excercise in prenancy

• related: OBGYN

• Recommended exercises:
  • 30 minutes of moderately intense aerobic exercise (the patient should be able to converse while exercising) on most or all days of the week
  • Patients who are already conditioned for long-duration, high-intensity exercise can safely continue their regimen during pregnancy.
  • light weight (10lb) resistance training is safe
• Not recomm

breast abscess in feeding

• related: OBGYN

• first use US for diagnosis
• Once diagnosed, use fine needle aspiration to remove abscess
• Incision with drainage is the preferred treatment for most skin abscesses. However, this treatment for a breast abscess has increased risk of complications (eg, milk fistulas), slower recovery time, and a less desirable cosmetic outcome. Therefore, incision and drainage ar

fetal growth restriction

• related: OBGYN

• pt: ultrasound-estimated fetal weight <10th percentile for gestational age
• cause: increased umbilical artery resistance
  • symmetric:
    • entire fetus affected
    • first trimester
    • Chromosomal abnormalities, infection (eg, cytomegalovirus, toxoplasmosis)
  • asymmetric:
    • head sparing (blood redistribute to brain and away from abd)
    • 2nd/

Breast Cancer risks

• related: OBGYN, breast cancer screening

High-risk family history includes:

• Two 1st-degree relatives with breast cancer, including 1 relative age <50
• Three or more 1st- or 2nd-degree relatives with breast cancer
• 1st- or 2nd-degree relative with breast & ovarian cancer
• 1st-degree relative with bilateral breast cancer
• Breast cancer in a male relative
• Ashkenaz

• related: OBGYN

Cervical cancer

The most appropriate screening strategy is to obtain the results of the patient's last cervical cancer screening examination. Both the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend against cervical cancer screening in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. The USPSTF defines adequate screening as three co

Medicine

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• Related: Step 3, Step 1, mksap, notes

Todos

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• MKSAP todos
  • heart murmurs

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• [[Geriatric

menopause

• related: OBGYN

• menopause supplements

Hot flash

• first line: estrogen based hormone replacement therapy
  • add progestone for people with intact uterus
  • CI include history of thromboembolism, coronary heart disease, breast cancer, and endometrial cancer.
• nonhormonal treatment: selective serotonin reuptake inhibitor (eg, fluoxetine) or serotonin-norepinephrine reuptake inhibitor (eg, venlafax

Postpartum depression

• related: OBGYN

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This patient's symptoms are concerning for major depressive disorder (depressed mood, anhedonia, sleep disturbance, poor appetite, impaired concentration, tearfulness, guilt). All patients should be screened for postpartum depression at the postpartum visit. Postpartum depression is diagnos

Thyroid in pregnancy

• related: OBGYN, Endocrine

Pregnancy and thyroid medications

However, methimazole is a potential teratogen and should not be used during the first trimester. These teratogenic effects consist of scalp defects, tracheoesophageal fistula, and choanal atresia. During the first trimester, pregnant patients should be switched to propylthiouracil, which carries less risk of birth defects.

appendicitis in pregnancy

• related: OBGYN, pylephlebitis

This pregnant patient's fever, right-sided abdominal pain, and leukocytosis are concerning for possible acute appendicitis. Pregnant patients with acute appendicitis can have a typical presentation (eg, anorexia, periumbilical pain that migrates to the right lower quadrant). However, due to the displacement of the appendix by the growing uterus during pregnancy, atypical presentations

breast mass

• related: OBGYN, breast pain
• tags: #obgyn

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A firm, palpable breast mass with ill-defined borders is concerning for malignancy. Additional clinical features suggestive of malignancy include an immobile mass with associated lymphadenopathy, expressed nipple discharge, skin changes, or new-onset nipple inversion. However, h

Emergency contraception

• related: OBGYN
• tags: #obgyn

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Victims of sexual assault should be offered information about emergency contraception to prevent pregnancy. In women with regular ovulatory cycles, the probability of pregnancy is as high as 30% prior to ovulation (eg, 2 weeks after the last menstrual period). ==A negative pregnancy t

getational diabetes

• related: OBGYN

During the second and third trimesters, the placenta secretes increasing amounts of hormones (eg, human placental lactogen) that induce maternal insulin resistance. This insulin resistance ensures that there is a sufficient supply of glucose for fetal development. However, patients with inadeq

lichen sclerosis

• related: OBGYN, lichen simplex

• Pt: postmenopausal women
• cause: autoimmune, atrophy etiology. Benign lesion characterized by a thinning of the epidermis and fibrosis (sclerosis) of the underlying dermis.
• sx:
  • early stage: hypopigmented areas, increase sensitivity = intense itching with erosions/excoriations
  • chronic stage: scratching/irritation causes thickened skin (l

neisseria gonorrhea

• related: OBGYN

Disseminated gonococcal

Disseminated gonococcal infection (DGI) can present as either purulent monoarthritis or as a triad of:

• Tenosynovitis: typically involving the distal extremities
• Dermatitis: isolated pustules or papules, primarily on the hands and feet
• Polyarthralgia: asymmetric, migratory joint pain

