OB
Components of lung volume that increase significantly in pregnancy:
a. Functional residual capacity, expiratory reserve volume, inspiratory capacity
b. Tidal volume, inspiratory capacity, inspiratory reserve volume
c. Functional residual capacity, tidal volume, expiratory reserve volume
d. Tidal volume, functional vital capacity, residual volume
B. Tidal volume, inspiratory capacity, inspiratory reserve volume
Percentage that male factor contributes to infertility in heterosexual couples
40-50%
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A 32-year-old woman presents for routine cervical cancer screening with Pap and human papillomavirus (HPV) co-testing. She has obtained regular cervical cancer screenings since age 21, and she has never received an abnormal result. The results of cytologic evaluation from this visit are normal, but she is positive for HPV subtype 16. What is the most appropriate next step?
a)repeat screening 3 years b) repeat screening 1 year c) repeat screening in 6 months d)colposcopy with biopsy e)excision
d) colposcopy with biopsy
Immediate risk of CIN3+ is 5.3%. Patient needs additional evaluation by colposcopy with biopsy, regardless of the cytology results being negative.
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Genetic dysfunction associated with BRCA1/BRCA2
a)CpG island hypermethylation b)homologous recombination repair c)microsatellite instability d)single-strand DNA adduction e)trinucleotide repeat
b) homologous recombination repair
Surgical wound class for an uncomplicated TLH
Class II: clean contaminated - genital tract entered under controlled conditions without unusual contamination
Explain the physiology of why total thyroid hormone levels increase in the first trimester
(Don't just mention the buzzword)
Increased estrogen -> higher hepatic synthesis rates of thyroid binding globulin (TBG) -> increases the overall amount of thyroid hormones (both T3 and T4) but does not affect the free T3/T4 levels
Williams Obstetrics 26e pg71
Most common parental chromosomal abnormality associated with recurrent pregnancy loss
a) trisomy 21 b) mosaicism c) monosomy 45XO d) balanced translocation
D balanced translocation
Parental karyotypes are recommended for the man and the woman in cases of recurrent pregnancy loss. The goal is to identify reciprocal and Robertsonian translocations, which have a higher loss rate. Approximately 2–5% of couples who experience recurrent pregnancy loss have an abnormal karyotype, and for these couples with abnormal parental karyotypes, preimplantation genetic testing for aneuploidy with in vitro fertilization is recommended.
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The classic triad for urethral diverticulum
3D’s: dysuria (most common), dyspareunia, dribbling post-void
Patients may also be asymptomatic
Name one FIGO/WHO criteria for diagnosing post-molar gestational trophoblastic neoplasia
1. Plateauing of hCG +/− 10% for 4 consecutive values over 3 weeks (i.e., days 1, 7, 14, 21)
2. A rise in hCG levels of ≥10% for 3 values over 2-week period (i.e., days 1, 7, 14)
3. Histologic diagnosis of choriocarcinoma or clinical and/or radiologic evidence of metastases
SGO
2 cystoscopy findings in interstitial cystitis
Hunner's ulcers and glomerulations
Appropriate placement of a vacuum extractor on the fetal head (relative to fontanelles)
Center of vacuum 3-cm anterior to the posterior fontanelle along the sagittal suture
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When to test for serum progesterone as a measure of ovulation
Approximately 1 week before expected onset of next menses (as opposed to day 21)
ASRM Fertility evaluation of infertile women 2021
Recommendations for breast cancer screening in transfeminine individuals
After 50 years of age and a minimum of 5 years of feminizing hormone use
ACOG PB 823
Most common ovarian malignancy detected in pregnancy
Dysgerminoma
A 70-year-old woman presents to ED with abdominopelvic pain and purulent vaginal discharge for 2 weeks. Afebrile with stable vitals. +CMT on exam. WBC 20,000. TVUS 12x8cm multiloculated right adnexal mass. Next step?
a)observation b)oral abx c)IV abx d)IR drainage e)surgical exploration
e) surgical exploration
TOA/pelvic abscesses in postmenopausal patient is strongly associated with underlying malignancy.
