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Clinical Guidelines

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Adnexal Cyst

1. Criteria to Determine Observation vs. Surgical Treatment:

• Size of the cyst (larger cysts may require closer monitoring or surgery).

• Symptoms (e.g., pain, pressure, or signs of complications like torsion).

• Age of the patient (higher malignancy risk in postmenopausal women).

• Ultrasound characteristics (solid components, septations, irregular borders).

• Elevated tumor markers (e.g., CA-125).

2. Criteria for Malignancy Likelihood:

• Irregular borders.

• Presence of solid or complex structures.

• Rapid growth or sudden onset.

• Ascites (fluid accumulation in the abdomen).

• Elevated tumor markers (e.g., CA-125, HE4).

3. Laparoscopy vs. Laparotomy:

• Laparoscopy: Preferred for smaller, benign-appearing masses and less invasive exploration.

• Laparotomy: Chosen for larger masses, suspected malignancy, or need for extensive exploration.

Alcohol

1. Screening Protocol for Suspected Alcoholism:

• CAGE Questionnaire: Quick assessment (Cut down, Annoyed, Guilty, Eye-opener).

• AUDIT (Alcohol Use Disorders Identification Test): Comprehensive screening tool.

• Detailed history of alcohol use, including quantity and frequency.

2. Fetal Alcohol Syndrome (Brief Overview):

• Growth retardation.

• Facial anomalies (e.g., smooth philtrum, thin upper lip).

• Neurodevelopmental issues (e.g., cognitive impairment).

Ambiguous Genitalia

1. Steroidogenesis Overview:

• Conversion of cholesterol to pregnenolone.

• Pathways for cortisol, aldosterone, and androgens.

• Enzyme deficiencies (e.g., 21-hydroxylase) can disrupt these pathways.

2. Workup for Ambiguous Genitalia:

• Detailed history and physical exam.

• Hormonal assays (e.g., 17-hydroxyprogesterone, testosterone).

• Genetic testing (e.g., karyotyping).

• Imaging (e.g., ultrasound, MRI).

3. Gender Determination:

• Chromosomal analysis (karyotyping).

• Hormonal levels for sex hormone profile.

• Phenotypic assessment.

4. Congenital Adrenal Hyperplasia:

• Autosomal recessive disorder, often 21-hydroxylase deficiency.

• Leads to excess androgen production.

• Can cause salt-wasting crisis in severe forms.

Amenorrhea

1. Workup for Amenorrhea:

• History and physical exam.

• Pregnancy test.

• Hormonal assays (FSH, LH, prolactin, TSH).

• Imaging (e.g., ultrasound, MRI if central causes are suspected).

• Karyotyping if primary amenorrhea with atypical features.

2. Management of PCOS:

• Lifestyle modifications (diet, exercise).

• Oral contraceptives for cycle regulation.

• Metformin for insulin resistance.

• Clomiphene for ovulation induction if fertility desired.

Abnormal Uterine Bleeding (AUB)

• Conservative Treatments Before Hysterectomy:

• Hormonal therapy (e.g., OCPs, progestins).

• NSAIDs for pain and bleeding.

• Tranexamic acid to reduce bleeding.

• Endometrial ablation for those done with childbearing.

Bacterial Vaginosis

1. Clue Cell:

• Vaginal epithelial cell covered with bacteria.

• Appears granular or stippled under a microscope.

Bartholin’s Abscess

1. Treatment Decisions:

• Incision and drainage: For large, symptomatic abscesses.

• Marsupialization: For recurrent abscesses.

• Word catheter: To allow drainage and prevent recurrence.

• Excision: For chronic or recurrent cases not responding to other treatments.

Breast Mass

1. Breast Self-Assessment vs. Self-Examination:

• Self-assessment: Awareness of any breast changes.

• Self-examination: Systematic palpation and visual inspection.

2. Screening Protocol for Breast Carcinoma:

• Regular mammograms based on age/risk.

• Clinical breast exams.

• Self-awareness of changes.

3. Role of Imaging and Biopsy in Breast Mass Workup:

• Mammography: Initial imaging, especially for screening.

• Ultrasound: Further evaluation, especially in younger women.

• Aspiration: Differentiates cystic from solid masses.

• Needle localization: Assists in precise biopsy.

• Excision biopsy: Confirms diagnosis when non-invasive biopsy inconclusive.

4. Breast Cyst Aspiration:

• Clear fluid: Typically discarded.

• Bloody or turbid fluid: Sent for cytology.

5. Significance of Menopause, Receptor, and Nodal Status in Breast Cancer:

• Menopausal status: Affects hormone therapy.

• Receptor status (ER/PR/HER2): Determines targeted therapy.

• Nodal status: Influences staging and treatment intensity.

Clomid

1. Mechanism of Action:

• Selective estrogen receptor modulator (SERM), increasing FSH and LH for ovulation induction.

2. Dosage:

• Typically 50 mg daily for 5 days, starting on day 2-5 of the menstrual cycle.

3. Side Effects:

• Hot flashes, ovarian enlargement, visual disturbances.

4. Monitoring:

• Ultrasound for follicular development.

• Hormone levels (e.g., estradiol) as needed.

5. Multiple Gestation Risk:

• Clomid: 5-10%.

• Pergonal: Higher due to multiple follicles stimulated.

Condyloma Acuminata (CHPV)

• Caused by HPV (human papillomavirus).

• Appears as genital warts.

Congenital Uterine Anomalies

1. Embryology of Internal and External Genitalia:

• Development from the Müllerian ducts.

• Fusion and canalization processes form uterus, fallopian tubes, and upper vagina.

2. Types of Uterine Anomalies:

• Septate uterus: Incomplete septum resorption.

• Bicornuate uterus: Partial Müllerian duct fusion.

• Didelphys uterus: Complete fusion failure, double uterus.

Drug Addiction

1. Medical, Social, and Obstetrical Consequences:

• Medical: Infectious diseases, organ damage.

• Social: Legal issues, family disruption.

• Obstetrical: Preterm birth, fetal growth restriction.

2. Methadone vs. Buprenorphine:

• Methadone: Effective but has a higher overdose risk.

• Buprenorphine: Partial agonist, lower overdose risk.

3. Effects of Marijuana:

• Cognitive impairment, respiratory issues, potential fetal growth restriction.

Dysmenorrhea

• Conservative Treatments:

• NSAIDs, hormonal contraceptives, heat therapy.

Dyspareunia

1. Causes:

• Infections, endometriosis, pelvic floor dysfunction.

2. Workup:

• History, physical exam, imaging, lab tests.

3. Treatment Options:

• Pelvic floor therapy, lubricants, addressing underlying causes.

Dysplasia

1. Cone vs. LEEP for Cervical Dysplasia:

• Cone biopsy: For larger or glandular lesions.

• LEEP: For smaller, squamous lesions.

2. Counseling for CIN 1, 2, and 3:

• CIN 1: Observation and follow-up.

• CIN 2: LEEP or cryotherapy.

• CIN 3: LEEP or cone biopsy.

3. Colposcopic Features of CIN 1, 2, and 3:

• CIN 1: Mild acetowhite.

• CIN 2: Moderate acetowhite, mosaic pattern.

• CIN 3: Dense acetowhite, punctation.

Abnormal Pap Smears

• Carcinoma Evaluation Post-Hysterectomy:

• Hysterectomy does not completely rule out carcinoma; further pathological examination of the uterus is necessary.

This organized response provides succinct yet comprehensive answers under each relevant category. Let me know if any additional details are needed!

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