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Rezi FC > Ginecologie > Flashcards

Ginecologie Flashcards

1
Q

Ordine cronologica a evenimentelor pubertare la femeie

A

Adrenarha
Gonadarha
Telarha
Pubarha
Puseu de crestere
Menarha

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2
Q

Factori de risc menopauza prematura

A

Fumat
BAI
RTx
CTx
Dupa interventii abdominale/pelvine

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3
Q

I/E menopauza

A

Dereglari menstruale - chiar amenoree
Posibil menoragie
Dispareunie - prin atrofie vaginala, scaderea lubrifierii
Mastodinie
Scaderea libidoului
Fatigabilitate
Depresie
Iritabilitate
Anxietate
Tulburari de somn
Declin cognitiv
Bufeuri - secundar disfunctiei termoreglarii
Transpiratii
Disurie
Polakiurie
Tulburari intestinale

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4
Q

Complicatii menopauza

A

Osteoporoza
Boala coronariana
Dementa

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5
Q

Factori de risc osteoporoza

A

Varsta avansata
Rasa alba/asiatica
Menopauza
Greutate redusa
Fumat
Consum excesiv de alcool
Hipovitaminoza D

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6
Q

RA COC

A

Greata
Varsaturi
Senzatie de balonare
Modificari de dispozitie
Risc crescut de TVP

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7
Q

CI COC

A

APP de TVP
Marile fumatoare
Malignitati dependente de estrogeni
Boli hepatice
Hipertrigliceridemie

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8
Q

RA patch contraceptiv transdermic

A

Greata
Cefalee
Crestere ponderala
Sangerari vaginale neregulate, mastodinii
Risc crescut de TVP
Risc de detasare a patchurilor

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9
Q

RA inel transvaginal

A

Sangerari de privatie
Disconfort legat de dispozitiv
Cefalee
Risc crescut de TVP

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10
Q

RA contraceptive de urgenta

A

Greata
Cefalee > COC
Sangerare menstruala la aprox 1 sapt de la administrare

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11
Q

RA diafragme/cupole cervicale

A

Inconvenient
Complianta slaba frecventa
Risc crescut de ITU

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12
Q

Etiologie amenoree primara

A

Disfunctie HT/HF
Anomalii anatomice - absenta uter, sept vaginal
Anomalii cromozomiale cu disgenezii gonadice

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13
Q

Etiologie amenoree secundara

A

Boli HT/HF
Anomalii uterine - sindrom Asherman
Sarcina
Hipogonadism (insuficienta ovariana)
SOPC
Anorexia nervosa
Malnutritie
Boli tiroidiene
Medicamente - contraceptive, antagonisti de dopamina

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14
Q

In amenoree, anamneza trebuie sa stabileasca

A

Daca au existat menstruatii - DDX primara-secundara
Obiceiuri alimentare, activitate fizica
Istoric familial
Medicatii specifice
Semne de hiperandrogenism (par facial, ingrosarea vocii)
Comorbiditati

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15
Q

Amenoreea atletelor - triada

A

Amenoree
Osteoporoza
Tulburari de alimentatie

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16
Q

Cauze dismenoree

A

Primara
Secundara
* Endometrioza
* Adenomioza
* BIP
* Fibroame uterine
* Chiste ovariene

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17
Q

Factori de risc dismenoree

A

Fumat
IMC < 20 kg/m2
Agresiune sexuala
BIP
SPM
Menoragie
Menarha < 12 ani

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18
Q

I/E dismenoree

A

Greata
Varsaturi
Cefalee
Diaree
Sensibilitate abdominala moderata
Dureri colicative in abdomenul inferior

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19
Q

I/E SPM, TDPM

A

Sensibilitate abdominala
Durere abdominala/pelvina
Cefalee
Acnee
Edeme
Mastodinie
Pofte alimentare
Crestere ponderala
Meteorism
Modificari de tranzit
Labilitate emotionala - marcata in TDPM
Iritabilitate
Depresie
Fatigabilitate
Disautonomii

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20
Q

Tratament SPM, TDPM

A

Exercitii fizice
Vit B6
AINS
COC
Progestative
SSRI +/- alprazolam - amelioreaza labilitatea emotionala (in ambele boli)

