DIP Episode 157 - Comprehensive USMLE Step 1 Repro Review (Part 2 of 2)

Okay, welcome. My name is Devine. I'm a resident. This is episode 157 of the Devine intervention podcasts. And in this podcast, tightly in this, the comprehensive USMLE step one, repr or review. This will be part two of two. Part one was, I believe, episode 142. So we're going to continue and finish it up today. That's my go. I just hope it doesn't go too long. So I don't have to split this to a different podcast. Well, let's go ahead and jump right into it. So again, I'll just go over Viniettes and then we'll discuss that right. So what if you get a question about a like a 35 year pre-migravida female, she presents at like 26 weeks gestation and you know, she comes in for like a pre-nether evaluation. And you notice that have lot pressures 155 over 96. And then on another visit at like 27 weeks, have lot pressures like 156 over 97. What's your diagnosis? I would hope you're telling me that this person has gestational hypertension, right? Remember, gestational hypertension, you typically make the diagnosis before the 20 weeks of pregnancy, right? And most times, if a person has gestational hypertension, it tends to remit around like 12 weeks a postpartum, although you're not supposed to be hypertensive during the process of pregnancy. Now, what if you get a question about like a 35 year pre-migravida, you know, 26 weeks gestation, comes for pre-nedotes and have lot pressures like 155 over 96. So notice is a 26 week gestation.

And then they tell you that on another visit at 27 weeks, have lot pressure is, have lot pressure is 157 over 98. And then let's say you know, you're measured like a 24 year in protein collections like 1.2 grams. This person has what? Right? I hope you're telling me this person has pre-clamsia, right? Essentially, if you have a lot pressure rated at 140 over 90 with protein area, that buys you the diagnosis of a pre-clamsia. And then let's assume we have a patient that you know, 32 year old pre-migravida, eight weeks gestation, comes for a first trimester visit. And a lot pressure is like 149 over 97. And then let's say another blood pressure that you know, you measure the following week is like 152 over 98. What does this person have? This person obviously has chronic hypertension, right? I remember the diagnosis, right? This again, you make the diagnosis prior to 20 weeks versus gestational hypertension where you make the diagnosis past 20 weeks, right? And I mean, remember, if you want to treat this hypertension in pregnancy, you can use drugs like like hydrozene, right? You can use alpha methyl dopac, you can use labidolol, you can use my phydeping, right? You've probably heard of this on the morning that hypertensive moms love my phydeping to remind you of the anti-hypertensives that are safe in pregnancy, okay? Hydralzene alpha methyl dopac labidolol and my phydeping. And remember right now, hydrozene can cause a drug induced lupus, right?

With those fancy antihistone antibodies. Okay, now what if you get a question about like a 32 year old pre-migravida? She's a 30 weeks gestation, you know, presents with shortness of breath and you measure blood pressures, one in over one twin. What's your next best step in management? Again, I would hope you want to again, administer one of these big time anti-hypertensives. A classicly on MDN is you use labidolol, right? You use labidolol. Again, you can use the other stuff like my phydeping, alpha methyl dopac Hydralzene, but labidolol. If they give you all those as answer choices, go with labidolol, okay? Typically in pregnant women, you begin to intervene with your blood pressures when they have a systolic blood pressure gridded at 160 or a dastolic blood pressure gridded at 110, right? And then let's assume this patient, you know, begins to have like generalize, you know, like violent motor contractions. What's your next best step in management? And I guess what's your new diagnosis at this time? This person has a clumsy right? Your next step in management will be to administer magnesium sulfate, right? And you need to deliver the baby pronto, okay? You need to deliver the baby as quickly and as rapidly as possible.

And then let's assume this patient, you know, she has a bleak kind of like 45,000, her ESD health is like a thousand and you know, you get a CBC and like a blood smear or whatever and you notice that the haptoglobin is decreased, you notice that the LDH is increased and you notice that she has an indirect type of bylurbenemia. Well, what's your new diagnosis? Well, I hope you're telling me that this person has helped syndrome, right? He double LP syndrome, right? Remember, he stands for like hemolysis, elevated liver enzymes, low platelets. I mean, this question I'm just essentially trying to see if you can integrate hematology with a repro, right? The thing is the MDME, they love to do stuff like this, right? So the haptoglobin is low because she has a hemolytic anemia, right? She has an elevated lactate dehydrogenase because as the red blood cells hemolysis, remember LDH is in the cytosol. So as the red blood cell hemolysis, you release the LDH into circulation so it goes up. And whenever you have a hemolytic anemia, you tend to have an indirect hyperbylurbenemia, right? So those are all different ways of just telling that the person has a help syndrome.

Now, what if you get a question about like an Latino female, you know, she has like a sodium unsent flung pain, a wild study, and then they tell you that you know weeks ago, you know, they did like an ultrasound because she was having like non-specific abdominal pain and they found like, you know, like a six centimeter mass in her like her under ovary. What does this person have right now? Well, I would hope you're telling me that this person has ovarian torsion, right? Again, remember, the thing that like sort of puts you at high risk for ovarian torsion is if you're female and you have like anything that makes the ovary bulky, right? So like a cyst or like a new plasm, like a like a dermoid cyst or something like that, right? Essentially what happens is the suspense really gammett of the ovary sort of twists on itself and you kind of run into trouble because you caught a blood supply to the ovary, right? You can make the diagnosis with an ultrasound, right? You do an ultrasound with Doppler to check for floor in your ovarian vessels and you need to detours this as quickly as possible, right? Into the torsion as quickly as possible. The thing is sometimes you'll try to trick you on exams, you'll put ovarian torsion as an answer and then you'll put like rupture of something as an answer like rupture of a cyst. The thing is to decipher which one they are going after on the test, ask yourself what are the results of the ultrasound.

If you see free fluid like in the pouch of dogless, I believe that's known as direct to uterine pouch. If you see free fluid in the abdomen, then it's a rupture, something must have rupture for that free fluid to be there. But if they don't mention that it's a good old ovarian torsion. Now let's assume they give you like this cluster of information, tell me what do you think the diagnosis is, right? So what if the teluriperson has like pin with intercourse and then they tell you that oh as this person's mences approach the pin gets even worse. In fact at the onset of mences, boom the pin really gets to its peak. And then let's assume that this patient is like a theory-owned female that has been trying to get pregnant for many years. What's your diagnosis? I would hope you're telling me that this person has endometriosis, right? The thing is endometriosis almost always, it's kind of like varicose synonymium exams, almost always presents us some kind of infertility, right? It's a very high old cause of infertility. Again, I remember the classic triad, right? There are the three d's of endometriosis like dysmenoria, right? That's like the pinful mences. There's a dyspironia, right? That's like the pin with intercourse, pin with penetration. And then there is a dyschisia, right? Like pinful, pooping. I guess if you wanted to add, in fact, if I were you, or maybe make it a tetrad, adding fertility to that.

And essentially, the thing that happens with endometriosis is you have endometriol glands in sites other than the uterus itself, right? So please, please, please. I just said endometriosis. Please don't confuse endometriosis with adnomyosis, right? Adnomyosis is where you have endometriol glands in the myometriol. People that have adnomyosis on physical exams tend to have like a soft globular buggy uterus that is tender, okay? And one high old thing that for whatever reason tends to pop up quite frequently on MDME exam says, when a person has endometriosis, they will have tenderness or nodularity of the uterine sacral ligament or repeat that again, it's floorily high you to know this. They will have tenderness or nodularity of the uterine sacral ligament. If you see that, I really want you to think about endometriosis. Now, wouldn't they give you a question about like a 71 year old female? And you know, she has like a sideys, like rebutt a sideys and like a pelvic mass. And then let's say they show you histology and they show you like all these blue things that kind of look like, it's like, you know, you see like ovarian tissue, but you see like blue like circuits that almost look like some of my buddies. What kind of ovarian malignancy are you thinking about? Well, I would hope you're thinking about an ovarian cirrus cystadenocarcinoma, right? Remember, it's actually the most common malignant ovarian leoplasm and a cirrus cystadenocarcinoma.

And again, don't forget the association with some of my buddies, right? And for purposes of the USMLE exams, right? You absolutely positively want to know all your some of my buddies. All your malignancies that have associations with some of my buddies, right? So remember, cirrus cystadenocarcinoma, the ovary has that association. I mean, in joma has that association. A misotheloma has that association as well, right? And a papillary thyroid cancer also has a some of my buddies. So again, I repeat it again. Papillary thyroid cancer, meninjoma, cirrus cystadenocarcinoma, and misotheloma. Those are all associated with some of my buddies. Now again, what if you get another question, you know, some one-year female at Nexomas and then they tell you that on ultrasound, you notice that she has a thick endometro stripe, a thick endometro stripe, right? And then let's say they show you like a histology picture and you see all these things that it's kind of like columnous cells, like all around in circles, circles, circles, circles. And let me maybe give you an extra hint. Let's assume if a person, if a kid that was like six years old, like a six-year-old female had this tumor, should have precocious puberty. What kind of tumor am I thinking about? Again, I will hope you're telling me about like the granulosa cell tumors, right? Remember, it secrets estrogen, right?

So it can essentially present like in a young kid, like a six-year-old kid with like precocious puberty because with all that estrogen, she'll be attaining puberty pretty quickly. On the other hand, if it's a postmenopausal female, right? You'll notice that she may have like bleeding, she may have like endometro hyperplegia. That's why I say that this person had a thick endometro stripe. For these people, you typically also have to do like an endometro biopsy just to make sure they don't have like endometro hyperplegia or cancer or something like that because that unopposed estrogen will stimulate the endometrium and you'll proliferate. So so it'll tell you because if your postmenopausal your endometro stripe should be super super thin or almost like barely visible. So if you're seeing it and you see a pelvic mass, you really want to think about a granulosa cell tumor and remember that granulosa cell tumors are so you don't call exner buddies. I'll encourage you to look up a picture of this. So you'll call exner buddies. Now what if you have a question about like a 16-year-old female, she has like a larger nexomas and then they show you a picture and you see like you know like thyroid tissue, you see like cartilage, you see adipose tissue and all that. What are you thinking about? Well I hope you're telling me that you're thinking about like a mature cystic tumor, right? Sometimes it's called like a dermoid cyst.

