MedReady - Podcast Details

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Clerkship Ready: PediatricsBefore You Counsel on Introducing Complementary Foods, Including Potentially High Allergen FoodsIn this episode, we will discuss when and how to advise parents on introducing complementary foods (aka “solids”), including foods that are potentially allergenic. This is a topic that will invariably come up for you during your rotation. We’ll discuss the timing and sequence of introducing solids, and then talk about the rationale behind early introduction of potentially allergenic foods. Definition of “complementary” foods” - a catch all category for “all solid and liquid foods other than breast milk or infant formula”. Also referred to as “solid foods” Definition of potentially allergenic foods - eggs, peanut butters, nut butters, fish, shel...2025-06-1315 min

Clerkship Ready: PediatricsBefore Your First Discussion about Infant FormulaIn this episode, we will be reviewing what you need to know before your first discussion about infant formula. We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it. Reasons for formula feeding Human milk is first choice for most infants Concern about lactating parent’s milk supply Workplace conditions make it difficult to sustain human milk feeding Parent preference There are few true contraindications to bre...2025-01-2712 min

Clerkship Ready: PediatricsBefore You See a Pediatric Patient with Sore ThroatListen along as we dive into the many causes of sore throat. Learn about the common causes such as allergies and viral illnesses while also what to do when a child with epiglottitis comes in. We will cover CENTOR criteria as well and when you should think about Group A strep testing. Common Causes Viral Presentation HSV Mononucleosis Allergic Presentation Group A Strep CENTOR Criteria Emergency Causes Peritonsillar Abscess Retropharyngeal Abscess Epiglottitis Wrap Up & Conclusion Resources/Links: https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology https://www.mdca...2024-09-0515 min

Clerkship Ready: PediatricsBefore You Care for a Pediatric Patient with AsthmaAsthma is a common chronic disease of childhood that affects 1 in 12 children in the United States. It can range from mild respiratory symptoms to life threatening respiratory failure, with a range of treatment options in-between from the primary care setting to the pediatric ICU. In this episode, we will discuss the underlying pathophysiology, diagnosis, evaluation, and management of patients with asthma, along with some useful clinical pearls to help you take care of these patients! Cause of asthma Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis Prenatal and childhood environmental factors: maternal smoking and aller...2024-06-1215 min

Clerkship Ready: PediatricsBefore You Order Lead Testing for Your PatientIn this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level. Sources of lead exposure Ingestion of contaminated food or water Ingestion or breathing in of lead dust Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys For families from other cultures, think about cera...2024-06-1212 min

Clerkship Ready: PediatricsBefore Your First Time Completing a Neuro ExamIn this episode of Clerkship Ready – Pediatrics Dr. Jared Barkes, a Child Neurology resident at The University of Virginia, will be walking you through how to complete the neurologic exam! Throughout the episode he will cover in detail the different parts of a formal neuro exam while also providing useful tips for remembering commonly tested facts, reviewing specific examples of abnormal findings and common neurologic conditions, and offering helpful advice for completing a neuro exam on a pediatric patient. After listening to this podcast you will have all the tools necessary to shine on your first day of your ne...2024-06-1240 min

Clerkship Ready: PediatricsBefore Your First Neonatal Sepsis Work UpSepsis is a clinical syndrome in which an infection leads to an inflammatory response throughout the body that rapidly progresses to organ dysfunction or even death. Worldwide, neonatal sepsis affects 2,202 infants per 100,000 live births, and has a mortality rate of >11%. In the United States, early onset sepsis affects 50 in 100,000 live births, with a mortality rate of about 3%. So it’s a big problem that we don’t want to miss. In this episode, we will define neonatal sepsis, talk about the presentation of sepsis, what a sepsis workup entails, how to make the diagnosis and treatment of neonatal sepsis. ...2024-04-0126 min

Clerkship Ready: PediatricsBefore You See a Child With Possible Iron DeficiencyIron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency. Importance of Iron Iron and Hemoglobin Iron and Neurodevelopment Iron and the Immune System What happens in iron deficiency Reasons that children are at high risk for iron deficiency Rapid Gro...2024-01-1820 min

