MEDICAL DIAGNOSIS AND TREATMENT Flashcards by Daniel Evans

A 32 Y/O FEMALE SAILOR REPORTS TO MEDICAL C/O DISCOMFORT IN HER L BREAST. UPON OBTAINING HPI SHE STATES THIS HAS BEEN HAPPENING BEFORE HER PERIOD STARTS. SHE DRINKS 1/2 A BOTTLE A NIGHT OF RED WINE AND NOTICES A MASS EVERY NOW AND AGAIN THAT FLUCTUATES IN SIZE, WHICH AGAIN IS NOTED DURING PRE MENSES.

BREAST MASS

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IN REGARDS TO A PATIENT WITH BREAST MASSES,

WHAT LABS WOULD YOU ORDER?

WHAT IMAGING WOULD YOU ORDER?

NO LABS ARE REQUIRED

FOR RADS WE WILL GET AND ULTRASOUND AND MAMMOGRAPHY.

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IN REGARDS TO A SUSPECTED BREAST MASS,

WHAT MEDS WILL YOU GIVE AND WHAT EDUCATION WOULD YOU PROVIDE?

MEDS OF CHOICE WILL BE NSAIDS

EDUCATION WILL BE AROUND TELLING PATIENT TO:

AVOID TRAUMA
WEAR SUPPORTIVE BRA DAY AND NIGHT
DECREASE FAT INTAKE WITH DIET.
CONSIDER ELIMINATION OF CAFFEINE
VITAMIN E SUPPLEMENTATION
ENSURE MONTHLY BREAST SELF EXAMS ARE DONE

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YOU HAVE A 36 Y/O BLACK FEMALE THAT REPORTS SHE NOTICED A LUMP ON HER BREAST A WEEK AGO. UPON EXAMINATION YOU FEEL A ROUND/OVOID MASS THAT IS RUBBERY, MOVABLE AND IS NON-TENDER. V/S UNREMARKABLE AND PATIENT ONLY REPORTS THAT SHE JUST WANTS TO GET THIS CHECKED AND IT DOESN’T HINDER HER LIFE AT ALL.

DX: FIBROADENOMA
ANCILLARY: ULTRASOUND
TX: SHOULD BE REFERRED TO GENERAL SURGERY FOR FURTHER EVALUATION AND WORK UP.

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YOU HAVE A PATIENT WHO JUST UNDERWENT BREAST AUGMENTATION SURGERY AND COMES INTO MEDICAL BECAUSE SHE NOTICES A MASS ON HER BREAST. UPON EXAM YOU NOTICE SOME ECCHYMOSIS AND RETRACTION OF THE NIPPLE. WHAT WOULD YOU TELL THE PATIENT THIS LIKELY IS AND WHAT COURSE OF ACTION WOULD YOU WANT TO DO?

PATIENT IS HAVING FAT NECROSIS, AND SHOULD GET A BIOPSY TO RULE OUT MALIGNENT GROWTHS.

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YOUR EXECUTIVE OFFICER COMES DOWN TO MEDICAL ONE DAY COMPLAINING THAT WHILE GETTING HERSELF READY FOR WORK SHE NOTICED A LUMP IN HER BREAST A WEEK AGO. SINCE THEN, SHE’S HAD SOME NIPPLE DISCHARGE AND HER NIPPLE HAS ENLARGED AND FEELS ITCHY. WHILE CONDUCTING YOUR EXAM YOU FELL A SINGLE, NON-TENDER MASS THAT IS HARD AND ILL DEFINED MARGINS. WHAT WOULD YOU SUSPECT THE XO HAS AND WHAT WOULD YOU WANT TO DO FOR HER?

DX: BREAST CARCINOMA
TX PLAN: REFERRAL TO GENERAL SURGERY/ONCOLOGY FOR FURTHER WORK UP AND SURGICAL REMOVAL TO DETERMINE STAGE OF CANCER TO DETERMINE TREATMENT.

MEDEVAC

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AFTER PRIMARY TREATMENT OF BREAST CARCINOMAS. A PATIENT SHOULD BE MONITORED AT WHAT TIME INTERVALS?

EVERY 6 MONTHS FOR THE FIRST 2 YEARS AND THEN ANNUALLY AFTER THAT.

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HOW LONG DOES NORMAL MENSTRUAL BLEEDING LAST FOR?

5 DAYS NORMALLY

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HOW MUCH BLOOD IS NORMALLY LOST DURING MENSTRATION FOR FEMALES?

MEAN BLOOD LOSS IS ABOUT 40 ML

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MENORRHAGIA IS BLOOD LOSS OVER……

80ML

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BLEEDING THAT OCCURS BETWEEN PERIODS?

METRORRHAGIA

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POLYMENORRHEA

BLOOD FLOW OCCURS MORE OFTEN THAN EVERY 21 DAYS.

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ACUTE UTERINE BLEEDING WAS PREVIOUSLY KNOWN AS THIS TERM

DYSFUNCTIONAL UTERINE BLEEDING.

DUB

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ABNORMAL UTERINE BLEEDING IN WOMEN AGES 19-39 IS OFTEN A RESULT OF THESE FACTORS.

PREGNANCY
STRUCTURAL LESIONS
ANOVULATORY CYCLE
USING HORMONES
ENDOMETRIAL HYPERPLASIA

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ABNORMAL UTERINE BLEEDING IN WOMEN AGES 19-39 IS OFTEN A RESULT OF THESE FACTORS.

