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OBGYN Flashcards

1
Q

Types of Breast CA

A

Infiltrative ductal
Infiltrative lobular
Paget dz of breast

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2
Q

Most common type of breast CA

A

INFILT DUCTAL carcinoma

  • assoc w/ METs to Axillar nodes
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3
Q

Ductal cancer of breast presenting as Eczematous nipple lesion

A

Paget dz of the breast

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4
Q

Pre-malignant breast lesion

A

Lobular carcinoma in situ

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5
Q

Clinical sx of breast CA

A

painless, hard fixed nodule

unilateral d/c

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6
Q

PE of breast CA nodule

A

most common in Upper Outer quadrant

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7
Q

Most common site of breast CA mets after Axillary lymphnodes

2 Bs and 2 Ls

A

Brain
Bone

Lungs
Liver

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8
Q

Peau d’orange

often no lump, just the weird skin appearance

A

a type of Inflammatory breast CA- red, swollen, warm

orange peel is d/t Lymphatic obstruction

Poor prognosis

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9
Q

Masses that are highly concerning on Mammogram

A

Microcalcifications

Spiculated

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10
Q

Women is older than 40, what do you use to evaluate breast mass?

A

Mammogram

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11
Q

Women is younger than 40, what do you use to evaluate breast mass?

A

Ultrasound

d/t breast density

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12
Q

Most accurate diagnostic test for Breast CA

A

Open biopsy

as opposed to Fine needle or Large needle

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13
Q

Tx for Early stage breast CA

A

Breast conservation therapy (Lumpectomy)
Sentinel node biopsy
Then, Radiation

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14
Q

What does a Sentinel node biopsy test for

A

the need for Axillary lymph node dissection or not

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15
Q

When is Tamoxifen used to treat breast CA?

A

Estrogen receptor positive tumors

best in Pre-menopausal women

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16
Q

Adverse effects of Tamoxifen

A

Vein clot

Endometrial CA

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17
Q

Is women is POST menopausal with breast CA, what therapy should we use?

A

Aromatase inhibitor Hormonal therapy

  • Letrozole
  • Anastrozole
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18
Q

When is Mammogram recommended?

A

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

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19
Q

How often to get a clinical breast exam?

A

Every 3 years in women 20-40, then yearly after age 40

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20
Q

2 meds that can be used as Breast CA prevention in high risk individuals

Both are SERMS

A

Tamoxifen
Raloxifene

post menopausal or >35 with high risk

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21
Q

HPV Vaccine

A

Gardasil 9

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22
Q

What strains of HPV usually cause Cervical and Anal CA

A

16 and 18

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23
Q

What strains of HPV usually cause Genital warts

A

6 and 11

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24
Q

How many doses of Gardasil 9 (The HPV vaccine) should be given if you are YOUNGER than 15?

