OB/GYN stuff Flashcards
At what age should breast cancer screening start?
All groups agree 50-75 mammography is preferred. Ages 40-49 shared decision making. <40 usually the risk outweighs the benefits
True or false: breast self exam teaching is recommended as a positive screening tool.
False! it is no longer recommended due to false positive findings and lack of benefit.
What is Cyclic mastalgia?
Bilateral “soreness” that is relieved after menses, related to a hormonal cause.
What is non-cyclic mastalgia? What age does it most commonly occur in?
Most commonly occurs in women 40-50. It is a unilateral, sharp, burning sensation with multiple potential causes including: large breasts, fibroadenoma, cyst, ductal ectasia (inflammation/distension of ducts), mastitis, inflammatory breast CA
What is part of a Galactorreha lab workup? When would this be ordered?
TSH Prolactin Renal labs Pregnancy test. Referral for imaging: US for everyone, Mammogram for women >30 yrs.
This would be ordered if there was visual nipple discharge of unknown cause.
What is the HPV vaccine in the US?
Gardasil
What is the recommended age to receive the HPV vaccine?
Ideally 11-12 (2 doses) but is recommended for 9-26 and approved through age 45. For adults 27+ catch-up vaccination is not routinely recommended d/t likelihood of previous HPV exposure
If ages 15-26, how man doses of HPV vaccination will one receive?
Three! Typically it is two but if received late 3 is recommended.
What are risk factors for HPV infection and cervical cancer?
- Early onset of sexual activity
- Multiple partners
- High risk sexual partner
- Hx of STIs
- Hx of vulvar or vaginal squamous intraepithelial neoplasia or cancer
- Immunosuppression
- Lower socioeconomic status, non-white race
What is the preferred screening for average risk, asymptomatic, immunocompetent patients?
Ages 21-24
25-29
30-65
21-24: cytology alone every 3 years
25-29: cytology with reflex HPV test every 3 years
30-65: cotesting (cytology + HPV test) every 5 years or cytology alone every 3 years
What are risk factors for ovarian cancer?
Hereditary factors
Having children later in life or never having children
Use of estrogen after menopause
What are risk factors for uterine/endometrial cancer?
Obesity Unopposed estrogen therapy increased number of lifetime menstrual cycles Use of Tamoxifen Age: >55 yrs PCOS Hereditary DM2
What are the presenting sx of Ovarian cancer?
Nonspecific subacute symptoms: adnexal mass, pelvic pain, bloating. Acute include: pleural effusion, bowel obstruction
What are the presenting sx of Uterine/Endometrial cancer?
Abnormal uterine bleeding= CARDINAL symptom
abnormal cervical cytology
What are common symptoms of Menopause? What age do women go through this?
Age: 43-57 but average is 51.4. Symptoms: -menstrual irregularities -hot flashes -sleep disturbances -mood symptoms Atrophic vaginitis: dryness, itching, pain with sex -joint pain/OA
What are common side effects of estrogen?
Breast tenderness, bloating, uterine bleeding
What are absolute contraindications to systemic estrogen therapy?
Unexplained vaginal bleeding Hx DVT, PE or clotting disorder Hx breast/endometrial or other estrogen-dependent cancer Hx CHD, stroke or TIA Hypersensitivity to hormone therapy
What are benefits of hormone therapy for menopause treatment?
lowers the risk of: hip fracture, vasomotor symptoms, diabetes
What are risks of hormone therapy for menopause treatment?
Increased risk of stroke, VT and gallbladder disease
What are the major risk factors for decreased bone density (in osteopenia and osteoporosis)?
Increased age Previous fracture long term glucocorticoid treatment low body weight (<127 lbs) Parental history of hip fracture Excess alcohol intake White race Cigarette smoking
When should bone density screening occur for women?
Women: 65+ OR postmenopausal women <65 at increased risk for osteoporosis
What’s the initial pharmacological therapy of Osteopenia and Osteoporosis treatment?
Additional therapy?
Bisphosphonates including Alendronate or Risedronate.
MOA: inhibit bone resorption
Contraindications: esophageal disorders, CKD, inability to sit up for 30-60 min following dosing
Additional: Selective estrogen receptor modulators (Raloxifene, Tamoxifen), Estrogen/progesterone therapy, Anabolic agents
What are the top tier birth control methods?
the implant
IUDs
Copper IUDs
Sterilization
What are mid tier birth control methods?
The pill, the patch, the ring, the shot
