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Women's Health > Women's Health Exam 2 > Flashcards

Women's Health Exam 2 Flashcards

1
Q

PMDD

A

Premenstual dysphoric dysorder

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2
Q

Premenopause

A

Erratic hormones, menses begin to be irregular

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3
Q

Postmenopause

A

No menses for a year

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4
Q

Dysmenorrhea

A

Painful menstrual bleeding

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5
Q

Metorrhagia

A

Menstrual bleeding between periods

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6
Q

Menometorrhagia

A

Irregular, unpredictable bleeding

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7
Q

Oligomenorrhea

A

Periods more than 35 days apart

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8
Q

BSO

A

Bilateral salpingo-oophorectomy

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9
Q

TAH

A

Total abdominal hysterectomy - through abdomen

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10
Q

TVH

A

Total vaginal hysterectomy - comes out through vagina

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11
Q

Radical hysterectomy

A

Takes out uterus and additional tissue including the cervix

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12
Q

Term pregnancy

A

37-42 weeks

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13
Q

Preterm

A

20-36 weeks

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14
Q

Abortion

A

Before 20 weeks

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15
Q

Puerperium

A

Birth to 6 weeks postpartum

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16
Q

3 trimesters

A

1 - 0-14
2 - 15-28
3 - 29-42

Each is 2 Weeks

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17
Q

FHT

A

Fetal Heart Tones

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18
Q

Grand multigravida

A

More than 5 times pregnant

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19
Q

GTPAL

A

Gravida
Term
Preterm
Abortions
Lived 30 days

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20
Q

Para

A

Pregnancies carried to term

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21
Q

Recommended age for 1st reproductive health visit

A

Age 13-15
Only screen if STD suspected or symptomatic

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22
Q

Age to begin pelvic exams and pap smear

A

21 years old
Frequency of pelvic depends on risk factors with pap every 3-5 years

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23
Q

General breast exam screening

A

Every 1-3 years 20-39, yearly after 40 with mammograms done starting at 40

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24
Q

Speculum lubrication for pap smear

A

Use warm water (officially)

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25
Q

Two ways to do pap smear

A

Use scraper and brush, or use the combo tool

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26
Q

General breast exam method

A

Palpate 4 quadrants and 4 positions
Palpate for regional lymphadenopathy
Palpate tail of spence

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27
Q

Bimanual exam

A

One hand in vagina and one on lower abdominal wall
Test for size shape, mobility, and consistency of organs

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28
Q

Skin exam recommendations

A

Q3 years 20-40 and then yearly 40+
Same as pap smears!!

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29
Q

Pap screening recommendations

A

21-29 every 3 years
30-65 every 3 years or HPV with pap every 5 years
Stop screening at 65

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30
Q

Reasons to stop pap smears after 65

A

No hx of dysplasia/cancer
3 negative smears or 2 negative Pap+HPV in a row

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31
Q

When do pap smear guidelines NOT apply

A

Hx of cervical cancer, HIV+, Immunedeficient, DES exposure

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32
Q

STD screenings for ALL pregnant women

A

Hep B, HIV, Syphillis

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33
Q

STD screenings in all women under 25

A

Gonorrhea and Chlamydia

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34
Q

STD to screen for in high risk sexual behavior women

A

Hep C

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35
Q

STD screening for all sexually active women

A

HIV - One time screen
Gonorrhea and Chlamydia - Yearly if under 25

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36
Q

STD screenings for High risk sexual behavior women

A

Annual for All:
HIV
Syphillis
Trichomoniasis
Hep B and C
G/C
HSV

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37
Q

Breast cancer screening

A

Depends on agency - start yearly 40-50 years old - definitely by 50
Clinical breast exam optional, Mammogram required

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38
Q

When to stop mammograms

A

When you wouldn’t treat cancer if you found it
74 per official guidelines

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39
Q

Colon cancer screening recommendations

A

FOB, FITm CT Colonoscopy 45-75 - recommended against after 75

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40
Q

Bone density screening recommendations

A

65 years old
Or any woman who’s risk is equal to a 65 year old woman

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41
Q

Bethesda system

A

Pap smear evaluation - grades pap cells for cancer

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42
Q

Atypical squamous cells

A

ASC - Lowest concern abnormal pap smear cells, can see in infection or atrophy
Undetermined significance = ASC-US
Cannot exclude High Grade = ASC-H

