Review - Clinical XVIII (Gynecology)

dark jazz, avant-garde jazz, spoken-word jazz

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V5.5

[Verse 1: The bass walks a slow, uneasy rhythm. The Poet speaks softly, right by the listener's ear.]

Most effective contraceptives; I.U.D., implant, sterilization

Emergency contraception within 5 days; Levonorgestrel, ethinyl estradiol and levonorgestrel , ulipristal acetate , copper  or levonorgestrel I.U.D.

Progestin-only ; contraindicated in undiagnosed vaginal bleeding, benign or malignant liver disease, breast cancer

Combined contraceptives, “absolute contraindications”; Pregnancy or below  21 days postpartum; thrombophlebitis or thromboembolic disorders, known thrombophilia, stroke or C.A.D., breast cancer, undiagnosed vaginal bleeding,

estrogen-dependent cancer, hepatocellular adenoma, uncontrolled hypertension, Age above 35 and smoking above 15 per day,
 migraine with aura, active hepatitis, surgery or injury requiring prolonged immobilization

[Verse 2: The snare brushes get louder and more erratic. The violin plays sharp, staccato plucks.]

Bartholin duct cyst and abscess; under 40, asymptomatic, not require therapy; over age 40, biopsy or removal to rule out vulvar carcinoma. For symptomatic - Word catheter or marsupialization

P.I.D.; “lower abdominal pain, A.U.B., abnormal discharge, fever if severe. R.U.Q. pain -perihepatitis, “Fitz-Hugh-Curtis”. Ceftriaxone P.L.U.S. doxycycline ± metronidazole
Intervention for large T.O.A. , suspected T.O.A. rupture, or a poor antibiotics response

Condyloma Acuminata, “Warty growths, pregnancy and immunosuppression favor growth” treat with cryotherapy, surgical removal, 80–90% trichloroacetic or bichloroacetic acid application

[Avant-Garde Violin Solo: The drums break into a chaotic, free-jazz flurry. The violin absolutely erupts—screeching, bending, and sawing aggressively against the upright bass for a full 15 seconds of pure, dissonant tension. It abruptly stops, leaving just a swinging ride cymbal.]

[Verse 3: The Poet returns, his voice more urgent and rhythmic, riding the swinging cymbal.]

Primary amenorrhea; absence of menses by 13 lack secondary sexual characteristics, if not by age 15. Test; F.S.H., L.H., prolactin, testosterone, T.S.H., T4, h.C.G.. Absent uterus in U.S.G. – karyotype

Secondary amenorrhea “absence of menses for > 3 months if previous cycles regular; above 6 months if irregular. Exclude pregnancy, then T.S.H., F.S.H., prolactin, and estradiol

Primary ovarian insufficiency; menopause before 40; premature menopause aged 40–45.

[Verse 4: The violin returns with a long, mournful drone. The bass slows down to a crawl.]

3–5 percent acetic acid dissolves mucus, and sharpens the contrast between normal and proliferating epithelium

9v.H.P.V. is recommended for vaccination of females and males aged 9–26, aged 27 to 45 years based on risk factors (coverage of all carcinogenic types is not provided by the 9v.H.P.V., still needs screening).
Abnormal cytology – perform colposcopy

C.I.N. 2 & 3, L.eep.; if pregnant, observe. H.P.V. testing at 6-12 months posttreatment, at least 20 years follow up
C.I.N. 1; test in 1 year, if -, continue normal screening. If persists 24 months, excise or observe

[Outro: The jazz club feels suffocatingly dark. The drums stop entirely. The Poet delivers the final oncological notes completely a cappella, accompanied only by the haunting, dying squeal of the violin.]

Cervical cancer “often asymptomatic; bleeding, postcoital spotting. Bladder, rectal dysfunction, fistulas, pain are late sequelae

Adenocarcinoma of the endometrium; Obesity, nulliparity, diabetes, polycystic ovaries with prolonged anovulation, estrogen (clomiphene), and tamoxifen. Presents with Abnormal bleeding
(Presents with Abnormal bleeding...)

Vulvar cancer; history of prolonged vulvar irritation, with pruritus, local discomfort, or bloody discharge, most after 50

[Ending: A single, sharp snap of the fingers. The upright bass plays one final, low, dissonant thump. Total silence.]

