EM Boards Survival Guide: Obstetrics/Gynecology 1
- Nov 29th, 2018
- Alex Koyfman
Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)
emDocs will be providing you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system.
1) Bartholin’s cyst/abscess: Posterior introitus. I&D on vaginal mucosa. Word catheters controversial, but on exam you may still be expected to place one. Patients need follow up to make sure not malignant lesion.
2) Chlamydia: Know various clinical presentations (conjunctivitis, cervicitis/urethritis, PID, TOA, etc.) and how to treat them. Azithromycin med of choice; safe in pregnancy.
3) Gonorrhea: Know various clinical presentations; the Boards especially love disseminated gonococcal disease (skin lesions, tenosynovitis). Ceftriaxone is your friend; don’t forget to treat for chlamydia as well.
4) Emergency contraception: Ideally administer within 72 hours s/p unprotected intercourse. Patient weight affects efficacy for levonorgestrel. If patient overweight, use ulipristal.
5) Ectopic pregnancy: Many clinical traps/myths here, thus the Boards love this topic. Know risk factors (previous ectopic and prior PID are the big ones); consider heterotopic in those who have undergone in-vitro fertilization. Know b-HCG cut-offs and what you should see on trans-abdominal and trans-vaginal ultrasound. Know who is a candidate for methotrexate. Don’t forget about who gets RhoGAM.
6) Postpartum endometritis: Know risk factors and clinical presentation. Know bugs and drugs.
7) Vaginal bleeding: Resuscitate first, then determine pregnancy status.
– WikEM– Pregnant < 20 weeks
– WikEM– Pregnant > 20 weeks
– WikEM– Not pregnant
– EMin5– 1stTrimester
– EMin5– 3rdTrimester
– EMBasic– 1stTrimester
– EMBasic– Not pregnant
8) Pre-eclampsia / HELLP / eclampsia: know clinical presentations and consider postpartum as well. Know lab findings. Magnesium is most important; blood pressure control will also be tested; definitive treatment: delivery.
9) Mastitis: Know clinical presentation; if unclear, obtain an US to r/o abscess, galactocele, etc. Cover skin flora and instruct to continue pumping/feeding.
10) “Miscarriage”: Know different types and management => threatened // inevitable // incomplete // complete // missed // septic.
From Dr. Katy Hanson at Hanson’s Anatomy: