Reproductive Flashcards
when does obstetrical dating start
the first day of the LMP
what is the average length of pregnancy
266 days from conception
280 days from LMP
what percept of prenancies are ectopic
what percent of those are in the fallopian tube
0.5%
95% in the fallopian tube
risks for ectopic pregnancy
salpingitis
prior ectopic pregnancy
prior tubal surgery
cigerette smoking
what percent of people with ecoptic pregnancy will have at least one risk factor
50%
what is the presentation of ectopic pregnancy
vaginal bleeding
pelvic pain
usually starts in the firs ttrimester
describe pelvic pain associated with ectopic pregnancy
usually mild, starts at 6-8 weeks in
describe pelvic pain associatd with ectopic pregnancy
usually starts at weeks 7-9
can vary from cramping to sharp pain
what is necessary for the evaluation of first trimester pain and bleeding
ultrasound is mandatory to catch ectopic pregnancy brefore rupture
US findings of ectopic pregnancy
No IUP “empty uterus”
adnexal mass
free fluid in the cul de sac
IUP
intrauterine pregnancy
what is the risk of a ruptured ectopic pregnancy
death
what is the presentation of ruptured ectopic pregnancy
massive intrabdominal blood loss
severe pain
syncope
what is the treatment of an ectopic pregnancy
removal of affected tube
blood transfusion
treatment of unruptured ectopics
methotrexate with follow up
laproscopy with preservation (little) or removal (big) of the tube
endometriosis
endometrial glands and stroma outside the uterus
what demographic is more likley yo hae endometriosis
infertile women 25-35%
symptoms of endometriosis
dysmenorrhea
dysparenunia
constant deep seated pelvic or rectal pain
infertility
dyspareunia
painful intercourse
what are the diagnostic considerations for endometriosis
laparoscopy
open surgery
US
two variants of endometriosis
benign and aggressive
benign variant endometriosis characteristics
later onset
superficial lesions
slow progression
aggressive variant endometriosis characteristics
early onset
invasive lesions
rapid progression
causes of endometriosis
retrograde mensturation that allows viable endometrial cells to implant on pelvis structures or travel in lymph that the immune system fails to elimante
5 common locations of distant endometriosis
umbilicus
intestine
upper abdomen
lung
brain
treatment for endometriosis
NSAIDs for dysmenorrhea
ovarian suppresssion
surgery
three ways to use hormone suppression to treat endometriosis
contraceptives
Pituitary down regulation
mild androgens
what is the definitive surgical treatment for endometriosis
hysterectomy and oophorectomy
three areas of cancer of the reproductive system
breast cancer
ovarian
uterine
four facts regardings breast cancer and age
increasing risk
rare before…
mean age
diagnosis time
risk increases with age
rare before 40
mean age of diagnosis 60-61
time from origin to diagnosis 2-8 years
how long does it take for a breast cancer tumor to double in size
20-100 days
what is the risk of breast cancer in females without estrogen
what about men with estrogen
male level risk
increased risk because of estrogen
what is the risk factor for breast cancer associated with familial linkage
but…
risk is increased 3-4x if a mother or sister has breast cancer
75% of patients have no history
two breast cancer mutations that increase risk
what type of genes are mutated
what is the life time risk with the mutation
BRCA 1 and 2
tumor suppressor mutations
50-85%
what other cancers are associated with BRCA 1 and 2
ovarian
pancreatic
fallopian
prostate
in what countries are breast cancers most commonly found
why
developed countries
related to fat content
what is the connection between ethanol and breast cancer
slight increase in ris
what is the usual presentation of breast cancer
a painless lump found by the patient
what are three less common presentations of breast cancer
nipple erosion or discharge
skin dimpling
inflammatory breast carcinoma
four types of breast cancer screenings
monthly self exam
annual breast exam
mammography
blood test for tumor markers
at what age does mammography have a proven value
between ages 50-70, no value under age 40
five ways to treat breast cancer
surgery
radiation
chemo
anti estrogen driugs
antibodies against growth factors
what are the three primary surgical treatments of breast cancer
lumpectomy
mastectomy
axillary node dissection
what factors decrease risk for ovarian cancer
pregnancy
oral contraceptive use
tubal ligation
three orgin sites for ovarian cancer
which is the most common
epithelial
germ cell
stromal/sex cord
epithelial
serous and mucinous cystadenocarcinoma are examples of what type of ovarian cancer origin
epthelial
does removing or blocking fallopian tubes increase to decrease risk of ovarian cancer
decrease
how does early diagnosis effect prognosis of ovarian cancer
but…
early detection increases prognosis
