Module 3B Gynecology Flashcards
1
Q
what are the two mechanisms of action for contraceptives?
A
1.) inhibiting the development of the ova
or
2.) blocking the meeting of ova and sperm.
2
Q
What contraceptives work by “inhibiting the development and release of the egg”?
A
Oral contraceptive pills (OCPs), long-acting progesterone injection, contraceptive patch, contraceptive ring
3
Q
What contraceptives work by “imposing a mechanical chemical, or temporal barrier between the sperm and egg”?
A
Condom, diaphragm, spermicide, intrauterine contraception, and fertility awareness
4
Q
Describe what the “Typical use failure rate” is
A
the failure rate seen when the method is actually used by patients, that is, factoring in the mistakes in usuage everyone will make from time to time and actual noncompliance
5
Q
Describe what the “Method or perfect use failure rate” is
A
The failure rate inherent in the method if the patient uses it correctly 100% of the time
6
Q
what is the method of contraception causes the most unintended pregnancies?
A
Withdrawal method
7
Q
what are the two most effective contraceptive method?
A
1 is an Implantable contraceptive rod (0.05 unintended pregnancy)
#2 Progesterone IUD (0.2 unintended pregnancy)
8
Q
what are three examples of long-acting reversible contraception?
A
IUD (copper, levonorgestrel)
Implantable
Injectable
9
Q
what method of contraception can last up to 10 years?
A
Copper IUD
10
Q
An IUD with progesterone can last up to how many years?
A
3-5 years
11
Q
What method of contraception can result in an abnormal pap test?
A
Cervical cap with spermicide
12
Q
what is the size of the implantable rod?
what hormone does it contain?
A
4cm by 2mm rod
It contains a progestin (Etonogestrel)
13
Q
what is the main side effect of nexplanon?
A
It is irregular, unpredictable vaginal bleeding that can continue even after several months of use
14
Q
why was there a disinterest in IUDs in the past?
A
Because the risk associated with pelvic inflammatory disease and infertility
15
Q
when is IUD insertion best accomplished? and why?
A
when the patient is menstruating
this time is beneficial because the patient is not pregnant and her cervix is slightly open
16
Q
Can breastfeeding women get an IUD?
A
yes, they also demonstrate a lower incidence of post insertional discomfort and bleeding
17
Q
What does IUD insertion include?
A
Sterile procedure, vaginal prep with povidone-iodine solution prior to insertion, bimanual examination before insertion to determine likely direction of insertion into the endometrial cavity, loading of the iud into the inserter then careful placement to the fundal margin of the endometrial cavity
18
Q
IUD expulsion rate is greatest when?
A
It is greatest in the first few months of use
19
Q
What are symptoms of IUD explusion?
A
cramping, vaginal discharge, or bleeding though it can be asymptomatic, sometimes the lengthening of the IUD string or the partner feeling the device during intercourse is a sign
20
Q
How quick can an IUD be placed postpartum?
A
After 10 minutes of delivering the placenta or intraoperative during a cesarean before the closure of the hysterotomy incision.
**expulsion rate is higher
21
Q
what is the mechanism of action of a hormonal IUD?
A
Prevents the sperm and egg from meeting by thickening the cervical mucus. This decreases the number of sperm that enter the uterine cavity, the uterine lining thins
22
Q
What is the mechanism of action for the copper IUD?
A
The copper ions act as a spermicide which inhibits sperm motility
23
Q
what are side effects of LNG-IUD?
A
decrease in menstrual blood loss (up to 50%) and severity of dysmenorrhea
**serum progesterone levels are not affected
24
Q
what are side effects of the Cu-IUD?
A
associated with heavier periods and dysmenorrhea that often result in discontinuation
25
when is risk for infection greatest with an IUD?
the first 20 days after insertion
26
If a pelvic infection occurs 3 months or more after IUD insertion, what can be presumed?
An acquired STD
27
Can IUD remain in place if patient tests positive for STIs or BV?
Yes it can remain in place unless there is evidence of spread of the infection to the endometrium or fallopian tubes and/or failure of treatment with appropriate abxs.
28
Patients who become pregnant with an IUD will likely what?
have a spontaneous abortion in the first trimester
IUD removal should be offered if string is visible
29
Pregnancy with IUD instrumental removal may be performed but
risk of pregnancy disruption is increased
30
If an IUD is left in place while pregnant, what is the risk?
