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OBGYN > GYN 1 > Flashcards

GYN 1 Flashcards

1
Q

What are common presenting symptoms of breast cancer?

A

Mass (often detected through self breast exam, clinical, or screening) Nipple discharge. Change in breast shape Skin changes

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1
Q

Which organ transports the ova from the ovaries to the uterus and is the normal site of fertilization?

A

Fallopian tubes

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2
Q

What is the correct terminology for confirming radiologic testing?

A

Diagnostic mammography Directed/targeted sonogram

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3
Q

What are the S/S of a breast abscess?

A

Localized collection of pus, usually in a blocked milk duct/galactocele.

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3
Q

What common meds can cause non cyclic breast pain?

A

OCPs HRT SSRIs Spironolactone Digoxin

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4
Q

What is the leading cause of death overall for women aged 40-59?

A

Breast cancer

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5
Q

Describe a cyst.

A

Fluid filled sac. Palpable, Unilateral, soft to firm, round, mobile. Often Tender! Usually benign

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5
Q

The second half of the cycle is dominated by what hormone?

A

Progesterone

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6
Q

This hormone stimulates the development and maintenance of female reproductive structures, including secondary sex characteristics.

A

Estrogen

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7
Q

The inner layer of the uterus is the…

A

endometrium

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8
Q

When would you excise a cyst.

A

bloody fluid palpable after aspiration fluid reaccumulates in 2 weeks cyst recurs after 2 aspirations

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8
Q

What are the USPSTF’s recommendations for breast cancer PREVENTION?

A

Women at increased risk of breast cancer and low risk of adverse med effects, offer to prescribe risk-reducing meds: tamoxifen or raloxifene.

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8
Q

What is the treatment of drug induced gynecomastia?

A

Stop the drug! Some cause irreversible gynecomastia: exogenous testosterone, tamoxifen, marijuana, heroin, and amphetamines.

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9
Q

What ages do cysts usually occur?

A

Occurs in middle aged women

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10
Q

What are red flags of nipple discharge?

A

bloody unilateral and persistent associated with a mass spontaneous

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11
Q

The first half of the cycle is dominated by what hormone?

A

Estrogen

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12
Q

What is the most common cause of mastitis?

A

Staph aureus

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13
Q

What are the symptoms of mastitis?

A

localized redness warmth tenderness fever/lymphadenopathy common

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13
Q

When is the best time to do a breast examination?

A

soon after menses, when least engorged.

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13
Q

At what age does puberty start in a girl?

A

Between 6-8, adrenal gland starts to increase production of androgens.

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13
Q

What is the average age of menopause?

A

51

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14
Q

How often does USPSTF recommend mammograms?

A

Every 2 years in patients 50-74 years old.

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15
Q

How often should self breast exams be conducted?

A

Controversial. But past has said monthly (after menses) for all women over age 20.

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15
Q

How long are menstrual cycles typically irregular after menarche?

A

1-2 years

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16
Q

BRCA1 and BRCA2 gene mutations are associated with what?

A

PREMENOPAUSAL breast AND ovarian cancers.

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16
Q

The first half of the cycles are called:

A

Menses and preovulatory Follicular phase Proliferative phase

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17
Q

How often should clinical breast exams be conducted?

A

every 3 years in patients age 20-40 annually after age 40 (USPSTF disagrees)

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17
Q

How should abnormalities be documented?

A

by location

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18
Q

What is the treatment of a breast cyst?

A

Aspirate the cyst. Bloody or turbid aspirate should be sent to cytology. Sometimes excision.

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19
Q

The space between the uterus and the rectum is called the…

A

rectouterine pouch (Pouch of Douglas)

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20
Q

What are the most common causes of nipple discharge?

A

intraductal papilloma carcinoma galactorrhea

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20
Q

How often does ACOG recommend mammograms?

A

Annually beginning at age 40.

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20
Q

What is the treatment of a breast abscess?

A

Dicloxacillin 500 mg qid x 10 days (Bactrim if MRSA suspected) Drain the abscess with needle or incision. Biopsy if it does not resolve promptly and pt is not lactating. Continue nursing!

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20
Q

What is menopause?

A

12 months of amenorrhea after the final menstrual period

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21
Q

What are the organs of the female reproductive system?

A

Ovaries Fallopian tubes Uterus Vagina External Genitalia/Vulva Mammary Glands

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22
Q

The outer layer of the uterus is the…

A

perimetrium

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23
Q

What abnormalities should be looked for in the palpation of the breast?

A

lump or mass lymphadenopathy nipple discharge when squeezed or pressure to areola

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24
Q

At what age to physical changes start to take place in puberty?

A

Around age 10

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25
Q

What treatment should hormone-receptor positive cancer patients receive?

A

Hormonal therapy with tamoxifen or raloxifene to decrease recurrence. Tx lasts 5 years following CA treatment. Post-menopausal women can also receive Aromatase inhibitors in combination with hormonal therapy.

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26
Q

The function of the OVARIAN cycle is…

A

to assist in the maturation of an ovum.

