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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
Q

fibroadenoma changes in response to what?

A

estrogen sensitive - changes size in pregnancy and regressed in menopause

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26
Q

fibroadenoma on physical exam

A 
round
firm
discrete
relatively movable
nontender mass 1-5cm in diameter
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27
Q

diagnostic of fibroadenoma

A

ultrasound and to confirm, core needle biopsy

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28
Q

“breast mouse”

A

fibroadenoma

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29
Q

common breast lesion in perimenopause or menopause

A

intraductal papilloma

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30
Q

Bloody, serous, or turbid nipple discharge from a single duct that stains bra/clothing (>80%)

A

intraductal papilloma

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31
Q

Generally unilateral,

small subareolar tumor (most ~3-5 mm, may be up to 3 cm)

A

intraductal papilloma

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32
Q

intraductal papilloma diagnostics

A

Mammogram &/or ultrasonography: may reveal ductal abnormalities

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33
Q

main prolactin inhibiting factor

A

dopamine

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34
Q

mastitis

A

infection of breast tissue characterized by sudden onset of fever with localized pain and swelling

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35
Q

causes of mastitis

A

Staph aureus

Group A/B Strep

Beta Haemophilus

E. coli

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36
Q

can a patient continue breast feeding with mastitis and being treated with ABX?

A

yes, continue if the child is a full term, healthy child

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37
Q

how do you improve mastitis?

A

continue to empty the breast to prevent delay of healing or painful engorgement of the breast

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38
Q

if pain continues after ABX treatment of mastitis, think of…

A

an abscess

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39
Q

second most common cancer in women

A

breast cancer

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40
Q

Most aggressive breast cancer occur in…

A

< 40 yo

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41
Q

Most breast cancer cases occur in…

A

> 50 y/o

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42
Q

If cancer appears in individuals < 40y/o, consider…

A

genetics - check for BRCA1 and BRCA2

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43
Q

extranodal spread of breast cancer goes to…

A 
lungs
bone
liver
brain
ovaries
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44
Q

3 categories of breast cancer malignancies

A
  1. Ductal
  2. Nipple
  3. Lobular
45
Q

MC ductal breast cancer malignancy

A

invasive ductal carcinoma

46
Q

MC nipple breast cancer malignancy

A

Paget disease causes a ductal carcinoma that effects the nipple

47
Q

MC lobular breast cancer malignancy

A

invasive lobular carcinomas

48
Q

what happens within the breast in ductal carcinoma

A

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
Q

What do you see on mammogram with ductal carcinoma?

A

irregular calcifications (microcalcifications) in an otherwise asymptomatic woman

50
Q

Fissured and ulcerated skin tissue of the breast

orange peel appearance of the breast

These manifestations suggest what?

A

Paget’s disease of the breast which is a form of ductal carcinoma in situ

51
Q

Lobular carcinoma-in-situ

A

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
Q

A marker for invasive cancer

A

lobular cacinoma in situ

53
Q

MC invasive breast cancer from chart (50-75%)

A

invasive ductal carcinoma

54
Q

Second most invasive breast cancer (10-15%)

A

invasive lobular carcinoma

55
Q

Invasive breast cancer common among younger women and women with BRCA1

A

medullary carcinoma

56
Q

Invasive breast cancer common among older women with a good prognosis

A

mucinous (colloid) carcinoma

57
Q

How often should women 40+ or women that are high risk for breast cancer be screened for breast cancer?

A

annually

58
Q

How often should women 20-30 be screened for breast cancer?

A

Every 1 - 3 years

59
Q

When do you start screening mammograms?

A

Annually starting at age 40y/o

60
Q

first step in pathologic evaluation of cystic or solid breast mass

A

fine needle aspiration

61
Q

gold standard pathologic evaluation for diagnosis

A

excisional biopsy - diagnostic and therapeutic when entire lesion can be removed

62
Q

pathologic evaluation often used in conjunction with US or stereotactic imaging for difficult to palpate or small lesions

A

Core needle biopsy: 2-6 cores needed

63
Q

The principal mammographic signs of breast carcinoma are

A

densities and calcifications

64
Q

Review: ductal carcinoma in-situ has a ___ malignant potential

A

mild

65
Q

Review: lobular carcinoma in-situ has a ___ malignant potential

A

mild

66
Q

MC breast cancer by far

A

infiltrating dutcal carcinoma

67
Q

5-10% of all breast cancers is…

A

infiltrative lobular carcinoma

68
Q

function of bartholin glands

A

maintain moisture of vaginal mucosa’s vestibular surface

69
Q

infections of the bartholin gland of vulva presents as what?

