Gynecology Flashcards

Question

Side effects of progesterone therapy

Answer 1

acne depression hypertension

Answer 2

16yo with normal secondary sex characteristics but no menses 13yo with absence of both menses and secondary sex characteristics

Answer 3

hypothalamic or pituitary dysfunction anatomic abnormalities - absent uterus - vaginal septum - imperforate hymen chromosomal abnormalities with gonadal dysgenesis -Turner syndrome (45XO)

Answer 4

absence of menses >6 months in a patient with a prior history of menses ``` causes: pregnancy premature ovarian failure hypothalamic or pituitary disease acquired uterine abnormalities polycystic ovarian syndrome hyperprolactinemia thyroid disease anorexia nervosa or over-eating ```

Answer 5

scarring of the uterus that follows infection or postpartum procedure ``` H and P menstrual history family history medications signs of masculinization -facial hair -voice deepening Tanner stages ```

Answer 6

``` 1. beta HCG Thyroid studies (TSH and free T4) Prolactin FSH and LH Androgens -testosterone and DHEA ``` 2. progesterone challenge estrogen-progesterone challenge

Answer 7

is the woman producing estrogen and/or having ovulatory cycles? estrogen stimulates growth of endometrial lining If a woman doesn't ovulate then there isn't a release of progesterone that stabilizes what has grown After stopping progesterone, there should be menstruation, but only if estrogen was normal and built up the endometrial lining If progesterone challenge lead to bleeding, consider anovulation to be the explanation for amenorrhea if progresterone challenge has no effect, then suspect low estrogen levels or outflow tract obstruction to be the causes of amenorrhea 2. estrogen-progesterone challenge

Answer 8

Give estrogen to ensure that the endometrial lining can be present If the withdrawal of these hormones induces menstruation then you know the patient has a normal outflow tract

Answer 9

1. congenital defects: imperforate hymen, transverse vaginal septum, vaginal agenesis 2. if signs of hyperandrogenism, serum testosterone and DHEAS to assess for androgen- secting tumor 3. if galactorrhea, then serum prolactin and thyrotropin to assess for prolactinoma If physical exam shows possible absence of uterus, then obtain a pelvic sonogram 4. if uterus absent, then check karyotype and serum testosterone - androgen insensitivity syndrome (46,XY; elevated testosterone) - abnormal mullerian development (46, XX; normal female testosterone levels) 5. If the uterus is present, check beta-HCG and FSH - if beta-HCG is high- pregnancy - if FSH low -cranial MRI for hypothalamic or pituitary diseas - if FSH normal- serum prolactin and thyrotropin

Answer 10

1. serum bHCG to rule out pregnancy 2. thorough H and P 3. serum prolactin (rule out hyperprolactinemia), serum TSH (rule out thyroid disease), serusm FSH (rule out ovarian failure) 4. If signs of hyperandrogenism, then serum DHEAS and total tetosterone 5. If all the above are normal or history of dilatation and curettage (D and C), abortion, miscarriage, then progestin withdrawal test (rule out Asherman syndrome)

Answer 11

1. modify behavior 2. surgical correction 3. GnRH or gonadotropin replacement- Leuprolide 4. Dopamine agonists 5. hormone replacement therapy for symptom management 6. Lysis of adhesions and estrogen administration if Asherman syndrome

Answer 12

inflammation/trauma of shedding of endometrial lining ``` crampy lower abdominal pain n/v HA diarrhea mild tenderness ```

Answer 13

