OB-G in YEG: Recent Episodes

Drs. Kristin Black and Lindsay Drummond

This is a medical education podcast hosted by Obstetrics and Gynecology residents at the University of Alberta covering a wide variety of topics in OBGYN. This podcast will include Canadian-specific content for medical students and residents, covering the basics and beyond.

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Episode 3 in our series will focus on the history of cervical cancer screening, with a special focus on Alberta. Even if you are located outside of our province, you may enjoy learning about different ways to screen for cervical cancer during this podcast. We will first review the basics of cervical cancer screening. Next, we will talk about the history of cervical cancer screening, including how the pap smear was first developed, and how screening initiatives were eventually rolled out in Alberta. Finally, we will talk about two different ways to screen for cervical cancer: conventional cytology and liquid-based cytology.

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Episode 2 in our colposcopy series will look at Adenocarcinoma in situ (AIS) which is a precursor to adenocarcinoma. For more information, please refer to the link below:

https://www.mdpi.com/1718-7729/30/6/431

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This podcast is the first episode in our colposcopy series. This series will be a compilation of various different topics within colposcopy and will be brought to you by learners who complete a colposcopy elective at the UofA. Each episode is meant to explore a debated topic and be a tangible and digestible resource for learners and staff colposcopists.

Today we will be exploring the role of intravaginal estrogens in colposcopy. Many colposcopists wonder specifically about the use of intravaginal estrogens in the post-menopausal patient on the interpretation of pap smear and biopsy results. Similarly, they wonder if there is a role for intravaginal estrogens in post-menopausal women pre/post LEEP or laser for preventing cervical stenosis.

As this is the first episode in our colposcopy series, we will start with a brief overview of cervical cancer, the importance of screening and colposcopy practice. This will help us lay a foundational understanding of the importance and uniqueness of the post-menopausal patient.

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In this episode, we'd like to welcome Hailey Lafave, a second year medical student from the University of Calgary, to discuss uterine fibroids. Thanks to Dr. Matt Grossi from the Rockyview Hospital in Calgary for his help in reviewing this episode.

At the end of this podcast, listeners will be able to:

  • Describe the clinical features associated with uterine leiomyomas.
  • Review the appropriate investigations for a patient presenting with abnormal uterine bleeding.
  • Discuss the management of asymptomatic and symptomatic uterine leiomyomas.

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Test your knowledge

  1. Which of the following is not a type of urinary incontinence?
    1. Mixed
    2. Stress
    3. Adaptive
    4. Urge
  2. What is not appropriate conservative management of incontinence?
    1. Physiotherapy
    2. Pessaries
    3. Decreased exercise
    4. Weight loss
  3. What are the initial tests every patient with incontinence should get?
    1. CBCd, urinalysis, electrolytes
    2. CBCd, urinalysis, urine culture
    3. Urinalysis, post void residual, urine culture
    4. Urinalysis, electrolytes, urine culture

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Answers

  1. C
  2. C
  3. C

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In this episode, Jennifer Gelfand discusses conservative management of urinary incontinence.

At the end of this podcast, listeners should be able to:

  1. Understand a working definition of urinary incontinence and its characteristics
  2. Demonstrate an approach to differentiating the different types of urinary incontinence when taking a patient history
  3. Have an understanding of appropriate investigations for a woman with urinary incontinence
  4. Understand the conservative management of a woman presenting with urinary incontinence

For references for this podcast and more information, please visit: http://obginyeg.libsyn.com

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In this episode, second year Ob/Gyn resident Tania Luthra discusses risk factors, clinical features, and diagnosis of preterm birth.

After this podcast, the listener should be able to:

  1. To define preterm birth and preterm labour
  2. To recognize the important causes of preterm birth
  3. To understand the risk factors associated with preterm birth
  4. To discuss the diagnosis of preterm labour

Thanks for listening, stay tuned for part 2 where we review the management and prevention of preterm birth.

For references and more information, visit: https://obginyeg.libsyn.com

Follow us on Twitter @OBGinYEG.

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In this episode, Kristin discusses the epidemiology, screening, and prevention of cervical cancer and management of cervical dysplasia. 

After this podcast, the listener will be able to:

  • Define risk factors for cervical cancer
  • Discuss cervical cancer screening practices
  • Identify patients with cervical dysplasia who should be referred for further assessment

Thanks for listening, stay tuned for part 2 where we review the diagnosis and management of cervical cancer.

For references and more information, visit: https://obginyeg.libsyn.com

Follow us on Twitter @OBGinYEG.

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In this episode, Kristin discusses the diagnosis and management of ovarian torsion.

At the end of this episode, the listener will be able to:

  1. Define ovarian/adnexal torsion
  2. Describe the clinical features of adnexal torsion
  3. Review the management principles of adnexal torsion

Thanks for listening, follow us on Twitter @OBGinYEG.

