Family Medicine EOR
a 35-year-old woman who comes to your office with a 1-year history of “aching
and hurting all over.” She also complains of a chronic headache, difficulty
sleeping, and generalized fatigue. When questioned carefully, she describes
“muscle areas tender to touch.” Although the pain is worse in the back, there
really is no place free of pain. She also describes headaches, generalized
abdomen pains, and some constipation. Likely diagnosis?
fibromyalgia
Treatment of hepatitis C
antiretrovirals: sofosbuvir + velpatasvir or daclatasvir
a 27-year-old female who comes to the emergency department with a 2-day
history of lower abdominal pain, fever, chills, and malaise. The patient also
complains of nausea and multiple episodes of vomiting in the past 24 hours. On
physical examination, there is bilateral adnexal tenderness, mucopurulent
cervical discharge, and cervical motion tenderness. Likely diagnosis?
Pelvic inflammatory disease
Common causative agents of pelvic inflammatory disease
gonorrhea and chlamydia
Chandelier sign
Cervical motion tenderness associated with PID
Outpatient treatment for pelvic inflammatory disease
Ceftriaxone IM + doxycycline PO +/- metronidazole
,treatment for inpatient pelvic inflammatory disease
doxycycline + cefotetan/cefoxitin; or clindamycin + gentamicin
a 45-year-old female complaining of pressure in the pelvis and vagina along with
discomfort when straining. She also feels that her bladder hasn’t fully emptied
after urinating. Pelvic exam reveals a bulge in the anterior vaginal wall. Likely
diagnosis?
Cystocele
Treatment for cystocele
flexible ring pessary to support bladder, surgical repair with mesh augmentation
a 52-year-old postmenopausal woman presents with a sensation of a bulge in
her vagina and difficulty with bowel movements for the past year. She reports
needing to manually reduce the bulge to complete defecation. She has had two
vaginal deliveries and underwent a hysterectomy 5 years ago. Physical
examination reveals a posterior vaginal wall bulge that is reducible. Likely
diagnosis?
rectocele
Treatment of rectocele
Kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen,
pessary, surgical repair
a 27-year-old female with a painless mass in the left breast. She discovered this
mass three months ago while showering and reports it has been unchanged
since that time. Her last menstrual period was 10 days ago. There is no family
history of breast cancer. On physical exam, you palpate a 3 cm, firm, non-tender
mass in the upper lateral quadrant of the left breast. The mass is smooth,
,well-circumscribed, and mobile. There are no skin changes, nipple discharge, or
axillary lymphadenopathy. Likely diagnosis?
Fibroadenoma
buzzwords for fibroadenoma
rubbery and mobile
diagnosis of fibroadenoma
mammogram + US
FNA if indeterminant
Biopsy if < 25 yo
Management of fibroadenomas
careful follow-up and reassurance
a 42-year-old woman with breast masses that change in size, especially during
her menstrual cycles. These masses are usually painful, and pain radiates into
the axillae. She reports that her breasts often feel full and heavy. Occasionally,
she has a small amount of greenish-brown nipple discharge. An ultrasound exam
shows cystic masses within the breasts. Likely diagnosis?
fibrocystic changes
Characteristics of fibrocystic changes
multiple bilateral breast masses that increases in size and pain before menses
Diagnosis of fibrocystic changes of the breast
breast cyst aspiration + US and/or mammogram
, Aspiration finding of fibrocystic changes of the breast
straw-colored fluid with no blood
Treatment for fibrocystic changes of the breast
NSAIDs, OCPs
a 32-year-old lactating female with breast pain, swelling, fever, chills, and a
fluctuant mass of her left breast. The area directly above the lesion is warm,
erythematous, and tender to touch. Likely diagnosis?
breast abscess
MCC agent of breast abscess
S. aureus
Treatment for breast abscess
I&D and antibiotics (nafcillin, cefazolin, vancomycin)
encouraged to continue breastfeeding
22yo patient presents with ASCUS on her pap smear, what is the next step in
management?
Repeat pap in 1 year
28 yo patient presents with ASCUS on her pap smear, what is the next step in
management?
HPV test
28 yo patient presents with LSIL on her pap smear, what is the next step in
management?
