00000000001board review and book misc

leiomyoma

"fibroid tumor" =MC benign neoplasm of F genital tract *discrete, round, firm, often mult (made of smooth musc & CT) SSX: usu asymp 1. endometrial(internal): ↑bleed (irreg, heavy) & ↑pain 2. external side uterus/wall: pelvic fullness 3. external: constipation (press aga rectum) Lab: Hgb poss ↑ Dx: US or bimanual exam Tx: 1. OC (GnRH analogs), progestin IUD (morena IUD to ↓tumor size, then usu remove tumor) 2. surg: endometrial ablation(scoop out), uterine a. emboliz (clot off then shed to preserve fertility)

endometrial CA

(*any F >40yo with increase in periods(more frequ and/or heavier bleeding): needs endometrial bx) *MC= adenocarcinoma

who is most likely to have dysmenorrhea?

(35yoF with reg menses) *F with reg menses bc dysmenorrh causes by excess prostaglandF2α *prostaglandin production ↑ under influ of progest, reaching peak @, or soon after, start menses VS.:no dysmenorr in: 1)young teen just started menses: bc usu anovulatory for up to 1y 2)F on OCP bc do not ovulate on OCP & OCP are used to tx dysmenorrhea 3)marathon runner w/1 menses/yr bc dysmenorrhea is a function of oculatory cycles and runners usu have amenorrhea or oligoamenorrhea

Heinz bodies

(abcdef..G,H..) G6PD def

breast abscess

(collection of pus) S.aureus (MRSA) RF=lactating mothers SSX:red, pain, heat, +/-drainage Tx: I&D (surg drainage or needle aspiration) + Abs to cover staph & MRSA: Vanco (1g IV q12h) (OR cefotetan) "pump & dump"-for mastitis and abscess (?can continue breastfeeding during tx)

which hormones comes from posterior pituitary?

(only 2) vasopressin(ADH) & oxytocin

brief LOC assoc with abn blinking (Dx? TOC?) a. generalized convulsive seizure b. generalized nonconvulsive seizure c. simple-partial seizure d. complex-partial seizure

(or kid day dreaming during school) absence seizure= under category of : b. generalized nonconvulsive seizure TOC= ethylsuccinmide

pregnancy complications: UTIs

*2/2 urinary: stasis(progrest eff on smooth musc of uterus, mech compression of ureters & bladder) & glucosuria *any preg F with UTI - Urine Culture *E= e coli *Tx: 1st line: amox 500mg q12h x 5-7d [OR Cephalexin(Keflex)] poss:Nitrofurantoin 100mg q12hx5-7d 2nd line: Fosfomycin 3g single dose AVOID: TMP-SMX(bactrim) & cipro

endometriosis - dx, tx

*found on dep surfaces of pelvis, MC affects post cul-de-sac & ovaries *also on abd viscera, urinary tract, lungs *↑assoc: infertility & interstitial cystitis *ssx: dysmenorrhea, pelvic pain, dyspareunia, infertility *Exam=norm *Dx= only w/ laparoscopy or explor laparotomy (≠seen on imaging) (found on laparoscopy 1/3 infertile F) Tx= 1. hormonal (OC, progestins,GnRH agonists (lupron) 2. surg (excision, vaporiz, coag)

pregnancy complications - gestational diabetes

*hgb1c or GTT *targets: (mg/dL) FBG≤95 (vs norm adult 120) GTT 1hrPP 130-140, 2hrPP ≤120 2 or more abn=GD→insulin (bolus) NPH+Regular ideal weight 30 kcal/kg/d

Pregnancy - ssxs (skin∆s; Wks 7, 10, 12, 20)

