DIP Episode 239 - The NBME and OBGYN Risk Factors (+ Upcoming Step 2CK Course)

Okay, welcome. My name is Divine Amma resident and this is episode 239 of the Divine Intervention Podcast. This is going to be a pretty short podcast but it's going to be a floridly high-end podcast. Basically if you're about to take step 2 CK or you're about to take your OB-GYN shelf, I will strongly encourage you to listen to this podcast and it's going to be short and sweet. Basically in this podcast I'm going to catalog all the OB-GYN risk factors that are classically tested on the exam. So I'll talk about all the OB-GYN 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'll talk about some minor things like housekeeping things that a lot of people have been asking me questions about in recent times. Many people were asking me about the course that I held on Saturday so I'll kind of talk about that at the end. Okay, so what is the biggest risk factor for post-partum depression? Well I hope you're seeing it's having a personal history of depression. So if a person has a personal history of like major depressive disorder that's the biggest risk factor for post-partum depression and then what is the most reliable indicator of successful labor induction? These are one of those ones where if he shows up on exams pretty much everyone gets it wrong but there's this thing known as the Bishops score.

The Bishops score is actually the most reliable indicator of a successful labor induction just know what it is. I would not try to like oh how do I calculate it? No, you're not an OB-GYN resident so we're gonna skip that. Now what is the most common cause of infertility? What is the most common cause of infertility on NVM exams? Well on tests you want to pick ovulatory dysfunction as the cause. Right, remember PCOS is like the chief chief chief cause of ovulatory dysfunction, right? But the biggest risk factor for infertility on NVM is usually is ovulatory dysfunction. And then the next one what's the most common lead adverse effect of a person getting like pelvic radiotherapy? So let's say a person is getting like radiation therapy to the pelvis. What is the most common lead adverse effect? So I want you to think about vaginal stenosis. Okay, so you mean cause like pain with intercourse and stuff and also don't forget that when a person gets pelvic radiotherapy that's actually the biggest risk factor for the development of a uterine sarcoma, right? So uterine sarcoma is just like muscle amalgamances. They are super rare but when they come they are very gnarly, very nasty, right? So the biggest risk factor for uterine sarcoma is in fact a prior radiotherapy to the presence of pelvis. Now what is the biggest risk factor for scrimal cell cancer of the vagina? Well I hope you're telling me HPV, right? Remember those HP Vs in like the 16, the 18s and those in the 30s.

Okay, now what is the biggest risk factor for clear cell adenocarcinoma of the vagina? This one is easier, right? It's maternal exposure to DS, like diethyl steel best shrunk while show us pregnant with the child. Remember DS also causes some other problems like a T-shaped uterine or a switch that cause like recurrent like second trimester pregnancy losses on immune exempts. Okay, now what is the biggest risk factor for vulva carcinoma? What is the biggest risk factor of vulva carcinoma? So you want to pick HPV exposure on your test but very likely they won't put HPV exposure as an answer. If you don't see that as an answer choice, go with lycan sclerosis. Okay, go with lycan sclerosis. Remember that figure of eight parchment paper, thin vulva, thin that presents on MVM Es. Remember for those people you want to get a punch biopsy or you want to get a punch biopsy for those for those folks. Okay, now what is the biggest risk factor for postpartum endometritis? What is the biggest risk factor for postpartum endometritis? Well, I'll hope you're thinking about like having a history of a C-section, right? Having a history of C-section is the biggest risk factor for postpartum endometritis. Remember that'll present as like abdominal pain, like uterine tenderness and fever, like two to three days after a person just had a C-section, right? Now what is the biggest risk factor for septic pelvic thrombophlobitus? What is the biggest risk factor for septic pelvic thrombophlobitus?

This one is kind of unusual and bizarre. It's not really having a prior history or I mean, sorry, it actually is having a history of a postpartum endometritis. So if you've had endometritis, that places you at very, very high risk of getting septic pelvic thrombophlobitus. Now what is the most important predictor of prognosis in a patient that has breast cancer? What is the most important predictor of prognosis in a patient that has breast cancer? I hope you're telling me involvement of the axillary lymph nodes, right? If there is axillary lymph node involvement, that definitely is a very important predictor of prognosis. Okay, now what are the key or what are some? This one there's no big guess to whatever, but what are some predictors of prognosis in a person that has gestational thromboplastic disease? Well, for this you want to think about like having a high beta-HCG, right? So if you have a higher beta-HCG, that means it's a worse prognosis. If the person has 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 when they were pregnant and when we have the gestational thromboplastic disease, then that warms in their prognosis, right? So see for example, like a person delivered a child or an ectopic pregnancy or whatever, like three months ago versus a person that delivered it six months ago. The person at six months that develops gestational thromboplastic disease has a worse prognosis.