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43
Q

Low grade squamous intraepithelial lesion

A

LGSIL or LSIL
Corresponds to CIN-I

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44
Q

High grade squamous intraepithelial lesion

A

HGSIL or HSIL
Corresponds to CIN II or CIN III

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45
Q

Atypical glandular cells

A

Do not match normal cervical glandular cells but are also not cancer
Associated with adenocarcinoma of endocervix or of endometrium

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46
Q

CIN I

A

Disordered growth of lower 1/3 of epithelial lining - mild

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47
Q

CIN II

A

Disordered growth of lower 2/3 of epithelial lining - moderate

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48
Q

CIN III

A

Disordered growth of over 2/3 of epithelial lining of cervix - considered full thickness

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49
Q

CIN

A

Cervicle Intraepithelial Neoplasia

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50
Q

Treatment for CIN stages

A

Always treat CIN II or III
Except for in pregnant women (wait till after birth) or in adolescents with CIN II we can observe

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51
Q

Risk factors for cervicle dysplasia

A

Multiple sexual partners
High risk partner
HPV hx
Other STIs
Immune suppressed
Contraceptive use long term
Multiparous

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52
Q

Management for ASC-US

A

Repeat pap in 6 months and then again in 6 more months
Second abnormal smear - refer for colposcopy
Test for HPV - colposcopy if positive
Colposcopy

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53
Q

Colposcopy

A

Like a cervicle exam - use a magnifying light as well as acetic acid
Curette or brush endocervical canal

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54
Q

Indications for coloposcopy

A

Abnormal cervicle cytology
CLinically abnormal cervix
Unexplained intermenstrual or postcoital bleeding
Vulvar or vaginal neoplasia
In utero DES exposure

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55
Q

CIN I on colposcopy management

A

Expectant management
2 pap q6 months as with ASC-US
Repeat colpscopy if positive or +HPV

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56
Q

CIN II-III or cancer on colposcopy management

A

Surgery

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57
Q

Cervix surgery

A

Take out part of the cervix for cancer

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58
Q

3 estrogens in women

A

Estrone (E1) - Order when worried that thye have little estrogen
Estradiol (E2) - What we are usually talking about when talking about estrogen - ordered to monitor menopause, etc.
Estriol (E3) - Screen for fetal pathology and assess preterm labor risk

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59
Q

Where progesterone is produced

A

Corpus luteum
Placenta
Biotin - causes flase elevation
Should not be present post menopause

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60
Q

Percent of pregnancies that are unintended

A

50%

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61
Q

Percent of pregnancies that were unwanted but women not using birth control

A

40%

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62
Q

Coitus Interruptus

A

Pull out method
Very ineffective - very high failure rates
Semen can leak out before orgasm
Not recommended

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63
Q

Postcoital Douche

A

Fluch semen out of vagina
Not reliable - sperm are fast
Not recommended

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64
Q

Lactational amenorrhea

A

Suckling to reduce GnRH to suppress ovulation
Pregnancy rate of 7.4% after 12 months - less effective with time
Need to be amenorrheic
Start other birth control at 3 months postpartum

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65
Q

Periodic abstinence

A

Calendar methods - 11-25% failure rate
May be related to birth defects

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66
Q

Most effective determinant for ovulation

A

serum LH - not practical

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67
Q

Fertile period for periodic abstinence

A

2 days before and after ovulation - not very reliable

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68
Q

Temperature method of birth control

A

Check temp in the morning
first three days of elevated temperature after drop are the fertile period

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69
Q

Failure rate of combined temp/calendar method

A

5 per 100 couples per year - if consistent, need to be consistent

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70
Q

Cervical mucous method

A

Billings method
Check cervical mucus - when its thin, patient is fertile

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71
Q

Symptothermal method

A

Notice ovulation symptoms and be aware - most effect natural method

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72
Q

2 types of OCP

A

Combo or Progestin only pills

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73
Q

Combination OCPs

A

Include estrogen and a progestin -some kind of both

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74
Q

3rd or 4th generation progestins

A

Better to avoid male secondary sex characteristics
Worse for risk of clotting - DVT, etc.

