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OBGYN > GYN 2 - Breast, Vagina, Vulva, Cervix > Flashcards

GYN 2 - Breast, Vagina, Vulva, Cervix Flashcards

1
Q

estrogen does what functionality of the breast

A

growth & development of duct system for delivery of milk

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2
Q

progesterone does what functionality of the breast

A

lobular/duct development of breast

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3
Q

prolactin does what functionality of the breast

A

production (lactogenesis) and maintenance of breast milk

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4
Q

oxytocin does what functionality of the breast

A

released from posterior pituitary to stimulate the contraction and expulsion of breast milk from the breast

this is released by the suckling reflex

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5
Q

what causes breast budding

A

production and release of estrogen at the beginning of puberty

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6
Q

mastalgia

A

breast pain

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7
Q

MCC of pain in breasts

A

fibrocystic changes that occur throughout the menstrual cycle

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8
Q

common benign breast conditions (5)

A
  1. fibrocystic
  2. fibroadenoma
  3. intraductal papilloma
  4. galactorrhea
  5. mastitis/abscess
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9
Q

nonproliferative breast masses have a ___ % of developing invasive breast cancer

A

1%

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10
Q

proliferative without atypia breast masses have a ___ % of developing invasive breast cancer

A

1.5 - 2%

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11
Q

proliferative with atypia (abnormal changes) breast masses have a ___ % of developing invasive breast cancer

A

8 - 10%

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12
Q

hyperplasia is causes by _____ progesterone and _____ estrogen

A

decreased progesterone

increased estrogen

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13
Q

nipple discharge triggers for milky

A

galactorrhea, can be normal

drug related

thyroid related

prolactinoma

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14
Q

nipple discharge triggers for bloody

A

intraductal papilloma (nonmalignant)

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15
Q

nipple discharge triggers for greenish/brown color

A

mammary duct ectasia

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16
Q

nipple discharge triggers for purulent

A

acute mastitis

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17
Q

fibrocystic changes are found in…

A

50% of women of reproductive age (25-45)

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18
Q

fibrocystic changes are clinically really described as

A

nodular sensitive breasts without malignant potential

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19
Q

MC painful breast mass <50y/o

A

fibrocystic changes

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20
Q

why are fibrocystic changes thought to be painful

A

pain is caused by the proliferation of normal glandular breast tissue with estrogen stimulating the ductal elements and progesterone stimulating the stroma

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21
Q

thought to may be a provoking factor for fibrocystic changes

A

caffeine

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22
Q

how do you differentiate fibrocystic changes from cancer? (3)

