Divine Intervention Episode 239 – The NBME and OBGYN Risk Factors - Step 2 CK / Shelf Review

Speaker 1 Okay, welcome. My name is Speaker 2 divine. I'm a Speaker 3 resident and this is official 239 of the divine intervention podcasts. This is going to be a pretty short podcast, but it's going to be a floor at Lehigh your podcast. Basically, if you're about to take Step 2, CK, when you're about to take your begun shelf, I would strongly encourage you to listen to this podcast and it's going to be short and sweet. Speaker 1 Basically, in this podcast, I'm going to catalog. All the Speaker 3 ob/gyns risk factors that are classically tested on the exam. So I'll talk about all the OB Gonna risk factors that are classically tested on the exam. And if you have any questions, feel free to reach out to me. Okay? So let's just get right to it and at the end I will talk Speaker 1 about. I'll talk about some Speaker 3 minor things like housekeeping things that a lot of people have been asking me questions about enough in recent times many people were asking about the course that I held on Saturday. So I'll kind of talk about that at the end. Okay. Speaker 1 So what is the biggest risk factor for Speaker 3 postpartum? From depression. Well, I hope you've seen its having a personal history of depression. So everybody has a personal history of like, major depressive disorder. That's the biggest risk factor for postpartum depression. And then what is the most reliable indicator of successful labor? Induction Speaker 2 is one of those ones were. If he shows up on exams, pretty much, everyone gets it wrong. Speaker 1 But there's this thing known. As the Bishop Speaker 3 score, the Bishop score is actually the most reliable indicator of a successfully brinjal. Induction, just know what it is. I wouldn't try to like, oh, like how do I calculate Let it know. You're not an Omega n residents, we're going to skip that. Speaker 1 Now, what is the most common cause Speaker 3 of infertility? What is the most common cause of infertility on in beam exams? Well, on Speaker 1 tests want to pick over Latorre Speaker 3 dysfunction as the cards, right? Remember PCOS is like the cheap cheap cheap cause of obligatory dysfunction, right? But the biggest risk factor for infertility. On MBA means, usually is obligatory dysfunction Speaker 1 and then the next one was the most Speaker 3 common late adverse effect of a person getting They'll be creating a therapy. So let's say a person is getting, like, radiation therapy to the pelvis. What is the most common leaked adverse effect? Speaker 2 So I want you to think about vaginal Speaker 3 stenosis, okay, so you because like pain with intercourse and stuff and also don't forget that when a person gets public radio therapy, that's actually the biggest risk factor for the development of a uterine sarcoma, right? So your instructor comments they're just like mosula malignancies the a super rare, but when they come, they're very nervous, very nasty, right? So the biggest risk factor for uterine. Sarcoma is in fact. Priority of therapy to the presence of pelvis. Speaker 1 Now, what is the biggest risk factor for squamous cell cancer of the Speaker 3 vagina? Well, I hope you're telling me he HPV, right? Remember those hpvs in like the 16, the 18s and those in the 30s. Okay. Now, what is the biggest Speaker 1 risk factor for Clear cell adenocarcinoma of the Speaker 3 vagina? This one is easy, right? It's maternal exposure to dies like diethylstilbestrol while she was pregnant with the child. Remember D is also causes some other problems like a t-shaped uterus, which can cause like recurring to like second trimester. Pregnancy loss is an Indian exams. Okay. Now, what is the biggest risk Speaker 1 factor for Volvo Speaker 3 carcinoma? What is the biggest risk factor of over carcinoma? Speaker 1 So you want to pick HP V exposure on your test but very likely they won't put each Vivo exposure Speaker 3 as an answer if you don't see that as a Speaker 1 I would liken sclerosis, okay. Speaker 2 Go like and sclerosis. Remember that figure of Speaker 3 eight parchment paper thin vova thing that prep presents. An MBA means remember, for those people who want to get a punch biopsy. You want to get a punch biopsy for those are for those folks, Speaker 1 okay? Now, what is the biggest Speaker 3 risk factor for postpartum? Endometritis. What is the biggest risk factor for postpartum? Endometritis? Well, I hope you're thinking about like having a history of a C-section, right? Having a history of CC. What is the biggest risk factor for postpartum? Speaker 2 Endometritis remembered. Our