*linea nigra(black line bellybutton to pubic symphysis) *malasma/chloasma (darkening face, ↑w/sun) 7th wk: *cyanosis vag&cervix=chadwicks sign (see blue on bimanual) *softening cervix=Hegars sign 10wks: *fetal heart tones norm=120-160 (double that of adult) 12wks: *palp uterine fundus@pubic symphysis 20wks: *palp uterine fundus@umbilicus (should=20cm bellybut→pubic symp @20wks & +1cm ea wk after 20wks) (so =approx 40cm frm bellybut down when ready to deliver))

pregnancy complications - Anemia

*plasma vol ↑during preg Def= Hct<30% OR Hgb<10 g/dL MC=Fe def: Tx= ferrous sulfate 325mg bid 2nd MC/most worrisome=folate def: requiremt= 800 mcg/d

OC - Intrauterine device

*removable IUD for OC *inhib tubular transport, prevents fertiliz of egg, prevents attachmt of blastocyst *types: 1)Paragard: copper 2)Mirena: progest CI: 1. preg, 2. infection(≠insert into frank disch or erythem cervix, 3. uterine abn ie/ bicornuate uterus, fibroid(+/-insert under US guidance)

OC Absolute CI

1. prev thromboembol(DVT,PE), CVA 2. Hx estrog-dep tumor 3. active LIVER dz 4. preg 5. undx'ed abn uterine bleeding 6. hyperTGLemia 7. F >35yo smoke heavily (>15cig/d)

amenorrhea workup

1. S. HCG 2. Prolactin 3. FSH: (tells ovary to create follicle) if↑=ovarian failure (got signal but ovary ≠working) if↓=pituitary abn 4. TSH 5. progesterone challenge: withdrawal bleeding should occur after giving 10 days of progest then stopping *if bleeding occurs, problem=anovulation

vaginitis

1. candida= RF: preg/DM/Ab/steroids/HIV/obesity/heat/moisture; *pruritus, erythema, white curd disch (cottage cheese) *10%KOH= hyphae/spores/filaments Tx=antifungal cream or po fluconazole 2. BV=gardnerella Amsel criteria= 1)pH>4.5; 2)clue cells>20%; 3)whiff fishy/amine with 10%KOH; 4)disch:malodor,thin,gray, homogenous Tx=metronidazole (or clinda) oral or intravag 3. trich=STD; pruritus, frothy, malodor, yellow-green, strawberry cervix; wet mount motile; Tx=metronidazole (tx partners too) 4. condylomata acuminata=STD: HPV 6, 11 (more benign) (men aggress head neck) Dx=4%acetic acid + colposcopy Tx=podophyllin (or electrocautery, liqu nitro, imiquimod cream)

Pregnancy complications:

1. ectopic preg: tubal 2. fetal etoh synd 3. hyperemesis gravidarum 4. anemia 5. UTIs 6. mult gestations 7. gestational Diabetes 8. preg-induced HTN 9. Preeclampsia/Eclampsia

menstrual cycle (28d cycle)

1. follicular/proliferative phase: d1-14 "estrogen phase" *estrog increases at peaks at ovulation (proliferates endometrium) (ovaries: ↑estrog, ↓progest) *ovulation at end on d14 *LH & FSH (frm any pitutiary) spike right b4 ovulation 2. luteal/secretory phase: d14-28 "progesterone cycle" *progest ↑ to prep for poss implantation of fertilized egg (produced by corpus luteum) (∆s endometrium) *cycle ends in menses if theres no fertilized egg

ovarian cysts

1. functional cyst: norm, +/-pain bw ovulation→menses, fluid filled 2. corpus luteum cyst:: norm after ovulation, often seen 1st trimester, +/-pain 3. endometrioma: "chocolate cyst"(full of blood/endometrial tiss) benign palpable mass on ovary, +/-pain 4. dermoid cyst: benign germ cell tumor, usu asymp, poss bilat, remove to avoid bleeding or TORSION(bc makes ovary top heavy)

