Obgyn Flashcards
Adenopathy
Enlargement of LN d/t gyne infx, maligancy or inflammation
MC breast dz - axillary
Skin Changes ddx
Melasma - hyperpigmentation in pregnant women or those taking OCP
Vascular Changes - estrogen causes vascular distention and instability, blood vessel proliferation during pregnancy
- Spider angiomas - 2nd to 5th month of pregnancy
- Varicosities - saphenous, vulvar and hemorrhoidal varicosities occur at incr rates during pregnancy.
Striae gravidarum - stretch marks
Pruritis - physiologic
- Chlorpheniramine - 1st gen AH choice during pregnancy
Hirsutism - face but also arms, legs, back
Nails grow faster
Androgenic alopecia - rarely, late, frontoparietal area
Vaginal - bluish/purplish coloration of vagina (Chadwick sign) and cervix (Goodell)
Fibroadenomas
Benign Breast Disease
MC Benign breast condition = young adolescent women
Sxs:
- painless, firm, smooth, well circumscribed, mobile nodule, gradually grows over time
- No axillary or nipple invovlement
Dx
- US +/- mammogram OR
- FNA or excision bx
Tx - FNA bx or excisional bx
Fibrocystic
Benign Breast Disease
2nd MC benign breast condition
Sxs
- painful, swollen, lumpy, breast, bilaterally
- well circumscribed, rubbery lumps, discrete, relatively moveable
- Change in size correlates w/ menstrual cycle - resolves at start
Dx
- breast cyst aspiration = straw color liquid w/ no blood
- US +/- mammo
Tx
- NSAID
- heat/Ice, supportive bra
- Resolves spontaneously
Nipple Discharge
MCC of nipple discharge in nonlactating breast -
- Ductal Ectasia
- Intraductal papilloma
- Carcinoma
Premenopausal women - spontaneous nipple discharge - just before menstruation, mc d/t fibrocystic changes (green or brownish)
- milky discharge mc d/t hyperprolactinemia
- Neoplastic
- Single duct
- Associated mass
- Bloody dc
Dx
- Mammogram + US
- serum prolactin r/o pituitary tumor
- TSH r/o hypothyroidism
Tx
- dep on cause
- Proximal duct excision - tx and dx
Breast Carcinoma
RF, Tumor types
RF
- Nulliparity
- early menarche < 12 or late >17
- fam hx - BRCA1, BRCA2
- incr estrogen exposure - postmeno HRT
Tumor types
- MCC - Infiltrating Intraductal Carcinoma (DCIS)
- classic painless, stony, hard unilateral mass
- Infiltrating Lobular - bilateral
- Inflammatory Breast cancer - Padget’s disease of the breast; tough skin, peau d’orange
- ER + or PR + or HER +
Breast Carcinoma
Screening, dx
Mammogram Guidelines
- age 40-44 - choice to start mammogram
- 45-54yo - mammogram q 1 year
- 55+ = mammogr q 2 years
- no more screening 75+
Dx
- Aspiration
- Mammography - microcalcification
- US - delineating cysts
- Breast bx** - gold std
Breast Carcinoma
tx
Segmental mastectomy/lumpectomy => breast irradiation in all patients w/ adj chemo, with + nodes
- Anti-estrogen (Tamoxifen)- ER+ tumors
- Aromatase inhibitors (Anastrozole, letrozole) - post menopausal ER+ w/ breast cancer
- Monoclonal AB (Trastuzumab) tx - HER2+
-
SERM
- Tamoxifen or Raloxifene
- post menopausal F > 35yo w/ high risk
- treat for 5 years
Pain ddx
Perioperative pain
- usu from inflammation from tissue trauma, direct nerve injury
- Pain control tailor for individual need - minimize opioid
Following Ambulatory Sx
- Tx acute pain w/ IV opioids => PO opioids or acetaminophen/opioid combo
Minimally Invasive Intraabdominal Sx
- Regional analgesic techniques
- PCA
Major Open thoracic or abdominal Sx
- Morphine via epidural (up to 3mg) or intrathecal (0.2mg morphine)
- if post op prolonged fasting => fentanyl patch
For those taking Methadone - continue usu dose or 1/2 IV dose
Continue buprenophrine - & max nonopioid analgesic
For morbidly obese pats - use postop epidural anagelsia to reduce systemic opioid req’s
