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Dysmenorrhea

Primary Dysmenorrhea is painful menses due to excess prostaglandin production by the endometrium → uterine contractions and ischemia. There is no identifiable pelvic pathology. Typically begins 6–12 months after menarche (after ovulatory cycles start) Clinical Presentation * Crampy lower abdominal pain that starts 1–2 days before menstruation * Peaks on the

Bronchiectasis

Due to chronic inflammation, this causes permanent dilation of bronchi due to recurrent infections or impaired mucociliary clearance. This trapped mucus further causes the chronic infection cycle and airway damage Etiologies * Cystic fibrosis (most common in U.S.) * Recurrent bacterial or viral infections (e.g. post-TB, pertussis) * Immunodeficiencies (e.g.

Multiple Myeloma

Multiple Myeloma

Caused by malignant proliferation of plasma cells producing monoclonal immunoglobulin (M protein) that usually affects older adults (~60-70 years). This causes bone marrow infiltration and osteolytic bone lesions. Clinical Features (CRAB) * C: HyperCalcemia → confusion, constipation, polyuria * R: Renal failure (due to light chain cast nephropathy) * A: Anemia (normocytic, normochromic) * B:

Ovarian Torsion

Ovarian Torsion

Caused by twisting of the ovary and sometimes fallopian tube around the vascular pedicle. This leads to venous and lymphatic obstruction, then arterial compromise → ischemia. It is most often caused by an ovarian cyst or mass (especially >5 cm) Epidemiology * Mostly affects reproductive-age women * Also can occur in children

Pernicious Anemia

Pernicious Anemia

Caused by autoimmune destruction of parietal cells in the stomach. This leads to decreased Intrinsic factor → ↓ B12 absorption in terminal ileum. * Associated with autoimmune gastritis & other autoimmune diseases (e.g., thyroiditis, vitiligo) Clinical Features * Macrocytic anemia (MCV >100) * Loss of B12 * Neurologic symptoms (specific to B12 deficiency): * Peripheral

Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS)

A neurological sensorimotor disorder characterized by uncomfortable urges to move the legs, especially at rest and during the evening/night. Pathophysiology: * Dopamine dysregulation in the CNS * Often associated with iron deficiency (↓ brain iron levels affect dopamine pathways) 1. Urge to move the legs, usually with uncomfortable sensations 2. Worse at

Vomiting vs Laxatives

Vomiting vs Laxatives

* Vomiting = loss of gastric acid → metabolic alkalosis * Laxatives = loss of bicarbonate-rich intestinal fluid → metabolic acidosis Vomiting * Metabolic alkalosis * Increased H+ loss from stomach acid → Retained HCO3- * ↓ Cl- * ↓ Urine Cl- (Kidney tries to retain) * ↓ K+ * Hypovolemia Laxative Abuse * Metabolic acidosis * ↓ HCO3- → lost in diarrhea * ↓ Cl- * ↑ Urine Cl- saline laxatives * ↓ Urine Cl-

Hyperparathyroidism

Hyperparathyroidism

PTH Actions - Core Physiology PTH raises serum calcium and lowers serum phosphate by: * ↑ Bone resorption → ↑ Ca²⁺ and ↑ phosphate * ↑ Activation of vitamin D → ↑ GI absorption of Ca²⁺ and phosphate * ↑ Renal calcium reabsorption (DCT) → ↑ Ca²⁺ * ↓ Renal phosphate reabsorption (PCT) → ↓ phosphate (phosphaturia) * Normal state: ↑ Ca²⁺, ↓ phosphate Primary Hyperparathyroidism * Hyperfunction of parathyroid cells

AML, CML, ALL, CLL

AML, CML, ALL, CLL

Acute Myeloid Leukemia (AML) * Definition: Malignant proliferation of myeloblasts (>20% blasts in bone marrow). * Common in: Adults, especially >60 years. * Risk factors: Previous chemotherapy/radiation, myelodysplastic syndromes, exposure to benzene. * Presentation: Fatigue, anemia, infections, bleeding (petechiae, bruising). * Labs: * ↑ WBC with blasts * ↓ Platelets, anemia * Auer rods (pathognomonic) * Diagnosis: Bone

Neuropathic Arthropathy (Charcot Joint)

Neuropathic Arthropathy (Charcot Joint)

Progressive degeneration and destruction of a joint due to loss of sensory innervation (proprioception and pain). This leads to repeated trauma and joint damage without the patient noticing pain. Causes * Diabetes mellitus (most common cause in the US; affects feet and ankles) * Syphilis (tabes dorsalis) – historically common cause; affects knees,

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis

Narrowing of the spinal canal in the lumbar spine → compression of nerve roots * Leads to neurogenic claudication Causes * Degenerative arthritis (most common in older adults) * Intervertebral disc herniation * Spondylolisthesis * Ligamentum flavum hypertrophy * Congenital canal narrowing (rare) Clinical Features Neurogenic Claudication (classic finding) * Leg pain/weakness with standing or walking * Pain

Vulvar Carcinoma

Vulvar Carcinoma

* Rare gynecologic cancer (<5% of GYN malignancies) * Most common type: Squamous cell carcinoma (~90%) * Two main pathways: * HPV-associated (younger women) * Types 16, 18 * Risk factors: multiple sexual partners, early sexual activity, smoking, immunosuppression * Often associated with vulvar intraepithelial neoplasia (VIN) * Non-HPV-associated (older women) * Usually postmenopausal * Associated with chronic inflammatory

