Tuesday, December 13, 2005

Tuesday, November 29, 2005

History and Physical for Pulmonary Embolism

Chief Complaint
chest pain and shortness of breath
History of Present Illness
23 year old female with past medical history significant for birth control use of five years and 15 smoke pack years presents witch chest pain and shortness of breath. Four days prior to admission, she started to experience a dull, substernal pain with deep breaths. Two days prior to admission, she experienced shar pain in lower left anterior axillary line with deep breaths. One day prior to admission, she started to experience upper left sided chest pain. While at her Ob-Gyn office on the morning of admission, she was experiencing shortness of breath, and she was told to go to the ER. Currently, her chest pain is constant on the left side. She says she can walk ten steps before becoming short of breath. She denies palpitations, leg pain, nausea, vomiting, diarrhea, cough, pain radiation. Previously, she experienced chest pain during this current summer which went away in four days without hospital admission.
Past Medical History
Patient denies hypertension, diabetes, stroke, coronary artery disease, rheumatic fever, asthma, or spontaneous abortions. Patient has been on Depo-provera for five years prior to current birth control of Norgestrel.
Past Surgical History
Patien did not have previous surgeries.
Medications
Norgestrel
Unisom
Immunizations
Patient has not received her pneumococcal, hepatitis, or flu vaccine.
Allergies
NKDA
Family History
Father is alive, 52 years old without hypertension, diabetes, coagulopathy, or coronary artery disease. Mother is alive, 46 years old. She has hypertension. She has no history of coronary artery disease, coagulopathy, or diabetes.Both grandmothers had strokes at old ages. Her family has no history of cancer or coagulopathy.
Social History
Alcohol - She drinks up to 12 beers during the weekend over one to two nights.
Tobacco - She has been smoking 1.5 packs per day for 10 years
Substance - She denies any substance abuse.
Psychosocial - She denies any changes in her general behavior. She lives with her friend after leaving her family residence.
Functional - She believes she has normal function.
Review of Systems
General: () weight loss () fever () night sweats () weakness/fatigue () appetiteEndocrine: () heat intolerance () decreased energy () thyroid/reanl dz () polydipsia () polyuriaLympatics: () lymphadenopathySkin: () itching () pale () palmar creases Hematology: () anemia () bruising () bleedingHead: () seizures () trauma () loss of conscioussness () headache () vertigo () dizzinessEyes: () visual changes (X) blurred vision () loss of vision () dischargeEars: () discharge () ear pain () tinnitus () ototoxic drug history () hearing lossNose: () discharge () rhinorrhea () epistaxisMouth and Throat: () lip cracking () gum soreness () gum hypertrophy () dryness () thirst () excessive salivation () throat pain () hoarsenessCardiorespiratory: (X) SOB () valvular disease (X) orthopnea (X) dyspnea on exertion () nocturia () edema (X) paroxysmal nocturnal dyspnea () cough () cyanosis () hemoptysisGastrointestinal () dysphagia () abdominal pain () vomiting () hematemesis () melena () hematochezia () change in appetite () diarrhea () constipation () jaundiceGenitourinary: () change in bladder function () change in amount () dysuria () hematuria () dischargeNeuropsychiatric: () weakness () motor/sensory deficit () depression () anxietyPain: Chest pain on left side
Physical Exam
General Appearance:Vital Signs:Temperature: 98.1 F Oxygen Saturation: 100% on RA Blood Pressure: 125/82 Respiratory Rate: 18 Pulse Rate: 117Skin/Nails:Head:Eyes:Ears:Nose:Throat/Mouth:Neck:Lymph:Pulmonary: CV:Abdomen:Breasts:Rectal:Genitals:Peripheral pulses:Musculoskeletal:Neurologic:Mental StatusCN ICN IICN III,IV, VI CN V, VIICN VIICN VIIICN IX, XCN XICN XIICerebellarDTRs
Labs
Troponin I <0.05,>D-Dimer 3.20
Imaging
CT - Multiple pulmonary embolisms on the right upper lobe, right lower lobe, left upper lobe, and left lower lobe in the segmental and subsegmental branches. Her right middle lobe does not have a pulmonary embolism.
Na:138Cl:103BUN:9Glucose:80
K:4.1CO2:24Cr:0.8Ca:9.6
WBC:11.0Hgb:14.1
Hct:41.9
Plt:254
MCV:in
PT: 13.7 PTT: 30
INR: 1.05
Assessment/Plan

23 year old female with a past medical history significant for smoking and contraceptive use presenting with multiple, acute pulmonary embolisms. She presented with some classic signs of pulmonary embolism including dyspnea and chest pain (1).

1. Tierney, Lawrence M., ed. Current Medical Diagnosis & Treatment. 44th ed. New York: McGraw Hill, 2005.

Created with H and P

Wednesday, November 23, 2005

Open CD 2.0

http://theopencd.org/index.php?option=com_frontpage&Itemid=1

Provides free programs such as Open Office, Blender, Mozilla, GAIM, and others. Can be bought or downloaded for free.

Tuesday, November 08, 2005

Chronic Diarrhea


  • Secretory Causes
  • Medications
  • Bowel Resection, Mucosal Disease, Enterocolic Fistula
  • Hormones

    • Carcinoid Tumor
    • Serotonin
    • Histamine
    • Prostaglandins
    • Kinins
    • Gastrinoma
    • VIPoma
    • Calcitonin
    • Somatostatinoma

  • Congenital Defects in Ion Absorption
  • Osmotic Causes
  • Osmotic Laxatives
  • Carbohydrate Malabsorption
  • Steatorrheal Causes
  • Pancreatic Exocrine Insufficiency

    • Chronic Pancreatitis
    • Cystic Fibrosis
    • Pancreatic Duct Obstruction

  • Mucosal Malabsorption

    • Tropical Sprue
    • Whipple's Disease
    • Abetalipoproteinemia
    • Medications - colchicine, cholestyramine, neomycin
    • Chronic Ischemia

  • Postmucosal Lymphatic Obstruction
  • Inflammatory Causes
  • Idiopathic Inflammatory Bowel Disease
  • Eosinophilic Gastroenteritis

Saturday, November 05, 2005

History and Physical for SOB

Informant: Patient - mostly reliable
Age: 79 Sex: Male

CC: Chest pain, SOB for one day
Reason for Admission: Chest pain, SOB for one day

HPI: 79 yo AAM c right sided CP, not radiating, sharp, pleuritic, no aggravating or relieving factors. CP accompanied with SOB with acute to sub-acute onset. Pt has cough producing whitish sputum. He has chills, and currently, the patient is feeling better than last night.

PMH:
Sarcoidosis
COPD
PVD
DM
Glaucoma BL
Immunizations - he recieved his pneumo and flu vaccines last year.