Again, it essentially contains tissue from many different germ cell layers, right? And the thing is these things can be very large so they can actually cause a very entosure. And if you were to find this kind of tumor like a dermoid sister a teratoma in the medias thinum, where do you think you'll be found? Well I hope you're telling me that you'll be found in the anterior medias thinum, remember your terrible teeth thymomas, teratomas, they tend to be found in the anterior medias thinum. Contrast that with neuro-based tumors like neuroblastomas and all that stuff that tend to be found when the posterior medias thinum. And again, remember that some of these things can contain a thyroid tissue. Whenever you have like a dermoid cyst that contains thyroid tissue, it's known as stromovaria, right? That can cause hyperthyroidism. So obviously if this thing, if you have like thyroid tissue that's a ingredient thyroid hormone, those people, right, they can actually stretch these to integrate repro with endocrine on your exam. But the thing is the thyroid hormone that's been released, right? It will shut down the production of TSH. So these people's TSH will be low, right? And the thing is the thyroid globulin will actually be eliminated because the thyroid hormone is coming from native thyroid tissue. It's just that native thyroid tissue is elsewhere, where it's not supposed to be.

But if you were to perform a rye of skin like a radioactive iodine optic scan on these people, you will actually have decreased optic, very minimal optic on a rye of skin because TSH is suppressed so the native thyroid gland is not being stimulated in these people. Very, very high yield to understand what I just described. Now, what if you get this closer of information, right? So what if you get a question about like a 70-year-old female, she's presenting like early satiety and there's like an exomasthia detecting on physical exam. And she has like, you know, like massive GIS I Ds, she has like lesions in the liver, she has like lesions like in the stomach, and then they tell you that histology reveals like signet ring cells. On that, those circumstances are a whole thing about like a crooked convert tumor, right? Remember, it's essentially like a GI malignancy that essentially like metastasizes to the ovary. It's usually like a, it can be like a liver tumor that it metastasizes to the ovary. It can be like stomach cancer that metastasizes to the ovary, okay? Essentially any GI malignancy that metastasized to the ovary, right? It's called a crooked convert tumor. Again, remember the classic, classic association signet ring cells? It has a terrible prognosis, right? And the thing is, when the thing is, I want you to think of signet ring cells as a concept. The thing is, if you see a signet ring cells in the ovaries, think about a crooked convert tumor.

If you see signet ring cells in the breast, I also want you to think about lobular carcinoma inside two, okay? Lobernacarcinoma inside two, I mean, for the most part, lobernacarcinoma inside two, you can't increase your risk of bilateral breast cancer, right? And it's also associated with like mutations in e-cardhear, e-cardhear in helps cells, epithelial cells adhere to each other. And then, if you're looking at a higher resolution CT scan, now you notice that you see like a signet ring cell pattern, then I really want you to think about a person potentially having bronchietasis, okay? Bronchietasis, that's a classic presentation on imaging, on NV Me, except. Now, what if you get a question about like a 35-year-old female, you know, she comes in six-month history, painful intercourse, right? Sex hurts a ton, right? So she's having marital problems with her husband. And then they tell you that when you do a pelvic exam, you'll notice that she has like involuntary contractions of the perinoma salts. And then she tells you that, you know, sexual desire is normal, and that she's like, let's assume this person's actually like a vice president at a hedge fund. What do you think this person has? So this person has something called vaginismus, although I believe the name has changed fairly recently, sometimes it's called a genital pelvic pain disorder, right? GPPD, genital pelvic pain disorder, sometimes it's called like penetration disorder.

Essentially, this question's theme I've given you, essentially gives you the key pieces of information you will most likely be tested on. It'll be a person that has painful intercourse. The hotel on pelvic exam, you know, she kind of has like a touch-happereinial earion bone, they're like all these weight-involuntary contractions, she'll have like good sexual desire, but she'll also be like, you know, like a highly placed person in society. That's the class, like a person that is like, you know, like very driven, very ambitious stuff like that. That's the classic presentation. Again, not saying this to be sexist, but that's the classic presentation, unfortunately, on NV Me exams. And then, and actually in the rural world, if I'm not mistaken, that's how it tends to classically present as well. Now, what if you get a question about like a 35-year-old female, you know, comes in six-month history painful intercourse, and then a physical example is stoncord normal, right? And then, when you perform like light touch or light stroking of the perennial area, this lady has like intense pain. What are you thinking about? Well, I hope you're thinking about something called vovoidemia, okay? Vovoidemia. Basically, these patients, they have like in super-increase sensitive, which is like any kind of touch in the avolva in the vaginal area. And it actually has like a weird, very high-yield, but weird association with using those C Ps for a prolonged period of time.

Now, what if you get a question about the 33-year-old female that has like a blood-in-iple discharge? This is easy, right? You should never, if you get this wrong on an exam, you should feel, you should feel very bad, right? This is an introductory papilloma. This is like, floridly high-yield to know, not just for your test, but for tons and tons of exams in the future. Even like your 30 or 40 or like your surgery shelf, your medicine shelf, your OB-GYN shelf, they test this thing all the time, okay? Blood-in-iple discharge burned this into your brain forever. It's an introductory papilloma. Now, what if you get a question about a 23-year-old female, you know, on eventful delivery like three, like see she had a kid like three weeks ago, and she's presenting like a lateral like breast swelling and every theme, right? And then they tell you that, oh, when you actually like, palpide the affected breast, you can express some purulent discharge. And her body temperature is like 103. What does she have? So she has my studies that has led to a breast abscess, right? This thing is super, super common in like breastfeeding women. And again, for the most part, it's caused by staff warriors from like cracks in the nepot. You need to continue breastfeeding so you can wash away the bacteria. They will try to trick you to stop breastfeeding. Don't do that. Continue breastfeeding. And for the most part, you treat it with an anti-MSS-y penicillin, right?

So like an anti-stuff local penicillin, like naphthalene or oxacillin or di-glocsacillin on endemic exams. And there's a short podcast I have, I know it's passed like episode 100. I call it like some confusing breast pathologies. Super short podcast like 10 minutes or less, I think. But it covers like these high, like breast pathologies and sort of talks about them in some kind of like nice detail that can help you in exams. Because those things occasionally, especially more for step two, seek it, it tends to write those questions in ways that they write it well enough to like confuse you on a test. Now, what if you get a question about like a 22 year old female? She comes in, you know, completely not bilateral breast pain. And the tell you that on physical exam, you notice that she has like a lumpy, bumpy breast bilaterally. And then you get a bite, you know, you're like super concerned or she's concerned, you get a biopsy of one of the lesions and you see like something that's like a blue domed cyst. I promise you, come eat this buzzword to memory. A blue domed cyst, a blue domed cyst, okay? If you ever see this, think about fibrosistic change, right? It's the most common cause of like a penful breast mass in the US. For the most part, I don't know if you notice this. And I encourage you to look at a picture of this. You look at a fibrosistic change on on on on histology. And you notice that you see all these cysts and they tend to look like weird animals.

Like you see like someone looks like an ox or like a goat or whatever. Like a promise you like look up pictures of fibrosisic change, you always look super bizarre. Like the white species, it's almost like animals on on histology. And the thing is you essentially have like cysts, those are like clear spaces. And then you have fibrosis around the cysts. That's why it's called fibrosistic, fibrosistic change. Now, so I guess all the higher things, I guess I'll just sort of tell you because I really want to keep try to, you know, sort of like bear down the spot cast. Not bear down in terms of knowledge but make it short. But basically, right, you want to know that breastfeeding, right? It's a sort of like decrysters called like breast cancer, right? Because if you breastfeed, for you to be able to breastfeed, you need high levels of prolactin. Remember, prolactin is prolactitional, right? So now high levels of prolactin, that'll shut down GNRH. And if you shut down GNRH, you'll shut down the estrogen production, right? Remember, estrogen drives many breast cancer. So if a person is breastfeeding, that decreases the risk of breast cancer. It also decreases in the same thing, the risk of ovarian cancer, right? Because again, prolactin will shut down the GNRH axis. So you have an ovulation, with an ovulation, your ovarian epithelium, you know, doesn't have to be broken down every month or the however long your cycles are.

It doesn't need to be broken down all the time and repair each month, right? So that which is what happens when you ovulate, right? So your breastfeeding, producing is how you shut down the GNRH axis, right? So this essentially like reduces the potential for malignant transformation of the ovulation epithelium, right? And then breastfeeding also actually helps with weight loss. If I'm not mistaken, I think a riddance statistic that says that you lose about, you essentially burn like 500 calories every day if your breastfeed as a as a lady. And so, again, all the weird considerations, right? If a woman has like active TB, or she has like HIV, or she has like active like herpes lesions on the breast, you should actually not breastfeed. These people should not breastfeed. That's a very high health thing to know for example. Although remember again, don't mix the sulfur. The person has mastitis, right? Remember mastitis caused by staff workers for the most part, you give that close gasoline. A person with mastitis should breastfeed, okay? Another high yield contraindication to breastfeeding is actually galactocemia, right? Remember galactocemia, I realize this when you have like a deficiency of galactose one phosphorydial transfer, right? Like a gold deficiency. So you are not able to, you know, like metabolize that galactose appropriately. Those people cannot breastfeed because breast milk contains like lactose, right?

And lactose, right, can give rest of glucose and galactose, right? So they can run into problems. So a presence of galactocemia is a contraindication to breastfeeding. And remember, the most common cause of death in kids with essential galactocemia, right? This substance from E. coli. No one knows why, but it's a high yield association, you want to keep at the back of your mind. Now, when if you get a question about like a 41-year-old female, you know, she presents with like a poppable breast mass. And then they tell you that you perform a mammogram and you see like the focus of calcification in your product or turn of the left breast. And then they tell you that, oh, on histology, you're seeing like these like lipid leading mono nuclear cells. They won't see macrophages because that's too easy. They will say lipid leading mono nuclear cells, right? And then they tell you that some loser recently, like, punched in the breast. What are you thinking about on the those circumstances? Well, I hope you're telling me fattening crosses, right? Fattening crosses the history tells you essentially how you're looking for, although for the... Okay, I think I've already mentioned that so I'll move on. So, what if you get a question about like a 23-year-old female? You know, she presents with like a painless, discreet, movable breast mass, right? And then they tell you that she's like 25 weeks pregnant by her last menstrual period.