``` Endometriosis PID Fibroids Cysts Adenomyosis ```

Answer 14

menorrhagia | menarche

Answer 15

``` rule out pregnancy cervical or vaginal cultures urinalysis NSAIDs (less pain and less bleeding if initiated the day before bleeding and continued 16hrs throughout bleeding) hormonal contraception ```

Answer 16

pain abnormal mood autonomic symptoms in the luteal phase ``` interferes with daily life characterized by weight gain HA abdominal/pelvic pain abdominal bloating change in bowel habits food cravings mood lability depression fatigue irritability breast tenderness edema abdominal tenderness acne ``` RF: family history Tx: NSAIDs, hormonal contraception, exercise, B6, progesterones, SSRIs just during symptoms (5 days per month)

Answer 17

endometrial tissue outside of the uterus ``` ovaries broad ligament bowel bladder lungs brain ``` ``` Theories: retrograde menstruation vascular spread lymphatic spread iatrogenic spread metaplasia ``` RF: nulliparity family history infertility (50% of cases) clinical features; - pelvic pain (most severe during menses, 2-7 days prior to menses and possibly at ovulation) - 3Ds: dysmenorrhea, deep dyspareunia, and dyschezia (painful defecation during menses), possible blood in stools during menstruation - infertility Physical findings: - localized tenderness in the cul-de-sac or oterosacral ligaments (especially at the time of menses) - palpable, tender nodules in the cul-de-sac, uterosacral ligaments or rectovaginal septum - pain with uterine movement - tender, enlarged adnexal masses especially if there are endometriomas - Adhesions causing a fixed or retroverted uterus Labs: CA-125 increases, not very meaningful though Biopsy:gunpowder, chocolate Treatment: expectant management pain control with NSAIDs hormonal therapies: combined OCPs dosed continuously GnRH agonist given continuously for 6-12 months Progestin Danazol Aromatase inhibitors stop conversion of androgens to estrogens, to decrease stimulation to endometrium Surgical intervention laparoscopic surgery lysing adhesions, addressing infertility, and collecting biopsy specimens in doing so hysterectomy with bilateral salpingo-oophorectomy (take the ovaries, which secrete much hormone), then proceed with hormone replacement

Answer 18

growth of endometrial tissue within uterine wall painful

Answer 19

dysmenorrhea deep dyspareunia dyschezia

Answer 20

``` fibroids cancer HPO dysfunction clotting disorders-von Willebrand disease Threatened abortion Molar pregnancy Ectopic pregnancy ```

Answer 21

``` PALM-COEIN polyp adenomyomas leiomyoma malignancy and hyperplasia coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified ```

Answer 22

H an P: Ask about the menstrual cycle: how long is it usually? ``` is it heavy? is it related to intercourse? associated symptoms? family history of bleeding disorder bleeding with medical procedures? contraceptive history rule out GI bleeding and bleeding from the urinary tract ``` A change in the menstrual cycle clues us into abnormal pathology ``` Labs: pregnancy test CBC homrones: testosterone, TSH, FSH, LH, prolactin coagulation studies ``` pap smear STD testing endometrial biopsy if >45yo or if

Answer 23

21-35 days

Answer 24

menstrual cycle >35 days

Answer 25

Generally 3 hrs | seldomly needs to change pads during the night, only passes clots

Answer 26

Excessive bleeding

Answer 27

frequent bleeding

Answer 28

ovulatory dysfunction anovulatory bleeding is typically heavy, as it occurs only when blood supply to an overgrown endometrium becomes insufficient regular heavy bleeding suggests fibroid, adenomyosis, or polyp

Answer 29

cervical lesion or polyp | glandular tissue on cervix

Answer 30

ovulatory dysfunction

Answer 31

threatened abortion

Answer 32

fibroids, molar pregnancy, adenomyosis

Answer 33

endometriosis, adenomyosis

Answer 34

endometrial cancer or hyperplasia

Answer 35

coagulopathy, vWF

Answer 36

ectopic pregnancy

Answer 37

polyp or glandular tissue on cervix

Answer 38

hypothyroidism

Answer 39

MCC is anovulatory cycle, in which case OCP is helpful NSAIDs reduce uterine bleeding by reducing prostaglandin synthesis in the endometrium, leading to vasoconstriction Endometrial ablation Hysterectomy Otherwise, treat the underlying cause Admit if hemodynamically unstable -IVF, blood transfusion, intrauterine tamponade, uterine curettage (hyperplasia, neoplasia?), IV high-dose estrogen + antiemetic which will stabilize the lining of the endometrium, uterine artery embolization, hysterectomy

Answer 40

over 45yo multiple risk factors for endometrial cancer persistent abnormal uterine bleeding > 6 months

Answer 41

MCC androgen excess in women MCC amenorrhea from a pathologic standpoint ``` overproduction of LH increased androgen produced in both ovaries and adrenals, increased estrogen in the periphery... leading to -amenorrhea -infertility -DM -hirsutism ``` increased ovarian androgen production through estrogen diagnosis: 2 of these 3 things: 1. anovulation or oligoovulation (amenorrhea or oligomenorrhea) 2. androgen excess 3. polycystic ovaries on US Excess LH stimulates the theca cells of the ovaries to produce androgens Some of the androgens are converted to estrogens by aromatase enzymes in adipose cells in the periphery Increased LH secretion Insulin also stimulates androgen production and inhibits sex hormone binding globulin (increased proportion of free hormone)

Answer 42

