STDs, STIs, Contraception, Menstrual Disorders
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| What age group does the majority (50%) of STDs occur? | 15-24
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| In what ethnic group does the majority of gonorrhea (71%), chlamydia (48%), and syphilis (50%) occur? | African American
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| What population has the greatest rate of syphilis (62%) | Men who have sex with men
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| What 8 actions are important for the health care provider to do to help prevent STDs? | Discuss pre-exposure vaccines, provide prevention/risk-reduction counseling, discuss testing, assess pt's risk and test, diagnose and treat infections, provide/refer treatment for partners, report STD/HIV, keep STD/HIV confidential
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| What percent of women experience at least 1 yeast infection (candida albicans)? | 75%
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| What percent of women experience more than 1 yeast infection (Candida albicans)? | 40-45%
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| What 6 signs/symptoms occur with a yeast infection (Vulvovaginal candidiasis)? | External dysuria (painful urination), vulvar pruritis (itch), pain, swelling, redness, thick curd-like vaginal discharge
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| What are 2 risk factors for yeast infections (Vulvovaginal candidiasis) | Antibiotics, immunocompromised
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| What 2 tests are used to diagnose yeast infections (Vulvovaginal candidiasis)? | Wet prep (saline + 10% KOH) with microscope visualization of yeasts, hyphae, or pseudohyphae; or a Candida culture
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| What is the treatment for uncomplicated yeast infections (Vulvovaginal candidiasis)? | Short course (1-3 days) of a topical azole: Clotrimazole
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| What is the treatment for complicated yeast infections (Vulvovaginal candidiasis)? | Long duration (7-14 days) of a topical azole or oral fluconazole (Diflucan)
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| What yeast infections are considered "complicated" and require long-duration azole treatment? | Recurrent infections (>4 in 1 year), severe infections, non-albicans infections, DM or immunocompromised
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| When should fluconazole (Diflucan) not be used to treat a yeast infection? | If the infection is non-albicans
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| When would a male partner need treatment if his female partner has a yeast infection? | If he has balanitis (inflammation of skin covering glans of penis = uncircumsized)
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| What bacterial species makes up the normal flora of the vagina, and what is their function there? | Lactobacillus prevents bacteria overgrowth
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| What two species are often a cause of bacterial vaginosis? | Gardnerella vaginalis and Mobiluncus (although often polymicrobial)
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| What is the condition with the clinical presentation of vaginal irritation, thin white/gray discharge, and a strong fishy odor? | Bacterial vaginosis
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| What 2 risk factors are associated with bacterial vaginosis? | New/multiple sex partners, douche
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| What clinical criteria are used to diagnose bacterial vaginosis? | Amsel's criteria: need 3/4: Thin white homogenous discharge, clue cells on microscopy, vaginal fluid pH >4.5, and release of fishy odor when adding KOH solution
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| What lab test is the best for diagnosing bacterial vaginosis? | Gram stain: lack of Lactobacilli, anaerobes known to cause bacterial vaginosis are present. **Not used clinically
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| What patients should be treated for bacterial vaginosis? | All patients with symptoms
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| What treatment is most common for bacterial vaginosis? | Metronidazole for 7 days **Avoid EtOH
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| What is the causative organism of Trichomoniasis? | Trichomonas vaginalis
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| When do symptoms for trichomoniasis usually occur? | 1-4 weeks after exposure
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| What condition presents with vaginal irritation, a malodorous frothy yellow-green discharge, and petechiae on the cervix/vagina? | Trichomoniasis
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| What diagnostic techniques are used to diagnose trichomoniasis? | Visualize motile organisms on a wet mount, swab and culture, nucleic acid amplification test
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| 5-20% of men with non-gonococcal urethritis also have what condition? | Trichomoniasis
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| What is the treatment for trichomoniasis, who should be treated, and what advice should be given? | The patient and sexual partner(s) should be treated with Metronidazole. Patient and partners should abstain from sex until treatment is complete
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| What is the most common bacterial STI in the US? | Chlamydia
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| What is the highest age-group for chlamydia infection? | Late teens-early 20's
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| Women frequently co-infected with gonorrhea should be tested for what other condition? | Chlamydia
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| What is the clinical presentation of chlamydia in women? | Often asymptomatic, cervical discharge, lower abdominal pain, fever/chills, adnexal tenderness
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| What is the clinical presentation of chlamydia in men? | Often asymptomatic, urethritis, penile discharge, dysuria
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| What are common diagnostic techniques for chlamydia? | Swab (cervical or male urethral), urine sample, pharynx/rectal swab
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| What does the chlamydia treatment regimen consist of? | Treat patient and partners with Doxycycline for 7 days or a single dose of Azithromycin, abstain from sex during treatment, consider gonorrhea treatment, and re-test in 3-4 months
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| A pregnant patient with chlamydia should avoid what treatment? | Doxycycline
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| When do symptoms of Gonorrhea usually occur? | 1-14 days after exposure
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| Patients with gonorrhea should also be tested for what condition? | Chlamydia
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| What is the clinical presentation of Gonorrhea in women? | Similar to chlamydia, but more severe: Vaginal discharge, lower abdominal pain, fever, cervical motion tenderness = chandelier sign
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| What is the clinical presentation of gonorrhea in males? | Urethritis, white/yellow/green penile discharge, dysuria
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| What diagnostic techniques are used for gonorrhea? | Swab or urine samples
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| What treatment regimen is used for gonorrhea? | Treat patient and partners with IM Ceftriaxone plus Azithromycin or doxycycline (= also treats chlamydia), abstain from sex during treatment, restest in 3-4 months
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| What complications can occur with gonorrhea? | Conjunctivitis, meningitis, endocarditis, disseminated disease
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| What are the potential dangers of gonorrhea in newborns? | Conjunctivitis, globe perforation, blindness
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| What is the most common causative organism of Nongonococcal urethritis? | Chlamydia trachomatis
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| What two organisms are common in causing Nongonococcal urethritis? | Chlamydia trachomatis, and Mycoplasma genitalium
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| Which strain of herpes usually causes genital lesions? | Herpes Simplex Virus 2
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| How is genital herpes most commonly acquired? | From an asymptomatic partner
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| How is genital herpes spread? | Direct contact with saliva, lesions, semen, cervical secretions
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| Must lesions be present for herpes viral shedding to occur? | No
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| Where does the herpes virus remain latent? | In nerve root ganglion
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| What may trigger reactivation of the herpes virus? | Change in immune status (stress, menses, infection, etc.)
