OB/GYN Emergencies

Question 1

A patient who is over 20 weeks pregnant presents with painless vaginal bleeding. What should be deferred until placenta previa can be ruled out?

Answer 1

pelvic exam

Question 2

What are clinical signs of PCOS?

Answer 2

obesity, hirsutism, dysmenorrhea, acne

Question 3

Symptomatic patients with what HCG level are more likely to have an ectopic pregnancy?

Answer 3

> 1000 mIU/mL

Question 4

Appropriate STI test for suspected PID

Answer 4

NAAT

Question 5

How would you distinguish between vulvovaginitis and foreign body in a prepubertal patient with bloody vaginal discharge?

Answer 5

vulvovaginitis would itch and foreign body would smell

Question 6

What would be your top two diagnoses for a premenopausal patient who is not pregnant but presents with vaginal bleeding?

Answer 6

ruptured ovarian cyst and ovarian torsion

Question 7

What is your primary concern in a peri- or post-menopausal woman who presents with vaginal bleeding?

Answer 7

endometrial cancer

Question 8

What do women who are Rh neg need after ANY bleeding episode while pregnant?

Answer 8

Rhogam

Question 9

What type of miscarriage is characterized by a closed cervix, positive fetal cardiac activity, and no cramping?

Answer 9

threatened miscarriage

Question 10

What type of miscarriage is characterized by an open cervical os, no fetal cardiac activity, bleeding, and cramping?

Answer 10

inevitable miscarriage

Question 11

What is your suspected diagnosis for a pregnant patient who has moderate/severe cramps, bleeding, open cervical os and a boggy uterus?

Answer 11

incomplete miscarriage

Question 12

What are the following conditions risk factors for: previous ectopic pregnancy, tubal surgery, hx of PID, fertilization treatment

Answer 12

ectopic pregnancy

Question 13

Most common symptom of ectopic pregnancy

Answer 13

abdominal pain

Question 14

What is the most helpful imaging technique to determine if an intrauterin pregnancy is present?

Answer 14

transvaginal US

Question 15

Where is the most common location of an ectopic pregnancy?

Answer 15

fallopian tubes

Question 16

What is your next step in a suspected ectopic pregnancy is the TUS is inconclusive and the patient is stable?

Answer 16

follow serial quantitative hCG’s

Question 17

What is the appropriate treatment for a patient with a hetertopic pregnancy (an intrauterine & an extrauterine gestation are concomitant) if the mother is stable?

Answer 17

consider methotrexate and an OB consult

Question 18

What is the abx treatment for cervicitis secondary to infection?

Answer 18

rocephin 250mg IM and 1 g PO azithromycin

Question 19

Name two antenatal corticosteroids that enhance lung maturation lung and induce lung enzymes in preterm fetus

Answer 19

betamethasone 12mg IM 2 doses 24 hrs apart or dexamethasone 6mg IM 4 doses 12 hrs apart

Question 20

Why are coag studies and 4 units of typed and cross-matched blood needed for management of placenta previa if patient is acutely bleeding?

Answer 20

can develop DIC

Question 21

What tocolytic agent can be given to manage a stable patient with placenta previa if they are having contractions?

Answer 21

magnesium sulfate

Question 22

What are indications of fetal distress?

Answer 22

lack of variability, late decelerations, sinusoidal pattern, and HR <120 bpm

Question 23

Should be discontinued in situations of fetal distress and tocolytics should be considered for continued distress with contractions

Answer 23

utertonic drugs

Question 24

Pregnant patient presents with uterine bleeding, abdominal pain/contractions, and fetal distress

Answer 24

placental abruption

Question 25

2 BP measurements 6 hrs apart >140/90 and usually proteinurea >0.1 g/L on urine dipstick or > 300 mg protein 24 hr

Answer 25

mild pre-eclampsia

Question 26

2 BP measurements 6 hrs apart > 160/110, proteinurea > 5 g/L, and oliguria <500 ml in 24 hrs

Answer 26

severe pre-eclampsia

Question 27

How many weeks should a baby be before considering delivery of mild pre-eclampsia?

Answer 27

at least 37 weeks

Question 28

First sign of hypermagnesemia after delivering magnesium sulfate to woman with severe pre-eclampsia for the prevention of seizures

Answer 28

loss of reflexes

Question 29

The occurrence of 1 or more general tonic-clonic seizures or coma in a preeclamptic woman

Answer 29

ecclampsia

Question 30

Medications used to lower blood pressure and stop seizures in ecclamptic patient

Answer 30

hydralazine or labetolol to lower BP. lorazepam or diazepam to stop seizures

Question 31

What is a patient who experiences a death in utero during the 2nd and 3rd trimesters at greater risk if they’ve had a prior c-section?

Answer 31

uterine rupture with induction of labor

Question 32

During a breech delivery, what is checked in addition to pulling down a small loop to prevent traction after the trunk has been delivered up to the scapula?

Answer 32

cord pulsation

Question 33

What position should a babies head be during a breech delivery and can be maintained by applying suprpubic pressure?

Answer 33

flexion

Question 34

Manuever done for shoulder dystocia where two assistants sharply flex the maternal thighs back against the abdomen. suprapubic pressure is applied with palm or fist

Answer 34

McRoberts maneuver

Question 35

Manuever done for shoulder dystocia where clinician places one hand in vagina behind poterior shoulder rotates it antior toward fetal face.

Answer 35

Rubin maneuver