Pimped: Ob/Gyn

Cancer Screening * Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal. * ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf [http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf] ) * Breast: ACOG: 40-75 annual mammogram * Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger. * Lung: 55-80 with 30pack-year hx, annual low-dose CT Vaccinations * HPV: 3 dose series age 12-26 * Influenza: annual * Pneumovax: 1 dose and 1 booster any age if risk factors. After age 65 if no risk factors * Shingles: 2 dose age 50+ * Hep B: initial vaccination in youth, vaccination for anyone non-immune * MMR: if not immune * Varicella: if not immune * Tdap: Booster at 10yrs, new parents

Cancer Screening Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal. ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf ) Breast: ACOG: 40-75 annual mammogram Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger. Lung: 55-80 with 30pack-year hx, annual low-dose CT Vaccinations HPV: 3 dose series age 12-26 Influenza: annual Pneumovax: 1 dose and 1 booster any age if risk factors. After age 65 if no risk factors Shingles: 2 dose age 50+ Hep B: initial vaccination in youth, vaccination for anyone non-immune MMR: if not immune Varicella: if not immune Tdap: Booster at 10yrs, new parents

Swab/Urine * Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1 * Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin * Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once. * HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed. Serum * Syphilis: Painless chancre followed by latent, then secondary with palmar/plantar rash. If unsure stage, treat as if latent, PCN IM x3 * HIV: Universal screening. PREP if high risk. Referral to ID and counseling if positive. * Hep B: Treatable, not curable. Routine serum screening. No Routine Screening, diagnose if lesion * HSV: Antivirals as needed for outbreaks, can prophylax if frequent outbreaks/immunosuppressed. Valacyclovir or acyclovir are most common.

Swab/Urine Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1 Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once. HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed. Serum Syphilis: Painless chancre followed by latent, then secondary with palmar/plantar rash. If unsure stage, treat as if latent, PCN IM x3 HIV: Universal screening. PREP if high risk. Referral to ID and counseling if positive. Hep B: Treatable, not curable. Routine serum screening. No Routine Screening, diagnose if lesion HSV: Antivirals as needed for outbreaks, can prophylax if frequent outbreaks/immunosuppressed. Valacyclovir or acyclovir are most common.

Why: ASCCP guidelines (there is an app! Or PDF [http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf]) Cervical dysplasia — caused by HPV CIN I–CIN3 is a progression Risk factors: Smoking, other STIs including HIV, immunodeficiency Histology: Increased Nuclear: cytoplasmic ratio when abnormal Acetic Acid: exact mechanism unknown, the higher N:C ratio cells (aka abnormal cells) reflect more light and appear white. Lugols: Iodine rich-reacts with glycogen in normal squamous cells so they appear dark.  Non-staining cells are abnormal. HPV — changes Colpo: Increased vascularity, punctations, mosaicism, surface contour changes LEEP: Stain abnormality and know where abnormal biopsy was taken Single pass is ideal–tag a side for orientation +/- Top Hat depending on ECC result CKC: Higher up in cervical canal, but more complications No electricity– okay if pregnant