tenderness
- Diet : Caffeine may increase symptoms of tenderness
- Medications : Oral contraceptive / Hormone use Psychiatric Drugs / Herbal Rx
- Family History : Breast Cancer Maternal and Paternal , particularly in young women
7
Q
NIPPLE DISCHARGE features & DDx
A
- Sero-sanguineous ( watery-bloody ) or bloody : Intraductal papilloma (usually benign) Intraductal carcinoma
- Purulent : infection
- Milk or colostrum: pregnancy, psychiatric medications, pituitary adenoma
8
Q
FCC
A
**Clinical Presentation **
- Dense, usually bilateral, upper outer breasts
- DIFFUSE - no discrete mass
- Not a discrete mass
- Increased premenstrual
- Resolves or decreases post menses
Dx
- re-evaluate post menses in 1-2 cycles
- Consider Ultrasound if persistent or Strong Family History of breast cancer
- FNAC if suspicious ultrasound, clinically suspicious ie asymmetric, persists through menses patient feels mass
9
Q
Common Breast Masses felt on palpation
A
- Fibroadenoma
- Cysts
- Cancer
10
Q
Fibroadenoma
A
**Clinical Presentation **
- Young women ages 15-25
- Mobile
- Firm, rubbery
- Well circumscribed
- Usually not tender / may be tender in pregnancy
Dx
- US
- FNAC
11
Q
Breast Cysts
A
**Clinical Presentation **
- Ages : 25-50
- Tender area
- Most common breast mass
- Soft , well circumscribed , round , mobile mass, tiny or large
- May be tender; tenderness may increase pre menses
- One or both breasts
**Dx: **
- US
- Aspirate
- Cytology
12
Q
Signs of Breast Cancer
A
- Nipple Retraction and deviation,
- Paget’s disease of the nipple,
- edema of skin (peau d’ orange)
Nipple
- Some women have always had inverted nipples ( Not Pathological ), often bilateral
- Signs of Malignancy :
- Thickening or loss of elasticity of the nipple
- Nipple deviation
- Retractions
- Inversions
- Serosanguinous
- hard, non-painful, non-mobile, bloody nipple dischg, no chg with menstrual cycle
Areolar : Paget’s Disease
- Symptom:Dry, Scaly, itchy nipple
- Eczematous ,excoriated nipple – areola complex
- May be associated with underlying malignancy
Dx
- Small non palpable lesions
- Diagnosis is 7 years prior to palpable size ( 1-2cm )
- Palpable lesions REQUIRE biopsy
- Core Biopsy is for mammographic lesions:
- role of mammography in palpable lesions is to evaluate the remainder of the breast , and the contralateral breast
13
Q
Mentrual pain (dysmennorhea)
A
- endometriosis
- leiomyoma
14
Q
Vulva lesionsDDx
A
- Benign vs Malignant
- Common Benign Mass: Bartholin’s cyst/ abscess
- Candida Vulvovaginitis ( Pruritis / redness )
- Lesions : Condyloma , HSV, Chancre,
- Malignant : Persistent pruritis ( itching ) or , raised, bleeding , malodorous lesion
15
Q
Cervix lesions DDx
A
- Cervical polyps are red soft benign growths seen coming through the cervical os (opening)
- Post coital bleeding is associated with cervical polyps and cervical cancer
Screening
- Cytology (Pap; image below) alone every 3 years
- HPV and cytology co- testing every 5 years