Pregnancy - labs

1. hCG (quant#&qual+/-): double q48hrs, peak d50-75, & ↓ in 2nd&3rd trimesters *ectopic preg= lower hCG (used in looking for spont miscarrage) (twins&mult gestational preg throw off) 2. CBC(anemia), UA, PAP(CA), GC/Chlamydia(STDs), Bl type&scn(compatible), VDRL(congenital syphilis), HIV, rubella titers(german measles): *MMR=live vaccine so annual well women exam, ask preg plans and get rubella titer to can boost b4 get preg *(if unsure bout preg plans& not on OC, put on prenatal vit too)

abn uterine bleeding - terms

1. oligomenorrhea: intervals >35d (prolonged time bw periods) 2. polymenorrhea: interbals <21d (more frequent periods) 3. hypomenorrhea: ↓flow/duration (norm intervals) 4. menorrhagia: prolonged/excess bleed (norm intervals) 5. metrorrhagia: irreg bleeding bw periods (spotting-irreg intervals but norm amt of bleeding) 6 menometrorrhagia: prolonged bleeding at irreg intervals

abn uterine bleeding

1. organic (systemic or reprod tract dz) 2. dysf uterine bleeding (DUB): a) anovulatory(90%)=no cycles b) ovulatory(10%)=↓estrog

PID - tx

1. outpt: ceftriaxone+doxy x 14d or(ceftriaxone+azithr+flagyl+diflucan) rocephin(ceftriaxone) diflucan(fluconazole) flagy(metronidazole) --------------------- 2. Inpt: IV clindamycin+gentamycin OR cefoxitin(or cefotetan) + doxy

OC Relative CI

1. poorly controlled HTN 2. on anticonvulsant med (also some IV only Ab & rifampin) 3. F migraines: >35yo OR any age if +aura (?progestin only ok) 4. some diabetic F may need small↑ insulin dose

prolapse: uterine, cystocele, rectocele, eterocele

1. uterine prolapse: hits top your fingers during bimanual 2. cystocele: bulging ant vag wall, ↑ w/ bearing down, +/-urinary incontinence 3. rectocele:bulging post vag wall, ↑w/ bearing down, +/-constipation; hits back of your hand during bimanual 4. enterocele: hits back of your hand during bimanual

surgical prevention (of pregnancy)

1. vasectomy(M), tubal ligation(F) 2. usu not reversible 3. falure rate 0.5-1.5% 4. if preg occurs w/tubal ligation→↑incidence ectopic preg 5. small risk of infection

Breast CA RFs

1. white (vs risk dying frm AA..) 2. older 3. 1st gen relative(MorF)gyn heredit CA (MorF; mother/sis/daughter with uterine/endometr,breast, ovarian) 4. Hx GYN CA with hereditary link (uterine/endometr, breast, ovarian) (≠cervical bc≠hereditary as 2/2 HPV) 5. BRCA1 or 2 mutat 6. early period<12y)/late menop>50y (bc ↑periods=↑hormone exposure) 7. nulliparous or late 1st preg (risk↓ GYN CA if on OCP)

Delivery of baby - Cervical exam

1.Dilation:opening cervical os (up to 10cm) 2.Effacement: cervical thinning (up to 100%) 3.Station: location of presenting part compared to maternal ischial spines (up or down)

Pregnancy f/u appointmts

16-20wks= AFP, hCG, unconj estriol 24-28= 1hr glu challenge 28= H&H, repeat VDRL(inital& 1/2thru) 28-30= RhoGAM if needed (preventative-had no bleeding b4 now) & do again @delivery if O/A/B-neg 33-37= Gr-B strep cult vaginally (or if PROM can do as well) US in 1st trimester, & then in 2nd

threatened abortion

1st trimester bleeding without loss of fluid or tissue

Delivery of baby - Stages

1st=onset true contractions→full dilation 2nd=onset full dilation→delivery infant (up thru delivery) 3rd: separation & expulsive of placenta (delivery of placenta) 4th: the hour after delivery

what is lowest grade murmur that will cause a thrill?