PSH:
Fem-Pop bypass on left leg

Injuries/Disabilities: none

Medications:
Lovastatin 20 mg PO qday
Lasix 20 mg PO qday
Prednisone 5 mg PO qday
Lasix 40 mg PO qday PRN edema
Calcium 600 mg PO bid

Immunizations:
Pneumo and Flu received in 2004

Family History:
NA

Social History:
lives alone
past smoker for 50 years
past etoh
no IVDU


Review of Systems:
nausea, vomiting 2-3 times, no change in bowel movements, no dysuria

Physical Exam:
VS: Temp-101.5 BP-127/70 HR-90 Pulse Ox 80s in Er, currently went from 90 to 99, 101.5 degrees
Gen: mildly tachypnic, AO*3
HEENT: -JVD, carotid pulse- 2+ with no bruits, PERRL
Chest: CTA BL, -w/c/r
CVS: irregular rhythm, SEM II/VI
Abdomen: NT/ND, soft, +BS
Ext: -edema. -DP, Left calf tenderness
Neuro: no focal deficits present

Imaging:
CXR - Infiltrates R side and base

Labs:
Na - 140
K - 4.1
Cl - 101
CO2 - 29
BUN - 14
Cr - 1.0
Glucose - 137
Ca - 8.4
WBC - 11.4
HGB - 13.2
HCT - 39.3
PLT - 268
MCV - 81
EKG - freq PACs, LAD, Q waves in V2-V3, TWI in V1
CKMB - 1.3
Myoglobin - 142
Troponin - 0.05

Assessment:
79 yo AAM presented with intermittent SOB and chest pain on right side.

Problems List:
1. SOB
2. Chest pain

Differential Diagnosis:
1. COPD exacerbation - can present with cough, sputum production, and SOB.
2. Pulmonary Embolism - Pain in left calf could be a sign of a DVT and subsequent clot could have moved to the lungs. This could have caused the current symptoms of SOB and chest pain.
3. Pneumonia - CXR infiltrates, SOB, and chest pain can be from a community acquired pneumonia. Possible organisms include Streptococcus pneumoniae, Haemophilus influenza, Mycoplasma pneumoniae, Chlamydia pneumoniae, Staphylococcus aureus, Neisseria meningitidis, Moraxella catarhallis, and Klebsiella pneumoniae.
4. Sarcoidosis - a sarcoid inflammation of the lung can present with malaise, fever, and dyspnea. No hilar lymphadenopathy was present on CXR. No other findings of sarcoidosis were present: erythema nodosum, parotid gland enlargement, hepatosplenomegaly, and lymphadenopathy. Symptoms referable to other organs were not present either.
5. MI - a myocardial infarction can present with chest pain and SOB. The patient's location of pain on the right side, and lack of radiation make this less likely. His cardiac chemistry levels were well within normal limits.

Diagnostic Plan:
1. CT angio scan of chest
2. Pulmonary function tests
3. Pulse oximetry
4. Consult pulmonology

Therapeutic Plan
1. DVT prophylaxis
2. Heparin qtt
3. Antibiotics - Zithromax 500mg IV qday
4. O2 support 2L
5. Steroids

History and Physical for Sickle Cell Crisis

H and P SC Crisis

Informant: Patient - reliable
Age: 43
Sex: M

CC: pain in head, neck, arms, stomach, and legs
Reason for Admission: pain in head, neck, arms, stomach, and legs

History of Present Illness:
Patient 43 yo AAM presented with pain in arms, back, stomach and legs which started yesterday morning. His last crisis was 2-3 years ago. It is well localized to the areas mentioned. He tried using Percocet and Oxycontin but they were ineffective in controlling his pain. He also complains of a productive cough with yellow phlegm for 2-3 weeks. He had no associated chest pain. He had no nasal congestion, but he did have post nasal drip. He has no nausea, vomiting, diarrhea, fever or chills.



Past Medical History:
Sickle Cell Disease (SC) diagnosed at age 12. Not significant for any other chronic conditions such as diabetes or hypertension.

Past Surgical History:
No surgical history.

Injuries/Disabilities: Considers SC a disability.
Medications:
Oxycontin 80 mg po bid
Percocet 5 mg 1-2 tablets q 4-6 hours prn pain
Folic Acid 1mg po qday

Herbal Meds: none
Immunizations: Pneumo and flu vaccines up to date since last year
Allergies: hay
Drugs: Morphine - lack of coordination, nervous; toradol - lack of coordination
Food: none
Family History:
Mother has sickle cell disease and diabetes. His family has no history of hypertension, cancer, cardiac diseases, or thalassemia.
Social History:
He lives in an appartment with his fiance. He's currently unemployed due to his sickle cell disability. He has no history of alcohol abuse. He smokes 3-4 cigarettes per day.

Review of Systems:
Summary: - f/c, -n/v/d, -dysuria, + cough for 3 weeks, - rhinorrhea, - headache

Physical Exam
General Appearance: Pt in acute distress from pain
Vital Signs:
Temperature: 96.7 F Oxygen Saturation: 98% Room Air
Blood Pressure: 100/46
Respiratory Rate: 16 Pulse Rate: 68
Skin/Nails: no clubbing
HEENT: PERRL, clear nasal turbinates, non-erythematous pharynx, no thyroid enlargement, no lymphadenopathy
Pulmonary: CTA BL, -w/c/r
CV: S1S2, RRR, II/VI SEM
Abdomen: soft, NT, ND
Peripheral pulses: 2+ DP
Musculoskeletal: pain in both arms, legs, and neck
Imaging:
CXR - clear and normal

Labs:
WBC 18.4
HGB 7.3
HCT 21.8
PLT 482
Na 138
K 4.7
Cl 108
CO2 26
BUN 6
Cr 0.6
Glucose 81
Ca 8.4
Retic 8.71
Retic Index 8.9




Assessment: 43 yo AAM with sickle cell crisis in arms, legs, neck, and head.

Problem List:
1. sickle cell crisis
2. increased white count

Differential Diagnosis:
He's presenting with acute onset of pain which is most likely related to a sickle cell crisis. He presents with no other signs, symptoms, or lab values suggesting other etiologies such as acute rheumatic fever, osteoid arthritis, or any other polyarticular arthritis. His pain is spread throughout his bones and joints which makes an SC crisis more likely.
His white blood count could be due to an infection, but he is not presenting with fever or any inflammatory reaction symptoms. He has no tachypnea, but he does have upper respiratory infection symptoms. His pulse ox is normal. His CXR is clear and this does not appear to be pneumonia. He should be worked up with urine cultures, urine analysis, and blood cultures.
Diagnostic Plan:
1. CBC w diff
2. Screen 8
3. Retic count and Retic Index
4. Blood Cx
5. Urine Cx
6. Urine Analysis
Therapeutic Plan:
1. Dilautid 4mg IV q4h
2. 125 cc/hr D5W

