This document discusses the differential diagnosis and management of vulvovaginal disorders. It begins by categorizing common conditions into infections (trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis), skin conditions (fungal vulvitis, contact dermatitis, vulvar dermatoses), and psychogenic causes. It then provides detailed guidelines on evaluating, diagnosing, and treating specific infections like trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. It also reviews vulvar conditions like lichen sclerosus, contact dermatitis, and classifications of vulvar dermatoses.
Lec 24 24 female reproductive system pathologyimrana tanvir
This document provides information on pathology of the female reproductive system. It discusses various non-neoplastic and neoplastic lesions that can occur in the vulva, vagina, cervix and ovaries. Some of the key points mentioned include vulvar leukoplakia and lichen sclerosus, cervical intraepithelial neoplasia and invasive squamous cell carcinoma, ovarian serous and mucinous tumors, endometrial hyperplasia and endometrioid carcinoma of the uterus. Risk factors, histological features and clinical implications of these conditions are summarized.
preinvasive lesion of cervix and management ,quick revise toolmahadevbpatil
The document discusses the transformation zone of the cervix, metaplasia, dysplasia, cervical intraepithelial neoplasia (CIN), the Bethesda system for cervical cytology reporting, the Pap test procedure, HPV vaccination, and management of preinvasive cervical lesions including local excision and radical excision procedures. Key points include that the transformation zone is the region of active metaplastic changes, CIN is graded from I to III based on severity of dysplasia, and management depends on grade, with local excision used for higher grades and follow up for mild dysplasia.
This document discusses pre-malignant and malignant conditions of the vulva. It begins by describing vulvar intraepithelial neoplasia (VIN), the pre-malignant condition where cellular changes are limited to the epithelium. VIN is graded based on the depth of atypical cells. Vulvar cancer most commonly presents as squamous cell carcinoma in older women. Risk factors include HPV infection, smoking, and immunosuppression. Examination may reveal irregular growths or ulcers. Biopsy is needed for diagnosis. Treatment options depend on the grade of the lesion and include local excision, laser ablation, or topical therapies. Follow up is important due to the risk of recurrence.
The document describes different types of skin lesions. It notes that when describing a skin lesion, it is important to document features such as size, type, shape, color, surface area, and distribution on the body. Skin lesions are broadly categorized as primary, secondary, or special. Primary lesions are basic skin reaction patterns with a definite morphology, while secondary lesions develop from skin diseases or injuries. The document then lists and describes different types of primary skin lesions as well as scabies and pediculosis.
Benign lesions of the cervix, vagina and vulvaNick Harvey
The document discusses benign lesions that can occur on the cervix, vagina, and vulva, describing common conditions such as cervical polyps, Nabothian follicles, vaginitis, vulvar cysts and infections. It provides details on the presentation, causes, diagnosis, and treatment of these various lesions. A wide range of benign gynecological conditions are examined to help clinicians properly identify and manage non-cancerous abnormalities in these areas.
This document discusses recurrent miscarriage, providing definitions and epidemiology. It defines recurrent miscarriage as 3 or more consecutive miscarriages. Causes discussed include polycystic ovary syndrome, antiphospholipid syndrome, chromosomal abnormalities, endocrine disorders, and uterine abnormalities. Investigation and management strategies are presented for different potential causes. For unexplained recurrent miscarriage, progesterone and aspirin are discussed but evidence for their effectiveness is limited. Counseling and lifestyle modifications are recommended.
This document discusses abdominal pain during pregnancy, which can be difficult to distinguish between physiological and pathological causes. A thorough history and examination is most important to determine the cause, which could include issues like miscarriage, ectopic pregnancy, urinary tract infections, appendicitis, or preeclampsia. Treatment depends on the identified cause, and urgent referral is needed if the cause is unclear or if maternal or fetal distress is present. Surgery may be required in some cases but is best performed in the second trimester if possible.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
Lec 24 24 female reproductive system pathologyimrana tanvir
This document provides information on pathology of the female reproductive system. It discusses various non-neoplastic and neoplastic lesions that can occur in the vulva, vagina, cervix and ovaries. Some of the key points mentioned include vulvar leukoplakia and lichen sclerosus, cervical intraepithelial neoplasia and invasive squamous cell carcinoma, ovarian serous and mucinous tumors, endometrial hyperplasia and endometrioid carcinoma of the uterus. Risk factors, histological features and clinical implications of these conditions are summarized.
preinvasive lesion of cervix and management ,quick revise toolmahadevbpatil
The document discusses the transformation zone of the cervix, metaplasia, dysplasia, cervical intraepithelial neoplasia (CIN), the Bethesda system for cervical cytology reporting, the Pap test procedure, HPV vaccination, and management of preinvasive cervical lesions including local excision and radical excision procedures. Key points include that the transformation zone is the region of active metaplastic changes, CIN is graded from I to III based on severity of dysplasia, and management depends on grade, with local excision used for higher grades and follow up for mild dysplasia.
This document discusses pre-malignant and malignant conditions of the vulva. It begins by describing vulvar intraepithelial neoplasia (VIN), the pre-malignant condition where cellular changes are limited to the epithelium. VIN is graded based on the depth of atypical cells. Vulvar cancer most commonly presents as squamous cell carcinoma in older women. Risk factors include HPV infection, smoking, and immunosuppression. Examination may reveal irregular growths or ulcers. Biopsy is needed for diagnosis. Treatment options depend on the grade of the lesion and include local excision, laser ablation, or topical therapies. Follow up is important due to the risk of recurrence.
The document describes different types of skin lesions. It notes that when describing a skin lesion, it is important to document features such as size, type, shape, color, surface area, and distribution on the body. Skin lesions are broadly categorized as primary, secondary, or special. Primary lesions are basic skin reaction patterns with a definite morphology, while secondary lesions develop from skin diseases or injuries. The document then lists and describes different types of primary skin lesions as well as scabies and pediculosis.
Benign lesions of the cervix, vagina and vulvaNick Harvey
The document discusses benign lesions that can occur on the cervix, vagina, and vulva, describing common conditions such as cervical polyps, Nabothian follicles, vaginitis, vulvar cysts and infections. It provides details on the presentation, causes, diagnosis, and treatment of these various lesions. A wide range of benign gynecological conditions are examined to help clinicians properly identify and manage non-cancerous abnormalities in these areas.
This document discusses recurrent miscarriage, providing definitions and epidemiology. It defines recurrent miscarriage as 3 or more consecutive miscarriages. Causes discussed include polycystic ovary syndrome, antiphospholipid syndrome, chromosomal abnormalities, endocrine disorders, and uterine abnormalities. Investigation and management strategies are presented for different potential causes. For unexplained recurrent miscarriage, progesterone and aspirin are discussed but evidence for their effectiveness is limited. Counseling and lifestyle modifications are recommended.
This document discusses abdominal pain during pregnancy, which can be difficult to distinguish between physiological and pathological causes. A thorough history and examination is most important to determine the cause, which could include issues like miscarriage, ectopic pregnancy, urinary tract infections, appendicitis, or preeclampsia. Treatment depends on the identified cause, and urgent referral is needed if the cause is unclear or if maternal or fetal distress is present. Surgery may be required in some cases but is best performed in the second trimester if possible.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
This document summarizes information about endometrial cancer from Shaukat Khanum Memorial Cancer Hospital and Research Centre. It discusses the epidemiology, risk factors, classification, diagnosis, staging, treatment approaches including surgery and adjuvant therapy, prognosis, and recurrent disease. The summary provides an overview of endometrial cancer including that it is the most common female genital tract cancer, obesity is a strong risk factor, around 80% of cases present at an early stage, surgery is the main treatment, and refinement of adjuvant therapy for early stage disease remains challenging.
- Mucinous cystadenoma is a benign ovarian tumor composed of epithelial cells that secrete mucin, forming multiple cysts. It typically presents in women aged 30-50 as a large pelvic mass. Treatment is unilateral salpingo-oophorectomy.
- Thecoma is a sex cord-stromal tumor composed of lipid-containing theca cells. It most commonly presents in postmenopausal women as a pelvic mass and can cause endometrial hyperplasia and adenocarcinoma due to estrogen secretion. Treatment is unilateral salpingo-oophorectomy.
