HY lecture notes:
Notes here start out very family medicine-ish, but super HY.
Don’t forget basic screening tests that they like to throw into the mix:
Colonoscopy at age 50, and every ten years. If family Hx in first-degree relative (parent or sibling), start age 40 OR ten years before age of Dx in the family member (whichever is earlier), then every five years. So for instance, if dad was Dx with colon cancer at age 48, patient gets colonoscopy every five years from age 38.
Bone densitometry at age 65; no more than every two years (depending on risk).
Mammograms age 50-74, and every two years
Start pap smears at age 21, not from age of onset of sexual intercourse. Pap smears do age 21-65, and every three years. Starting age 30, woman has the option to do every five years if with concurrent HPV testing. Can stop at age 65 if no Hx of moderate or severe dysplasia AND all Pap evaluations in past ten years have been normal.
Pap smears in HIV: done once a year for three years; if three in a row are normal, then can commence every three years.
Start STI checks from age of onset of sexual intercourse.
Finger-stick glucose for diabetes starting age 45, and every three years.
Lipid testing age 20-onward, and every five years.
Thyroid screening (TSH) starting age 35, and every five years.
Killed influenza vaccine safe during pregnancy; never give live-attenuated influenza vaccine or MMR to pregnant women
TORCHeS infections are HY of course.
Amniotic fluid embolism vs standard pulmonary embolism:
2-30 minutes following delivery of placenta –> shortness of breath, tachycardia –> amniotic fluid embolism –> treat supportively (not a clot, so don’t use heparin) –> amniotic fluid embolism can cause DIC.
Two days after C-section, woman gets up to go to the bathroom –> shortness of breath + tachycardia –> PE; do standard heparin followed by spiral CT.
Placenta previa –> painless third trimester bleeding.
Abruptio placentae –> painful third trimester bleeding.
Placenta previa –> placenta can move off the cervical os up until ~36 weeks gestation, so women before this gestational age aren’t automatically recommended a Caesar. After 36 weeks, plan for C-section.
Abruptio placenta –> deceleration injury (car accidents) + cocaine use
Velamentous cord insertion –> abnormal cord insertion where umbilical cord inserts into chorioamniotic membranes, and then fetal vessels travel between the chorion and amnion unprotected by Wharton jelly –> increases risk of fetal vessel rupture because they’re not protected.
Vasa previa –> fetal vessels overlie the cervical os –> associated with velamentous cord insertion; vasa previa presents with classic triad of:
- Rupture of membranes
- Third-trimester painless bleeding per vaginum
- Fetal bradycardia
Uterine inversion –> they’ll say gentle cord traction (doesn’t have to be vigorous) was applied during stage 3 of labor (delivery of placenta) + now uterine fundus is not palpable + maternal hypotension.
Uterine rupture –> often associated with oxytocin administration resulting in tachysystole (>6 contractions every 10 minutes) and/or uterine hypertonus (contraction lasting >2 minutes) –> abnormal abdominal exam (e.g., mass palpable in upper-outer quadrant –> supposed to be fetal parts) + maternal hypotension.
