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274 Cards in this Set
- Front
- Back
Normal AFI Oligo- Poly- |
Normal AFI - 8 - 15cm Oligo- < 5 cm Poly-> 25 cm |
|
Bartholin’s cyst/abscess rx |
Incision and drainage |
|
HTN drugs for preg. pts. |
Labetelol, Methyldopa (Aldomet), Nefidipine |
|
Benign ovarian tumors |
- Serous cystadenoma - most common - Mucinous cystadenoma - Endometrioma/Endometriosis - Teratoma/dermoid cyst - can have thyroid tissue - Brenner tumor - looks like bladder, coffee bean nucei on H&E - Fibroma - Thecoma - makes estrogen |
|
Malignant ovarian tumors |
- Granulosa cell tumor - most common malignant stromal tumor. women in 50s. makes estrogena and progesterone, postmeno bleeding, breast tenderness. Call-Exner cell. - Serous cystadenocarcinoma - most common - Mucinous cystadenocarcinoma - immature teratoma. Dx after menopause - dysgerminoma - girls and young women - yolk sac - young children - krukenberg |
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Meigs syndm
|
Meigs syndrome—triad of ovarian fibroma, ascites,hydrothorax. “Pulling” sensation in groin. |
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dysgerminoma - tumor marker |
hCG, LDH |
|
yolk sac tumor - tumor marker |
AFP |
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Drugs causing gynecomastia |
Spironolactone, Hormones, Cimetidine, Ketoconazole |
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Loop electrosurgical excison procedure (LEEP)/ cone biopsy - indication |
+ ECC Colposcopy inadequate - border/transformation one is not recognized Discrepancy between pap smear and biopsy Microinvasive cervical cancer < 3mm |
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OCP - contraindication |
smokers > 35 years old ( risk of cardiovascular events), patients with risk ofcardiovascular disease (including history of venous thromboembolism, coronary artery disease,stroke), migraine (especially with aura), breast cancer Liver disease |
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False positive VDRL |
Viral infection (eg, EBV, hepatitis) Drugs Rheumatic fever Lupus and leprosy |
|
neural tube defect - maternal serum screening |
incr. AFP, incr. acetylcholinesterase (AChE) Spina bifida occulta - normal |
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downs sydm - maternal serum screening
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low α-fetoprotein, low estriol, high inhibin A, high β-hCG |
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Edward - serum screening |
ALL LOW α-fetoprotein, β-hCG, estriol, or normal inhibin A. |
|
Patau - serum sreening |
both low freeβ-hCG, PAPP-A. |
|
what is the newborn given on birth. What should you give the newborn before discharging? |
- IM Vit. K - Erythromycin ophthalmic ointment - Hep B vaccine if mom is HBsAg -ve Hep B IVIG if mom is +ve - hearing test - Neonatal screening tests PKU Galactosemia Hypothyroidism |
|
new born with eye drainage. next step? |
Gram stain, culture. PCR for N. gono. and chlamydia |
|
N. gono ophthalmia rx? |
slver nitrate eye drops |
|
newborn with no eye drainage but crying with bulging eyes |
urgent ophthalmologist referral. suspect glaucoma |
|
Infant, child or aldolesent with red eye - no penetrating injury. Rx? |
examine and irrigate |
|
Infant, child or aldolesent with red eye- H/O trauma |
- Examine with topical anesthetic - fluorescein with wood lamb exam - corneal abrasion will show up as green - topical antibiotic - Patch |
|
periorbital cellulitis vs. orbital cellulitis |
periorbital cellulitis: eyeball can move PO/IV Antibiotics orbital cellulitis eyeball may not move MRI/CT to see extent ophthal and sx consult IV Antibiotics |
|
Hypospadias - ass. anomaly and mngt? |
undescended testes or inguinal hernia - do not circumcise - further genetic and endocrine evaluation for hermaphroditism |
|
Epispadias - ass. anomaly and mngt? |
Urinary incontinence - surgical evaluation for bladder exstrophy |
|
infant of diabetic mother - lab findings? |
hypoglycemia hyPO calcemia, magnesemia hyPER bilirubinemia POLYcythemia |
|
Neonate with resp. distress sydm. Mngt.? Tests? |
Tests: ABG, Blood culture, Blood glucose, urine culture, CBC, elec, CXR, Pulse oximetry, cranial U/S Check L/S ratio if done on amnotic fluid prior to birth. Mngt: Nasal CPAP with 100% O2 - target O2 sat 93-96% cardiac and resp. monitor umbilical vein catheter with fluids consider empiric antibiotics ? exogenous surfactant if baby doesnt improve look for cardiac causes. do echo. |
|
exogenous surfactant- name of the drug |
Lucinactant |
|
possible complications of neonatal RDS |
retinopathy of prematurity bronchopulmonary dysplasia Intraventricular hemorrhage |
|
transient tachypnea of newborm Rx? |
O2 rapid improvement within hours to days |
|
Meconium aspiration - newborn in severe resp. distress. what will the Xray show? |
patchy infiltrates increased AP diameter (barrel chest) flattening of diaphragm |
|
Meconium aspiration Rx |
Positive pressure ventilation high frequency ventilation nitric oxide therapy extracorporeal membrane oxygenation |
|
meconium plugs are seen in which conditions? |
small left colon in infants of diabetic mothers cystic fibrosis - can also have meconium ileus Hirschsprung disease maternal drug abuse |
|
necrotizin enterocolitis (NEC) - features |
medical emergency. - premature infants with low APGAR score - bloody stool - apnea and lethargy on feeding |