- Fibromas are benign ovarian tumors not associated with hormone secretion. While typically asymptomatic, cellular fibromas have
This document discusses common causes and approaches to evaluating and managing postmenopausal vaginal bleeding. Key causes mentioned include atrophic vaginitis, endometrial hyperplasia, uterine polyps, endometrial cancer, and exogenous estrogen use. The diagnostic approach involves a detailed history, examination, transvaginal ultrasound, hysteroscopy, and biopsy. Initial stabilization priorities bleeding control. Long-term management depends on the underlying cause and may involve hormone therapy, surgery, or chemotherapy/radiotherapy. Counseling supports informed decision making and long-term follow up.
Mastocytosis is a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells in the skin and sometimes in other organs. The summary is:
1. Mast cells are derived from bone marrow precursors and mature in tissues where they play roles in both innate and acquired immunity.
2. Mastocytosis includes cutaneous and systemic forms, with cutaneous forms showing mast cell infiltration of the skin and systemic forms showing infiltration of other organs.
3. Symptoms result from mast cell mediator release and can include skin lesions, gastrointestinal issues, bone pain, and constitutional symptoms. Diagnosis involves skin biopsy, serum tryptase levels, and bone marrow biopsy in systemic forms.
The document provides information on different types of vasculitis:
[1] Any blood vessel can be affected by vasculitis, causing inflammation that leads to occlusion, aneurysm, ischemia and hemorrhage. The small vessel vasculitides include ANCA-associated disorders like Wegener's granulomatosis and types mediated by immune complexes.
[2] The approach to a patient with vasculitis involves considering signs and symptoms, performing tests and biopsies of affected organs to determine which organ systems are involved and the extent of involvement. Treatment depends on the specific type of vasculitis.
[3] Examples of specific vasculitides discussed include giant cell arteritis, poly
A concised information regarding use of photo therapy in dermatology. made by me as a part of MD dermatology residency. includes additional information about sunscreens.
This document discusses ulcerative lesions of the intestines, including peptic ulcer disease, infectious causes like typhoid and tuberculosis, and inflammatory bowel disease like ulcerative colitis and Crohn's disease. It provides details on the definition, sites, epidemiology, etiology, pathogenesis, clinical features, investigations, management and complications of these conditions. Peptic ulcer disease is most commonly caused by H. pylori infection or NSAID use. Typhoid causes circumscribed ulcers in the ileum due to Salmonella typhi infection. Tuberculosis can cause ulcers in the ileocecal region. Ulcerative colitis causes continuous ulcers in the colon, while Crohn's disease causes transm
This document provides guidance on managing abnormal vaginal bleeding in the emergency department. It outlines how to assess patients presenting with vaginal bleeding, including determining if they are pregnant and stable. Common causes of vaginal bleeding are discussed for different age groups and pregnancy statuses, such as miscarriage, ectopic pregnancy, and issues later in pregnancy like placenta previa. Recommendations are provided on investigations, treatment options, and discharge criteria depending on the identified cause. Pelvic exams are not recommended for those in the third trimester due to risk.
This document outlines a plan for discussing cervical intraepithelial neoplasia (CIN) and cervical cancer screening. It covers the incidence, pathogenesis and prevention of CIN, describing how persistent high-risk HPV infection can lead to precancerous lesions and cancer. It then discusses cervical screening guidelines, procedures for Pap tests and HPV tests, and approaches for diagnosing and treating abnormal screening results, including excision or ablation depending on factors like lesion size and margins. Follow-up testing and surveillance is recommended based on screening and treatment outcomes.
The document discusses three cases of patients presenting with acanthosis nigricans. Acanthosis nigricans is a skin condition linked to insulin resistance and hyperinsulinemia, often seen in obese individuals. It is characterized by thickening and darkening of the skin in body folds and creases. The best treatment is weight loss and exercise to reduce blood insulin levels and correct the underlying endocrinological abnormality.
- The epidermis maintains homeostasis through balanced cell production and loss in the basal layer. Three cell populations exist: stem cells, transient amplifying cells, and post-mitotic cells.
- Stem cells give rise to the epidermis and reside in the basal layer and hair follicle bulge. Transient amplifying cells can undergo limited proliferation.
- Keratinocytes take 12-19 days to transit from basal layer to stratum corneum, and 14 more days to transit through the stratum corneum. A variety of growth factors regulate epidermopoiesis.
This document provides an overview of diseases of the ovary, including both non-neoplastic and neoplastic lesions. It discusses common non-neoplastic conditions like follicular cysts and polycystic ovarian disease. It also covers the various types of ovarian tumors, including surface epithelial tumors (serous, mucinous, endometrioid), germ cell tumors, and sex cord-stromal tumors. For each type, it describes the gross and microscopic appearance as well as examples of histopathology slides. Metastatic tumors to the ovaries are also briefly discussed.
This document summarizes the anatomy, histology, and pathologies of the uterine cervix. It discusses the normal cervix epithelium and how cervical inflammation and infections can cause conditions like cervicitis. Precancerous lesions like cervical intraepithelial neoplasia are often caused by human papillomavirus infection and can progress to invasive cervical cancer if left undetected and untreated. Screening methods like the Pap test aim to detect these early lesions to prevent cervical cancer.
This document summarizes information about uterine sarcomas, with a focus on leiomyosarcomas and endometrial stromal sarcomas. It discusses the clinical presentation, diagnostic challenges, classification, staging, prognostic factors, surgical management, and adjuvant therapies for these rare but aggressive uterine cancers. Key points include the difficulty of pre-operative diagnosis, the importance of surgical staging and cytoreduction, and the limited but emerging role of adjuvant therapies like radiation and chemotherapy.
This document discusses various skin conditions that can occur during pregnancy, categorized as physiologic changes, preexisting conditions exacerbated by pregnancy, and dermatoses specific to pregnancy. Some key conditions covered include melasma, striae gravidarum, pemphigoid gestationis (herpes gestationis), pruritic urticarial papules and plaques of pregnancy (PUPPP), intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and atopic eruptions of pregnancy. Many of these conditions involve rashes or lesions on the abdomen and resolve after delivery, when hormone levels return to normal. Their management may involve topical or oral corticosteroids, anti
This document defines and describes gestational trophoblastic disease, which includes abnormal placentas and gestational tumors. It covers topics like complete and partial hydatidiform moles, invasive and metastatic moles, gestational choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Prognostic factors, treatment approaches, and histopathological features are discussed for different conditions. The genetics, clinical presentation, imaging and spread of these gestational diseases are also summarized.
The document provides information on normal ovaries and ovarian masses. It discusses:
1. The typical size of normal ovaries and factors that can affect size.
2. Risks of ovarian neoplasms - a woman has a 5-10% lifetime risk of surgery for a suspected ovarian mass, of which 13-21% will be malignant.
3. Differential diagnosis of adnexal masses varies with age, with masses in pre-menarchal/post-menopausal women considered highly abnormal.
This document summarizes information about premature ovarian failure (POF). It defines POF as amenorrhea, hypoestrogenism, and elevated gonadotropins in women under age 40. POF prevalence is 1-4% under age 40, increasing to 1% by age 30 and 4% by age 40. Causes include genetic factors, autoimmunity, environmental exposures, infections, and iatrogenic factors. Symptoms include menopausal symptoms and long term risks of osteoporosis and cardiovascular disease. Diagnosis involves lab tests of hormones and imaging. Treatment is hormone replacement therapy. Annual follow up is needed to monitor treatment and screen for other related conditions.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
The document discusses several diseases that can affect the vulva, including Bartholin's gland cysts and abscesses, Herpes vulvitis, Molluscum contagiosum, HPV warts, Tinea cruris, lichen sclerosis, Paget's disease, vulvar hematoma, primary syphilis, condyloma lata, chancroid, lymphogranuloma venereum, and granuloma inguinale. For each condition, it describes symptoms, diagnosis, and treatment options.
