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18 Cards in this Set

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Cyclic Breast Pain
common***
Age<40***
bilateral***
related to menstrual cycle***
Noncyclic Breast Pain
Age>40
unilateral
unrelated to menstrual cycle
Physiologic Differentials for nipple discharge
(bilateral milky or watery)***
Idiopathic***
Galactorrhea***
Medication***
Anovulatory sndromes also have irregular menses***
Sella Turcica Lesions also have irregular menses
Pathologic DDx for nipple discharge
Duct papilloma***
Fibrocyst***
Duct ectasia***
Eczema***
Paget's Dz***
Early ductal CA***
Infection/Inflammation***
Red flags of breast cancer
**pain-unilateral, noncyclic**
**nipple d/c-unilateral, serosanguineous, serous, single duct***
**breast mass-immobile, noncystic**
Diagnostic tests for breast mass
CBE,
Mammography,
FNA,
US
Triple Approach with new breast mass
**1. CBE**
**2. FNA**
**3. Mammography**

**Negative only if all are negative**

**Minimizes the number of excisional bx for benign dz**

gold standard for breast mass evaluation
Top organisms that cause UTI's
**E. Col: 80-90%**

**Other Gram (-): proteus, klebsiella pneumoniae, pseudomonas aeruginosa (usually nosocomial)**

**Gram (+): Staph saprophyticus, S. aureus, group B strep, and enterococcus faecium**
UTI clinical Hx
frequency,
nocturia,
pain on urination,
supraprubic discomfort
pyelonephritis clinical Hx
fever,
chills,
abd pain,
flank pain,
vomiting
common urinary tests
**Leukocyte esterase detectss presence of esterase from WBC**
**Nitrate dietary nitrates in urine are converted to nitrite by bacteria**
**blood-negative is common, but if positive can help rule in dx**
common Tx of uncomplicated UTI
**3 days**
**Analgesic: phenazopyridine**
**Bactrim, Trimethoprim alone, Nitrofurantoin, or a fluoroquinalone (Cipro)
DDx for Secondary Dysmenorrhea
**Cervical Stenosis**
**Cervical polyps**
**Ovarian csts**
**PID**
**Endometriosis**
**Leomyomas/fibroids**
**IUD complications-uncommon**
**Endometrial Cancer-uncommon**
Tx for Primary Dysmenorrhea
**NSAIDS**
**OC**
**together provide additional pain relief**
Drugs to tx PMS
**Calcium Supplement 1,200 mg/day**
**SSRIs first line-intermittent tx during luteal phase also effective**
**Magnesium: 200-300 mg/day**
**Pyridoxine (B6) 50 mg**
**Buspirone 25-60 mg intermittently**
**Alprazolam 1-2 mg intermittently**
**OC's effect unclear**
Non-Estrogenic Meds for Vasomotor sx of menopause
**Gabapentin**
**Paroxetine**
**Venlafaxine (effexor)**
**Clonidine**
**Megestrol (megace)**
Hormone prep for Perimenopausal women
**Estrones-premarin**
**Estradiols-micronized estradiol**
**Progestins-Provera**
**Combined estrogen/progesterone-Prempro**
**Androgens-Testosterone (androgel)**
**Combined Estrogen/Androgen-estratest**
Rx for osteoporosis
**Bisphosphonates**
**Alendronate (fosamax)**
**Alendronate+Cholecalciferol (fosamax plus D)**
**Ibandronate (boniva)**
**Risedronate (actonel)**
**Risedronate and Calcium (actonel and calcium)**