Usmle Step 2 Ck Review Notes

J 1 J Premenopausal Pelvic mass ?-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 â€Å"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 HistoryTreatment Non-contraceptive Benefits Steroid Contraception Progestin Progestin Progestin Hysterectomy v Dysmenorrhea v DUB v PID v 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 He althy lipid profile (^ HDL, v LDL) Oral Contraceptives Risk of CANCER Estrogen mediated THROMBOSIS ^ venous & arterial v Endometrial ^ Cervical = ^ Breast Ovarian Unhealthy lipid profile (v 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? -hCG ? -hCG ? -hCG ? -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 need ed: 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 â€Å"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 1 3 4 (c) Elmar P. Sakala, MD MPH (2011) 9 Described in notes p. 44 Agent TOCOLYTIC agents Side Effects Contraindications J MgSO4 ? -Adrenergic Agonists Ca++ channel blockers PG synthetase inhibitors Muscle weakness Renal insuffic Respiratory depression Myasthenia gravis Pulmonary edema v? BP, tachycardia, ^ glucose, v K+, Pulmonary edema Tachycardia, v 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