KIDNEY PAIN

1. Mechanism
2. Description

3. Potential Causes

1. Stretching of the Renal Capsule

2. Dull, Steady (does Not come and go), near CVA and may radiate to the Umbilicus

3. Kidney ONLY hurts when swollen or ede matous (Pylenephritis, Hematoma, Trauma)

URETER PAIN (RENAL COLIC)

1. Mechanism

2. Description

3. Potential Causes

1. Sudden distention of the ureter

2. Very Severe, Colicky, near CVA, and radiates DOWN the trunk into the lower quadrant and down to the scrotom of labium

3. Things that obstruct ureter, and thus cause Peristalsis to intensify and get extreme.  Stones (nephrolithiasis), blood clots

BLADDER PAIN: Mechanism of Irriration or Inflammation

1. Description

2. Potential Causes

BLADDER PAIN: Mechanism of Sudden overdistention

1. Description

2. Potential Causes

BLADDER PAIN: Mechanism of Irriration or Inflammation

1. Dull, Steady, pressure, discomfort, suprapubic

2. Cystitis: infection or inflammation

BLADDER PAIN: Mechanism of Sudden overdistention

1. Agonizing, suprapubic

2. Acute Bladder Outlet obstruction

PROSTATE PAIN: Mechanism of Irritation or Inflammation

1. Description

2. Potential Causes

PROSTATE PAIN: Mechanism of Hyperplasia with partial bladder outlet obstruction

1. Description

2. Potential Causes

PROSTATE PAIN: Mechanism of Irriration or Inflammation

1. Dull, discomfort, perineal or suprapubic and may radiate to rectum.  (Pain is more between the legs).  Irritative Voiding symptoms

2. Prostatitis (usually bacterial)

PROSTATE PAIN: Mechanism of Hyperplasia with partial bladder outlet obstruction

1. Hesitancy, Straining, Dribbling, and reduced stream

2. Benign Prostatic Hypertrophy

URETHRA PAIN

1. Mechanism

2. Description

3. Potential Causes

1. Irritation or inflammation

2. Burning, Stinging, Discomfort proximal or near to the glans.  Usually pain INITIALLY when start urinating, and may get better once stream has flowed)

3. Urethritis, trauma (catheter or stones)

DYSURIA

1. What is it?

2. What does it usually indicate pathology of?

1. Pain, Burning, Discomfort, Pressure, Stinging, or ANY irritative voiding symptoms (always WITH Urination)

2. Indicates pathology of...

 a. Bladder

 b. Prostate

 c. Urethral

URGENCY

1. What is it?

2. What pathology does it suggest (one organ system, two things)

1. Intense desire to void resulting from detrusor muscle contractions

2. Suggests Bladder Pathology (infection or irritation)

FREQUENCY

1. What is it?

2. It suggests 4 disorders of the bladder or bladder emptying.  Name them

3. What other finding is it a/w?

1. Abnormally frequent voiding.  Urine volume is SMALL (DO NOT confuse frequency with Polyuria)

2. Suggests disorders of the bladder or bladder emptying...

 a. Increased bladder sensitivity to stretch (Cystitis)

 b. Decreased bladder elasticity due to tumor or scar tissue

 c. Decreased cortical inhibition of bladder contractions due to stroke or brain tumor

 d. Partial obstruction of the bladder neck of proximal urethra

3) Frequency is usually with urgency

POLYURIA

1. What is it?

2. Name four causes.

1. Large urine volume (>3 L per day)

2. Causes include...

 a. ADH deficiency (central diabetes insipidus, DI)

 b. ADH resistence (nephrogenic DI)

 c. Solute or Osmotic Diuresis (uncontrolled DM)

 d. Excessive Water intake (primary polydipsia)