Preterm labor and delivery
31
What are the routes of administration of Depot medroxyprogesterone acetate?
A injectable progestin given as IM or Subcutaneous injections
32
How often does the Depot medroxyprogesterone acetate need to be given?
every 13 weeks though it can be given up to 15 weeks after the last injection without requiring additional contraceptive production
33
When the the first Depot shot be given?
within the first 5 days of the current menstrual period, if not a backup method of contraception is necessary for two weeks
34
what is the mechanism of action for DMPA?
acts by maintaining a high level of progestin to block LH surge and thus ovulation. suppresses estradiol
35
What is the side effect of DMPA?
Suppresses production of estradiol and associated with bone mineral density loss.
36
What is the FDA warning for DMPA?
limit or consider alternative use beyond 2 years
37
what are noncontraceptive benefits of DMPA?
decreased risk of endometrial carcinoma and iron deficiency anemia.
can improve pain management associated with endometriosis, endometrial hyperplasia, and dysmenorrhea
38
what are the side effects of DMPA?
irregular bleeding which decreases with each injection so that 80% of women are amenorrheic after 5 years
39
When DMPA is discontinued when do normal menses usually resume?
within 6 months
40
what education is important for postpartum women that elect to receive the depo shot?
no effect on milk quality of breast milk or on baby, increases the quantity of breast milk, can be administered immediately postpartum.
41
What indications are some indications for women to take DMPA?
Breast feeding
women with seizure disorders
sickle cell anemia
anemia secondary to menorrhagia
42
Describe the effect DMPA has on seizure medications
There is no effect, antiseizure medications are unaffected. sedative effects of progestins may aid in seizure control
43
What is the mechanism of action for the the progestin component of combination OC ?
suppressing secretion of Luteinizing hormone and in turn, ovulation....it thickens cervical mucus, inhibiting sperm migration
44
what is the mechanism of action for the estrogen component of combination OC?
suppressing secretion of the follicle-stimulating hormone and preventing maturation of the follicle
45
what hormonal component regulates the cycle?
Estrogen
estrogen improves the cycle control by stabilizing the endometrium and resulting in more regular cycles, allows for less break through bleeding
46
what are important pearls to educate patients about if they chose to do progestin only oral contraceptive?
There is no effect on breast milk production or affect on infants
can be started immediately after delivery
the minipill must be taken at the same time each day, starting on the first day of menses
**if a woman is more than 3 hours late, back-up contraceptive method should be used for 48 hours
offers poor cycle control
47
which predominate hormone effects these:
lipid metabolism, sodium and water retention, increase renin substrate, stimulate cytochrome p450 system , increase sex hormone-binding globulin, reduce antithrombin III
Estrogen
48
which predominate hormone effects these:
increases sebum, stimulate the growth of facial hair and body hair, induce smooth muscle relaxation, increase the risk of cholestatic jaundice
Progestin
49
what are the benefits of oral contraceptives?
menstrual periods are predictable for combination users, shorter and less painful
reduced risk of iron deficiency anemia
lower incidence of endometrial and ovarian cancers, reduced risk of benign breast and ovarian disease, and pelvic infection
50
what is the most common reason for discontinuation of oral contraception?
abnormal bleeding pattern
this should be managed by encouragement and reassurance, will resolve on its own
51
If breakthrough bleeding occurs while on oral contraceptives, it is associated with progestin-induced decidualization, what is the treatment?
a short course of exogenous estrogen (1.25 mg conjugated estrogen for 7 days) given while the patient continues cOCP use usually stabilizes the endometrium and stops the bleeding
52
What are some side effects of estrogen?
bloating, weight gain, breast tenderness, nausea, fatigue, or headache
53
what are some drugs that decrease the efficacy of contraceptive?
barbiturates, benzos, phenytoin, carbamazepine, rifampin, sulfonamides.
other that can slow the biotransformation: anticoagulants, methyldopa, phenothiazines, reserpine, and TCAs
54
when should the patch be applied?
start the patch during the first 5 days of her menstrual period and replace it weekly for 3 weeks.
