Women's health starred slides Flashcards
1) Define gravidity
2) Define parity
1) # of pregnancies, current and past, regardless of outcome (multiple gestation only counts once)
2) # of times a woman has given birth to an infant ≥20 weeks of gestation regardless of outcome
multiple gestation only counts once (except for living children)
How do you document OB history?
GTPAL (ex, G2P1001): gravidity, term, preterm, abortion/(miscarriage), living
1) Define term
2) Define preterm
3) Define abortion
4) Define living
1) Number of times a woman has given birth to an infant ≥37 weeks gestation
2) Number of times a woman has given birth to an infant between 20-36 6/7 weeks gestation
3) Number of losses before 20 weeks
4) Number of living children
1) Define gravida
2) Define primigravida and multigravida
3) Define nulligravida
1) Is or has been pregnant
2) Is in or has had one pregnancy; has been pregnant more than once
3) Has never been pregnant
1) Define primipara
2) Define multipara
3) Define nullipara
1) Has only birthed one child or is pregnant for the 1st time
2) Has given birth 2+ times
3) Has never given birth or had pregnancy go past gestational abortion age
What does GTPAL stand for?
G = total pregnancies
T = # born ≥37 weeks (= term)
P = preterm
A = miscarriages/abortions
L = living children
1) Define “breast self-examination”
2) Is it generally currently recommended for average-risk women? Why or why not?
1) Self-inspection in a systematic way on a regular, repetitive basis (e.g., monthly) for detection of breast cancer.
2) No longer recommended for average-risk women, lack of evidence for benefits (beyond mammography) and potential harm from false-positives.
Pt education on “Breast Self-Awareness” is recommended; what does this include?
1) Being aware of normal appearance and feel of one’s breasts
2) Be educated on signs/symptoms of breast cancer and notify health care provider if any changes (pain, mass, new nipple discharge, redness).
1) True or false: Breast cancers are not frequently self-detected
2) True or false: Breast cancer is the most common female malignancy
1) False; they are frequently self-detected
2) True
When should clinical breast exams (CBE) be recommended to each of the two age groups?
1) 25-39 yo: may be offered every 1-3 yrs based on shared decision-making*
2) ≥40 yo: may be offered annually based on shared decision-making*
*Uncertainty if CBE offers additional benefits beyond screening mammography, and there is possibility of false positives/harm.
When should mammography be recommended to each of the two age groups?
1) 40-75 years old: screen every 1-2 yrs
2) Older than 75 years: shared decision-making process about whether to continue screening (dependent on health/life expectancy)
1) What should you do first in a breast exam?
2) Is asymmetry of breasts common?
3) What should you further evaluate for?
4) What should you describe about any masses?
5) What is normal for large breasts?
1) Visual inspection first; have pt lean forward for large and/or pendulous breasts
2) Yes, some asymmetry is common
3) Marked differences or recent changes
4) Size, shape, consistency, position, & mobility
5) Normal firm transverse inframammary ridge with large breasts
1) When should you palpate the breast?
2) In what 2 positions should you inspect?
3) In what positions should you palpate? How should you palpate?
1) After visual inspection
2) With pt seated with arms at sides, then with pt supine and ipsilateral arm above head*
Palpation with pt supine, ipsilateral arm above head; use pads of fingers for palpation (not tips/no nails)
1) What should you thoroughly palpate during a breast exam?
2) What technique is best validated?
3) What should you squeeze?
1) Rectangular area extending from clavicle to inframammary fold and from midsternal line to posterior axillary line and well into axilla (tail of breast)
2) Vertical strip
3) Not nipple, but rather tissue surrounding
What are 8 symptoms concerning for malignancy?
1) Rapid change in the appearance of one breast
2) Thickness, heaviness or visible enlargement of one breast
3) Discoloration, giving the breast a red, purple, pink or bruised appearance
4) Unusual warmth of the affected breast
5) Dimpling or ridges on the skin of the affected breast, similar to an orange peel
6) Itching
7) Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
8) Flattening or nipple inversion
1) What does redness of the breast suggest?
2) What is it often due to?
3) In women who have not recently nursed a baby it is worrisome for what?
