Fragile Handle with Care (Osteoporosis)
We all know that weight bearing exercise is recommended to help prevent osteoprosis, but how much is recommended? ( in mins per week)
The CDC recommends that all adults engage in at least 150–300 minutes per week of moderate-intensity activity or 75–150 minutes per week of vigorous-intensity aerobic physical activity. Starting exercise early in life can help with high peak bone mass.
Who should get screened for Perinatal mood disorders?
Everyone! - Perinatal mood disorders cannot be diagnosed without clinical examination and screening. Universal screening in outpatient settings improves detection rates from 6.3% to 35.4%
Which therapy for menopausal vasomotor symptoms does not increase her risk of thrombotic event?
Paroxetine is approved by the U.S. Food and Drug Administration for vasomotor symptoms and does not increase risk of DVT.
Which of the following ultrasonographic findings is characteristic of ovarian torsion?
Twisted pedicle with a bullseye or whirlpool appearance
What are the T score values for diagnosis of normal bone density, osteoporosis and osteopenia
Normal Bone Density: -1.0 or higher
Osteopenia (Low Bone Mass): Between -1.0 and -2.5
Osteoporosis: -2.5 or lower
A 29-year-old gravida 1, para 1, is presenting for their 6-week postpartum visit. What score on the Edinburgh Postnatal Depression Scale (EPDS) would be concerning for evidence of major depression?
A cut-point of 13 is considered acceptable for identifying patients at risk for major depression postpartum. This score results in approximately 85% sensitivity (specificity, 78%; positive predictive value, 73%)
You have a patient being scheduled for induction of labor at 37 weeks due to newly diagnosed gHTN, She is on Lovenox due to history of antiphospholipid syndrome, how long should she hold her Lovenox prior to induction?
12 hours prior to induction
A 34-year-old woman, gravida 0, with a history of abnormal uterine bleeding is scheduled to undergo an abdominal myomectomy. She weighs 75 kg (165 lb), and her uterus is 36 cm long with multiple intramural and subserosal leiomyomas. The surgeon should consider a red blood cell transfusion if intraoperative blood loss exceeds what volume in milliliters?
When intraoperative blood loss exceeds 15% of a patient's estimated blood volume, the surgeon should consider a red blood cell transfusion. For any patient, 15% of blood volume can be estimated by multiplying the body mass in kilograms by 10. For this patient weighing 75 kg, that means an estimated intraoperative blood loss of 750 mL is the threshold for considering transfusion.
A 66-year-old presents to clinic for routine health evaluation. The patient reports feeling well, and does not believe she has any medical problems and takes no medications. She is active and walks with her neighbor for 30 minutes every morning. When should this patient begin bone mineral density screening for osteoporosis?
now - The American College of Obstetricians and Gynecologists recommends screening for osteoporosis in postmenopausal patients 65 years and older with bone mineral density testing to prevent osteoporotic fractures.
What is the major time frame difference between baby blues and postpartum depression?
Baby blues can affect up to 75% of individuals in the postpartum period, with the onset of symptoms typically occurring 1–2 days postpartum and resolving by 10–14 days postpartum. Postpartum depression symptoms typically start within 4 weeks of delivery and persist beyond 14 days postpartum.
Name 5 risks factors that increase peri-partum risk for DVT
cesarean delivery, diabetes, hemorrhage and anemia, hyperemesis, immobility, multifetal gestation, multiparity, preeclampsia, age 35 years or older, cancer, connective tissue disorder, dehydration, nephrotic syndrome, obesity, oral contraceptive pills, nephrotic syndrome, smoking, thrombophilia, sickle cell disease, orthopedic surgery, and paraplegia.
A woman precipitously delivers a term baby in the emergency department. On delivery, the baby is making no respiratory efforts and is blue and limp. Heart rate is 110. What is the initial Apgar score?
Apgar scoring is based on activity (tone), pulse, grimace (reflex irritability), appearance (color), and respiration. This infant has 0 for all categories except pulse. Heart rate greater than 100 gives 2 points.
How much vitamin D and calcium should we be consuming as a preventative measure against osteoporosis.
There is no recommendation for dietary supplementation of vitamin D or calcium as it has not been demonstrated to decrease fracture incidence. The recommended daily allowance of vitamin D (600 IU) and calcium (1,200 mg) (B) is considered important for general health and bone health
When does ACOG recommend screening for perinatal mood disorders in pregnancy?
The initial prenatal visit, later in pregnancy (ie, third trimester), and at any postpartum visits
A patient on warfarin presents to the emergency department with a ruptured ectopic pregnancy. They have evidence of blood in their abdomen on ultrasound. Their blood pressure is 102/64, and their international normalized ratio (INR) test is 3.8. You recommend surgical management. What is the best step to reverse anticoagulation in this patient?
Vitamin K and FFP
A 25-year-old postpartum patient is on methadone for opioid use disorder, has a past medical history of hepatitis C, and wishes to breastfeed. She is otherwise stable, adherent to treatment, and not using other substances. What is the recommended approach?
encourage patient to breast feed unless nipples are actively cracked/ bleeding - Patients on medication for opioid use disorder should be encouraged to breastfeed, provided they are stable, adherent to treatment, and not actively using illicit substances. Hepatitis C is not a contraindication to breastfeeding unless there is nipple trauma (eg, cracking or bleeding), which could increase the risk of bloodborne transmission.
An Asian 60-year-old woman with a BMI of 40 presents for her annual well-woman exam. She smokes a half pack per day and takes levothyroxine daily. Her sister was recently diagnosed with osteoporosis, and she would like to know if she should be screened. In her history, which factor increases her risk of osteoporosis the most?
The most common risk factors for osteoporosis include increasing age, parental history of hip or spine fracture, BMI less than 20 or body weight less than 127 lb, smoking, excessive alcohol use, and certain conditions and medications. In her history, her current smoking is her strongest risk factor
You have a patient exhibiting signs of postpartum psychosis, what medications are within the scope of an OBGYN while awaiting further assessment by Psych.
Postpartum psychosis is a psychiatric emergency. Treatment options that are within the scope of obstetricians, while awaiting further assessment, recommendations, and a treatment plan by a psychiatrist, include sedating antipsychotic medications such as olanzapine or haloperidol that can be used with benzodiazepines such as lorazepam. If haloperidol is used, benztropine or diphenhydramine should be administered to prevent extrapyramidal symptoms and dystonia.
A 33-year-old female presents to the emergency department with heavy vaginal bleeding. She is on rivaroxaban for a history of venous thromboembolism. Her last menstrual period (LMP) was 6 weeks ago and serum human chorionic gonadotropin (hCG) is 22,000 mIU/mL. Ultrasonography reveals a nonviable intrauterine pregnancy. On examination, her cervical os is dilated 1 cm and she is bleeding heavily. You estimate a 1-L blood loss since her arrival. You recommend emergent dilation and curettage. What is the best step to reverse anticoagulation in this patient?
recombinant coagulation factor Xa andexanet alpha (AndexXa) in 2018 for reversal of the effects of rivaroxaban and apixaban (Eliquis).
A 30-year-old primigravida with no family history of breast cancer is appreciated to have a 2-cm painless mass in her left breast. What is the preferred imaging modality to evaluate a breast mass in pregnancy?
Ultrasound is inexpensive, safe for the fetus, and can distinguish between solid and cystic lesions in 97% of patients. It is the preferred imaging in pregnancy. Mammograph provides negligible radiation doses to the fetus