USMLE Step 2 CK Lecture Notes 2019 ObstetricsGynecology (Kaplan Test Prep) h2book ir USMLE® STEP 2 CK OBSTETRICS AND GYNECOLOGY Lecture Notes ht2book.USMLE Step 2 CK Lecture Notes 2019 ObstetricsGynecology (Kaplan Test Prep) h2book ir USMLE® STEP 2 CK OBSTETRICS AND GYNECOLOGY Lecture Notes ht2book.
http://ebook2book.ir/ USMLE® STEP 2 CK: OBSTETRICS AND GYNECOLOGY Lecture Notes http://ebook2book.ir/ 2019 http://ebook2book.ir/ Table of Contents USMLE Step 2 CK Lecture Notes 2019: Obstetrics and Gynecology Cover Title Page Copyright Editor Feedback Page Part I: Obstetrics Chapter 1: Reproductive Basics Placental Hormones Physiologic Changes in Pregnancy Physiology of Lactation Embryology and Fetology Perinatal Statistics and Terminology Genetic Disorders Chapter 2: Failed Pregnancy Induced Abortion Early Pregnancy Bleeding Fetal Demise Ectopic Pregnancy Chapter 3: Obstetric Procedures Obstetrical Ultrasound Invasive Procedures Prenatal Diagnostic Testing Chapter 4: Prenatal Management of the Normal Pregnancy Diagnosing Pregnancy Establishing Gestational Age Identifying Prenatal Risk Factors Normal Pregnancy Events Normal Pregnancy Complaints Safe and Unsafe Immunizations Chapter 5: Prenatal Laboratory Testing First Trimester Laboratory Tests Second Trimester Laboratory Tests Third-Trimester Laboratory Tests http://ebook2book.ir/ Chapter 6: Late Pregnancy Bleeding Late Pregnancy Bleeding Chapter 7: Perinatal Infections Nonsexually Transmitted Sexually Transmitted Chapter 8: Obstetric Complications Cervical Insufficiency Multiple Gestation Alloimmunization Preterm Labor Premature Rupture of Membranes Post-term Pregnancy Chapter 9: Hypertensive Complications Hypertension in Pregnancy Gestational Hypertension Preeclampsia Preeclampsia with Severe Features Eclampsia Chronic Hypertension with or without Superimposed Preeclampsia HELLP Syndrome Chapter 10: Medical Complications in Pregnancy Cardiac Disease Thyroid Disease Seizure Disorders Diabetes Anemia Liver Disease Urinary Tract Infections Thrombophilias Antiphospholipid Syndrome Chapter 11: Disproportionate Fetal Growth Intrauterine Growth Restriction Macrosomia Chapter 12: Antepartum Fetal Testing Overview Nonstress Test Amniotic Fluid Assessment Biophysical Profile (BPP) http://ebook2book.ir/ Contraction Stress Test Umbilical Artery Doppler Chapter 13: Fetal Orientation in Utero Orientation in Utero Chapter 14: Normal and Abnormal Labor Overview of Labor Stages of Labor Conduct of Normal Spontaneous Labor Abnormal Labor Obstetric Complications During Labor Chapter 15: Obstetric Anesthesia Physiology Anesthetic Options During Labor Chapter 16: Intrapartum Fetal Monitoring Fetal Heart Rate Monitoring Intrapartum Fetal Heart Rate Monitoring Intrauterine Resuscitation Fetal pH Assessment Category III: Abnormal Tracings Chapter 17: Operative Obstetrics Operative Obstetrics Vaginal Birth After Cesarean (VBAC) External Cephalic Version Chapter 18: Postpartum Issues Postpartum Physiologic Issues Postpartum Contraception and Immunizations Postpartum Hemorrhage Postpartum Fever Part II: Gynecology Chapter 1: Basic Principles of Gynecology Female Reproductive Anatomy Gynecologic Procedures Chapter 2: Pelvic Relaxation Pelvic Organ Prolapse Vaginal Prolapse Urinary Incontinence Chapter 3: Disorders of the Vagina and Vulva Vaginal Discharge Vulvar Diseases http://ebook2book.ir/ Chapter 4: Disorders of the Cervix and Uterus Cervical Lesions Cervical Neoplasia Müllerian Anomalies Enlarged Uterus Endometrial Neoplasia Chapter 5: Disorders of the Ovaries and Oviducts Physiologic Enlargement Prepubertal Pelvic Mass Premenopausal Pelvic Mass Painful Adnexal Mass Postmenopausal Pelvic Mass Chapter 6: Gestational Trophoblastic Neoplasia Gestational Trophoblastic Neoplasia Chapter 7: Sexually Transmitted Diseases Spectrum of Organisms STDs with Ulcers STDs without Ulcers Hepatitis B Virus (HBV) Human Immunodeficiency Virus (HIV) Chapter 8: Pelvic Pain Pelvic Inflammatory Disease Primary Dysmenorrhea Secondary Dysmenorrhea Chapter 9: Fertility Control Fertility Control Barrier-Spermicidal Methods Steroid Contraception Intrauterine Contraception Long-Acting Reversible Contraception Natural Family Planning—Periodic Abstinence Coitus Interruptus Vaginal Douche Lactation Sterilization Chapter 10: Human Sexuality Human Sexual Response Cycle Sexual History-Taking Sexual Dysfunction http://ebook2book.ir/ Sexual Assault Chapter 11: Menstrual Abnormalities Menstrual Physiology Premenarchal Vaginal Bleeding Abnormal Vaginal Bleeding Primary Amenorrhea Secondary Amenorrhea Chapter 12: Hormonal Disorders Precocious Puberty Premenstrual Disorders Hirsutism Polycystic Ovarian Syndrome Infertility Menopause Chapter 13: The Female Breast Normal Breast Development Benign Breast Disorders Breast Cancer http://ebook2book.ir/ USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), neither of which sponsors or endorses this product This publication is designed to provide accurate information in regard to the subject matter covered as of its publication date, with the understanding that knowledge and best practice constantly evolve The publisher is not engaged in rendering medical, legal, accounting, or