DIP Episode 177 - USMLE Step 2CK Rapid Review Series 24 (OGBYN)

Okay, welcome. My name is Divine. I'm a resident. This is episode 177, I think. Yeah, episode 177 of the Divine Intervention Podcast. And in this podcast, I'll be continuing the Rapid Review series for the USML Step 2 CK exam. And I will be doing this with a focus on OB guy. Okay, but a focus on OB guy. And actually this podcast is a little on the higher, I mean, all my podcasts are high, but this one is like really, really high. Really, really help with this should hopefully really help with with the USML Step 2 CK exam. Okay, so first things first, what if you get a question? So let's start off on a simple note. So what if you get a question about a 30 year old female? Okay, she tells you that, you know, she's been having my little problems because for the past 15 months, she has not been able to get pregnant, even if she has been trained without contraception. And then they tell you that she tells you that she has a lot of irregular periods and a BMI is like 30, what's your diagnosis? This PCOS, right? This is pretty easy one. So this PCOS, and remember for PCOS, you would want to know the diagnostic criteria, right? Many people are used to making the mistake of saying insulin resistance, you know, all this crap with like insulin resistance and what else? Like insulin resistance and a VITED LH2 FSE3 show, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, don't get me wrong, right?

That's, you know, that's part of the, that's those associations, but they're not part of the criteria, right? So remember, to diagnose PCOS, you need to meet two out of three criteria, so what are the three criteria? So one, the person should have signs of hyperandrogenism, right? So like, um, chercotism, stuff like that. And then the second criteria is that they should have polycystic ovaries on ultrasound, right? That's an imaging clue there. And then the third thing is that these people should have signs of one of relation, right? The classic sign of one of relation is either they are not able to get pregnant or they have irregular periods, right? So those are kind of like the three big things, and you only need two out of three of, to meet two out of three of the criteria to meet the diagnosis. So hopefully you can already see that you do not necessarily need to, it's a diagnosis that can actually be meet clearly under the right circumstances, right? So how do we treat PCOS, right? Obviously, treat PCOS, the way you treat it on the exam kind of depends on your goals of care, right? Like what goal are you trying to accomplish in the question? So if, for example, they tell you that this person, you know, is trying to get pregnant like this lady, right? Then you want to give plumifin, okay? Remember, plumifin is a SIRM, so it actually acts as a partial agonist on estrogen receptors in the central nervous system.

So by doing that, it's effectively acting as an estrogen receptor and antagonist. And when you have things like that, right? That removes the negative feedback and that will increase like GNRH pulsatility, and that can promote pregnancy. That's one. Two, if you get a question about a person that has PCOS and you have her sutizen, right? You can actually treat the her sutizen with one of two options, right? So you can consider using OC Ps on your test or alternatively, you can use what is it called? You can use Spurnolactone. Remember, Spurnolactone is an aldosterone receptor antagonist. It's also an angrogen receptor antagonist. But remember this high yield thing that you don't really find in too many resources that it inhibits five alpha reducties in the skin, right? Because five alpha reducties, right, converts testosterone to DHT. And many of those hersute side effects arise from elevated levels of DHT. So if you are able to inhibit five alpha reducties in the skin, aka if you give Spurnolactone, which is again a five alpha reducties inhibitor in the skin, that can help with those symptoms. And then if a person is, you know, tired of the irregularities, you can give them some kind of OCP and they'll be fine. So those are all high yield things you want to keep at the back of your mind with PCOS for purposes of step two CK. Now, one thing I've noticed that the MBME loves to test is cervical cancer.