1) Infection or inflammation
2) Mastitis in postpartum patient.
3) Inflammatory breast cancer (IBC)
1) What is dimpling often a sign of?
2) In what positions should you assess it?
1) A tumor beneath.
2) With pt supine, sitting, and standing
1) Is it suspicious if there’s asymmetry of the breast?
2) What is nipple retraction a sign of if new?
1) Yes
2) A tumor beneath. Carefully palpate around and under the nipple
List 5 abnormal nipple findings
1) Discoloration or ulceration
2) Clear or milky discharge (galactorrhea)
3) Nipple discharge may be sent for culture & sensitivity and cytopathology
4) Bloody discharge (usually unilateral)
5) Pus/purulent discharge
1) What is galactorrhea and what may it be due to? Bilateral or unilateral usually?
2) Is bloody discharge of the nipple usually bilateral or unilateral? What is it associated with?
3) What does pus usually indicate?
1) Clear or milky discharge may be due to stimulation (normal) or elevated prolactin levels (abnormal).
-Bilateral (usually)
2) Usually unilateral, associated w. inflammation (usually intraductal papilloma).
-Evaluation to rule out malignancy is required.
3) Infection but may be due to underlying tumor.
1) Is nipple discharge usually cancer? Explain.
2) What can be a sign of ductal ectasia or fibrocystic changes?
1) Usually benign but may be an early sign of endocrine dysfunction or cancer
2) Non-bloody, bilateral discharge with nipple stimulation (“nonspontaneous”)
*spontaneous = occurring without nipple stimulation
1) When is milky discharge of the nipple common? What else is it associated with?
2) What is bloody unilateral nipple discharge concerning for?
What does it usually require?
1) During childbearing; hyperprolactinemia or hypothyroidism, OCPs, tricyclic antidepressants
2) Invasive ductal carcinoma, intraductal papilloma, or intraductal carcinoma (e.g., be concerned for cancer)
-Ductography and ductal excision
1) If you clearly identify a discrete mass, consider it to be _________ until proven otherwise.
2) In general, determination of final diagnosis requires a what?
1) malignant
2) Biopsy
1) Should a dominant breast mass that does not have a corresponding abnormality on Mammogram still be considered malignant until proven otherwise?
2) Mammograms miss up to ____% of cancers
1) Yes
2) 30%
True or false: While uncommon, breast cancer can occur in men
True
(Thus, discrete masses should be appropriately evaluated).
1) Breast cancer can occur in young women (20s and 30s) so what should be appropriately evaluated?
2) What is more difficult about evaluating young patients for breast cancer?
1) Thus worrisome masses in this population should be appropriately evaluated.
2) Mammograms more likely to be false-negative
1) True or false: you should pay very careful attention to any mass that the patient brings to your attention.
2) True or false: Women who are very self-aware can often detect subtle/early changes concerning for malignancy that an examiner may have difficulty identifying.
1) True
2) True
1) Define mastalgia
2) What percent of women does it affect during lifetime?
1) Breast pain
2) 70% of women
1) What is the most common type of mastalgia? What is it associated with? Bilateral or unilateral?
2) What is noncyclical mastalgia not associated with? What is it associated with?
3) What is extramammary (non-breast, pain referred from other locations) mastalgia associated with?
1) Bilateral and benign, begins during luteal phase, resolves with menses
2) Menstrual cycle; assoc with duct ectasia, mastitis, large breast size, meds, pregnancy, etc.
3) Chest wall trauma, rib fxs, shingles (varicella-zoster virus), heart, gallbladder, etc.
1) What is required to determine the cause of mastalgia?
2) What should be done if there’s concerning findings? Why? Give examples
1) Careful physical exam to determine cause.
2) Imaging to rule out malignancy/serious pathology (unilateral, noncyclical, localized pain, breast mass, skin changes, etc.)
1) Define fibrocystic breast changes
2) How common is it?
3) What are the symptoms?
1) Benign changes in breast epithelium producing a nodular, sensitive breast
2) Common; ½ of all women experience
3) Lumpiness, swelling, pain/tenderness; nodular, rope-like densities