NOCTURIA

1. What is it

2. Name three GROUPS of causes

1. Frequency at NIGHT (>1 void per night...or change in pattern)

2. Causes include...

 a. Causes of Polyuria

 b. Cuases of frequency

 c. Edematous States (CHF, Nephrotic Syndrome, Cirrhosis) with mobilization of edema in the recumbent position

HEMATURIA

1. What is it?

2. 5 causes

3. When Hematuria is initial, what area should you think of?

4. When hematuria is near end of peeing, what should you think of?

5. When hematuria is throughout, what should you think of?

6. What can cause Reddish urine without blood?

1. Blood in urine.  Urine could be Pinkish, Brownish, Frnkly bloody, or like "dark tea."

2. Causes include...

 a. Infection

 b. Malignancy

 c. Stones

 d. Trauma

 e. Glomerulonephritis

3.  Initial Hematuria indicates Prostate, Urethra problem. 

4. Late, Terminal Hematuria indicates bladder pathology (Bladder at end squeezes, so may squeeze out some blood). 

5. Whole Hematuria can be kidney bleed, etc.

6. Cuases of Reddish Urine without Blood...

 a. Eating certain foods (Beets)

 b. Ingesting certain drugs (Phenolphthalein in laxatives OR Phenazopyridine, which is Pyridium, a urinary tract analgesic)

URINARY INCONTENENCE: Involuntary Loss of Urine

1. What is Urge Incontenence?

2. What are some causes of Urge Incontenence?

3. What is Stress incontenence?

4. What are some causes of Stress incontenence?

5. What is Overflow incontenence?

6. What are some causes of Overflow incontenence?

7. What is Functional Incontence?

8. What are some causes of Functional Incontence?

1. Urge Incontence: Strong Detrusor Muscle contractions.  An URGE TO VOID usually precedes the incontenence

2. Causes of Urge Incontence...

 a. Bladder irritation--Hyperexcitability of sensory pathway (cystitis inflam or infection, stones, neoplasms, stool impaction)

 b. Decreased cortical inhibition (CNS lesion above the sacral level...ie brain tumor, stroke, dementia, spinal stenosis, herniated disk above S2, MS)

 c. Drugs (Alpha Adrenergic Blockers, because PNS contract bladder, will be overactive if SNS blocked)

3. Stress incontenence: Loss of urine with transient increases in intraabdominal pressure, such as during coughing or laughing.  It is the MOST COMMON CAUSE, usually only in WOMEN, Rare in Men.

4. Causes of Stress incontenence...

 a. Usually due to weakness of the pelvic floor post childbirth or surgery. 

 b. Impaired urethral support

 c. Intrinsic Sphincter deficeincy (trauma, scarring, mucosal atrophy)

 d. OCCASIONALY leakage of a small amount of urine may be seen in Normal women

5. Overflow incontenence: Bladder is full even after an effort to void.  Patient complains of continious dripping or dribbling.  (sometimes hard to tell apart from stress) The bladder is enlarged by exam.

6. Causes of Overflow incontenence...

 a. Due to weak detrusor muscle (lower motor neuron lesion at the sacral level)

 b. Neurogenic Bladder: diminished sensation of bladder fullness (diabetic nephropathy, Guillan Barre, LMN lesion at S2-S4)

 c. Bladder outlet obstruction (BPH)

 d. Drugs (Anticholinergic, Adrenergic, Calcium Channel Blockers, Narcotics/Sedatives)

7. Functional Incontence: Inability to get to the toilet in time.

8. Functional Incontence: Due to imparied general health status (weakness, arthritis, etc) (No anatomical lesion)

PENILE DISCHARGE

1. What is it indicative of?

2. How can it present?

3. What is profuse, yellow discharge consistent with?

4. What is Scanty and Clear discharge continoius with?

1. Urethritis

2. Can present as dripping or staining of underwear

3. Gonococcal infection

4. Nongonoccoal (ie Chlamydial)

TESTICULAR CANCER

1. Affects young or old

2. Frequently symptomatic or asymptomatic

3. Curable if detected early?

1. Young

2. Frequently asymptomatic

3. Yes, Curable if detected early

HIV-a merciless STD

Because pt will start to trust you, and so can ask them some more personal questions, and they will give you some better answers

1) When examining the male Genetalia, should the pateint be standing or in the supine position?

