An 81-year-old g3p3 woman presents to your office with a history of light vaginal spotting. she states this has occurred recently and in association with a thin yellow discharge. she has not experienced any vaginal bleeding since menopause at the age of 52 and denies ever having been on hormone replacement therapy. she has osteoporosis, well-controlled hypertension and diabetes. she is physically active and still drives to all her appointments. she is no longer sexually active since the death of her husband two years ago. on examination, she is noted to have severe atrophic changes affecting her vulva and vagina. a small pederson speculum allows for visualization of a normal multiparous cervix, and the bimanual examination is notable for a small, mobile uterus. rectovaginal exam confirms no suspicious adnexal masses or nodularity. which of the following is the most appropriate management for this patient? a. pelvic transvaginal ultrasound
b. office endometrial biopsy
c. reassurance and observation for further bleeding
d. vaginal estrogen therapy
e. clindamycin vaginal cream

Muscles in the body us with a lot of things for example, if i wanted to lift a heavy box and had no muscle i would just collapse where i was because of the fact muscles hold us together. overall they are 650 muscle in the human body, all of them have different purposes and ways to keep us together. there are three types of muscle in the body skeletal, smooth, and cardiac muscle. skeletal muscle are attached to the bone and with movement. smooth muscle, this is found in the wall of our organs, such as our stomach, this muscle with movement   as well, without this muscle, we would only be allowed to eat small amounts. the cardiac muscle is the heart muscle and probably the most important one. these are only found in the walls of the heart and the heart pump blood to the other parts of your body. we have two different types of muscle fibers, slow twitch and fast twitch. slow twitch muscles enable long-endurance feats such as distance running. fast twitch fatigue faster but are used in powerful bursts of movements like sprinting. there are three different types of muscle contractions concentric, eccentric, isometric. concentric contraction causes muscles to shorten, thereby generating force.   eccentric contractions cause muscles to elongate in response to a greater opposing force. isometric contractions generate force without changing the length of the muscle.: //athleticquickness.com/muscle-contraction-types-part-1/