Divine Intervention Episode 22 Comprehensive OBGYN 3rd Year Shelf Review

Comprehensive review for the NBME OBGYN Shelf Exam. Download the slides on my website;
www.divineinterventionpodcasts.com
I also offer 1-on-1 tutoring for med school exams and USMLE Step 1-3;
[e-mail]

[@reyazhussain3152]

Most underrated usmle lectures, knowledge yeild per minute of the lecture is v high👏🏻

[@nnn6054]

This video is a god send. I passed my oral exam for my OBGN rotation by using several key points from this video.

[@karataych0p]

I'm sooo late to your podcast. But better late than never! Great work. Your content made a huge difference for me

[@dwaynegarcia9986]

You are the best! Amazing job

[@Pseudomod]

Pregnancy loss per AMBOSS: Threatened: closed cervical os, bleeding, fetal activity Complete: closed cervical os, bleeding, POC completely out of uterus Missed: closed cervical os, no bleeding, no fetal activity Inevitable: open cervical os, bleeding, ± fetal activity Incomplete: open cervical os, bleeding, POC within uterus or cervical canal "Keep your I's (eyes) open" = Inevitable or incomplete --> open cervical os

[@smellypatel5272]

What's POC in this context?

[@blexibleep]

@@smellypatel5272 products of conception

[@ekisseka]

@@smellypatel5272 Products of conception

[@jg8198]

Thank you, Divine. God's Blessing

[@ImNotAdamBillig]

Q16a: >45 YO with palpable left breast mass with negative mammo findings. Next best step is ultrasound (>30 YO need both mammo + ultrasound), not core needle biopsy. Probably will need a CNB, but I got a uWorld question wrong on this.

[@montigo2063]

Saw it too 🤙🏾

[@d0h4]

the UW question you're referring to is about nipple discharge IIRC, for pathologic nipple discharge you do mammo, if -ve you do US and if that's also -ve, you proceed to MRI

[@Afro_Sensei]

Best review the night before any shelf.

[@xshezy890]

Amazing video! Thanks a lot

[@jwave07]

GOD BLESS YOU DIVINE!

[@shaki6500]

57:14 In this scenario, 45 yrs old with a breast mast and negative mammogram, I believe next step is to do a US of breast, then we can go to core needle biopsy ( or the best answer might be, ultrasound guided core needle biopsy). Correct me if I am wrong. Thank you for your amazing lectures.

[@d0h4]

does this apply breast mass or pathologic nipple discharge scenarios? because in UW the algorithm for nipple discharge indicates the women >40 with a normal mammogram should get an ultrasound and if the latter is also normal, an MRI should be requested (also applies to women 40

[@rachelcarrasquillo283]

I agree

[@manishsuryapalam364]

based on nbme + Uworld, if a mass is detected by ultrasound and unambiguous in nature (whether cystic or solid) then you can immediately aspirate/biopsy. If ambiguous, then mammogram.

[@johngrissom1504]

I was thinking the same exact thing

[@jjrusso8295]

You are an amazing human being

[@amandasicilia6007]

thank you so much! Awesome video

[@Soul1997Xtina]

You’re the best thank you 🙏🏻

[@huakanghuang4020]

Thank you so much Divine this is very helpful!

[@ApolyonTheSoulRender]

Thank you so much for this!

[@jackjohnson4586]

ACOG updated their postpartum hemorrhage guidelines in 2017 to define PPH as >1000ml EBL in 2017, don't let the old guidelines trip you up

[@reyazhussain3152]

God bless you🙏🏻

[@briwg9846]

thank you for making this!

[@aminacheema8391]

Thanku so much It’s a great help God bless u

[@SKMedicalinfo]

Excellent...

[@The_Kirk_Lazarus]

I took a shot every time he said okay and now I have no liver.

[@xKiB5]

I hate you, I hadn't noticed it before and now I can't stop hahaha

[@Felinal_19]

holy shit

[@eriktatos]

LMAOOOOOO

[@RealDaTruf]

Ok!!?!!

