Ob

Question 1

Prenatal vitamin contents

Answer 1

• doesn’t have to have iron
• should have 200 mg DHA for brain development
• should have 400 mcg folate

Question 2

short interval pregnancy

Answer 2

<18 months, <6 mths associated with even more complications

- in women with prior c/s short interval pregnancy increases risk of uterine rupture and post-partum hemorrhage

Question 3

New name vulvovaginal atrophy

Answer 3

Genitourinary symptoms of menopause (GSM)

Question 4

Tx GSM

Answer 4

• vaginal lubricants
• vaginal E
• Intrarosa (prasterone)
• osphena (ospemifene)

Question 5

Intrarosa (prasterone)

Answer 5

• synthetic form DHEA

- vaginal tx GSM

Question 6

Osphena (ospemifene)

Answer 6

• oral SERM

- used to tx moderate to severe dyspareunia and vaginal dryness

Question 7

lichen sclerosus

Answer 7

• chronic inflammatory dermatitis
• assoc with autoimmune and hypoE states
• severe pruritus and dyspareunia
• epithelial thinning and inflammation
• white, thin plaques on vulva but also involve perianal
• should get bx due to increased risk SCC

Question 8

tx lichen sclerosus

Answer 8

• ointment preferred
• clobetasol 0.05% bid, then 1-2 x/wk for 2 mths
• topical calcineurin inhibitor (pimecrolimus 1%) if severe and refractory to steroids

Question 9

lichen planus

Answer 9

• autoimmune condition
• T-cell mediated
• more 40-60 y/o
• can affect any skin or mucosal surface
• bright red vestibular patches, hyperkeratotic borders
• net-like plaque (wickham striae)
• should have bx

Question 10

tx lichen planus

Answer 10

• topical clobetasol 0.05% bid, then 1-2/wk for 2 mths
• may need additional steroid bursts
• risk of scarring and adhesions
• use intravaginal suppository of hydrocortisone acetate 25 mg to prevent

Question 11

lichen simplex chronicus

Answer 11

• lichenification (thickening) of vulvar skin due to chronic excoriation
• often associated with other atopic conditions
• intense pruritus, often affects sleep

Question 12

tx lichen simplex chronicus

Answer 12

• tx underlying infection
• avoid irritants
• mod potency steroids (triamcinolone 0.1% bid)
• high potency for 2-4 weeks
• hydroxyzine

Question 13

vulvodynia

Answer 13

• vulvar pain without identifiable cause
• occurs for at least 3 mths
• primary if always present
• secondary if normal prior
• need to r/o other causes (infection, trauma, cancer)
• dx with pressure testing with cotton swab

Question 14

vulvodynia tx

Answer 14

• avoid tight clothing and irritants
• pelvic floor PT
• CBT