2) When checking for hernias or verocieles, what position should the patient be in?

3) When the pt is standing, what should teh examiner be doing?

1. Either, usually can be in supine if more comfortable

2. Standing (need gravity to increase blood to these things...hernias and varicose veins)

3. Sitting comfortably

MALE GENETALIA EXAM: General Assesment

1) What do you look for in Pubic Hair?

2) If not already done, what two things need to be done in inguinal area?

1) Texture, symmetry, color, hygein

2) Palpate inguinal nodes and femoral pulses

MALE GENETALIA EXAM: Penis

1) Four things to inspect

2) Order of Palpation

1) Skin (all surfaces), Prepuce, Glans, Meatus

2) PALPATION: Use thumb and 1st two fingers.

 a. Retract Prepuce (or let pt do it), then replace it

 b. Compress the glans (esp if pt complains of dysuria, etc)

 c. Strip or milk the shaft of the penis (to see if can express some secretions)

 d. Palpate any visual abnormality for tenderness or induration

 e. Palpate penile shaft if pt is symptomatic or elderly

MALE GENETALIA EXAM: Scrotom and Testes

1) 5 things to inspect for

2) Palpation... (three things done, and one thing to suggest)

3) Transillumination

1) Inspect all surfaces for...

 a. Rashes

 b. Swelling

 c. Nodules

 d. Ulcerations

 e. Inflammation

2) Palpate...

 a. to identify the spermatic chord and epididymus

 b. to check testicular size, consistency, shape, and tenderness

 c. To check for masses or nodules

 d. Good time to reiterate the importance of the self exam

3) Transillumination for any scrotal swelling or nodule

MALE GU EXAM: Checking for Hernias

1) What is a Hernia

2) What should you ask pt to do when checking for one?

3) How do you check for an Inguinal Hernia?

4) How do you check for a femoral Hernia?

1) A protrusion of an organ or part of an organ or other structure through the wall of the cavity normally containing it

2) Inspect for any bulges, ask the pts to STRAIN DOWN

3) Use R and L hand for pts corresponding R and L inguinal region.  Invaginate the loose scrotal sac with the index finger and follow the spermatic chord toward the inguinal ligament until you find the external inguinal ring.  Ask the pt to bear down or cough

4) Place fingers on anterior thigh and ask the patient to strain down.

MALE GU EXAM: Rectal Exam

1) What two positions can the pt be in?

2) What two areas are inspected?

3) Name 6 normal things that can be palpated or reached on the rectal exam

1) Lateral Decubitus or standing

2) Sacrococcygeal and perianal areas

3) Normal Structures...

 a. Posterior Surface of the Prostate (Male)

 b.  Cervix or retoverted Uterus (Female)

 c. Seminal Vesicles (Normally NOT Palpable)

 d. Valve of Houston

 e. Peritoneal Reflection (Normally NOT Palpable)

 f. "Stool"

ANATOMY SAWAYA TALKED ABOUT...

1) Why is it impt to know where Kidneys are located?

2) How do you find L4, and why is this impt?

3) How do you find the CVA, and why is this impt?

1) Kidneys are usually higher (right below lower part of ribs) and more posterior than most people think.  Useful for localizing pain

2) L4: Find Iliac Crest, Finger walk over to spine, you are at L4, impt because put needle one above this for LP
3) CVA: CVA tenderness: Walk finger down to last rib (can hook it), and go over to spine, right there is where you check for CVA tenderness

Common drugs a/w Incontence (7) that should think about when taking HPI

*it is amazing how often the problem is right here...