And she actually like noticed this mass around like six weeks' gestation. And the mass has really grown a ton, right? Since she noticed it the first time. What is this? It's a fibroidanoma, right? It's a fibroidanoma. I remember this is actually the most common B9 breast mass in women, right? In women, especially women less than the age of 35. And it's actually like a tumor of like the fibros, like, some of the breasts, right? That's why, again, it has the name fibroidanoma, right? And the thing is, these things tend to be like estrogen sensitive. So with the menstrual cycle, with pregnancy, they can actually grow pretty significantly. And one thing I think that's kind of like important to remember, right? This is just a statistical, I guess epidemiological thing you need to come into memory. The foremost common gynecologic cancers in the US, right? We have like both by like incidence number of deaths. You won't think about it, but if you're going by incidence, right? And I have like breast cancer is number one, full of bando-micro cancer, full of bi-overean cancer, full of cervical cancer, right? Cervical cancer, badness has dropped because of like the vaccine, right? The gradacy or whatever it's called. But if you're going by death, right? Overean, breast cancer is still the number one cause of death, full of bi-overean cancer, and then endometrial and then cervical. The easy way to recover is really good to find out how to remember all this. It's pretty easy actually.

Just remember the first and the last breast and cervical, it doesn't change. Breast is always number one in incidence and in death, cervical is always number four. And then in the middle, remember the first one for incidence, right? We have endometrial and ovarian, right? So endometrial is number two, ovarian is number three. What I would encourage you is then flip the middle, right? So for deaths, put ovarian first and then endometrial next, right? And you will not miss your way, right? So again, by number of, by incidence, right? You want to think about breast number one, endometrial number two, ovarian number three, and cervical number four. And then by death, think about breast number one, ovarian number two, endometrial number three, and cervical number four. Now, what if you get a question about like a 53-year-old, you know, postman-oposo female, she comes in, she presents you like a papo-boobress mass, and then the tell you that this mass has been present for like six months and has not changed in size, right? So this is 53-year-old postman oposal female, right? And the tell you that again, on physical exam, you reveal a fixed mass, right? This is not a good sign, it's a worse sign, right? Now, what are the genetic, same, physical, disperseance breast cancer, if you're still wondering, right? So what are the genetic syndrome that can cause breast cancer? Well, I hope you tell me like, bracket one, bracket two, right? I remember HMPCC, right?

So hereditry, non-polliposis, acoolerectocancer, is also associated with the development of a breast cancer, and then leaf from an eye syndrome, so like L-I, and then a hyphen, and then from any, F-R-A-U-M-E-N-I, okay? That's also associated with the breast cancer. Remember, leaf from an eye syndrome is as usual, then like mutations in P53, and remember that P53 is a tumor, so breast surgery, right? And then what, I guess, does the age at menarchy, and the age at menopause do with the person's risk of breast cancer? Well, I will hope you're telling me that being young at menarchy and actually being old at menopause, that increases your total life finding like estrogen exposure, right? So that actually increases your breast cancer risk. And then let's assume the detail of that, oh, on physical exam, you notice like a firm, non-tendery regular mass, and you notice that this person has like renal like redness, skin dimplein, put orange appearance of the breasts, and nipple retraction, right? It's terrible, right? This is inflammatory breast cancer, basically, the cancer has involved the subtermal lymphatics. Now what is the most common kind of breast cancer? Well, I hope you're telling me if you're treating a doctor who has a no-mark, right?

And then, let's assume they tell you that, oh, a person, you know, has like, you know, breast mass, you perform an excision biopsy, you find your plastic cells with immunosystem chemistry that shows you that the ERPR positive, what's your next plus step in management? Well, if the person is less than 50, right? You want to use a serum like Tamox effect. The person is greater than 50, right? You want a postmanopausal, right? You want to use a, you want to use an aromatis inhibitor, right? Like an astrosol, electrosol, or extremist, remember? An astrosol, an astrosol, right? These an aromatis inhibitor, aromatis converts androgens to estrogen, right? So that's a big thing you want to keep in mind. And then, what if a person has like an examinous nipple change, and this is like a 70-year-old female plus-budget disease of the breast, right? Now, big things with breast cancer, right? Again, how do you scream for breast cancer? Yelling mammograms after 40, if you're saying the American Cancer Society, or mammograms every two years after the age of 50, if you're the, if you're the USPSTF, right? And again, most breast cancers, they go to axillary nodes sometimes in some rare situations, they go to the internal mammary, the good occasionally to the internal mammary nodes. And in your treating lobular carcinoma, right? It's, again, you want to, I know you may see the veins kind of sound weird, but I promise you it's not weird, it's very high autonoma.

If you're treating a lobular carcinoma, it's actually at associated with like e-cadherin mutations, right? So cells do not adhere, right? Cadherin cells do not adhere to each other properly, right? And these people tend to have like bilateral breast cancer. So, again, if they tell you that, oh, you, a person has breast cancer, you get a biopsy, and you notice that on biopsy, you notice like cancer cells that seem to stay like in a single far on histology. Think about, I'm feel-free-teen, a lobular carcinoma. And most times when people have breast cancer animals, that's the size of the, it loves to go to like the lungs, it loves to go to the, to the liver, to the brain, to the bone, right? Remember that the lung cancer, right? Does like, I mean, breast cancer does like blastic lesions, but it can also do liver lesions as well, but almost always on MBM exams, be put in in the context of blastic lesions. So remember that B in breast, for the B in blastic lesions. And the thing is, if a breast cancer has like a breast cancer, and it has like the ERB2 mutation, so sometimes it could either hurt or new mutation, you know, that's a not a good prognosis, it's treatable, right? But it's not a good prognosis, really your drug of choice is trans-tusumap. Remember, right? It's associated with a dilated cardiomyopathy, right?

So, compared to contrast the dilated cardiomyopathy, that's associated with taking trans-tusumap, and it's reversible with the irreversible dilated cardiomyopathy that's associated with taking the, the, the anthracyclids, right? Like a, uh, doxorobsin and donor-obesin. Remember, you can, those cause a irreversible dilated cardiomyopathy by precipitating the fainting reaction, because they're very powerful, uh, iron associated compounds, so you can prevent that by giving a drug known as a dexerzoxin. Believe it or not, this is something high or too long, because doxorobsin and donor-obesin, believe it, actually used to treat a breast cancer. And then, remember, if a person is having like breast surgery for like cancer removal or whatever, right? They can actually injure the long thoracic nerve, right? So remember, if you injure the long thoracic nerve, um, the serietos anterior will not work, so the person will have like wings capula. That's again, how they can integrate anatomy with your exam. And again, I've sort of talked about like, again, like, fibrosistic change again, right? Lumpy, bumpy breasts, usually it's in the upper quadrants of the breasts, right? And again, the hotel I've had on an example on the histology, you notice like a blue dome, a blue dome appearance. Um, um, that's a boss phrase you want to remember, right? Fiber adenoma, it's usually like, you know, like, also conscribed, it's like mobile, it's like rubber, it's encapsulated, right?

It's again, it's the most common benign tumor in women, usually on MDM is it's in a woman that will be less than like 30 years old, or actually should be premenopausal for the most part, right? And again, remember these things, the insurgents, insulated, right? So they can grudering pregnancy or they can grudering the menstrual cycle. And then in chiroptopapiloma again, I'm just trying to do a summary because these things are super, super high, you know, in chiroptopapiloma, unilateral, not bilateral, unilateral, blood-in-if-ordis-charge, premenopausal woman, right? Um, in fact, it's actually the most common cause of blood-in-if-ordis-charge, as a woman between like, the ages of like 20 to 40. And again, usually you don't see it on mammograms, but, um, yeah, so that's the big thing you want to know. Like, I promise you, like, if you're a second-year med student listening to this, before you graduate from med school, I can almost promise you're going to see at least this is me being like super conservative, 10 to 15-introductal papiloma questions. And then fat necrosis, right? Again, like, you know, like recent, like trauma to the breast, like breast surgery, or you were hitting the breast, or you hit your breast on a door, or whatever, right? Um, that's the classic, for example, fat necrosis, usually on, uh, on mammograms, right? You'll see like a mammocausification.

And the thing is, sometimes your friends at the end of the evening will try to ask you like, what's the mechanism behind the calcification that you're seeing fat necrosis of the breast? I would really, really hope you're telling me that, um, it arises from saponification. That is also the reason why you see calcifications in the pancreas. When a person has had recurring bouts of like good pancreatitis, so essentially they have like chronic pancreatitis. And then an abscess, right? Again, you'll be a lactating female, like a breast abscess, lactating female, um, she'll have like a breast that's like aerotherm at us, warm, you may get like a purulent discharge, um, um, you'll see like a flock trunk mass, right? Um, again, those are all big things you want to keep in mind. And again, the mechanism of infection is you have cracks in the nipple, um, and then bacteria mix its way through usually stuff or else. And then a galactoseal is something I don't think I've mentioned just yet. But basically the thing the way it presents is it'll be like, you know, like a pinfall, sometimes it's painless, uh, like mass, like a lactating woman, right? And they'll tell you in the question that the mass is not warm, it's not aerotherm at us, right? Um, usually it kind of happens when you stop like, you know, like breastfeeding. And for the most part, you manage it with like, you know, like you do like a breast massage or you try to aspirate or whatever it's in there.

And then, uh, we've again talked about like, uh, invasive doctorate carcinoma is the most common, uh, breast, uh, you know, is the most common, uh, breast tumor, um, malignant breast tumor, right? Remember, in visible blood carcinoma, they have like a high risk of like, um, bilateral breast disease. And remember, the association with like E-card hearing mutations. Um, and then inflammatory carcinoma, right, poldo, raja, appearance, mastitis, that doesn't seem to heal with antibiotics. That's the classic presentation on exams. And then the phyloidist tumor, right? Uh, typically, right, they will tell you that, you know, like the tip, the tumor will usually have like, you know, like this big fibres component and enough fibres component as it grows, grows, grows, grows like crazy, it'll sort of push the tumor out of the way, okay? Um, that's, uh, that's what you want to keep in mind, uh, on your exams. Um, and then, if for example, the, how do I put this? Um, just trying to think, if you think I've said most of the high-o thing for needing to breast cancer, yeah, I think, I think I'm, I think I'm, I think if you're pretty good about my discussion of breast cancer. So let's talk about ovarian cancer right now. Just do again a quick rapid summary. So ovarian cancer is right. Again, um, the as usual, like, elevations in C125, um, but C125 elevations doesn't mean that oh, you have like a malignant ovarian neoplasm.