Causes of Chest Pain



Chest Pain

Non-Cardiac
Pulmonary
  • pulmonary embolus
  • pleuritis
  • pneumothorax
  • COPD
Gastrointestinal
  • Gastroesophageal Reflux Diseases (GERD)
  • esophageal ulcer
  • peptic ulcer disease
  • Boerhaave's syndrome
  • Mallory Weiss Tear
Musculoskeletal

Chostochondritis

Other

psychiatric

Cardiac
  • myocardial infarction
    • ST elevation MI
    • non-ST elevation MI
  • Angina
    • stable angina
    • unstable angina
  • pericarditis
  • tamponade
  • myocarditis

Tuesday, October 25, 2005

Internal Medicine

I started week five of twelve for Internal Medicine. The hours are from 7 to 5 most days. I should be personally responsible for 1 to 3 patients, and we round on all patients in the morning with the senior resident or attending. On a regular day, patients are seen from 7 AM to 8:30 AM, and progress notes are written. From 8:30 to 10:30 AM is morning rounds. 10:30 to 12:00 PM is teaching rounds. After a one hour lunch break, the rest of the day till 5 PM involves placing orders and other tasks for patients. Call is every four days, and we stay until 10 PM. A typical day in Internal Medicine provides time for reading textbooks.

Saturday, October 22, 2005

Podscope

Podscope
Search through audio broadcasts with text.

Wednesday, October 12, 2005

H and P for PDA

Here's a typed up H and P for a PDA. You can put in on a Palm PDA as a memo or a Dataviz Documents to Go file. Fill in the details during the patient encounter, and then synch it with a desktop for printing. Feel free to make adjustments and post them as comments on this site.

H and P
Patient Name:
Hospital Unit:
Time of Admission:
Informant:
Birthdate:
Age:
Sex:

CC:
Reason for Admission:

History of Present Illness:






Past Medical History:

Past Surgical History:

Injuries/Disabilities:
Medications:




Herbal Meds:
Immunizations:
Allergies:
Drugs:
Food:
Family History:
Social History:

Review of Systems:
General: ( ) weight loss ( ) fever ( ) night sweats ( ) weakness/fatigue ( ) appetite
Endocrine: ( ) heat intolerance ( ) decreased energy ( ) thyroid/reanl dz ( ) polydipsia ( ) polyuria
Lympatics: ( ) lymphadenopathy
Skin: ( ) itching ( ) pale ( ) palmar creases
Hematology: ( ) anemia ( ) bruising ( ) bleeding
Head: ( ) seizures ( ) trauma ( ) loss of conscioussness ( ) headache ( ) vertigo ( ) dizziness
Eyes: ( ) visual changes ( ) blurred vision ( ) loss of vision ( ) discharge
Ears: ( ) discharge ( ) ear pain ( ) tinnitus ( ) ototoxic drug history ( ) hearing loss
Nose: ( ) discharge ( ) rhinorrhea ( ) epistaxis
Mouth and Throat: ( ) lip cracking ( ) gum soreness ( ) gum hypertrophy ( ) dryness ( ) thirst ( ) excessive salivation ( ) throat pain ( ) hoarseness
Cardiorespiratory: ( ) SOB ( ) valvular disease ( ) orthopnea ( ) dyspnea on exertion ( ) nocturia ( ) edema ( ) paroxysmal nocturnal dyspnea ( ) cough ( ) cyanosis ( ) hemoptysis
Gastrointestinal ( ) dysphagia ( ) abdominal pain ( ) vomiting ( ) hematemesis ( ) melena ( ) hematochezia ( ) change in appetite ( ) diarrhea ( ) constipation ( ) jaundice
Genitourinary: ( ) change in bladder function ( ) change in amount ( ) dysuria ( ) hematuria ( ) discharge
Neuropsychiatric: ( ) weakness ( ) motor/sensory deficit ( ) depression ( ) anxiety
Pain:


Physical Exam
General Appearance:
Vital Signs:
Temperature: Oxygen Saturation: Blood Pressure:
Respiratory Rate: Pulse Rate:
Skin/Nails:
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Neck:
Lymph:
Pulmonary:
CV:
Abdomen:
Breasts:
Rectal:
Genitals:
Peripheral pulses:
Musculoskeletal:
Neurologic:
Mental Status
CN I
CN II
CN III,IV, VI
CN V, VII
CN VII
CN VIII
CN IX, X
CN XI
CN XII
Cerebellar
DTRs

Labs:




Assessment:

Problem List:

Differential Diagnosis:

Diagnostic Plan:

Therapeutic Plan:

Sunday, October 09, 2005

Flash Drives Make Any Computer 'Personal'

Flash Drives Make Any Computer 'Personal': Financial News - Yahoo! Finance
Flash drives with built in software such as Migo allow users to carry their personal settings and files to any computer. Apparently, plugging in the USB flash drive will allow access to personal documents, e-mail, and internet favorites. It's a great idea for people who work in places with several computers and move among them, such as a hospital.

CMDT Review by MS3






Although CMDT appears as a tome of medicine at 1888 pages, its proven to be a good home reference book. Diseases are covered in a few pages, while still maintaining good attention to detail in presentation and management. This book is all text with a few tables and no pictures. More pages are dedicated to common diseases with varying presentations like pneumonia. It's main advantage over other books is it's updated every year.

Washington Manual Handbook Review by an MS3

The Washington Manual of Medical Therapeutics is a good handbook reference for the internal medicine rotation. It's descriptions of diseases can be succinct, but the book covers other aspects such as imaging and treatment well. The main drawback to the book is its size. The spiral bound can add a couple of pounds of weight to a white coat; a paper bound copy seems to be more compact. Overall, The Washington Manual is a good reference to have when free time is available during the day.

Saturday, October 08, 2005

Removing an Ink Stain from a Silk Tie

Today was a busy day in the hospital, and I was running around when I accidently left some pen marks on my tie. Luckily I found this site, and it suggested using alcohol to wipe away the stain. So I had some alcohol swabs from the hospital, and I was able to take away the marks.

Wednesday, October 05, 2005

Tom Evans' ECG Cribsheets - PDA Version

http://medicine.ucsf.edu/housestaff/ecg/pda.html

This is a great guide to reading ECGs, and this can also be downloaded to a Palm PDA device. Download the zip file for Pocket PCs, and then install Pluckr for your Palm PDA and Sunrise Desktop for your computer. After extracting the zip file, send the index.html file to Sunrise, and then synch your Palm PDA.

Sunday, October 02, 2005

More than 100 Links for Medical Students

http://www.medicalstudent.com/

This page links to several free online resources. I especially like the anatomy links.

Saturday, October 01, 2005

Indications for Oxygen Therapy to Treat COPD

COPD is a disease of airflow obstruction. It can be caused by chronic bronchitis and emphysema. Most of the people with COPD have an extensive cigarette smoking history. Patients are eligible for oxygen therapy at home if their room air resting ABG shows an SaO2 less than 88% or a PaO2 less than 55 mm Hg. With a PaO2 of 56-59 mm Hg or a SaO2 less than 89%, people who have polycythemia, heart failure or pulmonary hypertension can receive oxygen therapy. Oxygen therapy as a treatment for COPD has been shown to reduce mortality and morbidity.