4 (4, 5, 6 will have thrill)

HPV types

6, 11 - warts 16, 18 (31, 33, 35) - cervical dysplasia gardasil 6, 11, 16, 18 - M&F 9-26yo (routinely offer M&F 11-13yo) cervarix 16, 18 - F 9-25yo

Primary amenorrhea

= never had menses *13yo w/out 2°characterisitics *15yo with 2°characterisitics Causes: 1. outflow tract (Tx=surg) imperforate hymen; 2. ovarian (Tx=hormone replacmt) gonadal agenesus polycystic ovarian synd(XXY or XO);

Menopause - definition, tx

=12mo amenorrhea PLUS ↑FSH(>40) Tx: 1. vasomotor sxs: -uterus: estrog +uterus: estrog/progest SSRIs, gabapentin, clonidine 2. vag atrophy: estrog vag ring (or top) 3. OP: exercise, daily Ca & vitD

firey red, painful macular rash, well defined margins only on face Tx?

=erysipelas Tx= oral Ab

"string of pearls" polycystic ovarian synd (PCOS)

=polycystic ovarian synd (PCOS) (aka stein-leventhal synd) *chronic anovulatory synd *many cysts on US *ssx: 1. irreg/lack of periods: Oligo-(intervals>35d) /Amen-orrhea; 2. Obesity (adipose prod estrog); 3. INFERTILITY; 4. Androgen excess(acne, facial hair, M pattern in groin); 5. Insulin resistance(DM) Labs: 1.↑LH v.FSH 3:1 (FSH:abn corpuslutem) 2. hyperglycemia(metab synd) 3. ↑androg 4. norm estradiol, but ↑periph estrog ↑risk:ovarian&breast CA(unopp estrog) Tx: weight↓, OC, spironolac(antiandrog), metformin, clomiphene

Secondary amenorrhea

=used to be norm monthly, now no periods for at least 6mo Causes: 1. MCC=pregnancy 2. Endocrine: *thyroid dz *pituitary d/os: prolactinoma: Tx=bromocriptine or surg) *hypothalamic d/o: (GnRH:FSH,LH→estrog) *tumor *syphilis/Tb Tx: surg or hormones if needed

prerenal ARF - what is BUN/Cret ratio?

>20:1 (prerenal = MC type ARF, so ratio is elevated) only decreased is FEN (fractional excretion of Na=<1)

easy bleeding assoc with psoriasis

auspitz sign

precursor to squamous cell carcinoma of skin?

Actinic keratosis (irreg borders, sun exposed areas, redness)

which CN is involved with corneal reflex, salivation, facial movements, & taste?

CN 7 Facial

what type kidney stone is most common with hyperparathyroidism

Ca oxalate

Pregnancy - dx, documentation

Dx=US to confirm intrauterine preg (so if pain, hypotens suggestive of ectopic but see baby on US still keep looking- rare: twin gestation w/1ectopic & 1intrauterine preg) GP or GTPAL (G=gravida)(P=para) G=#gestations/times pregnant T=#term>36wks (born after 36wks) P=#preterm 20-36wks (b4 36wks) A=#abortions (spont or tx) b4 20wks=spont miscarriage L=#living kids

pregnancy-induced HTN

HTN after 20wk gestation >140/90 Tx: labetalol, hydralazine (nifedipine SR only) CI: ACEI, nitroprusside

endometritis

MC after C-section OR PROM>24hrs before delivery(rupt & dont deliver right away-more time for infection) SSX: fever, uterine tenderness, peritoneal irritation, ↓BS Lab: ↑WBC>20K, often anaerobic streptococci (but can be anything) Tx: hospitaliz & IV Abs (cover everything, tx mom & kid preventatively too) 1. Clindamycin+Gentamicin (may +ampicillin OR metronidazole) +/-cult, pelvic washout

fibrocystic breast dz

MC lesion of breast benign MC in F 30-50yo RF=estrog SSX: 1. pain/tender breast lump(s), 2. usu mult & bilat masses, 3. discomfort↑ during premenstrual phase, 4. fluctuation in size & rapid appearance=likely benign Dx: FNA bx Tx: OC +/-Vit E (NSAIDs)

farmer(sun exposure), slow growing papule, slightly depressed center, scabs over & bleeds