|
NEC - Dx test |
Abd Xray |
|
NEC Rx |
NPO decompress the gut - NG tube? antibiotics surgical resection |
|
when is hyperbilirubinemia pathologic? |
- occurs on first or after 2nd week - bilirubin > 12 - bili rises at 5 mg/day - direct >2 |
|
jaundice in newborn - direct. DDx? |
Infection: Sepsis/TORCH/ Endo: hypothyroidism galactosemia, tyrosinemia cystic fibrosis |
|
jaundice in newborn - indirect. next step? |
Do Coombs, CBC and ret count |
|
jaundice in newborn - indirect. Coombs -ve, high Hb. DDx? |
Polycythemia twin-twin transfusion IUGR delayed cord clamping infant of diabetic mother |
|
jaundice in newborn - indirect. Coombs -ve, low/normal Hb. DDx? |
spherocytosis G6PD def Pyruvate kinase |
|
Breast milk jaundice Rx? |
no rx needed |
|
Breast feeding jaundice |
fluids - rehydrate phototherapy |
|
neotal sepsis Rx? |
EMPIRIC ampicillin and gentamicin until 48-72 hrs cutures are negative if meningitis - ADD cefotaxime |
|
neotal sepsis tests |
CBC with diff., U/A, urine culture, blood culture, CXR BEFORE antibiotics |
|
List of notifiable diseases |
Hep A, B, C HIV Syphilis Gonorrhea MMR Varicella TB Salmonella Shigella Diphtheria |
|
Croup Mngt? |
Humidified O2 neb epinephrine and corticosteroids dont give antitussive, decongestants or antibiotic |
|
epiglottitis tests? |
- tests: Neck xray - blood cultures - nasopharyngoscopy in the OR - epiglottic swab |
|
epiglottitis mngt? |
- mngt:transfer to ORconsult - ENT and anesthesia - intubategive antibiotics (ceftriaxone) and steroids - rifampin proflyx to household IF H. influenza +ve |
|
retropharyngeal abscess pt. presentation |
pt. is drooling and difficulty swallowing |
|
pertussis features |
unimmunizated child cough for 1-2 wks with whoop and spells of cough (paroxysms) |
|
best prevention for bronchiolitis |
breastfeeding - IgA |
|
Peds - mngt of pneumonia |
outpatient: Amox/cefuroxime Inpatient: IV cefuroxime (if S. aureus ad Vanc.) Chlamydia or Mycoplasma - Erythromycin |
|
peds - viral pneumonia |
URI symptoms low grade fever tachypnea (imp finding) |
|
peds - bacterial pneumonia |
sudden onset chills high fever cough chest pain decr. breath sounds with dullness to percussion |
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peds - chlamydia pneumonia |
NO fever or wheezing (vs. RSV) with or without conjunctivitis at birth Staccato cough and peripheral eosinophilia |
|
pyloric stenosis elec imbalance |
low K and Cl |
|
peds - rx of diarrhea |
hydration with fluids and electrolyte replacement do not use anti-diarrheal |
|
hemolytic uremic syndrome (HUS) - symptoms and mngt |
- NEVER give antibiotics - pallor, weakness, oliguria, acute renal insuffieciency or acute renal failure, anemia, low platelets, hematuria, proteinuria mngt: supportive treat HTN early dialysis monitor BP for 5 years monitor renal function for 2-3 years after HUS |
|
MCC of ARF in children |
HUS |
|
infection that causes chronic diarrhea in children. test? |
giardia duodenal aspirate or biopsyor immunoassay |
|
after surgery to correct pyloric stenosis. what to follow |
follow electrolyte and replace losses |
|
meckel diverticulum. features and test. |
intermittent, painless rectal bleeding Ma - Tc-99m pertechneate scan |
|
Peds - Cystitis and pyelonephritis - Rx? |
cystitis - oral Amox pyelo - IV ceftrixone or ampicillin and gentamicin |
|
Peds - Cystitis and pyelonephritis F/U |
do urine culture 1 week after stopping antibiotics o confirm sterile urine. and reassess periodically for next 2-3 years VUGr - according to case |
|
peds - hemautria - imp. tests |
U/A U/C C3 level BP BUN/Cr |
|
beta thalassemia - tests and rx |
test: - hemoglobin electrophoresis - HbF, no or low HbA (thalessemia minor HbA2 will be high) - iron studies - CBC etc. Rx: transfusion to maintain hb >9 iron chelation - deferoxamine splenectomy routine: folate supplementation vaccine: pneumococcal, hep B, daily oenicillin proflyx growth hormone - excess iron related to reduced GH bone marrow transplantation |
|
significance of ristocetin cofactor assay |
vWF disease. ristocetin = pseudo vWF |
|
significance of mixing study |
factor deficiency |
|
west sydm. (infantile spasm) Rx? |
ACTH prednisone pyridoxine |
|
cerbral palsy test |
brain MRI serum CK to rule out muscular dystrophy |
|
by the age of 1 year. HIV positive babies should get which vaccines: |
Hib Heb B DTP IPV all are inactivated vaccines DO NOT GIVE ANY LIVE ATTENUATED VACCINE - MMR |
|
live attenuated vaccines? |
Live attenuated: smallpox, yellow fever,rotavirus, chickenpox (VZV), Sabin poliovirus, MMR, Influenza (intranasal). |
|
killed vaccines? |
Rabies, Influenza (injected), Salk Polio, andHAV vaccines. Killed/inactivated vaccinesinduce only humoral immunity but are stable. |
|
after which angle do you need to do ortho surgical consult for scoliosis |
25 degrees. less than that only monitor |
|
when do you admit anoexia nervosa pts. |
when their weight drops to 80% of their ideal wt. |
|
heat stroke vs. heat exhaustion - symptoms |
heat stroke - dry skin, alter mental status. temp >40 C heat exhaustion - excessive sweating, nausea vomiting 37-39 C |
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heat stroke vs. heat exhaustion management |
heat stroke - spraying with water, ice packs/bath, large amount of IV fluids heat exhaustion - NS IV and move to cold environment |
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how can you induce absent seizure in a office setting |