And cervical cancer, you know, there's just kind of like a lot of stuff going on, right? So let me just use this podcast to essentially give you like a comprehensive review of pretty much most of the high yield things you'll see on your test in relation to cervical cancer, right? So the first thing you want to keep at the back of your mind with cervical cancer is what is the biggest risk factor, right? The biggest risk factor for cervical cancer, right, is exposure to HPV. So HPV exposure, right, increases the presence risk of cervical cancer. Now, the thing is your friends at the MBME, right? You know, they may give you a simple question like that, like, oh, biggest risk factor and boom, HPV. Or they may give you a risk factor. So if they don't put HPV as an answer choice, they may give you an answer choice that links to having early exposure to HPV. So like early onset of sexual intercourse, yeah, yeah, yeah, yeah, right? Basically just find something that links to being exposed to HPV. And that is the biggest risk factor for cervical cancer on XEPS. That's one. Two, what is the most common cause of death in people with cervical cancer? Well, if you think about it, right, the cervical cancer can spread and then involve the ureters. And if that involves the ureters, right, that can cause an obstructive nephropathy, right? So reno failure from obstructive nephropathy, believe it or not, is actually the most common cause of death in people with cervical cancer.

So now the next big thing you want to keep in mind is, okay, how do you, how do you, how do you, how do I put this? How do you scream for cervical cancer, right? How do you scream for cervical cancer? Well, the treatment of cervical cancer depends on many different factors, right? And the thing is your friends at the MBM, there's a lot, a lot of love, love, love, love to test the stuff. And you know, it's confusing with many like not some bolts, right? So they love to throw it a lot on exams, right? So the thing with cervical cancer right is that essentially you start screaming when the person hits the age of 21, okay? Prior to the age of 21, you're not going to be screaming in your once or for cervical cancer on your test, okay? So if a person, once the person hits the age of 21, you can start cervical cancer screening, okay? And the big thing you want to keep at the back of your mind is that to scream a person for cervical cancer right between the age of ages of 21 to 29 years, okay? The thing you do is you do like a site like the Pops May every three years, that's kind of an easy one. You know, you know, Pops May every three years and the patient is good to them. Well, once the patient hits the age of 30, right? So once the patient is like past age 29, right? They're like 30 years old, they're all the way up to the age of 65. Your screening method, you have two options actually.

So you can do Pops May every three years or alternatively, you can do Pops May plus HPV Cortes in every five years. And the thing is that's actually kind of high up to know is that the Pops May plus the HPV Cortes in every five years is actually the preferred method, right? So a classic question that you may get on an exam is when should we stop, when should we stop Pops Mayors? Well, you can actually stop at the age of 65, okay? You can actually stop at the age of 65 because the thing is if a woman has had like multiple negative Pops Mayors, then you don't need to keep, you don't need to keep screening screening screening screening, right? Also, when he's 65, I just had like multiple negative Pops that you don't need to keep screening the person. But if a woman has a history of like anything from CIN to Ohio, right? Then you actually cannot stop at the age of 65. I'm not going to tell you an exact age here because there's a lot of controversy in the literature. But just in general, people that have like Pops Mayors and if have like CIN to Ohio, you really cannot stop at the age of 65. Usually you're screening for like 20 more years, something like that, but they probably won't go from the USM at least, but I'm just going to go ahead and leave that out there. And then, if for example a woman has got in a hysterectomy, right? If a woman has got in a hysterectomy, then do she need Pops Mayors after that? She doesn't, right?

If a woman has got in a hysterectomy, what here is where you need to be careful? If a woman has got in a hysterectomy for benign reasons, right? So let's say she got a hysterectomy because she's like, oh, she has like five breaks, right? So like Lyoma, Yomai, Yodora, right? If she has those kinds of problems, then of course you can stop blimp Pops Mayors after she gets the hysterectomy. But if a woman gets a hysterectomy for non-benign reasons, right? So again, usually like the cutoff is anything that's like CIN2 or higher, right? So like CIN2, CIN3, Admokasuma inside 2, Yara Yara Yara, and they get a hysterectomy, you do actually still need to do like a Pops Mayors. What the Pops Mayors do has to be a Pops Mayors of the vaginal cough, okay? That's a boss phrase that you absolutely want to remember for purposes of the USMLA exam. Now, one of the questions you may get maybe a question about a patient that has a hysterectomy, right? And then they're essentially asking about like, they may make it like a preventive medicine-style question, where do you mean say, oh, she got a Pops Mayors like so, so, so on, so time ago, and then he may ask for the next step in management. Don't forget that people that actually have a history of HIV, right? They do actually need Pops Mayors very regularly. They need Pops Mayors a lot more regularly than every three years. They have to need Pops Mayors every year, okay?