This document discusses carcinoma of the vulva, including its various types and stages. It describes preinvasive lesions like vulvar intraepithelial neoplasia (VIN), as well as invasive lesions including squamous cell carcinoma, melanoma, adenocarcinoma and sarcoma. It covers the presentation, investigations, staging and treatment of invasive vulvar carcinoma, noting that surgery is often the primary treatment and lymph node involvement determines need for lymphadenectomy. Prognosis depends on stage, with 5-year survival rates of over 90% for stage I disease but dropping significantly with increased stage.
This document summarizes information about endometrial cancer from Shaukat Khanum Memorial Cancer Hospital and Research Centre. It discusses the epidemiology, risk factors, classification, diagnosis, staging, treatment approaches including surgery and adjuvant therapy, prognosis, and recurrent disease. The summary provides an overview of endometrial cancer including that it is the most common female genital tract cancer, obesity is a strong risk factor, around 80% of cases present at an early stage, surgery is the main treatment, and refinement of adjuvant therapy for early stage disease remains challenging.
- Mucinous cystadenoma is a benign ovarian tumor composed of epithelial cells that secrete mucin, forming multiple cysts. It typically presents in women aged 30-50 as a large pelvic mass. Treatment is unilateral salpingo-oophorectomy.
- Thecoma is a sex cord-stromal tumor composed of lipid-containing theca cells. It most commonly presents in postmenopausal women as a pelvic mass and can cause endometrial hyperplasia and adenocarcinoma due to estrogen secretion. Treatment is unilateral salpingo-oophorectomy.
- Fibromas are benign ovarian tumors not associated with hormone secretion. While typically asymptomatic, cellular fibromas have
This document discusses common causes and approaches to evaluating and managing postmenopausal vaginal bleeding. Key causes mentioned include atrophic vaginitis, endometrial hyperplasia, uterine polyps, endometrial cancer, and exogenous estrogen use. The diagnostic approach involves a detailed history, examination, transvaginal ultrasound, hysteroscopy, and biopsy. Initial stabilization priorities bleeding control. Long-term management depends on the underlying cause and may involve hormone therapy, surgery, or chemotherapy/radiotherapy. Counseling supports informed decision making and long-term follow up.
Mastocytosis is a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells in the skin and sometimes in other organs. The summary is:
1. Mast cells are derived from bone marrow precursors and mature in tissues where they play roles in both innate and acquired immunity.
2. Mastocytosis includes cutaneous and systemic forms, with cutaneous forms showing mast cell infiltration of the skin and systemic forms showing infiltration of other organs.
3. Symptoms result from mast cell mediator release and can include skin lesions, gastrointestinal issues, bone pain, and constitutional symptoms. Diagnosis involves skin biopsy, serum tryptase levels, and bone marrow biopsy in systemic forms.
The document provides information on different types of vasculitis:
[1] Any blood vessel can be affected by vasculitis, causing inflammation that leads to occlusion, aneurysm, ischemia and hemorrhage. The small vessel vasculitides include ANCA-associated disorders like Wegener's granulomatosis and types mediated by immune complexes.
[2] The approach to a patient with vasculitis involves considering signs and symptoms, performing tests and biopsies of affected organs to determine which organ systems are involved and the extent of involvement. Treatment depends on the specific type of vasculitis.
[3] Examples of specific vasculitides discussed include giant cell arteritis, poly
A concised information regarding use of photo therapy in dermatology. made by me as a part of MD dermatology residency. includes additional information about sunscreens.
This document discusses ulcerative lesions of the intestines, including peptic ulcer disease, infectious causes like typhoid and tuberculosis, and inflammatory bowel disease like ulcerative colitis and Crohn's disease. It provides details on the definition, sites, epidemiology, etiology, pathogenesis, clinical features, investigations, management and complications of these conditions. Peptic ulcer disease is most commonly caused by H. pylori infection or NSAID use. Typhoid causes circumscribed ulcers in the ileum due to Salmonella typhi infection. Tuberculosis can cause ulcers in the ileocecal region. Ulcerative colitis causes continuous ulcers in the colon, while Crohn's disease causes transm
This document provides guidance on managing abnormal vaginal bleeding in the emergency department. It outlines how to assess patients presenting with vaginal bleeding, including determining if they are pregnant and stable. Common causes of vaginal bleeding are discussed for different age groups and pregnancy statuses, such as miscarriage, ectopic pregnancy, and issues later in pregnancy like placenta previa. Recommendations are provided on investigations, treatment options, and discharge criteria depending on the identified cause. Pelvic exams are not recommended for those in the third trimester due to risk.
This document outlines a plan for discussing cervical intraepithelial neoplasia (CIN) and cervical cancer screening. It covers the incidence, pathogenesis and prevention of CIN, describing how persistent high-risk HPV infection can lead to precancerous lesions and cancer. It then discusses cervical screening guidelines, procedures for Pap tests and HPV tests, and approaches for diagnosing and treating abnormal screening results, including excision or ablation depending on factors like lesion size and margins. Follow-up testing and surveillance is recommended based on screening and treatment outcomes.
The document discusses three cases of patients presenting with acanthosis nigricans. Acanthosis nigricans is a skin condition linked to insulin resistance and hyperinsulinemia, often seen in obese individuals. It is characterized by thickening and darkening of the skin in body folds and creases. The best treatment is weight loss and exercise to reduce blood insulin levels and correct the underlying endocrinological abnormality.
- The epidermis maintains homeostasis through balanced cell production and loss in the basal layer. Three cell populations exist: stem cells, transient amplifying cells, and post-mitotic cells.
- Stem cells give rise to the epidermis and reside in the basal layer and hair follicle bulge. Transient amplifying cells can undergo limited proliferation.
- Keratinocytes take 12-19 days to transit from basal layer to stratum corneum, and 14 more days to transit through the stratum corneum. A variety of growth factors regulate epidermopoiesis.
This document provides an overview of diseases of the ovary, including both non-neoplastic and neoplastic lesions. It discusses common non-neoplastic conditions like follicular cysts and polycystic ovarian disease. It also covers the various types of ovarian tumors, including surface epithelial tumors (serous, mucinous, endometrioid), germ cell tumors, and sex cord-stromal tumors. For each type, it describes the gross and microscopic appearance as well as examples of histopathology slides. Metastatic tumors to the ovaries are also briefly discussed.
This document summarizes the anatomy, histology, and pathologies of the uterine cervix. It discusses the normal cervix epithelium and how cervical inflammation and infections can cause conditions like cervicitis. Precancerous lesions like cervical intraepithelial neoplasia are often caused by human papillomavirus infection and can progress to invasive cervical cancer if left undetected and untreated. Screening methods like the Pap test aim to detect these early lesions to prevent cervical cancer.
This document summarizes information about uterine sarcomas, with a focus on leiomyosarcomas and endometrial stromal sarcomas. It discusses the clinical presentation, diagnostic challenges, classification, staging, prognostic factors, surgical management, and adjuvant therapies for these rare but aggressive uterine cancers. Key points include the difficulty of pre-operative diagnosis, the importance of surgical staging and cytoreduction, and the limited but emerging role of adjuvant therapies like radiation and chemotherapy.
This document discusses various skin conditions that can occur during pregnancy, categorized as physiologic changes, preexisting conditions exacerbated by pregnancy, and dermatoses specific to pregnancy. Some key conditions covered include melasma, striae gravidarum, pemphigoid gestationis (herpes gestationis), pruritic urticarial papules and plaques of pregnancy (PUPPP), intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and atopic eruptions of pregnancy. Many of these conditions involve rashes or lesions on the abdomen and resolve after delivery, when hormone levels return to normal. Their management may involve topical or oral corticosteroids, anti
This document defines and describes gestational trophoblastic disease, which includes abnormal placentas and gestational tumors. It covers topics like complete and partial hydatidiform moles, invasive and metastatic moles, gestational choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Prognostic factors, treatment approaches, and histopathological features are discussed for different conditions. The genetics, clinical presentation, imaging and spread of these gestational diseases are also summarized.
The document provides information on normal ovaries and ovarian masses. It discusses:
1. The typical size of normal ovaries and factors that can affect size.
2. Risks of ovarian neoplasms - a woman has a 5-10% lifetime risk of surgery for a suspected ovarian mass, of which 13-21% will be malignant.