Clerkship Ready: PediatricsBefore You See a Child Who Has Ear PainEar pain is one of the most common chief complaints pediatricians encounter in the outpatient setting and there are quite a few things you need to consider to make a thoughtful diagnosis, assessment, and plan. In this episode, we will discuss the differential diagnosis of ear pain in children, physical exam findings that will help you make a diagnosis, and treatment for the most common causes of ear pain. Ear anatomy Outer ear, tympanic membrane (TM), middle ear, inner ear Eustacian tube in children is smaller in diameter and angled more horizontally than in adults. This makes it mo...2024-01-1814 min

Clerkship Ready: PediatricsBefore You See a Child Who May Have Been AbusedChild abuse, which is sometimes called non-accidental trauma, is a public health problem with life-long health consequences for survivors and their families. In this episode, we will review what you need to know before you encounter your first patient who may have or has been abused. We will focus on physical and sexual abuse of children. Long term health consequences of child abuse Why identification of child abuse is difficult It is often difficult to distinguish an accidental injury from a non-accidental injury A caregiver who has abused a child rarely confesses to harming the child Child may b...2023-12-1135 min

Accessibility Minute with Laura MedcalfAM547 MedReady Pill DispenserHey there! Welcome to Accessibility Minute, your weekly look at Assistive Technology, those clever tools and devices designed to help people who have difficulties with vision, mobility, hearing, or other special needs! Many individuals aging in place may have difficulty remembering and taking their medications when they’re supposed to. The original MedReady Automatic Medication Dispenser […] The post AM547 MedReady Pill Dispenser first appeared on Assistive Technology at Easter Seals Crossroads.2023-10-2701 min

Accessibility Minute - Assistive Technology Tips and Tricks for EveryoneAM547 MedReady Pill DispenserHey there! Welcome to Accessibility Minute, your weekly look at Assistive Technology, those clever tools and devices designed to help people who have difficulties with vision, mobility, hearing, or other special needs! Many individuals aging in place may have difficulty remembering and taking their medications when they’re supposed to. The original MedReady Automatic Medication Dispenser can help with that! According to the product’s website, “MedReady increases medication compliance up to 96.7% by virtually eliminating missed doses and overdosing medication. If the medication is prescribed correctly, the effectiveness of the drugs remains high because the blood pl...2023-10-2701 min

Clerkship Ready: PediatricsBefore You Counsel About Contraception OptionsDiscussing menses and pregnancy prevention is an important part of preventative care and reproductive health. Patients and parents come in with a wide range of preconceptions and understanding. It can be daunting to counsel about the many types of contraception to come to a shared decision about what is best for the patient. This podcast will review the following about contraception: Medical contraindications Physiology of hormonal options Efficacy of pregnancy prevention Patient considerations and concerns Emergency contraception Myths Resources/links: CDC MEC: https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf ACOG contraception c...2023-10-2416 min

Clerkship Ready: PediatricsDevelopmental Milestones for ChildrenIn today’s episode, we are talking about normal child development. We will talk about why this is important and how you will be evaluating children’s development. We will go over major milestones in the 4 developmental domains: movement/physical development – or gross and fine motor, language/communication, cognitive, and social/emotional. We will go over some common cases. Finally, we will briefly discuss what you should do if you suspect developmental delay. Why it is important to learn about developmental delay. Why it is important to learn about development Developmental surveillance versus developmental screening versus diagnosis of develo...2023-10-1130 min

Clerkship Ready: PediatricsBefore your first day caring for newborns – understanding neonatal hypoglycemiaNeonatal hypoglycemia is a common and often transient issue for newborns during a period of transition from intrauterine to extrauterine life. Many infants with hypoglycemia are screened for it and treated for it in the nursery, and a handful will require NICU admissions. This podcast will help you understand these things about neonatal hypoglycemia: Why we worry What causes it Which infants are most at risk How to treat it and who needs the NICU Resources/Links: https://downloads.aap.org/AAP/PDF/Seminars_in_Fetal_Neonatal_Medicine.pdf https://publications.aap.org/hospitalpediatrics/article/11/6/595/180015/Practice-Variations-in-Diagnosis-and-Treatment-of h...2023-09-2917 min