So a Pops May every year is indicated in a person that has a history of, in a person that has a history of, of a HIV, okay? Do Pops Mayors every year? Now, how can we actually prevent HPV? How can we actually prevent HPV? How can we actually prevent HPV? What do you think? Well, you should already know that HPV can be prevented by giving the HPV vaccine, right? And the thing is, again, it's very high you to know for the purposes of the USMLA exams that you want to, you want to start the HPV vaccine as early as the age of nine. In fact, it's like essentially being approved. If a person hits the age of nine, both males and females, they absolutely can get the absolutely can get the HPV vaccine. And for the most part, you can go up until the age of like 25 to 26 with regards to the HPV, with regards to the HPV vaccine. So you can go from nine to somewhere between 25 and 26. Again, these are all very high you things to know for the purposes of the USMLA exams. And then one other thing that the MBME, you know, they kind of like to go after with these HP Vs, they may give you like Pops Mayors results and kind of expect you to manage them, right? So I'll just talk about because again, this thing can get endlessly confusing and like really fast. So I'm just going to talk about some big things you should consider or some classic ones that tend to show up on tests. So the first one is, what if they give you a question about a person that, you know, has like HPV testing.

I mean, like Pops Mayors, the Pops Mayors is negative. Well, what's your next step in management? Well, you repeat the Pops in three years, right? I mean, kind of depending on the age or you do like the Pops plus the HPV code testing every, every five years. Okay, so that's done. Now, what if they give you a question about a person and they tell you that they get a Pops Mayors and they tell you that the, the cytology is like indeterminate and the pathologist, you know, feels that it's an inadequate sample. What would your next step in management be? You'll actually want to go ahead and repeat the Pops Mayors with a cytology. Now, what if they give you a question about a patient and they tell you that, oh, on Pops Mayors, the results you get is something called ASCAS, right? So like 80-bit code squamous cells of indetermined significance. Well, basically, there are two options that you have on exams, right? In fact, let me put it this way. Yeah, there are two options that you do have on exams, right? So one option you have on your test is to proceed to doing HPV testing like reflex HPV testing. If you do this reflex HPV testing and you detect one of those nasty HP Vs, right? Like the HPV 16, 18, those in the 30s. And after that, you do need to do performs some kind of goposcopy, right?

But another option that's available to you on your exam is you can actually just do, especially if it's a young person, this is usually like another decent option, especially people that are less than the age of like 29. For these people, you can actually go ahead and do a repeat the Pops Mayors in a year. That's, that's safe with those people, that's safe in those people. But again, if you ever have like ASCAS, right, you can do one of these two things. You can either do like reflex HPV testing to see what's going on there, or you can go ahead and repeat the Pops Mayors within a year. Now, what do they give you a question about a patient and they tell you that, oh, they do a Pops Mayors. And that Pops Mayors shows that this person has 80% glndular cells. Whenever you see the buzzword, 80% glndular cells, that's bad, right? That's bad. You do need to, you know, kind of act on it. And what do I mean by, oh, you need to act on it? Well, act on it means you need to do a goposcopy with biopsy. That's standard. But in addition to that, you also need to do something called endometrial sampling. Because when people have 80% glndular cells on a Pops Mayors, it's usually indicative of some kind of, they may also have like some concurrent endometrial malignancy. So in addition to doing that co-poscopy with biopsy, you do also need to do something known as endometrial sampling. You do also need to do something known as endometrial sampling.

