Ovarian/Breast Disorders Lecture Flashcards
(67 cards)
1
Q
- follicle
- maturing follicle
- ovulation
- corpus luteum
Whats next (if not pregnant)
A
Degeneration of corpus luteum
2
Q
When does estradiol peak?
A
Right before ovulation
3
Q
When do lutenizing hormone (LH) and follicle stimulating hormone (FSH) peak?
A
During ovulation
4
Q
When is Progesterone highest?
A
Luteal phase
5
Q
When does body temperature increase?
A
Second half of ovulation into luteal phase
6
Q
Adnexal refers to the…
A
ovary
7
Q
Follicular cyst
A
most common ovarian cyst
8
Q
Usually not symptomatic
Usually resolve spontaneously
Result from failure of ovulation
A
Follicular cyst
9
Q
Cysts that occur after ovulation
Thin-walled, unilocular
A
Corpus luteum cyst
10
Q
Cysts in pregnancy or molar gestation
*bilateral functional cyst greater than 3 cm
A
Theca-lutein
11
Q
What type of cyst can sometimes occur with endometriosis
A
Hemorrhagic cyst
12
Q
Management of fluid filled cysts
A
Monitor with period ultrasound
13
Q
Management of non fluid filled cysts
A
Remove it (laparoscopic)
14
Q
If cyst greater than 6 cm, what might happen?
A
TORSION! must remove cyst!
15
Q
How can you prevent ovarian cysts?
How can you tx pain?
A
Prevent with OCPs
Tx pain with NSAIDs
16
Q
Diagnose clinically if 2 of 3 conditions:
Oligo or amenorrhea and anovulation
Hyperandrogenism
Obesity (50%)
Hirsutism (30-75%)
Ultrasound: evidence of polycystic ovaries (not always)
A
PCOS
17
Q
- Most common cause of infertility in women
- Insulin resistance (higher risk of diabetes)
- Unopposed estrogen
A
PCOS
18
Q
- OCPs tx unopposed estrogens and hirsutism
- can cycle with progesterone
- metformin for insulin resistance (may improve infertility)
- clomiphene citrate for infertility
A
PCOS tx
19
Q
What part of the pituitary produces FSH and LH?
A
Anterior
20
Q
Granulosa cells (which act as neg feedback to ant. pituitary ) Development of oocytes
This is done by FSH or LH?
A
FSH
21
Q
Theca cells which produce androgens
This is done by FSH or LH?
A
LH
22
Q
Never progress to luteal phase- creates exogenous estrogen
A
PCOS
23
Q
Abnormal feedback regulation promotes more LH than FSH
A
PCOS
(insufficient FSH to stimulate granulosa cells
24
Q
Enlarging ovarian mass with a solid component or change in character, especially in a postmenopausal woman
What is the management?
A
REMOVE IT
25
Is screening for ovarian cancer (ultrasound or CA-125) recommended?
NO
26
Where do 85-90% of ovarian cancers originate?
Epithelium
27
young women with ovarian tumors are typically this kind...
germ cell tumors
28
appear in connective tissue cells of the ovaries that produce estrogen and progesterone
stromal carcinoma tumors
| rare, low grade malignancies, produce hormones
29
Oral contraceptives
More than 1 full term pregnancy before age 35
Breast feeding
Tubal ligation
protective against ovarian cancer
30
risk peaks 65-75 yo
The most lethal gynecologic malignancy- “silent killer”
Ovarian cancer
31
Most women present with late stage disease:
Abdominal pain/bloating
Early satiety
Urinary urgency/frequency
Ovarian cancer
32
Transvaginal Ultrasound
| Laproscopic Evaluation
used in dx of ovarian cancer
33
most common breast complaint in primary care
breast pain
34
Associated with hormonal changes, usually 1 week prior to onset of menses (due to proliferation of normal glandular breast tissue)
Cyclic breast pain
35
```
Spontaneous
Unilateral
Confined to one duct
Bloody
Clear, yellow, white, dark green
Associated with a mass
Women age >40
```
Pathologic nipple discharge
36
Discharge only with compression
Often bilateral
Multiple ducts involved
Fluid may be clear, yellow, white or dark green
Benign nipple discharge
37
physiologic nipple discharge
Usually bilateral milky nipple discharge involving multiple ducts
Caused by hyperprolactinemia
galactorrhea
38
Solid, firm & mobile mass- “rolled to an edge”
| typically in young women
Fibroadenoma
39
Fluid-filled mass, compressible or ballotable
| Premenopausal and perimenopausal women
Cyst
40
Diffuse, tender, does not form discrete or well-defined mass
Associated with breast pain, cyclic, premenopausal
PE: breast tissue frequently nodular
Fibrocystic changes
41
Gold standard of dx breast cancer
biopsy
42
Milk retention cyst in breastfeeding women
Galactocele
43
Can develop after trauma, surgery , radiation- diff. to distinguish
*seen in breast augmentation or reduction procedures
Fat necrosis
44
3 steps of assessing to diagnose or rule out breast cancer
1. physical exam
2. mammogram
3. needle biopsy (fine needle aspiration or core needle biopsy)
45
```
Most common solid benign breast mass
Well-defined, mobile solid mass
Etiology unknown but hormonal relationship likely
Most commonly found between ages 15-35
Definitive diagnosis: CNB or excision
```
Fibroadenoma
46
Localized, painful inflammation of breast associated with fever & malaise
Occurs in 2-10% of breastfeeding women
Usually due to breastfeeding problems
If left untreated – local abscess formation
PE: hard, red, tender, swollen area of 1 breast
Staph aureus
Treatment: dicloxacillin or clindamycin (MRSA)
Lactational mastitis
47
BRCA genes increase lifetime risk of breast cancer by.....