You could also have like, you could also have like a benign ovarian neoplasm. So really, how do we break on this ovarian cancer? Right? We can bring them up into three big groups. First big group is like a sophisticated phyloid tumor, right? Actually, that's the most common, like 70% of all ovarian malignancies. And then the second big group we have, we have the germ cell tumors, right? These are the second most common. There's about 20% of them. So we've made up 90% already. And then the third red group, we have like the sex cord, a stromo tumors. So let's talk about the different malignancies that fall on them. These are pervies, right? So the first one is, um, so let's talk about the surface epithelial tumors, you know, again, 70% of ovarian cancers. Um, the first type, what I want to talk about is the serous type, right? Um, you want to be able to compare like serous to mucinous. Serous and mucinous ovarian cancers, they're both examples of surface epithelial ovarianoplasms. Um, the thing is, the serous, uh, serous ovarian cancer, right? It tends to, you know, it tends to be more likely to be bilateral, okay? Um, it tends to be more likely to be malignant, right? And most times these cancers tend to contain epithelial cells that look like fallopian tube epithelium, right? And again, remember the association for some more bodies and the metelier that on endgame is the metelier that on histology, notice that, um, the tumor has like papillary projections.

If you see that, again, I really want to think about, um, serous, the serous type of the surface epithelial ovarianoplasms. And then the second type, right, um, is the mucinous. So mucinous, again, falls on the surface epithelial business, um, again, it's more likely to be unilateral, right? In fact, let me put it this way. Serous ovarianoplasms tend to be, are more likely to be bilateral. Mucinous tend to be more likely to be unilateral. Serous tends to be uniloculated, right? So like unilocular mucinous tends to be multi-loculated, right? So like multiple walls within the tumor. And then, unlike serous, uh, ovarian cancers that contain, um, fallopian tube like epithelium, for mucinous kind, it tends to contain like glenderly epithelium. And the, uh, one weird presentation of mucinous ovarian cancer mucinous exams is a person that has like mucinous societies. And then they have like, uh, like, uh, like all these weird cystic implants that are all scattered around the peritoneum. One of those circumstances you want to think about something called a sudomixoma peritoneae, okay? Sudomixoma peritoneae tends to show up a lot on tests. And then, uh, there is also an endometriolid, surface epithelial ovarian cancer. Basically, there are five types of surface epithelial ovarian cancers. There's serous, there's mucinous, there's endometriolid, there's clear cell and there's brener, right?

So the endometriolid, it essentially looks like endometriolid no-carcinoma, um, and then clear cell, again, clear cell is handled, uh, um, that's probably you don't need to know much about it. And then the brener, right? The brener tumor, um, it's usually be nine, it tends to contain like a transitional center pithelia. So again, these five groups, serous, mucinous, endometriolid, clear cell, and brener tumors, those are all examples of, uh, those are all examples of a surface epithelial tumors. And then the germ cell type, right? That we're getting, we said, there's like 20 percent, although those we have like embryonal or carcinoma, we have like the dysjeminoma. I remember, dysjeminomas are always malignant, and um, they essentially like the, um, they're essentially like the semi-nomas infimian, okay? Disjeminomas. And then we have choreocrycinoma, and then we have cystic teratomas, which we've talked about. Again, remember, cystic teratomas contain many different tissue types, can be in the endometriolid, just thinam, right? It can make a, uh, thyroid tissue, right? So it can cause femoral virus, those patients can be hyperthyroid. And then the six quarts femoral tumors, there's three big ones we want to think about. Uh, the first one is, um, the sirtolylytic cell tumor, right? So you can make the testosterone, um, it can cause like the realization in a lady, um, and then, granulose cell tumors, right? They tend to produce estrogen.

Remember the estrogen, the call exnerbodies, right? Um, um, and remember, it can cause endometriolidiproplizion cancer, because you are producing an unopposed estrogen. And then, um, there's also something called the fibrothicoma. So fibrothicoma, f-I-B-R or THAC-O-M-A, rarely pops up on test, right? But the thing is when it, um, when it pops up, the classic presentation is, it's, so it's usually benign, right? But these people tend to have like a side is, and then they'll have something called a hydro thorax, a hydro thorax, where the acidic fluid goes through the, you know, somewhat permeable or porous, um, um, um, diaphragm, and then the essentially mica pure fluid from that. So that's the classic presentation of a fibrothicoma. And then, so let's talk about some contraceptives, okay? Um, I'll give you a description and tell me what kind of contraceptive this is. So what if you get a question about like a contraceptive that lasts 10 years, right? That's paraguard, right? That's the copper IUD um, contrast is with myrina, right? Myrina is a proof of five years in the US, and a proof of seven years, um, um, um, but it's like seven years in Europe for the myrina, right? And I believe the paraguard, the copper IUD is seven years in the US, but it's actually 10 years in Europe, but think that what you will, I guess you can uh, sort of like pursue that with the pharmaceutical companies.

And then what is the contraceptive option that works by triggering an inflammatory reaction in the US? That's paraguard, right? That's the copper IUD. What's the contraceptive option that thickens cervical mucus? Those are your progestines, right? Like your myrina IUD. And then what's the most effective means of contraception? It's abstinence, right? If you don't have sex, can get pregnant, right? And then, uh, what if you, uh, what is the permanent method of contraception that applies to meals? That's a, the septomy, right? Now what is the permanent contraception option that applies to females? That's a tubule ligation. And really, between these two, which one is more easily reversed? It's actually a vasectomy, the, the septomy is a truly more easily reversed. And then what are the two least effective methods of contraception? Right? There's like the natural family planning. Don't do that. It doesn't really work. And then for guys, right? The pull-out method, it's not prudent at all, right? It's not prudent at all. I'll tell you that. And then what is the contraceptive option that provides protection against ST Is? That's, that's the use of condoms, right? And then what do spermisides increase your susceptibility to? What does spermisides increase your susceptibility to? It actually increases your susceptibility to HIV, right?

The thing is the inflammation that sort of happens when you use a spermiside around like the vaginomicosa, that inflammation can disrupt the epithelial ear, and that can make it much easier for HIV to gain access to you, right? And then what is the lifestyle factor that essentially contraindication to get in a combined OCP? That'll be smoking, right? That'll be smoking. If in five to five years old, are you smoke? You should absolutely positively not get estrogen, container, contraceptive options. And then if you remember, if a person has a history of like hepatic adenoma, or like liver-based problem, then you also cannot use an estrogen-contained option. And again, if you have like an issue of breast cancer and the metro cancer, right? An estrogen-contained option is also not a great idea either. Now, what is the primary mechanism of oxygen of OCP? How do they work for the most part? They should have the HPG access, right? And then what are the two cancers with like the incidence is going to know when you're using OC Ps? That's endometrial cancer and ovarian cancer, right? And then what if a person has like irregular bleeding, weight gain? And so let's say they studied on a contraceptive option, and then they have like irregular bleeds, they've been getting weight, and it actually takes a long time for fertility to return. And these people may actually have depression. What kind of ovarian malignancy are we thinking?

I mean, what kind of contraceptive option are we thinking about here? That'd be depoprovera, right? The three month progestin shot. And then what is the contraceptive option that provides like three year protection? It's a progestin and it actually has like no impact on like a person's weight or a person's mood or a person's bone, unlike depoprovera. So this is actually an explanar, right? So progestin and implant is already implanting in the operating room, it's like usually somewhere in the air, works pretty well. And then again, remember only contraceptive option method that protects against ST Ds, right? Abstinence condoms, combine those C Ps, right? Again, remember they work by essentially inhibiting ovulation, right? Because that is changing the combined acetyl, exerts a negative feedback. And then remember that progestin works by increasing the thickness of a cervical mucus. And again, OC Ps, the contraindications OC Ps, they are numerous, but they are high, you know, right? You want to avoid a combined OC Ps in anyone that has like, you know, like weird genetic disease like factor five lied in or a DVT, history of a DVT or PE, right? And if people have like a history of cancers that are driven by estrogen, right? So like breast cancer, endometrial cancer, again, you want to go ahead and shut down, you don't want to give these people an estrogen-containing contraceptive option.

And then if people have like bad hypertension, in fact, if I'm not mistaken, OCP is actually one of the most common, if not the most common cause of hypertension in a pregnancy age to females. And then, if a person has a history of like hepatic adenomas, again, or smoke regret in 35 years old, can give them an estrogen-containing, can give those people an estrogen-containing a contraceptive option. And then if a person has like a history of like migraines with aura or like atypical migraines where they have like these weird neurological deficits, those people also should not get, should also not get a combined OC Ps, right? And then, what did they give you a question about like a lady that's being treated for TB? She becomes pregnant. And you know, she's like, don't quite get pregnant but I'm on a combined OCP and I'm taking regularly. What are you thinking about? Well, I hope you're thinking about like a revved-up metabolism of the drug from like using right fampin. Okay, remember, right fampin is an inducer of cytokromp 450. And remember, I'm just in only pills, right? They work by you, again, like I said, thickness, cervical, mucus, don't forget, right? Pregesting causes like weight gain, right? And it actually causes like a reversible, not irreversible, reversible osteoporosis. And then one of the weird things, when I guess maybe let me sort of throw this in there as a bonus for you, majestral is actually a derivative of a progestin.

It's actually given to you know, like simulates to stimulate appetite in like patients that have cachyxia, right? So patients like terminal terminal cancers, for example. And then remember, your copper IUD, it's actually an excellent contraceptive, it works by essentially, right? Causing like a, like an inflammatory reaction, in that makes the uterus, right? Kind of like inhospitable. So eggs are not sperm and eggs are not liable to you know, like leave and fertilize their successfully, right? And again, if a woman has a history of heavy mencees, you actually do not want to give her a copper IUD because copper IUD is the causing frequent bleeding. But when they cause bleeding, the bleeding tends to be very heavy, right? And also don't forget that if a person has a histone willsins disease, okay? They should not get the copper IUD as well. They should not get the copper IUD as well because obviously they have like copper metabolism or problems, right? And again, don't forget, just again, throw this as a sidebar. If a person has a histone of tubal ligation, that actually has a strong association with a topic pregnancies. Now, what if you get a question about like a 22-year-old female? She's like tearful and she delivered a baby like three days ago and she has been breastfeeding, you know, taking care of like good care of the baby. What's your diagnosis here? Right? These are your postpartum blues, right? You were a short-of-patient.

