Lecture 5 Flashcards
To be diagnosed with PMS, need 1 symptoms in 5 days pre-menses for how many cycles?
3 cycles
When are PMDD symptoms absent?
Week post menses
What are 4 main somatic symptoms of PMS?
Bloating, mastodynia, HA, swelling
What are three affective symptoms of PMS?
Irritable, angry outbursts, moodiness
When are symptoms relieved with PMS?
Within 4 days of menses
What are some core symptoms of PMDD?
Marked depression, marked anxiety, sudden tearfulness/ sadness, increased interpersonal conflicts or persistent & marked anger or irritability
What is the gold standard for treatment of PMDD?
SSRIs
What are some common meds for PMS?
NSAIDs, spironolactone (diuretic), ovulation suppression (OCPs, danazol (blocks all hormones- become male like) GnRH agoinst)
What are 3 common SSRIs prescribed for PMDD?
Fluoxetine (Prozac), Sertraline (Zoloft), Paraxetine (Paxil)
What are some ADRs associated with SSRIs for treatment of PMDD?
GI upset, insomnia, sexual dysfunction, wt gain, increased nervousness
What is transition time to non-reproductive years prior to menopause?
Peri-menopause
What is the pernmanet cessation of menses. 12 consecutive months w/o menses. Change in follicular phase, luteal phase constant.
Menopause
Under what age is premature ovarian failure considered?
Under 40 years old
What is the primary hormone in menopause?
Estrone (E1)
What hormone becomes higher with menopause?
FSH
What does estrone produce?
androstenedione & testosterone
What do bisphosphonates do? (ex- alendronate, risedronate)
Inhibit osteoclastic activity
What do SERMS (selective estrogen receptor modulator, raloxifene) do?
nhibit bone resorption & turnover.
What is a a precaution with bisphosphonates?
Sit up and don’t eat for at least 30 minutes after
What can St. John’s wort work to help?
Vasomotor symptoms, depression
What 2 other supplements can help with vasomotor symptoms of menopause?
Soy/isoflavones
Black cohosh
If an individual has a uterus, what do they need to be on for hormonal replacement?
Progesterone and estrogen
What are some contraindications for estrogen therapy?
CVA, thromboembolic disease, undiagnosed genital bleeding, biliary tract disorder, known estrogen dependent tumor
Where are the majority of breast cancers found?
In outer, upper quadrants
Higher risk of cancer with Menarche <___ years
12 years old
Menopause > ___ increases risk of breast cancer?
55 years old
No IUP or IUP > ____ year old increases risk of breast cancer.
30 y/o
Why do you preferable do the CBE during the follicular phase?
Estrogen dominant cycle, can then compare with mass in other phase
Which nodes do you check on a CBE?
axillary, epitrochlear, supraclavicular
What are the two types of mammography and what is the difference?
Screening vs. diagnostic
Screening if for an individual with no mass
How many views on done on screening mammogram?
4 views (2 on each)
What are 2 other things they can do with diagnostic mammography?
Compress more, and magnify
What are the three types of mastalgia?
Cyclic, non-cyclic & extra-mammary
What are some Rx for mastalgia?
Appropriate bra
weight loss, less caffeine
Vit E
Meds
What are some Meds for mastalgia?
OCPS Depo-provera (progesterone only) Bronmocriptine & lisuride Danazol SERMS (off-label tamoxifen, raloxifen)
What does nonspontaneous, nonbloody & B/L breast discharge indicate?
Ductal ectasia (fibrocystic changes)
What does purulent nipple discharge indicate?
Abscess
What meds can cause milky discharge?
Tricyclics, OCPs
What does bloody, unilateral nipple discharge indicate?
Intraductal CA, invasive ductal CA, papilloma (benign)
What are some symptoms of a prolactinoma?
HA, diplopia, vision change,
What are two causes of hyperprolactinemia?
Tumor in pituitary or tumor secreting prolactin.
If prolactin is elevated what do you do?
MRI sella turcica along with visual fields
What is dense epithelial & fibroblastic tissue: encapsulated, solid, round, mobile & rubbery often found in adolescents and young women?
Fibroadenoma
What is inc’d fibrosis w/in lobule along w/compression & distortion epithelium?
sclerosing adenosis
What is a benign disease that is proliferative w/out atypia. >2 2 cell ayers above basement membrane.
Epithelial hyperplasia
What is neoadjuvant chemo ?
Chemo used to shrink mass before it is removed
After initial treatment how often are women seen by gyn?
First 2 years- 3-6 months
3rd year and beyond see annually
What stage of breast cancer do you: mastectomy or BCT w/ or w/out irradiation
Stage 0
What stage of breast cancer do you: surgery local control, chemo +/or hormonal
Stage IV
What stage of breast cancer do you: modified radical or or BCT w/irradiation, axillary node, + chemo, + tamoxifen, + neoadjuvant chemo (try to shrink mass with chemo before you go to remove mass), radiation supraclavicular LN + chest wall & breast (inflammatory type)
Stage III
What stage of breast cancer do you: mastectomy or BCT w/or w/out irradiation, sentinel node/axillary node, + chemo.
Stage I
What stage of breast cancer do you: modified radical or or BCT w/irradiation, axillary node, + chemo, + tamoxifen, radiation supraclavicular LN (+ 4 LN) + chest wall?
Stage II
What is the only med approved by the FDA to treat mastalgia?
Damazol
What are the two types of carcinoma in situ?
Lobular carcinoma in situ (LCIS)
Ductal carinoma in situi (DCIS)
What is the single largest risk factor for development cancer?
Age- Over 50
If ER positive or negative breast cancer easier to treat?
ER positive- can attack estrogen receptors
Is Her2/neu positive good or bad?
Bad
What is normal cyclic symptoms associated with ovulation which do not interfere w/ the patient’s daily routine?
Molimina
What are the most common somatic symptoms that occur with PMS?
Abdominal bloating and fatigue
What is the term for breast pain and swelling?
Mastodynia
What is the most common behavioral symptoms of PMS?
Emotional lability
What is the current theory for what causes of the basis of PMDD?
Serotoninergic dysregulation
What 2 supplements have shown to decrease symptoms of PMS and PMDD?
carbonate and magnesium
What are the 4 FDA approved drugs for PMDD?
Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and drospirenone/ ethinyl estradiol
What is the time period during which the changes of menopause occur
climacteric
The plasma concentration of _______ begin to increase several years in advance of actual menopause.
FSH
What is usually the first physical manifestation of decreased ovarian function
Hot flush
What is the only FDA approved med for treating mastalgia?
Danazol
