Women's Health Flashcards
(120 cards)
1
Q
Breast Exam includes
A
neck
chest wall
both breasts
axillae
2
Q
Timing of breast exam
A
9 days after onset of menses
3
Q
Palpable mass <30
A
usually benign attributed to normal physiologic changes fibrocystic fibroadenoma cyst
4
Q
Management of palpable mass <30
A
recheck in 2 weeks
monthly BSE
Imaging by sonogram (harder to see on mammogram b/c younger breasts more dense)
for this pt you would get a sonogram of breast
5
Q
Palpable mass 55 y.o.
A
R/O malignancy first
then consider a cyst
6
Q
Management of palpable mass 55 y.o
A
Diagnostic mammogram
35 and older mammogram the test of choice
7
Q
The triple test
A
physical exam70% accurate
radiographic imaging 85% accurate
pathology 95% accurate
8
Q
BIRADS category #4
A
suspicious, core needle biopsy or neele localization biopsy as soon as possible
9
Q
Breast pain 3 types
A
cyclic
noncyclic
extramammary
10
Q
Refer breast issues when
A
any mass if imaging studies are neg
when in doubt
11
Q
cyclic breast pain
A
follows mentrual pattern
common during leuteal phase and may last 7 days
hormones
12
Q
noncyclical breast pain
A
does not follow menstrual pattern
unilateral
could describe menopause women on hormone therapy
coopers ligaments stretching from large pendulous breasts
13
Q
extramammary breast pain
A
chest wall pain
shingles
pleuritic,cardiac,GI
(costrochondritis)
14
Q
most important question with pain evaluation
A
does the pain change in menstrual cycle
15
Q
Benign breast pain tx
A
NSAIDS, tylenol well fitting bra oral contraceptives primrose oil 1500 BID x 4 months Danazol Vitamin E
16
Q
Nipple discharge
A
common in reproductive years
most benign
17
Q
Galactorrhea
A
discharge of milk beyond 6 month PP
white or clear
18
Q
Abnormal nipple d/c
A
uniductal unilateral persistent sanguineous/ serosanguineous mammogram in those >30
19
Q
Questions to ask with nipple d/c
A
lymph nodes enlarged?
change in color?
dimpling?
20
Q
Benign rashes
A
canida: keep dry, nystatin cream
eczema: nipple not involved
contact dermatitis: topical steroids
21
Q
Paget’s disease
A
detect early to avoid lymph involvement
looks like eczema but involves nipple
22
Q
most aggressive type of breast cancer
A
inflammatory breast cancer
23
Q
BIRADS scoring
A
0-6 (mild-severe)
24
Q
BIRADS 0
A
need additional imaging
spot compression and magnification with ultrasound
25
BIRADS 1
Negative
routine follow up
0% malignancy
26
BIRADS 2
Benign
routine follow up
0% malignancy
27
BIRADS 3
Probably benign finding
diagnostic view of breast in 6 months
2% malignancy
28
BIRADS 4
Suspicious
core-needle biopsy
>2-95% malignancy
29
BIRADS 5
Highly suspicious of malignancy
core-needle biopsy
95% malignancy
30
BIRADS 6
biopsy proven carcinoma
31
Documenting mass
location with measurement and distance from nipple
tender/nontender
mobile
32
Fibrocystic changes with breasts
normal to have grainy feeling bilaterally with pain
common in those 30-50
can be related to estrogen
33
Fibroadenoma
common in young women in teens
| mass is rubbery, mobile and non tender
34
Breast cyst classifications
simple
complicated
complex
35
Simple cysts
```
common in peri-menopausal
oval
smooth
mobile
well circumscribed
```
36
Complicated/Complex cysts
contain mixed cystic and solid components
high rate of cancer
aspirate and send to cytology
37
Normal vaginal environment
can have thick, pasty, dry or stringy d/c that is odorless
1-4ml d/c/24 hours
normal pH 3.8-4.2
38
Whiff test and KOH
take vaginal swab and add to slide
add 10% potassium hydroxide
if smell fishy then positive and eval for yeast
39
3 most common causes of vaginitis
trich
BV
candida
40
protozoa flagella
Trichomoniasis
41
symptoms of trich
```
50% asymptomatic
pruritis
vulvovaginal erythema
strawberry cervix
frothy yellow-green d/c
```
42
Dx trich
pH > 4.0
+ whiff test
wet mount with pos motile trich
43
Tx trich
metronidazole 2g PO x1 dose
no alcohol with this or will feel ill
safe with pregnancy
44
Vulvovaginitis Candidiasis
```
Yeast infection
bacterial over growth
pH 4.0-4.5
