Obstetrics and Gynecology

Question 1

What is adenopathy?

Answer 1

enlargement of lymph nodes due to gynecologic infections, malignancy or inflammation

• the most commonly seen adenopathy in breast disease is axillary adenopathy (85%)
• other adenopathies seen are internal mammary, parasternal, and supraclavicular

Question 2

What is benign breast disease?

Answer 2

A 28-year old women with unilateral green-brown nipple discharge increasing immediately before menses

Question 3

What is a fibroadenoma?

Answer 3

solid, mobile, well-circumscribed round breast mass

-most common breast tumor in women < 30 years

Question 4

What is fibrocystic breast disease?

Answer 4

common benign breast condition consisting of fibrous and cystic changes in breast

• breast pain or tenderness that varies with menstrual cycle; cysts; and fibrous (“nodular”) fullness
• aspirated cysts - usually straw-colored or green fluid

Question 5

What is a breast carcinoma?

Answer 5

most common malignancy in women: breast mass - immobile, irregular, nipple retraction, bloody discharge, spiculated mass on mammogram

Question 6

What are the risk factors of breast carcinoma?

Answer 6

increased exposure to estrogen: NAACP

• nulliparity
• age at menarche (<13 years)
• age at menopause (> 55 years)
• breast cancer (self, family)
• pregnancy of 1st child > 30 years

Question 7

What are the USPSTF guidelines for breast cancer screening?

Answer 7

• baseline mammogram every 2 years from age 50-74
• every 2 years beginning at age 40 if increased risk factors - 10 years prior to the age of the 1st degree relative was diagnosed
• clinical breast exam: every 3 years in women age 20-39 years then annually after age 40
• breast self-exam - monthly beginning at age 20 - immediately after menstruation on days 5-7 of the menstrual cycle

Question 8

What is the most common type of breast carcinoma?

Answer 8

infiltrating intraductal carcinoma

• infiltrating ductal carcinoma (75%)
• medullary carcinoma (15%)
• infiltrating lobular carcinoma (5%)
• tubular carcinoma (2%)
• mucinous colloid carcinoma (1%)
• inflammatory breast cancer (1%)

Question 9

What are the sites of metastasis of breast carcinoma?

Answer 9

• lymph nodes (most common)
• lung/pleura
• liver
• bones
• brain

Question 10

what is nipple discharge?

Answer 10

intraductal papilloma - the most common cause of blood niplle discharge

Question 11

What causes pain from the breasts?

Answer 11

32 year old lactating female with breast pain, swelling, fever, chills, and a fluctuant mass of her left breast
-the area directly above the lesion is warm, erythematous, and tender to touch

Question 12

What is mastitis?

Answer 12

superficial infection of the breast - usually occurs during breastfeeding

Question 13

What is a breast abscess?

Answer 13

often a progression of mastitis

• nursing: staphylococcus aureus
• nonlactating: mixed infection

Question 14

What is paget’s disease of the breast?

Answer 14

scaling rash/dermatitis of the nipple caused by an invasion of skin by cells from a ductal carcinoma

Question 15

What is melasma?

Answer 15

(chloasma or mask of pregnancy) is the most cosmetically disturbing pigmentary change and occurs in up to 75 percent of pregnant women
-the characteristic hyperpigmentation of the face may also occur in nonpregnant women and women taking oral contraceptive pills

Question 16

What are vascular changes?

Answer 16

estrogen, and other factors, cause vascular distention and instability, and proliferation of blood vessels during pregnancy

Question 17

What are spider angiomas?

Answer 17

They appear in the second to fifth month of pregnancy as red lesions with branches extending out from a central puncta

Question 18

What are varicosities?

Answer 18

saphenous, vulvar, and hemorrhoidal varicosities all occur at an increased rate during pregnancy and cannot be prevented

Question 19

What is striae gravidarum?

Answer 19

connective tissue changes, such as stretch marks (ie striae distensae, striae gravidarum), are a common source of cosmetic concerns among pregnant women

Question 20

What is pruritus in pregnant women?

Answer 20

may be physiologic, related to a flare of disorder present prior to conception, or related to pregnancy-specific dermatoses
-chlorpheniramine has been recommend as the first generation antihistamine of choice for use during pregnancy

Question 21

What is hirsutism?

Answer 21

noted most frequently on the face, but may also be seen on the arms, legs, back and suprapubic region

Question 22

Do nails grow faster during gestation?

Answer 22

yes - changes that may occur include development of transverse grooves, subungual keratosis, and distal onycholysis, and melanonychia

Question 23

What is androgenic alopecia?

Answer 23

rarely, late in pregnancy, hair in the frontoparietal area recedes in a mild form of androgenic alopecia

Question 24

What are the vaginal changes during pregnancy?

Answer 24

bluish/purplish coloration of the vagina (Chadwick sign) and cervix (Goodell sign) are early anatomic changes historically important in the diagnosis of pregnancy
-the blue appearance is related to increase blood flow