Clerkship Ready: PediatricsBefore Your First ADHD Clinic VisitAttention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. In this episode, we will discuss ADHD, including the different types, evaluation, management, and follow up. General definition of ADHD and its types Preparing for your first visit Initial evaluation of ADHD vs. med check Reviewing prior visits During an initial visit: Evaluating historical features Behaviors at home, behaviors at school Common misconceptions about ADHD Surrounding factors and comorbidities/misdiagnosis Physical Exam Important features of the exam Observing the child’s behavior Role of the Vanderbilt Scoring a Vanderbilt Treatment Medication vs. non-pharmacologic interventions Ove...2023-09-2218 min

Clerkship Ready: PediatricsBefore You See an Infant with JaundiceIn this episode, we discuss things you’ll need to know and think about before seeing an infant with jaundice. We will focus on infants from birth to 2 months of age. We will discuss the pathophysiology of hyperbilirubinemia, the difference between unconjugated and conjugated hyperbilirubinemia, the differential diagnosis, key elements of the history and physical exam, laboratory and imaging workup, and management. Introduction to jaundice and hyperbilirubinemia Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology Review of...2023-09-1126 min

Clerkship Ready: PediatricsBefore the First Time You Order Fluids or Electrolyte ReplacementMany of the pediatric inpatients you care for will need intravenous fluids and electrolytes. This episode describes what you need to know before you order fluids or electrolyte replacement for your patient. We will discuss maintenance fluid needs and talk more in depth about what fluids to order and at what rate. We will also talk about managing patients with dehydration and how to replete fluids. Then we will discuss a few cases where we will work through some more common electrolyte derangements and discuss how to manage them. We will end with additional clinical pearls that will be...2023-09-1121 min

Clerkship Ready: PediatricsBreastfeeding 102- Initiation and Management of Common Early Breastfeeding ConcernsThis episode is a follow-up to “Before Your First Time Working with a Breastfeeding Mother”. We’ll be reviewing additional details about breastfeeding that can help you to answer some of the most common questions that come up for families. We will discuss strategies to improve milk production, newborn stomach volumes, how to know if baby is getting enough milk, what to do if baby isn’t getting enough milk, and breastfeeding complications. Strategies to improve milk production Latching Newborn stomach volumes How to know if baby is getting enough milk What to do if baby isn’t getting en...2023-09-1113 min

Clerkship Ready: PediatricsBefore Your First Time Working with a Breastfeeding MotherThis episode describes what you need to know before your first time working with a breastfeeding parent. This will include topics such as how to ensure families feel comfortable, benefits of and contraindications to breastfeeding, how to approach conversations about breastfeeding, and the science behind lactation or milk production. Making families feel comfortable Benefits of breastfeeding for mom and baby Contraindications to breastfeeding Approaching conversations about breastfeeding with families The process of lactogenesis (milk production) Resources/Links: Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org Virginia Department of Health/Breastfeeding Education Consortium Online Course (f...2023-09-1111 min

Clerkship Ready: PediatricsBefore Attending Your First Delivery in Labor and DeliveryToday we will talk about what to expect before attending your first delivery as part of the pediatrics team while on the Newborn rotation. Each delivery is different and what is needed for each infant at the delivery can be different depending on the status of the infant at birth. In this episode, we will focus on the lower risk deliveries that you are most likely to attend during your newborn rotation, and what you can expect once the baby is born. Newborn deliveries: Low Risk Low-risk delivery team members What constitutes a low-risk delivery page Di...2023-08-2816 min