hyperventilation |
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otitis media with effusion (OME) - effusion that can occur after OM - feature and mngt |
(A retracted tympanic membrane with an effusion in the middle ear and mild hearin gloss suggests that the eustachian tube is blocked.) follow the pt. for 4-6 months without treatment. if effusion does not then ENT consult for tympanostomy tube |
|
in rickets. alk. phos. is high or low and why? |
Alkaline phosphatase is high in all forms of rickets, indicating increased osteoblast activity. |
|
RDW in thalassemia |
normal |
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when do you give endocarditis proflx if pt. is to under go dental procedure |
amox 50mg one dose, one hour before procedure |
|
ADHD presents before the age of..? |
seven |
|
Fanconi syndrome |
hyperchloremia hyperphosphotemia aminoaciduria |
|
duchenne muscuar dystrophy - caused by? |
defective dystrophin gene |
|
duchenne muscular dystrophy - muscle biopsy |
muscle biopsy shows atrophic and hyper-trophic muscle fibers - enlarged calfs - high CK |
|
Kawasaki diagnostic criteria |
To meet the criteria for classic Kawasaki disease, there should be evidence of fever for at least 5 days plus four of the followingfive criteria: 1) bulbar conjunctival injection without exudates, 2) mucosal changes such as dry, fissured lips; strawberry tongue or injected pharynx, 3) unilateral cervical lymphadenopathy,usually, greater than 1.5 cm 4) induration or edema of the hands and feet, and 5) generalized erythematous rash, which can vary from maculopapular to one resembling erythema multiforme. |
|
amblyopia - rx nd f/u? |
Patch the normal eye for younger children weeks = their age eg: 4 months old, f/u after no more than 4 wks older children - 3 months |
|
Stroke initial tests |
Head CT without contrast MRA |
|
Stroke Rx |
- tPA if <3hrs. If more than 3 hrs, give aspirin - Aspirin/Clopidogrel/aspirin with dipyridamole - if pt. is already on aspirin then add dipyridimole or switch to clopidogrel - statins - for all nonhemorrhagic stroke goal < 100 |
|
Stroke - after initial mngt and pt. stabilization, what is further mngt? |
Echocardiogram - Anticoag. if clots Carotid doppler - endarterectomy if stenosis > 70% EKG or Holter monitor Control HTM, DM, hyperlipidemia, no smoking, physical and stretch therapy |
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Young pt. <50 with stroke, no significant medical history. tests? |
VDRL ANA, dsDNA ESR Protein C, protein S, factor V leiden mutation, antiphospholipid sydm |
|
Mulltiple Sclerosis Rx |
- STEROIDS - best initial - Disease modifying agents - beta-interferon..etc - symptomatic - amantadine, baclofen |
|
Huntington's Rx |
Tetrabenazine for movement disorder Antipsychotics |
|
do not give -triptans to pts. with.. |
pregnancy HTN coronary disease - causes vasodilation |
|
migraine - when should you do head CT/MRI |
- sudden/severe onset, or getting worse - onset age >40 - associated focal neuro. findings |
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migraine Rx and proflx |
Bi - sumatriptan or ergotamine Proflx if > 4 episodes per month - several weeks for effect - propranolol, CCBs, TCAs or SSRIs |
|
Benign positional vertigo/Vestibular neurtis/Labyrinthitis Rx? |
Meclizine labyrinthitis - meclizine and steroids |
|
acoustic neuroma - test and Rx |
Test - MRI of the internal audiory canal Rx - Surgical resection |
|
Meningitis - initial mngt. |
Empiric - IV ceftriaxone, IV vanc, IV dexamethasone add Ampicillin if risk of Listeria (HIV, older pts, steroid use) |
|
Meningitis - imp. thing to remember before ordering tests |
if pt. has papilledema, focal neurologic symptoms, seizures, confusion - ORDER HEAD CT BEFORE LP |
|
large intracranial hemorrhage with mass effect - mngt. |
- Admit to ICU - maintain systolic >100 - Intubate/hyperventilate - to decrease ICP. Decrease pCO2 to 28-32, which will constrict blood vessels. - IV mannitol - Surgical evacuation - neurosurgical consultaation |
|
SAH - do you need to do LP if Head CT shows bleed? |
No. Do LP (Ma test) only if CT doesn't show bleed. LP - Xanthochromia |
|
SAH - Mngt? |
- Angiography - Embolize site of bleeding - Insert a Ventriculoperitoneal shunt if hydrocephalus develops - Oral Nimodipine |
|
spinal cord compression -mngt |
usually due to tumor. first give steroids |
|
epidural abscess - spine - mngt |
- MRI spine - Oxacilling/Nafcillin - surgical decomp. |
|
spinal stenosis - features and mngt |
- seems like Peripheral artery disease but pulses are normal. - pain is worse on going downhill, but improves on going uphill - MRI - surgical decomp. |
|
Restless leg sydm. Rx? |
Pramipexole or ropinirole. |
|
Myasthenia gravis. Rx? |
Bi - Pyridostigmine or neostigmine - if fails, thymectomy (if age < 60) - if fails, Prednisone |
|
Phenytoin toxicity - symptoms |
- vertical nystagmus NOT horizontal - ataxia - dysarthria |
|
Breast ca. screening should be done between __ and __ ages |
Start at age 50. 50-75 |
|
BRCA is ass. with increased risk of? |
familial breast ca. and ovarian ca. not a routine screening test |
|
colon cancer screening |
- Colonoscopy age 50, then every 10 years. - Occult blood testing age 50, then every year. |
|
lung ca. resection cannot be performed if.. |
- B/L disease - Metastases - Malignant pleural effusion - Involvement of aorta, vena cava, heart - Lesions within 1-2cm of the carina |