1) Caffeine

2) Alcohol

3) Antidepressents

4) Antipsychotics

5) Sedatives

6) Diuretics

7) Decongestants

1) Discharge

2) Lesions

3) Pain

4) Swelling

5) Sexual Function (always ask about it)

KLINEFELTER'S SYNDROME

1) What do the testicles look like?

2) How does this differ from testicles in cirrhotic patient?

1) testicles will be small and HARD

2) Testicles in cirrhotic patient will be small and SOFT

1) Anytime with FLUIDS

2) Anytime with MUCOSA (ie Rectum, Mouth, etc)

3) OPEN SORES

PENILE LESION/ABNORMALITY: Phimosis

1) What is it?

2) What is tx?

3) What is paraphimosis

1) Tight prepuce (foreskin) that cannot be contracted (so tight, cannot pull below glans.  Hurts with erection.

2) Circumcision

3) Foreskin stuck BELOW glans, forming ring around glans, and it does not slide above it, can be tough and not distendable.  ("Tight Prepuce that, once retracted, cannot be returned") Also hurts with erection

PENILE LESION/ABNORMALITY: Balanitis

1) What is it?

2) What is cause?

1) inflammation of the glans (redness just around glans)

2) Could be bacterial, could be anything

PENILE LESION/ABNORMALITY: Genital Herpes

1) What does it look like?

2) What happens once vesicles have ruptured?

1) Very Painful cluster of vesicles having Erythematous Base

2) Once these vesicles have ruptured, a shallow and soft (non-indurated) ulcers are formed

PENILE LESION/ABNORMALITY: Syphillitic Chancre (primary syphillis lesion)

1) Describe it

2) Frequently a/w what?

1) PAINLESS Ulcer or Erosion with an indurated (HARD) base...doesn't fold when touch

2) Frequently a/w inguinal lymphadenopathy

PENILE LESION/ABNORMALITY: Carcinoma of the Penis

1) What is it?

2) Where usually located?

3) What type of lesion is considered suspicious?

1) Nontender, indurated nodule or ulcer

2) usually underneath the prepuce. 

3) Any PERSISTENT lesion must be considered suspicious

Inspecting a Hernia. 

Invaginate loose scrotal sac, follow spermatic chord up toward inguinal ligament until find external inguinal ring, ask pt to bear down, cough, etc, and can feel the triangle shape.  If feel it coming through the ring, it is INDIRECT (INDIRECT is THROUGH THE CANAL, usually in YOUNG KID)

If feel it to the SIDE of your finger as they cough, NOT THROUGH CANAL, it is DIRECT HERNIA (more common in OLDER PERSON)

FAR LEFT: Herpes Simplex

MIDDLE: Syphillitic Chancre

FAR RIGHT: Penile Cancer

INGUINAL HERNIAS

FAR LEFT IS INDIRECT (feel it coming through canal when cough, younger person).  (Rarely that indirect goes ALL the way down into the scrotom.)

FAR RIGHT is DIRECT (Older person, to side of canal)

FAR LEFT IS PHIMOSIS

FAR RIGHT IS BALANITIS

FAR LEFT IS SCROTAL MASS

FAR RIGHT IS AN INDIRECT HERNIA

The main difference between a Hydrocele and Indirect Hernia just initially is that you CANNOT ROOF an INDIRECT HERNIA, while you can ROOF a Hydrocele

FAR LEFT is SPERMATOCELE (similar to Hydrocele, but in spermatic chord.  In contrast to Hydrocele, can clearly feel the testicle)

MIDDLE IS HYDROCELE

FAR RIGHT IS VARICOCELE

FAR LEFT is TESTICULAR CANCER

FAR RIGHT is EPIDIDYMITIS

PENILE LESIONS/ABNORMALITIES: Hypospadias

1) What is it?

PENILE LESIONS/ABNORMALITIES: Venereal Warts

1) Another name

2) What are they?

3) Caused by?

