Med Ready

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Season 1, Episode 7

Before Your First: Hysteroscopy

Headed into the OR for your first hysteroscopy? In this episode, we walk through everything you need to know before you scrub in — from indications and pre-op preparation to OR equipment, distension media, fluid deficit management, and how to handle complications when they arise. I. Introduction & Learning Goals Purpose: Guidance for an intern's first hysteroscopy in the OR. Objectives: Review indications, pre-op preparation, OR setup/equipment, fluid media, and complications. II. Indications for Hysteroscopy Diagnostic Hysteroscopy: Abnormal uterine bleeding (AUB) or postmenopausal bleeding Infertility workup Evaluation of abnormal imaging findings Operative Hysteroscopy: Polypectomy (removal of polyps) Myomectomy (removal of submucosal fibroids) Septum resection Lysis of adhesions (Asherman syndrome) Foreign body removal (e.g., "lost" IUD) III. Pre-Operative Preparation Chart Review Checklist: Indication: Understand the clinical reason for the procedure Imaging (US/MRI): Confirm uterine size (to avoid over-dilating) and location of pathology Comorbidities: Check cardiac, renal, and pulmonary history to set fluid management thresholds Cervical History: Assess risk for stenosis (prior procedures or menopause) Menstrual Cycle: Check current phase (bleeding can obscure visualization) Patient Counseling (Benefits & Risks): Benefits: Superior diagnostic sampling and therapeutic symptom relief Standard Risks: Pain, bleeding, infection (low risk) Specific Risks: Uterine perforation (may require laparoscopy if energy was used or if there is concern for bowel injury) IV. Equipment & OR Setup The Hysteroscope Components: Telescope: The lens (0-degree for forward viewing vs. 30-degree for lateral angles) Sheaths: Inner and outer sheaths to house the telescope and allow fluid flow Inflow/Outflow Ports: For fluid delivery and drainage (use under-the-butt drapes to catch fluid for deficit calculation) Light Source: Warning — becomes extremely hot; keep away from drapes/patient Camera System & Monitor Working Channel: For operative instruments (graspers, scissors) V. Distension Media (Fluids) Isotonic Solutions (Preferred): Normal Saline: Compatible with bipolar electrosurgery; same osmolality as blood Hypotonic Solutions: Glycine (1.5%), Sorbitol (3%), Mannitol (5%) Used only for monopolar surgery; higher risk of hyponatremia Fluid Deficit Management: Definition: The difference between fluid into the uterus vs. fluid recovered ACOG Threshold: Max 2,500 mL for isotonic; however, many surgeons stop at 1,500 mL (or 750–1,000 mL for high-risk patients) VI. Procedural Steps & Tips Cervical Dilation: Can use mechanical dilators or "hydrodilation" using fluid pressure through the scope Tenaculum Tip: Take a "sturdy bite" of the cervix to prevent tearing/lacerations Pressure Management: Keep intrauterine pressure lower than the patient's Mean Arterial Pressure (MAP) to limit fluid extravasation into the body VII. Complications Uterine Perforation: Often occurs during dilation; recognized by a "loss of resistance" Fluid Overload: Can lead to hyponatremia, distributive shock, or flash pulmonary edema Hemorrhage: More common in operative cases (3% for myomectomy); manage with massage, uterotonics, or intrauterine balloons Vasovagal Reaction: Can occur during cervical manipulation or distensio...

S1, E7

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19 min
Season 1, Episode 20

Induction of Labor

Induction of labor is one of the most common procedures on L&D. This episode covers the indications (including the landmark ARRIVE trial for 39-week elective induction), the Bishop score for determining readiness, cervical ripening options, pitocin protocols, and the criteria for failed induction. Show Outline: Indications – Post-dates (42+wks), late term (41+wks), elective 39+wks, diabetes, hypertension, and many more per ACOG ARRIVE Trial – Multicenter RCT showing 39wk IOL in low-risk primips had a LOWER c-section rate vs. expectant management to ~41wks, with a trend toward fewer neonatal complications. Many pregnant people are now offered a 39wk IOL. Evaluate and Prep – Full H&P, ultrasound for vertex position, cervical exam (dilation/effacement/station/position/consistency), calculate Bishop score Options for IOL If Bishop 8 (primip) or 6 (multip) → ripen first! Mechanical cervical ripening (balloon) Chemical cervical ripening (misoprostol or cervidil) Best yet – both! Contractions (Pitocin) – Primip: alone if Bishop ≥8. Multip: alone if Bishop ≥6. Augmentation – AROM (amniotomy) Failed IOL – Failure to reach active labor after 18+hrs ruptured on pitocin (definition varies 12–24hrs). If she reaches active labor (6+cm), it's no longer failed IOL – now it's arrest of dilation or descent. Resources/Links: ACOG – Medically Indicated Late-Preterm and Early-Term Deliveries Links: ACOG – Medically Indicated Delivery: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E20

