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47 Cards in this Set
- Front
- Back
Breast Sef-examinations |
2. Patients who choose to perform self-examination should be trained in technique
3. Self breast exam allows motivated women to be in control of their health care |
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Visual inspection of Breast |
2. erythema
3. retractions/dimpling (lift hands overhead to accentuate any retraction or dimpling)
4. nipple changes |
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Palpation of breast |
1) place hands over head -> flattening the breast tissue on the chest wall
2) Examine each breast using a vertical strip pattern using finger pads
3) palpate both axillary and supraclavicular lymph nodes.
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squamo-columnar junction |
area of the endocervix where there is rapid cell division and where dysplastic cells originate |
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Pap -test |
Use cytobrush to get sample from
1) ectocervix (body of donut)
2) squamo-columnar junction of endocervix (the hole of donut) |
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Bimanual Exam |
1) Lubricate index finger
2) Palpate cervix ensuring it's nontender& mobile
3) Place non-gloved hand on abdomen, superior to symphysis pubis, feel for uterus between your two hands (provides sense of size and position) 4) feel for ovaries |
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Cervical Cancer Screening Guidelines |
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Risk groups needing more frequent
Cervical Cancer Screening |
♀'s with 1) compromised immunity (e.g. HIV+)
2) history of cervical intraepithelial neoplasia grade 2, 3 or cancer
3) exposure to diethylstilbestrol (DES) in utero (DES = nonsteroidal estrogen once given to pregnant ♀ to prevent miscarriages but linked to clear cell adenocarcinoma of the vagina |
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Who can stop cervical cancer screening |
> 65 y.o. ♀'s with adequate screening within the last ten years
Adequate screening = 3 consecutive normal pap tests with cytology alone or two normal pap tests if combined with HPV testing
Women who underwent total hysterectomy for benign reasons |
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Risk factors for developing cervical cancer |
Virtually all cervical cancers are caused by infection with certain high-risk types of HPV
1) Early onset of sexual intercourse
2) Multiple sexual partners
3) Cigarette smoking & DES exposure in utero
4) Immunosuppression |
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Characteristics of a Good Screening Test |
1) High sensitivity and specificity
2) Able to detect disease in an asymptomatic phase (this is why people die from lung cancer b/c no good screening test in asymptomatics)
3) Minimal risk (don't hurt patient with test)
4) Affordable (Reasonable cost)
5) Acceptable to patients (not super unpleasant) |
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sensitivity |
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Specificity |
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Why is pap smear good screening test |
1) relatively inexpensive
2) easy to perform
3) acceptable to patients 4) Cervical cancer has long asymptomatic pre-invasive state (> 10 years)
5) effective treatments for pre-invasive disease
* Sensitivity only between 30-80% and a specificity of 86-100% but cervical cancer ↓ markedly b/c all other factors good
This means = that if you have + result, you almost certainly have Cervical cancer b/c specificty very good (captures all the true negatives). The problem is that if your result is Negative, you might still have Cervical Cancer b/c low Sensitivity (Only catches 30-80% of true positives) |
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When to screen for ovarian cancer? |
Only in symptomatic Women |
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When to screen for Endometrial cancer? |
Only post-menopausal women with unexpected symptoms bleeding or spotting
OR women with high risk for hereditary non-polyposis colon cancer (HNPCC)-> screening should be offered with endometrial biopsy beginning at age 35 |
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When to screen for lung cancer? |
Only patients 55-65 years old with 30-pack-history of smoking by low-dose CT scan |
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US Preventive Services Task Force Recommendations for Breast Cancer Screening Mammography |
Biennial screening mammography for women aged 50-74 years
Amer. Cancer Society: Yearly mammograms starting at age 40 and continuing |
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Evaluating a Breast Lump: History |
take a good history from the patient, including: 1) Precise location of lump
2) How first noticed (accidentally/breast self-exam/clinical breast exam/mammogram)
3)How long it has been present?
4) Presence of nipple discharge
5) Any change in size of the lump (is lump changing in size according to menstrual cycle) |
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Evaluating a Breast Lump: Physical Exam |
Certain characteristics on physical exam increase suspicion of malignancy.