A

acute inflammation (adenitis)

may progress to an abscess

see an enlarged, painful, and erythematous cyst that can be quite uncomfortable

70
Q

Pathophysiology of bartholin cyst infection

A

gland becomes obstructed and an inflammatory process ensues

71
Q

how do you treat a bartholin cyst

A

I&D

ABX as needed

72
Q

MC microbe of bacterial vaginosis

A

gardnerella vaginalis

73
Q

“Musty”, “amine”, or “fishy” odor, commonly referred to as “positive whiff test”

A

BV

74
Q

Clue cells (saline wet mount)

A

BV

75
Q

Diagnosis involves 3 of the following 4:

  1. Abnormal gray discharge
  2. pH > 4.5
  3. Positive “whiff test”
  4. Presence of “Clue Cells”
A

BV

76
Q

causative agent of vulvovaginal candidiasis

A

candida albicans

77
Q

Is vulvovaginal candidiasis an STI?

A

no

78
Q

+ KOH prep

A

vulvovaginal candidiasis

79
Q

Flagellated protozoan that lives only in:
Vagina
Skene Ducts
Male and Female Urethra

A

trichomonas vulvovaginitis

80
Q

Copious discharge with rancid odor which can be:
“Frothy”
Thin
Yellow-green to gray color

A

trichomonas vulvovaginitis

81
Q

Petechia or strawberry patches
Upper vagina
Cervix

A

trichomonas vulvovaginitis

82
Q

thick, curdy, white vaginal discharge

A

vulvovaginal candidiasis

83
Q

three main types of vulvar cancers

A
  1. squamous cell (90%)
  2. melanoma (2%)
  3. Adenocarcinoma
84
Q

vulvar cancers are MC in…

A

postmenopausal women 70-80 y/o

85
Q

Can develop thru a precancerous condition, called vulvar dysplasia or vulva intraepithelial neoplasia (VIN)

A

squamous cell vulvar cancer

86
Q

vulvar cancer that occurs most often on the clitoris or labia minora

A

melanoma vulvar cancer

87
Q

where does adenocarcinoma (vulvar cancer) start in the body?

A

bartholin glands

88
Q

MC complaint of vulvar cancer

A

vulvar pruritus

89
Q

MC location of vulvar cancers

A

posterior 2/3 of labia

90
Q

vaginal disease categories (3)

A
  1. benign
  2. precancerous
  3. cancerous
91
Q

Vaginal neoplasia are rare & usually occur 2nd to…

A

cervical or vulvar cancers

92
Q

Vaginal neoplasia is classified as

A

Vaginal Intraepithelial Neoplasia (VAIN)

93
Q

VAIN 1

A

involves basal epithelial layers

typically no therapy

many have HPV and vaginal atrophic changes

94
Q

VAIN 2

A

involves up to 2/3 vaginal epithelium

requires tx and will not go away

95
Q

VAIN 3

A

involves > 2/3 of vaginal epithelium

common in 3rd or + decade

can progress to invasive vaginal carcinoma

96
Q

Cervicitis is…

A

an inflammation of the cervix

97
Q

2 main infections of cericitis

A

gonorrhea
and/or
chlamydia

98
Q

PID is an ____ infection caused by ____

A

Ascending infection by gonococcal or chlamydia organisms primarily but can be Enteric bacteria

99
Q

Pyosalpinx is a

A

fallopian tube filled with pus

100
Q 
The following are complications of...
Infertility
Ectopic pregnancy
Chronic pelvic pain
Preterm labor
Endometritis
A

Complications of PID

101
Q

chandelier sign

A

severe cervical motion tenderness seen in PID

102
Q
  • lower abd pain
  • lower abd tenderness
  • cervical motion tenderness
  • adnexal tenderness
A

Major criteria of PID

103
Q
  • fever >38C
  • abd vaginal discharge
  • positive cx for gonorrhea/chlamydia
  • WBC >10,000
  • Elevated CRP/ESR
A

supporting criteria of PID

104
Q

abnormal changes in the cells on the surface of the cervix

changes are not cancerous

most often caused by HPV

usually no sx

A

cervical dysplasia

105
Q

high risk HPV types causing cervical cancer

A

16, 18, 31, 45

106
Q

PAP smears: younger than 21

A

no screening

107
Q

PAP smears: 21-29

A

every 3 yrs with cytology

108
Q

PAP smears: 30-65

A

every 3 yrs with cytology or every 5 yrs with cytology & HPV testing

OBGYN (12 decks)

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