UWorld OB

Question 0

Serious side effects of OCPs?

Answer 0

1. Thromboembolus
2. Hypertension
3. Hypertriglyceridemia
4. Diabetes
5. Cholestasis/cholecystitis
   6, MI in smokers over 35

Question 1

OCP is protective against?

Answer 1

1. Benign breast disease
2. Ovarian cysts /cancer
3. Endometrial cancer
   4 Dysmenorrhea

Question 2

Acute fatty liver pregnancy – Trimester? Symptoms? Labs? Histology? Can lead to?

Answer 2

Third;

nausea, abdominal pain, headache

Prolonged prothrombin time and elevated transaminases

Micro vesicular deposition in about a site without inflammation or necrosis

Acute renal failure

Question 3

Risk factors for cervical insufficiency during pregnancy?

Answer 3

1. Procedures - elective abortions, LEEP procedure or cone biopsy
2. Obstetrical trauma
3. Multiple gestation
4. History of second trimester pregnancy loss
5. Mullerian abnormalities

Question 4

Risk factors for placental abruption?

Answer 4

1. Maternal disease – Diabetes, SLE
2. Hypertension
3. Maternal drugs - smoking, Cocaine, alcohol
4. External cephalic version

Question 5

Risk factors for uterine rupture?

Answer 5

1. Multiparity
2. Advanced maternal age
3. Previous C-sections/myomectomies

Question 6

Risk factors for polyhydramnios?

Answer 6

1. Fetal malformations/genetic disorders
2. Diabetes
3. Multiple gestation
4. Fetal anemia

Question 7

Cervical length at 24 weeks? Gold standard for evaluating Surbex for cervical incompetence?

Answer 7

25 mm; transvaginal ultrasound

Question 8

Patient with septic abortion – treatment?

Answer 8

1. Cervical/blood cultures
2. Antibiotics
3. Gentle suction curettage (Vigorous curettage may perforate uterus)

Question 9

Postterm pregnancy associated with an increased risk for?

Answer 9

Oligohydramnios

Question 10

UTI drugs contraindicated in pregnancy? Use instead?

Answer 10

Tetracyclines, fluoroquinolones, Bactrim

Use nitrofurantoin, amoxicillin, cephalexin

Question 11

Risperidone – used to treat? Mechanism of action? Side effects in women?

Answer 11

Schizophrenia bipolar; dopamine antagonist

Increases serum prolactin levels causing oligomenorrhea, galactorrhea

Question 12

Pregnant patient comes in complaining of brown vaginal discharge – Suspect? Test? If positive, tx?

Answer 12

Missed abortion; pelvic ultrasound

D&C, misoprostol/mifepristone or expectant management for POC elimination

Question 13

TSH and thyroid hormone in pregnancy?

Answer 13

1. Estrogen in pregnancy increases thyroid binding globulin, increasing TDG-bound T3 and T4. Free T3 and T4 remain normal. Therefore total T3 and T4 are elevated
2. HCG in pregnancy can mildly stimulate TSH receptor, resulting in a small increase in free T3/T4. Levels are slightly elevated and remain within normal range
3. TSH remains the same

Question 14

Patient with suspected lichen sclerosis - next step? (Why?)

Tx?

Answer 14

Punch biopsy (r/o vulvar squamous cell carcinoma)

Topical steroids

Question 15

Premature ovarian failure – FSH to LH ratio?

Answer 15

FSH increases more than LH

FSH/LH ratio >1

Question 16

Tests for every pregnant patient?

Answer 16

FRIED (flu, Rh/type and screen/CBC, infection, exam, down syndrome screening)

1. Cervical psychology
2. Rh type and antibody screen
3. Hematocrit, hemoglobin, MCV
4. Rubella, varicella, hepatitis B screening
5. STI – syphilis, HIV
6. Flu vaccine during flu season
7. Screening for down syndrome, cystic fibrosis

Question 17

Test for specific, at risk pregnant patients?

Answer 17

CHLamydia TTTrachomatis

1. Thyroid function
2. TB
3. Toxoplasmosis
4. Hemoglobin electrophoresis
5. Lead levels
6. Chlamydia

Question 18

Indications for GBS prophylaxis if status is unknown?