|
cervical ca. screening age |
start at age 21, every 2-3 years till age 65 OR every 5 years with Pap and HPV test |
|
HPV vaccine |
all females ages 13-26 |
|
meningococcal vaccination is given at what age? |
all at age 11. earlier for asplenic pts. and those with terminal complement deficiency |
|
osteoporosis screening |
from age 65 |
|
Abd. aortic aneurysm screening |
all men age 65 and with h/o smoking. screen once with U/S |
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Hyperlipidemia screening |
men > 35 and women > 45 |
|
Pregnancy F/U return visits and complications to remember in each visit |
every 4 weeks up to 28 weeks (7 mos) - few comp. every 2 wks up to 36 weeks (final 2 months) - GDM, anemia, preclampsia, SPROM, IUGR every 1 week until delivery - more comp. |
|
Rh negative mom. When should you give RhoGAM |
28 weeks after first rescreening for absence of anti-D antibodies. give RhoGAM after any procedure (CVS, amniocentesis) and after delivery. |
|
second trimester optional tests |
triple marker screen MS-AFP beta-hCG Estriol Add inhibin in high-risk women |
|
when MS-AFP is high or low - after date confirmation - next step? |
High MS-AFP --> amniocentesis for amniotic fluid AFP (AF-AFP) and acetylcholinesterase activity Low MS-AFP --> Amniocentesis for karyotyping Genetic counseling, genetic sonogram before amniocentesis |
|
3rd trimester routine tests |
OGTT - 1 hr 50 g CBC Indirect Coombs GBS - vaginal and rectal culture |
|
preg. woman - positive GBS - Rx |
INTRAPARTUM IV Penicillin or IV clindamycin/erythromycin if penicillin allergy give the treatment if previous delivery was complicated by GBS - even if GBS is negative in this delivery |
|
N&V in Preg. - meds that can be given |
Doxylamine Metoclopramide Odansetron Promethazine Pyridoxine |
|
CCS: mngt of late preg. bleeding |
Get Vitals Place external fetal monitor start IVFs with NS lab tests: DIC workup (PT, PTT, fibrinogen, D-dimer) Blood type and cross-match Obstetric U/S to rule out placenta previa - Must do this before vaginal exam further: blood transfusion if large blood loss Foley's to measure urine output Vaginal exam - to rule out laceration ? schedule delivery |
|
triad of vasa previa next step? |
rupture of memebranes painless vaginal bleeding fetal bradycardia emergency c-section |
|
varicella - greatest risk for the fetus? |
if the rash appears in the mother between 5 days antepartum and 2 days postpartum |
|
congenita varicella features |
zigzag lesions on skin, limb hypoplasia, microcephaly, microphthalmia, choriorenitis and cataracts |
|
prevention of congenital varicella |
live attenuated vaccine to NONpreg. women |
|
congenital varicella- post exposure proflyx. Mom unimmunized |
VariZIG wthin 10days of exposure |
|
uncomplicated maternal varicella Rx |
Oral acyclovir to mother VariZIG to mom and neonate |
|
congenital varicella Rx |
VariZIG and IV acyclovir to neonate |
|
Rubella - (has no postexposure Rx) - congenital rubella features |
congenital deafness congenital heart disease - PDA mental retardation hepatosplenomegaly thrombocytopenia blueberry muffin rash |
|
HIV positive mother - steps for prevention of transmission to baby |
triple-drug therapy (must have ZDV) give infant proflyx - 6 wks of ZDV DO NOT BREASTFEED schedule c-section at 38 wks unless viral load <1000 avoid invasive procedures - fetal scalp electrodes, artificial ROM |
|
preeclampsia and eclampsia mngt (lab etc) |
labs: U/A, Urine tox, CBC, BUN, Cr, Uric acid, PT, PTT, AST, ALT only HTN: conservative mngt, repeat BP in 15-20 min mild preclampsia: Hospitalize and observe Don't treat until BP> 160/100 (goal - 140-150 and 90-100) 1st line- methyldopa, labetalol 2nd line - nifedipine - if seizure -MgSO4 bolus - protect pt. airway and tongue Monitor: serial sonograms serial BP monitoring and urine protein labor: < 34 wks - Im betamethasone > 36 wks - mild preclampsia - attempt vag. with IV oxytocin severe preclampsia or seizures - prompt delivery irrespective of fetal age - give intrapartum IV MgSO4 and hydralazine/labetelol - continue Mg So4 24 hrs after delivery |
|
eclampsia pt. given mgso4, has resp. depression. next step? |
stop mgso4 and give IV calcium gluconate and O2 |
|
when does HELLP usually occur |
3rd trimester 2 days after delivery |
|
HELLP mngt |
- delivery - any gest. age - if platelet < 100,000 - give IV corticosteroids ante- and post-partum. continue till platelets and LFTs normalize - platelet transfusion if count < 20,000 or <50,000 for C-section - IV mgso4 proflyx - ? steroids - lung maturity |
|
preg. grave's disease Rx |
PTU in 1st trimester |
|
gest. DM. Mngt |
initial: diet and exercise diabetic counseling home glucose monitoring weekly F/U U/S if still uncontrolled: insulin therapy 2x/week fetal surveillence - NST, AFI, BPP |
|
abortion before 13 wks |
D&C |
|
medical abortion |
oral mifepristone (progesterone antagonist) AND oral misoprostol (prostaglandin) first 63 days of amenorrhea |
|
When do you do elective c-section in macrosomia - EFW |
if EFW > 4500 g in diabetic mother or > 5000 g in nondiabetic mother |
|
normal fetal heart rate |
110-160 |
|
umbilical cord prolapse mngt |
High flow O2 by mask Never attempt to replace the cord place pt in knee-chest position, elevate presenting part, give terbutaline immediate c-section |
|
early decelerations |
mirror images normal due to head compression |
|
variable decelerations |