Colposcopy
a 35-year-old woman who comes to your office with a 1-year history of “aching
and hurting all over.” She also complains of a chronic headache, difficulty
sleeping, and generalized fatigue. When questioned carefully, she describes
“muscle areas tender to touch.” Although the pain is worse in the back, there
really is no place free of pain. She also describes headaches, generalized
abdomen pains, and some constipation. Likely diagnosis?
fibromyalgia
Treatment of hepatitis C
antiretrovirals: sofosbuvir + velpatasvir or daclatasvir
a 27-year-old female who comes to the emergency department with a 2-day
history of lower abdominal pain, fever, chills, and malaise. The patient also
complains of nausea and multiple episodes of vomiting in the past 24 hours. On
physical examination, there is bilateral adnexal tenderness, mucopurulent
cervical discharge, and cervical motion tenderness. Likely diagnosis?
Pelvic inflammatory disease
Common causative agents of pelvic inflammatory disease
gonorrhea and chlamydia
Chandelier sign
Cervical motion tenderness associated with PID
Outpatient treatment for pelvic inflammatory disease
Ceftriaxone IM + doxycycline PO +/- metronidazole
,treatment for inpatient pelvic inflammatory disease
doxycycline + cefotetan/cefoxitin; or clindamycin + gentamicin
a 45-year-old female complaining of pressure in the pelvis and vagina along with
discomfort when straining. She also feels that her bladder hasn’t fully emptied
after urinating. Pelvic exam reveals a bulge in the anterior vaginal wall. Likely
diagnosis?
Cystocele
Treatment for cystocele
flexible ring pessary to support bladder, surgical repair with mesh augmentation
a 52-year-old postmenopausal woman presents with a sensation of a bulge in
her vagina and difficulty with bowel movements for the past year. She reports
needing to manually reduce the bulge to complete defecation. She has had two
vaginal deliveries and underwent a hysterectomy 5 years ago. Physical
examination reveals a posterior vaginal wall bulge that is reducible. Likely
diagnosis?
rectocele
Treatment of rectocele
Kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen,
pessary, surgical repair
a 27-year-old female with a painless mass in the left breast. She discovered this
mass three months ago while showering and reports it has been unchanged
since that time. Her last menstrual period was 10 days ago. There is no family
history of breast cancer. On physical exam, you palpate a 3 cm, firm, non-tender
mass in the upper lateral quadrant of the left breast. The mass is smooth,
,well-circumscribed, and mobile. There are no skin changes, nipple discharge, or
axillary lymphadenopathy. Likely diagnosis?
Fibroadenoma
buzzwords for fibroadenoma
rubbery and mobile
diagnosis of fibroadenoma
mammogram + US
FNA if indeterminant
Biopsy if < 25 yo
Management of fibroadenomas
careful follow-up and reassurance
a 42-year-old woman with breast masses that change in size, especially during
her menstrual cycles. These masses are usually painful, and pain radiates into
the axillae. She reports that her breasts often feel full and heavy. Occasionally,
she has a small amount of greenish-brown nipple discharge. An ultrasound exam
shows cystic masses within the breasts. Likely diagnosis?
fibrocystic changes
Characteristics of fibrocystic changes
multiple bilateral breast masses that increases in size and pain before menses
Diagnosis of fibrocystic changes of the breast
breast cyst aspiration + US and/or mammogram
, Aspiration finding of fibrocystic changes of the breast
straw-colored fluid with no blood
Treatment for fibrocystic changes of the breast
NSAIDs, OCPs
a 32-year-old lactating female with breast pain, swelling, fever, chills, and a
fluctuant mass of her left breast. The area directly above the lesion is warm,
erythematous, and tender to touch. Likely diagnosis?
breast abscess
MCC agent of breast abscess
S. aureus
Treatment for breast abscess
I&D and antibiotics (nafcillin, cefazolin, vancomycin)
encouraged to continue breastfeeding
22yo patient presents with ASCUS on her pap smear, what is the next step in
management?
Repeat pap in 1 year
28 yo patient presents with ASCUS on her pap smear, what is the next step in
management?
HPV test
28 yo patient presents with LSIL on her pap smear, what is the next step in
management?
Colposcopy