PREGNANCY
STRUCTURAL LESIONS
ANOVULATORY CYCLE
USING HORMONES
ENDOMETRIAL HYPERPLASIA

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DIAGNOSIS OF ABNORMAL UTERINE BLEEDING DEPENDS ON WHAT FACTORS DURING ASSESSMENT

HISTORY OF DURATION AND AMOUNT OF FLOW

ASSOCIATED PAIN
RELATION TO LAST MENSTRUAL PERIOD

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WHEN SUSPECTING A PATIENT SUFFERING FROM ABNORMAL UTERINE BLEEDING, WHAT ARE SOME LABS THAT WOULD BE USEFUL IN VALIDATING YOUR DIAGNOSIS?

CBC
HCG
TSH
CLOTTING STUDIES

IF BLEEDING,

GONORRHEA/ CHLAMYDIA
PAP SMEAR
ENDOMETRIAL SAMPLING

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FOR FEMALES SUSPECTED OF ABNORMAL UTERINE BLEEDING, WHAT IMAGING WOULD YOU WANT TO GET?

INTRAVAGINAL ULTRASOUND

CHECKING FOR:
MASSES
ECTOPIC PREGNANCY
THICKNESS OF THE ENDOMETRIUM

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ALL AUB PATIENTS SUSPECTED OR DIAGNOSABLE SHOULD BE REFERRED TO:

OB-GYN

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ALL POST MENOPAUSAL BLEEDING IS THIS UNTIL PROVEN OTHERWISE

CANCER

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IN PATIENTS WITH AUB-O WHAT MEDS WILL HELP REDUCE BLEEDING ?

PROGESTIN AND NSAIDS

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THIS CONDITION IS DEFINED AS:

VARIABLE CLUSTER OF TROUBLESOME SYMPTOMS THAT ARE PHYSICAL AND EMOTIONAL IN NATURE AND TAKE PLACE 5 DAYS BEFORE MENSES AND RELIEVE ABOUT 4 DAYS AFTER MENSES OCCUR.

PREMENOPAUSAL SYNDROME

PMS

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WHAT PERCENTAGE OF PRE-MENOPAUSAL WOMEN ARE AFFECTED BY PREMENSTRUAL SYNDROME?

40 %

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YOUR FEMALE CPO COMES TO MEDICAL AND IS THROWING A FIT OVER WORK AND SCREAMING AT EVERYONE. ONCE YOU GET HER INTO YOUR OFFICE AND SHE CALMS DOWN AFTER ALSO CRYING, SHE STARTS TO TELL YOU THAT SHE HAS BEEN FEELING BLOATED, FEELING LETHARGIC AND HER ANKLES HAVE BEEN SWOLLEN THE LAST 2 DAYS AND IT KILLS HER TO WALK AROUND SHIP. V/S ARE WNL. SHE SAYS THAT SHE NORMALLY GETS THIS WAY BEFORE HER WOMANLY CYCLE COMES BUT THIS TIME IT’S WAY DIFFERENT.

WHAT ARE YOU SUSPECTING?
WHAT IS THE WORK UP/ TX?
IS THIS A REFERRAL?

PREMENSTRUAL DYSPHORIC DISORDER
WORK UP IS MOSTLY EMOTIONAL AND SUPPORT BASED . GOOD TO TELL PATIENT TO KEEP AN EMOTION DIARY FOR DAILY RECORD.
TX OF THIS INCLUDES:
- AEROBIC EXERCISE
- REDUCE CAFFEINE AND/OR SALTS
- INCREASE CALCIUM, VIT D AND MAGNESIUM
- INCREASE COMPLEX CARBOHYDRATES

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SOMEONE SUFFERING FROM SUSPECTED PREMENSTRUAL DYSPHORIC DISORDER WOULD BENEFIT FROM WHAT MEDICATIONS THERAPIES?

COMBINED ORAL CONTRACEPTIVES SUCH AS - DEPOPROVERA - NEXPLANON SSRIS SUCH AS: PAROXETINE SERTRALINE FLUOXETINE

VAGINITIS CAN USUALLY BE BROUGHT ON FROM THE FOLLOWING

PATHOGENS ALLERGIC REACTIONS TO VAGINAL CONRRACEPTIVES OR OTHER PRODUCTS VAGINAL ATROPHY FRICTION DURING SEX

WHEN SUSPECTING A PATIENT TO HAVE VAGINITIS WHAT ARE SOME PERTINENT QUESTIONS TO ASK FOR HISTORY?

ONSET OF LAST MENSTRUAL RECENT SEXUAL ACTIVITY USE OF CONTRACEPTIVES, TAMPONS OR DOUCHES RECENT MEDICATION CHANGES OR ANTIBIOTIC USE.

A 24 Y/O FEMALE REPORTS TO MEDICAL WITH THE FOLLOWING SYMPTOMS AFTER THE UNDERWAY PERIOD. - VAGINAL PAIN - MALODOROUS DISCHARGE PERTINENT HX WAS SHE WAS HAVING SEX ALL WEEKEND WITH HER BOAT BOO AND RECENTLY STARTED A NEW B.C PRODUCT THAT MADE HER FEEL WEIRD AT FIRST, BUT DIDN'T THINK MUCH OF IT. WHAT WOULD BE A GOOD FIRST DX FOR THIS PATIENT IF UPON EXAM YOU NOTE ADNEXAL TENDERNESS OR CERVICAL MOTION TENDERNESS FROM BIMANUAL PALPATION?

