(c) Elmar P. Sakala, MD MPH (2011) 1
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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- β-hCG test
Sono: simple cyst
Sono: complex/solid
Acute severe pain
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Premenopausal Pelvic mass
© Elmar P. Sakala, MD, MPH
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CV disease & Hormone Therapy
Recommendations: HT (E+P) 2003
© Elmar P. Sakala, MD, MPH
Critique of WHI study
© Elmar P. Sakala, MD, MPH
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“WINDOW of OPPORTUNITY” Critical period for maximum response to HT
© Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004
WHI
Not Here
Start HT here
Menopause
10 yrs too Late!!
Progestin
Progestin
Progestin Hysterectomy
TAH, BSO
Natural History Treatment
© Elmar P. Sakala, MD, MPH
Non-contraceptive Benefits Steroid Contraception
↓ Dysmenorrhea
↓ DUB
↓ PID
↓ Ectopic preg
suppress PG release
stabilizes endometrium
thickens cervical mucus
thickens cervical mucus
© Elmar P. Sakala, MD, MPH
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Metabolic Effects Steroid contraception
Estrogen mediated
Progestin mediated
THROMBOSIS ↑ venous & arterial
Unhealthy lipid profile (↓ HDL, ↑ LDL)
Healthy lipid profile (↑ HDL, ↓ LDL)
© Elmar P. Sakala, MD, MPH
Oral Contraceptives Risk of CANCER
Ovarian
Endometrial
Breast
Cervical
↓
↑ ↑ =
© Elmar P. Sakala, MD, MPH (August, 2011)
Intrauterine Contraception
Steroid Contraception
Contraception Review
© Elmar P. Sakala, MD, MPH
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Contraceptive Failure Rates Reversible Methods
© Elmar P. Sakala, MD, MPH
Basic Principles of Contraception Avoid contraindications
© Elmar P. Sakala, MD, MPH
Basic Principles of Contraception Avoid contraindications
Completed childbearing Sterlization
© Elmar P. Sakala, MD, MPH
FEW Complic
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FEMALE - Next step in management?
β-hCG
β-hCG
β-hCG
β-hCG
PREGNANCY - Next step in management?
OB sono OB Sono OB Sono OB SONO
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Pathophysiology
F E T U S
M O M
Vol of RBC needed: varies from 0.1mL to 450 mL
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HEAD Compression
CORD Compression
PLACENTAL Insufficiency
© Elmar P. Sakala, MD, MPH
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© Elmar P. Sakala, MD, MPH
Fetal Fibronectin
Matrix that bonds Trophoblast to Decidua
Predictor of Preterm Delivery
“Trophoblast Glue”
Cervical Length
Saggital Image
Normal: > 25 mm
Vaginal Sonogram 1
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TOCOLYTIC agents
Agent
β-Adrenergic Agonists
Ca++ channel blockers
Side Effects
↓ BP, tachycardia, ↑ glucose, ↓ K+, Pulmonary edema
Tachycardia, ↓ BP Myocardial depression
Contraindications
Cardiac disease Diabetes Uncontrolled ↑T4
Cardiac disease Hypotension
PG synthetase inhibitors
Oligohydram, IU closure PDA, Necrotiz enterocolitis
Gestational age > 32 weeks
MgSO4
Muscle weakness Respiratory depression Pulmonary edema
Renal insuffic Myasthenia gravis
Described in notes p. 44
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