module 16 women abnormalities Flashcards
fibrocystic changes patho
benign fluid filled cyst formation caused by ductal enlargement
fibrocystic changes subjective
tender and painful breasts and/or palpable lumps that fluctuate with menses
usually worse premenstrually
fibrocystic changes objective
round, soft-to-firm, tense, mobile masses with well-delineated borders
usually tender
usually bilateral
multiple or single
fibroadenoma patho
benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit
fibroadenoma subjective
painless lumps that do not fluctuate with the menstrual cycle
may be asymptomatic with discovery on clinical breast examination or breast imaging
fibroadenoma objective
round or discoid, firm, rubbery, mobile masses with well-delineated borders
usually non-tender
usually bilateral
single; may be multiple
biopsy often performed to rule out carcinoma
malignant breast tumors patho
ductal carcinoma arises from the epithelial lining of ducts; lobular carcinoma originates in the glandular tissue of the lobules.
malignant breast tumors subjective
painless lump, change in size, shape, or contour of breast
axilla may be tender if lymph nodes involved
may be asymptomatic with discovery on clinical breast exam or breast imaging
malignant breast tumors objective
may have palpable mass that is usually single, unilateral, irregular, or stellate in shape
poorly delineated borders, fixed, hard or stone-like, non-tender
- breast may have dimpling, retraction, prominent vasculature
- skin may have peau d’orange or thickened appearance
- nipple may be newly inverted or deviate in position
fat necrosis patho
benign breast lump occurs as inflammatory response to local injury
fat necrosis subjective
hx of trauma to the breast
painless lump
fat necrosis objective
- firm, irregular mass, often appearing as an area of discoloration
- may mimic breast malignancy on clinical examination or breast imaging, requiring biopsy for diagnosis
intraductal papilloms and papillomatosis patho
benign tumors of the subareolar ducts that produce nipple discharge
intraductal papillomas and papillomatosis subjective
spontaneous nipple discharge
usually unilateral
usually serous or bloody
intraductal papillomas and papillomatosis objective
single-duct unilateral nipple discharge provoked on physical examination
mass behind the nipple may or may not be present
may need excisional biopsy to rule out malignancy
duct ectasia patho
benign condition of the subareolar ducts that produces nipple discharge
duct ectasia subjective data
spontaneous nipple discharge
discharge often green or brown in color
discharge may be sticky
duct ectasia objective
single or multi-ductal discharge provoked on physical examination
mass behind the nipple may or may not be present
breast may or may not be tender
nipple retraction may be present
galactorrhea patho
lactation not associated with childbearing
inc. levels of prolactin: disruption of communication between the pituitary and hypothalamus
galactorrhea subjective
spontaneous nipple discharge
- bilateral, serous or milky
possible hx:
- amenorrhea, pregnancy, post abortion, hypothyroidism, cushing syndrome, CRF
possible med hx:
- phenothiazines, tricyclic antidepressants, some anti-HTN, estrogens, H2 Rc blockers, marijuana, amphetamines, opiates
possible physiologic hx:
- suckling, stress, dehydration, exercise, nipple stimulation
galactorrhea objective
multi-ductal nipple discharge may or may not be provoked on physical examination
no mass
paget disease patho
surface manifestation of underlying ductal carcinoma
- migration of malignant epithelial cells from the intraductal to the nipple skin
- tumor cells disrupt the epithelial barrier, allowing extracellular fluid to seep out onto the nipple surface
paget disease subjective
crustiness of the nipple, areola, and surrounding skin
pruritus of the nipple
paget disease objective
red, scaling, crusty patch on the nipple, areola, and surrounding skin
may be unilateral or bilateral
appears eczematous but does not respond to steroids
mastitis patho
inflammation and infection of the breast tissue
most common in lactating pts
mastitis subjective
sudden onset of swelling, tenderness, redness, and heat in the breast
fever and chills
mastitis objective
tender, hard breast mass, with and area of fluctuation, erythema, and heat
may have discharge of pus
underlying pus-filled abscess may impart a bluish tinge to the skin
gynecomastia patho
breast enlargement in males
testosterone levels low relative to estrogen
inc. body fat -> inc. estrogen
gynecomastia subjective
breast enlargement
med hx:
- estrogens, anti-androgens, anabolic steroids, tricyclid antidepressants, spironolactone, 5a reductase inhibitors, ketoconazole, cimetidine, recreational drugs
gynecomastia objective
smooth, firm, mobile, tender disk of breast tissue located behind the areola
usually non-tender
may be unilateral or bilateral
premature thelarche patho
breast enlargement in girls younger than 8
premature thelarche subjective
breast enlargement
premature thelarche objective
degree of enlargement: slight to fully developed
usually bilateral
other signs of sexual maturation may be absent
premenstrual syndrome patho
collection of physical, psychological, and mood symptoms related to the menstrual cycle
- usually begins in late 20’s
premenstrual syndrome subjective
may include