but only 20% of cases are detected earyl
what is common when ovarian cancer starts to spread in the abdomen
obstruction, malabsorption
three sites of distant metastases in ovarian cancer
liver
lung
bone
two treatment options for ovarian cancer
surgery
chemo
when pursuing surgical treatment of ovarian cancer, what needs to be removed
uterus, ovaries, fallopian tubes, omentum
three types of uterine cancer
cervical cancer
endometrial cancer
leiomyosarcoma
what is the main cause of cervical cancer
what are two synergistic factors
HPV
smoking, immunosuppression
what types of HPV are associted with warts
what are associated with cervical cancer
6, 11, 42, 43
16, 18, 33, 35, 45
how effective is gardasil against cervical cancer
what about genital warts
prevents 70-90% of cervical cancer
only some protection
what are the conventional screens for HPV
pap smear
liquid based medium
three treatments of cervical cancer
radial hysterectomy and lymph node dissection
radiation
chemo
three factors that increase risk for endometrial cancer
two factors that decrease risk
estrogen exposure, insufficient progesteron, genetics
oral contraceptives, progestin use
what is the effect of birth control on the risk for the following cancers
breast
ovarian
cervical
endometrial
possible increased risk
decreased risk
no impact
decreased
how is endometrial cancer diagnosed
post menopausal bleeding
endometrial biopsy/d & c
ultrasound
MRI for staging
treatment for endometrial cancer
radiation
surgery
hormones
chemo
psoriasis
chronic, relapsing skin disorder that causes itching, joint inflammation, and depression
how common is psoriasis
what is the typical age of onset
what is the gender bias
very common (1-3%)
15-25 yrs
none
describe the incidence of psoriasis from the follow ethnicities
caucasians
african americans
native americans
most common
uncommon
very rare
psoriasis is associated with increased risk for what diseases
inflammatory bowel disease
skin cancer
upper GI cancer
lung cancer
what is the etiology of psoriasis
it is a T cell mediated immune disease which also involves TNF and interleukins
what is the familial genetic influence with psoriasis
1/3 of people will have a positive FHx
70% chance that twins will have this together
what is the pathophysiology of psoriasis
excessively rapid turnover of the epidermis (3-5 days instead of 21-30 days)
what is the goal of psoriasis treatment
slow the turnover rate of the epidermis
what are the treatments for psoriasis ranked by toxicity
what is the relationship between toxicity and effectiveness
topical, photo, systemic
increasingly effective treatment is increasingly toxic
three examples of topical psoriasis treatment
corticosteroids
anthralin
coal tar
two photo treatments of psoriaisis
UVB, PUVA
three systemic treatments of psoriaisis
cyclosprin
methotrextate
retinoids
hypertrophic scars
raised or expanded scars that often form in reaction to suboptimal healing
keloid scars
idiopathic benign neoplastic extension of scars
what is the relationship between keloids and skin pigmentation
increasing pigmentation increases risk
what is the most common age group to form keloids
10-20
five treatment options for keloids
corticosteroid injections
cryotherapy
radiation
surgical excision
laser reduction
two benign forms of skin cancer
one maglignant type
basal cell and squamous cell carcinoma
melanoma
what is the most common form of skin cancer
what is the common cause
what is the risk if left untreated
basal cell carcinoma
UV light
local destruction, rarely metastasis
what is the common cause of squamous cell carcinoma
when would it be considered deadly
UV light
when it is in the oral cavities or mucus membranes
two treatment options for basal or squamous cell carcinoma
outpatient excision or thermal ablation
what is the main risk factor for melanoma
why is the incidence increasing but the mortality decreasing
sun exposure
sun worship - early detection, better treatment
diagnosis of melaoma
biopsy
ABCDE
ugly duckling
ABCDE for melanoma
assymetry
border
color
diameter
evolution
treatment for melanoma
excision
chemo
immunotherapy
two considerations to account for with surgical excision of melanoma
wide surgical margins with lymph node sampling
three forms of immunotherapy against melanoma
interferon
tumor vaccines
lymphocyte training
dermatological manifestation of heart failure
pitting edema
dermatological manifestation of insufficient oxygenation
clubbing and cyanosis
dermatological manifestation of vascular insufficiency
venous stasis ulcers
three types of coagulopathies
low platelet counts
clotting factor deficiencies
excessive anticoagulation
three signs of clotting abnormalities in the skin
petechiae
purpura
easy bruising
two types of lupus
systemic
discoid (only skin)
three causes of contact dermatitis
allergic reaction similar to poison ivy/oak/sumac
