504 Final - New Content & Key
Concepts
Congenital Breast Anomalies - answer- Inversion
- Athelia (no nipple)
- Polythelia (multiple)
- Amastaia (no breast tissue)
- Polymastia (accessory tissue)
Mammography Education - answerNSG: discomfort, pain; take NSAIDs, no
perfume/deo
Results: benign cyst, calcification, cancerous
Macromastia - answerS/S: large breast, chronic pain, paraesthesia
Tx: breast reduction
Micromastia - answerS/S: small breast, body image
Tx: implant (silicone, saline); sub-glandular or muscular
Fibrocystic Breast - answerS/S: smooth cysts, tender
Tx: low caffeine, low fat, no smoke/alcohol, heat
Fibroadenoma - answerS/S: fibrous, mobile, firm, rubbery; increase w/ preg.
Tx: observe, biopsy, excision
Ductal Ectasia - answerS/S: dilation of duct; inflammation, enlarged nodes; pain
Tx: biopsy
Intraductal Papilloma - answerS/S: solid mass in duct; serosang discharge
Tx: biopsy
Breast Cellulitis - answerS/S: infection, inflammation; red, irritated
Tx: antibiotics
Triple Negative Breast Cancer - answerDef: estrogen (-), progestin (-), HER2 (-)
Tx: difficult, not responsive to normal meds
Breast Cancer Staging - answerTNM
T - tumor size (1-4: size, growth into other tissues)
N - lymph node status (1-3: number of nodes)
M - metastatic disease (0=no spread, 1=spread)
,Stage 1: <1 inch
Stage 2: <2 inches
Stage 3: >2 inches + axillary lymph nodes
Stage 4: metastasis beyond breast
Tamoxifen - answerMOA: oral, anti-estrogen (adjuvant breast cancer tx)
SE: vasomotor symptoms (hot flash, palpitations)
Toxicity: visual changes
Uterine/Endometrial Cancer - answerRisks: hormone imbalance, obesity/DM/HTN, early
menses/late meno, AMA childbirth
S/S: postmenopausal bleeding, dyspareunia, B/B changes
Dx: pelvic exam, transvaginal US, biopsy
Tx: hysterectomy (+/- tubes, ovaries)
Meds: Tamoxifen (block est.), Progestin (slow growth endo), GNRH agonist (block est.)
Ovarian Cancer - answerRisks: early menses/late meno, AMA childbirth
S/S: vague; spotting, fullness, B/B changes, back pain
Dx: late stage; blood test CA-125
Tx: oophorectomy
Meds: Tamoxifen (block est.), LHRH agonist (block est.), Bevacizumab (prevent tumor
growth)
Cervical Cancer - answerRisks: HPV 16/18; multiple partners, STI hx
S/S: Early (discharge, bleeding); Late (weight loss, fatigue, swelling, incontinence)
Dx: Pap smear, Colposcopy (visual insp.)
Tx: Cryosurgery (cramping, DC), laser ablation (discomfort, faster recovery), LEEP
(sedation)
Vulvar Cancer - answerRisks: HPV, skin conditions (Lichen, Paget's)
S/S: itching, skin color changes, burning
Dx: exam, biopsy
Tx: vulvectomy
Vaginal Cancer - answerRisks: older age >70
S/S: asymptomatic; painful ruination, painful sex, bleeding
Tx: surgical removal vagina
Perimenopause - answerDef: onset of menopause symptoms --> 1 year FMP
Changes:
- no ovulation
- heavy, prolonged or irregular bleeding
- endometrial hyperplasia (risk cancer)
Tx: low dose birth control, cyclic progesterone
, Menopause Hormone Changes - answer- Low estrogen (hot flash, night sweat,
palpitations)
- Low progesterone (irregular menses)
- High GnRH
- High FSH/LH (d/t low estrogen)
- High androgen/testosterone (hair growth)
Effects of Low Estrogen - answerShort Term: (vasomotor)
- hot flash, night sweat, palpitation
- anxiety, fatigue, irritable, depression
Long Term: (urogenital)
- vaginal dryness
- bone loss
- early dementia, macular degeneration
- insulin resistance, ASVD risk --> CHF, HTN, stroke
Vasomotor Symptoms - answerHot Flashes: NSG = layers, deep breathing, cool drink
Night Sweat: NSG = cotton PJs, cool drink bedside
Food triggers: be aware
Tx: bioidentical hormones (plant-based estrogen), SSRIs, gabapentin, clonidine
Sleep Disturbances - answerS/S: fatigue, mood swings, poor concentration
NSG: regular bedtime, avoid naps, sleep aids
Urogenital Symptoms - answerGenital: dryness, itching, burning, bleeding
Urinary: dysuria, frequency, stress incontinence
NSG: Kegels, lubricants
Meds: low-dose estrogen if intolerable
Psychological Symptoms - answerS/S: mood swing, depression, anxiety
NSG: rule out pathology
Tx: SSRIs, CBT, exercise
Hormone Replacement Thearpy - answerIndications: short-term use, small dose
Risks (long-term use): DVT, breast cancer, CVD, stroke
Medications: pill, patch, gel (taper down if stop)
- Uterus: estrogen + progesterone
- Hysterectomy: estrogen only OK
SE: endometriosis, bleeding, HTN, HA, fluid retention, NV
CONTRA: hx breast cancer, undx bleeding, DVT/PE, liver or heart disease
Cardiovascular Disease Risk - answerPatho: low estrogen = more inflammation, less
fibrinolysis
NSG: manage BP, stop smoking, daily aspirin, exercise
Concepts
Congenital Breast Anomalies - answer- Inversion
- Athelia (no nipple)
- Polythelia (multiple)
- Amastaia (no breast tissue)
- Polymastia (accessory tissue)
Mammography Education - answerNSG: discomfort, pain; take NSAIDs, no
perfume/deo
Results: benign cyst, calcification, cancerous
Macromastia - answerS/S: large breast, chronic pain, paraesthesia
Tx: breast reduction
Micromastia - answerS/S: small breast, body image
Tx: implant (silicone, saline); sub-glandular or muscular
Fibrocystic Breast - answerS/S: smooth cysts, tender
Tx: low caffeine, low fat, no smoke/alcohol, heat
Fibroadenoma - answerS/S: fibrous, mobile, firm, rubbery; increase w/ preg.
