MS FINALS Q3
Fibrocystic Changes in Breast (Breast Pain)
- Should be gone after menstruation
- Can be hard or fluid like
- Not dangerous
- General Symptoms: Chest pain
RF:
- Increase in estrogen stimulation:
increased estrogen allows dilation of the
inframammary ducts which then
increases the fluids in breast
 Inframammary is the cell
responsible for production of breast
milk
 If the Fibrous is large, it will crush
the nerves causing breast pain
Manifestations
- Cystic= soft lump
- Fibrous= hard Lump
- Tender and sometimes non tender
Possible nipple diagnostics
Ask if they only felt the lump during their mens
or not: note* it should only be felt during mens
Diagnostics:
1. Physical Examination
 If in 2 mens cycle the lump is
present and not present= confirmed
fibrocystic
2. Ultrasound/ mammography
3. Aspiration
*Note: Increase in production of milk causes
lump in the breast
MX:
- Observation: BSE
- Pain meds: NSAIDS (IBUPROFEN,
MEFENAMIC)
- BROMOCRIPTINE: decreases
progesterone and inhibits the hormone
that stimulates breast milk which is the
PROLACTIN
 Increase dopamine levels
*Note: post abortion patient can still produce
breast milk hence give bromocriptine to avoid
cases of fibrocystic formation
Breast Anatomy
- Decrease Progesterone and estrogen
triggers mens and sends signal to the
pituitary gland.
- Pituitary gland is responsible for
increasing the proge and estro
- When PG is triggered, it releases:
 FSH: this hormone goes to the
ovaries and produces estrogen, now
the estro is elevated and proge is
not
 LH: this hormone will then go to the
corpus luteum where progesterone
is produced, now both hormones are
elevated= Good
Benign Tumor of the breast
- Fibrocystic changes: clear fluids
- Galactocele: if the content of the cyst is
milk
- Fibroadenoma: high risk for developing
Breast CA
 Does not occur during mens
 Can only be seen or diagnosed
during mammography
 MX: Excision Biopsy= curative
 Manif: Movable, Painless, Regular
border/ smooth
BREAST CA
RF:
- Primary (absolute RF for Breast CA)
 Advancing age
 Female
 History: personal (if have tumor sa
left, possible na meron din sa right).
Family: genes BRCA1 and BRCA2,
if these two are mutated or
defective= increase risk for Breast
CA
- Secondary
 Nulligravid
 Gave birth for the first time @ 30 y.o
 Prolonged estrogen exposure: Early
Menarche and Late Menopause
 Hormone Replacement therapy:
dangerous if its pure estrogen
instead give a mixture of proge and
estro
Manifs:
- Lump: most commonly located @
UPPER OUTER QUADRANT
- Characteristics: Painless to painful:
painful indicates that it is already at the
end stage
- Immovable/ Fixed
- Asymmetry: obvious
- Changes in breast skin
 Scaling/ Scale: PAGETS DISEASE
of the breast
- Peau d’ orange: orange peel skin=
advanced stage
- Erythematous: Reddish: indicated
inflammatory BCA
- Necrotic: due to decreases blood
supply. Oxygen received by the tissue
lessened to none
- Nipple:
 Unusual Discharges (blood and pus)
 Nipple inversion
STAGING
0- Carcinoma in situ without Lymph Node
Involvement (LNI)
1- Tumor size: <2cm w/out LNI
2- 3 classifications:
 <2cm but w/ 1-3 LNI
 2-5 cms w/w/out LNI
 >5cms w/out LNI
3- Any size of tumor + >4 LNI
4- Distant metastasis
MS FINALS Q3

MX:  Overflow incontinence: excessive

*Surgery w/ axilla lymph node dissection
- Lumpectomy: X of lump only and LN
- Simple Mastectomy: X breast only
- Modified Radical Mastectomy: X
Breast and LN
 Radical Mastectomy: X
Breast+LN+Muscles
Post Op care:
Lymphedema
- Side lying on the unaffected side w/ arm
raised
- X any procedure on the unaffected side:
if both breast was removed, choose the
side where less lymphedema occurred
*Radiation: External Teletheraphy
*Chemo
*Meds:
volume of urine in the bladder (most
common in BPH)
 Urge incontinence: can still control it
but to the urge to urinate, it
becomes uncontrollable
- Nocturia: urinate at night
- Urinary frequency
- Urinary urination: urine backflows to the
kidneys then ureter= recurrent UTI
 Bladder: Cystitis
 Kidneys: Tialonephritis
 Ureter: Ureteritis
 Urethra: Urethritis
Note* as long as there’s a male hormone
(Testosterone), there will always be an
increased risk for BPH due to increasing
androgen
Diagnostics:
Note* we don’t entertain BPH as cancer hence
don’t automatically do biopsy

