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English 2 > Gynecology > Flashcards

Gynecology Flashcards

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1
Q

Normal female vs male development

A

Fem: growth accel → thelarche (brst) → pubarche (pub hair) → menarche

Male: testic enlarg → penile growth → pubarche → facial hair

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2
Q

Menopause (PE, dg)

A

≤12 months; average 51yo
Hot flashes; vag atroph; insomn; anxiety/irritab; poor concent; mood chang; dyspareu; loss libido
-Premature if <40yo

Dg: clinic; ↑FSH then ↑LH; ↑tot cholest w/ ↓HDL

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3
Q

Menopause (ttt)

A

-Horm replac ttt (estro+progest): if mod-sev vasomotor sympt (SHORT term ttt); ↑R breast cancer; ↑CV morbi/morta
CI: vag bleed; breast K; unttt endomet K; Hx of thromboemb; chron liv ds; hyperTg
-Non-HRT: SSRI/SNRI; clonidine; gabapentine (↓hot flsh)
-Topical estro: vag atroph
-Supplem+/-bisphosph: osteopor (Ca/vitD/exo)

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4
Q

Contraception (methods)

A

85% pgncy in 1y if no contracept*

  • Eff >99%: progest arm implant; IUD progest; copper IUD; surg steriliz (vasectomy; tubal ligat*)
  • Eff 90-99%: medroxyprogest IM; patch (E+P); ring (E+P); OCP (E+P); progest pill
  • Eff 75-90%: male/female condoms; diaphragm w/ spermicide; awarness (no sex during ovulat*)
  • Eff 68-74%: withdrawal (before ejacul); spermicide
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5
Q

Contraception (CI)

A

-Estrog: pgncy; stroke/HTN/DVT/PE; breast K; abNl vag bld; estrog-dep K; liver neopl; abNl liv fct*; tobacco+>35yo

  • IUD both: sev ut structural abNl; pgncy; gyneco inf; vag bld; gyneco malign
  • IUD copper: copp allergy/Wilson ds; sev dysmenorrhea; menorrhagia
  • IUD progest: levonorg allergy; breast K; acute liv ds; liv tumor
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6
Q

Emergency contraceptive methods

A

Morning-after pill (E+P) (in 120h)
Morning-after pill (progest)
Copper T IUD (in 7d)

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7
Q

1* amenorrhea / Delayed puberty (etiologies)

A

1- No menses by 16yo; presence of 2* sexual develop

  • 1* ov insuff (50%): esp Turner sd; radio/chemo therapy
  • Central hypogon: undernourish; stress; hyperprolac; exo; CNS tumor (pituit; radiat*); Kallmann (gonadotrop def); constitutional growth delay

2- No 2* sexual charact by 14yo (No estrog; anatom/genet probl): Mullerian agenesis; imperfor hymen; complete androgen insensitivity; congen adren hyperplasia

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8
Q

1* amenorrhea (dg)

A 
Pgncy test (#1); general detailed PE; US
Karyotype/testo level: if no uterus
FSH/LH: if uterus present
Prolact level; DHEAS
If HTN: 17a-OH and 11-OH def
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9
Q

1* amenorrhea (ttt)

A

No ttt: constitutional growth delay
Hypogonadism: HRT (just estrog) then 12-18mo later, E+P
Surg: if anatomic abNl

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10
Q

2* amenorrhea (etiologies)

A

No menses for 6 consecutive months

By pgncy; ovary (PCOS, premature ov failure); hypothal (neopl, fctional/nutrit*/exo/stress, systemic ds/DM1/celiac); pituit (adenoma, mass, Sheehan); hypothyroid; uterine (Asherman, cervical stenosis)

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11
Q

2* amenorrhea (dg)

A

Hx, PE, pgncy test, TSH, prolact (if ↑, MRI)
Progestin challenge
If hyperglyc or hypoTN: 1mg DXM suppr test (CAH#Cushing#Addison)
If viriliz: level testo, DHEAS, 17-HOprogest

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12
Q

2* amenorrhea (ttt)

A
  • Hypothal: underl cause; OCPs; induce ovulat* w/ gonadotropins to get pgnt
  • Tumor: excision; cabergol/bromocr for prolactinoma
  • Premature ov fail: combined OCPs
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13
Q

1* dysmenorrhea

A

By ut vasoconstr, anoxia, sustained contract* by ↑PGF2a
Low midline spasmodic pelvic pain; first 1-3d of menses
Ass w/ nausea, diarr, headac, flush; No pathol finding

