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Human Disease and Therapeutics > Quiz 5 Study Guide: Reproductive and Breast > Flashcards

Quiz 5 Study Guide: Reproductive and Breast Flashcards

1
Q

What are the common symptoms of Breast Disease?

A

Pain
Palpable Masses
Nipple Discharge

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2
Q

When do you start screenings with Mammography?

A

40 Years of age

*younger women have more dense breast tissue making discovering a mass more difficult.

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3
Q

What Does a Mammography Show?

A 
Density
Architectural Distortions
Calcification
Changes over time
Can help guide biopsy needle
85-90% predictive
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4
Q

What is characteristic of Acute Mastitis?

A

Breast accesses and necrosis
Usually associated with breast feeding
Can be from plugged ducts
Can be infectious or non-infectious

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5
Q

What is characteristic of Fat necrosis?

A

Trauma

*seat belt during an accident

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6
Q

What is characteristic of Breast Cysts?

A 
Fibrocystic changes
Higher breast cancer risk in aggressive proliferative type
Occurs in 20-40 year olds
usually not in post menopause women
Can calcify
Can look like cancer on a Mammogram
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7
Q

What are the 3 Fibrocystic changes seen with Breast Cysts?

A

Fibrosis
Cysts
Palpable changes making detection of cancer difficult

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8
Q

What are characteristics of a benign neoplasm of the breast?

A

Fibroadenomas (most common)
Mostly Connective Tissue
Well Circumscribed
Don’t typically remove unless uncomfortable

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9
Q

What are characteristics of Breast Carcinomas?

A 
Rarely occurs <25 years of age
Mostly in more affluent societies
30% incidence by 70 Years old (1 in 9 die)
Inherited = 5-10% (BRCA 1 &amp; 2)
Family tendency = 20-30% risk
Sporadic = 70-80%
250,000 new cancers /year in US
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10
Q

What are the symptoms of Breast Carcinomas?

A
  • Pain

- Masses (Assessed by, palpitation, mammography, ultrasound, MRI, or biopsy)

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11
Q

What are the factors relating to Prognosis of Breast Carcinomas?

A
  • Based on size, axillary node status, and far metastasis
  • 5 year survival @ stage 0 = 92%; stage IV = 13%
  • Tumor expressing estrogen/progesterone often responds to hormonal treatment
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12
Q

Characteristics of types of breast cancer…

A
  • Invasive Carcinomas = 75-85%
  • Generally all are adenocarcinomas from epi cells in terminal ducts.
  • Most are ductal and incidence increases with age
  • Lumpectomies can treat smaller masses
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13
Q

What is characteristic of Benign Epithelial Lesions of the Breast?

A

Fibrocytic changes

e.g. 60% of women have microscopic cysts associated with epithelial tissues

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14
Q

What is usual cause for Cervical Cancers?

A

HPV - associated squamous cell neoplasm

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15
Q

What is used to detect Cervical Cancers early?

A

Pap Smear

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16
Q

What are the risk factors of Cervical Cancers?

A 
Multiple Partners
Immunosuppression
Early age of first sexual contact
Oral Contraception for >5 Years
Nicotine Use
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17
Q

What are the causes of endometrial polyps?

A

Hypertension
Obesity
Late Menopause

*Progresses to Cancer in 2%

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18
Q

What are characteristics of Leiomyoma of the endometrium?

A

Benign Smooth Muscle Neoplasm
Estrogen-Dependent
Bleeding and Painful
May Cause Infertility

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19
Q

What are the risks of endometrial Cancer (adenocarcinoma)?

A

Obesity
Diabetes
Hypertension

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20
Q

What are the Treatments for endometrial cancer?

A

Hysterectomy- Treatment of choice

Radiation/Chemotherapy adjunctive

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21
Q

What is the cause of endometritis? (Infections)

A

Intrauterine Devices (IUD’s)

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22
Q

What can endometrial hyperplasia progress to?

A

Cancer

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23
Q

What is characteristic of endometrial hyperplasia?

A

Exaggerated responses due to excessive estrogen

-Excessive ovarian activity

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24
Q

What is the treatment of endometrial hyperplasia?

A

Progesterone

Hysterectomy

25
Q

What are the two types of Ovarian Masses?

A

Non-neoplastic cysts (e.g. follicular)

Neoplastic (e.g. endometroioid)

26
Q

What are characteristics of Neoplastic Ovarian Masses?

A

Most are sporadic (90%)
Contraceptives can decrease risk
10% are Hereditary (BRCA 1&2)

27
Q

What is treatment for Neoplastic Ovarian Masses?

A

Total Hysterectomy + removal of surrounding tissue + chemotherapy

28
Q

What are the symptoms of Ovarian Masses?

A

Pelvic Pain
Pelvic Mass
Abdominal Bleeding

29
Q

Is there an effective screening for ovarian cancer?

A

NO

30
Q

Characteristics of Estrogens and Progestins…

A
  • Natural estrogens are Steroid hormones (Not Synthetic)

- They cross cell membranes and activate estrogen receptors inside cell (modulate gene expression)

31
Q

What are the 3 stages of the Menstrual Cycle?