Source:
The Washington Manual of Medical Therapeutics, 31st edition.

Saturday, September 24, 2005

Practice questions for USMLE Step 2

I've heard good reviews for this book of practice USMLE step 2 questions. The questions are considered to be very similar to the ones found on the shelf exams.

Books for MS3 Surgery

I would recommend the books below for the third year medical student on a surgery rotation. Blueprints was a superficial review of all subjects, while Essentials gave a thorough explanation of surgical conditions. Sabiston provides a good pocket reference. Surgical Recall is excellent at the hospital or in lecture situations. The basic important questions surgeons will ask can be found in Surgical Recall; however, this book lacks any depth to the coverage of its subjects. Appleton & Lange's Surgery Review provides great questions with explanations. Combining several books for studying will provide a good foundation for MS3 surgery.














USMLE STEP 2 CS TIPS AND TRICKS

USMLE STEP 2 CS TIPS AND TRICKS

A good blog of USMLE Step 2 tips.

Thursday, September 22, 2005

Free USMLE Step 1 and Step 2 practice questions

USMLEasy.com (http://www.usmleasy.com) has free access to 1700 questions for USMLE Step 1 and Step 2 with registration. The questions can be organized by subject, and after taking a practice exam, full answer explanations are given. This free offer is only available to students at medical colleges with subscriptions to AccessMedicine. Anyone can buy ne month access to all 3000 questions along with analysis for $99.

Wednesday, September 07, 2005

Medical Student Surgery Hours

Wake up 4 am
Start seeing patients 5 am
Round with the team 6 am
Operating Room 8 am to 4 pm
Evening Sign Out 6-7 pm
Sleep 9pm
Overnight Call every four days, Weekend call 24 hours starting at 6 am

Scrub Attire

Scrubs are the most comfortable type of clothing invented. Currently, I'm doing surgery, and it's great wearing scrubs daily. It takes a lot less time than putting on a shirt and tie; also, the laundry is a lot simpler when wearing scrubs all week.

Sunday, August 21, 2005

AccessMedicine on a PDA

AccessMedicine is Lange publishing group's website with access to all their textbooks. For each article found on the website, it can be saved to a PDA. After downloading the PDA program from the website, users can save the documents for PDA synchronization. With the articles on the PDA, it's easier to read selected chapters from books during down time at the hospital.

Wednesday, July 27, 2005

Technology in Medicine

Currently, I'm learning how to use computer software for managing patient information. However, during the last month in outpatient care, after learning about the computer software, the software has been of little use. I've never used it to look up patient information. Basically, all the patient information can be found in the patient's folder. A computer's not needed in this situation. At the hospital, I could see the use of having patient information from several different sources in one point. One specific situation would be having lab information delivered instantly. Otherwise, all the patient information could be put into one folder. Software could be used to collect data and analyze data based on diseases and symptoms.

USMLE Score Reports

Step 1 scores are being released for those people who took the test this summer. Apparently, they're being released weekly, and arrive in the mail.

Thursday, July 21, 2005

Blueprints in Pediatrics

Blueprints in Pediatrics is part of a line of textbooks for third year of medical school. It's got a very concise review of important topics for the clinics. Each topic has sections for diagnosis, differential diagnosis, evaluation, and treatment. For more detail, look at the textbooks and handbooks found in the hospital clinics and nursery.

Saturday, July 16, 2005

Buying a PDA on eBay

I just recently bought a Tungsten E on eBay, and I'm disappointed with my purchase. After noticing my battery was drained within one day of use, I noticed on the internet several posts about the E having a battery that wore out after 6 months or less. I would have to advise against getting a used PDA on ebay, and only buying new models. Although even with buying a new PDA, eventually the battery will stop holding its charge for very long. Its a large problem since the Palm battery is not replaceable. I've read this is a common problem with many lithium ion battery powered products like mp3 players. Why would somebody pay 200 dollars plus for a device that will function optimally for only 6 months to 2 years?

Monday, July 11, 2005

Babies in Peds

One of the greatest aspects of pediatrics is taking care of newborn babies. They're anywhere from three days old to a month old, and you're one of the first people to take care of them and make sure they're doing well.

Friday, July 08, 2005

First Full Day of Peds

I saw a grand total of three patients by myself. The emphasis is on being by myself. Basically, I see a patient and report the findings to the attending. Then, the attending sees the patient for the final assessment and plan. It's similar to being an intern with a lot less responsibility.

Thursday, July 07, 2005

What I learned my first day of pediatrics

Little kids punch anything at their level, so watch out for low blows from 2.5 year olds. Sick kids are still hyper-active.

Saturday, July 02, 2005

PDA for Rotations

I have to get a PDA as I start rotations for third year. Minimum requirements are 32 megabytes in memory space for medical programs.










Palm LifeDrive
Its got a 4 gigabyte hard drive, which sets it apart from any other PDA on the market. Another distinguishing aspect is its price, $500. It might be more than I need for rotations at the hospital, but it would also serve as an mp3 player.


Treo 650
This PDA has everything bundled into one small package, including a a camera and a phone. I would only have to carry one device to the hospital, and its memory is expandable with SD cards. One drawback is its small size. The Treo has a much smaller screen than other PDAs after seeing it at an electronics store. The size is good for carrying it around as a phone, but I wouldn't be too happy staring at a small screen in the hospital.



Tungsten T5
The T5 is the top of the line flash drive based PDA, with a large 256 mb of internal memory. This is its main selling point, along with its fast processor and large screen.



Tungsten T3
The T3 is probably the best value for the money among the high end PDAs. Its got a large screen accessible by pulling open the PDA. Its a unique design, but I would rather have a large screen available at all times.



Tungsten E
This is the minimum suggested PDA for rotations. Its got 32 mb of internal memory, which is enough for medical applications.

Friday, July 01, 2005

Saturday, June 25, 2005

Two Days Before Step 1

I'm glad I put in this much work; it's one reason I feel calm about the upcoming test, putting in everything I had for this time.

Wednesday, June 22, 2005

bald 1


bald 1
Originally uploaded by jks184.
Advantages of being bald - less shampoo, no need to dry hair, no need for a comb.

bald 2


bald 2
Originally uploaded by jks184.
I lost about 2 pounds of hair since the previous picture.

Monday, June 20, 2005

my life right now


IMG_0381
Originally uploaded by jks184.
Laying on a bench in the quad, with my full beard, and using my bookbag as a pillow, the only thing distinguishing me from a bum was reading my pathology flashcards.

Thursday, June 16, 2005

Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value

Go across for the PPV and NPV formulas; go down for the sensitivity and specificity formulas.






