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Exam 5
Fibroadenoma
Most Common Benign Breast Tumor
Stromal Tumor
Presentation
Women under 40
Small, firm mass
Sharp Edges
Increased tenderness and size with Estrogen
Management
Biopsy
1 min
Intraductal Papilloma
Presentation
Bloody nipple discharge
Women 20-40 years old
Mechanism
Small tumor in lactiferous ducts
Occurs Centrally
Occurs Peripherally
Increased malignancy
Diagnosis
Too Small to Palpate
Galactogram biopsy
1 min
Phyllodes Tumor
Presentation
Common in 40's
Large Palpable Mass
Mechanism
Benign
Rarely Malignant
Low-Grade Tumor
Leaf-Like
Stromal Tumor
Treatment
Wide Resection
2 mins
Paget Disease Of The Breast
Clinical Manifestations
Spreading Ulceration At Nipple/Areola
Eczematous Or Vesicular Rash
Pruritus
Breast Mass
Bloody Or Yellow Discharge
Pathophysiology
Associated With Underlying Ductal Adenocarcinoma
Caused By Ductal Adenocarcinoma Cells Migrating To Surface
Workup
Biopsy
Bilateral Mammogram
4 mins
Fibrocystic Changes of Breast
Characteristics
Benign
Premenopausal Women
Presentation
Bilateral, Multifocal Breast Pain
Diagnosis
Ultrasound
Mammogram
Biopsy
Nonproliferative
Sclerosing Adenosis
Ductal Hyperplasia
Management
Observation
Pharmacologic Interventions
Surgery
3 mins
Lobular Carcinoma in Situ of Breast
Characteristics
Noninvasive Malignancy
Absent Microcalcifications
Decreased E-Cadherin
Often Asymptomatic
Considerations
Surveillance
Chemotherapy
Prophylactic Surgery
2 mins
Invasive Ductal Carcinoma of Breast
Characteristics
Most Common Breast Cancer
Presentation
Firm, Palpable Mass
Nipple Retraction
Histologic Findings
Spiculated Margins
Microcalcifications
Stromal Glandular Cells
Management
Surgery
Chemotherapy
Radiation
2 mins
Inflammatory Carcinoma of Breast
Characteristics
Invasive Malignancy
Invades Dermal Lymphatic Vessels
Mimics Mastitis and Paget Disease of Breast
Clinical Features
Peau d'Orange
Breast Tenderness
Bloody Nipple Discharge
Considerations
Poor Prognosis
2 mins
Invasive Lobular Carcinoma of Breast
Characteristics
Multifocal and Bilateral
Decreased E-Cadherin
"Single File" Cells
Presentation
Often Asymptomatic
Management
Surgery
Chemotherapy and Radiation
2 mins
Ductal Carcinoma in Situ of Breast
Characteristics
Noninvasive Malignancy
Terminal Duct Lobular Unit (TDLU)
Microcalcifications
Comedo Necrosis
Comedocarcinoma
High Grade
Dystrophic Calcification
Management
Surgical Resection
Considerations
Progresses to Invasive Breast Cancer
2 mins
Naloxone (Narcan)
Mechanism
Competitive Opioid Receptor Antagonist
Indications
Opioid Induced CNS Depression
Side Effects
Severe Nausea and Vomiting
Excitable State
Opioid Withdrawal Symptoms
Considerations
Repeated Dosing Often Required
1 min
NSAIDs
Indications
Anti-inflammatory
Analgesic
Fever
Closure of Patent Ductus Arteriosus
Mechanism of Action
Reversible Inhibition of COX-1 and COX-2
Block Prostaglandin Synthesis
Side Effects
Interstitial Nephritis
Gastric Ulcer
Renal Ischemia
1 min
Aspirin
Indications
Fever
Pain and Headache
Cardiovascular Disease (CAD)
Mechanism of Action
Irreversible inhibition of COX-1 and COX-2
Suppress Thromboxanes and Prostaglandins
NSAID
Side Effects
Reye's Syndrome
Tinnitus
Peptic Ulceration
Mixed Acidosis/Alkalosis
Nephropathy
2 mins
Acetaminophen
Indications
Fever
Pain
Mechanism of Action
Reversibly Inhibits COX
Acts Primarily in CNS
Side Effect
Hepatic Necrosis
N-acetylcysteine Antidote
51 secs
Morphine
Mechanism
Opioid Receptor Agonist
Indications
Pain
Myocardial Infarction
Side Effects
Nausea and Vomiting
CNS Depression
Biliary Colic
Constipation
Increased Intracranial Pressure (ICP)
Pupillary Constriction
Hypotension
2 mins
Endometriosis Symptoms and Treatment
Symptoms
Dysmenorrhea
Cyclic Pelvic Pain
Dyschezia
Dysuria
Dyspareunia
30-40% are Infertile
Treatment
Surgery
NSAIDs
OCPs
Progesterone (Progestins)
GnRH Agonists
1 min
Endometriosis Characteristics
Endometrial Tissue Outside of Uterus
Glands and Stroma
Most Common in Ovary, Pelvis, Peritoneum and Bowels
"Chocolate Cyst" in Ovary
Adenomyosis
Theories
Retrograde Flow
Metaplastic Transformation
Mullerianosis
2 mins
Dysfunctional Uterine Bleeding
Assessment
Bimodal Age Distribution
Painless Vaginal Bleeding
Amenorrhea
Menorrhagia (Heavy Menstrual Bleeding)
Metrorrhagia (Bleeding Between Menses)
Interventions
Balloon Thermotherapy
Hormone Medications
Dilation and Curettage (DandC)
Considerations
Monitor for Anemia
3 mins
Cervical Cancer Assessment
Cause/Mechanism
Human Papillomavirus (HPV)
Assessment
Metrorrhagia
Leukorrhea
Pain
Abnormal Pap Test
May Be Asymptomatic
Considerations
HPV Vaccine
2 mins
Uterine Leiomyoma (Fibroids) Characteristics and Presentation
Most Common Gynecologic Tumor
Benign Smooth Muscle Tumor
Risk Factors
Early Menarche
Hormone Sensitive
African Americans
Presentation
Abnormal Menses
Infertility
Urinary Symptoms
Irregularly Enlarged Uterus
3 mins
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