1) Condyloma Acuminatum

2) Rapidly growing cauliflower like lesions that are moist and malodorous

3) HPV

SCROTAL ABNORMALITIES: Hydrocele

1) What is it?

2) Tender or non-tendor

3) 2 Unique PE findings

4) Can you feel the testicle?

1) A swelling in the scrotom caused by fluid accumulation in the tunica vaginalis

2) Usually non-tender

3) Transilluminates with light, Can "Roof," which is ability to get examiner's hand above the mass within the scrotom

4) In contrast to Spermatocele, you cannot feel the testicle

SCROTAL ABNORMALITIES: Testicular Cancer

1) How does it progress?

2) Tender on nontender

3) What should raise suspicion of maliggers?

1) Starts as nodule in testes, and grows to replace the whole organ

2) Non-Tender.  LIKE A PEA

3) Any nodule within the testes must raise suspciion of a malignancy

SCROTAL ABNORMALITIES: Varicocele

1) What is it?

2) What side more common on and why?

3) What does the chord feel like when pt is STANDING?

4) What happens when elevate the scrotom in the supine position?

5) What may this lead to (the MOST common cause of)

6) What is the tx

1) Varicose Veins (Dilated Veins) of the SPERMATIC CHORD

2) Most common on LEFT SIDE because Left Spermatic Vein empties into Left Renal Vein, while right spermatic vein empties into IVC. 

3) On exam w/ pt STANDING, Chord feels like BAG OF WORMS

4) BAG OF WORMS will collapse when the scrotom is elevated in the supine position

5) Dilated veins can increase the scrotal temperature and lead to male infertility (MOST COMMON CAUSE)

6) Just clamp vein, and cure pt

SCROTAL ABNORMALITIES: Scrotal Hernias

1) Usually direct or indirect?

2) Can you roof it?

3) What does the mass feel like?

4) Can it be returned into abdominal cavity?

5) What can be heard?

1) Usually is indirect hernia (passing through the inguinal canal)

2) Cannot get hand above the mass within the scrotom (since hernia is originating from Above the Hernia)

3) Mass usually soft and Non-Tender (UNLESS it is Strangulated)

4) Can be returned to abdominal cavity with gentle pressure and the pt in the supine position (unless it is incarcerated)

5) Bowel sounds can be heard over the scrotom

Scrotol Abnormalities: Cryptorchidism

1) What is it?

2) Where may the testis be?

3) Occurs in what pt population?

4) What three things may it lead to

1) Absence of testis and Epididymis in one or both sides of the scrotom

2) The testis MAY lie in the inguinal canal or the abdomen

3) Occurs in 20% of premature male Newborns and in 3-6% at full term

4) May lead to testicular atrophy, infertility, and an intra-abdominal testis increases the chance of testicular Malignancy

Scrotol Abnormalities: Small Testis

1) Adult Testes are considered small when they are what size?

2) Name three things small and soft testes suggest

3) What is small and firm testes consistent with?

1) Small is less than 3.5 cms

2) Small and soft testes suggest...

 a. Hypopituitarism

 b. Cirrhosis

 c. Estrogen Administration

 d. Other conditions

3) Small and FIRM testes are consistent with

 a. KLINEFELTER'S SYNDROME (XXY Chromosome abnormality)

PAINFUL AND TENDER SCROTOM

1) Name three causes

2) How do you differentiate two of them?

3) what is BEST test?

1) CAUSES

 a. Acute Epididymitis

 b. Torsion of Spermatic Cord

 c. Acute Orchitis

2) Need to differentiate Acute Epididymitis from Torsion of Spermatic Cord.  Acute Epididymitis may have more infecteous symptoms, and the pain will improve when you lift the scrotom (relief of gravity relieves stretching, etc), while Torsion of Spermatic Cord does NOT improve with lifting the scrotom

3) BEST test is ULTRASOUND

PAINFUL AND TENDER SCROTOM: Acute Epididymitis

1) What is it?

