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Endo - Week 6
Intraductal Papilloma
Presentation
Bloody nipple discharge
Women 20-40 years old
Mechanism
Small tumor in lactiferous ducts
Occurs Centrally
Occurs Peripherally
Increased malignancy
Diagnosis
Too Small to Palpate
Galactogram biopsy
1 min
Fibroadenoma
Most Common Benign Breast Tumor
Stromal Tumor
Presentation
Women under 40
Small, firm mass
Sharp Edges
Increased tenderness and size with Estrogen
Management
Biopsy
1 min
Phyllodes Tumor
Presentation
Common in 40's
Large Palpable Mass
Mechanism
Benign
Rarely Malignant
Low-Grade Tumor
Leaf-Like
Stromal Tumor
Treatment
Wide Resection
2 mins
Ectopic Pregnancy
Signs and Symptoms
Lower Abdominal Pain
Delayed Menses
Abnormal Vaginal Bleeding
Shock
Referred Shoulder Pain
Cullen Sign
Considerations
Methotrexate
Surgery
RhoGAM
2 mins
Abruptio Placentae
Mechanism
Premature Separation of Placenta
Assessment
Tearing Pain
Bleeding (Often Concealed)
Rigid Uterus
Contractions
Interventions
Corticosteroids as Needed
Emergent Delivery
Considerations
Increased Risks for Neonate
Rh (Rhesus) Incompatibilities
Increased Risk for Shock
Monitor Fetal Heart Rate
3 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
2 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
1 min
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
3 mins
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
2 mins
Placenta Previa
Mechanism
Placenta Covers Cervical Os
Assessment
Painless
Bright Red Vaginal Bleeding
Interventions
Stable Fetus
Bed Rest
Observation
Unstable Fetus
C-section Delivery
Considerations
Risk for Shock
Magnesium Sulfate
Tocolysis
3 mins
Magnesium Sulfate
Mechanism
Muscle Relaxant
Indications
Preterm Labor Contractions
Preeclampsia
Side Effects
Warm Feeling
Hypotension
Decreased Deep Tendon Reflexes (DTRS)
Decreased Respiratory Rate
Decreased Urine Output
Paralytic Ileus
Antidote
Calcium Gluconate
2 mins
Amniocentesis
Mechanism
Transabdominal Puncture
> 14 weeks gestation
Indications
Genetic and Congenital Anomalies
Fetal Hemolytic Disease
Fetal Lung Maturity
Complications
Miscarriage
Hemorrhage
Infection
Considerations
RhoGAM (Rh Immune Globulin)
2 mins
Chorioamnionitis
Fever
Maternal or fetal tachycardia
Leukocytosis
Foul Odor to Amniotic Fluid
Treatment: Antibiotics
Monitor uterine tenderness, contractions and fetal activity
Monitor maternal vital signs & FHR
2 mins
Toxoplasma gondii TORCH
Signs and Symptoms
Congenital TORCH Infection
Mom Usually Asymptomatic
Rarely Lymphadenopathy
Nonspecific TORCH Signs
Intrauterine Growth Retardation
Hepatosplenomegaly
Deafness
Chorioretinitis
Hydrocephalus
Diagnosis
Calcifications
1 min
Toxoplasma gondii
Characteristics
Protozoa
Cysts in Meat or Cat Feces
Signs and Symptoms
Brain Abscess in HIV Patients
Ring-enhancing Brain Lesions
Crosses Placenta in Pregnant Women
Congenital TORCH Infection
Treatment
Pyrimethamine
Sulfadiazine
2 mins
Syphilis TORCH
Signs and Symptoms
Nonspecific TORCH Symptoms
Often Results in Stillbirth
Hydrops Fetalis
Saber Shins
Notched Teeth
Saddle Nose
Blindness
Deafness
Hepatitis
3 mins
Varicella Zoster Virus (VZV)
Herpesvirus 3
Characteristics
Enveloped
Double Stranded DNA
Signs and Symptoms
Chickenpox
Pneumonia
Encephalitis
Trigeminal and Dorsal Root Ganglia
Shingles
Diagnosis
Tzanck Test
Multinucleated Giant Cells
Cowdry A Inclusion
Treatment
Acyclovir
2 mins
Rubella TORCH
Signs and Symptoms
Nonspecific TORCH Symptoms
Patent Ductus Arteriosus
Pulmonary Artery Hypoplasia
Cataracts
Deafness
Blueberry Muffin Rash
Glaucoma
1 min
Rubella
Characteristics
RNA Virus
Matonaviridae
Enveloped
Icosahedral
SS Positive Linear
Signs and Symptoms
German Measles or Three-Day Measles
Fever
Postauricular Tenderness
Lymphadenopathy
Truncal Rash
Arthritis
Congenital TORCH Infection
2 mins
Cytomegalovirus (CMV) TORCH
Signs and Symptoms
Nonspecific TORCH symptoms
Intrauterine Growth Restriction (Retardation)
Deafness
Microcephaly
Seizures
Periventricular Calcifications
Petechial Rash
Blueberry Muffin Rash
Chorioretinitis
Diagnosis
Urine Viral Culture or PCR
2 mins
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