[@Porsh27]

😂😂😂😂😂😂😅😅😅😅

[@amyamelie7]

you're amazing !

[@elainesong5024]

You are correct about giving aspirin as prophylaxis for preeclampsia

[@owensaenz1065]

This is amazing

[@usmlecoach7704]

Love this

[@sambrown8941]

Hi Divine, great work again. Do you have the PDF for this lecture on your website?

[@divineinterventionpodcasts]

Yes. It's hyperlinked under the respective video on the website.

[@charu2115]

@1:58 --hcg needs to be >3500 in order to be visualized on TVUS

[@ahmedadnan6144]

which question are you talking about?

[@lousy7580]

On Question 16A, I believe if a mammogram is negative, you should do an ultrasound then proceed to biopsy, is that correct?

[@justineenglanoff8477]

you calling every patient a "lady" is wholesome af

[@erwinrommel9963]

he has made all these videos for free , try to appreciate that before finding faults in his work

[@sulmazz]

@@erwinrommel9963 it's not a fault, he's pointing out, he's saying its so nice that he's calling the patients lady :) I agree it's very gentlemanly of him

[@xKiB5]

@@erwinrommel9963 Lol do you not understand what wholesome means? Hint, it's not a bad thing!

[@gettygets872]

@@erwinrommel9963 is English your native language?

[@mmbabit]

This is OBGYN shelf

[@jakerisher4000]

Hey great video. But on Question 5 UWORLD disagrees. They said no fetal movement plus no heart sound on doppler is not enough to induce delivery of a supposed dead fetus. They said you have to do an ultrasound transabdominal over transvaginal just because it is less traumatic.

[@bryannicolalde299]

I agree

[@USMLEBOOSTER]

@@bryannicolalde299 yes agree. Dead baby can stay in uterus for week will not cause a problem

[@sanja3926]

P

[@yousraabdalla5577]

Q12: Yes, if a patient has preeclampsia give her prophylactic aspirin in her next pregnancy. Low dose (81mg/day) between 12-28 weeks of gestation.

[@ObviouslyMurtaza]

Can I please know all the episodes you have done for ObGyne because my OBGYNE is really really weak from basics Please help

[@dimejiw452]

Thank you! Excellent work my African brother

[@henryduran4582]

this whole video is floridly HY for the purposes of our USMLE exams

[@jasrinakaushal311]

Great video! However for #5PPH uterine inversion, according to UWORLD, we should discontinue uterotonics (eg oxytocin) because they increase uterine tone (ie. contractility) and may make manual uterine replacement impossible to perform. And If attempts at manual uterine replacement fail, the next step in management is laparotomy to prevent exsanguination.

[@brennengodeen3796]

Agreed

[@NS-yt1vy]

Does anyone else have audio difficulties with these videos? How do I fix it?

[@emilbabajanyan8484]

Amazing

[@user-di3kw4pd2v]

On Q5 at 20:15 , why is the answer not TVUS? I believe I have seen on a uWorld or APGO quiz question that when doppler has no findings, you have to confirm fetal demise through U/S visualization of the fetal heart. Can someone explain why this is different?

[@Read241]

The question that you are talking about is pt with vaginal bleeding and positive beta HCG what's next step...tvus...if u can't see anything repeat HCG after 48 hrs...untill u get HCG morethan 3500

[@bow2myia]

For Q19 (the question on shoulder dystocia) you said the answer was waiters tip, but you described upward traction on the shoulder and arm.. Isn't that normally klumpke palsy? I thought Erb's palsy was traction on the neck.

[@DanielKaganov]

the GOAT

[@saeedmahmood3529]

👌

[@monye9963]

Awesome

[@frazzle557]

@1:55:46 the random Ben Carson reference in the middle of this lollll

[@johnbryanjamison8999]

Thank you for this!! huhuhuhu I hope this will help in my Comprehensive exam in OBGyn

[@charu2115]

Q26--if the woman already has antibodies, shouldn't she not be getting rhogam?