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| What condition presents with a prodrome of burning/itching/tingling, followed by an outbreak of painful vesicles on an erythematous base? | Genital herpes
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| What is the preferred method for diagnosing genital herpes? | Culture blister juice
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| What is the limitation to the serology (blood) test to detect HSV-1 and HSV-2 specific antibodies to diagnose genital herpes? | Antibodies usually don't appear until 3-4 weeks after exposure
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| What is the treatment regimen for genital herpes? | Acyclovir, Valacyclovir, or Famciclovir for 7-10 days if initial outbreak, 1-5 days for a recurrent outbreak, 1 year daily dose to suppress
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| At what point can herpes be transmitted to a baby? | Before, during, or after delivery
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| What are 3 potential syndromes a baby can contract from Herpes Simplex Virus? | Localized skin eye mouth disease, CNS disease (encephalitis), Disseminated disease
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| What might help to reduce the risk of herpes transmission during delivery? | Cesarean section
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| What 2 actions might help to prevent herpes transmission to a baby? | Offer suppressive viral therapy (acyclovir) at 36+ weeks gestation to women with active recurrent genital herpes; perform C-section at delivery
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| What is the most common STD? | HPV
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| How often is HPV cleared and in what amount of time? | 90% of infected patients clear the infection within 2 years
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| Where in the body can HPV infection occur? | Skin of vulva, vaginal lining, penis, anus, mouth, throat
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| What is the clinical presentation of HPV? | No symptoms, visible genital warts (soft, flesh-colored, single or multiple flat, cauliflower-like warts), or precancerous/cancerous changes
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| A patient has been diagnosed with condyloma acuminata. What condition is this consistent with? | HPV
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| What techniques are used to diagnose HPV? | Visible warts: vinegar may turn warts white but no test to confirm warts are HPV. Abnormal PAP: HPV DNA
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| What HPV diagnostic techniques are available for men? | None
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| What treatments are available for HPV? | No cure. Destroy warts, treat precancerous/cancerous changes.
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| Which 2 types of HPV are the most common (70%) causes of cervical cancer? | Types 16 and 18
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| Which HPV vaccine is qaudrivalent (protects against types 16, 18, 6, and 11) and is approved for girls and boys? | Gardasil
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| Which HPV vaccine protects against cervical, vulvar, vaginal, and anal cancers as well as warts? | Gardasil
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| Which HPV vaccine is bivalent and protects against types 16 and 18? | Cervarix
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| Which HPV vaccine protects only against cervical cancer? | Cervarix
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| What is the causative organism of syphilis? | Treponema pallidum
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| How is syphilis transmitted? | Through direct contact with an infected lesion
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| Which STD is known as the great imitator? | Syphilis
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| The emergence of a painless chancre at the site where bacteria entered the skin 10-90 days after contact and persists for 4-6 weeks is indicative of what stage of syphilis? | Primary
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| What clinical presentations are common with the secondary stage of syphilis? | **Rash: non-pruitic not contagious on palms & foot soles; condyloma lata: heaped wart-like papules commonly in gluteal folds perineum or perianal area contagious; Mucous patches: highly infectious painless flat patches in oral cavity pharynx or genitals
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| Which stage of syphilis is asymptomatic, is no longer sexually transmissable, and may persist for years? | Latent stage
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| Which stage of syphilis involves neurologic deficits and damage to internal organs 10-20 years after infection is acquired? | Late stage
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| What diagnostic techniques are used for syphilis? | Bacteria from chancre visible under darkfield microscopy; Serology (blood) test: Rapid Plasma Reagin or Venereal Disease Research Laboratory; Lumbar puncture if neurosyphilis suspected
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| What is the treatment regimen for syphilis? | 1 IM shot Benzathine Penicillin for pt. and partner. More doses of infected >1 year. Oral Doxycycline if PCN allergies. Report to health dept.
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| What are potential pregnancy complications of syphilis? | Stillbirth, neonatal death, deafness, neurologic impairment, bone deformities
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| What is the causative organism of a chancroid? | Haemophilus ducreyi
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| What is the clinical presentation of chancroid? | Painful genital ulcer that produces a foul-smelling discharge, inguinal adenitis (swollen lymph nodes)
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| What is the causative organism of Lymphogranuloma venereum? | A serotype of Chlamydia trachomatis
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| What population is Lymphogranuloma venereum most common in? | Men who have sex with men
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| Unilateral inguinal bubo, self-limited genital ulcer/papule, and anal discharge/rectal bleeding are indicative of what STD? | Lymphogranuloma venereum
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| What is the causative organism of Pediculosis Pubis (pubic lice)? | Pthirus pubis
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| What is the treatmen for Pediculosis Pubis (pubic lice)? | Permethrin cream rinse
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| What are the most common causative organisms of pelvic inflammatory disease? | Chlamydia and gonorrhea
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| What organisms can cause pelvic inflammatory disease? | Chlamydia, gonorrhea, Haemophilus influenza
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| Which STD/STI is characterized by an ascending infection from vagina/cervix to upper genital tract? | Pelvic inflammatory disease
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| What is the clinical presentation of acute pelvic inflammatory disease? | Vaginal discharge, lower abdominal pain, cervical motion tenderness (chandelier sign), uterine/adnexal tenderness, dyspareunia (painful intercourse), fever >101F
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| What are the 7 risk factors for pelvic inflammatory disease? | <25 years old, African American, young age of sexual activity onset, multiple partners, douche, first 3 weeks of IUD insertion, women who have had 1 episode already
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| What are 5 potential complications of pelvic inflammatory disease? | Infertility, Ruptured tubo-ovarian abscess, chronic pelvic pain, increased risk of ectopic pregnancy, and Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain and adjesions)
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| What action should be taken for a child presenting with an STD? | Involve child protective services
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| What are the 5 hormones of the reproductive cycle? | GnRH (Gonadotropin releasing hormone), FSH (follicular stimulating hormone), LH (lutenizing hormone), Progesterone, Estradiol
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| Phase I of the menstrual cycle, where menstruation and the follicular phase occur, happens during what days of the cycle? | Days 1-13
