Episodes
Cancer Screening
Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal.
ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf )
Breast: ACOG: 40-75 annual mammogram
Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger.
Lung: 55-80 with 30pack-year hx,...
Published 08/15/18
Swab/Urine
Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1
Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin
Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once.
HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed.
Serum
Syphilis: Painless chancre followed by latent,...
Published 08/15/18
Why: ASCCP guidelines (there is an app! Or PDF)
Cervical dysplasia — caused by HPV
CIN I–CIN3 is a progression
Risk factors: Smoking, other STIs including HIV, immunodeficiency
Histology: Increased Nuclear: cytoplasmic ratio when abnormal
Acetic Acid: exact mechanism unknown, the higher N:C ratio cells (aka abnormal cells) reflect more light and appear white.
Lugols: Iodine rich-reacts with glycogen in normal squamous cells so they appear dark. Non-staining cells are...
Published 02/13/18
Why: ASCCP guidelines (there is an app! Or PDF)
Cervical dysplasia — caused by HPV
CIN I–CIN3 is a progression
Risk factors: Smoking, other STIs including HIV, immunodeficiency
Histology: Increased Nuclear: cytoplasmic ratio when abnormal
Acetic Acid: exact mechanism unknown, the higher N:C ratio cells (aka abnormal cells) reflect more light and appear white.
Lugols: Iodine rich-reacts with glycogen in normal squamous cells so they appear dark. Non-staining cells are...
Published 02/13/18
Every visit:
Doptones, fundal height, vitals
Four question: Vaginal bleeding, contractions, leaking fluid, fetal movement
By Weeks:
20wks – get and review anatomy US
24wks – order glucola, cbc (check for anemia), discuss normal growing pains
28wks – Tdap and Rhogam if needed, discuss kick counts
32wks – Discuss BCM, sign tubal papers if needed, discuss TOLAC if needed
36wks – GBS screening, birth expectations, US for position
38-40wks – VE, “sweep membranes”
Published 02/11/18
Every visit:
Doptones, fundal height, vitals
Four question: Vaginal bleeding, contractions, leaking fluid, fetal movement
By Weeks:
20wks – get and review anatomy US
24wks – order glucola, cbc (check for anemia), discuss normal growing pains
28wks – Tdap and Rhogam if needed, discuss kick counts
32wks – Discuss BCM, sign tubal papers if needed, discuss TOLAC if needed
36wks – GBS screening, birth expectations, US for position
38-40wks – VE, “sweep membranes”
Published 02/11/18
Planned/Desired
Options counseling if needed
Exam/pelvic/pap
Ultrasound for dating
Screening options: QUAD, Sequential, NIPS, invasive testing
Pregnancy guidelines
Weight:
BMI under 18.5 should gain 28–40 pounds.
Normal-weight women (BMI, 18.5–24.9) should aim for 25–35
Overweight women (BMI, 25–29.9) should aim for 15–25
Obese women (BMI, 30 or more) should gain only 11–20
Food: Avoid unpasteurized dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked...
Published 02/08/18
Planned/Desired
Options counseling if needed
Exam/pelvic/pap
Ultrasound for dating
Screening options: QUAD, Sequential, NIPS, invasive testing
Pregnancy guidelines
Weight:
BMI under 18.5 should gain 28–40 pounds.
Normal-weight women (BMI, 18.5–24.9) should aim for 25–35
Overweight women (BMI, 25–29.9) should aim for 15–25
Obese women (BMI, 30 or more) should gain only 11–20
Food: Avoid unpasteurized dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked...
Published 02/08/18
Hysteroscopy = looking inside the uterus with a scope
Steps:
Dilate the cervix
Distend the uterus with fluid
Look around, identify pathology, identify tubal ostia, remove pathology if using an operative scope or Myosure or another resectoscope.
Feared complication: Hyponatremia from excessive hypotonic fluid absorption.
Published 01/10/18
Intrapartum
Differential diagnosis for Temp >38.0C
Epidural fever (transient), DVT/PE (if prolonged IOL or limited mobility), UTI, Intraamniotic infection (with or without ROM), etc
Chorioamnionitis aka IAI aka Triple-I (intrapartum intraamniotic Infection)
One temp >39.0C
One temp 38.0C-39.0C AND one or more risk factors
Two temps >38.0C 30+ mins apart
Tx: the standard is Ampicillin/Gentamycin until delivery. Tylenol prn temp>38C, IVF for maternal/fetal tachycardia,...
Published 01/08/18