due to umbilical cord compression fetal acidosis rapid drop and rise. last 60secs - FHR drops by 60 |
|
late decelerations |
uteroplacental insufficiency FHR - check --tachycardia fetal acidosis urgent help |
|
nonreassuring fetal monitoring pattern mngt |
check for factors like - drugs, sleep etc. - ensure IV assess 16 gauge needle - stop oxytocin, give terbutaline - give 500ml bolus RL - give 8-10 L O2 by face mask - change pt's position - digital vag. exam to rule out prolapsed cord - perform digital scalp stimulation to observe for accelerations fetal scalp pH - normal >7.2 if all fails - prepare for delivery |
|
trial of vaginal birth after c-section |
when the previous c-section was a low segment uterine incision |
|
uterine inversion - Rx |
uterine replacement then IV oxytocin |
|
only contraception that can be used during breastfeeding |
progestin |
|
diaphragm or IUD use after birth |
not until 6 weeks later |
|
OCP use after birth |
not for 3 weeks post partum |
|
contraceptive use and breastfeeding |
can be deferred for 3 months |
|
breast ca. preinvasive - ductal carcinoma in situ. next step? |
schedule surgical resection with clear margin (lumpectomy i.e. breast conserving sx). Then radiation and tamoxifen for 5 years. |
|
breast ca. preinvasive - lobular carcinoma in situ. next step? |
tamoxifen alone for 5 years |
|
tamoxifen ass. with risk of |
endometrial ca. thromboebmolism |
|
when to test for BRCA1 and BRCA2? |
- Family h/o early onset (<50) breast or varian ca. - family h/o mae breast ca. - breast and/or ovarian ca. in same person - ashkenazi Jew |
|
invasive breast ca. Rx |
size <5 lumpectomy, + radiotherapy + adjuvant therapy +chemo size > and metastatic disease - systemic therapy |
|
tamoxifen - agonist and antagonist action |
antagonist at breast agonist at bone |
|
tamoxifen MOA |
competitively binds estrogen receptors |
|
anastrozole, exemestane, letrozole MOA
|
aromatase inhibitor. block peripheral production of estrogen |
|
aromatase inhibitor side effects |
do not cause menopausal symptoms but increase risk of osteoporosis |
|
h/o tamoxifen use and now vag. bleeding. next step? |
endometrial biopsy |
|
invasive breast ca. HR -ve, pre- or postmenopausal woman |
chemo +/- Radiation alone |
|
invasive breast ca. HR +ve, pre-menopausal woman |
chemo +/- RT and Tamoxifen |
|
invasive breast ca. HR +ve, postmenopausal woman |
chemo +/- RT and aromatase inhibitor |
|
uterus - soft, symmetric, globular with menorrhagia and dysmenorrhea |
adenomyosis |
|
adenomyosis Rx |
no Rx really. levonorgestrel intrauterine system (IUD), may decrease heavy mens. bleeding |
|
uterine prolapse degrees |
2nd degree - prolapse till introtus 3rd degree - past introtus |
|
uterine prolapse Rx nonpreg women |
prolapse - total vaginal hysterectomy (ccs: Laparatomy) cystocele - anterior vag. wall repair rectocele - anterior vag. wall repair if sx. not possible - Pessary |
|
postmenopausal women endometrial thickness ?mm |
< 5mm |
|
postmenopausal women, biopsy +ve for endometrial ca. next step? |
+ve adenocarcinoma perform surgery staging - TAH&BSO, paraaotic lymphadenectomy, peritoneal washing if lymph node mets -radiation if mets - chemo |
|
postmenopausal women, biopsy +ve for endometrial HYPERPLASIA. next step? |
simple hyperplasia - progestin complex hyperplasia - progestin complex hyperplasiawith atypia - progestinwith hysterectomy |
|
ovarian cyst - simple cyst mngt |
transvaginal or tranabd U/S to assess. asymptomatic and <7 cm - observe - F/U 6-8 wks if >7cm or h/o previous steroid contraception (estrogen/progesterone) then laparascopic removal |
|
cause of death in ovarian mass |
recurrent bowel obstruction |
|
post meno. woman with ovarian mass. dx? and order which markers? |
most likely epithelial tumor. CA-125, CEA |
|
young women (can be kid) with ovarian mass. dx? and order which markers? |
most likely germ cell tumor - dysgerminoma. LDH, b-hcg, AFP |
|
post meno. woman with ovarian mass and endometrial hyperplasia. dx? and order which markers? |
granulosa theca (stromal tumor). estrogen |
|
woman with ovarian mass and facial hair and deeping voice . dx? and order which markers? |
sertoli leydig cell - stromal tumor. testosterone |
|
krukenberg tumor marker? |
CEA |
|
drug for prevention of genital warts in males |
gardasil (quadriavalent HPV recombinant vaccine) |
|
acute salpingo-oophoritis - similar to PID + lower pelvic pain after menses. Rx |
out pt. - one dose IM ceftriaxone and PO doxy in pt. -IV cefotetan/cefoxitin and PO doxy |
|
tubo-ovarian abscess. Rx |
admit IV cefoxitin and doxy (IV?) if fails/no response for 72 hrs or rupture then exploratory laparatomy +/- TAH and BSO or percutaneous drainage |
|
endometriosis Rx |
1st line - OCPs 2nd - danazol (testostrone derivative) or Leurolide (GnRH analog) |
|
vulvar itching and lesion. next step? |
biopsy |
|
vulvar squamous hyperplasia - benign |
Fluorinated corticosteroid cream |
|
lichen sclerosis (atrophy) |
clobestasol cream |
|
condylomata acuminata/wart |
podophyllin TCA acid imquimod laser cryo |
|
vulvar ca. |
radical vulvectomy |
|
premenarchal vag. bleeding work up |
pelic exam under sedation CT/MRI of pituitary, abd, pelvis for tumor if -ve, diagnosis - idiopathic precocious puberty |
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bromocriptin MOA |
dopamine agonist |
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LH:FSH in PCOs |
3:1 (normal 1.5:1) |