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| What happens on Day 14/Phase 2 of the menstrual cycle? | Ovulation
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| What phase of the menstrual cycle occurs during days 15-28? | The Luteal/secretory phase... Phase 3
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| What occurs during days 1-5 of the menstrual cycle? | Menstruation... uterine lining sloughs off
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| Which hormone is released as soon as menstruation starts? | FSH
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| What is the effect of the hormone estradiol? | Stimulates growth of endometrial lining, and stimulates LH receptors and progesterone productive cells, decreases FSH production via pituitary suppression
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| Which hormone stimulates growth of endometrial lining, and stimulates LH receptors and progesterone productive cells? | Estradiol
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| Which hormone decreases FSH production by suppressing the pituitary gland? | Estradiol
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| What phase occurs within 30-36 hours of the surge of LH release? | Ovulation
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| Which hormone release triggers ovulation? | LH
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| What is mittleschmertz? | Abdominal pain experienced by some women during ovulation
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| Which two hormones are important for adequate progesterone levels? | FSH and LH
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| Which hormone decreases the levels of FSH and LH? | Progesterone
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| When does Progesterone production begin during the menstrual cycle? | ~24 hours before ovulation. Maximum production occurs 7 days after ovulation
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| What happens to progesterone levels if no fertilization occurs? | Progesterone production drops rapidly
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| Which hormone prevails during the luteal phase? | Progesterone
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| Which hormone is responsible for stimulating the release of hormones from the pituitary, and where is it released from? | GnRH (gonadotropin releasing hormone) is released from the hypothalamus
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| Which 2 hormones are released by the pituitary after stimulated by GnRH, and what is their function? | FSH and LH stimulate hormone release from ovaries
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| What hormone is released from the ovaries in response to FSH and LH? | Estrogen
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| What hormonal changes occur during menopause? | Ovaries become resistant to FSH and stop producing estrogen
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| How do the contraceptives Progestins work? | Suppress LH
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| How do the contraceptives Estrogens work? | Suppress FSH
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| What 9 factors are important when helping a patient choose a method of birth control? | Efficacy, Convenience, Duration of action, Reversibility and time to return to fertility, effect on uterine bleeding, frequency of side effects/adverse events, affordability, protection against STIs, contraindications,
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| Which two contraceptive methods protect against STIs? | Abstinence, and condoms
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| What is the term used for he percentage of women who become pregnant per year using a particular contraceptive method? | Failure rate
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| What is the term used for the contraceptive failure rate that factors in patient error/compliance (incorrect use of method, or not used with every act of intercourse)? | Typical Use Rate
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| What is the term used for the failure rate when the contraception method was used correctly every time, but failed anyways? | Lowest Expected Rate
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| What is the typical use failure rate with coitus interruptus (Pull out method)? | 22%
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| What is the lowest expected failure rate with coitus interruptus (Pull out method)? | 4%
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| Which contraceptive method works by immobilizing sperm? | Spermicides
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| What is a disadvantage of using a spermicide as contraception? | Must use 10 minutes before intercourse, may not form a good barrier over the cervix if not used exactly as directed
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| What is the typical use failure rate with spermicides? | 28%
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| What is the lowest expected failure rate with spermicides? | 18%
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| What is the mechanism of action of spermicides? | Chemical spermicides immobilize sperm, foams block sperm from entering uterus and immobilize them, and creams/gels/films/suppositories melt into a thick liquid in the vagina and block sperm from entering uterus and immobilize them.
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| What is the mechanism of action of sponge contraceptives? | Block sperm from entering uterus by blocking cervix, and immobilize sperm by releasing spermicide
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| What are some disadvantages to sponge contraceptives? | They must be left in place for 6 hours after intercourse, difficult removal/insertion, may become stuck or break into pieces, contains sulfites = allergies
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| What is the lowest expected failure rate with sponge contraceptives? | 20% if previous birth, 9% if no previous birth
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| What is the typical use failure rate with sponge contraceptives? | 24% if previous birth, 12% if no previous birth
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| How much space should be left at the tip of a male condom to serve as a semen reservoir? | 1/2"
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| Which method of contraception is the second best in protecting against STDs after abstinence? | Male condoms
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| What is the lowest expected failure rate with male condoms? | 2%
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| What is the typical use failure rate with male condoms? | 18%
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| What are the disadvantages to male condoms? | Decreased sensation, interrupt the mood
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| What are the disadvantages to female condoms? | Outer ring could slip into vagina during intercourse, reduce sensation
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| What is the lowest expected failure rate with female condoms? | 5%
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| What is the typical use failure rate with female condoms? | 21%
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| Which contraceptive method is a shallow, dome-shaped cup with a flexible rim that fits securely in the vagina to cover the cervix? | Diaphragm
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| Which contraceptive method is a small silicone cup that fits securely over the cervix? | Cervical cap
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| Which contraceptive method is a silicone cup that fits over the cervix with an air valve, and a loop to aid removal? | Lea's shield
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| What is a disadvantage to the diaphragm? | It must stay in place for 6 hours after last act of intercourse, and can't be left in for more than 24 hours
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| What is the most common diaphragm size? | 75 mm
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| What position must the patient be in for a diaphragm fitting? | Dorsal lithotomy
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| What is a disadvantage to the cervical cap? | Cap must stay in place 6 hours after intercourse, and not longer than 48 hours
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| What is the main functional difference between the diaphragm and the cervical cap? | The diaphragm fits against the vaginal wall, while the cervical cap covers the cervix.
