OBGYN #4

Question 1

When does premature rupture of membranes occur?

Answer 1

Prior to 37 weeks gestation

Question 2

Symptoms of PROM

Answer 2

Gush of fluid or persistent leakage form vagina

Question 3

Diagnostics for PROM

Answer 3

• sterile speculum exam: pooling of secretions
• Nitrazine paper test: turns blue if pH > 6.5
• Fern test: amniotic fluid dries in a fern pattern

Question 4

90% will go into spontaneous labor within _____ hours after PROM

Answer 4

24 hours

Question 5

If under 34 weeks, administer ______ (Betamethasone) to enhance fetal lung maturity

Answer 5

Corticosteroids

Question 6

MC location of ectopic pregnancy implantation

Answer 6

Ampulla of fallopian tube

Question 7

Risk Factors for ectopic pregnancy

Answer 7

• Previous ectopic pregnancy
• History of PID
• IUD use
• Infertility
• Smoking
• Multiple Partners

Question 8

Symptoms of Ectopic Pregnancy

Answer 8

• Adnexal mass
• Cervical motion tenderness
• Triad: unilateral pelvic pain, vaginal bleeding, amenorrhea

Question 9

Symptoms of a ruptured ectopic pregnancy

Answer 9

• Severe abdominal, left shoulder pain (Kehr Sign)
• N/V
• Dizziness
• Syncope
• Hypotension
• Tachycardia

Question 10

What is endometriosis

Answer 10

Implantation of endometrial tissue outside the uterus

Question 11

MC location for endometriosis

Answer 11

Ovaries

Question 12

Risk factors for endometriosis

Answer 12

• Prolonged estrogen exposure (nulliparity, late first pregnancy, early menarche, family history, heavy menstruation)
• Age 25-35

Question 13

Symptoms of endometriosis

Answer 13

• Classic triad: cyclic premenstrual pelvic pain, dysmenorrhea, dyspareunia
• Fixed, retroverted uterus

Question 14

Initial imaging study of choice for endometriosis

Answer 14

US

Question 15

What is the definitive diagnosis for endometriosis

Answer 15

-Laparoscopy with biopsy

Question 16

Treatment for endometriosis

Answer 16

• Medical: combined OCPs first line. NSAIDs for pain.
• Surgical: Laparoscopy with ablation (if fertility desired)
• Total hysterectomy and bilateral salpingo-oophorectomy if no fertility desired

Question 17

Infection of the decidua (pregnancy endometrium)

Answer 17

Endometritis

Question 18

What is the biggest risk factor for endometritis

Answer 18

C-section

Question 19

Symptoms of endometritis

Answer 19

• Fever
• Tachycardia, abdominal pain
• Uterine tenderness 2-3 days after C-section

Question 20

Management for endometritis post C-section

Answer 20

Clindamycin + Gentamicin

• May add Ampicillin
• Augmentin is alternative

Question 21

Prophylaxis for Endometritis

Answer 21

Cefazolin x 1 dose during C-section

Question 22

MCC of Pelvic Inflammatory Disease

Answer 22

-Usually mixed (Chlamydia and Gonorrhea)

Question 23

Symptoms of PID

Answer 23

• Lower abdominal tenderness
• Fever
• Purulent Cervical discharge
• Cervical motion tenderness (Chandelier Sign)

Question 24

Diagnostics for PID

Answer 24

• Pregnancy test (rule out ectopic pregnancy)
• NAAT for Gonorrhea and Chlamydia
• Laparoscopy is the most specific

Question 25

Outpatient management for PID

Answer 25

• Ceftriaxone + Doxy

- Metronidazole often added

Question 26

Inpatient management for PID

Answer 26

-Cefoxitin or Cefotetan + IV Doxy

Question 27

Physical exam findings of an ectopic pregnancy?

Answer 27

• Adnexal mass
• Cervical motion tenderness
• Unilateral pelvic pain + amenorrhea + vaginal bleeding

Question 28

Diagnostics for ectopic pregnancy

Answer 28

• Quantitative beta-hCG: confirms pregnancy (fails to double)
• Transvaginal US: absence of gestational sac with HCG > 2,000

Question 29

Management of a stable ectopic pregnancy

Answer 29

-Methotrexate (destroys trophoblastic tissue)

Question 30

Management of unstable/ruptured ectopic pregnancy

Answer 30

-Laparoscopic salpingostomy

Question 31

What should be done after management of an ectopic pregnancy?

Answer 31

Beta HCG serial to make sure it returns to 0

-Contraception should be used for at least 2 months after