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27
Q

Describe a fibroadenoma.

A

Unilateral Round, smooth, mobile, firm/rubbery, usually 1 cm or larger. NON TENDER

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28
Q

What meds lower dopamine levels?

A

antipsychotics cimetidine (Tagamet) and ranitidine (Zantac) metoclopramide SSRIs TCAs Verapamil Opiates

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28
Q

How soon must the egg be fertilized after ovulation?

A

24 hours

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30
Q

Who should not receive hormone replacement therapy?

A

Breast cancer survivors.

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31
Q

Both cycles are controlled by

A

GnRF.

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32
Q

The vestibule includes the…

A

vaginal orifice urethral orifice Skene’s glands (Lesser vestibular glands) Bartholin’s glands (Greater vestibular glands)

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33
Q

What organ is responsible for producing and discharging the ova?

A

Ovaries

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34
Q

What percent of women diagnosed with breast cancer have no obvious risk factors other than age?

A

75%

34
Q

How long does it take to repair and grow the endometrium?

A

6-13 days

35
Q

The first menstrual cycle a girl has is called…

A

menarche

37
Q

What is the most common kind of breast cancer?

A

Infiltrating ductal carcinoma

39
Q

What are other symptoms of progressed breast cancer?

A

weight loss anorexia night sweats fatigue (possible metastasis - bone, liver, lung, pleura, brain, lymph)

41
Q

What diagnostic test is used to evaluate breast masses in women over the age of 30?

A

Mammography

41
Q

What is the most common cause of bloody nipple discharge?

A

intraductal papilloma BENIGN Tx: excise the duct

42
Q

What is the treatment for fibrocystic breast disease?

A

Centers around alleviation of pain. If diagnosis is uncertain (even after radiography), aspirate for biopsy.

43
Q

When should you consider imaging for a patient with breast pain?

A

Pain is focal No cause for pain identified Pt has risk factors

44
Q

What ages do fibroadenomas usually occur?

A

Less than 30 yoa.

45
Q

This is the external opening to the cervix.

A

External os

46
Q

What is the treatment of mastodynia/mastalgia?

A

NSAIDs (including topical diclofenac), vitamin B6, tamoxifen, danazol, well fitted bra.

46
Q

What stimulates the release of FSH and LH?

A

GnRF

47
Q

What is perimenopause?

A

a span of 2-8 years before menopause where estrogen levels decline and menstrual cycles may be irregular

48
Q

What are other possible causes of gynecomastia?

A

testicular tumor or other malignancy hypogonadism Klinefelter syndrome (XXY) Liver disease Hyperthyroidism Renal failure

50
Q

What diagnostic test is used to evaluate breast masses in women under the age of 30?

A

Sonogram

50
Q

What are clinical signs of Inflammatory Breast Carcinoma?

A

Aggressive. Erythematous, warm, peau d’ orange skin. Palpable axillary lymph nodes. NO detectable mass. (looks similar to mastitis)

51
Q

What should be considered if a patient presents with a breast abscess and is not lactating?

A

carcinoma

52
Q

The vulva includes the…

A

Labia majora Labia minora Clitoris Vestibule

53
Q

The secretion of FSH and LH in puberty eventually causes what?

A

Stimulation of the ovary to release estrogen.

54
Q

What are the current USPSTF’s risk assessment guidelines for genetic testing?

A

Fam hx of breast cancer before 50 yoa Fam hx of bilateral breast cancer Fam hx of both breast and ovarian cancer Fam hx of breast cancer in a male Multiple cases of breast cancer in the family Ashkenazi Jewish ethnicity

55
Q

Who are most likely to get a breast abscess?

A

Women who are breast feeding, may be associated with mastitis.

55
Q

What is the cause of newborn gynecomastia?

A

transfer of maternal estrogens. resolves spontaneously

57
Q

What are clinical signs of Paget Disease of the Nipple?

A

Only epidermis of nipple is affected. Crusting, scaling, erosion around the nipple. Discharge is common. A form of ductal carcinoma.

59
Q

How should a mass be documented?

A

Location size shape unilateral/bilateral soft/firm smooth/rough tender/non-tender mobile/non-mobile

61
Q

What are the four types of breast tissue?

A

Lobular Ductal Connective Adipose

62
Q

Menarche typically happens how soon after the development of breast buds?

A

2.5 years

63
Q

In puberty, after the adrenal glands start to produce androgens, what happens next?

A

The hypothalamus increases its production of GnRH

64
Q

The function of the MENSTRUAL cycle is…

A

to prepare the endometrium each month for the reception of a fertilized ovum.

65
Q

Describe Fibrocystic Breast Disease/Fibrocystic Condition.

A

Cysts of varying sizes develop, surrounding tissue becomes thickened, bumpy, fibrous. Usually benign. Bilateral Clumpy, Mobile, symmetrical, multiple. Tender! - cyclic Change in breast size - cyclic Serous discharge

66
Q

What are less common histologic types of breast cancer?

A

Invasive lobular carcinoma Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) - positive prognosis

68
Q

What is the treatment for breast cancer?