Although the infection originates in genito

Osteoporosis

• related: OBGYN, menopause

• screening
  • women age >65
  • women postmenopausal, < 65 with following risks
    • low body weight
    • smoker
    • fhx of hip fracture
    • steroid use
• treatment:
  • counseled on regular weight bearing exercises and menopause supplements
  • bisphosphonates (eg, alendronate) is indicated for patients who have:
    • Low bone mass with a hi

hydatidiform mole

• related: OBGYN

This patient's secondary amenorrhea, markedly enlarged uterus (infraumbilical mass), and hyperthyroidism are consistent with a hydatidiform mole, an abnormal gestation that results from the fertilization of an empty ovum. Additional clinical features can include hyperemesis gravidarum, abnormal vaginal bleeding, and bilateral enlarged ovaries (eg, theca lutein cysts). Risk factors for hydatidiform mole include extr

oral contraceptives can decrease ovarian cancer risks

• related: OBGYN

The lifetime risk of ovarian malignancy is 1.4%; epithelial ovarian carcinoma comprises the majority of these diagnoses. Persistent ovulation causing repeated damage to the epithelial surface of the ovary can result in malignant transformation. Therefore, women with more ovulatory cycles (eg, early menarche, late menopause, nulliparity) are at increased risk of ovarian cancer. Conversely, women

spontaneous abortions

• related: OBGYN

Spontaneous abortion (miscarriage) is a pregnancy loss at <20 weeks gestation. Spontaneous abortion occurs in as many as 20% of pregnancies, making it the most common complication of early pregnancy. Risk factors for spontaneous abortion include advanced maternal age (eg, >35), a history of a prior spontaneous abortion, and substance use. The risk th

PCOS

• related: OBGYN

Polycystic Ovarian Syndrome is a condition that affects roughly 5% of women of reproductive age, and is characterized by the formation of multiple ovarian follicular cysts due to hormone imbalance.

Pathogenesis

The pathogenesis of polycystic ovarian syndrome in general is poorly understood, however the followi

breast cancer screening

• related: Breast Cancer risks, OBGYN

• 50-74: Initiate biennial breast cancer screening

• 40-49: discussion with patient

breast cancer screening

• related: Breast Cancer risks, OBGYN

• 50-74: Initiate biennial breast cancer screening

• 40-49: discussion with patient

trichomoniasis

• related: OBGYN

The most appropriate additional management is to treat the patient's sexual partner for trichomoniasis. Trichomoniasis, which is caused by Trichomonas vaginalis, is the most common nonviral sexually transmitted infection (STI) worldwide. Unlike other STIs that predominate in adolescents and younger adults, rates of trichomoniasis are evenly distributed among women of all age groups. It is caused by motile flagellated protozoa that in

trichomoniasis

• related: OBGYN

The most appropriate additional management is to treat the patient's sexual partner for trichomoniasis. Trichomoniasis, which is caused by Trichomonas vaginalis, is the most common nonviral sexually transmitted infection (STI) worldwide. Unlike other STIs that predominate in adolescents and younger adults, rates of trichomoniasis are evenly distributed among women of all age groups. It is caused by motile flagellated protozoa that in

vaccinations during pregnancy

• related: OBGYN
• tags: #note

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The incidence of pertussis in the United States has increased due to waning immunity.  Pertussis in infants age <3 months, who are at highest risk of acquiring the infection from affected adults, is associated with high rates of morbidity and mortality.  Therefore,

primary dysmenorrhea

• related: OBGYN
• tags: #obgyn

---

Primary dysmenorrhea is painful menses (eg, cramping) due excessive prostaglandin production (eg, inflammation) that interferes with daily activities.  In addition to cramping, patients often have associated fatigue, headache, and nausea.  These symptoms typically begin just prior to the onset of menstruation and generally last 2-3 d

breast pain

• related: OBGYN, breast mass
• tags: #obgyn

---

Mastalgia (breast pain) is a common and benign symptom that most women experience due to estrogen and progesterone changes associated with the menstrual cycle.  The pain is often cyclic, beginning up to 2 weeks before menses and usually subsiding by the onset of menses; it is typically described as heavy, diffuse, dull, a

common lactation problems

• related: OBGYN
• tags: #obgyn

---

Breastfeeding women with plugged milk ducts typically have breast pain and tenderness, palpable masses, and no signs of infection.  Poor feeding technique, a decrease in feeding, inadequate emptying, and stasis can lead to breast engorgement (ie, breast tissue distension) and subsequent blockage of milk ducts.  Treatment of

aortic dissection in pregnancy

• related: OBGYN
• tags: #obgyn

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This pregnant patient with hypertension, chest pain, and Horner syndrome likely has a peripartum acute aortic dissection.  Spontaneous dissection of the aorta and coronary arteries can occur in pregnancy, most commonly in the third trimester, due to the hyperdynamic state and hormonal effect on vasculature.  Horner symptoms, (a

uti in pregnancy

• related: OBGYN
• tags: #obgyn

---

This pregnant patient in the third trimester has features of cystitis (eg, urinary frequency, suprapubic tenderness).  The additional features of high-grade fever, peripheral leukocytosis, and marked pyuria suggest early acute pyelonephritis (despite the absence of costovertebral tenderness).  Pyelonephritis during pregnancy causes an increa

primary ovarian insufficiency

• related: OBGYN
• tags: #obgyn

---

Primary ovarian insufficiency (POI) is ovarian failure in women age <40.  Patients typically present with irregular or absent menses, often after cessation of oral contraceptives, which can mask menstrual irregularities.  In younger women, symptoms (eg, hot flashes, flushing, night sweats) are often attributed to moo

Medicine

• Related: Step 1, mksap, notes

Todos

• tolearn

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• Geriatrics
• OBGYN
• Pediatric
• [