VAGINITIS

FOR VAGINITIS, WHAT LABS CAN WE DO IN AN OPERATIONAL SETTING?

NONE

FOR VAGINITIS, WHAT LABS WOULD YOU WANT TO ORDER FOR THE PATIENT

KOH WET PREP NAAT URINE (CH/GH)

WHAT IMAGING IS REQUIRED FOR VAGINITIS PATIENTS?

NONE

WHAT IS THE MEDICATION OF CHOICE FOR A PATIENT WITH VULVOVAGINITIS CANDIDIASIS?

DIFLUCAN (FLUCANOZOLE) 150 MG TABLET. ONE TABLET DOSE

FOR TRICHIMOSIS VAGINALIS VAGINITIS, A REGIMEN OF METRONIDAZOLE IS INDICATED FOR ....

BOTH PARTIES INVOLVED IN SEXUAL ENCOUNTERS

WHAT ARE THE MEDICATIONS OF CHOICE FOR BACTERIAL VAGINOSIS

METRONIDAZOLE CLINDAMYCIN METRONIDAZOLE GEL

WHAT IS THE ANTIBIOTIC OF CHOICE FOR A PATIENT WITH CHLAMYDIA?

DOXY 100MG

WHAT IS THE MEDICATION OF CHOICE IN SOMEONE SUFFERING FROM GONORRHEA?

CEFTRIAXONE

WHAT ARE SOME EDUCATION POINTS TO GIVE TO PATIENTS SUFFERING FROM VAGINITIS?

AVOID NON ABSORBENT UNDERWEAR AVOID DOUCHING DELAY SEXUAL INTERCOURSE UNTIL TREATMENT IS COMPLETE

BARTHOLIN GLAND CYSTS ARE USUALLY CAUSED BY THESE MAJOR STI

GHONORRHEA AND CHLAMYDIA

WHAT IS THE TREATMENT FOR SOMEONE WITH A BARTHOLIN GLAND CYST?

I&d MANUAL ASPIRATION WARM SOAKS ANTIBIOTICS IF CELLULITIC OR INFECTION IS SPREADING.

CERVICAL DYSPLASIA IS USUALLY DIAGNOSED WITH THIS LAB/ PROCEDURE

PAP SMEAR

WHAT AGE SHOULD A WOMAN BEGIN RECIEVING A PAP SMEAR REGARDLESS OF HER SEXUAL HISTORY

21 Y/O

THIS ENTITY RECOMMENDS SCREENING INTERVALS FOR WOMEN TO RECIEVE A PAP SMEAR AND/OR A CYTOLOGY AND HPV TEST

US PREVENTITIVE SERVICES TASK FORCE (USPTF)

A WOMAN WITH NO HISTORIC INDICATORS FOR HPV OR ABNORMAL PAPS SHOULD BE ABLE TO STOP RECIEVING THESE PROCEDURES AFTER WHAT AGE

65 PER THE USPSTF

WHAT IS THE SYSTEM USED WHEN DETERMINING A PAP SMEAR'S RESULTS

BATHESDA SYSTEM

WITHIN THE BETHESDA SYSTEM WHAT ARE THE TWO CATEGORIES?

ATYPICAL SQUAMOUS CELLS OF UNKNOWN SIGNIFICANCE (ACS-US) SQUAMOUS INTRAEPITHELIAL LESIONS (SIL) * LOW GRADE (LSIL) * HIGH GRADE (HSIL)

WOMEIN WITH ASC-US AND A NEGATIVE HPV TEST CAN FOLLOW UP FOR ANOTHER PAP WITH HPV IN HOW LONG?

1 YEAR

IF A WOMAN RECIEVES A PAP AND HPV SCREEN AND THE SCREEN COMES BACK POSITIVE WHAT PROCEDURE IS THEN WARRANTED

COLPSOSCOPY

A WOMAN WHO HAS BEEN RECIEVING GARDISIL FOR HPV SINCE SHE WAS 10 YRS OLD DOES NOT NEED A PAP

FALSE

ALL FEMALES WITH RESULTED PAP BEING ABNORMAL SHOULD BE REFERRED WHERE?

OB/GYN

WHAT IS THE MOST COMMON BENIGN NEOPLASM OF THE FEMAL GENITAL TRACT?

LEIOMYNOMA OFTHE UTERUS (FIBROID TUMOR)

FIBROID TUMORS ARE NORMALLY SYMPTOMATIC, BUT CAN ARISE WITH THESES SYMPTOMS TO CAUSE A FEMALE TO BE EVALUATED?

PAIN PELVIC PRESSURE UTERINE BLEEDING THAT IS ABNORMAL

SOMEONE THAT YOU SUSPECT TO HAVE A PELVIC MASS LIKE A FIBROID TUMOR SHOULD BE SENT TO GET WHAT LABS?

- CBC | - IRON ANEMIA

WHAT IMAGING IS REQUIRED TO HELP YOU DIAGNOSE A PATIENT WITH A PELVIC MASS?

