Lecture 5 Flashcards by Meg Dolohanty

To be diagnosed with PMS, need 1 symptoms in 5 days pre-menses for how many cycles?

3 cycles

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When are PMDD symptoms absent?

Week post menses

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What are 4 main somatic symptoms of PMS?

Bloating, mastodynia, HA, swelling

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What are three affective symptoms of PMS?

Irritable, angry outbursts, moodiness

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When are symptoms relieved with PMS?

Within 4 days of menses

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What are some core symptoms of PMDD?

Marked depression, marked anxiety, sudden tearfulness/ sadness, increased interpersonal conflicts or persistent & marked anger or irritability

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What is the gold standard for treatment of PMDD?

SSRIs

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What are some common meds for PMS?

NSAIDs, spironolactone (diuretic), ovulation suppression (OCPs, danazol (blocks all hormones- become male like) GnRH agoinst)

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What are 3 common SSRIs prescribed for PMDD?

Fluoxetine (Prozac), Sertraline (Zoloft), Paraxetine (Paxil)

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What are some ADRs associated with SSRIs for treatment of PMDD?

GI upset, insomnia, sexual dysfunction, wt gain, increased nervousness

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What is transition time to non-reproductive years prior to menopause?

Peri-menopause

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What is the pernmanet cessation of menses. 12 consecutive months w/o menses. Change in follicular phase, luteal phase constant.

Menopause

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Under what age is premature ovarian failure considered?

Under 40 years old

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What is the primary hormone in menopause?

Estrone (E1)

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What hormone becomes higher with menopause?

FSH

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What does estrone produce?

androstenedione & testosterone

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What do bisphosphonates do? (ex- alendronate, risedronate)

Inhibit osteoclastic activity

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What do SERMS (selective estrogen receptor modulator, raloxifene) do?

nhibit bone resorption & turnover.

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What is a a precaution with bisphosphonates?

Sit up and don’t eat for at least 30 minutes after

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What can St. John’s wort work to help?

Vasomotor symptoms, depression

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What 2 other supplements can help with vasomotor symptoms of menopause?

Soy/isoflavones

Black cohosh

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If an individual has a uterus, what do they need to be on for hormonal replacement?

Progesterone and estrogen

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What are some contraindications for estrogen therapy?

CVA, thromboembolic disease, undiagnosed genital bleeding, biliary tract disorder, known estrogen dependent tumor

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Where are the majority of breast cancers found?

In outer, upper quadrants

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Higher risk of cancer with Menarche <___ years

12 years old

Menopause > ___ increases risk of breast cancer?

55 years old

No IUP or IUP > ____ year old increases risk of breast cancer.

30 y/o

Why do you preferable do the CBE during the follicular phase?

Estrogen dominant cycle, can then compare with mass in other phase

Which nodes do you check on a CBE?

axillary, epitrochlear, supraclavicular

What are the two types of mammography and what is the difference?

Screening vs. diagnostic | Screening if for an individual with no mass

How many views on done on screening mammogram?

4 views (2 on each)

What are 2 other things they can do with diagnostic mammography?

Compress more, and magnify

What are the three types of mastalgia?

Cyclic, non-cyclic & extra-mammary

What are some Rx for mastalgia?

Appropriate bra weight loss, less caffeine Vit E Meds

What are some Meds for mastalgia?

``` OCPS Depo-provera (progesterone only) Bronmocriptine & lisuride Danazol SERMS (off-label tamoxifen, raloxifen) ```

What does nonspontaneous, nonbloody & B/L breast discharge indicate?

Ductal ectasia (fibrocystic changes)

What does purulent nipple discharge indicate?

Abscess

What meds can cause milky discharge?

Tricyclics, OCPs

What does bloody, unilateral nipple discharge indicate?

Intraductal CA, invasive ductal CA, papilloma (benign)

What are some symptoms of a prolactinoma?

HA, diplopia, vision change,

What are two causes of hyperprolactinemia?

Tumor in pituitary or tumor secreting prolactin.

If prolactin is elevated what do you do?

MRI sella turcica along with visual fields

What is dense epithelial & fibroblastic tissue: encapsulated, solid, round, mobile & rubbery often found in adolescents and young women?

Fibroadenoma

What is inc’d fibrosis w/in lobule along w/compression & distortion epithelium?

sclerosing adenosis

What is a benign disease that is proliferative w/out atypia. >2 2 cell ayers above basement membrane.

Epithelial hyperplasia

What is neoadjuvant chemo ?

Chemo used to shrink mass before it is removed

After initial treatment how often are women seen by gyn?

First 2 years- 3-6 months | 3rd year and beyond see annually

What stage of breast cancer do you: mastectomy or BCT w/ or w/out irradiation

Stage 0

What stage of breast cancer do you: surgery local control, chemo +/or hormonal

Stage IV

What stage of breast cancer do you: modified radical or or BCT w/irradiation, axillary node, + chemo, + tamoxifen, + neoadjuvant chemo (try to shrink mass with chemo before you go to remove mass), radiation supraclavicular LN + chest wall & breast (inflammatory type)

Stage III

What stage of breast cancer do you: mastectomy or BCT w/or w/out irradiation, sentinel node/axillary node, + chemo.

Stage I

What stage of breast cancer do you: modified radical or or BCT w/irradiation, axillary node, + chemo, + tamoxifen, radiation supraclavicular LN (+ 4 LN) + chest wall?

Stage II

What is the only med approved by the FDA to treat mastalgia?

Damazol

What are the two types of carcinoma in situ?

Lobular carcinoma in situ (LCIS) | Ductal carinoma in situi (DCIS)

What is the single largest risk factor for development cancer?

Age- Over 50

If ER positive or negative breast cancer easier to treat?

ER positive- can attack estrogen receptors

Is Her2/neu positive good or bad?

Bad

What is normal cyclic symptoms associated with ovulation which do not interfere w/ the patient's daily routine?

Molimina

What are the most common somatic symptoms that occur with PMS?

Abdominal bloating and fatigue

What is the term for breast pain and swelling?

Mastodynia

What is the most common behavioral symptoms of PMS?

Emotional lability

What is the current theory for what causes of the basis of PMDD?

Serotoninergic dysregulation

What 2 supplements have shown to decrease symptoms of PMS and PMDD?

carbonate and magnesium

What are the 4 FDA approved drugs for PMDD?

Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and drospirenone/ ethinyl estradiol

What is the time period during which the changes of menopause occur

climacteric

The plasma concentration of _______ begin to increase several years in advance of actual menopause.

FSH

What is usually the first physical manifestation of decreased ovarian function

Hot flush

What is the only FDA approved med for treating mastalgia?

Danazol