You don't need to prescribe any, you know, kinds of medications. Now, what if you get a question about like a 22-year-old female? She comes to the ED. I hope that brings us to the ED, you know, like she's less sick, she'll be about the baby like three days ago. And then, they tell you that her husband found like a small radio taped to her head and she says that she's receiving like detailed instructions from outer space on how sacrificing her baby will end a war hunger. What's your diagnosis here? Right? This is postpartum psychosis, right? So the person is having like auditory hallucinations, they're hearing voices. This patient needs to be hospitalized and you can actually hospitalize a patient involuntarily if need be, right? And then you start the patient on like usually like an eight-typical anti-psychotic, you can also start on a typical anti-psychotic like caloparynal on end-maving exams. Now, what if you get a question about like a 22-year-old female? You know, she comes from like her one-week postpartum visit. She looks like the shevelled and she tells you that, you know, she's been having like some occasional thoughts of like hurting the baby and she feels remorseful about it. She's been breastfeeding the baby, but you know, she's no longer enjoying activity she likes before she got pregnant and then they tell you that, you know, Husband Kim, we heard to the clinic and her husband looks pretty supportive. What's your diagnosis? Right?

This is postpartum depression, right? These people, you'll have like your seagull capsimtoms, they may not necessarily have like five out of nine, like you've come to no-one loving psychiatry, but you'll have many seagull capsimtoms, right? But the most part you prescribe an SSRI monitor the patient closely, stuff like that. Now, let me try to present a clinical vignette with multiple choice and they won't go from there, right? So let's assume you get a question about like a 15-year-old female, comes to the ED and let's see she's been having like CVF, they have no pain, CVF cramping and then they tell you that you perform a physical exam and you notice that she has like suprapubic tenderness to bowel patient and then they say that for the questioning, you know, tells you that, oh, this patient started having a period like three months ago and she's actually been having cycles for the past three days and then they tell you that there's actually like dried blood at the vaginal intruders and they tell you that a serum beta ECG is negative and the patient tells you that, you know, she's never been sexually active and then they tell you that her lab vital signs all within normal limits and then they ask for the next step in management, right?

And then let's see option E is to administer a cyclooxygenase inhibitor, option B is to perform exploratory laparadomy, option C is to prescribe broad spectrum antibiotics, and then option D is to, you know, begin like sexually in therapy for like depressive symptoms. What's your diagnosis here? I hope you're telling me that this patient has like primary dysmenorrhea, right? Like essentially painful mentees, for the most part you give end sets. If end sets are not caught in it, you can give like combined those C Ps, okay? That's like second line on NVM exams after end sets. Now what if you get a question about like a 32-year-old female comes to a PCP she's completely like painful periods, pain with sex, painful bowel movements, and they tell you that oh she's been trying to have like kids and she got married like two years ago, and then they tell you that on pelvic exam you notice that there's like a six-centimeter like tender mass in the rectal uterine pouch, and here's the kicker. There is modularity of the uterus sacral ligament. What's this? It isn't the mitralysis, right? Again, it's where you deposit in the mitral tissue outside the uterus. Again, no one really understands the mechanism, but one mechanism of disease that is one disease pathophysiology that's been proposed is that the person has like a retrograde menstruation, right? So memorize that buzzword, retrograde menstruation. That's like a common buzzword people tend to remember.

And really again, you want to consider this as a diagnosis when you have the 3 Ds, right? So like dyschisia, so painful, painful, painful dysmenorrhea, painful intercourse. I mean painful mentees and then dysparenia, right? So painful, so like painful intercourse, so like dysparenia. And really the most common location of these endometriors of endometriors is actually the ovaries, right? Because and things, it can actually when you have endometriosis, right? The thing is when you have the endometriors in the ovary, it can actually bleed and cause something called an endometrioma, okay? So the ovary is the most common location. Second most common location is direct to uterinear pouch, right? And again, the way you can actually make like the gold standard test for the diagnosis of endometriosis is actually to perform a laparoscopy. And really your treatment options, I mean there's not much, right? You can do like a combined slash, you know, you can give like a progestinocp, right? Because that will again, that will, you know, like look at the HPG axis, right? You can also give like continuous generic, right? Not positive, I remember positive generic promotes the development of the HPG axis, but if you give it in a continuous fashion, I'll show down the HPG axis, right?

So that can actually show down endometriosis because if you show down the HPG axis, then you have trouble, um, um, if you show down the HPG axis, you have trouble producing, um, you have trouble like producing estrogen. And if you're not producing estrogen, you will not stimulate endometriosis tissue, right? So that can actually decrease symptoms. And then if the patient actually desires fertility and they have a history of endometriosis, right? You can actually try to do surgery to remove the badness, right? Especially if the patient still wants to be fertile. But if the patient is like postmenopausal and she doesn't require, um, reproductive potential anymore, you can do a THBS or a total abdominal hysterectomy and bilateral salping going for rectum. Okay? So those are all high-yield things you want to keep in mind. Now, what if you get a question about like a 40-year-old female? She's a complaint of like increasing pain, what, with men's is for like the past like, I don't know, like 11 months. And then her peers are like super heavy and they tell you that her last child was delivered like 12 years ago with like a tubularization. And then they tell you, um, so she had a child like 12 years ago and then after that she had like a tubularization. And then they tell you that on pelvic exam, her uterus is like in large, it's tender, it's globular and it's soft. If you see this, that's adomyoces, okay? Adomyoces is when you put like endometriol glands in the myometrial, right?

Contrast this with lyomayomas, right? So lyomayomas tend to be like asymmetric, they tend to be firm. So the person's uterus tends to be asymmetric, tends to be firm, and tends to be non-tender. Contrast this with adomyoces with the uterus tends to be symmetric, tends to be soft, and tends to be tender, okay? And really adomyoces you make the diagnosis clinically, although you can actually also make the diagnosis by doing an MRI, the only way you can make conclusive definitive diagnosis of adomyoces is when you, uh, you don't like laparoscopy, right? And you examine like tissue after surgery. And really for the most part, your treatment, the treatment is something that many people don't think about, but it's super, super high you to know for exams. It's the Lovano-gestural, IUD, okay? It can actually help with the menstrual bleeding. Really, the way you treat adomyoces is definitively stupid, perform our historectum. Now what if you get a question about like a 43-year-old female, this is multiple trials, like for a 3-year-old female, she shadows an appointment with her gynecologist, you know, like three months after I don't check up. And you know, the tell you that she has felt irritable, she felt moody for the past nine weeks, and she has to like, you know, change out of a night gown every night. I don't know how would he call it in the US, but in the general call it like a night gown. So like almost like pajamas for females, basically, right?

So like, you know, she has to change out of a night gown like as her, like she's having like severe night sweats. And then the tell you that physical exam, you notice that she has like mild pretybular dima, and her vitals are notable for like mild tachypnea, so her respiratory disease, you know, mildly increased. And they tell you that this patient is in a good relationship with a husband 20 years, and she has like regular 30-day menstrual cycles, although she tells you that you know for the past two cycles, I haven't had any flow. What's your next best-temping management? So option A, let's say it's, you know, measure certain TSH levels. Let's see option B, so like check FSH and estrogen level, so that you roll out middle pause. Let's see option C is like performing something called like endometrial sampling and biopsy, right? To roll out like an endometrial malignancy. And then let's see option D is to re-assure the patient that this is normal. And then let's see option E is to measure certain beta HCG levels. What's your answer? I hope you're telling me to measure certain beta HCG, right? This lady may be pregnant. Remember, if you ever see like imminuria, either primary or secondary imminuria, you know, like an old person or like a woman that's like in her 40s or whatever, your first step is also shability CG. Just make sure she's not pregnant, right? Even if it's a kid as long as young as 11 or 12, right? Again, go ahead and perform the BWCG.

Again, as a role with very few exceptions, a productive H female with imminuria pregnancy test, okay? A reproductive H by my definition is a woman that's less than 50. So please don't get dinged on questions that make you like, you know, think because if you notice where the question right like said, like, oh, this person may have hypothyroidism or bloody, bloody, bloody blood, right? Don't get don't get a myth on your test. And again, watch out for these kinds of scenarios. They tend to pop up quite frequently on Amy makes sense. Okay, so now let's do some quick micro put in the context of OBGYN, right? So I give you a presentation and tell me what the most likely bug is, right? So let's say a person has like a kid with like, quarter at night, his hydrocephalus and for cranial calcifications, and then they tell you like, cut later, tell you that this person, you can treat this infection like pyramidid and sulfodias and what's this? This is toxoplasma gondii, right? In fact, I will just give you a buzzword and then you tell me what bug it is, right? Buzzwords so that you can, you know, be able to rapidly recognize these on exams. So, slap-cheekrush, a thritis and an adult, anemia, hydrocephalus and a kid. What is that? That's probably 19. Remember, it's a single stranded DNA virus.

Now, feed us born with like, scarred skin, hypoplastic limbs, life-threatening pneumonia in like a feed us, mom that had like a generalized rush like dream pregnancy that had like vesicles and blisters in different stages of healing. What is this? This is VZV, right? Virusela Zostovirus. Remember, if mom is exposed to dream pregnancy, right? And she's on vaccinated for like VZV. It's just like VZV, right? And again, if mom is exposed to dream pregnancy, she's on vaccinated, you give the Virusela Zostei immunoglobulin to try to trick you to give the hydro vaccine. Don't do that. If a woman is pregnant, if a kid is less than a year old, you absolutely positively cannot give the Virusela Zoster immunoglobulin. Again, if the neonitis is exposed, again, give VZV as well, right? If mom is infected with pregnancy, you can give her a psychrovere. But again, don't give the vaccine to a... Don't give the Virusela, because again, it's a live-atunnythed vaccine, right? You don't give live-atunnythed vaccines to pregnant women or kids less than a year old, okay? Or higher to know, for example. And then, what if they give you a question about a kid that has like a newborn that has like cataracts, has like deafness, and you hear like a machine like murmur in this newborn. And this newborn has like a blueberry muffin rash. What is this? That's rebella, right? Again, you cannot give the rebella vaccine because again, it's live-atunnythed.