Dg of exclus; r/o 2 dysmeno
ttt: NSAIDs, topic heat, combined OCPs, progest IUD

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14
Q

2* dysmenorrhea

A

Esp by endometrios, adenomyos, fibroids, adhes, PID
Ut mass, cerv mot tender, adnex tender, vag disch

Dg: B-hCG (ectopic); CBC w/ diff (inf/neopl); UA; STD/PID
ttt: etiology

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15
Q

Endometriosis (PE, dg)

A

Endomet glds + stroma outside ut
Cyclic pelv/rect pain; dyspareun; restricted range of mot* of uterus

Dg: laparosc; blue-black/brown les*; choc cyst in ovaries (endometrioma)

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16
Q

Endometriosis (ttt, complications)

A

ttt: inhib ovul; combined OCP #1, leuprolide, danazol, NSAIDs, progest
Conserv surg: excis, cauterizat, lysis of adhes*
Defin surg: TAH/BSO +/- lysis of adhes*

Compl: infertility

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17
Q

Adenomyosis (PE, dg, complications)

A

Endomet in myometrium
Triad: pain, menorrhagia, enlarged boggy symm uterus

Dg: MRI; US; anapath
Compl: rarely progr to endometr carcinoma

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18
Q

Adenomyosis (ttt)

A

Symptom relied: NSAIDs (#1) w/ OCPs or progest
Conserv surg: resect* by hysteroscopy
Defin surg: hysterectomy

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19
Q

Abnormal uterine bleeding (etiologies)

A

Alterat* in qtty, durat*, fqcy; by PALM-COEIN

  • Structur (PALM): Polyp, Adenomyos, Leiomyom, Malign/hyperplasia
  • Nonstruct (COEIN): Coagulop, Ovulatory dysfct, Endometrial, Iatrogenic, Not yet classified
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20
Q

Abnormal uterine bleeding (PE)

A 
Oligomeno: ↑length (35-90d) betw/ menses
Polymeno: fqt menses (<21d); anovul
Menorrh: ↑amount (>80mL) or prolong bld (>8d); anemia
Metrorrh: bld betw/ periods
Menometrorrh: excessive + irregular bld
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21
Q

Abnormal uterine bleeding (dg)

A

B-hCG; CBC (An); Pap smear (cerv K); gono/chlam; TFTs; prolact; plts/PT/PTT; US (mass, PCOS)
Endometr biopsy: if endom ≥4mm in postmenop or if >35yo w/ RF for endom hyperplasia (DM, obes)

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22
Q

Abnormal uterine bleeding (ttt)

A

-Acute heavy: high-dose estrog IV then E+P when bld stabilized. If estro CI, high-dose progest
If bld not stabil, D&C
-Ovulatory bld: NSAIDs; tranexamic acid (x5d); OCP/progest PO/inject/IUD
-Anovulatory bld: progest x10d; OCPs; progest IUD
-If all fails: D&C; hysteroscopy (biops/embolizat*); hysterectomy

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23
Q

Congenital adrenal hyperplasia (PE, dg, ttt)

A

Androg excess: gen ambig, premat pubarche, menstr irreg, infertil, hirsut, acne, palpable pelv mass

Dg: PE, Cosyntropin stimulat* test !!!; cortisol, androstened, DHEA

ttt: GC (DXM), + MC (fludrocortisone) if salt wast
Hair removal: ttt adren/ovar disorders; laser; electr

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24
Q

21-hydroxylase deficiency

A
  • Classic: most sev; bb girl virilizat* +/- salt wast
  • Nonclassic: late onset; androg excess or asympt
↓MC
↓Cortisol
↑Sex Hes
↓BP
↓K+
↑Renin and 17-HOprogest
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25
Q

11B-hydroxylase deficiency

A 
↓Aldost but ↑11-deoxycorticosterone
↓Cortisol
↑Sex Hes
↑BP
↓K+
↓Renin
XX: virilizat*
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26
Q

17a-hydroxylase deficiency

A 
↑MC
↓Cortisol
↓Sex Hes
↑BP
↓K+
↓Androstenedione
XY: pseudo-hermaph (ambig gen, undesc testes)
XX: no 2* sex dev
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27
Q

Polycystic ovarian syndrome (dg, PE)

A

Dg: ≥2 of these: PCOS on US; oligo-anovulat*; hyperandrog (clinic/biochem)