``` obesity hirsutism acne, male pattern hair loss voice deepening clitoromegaly menstrual dysfunction infertility ovarian enlargement that is mild to moderate- lots of small to moderate-sized follicles resulting from the disease, prevents formation of a normal dominant follicle so that ovulation is abnormal Labs: increased LH LH:FSH>2:1 increased androgens: testosterone, DHEA, androstenedione ``` positive progestin challenge, proving that the patient is not ovulating Radiology multiple small to medium sized follicles on the periphery of the ovary- string of pearls

Answer 43

Give progesterone to protect the uterus from cancerous change Exercise and weightloss Combined OCPs Progesterone Metformin (weightloss, improved BP, cholesterol, may assist with infertility) Spironolactone to decrease anti-androgen effects Statin Clomiphene can induce ovulation Antibiotics or dermatologic creams Complications: infertility diabetes increased risk of endometrial cancer (inadequate progesterone)

Answer 44

fascial defects ``` H and P: pelvic pressure/heaviness feeling that something is falling out of the vagina "I'm sitting on an egg" urinary/fecal incontinence dyspareunia ``` ``` Risk factors: age pregnancy vaginal delivery increased abdominal pressure -obesity -chronic cough -lifting -constipation ``` treatment: pelvic floor exercises pessary (space-occupying device) surgery

Answer 45

increased LH (LH:FSH ratio > 2:1) increased testosterone increased DHEA increased androstenedione

Answer 46

bacterial vaginosis trichomoniasis fungal vaginitis

Answer 47

imbalance of vaginal flora lactobaccili usually dominate they decrease in concentration while Garnerella vaginalis becomes more prevalent thin, white, gray discharge with fishy odor vaginal pH>4.5 wet mount- clue cells clue cells are epithelial cells covered in coccobacilli Whiff amine test: fishy odor emitted with 10% HCL is dropeed onto the vaginal discharge Treatment: metronidazole for 7 days

Answer 48

thick, frothy, green discharge "strawberry cervix" motile trichomonads on wet mount treatment- metronidazole (one large dose of metronidazole 2g) Both sex partners should be treated

Answer 49

``` RF: antibiotic use increased estrogen level DM immunosuppression ``` Diagnosis: Vaginal itching/irritation budding years and pseudohyphae on wet mount Treatment: oral fluconazole topical azole

Answer 50

prolonged tampon use ``` classic presentation: hypotension fever rash involving palms/soles sore throat HA myalgia GI symptoms ``` Dx: culture staph aureus from the vagina Tx: remove tampon clindamycin (decreases toxin production) vancomycin (covers MRSA until the strain is known)

Answer 51

Both G and C cause PID by breaking the cervical mucosal barrier, and ascending into the peritoneal cavity Asymptomatic: annual screening for all sexually active females

Answer 52

