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Clin Med- Repro > Ovarian/Breast Disorders Lecture > Flashcards

Ovarian/Breast Disorders Lecture Flashcards

1
Q
  1. follicle
  2. maturing follicle
  3. ovulation
  4. corpus luteum
    Whats next (if not pregnant)
A

Degeneration of corpus luteum

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2
Q

When does estradiol peak?

A

Right before ovulation

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3
Q

When do lutenizing hormone (LH) and follicle stimulating hormone (FSH) peak?

A

During ovulation

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4
Q

When is Progesterone highest?

A

Luteal phase

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5
Q

When does body temperature increase?

A

Second half of ovulation into luteal phase

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6
Q

Adnexal refers to the…

A

ovary

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7
Q

Follicular cyst

A

most common ovarian cyst

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8
Q

Usually not symptomatic
Usually resolve spontaneously
Result from failure of ovulation

A

Follicular cyst

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9
Q

Cysts that occur after ovulation

Thin-walled, unilocular

A

Corpus luteum cyst

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10
Q

Cysts in pregnancy or molar gestation

*bilateral functional cyst greater than 3 cm

A

Theca-lutein

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11
Q

What type of cyst can sometimes occur with endometriosis

A

Hemorrhagic cyst

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12
Q

Management of fluid filled cysts

A

Monitor with period ultrasound

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13
Q

Management of non fluid filled cysts

A

Remove it (laparoscopic)

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14
Q

If cyst greater than 6 cm, what might happen?

A

TORSION! must remove cyst!

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15
Q

How can you prevent ovarian cysts?

How can you tx pain?

A

Prevent with OCPs

Tx pain with NSAIDs

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16
Q

Diagnose clinically if 2 of 3 conditions:
Oligo or amenorrhea and anovulation
Hyperandrogenism
Obesity (50%)
Hirsutism (30-75%)
Ultrasound: evidence of polycystic ovaries (not always)

A

PCOS

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17
Q
  • Most common cause of infertility in women
  • Insulin resistance (higher risk of diabetes)
  • Unopposed estrogen
A

PCOS

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18
Q
  • OCPs tx unopposed estrogens and hirsutism
  • can cycle with progesterone
  • metformin for insulin resistance (may improve infertility)
  • clomiphene citrate for infertility
A

PCOS tx

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19
Q

What part of the pituitary produces FSH and LH?

A

Anterior

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20
Q 
Granulosa cells (which act as neg feedback to ant. pituitary )
Development of oocytes

This is done by FSH or LH?

A

FSH

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21
Q

Theca cells which produce androgens

This is done by FSH or LH?

A

LH

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22
Q

Never progress to luteal phase- creates exogenous estrogen

A

PCOS

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23
Q

Abnormal feedback regulation promotes more LH than FSH

A

PCOS

(insufficient FSH to stimulate granulosa cells

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24
Q

Enlarging ovarian mass with a solid component or change in character, especially in a postmenopausal woman

What is the management?

A

REMOVE IT

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25
Q

Is screening for ovarian cancer (ultrasound or CA-125) recommended?

A

NO

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26
Q

Where do 85-90% of ovarian cancers originate?

A

Epithelium

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27
Q

young women with ovarian tumors are typically this kind…

A

germ cell tumors

28
Q

appear in connective tissue cells of the ovaries that produce estrogen and progesterone

A

stromal carcinoma tumors

rare, low grade malignancies, produce hormones

29
Q

Oral contraceptives
More than 1 full term pregnancy before age 35
Breast feeding
Tubal ligation

A

protective against ovarian cancer

30
Q

risk peaks 65-75 yo

The most lethal gynecologic malignancy- “silent killer”

A

Ovarian cancer

31
Q

Most women present with late stage disease:
Abdominal pain/bloating
Early satiety
Urinary urgency/frequency

A

Ovarian cancer

32
Q

Transvaginal Ultrasound

Laproscopic Evaluation

A

used in dx of ovarian cancer

33
Q

most common breast complaint in primary care

A

breast pain

34
Q

Associated with hormonal changes, usually 1 week prior to onset of menses (due to proliferation of normal glandular breast tissue)

A

Cyclic breast pain

35
Q 
Spontaneous
Unilateral
Confined to one duct
Bloody
Clear, yellow, white, dark green
Associated with a mass
Women age >40
A

Pathologic nipple discharge

36
Q

Discharge only with compression
Often bilateral
Multiple ducts involved
Fluid may be clear, yellow, white or dark green

A

Benign nipple discharge

37
Q

physiologic nipple discharge

Usually bilateral milky nipple discharge involving multiple ducts
Caused by hyperprolactinemia

A

galactorrhea

38
Q

Solid, firm & mobile mass- “rolled to an edge”

typically in young women

A

Fibroadenoma

39
Q

Fluid-filled mass, compressible or ballotable

Premenopausal and perimenopausal women

40
Q

Diffuse, tender, does not form discrete or well-defined mass
Associated with breast pain, cyclic, premenopausal
PE: breast tissue frequently nodular

