Women's Health Flashcards
What disorder commonly occurs from breastfeeding?
Mastitis
What are the signs/symptoms of mastitis?
Sudden onset of pain
Inflammation
Induration
Tenderness
Warmth
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
What is galactorrhea?
Milk production when not breastfeeding
What things can cause galactorrhea?
Chronic breast stimulation
Steroids
Hormones
Pituitary tumor
Idiopathic
What are signs/symptoms of galactorrhea?
Milky discharge from nipples
Discharge has evidence of fat droplets on analysis
How do you treat galactorrhea?
Stop offending agent
Treat cause
What are the signs/symptoms of intraductal papilloma?
Bloody, serous discharge from the nipple
What diagnostic test is used in intraductal papilloma?
Ductogram
What is the treatment for an intraductal papilloma?
Excision of the duct
What is polythelia?
Accessory or supernumerary nipple that develop along the “milk line”
What is the most common benign breast tumor?
Fibroadenoma
What are signs/symptoms of a fibroadenoma?
Sharply circumscribed, freely mobile, “rubbery” lump
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
What is the most common type of breast cancer?
Ductal
What is the treatment for breast cancer?
Surgery (mastectomy, lumpectomy)
Radiation
Chemo
SERMs
Aromatase inhibitors
PD-L1 inhibitor
What tool can be used to assess risk of breast cancer?
Gail Model
What are the genes that are looked at when assessing genetic predisposition to breast cancer?
BRCA1 & BRCA2
Most breast cancer occurs in women with what type of risk factors?
Most occurs in women with no known risk factors
What is the 1st line diagnostic test for abnormal uterine bleeding?
Transvaginal ultrasound
What is the definitive treatment for abnormal uterine bleeding?
Hysterectomy
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
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
What procedure should be performed on all pts > 45 yo with abnormal bleeding?
Endometrial biopsy
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