These are all higher things to keep in mind, for example. And then, in general, I'll just tell you this. If a woman has a lesion that is CIN2 or higher by a Pops Mayors, your job is easy. Just always send her to goposcopy again. There are many other, there are many other permutations here. But this permutation I'm telling you should help you get the vast majority of your questions right on the test. Okay? The vast majority of your questions right on the test. So if a person has anything CIN2 or higher, right? Go ahead and perform a co-poscopy on your test. Okay? Go ahead and perform a co-poscopy on your test. Now, one of the weird ones you will see is if you tell you that the person has something known as ASC H. Right? ASC H is like 80 Bc, Scrimal cells cannot exclude hygrids, SIL. That's also easy as well. Those people, they do need a co-poscopy. Okay? They do need a co-poscopy. Again, these are all important things to keep at the back of your mind, for example. And then remember that it's HPV 1618 and those in the 30s that tend to cause cervical cancer. HPV 6 and 11, right? Those tend to cause genital orats. And then HPV 1 and 6, those in general tend to cause those in general tend to cause a plantar orats. Again, these are all important things to know for purposes of the USMD step 2 CK exam.

Now, what did they give you a question about a patient that you know, let's assume it's like a guy and he presents with like low abdominal pain, urinary continents, and he doesn't have a fever. Right? And he tells you that you know he just made a new sexual partner like, I don't know, like two weeks ago. Well, what's your diagnosis? Well, I'm really hoping you're thinking about some kind of UTI, right? That is likely, you know, I could likely go to him from his sexual partner. So this person obviously will have the status. So what's your next step in management of the status in a guy? They will try to trick you on your exam and to pick in mitrofurentowing. Don't pick mitrofurentowing your test. Okay? Mitrofurentowing is never used in men on the USMD exams, and also like in the real world. So what are some things you can consider for the status in a man on MDMA exams? You can consider something like trying metroprams often at the oxygen, EKE, back trip. Right? You can consider trying something like, you can try a fluorquin alone like siperflox, that also works pretty well for UT Is, but do not use nitrofurentowing. The same thing also kind of obtains in women, right? You can, for cystitis, you can do siperflox, the same. Obviously, she's pregnant, you can do that. Or if she's pregnant, you also can not do TMPSMX. So you can actually do mitrofurentowing. Nitrofurentowing actually works pretty well in women. Well, that's in women that have cystitis. Okay?

That's in women that have cystitis. That's again very high, you know, for MBME exams. And then all common questions may see, right? Maybe a woman that, you know, keeps getting like all these recurrent like UT Is and it's temporarily associated with sexual activity. If you see that, there are certain things you can do. You can actually prescribe the woman like a prophylactic antibiotic, like a prophylactic backtrem or prophylactic siper or something like that, that she can take before intercourse. Alternatively, one other thing you could consider is to give, um, is to tell her to, although this doesn't really work very well. So most people just give antibiotics. Now, you take not all the time, you take it before intercourse. Not after intercourse is not going to do squat for you, right? But before intercourse, you take the antibiotic. But another thing that, you know, is sending to make it to an exam is, you know, that if a woman piece after she has sex, that can also help as well. Okay? That can also help. Although again, it's very, it's not very effective. Let's just go ahead and, uh, leave it at that. It's not very effective. But if the UTI person has this pylon of Fridays, right? Pylon of Fridays, they'll be like fever, systemic symptoms, uh, flank pain, right? If you see that, right? Pylon of Fridays, if you suspect pylon of Fridays, first things first, what's your first step in diagnosis? Well, I hope you're seeing to get a CT scan of the abdomen with contrast, right?