3. Differential diagnosis of adnexal masses varies with age, with masses in pre-menarchal/post-menopausal women considered highly abnormal.
This document summarizes information about premature ovarian failure (POF). It defines POF as amenorrhea, hypoestrogenism, and elevated gonadotropins in women under age 40. POF prevalence is 1-4% under age 40, increasing to 1% by age 30 and 4% by age 40. Causes include genetic factors, autoimmunity, environmental exposures, infections, and iatrogenic factors. Symptoms include menopausal symptoms and long term risks of osteoporosis and cardiovascular disease. Diagnosis involves lab tests of hormones and imaging. Treatment is hormone replacement therapy. Annual follow up is needed to monitor treatment and screen for other related conditions.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
The document discusses several diseases that can affect the vulva, including Bartholin's gland cysts and abscesses, Herpes vulvitis, Molluscum contagiosum, HPV warts, Tinea cruris, lichen sclerosis, Paget's disease, vulvar hematoma, primary syphilis, condyloma lata, chancroid, lymphogranuloma venereum, and granuloma inguinale. For each condition, it describes symptoms, diagnosis, and treatment options.
This document discusses carcinoma of the vulva, including its various types and stages. It describes preinvasive lesions like vulvar intraepithelial neoplasia (VIN), as well as invasive lesions including squamous cell carcinoma, melanoma, adenocarcinoma and sarcoma. It covers the presentation, investigations, staging and treatment of invasive vulvar carcinoma, noting that surgery is often the primary treatment and lymph node involvement determines need for lymphadenectomy. Prognosis depends on stage, with 5-year survival rates of over 90% for stage I disease but dropping significantly with increased stage.
The document discusses the diagnosis of syphilis through various testing methods. Dark field microscopy can detect Treponema pallidum in lesions during primary or secondary syphilis. Non-treponemal tests like VDRL and RPR are screening tests but have low sensitivity in early and late syphilis. Treponemal specific tests like FTA-Abs are used to confirm syphilis diagnosis when non-treponemal tests are reactive. Both types of tests are used at different stages of syphilis to make or confirm the diagnosis.
Este documento presenta el caso de una adolescente de 16 años con una lesión vulvar diagnosticada inicialmente como Neoplasia Vulvar Intraepitelial de Alto Grado (VIN III) pero que luego de 20 días se redujo considerablemente en tamaño y cambió en apariencia, resultando finalmente ser VIN 1 Indiferenciado tras la escisión quirúrgica. El documento concluye que las VIN pueden evolucionar de manera sorprendente en adolescentes, incluso llegando a la regresión espontánea, por lo que el control sin tratamiento también es una op
This document discusses vestibulitis, a condition characterized by focal erythema and sometimes erosion at the junction of the hymen and vestibule. Women with vestibulitis experience pain with sexual intercourse or tampon insertion due to tenderness in the vestibular area. A careful examination looking for erythema or fissures at the hymenal-vestibular junction can help diagnose vestibulitis. Medical therapies for vestibulitis are generally ineffective as the condition renders the vestibular epithelium more susceptible to damage.
Este documento resume las lesiones malignas y neoplasias intraepiteliales de la vulva. Describe el VIN indiferenciado y diferenciado, así como su riesgo de progresión a cáncer. Explica la clínica, diagnóstico y tratamiento del cáncer de vulva, incluyendo factores de riesgo, tipos, estadificación y opciones terapéuticas como resecciones quirúrgicas y radioterapia. Finalmente, incluye una bibliografía sobre el tema.
Este documento presenta dos casos de pacientes mujeres con máculas pigmentadas irregulares en la vulva. La biopsia del primer caso mostró hiperpigmentación de la capa basal epidérmica con presencia de macrófagos que contenían melanina, lo que es compatible con un diagnóstico de melanosis vulvar. En el segundo caso, la histopatología también mostró un diagnóstico de melanosis vulvar.
This document summarizes guidelines for evaluating and managing vulvar cancer. It discusses performing a thorough pre-operative evaluation, imaging to determine resectability, and prognostic factors like tumor size and lymph node status. Treatment may involve surgery such as modified radical vulvectomy, radiation, and chemotherapy. The management of regional lymph nodes is also covered, including the importance of groin dissection and whether unilateral or bilateral dissection is needed based on tumor location. The document outlines approaches for different cancer stages and minimizing complications.
Este documento resume las lesiones premalignas de vulva y vagina. Describe la terminología y clasificación de las lesiones premalignas de vulva como el liquen escleroso y el VIN. Explica los factores de riesgo, manifestaciones clínicas, diagnóstico, y tratamientos como agentes tópicos, ablación con láser, y diferentes tipos de vulvectomía. También cubre las lesiones premalignas de vagina, incluyendo la terminología de VAIN, factores de riesgo, detección, y manejo con agent
The document summarizes key points from a presentation on sexually transmitted diseases given at a 2007 conference. It covers various genital infections including herpes, syphilis, chlamydia, gonorrhea, bacterial vaginosis, trichomoniasis, human papillomavirus, and their signs, symptoms, diagnostic testing, and treatment recommendations. Resources on STD guidelines and management from the CDC are also referenced.
This document provides guidelines for syndromic management of sexually transmitted infections (STIs). It discusses the syndromic approach to treating STIs based on common causative organisms for each syndrome. Flow charts are provided to guide clinicians through history taking, examination, risk assessment, diagnosis and treatment based on presenting symptoms and signs for various STI syndromes, including urethral discharge, vaginal discharge, lower abdominal pain, genital ulcers, scrotal swelling, and inguinal swelling. Treatment recommendations are given for each syndrome. The document emphasizes partner treatment, prevention counseling, and ensuring treatment compliance.
This document discusses fungal vulvovaginal infections, including candidiasis (yeast infection). It covers the vaginal environment and factors that can lead to infection. Candida albicans is noted as the most common cause of vulvovaginal candidiasis (VVC). Symptoms, diagnosis, classification as uncomplicated or complicated VVC, and treatment recommendations including topical and oral antifungal agents are summarized. Recurrent and severe VVC require longer treatment courses and consideration of maintenance therapy.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that can cause long-term complications if not treated promptly. It is usually caused by bacteria spreading from the vagina or cervix, such as Chlamydia trachomatis and Neisseria gonorrhoeae. Left untreated, PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and increased risk of HIV transmission. Treatment involves a combination of antibiotics to cover common causative organisms, with hospitalization recommended for severe cases. Prompt treatment is important to prevent long-term complications.
Management of perinatal infections and exposures was discussed. Congenital CMV is a leading cause of hearing loss and malformations. Treatment is recommended for moderate-severe cases while treatment for mild cases or isolated hearing loss is controversial. Congenital syphilis evaluation involves interpreting maternal tests and infant titers to determine treatment. HIV testing is recommended for all pregnant women and antiretroviral prophylaxis is given to exposed infants based on maternal viral load and treatment. Hepatitis C transmission risk is low but testing exposed infants allows early identification and monitoring. HSV exposed asymptomatic neonates do not require treatment but should be monitored for symptoms.
Here are three more potential causes of paralysis in patients with AIDS:
- Cryptococcal meningitis: The most common fungal infection of the CNS in AIDS patients. Can cause increased intracranial pressure, cranial neuropathies, and spinal cord compression.
- Progressive multifocal leukoencephalopathy (PML): Caused by JC virus reactivation in AIDS patients. Presents with cognitive impairment, visual changes, and sometimes motor deficits. MRI often shows multifocal white matter lesions.
- Vacuolar myelopathy: Caused by HIV itself. Presents with spastic paraparesis. MRI may show T2 hyperintensities in the lateral and posterior columns of the spinal cord. Treat
1. The document discusses several common infections that can affect the female genital tract, including bacterial vaginosis, trichomoniasis, vulvovaginal candidiasis, and cervicitis.
2. It provides details on the causes, symptoms, diagnostic criteria, and treatment recommendations for each infection.
3. The treatment sections emphasize using antibiotics, antifungals, or other medications to address the underlying causes of infection, while considering factors like pregnancy.
Miguel presents with anal pain and pimple-like lesions in his perianal area that have multiplied and popped, leaving the area moist with a weird smell. This clinical presentation is consistent with recurrent genital herpes simplex virus infection. The recommended treatment is acyclovir 400 mg orally three times daily for 10 days.
