CREOG Institutional Prep Exam Review

Question 1

Give 3 definitions for GTN by FIGO criteria

Answer 1

1) weekly hCG levels plateau over a 3 week period (+/- 10 % of the previous result)
2) hCG levels inc more than 10% across 3 values over a 2 week duration
3) persistence of detectable serum hCG levels for more than 6 months after evacuation

Question 2

What are 5 Lynch - syndrome related genes

Answer 2

Mell 1 , Mesh 2 & 6 , PMS 2, EPCAM

(MLH 1, MSH 2 , MSH 6, PMS 2, EPCAM)

Question 3

What is the most common symptom in patient with lactotroph microadenoma

Answer 3

Amenorrhea

Question 4

Most common complication of pelvic radiation

Answer 4

GI toxicity

Question 5

What is the most common congenital infection ?

when is the risk of severe infxn the highest?

When is the most common occurrence of vertical transmission?

Answer 5

CMV

1st trimester risk for severe infxn is highest

Vertical transmission is highest in third trimester

Question 6

Maximum lidocaine dosing without epinephrine vs with

Answer 6

Without - 5 mg/kg

With Epi - 7 mg/kg

Question 7

Define MTP

Answer 7

10 units in 24 hrs

4 units within 1 hour ( with more anticipated)

Replacement of a complete blood volume

Question 8

Risks associated with massive transfusion

Answer 8

Hyperkalemia ( from tissue damage or hemolysis)

Hypocalcemia ( due to citrate toxicity)

Metabolic acidosis ( production of lactic acid and decreased removal of citrate)

Hypothermia ( which reduces platelet and enzymatic activity)

TRALI and transfusion associated infections

Question 9

Diabetes with nephropathy ( >500 mg/day of proteinuria) is what White classification?

Answer 9

Class F ( for fucked up kidneys)

Question 10

Class D diabetes is defined as

Answer 10

Diagnosed when they were dumb young (<10 yrs old) and duration > 20 years

Question 11

Class B diabetes is defined as

Answer 11

Diagnosis in their BIG AGE (onset after age 20, duration < 10 years)

Question 12

Class C diabetes is defined as

Answer 12

Occurring during the CONFUSING ages of 10 - 19 yrs with duration between 10 - 19 years

Question 13

How is acetycholinesterase related in fetal development?

Answer 13

It is an enzyme present in the amniotic fluid of fetuses with an open neural tube defect

( when combined with ultrasound findings and AFP, it is diagnostic of open neural tube defect

Question 14

What clinical scenarios can one find acetylcholinesterase present

Answer 14

Open neural tube defects
Ventral abdominal wall defects
IUFD

Question 15

When do we screen for neural tube defects with MSAFP

What organs secrete MSAFP

Answer 15

15 - 18 weeks

Yolk sac and the liver

Question 16

MSAFP levels greater than _____ MoM are concerning for a NTD

Answer 16

2.5

Question 17

When can I deliver a patient with pregestational diabetes as early as 36 - 38+6

Answer 17

Poor glucose control
Hx of still birth
Vasculopathy
Nephropathy

Question 18

The endometrial lining is _____ before ovulation and ____ after ovulation

Answer 18

Proliferation before ovulation

Secretory after ovulation

Question 19

Cryoprecipitate contains ______________

Answer 19

VFF8-13

Vonwillebrand
Fibrinogen
Factors 8 & 13

Question 20

FFP contains

Answer 20

All soluble plasma proteins and clotting factors

• increases level of any factor by nearly 30%*

Question 21

Lifetime risk of ovarian cancer in general population is

Answer 21

1/70 ( 1.4%)

Question 22

What are three blood disorders that indicate the need for anticoagulant in in pregnancy

Answer 22

Homozygous factor V Leiden
Homozygous prothrombin G20210A mutation
Antithrombin deficiency

Question 23

A brand name for Low molecular weight heparin is

Answer 23

Lovenox

Question 24

What can u give to reverse unfractionated heparin in a pregnant women who didn’t get to stop her lovenox and transition to unfractionated heparin before delivery?

Answer 24

Protamine sulfate

Question 25

Epidural is associated with what two components of labor?

Answer 25

Shorter first stage when compared to systemic opioids Also longer second stage of labor by only a few minutes

Question 26

Gestational thrombocytopenia is most common at what point in pregnancy ? When do platelet counts resolve?

Answer 26

Most common in 2nd and 3rd trimester Return to normal within 1-2 months after delivery

Question 27

Prevalence of ectopic pregnancy among women in ED with 1st tri bleeding

Answer 27

5 - 18% (~15%)

Question 28

For women with hx of 2 or more ectopics, recurrence risk is ____

Answer 28

25%

Question 29

Most common sign of uterine rupture

Answer 29

Fetal heart rate anomalies

Question 30

Risk of uterine rupture with one prior scar

Answer 30

0.5 - 0.9%

Question 31

What is the work up for a baby with ambiguous genitalia

Answer 31

Karyotype to evaluate sex chromosomes ( fetuses with CAH will usually by 46 XX) Electrolytes 17 - hydroxyprogesterone levels

Question 32

What is the dosage and management for a patient who needs stress dose steroids while in labor?