A

2 doses

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25
How many doses of Gardasil should be given if you are older than 15?
3 doses interval of 0,2,6 mo
26
Ranking of gynecologic CA
``` #1- Endometrial #2- Ovarian #3- Cervical ```
27
Most common type of Cervical CA
Squamous cell Risk: HPV, many sex partners, smoking Age of dx: 40-50 yo
28
Most common sx of Cervical CA
Post coital bleeding
29
Pregnancy that ends before 20 weeks gestation
Spontaneous abortion | Cause: usually Chromosomal abnormality
30
Threatened abortion
Products of Conception intact Cervical os is intact Tx: supportive, observe at home, close f/u
31
POC intact, but Cervical Os is dilated
Inevitable Tx: surgical evac vs Meds: Misopristol
32
How to treat Septic abortion
Remove remaining products | Abx: Levofloxacin + Metro
33
Who should receive anti-D Rh Immunoglobulin at the time of abortion???
Rh-Negative mothers
34
Normal amt of blood loss during menses
5-80 mL
35
Abnormal Uterine Bleeding
Bleeding of abnormal quantity, duration, or schedule
36
Most common cause of AUB
Anovulation, Fibroids, Bleeding disorder, and Uterine tumor
37
PALM COEIN for AUB
Polyp Adenomyosis Leiomyoma Malignancy ``` Coagulopathy Ovulatory dysfx Endometrial Iatrogenic Not otherwise classified ```
38
Most common cause of AUB if you are 13-18 years old
Anovulation d/t immature HPO axis
39
Most common cause of AUB if you are 20-40 years old
Structural lesion- uterine fibroid or polyp
40
Most common cause of AUB if you are older than 40
- Ovaries running out of follicles - Endometrial hyperplasia - CA
41
Menorrhagia (heavy bleeding) is often associated with
``` STRUCTURAL lesions (fibroid, endometrial polyp), or COAGULATION disorder ```
42
Intermenstrual bleeding often d/t
Cervical dysplasia or infection
43
Post-menopausal bleeding is always concerning for
ENDOMETRIAL CA
44
Unopposed Estrogen is bad because
can lead to Endometrial Dysplasia
45
Who should undergo Endometrial biopsy sampling?
age >45 years with AUB AND Any post-menopausal women with AUB
46
Acute mgmt of AUB
Admit and give IV Estrogen
47
Outpatient Mgmt of AUB Hormonal Treatment
COC birth control Medroxyprogesterone (Provera) High dose Estrogen or Tranexamic acid (Lysteda) non hormonal
48
Chronic tx for AUB
Levonorgestral (Mirena) IUD is great option
49
Primary dysmenorrhea
Painful periods
50
Secondary dysmenorrhea
Painful menses but d/t a PELVIC disease something is wrong
51
What causes cramping and pain during/before periods?
Prostaglandins are released during cell lysis, causing Uterine contractions and ischemia --> Pain
52
How to diagnose Primary Dysmenorrhea (pretty much "period pain")
CLINICAL diagnosis - Pregnancy test - consider Pap or Vaginal culture
53
Tx for Primary Dysmenorrhea (period pain)
NSAIDs are 1st line Birth control next: COC, Depo-provera, Mirena, IUD
54
Secondary dysmenorrhea older women, age 30-40
associated w some underlying problem often also have sx of: Pain w sex, Infertile, or AUB
55
The song describing all of what can cause Secondary Dysmenorrhea
``` Endometriosis Adenomyosis Adhesions PID Leiomyoma ```
56
Tx of Secondary dysmenorrhea
Treat underlying cause Hormone therapy with COC Pelvic surgery for complicated cause
57
3 types of Vaginitis
Candidiasis BV Trich
58
Tx for Vulvovaginal Candidiasis
Oral Fluconazole OR Topical Clotrimazole
59
If pregnant pt has Vulvovaginal Candidiasis, tx is
TOPICAL Clotrimazole or Miconazole
60
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
61
Tx for BV
Metronidazole (Flagyl)
62
Most common NONVIRAL STI worldwide
Trich many have minimal or NO sx Flagellated protozoan
63
Post coital bleeding "Strawberry cervix" Gold standard test: NAAT
Trich
64
Tx for Trich
Metronidazole (Flagyl) Same as BV
65
Most commonly reported Bacterial infection in the US
Chlamydia most are asymptomatic
66
Clinical sx of Chlamydia
Cervicitis: change in d/c, intermenses or Post sex bleeding Urethritis: dysuria, urinary frequency
67
Classic PE finding of Chlamydia
Mucopurulent endocervical d/c Cervix friability Redness, swelling
68
Tx for Chlamydia
Azithromycin or Doxy (but avoid this if pregnant)
69
Gonorrhea has pretty much same sx and PE of chlamydia, something we worry about specifically in GONORRHEA though is
DGI: Disseminated Gonococcal Infection
70
Tx for Gonorrhea
Azithromycin + Ceftriaxone (Rocephin)
71
Menopause
when periods stopped for AT LEAST 12 months in a row
72
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 ```
73
Lab suggestive that Perimenopause is happening
high FSH FSH >25 is highly suggestive
74
Median age of Menopause
51.5 years
75
When is menopause abnormal?
If it occurs before 40 YO Premature ovarian failure
76
Post menopause
``` Hot flashes stop within 4-5 years of onset Vaginal dryness Inc risk of: -Osteoporosis -Heart dz -Dementia ``` Anxiety and Depression
77
Hormone therapy for Post-menopause
Estrogen (only those who have had hysterectomy) OR Estrogen with Progestin (most)
78
Guideline for Hormone replacement therapy for Post-menopause
No longer than 5 years | Not after 60 YO
79
Risk of Hormone Replacement Therapy
Increased risk of CLOT | and BREAST CA
80
Osteoporosis is considered a T-score of
< -2.5
81
What age to start screening for Osteoporosis
65
82
1st line therapy for Osteoporosis
Bisphosphonates SE: upper GI tract, Osteonecrosis of the jaw
83
Anterior compartment pelvic organ prolapse
Cystocele (bladder)
84
Posterior compartment pelvic organ prolapse
Rectocele
85
Risk factors of prolapse
Delivering big babies Older age Obesity Chronic dz (Constipation, COPD)
86
What ethnicity is at highest risk of Pelvic organ prolapse?
Hispanic women
87
Most effective procedure for prolapse, but can't have sex anymore
Obliterative procedure
88
POP is almost never urgent/emergent, UNLESS
Urinary retention Obstructive nephropathy What to do? - place catheter - Urogyn consult for pessary or surgery

Clinical Prep (41 decks)

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