55
what are some locations for the patch to be applied?
clean, dry skin located on the buttocks, upper outer arm, or lower abdomen
56
The contraceptive vaginal ring can be taken out for up to how many hours?
3 hours at most
57
how long should the sponge be left in the vagina after having sex?
leave in place 6-8 hours after coitus
58
the diaphragm can be inserted up to how many hours before intercourse?
up to 6 hours before intercourse
59
the diaphragm should be left in place how many hours after intercourse?
6-8 hours afterward
60
what is the important to know about diaphragms?
they have to be sized by a provider
significant weight change, vaginal birth, or pelvic surgery may suggest need for larger size.
61
what is a side effect of diaphragms?
women who use diaphragms are more likely to get a UTI
62
what is the active ingridient in spermicides?
nonoxynol-9
63
what is the basal body temperature method?
a biphasic pattern with a rise in basal body temperature of 0.5F to 1F is indicative of ovulation, the couple must abstain from intercourse from the end of the menstrual period until 3 days after the temp increases
64
Emergency contraception can be used up to how many days after unprotected sex?
5 days though most effective within 24 hours
65
what is vulvovaginitis?
a spectrum of conditions that cause vaginal or vulvar symptoms such as itching, burning, irritation, and abnormal discharge.
66
what are the three most common causes of vaginitis?
bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis.
67
The pH level of a patient with candidiasis is usually what?
Normal (compared to others being abnormal)
68
What is bacterial vaginosis?
It is a polymicrobial infection characterized by a lack of normal hydrogen-peroxide producing lactobacilli and overgrowth of facultative anaerobic organisms including G.Vaginalis, mycoplasma hominis, bacteroides species, peptostreptococcus species, fusobacterium species,etc.
69
on microscopic examination, what kind of cells are shown for bacterial vaginosis?
clue cells
70
What is the GOLD standard for laboratory diagnosis of BV?
Gram Stain (but its more commonly dx clinically)
71
what are the 4 criteria that a provider can diagnose bacterial vaginosis? (**only need 3 of the 4)
abnormal gray discharge
pH greater than 4.5
positive whiff test
presence of clue cells
72
what is the treatment for bacterial vaginosis?
can be treated with oral or topical metronidazole as well as clindamycin.
73
What is the treatment for a pregnant woman with Bacterial vaginosis?
the same as a non-pregnant patient
Oral or topical flagyl or clindamycin.
74
what is the most common complaint for women with candidiasis?
Itching is the most common
Other symptoms:
burning
external dysuria
dyspareunia
75
Patients who have self administered over the counter medications for candidiasis should stop how many days before their office visit?
should be advised to stop treatment 3 days before their office visit.
76
What is the treatment for candidiasis?
single dose oral therapy with fluconazole 150 mg.
It is recommended though that treatment for vulvovaginal candidiasis begin with topical imidazoles for 7 days (miconazole, clotrimazole, butconazole, tioconazole, and terconazole)
77
What type of organism causes Trichomonal vulvovaginitis?
It is a flagellate protozoan that lives only in the vagina, skene ducts, and male/female urethra
78
How is T.vaginalis (trichomoniasis) transmitted?
It is transmitted by sexual contact AND fomites (inanimate objects, clothes, utensils, furniture)
79
what can be seen on a patient's cervix or upper vagina in a person who has trichomoniasis?
Petechiae or strawberry patches (only in about 10% of pts)
80
what is the treatment for Trichomonas infections?
Metronidazole or tinidazole
81
What is important for patients to do while on metronidazole?
abstain from alcohol to avoid a disulfiram like reaction
82
Is metronidazole safe during pregnancy?
yes it is safe
83
What is the cause of atrophic vaginitis?
The atrophy of the vaginal epithelium is caused by diminished estrogen levels
84
what symptoms are common in women who have atrophic vaginitis?
decrease vaginal discharge, dryness, itching, burning, or dysparenuria
85
What is the treatment for atrophic vaginitis?
treated with local water-based moisturizing preparation or topical or oral estrogen therapy
86
what are some risk factors for pelvic support defects?
genetic predisposition, pairty-vaginal birth), menopause, advancing age, prior pelvic surgery, connective tissue disorders, factors associated with elevated intra-abdominal pressure (obesity, chronic constipation).
