10 High Yield Content Areas for the OBGYN Shelf Exam

OBGYN Shelf Exam

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  1. Urinary Incontinence: As with most of the items on this list, urinary incontinence in female patients has a workable differential of etiologies. Furthermore, it is a fairly common presentation that you can expect to see on the wards and in the clinics as a MS3/MS4. Focus on the various subtypes of urinary incontinence (e.g. – stress, urge, overflow, etc.), the associated risk factors for each, and the preferred treatments.
  2. Ovarian Tumors: This topic is an exercise in brute pathology, as the differential diagnostic considerations for ovarian tumors are extensive. At first, focus on the various categories of ovarian tumors (e.g. – epithelial, germ cell, etc.), subsequently leaning the different subtypes (e.g. mucinous cystadenoma, serous cystadenocarcinoma, etc.). Be sure to have a general sense about the incidence and mortality rates of the most common (and most lethal) subtypes. The more esoteric and rare ovarian tumors are lower yield.
  3. Sexually Transmitted Infections: Approach this topic by dividing it into several compartments. First, focus on the various vaginal infections (e.g. – bacterial vaginosis, trichomonas, etc.) and how to correctly diagnose/treat each subtype. Next, focus on the TORCH infections (e.g. toxoplasmosis, syphilis, etc.), and which symptoms they each can cause in newborns. Finally, treat HIV in pregnancy as its own distinct entity, reviewing which medications are contraindicated in pregnancy and how to best prevent vertical transmission from mother to newborn.
  4. Contraception: Focus on the various types of contraception, the benefits and drawbacks of each, the associated contraindications, and their relative efficacy rates. Be sure to also review the specific side effects for each method of contraception, and how they relate to other medical conditions (e.g. – systemic estrogen-containing OCPs can increase the risk of stroke).

  5. Amenorrhea: Another very large but important topic containing a wide differential. Focus on the various etiologies of primary and secondary amenorrhea, the workup and diagnostic considerations for each etiology, as well as optimal treatment and management strategies. Since the anatomy etiologies are quick to learn and fairly intuitive, this can be quickly reviewed first. Subsequently, turn your attention to the endocrine and environmental etiologies of amenorrhea.

  6. Infertility: Break this topic into male and female causes of infertility, and start with male as the differential is shorter (e.g. – varicocele, idiopathic abnormality of the sperm, etc.). Then, subdivide the various etiologies of female-based infertility in smaller groups (e.g. – ovulatory factors, tubal factors, endometriosis, etc.), and learn the approach to work-up that will help your distinguish between each clinical entity both on the exam and in clinic.
  7. Abnormal Bleeding: For this topic, make sure to risk stratify the patient into a broader category that fits their age, pregnancy status, and clinical history. For example, in a post-menopausal female, almost any vaginal bleeding is worrisome and is suggestive of endometrial malignancy until proven otherwise. However, in a patient who is in their third trimester of pregnancy, clinical entities such as threatened abortion or placenta previa are prioritized.
  8. Hypertensive States of Pregnancy: This broad topic includes items such as preeclampsia, eclampsia, HELLP syndrome, etc. Be sure to know the risk factors for each of these hypertensive states, the diagnostic criteria that distinguish between each individual entity, and the best next steps in diagnostic confirmation and management.
  9. Cervical Cancer Screening: The highest yield items within this topic encompass the general approach to cervical cancer screening, including when to begin a screening regimen, the preferred intervals between screening examinations, and when screening can be safely discontinued. Also, be sure to review the major classes of epithelial cell abnormalities that can be seen on Pap smear, as well as the management for each classification of cervical intraepithelial neoplasia (CIN). Finally, be aware of the relation between cervical cancer and the relevant HPV subtypes, as well as vaccination options.
  10. Breast Cancer Screening: Review the ACOG guidelines for breast cancer screening options, including the patient self-examination, the clinical breast exam and imaging studies such as mammography, ultrasound, and MRI. Review the risk factors (and protective factors) for breast cancer, as well as the various options of management. Similarly, review the differential for breast pain and nipple discharge, including both the neoplastic and non-neoplastic causes of both.
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