They'll help you diagnose the pylon of Fridays. And then in terms of treatment, what do you want to do? So I would really hope that for a person with pylon of Fridays, the first thing that comes to your mind is safe triaxle on an MDM exam, okay? Safe triaxle is the drug of choice in general on MDM is for treating pylon of Fridays. Although, don't forget, you can also use bathroom. So like trimethoprym, so from a foxes all. And you can also use super-fluxeset as well. Those are all high-yield things you can use for a purposes of the exam. But what if they give you a question about some diabetic? As you go ahead and shape this in here, what if they give you a question about a diabetic? And this diabetic came in with like flunk pain and fever. You got the CT scan of IV contrast. It showed pylon of Fridays, it was started on antibiotics. But this person doesn't seem to be getting better at all, right? So they tell you that this person is still getting high fever, still completing a worsening pain, and then the ask for your next best-tempo diagnosis. Your next best-tempo diagnosis would be to actually go ahead and get another CT scan of the abdomen, okay? Because you want to rule out a nasty complication of pylon of Fridays, right? So you want to rule out something like gangrenos pylon of Fridays, or you may see something referred to as emphysemarose. So EMPHY, SEMATOS, emphysemarose pylon of Fridays, those are things that can happen in diabetics, okay?

For those people, you probably need a urology console at that point, because they are very likely, almost certainly need an effect to remove out the disease that kidnaps. Now, one thing you want to keep at the back of your mind, notice I preloaded this question by saying the word diabetic. The thing is diabetics, they tend to get like pretty bad infections, right? So not just on MDM exams, but in the real world, if you see a diabetic-quitting infection, you always want to take it a little more, you want to take it pretty seriously, because the thing is they can go from bad to their dead, within a matter of hours or days, right? So diabetics, for whatever reason, because remember diabetes is an immunocompromised state, right? It tends to increase a person's risk of really severe complications of infection, right? So like diabetics, they can also get like gangrenos-cholitis studies, right? So it can present as like radical chocinping in a patient that has a history of diabetes, or remember diabetes can also have this milk-comacosis of the face, right? You have milk-comacosis of the face, where essentially the thing that happens is you have like some fungi like rhizopause or mucus species going in, and like essentially, tree-in-away these people's face. And obviously, the thing you want to do under those circumstances is to give them for terracing bee, and then you need to proceed with aggressive deep-rightment, okay?

If not, that patient will for sure die, especially when the fungus infects the brain. Now, another complication that can happen in diabetics, right? If something known as a phonyis gangrene, phonyis gangrene is essentially neck fash of phonyis and greens like the neck fash of the perineum, okay? So it's something that can happen in a diabetic, especially when you have like some kind of lower reproductive tract infection that can perceive all the way to becoming a phonyis gangrene. Again, these are all high-yield things to know for purposes of the USMLA exams. Now, what are the classic uses of an amnuyo infusion? What are the classic uses of an amnuyo infusion on the USMLA exams? What are the classic uses of an amnuyo infusion? Well, there's actually about two or three of those that you want to be able to recognize for purposes of your test. So one reason you need to have an amnuyo infusion is, so an amnuyo infusion literally means almost like putting like fig, it's not fig, but you know, you're putting artificial, let's use that word. You're putting artificial amnuyo fluid into the amnuyo cavity, right? Into the amnuyo exact. So, classicly, on MGME exams, you can do this for a person that has like a kid has like a chord compression or you suspect that a kid may get chord compression, right? Which can cause like a variable D cell on a fit-off heart rate monitor.