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75
Q

Monophasic COC

A

Same hormones daily

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76
Q

Multiphasic COC

A

Different doses during the cycle
May give placebo at some points

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77
Q

Administration of COC

A

Ideally start on first day of cycle or just start the day you pick it up and your body will adjust

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78
Q

Single missed dose COC

A

Single high monophasic - makeup on the next day

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79
Q

Multiple missed doses for COC

A

Double dose and use added barrier contraceptive for 7 days

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80
Q

Tx for missed COC w/ coitus in past 5 days,

A

consider emergency contraception

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81
Q

MOA of COCs

A

Suppress LH and FSH
Alter cervical mucus
Make endometrium less receptive to implantation

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82
Q

Drug interactions with COCs

A

Antibiotics, Anticonvulsants, NSAIDs, SSRIs

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83
Q

Benefits of COC

A

Lower risk of ovarian and endometrial cancer
MSK benefits
Lower ectopic pregnancy
Less menstrual pain

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84
Q

Major side effects of COCs

A

Increased thromboembolic risk
MI risk increases
Stroke
Liver disease
Cervical and Breast cancer increase

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85
Q

Cautions for COCs

A

No use in migraine HAs with aura
May impair breast milk

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86
Q

Four Minor SEs for COCs

A

Nausea, dizziness, fatigue
Weight gain 2-5lbs
Abnormal menses
Melasma

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87
Q

8 Contrindications for COCs

A

Pregnancy
Undiagnosed vaginal bleeding
Migraine with Aura
Prior history of thromboembolic event
Uncontrolled HTM DM, or SLE
Smokers over 35
Breast cancer hx
Active liver disease

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88
Q

Progestin only contraceptives

A

Does not suppress ovulation
Thicken cervical mucous and make endometrium unsuitable
Need to be very compliant

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89
Q

Disadvantages of POCs

A

Must take at same time of day daily
Higher bleeding and pregnancy rates
Cancer is still a risk

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90
Q

CI to POCs

A

Unexplained uterine bleeding
Breast cancer
Hepatic neoplasms
Pregnancy
Active severe liver disease

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91
Q

Three ,method of emergency contraception

A

Yuzpee method
Levonorgestrel
Copper IUD

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92
Q

Yuzpee method of contraception

A

Emergent
COC with levonorgestrel
1st dose within 72 hours of intercourse - sooner is better
Causes nausea

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93
Q

Levonorgesterol alone

A

Plan B - OTC
Single dose of 1500mcg
Within 72 hours ideally, stops LH surge - not useful if already ovulated

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94
Q

Ulipristal

A

Ella - OTC
Single dose of 30mg
Within 72 hours recommended
Prevents LH surge - slightly better than plan B

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95
Q

Emergent Copper IUD

A

May inhibit implantation or interfere with sperm function
Insert up to 5-7 after
OTC
Emergency contraception

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96
Q

Levonorgestrel IUD for emergency contraception

A

52 mg for emergency contraception
Insert up to 5 days post intercourse

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97
Q

Vaginal ring

A

Combination contraception
3 weeks per month
No fitting, can remove for three hours and still work

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98
Q

Failure rate of vaginal ring

A

0.65 per 100 women per year

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99
Q

Transdermal patch contraception

A

New patch weekly for 3 weeks a month, not directly on breast - rotate sites
Less than 1% failure with less efficacy in obese patients

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100
Q

CI of transdermal patch and detachment

A

Have to restart if it has been off for 24 hours

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101
Q

Depot Medroxyprogesterone Acetate

A

SepoShot
Progesterone Q3 months
3% failure rate for typical (imperfect) use
0.3 - Ideally

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102
Q

Benefits of Depot Medro shot

A

Lower risk of ectopic pregnancy
Lower risk of endometrial cancer
Lower sickle cell crises
May help endometriosis

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103
Q

Side effects of Depot Medroxyprogesterone Acetate Shot

A

Decreased bone density
Irregular menses
Takes 10 months to return to baseline and get pregnant

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104
Q

Levonorgestrel implant

A

Implanted in arm
Contains a progesterone - etonogesterol
Almost 100%
Up to 3 years - some studies is 5

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105
Q

SE of implants (nexplanon)

A

Minor bruising, swelling, and itching at insertion site
Irregular menses
Weight gain
HA