thick, clumpy, white
KOH test
```
45
Classification of candidiasis
complicated
| uncomplicated
46
uncomplicated candidiasis
sporatic or infrequent
mild to mod symptoms
C. albicans
not immunocompromised
47
complicated candidiasis
recurrent with 4 or more/yr
women with uncontrolled diabetes, immunosuppression or pregnant
severe symptoms
48
Tx candidiasis
uncomplicated: 3 day tx with azole
recurrent: 7-14 days with topicals
or
fluconazole 150mg x 1 dose and repeat in 3 days
49
Pregnancy tx for candidiasis
topical azole therapies x 7 days
50
Bacterial Vaginosis
most common cause of d/c without vulvitis or vaginitis
over growth of Gardnerella
lactobacilus
51
BV presentation
discharge
odor
vaginal irritation
feeling wet
52
Diagnose BV
```
with 3 of the following:
thin white d/c that coats vaginal wall
clue cells on microscope
pH >4.5
pos whiff test
```
53
Tx BV
oral or vaginal metronidazole or clinda (5g of 2%cream if not pregnant
orals only with pregnancy
54
Cervicitis causes
```
Gc/chlamydia
HSV
HPV
Trich
trauma
radiation
malignancy
```
55
Symptoms of cervicitis
abnormal d/c
| vaginal bleeding following intercourse
56
Dx 2 signs of cervicitis
purulent or mucopurulent endocervical exudate
| endocervical bleeding induced by cotton swab
57
Tx cervicitis
Azithromycin1g PO x1
or
Doxy 100 BID x 7 days
58
Pelvic Inflammatory disease
ascending spread of microorganisms from vagina to endometrium, fallopian tubes and ovaries
59
Clinical manifestations of PID categorized
Subclinical- not dx, most common
Mild to Mod
Severe
60
Subclinical signs of PID
irregular bleeding
| dysuria
61
Mild to Mod signs of PID
```
lower abd or pelvic pain
cramping
d/c
fever
cervical motion tenderness
```
62
Severe signs of PID
fever
chills
nausea
vomiting
63
Risks of PID
ectopic pregnancy
infertility
tubal infertility (increases with each time)
64
Minimum criteria to dx PID
uterine tenderness
adnexal tenderness
cervical motion tenderness
65
Other signs to dx PID
temp >101
abundant WBC on swab
elevated sed rate
Pos Gc/clyamydia
66
Oral tx for PID
```
Ceftriazone 250mg IM x1
plus
Doxy 100mg PO BID x 14 days
with or without
metronidazole 500mg PO BID x 14 days
```
67
Follow up from PID treatment
consider retesting for Gc/clamydia 4-6 weeks after
| treat male sex partners
68
Condyloma Acuminata
HPV
69
Types of HPV
Type 6 & 11 = genital warts (HSV II sexual contact)
| Type 16 & 18 = cancers
70
Primary HSV presentation
```
incubation 4 days after exposure
burning before lesion present
neurologic pain that radiates to back and hips
multiple vesicles rupture
persist for 2-6 weeks
flu like symptoms
```
71
Management of HSV
```
culture of vesicle (neg does not rule out genital herpes)
VCR gold standard
serologic assay
oral antiviral
pain meds
```
72
Recurrent HSV presentation
less sever of asymtomatic
| tx with antivirals
73
Chancroid
haemophilus ducreyi
| pustule ruptures
74
Tx haemophilus ducreyi
Azithro 1gm PO x1
| Ceftriaxone 250 mg IM x1
75
Chancre
Syphilis
painless, rounded, indurated ulcer with serous exudate
resolves spont 3-6weeks
76
Ulcerative vaginal lesions diff dx
HSV
syphilis
H. ducreyi
77
Bartholin's duct cyst
more common in women in reproductive age
most are small, larger result in more pain
IND to drain
78
Genital tract bleeding
most attributed to uterine source
| can arise from urethral, bladder, bowel
79
Normal menstrual cycle
average of 28 days (21-35 days)
menstruation 4-7 days
blood loss 35ml
80
chronic menstrual blood loss
>80 ml per cycle which can lead to anemia
81
pain with ovulation
Mittelschmerz
82
abnormal uterine bleeding
any bleeding that does not conform to the freq, duration or amount of bleeding that a woman considers normal
irregular menstrual cycles
83
Types of abnormal uterine bleeding
```
menorrhagia
metrorrhagia
menometrorrhagia
polymenorrhea
hypermenorrhea
```
84
Menorrhagia
bleeding occurs at normal intervals but is prolonged
85
Metrorrhagia
irregular bleeding between menstrual cycles
86
Menometrorrhagia
irregular noncyclic bleeding that is prolonged or excessive
