Week 5 pt 2 highlights Flashcards by Morgan Evans

Cautions in Hormone Therapy (HT):
A Randomized Clinical Trial in 2002 found:
1) ___________ risk of heart attack, stroke, thromboembolic disease, and breast cancer
2) __________ risk of colorectal cancer and hip fractures

1) Increased
2) Reduced

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Urgency Urinary Incontinence:
1) What causes this?
2) What are 3 Sx?
3) Who is it more common in?

1) Detrusor Overactivity
2) Urgency, frequency, nocturia
3) More common in older women and with comorbid neurologic disorder

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Overflow Incontinence:
1) Define this condition
2) What is the main Sx?

1) Bladder does not empty completely during voiding
2) May experience continuous bladder leakage

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What are 3 key parts of incontinence eval?

1) History, PE, and direct observation of urine loss
2) Urodynamic testing
3) Cystourethroscopy

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List 3 Nonsurgical Treatment Options for incontinence

1) Lifestyle
2) Kegel Exercises
3) Pharmacology

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Midurethral Sling is the most popular surgical Tx for what?

Incontinence

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What is the most common cause of UTI?

Fecal flora (E. coli)

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1) What is a lower UTI called? What Sx is uncommon?
2) What is upper UTI called? What are 2 Sxs?

1) Acute Simple Cystitis: fever uncommon
2) Acute Pyelonephritis: Fever, chills,

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List the important parts of Diagnostic and Laboratory Eval for UTI

1) Hx
2) PE
3) Labs: urinalysis, & culture if no improvement

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How long is the course of abx typically for UTIs?

3-5 days

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What abx do you use for UTIs in pregnancy?

1) Cephalexin 500 mg PO QID, Cefpodoxime 100mg BID, or
2) Amoxicillin 500 mg (or Augmentin) PO TID
x 5-7 days
-Both have low risk of teratogenicity

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Trimethoprim-Sulfamethoxazole (Bactrim) for UTIs: Risks/benefits in pregnancy must be weighed especially during what 2 times?

1st and close to term.

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UTIs in pregnancy: What is the DOC in the 2nd and 3rd trimesters?

Macrobid 100mg PO BID x 7d

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UTIs in pregnancy: When can you not give Macrobid?

1) Can be teratogenic at high doses and cause hemolytic anemia in the newborn if used in the mom in the last 2 weeks of the pregnancy
2) DO NOT GIVE TO MOM AFTER WEEK 37 (or in 1st trimester)

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ALL _________________________ are contraindicated in pregnancy and carries risk of spontaneous abortion and permanent teeth and bone discoloration.

tetracyclines (ex/doxycycline)

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What 2 things should you consider doing for treating recurrent UTIs?

Vaginal estrogen in postmenopausal women
Change contraception method

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Asymptomatic Bacteriuria: Screening and treatment not recommended in what 2 groups?

Nonpregnant premenopausal women

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Fecal Incontinence:
1) Is also called what?
2) What are 2 types?

1) Accidental bowel leakage
2) Sporadic or continual

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1) Women who have breastfed their infants have a ______________ risk of breast cancer.
2) _______ minutes of exercise 5 times per week decreases breast cancer risk

1) decreased
2) 30

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1) Drinking _____ to _____ alcoholic drinks per day is associated with a 20% increased risk of breast cancer
2) Does smoking increase breast cancer risk?

1) 2 to 3
2) Yes

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Give the when, where, how, and why of breast self awareness

1) When? First week after your period
2) Where? In the shower, when your skin is wet and your hands
3) How? Everywhere and consistently.
4) Why? Because many women find their own cancers that have been missed by mammography

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Clinical Breast Examination (CBE): Perform during _____________ phase of the menstrual cycle

follicular

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List some important symptoms concerning for malignancy of the breast

1) Rapid change
2) Enlargement of one breast
3) Discoloration
4) Warmth
5) Dimpling
6) Itching
7) Enlarged lymph nodes
8) Nipple inversion

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> /=40 y/o, the first-line study for breast cancer screening is what?

Mammography

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_____________ carcinoma is more difficult to detect with routine screening mammography

Lobular

List some diagnostic imaging for breast cancer

1) Mammography 2) Ultrasonography 3) Magnetic Resonance Imaging (MRI)

What is more commonly used in women <30 as initial modality for screening for breast cancer?

Ultrasonography

What screening for breast CA is limited due to cost?

MRI

What are 2 methods of diagnostic testing for breast CA?

1) Fine-Needle Aspiration 2) Core-Needle Aspiration

1) Sclerosing adenosis feel like what? 2) Is it cancerous? How do you Tx?

1) Small, firm, tender, palpable nodules 2) Benign condition and does not need treatment.

Radial scars (complex sclerosing lesions): Do they cause breast cancer?

No consensus on whether they increase risk of breast cancer

Most common benign tumor of the breast is what?

Fibroadenoma (No need to Tx usually)

Give the clinical features of fibroadenomas

Firm, smooth, rubbery and defined; highly mobile; painless

How do you Tx fat necrosis of the breast?

No treatment required once dx is confirmed

Breast abscesses are usually caused by what bacteria?

staph aureus

Lipoma: A _________ tumor of fat cells

benign

1) "Breast Pain” is also called what? 2) What are 3 types?