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106
Q

Copper IUD non-emergent

A

FDA approved for 10 years
Uncertain MOA
0.6-0.8 per 100 woman-years

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107
Q

Risks/SEs of Copper IUD

A

Ectopic pregnancy
Spontaneous abortion
Uterine perforation
Menstrual irregularities, cramping, vaginitis

108
Q

Contrindication to copper IUD

A

Pregnancy
Active infection
Wilson disease
Cancer or unknown bleeding
PID

109
Q

Levonorgestrel IUD

A

Good for people having heavy periods and cramping
8 year lifespan
Very low failure
Bleeding as a SE, helps with cramping, breast pain
52 mg

110
Q

Low dose levonorgestrel IUD

A

Kylea - 5
Skylea - 3
Not for cramps or menorrhagia

111
Q

IUD expulsion

A

Check for strings
Happens in up to 5% in first year of use
Test for pregnancy if expelled

112
Q

Spermicides

A

Most based on Nonoxynol-9
Phexxi - More natural
Most OTC
Placed in vagina and last around an hour
High pregnancy due to non-compliance

113
Q

Contraceptive sponge

A

Nonoxyl-9 impregnated disk
Inserted up to 24 hours before and keep in 6hrs post coitus
Less effective than condom

114
Q

Lamb skin condoms

A

Don’t protect against STD’s - latex DO

115
Q

Female condom

A

May prevent STDs, not as effective as a male condom

116
Q

DIaphragm and Spermicide

A

Rubber dome over cervix
Must use the spermicide
6 hours before and 24 hour max placement
6 per 100 with perfect use
15-20 per 100 with typical use

117
Q

Cervical cap

A

Smaller than a diaphrage -can stay in up to 48 hours
Just on cervix
May be hard to place

118
Q

Regret frequency for sterilization contraception

A

20% for women under 30 6% for women over 30

119
Q

Legal limitations to sterilization

A

Federal won’t pay for under 21 - some states may
None for incompetent patients

120
Q

4 types of female tubal sterilization

A

Electrocoagulation
Mechanical occlusion
Ligation with suture material
Salpingectomy

121
Q

Concerns with tubal sterilization

A

Tubal pregnancy
Chronic pelvic pain - tubal ligation syndrome
Irregular menses
Decreased ovarian cancer when removed

122
Q

Tubal occlusions

A

No longer done, used a hysteroscopic precedure

123
Q

Chemical tubal occlusion

A

Usually not done in US, never approved - seen in immigrants

124
Q

Vasectomy

A

30x less failure, 20x less post-op complications
Need 1-2 consecutive sperm counts of zero to confirm it is working
Easier reversal

125
Q

Suction curettage

A

Elective abortion performed 12 weeks for earlier
90% of US abortions
Cervical dilation and suction catheter insertion

126
Q

Surgical curettage

A

Scrape out fetal parts - more bleeding less common than suction

127
Q

Phamraceutical abortion

A

(Mifepristone OR methotrexate) and/or Misoprostol
Used in first trimester
SE of cramping/bleeding
CI in active liver/renal disease, anemia, bleed risk, IBF -may not expel everything

128
Q

Intraamniotic instillation

A

Hypertonic solution put into uterus to kill the fetus - lots of side effects

129
Q

Vaginal prostaglandins

A

For elective abortions - suppository containing misoprostal etc. to trigger preterm delivery
Can cause GI side effects, live abortion

130
Q

MOA of misoprostol

A

Causes uterine contractions and cervicle ripening
Used for abortions and induction

131
Q

Dilation and evacuation

A

Most common elective abortion for 2nd trimester
Cervical ripening agents used and forceps to break up tissue
Infection and blood loss - does not feel like a delivery

132
Q

Post abortion follow up

A

Rho-Gam
Avoid anything intravaginal for 2 weeks
Birth control
2+ elective abortions lead to higher risk of miscarriage

133
Q

Climacteric

A

Phase of aging from reproductive to non-reproductive age, before actual menopause occurs

134
Q

Average langth of per menopausal transition

A

1-3 years
Part of climacteric period

135
Q

Average age of final menstrual cycle

A

51

136
Q

Premature menopause

A

Menopause at 40 or younger

137
Q

Perimenopausal

A

Going through menopause but still having periods

138
Q

Change in follicles over time

A

Ones most responsive to FSH are ovulated first

139
Q

Estradiol of menopause

A

May see bursts of estradiol because follicles are not responding as well

140
Q

Predisposing factors for menopause

A

Smoking advances by 2 years
Reproductive tract disease
GU infections
Chemo or radiation
Surgical impairment to ovarian blood supply