Clerkship Ready: PediatricsBefore Your First Patient with an Eating DisorderToday, we’ll be discussing how to evaluate and work up a patient with a suspected eating disorder. We’ll use a general case for an adolescent with an eating disorder to examine the different aspects of care you should be thinking about, from lab work to admission criteria and what to do once the diagnosis is made. How to identify an eating disorder What to do if you suspect an eating disorder How to manage eating disorder patients in the outpatient setting or in the hospital Strategies and tips for talking to teens with eating disorders Resource...2023-08-2811 min

Clerkship Ready: PediatricsBefore You Choose Antibiotics for a Child or AdolescentAntibiotic selection can be complicated. In this episode, we discuss how you should approach choosing the appropriate antibiotic for your pediatric patient. There are multiple considerations, including: What organisms do you want to treat? What does anatomy have to do with antibiotic selection? You also have to think about individual circumstances, such as immunzation status, chronic disease, drug allergies, and environmental exposures. Know what organisms you want to treat Because we often treat empirically, we need to know organisms that typically case this typical infection Narrow-spectrum antibiotics if possible Anatomy of the infection For fever in first 4-6...2023-08-2212 min

Clerkship Ready: PediatricsBefore You Prescribe Medicines for a Child or AdolescentPrescribing medicines in pediatrics is different than prescribing medicines for adults. In this episode, we discuss what you need to know before prescribing medications for the pediatric population, including calculating dose for the child’s weight, choosing IV vs PO medications, and other considerations. 1) References to look up pediatric drug doses and frequencies. 2) Calculating weight-based doses 3) Maximum daily doses 4) Different formulations of medications 5) Prescribing oral medicines Pills vs Liquid Consider taste Use the most concentrated suspension Use milliliters instead of spoonfuls 6) What if the medicine is not available in liqui...2023-08-2213 min

Clerkship Ready: PediatricsBefore Your First Encounter Using an InterpreterMany of our patients and their families are not proficient in English, and it's important to be able to communicate effectively with them. In this episode, you’ll learn about how to work with an interpreter during encounters with patients who are not proficient in English. We’ll discuss dos and don’ts, common challenges, and tips for interacting with interpreters and families. Definitions Interpretation vs translation Modes of interpretation When do I need an interpreter? III. Who should not serve as an interpreter? Non-certified team members Patient’s non-certified friends or community members Patient’s family members Gettin...2023-08-1816 min

Clerkship Ready: PediatricsBefore You Counsel about Infant Safe SleepFollowing safe sleep guidelines is the best way to protect a baby from dying suddenly and unexpectedly from sudden infant death syndrome (SIDS), accidental suffocation or strangulation, and deaths with unknown cause. Today we’re going to talk about what you need to know before you talk to a family about what safe sleep looks like for their infant. We’re going to talk about the importance of safe sleep habits, the AAP safe sleep recommendations, guidelines for infant sleep products, and tummy time. Why do we talk about safe sleep for infants? What causes infants to die sudd...2023-08-1016 min

Clerkship Ready: PediatricsBefore You Get a Sexual HistoryThe sexual history is an important part of the adolescent visit. In this episode, we will discuss the importance of the sexual history and how to handle patient confidentiality. We will introduce the 5Ps framework for the sexual history. We will also brieflyy discuss screening for sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Sexual History - why it is important Confidentiality 5 Ps Framework Partners Practices Protection of STIs Past history of STIs Pregnancy Intention STI Screening and Treatment HIV screening algorithm References: 5 Ps Framework: https://www.cdc.gov/std/treatment/Se...2023-08-1013 min

Procedure Ready: Ob/GynOperative Vaginal Deliveries Incidence: 3.3% as of 2013 Indications: Prolonged second stage Risk of fetal compromise Shortening 2nd stage for maternal benefit (ex: cardiac conditions) Consent: Comparison is c-section typically Failure rate of OVD is ~3-6% Forceps has higher success rate over vacuum, but also higher risk 3rd/4th degree tear Risks to both mom and baby Prep: Fetus appropriate station/position Anesthesia Empty bladder Assess Pelvis/Passenger sizes/fit OR Ready Peds available Episiotomy – NO! Contraindications Fetal conditions, known or supspected: bone disorders (OI), bleeding disorders Maternal infections: Hep C, HIV, etc Concer...2023-06-0913 min

