Female Reproductive/Lymph Flashcards
These are found in all tissues except the CNS and tissues that do not have blood vessels
Lymph nodes
What are the lymphatic organs?
Bone marrow, thymus
How many lymph nodes are there in the body?
Over 600
Where do B cells mature?
Bone marrow
Where do T cells mature?
Thymus
Your patient comes in with signs of breast development. Approximately how long would you expect it to be until this patient experiences menarche?
2 years
What is an age related change in the breast tissue that occurs in woman?
The breast size decreases as a woman ages
Why is it easier to palpate masses in breasts of an older woman then breast of a younger woman?
The breast size and density decline during aging making masses more prominent and easily palpable
What are the two models to assess risk of breast cancer development in woman with increased breast cancer risk?
Claus Model and the BRCAPRO model
How long is the ovarian cycle normally?
Approximately 21-28 days
When does the follicular phase begin?
The day of menstration
What are the days in the follicular phase?
Day 1-14 of the cycle
When is the ovulatory phase?
Around day 14
When is the span of the luteal phase?
From the day of ovulation until menses again
When do you do a visual inspection of the genitals and breasts in the child?
At well visits during the age around puberty development (approx 8y/o)
When is menopause considered “premature”?
If if begins prior to 40 years old
What is the GTAPL accroynm?
G: gravida (pregnancies)
T: term (babies delivered at term)
P: preterm (premature babies, <35 weeks)
A: abortions (of any kind)
L: living (how many living children the woman has)
What is Goodell’s sign?
It is the softening of the cervix that can occur as early as 2 weeks after conception and is a sign of pregnancy
What is Chadwick’s sign?
It is the cyanotic appearance of the cervix due to the increased vascularization with pregnancy, it is seen around 6-8 weeks gestation
When do fundal heights begin to be measured?
At 20 weeks gestation
Do fundal heights correlate with gestation age?
They do until later into the third trimester when baby begins to drop to prepare for birth
Are these exams a diagnostic or screening tool:
-1st trimester screening
-Quad screening
-NIPT testing
-Serum single AFP
Screening, non-diagnostic tools
Are these exams a diagnostic or screening tool:
-Aminocentesis
-Chorionic villus sampling
Diagnostic tools used in the screening of genetic disorders
How much is the recommended folic acid intake for pregnant or planning to become pregnant woman?
0.4-0.8mg folic acid daily
When does screening for gestational diabetes normally occur?
24-28 weeks gestation
What is a widely debated obstetric treatment?
Labor induction
What is a woman’s lifetime risk of developing breast cancer with no high risk factors?
1 in 8
Key Findings/Physical Exam:
-Erythema, edema, purulent discharge at site of bite/scratch
-fever
-headache
-anorexia
-persistent lymphadenopathy
-Positive B. henselae IFA blood test
Cat scratch fever
Key Findings/Physical Exam:
Early stages:
-high risk sexual activity/IV drug use
-flu-like symptoms, fever, chills, lymphadenopathy, fatigue, myalgias, night sweats, sore throat, generally asymptomatic, high-risk period for transmission
Later stages:
-rapid weight loss, lymphadenopathy, chronic diarrhea, mouth/anus/genital sores, night sweats, opportunistic infections and cancers, memory loss, depression, decreased CD4+ count
HIV/AIDS
Key Findings/Physical Exam:
-fever, malaise
-enlarged lymph nodes
-abrasions, wounds, coexisting infections
-red streaking extending proximally from a wound/infection toward the regional lymph nodes
Lymphangitis
Key Findings/Physical Exam:
-unilateral
-lymph node enlargement
-pain/tenderness in lymph nodes
-lymph nodes filled with exudate
-erythema/streaking over lymph nodes
-fever, malaise
Lymphadenitis
Key Findings/Physical Exam:
-swelling of part or all of arm/leg
-heaviness, fullness, tightness in affected area
-restricted ROM
-aching, tingling, discomfort
-recurring infections
-changes in skin texture/turgor, appearance, etc.