4207/7500

[Intro: Free Time, roughly 80 BPM. A lone, dissonant upright bass plucks a slow, descending line. A snare drum is lightly scratched with wire brushes. Out of the darkness, a violin scrapes a horrific, screeching note. The Poet approaches the microphone, exhaling cigarette smoke.] [Verse 1: The bass walks a slow, uneasy rhythm. The Poet speaks softly, right by the listener's ear.] Most effective contraceptives; I.U.D., implant, sterilization Emergency contraception within 5 days; Levonorgestrel, ethinyl estradiol and levonorgestrel , ulipristal acetate , copper or levonorgestrel I.U.D. Progestin-only ; contraindicated in undiagnosed vaginal bleeding, benign or malignant liver disease, breast cancer Combined contraceptives, “absolute contraindications”; Pregnancy or below 21 days postpartum; thrombophlebitis or thromboembolic disorders, known thrombophilia, stroke or C.A.D., breast cancer, undiagnosed vaginal bleeding, estrogen-dependent cancer, hepatocellular adenoma, uncontrolled hypertension, Age above 35 and smoking above 15 per day, migraine with aura, active hepatitis, surgery or injury requiring prolonged immobilization [Verse 2: The snare brushes get louder and more erratic. The violin plays sharp, staccato plucks.] Bartholin duct cyst and abscess; under 40, asymptomatic, not require therapy; over age 40, biopsy or removal to rule out vulvar carcinoma. For symptomatic - Word catheter or marsupialization P.I.D.; “lower abdominal pain, A.U.B., abnormal discharge, fever if severe. R.U.Q. pain -perihepatitis, “Fitz-Hugh-Curtis”. Ceftriaxone P.L.U.S. doxycycline ± metronidazole Intervention for large T.O.A. , suspected T.O.A. rupture, or a poor antibiotics response Condyloma Acuminata, “Warty growths, pregnancy and immunosuppression favor growth” treat with cryotherapy, surgical removal, 80–90% trichloroacetic or bichloroacetic acid application [Avant-Garde Violin Solo: The drums break into a chaotic, free-jazz flurry. The violin absolutely erupts—screeching, bending, and sawing aggressively against the upright bass for a full 15 seconds of pure, dissonant tension. It abruptly stops, leaving just a swinging ride cymbal.] [Verse 3: The Poet returns, his voice more urgent and rhythmic, riding the swinging cymbal.] Primary amenorrhea; absence of menses by 13 lack secondary sexual characteristics, if not by age 15. Test; F.S.H., L.H., prolactin, testosterone, T.S.H., T4, h.C.G.. Absent uterus in U.S.G. – karyotype Secondary amenorrhea “absence of menses for > 3 months if previous cycles regular; above 6 months if irregular. Exclude pregnancy, then T.S.H., F.S.H., prolactin, and estradiol Primary ovarian insufficiency; menopause before 40; premature menopause aged 40–45. [Verse 4: The violin returns with a long, mournful drone. The bass slows down to a crawl.] 3–5 percent acetic acid dissolves mucus, and sharpens the contrast between normal and proliferating epithelium 9v.H.P.V. is recommended for vaccination of females and males aged 9–26, aged 27 to 45 years based on risk factors (coverage of all carcinogenic types is not provided by the 9v.H.P.V., still needs screening). Abnormal cytology – perform colposcopy C.I.N. 2 & 3, L.eep.; if pregnant, observe. H.P.V. testing at 6-12 months posttreatment, at least 20 years follow up C.I.N. 1; test in 1 year, if -, continue normal screening. If persists 24 months, excise or observe [Outro: The jazz club feels suffocatingly dark. The drums stop entirely. The Poet delivers the final oncological notes completely a cappella, accompanied only by the haunting, dying squeal of the violin.] Cervical cancer “often asymptomatic; bleeding, postcoital spotting. Bladder, rectal dysfunction, fistulas, pain are late sequelae Adenocarcinoma of the endometrium; Obesity, nulliparity, diabetes, polycystic ovaries with prolonged anovulation, estrogen (clomiphene), and tamoxifen. Presents with Abnormal bleeding (Presents with Abnormal bleeding...) Vulvar cancer; history of prolonged vulvar irritation, with pruritus, local discomfort, or bloody discharge, most after 50 [Ending: A single, sharp snap of the fingers. The upright bass plays one final, low, dissonant thump. Total silence.]

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