Procedure Ready: Ob/GynInduction of LaborIndications: Post-dates (42+wks) Late Term (41+ wks) Elective 39+wks Diabetes Hypertension Many more - check out ACOG Medically indicated delivery 39week induction ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks Included Primips No medical indications for IOL prior to 40+5 Results IOL group had LOWER c-section rate than expectant group Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group Conclusion IOL at 39wks is as safe as expectant management without increased ri...2023-06-0917 min

Procedure Ready: Ob/GynShoulder dystociaDefinition: Failure to deliver fetal shoulders with normal downward traction Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries Risk factors: DM, excessive weight gain in pregnancy, S>D, Large baby Hx of shoulder dystocia (~10-15% recurrence) Turtling while pushing Prevention No real prevention as SD is very hard to predict Offer cesarean delivery if EFW is >5000g and no DM, or >4500g and any type of DM What do to: Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are do...2023-06-0816 min

Clerkship Ready: PediatricsBefore You Examine A Pediatric Patient - Physical Exam Tips & TricksToday, we will be reviewing what you need to know to examine your pediatric patients. Examining children is a bit of an art form and is often unfamiliar to clerkship students who may have a varied degree of experience being around children, may never have worked with children and may not have been exposed to pediatric patients in the pre-clinical years. In this episode, we discuss tips and tricks to get the exam you need on your pediatric patient with as little crying as possible. How to examine a baby/infant How to examine a toddler/preschool aged...2023-06-0313 min

Clerkship Ready: PediatricsBefore You Counsel on VaccinesProviding vaccines is one of the most important health promotion activities that we do. However, it involves much more than just putting in the orders for the various vaccines. In this podcast episode, we will briefly review how vaccines work, the types of vaccines, what you need to do before the visit, what you should review with families before ordering the vaccines (including precautions and contraindications), and anticipatory guidance about vaccines. We will also talk a little bit about how to handle vaccine hesitancy. List of pediatric vaccines How vaccines work Harmless piece of the pathogen that is...2023-06-0226 min

Clerkship Ready: PediatricsBefore Your First Day on the WardsIn this episode, we discuss how to best prepare for your time on the inpatient wards, including how to prepare before the rotation, how to pre-round, how to present a patient, and how to be an effective team member. Before the Rotation Reach out to your team.. Understand what first day expectations are. Peruse the patient list. Identify what study materials and resources will help you excel. Come ready to learn and have fun! How to Pre-round Collect information on previous day and overnight events - includes talking with resident or night team, reading all notes from day pri...2023-06-0121 min

Clerkship Ready: PediatricsBefore Your First Adolescent Well Visit The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions. Before visit: Review normal psychosocial development of adolescence Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence Review past medical history, medications, v...2023-06-0124 min

Clerkship Ready: PediatricsBefore Your First Outpatient Newborn VisitThis episode describes how to prepare for a newborn’s first outpatient visit after they have been discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn. Introduction Socio-emotional state of parents Before the visit, you should review Prenatal history Delivery history, gestational age Physical exam at time of birth Preventative treatments Course in newborn nursery or NICU Type of feeding Concerns for in...2023-05-0125 min

Clerkship Ready: PediatricsPeds GI ClinicIn Pediatric Gastroenterology (or GI) clinic, you will see patients with a host of gastrointestinal, pancreatic, liver, and nutrition issues. This episode will discuss specific questions that you will want to cover in your history and the elements of a complete GI exam - which is a lot more than just an abdominal exam! Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues -3yr fellowship after peds residency Before Clinic Review what types of patients you will be seeing. It may be a mix of lots of is...2023-04-0113 min