A

Fibrocystic changes

41
Q

Gold standard of dx breast cancer

42
Q

Milk retention cyst in breastfeeding women

A

Galactocele

43
Q

Can develop after trauma, surgery , radiation- diff. to distinguish

*seen in breast augmentation or reduction procedures

A

Fat necrosis

44
Q

3 steps of assessing to diagnose or rule out breast cancer

A
  1. physical exam
  2. mammogram
  3. needle biopsy (fine needle aspiration or core needle biopsy)
45
Q 
Most common solid benign breast mass
Well-defined, mobile solid mass
Etiology unknown but hormonal relationship likely
Most commonly found between ages 15-35
Definitive diagnosis: CNB or excision
A

Fibroadenoma

46
Q

Localized, painful inflammation of breast associated with fever & malaise
Occurs in 2-10% of breastfeeding women
Usually due to breastfeeding problems
If left untreated – local abscess formation
PE: hard, red, tender, swollen area of 1 breast
Staph aureus
Treatment: dicloxacillin or clindamycin (MRSA)

A

Lactational mastitis

47
Q

BRCA genes increase lifetime risk of breast cancer by…..

48
Q
  • Eastern European heritage
  • African American female diagnosed before age 35
  • Test family members of any male diagnosed with breast cancer
  • When a woman has had breast cancer in both breasts
  • When multiple family members have had breast cancer or gynecologic cancers
  • When a blood relative has had breast cancer before age 50
A

Test for BRCA

49
Q

what type of aspiration can be used to confirm dx of breast cysts

A

fine needle aspiration

50
Q

which is more invasive, fine needle or core needle?

51
Q 
Spontaneous
Unilateral
Confined to one duct
Bloody
Clear, yellow, white, dark green
Associated with a mass
Often NO Pain
A

pathologic breast issues

malignant have less discharge

52
Q 
Discharge only with compression
Often bilateral
Multiple ducts involved
Fluid may be clear, yellow, white or dark green
Often present with Pain
A

Benign breast issues

53
Q

Often, the simplest way to determine whether a palpable mass is cystic or solid is to _______ the mass.

54
Q

ductal or lobular carcinoma (CIS)
+carcinoma in situ

invasive or non invasive?

A

non invasive

55
Q

most common type of non invasive breast cancer

  • non life threatening
  • can increase risk of developing invasive cancer
A

ductal carcinoma in situ (DCIS)

(ductal= milk
in situ=in its original place)

56
Q

lumpectomy only recurrence rate with DCIS

A

25%

down to 15% for lumpectomy plus radiation

57
Q

infiltrating ductal carcinoma

A

most common breast cancer (this is the kind men get also)

70-80% all breast cancers

58
Q 
swelling of all or part of the breast
skin irritation or dimpling
breast pain
nipple pain or the nipple turning inward
redness, scaliness, thickening of the nipple or breast skin
a nipple discharge other than milk
Enlarged lymph in axilla
A

infiltrating ductal carcinoma

59
Q
  • Size of the tumor
  • Whether the cancer has spread to lymph nodes, and if so, how many
  • Whether the cancer has spread to other parts of the body
  • ER/PR Her2/neu status
A

staging of breast cancer

60
Q

Estrogen down regulator drug

61
Q

Provider visit with exam every 3-6 months for first 3 years
Every 6-12 months for years 4 and 5
Every year post year 5
Yearly mammogram
Monitor for side effects of any medication
Yearly pelvic exams (some tx drugs increase unterine cancer risk)

A

Follow up guidelines for breast cancer

62
Q

second most common type of breast cancer

tends to occur later in life (early 60s)

A

invasive lobular carcinoma (ILC)

63
Q

rare
dx usually made w skin punch biopsy
*very invasive
*high mets rate

staging tests include:
CXR
CT of chest, abdomen, pelvis
Bone scan
Liver function test
A

inflammatory breast cancer

64
Q

Collection of abnormal cells

  • not a true cancer
  • increased risk of dev. invasive CA later in life
  • diagnosed b/f menopause
  • usually diagnosed because of a biopsy performed for some other reason
  • usually hormone receptor positive
A

lobular carcinoma in situ (LCIS)

65
Q
  • rare form of breast CA in which cancer cells collect in or around the nipple
  • less than 5% of all breast CA cases
  • 97% of patients also have DCIS or invasive CA somewhere else in the breast
  • ave. age of diagnosis = 62
A

Paget’s disease

66
Q

itching, tingling, and/or burning sensation
pain or sensitivity
scaling & thickening of the skin
yellowish or bloody d/c from the nipple

A

Paget’s disease

67
Q 
Lymph Nodes
Muscle , Fatty Tissue and Skin
Bones- ribs, spine, pelvis, & long bones arms /legs
Bone Marrow
Liver
Lungs
Brain
A

Most common sites of breast cancer metastasis

Clin Med- Repro (11 decks)

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