OBGYN Flashcards
Types of Breast CA
Infiltrative ductal
Infiltrative lobular
Paget dz of breast
Most common type of breast CA
INFILT DUCTAL carcinoma
- assoc w/ METs to Axillar nodes
Ductal cancer of breast presenting as Eczematous nipple lesion
Paget dz of the breast
Pre-malignant breast lesion
Lobular carcinoma in situ
Clinical sx of breast CA
painless, hard fixed nodule
unilateral d/c
PE of breast CA nodule
most common in Upper Outer quadrant
Most common site of breast CA mets after Axillary lymphnodes
2 Bs and 2 Ls
Brain
Bone
Lungs
Liver
Peau d’orange
often no lump, just the weird skin appearance
a type of Inflammatory breast CA- red, swollen, warm
orange peel is d/t Lymphatic obstruction
Poor prognosis
Masses that are highly concerning on Mammogram
Microcalcifications
Spiculated
Women is older than 40, what do you use to evaluate breast mass?
Mammogram
Women is younger than 40, what do you use to evaluate breast mass?
Ultrasound
d/t breast density
Most accurate diagnostic test for Breast CA
Open biopsy
as opposed to Fine needle or Large needle
Tx for Early stage breast CA
Breast conservation therapy (Lumpectomy)
Sentinel node biopsy
Then, Radiation
What does a Sentinel node biopsy test for
the need for Axillary lymph node dissection or not
When is Tamoxifen used to treat breast CA?
Estrogen receptor positive tumors
best in Pre-menopausal women
Adverse effects of Tamoxifen
Vein clot
Endometrial CA
Is women is POST menopausal with breast CA, what therapy should we use?
Aromatase inhibitor Hormonal therapy
- Letrozole
- Anastrozole
When is Mammogram recommended?
starting at age 50
50-74, every 2 years
UNLESS 1st deg relative, then start at 10 yrs prior to age that family member was diagnosed, whichever is earlier
How often to get a clinical breast exam?
Every 3 years in women 20-40, then yearly after age 40
2 meds that can be used as Breast CA prevention in high risk individuals
Both are SERMS
Tamoxifen
Raloxifene
post menopausal or >35 with high risk
HPV Vaccine
Gardasil 9
What strains of HPV usually cause Cervical and Anal CA
16 and 18
What strains of HPV usually cause Genital warts
6 and 11
How many doses of Gardasil 9 (The HPV vaccine) should be given if you are YOUNGER than 15?
2 doses
How many doses of Gardasil should be given if you are older than 15?
3 doses
interval of 0,2,6 mo
Ranking of gynecologic CA
#1- Endometrial #2- Ovarian #3- Cervical
Most common type of Cervical CA
Squamous cell
Risk: HPV, many sex partners, smoking
Age of dx: 40-50 yo
Most common sx of Cervical CA
Post coital bleeding
Pregnancy that ends before 20 weeks gestation
Spontaneous abortion
Cause: usually Chromosomal abnormality
Threatened abortion
Products of Conception intact
Cervical os is intact
Tx: supportive, observe at home, close f/u
POC intact, but Cervical Os is dilated
Inevitable
Tx: surgical evac vs Meds: Misopristol
How to treat Septic abortion
Remove remaining products
Abx: Levofloxacin + Metro
Who should receive anti-D Rh Immunoglobulin at the time of abortion???
Rh-Negative mothers
Normal amt of blood loss during menses
5-80 mL
Abnormal Uterine Bleeding
Bleeding of abnormal quantity, duration, or schedule
Most common cause of AUB
Anovulation, Fibroids, Bleeding disorder, and Uterine tumor
PALM COEIN for AUB
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy Ovulatory dysfx Endometrial Iatrogenic Not otherwise classified
Most common cause of AUB if you are 13-18 years old
Anovulation d/t immature HPO axis
Most common cause of AUB if you are 20-40 years old
Structural lesion- uterine fibroid or polyp
Most common cause of AUB if you are older than 40
- Ovaries running out of follicles
- Endometrial hyperplasia
- CA
Menorrhagia (heavy bleeding) is often associated with
STRUCTURAL lesions (fibroid, endometrial polyp), or COAGULATION disorder
Intermenstrual bleeding often d/t
Cervical dysplasia or infection
Post-menopausal bleeding is always concerning for
ENDOMETRIAL CA
Unopposed Estrogen is bad because
can lead to Endometrial Dysplasia
Who should undergo Endometrial biopsy sampling?
age >45 years with AUB
AND
Any post-menopausal women with AUB
Acute mgmt of AUB
Admit and give IV Estrogen
Outpatient Mgmt of AUB
Hormonal Treatment
COC birth control
Medroxyprogesterone (Provera)
High dose Estrogen
or
Tranexamic acid (Lysteda) non hormonal
Chronic tx for AUB
Levonorgestral (Mirena) IUD is great option
Primary dysmenorrhea
Painful periods
Secondary dysmenorrhea
Painful menses but d/t a PELVIC disease
something is wrong
What causes cramping and pain during/before periods?