Urethritis is inflammation of the urethra that can be caused by various pathogens like Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. It is characterized by dysuria with or without urethral discharge. Gonorrhea diagnosis involves Gram stain of urethral discharge to identify kidney bean shaped diplococci or culture. Treatment includes ceftriaxone or cefixime. Chlamydia diagnosis uses NAAT and treatment involves azithromycin or doxycycline. Trichomoniasis is diagnosed by culture or PCR and treated with metronidaz
Pelvic Inflammatory Disease (PID) is an inflammation of the female genital tract that is usually caused by bacterial infections such as Chlamydia trachomatis and Neisseria gonorrhoeae spreading from the vagina or cervix. Left untreated, PID can cause serious complications like infertility, ectopic pregnancy, and chronic pelvic pain. Treatment involves antibiotics to eradicate the infection as well as managing symptoms. Prevention focuses on screening and treatment of sexually transmitted infections, particularly among young sexually active women.
This document discusses sexually transmitted infections (STIs). It lists reportable STIs in South Carolina and provides statistics on STIs in the US, including that adolescents experience high rates of infection. It then covers specific STIs like chlamydia, gonorrhea, herpes, syphilis, and human papillomavirus. It discusses symptoms, treatments, and considerations for adolescents. Overall, the document is an informative overview of common STIs, reporting requirements, and management strategies.
Bacterial vaginosis by dr alka mukherjee DR APURVA MUKHERJEE nagpur m.s.alka mukherjee
Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance. Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age. Bacterial overgrowth in the vagina.
Bacterial vaginosis tends to affect women of childbearing age. Activities such as unprotected sexual intercourse or frequent douching can increase a person's risk.
In some cases, there are no symptoms. In other cases, there may be abnormal vaginal discharge, itching or odour. BV can clear up on its own.
Treatment can include prescription cream, gel or medication. Recurrence within three to 12 months is common, requiring additional treatment.
Very common
More than 10 million cases per year (India)
Treatable by a medical professional
Short-term: resolves within days to weeks
Requires a medical diagnosis
Lab tests or imaging often require
This document provides a summary of frequently asked questions about antibiotic use and infectious diseases. It addresses topics such as the treatment of asymptomatic bacteriuria, ESBL urinary tract infections, VRE in stool, C. difficile therapy, and molecular testing for tuberculosis diagnosis. It also compares antibiotics and provides guidance on de-escalation of empiric broad-spectrum therapy. Order sets are referenced for common infections like skin and soft tissue infections, neutropenic fever, sepsis, and pyelonephritis.
Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection within the first month of life. It is a leading cause of neonatal mortality, responsible for about 52% of neonatal deaths. The presentation and risk factors differ based on whether the onset of sepsis is early (within 72 hours of life) or late (after 72 hours of life). Management involves screening protocols to determine the need for antibiotics and treatment, which typically involves empiric broad-spectrum antibiotics that may need to be adjusted based on culture and sensitivity results. Close monitoring is important as the condition can deteriorate rapidly.
Genital HPV is very common, with a lifetime risk of 70% for HPV infection and 10% for genital warts. Spontaneously, genital warts resolve in 20-30% of cases within 3 months. Biopsy is usually not required for healthy women under 35 years old with typical genital warts. Treatment choices depend on factors like patient preference, provider experience, and pregnancy status. Combination therapies may be used. Even after treatment, the latent virus remains, with a 30% recurrence rate of warts and potential for transmission to partners.
This document discusses gynecological infections, including their symptoms, diagnostic approaches, and treatment options. It covers common infections like bacterial vaginosis, vulvovaginal candidiasis (yeast infection), trichomoniasis, atrophic vaginitis, herpes simplex virus, human papillomavirus, and gonorrhea. Diagnostic tests include cultures, smears, and exams. Treatments involve antibiotics, antifungals, and antivirals depending on the infection. Managing gynecological infections properly is important to prevent complications.
This document discusses altered vaginal discharge (AVD) and common causes. It provides guidance from various medical organizations on evaluating and diagnosing AVD in a clinical setting. The most common causes of AVD are bacterial vaginosis, candidiasis, and trichomoniasis. The document outlines the symptoms, risk factors, diagnostic approach, treatment recommendations, and management considerations for each of these conditions. It emphasizes the importance of correct diagnosis before initiating treatment for AVD.
This document discusses various reproductive tract infections that can occur during pregnancy including gonorrhea, syphilis, genital herpes, and cytomegalovirus. It defines the infections and describes their symptoms, effects on pregnancy and newborns, methods of diagnosis, and treatment approaches for both mothers and babies. Common sexually transmitted infections caused by bacteria, viruses, fungi and protozoa that can affect the reproductive system are also outlined.
This document provides an overview of sexually transmitted infections (STIs) for clinicians. It discusses the most common bacterial, viral and parasitic STIs including their epidemiology, diagnosis and treatment recommendations. Screening and prevention strategies are also reviewed, including behavioral counseling, vaccination, condom use and expedited partner therapy. The impacts of STIs on women's reproductive health are highlighted.
This document provides information about migraine in women. Some key points:
- Migraine is 3 times more common in women than men. Hormonally-associated migraines affect 12 million women in the US.
- Migraines are often associated with changes in hormone levels, such as during menstruation, pregnancy, use of oral contraceptives, and menopause.
- Diagnosis of migraine involves evaluating symptoms such as headache duration/intensity, nausea, light/sound sensitivity, visual/sensory disturbances (aura).
- Treatment involves both acute symptomatic relief and preventive medications, though choices are more limited during pregnancy/breastfeeding due to safety.
This document discusses 5 case studies involving GI disorders in women. The first case involves a 32-year-old woman with 5 years of diarrhea and abdominal pain. The next best step is reassurance without further testing, as her symptoms are consistent with irritable bowel syndrome. The second case involves a 38-year-old woman with vomiting after gastric bypass surgery, where an internal hernia is the most likely cause. The third case involves a pregnant woman referred for irritable bowel syndrome, where testing her for celiac disease is the next best step. The fourth case involves constipation, where pelvic floor dysfunction is the most likely diagnosis given her exam findings. The fifth case involves a 58-year-old woman with diarrhea
Here are my recommendations for the 56 year old woman with subclinical hypothyroidism:
1. Her diagnosis is subclinical hypothyroidism based on an elevated TSH of 7.1 and normal free T4.
2. Given her age (56), fatigue, and 3-4 lb weight gain, I would recommend a trial of levothyroxine therapy. Treatment is reasonable for patients with TSH >10 or positive thyroid antibodies, which she does not have data for. However, treatment may modestly improve her lipids and symptoms.
3. She should be monitored every 6 months with TSH checks to ensure her TSH is maintained between 0.5-2.0 and that she does not
The document announces the Women's Health 2012 Congress hosted by the NIH Office of Research on Women's Health. It will feature scientific poster awards for Women's Health and Sex Differences Research. The congress focuses on women's health issues and research.
The document discusses how the Affordable Care Act (ACA) aims to improve access to preventive health services for women by requiring new health plans to cover recommended preventive services without cost sharing. This includes services for cancer screening, chronic disease prevention and management, vaccinations, healthy behaviors counseling, pregnancy-related care, and reproductive health services. The new rules apply to new private health plans starting in 2010 and 2012, with some exemptions for grandfathered and religious plans. Implementation will consider factors like network restrictions, separate billing for visits and services, and ensuring adequate provider training and capacity.
The document summarizes the charge given by the Institute of Medicine to convene a committee of experts to review women's preventive health services and identify gaps. The committee was tasked with recommending services to be included in comprehensive national guidelines. After reviewing evidence, the committee made 8 recommendations, including screening for gestational diabetes, HPV testing, counseling on STIs and HIV, contraception services, lactation support, interpersonal violence screening, and annual well-woman visits.
This document summarizes key aspects of the Affordable Care Act (ACA) and how it benefits women's health and preventive care. It discusses how the ACA expands insurance coverage to over 34 million Americans, strengthens consumer protections, and requires insurers to cover preventive services for women at no additional cost. Specifically, it outlines services that must be covered for pregnant women, various cancer and disease screenings, counseling services, contraception and sterilization coverage, lactation support, and violence screening. It also notes that some existing "grandfathered" health plans are exempt from some ACA requirements but still must cover certain new benefits.