Actual



+
-
+
TP
FP
PPV
-
FN
TN
NPV

Sens
Spec

Tuesday, June 14, 2005

Silicosis

Silicosis is a nodular fibrosis of the lungs. Its typically found in people exposed to free silica (SiO2) in their working areas, such as mining or stonecutting. Patients develop a progressive fibrosis of their lungs based on their exposure, and the disease can be fatal within two years. Silicosis has a wide range of presentation. Acute silicosis has profuse miliary infiltration or consolidation. Milder silicosis show small opacities and possible coalescence. The hilar nodes are the lymph nodes of the lungs, and they may become calcified. Hilar lymph nodes with an "egg shell" appearance are a classic presentation of silicosis on radiographs. The pulmonary nodules of silicosis, which are found in the upper lobes of the lungs, may lead to progressive massive fibrosis and subsequent restrictive and obstructive lung disease. This may lead to ventilatory failure. Patients with silicosis are more prone to develop Tuberculosis (Mycobacterium tuberculosis) and other atypical mycobacterial infections.(1)
Even ten to thirty years after exposure, silicosis can be asymptomatic. Patients can present with dyspnea, cough, or sputum production. Chest radiographs show small pulmonary nodules, from 1 mm to 10 mm, in the upper lobes of the lungs. Silicosis' complications include with lung cancer, chronic respiratory failure, and cor pulmonale. Patients should be treated for tuberculosis infections and other lung ailments. Other than for severe cases, prognosis is generally good for silicosis with possible mild respiratory symptoms.(2)

Medical Student Report
(1) Harrison's Online
(2) Hanley Pulmonology
McGraw-Hill's AccessMedicine

Monday, June 13, 2005

BRS Biochemistry

BRS Biochemistry provides excellent diagrams explaining processes. Most of the book is in an outline format of the major pathways. The endocrine chapter seems to be covered in several other books. The last chapter on biochemical abnormalities provides a good summary of biochemical pathology. The clinical correlation at the end of each chapter provides excellent material for board review, and it may be the only important parts of this book for a person with a strong understanding of biochemistry. This book would be great to have during the course since it does provide sufficient detail.

Sunday, June 12, 2005

BRS Behavioral Science

At 260 pages, this is an easy read in two days. The tables covering physician and patient interaction are excellent. Some chapters are very good at covering other aspects of reviewing, such as the chapter on psychiatric medications. Much of this book is related to psychiatry.

Wednesday, June 08, 2005

Higher Student Loan Interest Rates for 2005

Effective July 1, 2005, student loans dispersed on or after 1998 will have an interest rate of 4.7% during school and 5.30% during repayment. Rates have increased significantly since last year's rate of 2.87%. If you still have the option of consolidating previous student loans at low rate, now is the time to consolidate outstanding debt at one low rate. This can reduce your interest payments and monthly payments. However, payingreduced monthly payments over a longer repayment time can cause increased interest payments overall. Online calculators for repayment and consolidation are available from lenders.

BRS Pharmacology

This is a difficult book to read during USMLE Step 1 review. Its very condensed, yet still maintains to be 428 pages long. It presents drugs basically in a list guideline format, and their descriptions are basic. A better resource would be a combination of First Aid's pharmacology section and PharmCards.

Saturday, June 04, 2005

Reviewing Qbank

Use First Aid to take notes while going over a Qbank test section. It's absolutely amazing how many questions can be answered from facts in First Aid for the USMLE Step 1.

Levinson & Jawetz : Medical Microbiology & Immunology

Although the sections on the pathogens may be too extensive for USMLE review, the introductory sections on virology and bacteriology are important to review. The 70 pages on immunology are excellent and concise, especially the hypersensitivity and immunodeficiency sections. The best part of this book is the Brief Summaries of Medically Important Organisms.

Tuesday, May 31, 2005

Clinical Microbiology Made Ridiculously Simple

In addition to being a good USMLE review book, Clinical Microbiology could replace the syllabus, especially for bacteria. Its easy to read and has enough supporting details to give a clear understanding of the pathogens. The virus, fungi, and parasite sections are very basic, and they hit the main topics of each pathogen. The medicine chapters are also very basic. Each chapter has a good summary table of pathogens or medicines. A pathology textbook would be good for associated color pictures and diagrams.

MedicalMnemonics.com | Browse | Browse by Category

MedicalMnemonics.com | Browse | Browse by Category

Contains contributions from around the world. Also available for download onto a PDA.

Saturday, May 28, 2005

BRS Physiology

Organized by organ systems, this 322 page book can be finished in four days with relative ease. It does not require any other supplementary books. Although the questions at the end of each chapter are good review questions of concepts, they seem to be a lot easier than board type questions. Related pathology and pharmacology are integrated well into the text. It's a good book to have during first year while taking physiology, and it would be a good idea to review of the physiology of an organ system before learning about its pathology. Important concepts can be found on pages 92-93, 142, 196, 200, 252, 256, 265, 270, and 283.

BRS Pathology

At 450 pages, this book can be finished in 5 days, spending about 8 hours a day, and finishing 90 pages per day. It is organized by organ systems. This book lacks color pictures, so its a good idea to use this book with a pathology textbook like Rubin's Pathology Fourth Edition. In addition to good microscopic, gross, and radiologic pictures, Rubin's has diagrams explaining diseases. Unlike a textbook, the main distinguishing factors of a disease are emphasized. The details are usually left out since they could cause confusion when covering several diseases in one organ system. This BRS book is purely a review book, and it would be difficult to understand unless you learned about the diseases while in class. This book is good to have while you take the course. In the second edition, important tables can be found on pages 6, 24, 62, 66, 75, 284, 320, and 384. The comprehensive examination at the end of book is a good, challenging review of the entire book.

Tuesday, May 24, 2005

USF USMLE 1

Contains several documents for Step 1 studying with hundreds of flashcards in Word documents for anatomy and biochemistry. Smaller documents on specific topics like metabolic diseases are available.
http://www.med.usf.edu/2003/usmlesmack.html

Monday, May 23, 2005

The New York Times > Technology > Circuits > State of the Art: A New Spin on a Palmtop (or Inside It)

The New York Times > Technology > Circuits > State of the Art: A New Spin on a Palmtop (or Inside It)

Great PDA, have to wait till the problems are worked out before it could be really useful in the field.

http://www.palmone.com/us/products/mobilemanagers/lifedrive/

High Yield Neuroanatomy

133 pages may seem like a lot to get through in one day for board review. The preface does a good job of highlighting important topics in each chapter for the USMLE Step 1. The clinical correlations at the end of each chapter are excellent. Pick and choose which chapters to review since a chapter like autonomics can be found in other review books. It's a good book to have while taking the course.

BRS Histology

Although this large book is too much for board review, it would probably help while taking the class, even in undergraduate. The first five chapters are sufficient for USMLE Step 1 Review, and it contains detailed review of the basic concepts of histology. The chapter on blood may overlap with immunology review.

