OBGYN (Alice) Flashcards
pain management in PACU following ambulatory surgery
short acting IV opioids
PO opioids
APAP/opioid combo
d.c: NSAIDs
pain management for minimally invasive intraabdominal procedures
regional anesthesia:
nerve blocks
PCA vs nurse administered opioid boluses
pain control for major open abd/thoracic surgery and for pt who is dependent on opioids
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
special considerations for opioid dependent pt’s
continue methadone/buprenorphine through perioperative period
if IV methadone: decrease to 1/2 dose
mc adenopathies seen w. gynecological infxns (4)
axillary
internal mammary
parasternal
supraclavicular
scaling rash/dermatitis of the nipple caused by an invasion of skin cells from a ductal carcinoma
paget’s dz of the breast
8 skin changes during pregnancy
melasma
spider angiomas/varicosities
striae gravidarum (stretch marks)
pruritis
hirsutism
nail growth
androgenic alopecia
chadwick/goodell sign
tx for pregnancy induced pruritis
chlorpheniramine (first gen antihistamine)
bluish/purplish coloration of the vagina during pregnancy
chadwick sign
bluish/purplish coloration of the cervix during pregnancy
goodell sign
mc benign breast tumor
fibroadenoma
do fibroadenomas wax/wane w. menstruation
no!
but pt may experience increased discomfort
describe a fibroadenoma
painless, firm, solitary, rubbery, well defined mobile mass
mc location for fibroadenomas
upper, outer quadrants
etiology for fibroadenomas
probs hormonal due to:
persist during reproductive years
increase during pregnancy or w. estrogen
regress after menopause
dx for fibroadenoma (4)
clinical
US
mammogram
FNA
3-6 mo f/u
US finding of fibroadenoma
well defined solid mass
t/f: mammograms are not indicated for adolescents to dx fibroadenoma due to large amt of glandular tissue
t!
definitive dx for fibroadenoma
core bx vs excision
tx for fibroadenoma
< 5 cm w.o red flags: obs q 2 mos
if persistent: US
if growth or > 5 cm: excisional bx/surgical removal
benign, slow growing breast tumor w. epithelial and stromal components
fibroadenoma
common benign breast condition consisting of fibrous and cystic changes in breast
fibrocystic breast dz
FNA findings of fibrocystic changes
straw colored/green fluid
tx for fibrocystic dz
no caffeine
NSAIDs
vit E
primrose oil
last resort: danazol, OCP
mcc of bloody nipple d.c in a young woman
intraductal papilloma
3 mc causes of nipple d.c in a non lactating woman: mc -> lc
duct ectasia
intraductal papilloma
carcinoma
characteristic of d.c due to fibrocystic dz (5)
premenopausal
spontaneous multiple duct
unilateral or bilat
just before menstruation
green/brownish
milky discharge in nonlactating breast
hyperprolactinemia
4 characteristics of neoplastic nipple d.c
bloody
associated mass
unilateral
single duct
work up for nipple d.c (3)
mammogram vs US
serum prolactin
TSH
tx for nipple d.c
treat underlying cause
proximal duct excision if benign but annoying
mc type of breast carcinoma
ductal located in upper outer quadrant
7 rf for breast carcinoma
first degree relative w. hx
age > 65
onset of menarche < 12 yo
postmenopausal HRT
obesity
etoh
BRCA1/BRCA2
hard non tender mass is likely what type of breast carcinoma
adenocarcinoma
pharm tx for breast ca (2)
raloxifene
tanoxifen
45 yo F w. itching of right nipple x 6 mos and a right breast mass
paget’s dz (infiltrating ductal carcinoma)
5 sx of late stage breast ca
bone pain
nipple retraction
breast pain
arm edema
peau d’ orange
mc ca in adult women
breast
BRCA1 and BRCA 2 increase risk for what 2 cancers
breast
ovarian
4 types of breast ca: mc -> lc
infiltrating intraductal (IIC)
infiltrating lobular
paget’s dz
inflammatory
painless, stony hard unilateral mass
IIC
IIC begins as _
ductal carcinoma in situ (DCIS)
what type of breast ca is frequently bilat
infiltrating lobular
chronic, eczematous, itchy, scaling rash on the nipples/areola
paget’s dz
red, swollen, warm, itchy breast
nipple retraction
peau d’ orange
inflammatory breast ca
what type of breast ca is not associated w. a lump
inflammatory
peau d’ orange is what type of breast ca
inflammatory
horomone receptor types w. breast ca: mc -> lc
estrogen receptive - mc
progesterone receptive
HER2
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
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
breast ca prevention in high risk pt’s
SERM: tamoxifen vs raloxifene
indications for SERM
postmenopausal women
> 35 yo at high risk (tx for 5 yr)
2 mammogram findings of breast ca
microcalcification
stellate/spiculated mass
US is the best imaging to
delineate cysts
definitive dx for breast ca
bx
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
preferred breast ca screening for women who are mutation carriers
MRI
spiculated mass
breast ca
best breast ca screening for women < 30 yo
US
breast ca sites of metastasis (5)
lymph nodes - mc
lung/pleura
liver
bones
brain
4 contraindications to lumpectomy plus xrt
pregnant
previous chest xrt
positive margins
collagen vascular dz (scleroderma)
moa for tamoxifen
binds estrogen receptors
t/f: tamoxifen can prevent breast ca
t
5 s.e of tamoxifen
endometrial ca
DVT/PE
cataracts
hot flashes
mood swings
6 characteristics of a high risk tumor w. nodal spread (consider chemo)
high risk
> 1 cm
nuclear grade
s phase
ER negative
HER2 positive