Now, what if mom has consumed like daily menstrual pregnancy and she delivers a fetus that is like steelborn. And this steelborn fetus has like... This steelborn fetus has like like abscesses in the heart, abscesses in the liver, in the spleen. Now, this infection is fetal and basically what is this? That's the stereomotocyte version is. Now, what if... What if... You don't see that there's this newborn and I'll image that this newborn has like peri-ventricular calcifications. So like calcifications are under a lot of ventricles. And then this person, this kid has like sensory neuro hearing loss, has jaundice, has epitomegal megaly, what is this? This is CMV, right? Cytomegalovirus. I think that's like herpes 5. You treat all guns like luvia, right? I remember. The way a person gets like guns like hervery resistance is when you have a mutation in a Chinese known as a UL-97 Chinese. That's Florida how you ought to know for exams. And then... If for example a woman has a history of HIV, right? How do you... How do you want to deliver a kid? You probably want to go ahead and do like a like a scheduled C-section, right? And you can actually give Zaidouviureening a part of, right? So again, sort of prevent transmission. Again, these are all again, high-youth hints to know. And really like remember that you should also place mom, right? From like highly active antiretroviral therapy. But please, please, please do not give a fabricance. This is a terrible idea, right?

A fabricance is an in-n-r-ti causes vivid dreams, but it's also terrible, right? So fabricance is like the one big booster child drug you never give to a HIV patient that's pregnant. And then if a person has like, you know, like if a kid like a new unit has like exposure to like HIV in utero, you can actually start before you even do any kind of testing. You can give like six weeks of Zaidouviureening prophylaxically, right? And then at some point in the future, you can do like a PCR to figure out if you actually have like a HIV floating around. And then what if mom has like HSV, right? Basically, the thing you start with is around like 36 weeks of gestation with a history of like HSV. So even if they don't even have lesions, if a person has a history of herpes, after 36 weeks, start giving prophylaxis psychrovere. Okay? Now here's one tricky, tricky, tricky, tricky, tricky area to exploit on the exam. If you do not see any visible herpes lesions on the vagina, you can deliver the baby. No problem vaginal. But if you see like visible lesions, then you need to go ahead and deliver by a C section. Okay? Very very high use to to know those. And then what if they give you a question about a newborn, you know, has like slough skin of the hands and feet, has tons of nasal secretions. And then let's see the tell you that let's assume the tell you that oh, this kid has like a permanent forehead, like a collapse nasal bridge, has like Hodgkin's teeth, has a tear bueno of the tibia.

What is this? This is syphilis, right? The syphilis, remember syphilis, right? You'll scream with RPRVDRL, right? And then to confirm you use, so you use a non-tripunimo test for screening, right? So like RPRVDRL. And then you use a trapeunimo test to confirm the diagnosis, right? And the boss or the owner member stands like a FTA ABS, MHATP stuff like that, right? And again, for syphilis, obviously you give a, you give penicillin. Then what is the most common cause of meningitis, pneumonia, sepsis, first 20 days of life? I hope your telomere group is strep, right? Strepic galactine. So now let's talk about endometrial cancer. We're almost done. We'll just let's fire through this and then you know that you know, you have everything you need for your test. So endometrial cancer, for the most part, it tends to be like adenocarcinoma. It typically arises in the setting of like endometrial hyperplasia. In fact, the biggest risk factor for endometrial cancer is exposure to an opus-desk surgeon. So again, risk factors are high, you know, the USML is beginning to, you know, focus pretty heavily on those. So yeah, that's the biggest risk factor. And then endometrial hyperplasia, right? Ultimately, it's the endometrial cancer, right? So what are some things that can cause an opus-desk surgeon? Well, for person who has PCOS, for person who's obese, remember if you are obese, you're a depotized, the express point of remedy, so convert more testosterone to adrogens, right?

So that can cause a, that can cause a lot of trouble. And then remember, if a person has a histropic US as well, right? histropic US, for person who's on tamoxifen, membrane tamoxifen, anesthesia, receptor agonist in the uterus, right? Those things can all cause endometrial cancer. Also, the genetic syndrome HNPCC, right? So like hereditry, non-poliposis, chalerectal cancer, post-sus-entesthesia on the endometrial cancer. And really for endometrial cancer, there's two types, right? There's type 1, there's type 2. Type 1 is like that classic one, right? And it's the one that's as usual like increased exposure to estrogen. On the other hand, type 2 is actually not associated with increased estrogen exposure. It actually has a pretty but, um, um, has like a terrible, terrible, terrible prognosis, not associated with increased exposure to estrogen, right? It's almost like ovarian cancer in the sense that type 2 endometrial cancer. And really the classic presentation of endometrial cancer, right? You'll be up no uiterine bleeding in a woman that is more than, um, how do I pull this? Women that's more than 50, right? Like a postman who was a female. And again, to me, the diagnosis, you perform an endometrial biopsy. And one weird high-yield scenario actually, you want to keep in mind is, you need to perform an endometrial biopsy, now if a person has like a long history of like some disorder that predisposes them to endometrial system, right?

So if, for example, a 36-year-old female that has like a 10-year history of, um, PCOS, right? Comes in like vag- like irregular, uh, mences and all that stuff, um, or like a non-mau-yieldering bleeding, you want to definitely think about endometrosis for sure. And really, the way you treat endometrial, uh, sorry, no endometrosis, endometrial cancer. Anyway, keep mixing up these words. Um, and then the way you treat endometrial cancer, right? You do a THBS, so you get rid of the, you do a total abdominal hysterectomy and a bilateral, subpingal refrectomy. If you're catching endometrial cancer, really, the prognosis is excellent, right? And then cervical cancer, right? Let's jump to that, right? So remember cervical cancer, the most common type of cervical cancer is the schromosyl type, right? And that tends to arise in the outer cervix, right? You can also have like adenocarcinoma, as we know, a lot of the cervix, right? But, um, those, uh, you know, they tend to be, um, more like in the inner cervix, not in the outer cervix, the inner cervix, right? And this inner cervix usually, you don't visualize it if you do like a speckonom exam, right? And the thing is most of these cervical cancers, they actually, there's this zone between the endoservic, so like the inner cervix and the ectoservic, which is the outer cervix, there's this transformation zone between those two. That is where, um, endometr, uh, what am I saying, endometrial cervical cancers? Oh, go on divine.

Stop mixing these words up. That's where cervical cancers tend to, tend to arise for the most part. And the biggest risk factor, again, super high-youtube, like OB-GYN question writers, they have this intense love for risk factors. The biggest risk factor for cervical cancer is actually a histro-exposure to HPV, right? So like, HPV 16 and 18, um, and then the ones in the 30s. And then I mean some other risk factors, right? Like if a person has like multiple sex partners, histro-ST Ds, histro-HIV, so a person that is immunosuppressed, um, those people have a high risk of, uh, having a cervical cancer, also smoking, living in the notice, a risk factor for cervical cancer. And really for the most part, if a person has like a histro-uh, HPV, right, use every woman, right? You know, get screened with a pap smear between the ages of every three years, up until the age of 30, studying at the age of 21. Um, after the age of 30, you can do the same thing, but, uh, you can actually do something called like a pap smear plus HPV, quote, testing every five years. That's actually preferred again past the age of 30. Um, if a person has had like, you know, like multiple, normal pap smears when the heat 65, you can stop. Um, and if a person has actually had like, you know, like, uh, let's say like a person has had like a histerectum, right? Or like a, two of them know, he's directly by a lot of people are freectiving. And let's say they have that for endometrial cancer.

Do you still need to do pap smears in those people? You absolutely do. You still need to do pap smears, but you need to do a pap smear of the vaginal cough. That's the boss freeze you want to remember on your exam. And if, for example, I tell you a question about, uh, patient, you know, that's like, premenopause, a liven, and she has like post-coid oblidating, and she has like those risk factors I kind of mentioned a few seconds ago. Um, think about endometrial, no, think about cervical cancer on those circumstances, right? So like post-coid oblidating, young female think about a cervical cancer, right? And the thing is cervical cancer, the most common cause of death. This is super high uterine, for example. The most common cause of death in cervical cancer is actually like renal failure from like hydronophoresis. Because many times cervical cancer loves to metastasize and binge on the, um, in binge on the ureters, okay? So the most common cause of death actually in cervical cancer is renal failure from hydronophoresis. Now, um, also please, right? Don't forget, right? If a person has like, um, like, you know, let's say like in the process of the like endometrial, motor endometrial cervical biopsy or whatever, and you do like all these like lip procedures and all that stuff or like this colonization procedures that actually increases the presence risk of a cervical insufficiency, right? So like, uh, where they have like a painless second trimester pregnancy loss. Okay.

Now, what if you hear all this? What are you thinking about? So like, hypoplastic fetal lungs, amniotic fluid index, so like an AFI of like two centimeters. So like oligohydramins, and like facial defects, skin defects, limb defects. What is this? This is a border-sane drum, right? Remember, it arises when you have like bilateral renal agent, it says not unilateral, bilateral renal agent, it says right. So you don't make urine. So you have oligohydramins, and with that you have all these other characteristic findings. One other thing that can actually cause oligohydramins is something called posterior urythrovolve, okay? You essentially again have some kind of blockade of the urinary system. Um, and then think, so I've just been harping on oligohydramins. Think about polyhydramins, right? When you have like a history, you get a question about a kid that has like a history of like an encephaly, where again you have like no swallow in center, right? So you just p p p p p and that's it. Um, maternal diabetes, right? Remember, if a mom has diabetes, the baby will have hyperglycemia, that hyperglycemia will dump, um, that hyperglycemia, that glucose will cause a urine as well, so it will cause polyurethane, right? If a kid also has like blood and allatrysia, right? Remember that the classically described double bubble sign that can also cause polyhydramins, right? And then if a kid has a history of like a subagilatrizia, right? Again, you can swallow anything, right?