2) Three PE findings

1) An acute bacterial infection of the epididymis (ex E. Coli)

2) PHYSICAL EXAM FINDINGS...

 a. Epididymis is swollen

 b. Epididymis is VERY TENDER/PAINFUL

 c. Scrotom is reddened

PAINFUL AND TENDER SCROTOM: Torsion of the Spermatic Cord

1) What is it?

2) Three things this leads to/PE Findings

3) Most common in what pt population?

4) What do you do if find it?

1) Twisting of the testicle on its spermatic cord

2) LEADS TO...

 a. Severe Tenderness/Pain

 b. Swelling

 c. Testis is usually retracted upward in the scrotom which may be reddened or swollen

3) Most common in ADOLESCENTS

4) Surgical Emergency

PAINFUL AND TENDER SCROTOM: Acute Orchitis

1) What is it usually due to?

2) May lead to three things/PE Findings...

3) If bilateral...

1) Usually due to Post-pubertal mumps

2)MAY LEAD TO...

 a. Painful/Tender testis

 b. Swollen Testis

 c. Scrotum may be reddened

3) If bilateral, may lead to infertility

HERNIAS IN THE GROIN: Incarcerated Hernia

1) What is this?

1) When the hernia contents cannot be returned to the abdominal cavity

(*STRANGULATED IS LOST BLOOD SUPPLY)

HERNIAS IN THE GROIN: Strangulated Hernia

1) What is this?

2) Two symptoms

3) What do you do with this?

1) When the herniated bowel contents blood supply is comprimised (NOT soft to touch like normal hernia)

2) SYMPTOMS of a Strangulated Hernia...

 a. Hernia becomes Very Tender

 b. Pts develops N+V

3) Strangulated Hernia is a SURGICAL EMERGENCY

RECTAL EXAM ABNORMALITIES: Anal Fissure

1) What is it?

2) Where is it usually found?

1) Very painful longitudinal ulceration of the anal canal.

2) Midline

RECTAL EXAM ABNORMALITIES: External Hemorrhoids

1) What is it?

2) Usual symptoms?

3) Symptoms when they Thrombose

1) Dilated Veins below the anorectal junction and covered with skin

2) Usually asymptomatic, except for some minor discomfort and itching

3) WHen THROMBOSED...

 a. Painful

 b. Tender

 c. Swollen

 d. Bluish

RECTAL EXAM ABNORMALITIES: Internal Hemorrhoids

1) Where do they originate from?

2) What may happen to them?

3) What might the pt see if have them?

1) Originate from ABOVE the anorectal junction

2) They may prolapse through the anal canal, and appear as reddish as moist masses

3) May cause bright red bleeding from the rectum, particularly during defecation

List three abdnormalities of the Prostate

1) Benign Prostatic Hyperplasia (BPH)

2) Cancer of the Prostate

3) Prostatitis

What is the bug associated with the following STDs? (The history of travel makes all these pathogens possible. )

1) Granuloma Inguinale

 a. how does it manifest?

2) Syphilis

3) Chancroid

 a. how does it manifest?

4) Lymphgranuloma Venereum

 a. how does it manifest

5) Ameibic Balanitis

6) Veneral Warts (condyloma acuminata if in perianal)

1) Granuloma inguinale - Calymmatobacterium granulomatis (Gram-negative)

 a. Granuloma inguinale (GI) manifests as an indurated papule that subsequently ulcerates with a foul-smelling discharge; inguinal adenopathy with suppuration may occur.

2) Syphilis - Treponema pallidum (spirochete)

3) Chanchroid - Hemophilus ducreyi (Gram-negative)

 a.  The primary lesion of Chanchroid may resemble syphilis, although multiple ulcers are seen.  Most important, however, is that Chanchroid produces a tender lesion and tender adenopathy, which like LGV and GI may suppurate and ulcerate.