TRANSVAGINAL ULTRASOUND MRI WITH CONTRAST HYSTEROGRAPHY OR HYSTEROSCOPE

A PATIENT WITH A FIBROID TUMOR SHOULD BE MEDEVAC'D WHEN

SUSPECTING TORSION, HEMORRHAGE

THIS DIAGNOSED CASE IS 90% ASSOCIATED WITH UTERINE BLEEDING PAP'S ARE FREQUENTLY NEGATIVE PAIN IS A LATE SYMPTOM

CARCIONOMA OF THE ENDOMETRIUM

CARCINOMA OF THE ENDOMETRIUM REQUIRES WHAT TREATMENT?

``` (SURGERY) TOTAL HYSTERECTOMY BILATERAL SALPINGO OOPHORECTOMY PERITONEAL WASHINGS LMYPH NODE SAMPLING (RADIATION) (CHEMO) ```

A WOMAN WHO IS ANY OF THE FOLLOWING: - OBESE - NULLIPARITY - DIABETIC - POLYCYSTIC OVARIES - TAKING ESTROGEN BLOCKERS FOR BREAST CANCER - FAMILY HX OF COLORECTAL CANCER Has the likelihood of developing ť this

CARCINOMA OF THE ENDOMETRIUM

WHAT PERCENT OF POST MENOPAUSAL BLEEDING REQUIRE FURTHER EVALUATION?

ALL

WHAT IS THE OVERALL 5 YEAR SURVIVAL FOR A PATIENT WITH ENDOMETRIAL CARCINOMA?

80-85%

ENDOMETRIAL CARCINOMA WITH A LESS THAN 66% INVASION HAS THIS PERCENT OF GOOD PROGNOSIS?

98%

ENDOMETRIAL CARCINOMA WITH AN INVASION OF MORE THAN 66% HAS THIS PERCENTAGE OF GOOD PROGNOSIS?

78%

ALL PATIENTS WITH CONCERN OF ENDOMETRIAL CARCINOMA SHOULD BE SENT AND EVALUATED BY THIS PROFESSIONAL

GYNECOLOGICAL ONCOLOGIST

ECTOPIC GROWTH OF ENDOMETRIUM OUTSIDE OF THE UTERUS, PARTICULARLY IN THE DEPENDENT AREAS OF THE PELVIS AND OVARIES

ENDOMETRISOSIS

DYSMENORRHEA CHRONIC PELVIC PAIN ABNORMAL BLEEDING DYSPAREUNIA PHYSICAL EXAM SHOWS: TENDER NODULES IN THE RECTOVAGINAL SEPTUM

ENDOMETRIOSIS

DIFINITIVE DIAGNOSIS OF ENDOMETRISOSIS IS MADE HOW?

MADE BY HISTOLOGY OF LESIONS REMOVED AT SURGERY. (LAPAROSCOPY)

WHAT ARE THE MAINSTAY MEDICAL THERAPIES FOR ENDOMETRISOSIS?

NSAIDS HORMONAL THERAPY

DEFINED AS A POLYMICROBIAL INFECTION OF THE UPPER GENITAL TRACT

PELVIC INFLAMMATORY DISEASE

PID IS COMMONLY ASSOCIATED WITH THIS POPULATION OF FEMALES

STI SUCH AS GHONORRHEA OR CHLAMYDIA MALLIPAROUS, SEXUALLY ACTIVE WOMEN FEMALES JUST RECIEVING A IUD

YOU HAVE A 28 Y/O BM1 WHO REPORTS TO MEDICAL WITH C/O LOWER BACK AND ABD PAIN. SHE REPORTS THAT SHE JUST RECIEVED AN IUD AND IS SEXUALLY ACTIVE WITH 4 MEN. SHE IS FEBRILE, REPORTS CHILLS, AND STATES SHES GOT STUFF COMING OUT FROM HER FLOWER.

PELVIC INFLAMMATORY DISEASE

FOR P.I.D. WHAT ARE THE MAIN LABS YOU WANT TO GET?

ENDOCERVICAL CULTURES TESTING FOR | CHLAMYDIA AND GHONORRHEA

WHAT IMAGING WOULD YOU GET FOR A PATIENT WITH PELVIC INFLAMMATORY DISEASE?

INTRAVAGINAL ULTRASOUND

WHAT IS THE ANTIBIOTIC REGIMEN FOR A PATIENT WITH PELVIC INFLAMMATORY DISEASE.

A STRONG CEPHALOSPORIN ACCOMPANIED WITH DOXYCYCLINE 100MG OR METRONIDAZOLE FOR AN ADDITIONAL 7 DAYS FOR A TOTAL OF 14 DAYS

PELVIC INFLAMMATORY DISEASE SUSECTED PATIENTS SHOULD BE MEDEVAC'D IF ANY OF THE FOLLOWING ARE PRESENT:

SUSPICION OF TUBO-OVARIAN ABCESS PATIENT IS PREGNANT PATIENT CAN'T TOLERATE TREATMENT PLAN NO IMPROVEMENNT IN 72 HOURS SYSTEMIC ABNORMALITIES SUCH AS FEVER, NAUSEA AND VOMITING CAN'T RULE OUT APPENDICITIS OR OTHER SURGICAL EMERGENCY

COMMON , MOST ARE BENIGN MALIGNANT TUMORS ARE THE LEADING CAUSE OF DEATH FROM REPRODUCTIVE TRACT CANCERS WOMEN WITH BRCA GENE MUTATION ARE AT INCREASED RISK

OVARIAN MASS/ CANCER

ONCE AN OVARIAN MASS IS IDENTIFIED, IT MUST BE WORKED UP AND CLASSIFIED AS ONE OF THE FOLLOWING:

BENIGN NEOPLASTIC FUNCTIONAL POTENTIALLY MALIGNANT

OVARIAN MASSES SHOULD HAVE WHAT LABS DRAWN?

HCG CANCER ANTIGEN 125 LACTATE DEHYDROGENASE

OVARIAN CANCER IS USUALLY DIAGNOSED :

AFTER LATENT SYMPTOMS OF DISEASE 75% OF THE TIME

WHAT IMAGING WOULD YOU WANT TO GET ON A PATIENT WITH SUSPECTED OVARIAN MASS?

TRANS VAGINAL U/S COLOR DOPPLER TO CHECK VASCULARITY

WHAT IS THE TREATMENT FOR : MALIGNANT OVARIAN MASS BENIGN OVARIAN MASS

- MALIGNANT- * EVALUATION BY GYNO ONCOLOGIST * COMBINATIONS OF HYSTERECTOMY AND BILATERAL SALPINGOOOPHORECTOMY WITH OMENTECTOMY AND SELECTIVE LYMPHADENECTOMY - BENIGN- * REMOVAL OF THE TUMOR * UNILATERAL OOPHORECTOMY

OVARIAN MASSES OR TUMORS HAVE THE RISK OF ALSO CONTRIBUTING TO WHAT MAJOR OVARIAN COMPLICATION?

OVARIAN TORSION

COMMON ENDOCRINE DISOR

COMMON ENDOCRINE DISORDER THAT AFFECTS 5-10% OF WOMEN IN THE REPRODUCTIVE AGE RANGE

POLYCYSTIC OVARIAN SYNDROME

YOU HAVE A NEW CS1 THAT CHECKS ONBOARD YOUR SHIP, SHE REPORTS AND WHEN YOU DO YOUR INITIAL INTERVIEW YOU NOTICE SHE IS OBESE, HAS FACIAL HAIR AND THICK ARM HAIR, AND HAS AN INFREQUENT SCHEDULE OF MENSTRATION

POLYCYSTIC OVARIAN SYNDROME (PCOS)

WHAT ARE SOME LABS YOU WOULD WANT TO GET FOR A PATIENT WITH POSSIBLE POLYCYSTIC OVARIAN SYNDROME

- FSH AND LH - PROLACTIN - TSH - HEMOGLOBIN A1C - LIPIDS

WHAT IS THE IMAGING OF CHOICE FOR POLYCYSTIC OVARIAN SYNDROME?

TRANSVAGINAL ULTRASOUND