- Selective Estrogen Receptive - Digital Rectal Exam

Modulators (SERM)  Enlarged= abnormal
 Blocks estrogen but blocks only the  Asymmetrical
estro from the breast - Prostate specific antigen (PSA)
 TAMOXIFEN: used only on pre- - Urinalysis + CBC: BPH is associated w/
menopausal age UTI/ infection hence we need CBC to
 RALOXIFENE: post menopausal confirm if there’s an infection or not
 Taken for 5 years
Meds:
- Aromatase Inhibitors
 Inhibits androgens: produced by Goal* decrease the androgen and muscle
adrenal glands: adrenal glands contraction. decreased androgen= decreases
stimulate androgen that increases muscle contraction= relaxed muscle= smooth
estrogen urination. (GOOD)
 ANASTRAZOLE: S/E increases risk
for osteoporosis FINASTERIDE
- High Dose estrogen - Decrease androgen
 DIETHYLSTILBESTROL - S/E: decrease libido, sperm count and
Benign Prostate Hyperplasia infertility issues
- NI: conserve sperm
- As men grows, their prostate shrinks
TERAZOSIN, TAMSULOSIN
RF:
- Relaxes muscle
- >50 y.o - S/E: hypotension
- Male (only if their prostate still exists)
- High fat diet (commonly associated w/ Hormones:
BPH DIETHYLSTILBESTROL
- Common in white/ western people
- give estrogen to lessen/ balance the
Manifs: amount of T hormones
Since the tumor is located in the ureter, it blocks - reversible
the urination Synthetic Steroids
- Incomplete voiding - S/E: high risk for infections and WT gain
- Decrease force in urination (they need
to force themselves to urinate because MX:
their urination is not continuous)
- Post- urination dribbling: starts with ORCHIECTOMY
droplets, then continuous, then droplets - X of testicle and scrotum (irreversible)
again  Testicle produces androgen,
- Incontinence: uncontrolled urination removing it will decrease the
 Stress incontinence: due to increase androgen which caused the BPH but
pressure in the abdomen, urination it causes body disturbed image to
becomes uncontrollable the PT
MS FINALS Q3

PROSTATECTOMY  Can work as long as not strenuous

as early as 4 wks
- X of prostates  Can resume sex acts after 4 wks
- PUDENDAL NERVE: a nerve in the  Hematuria (post operative only!):
prostate where if its hit, it’ll cause increase oral fluids to excrete blood
infertility clots
- Opens abdomen - RAD
TRANSURETHRAL RESECTION OF THE - CHEMO
PROSTATE TESTICULAR CA
- Insert scope in rectum to access RF:
prostate, once accessed, insert the
agent that shrinks the prostate and pull - 15-40 y.o
out the prostate - Can be congenital
- No incision so it mostly preferred that  CRYPTORCHIDISM: undescended
prostatectomy testes at birth= high risk for
- Disad: can injure the Blood V. which Testicular CA
might cause bleeding hence do the - Family history: especially if twins, the
 Continuous bladder irrigation: to other twin could also have TCA
prevent or remove clots formed in
the ureter which might be a Manifs:
hindrance to the urination - Enlargement/ swelling testes
 Expect clear/ pinkinsh color upon  Usually one side but rarely both
aspiration sides
 Since we instill fluids to remove  Painless: if have pain, it should be
bleeding, it might cause 3rd spacing abdominal pain
 TURP SYNDROME: if they drank
much water but they urinate few STAGES
only. It causes: fluid retention and
1. Localized without LNI
hyponatremia= seizure or any
2. Localized w/ LNI
malfunctions related to brain
3. DMT
PROSTATE CA
MX:
RF: same w/ BPH
- ORCHIECTOMY
- >50 y.o - Testicular self exam
- Male (only if their prostate still exists)
FEMALE REPRODUCTIVE
- High fat diet (commonly associated w/
BPH CERVICAL CA
- Common in white/ western people
- Increase in terms of numbers but not
Manifs: common
Musculoskeletal pain RF:
- Positive metastasis - HPV exposure (16,18 strains)
- Migrating pain  vax: GARDASIL: covers 8,11,16,18
- Stagnant pain strains. 3 DOSES IN 6 MO
 8,11 strains are most commonly
Urinary Problems same w/ BPH
found in genital warts
WT LOSS: sudden and unexplained - Engaged early sexual intercourse
 Either at age 21 or 3 yrs after sexual
ANEMIA intercourse
STAGING  NI: assess sexual history
 MX: PAP SMEAR: 3 yrs after sexual
1. Localized tumor in prostate: non contant
palpable - Multiple sexual partners
2. Localized tumor in prostate: palpable - Early pregnancy
tumor - SI/ Sexual intercourse/ Uncircumcised
3. Affects nearby structures SA vas male
deference, scrotum/ within prostate area  Their foreskin is a reservoir of
4. Distant Metastasis (DMT) microorganisms which causes
infection
MX: - Nutritional deficiency: obesity,
SURGERY malnutrition