Sunday, May 22, 2005

Gosling - Atlas of Human Anatomy

It has good gross pictures of anatomy with simple drawings accompanying them. The captions are concise.

Saturday, May 21, 2005

Step 1 Released Questions

http://www.usmle.org/Orientation/Step1MCQ.zip

This is the software link for the 150 questions released by USMLE.org. It can be taken in a test format or untimed. Kaplan provides detailed explanations for this series of questions.

Friday, May 20, 2005

High Yield Anatomy

This USMLE step 1 book is a lot more dense than the title implies. With over 180 pages, it does provide a good basis for anatomy based pathology. The MRI pictures are great. Key chapters would be heart, lung, upper extremity, spine, and lower extremity. Anatomy of the upper limb is extremely high yield review. A good understanding of the nerves and muscle enervation of the hands and arms will help answering several questions. An other priority is to understand fractures and their related deficiencies.

Wednesday, May 18, 2005

Student Loan Consolidation

Recently, loan companies have decided to allow students to consolidate their student loans while they are still attending college. Currently, interest rates are at a historic low around 2.77% for Stafford loans. The interest rate could be lower for people who pay their loans on time. By June 30, 2005, the rates will rise to 4%, and they will probably not decrease after this time. Students are eligible to consolidate loans accrued up to this time; loans for next year are not eligible. Although a student could save up to fifty percent on their loan repayments, the payment period could be extended from 10 years to 30 years. Currently, THE, Wells Fargo, and several other lending companies are offering consolidation.

Monday, May 09, 2005

Metabolic Bone Diseases

Condition
Thin Trabeculae
Numerous Osteoclasts
Excessive Osteoid
Fibroblast/ Collagen
Osteoporosis
X



Osteomalacia


X

Primary Hyperparathyroidism

X

X
Renal Osteodystrophy

X
X
X
Source: Rubin's Pathology 4th Edition

Sunday, May 08, 2005

Dermatopathology II

DiseasePathogenesisPathologyClinical Features/ Treatment
Erythema nodosumtrigger: drugs, microorganisms, systemic diseases
drugs: sulfonamides

fibrous septa of subcutaneous tissue - neutrophil inflammation, extravasation of erythrocytes
chronic - septa widened, giant cell macrophages, altered collagen

dome-shaped, tender, nodules on extensor surface of legs
3rd decade, 3xF:M
Erythema induratumMycobacterium tuberculosis

initially lobular panniculitis, vasculitis - ischemic necrosis of fat lobules
dense, chronic inflammatory infiltrate in fat lobules
extensive ischemic necrosis - ulceration of overlying epidermis

chronic, recurrent, subcutaneous plaques or nodules on legs, women

T - systemic steroids

Sclerodermapathcy lymphocytic infiltrate, loss of peri-eccrine fat, plugging of sweat glands, obliteration of hair follicles, subcutaneous fat turns into collagen

fibrosis and tightening of skin
mask face
4xF:M, 30-50y
non-pitting edema of hands or fingers

Granulomatous dermatitislocalized collection of epitheliod macrophages around insoluble antigen
Allergic Contact dermatitis

sensitization - haptens: oleoresins, Langerhans Cells - CD4+ T cells
Elicitation - activated T cells, IFN-gamma - Fas ligand on keritanocytes - apoptosis

spongiotic dermatitis - edema in epidermis
spongiotic vasculitis - vacuoles filled with lymphocytes and macrophages
immune rxn to poison ivy, poison oak, poison sumac


Source: Rubin's Pathology 4th Edition

Dermatopathology I

DiseasePathogenesisPathologyClinical Features/ Treatment
Pemphigus Vulgarisantibodies to keratinocytes, autoimmune IgG to desmoglein 3

seperation of stratum spinosum and outer epidermal layers from basal layer
blister - moderate lymphocytes, macrophages, eosinophils, neutrophils

blistering skin
large, scalp, mucous membranes, periumbilical and intertriginous areas
Diseases of the Basement Membrane Zone
Epidermolysis Bullosahereditarysplitting of epidermis at or near basement membraneblisters
Epidermolytic EBdisruption of basal keratinocytesvacuoles filled with abnormal keratin 5 and 14blisters from minor trauma - no scarring
Junctional EB

AR
benign - mutation in gene encoding for type XVII collagen
severe- laminin and integrin genes

lamina lucida blister
roof - intact epidermis
base - lamina densa

blisters
Dermolytic EBdefect in anchoring fibrils, defective collagen type VII

roof - normal epidermis, lamina lucida, lamina densa
floor - outer part of papillary dermis

atrophic scarring
Bullous Pemphigoidcomplement fixing IgG antibodies to BPAG1 and BPAG2subepidermal blisters
roof - intact epidermis
base - lamina densa
cytology - numerous eosinophils, arranged along BMZ
seperation at lamina lucida

large, tense blisters
erythematous base +/-

T - corticosteroids


Source: Rubin's Pathology 4th Edition

Saturday, May 07, 2005

Psoriasis

DiseasePsoriasis
PathogenesisGenetic factors - HLA-B13,HLA-B17, HLA-Bw57, HLA-Cw6 increased
Environmental factors - physical injury, infection, drugs
Abnormal cellular proliferation of keratinocytes
microcirculatory changes - "bridged" fenestrations, neutrophils at tipsof dermal papillae, dec cAMP
Immunologic factors - T cell infiltration
Pathologythickened epidermis -hyperkeratosis + parakeratosis
uniformally elongated rete ridges and dermal papillae
dilated and tortuous capillaries of papillae
epidermal hyperplasia
Munro microabscesses - dense collection of neutrophils
ClinicalFeatures/Treatmentlarge, erythematous, scalyplaques
dorsal extensor cutaneous surfaces
7% - seronegative arthritis, mild
neutrophilic pustules
T - coal tar or wood tar, anthralin, corticosteroids, methotrexate,vitamin A, vitamin D
Source: Rubin's Pathology 4th Edition

Ichthyosis

Disease
Pathogenesis
Pathology
ClinicalFeatures/Treatment
Ichthyoses
increasesed cohesiveness,abnormal keratinization, increased basal cell proliferation
abnormally thickened stratumcornerum, hyperkeratosis, thin nucleated epidermis
coarse, fish-like scales
Ichthyosis Vulgaris
Autosomal Dominant
- reduced or absent keratohyaline granules in epidermis
attenuated stratum granulosum - reduced profilaggrin
loose stratum corneum,basket-weave appearance
most common, begins earlychildhood, small white scales on extensor surfaces of extremities andon trunk and face, lifelong disease
abnormalities in lipid metabolism from drugs or other diseases
X- linked ichthyosis
deficiency of sterioid sulfatase
steroid sulfatase degrades cholesterol sulfate
persistent cohesion of stratumcorneum

