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Flashcards in Gyn and breast disorders Deck (43):
1

How do LH and FSH change from conception to birth in girls? Birth to 6mo? 6mo to 4yo?

Peak at 20wks gestation...and decrease 'til birth
Increases again until 6mo
Gradually decreases until 4yo

2

What is going on at the hormone level from 4-8yo?

Low FSH, LH, and androgen d/t GnRH suppression

3

What is the order of events in normal female puberty?

Adrenarche (adrenal androgen production)
Gonadarche (activation of gonads by LH and FSH)
Thelarche (appearance of breasts)
Pubarche (appearance of pubic hair)
Growth spurt
Menarche (~13yo)

4

What secretes estradiol and progesterone to maintain endometrium?

Corpus luteum

5

What initially secretes hCG? Why?

Endometrial cells (in response to implantation) to maintain corpus luteum

6

What is primary amenorrhea? What can cause it?

No menses by 16yo w/secondary sex characteristics; OR
No menses by 13yo w/o secondary sex characteristics

Hypothalamic or pituitary dysfunction, anatomic abnormalities (absent uterus, vaginal septa), chromosome abnormalities with gonadal dysgenesis

7

What is secondary amenorrhea? What can cause it?

Absence of menses for at least 6 months after previously normal menses

Pregnancy, ovarian failure, hypothalamic or pituitary disease, uterine abnormalities (Asherman syndrome...scarring), PCOS, anorexia nervosa/malnutrition, thyroid disease

8

What distinguishes primary from secondary dysmenorrhea?

Time...primary occurs at the beginning of menstruation and resolve over several days; secondary begins midcycle and increase in severity until conclusion of menstruation

Cause...primary has no pelvic pathology; secondary has pelvic pathology

9

How is primary dysmenorrhea treated?

NSAIDs or OCPs

10

What distinguishes PMS/PMDD from normal menstrual symptoms? How are they treated

They interfere with daily life

Exercise, B6, NSAIDs, OCPs, Progestins
SSRI +/- alprazolam for mood disorder (PMDD > PMS)

11

What is the most common cause of female infertility? How is it diagnosed?

Endometriosis (endometrial tissue outside the uterus)

Laparoscopy will show "powder burn" lesions and cysts on involved areas

12

What is adenomyosis?

Endometrial tissue invades myometrium --> uterine enlargement and cyclical pain

13

What does it take for uterine bleeding to be "abnormal"?

Less than 24 day interval
Greater than 35 day interval
Lasts more than 7 days
Loses more than 80mL blood

14

What causes amenorrhea with PCOS? Hirsutism?

Increased androgens --> increased estrogen --> abnormal LH and FSH (LH:FSH > 3)

Increased androgens (spironolactone can decrease this...but has to be stopped with pregnancy)

15

Do ovarian cysts cause PCOS symptoms?

No...the opposite really, excess androgen causes ovarian cysts

16

What bugs cause vaginitis?

Normal bacteria (Gardnerella vaginalis)...clue cells
Protozoans (Trichomonas)...green
Fungus (Candida albicans)...cottage cheese

17

How is vaginitis treated?

Gardnerella...Metronidazole
Trichomonas...Metronidazole (also treat partner)
Candida...azole or nystatin

18

A girl comes in really sick...vomiting, diarrhea, sore throat, headache, kinda shocky, and has desquamation of palms and soles. What is the cause? Risk factors? How is it treated?

Staph a exotoxin

prolonged tampon use, prolonged intravaginal contraception use, postpartum or postabortion infection

Remove object if there is one
Treat the shock
Clinda, PCN-beta lactam; vanc if necessary

19

Patient comes in with a painless ulcer on penis/vaginal wall. What is the likely cause? What is the near-future outcome?

Syphilis

It'll heal w/in 9 wks...but secondary symptoms began as it heals

20

What are secondary syphilis symptoms?

Headache, malaise, fever, lymphadenopathy
Maculopapular rash on palms and soles
Papules in moist areas (condloma lata)

21

A patient returns from the tropics with a painful ulcer with a grayish base and foul odor. What is going on? What caused it? How is it treated?

Chancroid...can have large inguinal swelling

H. ducreyi

Ceftriaxone, erythromycin, or azithromycin

22

A guy returns from a developing country with a painless ulcer on his penis. What causes lymphogranuloma venereum? What is the concern if this is lymphgranuloma venereum? How is it treated?

L1-L3 serotypes of C. trachomatis

Significant inguinal buboes...can ulcerate or cause elephantiasis

Tetracycline, erythromycin, or doxycycline

23

Woman comes in with a painless ulcer with a beefy red bas and irregular borders. What is the likely diagnosis? What caused it? What would be seen on Giemsa stain?

Granuloma inguinale

Klebsiella granulomatis

Donovan bodies (red encapsulated intracellular bacteria)

24

What is the most common cause of postmenopausal bleeding? What has to be ruled out? How?