For references and more information, visit: https://obginyeg.libsyn.com

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  1. Which of the following is not a component of your physical exam for a patient with an adnexal mass:
    a. Lymph node survey for lymphadenopathy
    b. Respiratory exam for pleural effusions
    c. Abdominal examination for ascites or hepatosplenomegally
    d. Nervous system exam for para-neoplastic symptoms
  2. A post-menopausal patient is diagnosed with an 8 cm complex adnexal mass with an elevated CA125. What is the next best step in her management?
    a. Laparoscopic ovarian cystectomy
    b. Laparoscopic oophorectomy
    c. Refer to gynecologic oncology
    d. Repeat ultrasound in 8-12 weeks
  3. A 25 year old nulliparous patient is diagnosed with an asymptomatic 5 cm simple ovarian cyst, with a negative CA125. What is the next best step in management?
    a. Laparoscopic ovarian cystectomy
    b. Laparoscopic oophorectomy
    c. Refer to gynecologic oncology
    d. Repeat ultrasound in 8-12 weeks

Scroll down for answers!

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  1. d

  2. c

  3. d

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In this episode, Kristin discusses the approach to investigation and management of adnexal masses. 

At the end of this episode, listeners will be able to: 

  1. Describe the common presenting features of adnexal masses
  2. Order initial investigations for a patient with a suspected adnexal mass
  3. Recognize which patients need to be referred for further investigation and management

Thanks for listening, follow us on Twitter @OBGinYEG

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  1. Which of the following is NOT part of the Rotterdam diagnostic criteria for PCOS?

  2. Ruling out other causes of hyperandrogenism

  3. Reduced ovulation (8 or fewer periods per year)
  4. Polycystic ovaries on ultrasounds
  5. BMI > 25
  6. Hyperandrogenism (based on clinical findings and/or laboratory tests)

2: All of the following could be used to promote ovulation in a woman with PCOS struggling with infertility except?

  1. Letrozole (an aromatase inhibitor)
  2. Clomiphene citrate (a selective estrogen receptor modulator)
  3. Metformin if the woman also has glucose intolerance
  4. Exercise and diet modifications
  5. GnRH agonist

Scroll down for the answer.

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  1. D

  2. E

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In this episode, medical student Qahir Haji will discussion PCOS - Polycystic Ovary Syndrome

After listening to this podcast, listeners should be able to:

  1. Define PCOS and list the Rotterdam diagnostic criteria
  2. Know the key findings for PCOS to watch out for on history and physical exam
  3. Describe the management of PCOS

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In this podcast, medical student Jennifer Gelfand will discuss an approach to management of chronic pelvic pain, a common gynecologic presentation.

At the end of this podcast, the medical student should be able to:

  1. Understand a working definition of chronic pelvic pain and its characteristics
  2. Demonstrate an approach to taking a history of a woman with chronic pelvic pain
  3. Develop a working differential of a woman with chronic pelvic pain
  4. Have an understanding of appropriate investigations for a woman with CPP

For references for this podcast and more information, please visit: http://obginyeg.libsyn.com

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In this episode, Kristin discusses risk factors, clinical features, and an approach to management of vulvar cancer.

At the end of this episode, listeners will be able to:

  1. Recall pertinent signs, symptoms, and risk factors for vulvar cancer
  2. Review the most important investigation for suspected vulvar cancer
  3. Discuss the approach to management of vulvar cancer

For references for this podcast and more information, please visit: http://obginyeg.libsyn.com

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In this episode, Kristin discusses the classification, diagnosis, and management of endometrial hyperplasia.

At the end of this episode, listeners will be able to:

  1. Define the classification system for endometrial hyperplasia
  2. Review important investigations for the patient with abnormal uterine bleeding
  3. Discuss the management of hyperplasia with and without atypia

For references for this podcast, please visit: http://obginyeg.libsyn.com

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After listening to Episode 2. Ectopic Pregnancy, we hope that you have a better understanding of the key clinical features of an ectopic pregnancy and how to manage it

To help you assess what you learned from the podcast, try these questions to test your knowledge!

Test your knowledge:

  1. What is the most common location of an ectopic pregnancy?
  2. List risk factors for an ectopic pregnancy
  3. What tests should you order when seeing a patient with a suspected ectopic pregnancy?
  4. What are contraindications to Methotrexate?

If you're struggling with the answers, head back to the podcast to listen for the answers!

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In this episode, resident physician Kristin Black discusses an approach to the risk factors, investigation, diagnosis, and management of endometrial cancer.

For references for this podcast, please visit: http://obginyeg.libsyn.com

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In this podcast, resident physician Lindsay Drummond will discuss the common causes of vaginal discharge, a frequent presenting complaint in family physician and gynecologist's offices.

At the end of this episode, listeners will be able to:

  • Identify characteristics of normal vaginal discharge
  • List common causes for pathologic vaginal discharge, including: Bacterial Vaginosis, Trichomoniasis, Candidiasis, Cervicitis
  • Describe clinical features and investigations to help differentiate causes
  • Identify appropriate treatments

For references for this podcast, please visit: http://obginyeg.libsyn.com/

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Welcome to the OB-G in YEG podcast. Today we're talking about an important topic in gynecology, ectopic pregnancy.

After this podcast, the listener should be able to:

  1. Review the risk factors for ectopic pregnancy
  2. Order pertinent investigations for a patient with suspected ectopic pregnancy
  3. Discuss management options for a patient with an ectopic pregnancy

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In this episode, resident physician Lindsay Drummond will describe the basic components of an obstetrical history for medical students and junior residents.

At the end of this podcast, listeners will be able to:

  1. List the components of a complete obstetrical history
  2. Demonstrate ways in which to ask the details of the four cardinal questions
  3. Describe elements on history which are relevant to current pregnancy management
  4. Summarize a patient’s presentation in a concise and clear manner