study guide 114 Final unit 2

  1. What are the layers of the uterus
    • endometrium (sheds away each month if egg not fertilized)
    • Myometrium (middle muscular layer where fibroids develop)
    • Perimetrium (outer layer of uterus)
  2. vagina
    collapsible hollow tube that is vulnerable to pressure from other structures
  3. Cervix
    bottom portion of the uterus
  4. what does PAP test check for?
    Cervical Cancer
  5. PAP Test Prep
    • no intercourse for 24 hours before test
    • no vaginal bleeding for best results
    • no douching
  6. if initial PAP test is positive what is done next
    • Colposcopy
    • which is PAP where vinegar is used to accentuate the features of the cervix and then a lighted instrument is used to look for lesions, cancerous area on the cervix
    • If any identifiable lesions are found a cervical biopsy is done
  7. Hysteroscopy
    should be done when pregnancy is least likely. 2-5 days after menses after bleeding but before ovulation
  8. laparoscopy
    • 3 small trochars placed into abdomen
    • abdomen is distended  with CO2 for visualization
  9. semen analysis looks at....
    • count
    • motility
    • shape
    • DNA
    • ability to swim
    • quality of fluid (should be alkaline)
  10. why should semen be alkaline
    to balance the female vagina is very acidic
  11. prostate biopy
    Why is it done and how is it done
    • looks for cancer cells
    • done either transrectal or transurethral
    • needle biopsy with multiple specimens to increase the chance of finding cancer
    • Normal PSA is less than 4ng/ml
  12. determining ovulation
    • 1st stage follicular phase can be any #of days
    • Last stage Luteal Phase is always 14 days
    • Ovulation triggers Luteal Phase to begin
  13. most patients that suffer from PMS or fibercystic breast disease have most symptoms ......
    during luteal phase right after ovulation
  14. Ductal Ectasia
    • benign breast problem of women approaching menopause
    • caused by the thickening of the ducts in subareolar area
    • Mass hard with irregular borders
    • Greenish Brown Nipple discharge
  15. Intraductal Papilloma
    • Benign occurs women 40-55
    • bloody nipple discharge as papilloma grown it causes trauma and erosion in the duct
  16. Fibroadnoma
    • Benign adolescence - 30
    • Solid, slowly enlarging, round, firm, easily movable, nontender, usually located in the upper outer quadrant
  17. Fibrocystic Breast Disease
    • nodularity of the breast occurs 20-30
    • can increase in severity until menopause
    • Cyclic in nature
    • pain tenderness, cysts in breasts
  18. Gynomastia
    • less than 1% of all breast cancer is men
    • Alcoholism
    • Obesity
    • Liver Disease
    • Hyperparathyroidism
    • Androgen Deficiency
    • Estrogen Excess
  19. What are the risk factors for developing breast cancer?
    • 1st degree relative
    • Obesity
    • early menarche, or late menopause
    • having no children, or having children late in life
    • not breast feeding
    • using oral contraceptives
    • More estrogen the more likely you are to  have breast cancer each of these thing would stop the estrogen for an amount of time
  20. DCIS
    What is it ad how is it treated?
    • Ductal Carcinoma in  Situ:cancerous cells in the mammary ducts. (not dangerous in ducts)
    • Usually treated very aggressively because once it leaves ducts it is very dangerous and they cannot predict if or when is will erupt for the ducts
  21. most common breast cancer
    Ductal Carcinoma
  22. Lobular Carcinoma
    • about 10%
    • does not always form palpable lump
    • harder to see on mamogram
    • Only type that may present in both breasts at one time
  23. Colloid Carcinoma
    • Occurs more frequently in older women
    • Good Prognosis
  24. Inflammatory Carcinoma
    • less tha 1%
    • very dangerous
    • sore, blister or lesion develops on the outer breast
    • often mistaken for mastitis
    • often metastasized at diagnosis
  25. Medulary CArcinoma
    occurs more frequently in younger wmen
  26. Triple Negative Breast Cancer
    • Poor Prognosis
    • Estrogen receptor negative
    • Progesterone Receptor Negative
    • Does not overexpress HER2NEU gene, less ways to treat because HER2NUE is not making it grow and Estrogen/progesterone are not feeding it
    • we don't  know why it is harder to treat and tends to reoccur quickly and is less responsive to chemo and rad
  27. treatment for estrogen/progesterone receptive tumor
    • Tamoxifen
    • or other estrogen blocking agent
    • give oral pill for 1-5 years
  28. Treatment for cancer that overexpresses HER2NEU gene
    Herceptin (IV treatment)
  29. lumpectomy
    • removal of the tumor
    • always accompanied by Radiation
  30. Mastectomy is only accompanied by radiation if...
    the lymph nodes are found to have cancer in them
  31. If axillary nodes are taken what effect does this have on the patient?
    • Increased risk of lymphedema
    • lymph nodes draw excess fluid from the body
    • doesn't  have good filtering system
  32. patient teaching for patients with ALND (axillary lymph node removal)
    • no lab sticks, IV, Blood draws or injections in affected extremity for 25 years
    • Keep arm elevated at night when possible
    • watch for S/S infection in extremity and report asap
  33. Adjuvant treatment for breast cancer
    • Chemo (IV Tx for prevention or to slow the growth of DISTANT metastasis)
    • Radiation (local external bream Tx to prevent LOCAL RECURRENCE)
  34. Primary Amenorrhea
    • 16 yr old with no menses
    • look for S/S of puberty
    • Anatomical anomalies
    • ask family about family history
  35. Secondary Amenorrhea