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| What is a disadvantage to lea's shield? | It must stay in place 8 hours after intercourse and not longer than 48 hours
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| Which method of contraception involves placing a barrier with air between it and the cervix that is released through a valve? | Lea's Shield
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| What is a common advantage to the diaphragm, cervical cap, and lea's shield? | Reusable for 2 years (diaphragm and cervical cap), or for 6 months (Lea's Shield)
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| What are a few disadvantages to diaphragms, cervical caps, and lea's shields? | Pelvic exam needed, can be jarred loose during intercourse, prescription only, not usable during menstruation, may cause frequent bladder infections
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| What is the lowest expected failure rate with diaphragms? | 6%
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| What is the typical use failure rate with diaphragms? | 12%
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| What is the lowest expected failure rate with cervical caps? | 26% if previous birth, 9% if no previous birth
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| What is the typical use failure rate with cervical caps? | 32% if previous birth, 16% if no previous birth
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| What is the lowest expected failure rate with Lea's Shield? | 8%
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| What is the typical use failure rate with Lea's Shield? | 20%
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| What is the primary mechanism of action of hormonal contraception? | Prevent ovulation
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| Combined oral contraceptives contain what 2 hormones? | Estrogen and Progesterone
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| What is the mechanism of action of combined oral contraceptives? | Prevent ovulation, thicken cervical mucus so sperm have greater difficulty in penetrating cervix, and thin the uterine lining to make implantation more difficult
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| Which type of combined oral contraceptive gives a constant dose of estrogen and progesterone in the hormonally active pills throughout the whole cycle? | Monophasic
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| Which type of combined oral contraceptive gives 2 different progestin doses, increasing halfway through the cycle? | Biphasic
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| Which type of combined oral contraceptive has three increasing estrogen doses? | Triphasic
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| What brand on oral contraceptive is chewable? | Femcon Fe
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| What is the typical use failure rate with combined oral contraceptives? | 5%
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| What is the lowest expected failure rate with combined oral contraceptives? | 0.l%
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| Which method of contraception involves a 91-day regimen of estrogen and progestin: 12 weeks of active pills with a period occuring during the 13th week? | Extended cycle oral contraceptives
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| What is the typical use failure rate with extended cycle oral contraceptives? | 5%
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| What is the lowest expected failure rate with combined oral contraceptives? | 0.1%
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| What are several disadvantages to the contraceptive patch? | Rotate locations, ineffective if loose/falls off for more than 24 hrs. or if same patch is left on for more than 1 week, must be <190 lbs., increased risk/side effects: potential increased VTE risk b/c 60% more estrogen enters bloodstream
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| What is the typical use failure rate with the contraceptive patch? | 5%
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| What is the lowest expected failure rate with the contraceptive patch? | 0.1%
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| What is the mechanism of action of the NuvaRing? | Similar to combined oral contraceptives: prevents ovulation, thickens cervical mucus, and thins the uterine lining
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| What are a few disadvantages to the NuvaRing? | Decreased effectiveness if expelled and out for 3+ hours, if it does now stay in vagina for full 3 week course, if left in vagina for >3 weeks; may feel during intercourse
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| What is the typical use failure rate of the contraceptive ring? | 6%
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| What is the lowest effective failure rate of the contraceptive ring? | 0.1%
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| In what population of women is progestin-only pills most commonly used? | Breast feeding women
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| What is a potential risk with progestin-only pills? | Follicular ovarian cysts
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| What is the typical use failure rate with progestin-only pills? | 8%
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| What is the lowest effective failure rate with progestin-only pills? | 0.5%
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| What is the mechanism of action of injected hormones (DepoProvera)? | It prevents ovulation, and may thicken the cervical mucus
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| How often is injected hormones (DepoProvera) administered? | Every 3 months *Check pregnancy test prior to injection
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| How quickly is injected hormones (DepoProvera) effective in preventing pregnancy? | Immediately if injected during first 5 days of period, otherwise must use backup method for 7 days
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| What are a few disadvantages with injected hormones (DepoProvera)? | Changes in menses, weight gain, headaches/dizziness, abdominal cramps/bloating, fatigue, and infertility 9-10 months after discontinuing injection
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| Which method of contraception causes infertility for approximately 9-10 months after discontinuation? | Injectable hormones (DepoProvera)
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| What is a potential health risk associated with injectable hormones (DepoProvera)? | Reduction in bone mineral density
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| What is the typical use failure rate with injectable hormones (DepoProvera)? | 0.3%
🗑
|
||||
| What is the lowest expected failure rate with injectable hormones (DepoProvera)? | 0.2%
🗑
|
||||
| How long is the contraceptive implant (Implanon) effective for? | 3 years
🗑
|
||||
| What is a disadvantage to the contraceptive implant Implanon? | Unscheduled vaginal bleeding
🗑
|
||||
| What is the mechanism of action of a copper IUD (ParaGard)? | Immobilizes sperm on the way to the fallopian tubes, and changes lining of uterus if egg becomes fertilized
🗑
|
||||
| What amount of time can the copper IUD (ParaGard) be left in place? | 10 years
🗑
|
||||
| What mechanism of action is unaffected by a copper IUD (ParaGard)? | Ovulation/menstrual cycle
🗑
|
||||
| What is the mechanism of action of hormonal IUDs (Mirena/LNG IUS)? | Progestin is released into the uterus to thicken cervical mucus = difficult for sperm to enter cervix, and slows proliferation of uterine lining = inhospitable to fertilized eggs
🗑
|
||||
| How long can hormonal IUDs (Mirena/LNG IUS) remain in place? | 5 years
🗑
|
||||
| What is the mechanism of action of a vasectomy? | Vas Deferens are surgically altered- outpatient procedure performed in a clinic or doctor's office
🗑
|
||||
| How long must contraception be used for after a vasectomy? | Usually about 1 month until a semen exam reveals complete absence of sperm in ejaculate
🗑
|
||||
| What is the typical use failure rate with a vasectomy? | 0.15%
🗑
|
||||
| What is the lowest expected failure rate with a vasectomy? | 0.1%
