TOPICS ON SHELF EXAM (NBME)

2. PRENATAL RISK ASSESSMENT AND ANTENATAL CARE

3. SUPERVISION OF NORMAL PREGNANCY

Read and review Guidelines for Perinatal Care Pages 154-175 (COVERS TOPIC 2 ALSO)

4. OBSTETRIC COMPLICATIONS

FOCUS ON THE FOLLOWING CONDITIONS: Hypertensive Disorders in Pregnancy, Alloimmunization, Multifetal Gestation, Third Trimester Bleeding, Preterm Labor, Premature Rupture of Membranes, Postpartum Hemorrhage, Intrauterine Growth Restriction

Hypertensive Disorders of Pregnancy Objectives:

• Define the types of hypertensive disorders in pregnancy

• Describe the pathophysiology of preeclampsia

• List risk factors for preeclampsia

• Recognize the signs and symptoms of diagnosing preeclampsia

• Explain the management and treatment of patient with preeclampsia

• List the maternal and fetal complications associated with preeclampsia-eclampsia

WATCH APGO VIDEOS AND READ CONTENT IN PERINATAL GUIDELINES CHAPTER 9

Alloimmunization

Describe the pathophysiology and diagnosis of alloimmunization

Describe the use of immunoglobulin prophylaxis during pregnancy for the prevention of alloimmunization

Discuss the management of a patient with Rh-D sensitization in pregnancy

Watch APGO video and review attached Practice Bulletins

Multifetal gestation

• List the risk factors for multifetal gestation

• Describe embryology of multifetal gestation

• Describe the unique maternal and fetal physiologic changes associated with multifetal gestation

• Describe the diagnosis and management of multifetal gestation

• Describe the potential maternal and fetal complications associated with multifetal gestation

Watch videos. and review practice bulletin.

Third Trimester Bleeding

• List the causes of third trimester bleeding

• Describe the initial evaluation of a patient with third trimester bleeding

• Differentiate the signs and symptoms of third trimester bleeding

• List the maternal and fetal complications of placental previa and abruption placenta

• Describe the initial evaluation and management plan for acute blood loss

• List the indications and potential complications of blood product transfusion

Watch video and review article.

Preterm Labor

• Identify the modifiable and non-modifiable risk factors and causes for preterm labor

• Describe the signs and symptoms of preterm labor

• Describe the initial management of preterm labor

• List indications and contraindications of medications used in preterm labor

• List the adverse outcomes associated with preterm birth

• Describe the counseling for reducing preterm birth risk

Watch the video.

Premature Rupture of Membranes

• List the history, physical findings and diagnostic methods to confirm rupture of the membranes

• Identify risk factors for premature rupture of the membranes

• Describe the risks and benefits of expectant management versus immediate delivery based on gestational age

• Describe the methods to monitor maternal and fetal status during expectant management

Watch the vido

Postpartum Hemorrhage

• List the risk factors for postpartum hemorrhage

• Construct a differential diagnosis for immediate and delayed postpartum hemorrhage

• Develop an evaluation and management plan for the patient with postpartum hemorrhage including considerazation of various resource settings

Watch the video and review chapter on Postpartum Care in Guidelines (pay attention to contraception)

Intrauterine Growth Restriction

• Define macrosomia and fetal growth restriction

• Describe etiologies of abnormal growth

• List methods of detection for fetal growth abnormalities

• Describe the management of fetal growth abnormalities

• List the associated morbidity and mortality of fetal growth abnormalities

Labor & Delivery

• Differentiate between the signs and symptoms of true and false labor

• Perform the initial assessment of the laboring patient

• Describe the four stages of labor and recognize common abnormalities

• Explain pain management approaches during labor

• Describe methods of monitoring the mother and fetus

• Describe the steps of a vaginal delivery

• List indications for an operative delivery

• Identify maternal risks specific to delivery in developing countries

Watch videos and read chapter Chapter 7 in Guidelines Perinatal care and watch video.

Puerperium, Including Complications

• Discuss the normal physiologic changes of the postpartum period

• Describe the components of normal postpartum care

• Outline topics to cover in postpartum patient counseling

• Describe appropriate postpartum contraception

Watch videos and review chapter

Newborn Care (birth to 4 weeks of age)

• List techniques for assessing newborn status

• Describe immediate care of the normal newborn

• Recognize situations requiring immediate intervention in newborn care

• Describe the risks and benefits of male infant circumcision

Read Chapter 10 in Guidelines

Congenital Disorders, Neonatal

Review conditions on the following CDC page:

https://www.cdc.gov/ncbddd/birthdefects/types.html

Adverse Effects of Drugs on Pregnancy

Review List of Medications and Adverse Effects on the following webpage:

https://www.merckmanuals.com/professional/gynecology-and-obstetrics/drugs-in-pregnancy/drugs-in-pregnancy#v26436056

Systemic Disorders Affecting Pregnancy

A student should be able to:

Identify the following medical and surgical conditions in pregnancy and discuss the potential impact of the conditions on the gravid patient and the fetus/newborn, as well as the impact of pregnancy (if any) on each condition, and appro- priate initial evaluation:

• Anemia

• Endocrinedisorders,includingdiabetesmellitusandthyroiddisease • Cardiovasculardisease