Clerkship Ready: PediatricsBefore Your First Well-Child CheckThis episode will prepare you for your first well child visit. In primary care, about half of a pediatrician's time will be spent in well child visits. We will talk about what you need to review before you walk into the patient's room, the elements of the history (diet, sleep, elimination, development, etc.) that you need to ask about in well child visits, tips to approaching the physical exam in children, and anticipatory guidance. Finally, we will provide an example of an oral presentation for a well child visit. 2023-03-0114 min

Clerkship Ready: PediatricsBefore Your First Day in Newborn NurseryThis episode will prepare you to see well newborn babies in the newborn nursery on day 1. We will talk about the typical newborn stay, the information you need to gather to successfully give oral presentations on your patients, the newborn physical exam, and the tests and procedures commonly performed on all newborns. Nursery orientation: family expectations and goals of the healthcare team, expected length of stay History Maternal History: Gs and Ps Prenatal Care: prenatal labs and ultrasounds Past Medical History & medications Social situation/support Baby History: Gestational Age Delivery type and why, resuscitation efforts and complications Growth p...2023-02-0120 min

Clerkship Ready: PediatricsYour Pediatrics Survival Guide - Tips and TricksPediatrics is different from any other rotation that you will do. Children are not just small adults. There is a huge range of ages and developmental stages. This episode will provide you with some general tips and tricks for all clerkships in general and the Pediatrics clerkship specifically, and essential resources that will help you to succeed in your clerkship. Essential Resources Podcasts: Clerkship Ready-Pediatrics Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed. Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pe...2023-01-0109 min

Procedure Ready: Ob/GynCancer Screening and Vaccinations (HCM)Cancer Screening Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal. ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf ) Breast: ACOG: 40-75 annual mammogram Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger. […]2018-08-1500 min

Procedure Ready: Ob/GynSTIsSwab/Urine Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1 Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once. HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed. Serum Syphilis: Painless chancre followed by latent, then secondary with palmar/plantar rash. If unsure stage, treat as if latent, PCN IM x3 HIV: Universal screening. PREP if high risk. Referral to ID and counseling if posi...2018-08-1519 min

Procedure Ready: Ob/GynBefore Your First: Colposcopy and LEEPWhy: ASCCP guidelines (there is an app! Or PDF) Cervical dysplasia — caused by HPV CIN I–CIN3 is a progression Risk factors: Smoking, other STIs including HIV, immunodeficiency Histology: Increased Nuclear: cytoplasmic ratio when abnormal Acetic Acid: exact mechanism unknown, the higher N:C ratio cells (aka abnormal cells) reflect more light and appear white. […]2018-02-1300 min

Procedure Ready: Ob/GynReturn OB VisitsEvery visit: Doptones, fundal height, vitals Four question: Vaginal bleeding, contractions, leaking fluid, fetal movement By Weeks: 20wks – get and review anatomy US 24wks – order glucola, cbc (check for anemia), discuss normal growing pains 28wks – Tdap and Rhogam if needed, discuss kick counts 32wks – Discuss BCM, sign tubal papers if needed, […]2018-02-1100 min

Procedure Ready: Ob/GynFirst Prenatal Visit Planned/Desired Options counseling if needed Exam/pelvic/pap Ultrasound for dating Screening options: QUAD, Sequential, NIPS, invasive testing Pregnancy guidelines Weight: BMI under 18.5 should gain 28–40 pounds. Normal-weight women (BMI, 18.5–24.9) should aim for 25–35 Overweight women (BMI, 25–29.9) should aim for 15–25 Obese women (BMI, 30 or more) should gain only 11–20 Food: Avoid unpasteurized dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked meat/seafood, uncooked deli meat, EtOH Drugs: Nothing unless cleared by MD. Tylenol okay if needed, PNV, Colace, FeSO4. NO NSAIDs! Exercise: Nothing that could leave a bruise on your belly! Moderate exercise is great. 2018-02-0817 min