Labs: ↑estrog+testo; !r/o other causes of hyperandr (adren/ovar tumor); 2-h gluc toler test; lipid/LPL
+/- ↑LH/FSH ratio; 24-h urin cortisol (r/o CAH/Cushing)

Obes, menstr disturb, infertil (#1 in W), acne, androg alopecia, hirsutism

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28
Q

Polycystic ovarian syndrome (ttt, complications)

A
  • No pgncy plan: OCP (E+P), progest, +/-metformin
  • Pgncy plan: clomiphene (SERM), +/-metformin
  • Hirsut: OCP (E+P) #1; antiandrog (spironolact/finaster); metformin
  • Obes/CV RF/lipid: diet, ↓weight, exo, statins

Compl: ↑R of DM2, metabolic sd, miscarr, breast/endomet cancer (unopposed estrog)

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29
Q

Infertility

A

After 12mo of normal regular unprotected sex
1* (no prior pgncy) or 2* (prior pgncy)
-Male: testes, meds, thyroid, liv, hypoth/pituit
-Ovulatory: age, thyroid, galactorrh, menstr abNl
-Tubal/pelvic: PID, adhes, endometriosis, surg
-Cervical: cryottt, conizat, DES expo in utero
-Uterine: polyp, fibroid, congen anomalies

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30
Q

Cyst of Bartholin duct

A

Obstructed gland duct w/ mucus accum
1-3cm, unilat, asympt. If larger, painful swell+dyspareun
Mass at medial labia majora or lower vestibule

No ttt +/- warm soaks if asympt
Drain + biopsy if >40yo to r/o carcinoma

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31
Q

Abscess of Bartholin duct

A 
Infected duct (polymicrob)
Extreme pain, warm fluctuant mass at medial labia majora or lower vestibule

ttt: aspirat* or incis*+drain; test gonorrh/chlam
AB just if +cellulitis or STI

32
Q

Vaginitis (PE, dg)

A

Itching, burning, irritation, abNl discharge, malodor, swelling, dyspareunia, dysuria
Exam of vulva, vagina, cervix

Dg: disch (pH, whiff test, wet mount, KOH)
If purulent + ↑WBCs + cerv friability + sympt PID → DNA/Cx gonorr/chlam to r/o cervicitis

33
Q

Bacterial vaginosis

A

Not inf + No infl; shift in org (↑anaer/↓lactobacilli)
RF: pgncy, multi/W sex partners, fqt douch
Grayish-white disch, fish odor, mild irritat*
Clue cells; ⊕whiff

ttt: PO/vag metronid or vag clindamycin
Compl: chorioamnio/endometritis; inf; preterm; miscarr; PID

34
Q

Trichomonal vaginitis

A 
RF: unprotected sex w/ multi partn
Strawb cervix; profuse malodor yellow-green disch; prurit
Motile trichom (protozoa)

ttt: 1-dose PO metronidazole or tinidazole
+ ttt partners + test for other STDs
Compl: chorioamnio/endometritis; inf; preterm; miscarr; PID

35
Q

Candidal vaginitis

A

RF: DM, AB use, pgncy, CS, HIV, OCP use, ↑sex, tight cloth
Prurit, dysuria, burn, disch (thick white, no odor), erythem vagina; Pseudohyphae

ttt: topic azole or PO fluconazole

36
Q

Cervicitis

A
  • Inf: chlam, gono, trichom, HSV
  • Noninf: trauma, radiat*, malign

Yellow-green mucopur disch, ⊕cerv mot* tendern; no other signs of PID
ttt: empiric for gono+chlam (ceftriax IM and azithrom PO)

37
Q

Pelvic inflammatory disease (RF, PE, complications)

A

Gonorrh; chlamyd trachom; endogen ae/anaer
RF: douch; smok; multi sex partners; prior STD/PID
Low abdo pain, fever, chill, menstr disturb, purul disch

Compl: recurr; chron pelv pain; dyspareun; ectop pgncy
Infertil; Fitz-Hugh-Curtis sd

38
Q

Pelvic inflammatory disease (dg)

A

Dg: acute low abdo/pelv pain + 1 of these (ut tendern, adnex tendern, cerv mot* tendern)
B-hCG (r/o pgncy); WBCs; US

ttt: ptt and partners

39
Q

Pelvic inflammatory disease (ttt)

A

Outptt: -Ceftiax IM 1-dose or cefoxit + probenecid + doxy x14d +/- metronid x14d
-Oflox or levoflox x14d +/- metronid x14d