141
Q

Artificial menopause

A

We do something that destroys the ovaries or take them out
May be due to endometriosis, cancer

142
Q

Postmenopausal androgens

A

Decreased production, but still have androgenic symptoms because ovaries make some testosterone and binding protein is not produced

143
Q

Gonadotropins in menopause

A

Increase because no estrogen - can be used for diagnosis

144
Q

Common classic menopause symptoms

A

Irregular bleeding
Irritability and mood swings
Vaginal dryness
Decreased libido
Hot flashes
Hair loss
Hirsutism
Weight gain

145
Q

Physical changes of menopause

A

Atrophy of cervix, uterus, tubes
Flattening of vaginal rugae

146
Q

Urinary and mammary changes of menopause

A

Urgency, frequency, dysuria
Urethral prolapse
Regression and flattening of mammary glands

147
Q

Atrophic vaginitis

A

Epithelium becomes thinner and rugae flatten out
Painful intercourse and friability
Smooth pale and shiny late
Diffuse patchy and red early
Increased pH

148
Q

Diagnosis of atrophic vaginitis

A

Clinical dx - may see atrophic cells in cytology

149
Q

Initial tx for atrophic vaginitis

A

Conservative first
Vaginal moisturizers AND lubricants - not the same thing
Moisturizers daily - not just for sex

150
Q

Treatment for moderate/severe atrophic vaginitis

A

Vaginal estrogen, restores pH and microflora
Fewer UTIs and overactive bladder symptoms
Can go systemic
DOn’t need a vaginal estrogen if systemic

151
Q

Ospemifene

A

For atrophic vaginitis
Only targets vaginal estrogen receptors, MC MC SE is hot flashes

152
Q

Prasterone

A

Vaginal DHEA that turns into estrogen for estrogen sensitive individuals

153
Q

Presentation of hot flashes

A

Elevated HR - normal rhythm and BP
Night sweats, Insomnia
Cutaneous dilation - flushing

154
Q

Risk factors for hot flashes

A

Obesity, Lower physical activity, Smoking, African american race

155
Q

Normal hot flash length

A

seconds to 10 minutes

156
Q

Tx for hot flashes

A

Estrogen = mainstay, give progestin if they cannot take it alone

157
Q

Reasons to take eastrogen with progestin

A

Intact uterus due to endometrial cancer risk

158
Q

First line for patients who don’t want hormones for hot flashes

A

SNRI/SSRI
Citalopram or Venlafaxine, Paroxetine but it reacts with tamoxifen
Gapapentin, Clonidine can also be used

159
Q

Protections of estrogen alone

A

CHD
Fractures
Diabetes
Not used to treat these conditions

160
Q

Risks of MHT (Hormone therapy

A

Estrogen causes endometrial cancer - add progestin to prevent
Increased risk of breast cancer with combo therapy - d/t progesterone!!

161
Q

Non-cancer risks of MHT

A

Thromboembolic diesease
Gallbradder disease

162
Q

MHT contraindication

A

Hx of breast cancer
Unknown bleeding
Endometrial cancer
Thromboembolic disease
Liver dysfunction
Pregnancy

163
Q

1st line MHT for vasomotor symptoms of menopause

A

Patch before pill - less risk of blood clots but insurance doesn’t like to pay so oral is often used

164
Q

Starting MHT

A

Increase at one month intervals if still symptomatic
Recommended not to use for more than 5 years - taper

165
Q

Progesterone only therapy for menopause

A

Can be oral or IM if we don’t want estrogen

166
Q

Tissue selective estrogen complex

A

SERM and estrogen
Reduces some of the risk of using a progesterine

167
Q

Oral estrogen and levonorgestrel IUD

A

May or may not help reduce risk of breast cancer - dubious

168
Q

Alternative hot flash pharm and GU symptoms

A

Doesn’t really help except oxybutynin

169
Q

CAM for menopause

A

Isoflavone/Phytoestrogens - soy, lentils, etc.
Black Cohosh
Vitamin E
Weight loss
CBT
Supplements can still have problematic effects

