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Colposcopy is indicated for all

If negative, then co-testing with


abnormal Pap test
cytology and HPV can be
repeated in three years
Sex active teen → Initiate
Doxycycline & Ceftriaxone
(counsel/screen for STD = best)
h/o hysterectomy = don't need 65-70yo can stop cervical cancer
pap test screening/pap if had 3
negatives, or 2 neg cotesting in
last 10yrs
Still need bimanual & rectovag
exam.

Mammograms YEARLY

50yo = Colon CA screen


Agree with her decision after
proper counseling and perform a
Cesarean section at 39 weeks
gestation

Low FSH, Tanner stage 2 breast, Risk dev: OSTEOPOROSIS


18yo still not had period for 1
yr.
Teen, pelvic pain n/v during Primary Dysmenorrhea
menses since 13yr. Now 17yo.
Menses occur at regular 26-
28days. Diagnosis?

teen 1day h/o fever, STAPH aureus (NOT Chlamydia


n/v/diarrhea + RASH. Diffuse red or GC)
MACULOPAPULAR rash on
perineum & thigs. PE: cervical
motion, uterine, b/l adnexal
tenderness w/no masses. Likely
bug?
Recrrent UTI, Recurrent 1st Congenital Uterine Anomalies
trimester abortions. IV
pyelogram shows single kidney.
PE pal uterus, and easy palp left
ovary. Diag?
10wks gestion, 5day h/o Admit for IV hydration &
n/vomiting/decreased appetite. parenteral anti-emetic therapy
Uterus consisisten with size
10wks. TSH & free thyroxin
pending. NEXT STEP?
Post-menopause + blood stians Hypoestrogenic state (not
on underwear. Atrophy, friable endometrial hyperplasia)
vag mucosa. Likely cause of
symptoms?
Stress/cough/sneeze urinary Decreased EXTERNAL urethra
incontinencye Likely cause of sx? SPHINCTER tone
MOA:
3 days post C-section. Fever, Breast Engorgement (not
breasts tense, red, tender. endometritis or mastitis)
Diagnosis?
4 weeks after c-delivery. Pulling Normal Postoperative course
feeling to right of
incision…tender to deep palp
lateral to & right & left of
incisions. Likely explained?
11yo girl…. Mom concerned Menarche is imminent (not
daughter periods will start soon. precocious puberty)
Mom's menarch at 14yo. Pt is
90th% for wt, 75% for height.
She's had recent mood changes.
Breast & pubic hair, tanner 3.
Recent pubic hair is most
predictive of which?
42yo g3p3 menses irreg 2-3 ANOVULATION (not
month intervals, lasted 7- multiparity, or age)
21days. Enlarged uterus,
Endometrial biopsy atypical
complex hyperplasia. DM2, BM
32. Which is strongest
predisposing factor for pt's
condition?
15yo 10 episodes of Hematocolpos??
cramps…tanner breast 5. Mass
palpated in suprpubic region at
midline. Cervix can't be
visualized bc of bluish bulging
vaginal tissue obscures upper
vagina. Diagnosis?
38weeks, 2cm dilated, vertex -1 Cephalopelvic Disproportion
station. Cervix & station
unchanged. 1 hr later,
conditions unchanged why?
21yo DC, purulent cervical DC & Gonorrhea (NOT chlamydia…bc
cervical motion tenderness. can't be gram stained)
GRAM STAIN of DC shows (pic:
red…+bugs) Bug?
Enlarged irreg, smooth, freely SubMUCOSAL (not subserosal)
mobile uterus, heavy periods.
US shos leiomya uteri. Which is
likely TYPE of leiomyoma?
33wks. US shows Uteroplacental insufficiency
Olighydramnios & fetus (NOT fetal renal agenesis)
consistent in size w/30wks.
Which is most likely cause of
oligohydramnios?
22yo comes bc of second Spontaneous disappearance of
episode of painful vesicular lesions within 1 week (herpes)
genital lesions. Nex sex parter
has similar lesions on penis.
Most likely CLINICAL course?
17yo, never had menstrual Follicle-stimulating hormone
period & has not had breast FSH (NOT GnRH)
development. BMI 31. Tanner
stage breast 1. Should check
serum concentration sof which?
24yo 3ows, bright red vaginal Cervical Trauma (not previa or
bleeding noticed as spotting on preterm labor or abruption)
underwhear first 12hrs after sex
intercourse. Bleeding has
increased. External fetal
monitoring shows 2 contractions
during next hour. Which is likely
Cause of pt's bleeding?
2mo h/o dull right-sided pelvic Oral Contraceptive therapy and
pain. Pain most severe during a second pelvic exam in 6 wks.
menses. U/S shows 5cm simple
cyst. She's anxious about paying (NOT: Reassurance & schedule
for tx bc insurance expires in 2 f/u in 1 yr, NOT: Ultrasound
wks. Which is next step? guided drainage of cyst)
18hrs post c-section. Pt has Atelectasis (not endometritis)
FEVER. PE: Decreased breath
sounds heard bilaterally.
Diagnosis?
67yo vulva itching for 2 years., Punch biopsy of affected areas
PE: shows 3 1cm areas of white
epithelium over left labium (NOT application of
majus. Which is next step? corticosteroid cream)
Prior to DC, pt likes to resume Decreased protein content in
combination OCP + breast feed, breast milk
Dr should warn about potential
problems? (not "decrased effectiveness in
preventing pregnancy", or
"Increased incidence of
mastitis")
Third UTI….Daily administration Trimethoprim-
of which is most appropriate sulfamethoxazole (daily is ok….
prophylaxis against recurrence? NOT: "Penicillin")
32wks, irreg uterine Chorioamnionitis
contractions for 3 hrs. Watery
vag DC that tests positive to
Nitrazine. Likely cause of
findings?
2oyo, hair grows on face…. INCREASED 5alpha-reductase
Likely cause of pt's hair growth? activity

