Case Files 49-54 (C) Flashcards Preview

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Flashcards in Case Files 49-54 (C) Deck (76)
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1

Which factors increase a woman's risk of breast cancer?

FHx in a first-degree relative (especially if the cancer occurred in a premenopausal woman and was bilateral)

 

BRCA-1/BRCA-2

 

Early menarche, late menopause, and nulliparity or first live birth after the age of 30

 

Obesity and alcohol use (> 3 drinks per day)

 

2

Approximately ___% of breast cancers occur in women older than age 50 years

70%

3

Acromegaly

A condition that results from the excessive production of growth hormone by a pituitary adenoma 

4

Physical Exam:

Benign vs Malignant

Benign: soft, smooth/regular, mobile, tender, < 30

 

Malignant: firm, irregular, fixed/tethered, painless, > 50

5

Triple Assessment 

  1. Clinical breast exam
  2. Imaging
  3. Pathology assessment (core biopsy or surgical excision)

6

True/False: Breast pain is not a common presentation of breast cancer, particularly when it is bilateral breast pain

True

7

Types of breast pain

  • Cyclic mastalgia: diffuse, bilateral, radiating, and related to the woman's menstrual cycle
  • Noncyclic mastalgia: continuous/intermittent, but not associated with the menstrual cycle
  • Extra-mammary pain: breast pain secondary to another etiology (ie, chest pain)

8

For women with unrelenting pain in spite of the above modifications, _______, an antigonodotropin, is FDS approved for the treatment of breast pain

danazol

 

side effects: hair loss, acne, weight gain, and irregular menses

 

other options include: tamoxifen, toremiphene, and bromocriptine

9

Discharge that is spontaneous, persistent, bloody, from a single duct, associated with a mass, and occurs in women over 40 years of age is more likely to represent a ________

pathologic process

 

most common causes are: intraductal papillomas, duct ectasia, cancers, and infections

10

The treatment of most unilateral, spontaneous, or bloody nipple discharges is:

surgical excision of the terminal duct

11

Define galactorrhea

Discharge of milk or a milk-like secretion from the breast in the absence of parturition or beyond 6 months postpartum in a non-breast-feeding woman

12

SSRIs

TCAs

Atenolol

Verapamil

Antipsychotics

Cimetidine

Opiates

Common medications associated with galactorrhea

13

Treatment for:

  1. Hyperprolactinemic disorders
  2. Hyperprolactinemic-induced anovulatory infertility
  3. Prolactinomas

  1. Dopamine
  2. Bromocriptine
  3. Surgical resection

14

Diagnosis of PCOS

Made by having 2 of the 3 factors:

hyperandrogenism

chronic anovulation

polycystic ovaries on ultrasound

15

What is the menstrual cycle irregularity associated with PCOS?

Anovulation

16

Treatment of insulin resistance and infertility in patients with PCOS

Metformin and thiazolidinediones

 

Weight loss, clomiphene citrate, aromatase inhibitors, and gonadotropins

17

Leiomyomata (fibroids)

Endometrial polyps

von Willebrand disease

Warfarin

Common causes of abnormal bleeding associated with regular menstrual cycles

18

Common causes of abnormal bleeding and irregular menstrual cycles

aka dysfunctional uterine bleeding (DUB)

 

generally implies an abnormality within the HPO axis

19

History of anovulatory menstrual cycles

Obesity

Nulliparity

> 35 years

Tamoxifen use

Risk factors for endometrial carcinoma

20

The evaluation of a woman with DUB is dependent on:

age and risk factors

 

in the period after menarche, watchful waiting is usually indicated 

in women < 35 who are not at increased risk of endometrial cancer, treatment may be offered without workup beyond the history and PE

21

Evaluation of DUB

Transvaginal pelvic ultrasound

Endometrial biospy

Hysteroscopy

D&C

22

Treatment of anovulatory bleeding after a workup has ruled out malignancy

*OCPs or progestin alone

Hysterectomy

Ablation

 

*Reduce the risk of developing endometrial hyperplasia and carcinoma

23

Which of the following increases risk of endometrial cancer:

smoking, having kids, being obese, or taking OCPs

being obese

24

Initial tests for the evaluation of menstrual irregularities

Pregnancy test

TSH

Prolactin level

25

Commonly isolated organisms found in cases of endometritis

Gonorrhea, Chlamydia, Ureaplasma urealyticum, Peptostreptococcus, Gardnerella vaginalis, and GBS

 

Diagnosis of endometritis can be confirmed with endometrial biopsy showing inflammatory cells (plasma cells)

26

The leading cause of blindness in working-age adults in the US

Diabetes

27

Goals for diabetic control

  1. Glycemic
  2. LDL
  3. BP
  4. Life style

  1. Hemoglobin A1C of 7% or less
  2. LDL 70-100
  3. BP < 130/80
  4. At least 150 min/wk of moderate-intesnity aerobic physical activity and resistance training 3x per wk

28

Diabetic ketoacidosis

Commonly seen in uncontrolled Type I DM

Type I diabetics are prone to metabolize fats, with the resultant production of ketones

 

A syndrome characterized by hyperglycemia, high levels of serum acetone, and an anion gap metabolic acidosis

29

True/False: Type II DM has a stronger familial predisposition than type I

True

30

Nonketotic hyperosmolar syndrome

Often seen with uncontrolled Type II DM

 

Occurs when blood sugar levels become highly elevated, often approaching 1000 mg/dL

Serum osmolarity is elevated (> 320 mOsm/kg) and the patient has a large fluid deficit (up to 9 L)