CREOG quiz, ACOG PB 174
Calculate APGAR. Floppy, HR 95 bpm, weak cry on suctioning, pale throughout, irregular breathing
3 point
0 points for floppy tone (Activity), 1 point for heart rate < 100 (Pulse), 1 point for weak cry from reflex irritability during noxious stimulus (Grimace), 0 points for color (Appearance), and 1 point for irregular breathing (Respiration)
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2 primary mechanisms of recurrent pregnancy loss in those with septate uterus
- Impaired uterine distension
- Abnormal placentation due to decreased vascularity in the septum
Truelearn question
A 45-year-old woman presents with unilateral, spontaneous, bloody nipple discharge from a single duct of her left breast. Her ultrasound and mammogram are unremarkable. Next best step:
a) cytology of discharge b) ductography c) oral abx d) duct excision e)bromocriptine
d) duct excision
Unilateral, spontaneous, bloody, or serosanginous discharge from a single duct is usually caused by intraductal papilloma or rarely by intraductal cancer. Evaluation should begin with ultrasonography (all ages), with additional diagnostic mammography for women aged 30 years and older (optional in younger women). Women with imaging findings suspicious for malignancy (BI-RADS 4–5) require tissue biopsy. Women with BI-RADS 1–3 imaging results but abnormal discharge generally should undergo duct excision. Ductography or magnetic resonance imaging are optional and can help in planning the excision. (ACOG PB 164)
2 types of gynecologic cancers that include hydronephrosis and/or renal dysfunction in their FIGO staging system
Cervical and vaginal
Pre-op eating instructions per ERAS protocol
Light meal up to 6 hrs before
Clear liquids up to 2 hrs before
Carbohydrate loading drink at 2 hrs before
Number of vials of rhogam needed for pt with 2% fetal RBC's in maternal blood volume of 6000mL
.2 x 6000 = 120 /30 = 4 vials
1 300-mcg vial of rhogam protects against 30 ml fetal whole blood (15 fetal RBCs)
1 clinical and 1 laboratory criteria for diagnosis of antiphopholipid syndrome
Need at least one clinical AND one laboratory criterion for diagnosis
Lab - Elevated levels 12 weeks apart - positive lupus anticoagulant, anticardiolipin IgG or IgM medium or high titer (greater than 40 GPL or MPL, or greater than the 99th percentile), or beta2 glycoprotein IgG or IgM >99%ile
Clinical -
- vascular thrombosis
- 1+ fetal loss (>10 wks GA) of otherwise morphologically normal fetus
- 1+ premature births of morphologically normal neonate before 34 wks due to severe preE/eclampsia or placental insufficiency
- 3+ unexplained CONSECUTIVE SAB before 10 wks, other causes excluded
Fun facts: Medical complications of APS include VTE (most common), AI thrombocytopenia (50%), autoimmune hemolytic anemia, livedo reticularis, cutaneous ulcers, chorea gravidarum, multi-infarct dementia, and transverse myelitis
ACOG PB 132
Difference between the clinical applications of T-score and Z-score on DEXA scan
BONUS +100 - True/false - Calcium and vitamin D supplementation helps prevent osteoporotic fractures
DAILY DOUBLE
T-score - used for diagnosing osteoporosis in POSTmenopausal population. Normal: -1.0+ Osteopenia: between -1.0 to -2.4; Osteoporosis: -2.5 or less
Z-score - used for identifying PREmenopausal patients who may be at risk for secondary osteoporosis and need further evaluation.
Z-score -2.0 or lower is considered below the expected range for age
Bonus - FALSE. Important for bone health and general health, but not preventing osteoporotic fractures in average risk individuals.
Fun facts: FRAX Score >20% = indication for medical therapy.
BMD screening should be repeated no sooner than 2 years for most patients (conditional recommendation, low quality evidence)
ACOG Clinical practice guidelines 1, 2021
31 yo 9 cm R ovarian mass, L/S oophorectomy performed--> granulosa cell tumor confined to ovary, no surface involvement. Pelvic washings negative. Next step? A) PET scan B) endometrial sampling C) comprehensive surgical staging D) adjuvant chemotherapy E) observation
Bonus (+100): what tumor marker (aside from CA-125) is associated with granulosa cell tumor?
B - Elevated estrogen can be found with granulosa cell tumors. Endometrial hyperplasia noted in 25-50% of pts with granulosa cell tumors of the ovary. 5-10% have coexisting endometrial cancer
Bonus: Inhibin, estrogen, AMH
Nerve that can be entrapped in sacrospinous ligament fixation (SSLF). How does it present?
Pudendal nerve. Entrapment causes severe perineal or buttock pain