Female Reproductive System & Breast Flashcards
Diagnosis:
bilateral breast tenderness and swelling 24-72 hours post partum
Most likely: Breast engorgement
Treatment:
Breast engorgement
Nothing, breast engorgement typically resolves spontaneously.
What is the peak onset for breast engorgment?
3-5 days after delivery
Mechanism of Action:
Raloxifene
- Estrogen receptor ANTAGONISTin (1) breast & (2) vaginal tissue
- Estrogen receptor AGONIST in bone tissue
Raloxifene is a selective estrogen receptor modulator (SERM) and has mixed activity at the estrogen receptor.
Function:
Raloxifene
SERM used as first line therapy to prevent osteoporosis
What are the risks associated with raloxifene?
I. Increased risks
II. Decreased risks
I. Increased risk of thromboembolism
II. Decreased risk of breast cancer.
Diagnosis:
- skin or nipple retraction
- calcifications on mammography
This could be either (1) fat necrosis or (2) breast cancer. Be careful diagnosing!
Diagnosis:
Biopsy reveals fat globules and foamy histiocytes in a woman with nipple retraction and calcifications on mammography.
Fat necrosis
Note, fat necrosis looks similar to breast cancer on physical examination and mammography. Differentiate between the two by performing a biopsy.
Treatment:
Fat necrosis of the breast tissue
none
Diagnosis:
- Erythematous and edematous cutaneous plaque overlaying breast mass
- axillary lymphadenopathy
Inflammatory breast cancer
Note, inflammatory breast cancer is very rare!
Prognosis:
Inflammatory breast cancer
Poor prognosis! 25% of patients with inflammatory breast cancer will have metastatic disease at the time of presentation.
What is the work up for an asymptomatic women with a pelvic mass?
- Transvaginal ultrasonography
2. Cancer antigen (CA)-125 level
You have a post-menopausal patient with an elevated CA-125 level. What if any are your concerns?
You are concerned about ovarian cancer
When can asymptomatic pelvic masses be followed conservatively?
- US suggests a simple cyst
- CA-125 level is not elevated
- Mass is
How do you manage the finding of “atypical squamous cells in the following patients:
I. Women age 21-24
II. Women age >/= 25 yo
III. Women age >/= 25 yo who test positive for HPV
IV. Women age >/=25 yo who test negative for HPV
I. repeat cytology in 1 year
II. Human papillomavirus (HPV) DNA test
III. Colposcopy
IV. repeat Pap smear PLUS HPV test in 3 years
What is the most common pelvic tumor found in women?
uterine leiomyomas (fibroids)
Diagnosis:
Pelvic mass w/
- Constipation
- Urinary frequency
- Heavy, prolonged menstrual bleeding
Uterine leiomyoma (fibroid)
Note, fibroids do not typically present with bleeding between cycles or postmenopausal bleeding.
How can you identify structural abnormalities in the uterus or fallopian tubes or a patient with suspected infertility?
Hysterosalpingogram
Treatment:
HER2 positive breast cancer
- Trastuzumab
- Anthracycline chemotherapy
HER2 oncogene positivity predicts increased susceptibility of breast cancer to the above medications.
When do you perform an endometrial biopsy on a patient with abnormal uterine bleeding (AUB)?
- All postmenopausal women with AUB
- Women >/= 45
- Women
Clinical Manifestation:
Menopause
- irregular or absent menses
- heat intolerance
- flushing
- insomnia
- night sweats
Why should you check TSH and FSH levels in a patient presenting with absent menses, heat intolerance, insomnia, flushing and night sweats?
Menopause and hyperthyroidism have similar presentations. You need to use the TSH and FSH levels to differentiate the two.
True vs. False
If a young women presents during menstruation with a breast mass it is ok to ask her to return after her menstrual period for reexamination?
True. It is ok to ask her to return after her period to assess for regression of the mass as long as there are no obvious signs of malignancy.
When can emergency (postcoital) contraception be used?
Within 3-5 days of unprotected intercourse
Mechanism of action:
Emergency (postcoital) contraception
- Delays ovulation
2. Impairs implantation to prevent pregnancy
What is the most effective emergency contraceptive method?
Copper IUD-99% efficacy; you can give copper IUDs to nulliparous and adolescent patients.
True vs. False
Emergency contraceptive pills (ulipristal, levonorgestrel and OCPs) are less effective than copper IUDs as a form of emergency contraception?
True, copper IUDs are 99% effective.
When should screening for cervical cancer begin in women?
Cervical cancer screening should begin at age 21 in women regardless of the age of onset of sexual activity. The only exceptions are: (1) HIV + (2) SLE (3) organ transplant & (4) immunocompromised patients.
True vs. False
Routine HPV testing is indicated for women
FALSE, women younger than 30 should not get routine HPV testing.
What are the risk factors for the development of acquired hypogonadotropic hypogonadism?
- Excessive stress
- Eating disorders
- Excessive exercise
Treatment:
Acquired hypogonadotropic hypogonadism
Pulsatile GnRH therapy
Function:
Pulsatile GnRH therapy in patients with acquired hypogonadotropic hypogonadism
induction of ovulation
What is the most accurate way to diagnose ectopic pregnancy?
Transvaginal ultrasound (TVUS) when beta-hCG levels are between 1,500-6,500 IU/L.
TVUS is better than transabdominal US when diagnosing an ectopic pregnancy.
Clinical Manifestation:
- vulvar pruritus
- vulvar discomfort
in a postmenopausal women
Lichen sclerosus
What is the necessary work up in a patient with suspected lichen sclerosus?
Biopsy is necessary to rule out vulvar SCC
Physical examination:
porcelain-white atrophy of the vulva
Lichen sclerosus
Be sure to do a biopsy to rule out vulvar SCC.
Treatment:
Lichen sclerosus
High-potency topical steroids
Clinical Manifestation:
- sudden onset unilateral lower abdominal pain (usually right)
- nausea
- vomiting
in a woman of reproductive age
most concerning for ovarian and adnexal torsion
Diagnosis:
Ovarian and adnexal torsion
Ultrasound using color Doppler
Treatment:
Ovarian and adnexal torsion
Laparoscopic surgery
What is the primary risk factor associated with ovarian and adnexal torsion?
ovarian enlargement (i.e. pregnancy or tumors)
Clinical Manifestation:
Polycystic ovarian syndrome
- anovulation or oligo-ovulation
- androgen excess: male-pattern hair growth or acne
- ovarian cysts
Diagnosis:
Endometriosis
- Laparoscopy
- Biopsy of implants
This is the only definitive way to diagnose endometriosis.
When is laparoscopy and biopsy indicated in a patient with suspected endometriosis?
If a patient fails NSAID and hormonal contraceptive therapy they must undergo laparoscopy and biopsy.
Pathophysiology:
Impaired fertility or infertility in endometriosis
Chronic inflammation and adhesion formation prevent fertility
Epidemiology:
What portion of women with endometriosis have impaired fertility?
50%
Epidemiology:
What portion of women with infertility have endometriosis?
25-50%
What is the greatest risk factor for the development of clear cell adenocarcinoma of the vagina and cervix?
In utero exposure to diethylstilbestrol (daughters of women who received diethylstilbestrol during pregnancy)
What are the obstetrics risk associated with in utero exposure to diethylstilbestrol?
- clear cell adenocarcinoma of the vagina and cervix (women)
- genital tract anomalies (women and men)