Dr. Iglesia has no conflicts of interest to disclose. The objectives of the document are to develop effective treatment plans, communicate treatment goals, minimize medication side effects, and describe new therapies for overactive bladder in women. Overactive bladder affects millions of Americans, especially women, and prevalence increases with age. New therapies aim to change stereotypes about overactive bladder and provide realistic information about prevalence and severity. Behavioral interventions like pelvic floor exercises and bladder training can be effective treatment approaches.
The document discusses cervical cancer screening guidelines and strategies, comparing the use of Pap tests, HPV tests, and primary HPV screening. It provides information on the epidemiology of HPV and progression to cervical cancer, as well as data from studies showing that primary HPV screening can detect more high-grade cervical lesions than cytology alone.
The document discusses depression in women and improving outcomes. Major depression has a significant public health impact and is the leading cause of disability among women worldwide. Women experience depression rates 1.5-2.5 times higher than men ages 15-54. Key ways to improve outcomes include considering differential diagnoses, treating to remission, measuring symptom improvement, using evidence-based interventions personalized to the individual woman, and providing self-help resources.
This document discusses strategies for managing obesity in women. It notes that obesity is influenced by multiple factors including genetics, environment, diet, physical activity, and life events. Key life events that can influence weight gain include pregnancy, menopause, and aging. Maternal obesity increases health risks for both mother and child during pregnancy and the child's future obesity risk. Abdominal obesity, as measured by waist circumference, is a better predictor of health risks than BMI alone. Managing obesity requires addressing its underlying causes through lifestyle changes.
This document is an in memoriam for Trudy L Bush, a professor of epidemiology and preventive medicine at the University of Maryland who passed away in 2001. It summarizes her landmark research on the effects of hormones on various body systems, her trailblazing leadership in the field of women's health, and her tireless commitment to medical education relating to women's health and menopause. The document honors her memory with an annual lecture series.
Evidence based management of cardiovascular disease in women plmiami
1. Evidence Based Management of Cardiovascular Disease in Women discusses the leading causes of death in Americans and how cardiovascular disease is the number one killer of women.
2. The document reviews gender differences in atherosclerosis, such as plaque erosion being more common in women than plaque rupture seen in men, making diagnosis of cardiovascular disease more difficult in women.
3. Prevention strategies discussed include reducing atherosclerosis, preventing plaque rupture and erosion, limiting thrombosis, and recognizing the presence of cardiovascular disease in women.
This document discusses care of cancer survivors and outlines the following key points in 3 sentences:
1) Approximately 3% of the population are cancer survivors, with many being elderly and having multiple comorbidities. 2) Both cancer-related and general medical needs must be addressed in cancer survivors, including surveillance for recurrence, late effects of treatment, and new primary cancers as well as screening and management of comorbidities. 3) The role of primary care physicians in providing ongoing care for cancer survivors along with survivorship care plans is reviewed.
This document discusses factors that influence peak bone mass attained during adolescence and young adulthood. It notes that genetics account for 80% of variability in peak bone mass, and lists several genes associated with bone mineral density and fracture risk. Nutrition, physical activity, body composition, endocrine status like age of menarche, and use of birth control also impact peak bone mass. Regular weight-bearing exercise and adequate calcium, vitamin D, and protein intake during growth can help increase bone mass accrual and attain a higher peak.
This document summarizes best practices in lesbian health based on a presentation by Dr. Patricia Robertson. It finds that lesbians have higher rates of smoking, childhood abuse, obesity, and certain STIs. They have lower rates of Pap smears and mammograms due to cost and prior adverse experiences. The document recommends screening lesbians appropriately, discussing family planning options, ensuring legal protections for partners, and advocating for lesbian health in the community. Providers should encourage disclosure of sexual orientation to provide culturally competent care.
Lee P. Shulman is the Anna Ross Lapham Professor of Obstetrics and Gynecology and Chief of the Division of Clinical Genetics at Northwestern University. He discloses advisory roles and speaking engagements with several genetic testing companies. His research focuses on inherited cancer risk assessment and genetic testing for hereditary cancer syndromes. He provides an overview of the genetics of cancer including tumor suppressor genes and oncogenes, as well as specific hereditary cancer syndromes like BRCA1/2, Lynch syndrome, and Cowden syndrome that increase cancer risk, especially for women's cancers.
This document summarizes evidence-based care of women with rheumatoid arthritis (RA). It discusses that RA is a chronic inflammatory disorder that principally affects the synovial joints. It is characterized by a proliferative response in the synovium leading to bone and cartilage destruction. The document reviews who is affected by RA, common articular features, characteristic deformities, and extra-articular manifestations. It also discusses the natural history of RA and whether there are any gender differences. Current management approaches from 2012 are presented, including early diagnosis, prompt initiation of traditional DMARDs, and appropriate use of biological DMARDs.
This document discusses gender differences in substance abuse. It finds that while males have higher rates of substance use, females are at least as vulnerable to substance abuse and may become dependent more rapidly if given the opportunity. Specifically, females are more likely than males to become dependent on sedatives, anxiolytics, and opioids. Animal studies also show females self-administer more of several substances and acquire drug conditioning faster. Overall, the document suggests the vulnerability to substance abuse is similar between males and females.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
4. CDC 2010: Trichomoniasis
Screening and Testing
• Screening indications
– HIV positive women: annually
– Consider if “at risk”: new/multiple sex partners, history of STI,
inconsistent condom use, sex work, IDU
• New assays
– Rapid antigen test: sensitivity, specificity vs. wet mount
– Aptima TMA T. vaginalis Analyte Specific Reagent (ASR)
• Other testing situations
– Suspect trich but NaCl slide neg culture or newer assays
– Pap with trich confirm if low risk
• Consider retesting 3 months after treatment
5. Trichomoniasis: Laboratory Tests
Test Sensitivity Specificity Cost Comment
Aptima TMA +4 (98%) +3 (98%) $$$ NAAT (like GC/Ct)
Culture +3 (83%) +4 (100%) $$$ Not in most labs
Point of care
•Affirm VP III +3 +4 $$$ DNA probe
•OSOM Rapid +3 (90%) +4 (100%) $$ CLIA waived
NaCl suspension +2 (56%) +4 (100%) ¢¢ 1st line
Pap smear +2 +3 n/a Confirm if low
prevalence
Accuracy data: Huppert CID 2007
6. CDC 2010: Vaginal
Trichomoniasis Treatment
• Recommended regimen
– Metronidazole 2 grams PO single dose
– Tinidazole 2 grams PO single dose
• Alternative regimen (preferred for HIV infected women)
– Metronidazole 500 mg PO BID x 7 days
• Metronidazole safe at all gestational ages
– Limited pregnancy data on Tinidazole
• Treat sex partner(s)
• Targeted screening for other STIs: GC, Ct, syphilis, HIV
7. CDC 2010: VT Treatment Failure
• Re-treat with either
– Tinidazole 2 g PO single dose
– Metronidazole 500 mg PO BID x 7 days
• If repeat failure, treat with
– Metronidazole 2 grams po x 3-5 days
• If repeat failureTinidazole 2-3 g po plus 1-1.5 g vaginally
x14 days
• Arrange for susceptibility testing: Call CDC!! (770-488-
4115)
8. BV: Pathophysiology
• Non-inflammatory bacterial overgrowth
– 100 x increase Gardnerella vaginalis
– 1000 x increase in anaerobes
– More pathogen types (Mobiluncus, Mycoplasmas)
• Suppression of H2O2-producing Lactobacillus crispatus and L.
jensenii (L acidophilus is not present)
• >50% women carry G. vaginalis in their vaginal flora in the
absence of BV
– Bacterial “C/S” of vaginal fluid doesn’t help in the
diagnosis of BV….or of any other vaginal infection
9. BV: Sexually Associated or Transmitted?
• “Sexually associated” in heterosexuals
– Rare in virginal women
– Greater risk of BV with multiple male partners
– Condom use decreases risk,
But
– No BV carrier state identified in men
– Treatment of partner does not affect recurrences
• Women having sex with women (WSW)
– Infected vaginal fluid between women causes BV
– Studies of concurrence in lesbian couples suggest
horizontal transmission
10. BV: Clinical Diagnosis
• Amsel Criteria: 3 or more of
– Homogenous white discharge
– Amine odor (“whiff” test)
– pH > 4.5 (most sensitive)
– Clue cells > 20% (most specific)
• Spiegel criteria, Nugent score: Gram stain with
– Few or no gram positive Lactobacillus spp.