other professional service If medical or legal advice or other expert assistance is required, the services of a competent professional should be sought This publication is not intended for use in clinical practice or the delivery of medical care To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book © 2018 by Kaplan, Inc Published by Kaplan Medical, a division of Kaplan, Inc 750 Third Avenue New York, NY 10017 All rights reserved under International and Pan-American Copyright Conventions By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this eBook on screen No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of the publisher ISBN-13: 978-1-5062-3627-8 http://ebook2book.ir/ Conservative Some clinicians advocate conservative management of fibroadenomas, especially in young women, because they can be diagnosed by ultrasonography and core-needle biopsy or fine-needle aspiration with a high degree of confidence, and in some cases they will resolve A survey of patient preferences, however, has revealed that many women choose excisional biopsy even when they are assured that the lesion is benign by fineneedle aspiration Excision Typically, the lesion is “shelled out” with a surrounding thin rim of breast tissue to avoid the necessity of re-excision in the rare instances when the tumor proves to be a phyllodes tumor This is a mixed epithelial and stromal tumor that has benign, borderline, and malignant variants The biology of the phyllodes tumor is determined by its stromal elements; in its fully malignant form, it behaves as a sarcoma http://ebook2book.ir/ MAMMOGRAPHY MICROCALCIFICATIONS A 45-year-old woman visits her gynecologist after having her yearly mammogram done The mammogram reveals a “cluster” of microcalcifications Diagnosis A geographic cluster of microcalcifications is nonpalpable Although most of these lesions are benign, approximately 15–20% represent early cancer An occult lesion requires stereotactic needle localization and biopsy under mammographic guidance The coordinates of the lesion are calculated by the computer according to the basic principles of stereotaxis The radiologist selects the length of the biopsy needle, and a core biopsy is obtained The procedure is performed in an outpatient setting Management Treatment is based on the established histologic diagnosis http://ebook2book.ir/ PERSISTENT BREAST MASS A 35-year-old woman has a persistent breast mass after a fine-needle aspiration has been performed The breast mass is confirmed by ultrasonography Diagnosis With the combination of physical examination, fine-needle aspiration or core biopsy, and mammography, open biopsies are being performed less frequently Excisional biopsy has the advantage of a complete evaluation of the size and histologic characteristics of the tumor before definitive therapy is selected An excisional biopsy is usually recommended in the following circumstances: Cellular bloody cyst fluid on aspiration Failure of a suspicious mass to disappear completely upon fluid aspiration Bloody nipple discharge, with or without a palpable mass Skin edema and erythema suggestive of inflammatory breast carcinoma, and a needle core biopsy cannot be performed In the past, recurrent or persistent simple breast cysts were routinely excised Because of improvement in ultrasonographic technology, these cysts may now be followed conservatively This patient, who has had a fine-needle aspiration before, is a candidate for an excisional biopsy Management Treatment is based on the established histologic diagnosis http://ebook2book.ir/ BLOODY NIPPLE DISCHARGE A 60-year-old woman comes to the gynecologist’s office complaining of a left breast bloody nipple discharge Diagnosis A bloody nipple discharge usually results from an intraductal papilloma The treatment is total excision of the duct and papilloma through a circumareolar incision Modern ductography does not reliably exclude intraductal pathology and is not a substitute for surgery in patients with pathologic discharge Its utility is in identifying multiple lesions or lesions in the periphery of the breast Management Treatment is based on the established histologic diagnosis http://ebook2book.ir/ BREAST CANCER A 65-year-old woman visits the gynecologist with a solid 2 cm mass in the upper outer quadrant of the left breast A biopsy of the lesion is done, which is consistent with “infiltrating ductal breast cancer.” Breast cancer continues to be the most common cancer diagnosed in women of western industrialized countries In 2018, an estimated 266,00 new cases of invasive breast cancer are expected to be diagnosed in women in the United States, along with 64,000 new cases of non-invasive (in situ) breast cancer Management The preferred treatment for most patients with stage I or II breast cancer is considered to be breast-conserving therapy with a wide excision, axillary lymph node dissection or sentinel lymph node biopsy, and radiotherapy Lymphatic mapping and sentinel lymph node biopsy are new procedures that offer the ability to avoid axillary lymph node dissection and its associated morbidity in patients with small primary tumors who are at low risk of axillary node