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EOR - Surgery > OBGYN > Flashcards

OBGYN Flashcards

1
Q

pain management in PACU following ambulatory surgery

A

short acting IV opioids
PO opioids
APAP/opioid combo
d.c: NSAIDs

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2
Q

pain management for minimally invasive intraabdominal procedures

A

regional anesthesia:
nerve blocks
PCA vs nurse administered opioid boluses

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3
Q

pain control for major open abd/thoracic surgery and for pt who is dependent on opioids

A

neuraxial analgesia:
continuous epidural analgesia vs single epidural/spinal opioid
epidural vs intrathecal morphine
PCA vs nurse administered bolus

maintain pt’s usual level of opioid therapy

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4
Q

special considerations for opioid dependent pt’s

A

continue methadone/buprenorphine through perioperative period

if IV methadone: decrease to 1/2 dose

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5
Q

mc adenopathies seen w. gynecological infxns (4)

A

axillary
internal mammary
parasternal
supraclavicular

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6
Q

scaling rash/dermatitis of the nipple caused by an invasion of skin cells from a ductal carcinoma

A

paget’s dz of the breast

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7
Q

8 skin changes during pregnancy

A

melasma
spider angiomas/varicosities
striae gravidarum (stretch marks)
pruritis
hirsutism
nail growth
androgenic alopecia
chadwick/goodell sign

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8
Q

tx for pregnancy induced pruritis

A

chlorpheniramine (first gen antihistamine)

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9
Q

bluish/purplish coloration of the vagina during pregnancy

A

chadwick sign

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10
Q

bluish/purplish coloration of the cervix during pregnancy

A

goodell sign

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11
Q

mc benign breast tumor

A

fibroadenoma

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12
Q

do fibroadenomas wax/wane w. menstruation

A

no!

but pt may experience increased discomfort

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13
Q

describe a fibroadenoma

A

painless, firm, solitary, rubbery, well defined mobile mass

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14
Q

mc location for fibroadenomas

A

upper, outer quadrants

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15
Q

etiology for fibroadenomas

A

probs hormonal due to:
persist during reproductive years
increase during pregnancy or w. estrogen
regress after menopause

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16
Q

dx for fibroadenoma (4)

A

clinical
US
mammogram
FNA
3-6 mo f/u

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17
Q

US finding of fibroadenoma

A

well defined solid mass

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18
Q

t/f: mammograms are not indicated for adolescents to dx fibroadenoma due to large amt of glandular tissue

A

t!

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19
Q

definitive dx for fibroadenoma

A

core bx vs excision

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20
Q

tx for fibroadenoma

A

< 5 cm w.o red flags: obs q 2 mos
if persistent: US
if growth or > 5 cm: excisional bx/surgical removal

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21
Q

benign, slow growing breast tumor w. epithelial and stromal components

A

fibroadenoma

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22
Q

common benign breast condition consisting of fibrous and cystic changes in breast

A

fibrocystic breast dz

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23
Q

FNA findings of fibrocystic changes

A

straw colored/green fluid

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24
Q

tx for fibrocystic dz

A

no caffeine
NSAIDs
vit E
primrose oil

last resort: danazol, OCP

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25
mcc of bloody nipple d.c in a young woman
intraductal papilloma
26
3 mc causes of nipple d.c in a non lactating woman: mc -> lc
duct ectasia intraductal papilloma carcinoma
27
characteristic of d.c due to fibrocystic dz (5)
premenopausal spontaneous multiple duct unilateral or bilat just before menstruation green/brownish
28
milky discharge in nonlactating breast
hyperprolactinemia
29
4 characteristics of neoplastic nipple d.c
bloody associated mass unilateral single duct
30
work up for nipple d.c (3)
mammogram vs US serum prolactin TSH
31
tx for nipple d.c
treat underlying cause proximal duct excision if benign but annoying
32
mc type of breast carcinoma
ductal located in upper outer quadrant
33
7 rf for breast carcinoma
first degree relative w. hx age > 65 onset of menarche < 12 yo postmenopausal HRT obesity etoh BRCA1/BRCA2
34
hard non tender mass is likely what type of breast carcinoma
adenocarcinoma
35
pharm tx for breast ca (2)
raloxifene tanoxifen
36
45 yo F w. itching of right nipple x 6 mos and a right breast mass
paget's dz (infiltrating ductal carcinoma)
37
5 sx of late stage breast ca
bone pain nipple retraction breast pain arm edema peau d' orange
38
mc ca in adult women
breast
39
BRCA1 and BRCA 2 increase risk for what 2 cancers
breast ovarian
40
4 types of breast ca: mc -> lc
infiltrating intraductal (IIC) infiltrating lobular paget's dz inflammatory
41
painless, stony hard unilateral mass
IIC
42
IIC begins as _
ductal carcinoma in situ (DCIS)
43
what type of breast ca is frequently bilat
infiltrating lobular
44
chronic, eczematous, itchy, scaling rash on the nipples/areola
paget's dz
45
red, swollen, warm, itchy breast nipple retraction peau d' orange
inflammatory breast ca
46
what type of breast ca is not associated w. a lump
inflammatory
47
peau d' orange is what type of breast ca
inflammatory
48
horomone receptor types w. breast ca: mc -> lc
**estrogen receptive - mc** progesterone receptive HER2
49
USPSTF guidelines for breast ca screening
-50-74 yo: mammogram q 2 yr -fam hx: q 2 y starting at 40 OR 10 years prior to dx of first relative -20-39 yo: breast exam q 3 yr 40 yo: breast exam annually self breast exam montly starting at 20 yo
50
when should self breast exams be performed (i thought we werent saying these are necessary anymore?)
immediately after menstruation or on days 5-7 of menstrual cycle
51
breast ca prevention in high risk pt's
SERM: tamoxifen vs raloxifene
52
indications for SERM
postmenopausal women > 35 yo at high risk (tx for 5 yr)
53
2 mammogram findings of breast ca
microcalcification stellate/spiculated mass
54
US is the best imaging to
delineate cysts
55
definitive dx for breast ca
bx
56
tx for breast ca
**all pt's:** lumpectomy followed by xrt **all pt's w. positive nodes** add chemo **ER positive:** tamoxifen **postmenopausal ER positive:** anastrozole (aromatase inhibitor) **HER2 positive:** monoclonal abs
57
preferred breast ca screening for women who are mutation carriers
MRI
58
spiculated mass
breast ca
59
best breast ca screening for women < 30 yo
US
60
breast ca sites of metastasis (5)
**lymph nodes - mc** lung/pleura liver bones brain
61
4 contraindications to lumpectomy plus xrt
pregnant previous chest xrt positive margins collagen vascular dz (scleroderma)
62
moa for tamoxifen
binds estrogen receptors
63
t/f: tamoxifen can prevent breast ca
t
64
5 s.e of tamoxifen
**endometrial ca** **DVT/PE** cataracts hot flashes mood swings
65
6 characteristics of a high risk tumor w. nodal spread (consider chemo)
high risk > 1 cm nuclear grade s phase ER negative HER2 positive

EOR - Surgery (13 decks)

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