``` WEIGHT LOSS AND EXERCISE METFORMIN THERAPY IN REGARD TO FERTILITY: (IF ) -OVARIAN STIMULATION WITH MEDS AND SURGERY (IF NOT) -COMBINED CONTRACEPTIVES -LNG IUD ``` TREATMENT OF MANLY CHARACTERISTICS THESE ARE ALL PERFORMED TREATMENTS DEALING WITH WHAT SYNDROME?

POLYCYSTIC OVARIAN SYNDROME

RECURRENT PAIN THAT IS ASSOCIATED TO SEXUAL INTERCOURSE WITH ABCENCE OF LACK OF LUBRICATION O R VAGINISMUS

DYSPAREUNIA

THIS IS THE MOST COMMON CAUSE OF DYSPAREUNIA IN PREMENOPAUSAL WOMEN.

VULVODYNIA- VULVULAR PAIN

A PATIENT COMES INTO MEDICAL WITH THE FOLLOWING SYMPTOMS DURING INTERCOURSE WITH THEIR SIGNIFICANT OTHER: - BURNING SENSATION - PAIN - ITCHING - STINGING - IRRITATION OR RAWNESS

DYPAREUNIA

AN INITIAL CASE OF DYPARENUNIA IS TREATED WITH WHAT ANCILLARY SUPPORT?

SEXUAL COUNCELING AND EDUCATION - USING ADEQUATE LUBE - POSSIBLE OPTIONS OF BOTOX INJECTIONS

A COUPLE IS CONSIDERED INFERTILE WHEN THEY HAVE BEEN ACTIVELY ATTEMPTING TO CONCIEVE FOR HOW LONG? AT MINIMUM HOW MANY TIMES A WEEK?

FOR 1 YEAR AT MINIMUM OF 2 X WEEK

INFERTILITY HAS A BIG FACTOR THAT PLAYS INTO IT AND ITS OUR.......

AGE

DECLINING FERTILITY HAPPENS AT WHAT AGE RANGE

EARLY 30'S AND ACCELERATES INTO LATE 30'S

MALE PARTNERS CONTRIBUTE TO WHAT % OF INFERTILITY

40%

A COUPLE YOU BELIEVE TO BE SUFFERING FROM INFERTIITY WOULD BENEFIT FROM WHAT LABS?

CBC GH/CL TESTING TSH SEMEN ANALYSIS

IN THE ABCENSE OF IDENTIFIABLE CAUSES. A COUPLE TRYING TO GET PREGNANT WILL HAVE A 60% LIKELIHOOD OF GETTING PREGGERS WITHIN HOW MANY YEARS?

WITHIN 3 YEARS

IN REGARDS TO FAMILY PLANNING, -WHAT PERCENTAGE END IN ABORTION?