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21
Q

Factori de risc endometrioza

A

AHC +
IMC scazut
Infertilitate
Nuliparitate

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22
Q

I/E endometrioza

A

Dismenoree
Dispareunie
Dischezie (perceptie dureroasa a miscarilor intestinale)
Durere pelvina - atinge maxim cu 1-2 saptamani inainte de menstruatie
Sensibilitate uterina/anexiala
Aderente palpabile la nivel de uter/ovare
+/- infertilitate

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23
Q

Tratament endometrioza

A

Jurnal al simptomelor
Ameliorarea simptomelor
* COC
* Progestative
* Danazol
* Agonisti GnRH
Ablatie laparoscopica - indepartarea leziunilor, ameliorarea fertilitatii
Forme severe
* Histerectomie
* Liza aderentelor
* Salpingo-ooforectomie (anexectomie)

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24
Q

Cauze sangerari uterine anormale

A

Fibrom uterin
Hiperplazie endometriala
Cancer endometrial
Sarcina molara
Sarcina ectopica
Iminenta de avort
Disfunctii HT-HF
Diateze hemoragice - boala vW, alterarea agregarii plachetare

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25
Q

I/E sangerari uterine anormale

A

Apar la intervale < 24 zile sau > 35 zile
Dureaza > 7 zile
Pierdere de > 80 mL (> 1 tampon la 2h)
Sunt neregulate

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26
Q

Investigatii laborator sangerari uterine anormale

A

Beta-HCG
HLG completa
Bilant coagulare
LH, FSH, TSH
PAP
Biopsie de endometru (prin D&C) - excludere neoplazii
Testare pentru BTS

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27
Q

I/E SOPC

A

Sindrom metabolic (obezitate, DZ, HTA)
Hirsutism
Acnee
Tulburari menstruale
Infertilitate
Cresterea dimensiunilor ovarelor

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28
Q

Tratament SOPC

A

Exercitii fizice
Scadere ponderala
COC
Metformin
Spironolactona
Clomifen - pentru infertilitate

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29
Q

Complicatii SOPC

A

Infertilitate
Risc crescut de
* DZ
* HTA
* BCI
* Torsiune ovariana
* Cancer endometrial

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30
Q

Factori de risc fibrom uterin

A

AHC +
Alimentatie bogata in carne
Consum de alcool
Descendenta afro-americana
Nuliparitate

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31
Q

I/E fibrom uterin

A

Posibil asimptomatic
Menoragie
Presiune pelvina/durere
Infertilitate
Tumora palpabila
Polakiurie
Constipatie

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32
Q

Factori de risc cancer endometrial

A

Varsta inaintata (postmenopauza)
Expunere la estrogeni exogeni
Dieta bogata in grasimi
Obezitate
HTA
DZ
AHC +
Nuliparitate
Anovulatie cronica (SOPC)
Cancer de colon - HNPCC

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33
Q

Factori de risc cancer de col

A

Fumat
COC
Primul contact sexual timpuriu
Parteneri sexuali multipli
Parteneri sexuali cu risc crescut
APP de BTS
HPV - tip 16, 18, 31, 33

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34
Q

Indicatii biopsie de endometru

A

Metroragie in postmenopauza
Metroragie disfunctionala > 45 ani
Metroragie disfunctionala < 45 ani in conditiile expunerii la estrogeni nebalansat cu progesteron
HNPCC
Celule glandulare atipice la PAP

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35
Q

Tratament ASCUS

A

Screening/tipizare HPV
Tulpina high-risk - colposcopie + biopsie SAU supraveghere atenta cu Pap anual
HPV negativ - screening de rutina

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36
Q

Tratament ASC-H

A

Screening HPV
Biopsie endocervicala (colposcopie)
Se repeta Pap la 6 si 12 luni (bianual)
Se repeta HPV anual

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37
Q

Tratament LSIL

A

Se repeta Pap la 6 si 12 luni (bianual)
Se repeta HPV anual
Excizie prin
* Electrorezectie cu ansa (LEEP)
* Conizatie
* Ablatie laser

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38
Q

Tratament HSIL

A

LEEP
Conizatie
Ablatie laser
Se repeta citologia (Pap) la 6 luni (bianual)

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39
Q

I/E tumori ovariene benigne

A

Febra
Greata
Varsaturi
Balonare - numai dupa crestere semnificativa
Dureri in abdomenul inferior (mai des in tumorile functionale/torsiune tumorala)
Sensibilitate abdominala
Masa ovariana palpabila

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40
Q

Tratament chist folicular

A

Supraveghere
Chistectomie ovariana - daca nu regreseaza/suspiciune crescuta de cancer

