OBGYN 3

Question 1

What is vasa previa

Answer 1

Umbilical vessels that are not protected by cord or membranes, which ross the internal cervical os in front of the fetal presenting part

Question 2

What does sinusoidal FHR pattern indicate

Answer 2

Usually indicates fetal anemia or bleeding

Question 3

What does chorionicity refer to

Answer 3

• The number of placentas in a twin or higher order gestation

Question 4

What does amnionicity refer to

Answer 4

• The number of amniotic sacs in a twin or higher order gestation

Question 5

Describe the chorionicity/amnionicity of twinning based on timing of division

Answer 5

♣ 0-4 days – dichorionic/diamniotic
♣ 4-8 days – monochorionic/diamniotic
♣ 8-12 days – monochorionic/monoamniotic
♣ >13 days – conjoined twins

Question 6

Describe possible chorionicity/amnionicity of mono vs. dizygotic twins

Answer 6

Dizygotic twins are always dichorionic/diamniotic

Monozygotic twins can be mono/mono, mono/di, or di/di

Question 7

Indications for C-sx in mom’s with HSV

Answer 7

Presence of prodromal sx of lesions along the genital tract

Question 8

What is the point of treating with Acyclovir in a primary infection of pregnant woman

Answer 8

Decreases viral shedding and duration of infection

Does NOT affect the likelihood of future recurrence, patient’s immune response, or transplacental transmission

Question 9

What are the 2 most common causes of antepartum hemorrhage

Answer 9

Placenta previa and placenta abruption

Question 10

Describe the difference in presentation between placenta previa and abruption

Answer 10

Previa = painless vaginal bleeding

Abruption = painful secondary to contractions

Question 11

Management of placenta previa

Answer 11

Expectant management as long as the bleedin is not excessive. C-sx at 34 weeks gestation

Question 12

Cocaine use is a risk factor for what antepartum complication

Answer 12

Placenta abruption

due to vasospasm

Question 13

What is the most significant risk factor for placenta abruption

Answer 13

Trauma

Question 14

Management of placental abruption with fetal demise

Answer 14

Vaginal delivery

Question 15

What is a myomectomy

Answer 15

Surgical removal of fibroids from the uterus

Question 16

Diagnose: No separation of placenta after delivery

Answer 16

Placenta accreta

Question 17

Management of placenta accreta

Answer 17

Hysterectomy

Question 18

Define placenta accreta

Answer 18

placenta attaches to myometrium without penetration

Question 19

Define placenta increta

Answer 19

placenta penetrates into myometrium

Question 20

Define placenta percreta

Answer 20

placenta penetrates and perforates through the myometrium

Question 21

Describe risk factors for placenta accreta

Answer 21

• Low-lying placentation
• Placenta previa
• Prior cesarean delivery
• Prior uterine curettage
• Prior myomectomy

Question 22

What is the recommendation for pap smear screening in older women

Answer 22

Patients with a uterus can discontinue cervical cancer screening between the ages of 65-70 if they have had three consecutive negative smears or two negative consecutive cotesting in the last 10 years and no history of high grade CIN or cancer

Question 23

What is the current guideline for screening of cervical cancer in women between 30-65 y/o

Answer 23

Cotesting [Cytology (pap smear) and HPV testing] every 5 years OR

Cytology (pap smear) alone every 3 years

Question 24

Next step in management of someone with ASCUS on pap smear

Answer 24

HPV typing

Question 25

Next step in management of patient with ASCUS + high risk HPV type

Answer 25

Colposcopy with biopsies

Question 26

At what age should women begin getting mammograms

Answer 26

40 y/o

Question 27

What is the recommendation for screening colonoscopies

Answer 27

For patients with average risk for colon cancer, begin screening at age 50 and then every 10 years if normal

Question 28

What is the best preventative measure for osteoporosis

Answer 28

Weight-bearing exercise

Question 29

Why might there be normocytic anemia in a pregnant woman?

Answer 29

Due to the relative hemodilution of pregnancy - there is normally a 47% increase in maternal plasma volume during pregnancy and only a 17% increase in RBC mass

Question 30

What might you expect to see in an arterial blood gas of a pregnancy woman

Answer 30

Compensated respiratory alkalosis (low CO2 with compensatory low HCO3) Low CO2 is due to the increased minute ventilation during pregnancy

Question 31

Describe the change in maternal cardiac output during pregnancy

Answer 31

It increased up to 33% due to increase in both HR and SV

Question 32

Describe change in thyroid hormone levels during pregnancy

Answer 32

Thyroid binding globulin (TBG) is increased due to increased circulating estrogens This causes increase in total thyroxine levels with normal free T3 and T4 levels

Question 33

Next step in management of patient with molar pregnancy

Answer 33

Chest x-ray - lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease

Question 34

What is the risk of fetal loss associated with chorionic villi sampling

Answer 34

1%

Question 35

What is the most common cause of inherited mental retardation

Answer 35

Fragile X Syndrome

Question 36

What is the most effective screening test for Down syndrome

Answer 36

Cell-free DNA

Question 37

What is the recommended amount of folic acid supplementation in a pregnancy woman with previous pregnancy complicated by NTD

Answer 37

4 mg of folic acid daily

Question 38

Folic acid amount recommendation for non-high risk patients

Answer 38

0.6 mg/day

Question 39

What is the diagnostic criteria for preeclampsia

Answer 39

Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two occasions at least four hours apart after 20 weeks of gestation in a previously normotensive patient AND Proteinuria – Urine P:C > 0.3, 24hr urine protein > 300mg

Question 40

Treatment for tachysystole

Answer 40

If during spontaneous delivery: - Cat I tracing = no intervention - Cat II/III = intrauterine resuscitative measures; if failed, consider tocolytics (e.g Terbutaline) If during induced labor: - Cat I = reduce uterotonics - Cat II/III = reduce or stop uterotonics; intrauterine resiscitation; if failed, consider tocolytics

Question 41

Describe presentation of ovarian torsion

Answer 41

Acute onset of COLICKY pain

Question 42

Describe presentation of ruptured corpus luteum

Answer 42

Sudden onset of severe lower abd pain; often presenting with hemoperitoneum

Question 43

Treatment of ruptured corpus luteum

Answer 43

Secure hemostasis. If bleeding stops, no further therapy required. If bleeding continues, cystectomy should be performed with preservation of the remaining normal portion of the ovary

Question 44

What must you do if you have to remove the corpus luteum surgically early in pregnancy

Answer 44

Recall that the corpus luteum is maintained by bHCG in order to produce progesterone until the placenta is capable (10-12 weeks) So if the corpus luteum is removed surgically prior to 10-12 weeks, exogenous progesterone is needed to sustain the pregnancy

Question 45

Describe the criteria for arrest of labor

Answer 45

No progress in the active phase of labor with ruptured membranes for 4 hours with adequate contractions, or 6 hours of inadequate contractions

Question 46

What is considered adequate contractions

Answer 46

at least 200 MVU (add up peak of each contraction) within a 10 min period

Question 47

What is the first sign of hypovolemia

Answer 47

Decreased urine output (even before tachycardia)