4) Lymphogranuloma venereum (LGV) - Chlamydia

trachomatis

 a.  LGV typically begins as papular primary lesion of the penis followed by prominent inguinal adenopathy which may suppurate and ulcerate.

5) Amebic balanitis - Entameba histolytica (see linked image)

6) HPV

True or False: Painless hematuria should suggest the diagnosis of malignancy of urogenital tract

If true, what are 2 examples

True

2 ex's: renal cell and transitional cell carcinomas

Adult Polycystic Kidney Disease

1) One of few causes of...

2) How is it inherited?

3) 4 things it is associated with

4) 50% of pts devop?

5) 5-10% of pts develop?

1) adult polycystic kidney disease with massive kidneys, one of the few causes of palpable kidneys. 

2) This disease is inherited in an autosomal dominant fashion

3) It is characteristically associated with..

 a. recurrent abdominal pain

 b. hematuria

 c. hypertension

 d. and renal stones. 

4) 50% of patients develop renal failure by age 60

5) In addition, 5-10% have cerebral anaerysms which may present as subarachnoid hemorrhage.

TRUE OR FALSE

1) BPH produces a symmetrically enlarged gland. 

2) Prostatic nodules should be considered carcinoma until proven otherwise.

FEMALE GU QUESTION

0) What is the adnexa?

1) What are adnexal masses due to?

2) Which of these has remarkeable adnexal and anterior cervical tenderness?

0) One dictionary includes the fallopian tubes, ovaries, and ligaments (Anything structurally and functionally related to the uterus)

1) Adnexal masses can occur due to ovarian tumors, tubo-ovarian abscess secondary to pelvic inflammatory disease (PID), ectopic pregnancy, and other disorders.

2) It is important to note that while the bimanual exam may be uncomfortable with any of these disorders, PID typically has remarkable adnexal and cervical motion tenderness (i.e. chandelier sign).

FEMALE BREAST QUESTION

1) What % of breast cancer is NOT found on mammogram?

2) As far as screening tests go, are MRI and mammography somewhat similar? (BUT...)

3) What is the median age for dx of breast cancer?

4) What is the median age for death FROM breast cancer?

5) Should you get regular biennial breast cancer screenings in your 40s?

6) What is the current USPSTF recomendation for screening?

7) Does the BSE reduce mortality?

8) Does the CBE help?

9) IF a mass is felt, is it cancer?

1) Impt to remember 5% are NOT found on mammogram

2) YES (Both better than CBE, which is alse better than BSE)  (BUT MRI is much more expensive, and perhaps more false +, so ONLY used in HIGH RISK cases)

3) 55-64 (it pyramids up and down before and after that)

4) 75-84.  A lot is due to recurrence.  Deaths peak up to this age and then falls after

5) Not recomended for everyone.  Is recomended once you turn 50, but before 50, based on personal hx and risk factors (Because women in their 40s have more fibrous tissue.  More likely to have false POSITIVES, more likely to be called back for biopsys.  BUT... many time that 5% of cancers not found on mammography are in this age group because can't see well through the fibrous tissue.)

6) Screening every other year from age 50-74 (not past 75...possibly harm and overdx) (Ages 60-79 get the GREATEST BENIFIT)

7) BSE does NOT reduce mortality (USED to tell pt to do this 7-10 days after 1st day of menses, every month) (It is recomended AGAINST BEING DONE "D" recomendation)

8) Indefinite evidence on the CBE (can't say good or bad if used alone as a test...but does help complement mammography well)

9) Majority of time will be a benign mass.  Probobly fibroadenoma or fibrocystic changes (only 11% masses felt are cancer)

BREAST CANCER IN MEN

1) What is the mortality rate?

2) What is the average age?
3) What are the risk factors?

1) Much higher mortality rate, because men have not had screening, etc, so by time find it it is huge and may have undergone metastasis

2) 65-67

3) Same risk factors (FAMILY HX!)