``` linked to GC infection untreated other pathogens: bacteroides e. coli streptococci ``` tubo-ovarian abscess ectopic pregnancy chronic pelvic pain infertility symptoms may be worse just after menstrual period, when the cervical barrier is broken for a short time ``` pe: cervical motion tenderness -Chandelier sign uterine tenderness lower abdominal tenderness -RUQ tenderness, Fitz Hugh Curtis syndrome ``` DX: nucleic acid test for G/C ``` Labs: pregnancy test WBC ESR nucleic acid amplification tests -gonorrhea -chlamydia ``` gram stain and culture culdocentesis- stain and culture purulent fluid radiology: transvaginal ultrasound can be used to detect an abscess risk factors: multiple sex partners 15-25yo age range barrier contraceptions provides some protection Treatment: polymicrobial- streptococci, gram neg cocci, anaerobes, g/c coverage determine if inpatient or outpatient if high fever, unstable VS, unreliable, keep patient inpatient ``` IV therapy example: Cefotatan+doxycycline or Cefoxitin+doxycycline or Clindamycin + gentamicin ``` outpatient therapy example: ceftriazone doxycycline metronidazole cefotaxime, cefoxitin + probenecid

Answer 53

treponema pallidum STD perinatal infection also possible primary: - papule - painless, clean base - heals spontaneously secondary: - fever, malaise, lymphadenopathy, RASH - mucous patches in the mouth, grey condyloma lata - early and late phase early latent or late latent phase: asx tertiary: end stage, 1-25 years after initial infection CNS:general paresis, tabes dorsalis, pain, Argyll Robertson pupil CV:aneurysm of ascending aorta skin gummas: granulomatous lesions in skin, bones, internal organs ``` Diagnosis: Nontreponemal tests- RPR VDRL Confirm with treponemal tests for antibodies against treponemes or direct observation of syphilis ``` Treatment: Penicillin G IM x1 for every primary, early, latent Penicillin G IM qweek x3 Late syphilis Penicillin G IV for neurosyphilis if allergic to PCN G, then tetracycline or doxycycline Follow treatment with RPR titer

Answer 54

will constrict on accomodation but not on direct light

Answer 55

HSV2 | first outbreak is largest, with recurrences smaller, painful, usually in the same place

Answer 56

``` types 6 and 11: genital warts treatment: -cryotherapy -lazer therapy -podophyllin -imiquimod -topical 5-fluorouracil -alpha-interferon injection -excision ``` remains latent in tissues and can recur

Answer 57

16 and 18: cervical cancer penile, anal, head and neck cancer Pap smear

Answer 58

``` rare in the US haemophilus ducreyi painful ulcer purulent ulcer enlarged lymph nodes that drain pus ``` gram stain of exudate shows GNR treatment: ceftriazone azithromycin

Answer 59

L1, L2, L3 serovars of chlamydia trachomatis causes a papule at site of inoculation that ulcerates, Painless, resolves spontaneously U/L lymphadenopathy that leads to buboe formation If acquired via anal sex, a bad proctocolitis can result! serology, nucleic acid therapy treatment: doxycycline complications: fistulas and strictures

Answer 60

Klebsiella granulomatis rare in the US beefy red painless ulcers that gradually progress no inguinal lymphadenopathy Donovan bods on wright-giemsa stain (they look like rods in the cell) Treatment: Doxycycline

Answer 61

whitish gray fishy discharge, clue cells, high pH (>4.5) trich has thick, frothy greenish discharge, motile trichomonads, high pH (>4.5) candida has pseudohyphae on wet mount, with pH 3.5-4.5

