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Surgery EOR > OBGYN (Alice) > Flashcards

OBGYN (Alice) 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
Q

mcc of bloody nipple d.c in a young woman

A

intraductal papilloma

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26
Q

3 mc causes of nipple d.c in a non lactating woman: mc -> lc

A

duct ectasia
intraductal papilloma
carcinoma

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27
Q

characteristic of d.c due to fibrocystic dz (5)

A

premenopausal
spontaneous multiple duct
unilateral or bilat
just before menstruation
green/brownish

28
Q

milky discharge in nonlactating breast

A

hyperprolactinemia

29
Q

4 characteristics of neoplastic nipple d.c

A

bloody
associated mass
unilateral
single duct

30
Q

work up for nipple d.c (3)

A

mammogram vs US
serum prolactin
TSH

31
Q

tx for nipple d.c

A

treat underlying cause
proximal duct excision if benign but annoying

32
Q

mc type of breast carcinoma

A

ductal located in upper outer quadrant

33
Q

7 rf for breast carcinoma

A

first degree relative w. hx
age > 65
onset of menarche < 12 yo
postmenopausal HRT
obesity
etoh
BRCA1/BRCA2

34
Q

hard non tender mass is likely what type of breast carcinoma

A

adenocarcinoma

35
Q

pharm tx for breast ca (2)

A

raloxifene
tanoxifen

36
Q

45 yo F w. itching of right nipple x 6 mos and a right breast mass

A

paget’s dz (infiltrating ductal carcinoma)

37
Q

5 sx of late stage breast ca

A

bone pain
nipple retraction
breast pain
arm edema
peau d’ orange

38
Q

mc ca in adult women

A

breast

39
Q

BRCA1 and BRCA 2 increase risk for what 2 cancers

A

breast
ovarian

40
Q

4 types of breast ca: mc -> lc

A

infiltrating intraductal (IIC)
infiltrating lobular
paget’s dz
inflammatory

41
Q

painless, stony hard unilateral mass

A

IIC

42
Q

IIC begins as _

A

ductal carcinoma in situ (DCIS)

43
Q

what type of breast ca is frequently bilat

A

infiltrating lobular

44
Q

chronic, eczematous, itchy, scaling rash on the nipples/areola

A

paget’s dz

45
Q

red, swollen, warm, itchy breast
nipple retraction
peau d’ orange

A

inflammatory breast ca

46
Q

what type of breast ca is not associated w. a lump

A

inflammatory

47
Q

peau d’ orange is what type of breast ca

A

inflammatory

48
Q

horomone receptor types w. breast ca: mc -> lc

A

estrogen receptive - mc
progesterone receptive
HER2

49
Q

USPSTF guidelines for breast ca screening

A

-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
Q

when should self breast exams be performed

(i thought we werent saying these are necessary anymore?)

A

immediately after menstruation or on days 5-7 of menstrual cycle

51
Q

breast ca prevention in high risk pt’s

A

SERM: tamoxifen vs raloxifene

52
Q

indications for SERM

A

postmenopausal women
> 35 yo at high risk (tx for 5 yr)

53
Q

2 mammogram findings of breast ca

A

microcalcification
stellate/spiculated mass

54
Q

US is the best imaging to

A

delineate cysts

55
Q

definitive dx for breast ca

A

bx

56
Q

tx for breast ca

A

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
Q

preferred breast ca screening for women who are mutation carriers

A

MRI

58
Q

spiculated mass

A

breast ca

59
Q

best breast ca screening for women < 30 yo

A

US

60
Q

breast ca sites of metastasis (5)

A

lymph nodes - mc
lung/pleura
liver
bones
brain

61
Q

4 contraindications to lumpectomy plus xrt

A

pregnant
previous chest xrt
positive margins
collagen vascular dz (scleroderma)

62
Q

moa for tamoxifen

A

binds estrogen receptors

63
Q

t/f: tamoxifen can prevent breast ca

A

t

64
Q

5 s.e of tamoxifen

A

endometrial ca
DVT/PE
cataracts
hot flashes
mood swings

65
Q

6 characteristics of a high risk tumor w. nodal spread (consider chemo)

A

high risk
> 1 cm
nuclear grade
s phase
ER negative
HER2 positive

Surgery EOR (17 decks)

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