[@obaid.h]

Hi, I can't find this slide on your website. Can you please share a link?

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@mane6377]

Same thing anyone finds a link to this pdf please share

[@ishitaray980]

audio not working for this video anyone else faced this prob

[@eliberg1990]

sound not working?

[@siddharthagrawal9074]

Anyone has notes for the lecture ?

[@johnswift3443]

"baby bleeds out, that's not ideal"

[@michaeldybala7863]

1:49:00 what you are describing, e.g. rupture of membranes without contractions is prelabor rupture of membranes not premature rupture of membranes. this patient is at 38 weeks which is a term gestation not preterm.

[@lanayounis8917]

Preterm premature rupture of membranes (PPROM) is when you have rupture of membranes (ROM) before onset of labor sometime before 37 weeks. Premature rupture of membranes is when you're at term (37 and above weeks) and have ROM before onset of labor. The preterm is describing the gestational age. If it's at term you don't include it. The premature part refers to rupture of membranes before onset of labor. I've seen premature interchanged with prelabor. It's talking about the same thing.

[@jeremiahwoods3714]

I am having issues with the sound, I tried using headphones, but that did not fix the problem. :( Such a good podcast and resource though in general.

[@malekayoub2041]

im watching this rn and the sound is fine

[@jeremiahwoods3714]

@@malekayoub2041 So I think that I found the issue, and it is with my computer, for some reason the audio for this specific video wont work on my computer, but it does work on my phone. It is odd since this is literally the only youtube video that I have had this issue with. But fortunately it does work on other devices.

[@amangoyal7404]

Switch to stereo audio from mono and that fixes it!

[@hassanbangash1940]

Why there is no sound of the video ??

[@harshitachaudhary4511]

I am not able to hear the audio clearly Even your main website link ain't working

[@juxsoundz4822]

12:07 - 12:12 me during my OBGYN oral exam

[@cheemag1971]

GET GAP for Metro

[@brittanyleighthebiogeek2236]

Twin-twin transfusion happens with Mono-Di twins

[@ehash070]

TURN OFF MONO AUDIO TO FIX AUDIO ISSUES WITH HIS VIDEOS.

[@afshannizami5339]

i did turn off but i cant hear them on headphones

[@afshannizami5339]

got it. we have to listen through both earphones

[@Rob-yd7su]

You are a legend -- just saved my life cramming for NBME. Turned off my mono via windows settings and this fixed it 100%!

[@hwahwa5]

"ok"

[@alexfallahi1683]

Can you share the slides?

[@divineinterventionpodcasts]

They are all available for free on the main website-www.divineinterventionpodcasts.com

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@BasilKazi]

​@@ObviouslyMurtaza He has a page on his website which breaks episodes by topic!

[@jerrychen8733]

Q1: most contraceptives including estrogen containing ones are okay postpartum. the risk of reducing milk supply is very low. per ACOG

[@mahmoudhadhoudahmed7156]

Uworld says not be used for at least a month postpartum

[@user-zu4dq4jy5p]

@1:39mins , i think TSH will be high from b-hCG stimulation. anybody who can actually confirm it?

[@faithfoi1303]

It binds to the TSH receptor on the thyroid cell membrane and is a weak stimulator, resulting in increased secretion of T4 and T3 and partial suppression of serum TSH

[@saco6347]

Hi Divine! Please help. A question I got on my nbme said - a woman had a pap smear showing HSIL and wants a 2nd opinion, she coms to you, whats the best next step? HPV testing, Repeat pap smear, Colposcopy, LEEP? Q44 says for HSIL, always do colposcopy but then you state that a weird answer on nBME is LEEP. If both options are given like in this question above , which is more correct?