50 %

IN REGARDS TO FAMILY PLANNING, -WHAT PERCENT OF BIRTHS WERE UNPLANNED?

38%

IF AN ACTIVE PILL IS MISSED AND NO INTERCOURSE OCCURED IN THE PAST 5 DAYS.......

TAKE 2 B.C PILLS

IF AN ACTIVE PILL IS MISSED AND WITHIN 5 DAYS THERE WAS INTERCOURSE........

TAKE AN EMERGENCY CONTRACEPTION

ADVANTAGES OF TAKING COMBINED ORAL CONTRACEPTIVES?

``` LIGHTER MENSES IMPROVEMENT OF DYSMENORRHEA DECREASED RISK OF OVARIAN CANCER IMPROVEMENT OF ACNE LESS LIKEY TO GET OVARIAN CYSTS DEVELOPING MYOMAS ARE LOWER BENEFICIAL EFFECT ON BONE MASS ```

WHAT ARE SOME ABSOLUTE CONTRAINDICATIONS IN PUTTING A PATIENT ON COMBINED ORAL CONTRACEPTIVES?

``` PREGNANCY/BREAST FEEDING THROMBOEMBOLIC DISORDERS STROKE OR CORONARY ARTERY DISEASE CANCER OF THE BREAST UNDIAGNOSED ABD VAGINAL BLEEDING 35 Y/O AND SMOKING 15 CIGS A DAY ```

EFFICACY OF THE PROGESTIN MINIPILL IS DEPENDENT ON THIS

ADHERENCE TO TREATMENT AND TAKING THE MEDICATION EVERY DAY AT THE SAME TIME WINDOW.

THIS CONTRACEPTIVE IS: ``` SAFE FOR LACTATING MOTHERS SAFE FOR WOMEN OVER 35 OKAY FOR SMOKERS HAVE CONDITIONS SUCH AS: -DVT -KNOWN THROMBOEMBOLITIC DISORDERS -DIABETES WITH VASCULAR DISEASE ```

PROGESTIN MINIPILL

INJECTIBLE PROGESTIN IS GIVEN AT WHAT INTERVAL?

3 MONTHS

THIS IMPLANT IS INSERTED INTO THE PROXIMAL ASPECT OF THE NON DOMINANT ARM, IS EFFECTIVE FOR 3 YEARS, AND HAS LITTLE TO NO DELAY IN RETURN OF OVULATION WHEN DISCONTINUING REGIMENS.

NEXPLANON IMPLANT

THIS PATCH IS APPLIED TO A FEMALE'S ABDOMEN, UPPER TORSO OR BUTTOCK ONCE A WEEK FOR 3 WEEKS AND THEN HAS AN OFF PERIOD OF 1 WEEK

TRANSDERMAL PATCHES

A FEMALE PATIENT DOESN'T KNOW THE NAME OF HER B.C. SHE STATES I'TS A RING THAT'S SOFT AND FLEXIBLE AND WAS PLACED IN HER UPPER VAGINA 3 WEEKS AGO. WHAT B.C IS THIS AND WHAT SHOULD SHE DO NEXT?

THIS IS A NUVARING B.C SHE SHOULD REMOVE THIS FROM HER VAGINA AND REPLACE IN A WEEK, ALTHOUGH SHE CAN LEAVE IN AND REPLACE FOR CONSTANT CYCLING AT THE 4TH WEEK.

THIS TYPE OF IUD CAUSES MUCOSAL THICKENING OF THE CERVIX, PREVENTING ENDOMETRIAL THICKENING AND INHIBITING OVULATION. CAN ALSO HELP REDUCE MENSTRUAL FLOW

LOVONORGESTREL (LNG)

THIS FORM OF IUD INHIBITS THE CAPACITATION AND TRANSPORT OF SPERM

COPPER BEARING

THE COPPER IUD CAN BE PLACED HOW MANY DAYS FOLLOWING AND EPISODE OF UNPROTECTED SEX

5 DAYS

A MEMBER WHO HAS AN IUD INSERTED FINDS OUT SHE IS PREGNANT. WHAT IS HER NEXT COURSE OF ACTION TO TAKE?

SET PATIENT UP FOR APPOINTMENT TO REMOVE THE DEVICE.

WHAT IS A COMMON COMPLICCATION FOR PATIENTS WITH IUD WITHIN THE FIRST FEW MONTHS?

PELVIC INFLAMMATORY DISEASE

SOME COMPLICATIONS OF A COPPER IUD INCLUDE THE FOLLOWING.

HEAVY MENSTRUAL PERIODS BLEEDING BETWEEN PERIODS MORE CRAMPING

A PATIENT WITH AN IUD COMES IN AND DURING THE PELVIC EXAM YOU CAN NOT VISUALIZE THE STRING WHAT IS THE NEXT COURSE OF ACTION?

MEMBER NEEDS A PELVIC ULTRASOUND AND GYN REFERRAL.

FAILURE RATE OF A MALE WHO USES CONDOMS "PERFECTLY"

18% WILL GET PREGNANT

TIME FRAME TO BEGIN EMERGENCY CONTRACEPTIVES?

ASAP WITHIN 120 HOURS OR 5 DAYS

WHAT INSTRUCTION GOVERNS THE NAVY'S POLICY ON ABORTIONS AND WILLINGNESS TO PAY FOR IT?