87
what is cytocele?
prolapse of the bladder
88
what is rectocele?
prolapse of the rectum
89
what is the uterine prolapse with enterocele?
hernia at the top of the vagina allowing the small bowel to herniate through
90
what are nonsurgical alternatives for women with prolapse ?
pessaries, pelvic floor exercises, and symptom directed management
91
what are pessaries?
They are removable devices made out of rubber, plastic, or silicone. They can be utilized as first-line therapy for most cases of prolapse regardless of the prolapse stage or the site.
92
what is the detrusor muscle?
it its the layer of muscle that lines the interior bladder wall which sends signals to the brain.
93
A patient with an overactive detrusor muscle has what type of incontinence?
urge incontinence
94
what is the most common form of incontinence in young women?
stress incontinence
95
what is mixed incontinence?
Stress and urge incontinence together
96
what is overflow incontinence ?
the bladder does not empty completely during voiding due to an inability of the detrusor muscle to contract--could be due to an obstruction of the urethra or a neurologic deficit that causes the patient to lose the ability to perceive the need to void
97
Evaluation of urinary incontinence includes what?
a history, physical exam, direct observation of urine loss, measurement of postvoid residual volume (PVR), urine culture, and urinalysis
98
what is the goal of initial testing for incontinence?
To rule out a UTI, neuromuscular disorders, and pelvic support defects
99
What are some lifestyle interventions that may help modify incontinence?
weight loss, caffeine reduction, fluid management, reduction of physical exertion (work and exercise), cessation of smoking and relief of constipation.
100
Pelvic muscle training (Kegel exercises) are extremely effective in treating what type of incontinence?
stress incontinence
101
Behavioral training is aimed at increasing the patient's bladder control and capacity by gradually increasing the amount of time between voids. It is often used to treat what type of incontinence?
Urge incontinence
(can also treat stress and mixed incontience)
102
what are some risk factors for UTIs in premenopausal women
history of UTI
frequent or recent sexual activity
diaphragm contraception use
use of spermicidal agents
increasing parity
obesity
DM
sickle cell trait
anatomic abnormalities-congenital
urinary tract calculi
indwelling catheter
103
what are risk factors for postmenopausal women
vaginal atrophy
incomplete bladder emptying
poor perineal hygiene
rectocele, cytocele, urethrocele, or uterovaginal prolapse
lifetime hx of UTi
DMT1
104
An upper UTI is also called what?
acute pyelonephritis
105
what are common symptoms of a lower urinary tract infection?
frequency, urgency, nocturia, and/or dysuria
106
what are the common symptoms of an upper urinary tract infection?
fever and chills, flank pain, and varying degrees of dysuria , urgency, and frequency
107
What is this definition?
Infection that is limited to the lower urinary tract and occurs with symptoms of dysuria and frequent and urgent urination and occasionally, suprapubic tenderness
Cystitis
108
What is this definition?
Infection of the renal parenchyma and pelvicalyceal system accompanied by significant bacteriuria, usually occurring with fever and flank pain.
Acute pyelonephritis
109
what is the American College of Obstetrics and Gynecology recommendation for routine cervical cancer in average-risk women for ages 21 to 29?
Every 3 years using cervical cytology(PAP), No HPV testing in women younger than 30 as it is not recommended.
110
what is the American College of Obstetrics and Gynecology recommendation for routine cervical cancer in average-risk women for ages 30 to 65?
A pap test and cervical HPV testing should be done every 5 years or pap test alone every 3 years.
111
what is the American College of Obstetrics and Gynecology recommendation for routine cervical cancer in average-risk women for ages older than 65?
In women who have had three consecutive negative pap tests results no longer needs screening
112
When should an IUD be placed?
within 7 days of the start of the menstrual period (no backup method is needed)
113
IF an IUD is inserted after day 7 of the start of menses what is recommended?
A backup method should be used to a minimum of 7 days
114
what is a major side effect of the copper IUD?
Heavy menstrual bleeding and bleeding between periods, with increased menstrual pain
115
what is the main hormone in the implant (implanon)?
progestin only etonogestrel (ENG) implant
116
When is back up contraception necessary after insertion of the implant?