So, um, those will obviously don't have polyhydramins, and remember that, uh, that the test, right, for a subagilatrizia, right? Is you try to pass an esogastric tube and you'll notice it called up in the thoracic cavity. You see that your diagnosis is done. That's, uh, that's, uh, uh, uh, a subagilatrizia, like a T-fistula. Okay. Now, what if you get a question about like a 15-year-old premigravida, so she's 15 years old, right? Comes to a PCP, says that she's been having like severe morning sickness and like vaginal bleeding, and then they tell you that she has been vomiting for like hours every day, and she has lost like 15 pounds since like a last menstrual period like eight weeks ago, right? And then they tell you that she's been taking Benadreul to, you know, help with an nausea, habloprasia is like 140 over 98, um, a heart rate is like 103 bits per minute, first bit of a rate is like 18, breaks per minute, and then they tell you that you perform like a transvaginal ultrasound, and you notice like a central heterogeneous mass in the uterus, and then they tell you that, oh, this central heterogeneous mass has like a solid, hyperacquick area, and then it's interspersed with a mixture of a cystic, uh, uh, species, and then they tell you that the BDHCG is positive. What is your next best step in management of this patient and give some options?

So let's say option A is like, recommendation for like small, um, you know, like option A, like, you know, let's say, um, let's see the your past recommendation, you know, for like small regular size meals, and then they tell you option B, suction cure attach, option C, on dance neutron therapy, option D, immediate C, C section, right, and then option E, um, total abdominal hysterectomy with bilateral sub-ingulpharctin, so that's option E, so what do you think the answer here is?

Or hope you're telling me that this is suction cure attach, right, so that's option B, uh, this patient essentially has like an high latiniform mole, right, and really the biggest factor for high latiniform mole, right, is having like a prior history of a high latin iform mole, and also, you know, like being like super young, super old, um, as a pregnant female, right, this person is, um, this person is a 15 years old, right, and really these moles, these had a typical moles, the T-shirt raises from like contents of the truffle blast, right, and there's actually two types, there's the complete mole, there's the partial mole, right, the partial mole, the mechanism behind the formation of the partial mole is you have, um, the fertilization of one egg, right, you have, uh, fertilization of contents of one egg by two sperm actually, right, so that gives you like a triploid embryo, so you can have like 69 triple eggs, 69 xxy, 69 xy y, right, and the thing is these partial moles, they actually contain fiddle tissue, right, they produce high levels of, um, they produce high levels of a beta-hecg, right, and these things, the partial moles, they actually have like a small risk, at least compared with the complete moles, we have a smaller risk of progressing to invasive moles, and the essentially almost never become a choreoclaccinone.

Now, compared contrast to the complete mole, right, the complete mole is a lot worse, right, it can arise this when you have like fertilization of an empty egg, so not like an egg with like mono, like unemployed material, like empty egg by two sperm, right, or you fertilize an empty egg with one sperm, and then that one sperm when it gets into the egg in duplicates, it's a genetic material, right, so ultimately you have like 46 chromosomes, complete moles, they have zero fiddle tissue, so they are like super abnormal, right, they produce a corrupt ton of beta-hecg even more than partial moles, and they have like very high risk of progressing to invasive moles, and also choreoclaccinone, right, and, um, um, one of the presentation, I guess, for molar pregnancies on NBM Es, is it can actually present as like size greater than dates, right, so like you're like, man, this person's uterus is like 30-week size, but this one is like 25 weeks from our last menstrual period, if you see that, you know, you want to think about, um, you want to think about, uh, molar pregnancies, right, and because of the high levels of BDAC that are produced, right, um, so that high level of BDACG can actually cause something called a hyperadmissive gravity arm, it's just like really bad morning sickness, you've made a ton in pregnancy, um, and really, if you, after you've done a performing like a suction curitash from like a molar pregnancy, the patient actually needs to be on breath control for about, you know, like, six months, right, and then you follow the HIG BDAHIG values all the way to zero, right, just to make sure that you're not having like recurrence or, you're not having like progression, um, to like choreoclaccinone, so that's why you want to track and follow these BDAHIG values.

Now, what if you get a question about like a 31-year female comes into a liberal delivery that's like 37 weeks gestation, she's having like, you know, consistent, moderately painful, like, urine contractions, and then they tell you that her pregnancy has been, uh, you know, quite complicated by a histral diabetes, um, so type 2 diabetes, and then they tell you that, uh, the phyto heart retreats in their own remarkable, and then they tell you that, you know, you offer this patient a C-section for phyto macrosomy, as she says, no, I want to have a natural birth, right, and then let's see, like, during the second stage of labor, um, the baby's anterior shoulder, let's see, you know, it gets stuck on that the pubic synthesis, and then, you know, after a while, thankfully, you subsequently deliver the baby vaginally, and, um, you, to deliver the baby vaginally, you have to, you know, like, have like a lot of like repeated traction on the shoulder, and arm, right, where you were like, uh, uh, flexing the, while flexing like mom's hip, and then they tell you that, oh, this baby, so let's say like with this baby's disruption of giving a detail, you're like, oh, this baby's delivering increases his risk of what, right, and then they give you some options, right, they tell you like injury to option A, injury to the C5, C6 roots of the brachial plexus, option B is injury to the C8, T1 roots of the brachial plexus, option C, it's injury to the C3, C3 to C5 roots of the brachial plexus, and then option D, uh, they tell you like injury to the C5 and T1 roots of the brachial plexus.

What is this? I will put the telemedia, and the answer is A, right, this baby essentially has my shoulder disto share, right, and remember, shoulder disto share, right, if you, you know, keep having like traction on the shoulder, um, that can, uh, that can actually increase a presence risk for, um, herb-dushin palsy, right, which is where you lesion like the C5, C6, shorts of the brachial plexus, remember, that's like the upper trunk of the brachial plexus, and again, remember, the classic description, right, for kids with herb-dushin palsy, they tend to have like something called a witter-stip deformity, right, so like the elbows will be extended, uh, so the elbows will be extended, right, their forearms will be pronated, and the uh, metacapofalangeogens will be flexed, right, that's the classic, uh, that's the classic description of the witter-stip deformity. Again, on your exam, they won't, they won't, uh, um, what are we thinking about?

on your exam, they likely will not write a witter-stip deformity, right, remember, one of the ways the mbmm makes exams harder is to take what you know and just describe it, right, so extended elbows, pronated forearm, flexed metacapofalangeogens, that's herb-dushin palsy, C5, C6, and again, usually these kids tend to be big, so they tend to be like infants of diabetic mothers on mbmm exams, right, um, in general, for bb is more than 45, like the estimated fiddle weight is like more than 4500 grams, you really should consider performing, uh, like a plant C section, right, because really the risk of cephalopelvic disproportion, uh, is like super, super-hard, right, so the bb may not fit properly, so that you don't start running to all these problems, and then, um, I think the last series of things I'll go ahead and talk about, let me just hit on some quick high ill topics here, so like post-partum hemorrhage, right, uh, acol, right, let's look no further than acol, to describe post-partum hemorrhage as if you lose more than 500 meals, 500 million liters, or 500 cc's of blood, after like a vaginal delivery, or if you lose more than a liter, right, so a thousand meals, a thousand cc's after, um, like a C section, so the thing is the most common cause of, of, uh, post-partum hemorrhage is actually uterine acne, right, uterine acne is the most common cause, if they give you like a non-descript, non-specific question about a patient's vision of tone, uh, after the delivery of a kid, think about uterine acne, right, and usually the presence of uterus will be above the level of the umbilikus on mbim exams, to tell you that it doesn't contract it down to its normal size, so what are the things that can cause uterine acne, right?

It can happen because the, because you lose tone when you're not strong enough, right, use that as a mantra, to understand what I'm gonna talk about, but basically what are the things that can cause the uterus to lose tone? Well, number one is if the uterus is overworked, right, so how can you overwork the uterus?

You can overwork the uterus if you have like, you know, like rapid labor or like prolonged labor, right, and that thing that can make the uterus lose tone is if a person has, um, like a uterus that's infected, right, like cori-mune-90s that can cause, uh, that can cause urine acne, and then if the person's uterus is too relaxed as well, right, so if the person got like, you know, like mega doses of topolytics or like a ton of like, halothane, or don't know, one releases this halothane anymore, that can be associated with a uterine acne, and then if the uterus is too distended, right, if it's too distended, so from anything that increases volume, right, so like multiple gestation, pregnancy, um, polyhydramneus, right, macrosomnia, uh, those things all sort of cling to, again, being causes of a uterine acne, and really the way you treat uterine acne, right, you can do like a uterine massage, that's usually the first thing you do, right, so you do a uterine massage, you can do something called the baccabalune, uh, uh, uh, the generally don't test the baccabalune on exams, but the uterine massage, you certainly test that, if that is not working, then you proceed to the next option, which is to do something called a B-link sutra, right, and then that's almost like, um, um, it's like a kind of sutra that used to sort of like stop bleeding from the vagina, and then if that's not working, you can use a tonic agent, for example, it's like third lines, right, so what do I mean by tonic agent?

Tonic agent just means something that's like a good visual constrictor, right, so like oxytocin, remember it works through GQ receptors, so it increases the activity of a phospholibacy and all that stuff, right, you can also use methrgine, methrgine I believe it's an agonist that uh, serotonin 5-HT2-A receptors I think, um, hemabit, right, it's another thing, it's a, a hemabit is used to stop phosphatome hemorrhage, sometimes it's called a caboprost hemabit, right, think about the name hemabit, hemabit, abit, hemabit bleeding, right, dynoprostone, right, it's another one, it's a PGE tour analog, you can use it against a triple sputome hemorrhage and then use a prostal, it's a PGE one analog, right, that can be used to triple sputome hemorrhage, remember if a person has a histro of like prince medallangina or some other like visual spastic disease like crest, like renofilomena and all that stuff, those people should not take methrgine, it can increase the risk of like stroking all this badness, um, and then hemabit, if a person has a histro of asthma, they cannot get hemabit because hemabit, right, caboprost causes a bronchoconstriction, so obviously you wouldn't want to give it to a person that has a histro of asthma, and then if a person has a, like, you know, like, low blood pressures, so like if a person is like hypotensive, you want to avoid dynoprostone, and again remember the di in dynoprostone for the two in BGI2, two kind of sounds like a die, right, does that make sense?

