Fibroadenoma
mobile
firm rubbery
nontender
smooth
bouncy ball
cyst
discrete
tender
mobile
lipoma
discrete
soft
nontender
may or may not be mobile
fat necrosis
ill defined
firm
nontender
nonmobile
phyllodes tumors
discrete
round
mobile
firm
palpable mass
hamartomas
discrete
nontender
nonmobile
galactocele
discrete
firm
sometimes tender
malignancy
fixed immobile
irregular boarders
non cyclical
documentation of masses
Which breast
Location on clock face
Distance in mm/cm from base of nipple
Size/diameter in mm/cm
Mass characteristics (shape, consistency, tenderness, mobility, borders)
what phase do the breasts most likely hurt in?
luteal phase
intraductal papilloma
wart like growth in the duct.
bloody discharge
unilateral
uniductal
benign
women 40-50 yrs old
Mammary duct ectasia
women >50
results from dilation adn clogging of ducts
bilateral discharge
multiductal
sticky, green, brown, black
cancer nipple discharge
spontaneous
unilateral
single duct
clear or bloody in color
associated with a mass
occurs in older women
less worrisome discharge
occurs with manipulation or stimulation
bilateral
multiductal
milky
yellow, green, brown, or black
carcinoma in situ
earliest form of breast cancer considered stage 0
most common malignancy of the breast
infiltrating ductal carcinoma
pagets disease
Causes eczematous nipple changes as well as ulceration, itching, erythema, and nipple discharge
inflammatory carcinoma characteristics:
Presents with erythema, edema, warmth, skin thickening, and peau d'orange (skin dimpling that looks like an orange skin)
What is the reason for the guidelines against routine self-breast exams?
No evidence that it leads to decrease in breast cancer mortality
More likely to lead to expensive and invasive overdiagnosis and overtreatment than to saving lives
Difficult to learn to perform it well
You can discuss with your patients how they can be aw
how old are the women who present with vulvar cancer?
>60 years old
risk factors for ovarian cancer
The more times you ovulate the higher your risk (early menarche, late menopause)- so things like pregnancies and birth control that halt ovulation for a time are protective factors
what causes endometrial cancer?
excess estrogen:
early period, late menopause, nulliparity
what are the high risk HPVs?
16 and 18
taking combined oral contraceptives does what to you risk of cervical cancer?
doubles the risk of getting it
when can you stop pap smears?
at 65 if they have had normal results for the last 10 years
unsatisfactory cytology next step?
repeat cytology in 2-4 months
2 unsatisfactory cytologies in a row next step
colposcopy
partially sufficient sample in ages 21-29
routine screening
partially sufficient sample in ages >30
if HPV negative- routine screening
if HPV positive- cytology and HPV test in one year OR genotypeing
>30 yrs cytology negative but Positive HPV
repeat cotesting in 1 year
if HPV 16 or 18 do colposcopy
ASC-US
preferred: if HPV negative repeat cotesting in 3 years and if positive do a colposcopy
acceptable: repeat cytology at one year and if >or=ASC to a colposcopy
ages 21-24 ASC-US or LSIL
preferred: repeat cytology in 12 months - need 2 negatives to return to regular screening- if positive again do a colposcopy
acceptable: test for HPV. if positive repeat cytology in 12 months, if neg do routine screening
>30 LSIL
LSIL with negative HPV test- repeat cotesting in one year
LSIL with positive HPV- colposcopy
vaginismus
where you cannot get anything (tampon, finger, penis) in the vagina because it starts to spasm and close off and cause pain it is usually a response to trauma or deep shame of sex or relationship problems. Hx of sexual abuse
vulvodynia
burning sensation with sex. Inflamed sensation, penetration is possible but it is painful but eventually vaginismus can happen because you are constantly having burning that can even increase after sex because the anticipation is terrible. can be provoked
what medication can be used to treat sexual interest disorder? premenopausal
flibanserin (Addyi) 100 mg taken at night- causes hypotension, fainting and drowsiness
what medication can be used to treat sexual interest disorder? postmenopausal
estrogen therapy