Back up contraception should be used if insertion occurs after day 5 of the start of menses
117
What conditions are contraindicated for combined oral contraception?
current breast cancer
being less than 21 days postpartum
severe cirrhosis of the liver
current or pmh of DVT
major surgery with prolonged immobilization
vascular disease
having DM for more than 20 years
diabetic retinopathy
hx of migraine with aura
118
if a patient misses to one dose less than 24 hours or one missed within 24-48 hours what is the recommendation?
Take the missed dose asap and then the next dose at the usual time. NO additional contraception is needed
119
if a patient misses two or more doses (more than 48 hours) what is the recommendation?
take the missed dose asap and discard any other missed pills and continue taking the remaining pills at the regular time. use a back up form of birth control or avoid sexual activity until the remaining pills have been taken for 7 consecutive days.
120
the US FDA package insert indicates that b/c the postpartum period lends itself to a higher risk of thromboembolism, OCPs should be started no earlier than 4-6 weeks after delivery in nonnursing mothers.
Many patients who are breastfeeding inquire about starting on OCP. B/c the estrogen decreases the amount and quality of breast milk, OCP ARE NOT RECOMMENDED for lactating women.
121
what type of oral contraception is okay to use in postpartum women who are breastfeeding?
Progestin only OCPs
122
Women who will be undergoing surgery and postoperative bed confinement should discontinue OCPS how many weeks before surgery?
at least 4 weeks before surgery
123
what are some side effects of the patch?
breakthrough bleeding, tenderness, headache, application site reactions, nausea, dysmenorrhea.
124
what are some medications that decrease the effectiveness of the ring?
Rifampin, Rifampicin, rifamate, griseofluvun, certain HIV meds, st.john's wart
125
Is the contraceptive vaginal ring combination or single?
combination
126
what are the advantages of a progestin only pill?
safe during lactation, may increase the flow of milk, can be used in women older than 35 years, it can be used in women with sickle cell disease, and it can be used in women with myomas. less likely to cause headaches, high blood pressure, depression, cramps,premenstrual syndrome, or elevations in glucose
127
what is the FDA black box warning for the DEPO shot?
long term use can cause loss of bone mineral density
128
what should the patient do to avoid UTIs with a diaphragm?
Urinate before inserting and after removing the diaphragm
129
what is the most common benign breast disorder?
Fibroadenoma--referred to fibrocystic changes or fibrocystic disease and the most common breast lesions
130
what are characteristics of benign breast disorders/
breast masses or lumps are tender and usually bilateral
there may be rapid fluctuation in the size of benign masses. Tenderness and size of the mass may increase before menses.
131
what is the first test performed for a breast mass?
diagnostic mammogram
132
if a woman who has breast tissue that is too dense, what alternative test may be done?
digital breast tomosynthesis
133
what is the treatment for fibrocystic breast disease?
Consists of avoiding trauma, wearing a firm bra throughout the day and night, eliminating coffee, tea, and chocolate from the diet, and taking 400 IU of vitamin E daily. Med-diuretics, oral contraceptives, NSAIDs, and supplemental progrstin
134
what is the treatment for fibrocystic breast disease?
Consists of avoiding trauma, wearing a firm bra throughout the day and night, eliminating coffee, tea, and chocolate from the diet, and taking 400 IU of vitamin E daily. Med-diuretics, oral contraceptives, NSAIDs, and supplemental progestin
135
what are the causes of abnormal uterine bleeding?
PALM-COEIN
polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified
136
what procedures are used to diagnose cervical cancer?
colposcopy, cervical biopsy, and endocervical curettage are used to diagnose cervical cancer
137
In women older than 30 years who are HPV positive and have an atypical squamous cells of undetermined significance or other abnormal pap test result should be referred for what?
colposcopy
138
In women aged 25 years and older with low grade squamous intraepithelial lesion should be referred for what ?
Colposcopy
139
If a teen is have abnormal uterine bleeding what 2 contraceptive methods are offered?
medroxyprogesterone (DEPO) or OCPs
140
what is dysparunia?
painful sexual intercourse, can be a result of introduction of the penis into the vagina or deep penile penetration. Can also be experienced by sex toys or multiple fingers.
