NAMS MENOPAUSE OBGYN PAEA COMPLETE SOLUTION RATED A+

NAMS MENOPAUSE OBGYN PAEA COMPLETE SOLUTION RATED A+ 1. What gene is associated with Ovarian Neoplasms? - P53 gene - CA 125 tumor marker 2. What is the first presenting symptom of cervical carcinoma? - Post coital bleeding/spotting 3. What is the proper clinical intervention for cervical carcinoma? - Diagnosis: colposcopy w/ bx. - Screening: Pap smear w/ cytology - CIN I-- repeat cytology q6mo x 2 or repeat HPV testing in 1 year - CIN II/III-- treat with surgical excision (LEEP cold knife cone) - If preinvasive / microinvasive (stage I-Ia) → simple hysterectomy, consider cold knife cone if fertility highly desired - If early (stage Ia-2 to IIa) → radiation or radical hysterectomy + bilat LN dxn •Includes parametria, upper vaginal cuff, uterosacral / cardinal ligaments, vascular supply •Decision based on age, ability to tolerate surgery, ? nearby rad facilities •If young, may lean towards surgery (keep ovaries!) - If advanced (IIb-IV), treat with chemoradiation (cisplatin-based + internal & external rad) - If recurrent, can treat with pelvic exenteration & get 50% survival - Palliation tx: cisplatin chemo and/or palliative radiation 4. Pt presents with a mosaic vasculature pattern, what is it? - CIN 5. When do paps start? - Age 21 Q2 yrs - 30 w/ 3 consecutive negative paps-- Q3 years ^^Unsure about that or where I found it... USPSTF -21-29: Every 3 years (no HPV) -30-65 every 5 years if want cytology + HPV OR cytology alone every 3 years 6. Know the different PAP smear staging and treatment for each -Positive ASCUS + negative HPV-- repeat pap in 1 year -Positive ASCUS + positive HPV-- Colposcopy -Negative ASCUS Pap + Positive HPV-- repeat pap in 1 year -Negative ASCUS + Negative HPV-- repeat in 5 years IF woman is 30yo -ASC-H or LSIL/HSIL or AGUS (atypical glandular cells)-- if 25 colposcopy (do not bother with HPV testing)...if 25 repeat pap 1 yr •ASCUS (Atypical Squamous Cells of Undetermined Significance): is the most common abnormal finding in a pap smear-- may be a sign of infection with a certain strain of HPV but future testing may be needed •ASCUS needs a follow up reflex HPV testing •If + HPV, needs a colpo •If - HPV repeat pap in 1 year 7. When do you start screening for Breast Cancer? - 50yo - 10 years before 1st degree relative was diagnosed 8. What is the most invasive type of Breast Cancer? - Infiltrating ductal Also most commong 9. How do you treat Breast Cancer? -LSIL: Observe, may use SERM -DCIS: surgical excision with wide margins -Anything that is invasive (infiltrating ductal, inflammatory, Invasive lobar): radical mastectomy OR lumpectomy + radiation (chemo if 1cm) -Chemotherapy: Indicated when tumors are larger than 1cm -Tamoxifen: Adjuvant therapy of choice in post-menopausal estrogen receptor positive, and axillary nodes are negative breast cancer -Lumpectomy -Simple Mastectomy (skin sparing): nipple, areola, and skin overlying tumor are removed; only if reconstruction will be done immediately; c/I in inflammatory cancer or tumor close to skin -Simply Mastectomy (nipple sparing): removal of all breast tissue w/o removal of any of the skin or nipple or areola; good for non-aggressive tumors or peripherally located small tumors -Modified Radical Mastectomy: entire breast removed; axillary LN dissection; no muscles removed -Sentinel Lymph Node Bx: indicated for pts w/ early stage tumors and w/o clinical evidence of LN involvement -Axillary LN dissection: 10-15% end up w/ chronic lymphadenopathy; need surgical drains post-op 11. How do you diagnose inflammatory breast cancer? - PE, mammogram/US (see skin thickening), biopsy - Presentation: older women, skin thickening & dimpling (peau d'orange), axillary lymphadenopathy, VERY AGGRESSIVE 12. How do you treat endometriosis? - NSAIDS, OCPs/progestins, Danzol, Lupron - TAH/BSO is definitive 13. Pt presents with white ulcerative lesion on the vagina, what is it? - Vulvar carcinoma 14. What CAs do OCPs protect against? - DECREASED risk for Endometrial Cancer & Ovarian Cancer