Usmle Step 2 Ck Review Notes
J
1
J
Premenopausal Pelvic mass β-hCG test +
Sono: simple cyst +
Sono: complex/solid +
Acute severe pain
© Elmar P. Sakala, MD, MPH
J
J
(c) Elmar P. Sakala, MD MPH (2011)
2
CV disease & Hormone Therapy
J
Recommendations: HT (E+P) 2003
Critique of WHI study
© Elmar P. Sakala, MD, MPH
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
3
Menopause
WHI
“WINDOW of OPPORTUNITY”
Critical period for maximum response to HT
10 yrs too Late!!
Start HT here
© Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004
Not Here
Natural History
Treatment
Non-contraceptive Benefits
Steroid Contraception
Progestin
Progestin Progestin Hysterectomy
↓ Dysmenorrhea ↓ DUB ↓ PID ↓ Ectopic preg
suppress PG release stabilizes endometrium thickens cervical mucus thickens cervical mucus
TAH, BSO
© Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
4
Metabolic Effects
Steroid contraception
Healthy lipid profile (↑ HDL, ↓ LDL)
Oral Contraceptives Risk of CANCER
Estrogen mediated
THROMBOSIS
↑ venous & arterial
↓ Endometrial ↑ Cervical
= ↑
Breast
Ovarian
Unhealthy lipid profile (↓ HDL, ↑ LDL)
Progestin mediated
© Elmar P. Sakala, MD, MPH
Contraception Review
Intrauterine Contraception Steroid Contraception
© Elmar P. Sakala, MD, MPH (August, 2011)
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
5
Contraceptive Failure Rates
Reversible Methods
Basic Principles of Contraception
Avoid contraindications
© Elmar P. Sakala, MD, MPH
© Elmar P. Sakala, MD, MPH
Basic Principles of Contraception
Avoid contraindications
FEW Complic
Completed childbearing
Sterlization
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
6
FEMALE - Next step in management? β-hCG β-hCG β-hCG β-hCG
PREGNANCY - Next
1
J
Premenopausal Pelvic mass β-hCG test +
Sono: simple cyst +
Sono: complex/solid +
Acute severe pain
© Elmar P. Sakala, MD, MPH
J
J
(c) Elmar P. Sakala, MD MPH (2011)
2
CV disease & Hormone Therapy
J
Recommendations: HT (E+P) 2003
Critique of WHI study
© Elmar P. Sakala, MD, MPH
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
3
Menopause
WHI
“WINDOW of OPPORTUNITY”
Critical period for maximum response to HT
10 yrs too Late!!
Start HT here
© Elmar P. Sakala, MD, MPH Nonoral Options in Hormone Therapy, OBG Management supplement to November 2004
Not Here
Natural History
Treatment
Non-contraceptive Benefits
Steroid Contraception
Progestin
Progestin Progestin Hysterectomy
↓ Dysmenorrhea ↓ DUB ↓ PID ↓ Ectopic preg
suppress PG release stabilizes endometrium thickens cervical mucus thickens cervical mucus
TAH, BSO
© Elmar P. Sakala, MD, MPH © Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
4
Metabolic Effects
Steroid contraception
Healthy lipid profile (↑ HDL, ↓ LDL)
Oral Contraceptives Risk of CANCER
Estrogen mediated
THROMBOSIS
↑ venous & arterial
↓ Endometrial ↑ Cervical
= ↑
Breast
Ovarian
Unhealthy lipid profile (↓ HDL, ↑ LDL)
Progestin mediated
© Elmar P. Sakala, MD, MPH
Contraception Review
Intrauterine Contraception Steroid Contraception
© Elmar P. Sakala, MD, MPH (August, 2011)
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
5
Contraceptive Failure Rates
Reversible Methods
Basic Principles of Contraception
Avoid contraindications
© Elmar P. Sakala, MD, MPH
© Elmar P. Sakala, MD, MPH
Basic Principles of Contraception
Avoid contraindications
FEW Complic
Completed childbearing
Sterlization
© Elmar P. Sakala, MD, MPH
(c) Elmar P. Sakala, MD MPH (2011)
6
FEMALE - Next step in management? β-hCG β-hCG β-hCG β-hCG
PREGNANCY - Next