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PCOs Rx |
OCPs Clomiphene citrate or human menopausal gonadotropin - if preg. is desired spironolactone metformin check serum lipids and fasting blood glucose |
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Dx of menopause |
2 high FSH levels - 2 wks apart. (CCS routine takes 3 days) FSH >50 |
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menopause mngt |
counseling ? HRT PO conjugated estrogen PO medroxyprogesterone acetate (estrogen progesterone combined) F/U 3 mos |
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gestational trophoblastic disease - symptoms |
bleeding < 16 wks gestation passages of vesicles fundus larger than dates |
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gestational trophoblastic disease - Rx |
Baseline quantitative beta-hCG titer CXR Suction D&C OCPs for 1 year |
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chemo for small cell lung cancer |
Etoposide and cisplatin |
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chemo for epithelial ovarian ca. |
Taxol and carboplatin |
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milk production hormone |
prolactin |
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milk let down hormone |
oxytocin |
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misoprostol (prostaglandin) contraindication |
asthma and glaucoma |
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mgso4 symptoms as dose increases |
EKG changes --> loss of DTRs --> warmth and flushing --> somnolence and slurry speech --> paralysis or resp. depression |
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MC pathogen in mastitis and breast abscess |
S. areus |
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where does squamous cell carcinoma of vagina mostly occur |
upper 1/3rd of vagina -drained my internal and common iliac nodes |
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ass. with bicornuate uterus |
Premature labor, second-trimester abortions,and fetal malpresentation (i.e., breech or trans-verse lie |
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choroid plexus cysts ass. with |
trisomy 18 |
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osteosarcoma (malignant) on xray. lab. |
sunburstcodman triangleAlk phos incr. and LDH incr. |
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osteogenesis imperfecta IP |
AD |
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Osteogenesis imperfecta - features. |
Blue sclerae, hearing loss, recurrent fractures, and opalescent teeth. Patients with osteogenesis imperfecta have normal intelligence. |
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Choledochal cysts. |
Choledochal cysts are congenital abnormalities of the biliary tree characterized by dilatation of the intra and/or extra hepatic biliary ducts. |
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An immediate anaphylactic reaction, an encephalopathy, or any CNS complication within 7 days of administration of the DTP vaccine. Cause? |
pertussis component of the vaccine.DT should be substituted for DTaP. |
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Meckel's diverticulum. Cause and features. |
most common congenital abnormality of the small intestine. It results from incomplete obliteration of the omphalomesenteric duct and usually contains ectopic pancreatic or gastric tissue. 2 yrs old. painless bleeding. |
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Choanal atresia. Features, test to confirm. Rx. |
Cyanosis that is aggravated by feeding and relieved by crying.Failure to pass catheter through nose.CT scan with intranasal contrast - narrowing at the level of the pterygoid.Rx: place oral airway, lavage feeding. surgery for repair. |
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cephaloma hematoma vs. caput succedaneum. |
Cephalohematoma - subperiosteal hemorrhage, limited to the surface of one cranial bone, no discoloration Caput succedaneum - diffuse, sometimes ecchymotic, swelling of the scalp. It may extend across the midline and across suture lines. |
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Chlamydia pneumonia Rx |
Oral Erythromycin |
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myotonic muscular dystropy. features. |
temporal wasting, thin cheeks, and an upper lip in the shape of an inverted V. Pertinent physical findings include emaciated extremities, atrophy of the thenar and hypothenar eminences, proximal muscle weakness, positive Gowers sign, winged scapula, and myotonia. Myotonia is defined as delayed muscle relaxation, and the classic example is the inability to release the hand after a handshake. In addition, abnormalities of the endocrine, immunologic, and nervous systems occur. Endocrine manifestations include diabetes mellitus, testicular atrophy, frontal baldness and hypothyroidism. |
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TCA toxicity. |
seizure, hypotension, and prolonged QRS complexes on EKG |
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Skull x-rays, taken after the age of 2 years, reveal gyriform intracranial calcifications that resemble a tramline. - Disease? |
Sturge-Weber syndrome. |
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Osgood-Schlatter disease |
is a traction apophysitis of the tibial tubercle. Radiographic findings include anterior soft tissue swelling, lifting of tubercle from the shaft, and irregularity or fragmentation of the tubercle. |