You can actually treat chord compression or prevent chord compression by administering, by doing this amnuyo infusion business, okay? So again, those are all high-yield things to know. Now, another thing that you may use amnuyo infusion for in MGM Es is to treat or prevent macronium aspiration syndrome, right? And remember that probably the biggest risk factor, not seeing all over the world, but in general, the biggest risk factor on MGME exams for macronium aspiration syndrome is actually being a post-term kid, okay? Post-term baby. Now, here's the thing. If you think about it, you may say, okay, why would a baby, why would being post-term increase a presence risk of macronium aspiration syndrome? Well, walk with me here for a second. The thing is, macronium, right, is essentially the baby's first poop, and it's supposed to happen within the first 48 hours of life, right? So the thing is, if a baby is post-term, and it's just hanging out, hanging out, hanging out, hanging out in the... hanging out in the... In the uterus, for longer than he has to, or she has to, then the thing that happens is the baby can sell him, and I'm tired of holding in this poop, right? Let me just go ahead and poop in the amnuyo influed, and he does that. The thing is, when the baby poops in the amnuyo influed, that's bad, right? Because that amnuyo influed can take up that macronium, take up that macronium, and if the baby, remember, baby is in here, amnuyo influed all the time.

If the amnuyo influed all the time, if the amnuyo influed all the time, the macronium deposits in there longs, it can cause pretty severe respiratory distress in a newborn. That's actually what's known as macronium aspiration syndrome, okay? So an MBM is in general. Being a post-term child is probably the biggest risk factor for macronium aspiration syndrome on tests. So macronium aspiration syndrome can actually treat or prevent it by doing an amnuyo infusion, because that amnuyo infusion will essentially dilute out the macronium, and that can help on the dosage or constancy zyrig. So keep that in mind for your test, but if you actually do consult the literature, the evidence behind that is super, super, super mixed, right? There are some studies that show benefit, there are some studies that show absolutely no benefit, okay? So again, those are all key, high-eal things to keep at the back of your mind for, for exams. Now, so those are the big things with, those are the big things with amnuyo infusion. Now I think the last thing I would focus on here, because I really don't want to keep this podcast under, under 30 minutes, is, I do actually want to talk about some key tests that are done during pregnancy. Even for everything, people tend to get the stuff wrong, so let me sort of clarify that and put everything in one spot for you. So the first test I want to talk about is the Klaihawa Becky Test, the Klaihawa Becky Test, the Klaihawa Becky Test.

So what is special about the Klaihawa Becky Test? Well, the thing with the Klaihawa Becky Test is that it's a test that you used to determine if you should give, like the dose of rogam that you should give after delivery, okay? It's a test that helps you determine the dose of rogam you should give after delivery, because remember, if mom is RH negative, right? We generally give rogam, you know what, like, I don't know, like 20 weeks there about something like that, but after delivery, you do also need to give rogam, right? You do also need to give rogam. And rogam in general, you give to determine the dose, right? You do this, this fancy shmancy Klaihawa Becky Test, because the Klaihawa Becky Test helps you. Klaihawa is spelled, I think, I think it's a German term, like K-L-E-I-H-A-U-E-R, okay? Klaihawa Becky, B-E-T-K-E, there's a hyphen between those two words. So Klaihawa Becky, you determine how much feed-up blood has mixed with mom blood, because you can tell you, okay? This is how much immunoglobulin I do need to give K-A-R-U-G-A, to prevent the development of a hemolylic disease of the newborn, or R-H-A incompatibility. Now, another test that you may see on the example is something known as the... ...the feed-up fiber-necked-in test, right? So the feed-up fiber-necked-in test, the big thing you want to keep in mind is, you use it when you're suspecting or you're worried about like preterm-liberum delivery, right?

The thing is, if the test is negative, the chance of the woman having a baby, right, within the next two weeks, probably less than 5%. Okay? Because fiber-necked-in is actually a protein that's secreted by the feed-us, right? So if you see it in the out, if you see it in like, I'm not even like in the outside world or something, then that tells you that, oh, the feed-us is probably on his way out, okay? So that's a high-yield thing to keep in mind for exams. And then, another test that you may see is like the Mitres-N-Piper test. Many people seem to confuse this, whatever bizarre reason with the fiber-necked-in test. The Mitres-N-Piper test is not used to determine preterm-liberum delivery, anything like that. It's just a test of if the fluya seen on women's vagina is a meonic fluid, right? It's almost like a way to tell, oh, has this woman's water broken, right? If I'm using a colloquial language, right? So essentially, you'll see like a fernin pattern, like a fernin, F-E-R-N-I-N-G-R. So you see a fernin pattern on a fernin pattern on the Mitres-N-Piper test, and that tells you that you're likely dealing with some kind of a meonic fluid. And then the last test, I guess I'll go ahead and talk about, we haven't, so I've talked about clay-how a bit, key. I've talked about fiber-necked-in, I've talked about mitres-in. Okay, so I think I'm gonna go ahead and stop here.