involvement, while still offering nodal staging information Prognostic Factors Some of the key decisions in the current management of primary breast cancer involve the need for prognostication Prognostic factors serve to identify those patients who might benefit from adjuvant therapy Lymph node status This is important in determining cancer staging and treatment options Axillary lymph node status is the most important factor in the prognosis of patients with breast cancer As the number of positive axillary lymph nodes increases, survival rate decreases and relapse rate http://ebook2book.ir/ increases An adequate dissection usually contains at least 10 lymph nodes; however, because these tumors in 25–30% of patients with negative nodes eventually recur, other biologic prognostic factors also are needed Tumor size This correlates with the number of histologically involved lymph nodes; however, it is also an independent prognostic factor, particularly in node-negative women The use of size of the tumor as the most significant prognostic factor is problematic because 15% of patients with small tumors have positive nodal involvement Receptor status It is standard practice to determine both estrogen and progesterone receptor status at the time of diagnosis for definitive surgical therapy Although hormone receptor status correlates with the prognosis, it does so to a lesser degree than nodal status Hormone receptor determination is, however, of critical importance as a predictive factor A predictive factor is any measurement associated with response or lack of response of a particular therapy Estrogen receptor status has clearly shown to be a predictive factor for hormone therapy, either in the adjuvant therapy or the metastatic disease setting HER-2 (also known as HER-2.neu and c-erbB-2) is an epidermal growth factor receptor on the surface of a cell that transmits growth signals to the cell nucleus Approximately 25–30% of breast cancers overexpress HER-2, and overexpression of the receptor is associated with poor prognosis This may be more of a reflection of the biologic correlates of HER-2 overexpression, e.g., rapid tumor cell proliferation, larger tumor size, and loss of hormone receptors, than an independent prognostic indicator DNA ploidy status DNA ploidy status of tumors is determined by flow cytometry It measures the average DNA per cell Tumors can be classified as diploid with normal DNA content or aneuploid Disease-free survival rates are http://ebook2book.ir/ significantly worse in patients with aneuploid tumors than in those with diploid tumors; however, it is unclear whether ploidy has an independent prognostic value http://ebook2book.ir/ INFILTRATING DUCTAL CARCINOMA This is the most common breast malignancy, accounting for 80% of breast cancers Most are unilateral and start as atypical ductal hyperplasia, which may progress to ductal carcinoma in situ (DCIS), which then may break through the basement membrane and progress to invasive ductal carcinoma Over time the tumor will become a stony hard mass as it increases in size and undergoes a fibrotic response http://ebook2book.ir/ INFILTRATING LOBULAR CARCINOMA This is the second most common breast malignancy, accounting for 10% of breast cancers Most are unilateral and start as lobular carcinoma in situ (LCIS), which then may break through the basement membrane and progress to invasive lobular carcinoma The prognosis is better with lobular than with ductal carcinoma http://ebook2book.ir/ INFLAMMATORY BREAST CANCER This is an uncommon breast malignancy that can mimic mastitis Usually, there is no single lump or tumor It is characterized by rapid growth with early metastasis As the lymphatics get blocked, the breast becomes erythematous, swollen, and warm to examination The edematous skin of the breast appears pitted, like the skin of an orange, giving the classic peau d’orange appearance http://ebook2book.ir/ PAGET DISEASE OF THE BREAST/NIPPLE This is an uncommon breast malignancy with a generally better prognosis than infiltrating ductal carcinoma The lesion is pruritic and appears red and scaly; it is often located in the nipple spreading to the areola The skin appearance can mimic dermatosis like eczema or psoriasis The nipple may become inverted and discharge may occur It is almost always associated with DCIS or infiltrating ductal carcinoma http://ebook2book.ir/ BREAST CANCER RISK FACTORS BRCA 1 or 2 gene mutation RR 15 Ductal or Lobular CIS RR 15 Atypical hyperplasia RR 4 Breast irradiation age 6 cycles of treatment http://ebook2book.ir/ ... USMLE? ? STEP 2 CK: OBSTETRICS AND GYNECOLOGY Lecture Notes http://ebook2book.ir/ 20 19 http://ebook2book.ir/ Table of Contents USMLE Step 2 CK Lecture Notes 20 19: Obstetrics and Gynecology. .. ISBN-13: 978-1-50 62- 3 627 -8 http://ebook2book.ir/ EDITOR Elmar Peter Sakala, MD, MA, MPH, FACOG Professor of Gynecology and Obstetrics Division of Maternal Fetal Medicine Department of Gynecology and Obstetrics. .. http://ebook2book.ir/ We want to hear what you think What do you like or not like about the Notes? Please email us at medfeedback @kaplan. com http://ebook2book.ir/ Part I http://ebook2book.ir/ OBSTETRICS