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57 Cards in this Set
- Front
- Back
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evaluation of pelvic masses
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pregnancy test
transvaginal US CT scan MRI hysterosonography hysteroscopy endometrial bx |
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__ is circumscribed, benign tumors, composed of muscle with fibrous connective tissue elements referred to as fibroids, myomas, or fibromyomas
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Myomata Uteri
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What is the MC benign lesion of the uterus, the MCC of uterine enlargement, and accounts for 30% of all hysterectomies?
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Myomata Uteri
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Risk factors of Myomata Uteri
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African American
sedentary lifestyle obesity nulliparas Fhx |
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__ is localized proliferation of smooth muscle cells; originate in myometrium; dependent on estrogen for growth
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Myomas
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Types of Myomas
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intramural (MC variety)
submucous (Beneath endometrium) subserous (grow toward peritoneal cavity & cause bulge) intraligamentous (round and broad ligament) |
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Sx of Myomata Uteri
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*varies greatly & depends on size/number/location/asx
abnormal menstrual bleeding (mc) pain pressure (urine freq/retention, asx, constipation) GI sx reproductive d/o bladder sx |
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Signs of Myomas
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smooth, irregular, nodular tumors
uterine enlargement (mc) |
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DDx of Myomas
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pregnancy
abdominal mass ovarian cyst adenomyosis malignancy GI disease ectopic uterine/cervical polyps interstitial cystitis TOA |
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Dx of Myomas
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H+P
endometrial bx US sonohysterography hysterosalpingography MRI laparoscopy/hysteroscopy |
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tx of Myomas
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*individualized tx to patient; if tumor is too large and there's no sx, tx may not be necessary
expectant medical surgical |
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Management of Myomas depend on __
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myoma size, location, number of tumors present, rate of growth, patient age, associated sx, desire, for future fertility
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What consist of expectant/observation tx of myomas?
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bimanual exams q 3-6mo
palpation of uterosacral ligaments regular blood count pelvic US |
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What consist of medical management of Myomas?
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GnRH agonists (Leuprolide, Nafarelin, Goserelin)
Danazol/17-alpha -ethinyl-testosterone Progesterone derivatives Anti-estrogens NSAIDS Iron supplements Non-traditional tx OCs |
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What consists of surgical tx of Myomas?
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hysterectomy (mc)
myomectomy hysteroscopic myomectomy laparoscopic supracervical hysterectomy laparoscopic myomectomy laparoscopic myolysis uterine artery embolization ExAblate 2000 |
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What must be done prior to a hysterectomy for myomata uteri to rule out pathology, especially endometrial neoplasia?
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curettage of endometrial cavity
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What are the complications of myomectomy?
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intra-operative/postoperative hemorrhage
late intestinal obx d/t adhesions btwn bowel & site recurrence depends of race and age |
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__ is complete total removal of uterus
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hysterectomy
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__ is removal of single/multiple myomas while preserving uterus
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myomectomy
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__ is for submucosal fibroids<5cm that preserves the uterus
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hysteroscopic myomectomy
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__ is removal of uterus and fibroids with leaving cervix intact
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laparoscopic supracervical hysterectomy
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__ is conservative procedure limiting to subserosal myomata and preserving uterus
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laparoscopic myomectomy
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__ is direct destruction of fibroid by laser, cryotherapy/electrosurgical heat source
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laparoscopic myolysis
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__ is nonsurgical technique by catheterizing femoral artery and halting blood flow to fibroids
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uterine artery emolization
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__ is MRI guided US beams to destroy fibroids
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ExAblate 2000
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What is the MC benign lesion of lining of uterus and usually present in 40s with abnormal bleeding?
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Endometrial polyps
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dx and tx of Endometrial polyps
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dx: hysteroscopy/curettage with ring forceps
tx: D&C with progesterone x3mo *if undiagnosed/untreated it can lead to adenomatous hyperplasia & ultimately endometrial cancer |
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__ presents >30y/o and is childbirth related; endopelvic fascia damaged during childbirth creating hernia thru vagina; dx by valsalva maneuver
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Uterine Prolapse (Procidentia)
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types of uterine prolapse
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1st degree - protrudes to mid vagina
2nd degree - protrudes to introitus 3rd degree - extends outside vagina |
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What is the association of uterine prolapse with urinary incontinence?
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usually pulls on other organs - bladder and rectum, leading to enterocele, rectocele, cystoceles
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tx of uterine prolapse
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nonsurgical: pessaries, kegel exercises, bladder ttraining, biofeedback
surgical: hysterectomy, supportive slings, vaginal occlusion, plastic surgical repairs |
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What is the MC benign growth of cervix with sx of postcoital bleeding*, intermenstrual bleeding, leucorrhea, asx?
