MTB (3) 2 Flashcards
MCC of nipple discharge
Intraductal Papilloma
- Bloody
Workup discharge that is what?
Unilateral
Spontaneous
Bloody
Ass’d with a mass
Workup for Intraductal Papilloma
Mammogram
Surgical duct excision
When do we do cytology for nipple discharge
Never
Workup for BL, milky nipple discharge?
Prolactinoma
How does fibrocystic dz of breast present
BL
Painful Breast lumps
Pain varies w menstrual cycle
Simple cyst with sharp margins, collapses on FNA
Tx for fibrocystic dz
OCPs
Presentation of fibroadenoma
Discrete, firm, nontender, highly mobile breast nodule
FNA of fibroadenoma
Epithelial stromal elements
Workup for pt with breast mass
Breast exam
US or Mammography
FNA Bx
First step in workup of a palpable mass that feels cystic
US
Invasive Ductal carcinoma
> 2cm
HER2 = prognostic factor
How to check for HER2 expression
FISH
IHC
Tamoxifen increases risk of what
Endometrial cancer
Tamoxifen benefits
Decrease serum cholesterol, CV risk
increased bone density = decreased Fx
d
Causes of enlarged uterus
Pregnancy
Leiomyoma
Adenomyosis
Leiomyoma Presentation
Smooth muscle growth of myometrium AA female Childbearing age Secondary dysmenorrhea and menorrhagia \+/- sx's of rectal, ureter or bladder compression
Workup for Ovarian mass
B-HCG
US
Laparoscopy/Laparotomy if complex of > 7 cm
Leiomyoma on pelvic exam
Enlarged
firm
asymmetric
NONtender uterus
What is the difference b/t leiomyoma and adenomyosis
Leio - Asymmetrically enlarged and NON tender
Adeno - Symmetric and tender
How do simple ovarian cysts present
Asymptomatic unless torsion
Dx test for simple cyst
US shows fluid-filled simple cyst
Management of simple cyst
F/U in 6-8 weeks + steroid contraception for PPX
Laparoscopic removal if > 7 cm or steroid did not prevent
What seizure medication is ass’d w PCOS
Valproic acid
Postmenopausal woman with severe hirsutism and virilization
Ovarian hyperthecosis - nests of luteinized theca cells in ovarian troma
High levels of androgens
Management of ovarian hyperthecosis
OCPs (both E and P) = suppress androgens by lowering LH of theca cells
Decrease free androgens = stimulate SHBG
How does a luteoma of pregnancy present
Incidental finding on c-section or postpartum tubal ligation
Fetal and maternal hirsutism and virilization
Theca Lutein cysts - what are they?
Labs?
In whom?
Benign neoplasms
High FSH and B-hCG
Twins/molar pregnancies
Theca Lutein cysts Management
Spontaneously regress
Postmenopausal woman w abdominal distension, ovarian mass - first step?
CT to assess mass and confirm ascites (peritoneal seeding)
If ascites present w ovarian mass postmenopausal woman, next step?
Laparotomy, oophorectomy, surgical staging
9 yo girl with R adnexal pain and complex cystic mass on US?
Germ cell tumor
MC malignant - dysgerminoma
Germ cell tumor markers
LDH
B-hCG
a-FP
67 yo woman w progressive wt loss, distended abdomen, and L adnexal mass
EPithelial tumor = MC ovarian cancer in postmenopausal women
MC malignant = serous
Tumor markers for Epithelial tumor of ovarian cancer
CA-125
CEA
58 yo w postmenopausal bleeding. EMB - endometrial hyperplasia. Pelvic US shows R ovarian mass
Granulosa-theca stromal tumor
Secretes estrogen causing causing endometrial hyperplasia
48 yo c/o increased facial hair and deepening of voice. Adnexal mass on exam
Sertoli-Leydig cell stromal tumor
Secretes testosterone
64 yo presents w hx of gastric ulcer, recent worsening dyspepsia, wt loss, abd pain. Adnexal mass is found
Mets gastric cancer
Krukenberg tumor
Tumor marker for krukenberg
Mucin producing tumor from stomach
TX for ovarian masses
Sonogram/CT = postmenopausal Bx via laparoscopy for simple cysts Tumor markers Cystectomy - benign Premenstrual - Salpinoophorectomy (SO) Postmenopausal - TAH, BSO, post op chemo
What is workup for pt with ASCUS
Do HPV testing:
Negative -> Repeat pap 6 mos
Positive -> Colposcopy
What imaging study is done for cervical cancer
None. Only gyn cancer that is not staged clinically
What is management for invasive cervical cancer
Simple hysterectomy
Modified radical hysterectomy
WU for pregnant patient and abnormal pap?
Same as non-pregnant
Except endocervical curettage
WHo gets HPV vaccine
All females 8-26
Men 11-22
DDx for Pelvic pain
Cervicitis
Acute salpingoophoritis
Chronic PID
Tuboovarian abscess
WU for Pelvic pain
- Pelvic Exam
- Cervical Culture
- Labs: ESR, WBC
- Sonogram
Pt c/o cervical motion tenderness + lower pelvic pain after menstruation
Acute Salpingoophoritis
Labs for Acute Salpingoophoritis
Positive cultures
High ESR and WBC
Tx for Acute Salpingoophoritis
ABX