Answer 18

1. Delivery under 37 weeks
2. Duration of membrane rupture over 18 hours
3. Any amount of GBS bacteriuria
4. Prior history GBS sepsis

Question 19

Intrauterine fetal demise may cause? Mechanism? Early sign?

Answer 19

DIC; due to release of tissue factor from the placenta into maternal circulation which triggers intrinsic pathway

Low normal fibrinogen (~160)

Question 20

Emergency contraception is offered up to how long after intercourse? Plan B a.k.a.?

Second trimester abortifacient?

Answer 20

120 hrs; levonorgestrel

Prostaglandin E2 suppositories

Question 21

NST – when to conduct?

Answer 21

Over 32 weeks with decreased fetal movements

Question 22

Contraction stress test?

Answer 22

Mother given oxytocin infusion until three contractions every 10 minutes.

Effect of contractions fetal heart activity is recorded. Test is positive and delivery recommended if late decelerations are present

Question 23

Most important risk factor squamous cell carcinoma the vagina?

Answer 23

HPV

Question 24

Female offspring of women who ingest DES during pregnancy are at an increased risk for developing?

Answer 24

1. Clear-cell adenocarcinoma of vagina/cervix 2. Cervical anomalies 3. Uterine malformations

Question 25

Amniotic fluid embolism Sx?

Answer 25

Sudden respiratory failure, seizures, cardiogenic shock, DIC

Question 26

Immediately postpartum, possibly worrisome symptoms that are actually normal?

Answer 26

Low-grade fever, leukocytosis, vaginal discharge, chills

Question 27

Patient given epidural for labor – side effect? Mechanism?

Answer 27

Hypotension from Venus pooling

Question 28

Ideal range for maternal glucose?

Answer 28

75-90

Question 29

Gestational diabetes – Child at increased risk for?

Answer 29

Macrosomia, hypoglycemia, hypocalcemia, polycythemia, respiratory difficulties, heart failure

Question 30

Contraception can be used postpartum?

Answer 30

Sterilization, barrier methods, IUD, progestin-only | OCP may decrease milk production and pass into milk

Question 31

Patient with cytologic specimens suggesting HSIL – next step? If pregnant?

Answer 31

Colposcopy and biopsy If not pregnant and colposcopy positive - LEEP excision If pregnant and Biopsy negative, second biopsy six weeks after delivery

Question 32

Preferred way to screen for gestational diabetes? If positive?

Answer 32

One hour 50 g glucose tolerance test Either: 1. 75 g oral glucose tolerance test 2. Three hour 100 g oral glucose tolerance test

Question 33

Gestational diabetes is diagnosed if three hour test values are?

Answer 33

Fasting glucose > 95 One hour glucose >180 Two hour glucose >155 Three-hour glucose >140

Question 34

hCG doubles until? Alpha versus beta subunits?

Answer 34

6-8 weeks Also similar structure to TSH, LH, FSH Beta subunits unique to HCG

Question 35

Roles of hCG in pregnancy?

Answer 35

1. Maintenance of corpus luteum 2. Promotion of male sexual differentiation 3. Stimulation of maternal thyroid gland

Question 36

Down syndrome markers?

Answer 36

``` Alphabetical order: AFP low Beta hCG high estriol low Inhibin high ```

Question 37

When to give RhoGAM? When will Standard dose need to be adjusted?

Answer 37

At 28 weeks of first pregnancy and immediately postpartum Maternal-feel hemorrhage (placental abruption) – will need to increase dose of RhoGAM based on Kleihaur-Betke

Question 38

Why is Rh incompatibility worse than ABO incompatibility? Why can ABO incompatibility happen in the first pregnancy?

Answer 38

ABO has fewer IgM antibodies that cross placenta, causing only mild disease A & B antigens are found in food and bacteria in the environment

Question 39

Discharge consistent with ovulation?

Answer 39

"Egg white like" thickening

Question 40

Management after biophysical profile?

Answer 40

8-10: normal 6 without oligohydramnios: deliver if greater than 37 weeks (Repeat BPP in 24 hours if less than 37 weeks, and deliver if no improvement) 6 with oligohydramnios – deliver if above 32 weeks (daily monitoring less than 32 weeks) 4 or less – deliver if greater than 26 weeks

Question 41

Infection post pregnancy?

Answer 41

``` 0 days - wind 1-2 - water 2-3 - womb (endometritis) 4-5 - wound 7+ - walking (septic thrombophlebitis) ```