presenters like abdominal pain. Like you during tenderness and Speaker 3 fever like two to three days. After a person, just had a C-section. Right Speaker 1 now, what is the biggest risk factor for septic pelvic Speaker 3 thrombophlebitis? What is the biggest risk factor for septic pelvic thrombophlebitis? Speaker 2 This one is kind of unusual and bizarre. It's okay. Having Speaker 1 a prior history or I mean sorry that it actually is having a history of a Speaker 3 postpartum endometritis. Speaker 1 So if you've had endometrioid is that Police Issue a Speaker 3 very, very high risk of getting Septic pelvic thrombophlebitis Speaker 1 now. What is the most important predictor of prognosis? In a patient that has Speaker 3 breast cancer? What is the most important predictor of prognosis? In a patient that has breast cancer? Speaker 2 I hope you're telling me involving of Speaker 3 the axillary lymph nodes, right? If there is axillary lymph node involvement, that definitely is a very important predictor of prognosis. Okay. Now, Speaker 1 what are the key or what are some, this one there is no biggest whatever, but what are some predictors of prognosis in a In that has gestational Speaker 3 trophoblastic disease. Well, for this want to think about like having a high beta HCG, right? So if you have a higher bidder, he see G. That means a worse prognosis. Speaker 1 If the person has Speaker 3 met to like weird organs, like the liver and the Brain, that's also like a bad prognostic factor and the more time you put between Speaker 1 when they were pregnant and when Speaker 3 we have the gestational trophoblastic disease, then Speaker 1 that worsens their prognosis, right? So say for example, like a person, Read a child or an ectopic Speaker 3 pregnancy or whatever like three Speaker 1 months ago versus president delivered. It six months ago, the person at six months that develops gestational trophoblastic disease, Speaker 3 has a worse prognosis. Speaker 1 Now, what is the most important predictor of prognosis in a person that has Volver cancer? Speaker 3 What is the most important predictor of prognosis and a person over cancer? Well, the number one is actually involvement of liminal lymph nodes, right? And then number two is how big Speaker 1 the lesion is. So the size of the lesion now what is the biggest risk? Actor for cervical cancer. Speaker 3 This is HPV right. Again, he'ii be 1618 and those in the 30s. Okay. What is the biggest risk factor for endometrial cancer? Well, for endometrial cancer. You want to think about Speaker 1 exposure to unopposed, estrogen. Remember unopposed estrogen is estrogen. That is not given with progestin. Write a post. Estrogen is estrogen that is giving with progestin but exposure to unopposed. Estrogen is the biggest risk factor Speaker 3 for endometrial cancer, if Speaker 1 you don't see that as an answer choice and they put some kind Speaker 3 of Hyperplasia. Like a complex atypical hyperplasia. That's also good answered of big, but the biggest risk factor is exposure to unopposed estrogen. Speaker 1 And then, what is the, most important Speaker 3 prognostic factor in a person that has endometrial cancer? The most important prognostic factor is actually the stage, right? So if you have stage 1 versus Teach three right Speaker 1 now, another common question, you may see, especially on these newer, MBM uses. The asked what is the most common presenting Speaker 3 complaint in a particular disease. Speaker 1 If you're thinking about endometrial cancer, the most common Speaker 3 presenting complaint is actually vaginal bleeding, right? Speaker 1 And then, what is the biggest risk factor Speaker 3 for endometriosis? Remember, in the matrices is dosed at those 3DS, right? So like dysmenorrhea so painful Menses dyspareunia, so painful intercourse and then this Speaker 1 Kezia painful popping. What is the biggest risk factor Speaker 3 of endometriosis? It's actually having a family history of endometriosis. Speaker 1 When a person has a family history Speaker 3 of endometriosis, they have like a seven to ten fold increased risk of In Speaker 1 endometriosis. Okay. Now, what is the most common cause of D Speaker 3 IC in pregnancy. What is the most common cause of the ice in pregnancy? I hope you're thinking about placental abruption. Right Speaker 1 abruptio placentae is the most common Speaker 3 cause of the ice in pregnancy, Speaker 1 right? And then what is the biggest risk factor for placenta Speaker 3 previa? What is the biggest risk factor for placenta previa? Well, I hope you're thinking about having a history of C-section, right? Speaker 