Answer 62

Ceftriaxone

Answer 63

Doxycycline, azythromycin

Answer 64

suspect chlamydia

Answer 65

atropine, pralidoxime

Answer 66

``` beta HCG Pap wet prep GC probe CBC bleeding time PT/INR PTT TSH Endometrial biopsy ```

Answer 67

benign tumors composed of smooth muscle each one is monoclonal stable and steady, then shrink after menopause as hormone levels drop ``` RF: family history ethnicity black>white 70-80% incidence nulliparity obesity PCOS ``` ``` H and P: asymptomatic menorrhagia dysmenorrhea pelvic pain/pressure infertility enlarged uterus with irregular contours ``` Radiology: transvaginal ultrasound hysteroscopy MRI If symptomatic, then treat ``` Treatment for menorrhagia: Continuous GnRH agonists -leuprolide hormonal contraception myomectomy to preserve fertility hysterectomy if patient is symptomatic uterine artery embolization (high rate of ovarian failure and impaired fertility after this, so only do this in women who are done with child-bearing) ```

Answer 68

Adenocarcinoma of uterine glands commonly caused by exposures to high estrogens or unopposed estrogens aka estrogens without progesterone Type 1: 85% estrogen- responsive Type 2: 15% not related to excess estrogen worse prognosis ``` RF: unopposed estrogen 2/2: PCOS Obesity HRT nulliparity ``` DM HTN age FHx of Lynch syndrome (HNPCC) ``` H and P: Abnormal bleeding -heavier or longer periods -bleeding between periods -postmenopausal bleeding ``` Labs/testing: atrophic vaginitis is common, but endometrial biopsy anyway to r/o cancer embx: 1. >35 and heavy menses 2. postmenopausal bleeding hysteroscopy CA-125 (better just for monitoring response to therapy) Radiology: ultrasound CT ``` Treatment: total abd hysterectomy with bilateral salpingo-oophorectomy lymph node sampling/dissection debulking chemotherapy radiation hormonal therapy ``` Complications: loss of organs metastasis prognosis is great if the cancer is caught early 96% 5 year survival if caught early

Answer 69

squamous cell cancer (pap), exterior adenocarcinoma (endocervical) Pap at the transitional zone ``` progression from normal to mild dysplasia (CIN 1) to moderate dysplasia (CIN 2) to severe dysplasia (CIN 3) to in situe carcinoma (CIN 3) to invasive carcinoma ``` RF: HPV Types 16 and 18 make up 70% of cervical cancers ``` Early 1st intercourse multiple sexual partners history of STDs immunosuppression tobacco use (decreases immune system) ```

Answer 70

initiate at 21yo screen every 3 years for ages 21-29 patients 30+ may continue pap smear every 3 years, or may opt for Pap smear and HPV testing every 5 years (preferred by some professional organizations) Screen more frequently in women who are in high risk groups stop as early as age 65 if adequate normal Pap tests if hysterectomy for benign disease, there is no need to screen for cervical cancer

Answer 71

Atypical squamous cells of undetermined significance (ASCUS) false positive? early dysplasia? high grade changes? repeat the test in one year if 21-24 yo if older than 25yo, test for HPV If the pap or HPV are positive, proceed to colposcopy, which allows you to do a directed biopsy

Answer 72

colposcopy

Answer 73

here we worry about adenocarcinoma, which arises high in the endocervical canal/ uterus/ fallopian tubes ``` Endocervical sampling Colposcopy Endometrial biopsy (>35 years old or risk factors) ``` Follow this patient very closely

Answer 74

Age: 21-24 yo: repeat pap in 1 year 25-29yo: colposcopy >30yo: HPV test (if positive then colpo, if negative then repeat Pap and HPV test in 1 year)

Answer 75

HSIL Age? 21-24 yo: colposcopy >25yo: Loope electrosurgical excision procedure (LEEP) people with positive pap later in life are not as good at fighting off the virus and are therefore at higher risk of cancerous change LEEP if patient is done having kids or if you are afraid of losing the patient to follow up If CIN2 or 3 on colpo, then LEEP. If high grade findings persist, low threshold for removing tissue

Answer 76

``` H and P: asx postcoital bleeding watery discharge symptoms related to lateral compression of lymphatics, veins, ureters ``` Pap test Colposcopy Excision procedures: - LEEP - Cold knife conization Radiology CT or MRI to look for spread IVP to look for compression of the ureters ``` Treatment: Microscopic invasion: -simple hysterectomy -conization -lazer ablation ``` Gross invasion: -radical hysterectomy and lymphadenectomy Extension and metastasis: -chemo and radiation

Answer 77

Age >35 - menometrorrhagia - postmenopausal bleeding Age

Answer 78

renal cell carcinoma

Answer 79

erythromycin neostigmine metoclopramide

Answer 80

stage 1 (2cm): external beam radiation Stage 2, 3, 4: external beam radiation +/- adjuvant therapy (RADIATION)

