Category: NBME Shelf Review

NBME Shelf Review (Part 11)- OBGYN

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

© 2020 EM Clerkship

Theme by Anders NorenUp ↑