Oligo- vs Poly- hydramnios

Oligo- vs Poly- hydramnios

Oligohydramnios * Definition: Too little amniotic fluid * AFI < 5 cm or Single Deepest Pocket < 2 cm * Key Features: * Poor fetal movement (cord compression) * Potter sequence * ↑ Risk of complications: cord compression, fetal distress, pulmonary hypoplasia * Common Causes: * Renal causes: * Bilateral renal agenesis * Posterior urethral valves * Polycystic kidney disease * Placental insufficiency:

Pericardial Effusion vs Cardiac Tamponade

Pericardial Effusion vs Cardiac Tamponade

Pericardial Effusion * Definition: Accumulation of fluid in the pericardial sac * Can be: Small or large, acute or chronic * Causes: * Infection (viral, TB) * Malignancy * Uremia * Autoimmune (SLE, RA) * Trauma * Post-MI (Dressler syndrome) * Symptoms: * Often asymptomatic if fluid accumulates slowly * May have chest discomfort, dyspnea * Physical Exam: * Muffled heart sounds * Dullness to

Types of Urinary Incontinence

Types of Urinary Incontinence

Stress Incontinence * Cause: Weak pelvic floor muscles → urethral hypermobility * Triggers: Coughing, sneezing, laughing, physical activity * Common in: Women post-vaginal delivery, menopause * Leak with: ↑ Intra-abdominal pressure * Tx: * First-line: Pelvic floor exercises (Kegels) * Pessary * Surgical: Midurethral sling Urge Incontinence (Overactive Bladder) * Cause: Detrusor overactivity * Symptoms: Sudden urge to void + involuntary leakage * Triggers:

Tanner Stages

* Assesses pubertal development based on secondary sexual characteristics * Rated from Stage I (prepubertal) to Stage V (adult maturity) * Focus areas: * Males: genital development and pubic hair * Females: breast development and pubic hair Males * Testicular enlargement is the first sign of puberty in boys (Tanner II) * Stage I: * Prepubertal; no genital

Gestation Hypertension and Eclampsia

Gestation Hypertension and Eclampsia

Gestational Hypertension Definition/Cause * New-onset BP ≥140/90 mmHg after 20 weeks gestation * No proteinuria or end-organ damage * Etiology: Unknown; possibly abnormal placentation → vascular dysfunction Clinical Symptoms * Often asymptomatic * No proteinuria, edema may be present * Normal labs Management * Monitor BP and symptoms closely * Weekly labs: CBC, liver function tests, urine

Breath Tests

Learn more about why a urea and hydrogen breath tests are used

Estrogen and Progesterone Effects during Pregnancy

Estrogen and Progesterone Effects during Pregnancy

Learn more about how both estrogen and progesterone cause changes throughout pregnancy

Common Sexually Transmitted Infections (STI)

Common Sexually Transmitted Infections (STI)

Herpes Simplex Virus (Genital Herpes) HSV-2 (most common), HSV-1 also possible * Presentation: * Painful grouped vesicles on erythematous base (genital, perianal) * Ulcerations after vesicle rupture * Systemic symptoms: fever, malaise, lymphadenopathy * Tender inguinal nodes * Recurrent outbreaks common * Diagnosis: PCR or viral culture of lesions * Treatment: * Acyclovir, valacyclovir, famciclovir * No cure; suppressive therapy

Contraceptives

Combined Hormonal Contraceptives Components: Estrogen + Progestin * Regulates cycles, reduces dysmenorrhea, acne * Decreases risk of endometrial and ovarian cancer Contraindications: * Aura migraine * Aura migraine -> increased risk of blood clots in the brain * Estrogen also increase the risk of clotting -> increase risk of stroke * Clotted history (DVT/PE)

Rh Immune Globulin (Rho(D) immune globulin)

Rh Immune Globulin (Rho(D) immune globulin)

Rh immune globulin is a medication used to prevent alloimmunization in Rh-negative individuals. They prevent the maternal development of anti-D antibodies that can cause hemolytic disease of the fetus and newborn (HDFN) in future Rh-positive pregnancies. If the mother is Rh- and the fetus is Rh+, the Rh antigens from

Leiomyomas vs Adenomyosis

Leiomyomas vs Adenomyosis

Uterine Fibroids (Leiomyomas) These are well-circumscribed, benign tumors of myometrial smooth muscle found in the uterus. * Women >35 years, especially African American women * Estrogen-sensitive (grow during pregnancy, shrink after menopause) Symptoms: * Heavy menstrual bleeding (menorrhagia) * Pelvic pressure or pain * Constipation, urinary frequency (mass effect) * Reproductive issues (infertility, miscarriage risk)

Endometriosis vs Endometritis

Endometriosis vs Endometritis

Endometriosis Presence of endometrial glands & stroma outside the uterine cavity (e.g., ovaries, peritoneum, fallopian tubes) - ectopic endometrial tissue outside the uterus. This is likely due to retrograde menstruation, metaplasia, or lymphatic spread. * Reproductive-age women * Often nulliparous or infertile EndometriOsis - O stands for outside Symptoms: * Cyclic pelvic

Fetal Heart Rate (FHR) Decelerations

Fetal Heart Rate (FHR) Decelerations

Early Decelerations * Timing: Gradual decrease and return to baseline FHR mirroring uterine contractions. * The lowest point is the same as the peak uterine contraction. * Nadir (lowest point): Occurs at the same time as the peak of the contraction. * Cause: Fetal head compression (vagal stimulation). * Clinical significance: Benign; typically seen in