BUMEDINST 6300.16

THIS METHOD OF FAMILY PLANNING IS UTILIZED WHEN THE MAN, WOMAN OR BOTH PARTNERS WANT NO MORE KIDS OR WORRY OF BECOMING PREGNANT

VESECTOMY FOR MEN TUBIAL LIGATION FOR WOMEN

A MALE WHO RECIEVES A VESECTOMY REQUIRES FOLLOW UP ANALYSIS AT WHAT INTERVALS.

ONCE A MONTH. FOR 3 MONTHS

WHAT IS THE NAVY INSTRUCTION ON SEXUAL ASSAULT

SECNAVINST 1752.4

NAVY DEFINES THIS AS INTENTIONAL SEXUAL CONTACT CHARACTERIZED BY THE USE OF FORCE, THREATS, INTIMIDATION, OR ABUSE OF AUTHORITY OR WHEN THE DOES NOT OR CAN NOT CONSENT.

SEXUAL ASSAULT

AS SOON AS SOMEONE REPORTS TO MEDICAL AND STATES THEY WERE SEXUALLY ASSAULTED WHAT ARE YOUR FIRST STEPS?

NOTIFY THE UVA IF NOT DONE SO ALREADY BE MINDFUL OF WHAT YOU SAY DUE TO THE POTENTIAL FOR UNRESTRICTED REPORTING.

WHAT TINDER OF SHIPS ARE AUTHORIZED THROUGH TYCOM TO PERFORM SEXUAL ASSAULT FORENSIC EXAMS AND PATIENT BASED CARE?

CVN | LHA/LHD

IF A PATIENT WAS REPORTED TO HAVE BEEN SEXUALLY ASSAULTED AND YOU SEE SHE IS BLEEDING FROM A STAB WOUND. WHAT IS YOUR FIRST PRIORITY

TREAT THE STAB WOUND AND ALL LIFE THREATENING INJURIES FIRST.

YOU'RE THE DUTY PROVIDER AND YOU GET A CALL FROM A SAILOR WHO TELLS YOU THEY THINK THEY HAVE BEEN SEXUALLY ASSAULTED OUT IN TOUWN. WHAT IS THE FIRST THING YOU WILL TELL THEM.

DON'T SHOWER OR CHANGE YOUR CLOTHES. COME STRAIGHT BACK TO THE SHIP. IF THEY DO SHOWER GATHER ALL GARMENTS OF CLOTHINNG WORN AND MEDEVAC WITH THE PATIENT.

WHAT ARE THE TWO PHASES OF RAPE TRAUMA SYNDROME

IMMEDIATE/ACUTE LATE/CHRONIC

A SEXUAL ASSAULT VICTIM SHOULD RECIEVE A PREGANCY TEST IF THEY REPORT THIS.....

MISSED MENSES

IF THE PATIENT SO DESIRES AFTER THEIR SEXUAL ASSAULT AND ARE NOT SYMPTOMATIC. WHEN WOULD YOU DRAW HIV, RPR, GC, CHLAMYDIA?

-HIV AT 2-4 MONTHS -RPR AT 16 WEEKS -GC CHLAMYDIA

TYPE OF ABORTION ALL CLINICALLY RECOGNIZED PREGNANCIES TERMINATE IN SPONTANEOUS ABORTION IN WHAT PERCENT?

20%

TYPE OF ABORTION PATIENT REPORTS TO MEDICAL SHE IS PREGNANT, SHE IS HAVING SOME CRAMPING AND BLEEDING UPON PELVIC EXAM THE CERVIX IS NOT DILATED.

THREATENED PREGNANCY | INCREASED RISK OF MISCARRIAGE

TYPE OF ABORTION PRODUCTS OF CONCEPTION ARE EXPELLED PAIN CEASES BUT SOME SPOTTING REMAINS CERVIX STILL CLOSED BUT SHOWS BLOOD IN VAGINAL VAULT

COMPLETE ABORTION

TYPE OF ABORTION CERVIX IS DILATED PORTION OF THE PRODUCTS OF CONCEPTION REMAIN IN THE UTERUS MILD CRAMPING IS REPORTED BLEEDING IS PERSISTENT AND OFTEN EXCESSIVE

INCOMPLETE ABORTION

TYPE OF ABORTION PREGNANCY HAS CEASED, CONCEPTUS HAS NOT EXPELLED FROM UTERUS. PATIENT SHOWS NO SYMPTOMS OF PREGNANCY SHOWS A BROWNISH TINTED DISCHARGE WITHOUT BLOOD FROM THE VAGINA PELVIC EXAM SHOWS A SEMI FIRM CERVIX, ADNEXA IS NORMAL, WHAT ABORTION IS THIS AND WHAT SHOULD THE PATIENT UNDERGO?