basal cell carcinoma (

endometrial CA

MC=adenocarcinoma *F 50-70yo *RF(↑estrog exposure): obesity, nulliparity, DM, polycystic ovaries, unopp estrog, tomoxifen ssx: post menop or abn bleeding dx: endometrial bx [to any F>40yo↑periods(↑frequ/heavy)] tx: TAH+BSO

breast mastiits

MCC fever after giving birth in nursing mothers *(in nonlactating F, think carcinoma) *E= S.aureus *SSX: pain, inflam, +/-mass (red, fever, enlargmt, ∆nipple sensation, disch, itching, tender) *Compli: abscess formation Tx: cover staph β-lactam (PCN products, augmentin, cefalexin(Keflex) 1. Dicloxacillin (500mg po x7-10d) pcn allerg: Cephalexin (500mg po qid) x10-14d (OR clindamy 300mg po tid) "pump & dump"-for mastitis and abscess (?can continue breastfeeding during tx)

which hormone has its peak highest around ovulation?

LH (tells corpus luteum to form) (vs. FSH=peaks earlier)

dystocia/abn labor

MC 2/2: 1. Pelvis: mom too small Tx: assist pulling out: vacuum extraction or forceps 2. Powers: inadeq contractions(not strong enough) Tx: strengthen contractr w/: oxytocin or pitocin 3. Passenger:macrosomia-baby too big Tx: C-section

dysfunctional uterine bleeding (DUB) *anovulatory=most, 90% (vs ovulatory, 10%-↓estrog)

MCC premenopausal irreg bleeding *anovulation→corpus luteum never form∴lack progest = unopposed estrog: ↑↑estrog→overgrowth uterine lining→heavy/prolonged bleeding (risk uterine CA with unopp estrog) Tx: hormone tx; weight loss(obesity)

fetal monitoring

baseline norm= 120-160 bpm *norm reactive response= 2 accelerations fetal HR in 20min of up to 15 bpm frm baseline *decelerations=decline in fetal HR of 15 bpm or lasting >15s persistent late decelerat(occur after peak of contraction)=very worrisome

ovarian carcinoma (low incidence - 1.5-2%)

RF: ↑age, nulliparity, 1°relat BRCA1&2 SSX: asym or vague Exam: palp mass, ascites Lab: +CA125: monitor only (baseline norm flux) (ie/after taking out 1 ovary, prev ovarian CA, strong FHx) Dx: transvag US Tx:surg, CTX

working on car, FB in eye, you remove small piece of metal, exam is negative - what do u do next?

Rx polymixin-bacitracin & f/u with ophthal in 24hr (rust ring needs removal by opthal)

which heart valves close with S1? with S2?

S1=lub= MV & TV close same time S2=dub= AV & PV same time

chancroid

STD Haemophilus ducreyi soft painful genital ulcer, with fluctuant inguinal adenitis Lab: gram neg streptobacillus (dash marks) Tx= azithro (or cefriaxone, erythromycin, cipro) (VS painless genital ulcer=granuloma inguinale)

cervicitis

STD; N.gonorrh, chlamy, trich,HSV; yellow disch, friable cervix 1. chlamydia=MC bact STD; asymp(PID-infertility) *cervicitis or urethritis, yellow mucopurulent *lab: cervical PCR, cult Tx=azithro ag once OR (doxy 100mg bid x7d)OR(erythro OR quinolone x7d) 2. N.gonorrheae=pus disch, dysuria Tx=ceftriaxone 250mg IM PLUS azithro 1gm (chlamydia) - OR- (doxy 100mg bidx7d) OR (cefipime 400mg PO) or (quinolones only is not resistant) 3. HSV: tzank smear, cult more specif IgM-immed, IgG-gradual + for life *Tx acyclovir 400mg tid 5-10d or till lesion healing (or famciclovir 500mg bid) (or valacyclovir 1gm bid) 4. syphilis=treponema pallidum (sphere); 1*chancre, 2*symm rash, palms&soles, condylomata lata, LAD; latent no lesions; 3*irrevers brain/heart *lab: RPR(also lyme), VDRL 3-6wk after infection Tx=PCN