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Erythema toxicum |
is a benign, self-limited condition in newborns characterized by an evanescent rash with red haloes, and eosinophils in the skin lesions. |
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Varicella zoster infection - describe rash |
- Pruritic rash - later develops into teardrop vesicles, which then ruptures to leave scabs. - Several stages of lesions (macules, papules, vesicles etc.) are present at the same time. |
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normal newborn wt. |
2.5kg-4kg |
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Lesch-Nyhan syndrome IP |
X R - all pts. are male |
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Diamond-Blackfan anemia (DBA) - features |
- congenital pure red cell aplasia - first 3 months of life - pallor and poor feeding - normocytic or macrocytic anemia with reticulocytopenia. Normal WBC and platelet counts. |
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Lesch-Nyhan syndrome - enzyme deficiency and mech. of disease. |
Hypoxanthine-guanine phosphoribosyl transferase (HPRT)enzyme involved in purine metabolism.This deficiency results in increased levels of uric acid and accumulation in peripheral tissue. |
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Lesch-Nyhan syndrome - features |
- age 6 months with hypotonia and persistent vomiting. - mental retardation, choreoathetosis, spasticity, dysarthric speech, dystonia and compulsive self-injury, especially biting of the upper extremities. - uric acid deposits - gouty arthritis, tophus formation and obstructive nephropathy. |
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young boy with gout - which disease should you think of? |
Lesch-Nyhan |
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Lesch-Nyhan - few points about mngt. |
- Allopurinol is used to reduce the uric acid levels.- Patients should be advised to take adequate intake of fluids. |
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Crigler-Najjar syndrome and Gilbert syndrome - which enzyme defect? |
uridine diphosphoglucuronic acid glucuronosyltransferase (UDPGA) |
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Biliary atresia - features |
- conjugated hyperbilirubinemia 1–6 weeks after birth- clay-colored stools, dark urine, and an enlarged liver. |
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Side effects of hydroxyurea |
- suppresses the bone marrow.- Leukopenia, anemia, and thrombocytopenia may occur |
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Dry and wet beri beri |
- dry - peripheral neuropathy - wet - peripheral neuropathy + cardiac involvement |
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Glioblastoma multiforme |
- adult brain tumor - highly malignant - cereberal hemisphere, can cross corpus callosum "butterfly glioma" - “Pseudopalisading” pleomorphic tumor cells —border central areas of necrosis and hemorrhage. - Stain astrocytes for GFAP. |
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Meningioma |
- adult brain tumor - parasagittal region - Spindle cells concentrically arranged in a whorled pattern; psammoma bodies (laminated calcifications). |
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Hemangioblastoma |
- adult brain tumor - cerebellar - Associated with von Hippel-Lindau syndrome when found with retinalangiomas. - Can produce erythropoietin |
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Schwannoma |
- adult brain tumor - cerebellopontine angle - Often localized to CN VIII vestibular schwannoma. - If B/L NF-2. - Resection or stereotactic radiosurgery. - Schwann cell origin S-100 positive |
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Oligodendroglioma |
- adult brain tumor - very rare- frontal lobe - "fried-egg" pattern |
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Pituitary adenoma |
- adult brain tumor - prolactinoma - can be hyper or hypo pituitarism- bitemporal hemianopia - due to pressure on optic chiasm |
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Craniopharyngioma |
- childhood brain tumor - bitemporal hemianopia - supratentorial- derived from Rathke's pouch - calcification or cholesterol crystals in fluid tumor "motor-oil" |
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Pinealoma |
- childhood brain tumor - parinaud sydm - verticle gaze palsy - obstructive hydrocephalus - precocious puberty - b-hCG |
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Pilocytic astrocytoma |
- childhood brain tumor - posterior fosa/supratentorial - GFAP +ve - benign with good prognosis - cystic + solid - Rosenthal fibers - eosinophilic corkscrew fibers |
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Medulloblastoma |
- childhood brain tumor - highly malignant - can compress 4th ventricle - noncommunicating hydrocephalus - can send mets. through spinal cord- Homer-Wright rosettes, small blue cells |
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Ependymoma |
- childhood brain tumor - mostly in 4th ventricle - hydrocephalus - poor prognosis |
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Trachoma - features, Dx test and Rx |
