From the Guidelines
Key concepts for OBGYN in STEP 2 include high-yield topics that frequently appear on the exam, such as pregnancy complications, normal labor stages, and gynecologic oncology basics. Focus on pregnancy complications such as preeclampsia (diagnosed with BP ≥140/90 and proteinuria after 20 weeks, treated with magnesium sulfate for seizure prophylaxis), gestational diabetes (screened with glucose challenge test, managed with diet or insulin), and placental abnormalities like placenta previa and abruption 1. Understand normal labor stages and their management, including partogram interpretation and indications for cesarean delivery. For gynecology, master contraceptive methods with their efficacy rates and contraindications, menstrual disorders including PCOS and abnormal uterine bleeding, and common infections like bacterial vaginosis, candidiasis, and PID (treated with ceftriaxone 250mg IM plus doxycycline 100mg BID for 14 days) 1. Know gynecologic oncology basics, particularly cervical cancer screening guidelines and management of abnormal Pap smears. Memorize first-line treatments for common conditions like metronidazole 500mg BID for 7 days for bacterial vaginosis and combined hormonal contraceptives for PCOS. Understanding the pathophysiology behind these conditions will help you answer clinical vignettes that require application of knowledge rather than simple recall.
Some key points to focus on include:
- Pregnancy complications: preeclampsia, gestational diabetes, placental abnormalities
- Normal labor stages: partogram interpretation, indications for cesarean delivery
- Gynecology: contraceptive methods, menstrual disorders, common infections
- Gynecologic oncology: cervical cancer screening guidelines, management of abnormal Pap smears
- First-line treatments: metronidazole for bacterial vaginosis, combined hormonal contraceptives for PCOS
It's also important to consider the social and economic factors that affect women's health, such as access to care, housing instability, and food access, as these can impact maternal morbidity and mortality 1. Providing quality family planning services, including counseling and education, is crucial in reducing unintended pregnancies and improving maternal health outcomes. By focusing on these high-yield topics and understanding the social and economic factors that affect women's health, you can improve your performance on the STEP 2 exam and provide better care for your patients.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Key Concepts in Obstetrics and Gynecology (OBGYN) for USMLE Step 2
- Pelvic Inflammatory Disease (PID): diagnosis, management, and prevention are crucial concepts in OBGYN, with PID being an infection of the upper genital tract that can lead to chronic pelvic pain, infertility, ectopic pregnancy, and intra-abdominal infections 2
- Preeclampsia: management and prevention are vital, with magnesium sulfate being a key treatment for preventing eclampsia and reducing maternal mortality 3, 4, 5
- Magnesium Sulfate: its use in preeclampsia, including its benefits and side effects, is an important concept, with studies showing it reduces the risk of eclampsia and probably reduces maternal death 4, 5
Diagnosis and Management of PID
- Diagnosis is made primarily on clinical suspicion, with empiric treatment recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination 2
- Treatment includes a single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days, with metronidazole recommended for 14 days in the setting of bacterial vaginosis, trichomoniasis, or recent uterine instrumentation 2
Preeclampsia Management and Prevention
- Magnesium sulfate is the drug of choice for treating eclampsia and preventing seizures in women with preeclampsia, with its use recommended for women with severe features of preeclampsia 3, 4, 5
- Aspirin is useful for reducing a patient's risk of preeclampsia, with providers who specialize in maternal-fetal medicine (MFM) more likely to prescribe aspirin for preeclampsia prevention in patients with chronic hypertension 3
Long-term Effects of Magnesium Sulfate
- Studies have shown that magnesium sulfate reduces the risk of eclampsia and probably reduces maternal death, with no clear effect on outcome after discharge from hospital 5, 6
- Long-term follow-up of women who received magnesium sulfate for preeclampsia has shown no excess of death or disability after 2 years 6