1 Having a c-section history is the biggest risk Speaker 3 factor for placenta previa. All right. And then how about Speaker 1 placental abruption? What is the biggest risk factor for placental abruption? The biggest risk factor, believe it or not is actually having a prior history of placental abruption, right? But if you don't see that as an answer Choice, go with hypertension hypertension has a very Speaker 3 well-established association with getting a placental abruption. Speaker 1 Okay. Now, what is the biggest risk factor for Speaker 3 preterm labor? What is the biggest risk factor for preterm labor? So, it's actually having a prior history of preterm Labor, right? Although remember in general, when a person has UTIs, right? Like pyelonephritis, asymptomatic bacteriuria, those are all very important risk factors for the development of preterm labor. But again, the biggest risk factor is a prior history of preterm Labor. And I mean, again, remember some of these bunks, especially like your plasma urine and they come your plasma. You're a little cam is a big red. Big risk factor for preterm labor or even having bacterial vaginosis with gardnerella vaginalis. That's a big Doctor for preterm labor. Speaker 1 Okay. Now, what is the biggest maybe put some caveats here? What is the biggest nvme exam? Risk Speaker 3 factor for cervical? Incompetence in competent, incompetence? Speaker 1 Well, I hope you're thinking about like having a prior history of like a Speaker 3 loop procedure, right? Like a leap like a leap. Excision Speaker 1 procedure in a way. You're working up like cervical cancer, right? All you want having like a prior colonization procedure, right? Those are the biggest MDMA Speaker 3 risk factors for cervical incompetence. Speaker 1 Now what? It is the most important intervention to reduce baby's risk of like respiratory distress syndrome or necrotizing enterocolitis or intraventricular Hemorrhage, or neonatal sepsis. What is the biggest risk factor, especially in, I mean Muslim was the most important intervention, right to decrease the risk of all these things in a premature baby in a premium. So that's actually the administration of betamethasone, right? Is one of those unusual questions that again. When it shows up the vast majority of people get it wrong. Speaker 3 Well, you don't have to be one of Speaker 1 them. Okay. Now what is the preventive measure in a woman with like a premature rupture of membranes that you know like it's like a preventive measure that you can employ to decrease the risk of getting like neonatal infection like fatal infection. You want to pick the answer that involves decrease in the number of like cervical exams on like vaginal exams. Okay now what is the most important risk factor for an intrauterine growth restriction? What is the most important? And risk factor for an intrauterine growth restriction. So this is actually having a prior history of an intrauterine growth restriction. Okay? Now what is the biggest risk factor for fetal? Macrosomia, this one is easy, right? Having a maternal Speaker 3 diabetes, okay. Speaker 1 Now, once some other things actually, what I want to talk about but let me leave it to the end. What is the biggest nbme exam risk factor for Fidel tachycardia? I hope you're telling me maternal fever. Remember animal, fetal. Heart rate is between 120 to 160. So, if you see a baby with a heart rate monitor 160, think about maternal fever and then what is the biggest risk factor on MDM is for Speaker 3 postpartum? Hemorrhage. That's uterine acne, right? Uterine atony is the most common cause Speaker 1 of postpartum Hemorrhage. Okay? Now what is the biggest risk factor for Peyton, dr. Speaker 3 Satcher osis on indium exams. It's actually being a premature baby, right? So having a premature like a Speaker 1 Unit. Okay. Now what is the biggest risk factor for an ectopic pregnancy? So it's actually having a prior history of an ectopic pregnancy. Okay? And again PLS, I'm going to repeat this again pyelonephritis, asymptomatic bacteriuria, right? Those things are all key risk factors or black bacterial vaginosis from Canela. Vaginalis unlike Speaker 3 Europe laws by your analytic, mm? Okay? Speaker 1 Those are all big time risk factors on exams for developing preterm labor and delivery. I mean preterm labor. But again remember the biggest risk factor for preterm labor is having a prior history of preterm Labor. Okay. Now, what is the Biggest risk factor for uterine rupture on an Indian exam? What is the biggest risk factor for uterine rupture on name? Demon example. So, I hope you're telling me