Now, what is the most important predictor of prognosis in a person that has vulvar cancer? What is the most important predictor of prognosis? And the person who vulvar cancer? Well, the number one is actually involvement of lymph nodes, right? And the number two is how big the lesion is so the size of the lesion. Now, what is the biggest risk factor for cervical cancer? This is HPV, right? Again, HPV 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 exposure to on-off-post-destrogen. Remember, on-off-post-destrogen is estrogen that is not given with progestin, right? Opposed estrogen is estrogen that is given with progestin, but exposure to on-off-post-estrogen is the biggest risk factor for endometrial cancer. If you don't see that as an answer choice and you put some kind of hyperplasia, like a complex atypical hyperplasia, that's also a good answer to pick, but the biggest risk factor is exposure to on-off-post-estrogen. And then, what is the most important prognostic factor in a person that has endometrial cancer? The most important prognostic factor is actually the stage, right? So if they are stage one versus stage three, right? Now, another common question you may see, especially on these newer NB Ms is the ask, what is the most common presenting complaint in a particular disease?

If you're thinking about endometrial cancer, the most common presenting complaint is actually vaginal bleeding, right? And then, what is the biggest risk factor for endometriosis? Remember, endometriosis is those at those three days, right? So like dysmenorrhea, so painful menses, dysparonia, so painful intercourse, and then dyschysia, painful, pulpit. What is the biggest risk factor for endometriosis? It's actually having a family histrovent endometriosis. When a person has a family histrovent endometriosis, they have like a seven to tenfold increase risk of getting endometriosis. Okay, now what is the most common cause of DIC in pregnancy? What is the most common cause of DIC in pregnancy? I hope you're thinking about placental abruption, right? Abruptio placente is the most common cause of DIC in pregnancy, right? And then, what is the biggest risk factor for placenta preview? What is the biggest risk factor for placenta preview? Well, I hope you are thinking about having a history of C-section, right? Having a prior C-section history is the biggest risk factor for placenta preview, right? And then, how about 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 well-established association with getting a placental abruption.

Okay, now what is the biggest risk factor for 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 UT Is, right? Like Pylonophritis, asymptomatic bacteria, 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 bugs, especially like your plasma, your illi-com. Your plasma, your illi-com is a big, big risk factor of preterm labor, or even having bacterial vaginosis with gannerella vaginalis. That's a big risk factor for preterm labor. Okay, now what is the biggest, I will maybe put some caveats here. What is the biggest MBME exam risk factor for cervical incompidant? Well, I hope you're thinking about like having a prior history of like a loop procedure, like a leap, like a leap excision procedure, you know, when you're working up like cervical cancer, right, or even having like a prior colonization procedure, right? Those are the biggest MBME risk factors for cervical incompidants. Now, what is the most important intervention to reduce a baby's risk of like respiratory distress syndrome or necrotizing enterocolitis or intraventricular hemorrhage or neonatal sepsis? What is the biggest risk factor, especially now? I mean, most , what's the most important intervention, right?

To decrease the risk of all these things in a premature baby in a preemie. So that's actually the administration of Bethemethzo, right? It's one of those unusual questions that again, when it shows up, the vast majority of people get it wrong, or you don't have to be one of 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 her risk of getting like neonatal infection or like fetal infection? You want to pick the answer that involves decreasing the number of like cervical exams or like vaginal exams. Okay, now what is the most important risk factor for an intra-yudruring growth restriction? What is the most important risk factor for an intra-yudr ingruth restriction? So this is actually having a prior history of an intra-yudruring growth restriction. Okay, now what is the biggest risk factor for fetal macrosomia? This one is easy, right? Having a maternal diabetes. Okay, now once some other things, actually one thing I want to talk about, but let me leave it to the end. What is the biggest MBME exam risk factor for fetal tachycardia? I hope you're telling me maternal fever, right? Remember, a normal fetal heart rate is between 110 to 160. So if you see a baby with a heart rate mother 160, think about maternal fever. And then what is the biggest risk factor on MBME's for postpartum hemorrhage? That's uterine acne, right?

