Obstetrics & Gynecology

2022-11-17 08:28:01 Open / Comment

2022-11-16 08:27:02 Open / Comment

2022-11-15 20:26:02 Educational objective: Migraine is an episodic neurological disorder that results in severe, unilateral, phonophobia, and nausea/vomiting;
throbbing headaches often associated with photophobia, they may be accompanied by aura (focal, reversible neurologic symptoms that precede or accompany the
headache). Estrogen-containing contraceptives are contraindicated in patients with migraine with aura due to the increased risk of ischemic stroke. Open / Comment

2022-11-15 08:25:02 Open / Comment

2022-11-15 08:25:02 An 18-year-old woman comes to the office due to recurrent headaches. In the past, the patient has had occasional headaches, especially during term exams or other stressful situations. However, over the past 3 months, she has had 4 episodes of severe headache. They are always left sided, throbbing, associated with nausea, and spontaneously resolve after 12-24 hours. The patient also reports feelings of numbness and tingling in her extremities prior to the headaches. She has no chronic medical conditions and underwent an appendectomy several years ago. The patient is sexually active with her boyfriend and began taking combined oral contraceptives 6 months ago. Vital signs are within normal limits. Physical examination, including neurological examination, shows no abnormalities. Open / Comment

2022-11-14 20:25:04 Open / Comment

2022-11-08 08:01:01 A 62-year-old man comes to the office due to tremors. The patient first noticed them several years ago, but they have progressively worsened and now cause difficulty with daily activities such as drinking tea and buttoning clothing. His wife reports that he also has a mild head tremor. His father had similar symptoms, which worsened as he advanced in age. The patient has a history of osteoarthritis, hypertension, and gastroesophageal reflux disease. He does not drink alcohol. Blood pressure is 144/80 mm Hg and pulse is 82/min. Physical examination shows a mild tremor of the head and a tremor of the bilateral upper extremities when the arms are extended. The tremor worsens during finger-to-nose testing. Muscle tone, deep tendon reflexes, limb coordination, and gait are normal. Open / Comment

2022-11-07 21:01:02 Educational objective: Multiple sclerosis is an immune-mediated demyelinating disease of the central nervous system. The disease is most common in Caucasian women age <50. Risk factors include vitamin D deficiency, geographic location, genetic predispositions (HLA-DRB1), and smoking. Open / Comment

2022-11-07 08:00:15 Open / Comment

2022-11-07 08:00:14 A 35-year-old woman comes to the office due to a 2-day history of weakness in her right hand. She has no other symptoms but reports a transient episode of lower extremity numbness that resolved spontaneously. The patient has a history of herpes labialis and she takes valacyclovir as needed. She recently began taking a vitamin D supplement after she was found to have low serum vitamin D levels. Other medications include oral contraceptive pills; she has also received annual influenza vaccines. The patient does not use tobacco, alcohol, or illicit drugs. Family history is significant for type 2 diabetes mellitus in her mother and hypertension in her father. BMI is 28 kg/m2. Examination shows mild spasticity in her right hand. MRI of the brain shows the findings seen below. Open / Comment