170
Q

Preparations for atrophic vaginitis

A

Ring, cream or tablet - every night for two weeks then two times per week
May use testosterone if estrogen is contraindicated

171
Q

Lobes per breast

A

12-20 lobes

172
Q

Apex of breast

A

Contains major excretory duct

173
Q

Base of breast

A

Near ribs

174
Q

Montgomery glands

A

Sebacecous glands of the areola - help the breast stay healthy while breastfeeding

175
Q

Percent of the breast that is adipose tissue

A

80-85% adipose tissue

176
Q

Coopers ligaments

A

Hold the breast to the chest wall - deeper

177
Q

Beginning age for breast deveopment

A

Ages 10-13

178
Q

Breast changes during menstrual cycles

A

Premenstrual - Epithelial cells proliferate - increased size by a little
Post menstrual - Epithelial cells die off, decreased turgor with some tenderness

179
Q

When does the breast reach full development

A

End of a full term pregnancy only

180
Q

Pregnancy changes of breast

A

Darkened areola - bulls eye for infant
Increased lubrication and milk ducts
Fatty tissue almost completely replaced by glands and ducts

181
Q

Trigger and regulator of breast milk production

A

Progesterone drop triggers and prolactin maintains

182
Q

Menopausal breast changes

A

Atrophy and loss of functional breast tissue

183
Q

Fluids from breast commonality

A

40% of premenopausal women
55% of parous women
75% who have lactated in the past 3 years

184
Q

Physiologic breast discharge

A

Expressed when pressure is applied and from multiple ducts/ both breasts

185
Q

Causes of physiologic breast discharge

A

Normal lactation
Galactorrhea
Benign phys discharge
Can be an intraductal papilloma

186
Q

Classical presentation of galactorrhea

A

Bilateral multiductal milky discharge, otherwise normal PE - may want to test for pregnancy

187
Q

Classic pathologic discharge

A

Unilateral spontaneous bloody for serous discharge from a single duct
Bloody is more suggestive of cancer but also more likely due to benign papilloma

188
Q

Cytology of breast discharge

A

Very los sensitivity - usually skip to imaging

189
Q

Ductography

A

May show a filling defect in cancer - flush contrast into ducts

190
Q

Ductoscopy

A

Use tiny endoscope for viewing

191
Q

Definitive diagnostic for pathologic discharge

A

Microductectomy - excise ducts below areola and send to pathology

192
Q

Gynecomastia

A

Glandular breast tissue in a biologic male
Normal in 60% of pubertal boys - usually resolves in a year
Anabolic steroids

193
Q

Psudogynecomastia

A

Fat tissue that looks like gynecomastia - should not seem a firm tender area beneath the areola - firm
Glandular tissue not enlarged

194
Q

Dx for gynecomastia

A

Elevated PRL or hCG
Can also chack testosterone, estradiol
Thyroid

195
Q

Tx for gynecomastia

A

If painful and persistent for 9-12 months
SERM - raloxifine or tamoxifen
Anastrozole - not recommended long term in teens

196
Q

When would we give testosterone to a male

A

Only for true hypogonadism

197
Q

MCC of mastitis

A

Staph areus

198
Q

Risk factors for mastitis

A

Seen in lactation and nursing in primiparous patients, rare before fifth day postpartum

199
Q

Presentation of mastitis

A

Painful, erythematous lobule in the outer quadrant of the breast 2nd or 3rd week after birth
Systemic signs of infection - high fever not due to simple breast engorgement
Antibody coated bacteria in breast milk

200
Q

Presentation of breast abcess

A

Pitting edema and fluctuation

201
Q

Tx for mastitis

A

Keep draining breast - feed or pump
Local heat, warm compress
Well fitted bra
Instruct on techniques
Acetominophen/ibuprofen

202
Q

Antibiotics for mastitis

A

Dicloxacillin of Keflex
Clinda or Bactrim (not for under 1 month old infants)

203
Q

Abx for severe mastitis

A

Van and Ceftriaxone OR Zosyn

204
Q

Tx for breast abcess

A

I&D with abx tx - oral abx usually not sufficient without draining

205
Q

Non nursing breast abcess - peripheral

A

On side is often because of folliculitis or infected cyst
I&D and mastitis abx

206
Q

Subareolar breast abcess

A

Due to keratin plugged milk ducts behind nipple
Simple I&D not enough
Requires duct excision with biopsy to rule out cancer