Procedure Ready: Ob/GynBefore your first: HysteroscopyHysteroscopy = looking inside the uterus with a scope Steps: Dilate the cervix Distend the uterus with fluid Look around, identify pathology, identify tubal ostia, remove pathology if using an operative scope or Myosure or another resectoscope. Feared complication: Hyponatremia from excessive hypotonic fluid absorption.2018-01-1000 min

Procedure Ready: Ob/GynBefore Your First: HysteroscopyHysteroscopy = looking inside the uterus with a scope Steps: Dilate the cervix Distend the uterus with fluid Look around, identify pathology, identify tubal ostia, remove pathology if using an operative scope or Myosure or another resectoscope. Feared complication: Hyponatremia from excessive hypotonic fluid absorption. 2018-01-1010 min

Procedure Ready: Ob/GynPeripartum FeversIntrapartum Differential diagnosis for Temp >38.0C Epidural fever (transient), DVT/PE (if prolonged IOL or limited mobility), UTI, Intraamniotic infection (with or without ROM), etc Chorioamnionitis aka IAI aka Triple-I (intrapartum intraamniotic Infection) One temp >39.0C One temp 38.0C-39.0C AND one or more risk factors Two temps >38.0C 30+ mins apart Tx: the standard is […]2018-01-0800 min

Procedure Ready: Ob/GynPostpartum HemorrhageCauses (Four T’s): Tone: Atony Pitocin Misoprostol: CI-allergy, SI-transient hyperthermia Methergine: CI-HTN, SE-HTN Hemabate: CI-asthma. SE-diarrhea Tamponade: bakri/utah balloons Trauma: Lacerations Tissue: Retained POC (placenta or membranes) Thrombin: Coagulopathy Other: Involution 2017-12-1400 min

Procedure Ready: Ob/GynWho's that collar?Hello from Addison and Lundy.2017-12-1400 min

Procedure Ready: Ob/GynPreterm Labor and PPROMACOG Practice bulletin: # 171 PTL or TPTL: Preterm <37wks, cervical change Evaluation: SSE first: Collect GC/CT cultures, FFN (no gel, blood or semen), GBS, eval for rupture if needed SVE: Cervical change–can dilation or effacement changes FFN: Fetal fibronectin If tPTL: Magnesium for neuroprotection if <32wks, decrease CP rates Betamethasone for fetal lung development […]2017-12-1400 min

Procedure Ready: Ob/GynPreterm Labor and PPROMACOG Practice bulletin: # 171 PTL or TPTL: Preterm 2017-12-1320 min

Procedure Ready: Ob/GynBirth ControlResources: https://www.bedsider.org/methods Table: http://www.womenscommunityclinic.org/wp-content/uploads/Bedsider-Birth-Control-Effectiveness-Poster.jpg Spanish: http://s3.amazonaws.com/providers/images/images/000/000/032/center/Spanish_tiers_of_effectiveness.png?1464661802 2017-12-0400 min

Procedure Ready: Ob/GynIndications for a c-section during labor Nonreassuring fetal heart tracing Category 2-remote from delivery Minimal/absent variability is most significant predictor of fetal acidemia Category 3 any time is emergent deliver Failed IOL Many different definitions: Most commonly 12-24hrs ruptured membranes on pitocin without active labor Arrest of dilation Can only meet criteria once in active labor 6cm or greater Do you know if her contractions are adequate? IUPC with MVUs>200-250 If the contractions are adequate, no change over 4hrs If contractions are inadequate or no IUPC, no change over 6hrs Arrest of descent Prime with...2017-12-0315 min

Procedure Ready: Ob/GynBefore Your First: HysterectomyWhat approach: Abdominal, laparoscopic, vaginal or combination Taking or leaving the tubes and ovaries? Tubes: What benefit do they provide? Risk? Ovaries: What benefit do ovaries provide? What about after menopause? Still have benefit for bones and cardiovascular health. 65yr old cut-off If it’s laparoscopic–listen to the LSC podcast for more details on the approach Let’s talk about important steps: The round ligament: What artery runs inside the round? Sampson’s. What structure conceals the blood flow to the ovary? The IP ligament (formerly the suspensory ligament of the ovar...2017-11-2020 min