    causes and treatment
    • Preg, Menopause, breast feeding, hysterectomy,
    • less obvious causes: anorexia, strenuous exercise, some antidepressants, stress and anxiety
    • Tx oral contraceptives, treat causes
  36. PMS
    • involves cognitive, physical and emotional symptoms
    • begins with ovulation
    • have pt make symptom chart to know what to expect
    • may use oral contraceptives or NSAID for relief
    • will increase in severity until menopause
  37. Meonpause
    • 12 months have passes with no menses
    • 45-55
    • Hot flashes, Headaches, Anxiety, depression, insomnia, vaginal dryness, stress incontinence, decreased libido
  38. why is hormone therapy no longer used to treat menopausal women?
    • It increases risk of
    • breast cancer
    • ovarian cancer
    • risk of heart disease and stroke
  39. endometriosis
    what is it
    what are symptoms
    • growth of endometrial tissue outside of the uterus
    • may grow on bowel, ovary, diaphragm
    • pain, dyspareunia, constipation, backache, pressure lower abdomen
  40. how to Dx Endometriosis
    Laparascopy (has to be visualized to Dx)

    • Tx Danocrine, Danozol, Lupron (causes medical menopause)
    • only use for 6-8 months
    • then allow pt to try conceive symptoms will reappear after childbirth and regress at menopause
  41. Endometrial cancer
    • Disease of postmenopausal women
    • Good Prognosis if treated early
    • ALWAYS follow up on postmenopausal BLEEDING
  42. If bleeding is not endometrial cancer evaluate for
    • Atrophic Vaginitis (due to dry Mucosa)
    • Cervical Polyps
    • Endometrial Hyperplasia
  43. endometrial hyperplasia
    endometrial layers build up and breaks down intermittently and erratically due to lack of estrogen
  44. cervical polys
    painless benign lump on cervix that bleed very easily
  45. cervical cancer
    • is almost always caused by HPV
    • Usually No Symptoms (sometimes painless vaginal bleeding)
    • Is a disease of progression, takes years to progress to invasive disease
    • vaccine is Gardisil
  46. Ovarian Cancer
    • is the most deadly GYN cancer
    • symptoms are very vague (indigestion, backache, constipation, dyspepsia)
    • Biopsy must be done by Laparoscopy because ovaries difficult to reach and not palpable until very large
  47. Toxic Shock Syndrome
    • still monitored by CDC
    • wash hands before and after
    • tampons dry out vaginal mucosa and cause fissures and microabrasion. Staph bacteria are rapidly absorbed to blood stream causing sepsis and often death
  48. Uterine Prolapse and causes
    • 3 grades of uterine prolapse
    • uterus drops caused by child birth
    • multiple pregnancies
    • weakening of pelvis support due to lack of estrogen
    • age and gravity
  49. Cystocele
    protrusion of bladder through the vaginal wall due to weakened pelvic structures
  50. rectocele
    protrusion of rectum through a weakened vaginal wall
  51. endometrial ablation
    • burning or freezing uterine layer away to destroy it as an alternative to hysterectomy for various gyn problems
    • Pt should not get pregnant as supportive endometrium is gone
    • If successful not more periods
Card Set
study guide 114 Final unit 2
study guide unit 2 chapters 72,72,74