- Irregular borders |
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Evaluating a Breast Lump: Diagnostic tests |
If feels cystic -> aspiration can be attempted and the fluid sent for cytology
If feels solid -> mammography is the next step
Ultrasound can be helpful in distinguishing solid mass from a cystic lesion |
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Evaluation of Nipple Discharge |
Physiologic:
Pathologic:
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What to ask about Nipple Discharge? |
Ask if discharge appears milky (check prolactin levels), purulent or bloody (more likely cancerous) |
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Tests for milky discharge |
Exclude endocrinological reasons, then consider:
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Mammography Benefits |
1) good screening test that can detect asymptomatic early stage disease
2) good evidence that mammography decreases breast cancer mortality |
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Mammography Risks |
1) false positive -> unnecessary procedures
2) false negative -> gives false sense of security Low sensitivity (60% and 90%) means more false negative results
3) Small radiation exposure
4) Discomfort |
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Breast MRI |
Not recommended for screening the general population of asymptomatic, average-risk women
May be indicated in the surveillance of women with more than a 20% lifetime risk of breast cancer (BRCA1/BRCA2) OR Hx of mantle radiation for Hodgkin’s Dz.
Potential diagnostic tool to identify extent of Dz. in patients w/ recently diagnosed breast cancer
Contrast-enhanced breast MRI may help in evaluation of patients w/ breast augmentation b/c mammography is difficult
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Breast Ultrasound
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Not recommended for screening
Used for evaluation of suspected abnormalities |
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Risk factors for developing breast cancer in the general population? |
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Factors associated with decreased cancer rates |
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Breast cancer: EtOH and Smoking |
limiting alcohol intake helps But smoking DOes NOT Increase risk of breast cancer. |
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Osteoporosis |
spinal or hip bone mineral density (BMD) of 2.5 standard deviations or more below the mean for healthy, young women (T-score of −2.5 or below) as measured by dual energy x-ray absorptiometry (DEXA). |
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Osteopenia |
spinal or hip BMD between 1 and 2.5 standard deviations below the mean (T-score between -1 and -2.5). |
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Menopause: Timing |
On average, women reach menopause at 51 A few start as young as 40, and a very few as late as 60
Smokers tend to start earlier than non-smokers
Can not be predicted |
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When can menopause be confirmed? |
Only when woman has not menstruated for 12 straight months |
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Perimenopause |
The gradual transition to menopause
- Ovaries don't abruptly stop; they slow down
- Still possible to get pregnant
- Ovaries still functional, & ovulation may occur intermittently (not monthly basis)
- Perimenopause can last from two to eight years. |
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Menopause Symptoms expectation |
Menopause affects each woman differently
Some have no troubles, others have severe symptoms that drastically hamper their lives
Menstrual irregularity is the hallmark of perimenopause |
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Menopause symptoms due to estrogen deficiency |
1) Hot flashes - 30 seconds to ten minutes of heat with possible flushing of face and neck & temporary red blotches on chest, back, & arms - Sweating and chills may follow
What helps? Dress in light layers, use fan, regular exercise, avoiding spicy foods & heat, and manage stress
2) Vaginal Dryness - intercourse uncomfortable, use lubricant, libido might change
3) Mood Swings - Mood swings, especially Depression, are common |
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Role of Estrogen in Osteoporosis |
Estrogen has benefits for bones and heart
Bones: causes apoptosis of osteoclasts and blocks IL-6 (IL-6 stimulates osteoclasts)
Heart: vasodilatory effects cause lower BP -> less vascular damage (that is why women get CHD when post-menopausal) |
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Calcium Intake |
premenopausal women: need ~1000 mg of calcium daily
postmenopausal women: need 1500 mg of calcium daily |
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Dairy calcium content |
300 mg of calcium
8 oz. of yogurt
milk 1 cup
1.5 ounces of cheese |
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Danger of Calcium supplementation for osteoporotic fracture prevention |
Increase the risk of atherosclerotic vascular disease as well as for kidney stones
USPSTF says to increase dairy intake & including weight bearing exercises such as walking into a daily routine |
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Recommendations for Osteoporosis Screening |
- Women >65 years old, screen with DEXA
- women <65 years old - DEXA screening recommended if fracture risk > or equal to that of a 65-year-old white woman without additional risk factors (9.3 percent over 10 years) - use calculator |
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Risk factors for osteoporosis |
Early menopause
Lack of physical activity
Obesity (BMI >30 (B)) -> high estrogen level and can be protective against menopausal symptoms and osteoporosis
White race
Family history of osteoporotic fracture
Personal history of previous fracture as an adult |
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elevated BMI are at greater risk of developing |
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Recommended Physical activity |
Most recommend 20-30 minutes of moderate activity five to seven days a week
Some research suggests the need for > 30 minutes of physical activity to aid with weight loss |
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Stages of Change Model |
Pre-contemplation Stage
Contemplation Stage
Preparation Stage
experiment with small changes as their determination increases (e.g. sampling low-fat foods)
Action Stage Maintenance Stage Relapse |