Usmle Step 2 Ck Review Notes

Only available on StudyMode
  • Topic: Combined oral contraceptive pill, Pregnancy, Cervix
  • Pages : 7 (447 words )
  • Download(s) : 47
  • Published : April 20, 2013
Open Document
Text Preview
J

1

J

Premenopausal Pelvic mass
β-hCG test +

Sono: simple cyst +

Sono: complex/solid +

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

J

J

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

2

CV disease & Hormone Therapy
J

Recommendations: HT (E+P) 2003

Critique of WHI study

© Elmar P. Sakala, MD, MPH

© Elmar P. Sakala, MD, MPH

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

3

Menopause

WHI

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

10 yrs too Late!!

Start HT here
© Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004

Not Here

Natural History

Treatment

Non-contraceptive Benefits
Steroid Contraception

Progestin

Progestin Progestin Hysterectomy

↓ Dysmenorrhea ↓ DUB ↓ PID ↓ Ectopic preg

suppress PG release stabilizes endometrium thickens cervical mucus thickens cervical mucus

TAH, BSO
© Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH

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

4

Metabolic Effects
Steroid contraception
Healthy lipid profile (↑ HDL, ↓ LDL)

Oral Contraceptives Risk of CANCER

Estrogen mediated

THROMBOSIS

↑ venous & arterial

↓ Endometrial ↑ Cervical
= ↑
Breast

Ovarian

Unhealthy lipid profile (↓ HDL, ↑ LDL)

Progestin mediated
© Elmar P. Sakala, MD, MPH

Contraception Review
Intrauterine Contraception Steroid Contraception

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

© Elmar P. Sakala, MD, MPH

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

5

Contraceptive Failure Rates
Reversible Methods

Basic Principles of Contraception
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)

6

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

J

J

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

7

Pathophysiology

J

F E T U S
Vol of RBC needed: varies from 0.1mL to 450 mL

M O M

J

Mechanism of FHR Decelerations HEAD

Compression

Compression

CORD

PLACENTAL
Insufficiency
© Elmar P. Sakala, MD, MPH

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

8

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 Normal: > 25 mm
2 1

3

4

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

9

Described in notes p. 44 Agent

TOCOLYTIC agents
Side Effects Contraindications

J

MgSO4 β-Adrenergic Agonists Ca++ channel blockers PG synthetase inhibitors

Muscle weakness Renal insuffic Respiratory depression Myasthenia gravis Pulmonary edema ↓  BP, tachycardia, ↑ glucose, ↓ K+, Pulmonary edema Tachycardia, ↓ BP Myocardial depression Cardiac disease Diabetes Uncontrolled ↑T4 Cardiac disease Hypotension

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

J

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

10

tracking img