merrk
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Q. 1 IUD deacreases the risk of Which of the following cancers?
A ovarian
B breast
C cervical
D endometrial
Q. 2 Women got breast augmentation surgery two months ago and is now pregnant. She is worried about breast feeding. What do you say?
A. breast feeding depends on the type of implant
B. Need to do a biopsy to see adequacy of glands, ducts, lobules
C. breast feeding is not possible
D. breast feeding is possible after implants and is usually successful
Q. 3. 24yr old female started OCP 2 mths back and she presents wiht no bleeding. she is on the 6th pill of a new pack. Last month she had wihtdrawl bleed 2 days after her last white pill. What should she do?
A. stop the pill
B. take two pills the next day
C. reassure her and tell her to continue the pills
Q. Pregnant female has pyelonephritis and is admitted for IV antibiotics and is ready for discharge. Next step in management?
A. renal ultrasound
B. CT scan
C. prophylaxix for the rest of her pregnancy
D. plenty of hydration, void early, and watch out for any signs of infection/ dysuria
E. voiding cystourethrogram
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| drkpp
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1) i dont think iucd can decrease the risk of any cancer
2) breast feeding not possible??
3)reasssurance cause it takes a couple of months for m.c. to regularize and patients should be warned about it..
4) i think its D
good ones merck, hope for a good discussion to follow..
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| chemamr
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i´m not too sure of all but this is what i think
1) A ??; 2) D????; 3) C; 4) D. 
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| merrk
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good tries... chemamr is closer  , anyone else?
Q. 3 you both got right. Yup, reassure the patient. If however after the next cycle she still does not get a withdrawal bleed, then discontinue the OCPs, and do a pregnancy test. If in this question there was an option of b-hcg, then that would have been a better answer.
Q. 2. D like how are we supposed to know this??? Implants dont interfere with lactation. try the others again
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| drkpp
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Q1 endometrial???
Q4 prophylaxis with nitrofurantoin????
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| merrk
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yup. IUD protects againts endometrial cancer, strange but that's the answer. one theory is that it changes the intrauterine environment to interfere wiht the response to hormones. anohter is that it produces a sterile inflammatory reaction whihc works against atypical endometrial hyperplasis.
After pyelo the patient needs prophylaxix for the rest of pregnancy
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| chemamr
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ok
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| drkpp
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| doc26inder
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hi guys found a reference
OBJECTIVE: Although the intrauterine device (IUD) is one of the most widely used forms of contraception throughout the world, its potential long-term effects on the uterus have not been thoroughly evaluated. This paper reports the long-term results of IUD use on the incidence of endometrial cancer. STUDY DESIGN: The data is part of a nationwide case-control, pilot study that was undertaken in order to evaluate the possible influence of ovulation induction drugs on the risk of endometrial cancer. The study included 128 living women 35-64 years old, with a histologically confirmed diagnosis of endometrial carcinoma. The controls were 255 women from the same dialing areas selected by random digit dialing. A multivariate logistic model, controlling for age, was used to assess the independent effects of factors found to be significantly associated with endometrial cancer on univariate analysis. RESULTS: The following parameters were found to be independently associated with endometrial cancer controlling for age: nulliparity OR=2.7 (95% CI 1.1-6.5, P=0.03); history of infertility OR=1.8 (95% CI 1.0-3.3, P=0.05); BMI>/=27 OR=2.3 (95% CI 1.4-3.8, P=0.001).The use of oral contraceptives and IUD were found to be protective; OR=0.29 and 0.37, respectively, (95% CI 0.14-0.61, P=0.001, 0.19-0.70, and 0.003, respectively). CONCLUSIONS: IUD use may have a protective effect on endometrial cancer risk. The protective effect of IUD may be either, through the intense inflammatory response that leads to other lisosomal and inflammatory actions, which may include cells responsible for early elimination of hyperplastic endometrial epithelial cells or, the more complete shedding of the endometrium associated with IUD use may decrease hyperplasia of the endometrium, a known risk factor for endometrial carcinoma.
a reference for breast implantshttp://www.breastimplants4you.com/breast_feeding_...
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| merrk
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thanks doc26 for the article!
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