Prostaglandins are released during cell lysis, causing Uterine contractions and ischemia –> Pain
How to diagnose Primary Dysmenorrhea (pretty much “period pain”)
CLINICAL diagnosis
- Pregnancy test
- consider Pap or Vaginal culture
Tx for Primary Dysmenorrhea (period pain)
NSAIDs are 1st line
Birth control next: COC, Depo-provera, Mirena, IUD
Secondary dysmenorrhea
older women, age 30-40
associated w some underlying problem
often also have sx of: Pain w sex, Infertile, or AUB
The song describing all of what can cause Secondary Dysmenorrhea
Endometriosis Adenomyosis Adhesions PID Leiomyoma
Tx of Secondary dysmenorrhea
Treat underlying cause
Hormone therapy with COC
Pelvic surgery for complicated cause
3 types of Vaginitis
Candidiasis
BV
Trich
Tx for Vulvovaginal Candidiasis
Oral Fluconazole
OR
Topical Clotrimazole
If pregnant pt has Vulvovaginal Candidiasis, tx is
TOPICAL Clotrimazole or Miconazole
Most common cause of Vaginitis in women of childbearing age
BV
- Thin d/c
- “Fishy odor” +whiff test
- Clue cells
- pH >4.5
This is Amsel’s Criteria
Tx for BV
Metronidazole (Flagyl)
Most common NONVIRAL STI worldwide
Trich
many have minimal or NO sx
Flagellated protozoan
Post coital bleeding
“Strawberry cervix”
Gold standard test: NAAT
Trich
Tx for Trich
Metronidazole (Flagyl)
Same as BV
Most commonly reported Bacterial infection in the US
Chlamydia
most are asymptomatic
Clinical sx of Chlamydia
Cervicitis: change in d/c, intermenses or Post sex bleeding
Urethritis: dysuria, urinary frequency
Classic PE finding of Chlamydia
Mucopurulent endocervical d/c
Cervix friability
Redness, swelling
Tx for Chlamydia
Azithromycin
or
Doxy (but avoid this if pregnant)
Gonorrhea has pretty much same sx and PE of chlamydia,
something we worry about specifically in GONORRHEA though is
DGI: Disseminated Gonococcal Infection
Tx for Gonorrhea
Azithromycin
+
Ceftriaxone (Rocephin)
Menopause
when periods stopped for AT LEAST 12 months in a row
Perimenopause or Menopausal Transition- typically 4 years before last period
Irregular period Hot flash/night sweats Mood sx- anxiety, depression Vaginal dryness Lipid and bone changes
Lab suggestive that Perimenopause is happening
high FSH
FSH >25 is highly suggestive
Median age of Menopause
51.5 years
When is menopause abnormal?
If it occurs before 40 YO
Premature ovarian failure
Post menopause
Hot flashes stop within 4-5 years of onset Vaginal dryness Inc risk of: -Osteoporosis -Heart dz -Dementia
Anxiety and Depression
Hormone therapy for Post-menopause
Estrogen (only those who have had hysterectomy)
OR
Estrogen with Progestin (most)
Guideline for Hormone replacement therapy for Post-menopause
No longer than 5 years
Not after 60 YO
Risk of Hormone Replacement Therapy
Increased risk of CLOT
and BREAST CA
Osteoporosis is considered a T-score of
< -2.5
What age to start screening for Osteoporosis
65
1st line therapy for Osteoporosis
Bisphosphonates
SE: upper GI tract, Osteonecrosis of the jaw
Anterior compartment pelvic organ prolapse
Cystocele (bladder)
Posterior compartment pelvic organ prolapse
Rectocele
Risk factors of prolapse
Delivering big babies
Older age
Obesity
Chronic dz (Constipation, COPD)
What ethnicity is at highest risk of Pelvic organ prolapse?
Hispanic women
Most effective procedure for prolapse, but can’t have sex anymore
Obliterative procedure
POP is almost never urgent/emergent, UNLESS
Urinary retention
Obstructive nephropathy
What to do?
- place catheter
- Urogyn consult for pessary or surgery