-pitting edema may be present
-swelling does not resolve with diuretics
Lymphedema
Key Findings/Physical Exam:
-travel to endemic areas
-gross edema of the entire limb with hardening and thickening of the skin
-increased infections in the skin and lymph system
-elevated IgG serum
Elephantiasis (lymphatic filariasis)
Key Findings/Physical Exam:
-family history
-history of EBV
-generalized, painless, lymphadenopathy, fatigue, fever, night sweats, unexplained weight loss, prurititis, chest/ab pain
Lymphoma
Key Findings/Physical Exam:
-fever
-swelling of ant/post cervical chains
-pharyngitis
-white exudate on posterior pharynx and tonsillar area
-swollen uvula, fatigue, petechiae on hard or soft palate, headache, myalgias, palpebral edema, splenomegaly, hepatomegaly, jaundice, elevated LFTs
Mono
Key Findings/Physical Exam:
-weight loss, fatigue, night sweats, fever, SOB, wheezing, dry cough, persistent regional or generalized lymphadenopathy, painful/tender bumps/ulcers, burning, itching, tearing, erythema, dryness, photophobia, blurred vision
Sarcoidosis
Key Findings/Physical Exam:
-generally asymptomatic, owning a cat puts you at higher risk
-generalized lymphadenopathy, myalgias, fatigues, positive IFA and IgG/IgM antibodies
-parasites in patient specimens
Toxoplasmosis
Key Findings/Physical Exam:
-mole/freckle like accessory tissue with or without a nipple with possible tenderness
Accessory breast tissue
Key Findings/Physical Exam:
-single, well-defined mobile ovoid and discrete lump palpable on exam
-mass tender to touch
-possible multiple massess noted
Fibroadenoma
Key Findings/Physical Exam:
-Related to hormonal changes
-Palpable, round, tender, mobile, fluid-filled masses
Breast cysts
Key Findings/Physical Exam:
-discrete firm mass on palpation
-speculated mass on mammogram
-prognosis varies on size, histologic grade, hormonal receptor expression, lymph involvement
Invasive ductal carcinoma
Key Findings/Physical Exam:
-palpable mass or mammography findings similar to IDC, but more subtle and underestimated
-area of thickening or induration on exam instead of palpable mass
-poorly defined area of asymmetry on mammography
Invasive lobular carcinoma
Key Findings/Physical Exam:
-pain bilateral in association with menstrual cycle
-pain is often generalized and described as heaviness or tenderness
Cyclic mastalgia
Key Findings/Physical Exam:
-pain unilateral with most severe pain in the breast/chest area not related to menses
Noncyclic mastalgia
Key Findings/Physical Exam:
-Milky, serous, bloody or purulent discharge from one or both breasts
-can have presence or absence of a mass
-related to menses or menopause
Nipple discharge
Key Findings/Physical Exam:
-Itching, tingling, or erythema of the nipple or areola
-Thickening, flaking, or crusting of the skin on/around the nipple
-Flat nipple
-Yellowish or bloody nipple discharge
-Breast lump may be present
Paget’s disease
Key Findings/Physical Exam:
-trauma/chaffing of the nipple
-breast engorgement that is prolonged
-smoking, nipple piercings
-warm, tender, erythematous, firm area of the breast
-fever, fatigue, chills, arthalgias, myalgias, malasie, poor appetite
-normally unilateral
-abrupt onset
Mastitis
Key Findings/Physical Exam:
-More often seen in Hispanic or African American women
-PMH of early menarche or early first live birth, obesity
-unilateral presentation of erythema or purplish, edematous, inflamed area of the breast involving 1/3 breast area
-Peau d’orange skin changes
-rapid breast change (<3 mon)
-fullness/heaviness, burning, tenderness, inverted nipple, axillary/supraclavicular lymphadenopathy
Inflammatory breast cancer
Key Findings/Physical Exam:
-asymptomatic in majority of woman
-mid-cycle vaginal bleeding
-vaginal discharge
-dysuria
-PID can develop if untreated
Gonorrhea
Key Findings/Physical Exam:
-asymptomatic in majority of woman
-abnormal vaginal discharge
-easily induced endocervical bleeding