Which radio-opaque kidney stone staghorn made of Mg, Al, and/or phosphate assoc with urease-forming organisms(proteus, pneudomonas)

Struvite

what study is indic for any patient >55yo with new-onset sx's dyspepsia

Upper endoscopy= to eval gastric CA or other serious organic dz *upper endoscopy=Study of choice for: dx gastroduodeno ulcers, erosive esophagitis, upper GI malig VS.: 1)PET CT scan= follow course of already dx'ed CA 2)Abd US= only when pancreatic or biliary dz suspected. 3)Gastric emptying studies= only with recurrent vomiting.

nasal polyps & hx asthma bronchospasm may occur if they take...?

aspirin

which of the following is least likely to be assoc with neuropathy? a. hyperthyroidism b. vitB12 def c. bells palsy d. severe diabetes e. botulism

a. hyperthyroidism (get neuropathy with hypothyroidism)

cervical CA screening guidelines

abn PAP→colposcopy w/ pinch bx or LEEP start scn= 21yo 21-29yo= cytology q3y 30-65yp= cytology q3y OR cytology+HPV q5y >65yo never abn= stop scn

6yo Amish boy, high fever, sore throat, difficulty swallowing Exam: drooling XR: thumb print sign Dx?

acute epiglottitis

corneal dendritic ulcer - tx?

acyclovir ointmt (do NOT use steroids!)

32yoAAF, fatigue, weakness, weight loss, amenorrhea, hypotension, hypoglycemia, skin x 3mo dx?

addisons (may use this example with AA F instead of caucasian F with "hyperpig" so must know other sxs)

most common breast lesions younger F <30yo?

adenoma (Breast Fibroadenoma) *≠rel to hormone(estrog) more consistent/ less flux (not cyclic wax/wane like in fibrocystic dz seen in older F,>30yo) 1. common benign mass in young F ages 20s & 30s 2. exam: round, rubbery, discrete, relatively movable, NONTENDER mass, 1-5mm diameter Dx: FNA bx (or follow serial US or diagnostic mamorgrams+US-to set baseline & monitor) (can do MRI if really unsure & want to avoid radiation but pricey) Tx: none

OCP (estrog & progrest) *MOA: inhib ovulation, thicken cervical mucus, hostile endometrial lining, ↓motility fallop tubes *SEs: BTB, amenorrh, bilat breast tender, HA, N, ↓libido

benefits: ↓cramp/flow/pain, ↓risk ovarian/endometrial CA, prevent ectopic preg(bc not ovulating), ↓acne, ↓risk benign breast dz, protect aga endometriosis/RA/OP risks: (rel to estrog) thromboembo (DVT/PE) arterial events (MI/CVA) breast CA(small risk), GB dz hypercoag: ≠give in: (only progest ok) antiphos lipid Ab Lupus OR migraine+aura

Progestin only OC

benefits: fewer complications risks: ↑BTB, ↓eff 98.5%(v. 99%+estrog) ∴must be more regimented w/taking, ↓noncontracep health benefits SEs: amenorrh, breast tender 1. PO: minipill;(Norethidrone/micronor) 2. shot: depot medroxyprogrest acetate (Depo-Provera) inj q3months 3. implant: Etonogestrel(implanon, nexplanon) 4. IUD: mirena (levonorgesterel-relasing intrauterine system)

optic chiasm lesion will produce:

bitemporal hemiaopia

postpartum hemorrhage

blood loss requiring transfusion OR 10%↓ in Hct (usu frm placenta coming off uterine wall-normally contractions continue enough to act as natural clamp) *Early=<24h after delivery (usu w/in 1st hr after) *Late=>24h after delivery SSX=↑bleeding after delivery Tx: 1. uterine massage & compression (as on way to OR) 2. thenIV push: oxytocin or prostaglandins, or ergonovine (if bleeding≠stop take it out cuz can bleed out easily) 3. blood transfusion

HPV subtypes most aggressive for cervical carcinoma? more benign, cause condylomata acuminata? HPV vaccine?

cancer= HPV 16, 18, 31, 33, 35 genital warts= HPV 6, 11 HPV Vaccine: 1. Gardasiil4 HPV 6, 11, 16, 18: M&F 9-26yo (9 covers 5 additional strains) 2. Cervarix HPV 16, 18: F 9-25yo (older ok if with higher risk factors)

incomplete abortion

cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os

Diethylstilbestrol (DES)

clear cell carcinoma of vagina (tx of diabetic pts for threatened abortion 1947-1971)

most common breast lesions older F >30yo?

cystic (breast fibrocystic dz) *rel to hormone/estrog cycle∴wax&wane (flux in size/discomfort-↑estduring premenstrual, rapid appearance)

PMS - tx

d 7-14 before onset menses Tx: 1. NSAIDs (bc inhib prostaglandins), OC, diuretics 2. exercise, vitamins, complex carbs diet 3. SSRIs, alprazolam(Xanax-FDA approv) +/-danazol, Yaz(FDA approv for PMDD)

urge incontinence - Tx?

detrol, (ditropan)

complete abortion

documented pregnancy that spontaneously passes all of the products of conception.

MCC premenopausal irreg bleeding?

dysfunctional uterine bleeding (DUB)

OC - NuvaRing

etonogestrel/ethinyl estradiol vaginal ring) once/month birth control *insert for 1st 3wks, then removed for 1wk *↓dose progestin & estrog *≠use during breast feeing *SEs: BV, HA (technically has 35days worth of hormone in it, leave out to have period)

Galactorrhea

fluid frm nipple (+/-milk) E: 1. pituitary (micro)adenoma: check prolactin 2. hypothyroid 3. meds: TCA, OC(Depo-Provera), psychotropics(risperidone)

preeclampsia

frm ≥20wk gestation→2wk postpardm *Triad: HTN, proteinuria, edema *RF: nullparity *mild: ≠end organ damage proteinuria: trace→+1 (dip) norm DTRs/LFTs/coag TX= BR, hyralazine/labetalol, daily weight/fetal movmt/BP *severe: >160/>100, proteinuria≥+2, altered (CNS)mental/hyperreflexia, abn LFT/coag/RF TX=hospitaliz, Mg sulfate(seiz prophy), methyldopa/labetalol, fetal monitor, steroids, delivery(if>36wk)

PID

gonorrh, chlamydia, aerobic, anaerobic ascending genital infection of fallopian tube dyspareunia, menorrhagia, fever, chills *Exam= mucupurulent cervicitis, adnexal tender, cervical motion tender(chandelier sign) *risk: ectopic preg, infertility Tx: OutPt= ceftriaxone

inevitable abortion

gross rupt membranes in presence of cervical dilation

student, began getting 1cm salmon colored papules on back during exam week Dx?

herald patch, christmas tree distribution pityriasis rosea

breast CA screening (if WITHOUT RFs ie/ 1°relative breast CA, hx endometrial CA..)

initial mamogra scn: 50yo (prev 40yo) & every other yr mammogram (vs yrly) (if + bx) (50yo recom= scn mammorg/PAP, colonscopy, discuss ASA tx) (>40yo: do not recom mamorg)

pregnancy complications - hyperemesis gravidarum

intractable N/V, beginning 1st trimester *poss 2/2 ↑hCG, estrodiol, progest Tx: hospitaliz, IVF Vit B6(pyridoxine)+Unicom (doxylamine) (Zofran CI till 2nd trim) +/-TPN

22yoF, small itchy bumps on hand Exam: tiny nodules & vesicles hand, web spaces, excoriations & crustings seen Tx?