60-80%
48
- Eastern European heritage
- African American female diagnosed before age 35
- Test family members of any male diagnosed with breast cancer
- When a woman has had breast cancer in both breasts
- When multiple family members have had breast cancer or gynecologic cancers
- When a blood relative has had breast cancer before age 50
Test for BRCA
49
what type of aspiration can be used to confirm dx of breast cysts
fine needle aspiration
50
which is more invasive, fine needle or core needle?
CORE
51
```
Spontaneous
Unilateral
Confined to one duct
Bloody
Clear, yellow, white, dark green
Associated with a mass
Often NO Pain
```
pathologic breast issues
| malignant have less discharge
52
```
Discharge only with compression
Often bilateral
Multiple ducts involved
Fluid may be clear, yellow, white or dark green
Often present with Pain
```
Benign breast issues
53
Often, the simplest way to determine whether a palpable mass is cystic or solid is to _______ the mass.
aspirate
54
ductal or lobular carcinoma (CIS)
+carcinoma in situ
invasive or non invasive?
non invasive
55
most common type of non invasive breast cancer
* non life threatening
* can increase risk of developing invasive cancer
ductal carcinoma in situ (DCIS)
(ductal= milk
in situ=in its original place)
56
lumpectomy only recurrence rate with DCIS
25%
| down to 15% for lumpectomy plus radiation
57
infiltrating ductal carcinoma
most common breast cancer (this is the kind men get also)
70-80% all breast cancers
58
```
swelling of all or part of the breast
skin irritation or dimpling
breast pain
nipple pain or the nipple turning inward
redness, scaliness, thickening of the nipple or breast skin
a nipple discharge other than milk
Enlarged lymph in axilla
```
infiltrating ductal carcinoma
59
- Size of the tumor
- Whether the cancer has spread to lymph nodes, and if so, how many
- Whether the cancer has spread to other parts of the body
- ER/PR Her2/neu status
staging of breast cancer
60
Estrogen down regulator drug
Tamoxifen
61
Provider visit with exam every 3-6 months for first 3 years
Every 6-12 months for years 4 and 5
Every year post year 5
Yearly mammogram
Monitor for side effects of any medication
Yearly pelvic exams (some tx drugs increase unterine cancer risk)
Follow up guidelines for breast cancer
62
second most common type of breast cancer
tends to occur later in life (early 60s)
invasive lobular carcinoma (ILC)
63
rare
dx usually made w skin punch biopsy
*very invasive
*high mets rate
```
staging tests include:
CXR
CT of chest, abdomen, pelvis
Bone scan
Liver function test
```
inflammatory breast cancer
64
Collection of abnormal cells
- not a true cancer
- increased risk of dev. invasive CA later in life
- diagnosed b/f menopause
- usually diagnosed because of a biopsy performed for some other reason
- usually hormone receptor positive
lobular carcinoma in situ (LCIS)
65
- rare form of breast CA in which cancer cells collect in or around the nipple
- less than 5% of all breast CA cases
- 97% of patients also have DCIS or invasive CA somewhere else in the breast
- ave. age of diagnosis = 62
Paget's disease
66
itching, tingling, and/or burning sensation
pain or sensitivity
scaling & thickening of the skin
yellowish or bloody d/c from the nipple
Paget's disease
67
```
Lymph Nodes
Muscle , Fatty Tissue and Skin
Bones- ribs, spine, pelvis, & long bones arms /legs
Bone Marrow
Liver
Lungs
Brain
```
Most common sites of breast cancer metastasis
