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submitted by step_prep2(66), visit this page

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Pregnant woman with history of 2 C-sections currently in her 3rd trimester presents with painless vaginal bleeding found to have a placenta previa
Key idea: Placenta accreta occurs in up to 15% of cases of placenta previa, with both conditions having previous C-section as the major risk factor

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osler_weber_rendu Why not amniotic fluid embolism? +1

mycoplasma [Placenta accreta with placenta previa after previous cesarean sections--a growing danger in modern obstetrics].Lachman E, Mali A, Gino G, Burstein M, Stark M.Harefuah. 2000 Apr 16;138(8):628-31, 712.PMID: 10883200 Hebrew. Abstract The increased rate of cesarean sections in recent decades has brought with it an increase in the frequency of placenta accreta.When performing a cesarean in cases of placenta previa with a history of cesarean sections, the possibility of placenta accreta should be considered. +

submitted by step_prep3(25), visit this page

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Pain in the hips/thighs that is exacerbated by walking and improves with leaning forward with normal posterior tibial pulses, most consistent with pseudoclaudication due to spinal stenosis
Claudication: Patient will have risk factors for peripheral vascular disease (diabetes, HTN, smoking, etc.), reduced lower extremity pulses, reduced lower extremity temperature, pain classically in the calves, reduced hair on legs
Pseudo-claudication (spinal stenosis): Positional (improves with flexion), classically affects buttocks and thighs, may be associated with back pain

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seagull Cannot a herniated lumbar disk lead to spinal stenosis? asking for a friend. +1

mycoplasma yes, it can cause stenosis. +

submitted by step_prep3(25), visit this page

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Pain in the hips/thighs that is exacerbated by walking and improves with leaning forward with normal posterior tibial pulses, most consistent with pseudoclaudication due to spinal stenosis
Claudication: Patient will have risk factors for peripheral vascular disease (diabetes, HTN, smoking, etc.), reduced lower extremity pulses, reduced lower extremity temperature, pain classically in the calves, reduced hair on legs
Pseudo-claudication (spinal stenosis): Positional (improves with flexion), classically affects buttocks and thighs, may be associated with back pain

https://step-prep.org/tutoring/

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seagull Cannot a herniated lumbar disk lead to spinal stenosis? asking for a friend. +1

mycoplasma yes, it can cause stenosis. +

submitted by step_prep2(66), visit this page

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Patient has classic presentation of a perimenopausal woman (menses become irregular, vaginal dryness, ~52 years of age)
Key idea: Perimenopausal woman can sometimes be treated with hormonal contraceptives to manage irregular bleeding, but this patient is over 35 and an active smoker, which is a contraindication to estrogen-containing OCPs
Key idea: Patient would be candidate for topical vaginal estrogen therapy (which does not carry same risks as systemic estrogen therapy)
Red flags requiring further work-up: Abnormal uterine bleeding (bleeding between periods, prolonged periods, or heavier bleeding during periods), especially in a patient with risk factors (obesity, PCOS, unopposed estrogen, etc.)

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mycoplasma why not endometrial biopsy?? she is obese - a risk factor requiring endometrial biopsy. Just because she has not had any signs of Abnormal uterine bleeding?? +

submitted by jlbae(159), visit this page

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DI, PP, SIADH, etc are all the fucking worst I swear I learned them at least 8 times but can never get the shit to stick

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mycoplasma same here. +