MISSED ABORTION MAY BE INDICATED FOR ABORTIFACIENT CORRETTAGE

A SPONTANEOUS ABORTION OF PREGNANCY CARRIES WHAT TREATMENT PLAN FOR THE IDC

``` LAB: CBC, HCG RAD:TRANSVAGINAL ULTRASOUND MEDS: ANALGESICS OR NARCOTICS REFERRALS: OB/GYN DISPOSITION: MEDEVAC ```

WHAT IS THE CAUSATIVE AGENT IN NORMALLY FOUND FOR MASTITIS?

STAPHYCOCCUS AUREUS

WHAT MUST ALWAYS BE CONSIDERED IN A PATIENT PRESENTING WITH POSSIBLE MASTITIS?

INFLAMMATORY CARCINOMA

A 23 Y/O FEMALE SAILOR JUST RETURNED TO SHIP FROM BABY LEAVE, SHE REPORTS TO MEDICAL WITH AN ENLARGED, TENDER BREAST. SHE STATES SHE IS NURSING AND PUMPING AND THE BABY HAS BEEN CLUSTER FEEDING. EXAM SHOWS: UNILATERAL CELLULITIS TO THE AFFECTED BREAST THAT IS RED , TENDER AND WARM. CBC COMES BACK WITH ELEVATED WBC WHAT IS THE DX OF THIS PATIENT

MASTITIS

WHAT IS THE TREATMENT FOR A PATIENT SUFFERING FROM MASTITIS?

- ANTIBIOTICS (CEPHALEXIN, SULFAMETHOXAZOLE/TRI, CLINDAMYCIN) - REGULAR EMPTYING OF THE BREAST( BREAST FEEDING IS OK) - PAIN AND INFLAMMATION MANAGEMENT (MOTRIN)

WHEN SHOULD A PATIENT WITH MASTOIDITIS FOLLOW UP WITH THE IDC?

IN 48 HOURS TO ENSURE IMPROVEMENT WITH THERAPIES. NO IMPROVEMENT IN 72 HOURS REQUIRES CALL TO PHYSICIAN SUPERVISOR OR OB/GYN.

WHAT IS THE DIFFERENCE BETWEEN PRIMARY MENORRHEA AND SECONDARY MENORRHEA?

PRIMARY AMENORRHEA IS LACK OF BLEEDING. SECONDARY IS WOMEN WHO ARE PAST MENARCHE STAGE THAT HAVE AMENORRHEA FOR 3 CONSECUTIVE MONTHS.

THIS CONDITION ASSOCIATED WITH AMENORRHEA IS: TERMINAL EPISODE OF NATURALLY OCCURING MENSES RETROSPECTIVE DIAGNOSIS USUALLY 6 MONTHS OR LONGER AMENORRHEA

MENOPAUSE

THE MOST COMMON CAUSE OF SECONDARY AMENORRHEA IN PREMENOPAUSAL WOMEN?

PREGNANCY

SECONDARY AMENORRHEA AFFECTED BY LOW GNRH LEVELS

HYPOTHALMIC-PITUITARY CAUSES

SECONDARY AMMENORHHEA WITH ELEVATED LEVELS OF TESTOSTERONE MAY HAVE MASCULINE CHARACTERISTICS

HYPERANDROGENISM

WHAT IS THE NORMAL AGE RANGE FOR MENOPAUSE?

48-55 Y/O

WOMEN WITH PREMATURE MENOPAUSE ARE WHAT PERCENT MORE LIKELY TO SUFFER FROM CORONARY DISEASE?

50%

PATIENTS SUFFERING FROM PREMATURE MENOPAUSE ARE AT WHAT PERCENT INCREASED RISK FOR STROKE?

23%

WHAT IS THE DISPOSITION OF A PATIENT WITH SECONDARY AMENORHHEA?

RTOB BUT REFER TO PHYSICIAN SUPERVISOR OR OB/GYN WHEN AVAILABLE

25 Y/O FEMALE REPORTS TO MEDICAL IN ACUTE DISTRESS AND SEVERE ABDOMINAL PAIN. SHE STATES SHE WAS RUNNING A COUPLE MILES WHILE SHE CAN CAUSE SHE'S PREGNANT.

OVARIAN TORSION

WHAT IS THE BEST TREATMENT FOR A PATIENT WITH SUSPECTED ANDNEXAL TORSION OR OVARIAN TORSION.

PROMPT DIAGNOSIS AND MEDEVAC FOR SURGERY

THIS PROCEDURE IS INDICATED WHEN: DIAGNOSTIC OR THERAPEUTIC DRAINAGE OF THE URINARY BLADDER NEED FOR A RELIABLE AND FREQUENT ASSESSMENT OF URINE OUTPUT LIKE TREATING SHOCK.

URINARY CATHETER

CONTRAINDICATIONS OF URINARY CATHETERIZATIONS

SUSPECTED URETHRAL INJURY HIGH RIDING PROSTATE BLOOD AT THE URETHRAL MEATUS PERINEAL HEMATOMA

HOW MANY ANTISEPTIC SWABS DO YOU USE FOR A FEMALE PATIENT ABOUT TO GET A URINARY CATHETERIZATION

4-5 SWABS 2 SUCCESSIVE FRONT TO BACH OVER THE LABIA. THEN 2 SUCCESSIVE SWABS FRONT TO BACK OVER THE URETHRAL MEATUS.

HOW FAR DO YOU ADVANCE THE URINARY CATHETER AFTER INSERTION INTO THE URETHRA?

YOU INSERT IT UNTIL YOU SEE URINE RETURN, THEN YOU ADVANCE ANOTHER 4-5 CM BEFORE INFLATING BALOON

IF WHEN DOING A URINARY CATHETER YOU MISS THE URETHRA AND YOU GO INTO THE VAGINA. WHAT IS YOUR NEXT STEP.

REPEAT THE PROCESS USING THE FIRST AS A REFERENCE ON WHERE NOT TO GO. THIS IS NOTED BY NO URINE RETURN

MEDICAL DIAGNOSIS AND TREATMENT Flashcards

(156 cards)