Women's Health Flashcards by Emily Rowe

What disorder commonly occurs from breastfeeding?

Mastitis

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What are the signs/symptoms of mastitis?

Sudden onset of pain
Inflammation
Induration
Tenderness
Warmth

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What is the treatment for mastitis?

No MRSA or abscess: dicloxacillin 500mg QID or Keflex 500mg QID
MRSA: bactrim 1-2 tabs PO BID or clindamycin 300mg TID
Warm compress & keep breastfeeding

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What is galactorrhea?

Milk production when not breastfeeding

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What things can cause galactorrhea?

Chronic breast stimulation
Steroids
Hormones
Pituitary tumor
Idiopathic

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What are signs/symptoms of galactorrhea?

Milky discharge from nipples
Discharge has evidence of fat droplets on analysis

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How do you treat galactorrhea?

Stop offending agent
Treat cause

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What are the signs/symptoms of intraductal papilloma?

Bloody, serous discharge from the nipple

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What diagnostic test is used in intraductal papilloma?

Ductogram

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What is the treatment for an intraductal papilloma?

Excision of the duct

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What is polythelia?

Accessory or supernumerary nipple that develop along the “milk line”

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What is the most common benign breast tumor?

Fibroadenoma

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What are signs/symptoms of a fibroadenoma?

Sharply circumscribed, freely mobile, “rubbery” lump

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What are the signs/symptoms of breast cancer?

Hard, non-mobile mass
Skin retraction
Nipple retraction
Peau d’orange
Commonly in the upper outer quadrant

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What is the most common type of breast cancer?

Ductal

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What is the treatment for breast cancer?

Surgery (mastectomy, lumpectomy)
Radiation
Chemo
SERMs
Aromatase inhibitors
PD-L1 inhibitor

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What tool can be used to assess risk of breast cancer?

Gail Model

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What are the genes that are looked at when assessing genetic predisposition to breast cancer?

BRCA1 & BRCA2

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Most breast cancer occurs in women with what type of risk factors?

Most occurs in women with no known risk factors

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What is the 1st line diagnostic test for abnormal uterine bleeding?

Transvaginal ultrasound

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What is the definitive treatment for abnormal uterine bleeding?

Hysterectomy

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What are the definitions of amenorrhea, oligomenorrhea, menorrhagia, and dysfunctional uterine bleeding?

Amenorrhea: absence of bleeding for > 3 cycles
Oligomenorrhea: > 35 days between cycles
Menorrhagia: excessive volume or > 7 days
Dysfunctional: anovulatory bleeding

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What are the normal ranges for a menstrual period (frequency, regularity, duration, volume)?

Frequency: 24-35 days
Regularity: 2-20 day monthly variance in 1 year
Duration: 4.5-8 days
Volume: 5-80mL

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What procedure should be performed on all pts > 45 yo with abnormal bleeding?

Endometrial biopsy

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What does PALM COEIN stand for?

Reasons for abnormal uterine bleeding P: endometrial polyp A: adenomyosis L: leiomyoma (uterine fibroids) M: endometrial cancer (malignancy) C: coagulopathy O: ovulation disorders E: endometrial disorders I: iatrogenic N: not otherwise classified

What are the signs/symptoms of leiomyoma (uterine fibroids)?

Heavy or prolonged menstrual periods Pelvic pain or "pressure" Enlarged or irregularly contoured uterus on PE

What are the signs/symptoms of endometrial cancer?

Postmenopausal bleeding (most common) Abdominal bloating/fullness/distention Back pain Dyspareunia

What is the mainstay treatment for endometrial cancer?

Total hysterectomy with bilateral salpingo-oophorectomy

Dysmenorrhea (painful menstruation) can either be _____ or ______

Primary; secondary

What are signs/symptoms of dysmenorrhea?

Primary: cramping pain w/every menstrual cycle Secondary: progressive worsening of pelvic pain

What is the 1st line treatment for dysmenorrhea?

NSAIDs (ibuprofen or naproxen)

What is the definition of premenstrual syndrome?

Emotional and/or physical symptoms occurring 1-2 weeks prior to menstruation & resolving 1-3 days after the onset of menstruation

Lifestyle mods can help alleviate PMS symptoms, but what is the 1st line treatment for PMS with predominantly emotional issues?

SSRIs

What typically causes cervical dysplasia?

HPV (16 & 18 commonly)

What is the gold standard diagnostic test for cervical dysplasia?

Colposcopy

What is the Bethesda classification?

A system/tool that describes pap smears to guide treatment (tells what kind of dysplastic cells are present)

What is the treatment for cervical dysplasia?