87
Polymenorrhea
bleeding intervals less than 21 days
88
Hypermenorrhea
amount of menses is abnormally hign or low
89
Dysfunctional uterine bleeding
abnormal bleeding without an organic etiology
anovulatory bleeding
ovulatory bleeding
example: >80ml bleeding in cycle
90
anovulatory bleeding
endometrium is cont. proliferating
endometrium is fragile and there is irregular sloughing
unpredicted bleeding
spotting
infrequent heavy bleeding
occurs in early menarche and premenopausal
91
ovulatory bleeding
```
regular cycle length
prolonged or excessive bleeding
less likely to respond to hormone therapy
loss of hemostasis in endometrium
NSAIDS good b/c they interrupt cycle
```
92
Testing for age 13-18 in abnormal uterine bleeding
screen for blood dyscrasias
| CBC to rule out coag issue
93
Testing for age 19-50 in abnormal uterine bleeding
TSH
FSH
CBC
fasting prolactin to r/o pituitary adenoma
94
indications for endometrial biopsy with abnormal uterine bleeding
19-39 years old if chronic anovulation or unresponsive to medication
40-49 years unless pregnant or reason to avoid
95
Tx abnormal uterine bleeding
```
NSAIDS b/c they decrease prostaglandins
oral contraceptives
danazole
gonadotropin releasing hormone agonists
ablation
hysterectoy
```
96
Primary amenorrhea
absence of menarche by age 16 in the presence of normal growth
97
Secondary amenorrhea
absence of menses for 3 consecutive cycles in women who were previously menstruating
could be stress or strict diet
98
lab for amenorrhea
```
prolactin
thyrotropin, FSH
dehydroepiandrosterone
testosterone
progesterone challenge test - give PO progesterone, stop pill and bleeding should occur within 10 days
```
99
dysmenorrhea
painful menstruation
primary (adolescents)
secondary (genital disorders)
100
dysmenorrhea with menstruation
with menstruation there is an increased prostaglandin synthesis and
increased markers of inflammation which causes decreased unterine blood flow and increased uterine contractility
101
Tx dysmenorrhea
NSAIDS
heat
Vit E
contraceptives
102
Location where you take Pap sample
SCJ zone or transormation zone
103
Optimal Pap testing
```
avoid anything in vaginal for 48 hours
avoid with heavy bleeding
take specimen before bimanual
remove excessive mucous or bleeding gently
ectocervical then endocervical
```
104
Squamous cell abnormalities
ASC- atypical squamous cells
LSIL- low grade squamous cell lesion (CIN1)
HSIL- high grade squamous cell lesion (CIN2-3)
Carcinoma
105
CIN 1
grade of neoplasia
corresponds to LSIL
mild dysplasia
confined to basal 1/3 of epithelium
106
CIN 2
grade of neoplasia
moderate dysplasia
basal 2/3 of epithelium
107
CIN 3
sever dysplasia
carcinoma-in-situ
may involve full thickness of epithelium
108
When pap is unsatisfactory
repeat in 2-4 months
| if cells obscured then tx infection or colposcopy
109
HPV self cure
75-90% of HPV will clear within 1 year due to immune response
Adolescents may take up to 24 months
110
HPV screening
not recommended less than 20 y.o.
not recommended 21-29 just routine cytology
routine screening >30 HPV and cytology q5 years or just cytology q3 years
not recommended after 65 or after hyst
111
HPV screen prior to gardasil
not needed
112
Standard mammography screening
annually for asymptomatic women age 40 and older who have no risk factors
113
Mammography recommendations for women at risk
start annual mammogram at 30, not before 25
114
Women who have 1st degree relative with BRACA mutation mammogram
yearly starting at 30 age
115
woman with a 20% or greater lifetime risk for breast cancer recommendations for mammogram
yearly starting at 30 age
116
When should mammography be stopped
there is no reason to stop
117
View of mammogram
craniocaudal and mediolateral oblique view of each breast
118
Gardasil vaccination guidelines
1st dose
1-2 months give 2nd dose
3rd dose is given 6 months after 1st dose
119
Age to start Gardasil
recommended 11 to 12 years
120
Catch up Gardasil
Females 13 through 26 years of age
| Males 13 through 21 years