-dysuria, pyuria, frequency
-PID and infertility can occur if untreated
-infection in rectum can result in rectal pain/bleeding/discharge
Chlamydia
Key Findings/Physical Exam:
-asymptomatic in majority of woman
-greenish-yellow, frothy, malodorus vaginal discharge
-dysuria
-irritation and itching of the vulva
-erythematous vulvar tissue and vaginal mucosa
-“strawberry cervix”
Trichomonas
Key Findings/Physical Exam:
Primary stage:
-Chancre 21 days after exposure, positive nontreponemal test
Secondary stage:
-Palmar rash to hands/feet, fatigue, fever, lymphadenopathy, hair loss, weight loss, myalgias
Will develop a latent phase
Tertiary stage:
-10-30 years after initial infection, can be fatal, organ damage
Syphilis
Key Findings/Physical Exam:
-flat/papular, pedunculated growths on the genital mucosa
-can be a single lesion or multiple with a cauliflower appearance
-rarely painful or pruritic
Genital warts
Key Findings/Physical Exam:
-Vesicular lesions on genitals or area that came in contact with infected area, vesicles can pop and ulcerate, has periods of dormancy
Herpes
Key Findings/Physical Exam:
-itching and irritation with visible nits/lice
Pubic lice
Key Findings/Physical Exam:
-asymptomatic or lower abdominal pain/pelvic pain
-vaginal discharge
-fever, pain with intercourse, frequent urination, tenderness with bimanual examination, positive STI cultures
PID
Key Findings/Physical Exam:
-vaginal itching or irritation with white or gray discharge
-strong fishy odor with positive whiff test
-clue cells on microscopy
BV
Key Findings/Physical Exam:
-vulvar itching/irritation
-dysuria, dysparenunia, symptoms worsen in the week prior to menses
-curd-like discharge that adheres to the vaginal walls
-erythematous vagina/vulvar tissue
-blasospores and pseudohyphae on microscopy
Candidiasis
Key Findings/Physical Exam:
-vaginal dryness, burning, irritation
-dyspareunia
-vaginal spotting/bleeding
-dysuria or urgency
-frequent/recurring UTIs
Genitourinary syndrome of menopause (formerly atrophic vaginitis)
Key Findings/Physical Exam:
-dysuria, dyspareunia, vulvar itching, postcoital bleeding, irritation to vulvar area, erosion and scarring
Lichen planus
Key Findings/Physical Exam:
-vulvar itching, typically worse at night
-dysuria, pain, urine/stool retention,
-plaques or patches that are ivory in color and waxy in appearance
-fissures, ulcerations, lichenification, scarring, and destruction of normal tissue structures
Lichen sclerosus
Key Findings/Physical Exam:
-irritation, erythema, itching in the skin folds
-typically occurs in axilla, groin folds, inner thighs, abdominal folds
Intertrigo
Key Findings/Physical Exam:
-chronic vulvar itching
-dyspareunia
-burning, tingling, soreness in vulvar region
-change in appearance of affected skin
-slightly raised skin lesions
Vulvar cancer
Key Findings/Physical Exam:
-dyspareunia, dysuria, hematuria, vaginal bleeding, bright red vascular lesion located on the posterior lip of the urinary meatus
Urethral caruncle
Key Findings/Physical Exam:
-painful (infected) or painless (uninfected) cyst
-discomfort while walking
-dyspareunia, fever, swelling of lump at the introitus
Bartholian gland cyst
Key Findings/Physical Exam:
-low-back discomfort
-pelvic pressure
-vaginal bleeding or discharge
-bulging in the vulvar area
Pelvic organ prolapse
Key Findings/Physical Exam:
-History of HSIL
-watery, bloody vaginal discharge that may be heavy or malodorous
-unusual vaginal bleeding
-pelvic pain
-dyspareunia
-cervix appearance with gross erosion, ulcer or massq
Cervical cancer
Key Findings/Physical Exam:
-unilateral, acute, pelvic pain
-irregular menstrual periods
-bloating
-can have palpable cysts
Ovarian cysts
Key Findings/Physical Exam:
-vaginal bleeding
-increasing unilateral pelvic pain
-altered menstrual cycle
-positive pregnancy test
-palpable adnexal mass on bimanual exam
Ectopic pregnancy
Key Findings/Physical Exam:
-nonspecific symptoms
-abdominal pain and bloating, increased abdominal size, urinary symptoms, constipation, early satiety or difficulty eating
Ovarian cancer
Key Findings/Physical Exam:
-heavy menstrual bleeding
-pelvic pain
-dyspareunia
-bladder dysfunction
-lump or mass on abdominal exam
-enlarged uterus in a non-pregnant woman
Uterine fibroid
Key Findings/Physical Exam:
-variable presentation
-irregular menstrual cycles
-infertility
-hyperandrogegism
-polycystic ovaries on US
PCOS
Key Findings/Physical Exam:
-hot flashes
-night sweats
-severe sweating
-flushing
-chills
VMS (hot flashes)
Key Findings/Physical Exam:
-dysuria, hematuria, increased frequency or urgency, incomplete bladder emptying
-flank/suprapubic pain
-uterine contractions/cramping
-fever
-pyuria, positive nitrates, hematuria on UA
acute cystitis UTI
Key Findings/Physical Exam:
-high level bacterial growth on UC in asymptomatic female
asymptomatic bacteruira
Key Findings/Physical Exam:
-fatigue, weakness, SOB, leg cramps, cold intolerance, headache, iron deficient diet, pagophagia or PICA, GI issues, Hx of closely spaced pregnancies, pallor, tachycardia, decreased H/H or ferritin levels
Anemia in pregnancy
Key Findings/Physical Exam:
-hard stools, difficult/painful BMs, straining with BM, infrequent BM
Constipation in pregnancy
Key Findings/Physical Exam:
-light spotting/vaginal bleeding
-recent intercourse
-presence of fetal heartbeat at 12 weeks
Benign 1st trimester bleeding
Key Findings/Physical Exam:
-Hx ectopic pregnancy, miscarriage, PID, endometrosis, presence of IUD
-varying amounts of vaginal bleeding
-passing tissue and/or large clots from vagina
-abdominal cramping, back pain, lightheadedness, absence of fetal heartbeat at 12 weeks
Miscarriage
Key Findings/Physical Exam:
-Hx of CKD or diabetes, multiple pregnancies, AA descent
-Elevated BP
-headache, edema, N/V, can develop preeclampsia
Gestational HTN
Key Findings/Physical Exam:
-proteinuria
-elevated BP
-thrombocytopenia, renal insufficiency, impaired LFTs, new-onset headache unresponsive to medications, severe persistenet RUQ or epigastric pain, pulm edema
Preeclampsia
Key Findings/Physical Exam:
-Seizures, coma, expiry
Eclampsia
Key Findings/Physical Exam:
-severe nausea with food aversions, dizziness, lightheadedness, persistent vomitting, dehydration, weight loss, abnormal electrolytes, thyroid function, liver function
-increased risk with having multiples or previous history
Hyperemesis gravida
Key Findings/Physical Exam:
-pruritic lesions
-lesions started in striae, no lesions in periumbilical area
-scattered erythematous papules
Pruritic urticarial papules or plaques or pregnancy
Which race or ethnicity has an increased risk for breast cancer diagnosis at a younger age and with more advanced disease?
African American
It is generally recommended that beyond mammogram screening, clinicians routinely endorse which strategies early detection of breast malignancy in asymptomatic women at average risk for breast cancer?
Education to support breast health assessment
A contributing factor to the development of mastitis in a woman is:
Breastfeeding
Which physical finding can help distinguish inflammatory breast cancer from mastitis?
Presence of erythema
Rudimentary breast components and several lobes
Prepubertal breast
Mammary gland, lactation lobules and ducts, tail of Spence, Cooper suspensory ligaments, areola, and nipple
Mature female breast
Synergistic effects on estrogen and progesterone for ducutlar-lobular-alveolar maturation are associated with the life-span differences of:
Adolescense
Significant ductular, lobular, and alveolar growth in breast due to estrogen, progesterone, and placental hormonal secretion are associated with the life-span differences of:
Pregnancy
Decline in production of estrogren and progesterone and reduction in breast density are associated with the life-span differences of:
Menopause