- PROSTATECTOMY STAGING
 Rest for 4-8 weeks 1. Localized in cervix
 Can drive after 2 wks 2. Spread to other pelvic organs (vagina,
uterus etc)
MS FINALS Q3

3. Spread to peritoneal cavity (GI TRACT) ENDOMETRIAL/ UTERINE CA

4. DMT
- Most common reproductive ca
Manifs:
RF:
- Vaginal Bleeding during SI
 From watery discharges- Bleeding - Early menarche
 Blood during sex should be minimal - Increase estro
 MENORRHAGIA: excessive blood - Late menopause
loss during mens - Nulligravid
 METRORRAGHIA: bleeding in - Hormone replacement therapy/
between mens interval ( Dec 11, Unopposed estrogen
Dec 28, Jan 11) TYPES
 Vaginal bleeding during douching:
sudden bleeding while doing simple Type 1.
acts
- Estrogen dependent
- DYSPAREUNIA
- Predictable
 Painful SI
- Low grade: Good prognosis
 Stabbing/ sharp pain
 Pain even if penis is already Type 2
withdrawing
 Severe pain - Estrogen independent
 Sometimes goes together with - Not predictable/ cant detect if its
bleeding estrogen related
- Pelvic pain - High grade: Bad prognosis

MX: Manifs:

NON INVASIVE CA Its common because its easily detected and

- COLPOSCOPY W/ LASER THERAPY
 Visualize tumor location and apply
laser to shrink the tumor
- CONIZATION
 If tumor is too deep for colposcopy
 Extract tissue in cone shaped for
biopsy
 Cervix: Columnar Tissue
 Vagina: Squamous Tissue
 Transition site: most common site
for cervical ca growth: found in
between columnar and squamous
tissue
happens only in post-menopausal
- Post-menopausal bleeding: foul smell
- Abdominal distention
- Constipated: in old people
- Pelvic pains
MX:
- Hysterectomy
- Rad: Internal, advice: low fiber diet to
not dislodge to implant
- Chemo
OVARIAN CA

INVASIVE - Leading cause of death for females

- Associated with BRCA1 and BRCA 2
If CA has spread upwards SA Uterus mutation
- Hysterectomy w//w/out: RF: (same w/ Endo. CA)
 Salpingectomy: X of fallopian tube
 Oophorectomy: X of ovaries - Early menarche
- Increase estro
Radiation: Internal rad - Late menopause
- Nulligravid
Chemo
- Hormone replacement therapy/
Unopposed estrogen

STAGING (same w/ cervical ca)

1. Localized in cervix
2. Spread to other pelvic organs (vagina,
uterus, fallop etc)
3. Spread to peritoneal cavity (GI TRACT)
4. DMT

Manifis:

Starts asymptomatic

Symptoms:

- GI disturbances
- Anorexia
- Abdominal distention
MS FINALS Q3

- Diarrhea  Triggers: high carbs diet: provide

- Constipation low card, high protein and high fats
diet
Advanced Complications:  Triggers: Sugar, chocolates. Milk
ASCITES  Advice: drink water in between
meals or after every meals
- PARACENTESIS: aspirate fluid in the  Position: rest and SUPINE
abdomen - PERNICIOUS ANEMIA
 Vit. B12 deficiency/
Intestinal obstructions
cobalamine/ cyanocobalamines
- Remove the obstruction through  The stomach produces intrinsic
surgery: Bowel Resection factor which is needed for vit.
- Advice: NPO, NGT b12 absorption
- Give TPN, central  In gastrectomy, intrinsic factor is
 Tpn has many glucose, since removed causing vb12
glucose increases bacteria and also deficiency hence we give:
causes hyperglycemia, give Central  Synthetic intrinsic factor for
to dilute the Glucose remedy
 Advice: alcohol/ handwashing
RAD
Deep Vein Thrombosis
CHEMO
- Give anticoagulants sa: HEPARIN
COLORECTAL CA
Lymphedema
- Affects the large intestine and rectum
- Elevate feet
RF:
MX:
- High fat diets
- Hysterectomy w/ oophorectomy - Processed foods
- Pelvic exenteration - Fried foods
 X Pelvic organs+ abdomen - Colorectal polyp
 Anterior PE: pelvic organs+  FAMILIAL ADENOMATOSIS
Urethra/ bladder except vagina POLYPOSIS: hereditary multiple
 Give: ILEAL CONDUIT: urinate/ polyps
divert urination in the abdomen  NON-HEREDITARY POLYPOSIS:
 Posterior PE: pelvic organs+ increase risks for polyposis but not
rectum give COLOSTOMY hereditary. Can also increase risk
- RAD for: pancreatic, ovarian, gastric,
- CHEMO endometrial, renal, and small
intestine ca
GI TRACT CA
Manifs:
GASTRIC CA
- Anorexia, wt loss: GENERAL
RF: - Right side colon:
- H.Pylori exposure  Changes in bowel habit = diarrhea
- Chronic gastritis and melena (affects ascending and
- Peptic ulcer disease transverse intestine)
- Gastric Polyp (dangerous if polyp’s size - Left side colon:
is big and w/ anaplasia)  Constipation= hematochezia (affects
transverse, descending, sigmoid
Manifs: and rectum)
- Rectal:
- Epigastric pain upon eating
 Alternating constipation and
- Anorexia
diarrhea
- WT loss
- Weakness MX:
- Melena
COLECTOMY
MX:
- Can be parts/ whole
GASTRECTOMY - STOMA:
 Should be pink
- X part of the stomach only
 1st 24 hrs: mild edema is normal
- Disad: DUMPING SYNDROME
 >24 hrs: edema is not normal
 Due to fast/rapid absorption of food,
already
mabilis lang sila mag poop
 NI: X irritants
 S&S: abdominal cramps, diarrhea,
 Give: PARSLEY: as natural
weakness
deodorizer (crush the parsley)
 X any gas forming foods SA eggs
MS FINALS Q3

 Empty pouch is its already 1/3 or ½ Manifs:

full
- Rad - Cough (dry cough and starts w/ non-
- Chemo productive but become productive as the
days go by)
- DOB w/ WHEEZING: heard upon
exhalation
LIVER/ HEPATOCELLULAR CA - HEMOPTYSIS: coughing blood (can be
RF: pure blood/ mixed w/ saliva, pure blood:
invasive ca already
- Hepa B and C - ANOREXIA
- Alcohol - WT LOSS
- Fatty foods - FATIGUE
- Smoking
- Cirrhosis (irreversible: liver does not Note* LCA also affects other organs SA heart
regenerate if theres cirrhosis) Cardiac Manifs:
MANIFS: - Chest pain
- RIGHT UPPER QUADRANT PAIN - Endocarditis: heart valves in the endo
- Jaundice (if black skin, check mucosa is destroyed, if endo is destroyed,
instead) backflows happen= decreased cardiac
- Itchiness/ pruritus output/ heart failures
- Anorexia - Increase risk for thrombophlebitis
- Weakness PARANEOPLASTIC SYNDROME
MX: - Symptoms that started from a certain
SURGERY organ ex: the problem started from the
lung but then affected the endocrine.
- Liver transplant Expect endocrine problems SA:
- You can X the liver but body might  Increase ACTH= Cushing’s disease
increase toxicity since toxins cant be  SIADH: increase ADH= cant pee
filtrated anymore (water retention, hyponatremia)
- Rad  HYPERCALCEMIA: increase PTH
- Chemo activity/ Parathormone activity
 Expect: porrus/ brittle bones
 Give: Calcitonin to bring the ca+
LUNG CA/ BRONCHOGENIC CARCINOMA from blood to bone
 Give: BIPHOSPHONATES sa
- Leading cause of death of all cancers in ALENDRONATE: to strengthen
both genders weak bones (it decreases
Only diagnosed in advanced stage ☹
osteoclastic activity)
-
 OSTEOBLAST: BUILDING
 OSTEOCLAST: CRUSHING
RF: - Cardio:
- Smoking: leading cause  Compression of superior vena cava/
- Exposure to chemicals SVC syndrome
 Radon: soil  If VC is compressed, it creates
 Asbestos: fabrics, pipes backflows and goes upward to facial
 Nickel metal used for money, and neck causing= EDEMA
miners, pollution from factory  Look for S&S of:
- Hereditary  Flushing
 Unilateral edema
2 classifications of LCA  Cyanotic
 Chest pain
1. Small cell carcinoma/ OAT CELL
 Stoke sign: difficulty in buttoning
 More aggressive
their buttons
 Grows and spreads rapidly
 If these signs are found= expect
 Seen as central lesion
RADIATION
2. Non-Small cell carcinoma
- CNS
 More common that SCC
 Peripheral neuropathy: damaged
 3 Types:
nerves= numbness. give vit.b for
 Adenocarcinoma: starts as
nerve function
peripheral carcinoma
 Cerebellar Dysfunction= unsteady
 Squamous cell carcinoma: starts
gait, walk like a drunk
centrally
 Large cell carcinoma: Peripheral
carcinoma but larger in size
MS FINALS Q3

