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19 Cards in this Set
- Front
- Back
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56 y/o female, vaginal bleeding. occasional spotting of blood which can range from pink to brown in color. No pain. History: HTN, past history of rheumatic fever. Menarche at age 12, G3P2, regular paps, no abnormal mammogram or pap. Breast cancer in maternal aunt, but that is it. Meds: ACEi, some other pill that she got a year ago,
what diagnostic measures would you recommend ? |
Ultrasound
thickness of endometrium (very thin) cystic masses fibroids |
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Which medications or class of meds would be most significant with regard to history of new uterine bleeding?
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Estrogen
Progesterone Aspirin Warfarin/Heparin Tamoxifen (stimulates endometrium, blocks breast, helps bone growth) |
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what are important parts to a post menopausal female physical exam
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Bimanual exam-masses, freedom of movement of the cervix
look for fibroids, palpate uterus below the pubic bone |
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for a post menopausal person with spotting bleeding, what is a medical tx you can use?
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cyclic progesterone
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7. Variability in the length of the menstrual cycle corresponds to variation in the length of time of the follicular or luteal phase? what hormone dominates in this phase? what does this due to the endometrium
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Follicular phase
dominated by estrogen--stimulates proliferation of the endometrium |
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a post menopausal lady comes in with painless bleeding... her Her PAP smear returns as ASCUS, Atypical Squamous Cells of Undetermined Significance. How does this relate to her potential uterine pathology?
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IT DOESNT
can have abnormal pap and uterine cancer |
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56 y/o female, vaginal bleeding. occasional spotting of blood which can range from pink to brown in color. No pain. History: HTN, past history of rheumatic fever. Menarche at age 12, G3P2, regular paps, no abnormal mammogram or pap. Breast cancer in maternal aunt, but that is it. Meds: ACEi, some other pill that she got a year ago,
12. Is this patient at low, average or high risk for breast cancer? |
Average
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components of the Gail Model for breast cancer
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Age
Age of 1st child age of menarche age at menopause breast biopsy |
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She agrees to have a screening mammogram and it returns with a report of Bi-Rads Category IV; clinical correlation and possible further work-up is recommended. Her physical exam does not reveal a palpable mass, and is entirely normal.
14. What measures, if any, do you recommend? US/surgical consult for biopsy/stereotactic biopsy/repeat mammogram in 3 mo/observation and repeat PE in 3 months? |
Stereotactic biopsy
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15. What would you expect a pt in post menopause circulating levels of FSH, LH, estrogen, progesterone to be? Why?
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FSH, LH: high, due to removal of negative feedback
estrogen low: done w/ ovulation |
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2. List five (5) common diagnoses that can cause this dymennorhea.
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Endrometriosis
PCOS Cervicitis Fibroids/Adenomyosis STD |
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0010
how many deliveries has she had? |
Zero
she has had an abortion TPAL |
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22 year old chick complaining of menstrual pain. has a grandma with breast cancer. Should she have a mammogram?
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No
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a 22 year old with no past remarkable paps should get a pap how often?
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yearly or when getting a new partner
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12. You perform a PAP smear at this visit and it returns as “LSIL"
13. What does this mean? 14. What additional tests should be performed on the PAP smear? |
low grade squamous intraepithelial lesion
Colposcopy (a special magnifying device to look at the vulva, vagina, and cervix) |
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A 36 year old female comes to the office for pelvic pain of 1 - 2 years duration. She is unable to relate the onset of the pain to any particular event, and is only able to tell you it is getting worse. She is very anxious and teary during the medical interview and informs you that you are her last hope. She states she has been to at least four other doctors and has had several tests, but still has a nearly constant feeling of fullness and discomfort in her lower pelvic area. It is worse just prior to her menses, but is not relieved after menses is complete.
2. Discuss the appropriate visceral somatic reflexes to evaluate and indicate spinal levels. |
T12-L3
S2-4 Visceral afferent T11-12 Genitofemoral nerve L1-2 |
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A 36 year old female comes to the office for pelvic pain of 1 - 2 years duration. She is unable to relate the onset of the pain to any particular event, and is only able to tell you it is getting worse. She is very anxious and teary during the medical interview and informs you that you are her last hope. She states she has been to at least four other doctors and has had several tests, but still has a nearly constant feeling of fullness and discomfort in her lower pelvic area. It is worse just prior to her menses, but is not relieved after menses is complete.
What is an important thing to asses? |
safety of relationships...look for abuse
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29 yo Female. Irregular menses. last menstrual period 5 months ago, interval btw periods increasing, heavy flow. G0P0. Sexually active, occasionally uses condoms, no history of STD. Dark chin hair on face, weight gain, acne, concerns that she has never gotten preggo
differential |
PCOS
Cushing Hypothyroid CAH Pregnancy |
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29 yo Female. Irregular menses. last menstrual period 5 months ago, interval btw periods increasing, heavy flow. G0P0. Sexually active, occasionally uses condoms, no history of STD. Dark chin hair on face, weight gain, acne, concerns that she has never gotten preggo
diagnostic tests |
TSH
ACTH Free testosterone b-hCG 24 hour cortisol LH/FSH |
