Gynecology Flashcards
A 52-year-old woman with a past medical history of hypertension presents to the office for her routine physical exam. She states that she is feeling well, although tired at times. Her colonoscopy, mammogram, and Pap smear done at age 50 were normal. She has blood pressure of 135/80 mmHg, RR 12, temperature 98.5F, and BMI 29. Physical exam is within normal limits. Which of the following screening tests is indicated at this time?
a. Colonoscopy
b. DEXA scan
c. Mammogram
d. Pap smear
e. Hepatitis B
C. Screening mammogram is recommended every other year for women age 50 to 74. Colonoscopy is done every 10 years in the general population; repeat colonoscopy is done every 3 to 5 years if there is a polyp present. Osteoporosis screening with a DEXA scan starts at age 65. Pap smear is done every 3 years if cytology alone is done or every 5 years if done in conjunction with HPV testing. Hepatitis B screening is not conducted routinely unless the patient is high risk.
When do you start breast cancer screening?
50 to 74
40 for those with family history
A 55-year-old woman presents to the office for a breast mass that she felt. The mass is painless and mobile, and it has been present for the past week. Her mammogram done last year was negative. Vital signs are stable. Physical exam is significant for a 3 cm by 3 cm, round, firm mass that is mobile and nontender, located on the right breast at the 4 o’clock position. No nipple discharge or skin changes are noted, and no axillary lymph nodes are palpated. What is the next step in the management of this patient?
a. Biopsy
b. Mammogram
c. Breast ultrasound
d. Breast MRI
e. No further treatment
B. Diagnostic mammogram is done as the first-line test in women with a palpable breast mass, regardless of when the last mammogram was done. Even in a woman under the age of 30, a mammogram should be performed first. Breast ultrasound is done first only if the woman is breastfeeding or pregnant. Breast MRI is not a screening test. Biopsy is never the first step in the workup.
Give the 4 most common breast masses
Fibroadenoma
Fibrocystic changes
Galactocele
Fat necrosis
This is a type of breast mass that can increase in size during pregnancy, common in 15-35-year-old women that presents with benign, well-defined, and mobile solid mass.
Fibroadenoma
This is a type of breast mass that is common in premenopausal women, cyclical breast pain that increases with approach of menses, returns to baseline once menstruation starts. It presents with nodular tissue on physical exam with diffuse tenderness and mass that is not discrete or well defined.
Fibrocystic changes
This is a type of breast mass that occurs in pregnancy, breastfeeding, or weaning. There will be milk retetntion cyst caused by blocked milk duct. It is usually painless but painful when infected.
Galactocele
This is a type of breast mass that occurs after blunt trauma to the breast. It may also occur after radiation, breast reconstruction, injection of substances into the breast, or breast reduction.
Fat necrosis
Define Primary Amenorrhea
It is defined as the absence of menstruation by the age of 15 years in a female who has normal secondary sexual characteristics.
Enumerate possible causes of primary amenorrhea.
Gonadal dysgenesis (Turner syndrome) Mullerian agenesis Delay of puberty PCOS Hypopituitarism
What are the initial tests for primary amenorrhea?
B-HCG TSK Prolactin FSH Pelvic ultrasound (to assess for presence of a uterus)
Define Secondary Amenorrhea
It is the absence of menses for more than 3 months in a female who menstruates regularly or absence of menses for 6 months in a female who menstruates irregularly.
What are the possible causes of secondary ammenorhea?
Pregnancy (most common) Hypothalamic amenorrhea Hyperprolactinemia Primary ovarian insufficiency Thyroid abnormalities
What are the initial tests for Secondary Amenorrhea
B-HCG
TSH
FSH
Prolactin levels
What is diagnostic for Menopause?`
increased FSH level