(NOT "Increased estrogen


concentration")
Yellow-gray frothy DC with fishy Flagellated Protozoa (Trich)
odor. A wet mount prep of DC
likely show which? NOT"Multinucleated giant cells
= BV")
32wks irreg uterine contractions Chorioamnionitis (not
3 hrs. Fever 100.8, Cervix 80% abruption, or preterm labor)
effaced, 2cm dilated, vertex -
1station. Watery vag discharge
tests positive to nitrazine.
Caused by?
She has hyperthyroid Propylthiouracil (PTU)
symptoms…. Give? (not potassium iodide)
67yo. DM2…redness, swollen DM-2
vulva, papules, pustules on
medial thighs. KOH prep of
pustule scrapings show budding
yeast. Which is underlying cause
of pt's failure to respond to
treatment?
Achondroplasia Autosome Dominant
Nonfluctuant red breasts Mastitis
10wks gestation, enlarged Suction & Curettage
uterus w/no fetus. B-hcg high.
Scattered hyperechoic material.
…what's next step?

 One of the biggest problems in families in this country is not having enough money

 Free since 40yo. Free on his 40th birthday. Been free for over 30 years. (started when 36…)
4yrs 4months

 Free, motivated, excited, Helping make a difference in the world “Not because I’m great, but
I’m involved in something great”

 He could see it when it didn’t exist. Now it exists, we could see it when others couldn’t see it.
We believed it. We believed so much, we believed it would happen.
He knew he would be able to find people somewhere who wanted to be free like him
He wasn’t the only freak in the world who wanted to be free. And he found a lot of them.

 Only reason you can’t do this business is you believe you can’t find other people who want to
be free.

 We’re in the education business


In this business, there’s Education
Success is nothing more applied education

 People that don’t go to the meetings don’t make it


People who made it, made the meetings important
The values of these meetings is valuable
If you apply yourself

 We’re the result of our thinking. If our thinking’s wrong, our results are going to be wrong.
We want to change that so people can think truth. Because TRUTH is what sets us free not
anything but truth. The only thinking that sets you free is truth

 That’s what the organization’s about. They don’t teach truth in schools, in college. They have
people teaching on theory. Here we teach on facts.
I just needed a piece of paper that said I was smart enough to have graduate from graduate
school. So I could be good in my profession.

 “a lot of people don’t like me…in the beginning. And I like that. I don’t like losers to like me. I’d
like them to like me when they’re winners.
“Cause I say some things that people don’t like when they’re broke
If anybody intends on staying broke, you’re going to hate me.”
If you want to be broke, you shouldn’t be in this room
If you want to work for someone for the rest of your life, you ought to get up and get out of
here”
If you’re serious about your future, you’re in the best place….to learn how to own your own
freedom. This IS the best business opportunity. We’ve proven it for over 30 years

We were told “it wouldn’t work”….. we didn’t believe them


Showed 19 people straight and got “NO”…. I thought I was doing something wrong….I was. I
didn’t know what I was doing.
Everyone has to go through NOT KNOWING what you’re doing to learn HOW to do what you
WANT to do

No one knows exactly how to do it. YOU GOT TO MAKE SOME MISTAKES, learn how to do it so
you can get GOOD AT IT.
Most things you do a lot of it, you’ll get good at it.

 Money doesn’t own me, I own it.

 Success cannot be measured by the dollar bill ever. It is only measured by the positive
influence in someone’s life. And through this business “I’ve” given hope and helped people. We
can be that positive influence. We can help people to help people to grow in what ever area of
life they need to grow. Because this opportunity is here. It is an opportunity – PEGGY BRITT

 One of the advantages of this business back then and even now. Many people can get started in
their own independent business without having to invest anything except what everybody has…
a little time.
Many people will say they don’t have any extra time. “we are busy people, but we found extra
time and INVESTED IN OURSELVES…which is important. OUR VALUABLE TIME we invested in
it. - Peggy

 That 4% bonus comes on and on and on for years etc. on time. Never late or never come in.
“the promises of the circles are still true”

 The bonuses came in because of our efforts

FOR COUPLES
 This is great because you’re in it together (for couples)
As a single, there will be couples in the downline… so know how they go thru it.