[@merylbraun]

Depends on age

[@darinization]

21-24 years, colposcopy. Older than 24, loop

[@medicane_iii]

some people are just made to be educators

[@aky19832001]

This video has quite a few errors. Mostly around management. Bevause the guidelines have chnaged

[@donovankearns7010]

better than emma holiday don't @ me

[@cesardavilachapa]

lol there is no emma holiday for obgyn

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@ObviouslyMurtaza]

@@cesardavilachapa

[@dogtorhouse]

@

[@chelsycalhoun4422]

Hi the audio isnt working for some reason? Is there a way I can still listen to this video -signed a desperate 3rd year

[@divineinterventionpodcasts]

Hi Chelsy. I just played the video and everything works just fine. One alternative you can explore is to watch the video on my actual website-www.divineinterventionpodcasts.com

[@theitdocchannel540]

Yes no audio

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@jeremiahwoods3714]

Were you ever able to figure out the audio?

[@NioshaPrice]

Are you guys actually able to hear the video?

[@CommentsComments]

What’s wrong with the audio

[@monitoler5721]

What if there's nobody in the hall and he was talking to himself the whole time? O.o

[@kevinlee8456]

Is the audio completely distorted for anyone else when playing on mobile? For some reason it's fine only on ipad or when I connect headphones

[@cbort8223]

Will someone please count how many times he says “okaeay” in this video, thx

[@ahsenaftab6220]

People complaining about audio, use earphones or some other speaker. It has some glitch.

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@user-js9ek5xs4q]

The voice is not working for me please

[@wk9980]

Use your phone not laptop

[@Trees922]

Nice. Why you call it divine intervention 🤔?interesting 😊

[@mgbeahurikechinwendu667]

His name is Divine

[@freshurbanstyles]

😂🤦🏽‍♀️ Because that’s his name. 👀

[@jjdagostino]

is there access to powerpoint

[@divineinterventionpodcasts]

Yes. There is. You can find them at the main website. www.divineinterventionpodcasts.com under the associated episode.

[@lukeshkumar306]

@@divineinterventionpodcasts there are only podcasts

[@divineinterventionpodcasts]

@@lukeshkumar306 Check under Episode 22 on the website and you'll find the slide PDF linked below the text.

[@ObviouslyMurtaza]

@@divineinterventionpodcasts i cant find the ep 22 on the site please help :(

[@ObviouslyMurtaza]

Can I please know all the episodes Mr Divine has done for ObGyne because my OBGYNE is really really weak from basics. Please help.

[@ranant34]

I wouldnt say 1h47m is PPROM... patient is 38 weeks so she is just PROM and i would give her IV clinda gent to prevent chorio and monitor NST for expectant vaginal delivery, if baby becomes breech or decels i would do crash section. THanks for your videos, they are awesome.

[@michaeldybala7863]

give ampicillin + azithromycin/erythromycin as abx prophylaxis. amp + gent not given until patient develops true IAI

[@sagarsanjeevdua2797]

The sound's not working. Can you fix it?

[@ahsenaftab6220]

Use earphones

[@mtee87]

I notice it works on my phone and not on my computer with windows 10…

[@HansGao95]

1:59:00 - I believe that there may be a mistake here. The combination of vaginal bleeding, a closed cervical os and non-viable fetus on US would be most consistent with an inevitable abortion. I've always interpreted missed abortions as completely silent, with no vaginal bleeding whatsoever. Is my understanding incorrect, or was there a mistake in this video?

[@caseynorlin9944]

Inevitable abortion = open cervical os!

[@londonb3578]

Missed abortions typically will have closed os, and non-viable intrauterine pregnancy (fetus retained), and +/- bleeding. I think of the difference as inevitable means its in the process of happening (unavoidable w open os) and missed means your body has not recognized (/missed) the abortus and fetus is still being held (closed os)

[@PPRGUN09]

You are wrong in saying an inevitable abortion = closed os. Inevitable and incomplete both have open os

[@farshaddehqani3502]

Audio is incomprehensible

[@matanatmammadova6178]

Aaaaa aaaaaaaa aaaaaaaa s and poor quality of voice ruins your hard work. But anyway thank you

[@cynthialanipekun6965]

Thank you so much for this!