🗑
|
||||
| What is the mechanism of action of tubal ligation (female sterilization)? | Interrupts passage through fallopian tubes
🗑
|
||||
| What are 5 techniques available for tubal ligation (female sterilization)? | Cauterization, tied and cut, banded, falope ring, or hulka clip
🗑
|
||||
| What is a serious potential risk if a pregnancy occurs after tubal ligation (female sterilization)? | Ectopic pregnancy, unless proven otherwise
🗑
|
||||
| What are the typical use and lowest expected failure rates in tubal ligation? | 0.5%
🗑
|
||||
| What is the mechanism of action of tubal obstruction (Essure)? | a 4cm long metal + polymer microinsert is placed into the fallopian tube. Polymer fibers stimulates tissue growth to occlude fallopian tube
🗑
|
||||
| How long must contraception be used after a tubal obstruction (Essure) procedure is performed? | 3 months
🗑
|
||||
| What are 5 contraindications for a tubal obstruction (Essure) procedure? | Pregnancy/suspected pregnancy, if it's been less than 6 weeks since delivery or abortion, if active or recent pelvic infection, nickel allergy or contrast media allergy, if uterine/tubal pathology that obstructs access
🗑
|
||||
| What is a serious potential risk of pregnancy occurs after tubal obstruction (Essure)? | Ectopic pregnancy... assume until proven otherwise
🗑
|
||||
| What are the typical use and lowest expected failure rates with tubal obstruction (Essure)? | 0.2%
🗑
|
||||
| What is the mechanism of action of emergency contraception? | Inhibit/delay ovulation, Interfere with fertilization/tubal transport, Prevent implantation
🗑
|
||||
| What hormone is in Plan B emergency contraception? | Progestin
🗑
|
||||
| What emergency contraception requires a prescription? | ella
🗑
|
||||
| How long may the emergency contraceptive ella be effective for? | 120 hours
🗑
|
||||
| How long may the emergency contraceptive Plan B be effective for? | 72 hours
🗑
|
||||
| What is a non-hormonal emergency contraceptive method? | Emergency Copper IUD
🗑
|
||||
| How long may the emergency contraceptive copper IUD be effective for? | 5 days after unprotected sex
🗑
|
||||
| The absence of menarche by age 16 despite sexual characteristics is classified as what type of amenorrhea? | Primary amenorrhea
🗑
|
||||
| The absence of menarche by age 14 in the absence of sexual characteristics is classified as what type of amenorrhea? | Primary amenorrhea
🗑
|
||||
| The absence of menses for 6+ months in women who were previously menstruating is classified as what type of amenorrhea? | Secondary amenorrhea
🗑
|
||||
| What is the most common cause of primary amenorrhea without secondary sexual characteristics (sexual infantilism)? | Primary ovarian failure due to gonadal dysgenesis (ovary malformation)
🗑
|
||||
| What is an example of gonadal dysgenesis (ovary malformation) that is a common cause of primary amenorrhea without secondary sexual characteristics (sexual infantilism)? | Turner's syndrome (45, XO)
🗑
|
||||
| In addition to gonadal dysgenesis, what is another cause of primary amenorrhea without secondary sexual characteristics (sexual infantilism)? | Hypogonadotropic hypogonadism (lack of gonadotropin secretion) by pituitary failure or hypothalamic failure
🗑
|
||||
| What is a genetic cause of primary amenorrhea with breast development and mullerian anomalies? | Androgen insensitivity syndrome (46 XY = male, but patient has androgen resistance)
🗑
|
||||
| What are 2 anatomic causes of primary amenorrhea with breast development and mullerian anomalies? | Uterovaginal septum and imperforate hymen (have vagina, but no cervix/uterus)
🗑
|
||||
| What are 2 causes of primary amenorrhea with breast development and normal mullerian structures? | Hypothyroidism and hyperprolactinemia (menstrual hormones suppressed: GnRH, FSH, and LH); and Polycystic ovarian syndrome
🗑
|
||||
| When should a patient with amenorrhea be evaluated? | At age 16, age 14 if no breast development, or age 14 if no menstruation within 2 years of breast development
🗑
|
||||
| What diagnostic tests can be performed to test reasons for primary amenorrhea? | HCG, Serum FSH/LH, Karyotype, Serum prolactin and TSH, Serum testosterone, Pelvic sonogram if pelvic anomalies suspected, CT/MRI if pituitary pathology suspected
🗑
|
||||
| What is an important etiology of secondary amenorrhea? | Pregnancy
🗑
|
||||
| What are 2 possible etiologies of secondary amenorrhea with hyperandrogenic disorders? | Polycystic ovarian syndrome or Autonomous hyperandrogenism (tumors of adrenal gland or ovaries)
🗑
|
||||
| What are 6 possible etiologies of secondary amenorrhea without hyperandrogenism? | Medication use (contraceptives), hypothalamus (GnRH suppression due to excess exercise, stress, too skinny), premature ovarian failure, hyperprolactinemia, thyroid disease, head trauma -> pituitary damage
🗑
|
||||
| The presence of what sign on a pelvic exam may indicate hyperandrogenism as a cause for secondary amenorrhea? | Clitorimegaly
🗑
|
||||
| What test could indicate pregnancy, severe hypoestrogenism, or uterine defect if no withdrawal bleeding occurs within 2 weeks? | Progestin challenge test to assess estrogen levels
🗑
|
||||
| A woman has abnormal uterine bleeding between menarche and menopause that can't be explained by medications, blood dyscrasias, systemic illness, trauma, uterine neoplasm, or pregnancy may be diagnosed with what (diagnosis of exclusion)? | Dysfunctional Uterine Bleeding
🗑
|
||||
| Abnormally frequent menses at intervals <24 days is defined as what? | Polymenorrhea (dysfunctional uterine bleeding)
🗑
|
||||
| A woman complains of saturating a tampon within an hour during each menstrual cycle. What condition might she have? | Menorrhagia (dysfunctional uterine bleeding)
🗑
|
||||
| When should a patient with amenorrhea be evaluated? | At age 16, age 14 if no breast development, or age 14 if no menstruation within 2 years of breast development
🗑
|
||||
| What diagnostic tests can be performed to test reasons for primary amenorrhea? | HCG, Serum FSH/LH, Karyotype, Serum prolactin and TSH, Serum testosterone, Pelvic sonogram if pelvic anomalies suspected, CT/MRI if pituitary pathology suspected
🗑
|
||||
| What is an important etiology of secondary amenorrhea? | Pregnancy
🗑
|
||||
| What are 2 possible etiologies of secondary amenorrhea with hyperandrogenic disorders? | Polycystic ovarian syndrome or Autonomous hyperandrogenism (tumors of adrenal gland or ovaries)
🗑
|
||||
| What are 6 possible etiologies of secondary amenorrhea without hyperandrogenism? | Medication use (contraceptives), hypothalamus (GnRH suppression due to excess exercise, stress, too skinny), premature ovarian failure, hyperprolactinemia, thyroid disease, head trauma -> pituitary damage
🗑
|
||||
| The presence of what sign on a pelvic exam may indicate hyperandrogenism as a cause for secondary amenorrhea? | Clitorimegaly
🗑
|
||||
| What test could indicate pregnancy, severe hypoestrogenism, or uterine defect if no withdrawal bleeding occurs within 2 weeks? | Progestin challenge test to assess estrogen levels
🗑
|
||||
| A woman has abnormal uterine bleeding between menarche and menopause that can't be explained by medications, blood dyscrasias, systemic illness, trauma, uterine neoplasm, or pregnancy may be diagnosed with what (diagnosis of exclusion)? | Dysfunctional Uterine Bleeding
🗑
|
||||
| Abnormally frequent menses at intervals <24 days is defined as what? | Polymenorrhea (dysfunctional uterine bleeding)
🗑
|
||||
| A woman complains of saturating a tampon within an hour during each menstrual cycle. What condition might she have? | Menorrhagia (dysfunctional uterine bleeding)
🗑
|
||||
| What is the term for heavy and irregular uterine bleeding? | Menometrorrhagia (dysfunctional uterine bleeding)
🗑
|
||||
| What is the term for irregular episodes of uterine bleeding? | Metrorrhagia (dysfunctional uterine bleeding)
🗑
|
||||
| What is the term for scant bleeding/spotting at ovulation for 1-2 days? | Kleine regnung (dysfunctional uterine bleeding)
🗑
|
||||
| What 6 differential diagnoses should be considered with dysfunctional uterine bleeding? | Pregnancy, iatrogenic causes (medications), and bleeding disorders **Von Willebrand, leukemia, thrombocytopenia, etc.; Systemic (hepatic/renal/thyroid disease); trauma; or organic (cancer, pregnancy complications, polyps, etc.)