Procedure Ready: Ob/GynHypertension in PregnancyHypertension in Pregnancy — One large spectrum Mild range: 140/90 Severe range 160/110 CHTN → SIPE gHTN → Pre-E BP meds: Methyldopa, labetalol, hydralazine, nifedipine Severe features: BPs Neurologic symptoms Lab findings: HELLP Hemolysis, Elevated Liver (enzymes), Low Platelets Eclampsia — Seizures 2017-11-2000 min

Procedure Ready: Ob/GynBefore Your First: LaparoscopyReview anatomy– you’ll be able to see well! Pimped- Youtube Channel videos for laparoscopic anatomy What case are you doing and why? Review common indications, steps to procedure and potential risks/complications Saying hi to the patient first Being helpful setting up — yellowfins or stirrups for lithotomy Scrubbing in — ask to grab your gown/gloves for the scrub, open carefully or get help if unsure Abx: If entering uterus or vagina ie hyst Prep: infection prevention with chloraprep or something EtOH based, needs to evaporate before draping...2017-11-1929 min

Procedure Ready: Ob/GynBefore Your First: Cesarean SectionWhy? Scheduled: Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accrete, etc) malpresentation (not cephalic), multiple gestation In labor: arrest of dilation, arrest of descent, nonreassuring fetal heart tones, elective Anatomy: Layers of anterior abdominal wall: skin, subcutaneous tissue, superficial fascia (Campers, scarpa’s), external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, preperitoneal adipose and areolar tissue, and peritoneum. Nerves, blood vessels, and lymphatics are present throughout. Now you’re at the uterus — or should be. Clear the surgical field, take down adhesions, bladder flap i...2017-11-1425 min

Procedure Ready: Ob/GynBefore Your First: Vaginal DeliveryCardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion Complete dilation, now station: Labor down vs push 2nd Stage of labor: Pushing Offer to help with maternal positioning—holding ankle/leg Delivery—downward traction on head, thumbs to nose, anterior shoulder, posterior shoulder, body. Skin to skin. Delayed cord clamping. 3rd stage placenta: […]2017-10-3000 min

Procedure Ready: Ob/GynBefore Your First: Vaginal Delivery Cardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion Complete dilation, now station: Labor down vs push 2nd Stage of labor: Pushing Offer to help with maternal positioning—holding ankle/leg Delivery—downward traction on head, thumbs to nose, anterior shoulder, posterior shoulder, body. Skin to skin. Delayed cord clamping. 3rd stage placenta: Active management, Pitocin, gentle cord traction. 3 signs of placental detachment Bleeding: Atony, meds Lacerations: degree, repair Postpartum: Fundal tenderness, lochia, voiding, BMC. 2017-10-2922 min

Procedure Ready: Ob/GynLabor and Delivery Triage The OB One-Liner: “This is a _ yr old G_ P_ @_ wks GA here for ____.” Ex: This is a 34yo G3P2002 @ 38wks3days GA here for contractions Triage: 4 essential questions to ask every pregnant woman in triage Contractions, leaking fluid, vaginal bleeding, fetal movement What is labor? Cervical change and contractions Evaluate for ROM: Pooling, nitrazine (pH), ferning. Vaginal bleeding—when do we care? 2nd or 3rd trimester worry about placenta: abruption, previa, vasa previa DFM: NSTs, BPPs, Kick counts 2017-10-2922 min

Procedure Ready: Ob/GynYour Ob/Gyn Survival Guide: Tips and TricksHigh yield resources and tips for your Ob/Gyn clerkship. Youtube Playlist: http://bit.ly/pimped-ob Books: Netters Obstetrics and Gynecology by Beckmann Apps: Pimped App – Clinical questions to expect in the OR and on the wards Uptodate Epocrates GoodRx LactMed – medications safe in breastfeeding ASCCP: Cervical cancer screening CDC STI guidelines ACOG app/website OB Wheel or […]2017-10-2300 min