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Bacterial vaginosis is diagnosed with Amsel's criteria 3 of the following must be present: - Thin, homogenous gray-white discharge - Positive Whiff test - Clue cells on microscopy - Vaginal pH > 4.5 #Gynecology

Life is nothing but the days you let pass and the ones yet to come. Yet, so often do we push dreams off for later, only to realize there is no later. Time is infinite, but yours is not. For the past 6 years, I’ve studied. Goal after goal, I postponed. Until after this test, I said, until after this rotation, until… when? My time has not been wasted. I learned. I gained memories. I did things that scared me and made stupid mistakes. I met people. And I hope that I impacted the souls I’ve came across. I hope their days where a little bit better because of the interactions we had. It was not a waste. How can you not dedicate your life to the study of medicine once aware of its significance? One day, I will hold the responsibility of a person’s health, and one misstep could ruin a life. Still, I mourn every dream I let die, every goal I failed to pursue. Later is not guaranteed. Life is not guaranteed. You don’t walk through life on a straight path. You walk on a rope, balancing its aspects on the two ends of a pole. Lean too much to one side and you’ll fall. Find your balance. Life is short and it’s passing you by. #Reflections

Absolute contraindications to OCP: ● History or risks of venous thromboembolism. ● Tobacco use (more than half a pack per day) and age ≥ 35. ● Liver disease (cirrhosis, liver cancer, etc.). ● Clinical history of atherosclerotic cardiovascular disease (ASCVD; e.g., coronary artery disease), or high ASCVD risk (e.g., uncontrolled diabetes). ● Hypertension (systolic of ≥ 160 mmHg or diastolic of ≥ 100 mmHg). ● Migraine with aura. ● Migraine without aura in > 35 years of age or with tobacco abuse. ● Breast cancer. ● Systemic lupus erythematosus. ● Complicated valvular heart disease. #Gynecology

Only contraceptive approved for hepatic adenoma patients is copper IUD. #Gynecology

Breakthrough bleeding from combined OCPs is more common when there is a lower estrogen component #Gynecology

- If Depo Provera injection is late by > 2 weeks, do pregnancy test before giving q3 monthly injection - If hormonal transdermal patch detaches from skin for > 24 hours, it needs to be replaced with a new one. #Gynecology

Contraceptives that increase the risk of sexually transmitted diseases (STD): - Spermicide Contraceptives that decrease STD risk: - Female/Male condom (also protects against HIV) Contraceptives that decrease the risk of Pelvic Inflammatory Disease (PID)*: - Oral contraceptive pills - Medroxyprogesterone acetate injection - Levonorgestrel IUD * Possibly due to thick impenetrable mucus #Gynecology

What are the forms of emergency contraception? - Copper IUD (most effective): placed within 5 days - Ulipristal (very effective): within 5 days - Levonorgestrel (effective): within 3 days #Gynecology

Copper IUDs cause heavy menstrual bleeding and cramping Levonorgestrel IUDs cause irregular bleeding or amenorrhea. #Gynecology

Prior STD or ectopic pregnancy is not a contraindication to IUD placement. Yet IUDs should not be placed within 3 months of an STD. #Gynecology

Forms of progesterone-only contraception: - Oral: Norethindrone (Mini pill) - Implant: Etonogestrol ~~Lasts 3 years - Injection: Medroxyprogesterone ~~Last 3 months - IUD: Levonorgestrel Lasts 7-8 years #Gynecology

Most effective to least effective contraception methods: - Vasectomy - Tubal ligation - IUDs - Depo Provera (Hormonal progesterone injection) - Hormonal transdermal patch (combined estrogen/progesterone) - Oral contraceptive pill (OCP) - Vaginal ring - Diaphragm - Female/male condom - Withdrawal method - Calender (Cycle tracking) method - Spermicide use #Gynecology

Rotterdam's Criteria for PCOS 2 of 3 are required to make the diagnosis - Oligomenorrhea or amenorrhea   - Hyperandrogenism (based on clinical (signs on the body) and/or biochemical signs (hormone levels in the blood)) - Polycystic ovaries on ultrasound #Gynecology

Polycystic ovarian syndrome is a diagnosis of exclusion. Rule out other causes of of late-onset virilization and hyperandogenism. DDx: ~ Nonclassic congenital adrenal hyperplasia ~ Ovarian or adrenal virilizing tumors ~ Ovarian hyperthecosis ~ Cushing syndrome ~ Acromegaly ~ Hyperprolactinoma #Gynecology

Polycystic ovarian syndrome (PCOS) is a result of abnormal steroidogenesis in ovaries with increased androgen production. Typical features include: ~ Hyperandogenism (acne and hirsutism) ~ Irregular menstrual cycle, amenorrhea, and anovulation ~ Insulin resistance, acanthosis nigricans, weight gain, obesity, and DM type 2 ~ Polycystic ovaries on ultrasound #Gynecology

All insulin formulations (short-acting, rapid acting... etc.) are excreted renally. Watch out for hypoglycemia if the patient develops renal failure. #Endocrinology #Diabetes

The main issue in adrenal crisis is the loss of mineralocorticoids (aldosterone), thus it is more common in primary adrenal insufficiency. It can be seen in secondary adrenal insufficiency if the loss of pituitary function is sudden and severe (e.g. Pituitary apoplexy) #Endocrinology #Adrenal

The hypotension is more severe in primary adrenal insufficiency than the secondary and tertiary types. The GI symptoms are more common in primary adrenal insufficiency than the secondary and tertiary types. GI symptoms include nausea, vomiting, abdominal pain, diarrhea alternating with constipation. #Endocrinology #Adrenal

The most common electrolyte abnormality in adrenal insufficiency is hyponatremia due to the increase in ADH. Cortisol suppresses ADH release. #Endocrinology #Adrenal

Useful apps: - Hospitalist Handbook The UCSF Hospitalist Handbook is a comprehensive, yet concise, bedside guide to inpatient medicine. It covers diagnosis and management for common issues in cardiology, critical care, pulmonology, nephrology, hematology/oncology, gastroenterology, endocrinology, infectious disease, rheumatology, neurology, among others. - ddxof A library of over 150 carefully-curated diagnostic and management decision support algorithms for common presentations in the emergency department.