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I want a baby now!
Antepartum Fetal Surveillance
I have this other problem...
It's gettin' hot in heerrre
My ovary hurts
100
What is the best surrogate marker for oocyte quality?
Age
100
Name 5 maternal conditions and 5 pregnancy conditions that warrant antenatal fetal surveillance.
Maternal conditions: DM, HTN, SLE, Chronic renal disease, Antiphospholipid syndrome, Hyperthyroidism (poorly controlled), Hemoglobinopathies (sickle cell, sickle cell– hemoglobin C, or sickle cell–thalassemia disease),Cyanotic heart disease Pregnancy-related conditions: GHTN, PreE, Decreased fetal movement, GDMA (poorly controlled or medically treated), Oligohydramnios, Fetal growth restriction, Late term or postterm pregnancy, Isoimmunization, Previous fetal demise (unexplained or recurrent risk), Monochorionic multiple gestation (with significant growth discrepancy)
100
What T score diagnoses osteoporosis? What class of medications are considered first line treatment?
lesser than or equal to -2.5; bisphosphonates
100
In a women with a uterus, when can estrogen alone be used for HRT?
Vaginal estrogen for vaginal atrophy sx
100
When should an adnexal mass be evaluated by a Gyn Oncologist? (5)
What is 1. elevated CA-125 (over 200 if premenopausal); 2. Ascites; 3. nodular or fixed pelvic mass (if postmenopausal); 4. Evidence of abdominal or distant mets; 5. FHx of breast or ovarian CA in 1st degree relative
200
Name 5 risk factors for reduced ovarian reserve?
1. age >35; 2. FHx of early menopause; 3. genetic conditions (45X mosaicism); 4. Fragile X premutation carrier; 5. conditions that cause ovarian injury (endometriosis, pelvic infection); 6. prior ovarian surgery; 7. oophorectomy; 8. use of gonadotoxic meds; 9. pelvic irradiation; 10. smoking
200
Define the components of a BPP
Nonstress test Fetal breathing movements—one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes Fetal movement—three or more discrete body or limb movements within 30 minutes Fetal tone—one or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand AFI
200
How often should these colon cancer screening tests be performed? 1. Colonoscopy 2. Flex Sigmoidoscopy 3. FOBT 4. Fecal Immunochemical Test (FIT)
1. every 10 years; 2. every 5 years; 3. annually; 4. annually
200
What is the incidence rate of VTE with combination HRT expressed in patient years as demonstrated in the WHI study?
What is 2.4/1000 patient years. (Incidence on no hormones --> 1.6/1000 patient years)
200
What is a woman's lifetime risk of developing ovarian cancer?
What is 1 in 70
300
What is the appropriate work up for ovarian reserve by a generalist?
FSH, estradiol. Can also consider AMH, antral follicle count
300
What is considered an adequate contraction stress test? Name the possible outcomes and their definitions
An adequate uterine contraction pattern is present when at least three contractions persist for at least 40 seconds each in a 10-minute period. Negative: no late or significant variable decelerations Positive: late decelerations after 50% or more of contractions (even if the contraction frequency is fewer than three in 10 minutes) Equivocal–suspicious: intermittent late decelerations or significant variable decelerations Equivocal: FHR decelerations that occur in the presence of contractions more frequent than every 2 minutes or lasting longer than 90 seconds Unsatisfactory: fewer than three contractions in 10 minutes or an uninterpretable tracing
300
What is the most common class of medications associated with sexual dysfunction?
SSRIs
300
Name 3 non-hormonal medications that have shown benefit for reduction of menopausal sx
What is paroxetine, gabapentin, clonidine
300
Name that tumor: 1. Schiller Duval bodies 2. Psammoma bodies 3. Call-Exner bodies 4. Signet ring
1. Endodermal sinus 2. Papillary serous 3. Granulosa cell 4. Krukenberg tumor
400
Who should receive ovarian reserve testing?
Women over 35 who have not conceived after 6 month and women at risk for diminished ovarian reserve
400
What definition of oligo should be used when making decisions for delivery?
What is single deepest vertical pocket. The available data from RCTs indicate that the use of the deepest vertical pocket measurement, as opposed to the amniotic fluid index, to diagnose oligohydramnios is associated with a reduction in unnecessary interventions without an increase in adverse perinatal outcomes
400
What medications should be offered to a patient that presents after a sexual assault
Flagyl, Azithromycin, Ceftriaxone, post-exposure prophylaxis for HIV, emergency contraception
400
The Women's Health Initiative showed an increased risk of what 4 things when taking combined estrogen and progesterone HRT? After 5 years of combined HRT, there was a decreased risk of what 2 things?
Increased risk - breast CA, stroke, coronary heart dz, VTE Decreased risk - fractures, colon CA Estrogen only shows an increased risk of only VTE/stroke
400
Name the FIGO Stage: 1. Tumor limited to both ovaries with surgical spill during removal 2. Extension &/or implant on uterus &/or fallopian tube 3. Pleural effusion with positive cytology
1. IC1 2. IIA 3. IVA
500
How is a clomid challenge test performed?
Measure FSH on CD3. Give 100mg clomid on CD 5-9. Measure FSH on CD10. Elevated FSH on CD10 = poor ovarian reserve.
500
Umbilical artery and other doppler velocemitry studies should only be used in fetuses with what condition?
What is growth restriction.
500
What is the medical eligibility criteria category for OCPs in the following conditions? 1. Current breast CA 2. First degree relative with VTE 3. Current gallbladder disease 4. SLE with positive or unknown antiphospholipid Ab
1. 4 2. 2 3. 3 4. 4
500
This estrogen agonist/antagonist has been FDA approved to treat moderate to severe dyspareunia in postmenopausal women. It has been shown to improve vaginal atrophy without stimulating the endometrium.
What is ospemifene (Osphena) Side effects include hot flushes, vaginal discharge, muscle spasms, genital discharge, excessive sweating.
500
Name that tumor! 1. CA 125 2. LDH 3. AFP 4. HCG 5. Inhibin 6. CA 19-9
What is 1. Epithelial; 2. Dysgerminoma; 3. Endodermal sinus (most germ cell tumors); 4. Embyonal carcinoma; 5. Granulosa cell; 6: Mucinous