OBGYN EOR Exam Questions With Best Graded Answers What is appropriate weight gain during pregnancy for single as well as twin pregnancies
-ANSWER- ●Singleton pregnancy •BMI <18.5 kg/m2 (underweight)- Weight gain 28 to 40 lb •BMI 18.5 to 24.9 kg/m2 (normal weight)- 25 to 35 lb •BMI 25.0 to 29.9 kg/m2 (overweight)- 15 to 25 lb
•BMI ≥30.0 kg/m2 (obese)- 11 to 20 lb ●Twin pregnancy •BMI <18.5 kg/m2 (underweight)- No recommendation due to insufficient data
•BMI 18.5 to 24.9 kg/m2 (normal weight)- 37-54 lb •BMI 25.0 to 29.9 kg/m2 (overweight)- 31 to 50 lb
•BMI ≥30.0 kg/m2 (obese)- 25 to 42 lb
How much does a dose of RhoGAM (anti-D immune globulin) cover? -ANSWER- A *single 300 microgram dose* (1 microgram = 5 international units) contains sufficient anti-D to suppress the immune response to *15 mL of D-positive red cells* (or 30 mL fetal D-positive whole blood). A single 50 microgram dose contains sufficient anti-D to suppress the immune response
to 2.5 mL of D-positive red cells (or 5 mL fetal whole blood).
Should D-negative women who screen positive for anti-D antibodies get RhoGAM -
ANSWER- No- it's too late for it to work
Intensely pruritic urticarial *plaques and papules* with or without erythematous patches of papules and vesicles; rash first appears on abdomen, often *along striae* and occasionally involves extremities; face usually is not affected
Rash of pregnancy -ANSWER- PUPPP (pruritic urticarial papules and plaques of pregnancy)
Tx: Oral antihistamines and topical corticosteroids for pruritus; systemic corticosteroids for extreme symptoms
Erythematous papules and nodules on the extensor surfaces of the extremities in pregnancy -ANSWER- Prurigo of pregnancy
Tx: Midpotency topical corticosteroids and oral antihistamines Pregnant woman presents with excoriations from scratching (but no primary skin lesions)- itchiness especially on the hands that is worse at night, and occurs in second half of pregnancy (late 2nd into 3rd trimester) -Dx and Tx -ANSWER- *Intrahepatic cholestasis of pregnancy (ICP)* is characterized by pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
-serum bile acid concentration elevated
-RUQ pain, nausea, poor appetite, sleep deprivation, or steatorrhea may occur
Tx: *Oral antihistamines* for mild pruritus; *ursodeoxycholic acid (ursodiol [Actigall])* for
more severe cases
Erythematous follicular papules and sterile pustules on the abdomen, arms, chest, and back during pregnancy
-Dx and Tx -ANSWER- Pruritic folliculitis of pregnancy
-despite the name, it's not actually that pruritic
Topical corticosteroids, topical benzoyl peroxide (Benzac), or ultraviolet B light therapy
m/c cause of dysfunctional uterine bleeding -ANSWER- Fibroids
Define these terms: -dysfunctional uterine bleeding
-polymenorrhea
-hypermenorrhea
-metorragia
-menometorragia -ANSWER- Dysfunctional uterine bleeding is abnormal uterine bleeding that, after exam and US, cannot be attributed to the usual causes (structural gynecologic abnormalities, CA, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of OCPs or certain drugs)
Polymenorrhea: menses that occur more frequently (menses < 21 days apart)◾
Hemorrhagic or hypermenorrhea: menses that involve more blood loss (> 7 days or > ◾
80 mL) during menses (menorrhagia)
Metrorrhagia: uterine bleeding that occurs frequently and irregularly between menses◾
Menometrorrhagia: more blood loss during menses and frequent and irregular ◾
bleeding between menses
Pruritic papules, plaques, and vesicles evolving into generalized vesicles or bullae (in a pregnant woman)