1) Mastalgia 2) Cyclical, noncyclical, and extramammary

List 2 medical therapies for mastalgia

1) Danazol 2) Selective estrogen receptor modulators (SERMs)

List 2 meds that can Tx mastalgia

1) Danazol 2) SERMS (tamoxifen or raloxifene)

Mastitis: 1) What are the Sx? 2) Who does it occur in? What is it assoc. with?

1) Pain, swelling, redness, warmth, fatigue, malaise, fever 2) Lactating or recently lactating women -Associated with incomplete emptying of the breast (engorgement) or plugged duct(s)

Mastitis: 1) What causes it? 2) What are some important parts of Tx?

1) Bacteria 2) Cont. breastfeeding -Dicloxacillin is first line Tx -If MRSA risk factors: Bactrim

Is nipple discharge always a concern?

Can be benign or early sign of endocrine dysfunction or cancer

Define Ductal Ectasia

Dilation of the mammary ducts, walls thicken, and fluid builds up

Intraductal Papilloma: Are they benign?

Yes; Small, benign, usually in women 35-55

Bloody discharge of the nipple may be due to what?

Intraductal papilloma

List 3 groups of medications that may cause Galactorrhea

1) Anti-psychotics 2) H2-receptor blockers 3) OCPs

What is the single largest risk factor for breast cancer?

Age

Breast Cancer Risk Assessment Tool: The Gail Model uses what 7 risk factors? ("good to know these")

1) Age 2) Onset of menstruation 3) Age at the time of first live birth 4) Number of 1st degree relatives with breast CA 5) History of breast biopsy 6) History of atypia on biopsy 7) Race/ethnicity

70-80% of breast cancers are _________________ carcinomas

invasive ductal

1) What Sx suggests infection or inflammation? 2) What is it worrisome for in women who have not recently nursed a baby?

1) Redness 2) IBC (inflammatory breast cancer)

List some skin changes that can be present in the symptomatic PT coming in for a breast concern

1) Redness 2) "Peau d'orange" quality 3) Dimpling 4) Asymmetry 5) Nipple retraction

Define inflammatory breast cancer (IBC)

A rare type that develops rapidly, making the affected breast red, swollen and tender.

IBC: Most patients have signs of _______________ cancer at the time of diagnosis, including lymphadenopathy and metastasis.

advanced

Eczema-like appearance to the nipple is a Sx of what?

Paget’s Disease of the Breast

The seriousness of invasive breast cancer is strongly influenced by the _________ of the disease.

stage

Breast CA: Once the ____, ______, and ________ are determined, a stage of I,II, III, or IV is assigned

T, N, and M

Breast CA staging: Nodes (N)

NX: cannot be assessed N0: no spread or requires PCR testing N1: involves 1-3 nodes N2: involves 4-9 nodes N3: >10 nodes or more distant nodes involved

10-17% of breast cancers, including the majority of cancers in patients with BRCA1 mutations, are what?

Triple negative

Triple negative breast CA: 1) What does it respond well to? 2) What is triple positive?

1) Tend to respond well to chemo 2) Triple positive: ER+ and PR+ and HER2+

Receptor _____________ tumors (although fewer in #) have a poorer prognosis

NEGATIVE

Endocrine receptor positive make up _____% of breast CA

75%

Endocrine receptor positive : 65% of breast CAs are ______

PR+

Endocrine receptor positive: _________ (20-25% of breast cancers) tend to be very aggressive and fast-growing tumors

HER2 positive

List 2 drugs that are widely used to Tx hormone-receptor positive breast cancers

1) Tamoxifen 2) Raloxifene (Evista)

Treatment of ER+ patients: What should you begin after surgery, chemo, and radiation?

Anti-estrogen therapy

List 2 surgical treatments for breast CA

1) Lumpectomy 2) Mastectomy

Current ACOG recommendations say that HT (hormone therapy) should only be used for what?

short-term relief and individually tailored

List 2 alternatives to hormone therapy during menopause

1) Black cohosh 2) Evening primrose oil

Pelvic Organ Prolapse: 1) Organs have lost their __________ 2) Might descend through the ______________

1) support 2) urogenital hiatus

Pelvic organs are supported by a complex interaction of what 4 things?

1) Levator muscles 2) Connective tissue 3) Uterosacral ligaments 4) Cardinal ligaments

1) Urethrocele and cystoceles occur in which compartment? 2) Where do Rectoceles occur? 3) What is an Enterocele?

1) Anterior vaginal compartment 2) Posterior vaginal compartment 3) Displaced small bowel

What are 3 important Hx points to consider when evaluating POP?

1) Intra-abdominal pressure 2) Chronic cough or constipation 3) Neurologic process

Describe the first 3 stages of pelvic organ prolapse (POP-Q)

Stage 0: No prolapse Stage I: edge is >1 cm above the hymen. Stage II: edge is < 1cm above or below the hymen.

POP: 1) How do you Tx Asymptomatic or mild cases? 2) What are the types of surgeries?

1) Observation 2) Compartment-specific reconstruction vs obliterative

Stress Urinary Incontinence: 1) Define this condition 2) Who is it most common form of incontinence in?

1) Intra-abdominal pressures exceed urethral closure pressures 2) Young women