207
Q

Breast fat necrosis presentation

A

Presents with nipple and skin retraction
May have signs or hx of trauma
Indistinguishible from breast cancer clinically
Biopsy if persistent

208
Q

Fibrocystic breast changes

A

MCC of cyclic breast pain or mastalgia in women 30-50
Epithelial cells become cystic
May be increased in drinkers and estrogen users
Worsened by caffeine

209
Q

Age of fibrocystic breast changes

A

30-50 - correlated with reproductive age, goes away with menopause

210
Q

Presentation of fibrocystic breast changes

A

Pain or tenderness with lump
Present or worse during the premenstrual phase (later half of cycle)
Multiple lesions that change in size

211
Q

Discharge of fibrocystic breast changes

A

Green or brown

212
Q

Dx for fibrocystic breast changes

A

Mammogram for over 30
US and aspiration -US can be better than an ultrasound to see if lesions are cystic
Be on the lookout for odd one out

213
Q

Tx for fibrocystic breast changes

A

Avoid trauma, well fitting bra
Avoid caffeine
Low fat diet may help

214
Q

Tx for severe fibrocystic breast changes

A

Danazol and Tamoxifen
Surgery for most refractory cases

215
Q

Prognosis for fibrocystic breast changes

A

Will subside with menopause
Usually not associated with breast cancer

216
Q

Fibroadenoma

A

Enlarged lobule in young women - early and mid 30s
Larger with hormones and usually solitary

217
Q

Presentation of fibroadenoma

A

Round, smooth, and nontender mass, discrete
Can dx clinically but usually get image to be sure

218
Q

Fibroadenoma on imaging and def dx

A

Well defined solid mass with benign features
Def. dx is core biopsy or mass excision

219
Q

Phyllodes tumor

A

Can become malignant - similar to a fibroadenoma

220
Q

Tx for fibroadenoma or phyllodes tumor

A

Unclear or rapid growth -surgical excision with wide margins
Can monitor/follow-up fibroadenoma if asymptomatic with biopsy or US breast exam

221
Q

Inheritance pattern of BRCA1 and 2

A

Autosomal dominant
Also causes risk in MEN!!

222
Q

Risk factors for breast cancer

A

Nulliparity
First full term pregnancy after age 30
Early menarche or late menopause (reverse decreases risk)
Combo HRT
Hx of uterine or breast cancer

223
Q

Usual presentation of breast cancer

A

Painless breast mass
Hard, fixed, irregular margins, nonmobile
May see metastatic symptoms first
May also see pain, discharge, erosion, retraction

224
Q

MC site of breast cancer

A

Upper outer quadrant

225
Q

4 positions for breast exam

A

Arms over head
Laying on back with arms up
Arms on hips
Leaning forward

226
Q

Concerning PE findings for breast cancer

A

New unilateral side change in size, contour
Unilateral retraction of nipple
Edema or erythema
Firm, non mobile, matted lymph nodes

227
Q

Main lymph nodes for breast drainage

A

85% goes to axillary but palpate everything

228
Q

Paget’s disease of the breast

A

Eczematoid eruption and ulceration - arises from nipple areola
Pain itching, burning discharge and superficial erosion or ulceration
Biopsy
Excision/Mastectomy to treat

229
Q

Inflammatory carcinoma

A

Diffuse, brawny edema with erysipeloid border
Orange peel skin may be seen
No mass
Aggressive but rare - rule out in refractory or unexplained mastitis

230
Q

BIRAD 1 and 2 on mammogram

A

Okay, anything higher is concerning

231
Q

Definitive diagnosis for breast cancer

A

Biopsy
Fine needle - less invasive but less sensitive
Core needle - MOre invasive better
Can also excise

232
Q

Hormone receptor sites for cancer

A

Can have estrogen, progesterone, and HER2 receptors - change how the cance will metastasize
Triple neg goes to lungs/liver

233
Q

Indication for hormonal therapy

A

Positive for ER/PR/HER2 hormone receptors

234
Q

Tamoxifen

A

Historically drug of choice for hormonal breast cancer - can cause clotting and endometrial cancer

