MKSAP: 19-year-old woman is seen for counseling regarding contraceptives

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old woman is seen for counseling regarding contraceptives. Medical history is unremarkable; she is nulliparous and has never taken prescription contraceptives. Her father had a pulmonary embolism at age 47 years, which was associated with arthroscopic knee surgery, and her 23-year-old sister experienced a deep venous thrombosis 3 weeks after delivering her first child. The patient does not smoke and takes no medications. On physical examination, she appears well. Vital signs are normal; BMI is 31. The remainder of the examination is unremarkable. She states that she does not want to use a copper intrauterine device (IUD). Which of the following contraceptive methods would be most appropriate for this patient? A. Estrogen-progestin vaginal ring B. Low-dose combination estrogen-progestin pill C. Progestin-releasing IUD D. Transdermal estrogen-progestin patch Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions OB/GYN Source Type: blogs

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To analyze the American College of Surgeons National Surgical Quality Improvement Program database to evaluate the incidence of deep venous thrombosis and pulmonary embolism in patients undergoing rotator cuff repair surgery. In addition, we aim to identify risk factors associated with the development of thromboembolic events following rotator cuff repair.
Source: Arthroscopy - Journal of Arthroscopic and Related Surgery - Category: Surgery Authors: Source Type: research
J Knee Surg DOI: 10.1055/s-0039-1693450There is a paucity of literature comparing the relative merits of open arthrotomy versus arthroscopy for the surgical treatment of septic knee arthritis. The primary goal of this study is to compare the risk of perioperative complications between these two surgical techniques. To this end, 560 patients treated for septic arthritis of the native knee with arthroscopy were statistically matched 1:1 with 560 patients treated with open arthrotomy. The outcome measures included major complications, minor complications, mortality, inpatient hospital charges, and length of stay (LOS). Major ...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
Conclusions: The incidence of VTE after pediatric sports medicine knee arthroscopies is low, 0.27%. Patients who present with calf swelling or pain, chest pain, or shortness of breath after arthroscopic surgery should be examined closely. Level of Evidence: Level III.
Source: Clinical Journal of Sport Medicine - Category: Sports Medicine Tags: Original Research Source Type: research
Authors: Ellis HB, Sabatino MJ, Clarke Z, Dennis G, Fletcher AL, Wyatt CW, Zia A, Wilson PL Abstract INTRODUCTION: Deep vein thrombosis and pulmonary embolism are major complications that can occur in common orthopaedic procedures such as knee arthroscopy. The purpose of this study is to determine the incidence of venous thromboembolism (VTE) risk factors in adolescent patients undergoing elective lower extremity arthroscopy. A second objective is to determine whether a targeted, standardized screening tool is both cost- and clinically effective in the identification of VTE risk factors in adolescents. METHODS:...
Source: The Journal of the American Academy of Orthopaedic Surgeons - Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research
Abstract Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). The American Academy of Orthopaedic Surgeons and the American College of Chest Physicians have no prophylaxis guidelines specific to shoulder arthroscopy, yet many surgeons prescribe aspirin following RCR. The purpose of this study was to evaluate the effectiveness of aspirin and mechanical prophylaxis compared with mechanical prophylaxis alone in preventing VTED following RCR. A total of 914 patients underwent RCR between January 2010 and January 2015. A retrospective case-control study was perfo...
Source: Orthopedics - Category: Orthopaedics Authors: Tags: Orthopedics Source Type: research
Publication date: Available online 19 September 2018Source: The Journal of Foot and Ankle SurgeryAuthor(s): Youichi Yasui, Yoshiharu Shimozono, Chun Wai Hung, Alberto Marangon, Eoghan T. Hurley, Arianna L. Gianakos, John G. KennedyAbstractResidual symptoms often persist even after successful operative reduction and internal fixation (ORIF) of ankle fractures. Concurrent ankle arthroscopic procedures (CAAPs) have been proposed to improve clinical outcomes; however, a dearth of evidence is available supporting this practice. The purpose of the present study was to investigate the reoperation and complication rates after ORIF...
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
ConclusionAlthough anterior cruciate ligament reconstruction is a common and safe procedure performed on a daily basis, unexpected complications may occur. One of these is venous thromboembolism which may be fatal.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionsSymptomatic bilateral pulmonary embolism may have a good prognosis if it is diagnosed early and treated appropriately. It is important to appreciate the risk of provoked thromboembolic events in healthy adolescents undergoing arthroscopic knee surgery.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
ConclusionAlthough anterior cruciate ligament reconstruction is a common and safe procedure performed on a daily basis, unexpected complications may occur. One of these is venous thromboembolism which may be fatal.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
AbstractArthroscopic knee surgery is the most commonly performed orthopedic procedure worldwide and whether thromboprophylaxis should be undertaken after knee arthroscopy is still controversial. To evaluate the efficacy of thromboprophylaxis for deep venous thrombosis (DVT) and venous thromboembolism (VTE) after knee arthroscopic surgery. A meta-analysis was conducted using data from eight randomized trials (4148 patients) to compare thromboprophylaxis with placebo or no prophylactic treatment in patients undergoing knee arthroscopy. The benefits and harms of thromboprophylaxis were evaluated, including the incidence of as...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
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