Inptt: -Cefox or cefotetan + doxycy x14d
-Clindam + gentam x14d

Surg: drain abscess if persist after AB; >4-6cm
Laparo if ptt deteriorates

40
Q

Toxic shock syndrome

A

Staph aureus toxin (TSST-1); in 5d of tampons
Dg: abrupt >38.9C, hypoTN, diffuse rash, vomit, watery diarrh; desquamat palms/soles in 1-2wks in recovery
Bld Cx ⊖bcz ds by preformed toxin

ttt: emergent rehydrat*, remov foreign body; drain; Clinda+vanco (if MSSA, clinda+oxac/nafcill) (if MRSA, clinda+vanco/linezo)
Compl: morta (cardio, ARDS, DIC)

41
Q

Uterine leiomyoma / fibroids (PE, complication)

A

Benign; multiple tumors; black>white
Hormone sensitive (↑ in pgncy; ↓ at menop)
Rare malign transfo

Asympt; menometrorr; mass effect (bladd/rect); pain (dysmeno, dyspareun); firm nontend irregul Ut
Compl: infertility

42
Q

Uterine leiomyoma / fibroids (dg, ttt)

A

Dg: TV US; MRI (prep surg; r/o cancer); CBC (anem)
ttt: if asympt, annual pelv exam + CBC
OCPs (E+P); medroxyprog/danazol (↓bld)
Leuprolide (↓size+Vx); NSAIDs (↓pain)

Surg: myomectomy (W wants child); hysterectomy (if not); Ut artery embolizat; emergent surg if tors

43
Q

Endometrial cancer (types, PE)

A

Type I: unopp estro (tamoxi/estro) → typ/atyp hyperplasia; 55yo; favorable pg
Type II: unrelat to estro; p53 mutat*; 67yo; poor pg

Vag bld (early); pain (late); metab sd

44
Q

Endometrial cancer (dg, ttt)

A

Dg: pgncy test if premenop; TV US (endom ≥4mm); endom/endocerv biopsy

ttt: high-dose progestins (W wants child)
TAH/BSO +/- radiat* (postmenop)
TAH/BSO w/ adj chemoth (adv-stage cancer)

45
Q

Cervical cancer (RF)

A

Endocervix (column); Ectocervix (squam)
↓pH → metapl of endocerv to squam
Junct* exposed to carcinogens → CIN

RF: HPV DNA in ~all (16 in squam K; 18 in adenoK); immsuppr; HIV; STDs; tobac; high parity; OCPs
Gardasil V: ag 6-11 (gen warts) and 16-18 (cancer)

46
Q

Cervical cancer (PE, screening)

A

Metrorrh; postcoital spot; bld/purul malodor nonprurit disch (after invas*)

Screen: starting 21yo regardless of sexual activ
(21-29yo Pap/3y; 30-65yo Pap/3y or Pap+HPV/5y)
Stop at 65yo if all previous ⊖ and if No DES expo and if No HIV/immsuppr

47
Q

Cervical cancer (dg, ttt, pg)

A

Dg: read the book (too complicated)
ttt: read the book (too complicated)

Pg: 5-y survival 68% caucasian; 55% black W

48
Q

Vulvar cancer (RF, PE)

A

RF: HPV (16/18/31); lichen sclerosus; infqt exams; DM; obes; HTN; CV ds; smok; high-R sex; immsuppr
VIN: vulvar intraepith neoplasia (precancerous)

Prurit, pain
Early: white, pigment, raised, thick, nodul, ulcer
Late: large, cauliflower-like, hard ulcer

49
Q

Vulvar cancer (dg, ttt)

A

Dg: punch biopsy (if suspic* or persist prurit esp postmenop)

ttt: high-grade VIN (chemoth, laser ablat*, vulvectomy)
Invasive: radical vulvectomy + LNectomy +/- preop radiation/chemoth/both

50
Q

Vaginal cancer (RF, types)

A

RF: immsuppr; chron irritat; prolapse; low SES; radiat; hysterectomy; multi sex partners; DES expo

Postmenop: squam cell carcinoma
Young: adenoK; clear cell adenoK from DES

51
Q

Vaginal cancer (PE, dg, ttt)

A

AbNl vag bleed; abNl discharge; post-coital bleed
Usually upper 1/3 of vag

Dg: cytology, colposcopy, biopsy
ttt: local excis; partial/complete vaginectomy; if invasive then radiat or radical surg

52
Q

Ovarian cancer (RF)

A 
#1 death from gynec cancers
RF: age; low parity; ↓fertility; delayed childbearing; ⊕fam Hx; BRCA1 (45% R); BRCA2 (25% R); HNPCC sd