A

All abnormal sono or mammogram should be referred for biopsy. Biopsy will look for estrogen/progesterone-receptor-positive status and HER2/neu mutation over-expression. Oncologist staging. Lumpectomy, mastectomy, axillary lymph node dissection, radiation, hormonal therapy, tissue-targeted therapy, chemotherapy.

69
Q

Who should be considered for genetic testing?

A

Women with BRCA 1 or 2 mutations.

70
Q

What should be looked for in the inspection of the breast?

A

redness of skin exceptional lack of symmetry dimpling swelling recent depression of nipple

72
Q

Describe common findings of breast cancer during a physical exam.

A

Firm-hard NON tender difficult to distinguish from surrounding tissue non-mobile (unless very early) Usually unilateral. Nipple discharge when squeezed.

73
Q

What percent of lymph drainage for the breasts is via the axillary nodes?

A

97%

74
Q

The middle layer of the uterus is the…

A

myometrium

75
Q

The second half of the cycles are called:

A

Postovulatory Luteal Phase Secretory Phase

77
Q

What are the causes of galactorrhea?

A

High levels of prolactin in blood: Pregnancy Pituitary tumor hypothyroidism excessive exercise Med side effects (those that lower dopamine levels)

79
Q

Who are most likely to get mastitis?

A

Women who are breast feeding

80
Q

Which organ produces the hormones progesterone, estrogen, and others?

A

Ovaries

81
Q

What stimulates the initial development of ovarian follicle and secretion of estrogen by the ovaries?

A

FSH

82
Q

What is the treatment of mastitis?

A

Dicloxacillin 500 mg qid x 10 days Hospitalize if conditions are severe. Continue to breast feed!

84
Q

The space between the uterus and the bladder is called the…

A

vesicouterine pouch

86
Q

What is the most common cause of a breast abscess?

A

Staph aureus.

87
Q

What ages do fibrocystic breast disease usually occur?

A

Middle aged women. Rarely postmenopausal.

89
Q

What should be included in documentation of nipple discharge?

A

Color bilateral/unilateral spontaneous or expressed presence/absence of associated mass or lymphadenopathy associated skin changes Hx of trauma

90
Q

Describe pubertal gynecomastia.

A

2-3 cm enlargement that is disc-like, tender and beneath the areola. Common in teens. Spontaneously resolves within 1-2 years. (further work up if longer)

91
Q

What is the treatment of fatty gynecomastia (pseudogynecomastia)?

A

Weight loss. It is not increase of glandular tissue, but is increase of adipose tissue.

92
Q

The average duration of the menstrual cycle is…

A

28 days, ranges from 24-35

94
Q

What is the treatment for fibroadenomas?

A

Less than 30, no family hx of breast CA = no further treatment beyond routine clinical evaluation. Any doubt = biopsy with fine needle aspiration. If biopsy confirmed, cryoablation. If large, can be excised. Phyllodes tumors > 5cm, require excision.

96
Q

How do you approach a new-onset breast mass in a woman over 50 yoa?

A

Cancer until proven otherwise.

97
Q

How often is nipple discharge a normal finding?

A

95% of the time

98
Q

What is the most common cause of gynecomastia?

A

Disruption in the estrogen-testosterone ratio, resulting in a glandular tissue proliferation.

100
Q

How would a normal breast exam documentation read?

A

Breasts are symmetrical without dimpling, retraction or skin changes. No masses, tenderness, or nipple discharge. No axillary lymphadenopathy.

101
Q

Mammary glands are separated by what?

A

Adipose tissue

102
Q

What are the 3 main subdivisions of the uterus?

A

Fundus (top) Body Cervix (bottom)

103
Q

The vaginal area that surrounds the cervix is called the…

A

fornix

104
Q

When would you use chemotherapy in breast cancer treatment?

A

when lymph nodes test positive. Tumor is larger than 1 cm. HER2/neu overexpression (+ tissue-targeted meds)

105
Q

The average age of menarche in the US is…

A

12-13

107
Q

How many glands are contained in each breast?

A

20-40

108
Q

The first half of the cycle is caused by:

A

Sudden reduction in progesterone and estrogen

109
Q

What are the most common breast masses?

A

simple cysts fibrocystic condition fibroadenomas cancer

110
Q

What triggers ovulation and stimulates the secretion of estrogen and progesterone from the ovaries?

A

LH

111
Q

Where are estrogen and progesterone synthesized?

A

The ovaries

112
Q

How long does menstruation typically occur?

A

5 days

114
Q

What are the most common breast infections?

A

Mastitis Abscess

115
Q

What are the physical borders of the breast?

A

Extends from the clavicle to the 6th rib, and from the sternum to the midaxillary line

116
Q

How often is breast pain associated with breast cancer?

A

1-6%

117
Q

The normal position of the uterus is…

A

anteflexion

118
Q

In puberty, the release of GnRH triggers what?

A

The secretion of FSH and LH from the anterior pituitary.

OBGYN (4 decks)

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