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41
Q

Tratament chist luteal

A

Supraveghere
Chistectomie ovariana - daca nu regreseaza/suspiciune crescuta de cancer
Hemostaza chirurgicala + chistectomie - in caz de ruptura + hemoragie

42
Q

Tratament chistadenom seros/mucinos

A

Anexectomie unilaterala
HTAB in menopauza

43
Q

Tratament endometriom

A

Chistectomie/ooforectomie - frecvent necesara (rata mare de recurenta)
Pot diminua simptomele
* COC
* Progesteron
* Danazol
* Agonisti GnRH

44
Q

Tratament teratom chistic benign (chist dermoid)

A

Chistectomie cu incercare de conservare a ovarului - daca e benign
Salpingo-ooforectomie - in caz de transformare maligna (1-2%)

45
Q

Tratament tumora cu celule stromale

A

Anexectomie unilaterala
HTAB in menopauza

46
Q

Factori de risc cancer ovarian

A

AHC +
Nuliparitate
Infertilitate
Mutatii BRCA1/BRCA2

47
Q

I/E cancer ovarian

A

De obicei asimptomatic/minim simptomatic pana in stadii avansate
Masa tumorala palpabila
CM neregulate
Durere abdominala
Scadere ponderala
Modificarea tranzitului intestinal
Ascita
Oboseala

48
Q

Tratament cancer ovarian epitelial

A

HTAB + biopsii peritoneale pelvine + apendicectomie
CTX adjuvanta - frecvent
Boala extinsa metastatica - citoreductie tumorala + rezectie de
* Intestine afectate
* Ficat
* Oment
* Splina
* Ganglioni limfatici
Ooforectomie unilaterala - tumori precoce, pacientele doresc pastrarea fertilitatii

49
Q

Tratament cancer ovarian cu celule germinale

A

Anexectomie unilaterala - boala limitata
Citoreductie chirurgicala - tumori avansate
CTX - de obicei adjuvanta

50
Q

Factori de risc vaginita

A

DZ
HIV
DIU
Fumat
Parteneri multipli
Contact sexual neprotejat
Varsta tanara la primul contact sexual
Dusuri intravaginale

51
Q

Tratament candidoza vaginala

A

Clotrimazol topic
Nistatina
Miconazol
Fluconazol - o doza pe cale orala

52
Q

I/E sindrom de soc toxic

A

Febra
Varsaturi
Diaree
Dureri in gat
Dureri de cap
Eruptie maculara generalizata

In cazuri severe
* hTA
* Soc
* Tulburari respiratorii
* Descuamare palmo-plantara

53
Q

Laborator sindrom de soc toxic

A

Cultura + din fluid vaginal

La cazurile cu evolutie spre agravare
* Trombocitopenie
* Uree, Cr crescute
* Transaminaze crescute

54
Q

I/E cervicita

A

Disurie
Dispareunie
Sangerare dupa contact sexual
Secretie vaginala purulenta - mai usoara in infectia cu Chlamydia

In gonoreea diseminata
* Dermatita pustulara
* Tenosinovita
* Poliartralgie asimetrica migratorie

55
Q

Factori de risc BIP

A

APP de BIP
Dusuri intravaginale
Parteneri multipli
Contact sexual neprotejat
Debut precoce al vietii sexuale

56
Q

I/E BIP

A

Febra
Greata
Varsaturi
Disurie
Secretie cervicala purulenta
Dureri in abdomenul inferior
Sensibilitate abdominala
Sensibilitate la mobilizarea colului
Sensibilitate anexiala
Posibil aparare abdominala

57
Q

Complicatii BIP

A

Infertilitate (aderente)
Risc crescut de sarcina ectopica
Dureri pelvine cronice
Abces tubo-ovarian

58
Q

I/E sifilis secundar

A

Febra
Cefalee
Stare de rau
Eruptie maculopapulara palmoplantara
Papule in zonele de mucoasa ale corpului = condyloma lata
Limfadenopatie

59
Q

Complicatii sifilis

A

Distrugerea gomatoasa a pielii, oaselor, ficatului
Sifilis CV - aortita luetica, regurgitare aortica
Neurosifilis - tabes dorsalis, atrofie cerebrala, meningita

60
Q

I/E infectie HPV

A

Multiple papule mici, roz, pe zona de contact
Infectia cu HPV 6 sau 11 - veruci exofitice, conopidiforme, in regiunea genitala

