ABSOLUTE
1) Cardiac disease
2) Hyperthyroidism
3) APH
4) Chorioamnionitis
5) Cervix Os > 5 cm
6) IUD
7) Fetal Anomaly
8) Fetal Distress
RELATIVE
1) PE/ Chronic HPT
2) DM
Herpesviridae
11 years ago
Contraindication of Tocolytic Agent
FIGO STAGING: Cervical CA, Ovarian CA, Endometrial CA
* First need to remember this;
Staging of Cervical CA by Clinical, Ovarian CA by Surgical & Endometrial CA by Histopathology
-------------------------------------------------------------------------------------------------------------
In Gynae Malignancy, this 3 cancer are very important; thus need to have at least a basic idea of their staging, because this will determine the management & prognosis of the patient
Common Gynae Complaint & its Differentials
1) Dysmenorrhea
- Primary
- Secondary
1) Endometriosis
2) Fibroid
3) Adenomyosis
4) PID
2) Menorrhagia
1) Fibroid
2) Adenomyosis
3) Endometrial Polyps
4) Endometrial Hyperplasia
5) Endometrial CA
6) Hyperthyroidism
7) DUB (dx of exclusion)
3) Bleeding Early Pregnancy
1) Abortion
2) Molar Pregnancy
3) Ectopic Pregnancy
4) Amenorrhea
- Primary
1) Kallman Syndrome
2) Gonadal Dysgenesis: Turner Syndrome, Testicular Feminizing Syndrome
3) Uterus: Mullerian Agenesis
4) Vagina Atresia, Imperforated Hymen
5) Any Chronic illness of Childhood eg: Thallasemia, CF etc
- Secondary
1) Pituitary: Exercise, Stress, Eating d/o, Sheehan Syndrome, HyperProlactinemia,
Hyper/HypoThyroid
2) Pregnancy (most common)
3) Menopause
4) PCOS
5) Uterus: Asherman's Syndrome
5) Post-Menopausal Bleed
1) Cervical CA
2) Endometrial CA
3) Endometrial Hyperplasia +/- Ovarian CA (Hormonal Secreting)
4) Endocervical Polyps
5) Atrophic Vaginitis (most common)
6) Bleeding Early Pregnancy
7) Blood Disorder
6) Infertility/Subfertilty
1) Uterus : Fibroid, Endometriosis
2) Tubal: PID (adhesion), Tubal Pregnancy
3) Ovary: PCOS, POF
4) Husband Related
5) Unexplained Fertility
* Selamat Belajar*
Metabolic Syndrome
I always forget the criteria to diagnose Metabolic Syndrome as I thought it is not much important, but nowadays... the incidence of Metabolic Syndrome is keep increasing as as result of Obesity and some other factors.... So you guys please remember this, I'm sure your lecturer going to ask about this quite often...
Digital Rectal Examination (DRE) : What to Examine?
- No Contraindication for DRE:- Pt refuse/ any painful anal condition
- Inspection of Anal region
- Insert Finger & check for anal tone
- Intraluminal Examination - any mass, impacted feces etc
- Extraluminal Examination ---> eg: Prostate
- Removal Finger --> Any melenic stool/ blood etc
* Painful Anal Condition
- Anal Fissure
- Anal Fistula
- Prolapse/Thrombosed Hemorrhoid
- Perianal Abscess
* learnt from Mr Nazli credit to him
Hernia Examination
INTRODUCE & Ask if any pain over the examination area
ON LYING SUPINE
1) Expose properly: Up to knee
2) Inspect: Testes & Groin
- Testicular swelling/ redness/ loss of wrinkle/ displacement of median raphe/ scar
- Groin swelling/ redness/ scar
3) Coughing Pulse
- with b/L groin palpation --> if +ve (EXPANSILE)
- then without palpation --> see the flow of swelling
4) Demonstrate inguinal ligament line
- show the swelling above & lateral to the inguinal line
5) Palpation: Testis & Groin
- Is the Testis separable, can get above the swelling, & feel for the cord
- Feel for tenderness, temperature, consistency, surface, margin, translumination, compressible
- Don't forget to measure the size of swelling/ or just estimate
ON STANDING
- Ask patient to put the swelling back in (REDUCIBLE)
- Upon standing, occlude deep inguinal ring (2FB above midpoint of ing ligament)
& ask patient to stand
- Ask patient to cough & then release your hand
- See again the flow of swelling ---> sausage shape/ go from inguinal to scrotum
- Here probably can see the shape more clearly & can measure the size more accurately
COMPLETE
- Do Abdominal & PR Examination : Any evidence of Increase Intraabdominal Pressure
- Examine the Lungs --> any Lung problem, chronic cough
-------------------------------------------------------------------------------------------------------------
Hernia Examination is very tricky, most of the problem student encounter is whether to examine patient on lying supine first or straight away ask patient to stand? the answer is it depends on patient position at the time, if patient is at the time lying supine & you test for coughing pulse & not really demonstrable, I think better you ask patient to stand straight away and start your examination from standing, but if the swelling very obvious o lying supine & coughing pulse is positive, you can just follow the examination flow I recommended here
Cushing Syndrome
* Clinical syndrome resulting from excess circulating glucocorticoid
Causes
1) Exogenous: Steroid Toxicity (Tx for Nephrotic, SLE, JRA, IBD)
2) Endogenous : Adrenal CA/Adenoma, CAH, Cushing disease, Ectopic-ACTH
Head-to-Toe Examination ---> Mainly for Exogenous Cause (as a cause for CS)
1) General
- Orange on stick appearance
- Central Obesity
- Hyperpigmentation (ACTH-dep)
2) Face
- Moon Face, Plethoric Face, Acne, Hirsuitism, Frontal balding (female)
3) Eyes
- Cataract, Papilloedema (funduscopy)
5) Oral
- Candidiasis
4) Back
- Dorsal fat pad, Vertebaral tenderness (osteoporosis)
- Neck: Skin Infxn
5) Arms
- Bruises, Thin skin, Skin Infxn (folds area), prox m/s wasting
- Test for Prox Myopathy
6) Fingers
- Bad ungual infection
7)) Abdomen
- Central Obesity, Striae (purple/red), Scar (any reason)
- Palpate --> Epigastric tenderness (>> steroid usage --> PUD)
- Check for Ascites
8) Legs
- Bruises, Thin skin, Thin limbs, Prox m/s wasting
- Palpate for leg edema also
- Test for Prox Myopathy
9) Complete with
- BP --> HPT
- RBS/ Dipstick --> DM
- Weight & Height --> Growth Failure
- Ask Hx of Long Steroid Tx
- Any Bony pain/ patho# --> Osteoporosis
 |
| Graphic presentation of Cushing Syndrome |
