Jennifer is a 28yo, G2 P0010, who is currently 23 weeks 0 days. She felt an impalpable mass on her neck and has had work-up. She has since been referred to ENT. Thyroid studies are normal with a TSH of 1.8 and a free T4 of .94 indicating a cold nodule per her report. An ultrasound performed recently was suspicious for a thyroglossal duct cyst. She is scheduled to have a biopsy on December 28, 2017. She was referred today to discuss the nodule.
On ultrasound there is a live fetus in breech presentation. Fetal biometry is consistent with dates. A detailed anatomic survey was overall unremarkable and there were no gross structural abnormalities seen. There was some concern for a mildly echogenic bowel, but no other common markers of aneuploidy were seen.
I had a long discussion with Jennifer and her partner today.
1. We first discussed her thyroid. If in fact this is thyroglossal duct cyst there should be no significant complications of pregnancy. The biopsy is important to rule-out anything that could be significant such as a malignancy. She will continue to follow-up with ENT per their suggestions.
2.
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In regard to her ultrasound, we discussed the finding of an echogenic bowel. I was able to get a verbal report on her quad screen that was screen negative with a risk at 1:7000. Even modifying that risk for echogenic bowel, we would still be better than her age based risk which is overall reassuring. We discussed the other etiologies of echogenic bowel including TORCH infections, cystic fibrosis, and bleeding. She has not had any obvious bleeding where we would suspect fetal swallowing, but it is still a possibility. Her CF screen is negative which reduces this risk significantly. I suggested that she have TORCH titers drawn, both IgM and IgG at her next visit for her Glucola in early
History of Present Illness: Ms. Lynehan is a very pleasant 34-year-old woman who I had seen previously in July 2014 for the evaluation of a right upper lobe pulmonary nodule. She is currently asymptomatic. She carries a diagnosis of carcinoid, which was resected from the right lower lobe. She additionally had a right upper lobe nodule that was resected, which was found to be a granuloma. Since that time, bronchoscopy has been performed which grew
Heather Kelly is a 42-year-old female here today with pain and a lump in the left axillary area. I am also concerned for some fullness that I feel that. I talked with her about the options. I am going to have her do an ultrasound of that area and I will review results with her when available. Should her symptoms change over the weekend, she can certainly seek care if necessary, though I suspect that will be necessary. I have asked her to avoid over manipulating the area, as she may inadvertently make that worse. She was comfortable this plan. She will contact me with questions or concerns. All questions were answered in the office
Our mutual patient Darlene Boyle was seen in the clinic on 7/5/16 for medical clearance. Her EKG and Chest X-Ray was within normal limits. Her CBC showed elevated WBC's and she will be referred to Hematology. However, there are no finding that would prevent the patient from going through with her surgical procedure.
She asked about the risk of HIV. I informed her that with a high viral load and not medication, this could be as high as 255. If she is on meds and her viral load is < 1000, the risk would be around 2-5%. I do think she has time to get her viral load under control, especially if she has previously been undetectable on Complera. I advised her to make sure that if she is nauseous that she take her Diclegis properly and then Phenergan prn for nausea. If she gets to a point where she cannot keep the Complera down, we may need to treat with Phenergan or Zofran. I scheduled her to return in 4 weeks for completion of the anatomy and growth. I also gave her notes for proof of pregnancy confirmation as well as note stating that she is unable to
Peterson-Iyer, Karen. "Confronting a Fetal Abnormality." http://www.scu.edu. Santa Clara University, Jan. 2008. Web. 13 Mar. 2014. .
The first days and weeks after conception are critical for fetus body formation. The most extensive transformation of life occurs before birth. The fetal period goes through major changes. During the third month male or female sexual organs begin to develop and is visible through ultrasound. During months 4-6, the baby’s heartbeat becomes stronger. The digestive and excretory systems begin to develop. Body parts such as the fingernails, toenails, and buds of teeth begin to form and hair grows. Brain development occurs in every prenatal month, but the first three months are crucial. The central nervous system becomes responsive during middle of the women 's pregnancy, and begins to regulate body functions such as breathing and sucking.
Osmara is a 22yo, primigravida, who is currently 34 weeks 5 days. She has been followed for an elevated inhibin. On her visit 2 weeks ago she was noted to be LGA that was symmetric and growth > 90%ile. Amniotic fluid was normal but generous at 19 cm. In the last week, she has gained a fairly significant amount of weight and has noted edema. She does tend to wake-up with the edema but it can be relieved with elevation. She has an occasional headache and has not really taken Tylenol but otherwise has no visual changes or nausea/vomiting.
Raisbeck, E. (2009) Understanding Thyroid Disease. Practice Nurse [online]. 37(1), pp. 34-36. [Accessed 16 March 2014].
When a mother finds out she is pregnant it is a wonderful experience. Most people are excited to see their first “picture” of their baby, the ultrasound. Even more exciting is getting an ultrasound to find out the sex of the baby. But ultrasounds are useful for more than just getting that first image of the fetus or finding out whether it is a boy or a girl. While it is something most parents dread finding out when pregnant, an ultrasound can also detect a birth defect. There are many different birth defects that can be detected by an ultrasound during pregnancy like Spina Bifida, Down syndrome, and abnormalities with the heart and lower urinary tract, and the importance of detecting them with an ultrasound is shown in the benefits of discovering the birth defect early, and the options it gives the parents after discovering the birth defect.
A 57-year-old female presents to her physician with changes in her bowel habits for the past few weeks. The patient reveals that she usually has soft bowel movements once a day. However, she has started passing pellet-like stools that alternate with loose stools. Her current symptoms are associated with sense of bloating and abdominal fullness. The patient denies seeing blood in her stool, weight loss, low-grade fever, a family history of colorectal cancer, or previous colon cancer screening. Abdominal examination reveals normal bowel sounds, no tenderness to palpation, and no evidence of a mass. Rectal examination is normal, and stool is negative for occult blood. Which of the following is the most appropriate next step in the management of
The good news is, that it can be detected as early as 14 weeks into the pregnancy. Regular check ups and regular ultrasounds are important to make sure that the organs are developing properly. It is also important to make sure that the hole that the organs have come through does not close too tightly. At that point delivery may become necessary for the health and safty of both mommy and baby. Also, just because one baby was born with gastroschisis doesn't make others to follow more likely to develop it according to different studies.
Obstetric Ultrasound -- a Comprehensive Guide to Ultrasound Scans in Pregnancy. Mar. 2006. Web. 13 Apr. 2011. .
"Pregnancy Fetal Development." Stages of Fetal Development. Professional Planets, 1999. Web. 13 Oct 2011. .
According to her parents, she was very active and didn’t have any other health histories. These changes had happened suddenly and they brought her to the hospital for further evaluation and checkup. Parents were very anxious, very tearful, and do not know how to help their child. Physician ordered a stat head computerized tomogram (CT) and the CT revealed a huge mass on her frontal area of the brain suspected malignancy. The neuro surgeon explained them she needed a stat surgical removal of the tumor and the girl need to be in the hospital for quite long time for further treatment. The doctor could not give them much hope on whether or not the girl’s tumor would be treated and if she would go back to her normal
...side begins to grow and develop at six weeks the baby is only five eights of an inch in measurement. As the months go on the baby goes thru many changes as well as the mother and her body. The mother may tend to get ill at times or may be fine during her pregnancy. There are also reports that the father may become ill at times as well along with the mother, this is common in men.