141
what is prostatodynia?
it is designated as unexplained chronic pelvic pain in men
141
what are some differentials for pelvic pain?
pelvic inflammatory disease, ruptured ovarian cyst, torsion of an ovarian cyst, ovary or fallopian tube, or ectopic pregnancy with rupture
142
what is puerperal mastitis?
a cellulitis that develops in the lactating or nonlactating breast after childbirth.
143
when does puerperal mastitis occur?
it usually occurs in the 2nd to 6th week postpartum though can occur even after breastfeeding for 1 year
144
what is periductal mastitis?
it is an inflammatory process that occurs around these ducts
145
what is the causative organisms for mastitis?
S.aureus
146
True or false:
Breast cancer is second only to lung cancer as the leading cause of cancer death among women and is the main cause of death in women aged 40 to 44 years.
True
147
what is the USPSTF's recommendation for breast cancer for biennial screening?
Start at age 50 to 74 years of age.
There is no recommendation for women over the age of 75.
148
what is the American cancer society's recommendation for breast cancer screening annually and biennial?
screening mammograms begin at the age of 45 and performed annually in women 45 to 54 years
biennial screening for women 55 years and older with the opportunity to screen annually.
149
what are the risk factors for breast cancer?
female gender
increasing age (over 50)
hx of breast ca in situ or invasive
residing in north america or northern europe
early menarche (before 12 yrs)
late menopause (after 55 yrs)
nulliparity or first live birth at a late stage (after 30 yrs)
long term use of postmenopausal hormone therapy especially combined hormonal therapy
exposure to high dose radiation
hx of ovarian or uterine ca
high fat diet, being overweight, obesity
alcohol consumption (2 or more drinks per day)
physical inactivity
cigarette smoking
exposure to pesticides and other chemicals
150
when a patient is diagnosed with breast cancer who do you refer the patient to?
Referred to oncology specialist, such as a surgeon, medical oncologist, and/or radiation oncologist for the treatment of the disease
151
what is a common medication used that is an anti-estrogen for women who have been diagnosed with breast cancer?
tamoxifen
the treatment period is 5 years
152
what are potential adverse effects of tamoxifen?
mild nausea, hot flashes, menstrual irregularities, vaginal discharge, vaginal dryness and irritation, benign ovarian cysts, thromboembolic events, and ophthalmological toxicities.
153
What is the follow up schedule for someone who has had breast cancer?
every 3-6 months during the first 3 years, every 6 months for the next 2 years, and annually after the fifth year
154
when should a baseline mammogram be done after tumor excision and at the completion of all treatment?
a baseline mammogram should be done at 3 to 9 months after
155
what hormone is mostly responsible for the growth of adipose tissue and lactiferous ducts?
estrogen
156
what hormone is responsible for lobular growth and alveolar budding?
Progesterone
157
when is the best time (phase) to do a breast examination?
In the follicular phase of the menstrual cycle
158
what is mammography ?
It is an x-ray technique used to study the breast. It is able to detect lesions approximately 2 years before they become palpable.
159
when is a diagnostic mammogram necessary?
It is done to supplement an abnormal screening mammogram or if a woman has a breast complaint and/or palpable mass especially if they are over 40 yrs.
160
in women younger than 30 years, what is the most common initial modality to use to evaluate a breast mass because the breast is mainly composed of glandular tissue?
Ultrasonography
161
when would you expect to use MRI as a breast diagnostic?
IT is used as an adjunct for early detection of breast cancer in women who are HIGH risk and can be used for postcancer evaluation of breast involvement
162
What is fine needle aspiration used for in evaluation breast cancer?
To determine if a palpable lump is a simple cyst. If fluid is clear, it does not need to undergo pathologic evaluation and the patient may return for a clinical breast exam in 4-6 months if the mass disappears.
If it reappears, the patient is managed with diagnostic mammography and ultrasonography.
blood aspiration should be evaluated cytologically and pt should have diagnostic mammography and ultrasonography
163
what is mastalgia?
breast pain
164
when does cyclic mastalgia begin?
In the luteal phase of the menstrual cycle, resolves after the start of menses. pain is usually bilateral, and often involves the upper quadrant of the breast.
165
what is noncyclic mastalgia?
it is not associated with the menstrual cycle and includes etiologies such as tumors, mastitis, cysts, and hx of trauma or breast surgery. Can be idiopathic
166
what is the only medication FDA approved for treating mastalgia?
