Ob/Gyn Shelf Exam Questions and Answers 100% Pass

Ob/Gyn Shelf Exam Questions and Answers 100% Pass Rx for advanced (Stages II ) ovarian cancer - Answer- Surgical removal, followed by adjuvant chemo (taxane carboplatin) When is magnesium sulfate given for preeclampsia? - Answer- During delivery and 24 hours postpartum Therapeutic level of mag sulfate - Answer- 4-7 Mag sulfate levels associated with respiratory depression and cardiac arrest - Answer- >12 and >15 Contraindications to expectant management of severe preeclampsia (e.g. indications for delivery) - Answer- Thrombocytopenia < 100,000, Inability to control BP w/ max doses of 2 antihypertensives, Non-reassuring fetal surveillance, LFTs < 2x nml, Eclampsia Persistent CNS Sx Oliguria How fast should hCG rise in a normal pregnancy? - Answer- Should double (or increase by 66%) every 48 hours Inappropriately rising (e.g. too low) beta-hCG levels indicate - Answer- Abnormal pregnancy (e.g. ectopic, incomplete abortion, or resolving complete abortion) Distinction btwn a normal gestational sac and a pseudogestational sac - Answer- Pseudo is located in the midline Serum progesterone <5 indicates - Answer- Specific for nonviable pregnancy What is the Arias-Stella reaction? - Answer- Hypersecretory endometrium of prengnacy on histology that occurs w/ BOTH ectopic and intrauterine pregnancies Culdocentesis is looking for - Answer- Blood in peritoneal cavity, e.g. from ruptured ectopic (or purulent fluid from infection) Medical Rx for ectopic - Answer- Methotrexate Relative contraindications to MTX for ectopic - Answer- Cardiac activity Mass >3.5cm (often correlates with b-hCG > 15,000) Absolute contraindications to MTX - Answer- Breastfeeding, immunodeficient, alcoholic, blood dyscrasia, pulmonary disease, PUD, hepatic/renal/hematology dysfxn When is more than one dose of MTX needed? - Answer- If beta-hCG levels plateau or increase after 7 days Asherman's Syndrome includes the presence of what? - Answer- Uterine synechiae (intrauterine adhesions) What is threatened abortion, what is the risk of subsequent spontaneous abortion, and what are the risks if carry to viability? - Answer- Bleeding in the first trimester without tissue or fluid loss 50% Greater risk of preterm and low birth weight What is inevitable abortion? - Answer- Gross rupture of membranes w/ cervical dilation (contractions typically begin soon afterward) After what time are the fetus and placenta typically expelled separately? - Answer- 10wks After how many days should surgical abortion be performed instead of medical? - Answer- 49 days since LMP 3 drugs for early medical abortion - Answer- Mifepristone (antiprogestin), MTX (antimetabolite), misoprostol (prostaglandin) All induce uterine contractility, either directly (misoprostol) or by decreasing progesterone inhibition Rx for a septic abortion - Answer- Broad spectrum IV Abx, IVF, prompt evacuation of uterus What is postabortal syndrome and how is it treated? - Answer- Uterus fails to remain contracted after spontaneous abortion or elective abortion (pain, bleeding, open cervix, hematometra) Suction curettage At what beta-hCG level can an intrauterine pregnancy be appreciated? - Answer- >2000 Most common abnormal karyotope in aborted fetuses - Answer- Autosomal trisomy Systemic maternal diseases associated w/ early pregnancy loss - Answer- DM, SLE, CKD Rx for significant anemia during spontaneous abortion - Answer- D Effect of single, prior first trimester surgical abortion on fertility/ likelihood of future early pregnancy losses - Answer- No effect/ no increased risk Once pt at high risk for cervical cancer and has lesion, management option - Answer- Cervical biopsy (can skip Pap smear, a screening test, as well as colposcopy since lesion can already be visualized) Screening tests for a normal African American couple wanting to conceive - Answer- CBC and Hb electrophoresis Valproic acid is associated with an increased risk of these three abnormalities - Answer- Neural tube defects, hydrocephalus and craniofacial malformations Women with poorly controlled DM during organogenesis are at risk for structural anomalies in these two systems - Answer- CNS and CV Chorionic villus sampling is used to detect - Answer- Chromosomal abnormalities Three components of triple screen extra of quad screen - Answer- AFP, hCG, unconjugated estriol Inhibin A Test for Down's in first trimester - Answer- PAPP A (pregnancy associated plasma protein A) Risk of fetal loss with CVS - Answer- 1%