Tx: observe, biopsy, excision
Ductal Ectasia - answerS/S: dilation of duct; inflammation, enlarged nodes; pain
Tx: biopsy
Intraductal Papilloma - answerS/S: solid mass in duct; serosang discharge
Tx: biopsy
Breast Cellulitis - answerS/S: infection, inflammation; red, irritated
Tx: antibiotics
Triple Negative Breast Cancer - answerDef: estrogen (-), progestin (-), HER2 (-)
Tx: difficult, not responsive to normal meds
Breast Cancer Staging - answerTNM
T - tumor size (1-4: size, growth into other tissues)
N - lymph node status (1-3: number of nodes)
M - metastatic disease (0=no spread, 1=spread)
,Stage 1: <1 inch
Stage 2: <2 inches
Stage 3: >2 inches + axillary lymph nodes
Stage 4: metastasis beyond breast
Tamoxifen - answerMOA: oral, anti-estrogen (adjuvant breast cancer tx)
SE: vasomotor symptoms (hot flash, palpitations)
Toxicity: visual changes
Uterine/Endometrial Cancer - answerRisks: hormone imbalance, obesity/DM/HTN, early
menses/late meno, AMA childbirth
S/S: postmenopausal bleeding, dyspareunia, B/B changes
Dx: pelvic exam, transvaginal US, biopsy
Tx: hysterectomy (+/- tubes, ovaries)
Meds: Tamoxifen (block est.), Progestin (slow growth endo), GNRH agonist (block est.)
Ovarian Cancer - answerRisks: early menses/late meno, AMA childbirth
S/S: vague; spotting, fullness, B/B changes, back pain
Dx: late stage; blood test CA-125
Tx: oophorectomy
Meds: Tamoxifen (block est.), LHRH agonist (block est.), Bevacizumab (prevent tumor
growth)
Cervical Cancer - answerRisks: HPV 16/18; multiple partners, STI hx
S/S: Early (discharge, bleeding); Late (weight loss, fatigue, swelling, incontinence)
Dx: Pap smear, Colposcopy (visual insp.)
Tx: Cryosurgery (cramping, DC), laser ablation (discomfort, faster recovery), LEEP
(sedation)
Vulvar Cancer - answerRisks: HPV, skin conditions (Lichen, Paget's)
S/S: itching, skin color changes, burning
Dx: exam, biopsy
Tx: vulvectomy
Vaginal Cancer - answerRisks: older age >70
S/S: asymptomatic; painful ruination, painful sex, bleeding
Tx: surgical removal vagina
Perimenopause - answerDef: onset of menopause symptoms --> 1 year FMP
Changes:
- no ovulation
- heavy, prolonged or irregular bleeding
- endometrial hyperplasia (risk cancer)
Tx: low dose birth control, cyclic progesterone
, Menopause Hormone Changes - answer- Low estrogen (hot flash, night sweat,
palpitations)
- Low progesterone (irregular menses)
- High GnRH
- High FSH/LH (d/t low estrogen)
- High androgen/testosterone (hair growth)
Effects of Low Estrogen - answerShort Term: (vasomotor)
- hot flash, night sweat, palpitation
- anxiety, fatigue, irritable, depression
Long Term: (urogenital)
- vaginal dryness
- bone loss
- early dementia, macular degeneration
- insulin resistance, ASVD risk --> CHF, HTN, stroke
Vasomotor Symptoms - answerHot Flashes: NSG = layers, deep breathing, cool drink
Night Sweat: NSG = cotton PJs, cool drink bedside
Food triggers: be aware
Tx: bioidentical hormones (plant-based estrogen), SSRIs, gabapentin, clonidine
Sleep Disturbances - answerS/S: fatigue, mood swings, poor concentration
NSG: regular bedtime, avoid naps, sleep aids
Urogenital Symptoms - answerGenital: dryness, itching, burning, bleeding
Urinary: dysuria, frequency, stress incontinence
NSG: Kegels, lubricants
Meds: low-dose estrogen if intolerable
Psychological Symptoms - answerS/S: mood swing, depression, anxiety
NSG: rule out pathology
Tx: SSRIs, CBT, exercise
Hormone Replacement Thearpy - answerIndications: short-term use, small dose
Risks (long-term use): DVT, breast cancer, CVD, stroke
Medications: pill, patch, gel (taper down if stop)
- Uterus: estrogen + progesterone
- Hysterectomy: estrogen only OK
SE: endometriosis, bleeding, HTN, HA, fluid retention, NV
CONTRA: hx breast cancer, undx bleeding, DVT/PE, liver or heart disease
Cardiovascular Disease Risk - answerPatho: low estrogen = more inflammation, less
fibrinolysis
NSG: manage BP, stop smoking, daily aspirin, exercise
