OBGYN COMAT
1. What is the criteria for sec- at least 3 hours of pushing in a primigravida w/o
ond-stage arrest? epidural or at least 4 w/ epidural
OR
at least 2 hours of pushing in a multigravida w/o
epidural or at least 3 w/ epidural
2. What is operative vaginal delivery? Birth that is assisted by vacuum extraction or forceps
3. What are the indications for opera- second stage arrest, maternal exhaustion, fetal distress,
tive vaginal delivery? and maternal conditions where valsalva is contraindi-
cated like hypertrophic cardiomyopathy
4. What is the ideal fetal head posi- occiput anterior
tion?
5. T/F: epidurals can lengthen the false - they can lengthen second stage but they do not
second stage of delivery and even cause full arrest
cause arrest of labor
6. What is internal podalic version? manual rotation of an infant to a breech position
7. Mastitis and breast abscesses are staph aureus
typically caused by what?
enters the tissue through nipple trauma (chafing, blis-
tering)
8. T/F: transient rigors/chills and True - due to decreased estrogen and progesterone
fever are normal in the postpartum levels, normal in the first 24 hours
period
9. What is lochia? the normal discharge from the uterus after childbirth
, OBGYN COMAT
10. What typically causes symmet- symmetric = first trimester insults such as chromosomal
ric fetal growth restriction versus abnormalities or congenital infection
asymmetric?
asymmetric = second or third trimester insults such as
uteroplacental insufficiency or maternal malnutrition
11. What are protective factors against OCPs, multiparity, breastfeeding
epithelial ovarian carcinoma?
the risk of the cancer correlates with the number of
lifetime ovulatory cycles, therefore things that decrease
those cycles are protective
12. On ultrasound, a 4cm adnexal epithelial ovarian carcinoma
mass that appears thin-walled with
multiple irregular thickened inter- malignant adnexal masses often have a complex ap-
nal septations is suspicious for pearance with abnormal internal features such as ir-
what? regular septations or papillary projections
13. Extreme fatigue followed by the multiple sclerosis
development of focal neurologic
findings in the early postpartum
period should raise suspicion for
what?
14. Unilateral bloody nipple discharge benign intraductal papilloma
without a coexisting breast mass
or lymphadenopathy is most com-
monly caused by what?
15. What is uterine tachysystole and more than 5 contractions in 10 minutes
how is it managed?
managed with supportive measures like lateral ma-
ternal repositioning or tocolysis and discontinuation
, OBGYN COMAT
of uterotonic agents until the excessive uterine activity
resolves
16. What is the most likely outcome spontaneous regression
for leiomyomas diagnosed in a
woman nearing menopause? fibroid proliferation is influenced by factors that in-
crease estrogen levels so menopausal patients typically
have spontaneous regression
17. A patient who underwent uncom- amniotic fluid embolism syndrome (AFES)
plicated spontaneous vaginal de-
livery 20 minutes ago is now ex- managed with intubation to correct hypoxemia, pres-
periencing hypoxemic respiratory sors to support BP, and massive transfusion to correct
failure, seizures, obstructive shock, DIC
and DIC. What is this and how is it
managed?
18. In a patient experiencing leakage keep a voiding diary
of urine with sneezing and the in-
tense urge to urinate with only a this is mixed (stress and urge) urinary incontinence,
small voiding volume, what should keep the diary to determine the predominant type to
be done? decide treatment
19. Ulipristal is a highly effective emergency contraception
(98-99%) option for what?
delays ovulation and impairs implantation
20. T/F: taking multiple OCPs simulta- False - it is an option as the elevated progestin would
neously is an effective option of delay ovulation but the method is only 47-89% effective
emergency contraception and causes intolerable side effects like severe nausea
21. What is first-line management for maternal repositioning to reduce cord compression
recurrent variable decelerations?
, OBGYN COMAT
if this does not work, amnioinfusion (saline) to artifi-
cially increase amniotic fluid can be used
22. How is the discovery of a likely fi- observation and repeat examination after completion
broadenoma managed in an ado- of full menstrual cycle (~6 weeks)
lescent?
23. T/F: current guidelines recom- True
mend that all pregnant women
with HIV begin taking ART as soon
as possible regardless of viral load
or CD4 count
24. How is suspected epithelial ovarian exploratory laparotomy with surgical staging and tu-
cancer managed? mor debulking
25. Should you biopsy epithelial ovari- No, it's contraindicated due to risk of rupture and re-
an cancer? sultant spread
26. What work up should be done prolactin, TSH, and pregnancy test
for bilateral nonbloody nipple dis-
charge with a normal breast exam- this is physiologic nipple discharge
ination?
27. How is seizure prophylaxis man- valproic acid
aged with pregnant women with
myasthenia gravis? magnesium sulfate is contraindicated as it may trigger
a myasthenic crisis
28. A patient undergoing ovulation in- ovarian hyperstimulation syndrome - ovulation trigger
duction for infertility presents with agents can cause an overexpression of VEGF resulting
ascites, respiratory distress, hemo- in increased vascular permeability and capillary leak-
concentration, and hypercoagula- age
bility. What is this?
