usmle step 3 essestial ob/gyn ppt

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USMLE Step 3 Obstetrics-Gynecology Supplement Elmar P. Sakala, MD, MPH Professor of Gynecology & Obstetrics Loma Linda University School of Medicine January, 2013 Copyright © Elmar P. Sakala, MD, MPH (2013) No part of this document can be reproduced or transmitted, in any form or by any means, without the written permission of the author.

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(c) Elmar P. Sakala, MD MPH (2011)

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Premenopausal Pelvic mass β-hCG test

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Sono: simple cyst

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Sono: complex/solid

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Acute severe pain © Elmar P. Sakala, MD, MPH

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(c) Elmar P. Sakala, MD MPH (2011)

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CV disease & Hormone Therapy J

Recommendations: HT (E+P) 2003

© Elmar P. Sakala, MD, MPH

(c) Elmar P. Sakala, MD MPH (2011)

Critique of WHI study

© Elmar P. Sakala, MD, MPH

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Menopause

WHI

“WINDOW of OPPORTUNITY” Critical period for maximum response to HT

10 yrs too Late!!

Start HT here

Not Here

Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004

© Elmar P. Sakala, MD, MPH

Natural History

Treatment

Non-contraceptive Benefits Steroid Contraception

Progestin

Progestin Progestin Hysterectomy

↓ Dysmenorrhea

suppress PG release

↓ DUB

stabilizes endometrium

↓ PID

thickens cervical mucus

↓ Ectopic preg

thickens cervical mucus

TAH, BSO © Elmar P. Sakala, MD, MPH

(c) Elmar P. Sakala, MD MPH (2011)

© Elmar P. Sakala, MD, MPH

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Oral Contraceptives Risk of CANCER

Metabolic Effects Steroid contraception

Ovarian

Healthy lipid profile (↑ HDL, ↓ LDL)

Estrogen mediated

THROMBOSIS

↑ venous & arterial

Unhealthy lipid profile (↓ HDL, ↑ LDL)

↓ Endometrial = ↑

Breast

↑ Cervical

Progestin mediated © Elmar P. Sakala, MD, MPH

Contraception Review Intrauterine Contraception

© Elmar P. Sakala, MD, MPH (August, 2011)

(c) Elmar P. Sakala, MD MPH (2011)

Steroid Contraception

© Elmar P. Sakala, MD, MPH

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Contraceptive Failure Rates

Basic Principles of Contraception

Reversible Methods

Avoid contraindications

© Elmar P. Sakala, MD, MPH

© Elmar P. Sakala, MD, MPH

Basic Principles of Contraception Avoid contraindications FEW Complic

Completed childbearing Sterlization © Elmar P. Sakala, MD, MPH

(c) Elmar P. Sakala, MD MPH (2011)

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FEMALE - Next step in management?

PREGNANCY - Next step in management?

OB sono

β-hCG

OB Sono OB Sono OB SONO

β-hCG β-hCG β-hCG

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(c) Elmar P. Sakala, MD MPH (2011)

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Pathophysiology

F E T U S

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M O M

Vol of RBC needed: varies from 0.1mL to 450 mL

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Mechanism of FHR Decelerations HEAD

Compression

CORD

Compression

PLACENTAL Insufficiency

© Elmar P. Sakala, MD, MPH

(c) Elmar P. Sakala, MD MPH (2011)

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Fetal Fibronectin “Trophoblast Glue” Matrix that bonds Trophoblast to Decidua Predictor of Preterm Delivery © Elmar P. Sakala, MD, MPH

Cervical Length Vaginal Sonogram Saggital Image

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Normal: > 25 mm

(c) Elmar P. Sakala, MD MPH (2011)

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Described in notes p. 44

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TOCOLYTIC agents

Agent

Side Effects

MgSO4

Muscle weakness Renal insuffic Respiratory depression Myasthenia gravis Pulmonary edema

β-Adrenergic Agonists

↓  BP, tachycardia, ↑ glucose, ↓ K+, Pulmonary edema

Cardiac disease Diabetes Uncontrolled ↑T4

Ca++ channel blockers

Tachycardia, ↓ BP Myocardial depression

Cardiac disease Hypotension

PG synthetase inhibitors

Oligohydram, Gestational age IU closure PDA, Necrotiz enterocolitis > 32 weeks

Contraindications

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(c) Elmar P. Sakala, MD MPH (2011)

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