ASC-US: repeat pap/HPV in 1 yr, colp if needed LSIL: repeat pap in 1 yr, colp if needed ASC-H: colposcopy HSIL: colposcopy or excisional tx Post-menopause: vaginal estrogen & repeat pap

What is the most common symptom of cervical cancer?

Post-coital bleeding

What is the gold standard diagnostic test for cervical cancer?

Colposcopy

What is used for staging cervical cancer?

FIGO

What is the treatment for cervical cancer?

Prevention w/routine pap smears, HPV vaccine, condom use Simple hysterectomy (for stage IA1 only) Total hysterectomy Conservative surgery (if fertility desired) > IA1 needs lymph node dissection & radical hysterectomy

What is the definition of menopause?

Permanent cessation of menses for 12 consecutive months

What are the signs/symptoms of menopause?

Vasomotor: hot flashes, night sweats, palpitations Urogenital: vaginal atrophy Psych: irritability, anxiety, depression

What test for menopause supports a diagnosis, but it not usually done?

FSH (> 40 supports dx)

What should post-menopausal women be screened for starting at age 65?

Osteoporosis w/DEXA scan

What is the treatment for menopause?

Hormone replacement (estrogen) SERMs (raloxifene, bazedoxifene) Non-hormone tx (SSRIs, gabapentin) Osteoporosis specific (bisphosphonates, Vit D, calcium) Non-prescription tx (Vit E, omega-3 fatty acids)

What are the stages of menopause?

Premenopause: no symptoms, still have period Perimenopause: symptoms of hormone change, can last 4 years & can still get pregnant Menopause: no period for 12 months Postmenopause: over 1 year since last period, stay in this stage for remainder of life

What risks of treatment of menopause should the pt be made aware of?

Hormones increase risk of cancer, stroke, embolism, CAD SERMs have risk of thromboembolism & stroke

What disorder is asymptomatic early and majority has mets once there are symptoms?

Ovarian cancer

What is the 1st line diagnostic test for ovarian and fallopian tube cancer?

Transvaginal ultrasound

What is the treatment for ovarian and fallopian tube cancer?

Refer to GYN oncologist Surgery Chemo

What procedure can be performed to prevent ovarian cancer in pts with a known BRCA gene?

Bilateral salpingo-oophorectomy

What are the 2 subtypes of vulvar and vaginal cancer?

Vulvar intraepithelial neoplasia from HPV infection Vulvar non-neoplastic epithelial disorder from chronic skin inflammation

What is the most frequent sign/symptom of vulvar cancer?

Chronic vulvar or vaginal itching

What is the gold standard treatment for vulvar and vaginal cancer?

Surgical resection

What is the most common chronic vulvar condition?

Vulvar lichen sclerosus

What are the signs/symptoms of vulvar lichen sclerosus?

Erythema & edema Development of white plaques Intense itching "Cigarette paper" appearance

What is the treatment for vulvar lichen sclerosus?

Stop itch-scratch cycle Vulvar hygiene Oral antihistamine High-potency topical steroids

Vulvar lichen sclerosus often gets mistaken for what in females that are prepubertal?

Sexual abuse

What is the length of time it takes vulvar epithelium to heal?

At least 6 weeks

What is the treatment for a Bartholin's cyst/abscess?

Stab incision & place Word cath I&D w/o Word cath GYN follow up in 5-7 days

What are the 6 P's of vulvovaginal lichen planus?

Pruritus Polygonal Planar Purple Papules Plaques

What are signs/symptoms of bacterial vaginosis?

Thin, white, homogenous discharge "Fishy smell"

What criteria is used to diagnose bacterial vaginosis?

Amsel's criteria (must have 3 of 4)

What is Amsel's criteria?

Thin, homogenous, white, non-inflammatory adherent discharge Clue cells on microscopic exam Vaginal pH > or = 4.5 Positive "whiff" test (fishy odor after KOH)

What is the treatment for bacterial vaginosis?

Metronidazole (flagyl) 500mg PO BID x 7 days OR MetroGel 0.75% 1 applicator 5g intravaginal QD x 5 days OR 2% clindamycin cream 1 applicator 5g intravaginal QHS x 7 days

What is characterized by perivaginal itching/burning, redness, and thick, white, curd-like discharge that adheres to the vaginal walls?

Vaginal candidiasis (yeast infection)

What is the treatment for vaginal candidiasis (yeast infection)?

Oral or intravaginal antifungals Butoconazole 2% 5g 1 dose OR Clotrimazole 500mg x 1 dose OR Fluconazole (diflucan) 150mg PO x 1 dose OR Nystatin vaginal suppository QD x 14 days

Women's Health Flashcards

(68 cards)