Contraception

Method of contraception
A. Traditional or folk methods
-coitus interruptus: failure may result from escape from semen before orgasm.
-postcoital douche: the sperm have been found within the cervical mucus within 90 seconds after ejaculation.
-lactational amenorrhea: suckling result in a reduction in the release of gonadotropin-releasing hormone, LH, FSH. During the first 6 months, if breastfeeding is exclussive, menses are mostly anovulatory and fertility remains low. Contraceptive method starting 3 months after delivery.
-periodic abstinence :
1. Calendar method: ovulation occurs 14 days before the first day of the next menstrual period. Fertile interval should be assumed to extend from at least 2 days before ovulation to no less than 2 days after ovulation.
2. Temperature method : temperature must be recorded before activities is undertaken.
3. Cervical mucus method : starting several days before and until just after ovulation, the mucus becomes thin and watery, whereas at other times the mucus is thick and opaque.
B. Barrier method
-condoms(male and female):
-diaphragm
-cervical cap
-vaginal sponge
-spermicides
C. Hormonal method
-oral
-inject
-implant
D. Armamentarium
-iud
-sterilization

Fibrocystic change

Essentials of diagnosis
-painful, often multiple usually bilateral mobile masses in the breast.
-rapid fluctuation in the size of the masses is common
-frequently, pain occurs or increases as does size during the premenstrual phase of the cycle.
-most common age is 30-50 years, occurrence is rare in postmenopausal women.
The term Fibrocystic disease or mammary dysplasia, is imprecise and encompasses a wide spectrum of pathologic entities.
Pain or tenderness is often the presenting symptom and calls attention to the mass. Increasing during the premenstrual phase of the cycle, at which time the cysts tend to enlarge. Multiple or bilateral masses are also common.
Treatment
Simple mastectomy or extensive removal of breast tissue is rarely if ever indicated for Fibrocystic change.
Breast pain associated with generalized fibrocystic change is best treated by avoiding trauma and by wearing a bra with adequate support.

Maternal physiology during pregnancy

Pregnancy involves a number changes in anatomy, physiology, and biochemistry, which can challenge maternal reserves
A. Cardiovascular system
-the heart rotates on its long axis in a left-upward displacement.
-the heart size increases by about 12%
-blood volume: 50% elevation in plasma volume, 30% increase in red cell mass.
-cardiac output increases approximately 40%, stroke volume increase 25-30%
-blood pressure: systemic arterial pressure declines slightly reaching a nadir at 24-28 weeks of gestation. Pulse pressure widens because the fall is greater for diastolic than for systolic pressures. Venous pressure increase in the lower extremities which can cause edema and varicosities.
-heart murmurs and rhythm can be detected in 90% or more gravidas. Its can be heard at the left sternal edge.
-peripheral vascular resistance decreases by enhancing local vasodilators(nitric oxide, prostacyclin, possibly adenosine)
-blood flow distribution: uterine blood flow can be as high as 800ml/min, breast 200ml/min.
B. Pulmonary system
-capillary dilatation leads to engorgement of the nasopharynx, larynx, trachea, and bronchi.
-diaphragma is elevated by as much as 4cm.
-dead space volume increase because of relaxation of the musculature of conducting airways.
C. Renal system
-the renal calyces and pelves are dilated
-ureters are dilated above the brim of the bony pelvis, with more prominent effects on the right.
-GFR increases 25%, renal clearence 50%
-sometimes glucosuria, protein loss <300mg
-urinary frequency increase
-bladder capacity up to 1,5L
D. Gastointestinal system
-salivation increases
-gums become hypertrophic and hyperemic
-esophageal peristalsis is decreased
-gastrin increases
-intestine motility decrease
-emptying gallbladder is slowed

Transient ischemic attacks

Essentials of diagnosis
*focal neurologic deficit of acute onset
*clinical deficit resolves completely within 24 hours
*risk factors for vascular disease often present
If the ischemia is in the carotid territory,common symptoms are weakness and heaviness of the contralateral arm, leg, or face, singly or in any combination.
Numbness or paresthesias may also occur either as the sole manifestation of the attack or in combination with the motor deficit.
Vertebrobasilar ischemic attacks may be characterized by vertigo, ataxia, diplopia, dysarthria,dimness or blurring of vision, perioral numbess and paresthesias, and weakness or sensory complaints.
There may be slowness of movement, dysphasia, or monocular visual loss in the eye contralateral to affected limbs.
Treatment is initiated with iv heparin (in a loading dose of 5000-10000 units of standard-molecular weight heparin and maintenance infusion of 1000-2000 units per hour depending on the partial thromboplastin time), while warfarIn sodium is introduced in a daily dose of 5-15mg orally depending on inr. Warfarin is more effective than aspirin in reducing the incidence of cardioembolic. Aspirin 325mg daily may be used in patients with nonrheumatic atrial fibrillation. In patients intolerant of aspirin, clopidrogel 75mg can be used instead.

Epilepsy

Essentials of diagnosis
+ recurrent seizures
+ characteristic electroencephalographic changes accompany seizures
+ mental status abnormalities or focal neurologic symptoms may persist for hours postictally.
Etiology
1. Congenital abnormalities
2. Metabolic disorders
3. Trauma
4. Tumor and other space-occupying lesions
5. Vascular disease
6. Degenerative disorders
7. Infectious disease
Treatment
-partial and secondarily generalized tonic-clonic seizures : carbamazepine 600-1200mg, phenytoin 200-400mg, valproic acid 1500-2000mg. Newer antiepileptic: gabapentin 900-1800mg, lamotrigine 100-500mg.
-absence/petit mal: ethosuximide 100-1500mg, clonazepam 0,04-0,2mg/kg, valproic acid.
- myoclonic seizures: valproic acid, clonazepam

Headache

Chronic headache are commonly due to migraine, tension, or depression, but they may be related to intracranial lesions, head injury, cervical spondylosis, dental or ocular disease, temporomandibular joint dysfunction, sinusitis, hypertension and a wide variety of general medical disorders. The intensity, quality, and site of pain-and especially the duration of the headache and the presence of assosiated neurologic symptoms-may provide clues to the underlying cause. Migrain or tension headaches are often described as pulsating or throbbing. A sense of tightness or pressure is also common with tension headache. Sharp lancinating pain suggests a neuritic cause. Ocular or periorbital icepick-like pains occur with migrain or cluster headache, and a dull or steady headache is typical of intracranial mass lesion. In patients with sinusitis, there may be tenderness of overlying skin and bone.
Treatment:
-A simple analgesic (aspirin,acetaminophen, ibuprofen, naproxen)
-cafergot(ergotamine tartrat,caffein) 1-2 tab.
-neuroleptic: droperidol
Prophylatic treatment of migraine
* amitriptyline 10-150mg
* fluoxetine 20-60mg
* cyproheptadine 12-20mg
* verapamil 80-160mg