1. What is the criteria for sec- at least 3 hours of pushing in a primigravida w/o
ond-stage arrest? epidural or at least 4 w/ epidural
OR
at least 2 hours of pushing in a multigravida w/o
epidural or at least 3 w/ epidural
2. What is operative vaginal delivery? Birth that is assisted by vacuum extraction or forceps
3. What are the indications for opera- second stage arrest, maternal exhaustion, fetal distress,
tive vaginal delivery? and maternal conditions where valsalva is contraindi-
cated like hypertrophic cardiomyopathy
4. What is the ideal fetal head posi- occiput anterior
tion?
5. T/F: epidurals can lengthen the false - they can lengthen second stage but they do not
second stage of delivery and even cause full arrest
cause arrest of labor
6. What is internal podalic version? manual rotation of an infant to a breech position
7. Mastitis and breast abscesses are staph aureus
typically caused by what?
enters the tissue through nipple trauma (chafing, blis-
tering)
8. T/F: transient rigors/chills and True - due to decreased estrogen and progesterone
fever are normal in the postpartum levels, normal in the first 24 hours
period
9. What is lochia? the normal discharge from the uterus after childbirth
, OBGYN COMAT
10. What typically causes symmet- symmetric = first trimester insults such as chromosomal
ric fetal growth restriction versus abnormalities or congenital infection
asymmetric?
asymmetric = second or third trimester insults such as
uteroplacental insufficiency or maternal malnutrition
11. What are protective factors against OCPs, multiparity, breastfeeding
epithelial ovarian carcinoma?
the risk of the cancer correlates with the number of
lifetime ovulatory cycles, therefore things that decrease
those cycles are protective
12. On ultrasound, a 4cm adnexal epithelial ovarian carcinoma
mass that appears thin-walled with
multiple irregular thickened inter- malignant adnexal masses often have a complex ap-
nal septations is suspicious for pearance with abnormal internal features such as ir-
what? regular septations or papillary projections
13. Extreme fatigue followed by the multiple sclerosis
development of focal neurologic
findings in the early postpartum
period should raise suspicion for
what?
14. Unilateral bloody nipple discharge benign intraductal papilloma
without a coexisting breast mass
or lymphadenopathy is most com-
monly caused by what?
15. What is uterine tachysystole and more than 5 contractions in 10 minutes
how is it managed?
managed with supportive measures like lateral ma-
ternal repositioning or tocolysis and discontinuation
, OBGYN COMAT
of uterotonic agents until the excessive uterine activity
resolves
16. What is the most likely outcome spontaneous regression
for leiomyomas diagnosed in a
woman nearing menopause? fibroid proliferation is influenced by factors that in-
crease estrogen levels so menopausal patients typically
have spontaneous regression
17. A patient who underwent uncom- amniotic fluid embolism syndrome (AFES)
plicated spontaneous vaginal de-
livery 20 minutes ago is now ex- managed with intubation to correct hypoxemia, pres-
periencing hypoxemic respiratory sors to support BP, and massive transfusion to correct
failure, seizures, obstructive shock, DIC
and DIC. What is this and how is it
managed?
18. In a patient experiencing leakage keep a voiding diary
of urine with sneezing and the in-
tense urge to urinate with only a this is mixed (stress and urge) urinary incontinence,
small voiding volume, what should keep the diary to determine the predominant type to
be done? decide treatment
19. Ulipristal is a highly effective emergency contraception
(98-99%) option for what?
delays ovulation and impairs implantation
20. T/F: taking multiple OCPs simulta- False - it is an option as the elevated progestin would
neously is an effective option of delay ovulation but the method is only 47-89% effective
emergency contraception and causes intolerable side effects like severe nausea
21. What is first-line management for maternal repositioning to reduce cord compression
recurrent variable decelerations?
, OBGYN COMAT
if this does not work, amnioinfusion (saline) to artifi-
cially increase amniotic fluid can be used
22. How is the discovery of a likely fi- observation and repeat examination after completion
broadenoma managed in an ado- of full menstrual cycle (~6 weeks)
lescent?
23. T/F: current guidelines recom- True
mend that all pregnant women
with HIV begin taking ART as soon
as possible regardless of viral load
or CD4 count
24. How is suspected epithelial ovarian exploratory laparotomy with surgical staging and tu-
cancer managed? mor debulking
25. Should you biopsy epithelial ovari- No, it's contraindicated due to risk of rupture and re-
an cancer? sultant spread
26. What work up should be done prolactin, TSH, and pregnancy test
for bilateral nonbloody nipple dis-
charge with a normal breast exam- this is physiologic nipple discharge
ination?
27. How is seizure prophylaxis man- valproic acid
aged with pregnant women with
myasthenia gravis? magnesium sulfate is contraindicated as it may trigger
a myasthenic crisis
28. A patient undergoing ovulation in- ovarian hyperstimulation syndrome - ovulation trigger
duction for infertility presents with agents can cause an overexpression of VEGF resulting
ascites, respiratory distress, hemo- in increased vascular permeability and capillary leak-
concentration, and hypercoagula- age
bility. What is this?
