investigation for the women with solitary palpable breast massesIn adolescents with a suspected fibroadenoma, reassurance and reexamination after the next menstrual cycle maybe appropriate.
However, adults with a palpable breast mass (such as this 24-year-old patient) ★require further evaluation with imaging because history and physical examination alone cannot reliably diagnose or exclude cancer in this population. breast surgeryreproductiveUWorld step2CK HirotoShishido
management of hypospadiasDefer circumcision
★Urologic evaluation for surgical repair
+ ★Karyotype, pelvic ultrasound (★if severe hypospadias (eg, scrotal/perineal urethral meatus) with bilateral, nonpalpable gonads may be indicative of a disorder of sex development (DSD)) reproductivepediatricsUWorld step2CK HirotoShishido
treatment for postpartum hemorrhageuterine massage, ¥oxytocin. If refractory, surgical ligation of uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation). reproductiveOBGYAmboss level4 HirotoShishido
↑/↓ hCG↑ → Down syndrome, multiple gestation, hydatidiform moles, choriocarcinomas
placenta accreta/increta/percreta(morbidity adherent placenta)
Placenta accreta—placenta attaches to myometrium without penetrating it; most common type.
Placenta increta—placenta penetrates into myometrium.
Placenta percreta—placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall) reproductiveOBGYUWorld HirotoShishido
manifestation/ risk factor of ovarian cancerPresent with abdominal distention, bowel obstruction, pleural effusion.
increased risk with advanced age(>55), infertility, endometriosis, PCOS, genetic predisposition (eg, BRCA1 or BRCA2 mutations, Lynch syndrome, strong family history).
reduced risk with previous pregnancy, history of breastfeeding, OCPs, tubal ligation. reproductive HirotoShishido
markers/ histology of epithelial ovarian tumor☆CA-125
Monitor response to therapy/relapse by measuring CA 125 levels (not good for screening).
☆anaplasia of epithelial cells with invasion into the stroma and multiple papillary formations
target of colposcopyThe TZ(transformation zone) undergoes active cell division, young women are vulnerable to the oncogenic effects of human papillomavirus (HPV) infection and tobacco use.
Therefore, ☆the TZ is the most common site of cervical dysplasia/neoplasia. A colposcopy visualizes this area for biopsy.
agglutination inhibition testβ-hCG in urine prevent anti-hCG antibodies from binding to latex particle coated with hCG causing agglutination
→ the presence of agglutination is a negative result for pregnancy reproductiveUWorld SIM2 HirotoShishido
clinical features/treatment of endometriosisdysmenorrhea, dyschezia, dyspareunia, pelvic pain(due to the formation of pelvic adhesions and fibrosis of uterosacral ligaments), ☆infertility(due to the distortion of the pelvic anatomy and impaired transport through the oviduct)
antiandrogenic effect of ketoconazolea weak antiandrogen that decreases synthesis of steroid hormones in gonads(lydig cells) and adrenals reproductive HirotoShishido
penis anatomy
which part does cGMP affectcorpus cavernosum/ corpus spongiosum
→ tunica albuginea→ Buck's(deep) fascia→ Dartos(superficial) fascia→ skin
