GYN Flashcards
What two benign breast masses are classically described as having cyclical growth and regression?
fibrocystic changes and fibroadenomas
How should fibroadenomas be managed?
- perform a core needle biopsy to make the diagnosis
- repeat ultrasound in 6 months and excise if it has increased in size
Describe the presentation and management of intraductal papilloma.
- it typically presents with bloody nipple discharge
- it should be imaged with US or mammography if younger or older than 30
- core needle biopsy is used to make the diagnosis and then it should be excised to rule out hidden cancer
How are mastitis and breast abscesses treated?
- both should receive dicloxacillin or cefalexin for antibiotic coverage; use bactrim or clindamycin if MRSA is suspected
- aspirate or drain any abscesses
What is the recommendation for breast cancer screening?
- perform mammogram every 1-2 years starting at age 50 for the general population and at age 40 or ten years younger than earliest relative in those with a FH
- stop at age 75
Who should have BRCA screening?
- FH of ovarian, fallopian tube, primary peritoneal cancer, or male breast cancer
- two family members with breast cancer under age 50
- personal history of two primary breast cancers, breast cancer before age 50, or triple negative breast cancer before age 60
Describe the presentation, association, and management of Paget disease of the breast.
- it is a migration of neoplastic ductal epithelial cells to the nipple
- presenting as a scaly, vesicular, or ulcerated lesion of the nipple
- usually associated with an underlying adenocarcinoma
- patients should undergo mammogram and wedge or punch biopsy followed by simple mastectomy
What is a phyllodes tumor? How does it present?
- it is a papillary projection of epithelial-lined stroma
- typically presents as a smooth, mobile, rapidly growing mass
What is LCIS and how does it present?
it is an atypical proliferation within terminal duct lobules and it is usually an incidental finding
What is DCIS and how does it present?
it is a proliferation of neoplastic epithelial cells within mammary ducts that presents as suspicious micro calcifications on mammography
The classic, hard, immovable, single breast lesion with irregular borers is most likely one of what two cancers?
ductal or lobular carcinoma
Which breast cancer demonstrates invasion of neoplastic cells into mammary storm and adipose in a single-file pattern?
lobular carcinoma
How do we define primary and secondary amenorrhea?
- primary amenorrhea is the absence of menses by age 13 without secondary sexual characteristics or by age 15 with those characteristics
- secondary amenorrhea is the absence of menses for 3 months in those with regular menses or 6 months in those with irregular menses
The first step in evaluating amenorrhea should always be what?
B-hCG to rule out pregnancy
Describe the workup for secondary amenorrhea.
- serum B-hCG to rule out pregnancy
- check TSH with follow up free T4 if abnormal
- check prolactin level and get an MRI head if elevated
- check FSH and look for symptoms of primary ovarian insufficiency if elevated
- check estradiol if FSH is low or normal, if estradiol is low, get a pituitary MRI for hypogonadotropic hypogonadism
- check testosterone or look for clinical hyperandrogegism suggestive of PCOS
- perform a progesterone withdrawal test; bleeding is indicative of anovulation
- if there is no bleeding, perform an estrogen-progesterone challenge test
> no bleeding suggests an outflow tract obstruction and a hysteroscopy or hysterosalpingogram should be performed
> bleeding suggests an estrogen deficiency and a pituitary MRI should be done for hypogonadotropic hypogonadism
Describe the presentation, diagnosis, and treatment of premenstrual syndrome and premenstrual dysphoric disorder.
- both present with headache, breast tenderness, pelvic pain and bloating, irritability, and lack of energy surrounding menses, but PMDD is more severe and disrupts daily activities
- diagnosis is based on patient journal of symptoms; must be present for two consecutive cycles with one symptom free week in the first part of the cycle
- treat with avoidance of caffeine, alcohol, cigarettes, and chocolate; use SSRIs for severe affective symptoms
What is the best diagnostic test for menopause?
an increased FSH level in the context of symptoms
What are the indications and contraindications for hormone replacement therapy?
- indicated for short-term symptomatic relief of menopause and the prevention of osteoporosis, but use should be limited to less than 5 years
- contraindicated for those with a history of PE, DVT, or estrogen-dependent breast or endometrial carcinoma
OCPs reduce the risk of which cancers?
ovarian and endometrial carcinoma
OCPs are contraindicated for which populations?
women with a history of migraine with aura or hypertension and smokers over 35
What are the adverse effects of depot medroxyprogesterone?
weight gain, acne, and vaginal spotting
How do copper and progesterone IUDs function?
- copper ions impair sperm migration and viability while the IUD impairs implantation
- progesterone thickens cervical mucus which impairs fertilization
What should be first-line for routine and emergency contraception?
- routine: IUD of any kind
- emergency: copper IUD