[醫如往常] Senior Clerkship Day 11: Ob/Gyn Cases; 乳房檢查

20160912 Cases

Vaginal bleeding

Hematometra

Endometrial cancer

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Amniotic band syndrome

Vascular ring

The primary symptomatology associated with vascular rings relates to the structures that are encircled by the ring, chiefly the trachea, and esophagus. Prompt diagnosis and treatment of these congenital abnormalities can be lifesaving.

來自 <http://emedicine.medscape.com/article/426233-overview>

Uterine atony

TAE uterine artery

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Edward syndrome Trisomy 18

1/3000

• Clenched hands
• CHD, CHD, USA,
• Mental retardation
• rocker bottom foot (congenital vertical talus)

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TOCC長灘島

Placenta previa

Vaginal bleeding

Antepartum hemorrhage

UTI

Dengue shock syndrome

Ddx HELLP syndrome

HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant or complication of pre-eclampsia.[1] Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. "HELLP" is an abbreviation of the three main features of the syndrome:[2]

• Hemolysis
• Elevated Liver enzymes
• Low Platelet count

來自 <https://en.wikipedia.org/wiki/HELLP_syndrome>

Zika report: skin rash common

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乳房檢查 張醫師

乳癌

美國 1/2 婦產科開

歐洲 3/4 婦產科開

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說明之後 informed consent

標準作業流程

技法

推撥 screen

搓 confirm 揉

淋巴結， 縮下巴摸

形狀, 大小, 固定性, 移動性, 分泌物

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Ovoid shape

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Positive finding

Cannot distinguish cancer, benign

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Male

Paget disease

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BRCA1

15% TW AD

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醫學六大核心能力

記憶方式：MISPPP （I 3P SM）

1. Medical knowledge （醫學知識）
2. Interpersonal commmunication（人際及溝通技能）
3. System-based practice（制度下之臨床工作）
4. Patient care （病人照顧）
5. Profesionalism （專業素養）
6. Practice-based learning and improvement （工作中學習成長)