61
Q

Tratament infectie HPV

A

Podofilina
Acid tricloracetic (ATCA)
5-FU topic
Injectare de alfa-interferon in leziunile mari
Crioterapie
Ablatie laser

62
Q

I/E limfogranulomatoza inghinala

A

In 2 saptamani de la contact
* Febra
* Cefalee
* Stare de rau
* Papule in zona de contact - se transforma intr-o ulceratie NEDUREROASA - se vindeca in cateva zile

Dupa 1 luna - adenopatii inghinale semnificative (mai des la barbati)

63
Q

Tratament abces tubo-ovarian

A

Internare
Reechilibrare HE IV
ABT IV
Drenaj chirurgical

64
Q

I/E lichen plan

A

Iritatie vulvara
Senzatie de arsura
Prurit
Sangerare
Dispareunie
Leziunile vulvei sunt
* Lucioase
* Reticulare
* Eritematoase
* Cu ulceratii

65
Q

I/E lichen scleros

A

Prurit intens
Dispareunie
Disurie
Defecatie dureroasa

66
Q

Factori de risc vaginism

A

Lipsa cunostintelor sexuale
Trauma sexuala
Istoric de abuz

67
Q

I/E vaginism

A

Durere la penetrarea vaginala - poate fi limitata la contactul sexual, dar poate aparea si la utilizarea tampoanelor/consultul ginecologic
Disconfort
Anxietate cu privire la simptome

68
Q

Tratament modificari fibrochistice

A

Reducerea cafeinei si grasimilor alimentare
COC
Progesteron
Tamoxifen

69
Q

Caracteristici clinice fibroadenom mamar

A
  • Unica
  • Ferma
  • Sferica
  • Mobila
  • Margini bine delimitate
  • Dimensiunea poate varia in perioada menstruatiei
  • Sensibila la estrogeni
70
Q

I/E cancer endometrial

A

Menstruatii abundente
Sangerare
- Neregulata
- La mijlocul CM
- Postmenopauza
Posibil dureri abdominale
Uter de obicei nedureros la examen clinic
Se pot palpa uterul/ovarele fixate daca tumora are extensie locala

71
Q

I/E cancer de col

A

De obicei asimptomatic in stadii incipiente
Sangerare vaginala spontana/postcoitala
Secretie cervicala
Durere pelvina
Tumora cervicala poate fi palpabila
Frecvent cancerul invaziv este observat la inspectia colului

72
Q

Tratament modificari fibrochistice

A

Reducerea cafeinei si a grasimilor alimentare
COC
Progesteron
Tamoxifen

73
Q

Factori de risc cancer mamar

A

AHC + (grad 1)
Mutatii BRCA1/BRCA2
APP +
Cancer endometrial
Cancer ovarian
Varsta inaintata
Obezitate
Consum de alcool
Expunere prelungita la estrogeni
Nuliparitate
Prima sarcina tarzie (> 35 ani)
Menopauza tardiva
Expunere la
* DES
* Chimicale industriale
* Pesticide
* Radiatii

74
Q

I/E cancer mamar

A

Masa tumorala mamara NEDUREROASA palpabila
* Solida
* Imobila (cand are dimensiuni suficiente)
Secretie mamelonara
Retractie mamelonara
Aspect de “coaja de portocala” = obstructie limfatica ce determina limfedem + ingrosare tegumentara

75
Q

I/E boala Paget a sanului

A

Leziune la nivelul mamelonului si areolei
* Descuamativa
* Eczematoasa
* Ulcerativa
Poate fi precedata de
* Durere
* Senzatie de arsura
* Mancarime

76
Q

I/E carcinom inflamator

A

Durere mamara
Sensibilitate la palpare
Eritem
Hiperemie
Tegument in “coaja de portocala”
Limfadenopatie

77
Q

Complicatii cancer san

A

Limfedem
Metastaze
* Cerebrale
* Hepatice
* Osoase
* Toracice

78
Q

I/E abces mamar

A

Masa tumorala DUREROASA
Febra
Masa palpabila rosie si calda
Sensibilitate mamara
Drenaj purulent din masa tumorala/mamelon

79
Q

I/E modificari fibrochistice

A

Multiple tumori mamare de mici dimensiuni
Sensibile
Bilaterale
Dureri mamare usoare premenstrual
Se atenueaza postmenstrual
Formatiuni tumorale mobile ce variaza ca marime in timpul CM