MX: - Aspiration from orogastric

Surgery
- Only indicated if the tumor is still small
SA NSCC
 Wedge resection: cut small portion
of bronchi
 Segment resection: all
tertiary/segments are removed
 Sleeve resection: major part of
secondary is removed and
reconstruct the remaining part
 Lobectomy: remove lobes of the
lungs (3 rights, 2 left): position on
the unaffected side
 Pneumonectomy: remove 1 lung:
position on the affected side
 Expect: PT might have
pneumothorax hence insert the
TUBE! (study 3 bottle system)
- Rad: Palliative rad
- Chemo: for SCC only
LYMPHOMA
- Systemic
- Decrease in lymphocytes that are
mature
- Increase in immature lymphocytes
- PT is considered
IMMUNOCOMPROMISED (decrease
wbc)
RF:
- Epstein Barr virus
 Seen in Africans only
- HIV/AIDS: in ph
- HEREDITARY
secretions: inhaled the aspirated acid
to the lungs after choking
- Droplets: inhaled
- Hematogenous spread: infected blood
Classifications
1. CAP (Community acquired pneumonia)
- <48 hrs from admission
2. HAP (Hospital ap)
- >48 hrs from admission
3. HCAP (Healthcare acquired/ associated
pneumonia)
- Non institutionalized/ outpatient/ not
admitted but has prolonged contact in te
hospital
- Ex: hemodialysis, nursing homes,
chemotherapy
Manifs:
- Fever
- Cough: rusty colored sputum
- Crackles
- Pleuritic chest pain (pain upon
inhalation)
- Pleural friction rub
- DOB
MX:
- Antibiotics
- Oxygenation: Venturi mask
- Bronchodilators: SALBUATAMOL
- Anti-cholinergic: IPRATROPIUM
BROMIDE
- Mucolytic: ACETYLCYSTEINE (once
daily for 3 days)
- Natural mucolytics: water

Types:

Hodgkins Non hodgkins ABG

Young adults: 20-40 Older adults: >60 y.o
y.o - PH: 7.35-7.45 [ <7.35= ACIDOSIS, >7.45=
Male Male ALKALOSIS]
LN affected is LN affected is
-PCO2(Partial pressure of o2, Respiratory): 35-
continuous (cervical regional/ patchy
45 mmhg [<35= ALKALOSIS, >45= ACIDOSIS]
LN)
(+)REED (-)REED -HCO3 (Bicarbonate, Metabolic): 22-26mmhg
STERNBERG CELLS STERNBERG CELLS [<22= ACIDOSIS, >26= ALKALOSIS]
Manifs:

- Painless enlargement of LN (Cervical,

supraclavicular LN): Unilateral  HYPOVOLEMIA- Flat Neck Vein: In
- Fever and chills (low grade fever) supine, the neck should distend, if
- Night sweats no distention/flat=abnormal
- Anorexia, wt loss
Diuretics
MX:
 Loop Diuretics (Restrict k+ in diet)
Rad (Local Rad)  Furosemide: k+ wasting: watch out
for hypokalemia and Hyponatremia
Chemo (Systemic chemo): mostly recommended and hypocalcemia
PNEUMONIA  Thiazide Diuretics
 Decreases k+, na+ and increases
- Simple lung infection CALCIUM
- Affects lower portion of lungs w/c affects  Watch out for hypercalcemia as it
the alveoli: responsible for gas causes renal stones
exchange  K+ wasting
 Potassium Sparring
Transmission:
 Increases k+, decreases
na+=Hyperkalemia
MS FINALS Q3

 Low c++
 Check out for: Spinoloractone,
Triamterene and Amiloride

HYPERNATREMIA

 >145

 Increased QRS amplitude

 PEAKED T WAVES
 ST segment elevation

HYPONATREMIA

 <135

HYPERCALCEMIA

 >10 CA

HYPOCALCEMIA

 <8.5 ca+