Answer 81

benign chronic inflammatory condition of the anogenital region, most commonly affecting postmenopausal women vulvar pruritis and pain PE: thinning skin with ivory white or porcelein white plaques and macules Treatment: low threshold for punch biopsy to rule out SCCl steroids (clobetasol) or pimecrolimus, steroids

Answer 82

arising from normal menstrual cycle If the follicle doesn't rupture on ovulation then you get a follicular cyst If the corpus luteum is supposed to involute but it doesn't then you end up with a corpus luteum cyst frequently asymptomatic, sometimes abd discomfort acute pain in the setting of rupture or torsion increased CA-125, though this is non-specific US: benign findings (cystic, smooth edges, few septa) malignant findings: irregularity or nodularity, multiple septa, extension or adhesions Treatment: observation, may go away on it's own - cystectomy unless there are malignant characteristics on ultrasound - oophorectomy - TAH-BSO Complications: ovarian torsion

Answer 83

``` epithelial tumors psammoma bodies can grow very large sometimes bilateral usually asymptomatic until very big not cancerous in general ``` Surgical excision allows confirmation of diagnosis, with reduced risk of ovarian torsion

Answer 84

seen with endometriosis walled off collection of endometrial tissue in ovary can bleed or shed in a monthly cycle; the blood doesn't have anywhere to go because it is walled off, so the endometrioma continues to enlarge and cause pain and scarring can be painful or asx if very large, doesn't regress on it's own and pt then benefits from surgical removal (chocolate cyst)

Answer 85

``` "dermoid cyst" benign germ cell tumor contains multiple dermal tissues -endoderm -mesoderm -ectoderm ``` can contain hair, teeth, sebaceous glands usually asymptomatic with a small chance of malignant transformation (1-2%) Treatment: cystectomy sometimes the ovary must be removed as well

Answer 86

arise from granulosa, theca, or Sertoli-Leydig cells granulosa and Leydig cells produce estrogen, leading to precocious puberty (granulosa) or virilization (androgen), depending on which cells are involved Malignant potential is significant Tx:U/L salpingo-oophorectomy

Answer 87

``` epithelial (65%) germ cell (25%) ``` RF: BRCA1 and BRCA2 mutations Nulliparity Early menarche Late menopause Infertility H and P: microscopic and asx in early stages there is no good screening advanced cancer presents with abdominal pain, fatigue, weight loss, change in bowel habits, menstrual irregularities, ascites, palpable mass on bimanual exam ``` Labs: CA-125, which has an especially strong association with epithelial cancer alpha- fetoprotein hCG LDH Estrogen Testosterone ``` Radiology: ultrasound MRI or CT to look for spread Treatment: surgical resection do not biopsy, because the risk of causing spread 2/2 cyst rupture is significant TAH- BSO Peritoneal washings Lymph node dissection Omentectomy infinite implants, microscopic debulking treat microscopic disease with chemotherapy adjuvant therapy with germ cell tumors: u/l salpingo-oophorectomy surgical debulking and chemotherapy for more extensive disease prognosis is low because we don't detect this until late false positive rate is high for available screenings

Answer 88

Serous cystadenocarcinoma

Answer 89

Granulosa-theca cell tumor

Answer 90

Sertoli-Leydig cell tumor

Answer 91

tricuspid stenosis

Answer 92

mitral stenosis

Answer 93

aortic stenosis

Answer 94

pulmonic stenosis

Answer 95

mitral prolapse

Answer 96

aortic regurgitation

Answer 97

tricuspid regurgitation

Answer 98

mitral regurgitation

Answer 99

a male breast disorder causes: puberty (resolves spontaneously in 6 months to 2 years) ``` Drugs: "some drugs cause awesome knockers" Spironolactone Digoxin Cimetidine Alcohol Ketoconazole ``` ``` STACKED Spironolactone THC Alcohol Cimetidine Ketoconazole Estrogen Digoxin ``` Herbal agents: tea tree oil, lavender oil ``` Cirrhosis Hypogonadism Testicular germ cell tumor Hyperthyroidism Hemodialysis patients ```

Answer 100

might start as mastitis -staph infection in the milk ducts that occurs during breastfeeding -walled-off collection of pus= breast abscess RF: smokers, diabetics ``` H and P: painful mass on the breast fever (102-103 F) broad area of redness, warmth, tenderness Purulent drainage ``` US if suspicion of abscess ``` Treatment: oral or IV abx: dicloxacillin caphalexin Amoxicillin-clavulanic acid TMP-SMX Metronidazole ``` drain the abscess pack the wound continue breast feeding to keep fluid moving (abscess forms because of static milk)

Answer 101

increase in benign cysts and fibrous tissue multiple bilateral masses hormone sensitive worse before menstruation (re-examine after her period) breast pain preceding menses Biopsy: epithelial hyperplasia US: distinguish between solid mass and large cyst Treatment: reduce caffeine or dietary fat birth control pills can prevent spike in estrogen

Answer 102

most common benign breast tumor especially in women under the age of 30 US:is it mass or cyst? FNA: mass or cyst? May not need a mammogram if 35, more concerned about cancer and you might want a mammogram surgical excision (symptoms with larger) cryotherapy may recurr

Answer 103

benign lesion of ductal dissue bloody nipple discharge could be serious spontaneous discharge is worrisome, especially bloody, excise papilloma to evaluate the cancer

Answer 104

large, bulky tumor more common in women in their 50s leaflike cleft:generally benign, can become malignant

Answer 105

fibroadenoma

Answer 106

fibrocystic change

Answer 107

intraductal papilloma

Answer 108

BRCA2 mutation

Answer 109