Atrophic vaginitis is most common

Endometrial cancer must be ruled out with a biopsy (CA-125 may be elevated...but shitty marker until postmenopausal)

25

A woman presents with abdominal pain and fullness. A palpable, tender mass is found on bimanual exam. What would suggest follicular cyst? What is the treatment?

Granolas cells with a 3cm cyst in first 2wks of cycle

Observation (may regress over menstrual period)
Ovarian cystectomy if mass does not regress or for increased suspicion of cancer

26

A woman presents with abdominal pain and fullness. A palpable, tender mass is found on bimanual exam. What would suggest a corpus luteum cyst? What are some concerns? What is the treatment?

Theca cells; cystic or hemorrhagic...usually larger and firmer than follicular cyst, also more common later in cycle

Increased risk of torsion or rupture

Observation...cystectomy if stays or cancer...surgical hemostasis and cystectomy if hemorrhage

27

A large growth is felt during both the bimanual exam and abdominal exam. What would be seen that would indicate mucinous or serous cystadenoma? How is it treated?

May resemble endometrial or tubal histology; psammoma bodies

Unilateral salpino-oophorectomy; TAH/BSO if postmenopausal

28

What is an endometrioma? How is it treated?

Spread of endometriosis to the ovary

OCPs, GnRH agonists, progestins, danazol may lessen symptoms
Cystectomy or oophorectomy for recurrence

29

A girl has precocious puberty and a cyst is found in her ovary. What kind of tumor is it?

Stromal cell tumor...granulosa theca cell tumor

30

A girl has virilization and a cyst is found in her ovary. What kind of tumor is it?

Stromal cell tumor...Sertoli-Leydig cell tumor

31

A young woman has multiple small, mildly painful masses in her breasts that vary in size during her cycle. What is this? How is it treated?

Fiborcystic changes

Caffeine and dietary fat reduction, OCPs, progesterone, or tamoxifen...in confirmed benign lesions

32

A young woman (less than 30yo) has a solitary, solid, mobile mass with well-defined edges. What is likely going on? What should be ordered? How is it treated?

Fibroadenoma (most common benign breast tumor)...proliferative process in a single duct

FNA to confirm benign

Surgical excision or US-guided cryotherapy

33

A woman has a palpable mass behind the areola and there is discharge from her nipple on stimulation. What is likely diagnosis? What would make it more concerning for malignancy? How is it treated?

Intraductal papilloma

Bloody discharge...get an excisional biopsy

Surgical excision

34

What is the downfall to FNA of potential breast cancer?

Cannot differentiate between in situ and invasive carcinoma

35

A mammogram showed a mass, so a biopsy was done that showed malignant cells in a duct without stream invasion. What is the diagnosis? What is a risk? How is it treated?

Ductal carcinoma in situ...often unifocal and may have calcifications

Higher risk of subsequent invasive cancer than LCIS

Lumpectomy and possible radiation

36

A mammogram showed a mass, so a biopsy was done that showed malignant cells in lobules without stream invasion. What is the diagnosis? What is a risk? How is it treated?

Lobular carcinoma in situ...can be multifocal; no calcifications

Lower risk of invasion than DCIS, but increased risk of contralateral malignancy

Close observation and tamoxifen or raloxifene...bilateral mastectomy if woman doesn't want to worry about it

37

A woman comes in because one of her breasts looks like an orange. A biopsy shows malignant cells in ducts with stream invasion and microcalcifications. What is the diagnosis? What else is likely to be seen?

Infiltrating ductal carcinoma (most common...80% of cases)

Fibrotic response in surrounding breast tissue

38

A woman comes in because her husband felt a firm mass in one of her breasts. A biopsy shows malignant cells in breast lobules with insidious infiltration. What is the diagnosis? What else distinguishes it from infiltrating ductal carcinoma?

Infiltrating lobular carcinoma

Less fibrous response
More frequently bilateral or multifocal
Slower metastasis
Greater association with hormone replacement therapy

39

A woman comes in because of a soft, well-circumscribed mass that has been growing rapidly in one of her breasts. What is the likely diagnosis? What is the prognosis?

Medullary carcinoma

Better than ductal carcinoma

40

An older woman comes in because of a gelatinous, well-circumscribed mass that has slowly grown. What is the likely diagnosis? What is the prognosis?

Tubular carcinoma

Better than ductal carcinoma

41

A woman in her late-40's is found to have a mass on mammogram. Biopsy shows well-formed tubular structures that invade the stroma. What is the diagnosis? What is the

Tubular carcinoma

Excellent

42

A woman comes in because her breast is warm and painful. On exam, lymphadenopathy is found. What is the likely diagnosis? What is the prognosis? Treatment

Inflammatory carcinoma...subtype of ductal carcinoma characterized by rapid progression and angioinvasion

Poor prognosis

Mastectomy + hormones + chemo

43

When are hormones or chemo used to treat breast cancer?

All node-positive cancers
Tumors >1cm or with aggressive histology