OBGYN #1 Flashcards
MCC Acute Mastitis
Staph Aureus
Symptoms of acute mastitis
Unilateral localized breast pain, cracked nipples or visible fissure, purulent nipple discharge, fever, myalgias, chills
Treatment for acute mastitis
- Supportive
- Anti-Staph ABX: Dicloxacillin, Nafcillin
- Continue breastfeeding
-Erythromycin if PCN allergic
Symptoms of a breast abscess
- Unilateral breast pain (symptoms of acute mastitis)
- Induration and fluctuance
- May have purulent discharge
Diagnostic for breast abscess
- Drainage via Needle aspiration
- I/D + ABX (Dicloxacillin, Cephalexin)
Congestive mastitis is
-Bilateral breast enlargement 2-3 days postpartum due to milk stasis
Management for congestive mastitis
- Breast drainage (manually or breast pump)
- If not breastfeeding, treat with ice packs, tight bras, analgesics and drainage
What is the MC benign breast disorder in reproductive age women
Fibrocystic breast changes
Symptoms of fibrocystic breast changes
-Multiple, painful or painless breast masses that may increase or decrease in size with menstrual hormonal changes (often worse prior to menstruation)
Diagnostic of choice for fibrocystic breast changes
US
What does a fine needle aspiration for fibrocystic breast changes show
straw colored or green fluid (no blood)
Treatment for fibrocystic breast changes
Supportive
Explain fibroadenoma of the breast
Benign solid tumor that is usually nontender.
-Firm, contender, solitary, smooth, well-circumscribed, freely mobile, rubbery lump in breast
-Does not change size with menstruation
Definitive diagnostic for fibroadenoma
-FNA: fibrous tissue and collagen arranged in a “Swirl.”
Treatment for fibroadenoma of the breast
-Conservative (observation, reassurance, and follow up)
Causes of gynecomastia
- Spironolactone, Ketoconazole, Digoxin
- Infants (due to high maternal estrogen)
- Hyperthyroidism, Cirrhosis, Klinefelter syndrome, large cell lung cancer
What is often the first line medication for gynecomastia if needed?
Tamoxifen (estrogen antagonist in the breast)
Risk factors for breast cancer
- Genetics: BRCA1 and BRCA2 genes
- Increasing age
- Increased number of menstrual cycles (nulliparity, late first pregnancy, early menarche, late menopause)
- Increased estrogen exposure (obesity, alcohol use, endometrial cancer, OCP)
MC type of breast cancer
Infiltrative Ductal Carcinoma
Paget disease of the breast presents as
Eczematous nipple lesion. May have bloody discharge from the nipple.
Symptoms of a breast cancer mass
- Painless, hard fixed immobile lump
- Unilateral discharge
- Upper outer quadrant
- Axillary lymphadenopathy
MC sites of METs from breast cancer
Bone, lungs, liver, brain
What initial diagnostic is used to evaluate breast masses in women > 40 y/o
Mammography
What initial diagnostic is used to evaluate breast masses in women < 40 y/o
US
What is the most accurate diagnostic test for breast cancer?
Open biopsy
Fine needle aspiration has an advantage and a disadvantage, name them
- Advantage: removes the least amount of tissue
- Disadvantage: if positive, doesn’t allow for receptor testing
Large needle (core biopsy) has an advantage and a disadvantage, name them
- Advantage: allows for receptor testing if positive
- Disadvantage: can leave greater deformity
For early stage breast cancer, what is the treatment?
-Breast conservation therapy (lumpectomy) with sentinel node biopsy and follow up radiation
In estrogen receptor positive tumors, what is the treatment of choice?
Anti-estrogen hormone therapy (Tamoxifen)
-Most useful in premenopausal patients
What is the treatment of choice for ER-positive patients if they are post-menopausal?
-Aromatase inhibitor hormonal therapy (Letrozole, Anastrozole, Exemestane)
What is the screening recommendation for mammograms?
Every 2 years starting at 50 until 74 years old
- Or 10 years prior to when a 1st degree relative was diagnosed
- If breast implants, same screening as without
How often should women have a clinical breast exam?
At least every 3 years in women 20-39 and annually after 40
What medications are used in women at high risk for breast cancer for prevention?
Tamoxifen or Raloxifene
What two types of HPV cause 70% of all cervical cancers worldwide, nearly 90% of anal cancers, and a lot of penile cancer, vaginal/vulvar cancer, and oropharyngeal cancer
HPV type 16 and 18
HPV types ____ and ____ cause 90% of genital warts
6 and 11
What HPV does Gardasil 9 target
6, 11, 16, 18, 31, 33, 45, 52, 58
Inability to maintain pregnancy secondary to premature cervical dilation (in 2nd trimester)
Cervical insufficiency (incompetent cervix)
Symptoms of incompetent cervix
-Painless dilation and effacement of the cervix
What is the most accurate and predictive test for incompetent cervix
Transvaginal US
-If length 25 cm or less before 24 weeks
Treatment for cervical insufficiency
- Cerclage (suturing of os) and bed rest
- May also use weekly injection of 17 alpha-hydroxyprogesterone
How to diagnose infertility
-Hysterosalpingography (to evaluate tubal patency or abnormalities)
What drug induces ovulation?
Clompihene
3rd MC gynecological cancer
Cervical cancer
#1: Endometrial #2: Ovarian
MC type of cervical cancer
Squamous cell carcinoma
What two types of HPV causes most cervical cancer?
16 and 18
Symptoms of cervical cancer
- Post-coital bleeding or spotting
- Cervical discharge (maybe)
Diagnostic for cervical cancer
Colposcopy with biopsy
For carcinoma in situ, what is the treatment of choice for cervical cancer?
Excision preferred (Loop electrical excision, LEEP) -Abalation
> 30 years old and HPV negative, how often should a Pap be done?
Every 5 years