that it's having a scar from a prior C-section, right? Having a scar from a prior C-section is the biggest risk factor for uterine rupture. Okay. Now, what is the biggest risk factor for developing breast cancer? That's age, right? I mean by Thunder woman, he's the age of 80 a chance of breast cancer is like one in eight. Okay. Now, what is the biggest risk factor for preeclampsia? Shh. So that's having a prior history of Speaker 3 preeclampsia. Okay Speaker 1 and then what's the biggest risk factor for uterine inversion? That's actually having a prior history of inversion. Okay, now, what is the biggest risk factor for chorioamnionitis? What is the biggest risk factor for corium, Unitas? So this is actually having a history of prolonged rupture of membranes, right? Remember if your membranes have ruptured, for more than 18 hours, you need to give Speaker 3 those women are Group B, strep Speaker 1 prophylaxis. Okay. Now, what are some key while say, like, maybe the two biggest risk factors on MDM exams, for gestational trophoblastic disease. It's actually been on the extremes of Each, right? So like having your first pregnancy like when you're very young or when you're close to 40, right? And also being only Paris, I think about 70 to 80% of women that have gestational trophoblastic disease. I've Speaker 3 never had any kids before. Speaker 1 So those are all things to know and then they'll one thing I want to mention it's just actually two things. I want to mention these are things that people classically get wrong when Speaker 2 exams. But again you don't have to be one of Speaker 1 those people, right? So what the people that are supposed to get Group B, strep prophylaxis on MDM exams, right? So Some key categories, right? Again, remember you screen for Group B Speaker 3 strep? I don't like 35 to 37 weeks, right? But remember, if Speaker 1 you have, if a woman has had like Speaker 3 a kid before, right? Speaker 1 And that kid has had, like rub it like that. And you need to side like Group, B strep like sepsis or whatever, like she has a history of Speaker 3 that mean, you need to give the woman Group B, strep prophylaxis. And if the woman has Speaker 1 had like a positive urine Speaker 3 culture for Group B strep at any point during the pregnancy, any trimester of the pregnancy? She also So Speaker 1 needs Group B strep a prophylaxis. And then, if you don't know, the Group B, strep status, right at the point of pregnancy, right? So Speaker 3 let's say you should, maybe she didn't have any prenatal care or, you know, you don't know the results for any reason. Right. Speaker 1 Then think of these other criteria Speaker 3 before you give Group B, strep Speaker 1 prophylaxis. So again, if you don't know the status and the woman has one of these problems you need to give Group B strep prophylaxis, right? So let's say, for example, this woman is about to deliver a baby at less than 37 weeks gestation. Speaker 3 That's And you don't know the Group, B, strep status give Group B, strep prophylaxis Speaker 1 another classic one. Is if the Speaker 2 woman's membranes have ruptured, Speaker 3 right? Young Eric, membranes are ruptured for more than 18 hours Speaker 1 if that's the case. So, if it's 18 hours or more, Speaker 3 right? You do need to give Group B strep prophylaxis. Speaker 1 And then if the person right, Speaker 2 you know like wow, she's wow. She's a Speaker 3 in labor and delivery like why she was in labor? Speaker 1 If I temperature is more than 100 point for like a hundred point for more. You also need to give Group B, strep prophylaxis and And those are kind Speaker 3 of like the big ones you tend to see on exams Speaker 1 and then rhogam right? Again, many people kind of mix-up Miss nbme situations where they're supposed to give organic, Speaker 3 right? Be kind of missing being in situations where they're supposed to give her a gift. So Speaker 1 you want to know stuff like this, right? So for rhogam on MBM exams, right Speaker 3 to you? Speaker 1 You want to think about want to think about a couple of situations, right? So obviously you give rhogam between Like 28 weeks, right? Are you give it in the first three days Speaker 3 postpartum right after you do that kleihauer-betke test, right? Speaker 1 But remember, there are all the times you give her again. If you're doing an Speaker 3 amniocentesis, you need to give her again. If you Speaker 1 do a cerclage on a patient, right to rescue her from cervical Speaker 3 incompetence, you need to give organ if a Speaker 1 woman delivers and like, has an Speaker 3 ectopic pregnancy. Need to give organ. Speaker 1 If a woman has gestational Speaker 3 trophoblastic disease, you need to give her again. If a Speaker 1 woman was in trauma of any sort like a motor vehicle accident, you need to give organ, right? Basically, anything that can cause mixing of blood between Mom and baby, you need to give Rogan, right? And one common thing that error that people make is like, gonna be like, oh, Divine, this woman has never been pregnant before. So she could never have made antibodies. That is absolutely not true. What if she has had a blood transfusion in the past from an RH positive person? You better believe. She's going to make antibodies are in that time circumstance. So, I think those are all the risk factors. I want to talk about. Again, if you, if you know this podcast really well, pretty much every OB guy nor I'll see the vast majority of the OB Gary's factors. Is he on your ob/gyns Speaker 3 shelf? And on Step 2, CK? You clear them, pretty pretty easily. Speaker 1 And one thing I guess I want to talk about is the because many people have kind of emailed me about this asking, if I'm going to do another one like this, right? So, Speaker 3 so I held Speaker 1 my, I mean, I've done this multiple times in the past. Uniformly, through my website, I held us they've to see course on actually on Saturday. Right. So we met for a little over, 10 hours, like four hours in the morning for hours, in the afternoon two hours at Speaker 3 night, right? You know, I answered questions from people and we Speaker 1 reviewed the highest yield stuff that's classically tested on the USMLE Step 2. CK exam. Right, we talked about Peds psych surgery, ob/gyns internal medicine and mirror, right? Speaker 3 And again I got Speaker 1 extremely good feedback from pretty much everyone that attended. And so many people have been sending me emails that divide. Are you going to hold this again in the future? I'm going to hold it in June. So for now, I have decided to hold it for sure. The next one on the 27th of June, the next one will for sure. Hold on, the 27th of June, I'm also considering holding one on the 13th of June again, just because the mode email requests have gotten if you're interested. So for sure, if you're interested in any of these things, reach out to me through the website, Or you can send me an email Speaker 3 at divine intervention podcast with an S at the end at gmail.com. Again Speaker 1 the course was relatively comprehensive, we covered a ton of stuff. I think I personally covered about 600 or 700 topics over the 10 appeared like, oh this is how we test on exams. These are the ways. The enemy tries to trip people up with this stuff Speaker 2 and again, I, you know, give people Speaker 1 opportunities to answer questions and, you know, I kind of talked about Speaker 2 some key details about the Step 2 CK exam during the course, so it's a group course. You know, about 20-ish people each time and it's held over zoom and again, it's a very convenient interface and I use the Whiteboard to, to teach. So, I'm so if you're interested in that, just reach out to me, go through the website. Or again, send me an email and divine intervention podcasts with an S at the end at gmail.com. So for sure, there will be a class holding on the 27th of June this month again. You'll be from 6 a.m. to 10 a.m. Pacific time for the morning section. No. To 4 p.m. Pacific time for the afternoon section and then 6 to 8 p.m. Pacific time for the evening section. And basically after you're done with that class, you will move the vast majority of what you need to know, for Step 2, CK. And then again, as I draw the end of every podcast and for one-on-one tutoring, for many exams Step 1 Step 2, CK step to see a step 3, preclinical, Medical exams, 30-ish of exams. Again, I've worked with tons of people. If you need any of those things, just reach out to me and I'll be happy to point you in the right direction. And then I also do like longitudinal tutoring. So if you know, studying off your first second and third year of med school, I consider it for your block or shelf exams. And at the same time, I will tutor you for your upcoming USMLE exam. And then, I offer these like booster courses, they are one-on-one. So it's 20 hours for Step 1 or step to secure step 3. And basically in those booster courses are very comprehensive and we review the vast majority of the high yield information that is going to be tested on each of those respective USMLE exams. And then, if you are mentioning playing to Mike residency, right? On your collagen, applying to med school, I draw for like coaching or like Consulting with like