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19 min
Season 1, Episode 32

Before You See a Pediatric Patient with Sore Throat

Listen along as we dive into the many causes of sore throat. Learn about the common causes such as allergies and viral illnesses while also what to do when a child with epiglottitis comes in. We will cover CENTOR criteria as well and when you should think about Group A strep testing. Common Causes Viral Presentation HSV Mononucleosis Allergic Presentation Group A Strep CENTOR Criteria Emergency Causes Peritonsillar Abscess Retropharyngeal Abscess Epiglottitis Wrap Up & Conclusion Resources/Links: https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis References Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575 Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8. doi: 10.1177/1941738114521984. PMID: 24790693; PMCID: PMC4000473. Chowdhury MDS, Koziatek CA, Rajnik M. Acute Rheumatic Fever. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594238/ Esposito, S.; De Guido, C.; Pappalardo, M.; Laudisio, S.; Meccariello, G.; Capoferri, G.; Rahman, S.; Vicini, C.; Principi, N. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022,9,618. https://doi.org/ 10.3390/children9050618 Martin JM. The Mysteries of Streptococcal Pharyngitis. Curr Treat Options Pediatr. 2015 Jun;1(2):180-189. doi: 10.1007/s40746-015-0013-9. PMID: 26146604; PMCID: PMC4486489. MCMILLAN, J. A. , WEINER, L. B. , HIGGINS, A. M. & LAMPARELLA, V. J. (1993). Pharyngitis associated with herpes simplex virus in college students. The Pediatric Infectious Disease Journal, 12 (4), 280-283. Mohseni M, Boniface MP, Graham C. Mononucleosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470387/ Roggen I, van Berlaer G, Gordts F, et al. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013;3: e002712. doi:10.1136/ bmjopen-2013-002712 Links: https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis https://www.ncbi.nlm.nih.gov/books/NBK594238/ https://doi.org/ https://www.ncbi.nlm.nih.gov/books/NBK470387/ About the Speaker: Host: Chris Stadnick, MD – Chris Stadnick, MD is a board-certified pediatrician at Metropolitan Pediatrics in Portland, Oregon. He earned his MD from the University of Tennessee Health Science Center and completed his pediatric residency at the University of Virginia. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

S1, E32

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16 min
Season 1, Episode 9

Postpartum Hemorrhage

Postpartum hemorrhage is one of the most critical obstetric emergencies. This episode organizes the causes using the "Four T's" framework, walks through the uterotonic medication options – including their contraindications and side effects – and covers mechanical interventions like intrauterine tamponade balloons. Show Outline: Causes – The Four T's Tone (Atony) – Pitocin; Misoprostol (CI: allergy, SE: transient hyperthermia); Methergine (CI: HTN, SE: HTN); Hemabate (CI: asthma, SE: diarrhea); Tamponade (Bakri/Utah balloons) Trauma – Lacerations Tissue – Retained products of conception (placenta or membranes) Thrombin – Coagulopathy Other – Involution About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E9

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25 min
Season 1, Episode 7

Preterm Labor and PPROM

Preterm labor and preterm premature rupture of membranes (PPROM) are critical diagnoses on L&D. This episode reviews the evaluation approach – from sterile speculum exam to fetal fibronectin – and the management protocols including magnesium for neuroprotection, betamethasone, tocolysis, and latency antibiotics. Based on ACOG Practice Bulletin #171. Show Outline: PTL/TPTL – Preterm (37wks) with cervical change Evaluation – SSE first: collect GC/CT cultures, FFN (no gel, blood, or semen), GBS, evaluate for rupture if needed. SVE for dilation/effacement changes. If tPTL Magnesium for neuroprotection (32wks to decrease CP rates) Betamethasone for fetal lung development PCN Tocolysis for the steroid window (48hrs) if 34wks (indomethacin if 32wks, nifedipine if 32+wks) IV fluids NICU consult PPROM – Preterm (37wks) with ruptured membranes. Confirm with pooling, nitrazine, ferning. If PPROM – Delivery at 34wks or at diagnosis if chorio/34+wks Latency antibiotics (Erythromycin/Azithromycin + Ampicillin × 2 days, then PO Erythro/Amoxicillin × 5 days) Magnesium, betamethasone, PCN NO tocolysis NICU consult About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E7

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22 min
Season 1, Episode 5

Hypertension in Pregnancy

Hypertensive disorders of pregnancy exist on a spectrum – from chronic hypertension to eclamptic seizures. This episode breaks down the classifications, blood pressure thresholds, antihypertensive options, severe features to watch for, and the HELLP syndrome. Show Outline: The Spectrum – Hypertension in pregnancy as one large continuum Blood Pressure Thresholds – Mild range: 140/90; Severe range: 160/110 Classifications – CHTN → SIPE (superimposed preeclampsia); gHTN → Pre-E (preeclampsia) BP Medications – Methyldopa, labetalol, hydralazine, nifedipine Severe Features – Severe-range BPs, neurologic symptoms, lab abnormalities HELLP Syndrome – Hemolysis, Elevated Liver enzymes, Low Platelets Eclampsia – Seizures in the setting of preeclampsia About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E5

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25 min
Season 1, Episode 6

Indications for a c-section during labor

When does a laboring patient need a cesarean delivery? This episode covers the six key indications – from nonreassuring fetal heart tracings to cord prolapse – including the specific time criteria for arrest disorders and what fetal heart rate findings are the most concerning. Show Outline: Nonreassuring Fetal Heart Tracing – Category 2 remote from delivery; minimal/absent variability as the most significant predictor of fetal acidemia; Category 3 at any time is emergent delivery Failed IOL – Most commonly defined as 12–24hrs ruptured membranes on pitocin without active labor Arrest of Dilation – Must be in active labor (6cm+). Adequate contractions (IUPC with MVUs >200–250): no change over 4hrs. Inadequate or no IUPC: no change over 6hrs Arrest of Descent – Primip with epidural: 3hrs; without: 2hrs. Multip with epidural: 2hrs; without: 1hr Cord Prolapse – Emergency! Malpresentation – Breech, transverse, compound About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E6

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17 min
Season 1, Episode 12

Before Your First: Hysterectomy

Hysterectomy is one of the most common major surgeries in gynecology. This episode reviews the different surgical approaches, the decision to take or leave the tubes and ovaries, the critical surgical steps – including the four sites of ureteral injury – and key anatomy like the IP ligament, uterine artery, and round ligament. Show Outline: Approach – Abdominal, laparoscopic, vaginal, or combination Tubes and Ovaries – What benefit do they provide? Ovaries still benefit bones and cardiovascular health even after menopause (65yr old cut-off for removal). Key Surgical Steps Round Ligament – Sampson's artery runs inside IP Ligament (formerly suspensory ligament of the ovary) – Conceals ovarian blood supply from the aorta. If transected before fully sealed, can hemorrhage while retracting into the retroperitoneum. Four Levels of Ureteral Injury – (1) Pelvic brim, (2) medial to IP ligament, (3) under the uterine artery (“water under the bridge”), (4) lateral to vaginal cuff closure Uterine Arteries – Ligate and transect; the uterus should blanch white Colpotomy – Disconnecting the uterus from the vagina Vaginal Cuff Closure – If total hysterectomy About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

S1, E12

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21 min
Season 1, Episode 9

Before You Examine A Pediatric Patient - Physical Exam Tips & Tricks

Today, we will be reviewing what you need to know to examine your pediatric patients. Examining children is a bit of an art form and is often unfamiliar to clerkship students who may have a varied degree of experience being around children, may never have worked with children and may not have been exposed to pediatric patients in the pre-clinical years. In this episode, we discuss tips and tricks to get the exam you need on your pediatric patient with as little crying as possible. How to examine a baby/infant How to examine a toddler/preschool aged child Focused information on the ear exam/otoscopy How to examine a school aged child/teen Engaging older children in your exam Focused information on the genitourinary exam Presenting your physical exam during oral presentation Resources/Links: Bates' Guide to Physical Examination and History Taking by Lynn Bickley (your pediatric clinics will generally have a copy) https://batesvisualguide.com Links: https://batesvisualguide.com/ https://batesvisualguide.com About the Speaker: Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

S1, E9

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14 min
Season 1, Episode 21

Before Your First ADHD Clinic Visit

Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. In this episode, we will discuss ADHD, including the different types, evaluation, management, and follow up. General definition of ADHD and its types Preparing for your first visit Initial evaluation of ADHD vs. med check Reviewing prior visits During an initial visit: Evaluating historical features Behaviors at home, behaviors at school Common misconceptions about ADHD Surrounding factors and comorbidities/misdiagnosis Physical Exam Important features of the exam Observing the child’s behavior Role of the Vanderbilt Scoring a Vanderbilt Treatment Medication vs. non-pharmacologic interventions Overview of different medications Stimulants Nonstimulants Choosing a medication Family history Comorbidities Titrating medications Follow-up visits Symptoms to look for Resources/Links: Vanderbilt Scoring: https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf Parent Training in Behavior Management for ADHD: https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html Dosing guidelines when switching from one stimulant to another in the treatment of attention deficit hyperactivity disorder in children and adolescents: https://www.uptodate.com/contents/image?imageKey=PEDS%2F61007 Links: https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html https://www.uptodate.com/contents/image?imageKey=PEDS%2F61007 About the Speaker: Host: Lauren Ferguson, MD – Lauren Ferguson, MD is an Assistant Professor of Pediatrics at the University of Utah. She graduated from Virginia Tech Carilion School of Medicine and completed her residency and chief year at UVA, with clinical interests in newborn medicine, breastfeeding, mental health, and ADHD management. Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

S1, E21

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19 min

Med Ready aims to advance clinical medical education by developing accessible resources for medical students and clinical educators. Our projects include the Pimped app, Procedure Ready: Ob/Gyn (a top 10 medical student podcast), and our new podcast, Clerkship Ready: Pediatrics.

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