case of the day Flashcards
• Contraindications of vaginal hysterectomy
A pubic arch less than 90 degrees, Narrow vagina, Undescended immobile uterus, Severe endometriosis, adnexal pathology, Pelvic adhesive disease, Enlarged Uterus >250 grams
Reasons to do a LAVH
Lysis of adhesions, Treatment of endometriosis, Management of leiomyoma that complicate the performance of a hysterectomy, Ligation of IP ligaments to facilitate difficult ovary removal, Evaluation of pelvic and abdominal cavity before hysterectomy.
How to repair bowel
Repair using 3-0 silk running suture perpendicular to the long axis of the bowel. Any laceration over 2cm would require bowel resection and anastomosis
Differential for vulvar ulcers in a young woman
Genital herpes, Folliculitis, Hidradenitis suppurativa, Trauma, Syphilis, Chancroid, Lymphogranuloma venerum, Granuloma inguinale
Difference between Herpetic and Syphilis ulcers
Herpes- painful/lymphadenopathy
Syphilis- non-painful and no lyphadeopathy
Treatment for Herpes
Acyclovir 400 mg PO tid 7-10 days
Mechanisum of Action of Acyclovir
The active metabolite of acyclovir inhibits herpes virus DNA replication – Acyclovir that is incorporated into viral DNA and acts as a chain terminator
When should you use suppression?
What is the dose for suppression?
HSV-2 primary
recurrent infections
acyclovir 400 mg BID
1) Describe an eclamptic seizure
2) What is the treatment?
3) What do you do for recurrent seizures?
4) Treatment if mag is not effective?
Starts with facial twitching, Body becomes ridged, Face appears cyanotic, May last for 10-20 seconds, Postictal – patient may be unconscious and confused or combative
2) 5 grams Mag IM each buttock (don’t forget routine management of seizures)
3) 2-3 gm mag bolus (IV)
4) 4 mg Ativan. Consider phenytoin 15-20 mg/kg with an infusion rate up to 50 mg/min