Okay, so hopefully it's something that you understand, and then other things that can cause postpartum hemorrhage, right, so again, I've kind of talked about like again the soft uterus, uterus, probably above the umbalicus, think about uterine acne, you treat out like the uterine massage, you can do the biline sutures, you can do the buckberry balloon, you can give your teratonic agents, I mentioned like a battery of those a few seconds ago. If the second most common cause actually a postpartum hemorrhage is like, if a person has like, you know, like vaginal or like cervical aspirations, for that you do surgery suture it up.

Third most common cause is like routine placental contents, basically the way you do it, routine placental contents, you do something called a cure attach, we do it under like ultrasound guidance, right, so you can see what you're doing, essentially if a person has like a succinct treat loop of the of the placenta, ready, can hang back in the uterus and cause like postpartum hemorrhage, and then some other things, right, what if they give you a question about a person, you know, that just delivered a kid, she's losing from every venue puncture site, this is DIC, right, this is DIC, ready for the most part, if a person has DIC, you move them to the ICU, to the intensive care unit, you give them like a ton of blood products, you'll try to remove the offend in the agent, but DIC has a very high mortality, right, and then if they tell you that a person, you know, postpartum, has like a non-pubble uterus, but they tell you that, oh, this person has like a beefy bulging mass that's coming out of the vagina, think about like uterine inversion, right, and actually the biggest risk factor, again, this is, I promise you're not seeing this for the for the fun of it, it's all high, you know, the biggest risk factor for uterine inversion is actually a prior history of uterine inversion, right, for the most part, you replace the uterus back into its normal position, and you give a uterotonic agent like oxytocin to squish the uterus back to its normal size, and then last result, right, if a person is still bleeding and tried everything, nothing is working, you can begin to call interventional radiology to do like fancy stuff like uterine adriam bulisitions, or you can like eat internal ida cardery, or you can do a hysterectomy, hysterectomy is like the last of the last option if nothing else, if nothing else is working.

Now, what if you get a question about like a 21-year-old female, you know, she comes to a PCP complaint of like severe facial acne, and in the tale that her last menstrual period was like one week ago, and she's like in a stable relationship with a boyfriend of like three months, and that they use condoms inconsistently, right, that's probably not a smart life zoon start with, and then they tell you that physical exam is notable for like open and close comedones, that's kind of clustered her own like her lower face, and they tell you that you know she has tried to try to try to clean, try to open, so I tried to try to try to combine those CPS, that doesn't yield any positive results for acne, and then they tell you that oh this patient actually smokes like two cigarettes per day, and she's requesting a prescription for isotractinoid, right? I guess my question here is what is the most likely contraindication to this patient's treatment regimen? What is the most likely contraindication to this patient's treatment regimen? Option one, absorption A like the patient's age, option B, the patient's history of smoking, option C, the patient's history of unprotected sexual intercourse, option D, the patient's history of pseudo-tomor cerebride, that's a bogus answer, option E, there are no contraindications whatsoever, to the use of isotretamine in like this patient I'm just referencing, what's the right answer? I hope you're telling me that the answer is C, right?

He's sure when protected sexual intercourse, right? Remember isotretamine knowing it's a potent teradogen, so if a patient is studying isotretamine they need to be like on a registry from mummesticking, and they need to have two forms of breath control, okay? And I guess to sort of discuss some of the other answers, right? Smoking is a contraindication to the use of combined those C Ps, especially if you're a female that's more than 35 years old, right? But smoking is actually not a contraindication to using isotretamine knowing, and then don't forget the association with anti-pileptic drugs with like neuro tube defects, right? Since we're talking about teradogency, and don't forget the association of talido-mine with like abnormalities of the lamp, right? So like a foco-milia, so pH, O, C, O, M, E, L, I, E. And then if mum uses cocaine during pregnancy, right? So, again I'm trying to finish this up real quick, so I really try to finish something like the next two minutes, at least like in terms of the core content, right? So, um, they tell you, you know, mum has used cocaine during pregnancy, so I'm trying to like, you know, be a little repeated, but again, I'm covering all the core core material, right? So mum, let's say, you know, she has used cocaine during pregnancy, she has like been full vaginal bleeding in the third trimester, what is that? That's placental abruption, right?

And they give you like a question about like a like a generally inconsolable newborn, and they tell you that mum has like dangerous habits, this should essentially clue into like withdrawal of some kind, right? More than likely it will probably be from an opioid, one MME example. Now, let's talk about some birth defects, and you tell me what the most likely heterogeneous, and then I promise I will stop here, and I'll be done with the reprim, at least the high yield reprim, I wanted to cover for step one. So, what if they tell you, so I'll give you like the buzzwords, you tell me the drug, right? So, right ventricular hypoplasia, that would displacement of the tricospid files, what is that? That's f-scenes abnormally, right? from like lithium toxicity, what if you see tooth discoloration? That's the chocyclean, right? Remember to chocyclean, it loves to bind calcium, you want to have, make sure you're waiting like pregnant women, or like kids less than eight. If a kid has lung disease and they're like eight years old or less, you can give that kid a moxicillin. Now, what is the heterogeneous in the causes carnage damage? Those are fluoroquine alarms, right? How about like, stippling of the epithesis? And this is the kind of anti-quagulant you don't want to use in a pregnant female, with a DVT, what is this? That's warframe, right? Remember warframe? Remember, in pregnancy, you have a hyperquagulable state, right? Especially with like verko's triad, right?

So, in general, in pregnancy, you want to use hapren as your anti-quagulation option. Also, it's actually kind of high yield to remember that if a woman is pregnant and she has a history of antifusuality, pedantibody syndrome, you can actually use hapren for that. You tend to inject that hapren into the bin. And women that have a history of like antifusuality, pedantibody syndrome, that's another high yield, but on usual contraindications to the use of combined OC Ps, right? On NV Me exams. And then, what if you see like player cell abnocarcinomob of the vagina? What's the drug that caused it? That's from biocuta, still best from, right? Biocuta, not that cute. What am I saying? Diethylsteobestrol is what you want to think about. I think I'm a little tired, so I think I need like some rest. I don't know my words and my minds, just playing a few tricks on me here and there, but yes, diethylsteobestrol. Remember, a DES can also cause like a T-shaped aeros, right? And then, if you see like renal problems in the fetus, think about like mom that used like A-senheveurs or ARBS. If you see grubby-be-sendra, right? That's clarinet, called if you see crainicters. Crainicters just is fancy terminology for like building up, like bilirubin, toxic bilirubin metabolites in the brain, think about back trim, so trimethoprims so from ethoxazole. If you see a smooth field trum, or like microcephaly, thin operelet, that's classic phenol alcohol syndrome, right?

And remember, kids of moms with phenol alcohol syndrome, they tend to get like VS Ds. And then, if you see like, you know, like an intra-gathering growth restriction, hypoplastic nails, microcephaly, cleft lip, and let's say mom has a history of seizures. Then all that those circumstances are you want to think about phenol, right? Phenol syndrome. Remember, another thing for phenol, this phenol, toxicity is fetal, high-dantol syndrome. So I hope you got something from these two podcasts, so episodes again, 142, and this podcast itself episode 157, this should cover the vast majority of the high-yield repro that you can see on your USMLA exams. As I do at the end of every podcast, I'd offer one or one to you for many exams, step one, two CK, two CS, step three, preclinical medical exams, 30-ish-off exams, internal medicine board exams, internal medicine, intriguing exams. And then, if you have a college buddy that needs to learn from like Gen CAM, OEM, physics, biochem, histology, physiology, alpha-turum for those things, if you're a medicine and a plan to residency, so like an era-sap, or a college student plan to Mexico, so I'm casap, I'd offer like one or one coaching for those with so like rec letters, personal statements, editing applications, mocking interviews, all for those things.

And then I talked about the USMLA booster course like two episodes ago, where like the last week before your exam, or if you feel like your knowledge base is pretty good, I'd offer like this 10-hour review course for like step one on one, for like step two CK and for step three, it's 20 hours for step one, we're in like a very short period, we review like a ton of the material that's tested on the respective USMLA exams. And then I also offer again, you should not tutor anywhere if you're a new first or second year med student or a new 30-year med student. I tutor you for your like your shelf exams or like your block exams, and then at the same time, I tutor you for the USMLA exam you have that's upcoming. And then when the time comes for your test, you feel like super ready, right? Even before your dedicated period, you feel very ready because you've been learning the USMLA material all along. So if you're interested in any of these things, reach out to me through the website or send out an email, divine intervention podcasts, with an sadeandaginil.com. So have a wonderful rest of your day, thank you so much for listening to this podcast. God bless you, thank you.

Dysmenorrhea (painful menses), Dyspareunia (painful intercourse/penetration), and Dyschezia (painful bowel movements).

Serous cystadenocarcinoma.

Hemolysis, Elevated Liver enzymes, and Low Platelets.

The anterior mesovarium (or anterior mesometrium).

Copper IUD (Paraguard).

Chronic exposure to high-risk Human Papillomavirus (HPV), especially types 16 and 18.

Hypothalamic-Pituitary-Gonadal (HPG) axis suppression.

Tenderness or nodularity of the uterosacral ligaments.

Serous (more likely bilateral) vs. Mucinous (more likely unilateral).

Decreased haptoglobin, elevated LDH, and indirect hyperbilirubinemia.

Fibroadenoma (or fibrocystic change).

Increased exposure to estrogen (unopposed estrogen), obesity/PCOS, and genetic syndromes like HNPCC.

Serum Beta-hCG level (to rule out pregnancy).

Smoking (especially over 35), history of hepatic adenoma/liver disease, and estrogen-dependent cancers (e.g., breast or endometrial cancer).

Tenderness or nodularity of the uterosacral ligaments.

Serous (more likely bilateral) vs. Mucinous (more likely unilateral).

Decreased haptoglobin, elevated LDH, and indirect hyperbilirubinemia.

Fibroadenoma (or fibrocystic change).

Increased exposure to estrogen (unopposed estrogen), obesity/PCOS, and genetic syndromes like HNPCC.

Serum Beta-hCG level (to rule out pregnancy).

Smoking (especially over 35), history of hepatic adenoma/liver disease, and estrogen-dependent cancers (e.g., breast or endometrial cancer).