!!! OCPs taken for ≥5y ↓R by 29%

53
Q

Ovarian cancer (PE, dg)

A

Asympt; mild GI/pelvic pressure/pain
Esp present advanced: abdo pain/ascites/palpable mass

Dg: ↑CA-125 (epith cell K if postmenop; maybe endometriosis if premenop; only for progr/recurr)
TV US (screen high-R W or if sympt)
54
Q

Ovarian cancer (markers)

A 
Epithelial: CA-125
Endodermal sinus: AFP
Embryonal carcinoma: AFP, B-hCG
Choriocarcinoma: B-hCG
Dysgerminoma: LDH
Granulosa cell: inhibin
55
Q

Ovarian cancer (ttt, prevention)

A

Surg: TAH/BSO w/ omentectomy + pelvic and paraAo LNectomy
Postop chemoth: except if early-stage or low-grade
Radiation: for dysgerminomas

Prev: BRCA1 mut (screen/y w/ US + CA-125 then prophyl oophorectomy at 40yo or if no more children)
OCPs ↓R; No routine screening for general pop

56
Q

Pelvic organ prolapse (RF, PE)

A

RF: vaginal birth; genet predisp; adv age; prior pelv surg; connect T ds; ↑intra-abdo pressure (obes/constip)

Sensat* of bulge in vagina
Urin/fecal incontin; incomplete bladd empty; dyspareun

57
Q

Pelvic organ prolapse (dg, ttt)

A

Dg: degree of prolapse (by Valsalva while in lithotomy)

ttt: support (↑fiber diet; ↓weight; limit straining/lifting)
Pessary; surgery (hysterectomy w/ vaginal vault suspens*)

58
Q

Urinary incontinence

A

Bladder dysfct or sphincter dysfct
R/o fistula (if total incont); neuro abNl (if urge incont); distended bladd (overflow incont)

Dg: UA; ur Cx; void diary; urodynamic test; creat; cystogram

59
Q

Urinary incontinence w/o genital pathology

A 
Delirium/confus*
Infect*
Atrophic urethritis/vaginitis
Pharmaceutical
Psychiatric causes
Excessive urine output
Restricted mobility
Stool impact*
60
Q

Types of urinary incontinence

A
  • Total: all times + all positions; ttt w/ surg
  • Stress: ↑intra-abdo P; ttt w/ Kegel/pessary or vag vault suspens
  • Urge: unrelated to posit*; ttt w/ anticholin or TCAs or behavior
  • Overflow: chron urin retent*; ttt w/ urethral cath in acute; ttt underl ds; timed voiding
61
Q

Pediatric vaginal discharge

A

Nl but r/o sexual abuse

  • Infec vulvovaginitis: malodo, yellow-green, purul disch; Grp A strep; Candida (recent AB, immsuppr); STDs
  • Foreign body
  • Noninf vulvovaginits: contact dermatitis; eczema
  • Sarcoma botryoides: malign
62
Q

Precocious puberty (etiologies)

A
  • Central: early activat* of hypoth GnRH product*
  • Periph: GnRH-independent

Signs of ↑estrog: brst dev, vag bld (ovar cyst/tumor)
Signs of ↑androg: pub/axill hair, ↑clitoris, acne (adr tumor/CAH)

63
Q

Precocious puberty (dg)

A

Bone age: pub not started or started >1y or rapid progr

GnRH agon stimulat* test w/ LH resp: ⊕ (central: CNS tumor or idiop); ⊖ (periph: US adren/ovar; cyst, tumor, exog estrog, CAH)

64
Q

Precocious puberty (ttt)

A

Central: leuprolide (#1)
Periph: ttt cause: cyst (regress spont); CAH (GC); adr/ov tumor (surg); McCune-Albright (antiestrog tamoxifen; estrog blockers ketoconazole)

65
Q

Nonproliferative breast lesions (types, RF)

A

No ↑R of breast cancer (unless complex cyst)
Esp simple cysts w/ fluid (↑resp to Hes/growth fact)
Or papillomatosis, adenosis, fibrosis, ductal epithelial hyperplasia
30-50yo; ass w/ trauma and caffeine

66
Q

Nonproliferative breast lesions (PE, dg, ttt)

A

Cyclic bilat mastalgia, swell, esp prior to menses
Rapid fluctuat* in size; irreg bumpy consistency

