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Test 2 PC1 > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Breast Exam includes

A

neck
chest wall
both breasts
axillae

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2
Q

Timing of breast exam

A

9 days after onset of menses

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3
Q

Palpable mass <30

A 
usually benign
attributed to normal physiologic changes
fibrocystic
fibroadenoma
cyst
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4
Q

Management of palpable mass <30

A

recheck in 2 weeks
monthly BSE
Imaging by sonogram (harder to see on mammogram b/c younger breasts more dense)
for this pt you would get a sonogram of breast

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5
Q

Palpable mass 55 y.o.

A

R/O malignancy first

then consider a cyst

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6
Q

Management of palpable mass 55 y.o

A

Diagnostic mammogram

35 and older mammogram the test of choice

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7
Q

The triple test

A

physical exam70% accurate
radiographic imaging 85% accurate
pathology 95% accurate

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8
Q

BIRADS category #4

A

suspicious, core needle biopsy or neele localization biopsy as soon as possible

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9
Q

Breast pain 3 types

A

cyclic
noncyclic
extramammary

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10
Q

Refer breast issues when

A

any mass if imaging studies are neg

when in doubt

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11
Q

cyclic breast pain

A

follows mentrual pattern
common during leuteal phase and may last 7 days
hormones

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12
Q

noncyclical breast pain

A

does not follow menstrual pattern
unilateral
could describe menopause women on hormone therapy
coopers ligaments stretching from large pendulous breasts

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13
Q

extramammary breast pain

A

chest wall pain
shingles
pleuritic,cardiac,GI
(costrochondritis)

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14
Q

most important question with pain evaluation

A

does the pain change in menstrual cycle

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15
Q

Benign breast pain tx

A 
NSAIDS, tylenol
well fitting bra
oral contraceptives
primrose oil 1500 BID x 4 months
Danazol
Vitamin E
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16
Q

Nipple discharge

A

common in reproductive years

most benign

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17
Q

Galactorrhea

A

discharge of milk beyond 6 month PP

white or clear

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18
Q

Abnormal nipple d/c

A 
uniductal
unilateral
persistent
sanguineous/ serosanguineous
mammogram in those >30
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19
Q

Questions to ask with nipple d/c

A

lymph nodes enlarged?
change in color?
dimpling?

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20
Q

Benign rashes

A

canida: keep dry, nystatin cream
eczema: nipple not involved
contact dermatitis: topical steroids

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21
Q

Paget’s disease

A

detect early to avoid lymph involvement

looks like eczema but involves nipple

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22
Q

most aggressive type of breast cancer

A

inflammatory breast cancer

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23
Q

BIRADS scoring

A

0-6 (mild-severe)

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24
Q

BIRADS 0

A

need additional imaging

spot compression and magnification with ultrasound

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25
Q

BIRADS 1

A

Negative
routine follow up
0% malignancy

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26
Q

BIRADS 2

A

Benign
routine follow up
0% malignancy

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27
Q

BIRADS 3

A

Probably benign finding
diagnostic view of breast in 6 months
2% malignancy

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28
Q

BIRADS 4

A

Suspicious
core-needle biopsy
>2-95% malignancy

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29
Q

BIRADS 5

A

Highly suspicious of malignancy
core-needle biopsy
95% malignancy

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30
Q

BIRADS 6

A

biopsy proven carcinoma

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31
Q

Documenting mass

A

location with measurement and distance from nipple
tender/nontender
mobile

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32
Q

Fibrocystic changes with breasts

A

normal to have grainy feeling bilaterally with pain
common in those 30-50
can be related to estrogen

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33
Q

Fibroadenoma

A

common in young women in teens

mass is rubbery, mobile and non tender

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34
Q

Breast cyst classifications

A

simple
complicated
complex

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35
Q

Simple cysts

A 
common in peri-menopausal
oval
smooth
mobile
well circumscribed
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36
Q

Complicated/Complex cysts

A

contain mixed cystic and solid components
high rate of cancer
aspirate and send to cytology

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37
Q

Normal vaginal environment

A

can have thick, pasty, dry or stringy d/c that is odorless
1-4ml d/c/24 hours
normal pH 3.8-4.2

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38
Q

Whiff test and KOH

A

take vaginal swab and add to slide
add 10% potassium hydroxide
if smell fishy then positive and eval for yeast

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39
Q

3 most common causes of vaginitis

A

trich
BV
candida

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40
Q

protozoa flagella

A

Trichomoniasis

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41
Q

symptoms of trich

A 
50% asymptomatic
pruritis
vulvovaginal erythema
strawberry cervix
frothy yellow-green d/c
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42
Q

Dx trich

A

pH > 4.0
+ whiff test
wet mount with pos motile trich

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43
Q

Tx trich

A

metronidazole 2g PO x1 dose
no alcohol with this or will feel ill
safe with pregnancy

