Lady Lumps
Diagnostic tool of choice for uterine fibroids?
The combination of transvaginal and transabdominal ultrasonography with Doppler is the diagnostic tool of choice for uterine fibroids.
This common nail disorder, affecting up to 20% of people—especially older women—causes nails to crack, split, or flake.
Brittle Nails
What is Slipped Capital Femoral Epiphysis?
What is the classic presentation?
Slipped capital femoral epiphysis (SCFE) is defined as inferior slippage of the femoral epiphysis from the femoral neck. It is caused by the failure of the physeal or growth plate and leads to displacement of the femoral head relative to the femoral neck
Overweight child or adolescent with dull, nonradiating, aching pain and a limp
Does therapeutic anticoagulation decrease mortality in patients hospitalized with COVID-19?
Yes
Patients hospitalized with COVID-19 who do not require oxygen benefit from therapeutic (high) dosing, which reduces 28-day mortality compared with prophylactic (low) dosing.
A 45 year old male with PMHx of HTN on HCTZ, amlodipine and losartan. Also has T2DM on metformin and empaglifozin. LDL is 167 and you prescribe Sinvastatin. At 3 month follow up he tells you he stopped working due to muscle pain.
What of the following medications contribute to the risk of statin-induced myopathy?
Amlodipine
Metabolized same cytochrome P450 3A4 - other meds: amiodarone, CCB, some HIV meds and antifungal meds
USPSTF recommendation about fibroid screening?
What grade is the recommendation?
The US Preventive Services Task Force and the American College of Obstetricians and Gynecologists identify insufficient evidence to assess the balance of benefits and harms of screening pelvic examinations for gynecologic conditions, including fibroids, in asymptomatic women
Chronic skin condition have nail involvement, commonly showing pitting, onycholysis, or salmon patches.
This nail dystrophy causes a spoon-shaped appearance and is commonly linked to iron deficiency anemia.
Psoriasis
Koilonychia
Diagnosis imaging recommended?
Bonus: Once identified, what is next step?
Plain Xray
non–weight-bearing status and urgently referred to orthopedic surgery
Is a urine dipstick analysis to identify or rule out urinary tract infection (UTI) in febrile infants 2 to 6 months of age as accurate as urinalysis?
What is the finding that can be used for diagnosis?
Yes
Nitrite or leukocyte esterase of 1+ or greater
46 year old female with BMI 36 and bilateral tubal ligation comes with intermenstrual bleeding. EMB shows endometrial hyperplasia with atypia.
What is the recommended next step?
Hysterectomy
When we should get EMB in patients as part of fibroid workup?
Endometrial biopsy should be performed when suspicion for malignancy is high, including abnormal uterine bleeding in women older than 45 years or younger than 45 years with history of unopposed estrogen exposure. Other indications include obesity, polycystic ovary syndrome, failed medical management, or persistent abnormal uterine bleeding despite treatment
Name the 9 topics we need to cover when asking questions about a nail concern?
Dietary habits, duration of symptoms, family history, hobbies, medical history, medications, nail care habits, nails affected, occupation
Name 3 Differentials
Transient Synovitis, Labral tear, muscle strain, apophysitis, femoral acetabular impingement, greater trochanteric pain, Legg-Calvé-Perthes, Septic Arthritis
What are the most effective drugs for providing meaningful pain relief in adults with fibromyalgia?
Duloxetine, milnacipran, and pregabalin
26 year old G2P1 30weeks pregnant diagnosed with GDM
What is the fasting blood glucose level for this patient?
And for the 1 hour and 2 hour postprandial levels?
Fasting: <95
1 hour: < 140
2 hours: < 120
What are the 3 surgical options for treating a fibroid?
Bonus chocolate: what are the alternatives therapies that studies shows can improve fibroid volume and symptoms?
Myomectomy, hysterectomy, uterine artery embolization
Green tea extract and Vitamin D
What is onychoscopy (nail dermoscopy)?
Diagnostic tool involves evaluating nail structures using polarized or non-polarized light and helps distinguish benign melanonychia from melanoma.
What is Drehmann sign?
While supine, the patient's hip is passively flexed to 90 degrees without rotation or lateral pressure.
For the unaffected hip, little to no hip rotation occurs.
For the hip with slipped capital femoral epiphysis, the hip involuntarily externally rotates and abducts. Movement occurs because the slipped epiphysis is displaced inferior and posterior of the growth plate.
What is telogen effluvium?
What test we do?
Medications associated?
large swathes of hair follicles transition from the anagen phase to the telogen (resting) phase of the growth cycle - diffuse hair thinning without scarring
Hair pull test
ACEs, beta blockers, anticonvulsants, anticoagulants, hormonal contraceptives, chemotherapy, lithium, and selective serotonin reuptake inhibitors (SSRIs) such as sertraline.
71 year old male with PMHx of AAA is diagnosed with CAP.
What antibiotic will increase the risk of a ruptured aneurysm?
Levofloxacin (fluoroquinolones)
Initial treatment for fibroids? Which one have a higher percentage of bleeding reduction?
What are the other pharmacological options we can try if initial fail? (would warrant GYN referral)
Combined pills, progesterone-only and IUD levonorgestrel
GnRH antagonist, SERMs, GnRH agonist
Name the etiology of the condition:
1. Azure Lunula
2. Leukonychia punctata
3. Lindsay nails
4. Terry nails
5. Onycholysis
1. Azure Lunula - Wilson disease, silver poisoning
2. Leukonychia punctata - trauma
3. Lindsay nails - rheumatoid arthritis or renal disorder
4. Terry nails - CHF, DM, hepatic or thyroid issues
5. Onycholysis - psoriasis, thyroids disorders, nutritional deficiencies, sarcoidosis, amyloidosis
What is the multiphase rehabilitation protocol? How long it last and is usually done?
4.5-6 months
First 6 weeks: passive movement and partial weight bearing (with crutches)
Next 4 weeks: Wean the crutches and attempt to stand pain free
Next 4-6 weeks: increase movement and start aerobic training
Last 4-6 weeks: Ensure adequate functional power for daily activities
After catheter ablation for AF, what strategy was found to reduce stroke and non major bleeding risk?
What is the limitation of the study?
Left atrial appendage occlusion
Evidence compared only with warfarin
58 year old female that was recently diagnosed with kidney stone. She currently takes Escitalopram, Levothyroxine, Lisinopril, Metformin and Topiramate.
Which medication increase her risk of kidney stone formation?
Topiramate
Carbonic anhydrase, induced metabolic acidosis leading to hypercalciuria and formation of calcium phosphate stone.