A

pain
fluctuation in size (fibrocysts can get smaller)
multiplicity in lesions

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23
Q

MC mass

A

fibroadenoma

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24
Q

makeup of fibroadenoma

A

fibrous and glandular tissue in young women

in older women, more calcified

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25
fibroadenoma changes in response to what?
estrogen sensitive - changes size in pregnancy and regressed in menopause
26
fibroadenoma on physical exam
``` round firm discrete relatively movable nontender mass 1-5cm in diameter ```
27
diagnostic of fibroadenoma
ultrasound and to confirm, core needle biopsy
28
"breast mouse"
fibroadenoma
29
common breast lesion in perimenopause or menopause
intraductal papilloma
30
Bloody, serous, or turbid nipple discharge from a single duct that stains bra/clothing (>80%)
intraductal papilloma
31
Generally unilateral, | small subareolar tumor (most ~3-5 mm, may be up to 3 cm)
intraductal papilloma
32
intraductal papilloma diagnostics
Mammogram &/or ultrasonography: may reveal ductal abnormalities
33
main prolactin inhibiting factor
dopamine
34
mastitis
infection of breast tissue characterized by sudden onset of fever with localized pain and swelling
35
causes of mastitis
Staph aureus Group A/B Strep Beta Haemophilus E. coli
36
can a patient continue breast feeding with mastitis and being treated with ABX?
yes, continue if the child is a full term, healthy child
37
how do you improve mastitis?
continue to empty the breast to prevent delay of healing or painful engorgement of the breast
38
if pain continues after ABX treatment of mastitis, think of...
an abscess
39
second most common cancer in women
breast cancer
40
Most aggressive breast cancer occur in...
< 40 yo
41
Most breast cancer cases occur in...
> 50 y/o
42
If cancer appears in individuals < 40y/o, consider...
genetics - check for BRCA1 and BRCA2
43
extranodal spread of breast cancer goes to...
``` lungs bone liver brain ovaries ```
44
3 categories of breast cancer malignancies
1. Ductal 2. Nipple 3. Lobular
45
MC ductal breast cancer malignancy
invasive ductal carcinoma
46
MC nipple breast cancer malignancy
Paget disease causes a ductal carcinoma that effects the nipple
47
MC lobular breast cancer malignancy
invasive lobular carcinomas
48
what happens within the breast in ductal carcinoma
cancer cells proliferate and obstruct ducts (do not enter other tissues of the breast - just in the ducts) ducts then become blocked & enlarge as cancer cells accumulate inside them calcium tends to collect in the blocked ducts
49
What do you see on mammogram with ductal carcinoma?
irregular calcifications (microcalcifications) in an otherwise asymptomatic woman
50
Fissured and ulcerated skin tissue of the breast orange peel appearance of the breast These manifestations suggest what?
Paget's disease of the breast which is a form of ductal carcinoma in situ
51
Lobular carcinoma-in-situ
proliferation of atypical cells in the terminal ductules and acini/lobules can present in both breasts and in multiple locations within the breast (involves 2 or more distinct primary tumors often in different quadrants)
52
A marker for invasive cancer
lobular cacinoma in situ
53
MC invasive breast cancer from chart (50-75%)
invasive ductal carcinoma
54
Second most invasive breast cancer (10-15%)
invasive lobular carcinoma
55
Invasive breast cancer common among younger women and women with BRCA1
medullary carcinoma
56
Invasive breast cancer common among older women with a good prognosis
mucinous (colloid) carcinoma
57
How often should women 40+ or women that are high risk for breast cancer be screened for breast cancer?
annually
58
How often should women 20-30 be screened for breast cancer?
Every 1 - 3 years
59
When do you start screening mammograms?
Annually starting at age 40y/o
60
first step in pathologic evaluation of cystic or solid breast mass
fine needle aspiration
61
gold standard pathologic evaluation for diagnosis
excisional biopsy - diagnostic and therapeutic when entire lesion can be removed
62
pathologic evaluation often used in conjunction with US or stereotactic imaging for difficult to palpate or small lesions
Core needle biopsy: 2-6 cores needed
63
The principal mammographic signs of breast carcinoma are
densities and calcifications
64
Review: ductal carcinoma in-situ has a ___ malignant potential
mild
65
Review: lobular carcinoma in-situ has a ___ malignant potential
mild
66
MC breast cancer by far
infiltrating dutcal carcinoma
67
5-10% of all breast cancers is...
infiltrative lobular carcinoma
68
function of bartholin glands
maintain moisture of vaginal mucosa's vestibular surface
69
infections of the bartholin gland of vulva presents as what?
acute inflammation (adenitis) may progress to an abscess see an enlarged, painful, and erythematous cyst that can be quite uncomfortable
70
Pathophysiology of bartholin cyst infection
gland becomes obstructed and an inflammatory process ensues
71
how do you treat a bartholin cyst
I&D ABX as needed
72
MC microbe of bacterial vaginosis
gardnerella vaginalis
73
“Musty”, “amine”, or “fishy” odor, commonly referred to as “positive whiff test”
BV
74
Clue cells (saline wet mount)
BV
75
Diagnosis involves 3 of the following 4: 1. Abnormal gray discharge 2. pH > 4.5 3. Positive “whiff test” 4. Presence of “Clue Cells”
BV
76
causative agent of vulvovaginal candidiasis
candida albicans
77
Is vulvovaginal candidiasis an STI?
no
78
+ KOH prep
vulvovaginal candidiasis
79
Flagellated protozoan that lives only in: Vagina Skene Ducts Male and Female Urethra
trichomonas vulvovaginitis
80
Copious discharge with rancid odor which can be: “Frothy” Thin Yellow-green to gray color
trichomonas vulvovaginitis
81
Petechia or strawberry patches Upper vagina Cervix
trichomonas vulvovaginitis
82
thick, curdy, white vaginal discharge
vulvovaginal candidiasis
83
three main types of vulvar cancers
1. squamous cell (90%) 2. melanoma (2%) 3. Adenocarcinoma
84
vulvar cancers are MC in...
postmenopausal women 70-80 y/o
85
Can develop thru a precancerous condition, called vulvar dysplasia or vulva intraepithelial neoplasia (VIN)
squamous cell vulvar cancer
86
vulvar cancer that occurs most often on the clitoris or labia minora
melanoma vulvar cancer
87
where does adenocarcinoma (vulvar cancer) start in the body?
bartholin glands
88
MC complaint of vulvar cancer
vulvar pruritus
89
MC location of vulvar cancers
posterior 2/3 of labia
90
vaginal disease categories (3)
1. benign 2. precancerous 3. cancerous
91
Vaginal neoplasia are rare & usually occur 2nd to...
cervical or vulvar cancers
92
Vaginal neoplasia is classified as
Vaginal Intraepithelial Neoplasia (VAIN)
93
VAIN 1
involves basal epithelial layers typically no therapy many have HPV and vaginal atrophic changes
94
VAIN 2
involves up to 2/3 vaginal epithelium requires tx and will not go away
95
VAIN 3
involves > 2/3 of vaginal epithelium common in 3rd or + decade can progress to invasive vaginal carcinoma
96
Cervicitis is...
an inflammation of the cervix
97
2 main infections of cericitis
gonorrhea and/or chlamydia
98
PID is an ____ infection caused by ____
Ascending infection by gonococcal or chlamydia organisms primarily but can be Enteric bacteria
99
Pyosalpinx is a
fallopian tube filled with pus
100
``` The following are complications of... Infertility Ectopic pregnancy Chronic pelvic pain Preterm labor Endometritis ```
Complications of PID
101
chandelier sign
severe cervical motion tenderness seen in PID
102
- lower abd pain - lower abd tenderness - cervical motion tenderness - adnexal tenderness
Major criteria of PID
103
- fever >38C - abd vaginal discharge - positive cx for gonorrhea/chlamydia - WBC >10,000 - Elevated CRP/ESR
supporting criteria of PID
104
abnormal changes in the cells on the surface of the cervix changes are not cancerous most often caused by HPV usually no sx
cervical dysplasia
105
high risk HPV types causing cervical cancer
16, 18, 31, 45
106
PAP smears: younger than 21
no screening
107
PAP smears: 21-29
every 3 yrs with cytology
108
PAP smears: 30-65
every 3 yrs with cytology or every 5 yrs with cytology & HPV testing

OBGYN (12 decks)

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