Lamellar ichthyosis
autosomal recessive - disorderof cornification, defect in lamellar body secretion
increased cohesivenss of stratumcorneum, numerous keratinosomes, abnormally large amount ofintercellular substance
severe and generalized ichthyosis
Epidermolytic hyperkeratosis
autosomal dominant, mutation inkeratin genes in suprabasal epidermis
faulty assembly of keratintonofilaments, impaired insertion into desmosomes, prevents normaldevelopment of cytoskeleton -> epidermal lysis and vesicles
generalized erythroderma,blistering, ichthyosiform skin
Source: Rubin's Pathology 4th Edition

Skin Layers and Diseases

Layer of Skin
Associated Disease
Basement Membrane
Bullous pemphigoid - antibodies to BPAG1 and BPAG2 - Type XVII colagen
Papillary dermis
psoriasis, lichen planus
Recticular dermis
scleroderma, erythema nodosum

Source: Rubin's Pathology 4th Edition

Skin Cell Types

Cell TypeFunctionStructures
Melanocytes
color of the skin
melanosome - melaninsynthesis
Langerhan cells
antigen presenting cells
Birbeck granules, MHC I, MHC II,receptors for Fc IgG and Fc IgE
Merkel Cell
neurosecretory, tactilemechanoreceptor
form desmosomes with keratinocytes, basal aspect apposed to a small nerve plate
Keratinocytes
produce keratin filaments
Keratohyaline granules, Odlandbodies - keratinosomes

Source: Rubin's Pathology 4th Edition

Gynecological Pathology Endometrium


Condition

Cause

Pathology/Histology

Clinical Features

Other Features

Proliferative Enodmetrium

· Straight glands

· Narrow lumens

· Pallisading nuclei

· Ovoid nuclei

· Mitoses

Early Secretory Endometrium

First manifestation of effect of ovulation on endometrium

· Glands remain straight

· Lumens remain narrow

· Subnuclear vacuoles appear

24-36 hours after ovulation

Mid Secretory Endometrium

· Glands become coiled

· Vacuoles no longer present in glands

· Secretory product appears in lumen

Postovulatory days 5-9

Late Secretory Endometrium

· Intralumenal secretions are spent

· Stromal predecidua appears

· First predecidua around spiral arteries

· Later predecidua beneath surface

Postovulatory days 10-14

Menstrual Endometrium

· Stromal collapse

· Fribrin thrombi and blood

· Glands are broken apart

· Glands have no secretions

Hyper-secretory Endometrium of Pregnancy

· Arias-Stella reaction

· large, hyperchromatic nuclei

· prominent cytoplasmic vacuolization

Atrophic endometrium

· short glands

· glandular cells – flat, without significant mitotic activity

Dysfunctional Uterine Bleeding

· anovulatory bleeding

· luteal phase defect

Unopposed Estrogen

· proliferative glands

· stromal breakdown

· fibrin thrombi

· wreathing of stroma by glandular cells

Contraceptives

Combined oral agents

· mix of proliferative and secretory changes

· long use

· atrophic glands

· stromal predecidual pattern dominates

Depoprovera

· unopposed progesterone

Tamoxifen

· inc risk of carcinoma

· inc incidence of polyps

· large, mucinous metaplasia, fibrotic

Endometrial Hyperplasia

· unopposed estrogen stimulation – exogenous, endogenous

· no progestational stimulation

· simple or complex architecture

· typical or atypical nuclei

Vaginal bleeding, 60s

Risk factors – obesity, diabetes, nulliparity, early menarche, late menopause

Complex atypical hyperplasia progresses to carcinoma – 1/3

T – hysterectomy, hormonal manipulation

Endometrial Carcinoma Type 1 Endometrioid

· PTEN gene mutation à cell growth and apoptosis

· squamous or mucinous

Grade determines prognosis

T – hysterectomy, good survival

Low grade – hormonal

Endometrial Carcinoma Type 2 Unfavorable Histology

· serous-p53 mutations

· clear cell

Early spread outside uterus long term survival uncertain

Gynecological Pathology I

Condition

Cause

Pathology/Histology

Surface Features

Other Features

Vulvar Malgnancies

Vulvar Intraepithelial Neoplasia

HPV

Varying degrees of loss of maturation of squamous cells

Single or multiple plaques or papules

Co-exists with cervical dysplasia

Invasive squamous cell carcinoma

Keratinizing squamous cell histology

Ulcerated exophytic lesions

Most common vulvar malignancy

Verrucous carcinoma

Well differentiated, locally invasive

Giant condyloma

Unlikely to metastasize, subset of invasive squamous cell carcinoma

Extramammary Paget’s Disease

Intraepithelial adenocarcinoma in the vulva

Red, moist plaque

Malignant Melanoma

Same as skin melanoma

Second most common malignant tumor in vulva

Benign Disorders of Vulva

Lichen Sclerosis

Atrophic epidermis, hyalinized epidermis

White plaques

Squamous hyperplasia

Thickened epidermis

White plaques

Hidradenoma

Benign tumor

Sweat gland origin – apocrine

Syringoma

Benign tumor

Sweat gland origin – eccrine

Hemangioma

Benign tumor

Mesenchymal

Vagina

Failure of squamous cell maturation

Absence of estrogen

Adenosis

DES exposure, sporadic

Abnormal retention of embryologic glandular epithelium

Benign disorder

Squamous cell carcinoma

Vaginala intraepithelial neoplasia

Most common vaginal neoplasm, assoc w cervical and vulvar SSC, 80% spread from cervix

Clear Cell Adenocarcinoma

Prior DES exposure

Peak age 17-22, very uncommon

Embryonal Rhabdomyosarcoma

Sarcoma of primitive skeletal muscle

Sarcoma botryoides – grape like

Seen in young children

Cervix

Cervical Intraepithelial Neoplasia

HPV esp types 16,18, 31, 33, 35 à Inactivation of suppressor gene products p53 and Rb

Occurs in transition zone

Degree of loss of maturation in squamous cells

Invasive Carcinoma of Cervix

Microinvasion, non-keratinizing squamous cel,l Advancing disease can obstruct ureters, invade locally