• Hypertension

• Pulmonary disease

• Renal disease

• Gastrointestinal disease

• Neurologicdisease

• Autoimmune disorders

• Alcohol,tobacco,and substance abuse

• Surgical abdomen

• Infectiousdiseases,including:

§ Syphilis

§ TORCH(Toxoplasmosis,Rubella,Cytomegalovirus,Herpes)

§ GroupBStreptococcus

§ Hepatitis

§ HumanImmunodeficiencyVirus(HIV)

§ HumanPapilomavirus(HPV)andothersexuallytransmittedinfections § Parvovirus

§ Varicella

Review Chapter 9 in Guidelines: Medical Complications Before Pregnancy

Adverse Effects of Drugs on Pregnancy

Review URL link (summary of medication effects-should cover any questions) and review URL on substance use in pregnancy and watch video

https://www.merckmanuals.com/professional/gynecology-and-obstetrics/drugs-in-pregnancy/drugs-in-pregnancy#v26435950

https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding

5. Gynecology: Female Reproductive System and Breast

Normal processes: menstrual cycle, ovulation, puberty

Breast Disorders

• List factors that place individuals at risk for breast disorders

• Describe symptoms and physical examination finding of benign or malignant conditions of the breast

• Demonstrate the performance of a clinical breast examination

• Discuss the steps in the evaluation of common breast complaints: mastalgia, mass, nipple discharge

• Discuss initial management options for benign and malignant conditions of the breast

Watch videos and review article

Infectious Diseases of Female Reproductive Tract

Watch videos. I have attached URL for CDC Guidelines for STIs. It is a long document so focus on individual infections and summaries.

https://www.cdc.gov/MMWR/pdf/rr/rr6403.pdf

Neoplasms in Gynecology

Cervical

• Describethepathogenesisofcervicalcancer

• Identifytheriskfactorsforcervicalneoplasiaandcancer

• Listtheguidelinesforcervicalcancerscreening

• DescribetheinitialmanagementofapatientwithanabnormalPapsmear

• Describethesymptomsandphysicalfindingsofapatientwithcervicalcancer

Ovarian Cancer

• Describetheinitialmanagementofapatientwithanadnexalmass

• Compare the characteristics of functional cysts, benign ovarian neoplasms and ovarian cancers

• Listtheriskfactorsandprotectivefactorsforovariancancer

• Describethesymptomsandphysicalfindingsassociatedwithovariancancer

• Describethethreehistologicalcategoriesofovarianneoplasms

Uterine Cancer and Hyperplasia

• Listtheriskfactorsforendometrialhyperplasia/cancer

• Describethesymptomsandphysicalfindingswithendometrialhyperplasia/cancer

• Outlinethecauses,diagnosisandmanagementofpostmenopausalbleeding

Vulvar Neoplasms

• Listtheriskfactorsforvulvarneoplasms

• Describesymptomsandphysicalexaminationfindingsofapatientwithvulvarneoplasms

• Listtheindicationsforvulvarbiopsy

Inflammatory and Immunologic Disorders of the Female Reproductive Tract

Read attached articles. Good for clinical care as well

Fertility and Infertility

• Define infertility

• List the causes of male and female infertility

• Describe the evaluation and initial management of an infertile couple

• Describe the psychosocial issues associated with infertility

• Describe management options for infertility

• Describe ethical issues confronted by patients with infertility

• Identify the impact of genetic screening and testing on infertility associated treatments.

Menopause

• Define menopause and describe changes in the hypothalamic-pituitary-ovarian axis associated with perimeno- pause/menopause

• Describe symptoms and physical exam findings related to perimenopause/menopause

• Discuss management options for patients with perimenopause/menopausal symptoms

• Counsel patients regarding the menopausal transition

• Discuss long-term changes associated with menopause

Menstrual and Endocrine Disorders

Amenorreha

• Define amenorrhea and oligomenorrhea

• Explain the pathophysiology and identify the etiologies of amenorrhea and oligomenorrhea, including

possible nutritional causes

• Describe associated symptoms and physical examination findings of amenorrhea

• Discuss the steps in the evaluation and initial management of amenorrhea and oligomenorrhea

• Describe the consequences of untreated amenorrhea and oligomenorrhea

Watch video

Hirsutism and Virilization

• Recognize normal variations and abnormalities in secondary sexual characteristics

• Define hirsutism and virilization

• Describe pathophysiology and identify etiologies of hirsutism

• Describe the steps in the evaluation and initial management options for hirsutism and virilization

• Describe how hirsutism and virilization are manifested in other medical disorders

Watch videos

Abnormal Uterine Bleeding

• Define the normal menstrual cycle and describe its endocrinology and physiology

• Define abnormal uterine bleeding

• Describe the pathophysiology and identify etiologies of abnormal uterine bleeding

• Describe the steps in the evaluation and initial management of abnormal uterine bleeding

• Summarize medical and surgical management options for patients with abnormal uterine bleeding

Watch video and read article

Dysmenorrhea

• Define dysmenorrhea and distinguish primary from secondary dysmenorrhea

• Describe the pathophysiology and identify the etiologies of dysmenorrhea

• Discuss the steps in the evaluation and management options for dysmenorrhea

Watch video and review

Premenstrual Syndrome and Premenstrual Dysphoric Disorder

• Identify the criteria for making the diagnosis

Miscarriage and Ectopic Pregnancy

Sexual Dysfunction