– Excess of other gram negative morphotypes
12. BV: Clue Cells on Saline Suspension
>20% of
epithelial
cells are
clues
Reduced
Lactobacilli
Ragged cell
border
13. BV: Laboratory Tests
Test Sensit Specif Cost Comment
Nugent score +4 +4 ¢¢ Labor intensive
Point of care tests
Affirm VP III +4 +3 $$$ DNA probe
OSOM BV Blue +3 +3 $$ CLIA moderate
G vag PIP +2 +3 $$$ CLIA moderate
pH + amines +2 +2 $ CLIA waived
Amsel criteria +3 +2 ¢¢ 1st line
Pap smear +1 +2-3 n/a Coccobacilli
14. Who Should Be Tested for BV?
• Routine screening (asymptomatic): not indicated
• Standard diagnostic testing
– Check discharge, amines, vaginal pH, clue cells
• Microscopy not available or inconclusive
– Affirm VP III
– OSOM BV Blue
– G vaginalis PIP, pH+amine test cards
• “Shift in vaginal flora” on Pap
– No consensus, but poor correlation with BV…most experts
recommend no further follow up
15. CDC 2010: BV Treatment
Recommended regimens
– Metronidazole 500 mg PO BID x 7 days
– Metronidazole gel 0.75% 5g per vagina QD x 5 days
– Clindamycin 2% cream 5g per vagina QHS x 7 days
Alternative regimens
– Tinidazole 2 g PO QD for 3 days
– Tinidazole 1 g PO QD for 5 days
– Clindamycin 300 mg PO BID x 7 days
– Clindamycin ovules 100 mg per vagina QHS x 3 days
16. CDC 2010: Recurrent BV
• Consider suppression with metronidazole vaginal gel twice
weekly for 4-6 months (after full initial treatment)
• No evidence yet to support use of probiotics
• Don’t douche…with anything!
• Use of condoms by male partners may reduce recurrences
• Clean sex toys (or use condoms) between uses
• Avoid vaginal insertion after anal insertion of a finger or penis
17. CDC 2010: VVC Classification
• Uncomplicated VVC (80-90%)
– Sporadic or infrequent VVC, and
– Mild-to-moderate VVC, and
– Likely to be Candida albicans, and
– Immunecompetant
• Complicated VVC (10-20%)
– Recurrent VVC, or
– Severe VVC, or
– Non-albicans candidiasis, or
– Uncontrolled DM, immunosuppression, pregnancy
18. VVC: Laboratory
• KOH suspension
− C. albicans: pseudohyphae and blastospores (buds)
− C. glabrata: blastospores only
• NaCl suspension: many WBC, normal lactobacillus
• pH: 4-6
• Amine test: negative
• Confirmatory tests
- Point of care test: Affirm VP III
- Candida culture (not: fungus culture)
- Candida PCR
19. Treatments for VVC
Drug Over the Counter Prescription
Length of Treatment 7d 3d 1d 7d 3d 1d
Butoconazole X
Clotrimazole X X X
Miconazole X X X
Terconazole X X
Tioconazole X X
Fluconazole (PO) X
20. CDC 2010: Uncomplicated
VVC Treatments
• Non-pregnant women
– 3 and 7 day topicals have equal efficacy and price
– Offer either: 1 or 3 day topical or oral fluconazole
• Topical: quickly soothing, but inconvenient
• Oral: convenient, but effect is not immediate
• If first treatment course fails
– Re-confirm diagnosis (r/o dual infection)
– Treat with an alternate antifungal drug
– Perform Candida culture to confirm and speciate
• No role for nystatin, candicidin
21. CDC 2010: Complicated
VVC Treatment
Severe VVC
• Advanced findings: erythema, excoriation, fissures
• Topical azole therapy for 7-14 days, or
Compromised host
• Topical azole treatment for 7-14 days
• Fluconazole 150 mg PO; repeat Q3 days 1-2 times
Pregnancy
• Topical azoles for 7 days
22. CDC 2010: Complicated
VVC Treatment
Recurrent VVC (RVVC)
• > 4 episodes of symptomatic VVC per year
• Most women have no predisposing condition
– Partners are rarely source of infection
• Confirm with Candidal culture before maintenance
therapy; also check for non-albicans species
• Early treatment regimen: self-medication 3 days with
onset of symptoms
23. CDC 2010: Complicated
VVC Treatment
• Recurrent VVC: Treatment
– Treat for 7-14 days of topical therapy or fluconazole
150 mg PO q 72o x3 doses, then
– Maintenance therapy x 6 months
• Fluconazole 100-200 mg PO 1-2 per week
• Itraconazole 100 mg/wk or 400 mg/month
• Clotrimazole 500 mg suppos 1 per week
• Boric acid 600 mg suppos QD x14, then BIW
• Gentian violet: Q week x2, Q month X 3-6 mo
24. Vulvar Candidiasis
• Vulva will be very itchy; often excoriated
• Presentation
– Erythema + satellite lesions
– Occasionally: thrush, LSC thickening if chronic
• Diagnosis: skin scraping KOH, candidal culture
• Treatment
– Topical antifungal therapy daily for 7-14 days, or
fluconazole 150 mg PO repeat in 3 days
– Plus: TAC 0.1% or 0.5% ointment QD-BID
26. Tinea Cruris: “Jock Itch”
• Asymmetric lesions on proximal inner thighs
– Plaque rarely involves scrotum; not penile shaft
• Well demarcated red plaques with accentuation of scale
peripherally; no satellite lesions
• Fungal folliculitis: papules, nodules or pustules within
area of plaque
• Treatment
– Mild: topical azoles BID x10-14d, terbinafine
– Severe: fluconazole 150 mg QW for 2-4 weeks
– If inflammatory, add TAC 0.1% on 1st 3 days
27.
28. Intertrigo
• Background
– Occlusion, rubbing of skin chafing, inflammation
– If moist, often superinfection with candida or tinea
– May lichenify to LSC
• Findings
– Dull red, shiny skin fold; if moist, white surface
– Follows clothing lines; under breasts, pannus
– No satellites; border not sharp
• Treatment
– Keep skin clean and dry; use cornstarch
– Reduce friction with bland emollient
– Treat secondary infection with topical azole
29. Contact Dermatitis
• Irritant contact dermatitis (ICD)
– Elicited in most people with a high enough dose
– Rapid onset vulvar itching (hours-days)
• Allergic contact dermatitis (ACD)
– Delayed hypersensitivity
– 10-14 days after 1st exposure; 1-7 d after repeat exposure
• ICD and ACD can present with
– Itching, burning, swelling, redness
– Small vesicles or bullae more likely with ACD
33. Contact Dermatitis: Treatment
• Exclude contact with possible irritants
• Restore skin barrier with sitz baths, compresses
• After hydration, apply a bland emollient
– White petrolatum, mineral oil, olive oil
• Short term mild-moderate potency steroids
– TAC 0.1% BID x10-14 days (or clobetasol 0.05%)
– Fluconazole 150 mg PO weekly
• Cold packs: gel packs, peas in a “zip-lock” bag
• Doxypin or hydroxyzine (10-75 mg PO) at 6 pm
• If recurrent, refer for patch testing
34. Why Not Steroid-Antifungal
Combination Drugs?
• Which products should be avoided?
– Lotrisone: Clotrimazole and Betamethasone 0.5%
– Mycolog II: Nystatin and Triamconolone acetonide
• Why avoid them?
