CF: 11-15

Question 1

22 yo G2P1 cocaine user at 35 wk gestation c/o abd pain and moderate vaginal bleeding/ Her BP in 150/90, HR 110. Fundal tenderness. Normal US. FHR 160s-170s.
Most likely Dx?
4 major Cpx?
Best management for this condition?

Answer 1

Placental abruption
Cpx:
-Hemorrhage
-Fetal-to-maternal bleeding
-Coagulopathy
-Preterm delivery
Deliver since she's >34 wk

Question 2

35 yo G5P4 woman at term w/ PMH myomectomy and C/S is undergoing vaginal delivery. Retained placenta is firmly adherent to the uterus when there’s an attempt at manual extraction.
Most likely Dx?
Next step in management?

Answer 2

Placenta accreta

Hysterectomy

Question 3

23 yo G2P1 woman at 16 wk gestation w/ an 8 cm ovarian cyst c/o 12 hr Hx of colicky RLQ pain w/ n/v. Tenderness in RLQ w/ significant involuntary guarding.
Most likely Dx?
Best treatment?

Answer 3

Ovarian torsion

Surgery (Laparotomy vs laparoscopy)

Question 4

24 yo G1P0 at 28 wk gestation c/o 2 wk duration of generalized pruritis. She’s anicteric and normotensive. No rashes. FHR in 140s.
Most likely Dx?

Answer 4

Intrahepatic cholestasis of pregnancy

Question 5

19 yo G1P0 woman at 20 wk gestation c/o acute onset pleuritic chest pain and severe dyspnea. HR 120 and RR 40. CTAB. Low O2 sat.
Test most likely to lead to Dx (name 2)?
Major concerning Dx?

Answer 5

Spiral CT, MRA

PE

Question 6

What is the best treatment for ovarian torsion (if it’s possible)?

Answer 6

Ovarian cystectomy, which removes only the cyst and leaves the remainder of normal ovarian tissue

Question 7

Which 2 major times in/around pregnancy are women at highest risk of ovarian torsion?

Answer 7

At 14 wk (when uterus rises above the pelvic brim)
Immediately postpartum (when uterus rapidly involutes)

Question 8

Name 6 common, but serious, causes of abdominal pain in pregnancy

Answer 8

1. Appendicitis
2. Torsion
3. Cholecystitis
4. Placental abruption
5. Ectopic pregnancy
6. Ruptured corpus luteum

Question 9

What hormonal change in pregnancy leads to red/carneous degeneration of a uterine fibroid?

Answer 9

High estrogen–> rapid growth of fibroid–> outgrowth of blood supply–> ischemia–> pain

Question 10

What’s the CC of patients with carneous degeneration of a fibroid, and how can you confirm the Dx?

Answer 10

Point tenderness at the fibroid

US

Question 11

Pregnant woman with n/v/a, fever, and RUQ/flank abdominal pain?

Answer 11

Acute appendicitis

Question 12

Why is abdominal pain superior and lateral to McBurney’s point in pregnancy?

Answer 12

Enlarged uterus pushes on appendix, moving it upward and outward toward the flank

Question 13

How do you diagnose acute appendicitis in pregnancy?

Answer 13

Clinically

Question 14

Treatment of acute appendicitis in pregnancy?

Answer 14

Surgery + IV Abx

Question 15

Why does pregnancy predispose to gallstones?

Answer 15

Increase in GB volume + biliary sludge

Question 16

Dx of cholelithiasis?

Answer 16

US

Question 17

Treatment of biliary colic in pregnancy?

Answer 17

Low-fat diet + obs until postpartum

Question 18

Tx of cholecystitis, biliary obstruction, or gallstone pancreatitis in pregnancy?

Answer 18

Surgery (typically after cooling off period)

Question 19

Most freq and serious Cpx of a benign ovarian cyst?

Answer 19

Torsion

Question 20

While doing surgery for ovarian torsion, what determines if you can do cystectomy vs oophorectomy?

Answer 20

If untwisting the adnexa–> reperfusion: cystectomy

If can’t restore perfusion: oophorectomy

Question 21

Leading cause of maternal mortality in 1st and 2nd trimesters?

Answer 21

Ectopic pregnancy

Question 22

Young woman w/ amenorrhea, vaginal spotting, n/v, and sharp/tearing lower abdominal/pelvic pain. PE: slightly enlarged uterus +/- palpable adnexal mass. Dx?

Answer 22

Ectopic pregnancy

Question 23

What 2 major s/s would make you think rupture of ectopic vs just presence of ectopic?

Answer 23

Syncope, hypovolemia

Question 24

2 major aspects of Dx of ectopic?

Answer 24

bhCG and TVUS

Question 25

2 major tx options for ectopic?

Answer 25

MTX vs surgery

Question 26

From what do corpus luteum cysts develop?

Answer 26

Mature Graafian follicles

Question 27

Why can there be hemorrhage in CL cysts?

Answer 27

Thin-walled capillaries invade the granulosa cells from the theca interna–> intrafollicular bleeding

Question 28

What’s the major thing leading to increased risk of rupture of a CL cyst?

Answer 28

Excessive hemorrhage

Question 29

Name 2 RFs for CL cyst rupture

Answer 29

Pregnancy

Anti-coagulants

Question 30

During what times of the menstrual cycle is cyst rupture most common?

Answer 30

Days 20-26

Question 31

Describe typical presentation of hemorrhagic CL cyst

Answer 31

Sudden onset severe lower abdominal pain w/ 1-2 wk Hx of unilateral cramping and lower abdominal pain.

Question 32

US findings for hemorrhagic CL cyst?

Answer 32

Free intraperitoneal fluid +/- fluid around the ovary

Question 33

How do you confirm diagnosis of hemorrhagic CL cyst?

Answer 33

Laparoscopy

Question 34

1st step in tx of ruptured CL cyst? What do you do after this?

Answer 34

Secure hemostasis

• If bleeding stops: you’re done
• If bleeding continues: perform cystectomy

Question 35

Supply of progesterone in pregnancy:
0-7 wk?
7-10 wk?
>10 wk?

Answer 35

0-7 wk: corpus luteum
7-10 wk: corpus luteum + placenta
>10 wk: placena

Question 36

What do you have to give patient if remove CL before 10-12 wk of gest?

Answer 36

Exogenous progesterone

Question 37

Which is an earlier indicator of hypovolemia: positive tilt table test or tachycardia?

Answer 37

Positive tilt table test

Question 38

MCC of hemoperitoneum in early pregnancy?

Answer 38

Ectopic pregnancy

Question 39

Next best step after diagnosis of acute pancreatitis in pregnancy?

Answer 39

US to look for gallstones (MCC of acute pancreatitis in preg)