``` family history genetic mutation estrogen exposure -early menarche -late menopause -nulliparity -late first pregnancy -HRT advanced age obesity alcohol certain chemicals and pesticides ```

Answer 110

asx until a mass is felt solid and immobile is worrisome peau d'orange- lymphedema new nipple retraction (ductal involvement or suspensory lig) axillary lymphadenopadhy upper outer quadrant most commonly affected

Answer 111

FNA: cyst versus solid solid can't diff between cis and invasive CA Core biopsy better for solic mass open biopsy- use US to locate then remove all around it

Answer 112

malignancy arising from duct without invasion precancerous Treatment: lumpectomy + possibly radiation mastectomy if high risk

Answer 113

malignancy arising from lobule without invation high likelihood of cancerous change somewhere in the breast, though not necessarily at that site higher likelihood of breast cancer than with DIS risk factor for subsequent cancer on the same side AND the contralateral side Always ER and PR+ Treatment: observe, overall higher risk of cancer than DCIS SERMs (tamoxifen or raloxifene) Excisional biopsy Prophylactic bilateral mastectomy drug therapy is helpful because LCIS is ALWAYS ER/PR positive

Answer 114

fibrotic response in the surrounding tissue most common form of invasive breast cancer (80%) palpable firm fixed mass ``` Treatment: indications for mastectomy + sentinel node biopsy: -early and focal, + radiation -large (>5cm) + radiation -multifocal ``` If metastatic disease or large tumor (>1cm) or aggressive tumor: chemotherapy

Answer 115

less fibrous than ductal (palpable, firm, fixed) often multifocal bilateral slower growing, slower to metastasize

Answer 116

inflammatory carcinoma: rapidly growing very poor prognosis looks like ductal, except that there are inflammatory changes (erythema, warmth, pain) high level of suspicion, perhaps a patient with recurrent mastitis

Answer 117

eczema-like patches on the nipple and areola caused by malignant cells that infiltrate the epidermis may also indicate underlying cancer in the breast parenchyma

Answer 118

Always look for these three receptor types: estrogen and progesterone receptors HER2/Neu: trastuzumab (hereptin) ab against those receptors

Answer 119

b/l ppx mastectomies and oophorectomies to reduce risk of breast cancer and ovarian cancer later in life

Answer 120

``` mets: bone thorax brain liver ``` lymphedema: wound healing, infection, ROM, pain

Answer 121

invasive ductal carcinoma

Answer 122

hyperdense regions | microcalcifications