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44
Q

Vulvovaginitis Candidiasis

A 
Yeast infection
bacterial over growth
pH 4.0-4.5
thick, clumpy, white
KOH test
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45
Q

Classification of candidiasis

A

complicated

uncomplicated

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46
Q

uncomplicated candidiasis

A

sporatic or infrequent
mild to mod symptoms
C. albicans
not immunocompromised

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47
Q

complicated candidiasis

A

recurrent with 4 or more/yr
women with uncontrolled diabetes, immunosuppression or pregnant
severe symptoms

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48
Q

Tx candidiasis

A

uncomplicated: 3 day tx with azole
recurrent: 7-14 days with topicals
or
fluconazole 150mg x 1 dose and repeat in 3 days

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49
Q

Pregnancy tx for candidiasis

A

topical azole therapies x 7 days

50
Q

Bacterial Vaginosis

A

most common cause of d/c without vulvitis or vaginitis
over growth of Gardnerella
lactobacilus

51
Q

BV presentation

A

discharge
odor
vaginal irritation
feeling wet

52
Q

Diagnose BV

A 
with 3 of the following:
thin white d/c that coats vaginal wall
clue cells on microscope
pH >4.5
pos whiff test
53
Q

Tx BV

A

oral or vaginal metronidazole or clinda (5g of 2%cream if not pregnant
orals only with pregnancy

54
Q

Cervicitis causes

A 
Gc/chlamydia
HSV
HPV
Trich
trauma
radiation
malignancy
55
Q

Symptoms of cervicitis

A

abnormal d/c

vaginal bleeding following intercourse

56
Q

Dx 2 signs of cervicitis

A

purulent or mucopurulent endocervical exudate

endocervical bleeding induced by cotton swab

57
Q

Tx cervicitis

A

Azithromycin1g PO x1
or
Doxy 100 BID x 7 days

58
Q

Pelvic Inflammatory disease

A

ascending spread of microorganisms from vagina to endometrium, fallopian tubes and ovaries

59
Q

Clinical manifestations of PID categorized

A

Subclinical- not dx, most common
Mild to Mod
Severe

60
Q

Subclinical signs of PID

A

irregular bleeding

dysuria

61
Q

Mild to Mod signs of PID

A 
lower abd or pelvic pain
cramping
d/c
fever
cervical motion tenderness
62
Q

Severe signs of PID

A

fever
chills
nausea
vomiting

63
Q

Risks of PID

A

ectopic pregnancy
infertility
tubal infertility (increases with each time)

64
Q

Minimum criteria to dx PID

A

uterine tenderness
adnexal tenderness
cervical motion tenderness

65
Q

Other signs to dx PID

A

temp >101
abundant WBC on swab
elevated sed rate
Pos Gc/clyamydia

66
Q

Oral tx for PID

A 
Ceftriazone 250mg IM x1 
plus
Doxy 100mg PO BID x 14 days
with or without
metronidazole 500mg PO BID x 14 days
67
Q

Follow up from PID treatment

A

consider retesting for Gc/clamydia 4-6 weeks after

treat male sex partners

68
Q

Condyloma Acuminata

A

HPV

69
Q

Types of HPV

A

Type 6 & 11 = genital warts (HSV II sexual contact)

Type 16 & 18 = cancers

70
Q

Primary HSV presentation

A 
incubation 4 days after exposure
burning before lesion present
neurologic pain that radiates to back and hips
multiple vesicles rupture
persist for 2-6 weeks
flu like symptoms
71
Q

Management of HSV

A 
culture of vesicle (neg does not rule out genital herpes)
VCR gold standard
serologic assay
oral antiviral
pain meds
72
Q

Recurrent HSV presentation

A

less sever of asymtomatic

tx with antivirals

73
Q

Chancroid

A

haemophilus ducreyi

pustule ruptures

74
Q

Tx haemophilus ducreyi

A

Azithro 1gm PO x1

Ceftriaxone 250 mg IM x1

75
Q

Chancre

A

Syphilis
painless, rounded, indurated ulcer with serous exudate
resolves spont 3-6weeks

76
Q

Ulcerative vaginal lesions diff dx

A

HSV
syphilis
H. ducreyi

77
Q

Bartholin’s duct cyst

A

more common in women in reproductive age
most are small, larger result in more pain
IND to drain

78
Q

Genital tract bleeding

A

most attributed to uterine source

can arise from urethral, bladder, bowel

79
Q

Normal menstrual cycle

A

average of 28 days (21-35 days)
menstruation 4-7 days
blood loss 35ml

80
Q

chronic menstrual blood loss

A

> 80 ml per cycle which can lead to anemia

81
Q

pain with ovulation

A

Mittelschmerz

82
Q

abnormal uterine bleeding

A

any bleeding that does not conform to the freq, duration or amount of bleeding that a woman considers normal
irregular menstrual cycles