- breast swelling and tenderness, acne, bloating, wt gain, headache, joint pain, food cravings, irritability, difficulty concentrating, mood swings, crying spells, depression
s/s 5-7 days before menses and subside with onset of menses
premenstrual syndrome objective
none
dx based on s/s and temporal relationship to menstrual cycle
infertility patho
inability to conceive over a period of 1 year of unprotected sex
infertility subjective
unsuccessful attempts to become pregnant
infertility objective
varies with underlying cause
often no physical findings
endometriosis patho
the presence and growth of endometrial tissue outside the uterus
- possible retrograde reflux of the menstrual tissue from the fallopian tubes during menstruation
endometriosis subjective
pelvic pain, dysmenorrhea, heavy or prolonged menstrual flow
endometriosis objecitve
no findings
bimanual exam: tender nodules may be palpable along the uterosacral ligaments
condyloma acuminatum (genital warts) patho
warty lesions due to STI with HPV
condyloma acuminatum subjective
soft, painless, wartlike lesions
hx of sexual contact
condyloma acuminatum objective
flesh-colored, whitish pink to reddish brown, discrete, soft growths on labia, vestibule or perianal area
lesions may occur singly or in clusters and may enlarge to form cauliflower-like masses
molluscum contagiosum patho
viral infection of the skin and mucous membranes
- STI in adults, not in children
caused by poxvirus, enters through small breaks in hair follicles
molluscum contagiosum subjective
painless lesions in genital area
molluscum contagiosum objective
- white or flesh-colored dome-shaped papules that are round or oval
- surface with central umbilication from which thick creamy core can be expressed
- lesions may last from months to years
syphilitic chancre patho
skin lesion associated with primary syphilis
- bacterium Treponema pallidum
- 2 weeks after exposure
syphilitic chancre subjective
often no lesion noted, as it may be internal
painless genital ulcer
sexually active
syphilitic chancre objective
solitary lesion; firm, round, small, painless
indurated borders with a clear base
scrapings from ulcer show spirochetes
condyloma latum patho
lesions of secondary syphilis
appear 6-12 weeks after infection
condyloma latum subjective
healed solitary genital lesion
condyloma latum objective
flat, round, or oval papules coved by a gray exudate
genital herpes patho
SHI viral infection of the skin and mucosa
- HSV
genital herpes subjective
painful lesions in the genital area
hx of sexual contact
burning or pain with urination
genital herpes objective
superficial vesicles in the genital area, internal or external
- may be eroded
initial infection often extensive
- recurrent infection is usually confined to small localized patch
inflammation of the bartholin gland patho
may be acute of chronic
inflammation of the bartholin gland subjective
pain and swelling in the groin
inflammation of the bartholin gland objective
hot, red, tender, fluctuant swelling of the bartholin gland that may drain pus
chronic inflammation results in a non-tender cyst on the labium
vaginal carcinoma patho
classified according to the type of tissue from which the cancer arises
- squamous: epithelial lining of vagina
- adenocarcinoma: glandular tissue
- melanoma: pigment-producing cells, melanocytes
- sarcoma: deep in the wall of vagina
vaginal carcinoma subjective
abnml vaginal bleeding difficult of painful urination pain with sex pain in the pelvic area, back, or legs edema in the legs risk factor: exposed in utero to DES
vaginal carcinoma objective
vaginal discharge, lesions, and masses
melanoma: lower or outer portion of the vagina
tumors vary in size, color, and growth pattern
vulvar carcinoma patho
classified according to the type of tissue from which the cancer arises
- squamous: epithelial lining of vagina
- adenocarcinoma: Bartholin glands, vulvar sweat glands
- melanoma: pigment-producing cells, melanocytes
- basal cell: sun-exposed areas, rare
vulvar carcinoma subjective
- lump or growth in or on the vulvar area or a patch of skin that is differently textured or colored
- ulcer persists longer than 1 month
- bleeding from vulvar area
- change in appearance of existing mole
- persistent itching, pain, soreness, or burning
- painful urination
vulvar carcinoma objective
- Squamous: ulcerated or raised lesion on vulva/labia
- Adenocarcinoma: ulcerated or raised lesion on sides of vaginal opening
- Melanoma: dark colored lesion most often on clitoris or the labia minora
- Basal cell: ulcerated lesion
physiologic vaginitis
subjective: inc. in discharge
objective: clear or mucoid discharge
dx: wet mount, 3-5 WBC; epithelial cells
bacterial vaginosis
subjective: foul-smelling discharge “fishy”
objective: homogenous thin, white or gray discharge
dx: +KOH “whiff” test, wet mount: + clue cells
candida vulvovaginitis
subjective: pruritic discharge, labia to thighs
objective: white, curdy discharge. cervix may be red, may have erythema of perineum and thighs
dx: KOH prep: mycelia, budding, branching yeast, pseudohyphae
Trichomoniasis
subjective: dysuria, dysparenunia w/ severe infection
- watery, foul discharge
objective: profuse, frothy, greenish discharge, red friable cervix with petechiae “strawberry cervix”
dx: wet mount: round or pear-shaped protozoa, motile gyrating flagella