🗑
|
||||
| What laboratory tests can be performed do determine cause of dysfunctional uterine bleeding? | HCG (prego), CBC, Iron, coagulation time, TSH, Liver fxn., FSH, PAP smear, pelvic sonogram, *Endometrial biopsy
🗑
|
||||
| What are 3 methods to manage dysfunctional uterine bleeding? | Hormones, endometrial ablation, or hysterectomy
🗑
|
||||
| What is the cause of primary dysmenorrhea (painful menstruation)? | No identifiable cause
🗑
|
||||
| What is the cause of secondary dysmenorrhea (painful menstruation)? | Organic pelvic disease
🗑
|
||||
| What is the cause of pain in primary dysmenorrhea? | Increased uterine contractions: ^uterine activity = ^resting tone = ^contractility and contraction frequency
🗑
|
||||
| A woman complaining of intermittent, cramp-like lower abdominal pain that radiates to lower back/upper thighs, lasting 12-72 hours that begins a few hours before or just after her period begins most likely has what condition? | Primary dysmenorrhea
🗑
|
||||
| What non-pharmaceutical treatments are available for primary dysmenorrhea? | Decrease caffeine use, apply heat, massage lower abdomen gently, enough sleep, decrease strenuous exercise during cycle days 1-3, yoga/acupuncture, stop smoking, nutritional supplements
🗑
|
||||
| What is the first line therapy for primary dysmenorrhea? | NSAIDS
🗑
|
||||
| What pharmacologic agents are used for treating primary dysmenorrhea? | NSAIDS, Hormonal contraceptives, or tocolytic agents/Ca-channel blockers in resistant cases
🗑
|
||||
| When should primary dysmenorrhea be followed up/referred? | When pain worsens with each menses, if pain lasts longer than first 2 days of menses, meds no longer control pain, heavier bleeding, pain + fever, pain not during menses
🗑
|
||||
| When do patients with secondary dysmenorrhea experience pain? | At any time, but worse with menses
🗑
|
||||
| What are 5 potenial underlying causes of secondary dysmenorrhea? | Pelvic inflammatory disease, uterine fibroids, ovarian cysts, pelvic congestion, or endometriosis
🗑
|
||||
| What is a widely successful treatment for secondary dysmenorrhea? | Oral contraceptives. Pelvic surgery if cases are complicated
🗑
|
||||
| What is the name for the group of disorders with regular ovulatory cycles that cause dysfunction in other organ systems? | Menstrual cycle associated disorders (ex: PMS)
🗑
|
||||
| Abdominal bloating, fatigue, breast tenderness, headaches, irritability, depression, increased appetite, forgetfulness, and difficulty concentrating are all symptoms of what condition? | PMS
🗑
|
||||
| What is the UCSD criteria for PMS? | 1 affective(mood) and 1 somatic (physical) symptom within 5 days of starting your period, 3 months in a row.
🗑
|
||||
| What are the 6 affective symptoms in the UCSD criteria for PMS? | Depression, Angry outbursts, Irritability, Confusion, Social withdrawal, and Fatigue
🗑
|
||||
| What are the 4 somatic symptoms in UCSD criteria for PMS? | Breast tenderness, abdominal bloating, headache, and swollen extremities
🗑
|
||||
| What is the term for the phase in a woman's reproductive life when a gradual decline in ovarian function results in decreased sex steroid production and sequelae? | Climacteric
🗑
|
||||
| Which phase of menopause exhibits a change in cycle length, with increased FSH levels until the final menstrual period? | Menopausal transition
🗑
|
||||
| Which phase of menopause exhibits a change in cycle length, with increased FSH levels until 12 months after the final menstrual period? | Perimenopause
🗑
|
||||
| Which phase of menopause exhibits 12 months of amenorrhea after the final menstrual period? | Menopause
🗑
|
||||
| Which phase of menopause consists of the first 5 years after the final menstrual period? | Early postmenopause
🗑
|
||||
| Which phase of menopause consists of 5 years after the final menstrual period until death? | Late postmenopause
🗑
|
||||
| What ages does menopause typically occur? | 50-55
🗑
|
||||
| After what age is it considered late menopause with menopause onset? | 55
🗑
|
||||
| What is the age range in which onset of menopause is considered early menopause? | 40-45
🗑
|
||||
| What is the term used for menopause occurring before age 40? | Premature ovarian failure
🗑
|
||||
| What 4 factors contribute to the age of menopause onset? | Genetics, ethnicity, smoking, and reproductive history
🗑
|
||||
| At what point, physiologically, do the ovaries begin to fail (what happens to the oocytes)? | When all 400,000 eggs as of menarche have been ovulated or become atretic
🗑
|
||||
| What are the symptoms of perimenopause/ impending ovarian failure? | Anovulation, irregular cycles, heavy menses, endometrial hyperplasia, increasing mood and emotional changes, hot flashes, night sweats
🗑
|
||||
| How long might perimenopausal symptoms last? | 3-5 years
🗑
|
||||
| What 3 major hormones decrease during menopause? | Estrogen, androgens, and progesterone
🗑
|
||||
| What is the cause of increased facial hair growth and decreased breast size in menopausal women? | Although androgens decrease, they are more sensitive to estrogen
🗑
|
||||
| Which hormone causes irregular bleeding, and possibly endometrial hyperplasia and cellular atypia in menopause? | Progesterone
🗑
|
||||
| Which hormone is thought to be responsible for hot flashes? | LH
🗑
|
||||
| What disease is a late complication of menopause? | Osteoporosis
🗑
|
||||
| What condition might a woman have with symptoms of insomnia, irritability, mood disturbances, urogenital atrophy, urinary stress incontinence, skin collagen loss, and hot flushes? | Menopause
🗑
|
||||
| What is often the most disturbing experience of menopause for women? | Hot flashes
🗑
|
||||
| What urogenital symptoms are secondary occurrences to lack of estrogen in menopause? | Vaginal tissue thins and dries (atrophy), vaginal canal shrinks in diameter = dyspareunia, elastic capacity of bladder decreases
🗑
|
||||
| When considering irregular menses, sweats, and mood changes as symptoms of menopause, what is an important differential diagnosis? | Hyperthyroidism
🗑
|
||||
| When considering menstrual changes in menopause, what are 3 important differential diagnoses? | Pregnancy, hyperprolactinemia, and thyroid disease
🗑
|
||||
| When considering hot flashes and night sweats in menopause, what are 3 important differential disgnoses? | Medication use, pheochromocytoma, and underlying malignancy
🗑
|
||||
| What is the first line treatment of menopause symptoms? | Non-hormonal vaginal moisturizers and lubricants for vaginal dryness
🗑
|
||||
| What is the most effective/second line treatment of menopause symptoms? | Vaginal estrogen therapy
🗑
|
||||
| Women who undergo menopause and still have a uterus should not use what hormone therapy? | Unopposed estrogen
🗑
|
||||
| In women who undergo menopause, still have a uterus, and want estrogen therapy, what other hormone should be given in combination? | Progesterone
🗑
|
||||
| What dosage of hormone replacement therapy should be used, and for what amount of time in menopausal patients with systemic symptoms? | The lowest effective dose for the shortest period of time
🗑
|
||||
| Why should hormone replacement therapy be used for as short amount of time as possible in menopausal women with systemic symptoms? | Increased cardiovascular risks
🗑
|
||||
| Estrogen only and Estrogen + Progesterone hormone replacement therapies both increase risk of what serious conditions? | Stroke and DVT/PE
🗑
|
||||
| Estrogen only and Estrogen + Progesterone hormone replacement therapies both decrease risk of what serious conditions? | Osteoporotic fracture
🗑
|
||||
| Estrogen + Progesterone hormone replacement therapy has an increase risk of what serious conditions not seen with Estrogen-only therapy? | Rate of coronary events and invasive breast cancer
🗑
|
||||
| Estrogen + Progesterone hormone replacement therapy has a decrease risk of what serious conditions not seen with Estrogen-only therapy? | Risk of colon cancer
🗑
|
||||
| Which bone cell becomes more active in the absence of estrogen? | Osteoclasts > osteoblasts
🗑
|
||||
| What are the 3 characteristics of osteoporosis? | Low bone mass, microarchitectural disruption, and increased skeletal fragility
🗑
|
||||
| What are the risk factors of osteoporosis? | *Advanced age, *previous fracture, FH of osteoporosis, lack of estrogen, sedentary, smoking, alcohol, white and asian, excess thyroid, etc.