Adenocarcinoma – less common, more aggressive

2nd most common cause of death WW

Gynecological Pathology





















































































































































































































































































































































































Condition

Cause

Pathology/Histology

Clinical Features

Other Features

Proliferative Enodmetrium

·
Straight glands


·
Narrow lumens


·
Pallisading nuclei


·
Ovoid nuclei


·
Mitoses

Early Secretory Endometrium

First manifestation of effect
of ovulation on endometrium

·
Glands remain straight


·
Lumens remain narrow


·
Subnuclear vacuoles appear

24-36 hours after ovulation

Mid Secretory Endometrium

·
Glands become coiled


·
Vacuoles no longer present in glands


·
Secretory product appears in lumen

Postovulatory days 5-9

Late Secretory Endometrium

·
Intralumenal secretions are spent


·
Stromal predecidua appears


·
First predecidua around spiral arteries


·
Later predecidua beneath surface

Postovulatory days 10-14

Menstrual Endometrium

·
Stromal collapse


·
Fribrin thrombi and blood


·
Glands are broken apart


·
Glands have no secretions

Hyper-secretory Endometrium
of Pregnancy

·
Arias-Stella
reaction


·
large, hyperchromatic nuclei


·
prominent cytoplasmic vacuolization

Atrophic endometrium

·
short glands


·
glandular cells – flat, without significant mitotic activity

Dysfunctional Uterine Bleeding

·
anovulatory bleeding


·
luteal phase defect

Unopposed Estrogen

·
proliferative glands


·
stromal breakdown


·
fibrin thrombi


·
wreathing of stroma by glandular cells

Contraceptives

Combined oral agents

·
mix of proliferative and secretory changes


·
long use à


·
atrophic glands


·
stromal predecidual pattern dominates

Depoprovera

·
unopposed progesterone

Tamoxifen

·
inc risk of carcinoma


·
inc incidence of polyps


·
large, mucinous metaplasia, fibrotic

Endometrial Hyperplasia

·
unopposed estrogen stimulation – exogenous, endogenous


·
no progestational stimulation

·
simple or complex architecture


·
typical or atypical nuclei

Vaginal bleeding, 60s


Risk factors – obesity, diabetes, nulliparity, early menarche, late
menopause

Complex atypical hyperplasia
progresses to carcinoma – 1/3


T – hysterectomy, hormonal manipulation

Endometrial Carcinoma Type 1
Endometrioid

·
PTEN gene mutation à
cell growth and apoptosis

·
squamous or mucinous

Grade determines prognosis


T – hysterectomy, good survival


Low grade – hormonal

Endometrial Carcinoma Type 2
Unfavorable Histology

·
serous-p53 mutations

·
clear cell

Early spread outside uterus
à long term survival uncertain

Uterine Mesenchymal Tumors

Leiomyoma

·

·
smooth muscle


·
multiple nodules


·
no coagulative necrosis


·
mitotic rate is low

Extremely uncommon

Leiomyosarcoma

·

·
increased mitotic rate (>10/10 hpf)


·
necrosis


·
cytologic atypia

Stromal Sarcoma

·

·
vascular invasion


·
receptors for progesterone

Appearance of endometrial stroma

T- hormonal therapy

Uterine Mixed Tumors

Adenomyoma

·

·
benign glands and stroma

Adenosarcoma

·

·
benign glands and malignant
stroma

Carcinosarcoma

·

·
malignant epithelial and
stromal elements

Fallopian Tube

Infection

·
STD


·
Polymicrobial infection

Important cause of infertility

Ecotpic Pregnancy

·
Possible result of salpingitis

Ruptured fallopian tube is life
threatening

Most common site of ectopic
pregnancy

Ovary and Placenta

Polycystic Ovary Syndrome


(Stein-Levanthal)

-
Increased ovarian androgen production


-
Arrested follicle development due to androgens

-
Androgen excess, ovarian cysts


-
Common cause of infertility

Endometriosis

-
Mestrual implantation


-
Surgical


-
Vascular spread


-
Coelomic metaplasia

-
Benign endometrial glands and stroma present outside the uterus

-
cyclic pain with menses


-
may cause infertility

Ovarian Tumors

-

-

-

Ovarian Epithelial Carcinomas

-
c-erbB-2 42%


-
K-ras mucinous lesions


-
P53 mutation 50-60%


-
BRCA1 and BRCA2 -15X risk, 10%


-
Lynch Syndrome II, subtype of HNPCC

-

-

Highest mortality rate of female
genital cancers


Difficult to detect early, spread beyond ovaries


Adults, first-degree relatives, industrialized


Inc with age, dec with parity and oral contraceptive

Benign Ovarian Germ Cell Tumors

-

-
mature adult type tissue


-
all three germ layers


-
“dermoid cysts”


-
adult type carcinoma arises from tissue elements

-

Wide age range

Malignant Ovarian Germ Cell
Tumors

-

-
Dysgerminoma – undifferentiated germ cells – best prognosis


-
Immature (malignant) teratoma
– fetal type tissue


-
Choriocarcinoma – mimics placental trophoblast


-
Endodermal sinus tumor – embryonic yolk sack type tissue

-

Highly malignant course but
responsive to chemotherapy or radiation


Exclusively children, young adults

Sex Cord Stromal Tumors

-
ovarian stroma or primitive sex cords

-

-

-
Variable from benign ot low grade malignancy


-
most hormonally active ovarian tumors

fibroma

-

-

-
hormonally inert

-
most common,

Thecoma

-

-
lipid laden theca cells

-
produces estrogen

-

Granulosa cell tumor

-

-

-
produces estrogen

-
low grade malignancy

Sertoli-Leydig cell tumor

-

-

-
produces androgens

-
rare

Metastatic Tumors to the Ovary
(Krukenberg)

-

-

-
can stimulate stroma to cause hormone production

-
3% of ovarian carcinoma


-
colon and upper GI

Placenta

-

-

-

-

Chorioamnionitis

-
ascending infection through the birth canal


-
coliforms, vaginal bacteria

-

-

-
preterm labor


-
neonatal infections

Villitis

-
blood borne source of infection


-
viral, parasitic, spirochetes

-

-

-

Sponataneous Abortion

-
infections


-
mechanical


-
endocrine


-
fetal abnormality


-
immunologic

-

-

-
15% of recognized pregnancy


-
30% of unrecognized pregnancy

Septic Abortion

-
uterine infection following induced abortion

-
acute inflammatory cells and necrosis

-

-
uncommon in hospital performed procedures

Toxemia of Pregnancy

-
failure of spiral arterioles to fully dilate


-
placenta shows acute atherosis in maternal vessels


-
kidney: vacuolization of endothelial and mesangial cells, fibrin
deposition

-

-
hypertension


-
proteinuria


-
edema


-
convulsions - eclampsia

-
more common in first pregnancy

Placental Abnormalities

-

-

-

-

Retroplacental Hematoma/ Abruption

-
Hematoma separates placenta from uterine blood supply


-
Abruption: premature separation of placenta

-

-

-

Placenta Accreta

-

-
abnormal adherence of placenta to myometrium


-
+/- invasion of myometrium

-

-

Gestational Trophoblastic
Disease

-

-

-

-

Complete Hydatidiform Mole

-
Fertilization of empty ovum


-
23x paternal chromosome


-
divides to 46xx (diploid)

-

-

-
Hydropic, avascular villi

Partial Hydatidiform Mole

-
Fertilization of normal ovum by 2 sperm


-
Triploid karyotype

-

-

-
some villi normal and others avascular

Choriocarcinoma

-
malignant tumor derived from trophoblast

-

-
vaginal bleeding


-
excessively high HCG levels

-
good response to chemotherapy