Answer 32

Hydrocortisone 25 mg IV q 6 hours At time of delivery, give 100 mg IV, then taper the dose to her baseline regimen over 3 days

Question 33

What 3 groups of patients don’t need stress dose steroids in labor?

Answer 33

A - ANY dose of steroids for <3 weeks M - MORNING dose <5 mg/day for any length of time E - <10 mg of prednisone EVERY other day

Question 34

Progesterone inhibits what stage of lactogenesis

Answer 34

Stage I —> so it inhibits alpha lactalbumin which is the main stimulator of lactose synthase

Question 35

What is the AFE triad for diagnosis ?

Answer 35

Breathing compromise + hemodynamic instability + DIC

Question 36

If one twin in a monochorionic gestation dies after 14 weeks there is a ____ chance that the surviving twin also dies

Answer 36

15% risk of death And almost 20 % risk of neurological injury to surviving twin ( compare to dichorionic twin where Neuro injury risk is 1% and risk of death is 3%)

Question 37

When to deliver placenta accreta?

Answer 37

34 - 35+6 weeks via C- hyst

Question 38

Risk factors for PPROM

Answer 38

Smoking 2nd tri bleeding 3rd tri bleeding Previous PPROM Short cervix Low SES Low BMI

Question 39

Preterm birth rate in US (2019)

Answer 39

~10 %

Question 40

Typical surgical site infxn occurs how many days after abdo surgery

Answer 40

4- 7 days ( Think 47 days and nights of struggle with that baby before a damn infection pops up!)

Question 41

About ____ % of women with PCOS have T2 diabetes

Answer 41

10 %

Question 42

Define periviability

Answer 42

20 + 0 - 25+ 6

Question 43

Suspected intramniotic infection criteria are

Answer 43

Maternal fever AND elevated WBC count OR Purple not cervical drainage OR Fetal tachycardia

Question 44

What labs should be ordered to work up primary amenorrhea ?

Answer 44

UPT ( obviously rule out pregnancy ) (Testosterone, FSH, Estradiol , LH, TSH, prolactin) and 17-OHP (Test FELT Pro) and 17-OH P

Question 45

Normal testoterone levels in women

Answer 45

40 - 60 ng/dL

Question 46

Normal follicular phase FSH

Answer 46

3 - 11 mIU/mL

Question 47

Normal follicular phase LH

Answer 47

1 - 11 mIU/ml

Question 48

What percent of survivors of neonatal herpes will have long term neuro issues

Answer 48

20% (including impairment within first 12 months of life

Question 49

Layers of bladder from inner to outer

Answer 49

Mucosa ( transitional then lumina propia) Submucosa Detrusor muscle Adventitious

Question 50

By how much does breastfeeding increase material caloric requirements?

Answer 50

500 kcal/ day

Question 51

The corpus luteum makes what kind of progesterone ?

Answer 51

17 alpha hydroxy progesterone

Question 52

The distal (lower) one third of the vagina drains to _______

Answer 52

Inguinal / femoral nodes then to pelvic nodes

Question 53

The upper 2/3rds of the vagina drains to what nodes?

Answer 53

Pelvic then para aortic

Question 54

Most common cause of intracranial hemorrhage AT TERM ? AT PRETERM?

Answer 54

Term - obstetric trauma PRETERM - hypoxia and ischemia

Question 55

UTI incidence in sexually active young women

Answer 55

0.5 - 0.7 per person-year

Question 56

What is the most commonly identified mutation in women who develop VTE during pregnancy

Answer 56

Heterozygous Factor V Leiden

Question 57

Heterozygous factor V Leiden accounts for ___ % of VTE in pregnancy

Answer 57

40%

Question 58

Women with heterozygous factor V Leiden deficiency and no hx of VTE have what % risk of developing VTE in pregnancy

Answer 58

< 2% (0.5 - 1.2%)

Question 59

How do you test for factor V Leiden mutation

Answer 59

Protein C resistance assay ( 2nd gen) ** this can be reliable in pregnancy and acute thrombosis but is NOT RELIABLE IF THE PATIENT IS ANTOCOAGULATED**

Question 60

What is the leading cause of death in pregnant women and women in the postpartum period

Answer 60

Cardiovascular disease (15.3%)

Question 61

Serum progesterone level of ________ is a objectively indicative that ovulation occurred

Answer 61

> 3 ng/mL

Question 62

Methimazole is associate with ___ in the ___ trimester PTU is associated with _____

Answer 62

Methimazole - MESSES up your nails ( aplasia cutis) in the first trimester PTU - pitiful liver ( hepatotoxicity) PTU - PRIMARY hyperthyroidism med in 1st trimester, THEN Methimazole to MAINTAIN