Dg: re-examine after menses; if unchang then US (liqu/solid); FNA (if cyst, ↓pain+dg); excis* biopsy (if no fluid or if bld on aspir); mammo? maybe if >35yo

ttt: reassure; aspirat* if pain; ↓caffeine; OCP (↓fluctuat*)

67
Q

Proliferative breast lesions without atypia

A

FIbroadenomas, intraductal papillomas, sclerosing adenosis, ductal hyperplasia
Ass w/ small ↑R of breast cancer

  • Intraduc papill: papill cells from wall of cyst into lumen; Dg w/ core biop; ttt w/ excis* bcz ass w/ atypia/DCIS
  • Sclerosing adenosis + ductal hyperpl: no ttt
68
Q

Fibroadenoma (PE, dg)

A

Prolif les* w/o atypia; benign; epith+stroma
Esp <30yo; round rubbery mobile 1-3cm
Solitary or 20% multiple
No chang during menses; ↑in pgncy/He ttt; ↓in menop

Dg: US (liq/solid); needle biopsy/FNA; excis* if uncertain
ttt: excis* curative but recurrence common

69
Q

Phyllodes tumor

A

dg: fibroadenoma

Larger, ↑meta ability than fibroad
Papillary project* of stroma, lined w/ epith
Ass w/ hyperplasia + atypia

70
Q

Atypical hyperplasia

A 
Ductal or lobular
Similar to low-grade DCIS or LCIS
↑R of breast cancer
Dg: biopsy after mammo
↓R w/ mammo/year + Tamoxifen or aromatase inh
71
Q

Breast cancer (RF)

A 
#1 W cancer
#2 cancer death in US
60% in upper outer quadrant

RF: W; older; caucasian; personal Hx; fam Hx (1st); genetic (BRCA1-2); alcoh; cigaret; radiat; fibrocystic chang w/ cell atypia; ↑expo to estrog (nullipa, early menarch, late menop, 1st pgncy >35yo)

72
Q

Breast cancer (PE)

A

-Early: single, nontender, firm/hard, immovable
Ill-defined margins; mammo abNl
-Later: axill LN, brst enlarg, pain, peau d’orange, fixat*
-Late: ulcer; supraclav LN; arm edema; scaling eros*
-Meta: bone (pain); lung (dyspn/cough); liver (pain/N/jaund); hard axill LN >1cm; supra/infraclav LN

73
Q

Breast cancer (screening, dg)

A
  • Screen: postmenop (mammo); premenop (US if <30yo)
  • Suspic les*: biopsy (mammo guided FNA; core needle; open)
  • Receptor status: ER, PR, HER2/neu
  • Tumor markers if recurr: CEA, CA 15-3, CA 27-29
  • Meta: ↑ESR, ↑ALP (liv/bon meta), ↑Ca; CXR, CT CAP, brain MRI, PET CT
74
Q

Breast cancer (ttt)

A
  • Early-stage: conserv surg + radiat* or mastectomy +/- radiat*; w/ sentinel LN + adjuvant ttt
  • Locally adv: neoadj chemo + trastuzumab (if HER2⊕); conserv surg or mastectomy w/ sentinel + adjuvant ttt

-Adjuvant ttt: all ER/PR⊕ give tamoxifen or aromatase inh (if postmenop); all HER2⊕ give trastuzumab
Triple⊖ give chemoth if >0.5cm (Not if already got neoadj)
-CI to conserv surg: large, subareolar, multifocal, fixed to chest, prior radiat* to chest, nipple/skin involv
-Stage IV: radiat* + hormon ttt +/- mastectomy

75
Q

Breast cancer (prognosis, complications)

A

Pg: TNM stage (I-IV) most reliable; ER⊕/PR ⊕ favorable pg; localized (75-90% cure); spread (40-50% 5y-survival)

Compl: pleural effusion; edema arm

76
Q

Sexual assault (PE, dg)

A 
#1 crime in US
Full Hx (last time, condom, OCP, drug/alcoh, STD), descript* of assailant, locat*/time; act* since assault (douch, ...)

Dg: complete PE; gono/chlam/trichom smear/Cx/wet mount; HIV/syphilis/HSV/HBV/CMV; pgncy test; bld alcoh; urine toxicology

77
Q

Sexual assault (ttt)

A

ttt traumatic injuries
STD ttt + prophyl (ceftriax + azithrom +/- metronid)
Hep B vaccine if not received
HIV prophyl
Emergency contracept*
Psychological counseling
Follow-up (repeat STD/pgncy screening, psychiatric care)

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