To be honest, there's actually so much stuff I want to recover, but again, I really want to try to keep this around 30 minutes, again, since it's a rapid review podcast, and God willing, in the next episode, like the next rapid review series, it'll probably be some kind of OBGYN interracial, because the topic I really want to cover, because many people are just getting way too many questions wrong on this, and it's kind of annoying from my own perspective, it's just this RH compatibility crap, like, what do I do next? What do I do first? What do I do second? I will spend about 10 minutes in one of the podcasts coming up within, hopefully this week, talking about like our chunking it up into steps, so that you know exactly what to do under any situation. If you kind of understand, hopefully, what I'm going to discuss, when I do the next rapid review guide podcast, you should really never get RH incompatibility question wrong anywhere. Okay, so let's go ahead and stop here. As I do at the end of every podcast, I do offer one or one tutorial for many exams, step one, step two, seek, step two, see a step three, preclinical medical exams, 30-ish-off exams, if you're a college student like Genk-Kam, O-Kam, Physics, Bio-Kam, Histology, Physiology, if you're a medicine resident, the ABA, internal medicine board exam, and then I also do longitudinal tutoring, right?

Right, if you're a first-second or 30-am Ed student, a tutor you for your block slash shelf exams, and then at the same time, I also tutor you for your upcoming USMLA exam. Another thing I also offer is like the USMLA booster courses, like 20 hours for step one, 10 hours for step two, see a step three, where again, it's good for people at the end of the dedicated period, so people that feel, you know, my knowledge base is pretty good, and you want someone to put in a Q&A fashion, put everything together for you, you know, put everything together for you, like essentially teaching like the most knows, the high-yield things you definitely want to know, walking into the exam. And then, if you're a medicine and a plan to residency, so like an ERAS application or a college student, a plan to a medical school, so an AMCA application, I offer like one or one advice, you know, coaching for that, right? So like, mock interviews, personal statements, rec letters, editing applications, I do offer those, and again, the vast majority of people have worked with, have matched into their first choice. So have a wonderful rest of your day, I'll see you in the next podcast. God bless you, thank you.

Hyperandrogenism (e.g., hirsutism), polycystic ovaries on ultrasound, and signs of anovulation/oligo- or amenorrhea.

Exposure to Human Papillomavirus (HPV).

Age 21 years.

Co-testing (Pap smear + HPV DNA test) every five years.

Nitrofurantoin (Nitrofurantoin is generally reserved for women with cystitis).

Emphysematous pyelonephritis or renal abscess.

The amount of fetal blood mixed with maternal blood to calculate the necessary dose of Rhogam.

Fiber-necked-in test (or $\beta$-casein).

The presence of amniotic fluid (meconium/amniotic fluid), indicating possible rupture of membranes.

Repeat Pap smear in one year OR Reflex HPV testing.

To prevent or treat cord compression and to reduce meconium concentration (in post-term gestation).

Nitrofurantoin.

The amount of fetal blood mixed with maternal blood to calculate the necessary dose of Rhogam.

Fiber-necked-in test (or $\beta$-casein).

The presence of amniotic fluid (meconium/amniotic fluid), indicating possible rupture of membranes.

Repeat Pap smear in one year OR Reflex HPV testing.

To prevent or treat cord compression and to reduce meconium concentration (in post-term gestation).

Nitrofurantoin.