 Have something to work together towards. Common Goals. Common interests. Having same
friends, rather than going your separate ways in the morning to work, and having a separate
set of friends.
The people in the business are the best. The cream of the crop

 SUCCESS. What is success?


The more people that are better off because you’ve lived….increases possibly with your success.
Success is how many people are better off because you lived.

….lead to other people benefiting from your life.


The better off the world is because the better off people are, that have benefit from your life.
But you look at HOW CAN YOU MAXIMIZE your life. There’s one answer.
That’s a business where you can EMPOWER people, that empower people, to empower
people….and that’s real POWER.
That’s real power that’s available for anyone to use. Those that will apply themselves

Thought: We this work around the world?


 Very few people know anything about the Laws that govern personal success, no matter which
country, no matter which part of the world you live in .

 Very few people understand the principles of TRUE SUCCESS

 THE POWER OF WORDS


People have great power and great AUTHORITY, is HOW YOU USE WORDS.
Words are the MOST POWERFUL things in the universe.
It’s how people use words that determine where they are and where they’re going.
Words are SEEDS. You say them, that’s planting them.
Whatever a man sows or woman sows, so shall he/she reaps.

POWER OF LIFE AND DEATH in your tongue

 It’s so simple, they make it complicated. It’s so simple, and factual and so absolute, that most
people never see it.
It’s fact that WORDS create war, peace, love, hate.

 You have friends because you’ve attracted them to you by the way you speak
And your actions and your words go together. When they’re not confusing each other.
(congruent with each other)

 You have unbelievable power. Because you have a brain that can do 20,000 calculations a
second. You’ve got a magnificent gift

 YOU have power. You have the power to EMPOWER people


And people who use that power to empower people for a good cause and good purpose,
become wealthy

 If you say “I can” – you can do it


 Say “it’s the right thing to do, and I’m going to do it.”

 If you can say

“I need to be free,
I will be free,
I know what to do to be free.
It would be silly Not to do it. , and I will do it.
Cause it’s the right thing to do.
That’s it, period.

 I don’t have to sell myself on being free


I ought to be free
I was born to be free
I wasn’t born to be someone’s slave
I wasn’t born to work all my life for nothing
I was born to WIN
I’m born to be a VICTOR
And that’s the way it is. If anybody doesn’t like it then take a flying leap

 You listen to the world, then you’ll work for somebody. That’s better than starving.
But that’s not where it is.
I have nothing against a job, I just know it’s not something you have to do for the rest of your
life.
Sometimes you need a job so you can get your future going

It’s okay to burn the candle from both ends for a while.

 If people

 Every single man, woman in this room, YOU HAVE POWER you never dreamed you have.
Because if you get your mind, and your subconscious and conscious mind agreeing with each
other, and headed in the right direction, there’s nothing that can stop you from making your
dream a reality.

Me: You have the power to go EMPOWER people

 When people SPEAK CRAP words, they plant “Crap” crops, and they reap CRAP.

 You go to college, you learn the crap words. When you say the CRAP words, you’ve planted
them. And that’s what you’re going to reap

 NO wonder there’s so many people broke in America. The symbol of the world of FREEDOM →
Free Enterprise , Entrepreneurship….. and 95% are broke.

Hurting. It don’t have to be. There’s power to be had, and authority. God gave you that power.
I have the power, and the authority to use that POWER that God gave me. And so do you. And if
you don’t accept that power and use that power, it’s as if I never had it.
THAT POWER IS TO EMPOWER OTHER PEOPLE

You got to empower others.


 You got to share that power.
And the one you share it with, has the same right to learn the same thing, and live at the level
that you live at if you help empower them to help empower other people.

 Never heard it elementary, middle, high, college, grad school


Never heard it until I got into this Silly Soap Selling Circle drawing business
(haha)

 Where did he get all this knowledge?


People stand around him and just listen to him talk
Told me the books he read, and I read the same ones
Audios he listened to, and I heard the same ones.
Then I got the same message that he did. Then people sat around me and listened to me

Cause I had the same power, and the same Authority to use it.

 Winners always know they’re going to win before they win. They don’t win by mistake. They
know they’re going to win, and they win.

 That’s why (Bill’s) daily income is more than most professional people make in America. He can
sleep until 12pm and make more than most people make all year.
It isn’t because how GREAT he is, it’s because HE LEARNED THE POWER, and learned the
Authority to use it.

THE POWER TO GO EMPOWER PEOPLE!

SELF TALK 42.00


 I WILL overcome whatever I have to overcome.
 I’ll get bigger than my problems. I’ll rise above whatever it is.
o Cause I got that Authority, and I got that power
 I’ll keep on keeping on.
 It WILL GET DONE
 I WILL NOT BE DENIED
 I REFUSE to be DENIED
 And that’s it. IF somebody don’t like it, they can hide in the bushes and watch
 I don’t let anybody STEAL MY DREAMS