– Inflammation usually clears up before fungal infection
– Steroid overshoot skin atrophy
– Local immunosuppression (from steroid) may blunt
antifungal effect
35. ISSVD 1987: Vulvar Dermatoses
Type ISSVD Term Old Terms
Atrophic Lichen • Lichen sclerosus et atrophicus
sclerosus • Kraurosis vulvae
Hyper- Squamous cell • Hyperplastic dystrophy
plastic hyperplasia • Neurodermatitis
• Lichen simplex chronicus
Systemic Other • Lichen planus
dermatoses • Psoriasis
Pre- VIN • Hyperplasic dystrophy/atypia
malignant • Bowen’s disease
• Bowenoid papulosis
• Vulvar CIS
ISSVD: International Society for the Study of Vulvar Disease
36. ISSVD 2006 Classification of
Vulvar Dermatoses
• No consensus agreement on a system based upon
clinical morphology, path physiology, or etiology
• Include only non-Neoplastic, non-infectious entities
• Agreed upon a microscopic morphology based system
• Rationale of ISSVD Committee
– Clinical diagnosis no classification needed
– Unclear clinical diagnosis seek biopsy diagnosis
– Unclear biopsy diagnosis seek clinic pathologic
correlation
38. Lichen Sclerosus: Natural History
• Most common vulvar dermatosis
• Prevalence: 1.7% in a general GYN practice
• Cause: autoimmune condition
• Bimodal age distribution: older women and children, but
may be present at any age
• Chronic, progressive, lifelong condition
39. Lichen Sclerosus: Natural History
• Most common in Caucasian women
• Can affect non-vulvar areas
• Part (or all) of lesion can progress to VIN, differentiated
type
• Predisposition to vulvar squamous cell carcinoma
– 1-5% lifetime risk (vs. < 0.01% without LS)
– LS in 30-40% women with vulvar squamous cancers
40. Lichen Sclerosus: Findings
• Symptoms
– Most commoly, itching
– Often irritation, burning, dyspareunia, tearing
– 58% of newly-diagnosed patients are asymptomatic
• Signs
– Thin white “parchment paper” epithelium
– Fissures, ulcers, bruises, or submucosal hemorrhage
– Loss of labia minora, fusion of labia and clitoral hood
– Depigmentation (white) or hyperpigmentation in
“keyhole” distribution: vulva and anus
– Introital stenosis
41. Lichen Sclerosus: Treatment
• Biopsy mandatory for diagnosis, unless classic findings
• Preferred treatment
– Clobetasol 0.05% ointment QD x4 weeks, then QOD x4
weeks, then twice-weekly for 4 weeks
– Taper to med potency steroid (or clobetasol) 2-4 times
per month for life
– Explain “titration” regimen to patient, including
management of flares and recurrent symptoms
– 30 gm tube of ultrapotent steroid lasts 3-6 mo
– Monitor every 3 months twice, then annually
44. “Late” Lichen Sclerosus
Agglutination of
clitoral hood
Loss of labia
minora
Introital
narrowing
Parchment paper
epithelium
45. Lichen Sclerosus: Treatment
• Second line therapy
– Pimecrolimus, tacrolimus
– Retinoids, potassium para-aminobenzoate
• Testosterone (and estrogen or progesterone) ointment
or cream no longer recommended
• Explain chronicity and need for life-long treatment
• Adjunctive therapy: anti-pruritic therapy
– Antihistamines, especially at bedtime
– Doxypin, at bedtime or topically
– If not effective: amitriptyline, desipramine PO
• Perineoplasty may help dyspareunia, fissuring
46. Lichen Simplex Chronicus =
Squamous Cell Hyperplasia
• Cause: an irritant initiates a “scratch-itch” cycle
• LSC classified as
– Primary (idiopathic)
– Secondary (superimposed upon lichen sclerosus,
candida vulvitis; vulvar contact dermatitis)
• Presentation: always itching; burning, pain, tenderness
• Thickened leathery red (white if moisture) raised lesion
• In absence of atypia, no malignant potential
– If atypia present , classified as VIN
48. L. Simplex Chronicus: Treatment
• Removal of irritants or allergens
• Treatment
– Triamcinolone acetonide (TAC) 0.1% ointment BID x4-
6 weeks, then QD
– Other moderate strength steroid ointments
– Intralesional TAC once every 3-6 months
• Anti-pruritics
– Hydroxyzine (Atarax) 25-75 mg QHS
– Doxepin 25-75 mg PO QHS
– Doxepin (Zonalon) 5% cream; start QD, work up
49. Lichen Sclerosus + LSC
• “Mixed dystrophy” deleted in 1987
ISSVD System
• 15% all vulvar dermatoses
• LS is irritant; scratching LSC
• Consider: LS with plaque, VIN,
squamous cell cancer of vulva
• Treatment
– Clobetasol x12 weeks, then steroid
maintenance
– Stop the itch!!
50. Vulvar Intraepithelial Neoplasia (VIN):
Prior to 2004
• Grading of VIN-1 through VIN-3, based upon degree of
epithelial involvement
• The mnemonic of the 4 P’s
– Papule formation: raised lesion (erosion also
possible, but much less common)
– Pruritic: itching is prominent
– “Patriotic”: red, white, or blue (hyperpigmented)
– Parakeratosis on microscopy
51. ISSVD 2004: Squamous VIN
• VIN 1 is not a cancer precursor…abandon the term
– Instead, use “condyloma” or “flat wart”
• Combine VIN-2 and VIN-3 into single “VIN” diagnosis
• Two distinct variants of VIN
– VIN, usual type
• Warty type
• Basaloid type
• Mixed warty-basaloid
– VIN, differentiated (simplex) type
52. ISSVD 2004:VIN, Usual Type
• Includes (old) VIN -2 or -3
• Usually HPV-related (mainly type 16)
• More common in younger women (30s-40s)
• Often asymptomatic
• Lesions usually elevated and have a rough surface,
• Often multifocal; multicentric in 50%
• Strongly associated with cigarette smoking
• Regression is less likely and progression to invasion more
likely with the basaloid type
53. VIN, Differentiated (Simplex) Type
• Includes (old) VIN 3 only
• Usually in older women with LS, LSC, or LP
• Not HPV related
• Less common than usual type
• Patients usually are symptomatic, with a long history of
pruritus and burning
• Findings
– Red, pink, or white papule; rough or eroded surfaces
– A persistent, non-healing ulcer
• More likely to progress to SCC of vulva than usual VIN
62. Indications for Vulvar Biopsy
• Papular or exophtic lesions, except obvious condylomata
• Thickened lesions (biopsy thickest region) to differentiate
VIN vs. LSC
• Hyperpigmented lesions (biopsy darkest area), unless
obvious nevus or lentigo
• Ulcerative lesions (biopsy at edge), unless obvious herpes,
syphilis or chancroid
• Lesions that do not respond or worsen during treatment
• In summary: biopsy whenever diagnosis is uncertain
63. References
• Heller DS. Report of a new ISSVD classification of VIN. J Low Genit
Tract Dis. 2007 Jan;11(1):46-7.
• Siderite M, et al. Squamous vulvar intraepithelial neoplasia: 2004
modified terminology, ISSVD Vulvar Oncology Subcommittee J
Reprod Med. 2005 Nov;50(11):807-10
• Wechter ME, Management of Bartholin duct cysts and abscesses: a
systematic review Obstet Gynecol Surv. 2009 Jun;64(6):395-404.
• vanSeters, et al, Treatment of vulvar intraepithelial neoplasia with
imiquimod. NEJM 2008;358:1465-73
• De Simone P Vulvar melanoma: a report of 10 cases and review of
literature. Melanoma Res. 2008 Apr;18(2):127-33
64. References
• Lynch PJ, etal, 2006 ISSVD Classification of Vulvar Dermatoses.
J Reprod Med 2007;52:3-9
• ACOG Practice Bulletin #93. Diagnosis and Management of
Vulvar Skin Disorders. Ob Gynecol 2008;111 (5);1243-1253
• Smith YR, Haefner HK. Vulvar lichen sclerosus: pathophysiology
and treatment. Am J Clin Dermatol. 2004;5(2):105-25.
• Edwards L, Vulvar fissures: causes and therapy. Dermatol Ther.
2004;17(1):111-6.
• Foster DC, Vulvar disease. Ob Gynecol. 2002;100(1):145-63.