Uterine acne is the most common cause of postpartum hemorrhage. Okay, now what is the biggest risk factor for a P10 doctor satiriosus on MBME exams? It's actually being a premature baby, right? So having a premature like a new 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, please, I'm going to repeat this again. Pylon of Fridays is symptomatic bacteria, right? Those things are all key risk factors or like bacterial vaginosis from gallerella vaginalis or like ure plasma ureleticum. Okay, those are all big time risk factors on exams for developing preterm labor and 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 MBME exam? What is the biggest risk factor for uterine rupture on an MBME exam? 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 the time the woman hits the age of 80, her chance of breast cancer is like one in eight. Okay, now what is the biggest risk factor for preeclampsia? So that's having a prior history of preeclampsia, okay? 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 chorium amnionitis? What is the biggest risk factor for chorium ionitis? 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 those women a group B-striperphylaxis. Okay, now what are some key, well, I'll say like maybe the two biggest risk factors on NBM exams for gestational trophoblastic disease? It's actually been on the extremes of age, right? So like having your first pregnancy, like when you're very young or when you're close to 40, right? And also being non-li-powers, I think about 70 to 80% of women that have gestational trophoblastic disease have never had any kids before. So those are all things to know. And then the one thing I want to mention is just actually two things I want to mention. These are things that people classically get wrong with exams, but again, you don't have to be one of those people, right? So what are the people that are supposed to get group B-striperphylaxis on NBM exams, right? So some key categories, right? Again, remember, you screen for group B-striper on like 35 to 37 weeks, right? But remember, if a woman has had like a kid before, right? And that kid has had like group B, like that new unit has had like group B-striper like sepsis or whatever, like she has a history of that.

I mean, you need to give that woman group B-striperphylaxis. And if the woman has had like a positive urine culture for group B-striper at any point during the pregnancy, any trimester of the pregnancy, she also needs group B-striperphylaxis. And then if you don't know the group B-striper status, right, at the point of pregnancy, right? So let's say you, maybe she didn't have any prenatal care or, you know, you don't know the results for any reason, right? Then think of these other criteria before you give a group B-striperphylaxis. So again, if you don't know the status and the woman has one of these problems, you need to give group B-striperphylaxis, right? So let's say, for example, this woman is about to deliver a baby at less than 37 weeks gestation. That's an, and you don't know the group B-striper status, give group B-striperphylaxis. Another classic one is if the woman's membranes have ruptured, right? The amniotic membranes have ruptured for more than 18 hours. If that's the case, so if it's 18 hours or more, right? You do need to give group B-striperphylaxis. And then if the person, right, you know, like while she's, while she's in labor and delivery, like while she's in labor, if a temperature is more than 100.4, like 100.4 or more, you also need to give group B-striperphylaxis. And those are kind of like the big ones you tend to see on exams. And then, roguam, right?

Again, many people kind of mix up mis-mbm-me situations where they're supposed to give roguam, right? They kind of mis-mbm-me situations where they're supposed to give roguam. So you want to know stuff like that, right? So for roguam, on mbm-exabs, right? You want to think about, you want to think about a couple of situations, right? So obviously you give roguam between at like 28 weeks, right? Are you giving it in the first three days postpartum, right? After you do that, cry, how a bet-key test, right? But remember, there are other times you give roguam. If you're doing an amniocentesis, you need to give roguam. If you do a sir clash on a patient, right? To rescue her from cervical incompidence, you need to give her roguam. If a woman delivers, like, has an ectopic pregnancy, you need to give her roguam. If a woman has gestational troffoblastic disease, you need to give her roguam. If a woman was in trauma of any sort, like a motor vehicle accident, you need to give her roguam, right? Basically, any thing that can cause mixing of blood between mom and baby, you need to give roguam, right? And one common thing that error that people make is like, they may 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 Irish positive person? You better believe she's going to make antibodies in that circumstance.

