Pregnancy loss per AMBOSS: Threatened: closed cervical os, bleeding, fetal activity Complete: closed cervical os, bleeding, POC completely out of uterus Missed: closed cervical os, no bleeding, no fetal activity Inevitable: open cervical os, bleeding, ± fetal activity Incomplete: open cervical os, bleeding, POC within uterus or cervical canal "Keep your I's (eyes) open" = Inevitable or incomplete --> open cervical os
@@zulyc8641 thanks I had no idea at the start of my obgyn rotation but now I've thankfully seen most of these terms enough to know 😂. Wish me luck on my shelf !
Q16a: >45 YO with palpable left breast mass with negative mammo findings. Next best step is ultrasound (>30 YO need both mammo + ultrasound), not core needle biopsy. Probably will need a CNB, but I got a uWorld question wrong on this.
the UW question you're referring to is about nipple discharge IIRC, for pathologic nipple discharge you do mammo, if -ve you do US and if that's also -ve, you proceed to MRI
57:14 In this scenario, 45 yrs old with a breast mast and negative mammogram, I believe next step is to do a US of breast, then we can go to core needle biopsy ( or the best answer might be, ultrasound guided core needle biopsy). Correct me if I am wrong. Thank you for your amazing lectures.
does this apply breast mass or pathologic nipple discharge scenarios? because in UW the algorithm for nipple discharge indicates the women >40 with a normal mammogram should get an ultrasound and if the latter is also normal, an MRI should be requested (also applies to women 40
based on nbme + Uworld, if a mass is detected by ultrasound and unambiguous in nature (whether cystic or solid) then you can immediately aspirate/biopsy. If ambiguous, then mammogram.
@@erwinrommel9963 it's not a fault, he's pointing out, he's saying its so nice that he's calling the patients lady :) I agree it's very gentlemanly of him
Great video! However for #5PPH uterine inversion, according to UWORLD, we should discontinue uterotonics (eg oxytocin) because they increase uterine tone (ie. contractility) and may make manual uterine replacement impossible to perform. And If attempts at manual uterine replacement fail, the next step in management is laparotomy to prevent exsanguination.
Hey great video. But on Question 5 UWORLD disagrees. They said no fetal movement plus no heart sound on doppler is not enough to induce delivery of a supposed dead fetus. They said you have to do an ultrasound transabdominal over transvaginal just because it is less traumatic.
On Q5 at 20:15 , why is the answer not TVUS? I believe I have seen on a uWorld or APGO quiz question that when doppler has no findings, you have to confirm fetal demise through U/S visualization of the fetal heart. Can someone explain why this is different?
The question that you are talking about is pt with vaginal bleeding and positive beta HCG what's next step...tvus...if u can't see anything repeat HCG after 48 hrs...untill u get HCG morethan 3500
1:49:00 what you are describing, e.g. rupture of membranes without contractions is prelabor rupture of membranes not premature rupture of membranes. this patient is at 38 weeks which is a term gestation not preterm.
Preterm premature rupture of membranes (PPROM) is when you have rupture of membranes (ROM) before onset of labor sometime before 37 weeks. Premature rupture of membranes is when you're at term (37 and above weeks) and have ROM before onset of labor. The preterm is describing the gestational age. If it's at term you don't include it. The premature part refers to rupture of membranes before onset of labor. I've seen premature interchanged with prelabor. It's talking about the same thing.
For Q19 (the question on shoulder dystocia) you said the answer was waiters tip, but you described upward traction on the shoulder and arm.. Isn't that normally klumpke palsy? I thought Erb's palsy was traction on the neck.
@@malekayoub2041 So I think that I found the issue, and it is with my computer, for some reason the audio for this specific video wont work on my computer, but it does work on my phone. It is odd since this is literally the only youtube video that I have had this issue with. But fortunately it does work on other devices.
I wouldnt say 1h47m is PPROM... patient is 38 weeks so she is just PROM and i would give her IV clinda gent to prevent chorio and monitor NST for expectant vaginal delivery, if baby becomes breech or decels i would do crash section. THanks for your videos, they are awesome.
Hi Chelsy. I just played the video and everything works just fine. One alternative you can explore is to watch the video on my actual website-www.divineinterventionpodcasts.com
1:59:00 - I believe that there may be a mistake here. The combination of vaginal bleeding, a closed cervical os and non-viable fetus on US would be most consistent with an inevitable abortion. I've always interpreted missed abortions as completely silent, with no vaginal bleeding whatsoever. Is my understanding incorrect, or was there a mistake in this video?
Missed abortions typically will have closed os, and non-viable intrauterine pregnancy (fetus retained), and +/- bleeding. I think of the difference as inevitable means its in the process of happening (unavoidable w open os) and missed means your body has not recognized (/missed) the abortus and fetus is still being held (closed os)
It binds to the TSH receptor on the thyroid cell membrane and is a weak stimulator, resulting in increased secretion of T4 and T3 and partial suppression of serum TSH
Hi Divine! Please help. A question I got on my nbme said - a woman had a pap smear showing HSIL and wants a 2nd opinion, she coms to you, whats the best next step? HPV testing, Repeat pap smear, Colposcopy, LEEP? Q44 says for HSIL, always do colposcopy but then you state that a weird answer on nBME is LEEP. If both options are given like in this question above , which is more correct?