Danazol (androgenic horomone)
167
what are some characteristics of breast mass malignancy?
size greater than 2CM, immobility, poorly defined margins, firmness, skin dimpling or color changes, retraction or change in the nipple (scaling), bloody nipple discharge, and ipsilateral lymphadenopathy
168
Masses that are solid, round, rubbery, and mobile on examination are typically what?
simple fibroadenomas
169
True or false:
Breast cancer is the second most common malignancy in women, ranking only behind skin cancer.
True
170
BRCA-1 gene is located on what chromosome ?
Chromosome 17
associated with nearly half the early-onset breast cancers and 90% of ovarian cancer
171
BRCA-2 gene is located on what chromosome?
Chromosome 13, this has a lower incidence of early-onset breast cancers and much lower risk of ovarian cancers compared to BRCA1
172
what is TNM stand for?
T is for primary Tumor
N is for regional lymph nodes
M is for distant metastasis
173
What is removed in a mastectomy ?
It is removal of all breast tissue and the nipple areolar complex with preservation of the pectoralis muscles.
174
what is a modified radical mastectomy?
removal of all breast tissue and nipple areolar complex and axillary lymph nodes.
175
what medication is typically given as adjuvant (systemic) therapy?
Tamoxifen and raloxifen, given as a 5 year course of therapy
176
what are the views of breast self exams between ACOG and USPSTF?
ACOG supports the practice of breast self exam only in high risk pts and for self-awareness in low risk pts.
USPSTF found insufficient evidence for teaching breast self exams.
177
what are the views of mammography between ACOG and USPSTF?
ACOG does not recommend mammography be performed until after the age of 40 yrs.
USPSTF recommends to start biennial screening before age 50 if it is an individual one and pt context taken into account.
178
For women who have inheirted genetic mutation placing them at increased risk, the recommendations are:
monthly breast self-exams beginning at 18-20
annual Clinical breast exams
screening mammograms beginning after age 25 (or 5-10 yrs before the age of diagnosis of the affected relative)
179
what are the cervical cancer subtypes of HPV?
16 and 18
180
what does ASC-US mean?
Atypical squamous cells of undetermined significance
181
what does LSIL mean?
Low grade squamous intraepithelial lesion
182
what does ASC-H mean?
Atypical squamous cells, can't rule out HSIL
183
what does HSIL mean?
High grade squamous intraepithelial lesion
184
For a woman aged 21-24, who gets a normal pap result, what is the recommendation?
Routine screening pap test every 3 years
185
for a woman aged 25 to 29, who has a normal pap, what is the recommendation?
routine screening pap test every 3 yrs
186
for a woman aged 30 and older with a negative pap and negative HPV, what is the recommendation?
co-test again in 5 yrs OR pap test alone in 3 yrs
187
for a woman aged 30 and older with a normal pap and positive HPV, what is the recommendation?
repeat co testing in 1 year
HPV typing acceptable
188
ACOG recommends women starting at what age for breast mammograms? and how often?
at age 40 and annual mammograms
to discontinue,
189
what is dysmenorrhea?
defined as painful menstruation
190
what are symptoms associated with dysmenorrhea?
diarrhea, nausea, vomiting, headache, and dizziness
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what is primary dysmenorrhea?
caused by excess prostaglandins, leading to painful uterine muscle activity that is produced by the endometrium.
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what is chronic pelvic pain?
refers to noncyclic pelvic pain that lasts more than 6 months
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what are some secondary causes of dysmenorrhea?
secondary dysmenorrhea is caused by structural abnormalities or disease processes that occur outside the uterus, within the uterine wall, or within the uterine cavity.
endometriosis, adenomyosis, pelvic inflammatory disease, leiomyomata
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what is endometriosis?
the presence of endometrial glands and stroma outside the uterus
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what is adenomyosis?
presence of ectopic endometrial tissues within the myometrium
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what is leiomyomata?
uterine fibroids
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when does primary dysmenorrhea occur?
occurs on the first 1 to 3 days of menstruation
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when does secondary dysmenorrhea occur?
the pain often lasts longer than the menstrual period. may start before, become worse during menstruation, persist after menstruation ends
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what is easily recognizable on a bimanual exam when assessing for secondary causes of dysmenorrhea?
adenomyosis