So I think those are all the risk factors I want to talk about. Again, if you know this podcast really well, pretty much every OB-GYN or I will say the vast majority of the OB-GYN risk factors is here in your OB-GYN shelf and on step 2ck, you clear them pretty easily. 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 I held my, I mean, I've done this multiple times in the past, but you know, formally through my website, I held a step 2ck course on actually on Saturday, right? So we met for a little over 10 hours, like four hours in the morning, four hours in the afternoon, two hours at night, right? You know, I answered questions from people and reviewed the highest yield stuff that's classically tested on the US Emily step 2ck exam, right? We talked about peeds, psych, surgery, OB-GYN, internal medicine and New York, right? And again, I got extremely good feedback from pretty much everyone that attended. So many people have been sending me emails that divine, are you going to hold this again in the future? Are you 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 based on all the email requests I've 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 at divineinterventionpodcastswithanesadien.gmail.com. Again, the course was relatively comprehensive, we covered a ton of stuff. I think I personally covered about 600 or 700 topics over that 10-hour period, like, oh, this is how it will be tested on an exam. These are the ways the Emily tries to trip people up with this stuff. And again, give people opportunities to answer questions and I kind of talked about some key details about the step to seek exam during the course. So it's a group course, about 20-ish people each time, and it's held over Zoom. Again, it's a very convenient interface and I use the whiteboards to teach. So if you're interested in that, just reach out to me through the website or again, send me an email at divineinterventionpodcastswithanesadien.gmail.com. So for sure, there will be a class holding on the 27th of June this month. Again, it will be from 6am to 10am Pacific time for the morning section, noon to 4pm Pacific time for the afternoon section, and then six to 8pm Pacific time for the evening section. And basically, after you're done with that class, you will know the vast majority of what you need to know for step 2ck. And then, again, as I do at the end of every podcast, I'll throw one on one tutoring for many exams. Step 1, step 2ck, step 2ck, step 3, pre-clinical med school exams, 30th shelf 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're studying off your first second or 30th of med school, I can tutor you for your block or shelf exams. And at the same time, I will tutor you for your upcoming USML exam. And then I offer these like booster courses, they are one on one. So it's 20 hours for step 1 or step 2ck or step 3. And basically, in those booster courses, they are very comprehensive and review the vast majority of the high-yield information that is going to be tested on each of those respective USML exams. And then, if you're a med student applying to residency or your college student applying to med school, I do offer coaching or consulting with applications, personal statements, recommendation letters, editing your ERAS application, doing more interviews. Again, I've worked with people matching into most of the specialties. And the vast majority of people have worked with, I've actually matched that their first choices. And I mean, again, if you have a tricky application, like you graduated from med school 10 years ago, or you have low scores, or you don't have research, or you don't have a ways.

If you have like essentially like a challenging part of your application that you need to explain a way, reach out to me again, I've worked with people that graduated from med school a long time ago have failed a USML exam or two and they've matched. So, if that's something you're interested in, reach out to me again. Either through the website or you send me an email at divineinterventionpodcasts.gmail.com. And then please, and the podcast has an S at the end. And please subscribe to the Word Press website, any support helps, subscribe to my You Tube channel, subscribe to its called divineintervention, USML podcast and videos. And then I also have these podcasts on like Apple podcasts, 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, let's say being thankful 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 it was like 104,000 people that are dead as of today, right? Ton of people have died from COVID. And then you know, like, I mean, I'm a Laker fan when Kobe Bryan died that really hit me really hard. That hit me really hard. I literally heard the information when I got back from church.

It was not the best deal 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 they're front page, we're just like I think like maybe like a hundred names or a thousand means of people that are perished from COVID, right? So notice today's the first of June. Your name is not on that list, right? Your name is not on that list or you're not had to be hooked up to a event, right? Where your loved ones cannot see you, right? The way any of those things. I mean, I personally know some people that have died of COVID and no one could attend the funeral. So they said they had last good buys over Face Time or Zoom, 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 pre-metrics quibbles that have been going on just be grateful. Just take today out literally to be grateful, to be thankful because there are 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 you, might be thankful.

That is actually one very good trick and strategy for improving wellness as a healthcare 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 does help with keeping perspective and with improving your quality of life. I mean, even there's this 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 old podcast and I hope you find it to be helpful. I will see you in the next episode. Thank you and God bless you.

The Bishop's score.

Ovulatory dysfunction (PCOS being the chief cause).

History of a C-section.

A history of postpartum endometritis.

High beta-hCG levels, involvement of distant organs (liver/brain), and increased time interval since pregnancy.

A scar from a prior C-section.

Administration of Betamethasone.

Ovulatory dysfunction (PCOS).

Diethylstilbestrol (DES) exposure while pregnant.

Lichen sclerosus.

Exposure to "on-off-post-estrogen" (Estrogen without progestin).

Prior history of postpartum endometritis.

Placental abruption.

Membranes ruptured >18 hours; unknown GBS status <37 weeks gestation; or maternal fever/infection during labor.

Ovulatory dysfunction (PCOS).

Diethylstilbestrol (DES) exposure while pregnant.

Lichen sclerosus.

Exposure to "on-off-post-estrogen" (Estrogen without progestin).

Prior history of postpartum endometritis.

Placental abruption.

Membranes ruptured >18 hours; unknown GBS status <37 weeks gestation; or maternal fever/infection during labor.