NBME Shelf Review (Part 11) – OBGYN
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 9 December 2018
⏱️ 12 minutes
🧾️ Download transcript
Summary
Think A-B-C-P (Airway, Breathing, Circulation, Pregnancy Test) in ALL Women of Child-Bearing Age!
* It changes the differential diagnosis* It changes the medications you can give* It changes the tests you can order
Vaginal Bleeding Pearls
* Non-pregnant vaginal bleeding* Order a pelvic ultrasound (for structural causes)* Order a CBC and coagulation panel (for anemia and coagulopathy)* Pregnant vaginal bleeding* If sick…* Think ectopic pregnancy (early pregnancy)* Think uterine rupture (late established pregnancy)* Think placental abruption (recent trauma or cocaine)* Don’t forget to order a type and screen* Rh- mothers will need RhoGam* If patient is unstable and you can’t wait for blood type…* Transfuse type O negative blood* Postpartum vaginal bleeding* Most common cause is retained products of conception* Order an ultrasound* Consider endometritis if patient also has fever* Treat with clindamycin and gentamycin
Vaginal Discharge Pearls
* Cervical motion tenderness?* Pelvic Inflammatory Disease (PID)* Thin, grey, and smells like fish?* Bacterial vaginosis (BV)* Treat with metronidazole* Warn patient not to mix metronidazole with alcohol* Thick like cottage cheese?* Vulvovaginal candidiasis* Diagnosis with KOH prep* Look for yeast and pseudohyphae* Treat with fluconazole* Thin Yellow/Green and “frothy”?* Trichomoniasis* Diagnose with wet prep* Look for mobile organisms* Treat with metronidazole* Partners should be checked and treated too
Ovarian Torsion
Severe and sudden pain
* Can be intermittent* Diagnose with Pelvic ultrasound with Doppler* PITFALL: Frequently has normal arterial flow (dual blood supply to ovary)
Additional Reading
* Approach to Non-Pregnant Vaginal Bleeding (EM Clerkship)* Approach to 1st Trimester Vaginal Bleeding (EM Clerkship)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
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| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.aI. Hey guys, what's going on? This is Mike Estefan from the University of Rochester |
| 0:50.4 | School of Medicine, bringing you episode 11 in the emergency medicine shelf exam review |
| 0:56.1 | series. In this week's episode, we're going to be covering a couple topics from Obie Gein that |
| 1:01.4 | will be high yield for your shelf exam. Now, just a disclaimer, this is not meant to be an end-all |
| 1:08.1 | be-all resource for Obi-Gine. Okay, this is meant to help you guys score |
| 1:12.6 | a couple more points on your shelf exam. With that being said, let's get started by talking about |
| 1:17.8 | how I generally approach these questions. For any question involving a pre-menopausal woman, |
| 1:24.2 | you must start out with your ABCPs. A for airway, B for breathing, C for circulation, |
| 1:32.5 | and P for pregnancy test. Every premenapausal woman needs a pregnancy test. Even if they're not |
| 1:40.1 | presenting with an abdominal or a pelvic complaint, they still need a pregnancy test. This is because, |
| 1:46.6 | obviously, it'll affect what type of imaging you can order and which type of medications you can give. |
| 1:52.8 | So if the vignette gives you a premenopausal female and does not give you the result of a urine |
| 1:58.2 | pregnancy test, boom, you're done. The answer is urine pregnancy |
| 2:02.2 | test. That is, assuming her ABCs are fine. Now, the biggest topic for this shelf exam in the realm |
| 2:09.1 | of OB-Gyne is going to be vaginal bleeding. You can break this up into three separate categories. |
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