80
Q

ABT SST

A

Clindamicina
Beta-lactamine penicilinazo-rezistente = oxacilina, nafcilina
Vancomicina - MRSA

81
Q

Tratament cervicita

A

Ceftriaxona - gonoree
Doxiciclina, azitromicina - Chlamydia
Deseori ambele
Tratament partener

82
Q

Caracteristici vezicule in herpes genital

A

Dureroase
Multiple
Mici
Baza eritematoasa
Asociaza limfadenopatie usoara

83
Q

Tratament sancru moale

A

Ceftriaxona
Eritromicina
Azitromicina

84
Q

Tratament limfogranulomatoza inghinala

A

Tetraciclina
Doxiciclina
Eritromicina

85
Q

Tratament granulom inghinal

A

Doxiciclina
Cotrimoxazol

-> 3 sapt

86
Q

Aspecte ecografice in BIP

A

Uter inflamat + marit
Abcese tubo-ovariene
Lichid liber intraperitoneal

87
Q

Investigatii laborator cervicite

A

Coloratie Gram epiteliu cervical
Cultura pe agar Thayer Martin
Teste imunoenzimatice
NAAT
PCR

88
Q

Investigatii laborator BIP

A

Leucocitoza
VSH crescut
Coloratie Gram
Cultura
Analize imunologice
Culdocenteza cu aspiratie de puroi

89
Q

Tratament BIP

A

ABTE
* Doxiciclina
* Ceftriaxona
* Cefoxitina
Febra mare/varsta tanara - internare
Tratament partener

90
Q

Agenti etiologici BIP

A

Gonococ
Chlamydia
Mai rar
* Streptococi
* E. coli
* Bacteroides

91
Q

Investigatii sifilis

A

VDRL, RPR = screening
FTA-ABS, MHA-TP = confirmare
Frotiu la microscopul cu camp intunecat
Examinare LCR - confirmare sifilis tertiar - neurosifilis (in caz de afectare neurologica)

92
Q

Ce metode contraceptive au eficacitate 100%?

A

Implanturi cu progestativ
Chirurgia (vasectomie, ligatura trompe)
Abstinenta

93
Q

Metode contraceptive care cresc riscul de TVP

A

COC
Patch transdermic
Inel intravaginal

94
Q

RA medroxiprogesteron

A

Greata
Varsaturi
Crestere ponderala
Osteoporoza
Sangerari vaginale neregulate

95
Q

Tratament menopauza

A

Agenti lubrifianti - pentru dispareunie
Cura scurta de estrogeni intravaginal - pentru simptome vaginale semnificative
Scadere ponderala - pentru bufeuri (Tx de prima linie)
Ca, vit D, bisfosfonati, exercitii fizice - preventie osteoporoza
Raloxifen, tamoxifen - reducere osteoporoza si risc CV

96
Q

Caracteristici Mittelschmerz

A

Durere usoara
Unilateral
Recurent
La mijlocul ciclului
Preovulator
Dureaza ore -> zile

97
Q

Manifestari adenomioza

A

Crestere simetrica a uterului
Sensibilitate uterina
Durere pelvina ciclica
Menstruatii abundente

Frecvent - prezentare ca dureri cronice la pacienta > 40 ani

98
Q

Tratament CIS mamar

A

CDIS = tumorectomie + RTx, mastectomie - pentru pacientele cu risc crescut
CLIS = monitorizare + raloxifen/tamoxifen, mastectomie bilaterala - la pacientele care nu doresc monitorizare pe termen lung
Cancer cu receptori hormonali pozitivi = tamoxifen

99
Q

Tratament carcinom mamar invaziv

A

Focal precoce = tumorectomi + RTx
Multifocal/iradiere mamara in antecedente = mastectomie
Invazie axilara = biopsie ganglion santinela => daca e (+) => tumorectomie + limfodisectie axilara
Ganglioni pozitivi + tumora > 1 cm + histologie agresiva = hormonoterapie
Ganglioni +/- = CTx
Receptori corespunzatori = trastuzumab (anti HER2/neu)

100
Q

Tratament cancer mamar avansat

A

Local avansat + extensie in afara sanului = CTx + HTx
Rezectie si/sau RTx dupa ce terapia sistemica a micsorat tumora
Tratament metastaze cu terapie sistemica
Rezectie/RTx pe leziuni (metastaze) solitare

Rezi FC (28 decks)

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