🗑
|
||||
| What are the 2 most common places for osteoporotic fractures? | Spine and neck of femur. Other: wrist and hip
🗑
|
||||
| What are 2 clinical signs of osteoporosis? | Decreased height by 1.5 inches, fractures (spine, femoral neck, wrist, hip)
🗑
|
||||
| What diagnostic test is done to confirm osteoporosis? | Dual Energy X-Ray Absorptiometry Scan (DXA)
🗑
|
||||
| DXA results for osteoporosis are defined as what T-Score? | Less than -2.5 SD
🗑
|
||||
| DXA results for osteopenia are defined as what T-Score? | Between -1.0 and -2.5 SD
🗑
|
||||
| In what 2 situations is pharmacological therapy indicated for osteoporosis? | Women with a T-Score less than or equal to -2.5 SD, and women with an osteopenic T-Score (between -1.0 and -2.5 SD) with more than one risk factor
🗑
|
||||
| What medications are available for osteoporosis treatment? | Selective estrogen receptor modulators: Evista reduces risk of vertebral fractures and invasive breast cancer; Bisphosphonates: Actonel, Fosamax, and Boniva;
🗑
|
||||
| What lifestyle/dietary modifications should be made with osteoporosis? | Quit smoking, decrease alcohol consumption, weight-bearing exercise, and calcium + D3 supplements
🗑
|
||||
| Which organ prolapse is defined as the herniation of the pelvic organs to or beyond the vaginal walls? | Pelvic organ prolapse
🗑
|
||||
| Which organ prolapse is defined as the herniation of the anterior vaginal wall, often associated with bladder descent/cystocele? | Anterior compartment prolapse
🗑
|
||||
| Which organ prolapse is defined as the herniation of the posterior vaginal segment often associated with rectal descent/rectocele? | Posterior compartment prolapse
🗑
|
||||
| What is the term used for the herniation of the intestines to or through the vaginal wall? | Enterocele
🗑
|
||||
| What is the term used for the descent of the apex of the vagina into the lower vagina beyond the introitus? | Apical compartment prolapse
🗑
|
||||
| What is the term used for the herniation of all three compartments through the vaginal introitus? | Procidentia
🗑
|
||||
| What is the name of the condition where there is a downward placement of the bladder into the vagina? | Cystocele
🗑
|
||||
| What pelvic organ prolapse is typically associated with childbirth? | Cystocele
🗑
|
||||
| A woman complaining of lower back pain and the sensation of sitting on a ball, aggravated by coughing or sneezing, urinary incontinence, and dyspareunia likely has what condition? | Cystocele
🗑
|
||||
| What diagnostic tests may be used to confirm a cystocele? | Usually a clinical diagnosis, but intravenous pilogram (IVP), U/S, or MRI may be helpful
🗑
|
||||
| What management techniques are used for a cystocele? | Kegel exercises to strengthen pubococcygeus muscles... vaginal weights; pessary
🗑
|
||||
| What is the name of the condition where there is a rectovaginal herniation between the rectum and vagina? | Rectocele
🗑
|
||||
| What pelvic organ prolapse is common in multiparous females? | Rectocele
🗑
|
||||
| What diagnostic technique is used to confirm a rectocele, rather than an enterocele or sigmoidocele? | Cystoproctography
🗑
|
||||
| When is medical management used in a rectocele? | For a patient who desires more children
🗑
|
||||
| What medical management options are available for a rectocele? | Stool softeners, kegel exercises, pessary, or surgical intervention if also have a uterovaginal prolapse
🗑
|
||||
| What is the name of the condition where there is a downward placement of the vaginal apex due to loss of muscle and ligament support? | Vaginal prolapse
🗑
|
||||
| Which pelvic organ prolapse typically follows a hysterectomy? | Vaginal prolapse
🗑
|
||||
| A woman presents with low back pain, dyspareunia, and a sensation of bearing down. What condition might she have? | Vaginal prolapse
🗑
|
||||
| What medical management techniques are used for vaginal prolapse? | Surgery (vaginal suspension) if patient has a desire to remain sexually active. If not: colpectomy and colpocleisis (surgically remove vagina and close off space)
🗑
|
||||
| Which quadrant of the breast contains the greatest volume of tissue? | Upper outer quadrant
🗑
|
||||
| What are the 3 types of imaging studies? | Mammograms, ultrasound, and MRI
🗑
|
||||
| Which imaging technique is used to identify a cyst vs. fibroadenoma vs. cancer in the breast? | Ultrasound
🗑
|
||||
| Which imaging technique is useful in staging breast cancer? | MRI
🗑
|
||||
| Which imaging technique is used to screen for breast cancer? | Mammogram
🗑
|
||||
| Which imaging techniques may be used to guide biopsies? | Ultrasound or MRI
🗑
|
||||
| What technique is used to determine the presence of malignant cells in breast cancer, as well as estrogen and progesterone receptor status? | Biopsy
🗑
|
||||
| A woman older than 40 years of age presents with unilateral bloody nipple discharge. What condition might this suggest? | Cancer
🗑
|
||||
| A woman who is younger than 40 has bilateral milky, blue-blue/green breast discharge. Does this suggest a benign or malignant condition? | Benign
🗑
|
||||
| A woman presents with unilateral bloody discharge. There is no palpable mass. A mammogram returns negative, and a ductogram shows a lesion inside a duct. What is her most likely diagnosis? | Intraductal papilloma
🗑
|
||||
| A woman presents with bilateral milky nipple discharge and elevated serum prolactin levels. What condition might she have? | Pituitary adenoma
🗑
|
||||
| What are the 2 most common causative organisms of mastitis? | S. aureus and S. epidermidis
🗑
|
||||
| A woman who is in her 3rd week of breast feeding present with a hard, painful, hyperthermic, erythematous breast. What condition does she most likely have and what is the treatment? | Mastitis; Treat with antibiotics, cut and drain if fluctuance, and pain control
🗑
|
||||
| A woman between 30-40 years old complains of a tender, smooth, mobile breast mass that is well-defined, firm, and appears jet black on ultrasound. What is the most likely diagnosis? | Breast cyst
🗑
|
||||
| What is the treatment for a breast cyst that is both diagnostic and therapeutic? | Aspiration... cyst should not be palpable afterwards
🗑
|
||||
| A woman younger than 30 presents with a smooth, firm, rubbery, mobile, non-tender mass that changes in size with her menstrual cycle and also becomes more tender with her menstrual cycle. What might the mass be? | Fibroadenoma
🗑
|
||||