235
Q

Newer treatment for hormonal breast cancer

A

Anastrozole - aromatase inhibitor, more effective than tamoxifen

236
Q

Therapy for non hormonal (triple neg) breast cancer

A

Consider an adjuvant -pembrolizumab (keytruda)

237
Q

Selective estrogen receptor modulators

A

Bind to estrogen receptors and block estrogen SERMs -selective for tissues, tamoxifen is specific to breast tissue
Roloxifene blocks in breast and uterus

238
Q

SEs of SERMs

A

Hot flashes, thin hair, thrombosis
Can stimulate OR inhibit estrogen

239
Q

Aromatase inhibitors

A

Anastrozole, exemastane, letrozole
Inhibit aromatase which produces estrogen
Menopausal symptoms - hot flash, brain fog, thinning hair
Newer for breast cancer

240
Q

Fulvestrant

A

Little brother elacestrant
Destroys estrogen receptors
Used for metastatic breast cancer
No blood clots or cancer
Need receptors to work

241
Q

Breast cancer follow ups

A

Q4 months for 2 years
then Q6 for 3 years for PE
Mammogram in 6 months then yearly

242
Q

Median time of breast cancer recurrence

A

At 4 months

243
Q

Percent of those trafficked who are female and minors

A

55-70% female
About half minors

244
Q

Warning signs of human trafficking

A

Social withdrawal
Physical abuse
Neglect
Practiced hx
Living in unsuitable conditions

245
Q

What to do if you suspect human trafficking

A

Send tip to national hotline
Give resources to patient
DOCUMENT

246
Q

Percent of domestic violence victims who are female

A

85%

247
Q

Women killed by male partner or ex 2001-2012

A

11,766, more than died in the iraq war in the same period

248
Q

DV

A

Domestic violence
Controlling with disregard for wellbeing

249
Q

Risk factors for DV/IPV

A

Race - AA
Pregnancy is a huge risk factor - DV is the leading cause of death in pregnant women
Younger age (16-24)
Childhood exposure to violence

250
Q

Presentation of domestic violence

A

Often vague
Chronic pelvic pain
Sexual dysfunction
Recurrent vaginitis
Anxiety and tearfulness during breast and pelvic exam

251
Q

Body complaints of DV

A

HA
Fatigue
Sleep disturbance
Seems like a somatoform disorder

252
Q

Percent of pregnancies with violence

A

4-9%

253
Q

Cycle of abuse

A

Tension building
Incident
Reconciliation
Calm “Honeymoon” phase

254
Q

Screening for domestic violens

A

Screen everybody at all checkups, especially in pregnancy screen at least once per trimester and postpartum

255
Q

Bestway to screen for domestic violence

A

Do it in person
Say something universal first: Because so many people are abused…..I want to ask
Ask about specific behaviors - not general like “rape” or “abuse”

256
Q

Mandatory report events in WV for abuse

A

Gunshot, Stab, Burn

257
Q

After dx tx for DV

A

Acknowledge trauma
Document with photographs - flag to withold
Assess safety and lethality, substance abuse
Create safety plan

258
Q

What to do if patient does not want to leave abusive situation

A

Don’t place blame
Document
Support patient
Follow up with patient

259
Q

Majority of teenage rapes

A

Acquaintance rape - by someone they know

260
Q

Presentation of sexual assault

A

May say they were mugged, May be asking AIDS or STD screening
60-70% have no obvious physical injury
May have bleeding and vaginal irritation, few have major injuries

261
Q

Rape trauma syndrome

A

Detached shock like state
Acute phase - hours to days, tired, HA, startled abates after about two weeks
Delayed phase - Months to years, chronic anxiety, mistrust, depression, sexual dysfunction

262
Q

PE for sexual assault

A

Have a trained person do a sexual assault assessment kit
Sexual assault nurse examiner - take care not to tamper with evidence

263
Q

Hx for sexual assault

A

Describe what happened
Any consensual sex
What happened between
Any infections
State “Use of Force”

264
Q

Tx for sexual assault

A

Emergency contraception after pregnancy test - IUD
Ceftriaxone and potentially metronidazole or Doxycycline
Hep B and HIV prophylaxis
HPV vaccine

265
Q

Psych tx for sexual assault

A

Refer to counseling even if they appear calm, admit if unstable

266
Q

Follow up for sexual assault

A

2 weeks - for psych and other issues

Women's Health (3 decks)

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