RISKY BUSINESS
PHARMACEUTICAL POISON
SURGERY
LOCATION, LOCATION
DIAGNOSIS
100
Since 1970 there has been a 4 fold increase in the incidence of ectopic pregnancies. Name 2 factors that have increased the incidence of ectopic pregnancies?
Greater prevalence of STD’s, More sensitive diagnostic tools, Restoration of tubal patency, Delayed childbearing, IUD and tubal sterilization rates have increased, Per Williams GYN: ART is not listed as an explanation: but would accept
100
According to PB #94, Medical Management of Ectopic pregnancy. Name 2 absolute contraindications to methotrexate therapy?
Breastfeeding, evidence of immunodeficiency, alcoholism or other chronic liver disease, Blood dyscrasia(thrombocytopenia, bone marrow hyperplasia,leukopenia, significant anemia), Sensitivity to methotrexate, active pulmonary disease, peptic ulcer disease, hepatic, renal or Hematologic dysfunction
100
Which method of permanent sterilization has the highest failure rate: Bipolar cautery or puerperal partial salpingectomy?
Bipolar cautery 3.2/1000 procedures vs 1.2/1000 in partial salpingectomy
100
What is the most common tubal site of an ectopic pregnancy?
Ampullary (70%)
100
What is the most common symptom of an ectopic pregnancy?
Abdominal pain
200
Which of the following carries the highest risk of a subsequent ectopic pregnancy? Smoking, 3 or more prior SAB’s, or prior medical/surgical abortion?
Smoking 3.5OR, Prior SAB’s 3.0 OR, abortion 2.8 OR
200
According to ACOG Practice Bulletin #94, name 1 relative contraindication to methotrexate therapy?
Embryonic cardiac motion, GS>3.5cm
200
According to PB#94. What percentage of pregnancies that occur after sterilization failure are ectopic implantations?
33% or 1/3
200
What is the most common tubal site of an ectopic pregnancy if the patient conceived by IVF?
Ampullary (make sure you consider heterotopic pregnancy)
200
How soon after the LH surge can chorionic gonadotropin be detected in serum? A. 8-10 days B. 10-12 days C. 12-14 days D. 16-18 days
A. as early as 8 days
300
Name 1 of the 3 risk factors or clinical findings that increase the likelihood of tubal rupture?
Beta > 10000, h/o never used contraception, ovulation induction
300
Practice Bulletin #94 states that patients should be counseled on the common symptoms (side effects) of methotrexate. Name 2 of the 4 "common symptoms"?
Nausea, vomiting, stomatitis, abdominal pain
300
True or false: Retrospective reviews show equivalent subsequent uterine pregnancy rates for patients treated with salpingostomy versus those treated with salpingectomy?
True
300
Nearly 95% of ectopic pregnancies implant in the fallopian tube. Where is the second most common location?
Ovary (3.2%)
300
In a normal intrauterine pregnancy, a gestational sac should be seen within the uterus when the beta hcg is greater than _____ IU/L?
1500-2000
400
Name one of the two forms of contraception that do not increase the relative incidence of an ectopic pregnancy?
Paragard IUD, Barrier methods
400
Methotrexate affects rapidly dividing tissues. Gastrointestinal side effects, such as nausea, vomiting, and stomatitis, are the most common. Name one of the two things that patients should avoid when receiving methotrexate therapy?
NSAIDS and Alcohol
400
Which vascular injury is most commonly encountered with laparoscopic surgery?
Inferior epigastric artery The inferior epigastric artery arises from the external iliac artery and has an anastomosis with the superior epigastric argery
400
When subdiaphragmatic blood is present, what nerve is responsible for the shoulder pain associated with inspiration?
Phrenic
400
Most ectopic pregnancies will have a serum progesterone level between ___ and ___ng/ml, thus limiting the clinical utility of this test?
10-20ng/ml
500
What type of induced abortion is NOT associated with an increased risk of ectopic pregnancy in the future: Conservative, pharmacologically induced, or surgical?
Surgical
500
You are assessing a patient with first trimester bleeding and abdominal pain. Name 3 risk factors that should be asked if you are concerned about an ectopic pregnancy?
Prior surgeries, smoking, prior STD's/PID, prior ectopic, Current IUD use
500
True or False: According to PB#94, treatment with methotrexate versus salpingostomy has shown a decrease in the chance of having another ectopic pregnancy?
False (no difference)
500
What is the most recent reported rate of a heterotopic pregnancy?
1 in 100
500
A patient is seen for an early pregnancy visit. There is no evidence of an intrauterine or ectopic pregnancy on ultrasound. She does not have abdominal pain or bleeding. Her beta increased from 475 to 525 IU/L in 48 hours. What is your next step?
Diagnostic D&C, consider MTX if they can explain the logic
M
e
n
u