Initial periumbilical lesions may generalize, although the face, scalp, and mucous membranes usually are not affected
Dx and Tx -ANSWER- Pemphigoid gestationis
-autoimmune skin disorder -may be associated with mild placental failure
Oral antihistamines and topical corticosteroids for mild cases; systemic oral corticosteroids for severe cases
Common causes of DUB in pts < 16 -ANSWER- DUB in patients < 16 years old
Pregnancy◾
Anovulation◾
Breakthrough bleeding on OCP's - expect 3 months of breakthrough bleeding◾
Blood dyscrasias (ex. VWD)◾
Common causes of DUB in patients 16-40 yo -ANSWER- DUB in patients 16-40 years old
Pregnancy◾
Anovulation◾
BTP on OCPs◾
STIs/PID◾
Endometriosis/Adenomyosis◾
Endometrial Cancer◾
Common causes of DUB in patients > 40 -ANSWER- DUB in patients > 40 years old
Pregnancy◾
Anovulation◾
OCPs or hormone replacement therapy◾
Endometrial Cancer - all patients > 40 need endometrial sampling◾
Dx of DUB (what is the gold standard) -ANSWER- Look for an underlying cause: Ultrasound, FSH, LH, Prolactin, Estradiol, Testosterone, TSH, T3, T4, DHEAS
*Uterine Dilation and Curettage (GOLD STANDARD)*: Especially when done with hysteroscopy, uterine dilation and curettage can be diagnostic and therapeutic
Possible tx of DUB -ANSWER- Tx is aimed at causing cyclic bleeding and protection of the endometrium
Progesterone therapy (oral or IUD), OCPs, Estrogen therapy, GnRH agonists◾
Hysteroscopy, endometrial curettage, polypectomy, endometrial ablation◾
NSAIDS◾
How thick should the endometrium be in a postmenopausal woman -ANSWER- Less than *4 mm*
If not, you MUST do endometrial biopsy esp in the setting of abnormal bleeding
Tx of endometrial cancer -ANSWER- Usually total hysterectomy and bilateral salpingo-
oophorectomy Pelvic and para-aortic lymphadenectomy for deep (> 50% myometrial invasion) grade◾
1 or 2 and for grade 3
Pelvic radiation therapy with or without chemotherapy for stage II or III◾
Multimodal, individualized therapy for stage IV
Medical: Progestins, Tamoxifen or both◾
GnRH agents◾
What is endometriosis -ANSWER- Endometriosis is a condition in which ectopic endometrial tissue implants are found in extrauterine sites, m/c the ovaries, fallopian tubes, cul-de-sac, and uterosacral ligaments.
Benign disease related to the menstrual cycle, usually cyclical associated with the 3 ◾
D's: Dyspareunia (painful intercourse), dyschezia (difficulty in defecating), dysmenorrhea
Hx of infertility is also common (30-45% ). 20% of women with chronic pelvic pain will ◾
have endometriosis
PE will show uterosacral nodularity or a fixed or retroverted uterus◾
Dx of endometriosis -ANSWER- Ultrasound. Definitive diagnosis is made by laparoscopy
Dx is suspected based on typical symptoms but must be confirmed by biopsy, usually◾
via pelvic laparoscopy (definitive study) but sometimes via laparotomy, vaginal examination, sigmoidoscopy, or cystoscopy
Imaging tests (eg, ultrasonography, barium enema, IV urography, CT, MRI) are not ◾
specific or adequate for diagnosis. However, they sometimes show the extent of endometriosis and thus can be used to monitor the disorder once it is diagnosed.
m/c sites of endometriosis -ANSWER- (Most common at the top)
-ovaries
-anterior and posterior cul-de-sac
-posterior broad ligaments
-uterosacral ligaments
-uterus
-fallopian tubes
-sigmoid colon and appendix
-round ligaments
Sx of endometriosis -ANSWER- Dyspareunia (painful intercourse)
Dysmenorrhea (painful periods)
Dyschezia (painful defecation)