applications, you know. So like personal statements, recommendation letters, editing your ear has application doing mock interviews. Again, I've worked with people marching into most of the Specialties, right? And the vast majority of people have worked with have actually much that they are first choices. And I mean, again, if you have a tricky application, like you graduated from med school, 10 years ago or Or you have low scores or you don't have research or you don't have a waist, right? If you have like, essentially like challenging, part of the application that you need to explain away, reach out to me again, I've worked with people that graduated from med school a long time ago, have failed USMLE exam or two and they've matched, right? So if that's something you're interested in our reach out to me again, either through the website or send me an email at divine intervention podcasts and gmail.com and then please and the podcast has an S at the end and please. You don't subscribe to the WordPress website. Any support helps. Subscribe to my YouTube channel. Subscribe to, it's called divine intervention, yes! Emily podcasts and videos. And then also have these podcasts on like a podcast Spotify, Google play, right? So you can subscribe to that. That's also helpful as well. And then my life lesson for today, is the importance of being thankful. The importance of being thankful. If anything? Yeah, that's a big thing. Well, is this is probably an appropriate time to discuss this, right? So we know all the stuff that has happened in the first five months of this year, right? Like tons of people have died from covid. I mean, I checked this afternoon or morning, I think was like, 140,000 people that have died as of today, right? Total people have died from covid and then you know like I mean I'm a Laker fan when Kobe Bryant died that really hit me. Really hard. That hit me really hard. I like literally heard the information when I got back from church. It wasn't, it was not the best day for me. I'll tell you that right now. And, you know, I know the New York Times last week they published like a, like they had like a full page. Like, I think their front page we're just like I think like maybe like a hundred names or thousands of people that are perish from covid, right? So notice today is the first of June, your name is not on that list. Write your name is not on that list or you're not have to be hooked up to a vent, right? Where your loved. One cannot see you, right there, any of those things. I mean, I personally know some people that have died of covid and no one could attend your funeral, so, the say, their last goodbyes over FaceTime resume, right? Those are pretty awful circumstances. So, regardless of what you're going through, now, if you don't have money, or you're in the depths of your dedicated period and you're like, man, this life sucks with all these Prometric, scribbles that have been going on just be grateful, just take today out. Literally to be grateful to be thankful because they People that wish again, I'm not saying this to be judgmental, but I can pretty much promise you that there are people that wish that they were in the circumstances you were in. Now, if they did not have to be in the, in the in, at a cemetery, right? Being buried for covid, right? So just going to keep those things at the back of your mind, be thankful. That is actually one very good trick and strategy for improving Wellness. As a health care, professional, just be thankful, keep a diary, keep a journal, and just write down a few things. You're thankful for each day or each week, it really Ali does help with keeping perspective and with improving your quality of life. I mean even this is part of the Bible that says in everything give thanks, right? Because this is the will of God, the father. So just be thankful. I feel like it really helps to get people through, you know some pretty tough. Pretty tough times. So thank you for listening to this podcast again. It's a high-yield podcast and I hope you find it to be helpful. I will see you in the next episode. Thank you and God bless you. Ali does help with keeping perspective and with improving your quality of life. I mean even this is part of the Bible that says in everything give thanks, right? Because this is the will of God, the father. So just be thankful. I feel like it really helps to get people through, you know some pretty tough. Pretty tough times. So thank you for listening to this podcast again. It's a high-yield podcast and I hope you find it to be helpful. I will see you in the next episode. Thank you and God bless you.