| When should a fibroademona be removed surgically? | If it is greater than 2 cm, if it increases in size, if it is symptomatic, or if a pregnancy is being planned
🗑
|
||||
| A woman age 30-40 presents with a large, smooth, lobulated mass that has grown rapidly and has well-circumsized, smooth borders on imaging. What might her diagnosis be? | Phyllodes tumor
🗑
|
||||
| What is the treatment for phyllodes tumor? | Surgical removal, occasionally a total mastectomy, radiation if tumor >5 cm, or chemotherapy if tumor >5cm and stromal overgrowth
🗑
|
||||
| What gene is associated with the greatest rates of breast and ovarian cancer? | BRCA1
🗑
|
||||
| What gene is associated with breast cancer, and a low risk of ovarian cancer? | BRCA2
🗑
|
||||
| A woman who is BRCA + should take what precautions (3)? | Increased surveillance, chemoprevention (tamoxifen if >35 yo), or surgical prevention
🗑
|
||||
| What are important risk factors of breast cancer? | Age**, BRCA +, Family history (especially 2 first-degree relatives diagnosed at an early age), personal history, Ashkenazi Jewish heritage
🗑
|
||||
| A woman present with bloody nipple discharge, breast dimpling, nipple retraction/inversion, breast erythema, breast edema, and peau d'orange. A mammogram shows a suspicious lesion that is palpable (or not). What is the most likely diagnosis? | Breast cancer
🗑
|
||||
| What are the two types of noninvasive breast cancer? | Lobular (LCIS) and Ductal (DCIS)
🗑
|
||||
| What is the type of non-invasive breast carcinoma that is considered a precancerous lesion, not a cancer? | Lobular (LCIS)
🗑
|
||||
| What is the type of non-invasive cancer that should be treated as a malignancy because it has potential to develop into invasive cancer? | Ductal (DCIS)
🗑
|
||||
| Which non-invasive carcinoma has clustered pleomorphic calcifications on imaging? | Ductal (DCIS)
🗑
|
||||
| What is the treatment for lobular non-invasive breast carcinoma, LCIS? | Lifelong close surveillance
🗑
|
||||
| What is the treatment for ductal non-invasive breast carcinoma, DCIS? | Surgical removal, radiation, adjuvant hormone therapy
🗑
|
||||
| Which invasive carcinoma is more likely to present bilaterally, but not form microcalcifications? | Lobular
🗑
|
||||
| Which invasive carcinoma is the most common breast malignancy? | Ductal
🗑
|
||||
| What are the treatment options (2) for a localized/regional invasive carcinoma? | Surgery or radiation
🗑
|
||||
| What are the treatment options (2) for systemic invasive carcinoma? | Chemotherapy or hormone therapy
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| What management option has the greatest cure rate in patients with stage I or II breast cancer? | Surgery
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| What management option for stage I or II breast cancer has a decreased morbidity and is most appropriate for stage I or II breast carcinoma? | Breast conservation surgery
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| In what breast cancer patients is chemotherapy used? | Primary and metastatic cancers, and + lymph nodes
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| If breast cancer is responsive to estrogen/progesterone receptors (ER+), what management options are used (3)? | Selective estrogen-receptor modulators (SERMs), Aromatase inhibitors
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| In which breast cancer patients are aromatase inhibitors used, and what is a benefit to them in comparison to Tamoxifen (hormone therapy)? | Post-menopausal women; fewer side effects
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| In which breast cancer patients is chemo + radiation illicited? | Cancer is not responsive to estrogen/progesterone receptors (ER-), no genes for breast cancer
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| If breast cancer has lymphatic spread, where is the primary place it spreads to? | Axillary lymph nodes
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| What is the breast TNM classification for no evidence of a primary tumor? | T0
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| What is the breast TNM classification for carcinoma in situ? | Tis
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| What is the breast TNM classification for a primary tumor <2 cm? | TI
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| What is the breast TNM classification for a primary tumor >2 cm but <5 cm? | TII
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| What is the breast TNM classification for a primary tumor >5cm? | TIII
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| What is the breast TNM classification for a primary tumor of any size with direct extension to the chest wall or skin? | TIV
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| What is the breast TNM classification for no lymph node metastasis? | N0
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| What is the breast TNM classification for metastasis to 1-3 axillary lymph nodes? | N1
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| What is the breast TNM classification for metastasis to 4-9 axillary lymph nodes? | N2
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| What is the breast TNM classification for metastasis to 10+ axillary lymph nodes? | N3
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| What is the breast TNM classification for no distant metastasis? | M0
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| What is the breast TNM classification for distant metastasis? | M1
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| A woman presents with a palpable breast mass, eczematous changes in the nipple, complaining of nipple irritation and itching, and a biopsy confirms carcinoma. What condition, specifically, might she have? | Paget's Disease
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| What breast cancer is the most rapidly lethal? | Inflammatory breast cancer
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| A woman presents with a palpable breast mass (or not), dermal and lymphatic invasion, diffuse induration, erythema, warmth, edema, peau d'orange, and commonly distant metastasis. What is the most likely diagnosis? | Inflammatory breast cancer
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| How often should history and physical exam be performed as follow-up care for breast cancer? | Every 3-6 months for 5 years, then annually
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