83
Q

Types of abnormal uterine bleeding

A 
menorrhagia
metrorrhagia
menometrorrhagia
polymenorrhea
hypermenorrhea
84
Q

Menorrhagia

A

bleeding occurs at normal intervals but is prolonged

85
Q

Metrorrhagia

A

irregular bleeding between menstrual cycles

86
Q

Menometrorrhagia

A

irregular noncyclic bleeding that is prolonged or excessive

87
Q

Polymenorrhea

A

bleeding intervals less than 21 days

88
Q

Hypermenorrhea

A

amount of menses is abnormally hign or low

89
Q

Dysfunctional uterine bleeding

A

abnormal bleeding without an organic etiology
anovulatory bleeding
ovulatory bleeding
example: >80ml bleeding in cycle

90
Q

anovulatory bleeding

A

endometrium is cont. proliferating
endometrium is fragile and there is irregular sloughing
unpredicted bleeding
spotting
infrequent heavy bleeding
occurs in early menarche and premenopausal

91
Q

ovulatory bleeding

A 
regular cycle length
prolonged or excessive bleeding
less likely to respond to hormone therapy
loss of hemostasis in endometrium
NSAIDS good b/c they interrupt cycle
92
Q

Testing for age 13-18 in abnormal uterine bleeding

A

screen for blood dyscrasias

CBC to rule out coag issue

93
Q

Testing for age 19-50 in abnormal uterine bleeding

A

TSH
FSH
CBC
fasting prolactin to r/o pituitary adenoma

94
Q

indications for endometrial biopsy with abnormal uterine bleeding

A

19-39 years old if chronic anovulation or unresponsive to medication
40-49 years unless pregnant or reason to avoid

95
Q

Tx abnormal uterine bleeding

A 
NSAIDS b/c they decrease prostaglandins
oral contraceptives
danazole
gonadotropin releasing hormone agonists
ablation
hysterectoy
96
Q

Primary amenorrhea

A

absence of menarche by age 16 in the presence of normal growth

97
Q

Secondary amenorrhea

A

absence of menses for 3 consecutive cycles in women who were previously menstruating
could be stress or strict diet

98
Q

lab for amenorrhea

A 
prolactin
thyrotropin, FSH
dehydroepiandrosterone
testosterone
progesterone challenge test - give PO progesterone, stop pill and bleeding should occur within 10 days
99
Q

dysmenorrhea

A

painful menstruation
primary (adolescents)
secondary (genital disorders)

100
Q

dysmenorrhea with menstruation

A

with menstruation there is an increased prostaglandin synthesis and
increased markers of inflammation which causes decreased unterine blood flow and increased uterine contractility

101
Q

Tx dysmenorrhea

A

NSAIDS
heat
Vit E
contraceptives

102
Q

Location where you take Pap sample

A

SCJ zone or transormation zone

103
Q

Optimal Pap testing

A 
avoid anything in vaginal for 48 hours
avoid with heavy bleeding
take specimen before bimanual
remove excessive mucous or bleeding gently
ectocervical then endocervical
104
Q

Squamous cell abnormalities

A

ASC- atypical squamous cells
LSIL- low grade squamous cell lesion (CIN1)
HSIL- high grade squamous cell lesion (CIN2-3)
Carcinoma

105
Q

CIN 1

A

grade of neoplasia
corresponds to LSIL
mild dysplasia
confined to basal 1/3 of epithelium

106
Q

CIN 2

A

grade of neoplasia
moderate dysplasia
basal 2/3 of epithelium

107
Q

CIN 3

A

sever dysplasia
carcinoma-in-situ
may involve full thickness of epithelium

108
Q

When pap is unsatisfactory

A

repeat in 2-4 months

if cells obscured then tx infection or colposcopy

109
Q

HPV self cure

A

75-90% of HPV will clear within 1 year due to immune response
Adolescents may take up to 24 months

110
Q

HPV screening

A

not recommended less than 20 y.o.
not recommended 21-29 just routine cytology
routine screening >30 HPV and cytology q5 years or just cytology q3 years
not recommended after 65 or after hyst

111
Q

HPV screen prior to gardasil

A

not needed

112
Q

Standard mammography screening

A

annually for asymptomatic women age 40 and older who have no risk factors

113
Q

Mammography recommendations for women at risk

A

start annual mammogram at 30, not before 25

114
Q

Women who have 1st degree relative with BRACA mutation mammogram

A

yearly starting at 30 age

115
Q

woman with a 20% or greater lifetime risk for breast cancer recommendations for mammogram

A

yearly starting at 30 age

116
Q

When should mammography be stopped

A

there is no reason to stop

117
Q

View of mammogram

A

craniocaudal and mediolateral oblique view of each breast

118
Q

Gardasil vaccination guidelines

A

1st dose
1-2 months give 2nd dose
3rd dose is given 6 months after 1st dose

119
Q

Age to start Gardasil

A

recommended 11 to 12 years

120
Q

Catch up Gardasil

A

Females 13 through 26 years of age

Males 13 through 21 years

Test 2 PC1 (4 decks)

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