lindane cream =scabies (do NOT give steroids bc worsens it)

breast CA

mean age 60yo; painless mass *Exam: single, nontender, firm-hard, mass with ill defined margins (often fixated to tissue underneath) *late: skin or nipple retraction, axillary LAD, red, pain, +/-disch (any of these findings:get Diagnostic mamogr+US - *always get mamogr with: axillary or clavicular LA) Labs: hyperCa in advanced breast CA *CEA & CA15-3: markers for reucurr ie/Hx lumpectomy (CEA=breast vs. CA125=ovary) RFs: older, white, FHx, PMHx, early menses/late menop,nullp/late 1st preg MC(80%)=Infiltrating Ductal Carcinoma Dx: 1)Bx=gold stand definitive 2)mamorg: most useful detect CA, (poss 2yr b4 mass felt; calcif are most commonly confused(prompting MRI or more often Bx)) *helps ID ∆s, calcif, abn masses - begin @40yo TX: lumpectomy, mastectomy & hormone tx(Tamoxifen(antiestrog)) & Rad or CTX(doxorubicin(Adriamycin))

secondary dysmenorrhea

menstrual pain 2/2 organic cause *new onset, older F (younger=stds)(≥20yo=endometriosis, fibroids) *Hx suggests endometriosis, fibroids, or PID Dx: US, laparoscopy(only was to dx endometriosis), cult (r/o endometriosis or PID) Tx: NSAIDs *OC, Danazol, & GnRH agonists: endometriosis *uterine artery emboliz: fibroid

primary dysmenorrhea

menstrual pain assoc with ovular cycles in absence of patholog findings *younger F *caused by uterine vasoconstriction & proastaglandins *exam=norm Tx= TOC=OC, NSAIDs (200mg 3/d 3d b4 period), topical heat, IUD

any F inflam breast who is not lactating & not recently preg..?

need to R/O breast carcinoma then consider abscess, mastitis...etc

cellulitis - tx

oral Ab immed - cover Hflu, strep, staph 1. mild/early infections: oral penicillinase-resistant PCN: dicloxacillin OR CSP if allergy to PCN: Erythromycin 2. severe: 1st gen CSP IV, then switch to oral Ab once fever/chills/malaise subside 3. if no response - surgical debridemt/intervention mandatory

pregnancy complications - Ectopic pregnancy

preg outside cavity of uterus *95%=tubal *RFs= prev ectopic, PID, tubal surg, IUD, DES(causing uterus deformity) SSX: 1. preg=amenorrhea or irreg bleeding 2. unilat adnexal (pelvic)pain (pain localiz to 1 side) 3. pelvic(adnexal) mass formation Lab: ↓er hCG than usual for preg (& not rising normally) (very early preg, cant see ectopic on US, so repeat hCG in 24-48hrs usu) Dx: US (gestational sac 6wks) Tx: surg-laparoscopy OR methotrexate(only if early)(catX-induces miscariage, stops fetal heart tones if any & then can be removed)

what is most specific physical exam finding in dx of diphtheria?

pseudo-membrane (gray, in back of pharynx) Diphtheria MC pw: sore throat, adherent tonsillar, pharyngeal, or nasal pseudo- membrane & low grade fever.

erythema marginatum

rheumatic fever jones criteria

PROM

rupt of membranes anytime before onset of labor (maj risk=infection) *most go into spont labor w/in 24hs after PROM (or need induction) ie/if 37wks,water breaks→induce VS if 30wks:poss BR, try keep baby as long as poss, maybe preventative Abs, but eventually out) SSX= gush of fluid Dx=+fern test - or pH strip for amniotic fluid or US Tx: 1. help induce: prostaglandin cervical gel or misoprostol or oxytocin 2. steorids: close PDA 3. Ab - for infection 4. delivery

stuck on, blackish plaques, all over face & back Dx?

seborrheic keratosis

75yo, longstanding hx HTN w/ SOB Exam: diastolic murmur LUSB. What would accentuate this murmur?

sit & lean forward = AR VS.murmurs accentuated with: 1)L lat decub=MS 2)valsalva & standing: ddx AS vs. HCM *HCM: valsalva=↑ ;handgrip=↓