- follicular conjunctivitis - pannus (neovascularization) formation in the cornea - nasal discharge - major cause of blindness worldwide - caused by Chlamydia trachomatis serotype A-C - Repeated infections can lead to scarring of the cornea. - Dx - Giemsa stain examination of conjunctival scrapings - Rx - Topical tetracycline or oral azithromycin should be started immediately. |
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most common cause of polycythemia in term infants |
- delayed clamping of the umbilical cord |
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manifestations of polycythemia in newborns |
- respiratory distress - poor feeding - neurologic manifestations. |
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Granuloma inguinale (Donovanosis) - features |
- painless genital ulcers - a red, beefy base and there is no associated adenopathy - does not resolve without antibiotic treatment. |
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pregnancy and thyroid |
Pregnancy is associated with an increase in TBG (due to estrogen), resulting in - increased total T4 and T3 - normal free T4 and T3, and a normal TSH. |
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Turner's - LH and estrogen level |
FSH high Estrogen low - ovarian agenesis |
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BUN and Creatinine in pregnant pts. |
Serum BUN and creatinine are usually decreased in pregnant patients due to an increase in renal plasma flow and glomerular filtration rate. |
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Raloxifene- mech and contraindication |
- mixed agonist/antagonist of estrogen receptors. In breast and vaginal tissue, it is an antagonist, whereas in bone tissue, it is an agonist. - It is a first-line agent for the prevention of osteoporosis, and it decreases breast cancer risk. - It increases the risk of thromboembolism.- contra - DVT |
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PCOS - ass. with increased risk of which cancer |
is characterized by an unbalanced estrogen secretion that may result in endometrial hyperplasia and carcinoma. |
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complex hyperplasia (endometrium) WITH atypia - Rx |
hyterectomy. if want to preserve fertility - cyclic progestins |
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RhoGAM and maternal titer |
If a mother is not sensitized (or has a VERY weak titer, as in this case 1:4) anti-D immunoglobulin is indicated. If a mother is already sensitized (antibody titers ≥ 1:6), administration of RhoGAM is not helpful and close fetal monitoring for hemolytic disease is required. |
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Postterm pregnancies should be monitored for..? |
oligohydramnios twice weekly. |
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Reason for anovulation and amenorrhea in lactating mothers. |
Elevated prolactin levels suppress GnRH release thereby suppressing LH and FSH production and ovulation. |
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most effective parameter for estimation of fetal weight in cases of suspected FGR. |
Abdominal circumference |
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squamous cell carcinoma (SCC) vagina - symptoms |
vaginal bleeding and malodorous vaginal discharge |
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squamous cell carcinoma (SCC) - Treatment |
- Stage I and II tumors (no extension to the pelvic wall and no metastases) which are less than 2 cm in size may be removed surgically. - Stage I and II tumors which are greater than 2 cm in size are treated with radiation therapy. - Combination chemotherapy is used for Stage III and IV tumors |
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Asymptomatic patients with cervical swab +ve for chlamydia, -ve for gono. Next step? |
single dose of azithromycin or a 7-day course of doxycycline |
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HIV +ve mother - how would you reduce transmission to baby? |
zidovudine throughout pregnancy and labor, and treating the newborn for the first 6 weeks of life |
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PID Rx |
Outpt: IM Ceftriaxone and Oral doxy Inpt.: IV Cefoxitin and IV doxy or IV Clindamycin and IV gentamicin |
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when is corticosteroid for fetal lung maturity useful? |
period between 24 and 34 weeks |
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fetal heart changes progressing from tachycardia to bradycardia and finally to a sinusoidal pattern occurring suddenly after rupture of membranes - Dx? |
An antepartum hemorrhage - vasa previa If fetal bleeding is suspected, an Apt test - which differentiates maternal from fetal blood - can be performed to confirm the diagnosis. |
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postpartum bleeding - initial mngt |
Initial treatment includes bimanual uterine massage, fluid resuscitation, uterotonic agents (oxytocin, methylergonovine, carboprost), and blood transfusion as needed. |
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how is penicillin desensitization done? |
first confirm penicillin allergy using skin test. then desensitize - accomplished using incremental doses of oral penicillin V. |
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Ovarian torsion - features |
- medical emergency. - suddn-onset lower quadrant abdominal pain that radiates to the groin or back and is accompanied by nausea and vomiting. An adnexal mass is usually present. |