A

Menstrual Stage - Menses
Follicular Stage - Proliferative
Luteal Stage - Secretory

32
Q

What are the 3 natural Estrogens?

A

Estrone (E1) - Menopause
Estradiol (E2) - Productive Years
Estratriol (E3) - Pregnancy

33
Q

What are the 2 Synthetic Estrogens?

A

Ethinyl Estradiol - Steroidal

diethylstilbesterol - Non-steroidal

34
Q

What are the physiological functions of Estrogens?

A 
Sexual Maturity
Increased CNS excitability (Seizures???)
Increased Endometrial and Uterine Growth
Maintain Skin Elasticity
Reduce bone adsorption
Increase Blood Coagulability
35
Q

What are the clinical uses of Estrogens?

A

Primary Hypogonadism
Post-menopausal problems

  • always used smallest dose for shortest time possible
  • Local creams can be preferred to minimize exposure
36
Q

What are the adverse effects of Estrogen use?

A

Postmenopausal Bleeding
Nausea
Breast Tenderness
Migraines
Hypertension
Hyperpigmentation (especially around eyes)
Increases some cancers (breast & endometrial)

37
Q

What are the contraindications for Estrogen use?

A 
Liver Disease (Slows Metabolism)
Breast and Endometrial Cancers
Thrombolytic Disorders
38
Q

What are characteristics of Progestins?

A

Made from Cholesterol

Present in males/less in females

39
Q

What is the natural Progestin?

A

Progesterone

40
Q

What are characteristics of Progesterone?

A
  • Precursor to estrogen, androgen, and adrenal cortical steroids. (e.g. Cortisol)
  • Also precursor to testosterone and estradiol.
41
Q

What is the half life of Progestins?

A

Very Short Acting (5 min)

42
Q

What are the effects of Progestins?

A

Increase Fat Deposition
Decrease CNS Excitability (Anti seizure - opposite estrogen)
Increase Aldosterone
Increase Na+ retention
Increase BP
Increase water retention and blood volume
Increase Body Temperature

43
Q

What are the clinical uses of Progestins?

A
  • Replacement Therapy
  • Oral Contraception
  • Long term ovarian suppression
  • No problem with bleeding or clotting (contrast to estrogens
44
Q

What are the contraindications for the clinical use of Progestins?

A

Breast Cancer Risk

Severe hypertension/heart disease

45
Q

What makes up the combination of drugs used as a contraceptive?

A

Progesterone + Estrogen

46
Q

What are characteristics of Combo contraceptives?

A

Decreases Ovulation near (100%)

Decreases conception and Implantation

47
Q

What are characteristics of Progestin only contraceptives?

A

Less effective (80-90%)
Decreases ovulation 50-80%
Thickens mucus and reduces sperm penetration
Impairs implantation

48
Q

What are the delivery forms of Contraceptives?

A 
Combinations
Progestin only
Implantable
Injections
Intravaginal rings
IUDs with or without estrogen/progestin
Transdermal Combinations
49
Q

What are the three phases of Combinations?

A

Monophasics -constant doses of estrogen/progestin
Biphasics- dosage of one or both change one time / cycle
Triphasics- dosages change two times

50
Q

What are side effects of Combination contraceptives?

A

Reduced Ovarian Functions and Size
Increased Breast Size and Tenderness
Increased Thrombolytic Events
Increased HR and BP
Hyperpigmentation (especially around the eye)
Mild Nausea
Breakthrough Bleeding
Headaches
*May interact with antibiotics (wide-spectrum)
- Absorption of contraceptive depends on normal GI flora.

51
Q

What are uses for Contraceptives?

A 
Oral Contraception
Menstrual Disorders
Irregularity
Heavy Discharge
Acne
52
Q

What are three hormone antagonists?

A

Tamoxifen
Mifepristone
Danazol

53
Q

What is the Mechanism of action of Tamoxifen?

A

Blocks actions of estrogen in breasts

- Used to treat breast cancers

54
Q

What is the Mechanism of action of Mifepristone?

A

Morning after contraceptive: Blocks progesterone and glucocorticoid receptors (99% effective if used within 3 days)

55
Q

What is the Mechanism of action of Danazol?

A

Surpasses ovarian function

*masculinizing effect

56
Q

What drug is Ovulation inducing or promotes fertilization and pregnancy?

A

Clomiphene (Clomid)

*increased risk of multiple births (twins)

57
Q

What is an example of an androgen?

A

Testosterone

*Causes male puberty

58
Q

What are characteristics/uses of Testosterone?

A

Converts to estradiol
Replacement therapy for males
Gynecological Disorders-reduces breast size
Has protein anabolic effects - replace muscle loss
Growth Stimulation- premature close growth plates
Counter some age-related loss of muscle mass
Adverse effects in women especially-masculinization
Testosterone analogs abused for muscle and strength building
- Can cause acne, aggressiveness and roid rage

Human Disease and Therapeutics (24 decks)

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