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cervical polps
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DDx of cervical polps
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endometrial polyps
prolapsed myoma cervical cancer retained products of conception endocervical hyperplasia squamous papilloma sarcoma |
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tx and complications of cervical polyps
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tx: remove with hemostats/electrocautery
contraindications: PID, bleeding d/o, cervicitis complications: bleeding, infection |
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__ is a cystic teratoma; mc ovarian tumor in pregnancy usually asx that can be dx with US/plain film/ pelvic exam
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Ovarian dermoid cyst
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What is mammography and when should screening begin?
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low dose radiograph of the breast
begin screening at 40y/o |
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What is the mc imaging study used after mammography?
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US
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What is more sensitive than mammography/clinical exam but less specific?
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MRI
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What is the mc anomaly found on clinical/self exam?
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breast lumps/masses - most benign; cancer (unilateral, hard, non-tender, fixed)
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What skin changes require imaging?
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erythematous, scaly nipple rash, Peau d' orange
nipple discharge |
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Breast Imaging Report and Data System (BI-RADS)
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1: no visible abnormality, reg mammo
2: describes presence of benign lesion; no further action; normal mammo 3: describes findings most likely benign, but follow up recommended 4: describes indeterminate abnormality; refer to surgeon for bx 5: most serious designation; abnormality probably CA |
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essentials of dx of fibrocystic breast dz
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painful/multiple/usually unilateral breast masses
rapid fluctuation in size of masses freq pain occur/inc & size inc during premenstrual cycle mc in 30-50y/o |
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__ is mc benign condition of breast; pain, fluctuation in size, and multiplicity of lesions are features most helpful in differentiation from carcinoma; always bx any dominant mass
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fibrocystic breast disease (mammary dysplasia, fibrocystic disease, chronic cystic mastitis)
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Fibrocystic breast dz is associated with what benign changes in breast epithelium?
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cysts
papillomatosis adenosis fibrosis ductal epithelial hyperplasia |
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Management of fibrocystic breast dz?
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FNA (no fluid obtained-blood fluid/mass persist after aspiration-bx should be performed)
open bx dietary/behavior modification (avoid caffeine, good support bra) med (diuretics, bromocriptine) |
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__ is mc benign neoplasm of breast; "mouse tumors"; occur in 12-25y/o women; blacks; rubbery,round, firm, discrete relatively movable, non-tender mass
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fibroadenoma of breast
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describe lipomas and fat necrosis
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ill-defined tumors of breast
lipoma - diffuse, usually non-tender fat necrosis - uncommon, usually from trauma, solitary/tender/ill-defined mass/skin retraction |
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__ is ductal obx and inflammation during/soon after lactation with cystic dilations of ducts
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Galactocele
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What is the USPSTF recommendation for mammography screening?
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with/without clinical breast exam - every 1-2yrs for women >40y/o
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__ is 2nd leading cause of cancer death in women after lung cancer, mc sign is finding a lump, and mammo is best way to detect
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breast cancer
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non-modifiable risk factors for breast cancer
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female
inc age Ashkenszaki, Caucasian, eastern European Jew personal hx fhx menarche<12y/o menopause>55y/o BRCA1 gene abnormal breast bx benign proliferative breast dz previous chest wall irradiation |
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modifiable risk factors for breast cancer
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nulliparity
1st live birth>30y/o no breast feeding OCs prolonged postmenopausal HRT obesity etoh tobacco sedentary lifestyle |
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What are the essentials of dx for breast cancer?
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early: single, non-tender, firm-hard mass with ill-defined margins; mammo
later: skin/nipple retraction, axillary lymphadenopathy, breast enlargement, redness, edema, pain, fixation late: ulceration, supraclavicular lymphadenopathy, arm/bone/lung/liver/brain/distant mets edema *by US, mammo, FNA, bx |
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Types of breast cancer
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ductal carcinoma in situ
infiltrating ductal carcinoma (mc breast cancer) infiltrating lobular carcinoma inflammatory breast cancer (most aggressive) |
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tx of breast cancer
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TMN staging
surgery, radiation therapy, chemotherapy, hormonal therapy, combo |
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__ is a type of ductal cancer in excretory ducts out to skin thru nipple that is NOT common type of breast cancer
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Paget's disease
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What is the 1st sx and dx of Paget's disease?
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sx: itching/burning of nipple with superficial erosion/ulceration (red, scaly lesion of nipple/areola)
dx: bx of erosion (tx with surgery and chemo or RT) |
