ObGyn2

Question 1

Pathogenesis of HELLP syndrome:

Answer 1

Due to abnormal placentation&raquo_space; triggers systemic inflammation and activation of coag system and complement cascade&raquo_space; rapid consumption of platelets and MAHA (microangiopathic hemolytic anemia)&raquo_space; liver damage.

Question 2

Why do you do a CS for breech presentation?

Answer 2

Done to reduce risk of fetal trauma and asphyxia assoc with vaginal delivery (head entrapment). Really it’s more to reduce risk to baby than mom.

Question 3

Treatment for acute PID:

Answer 3

third gen ceph + azithro or doxy

Question 4

Can you use asthma meds (albuterol and beclomethasone) in pregnancy?

Answer 4

Yes, it’s safe.

Question 5

Rx for lactational mastitis:

Answer 5

Dicloxacillin. Covers MRSA and group A strep

Question 6

Rx for breast abscess:

Answer 6

Vanc for MRSA

Question 7

Common risk of continuous prolonged use of OCP that typically resolves when OCP is discontinued:

Answer 7

HTN

Question 8

How do you perform a contraction stress test?

Answer 8

Admin oxytocin or use nipple stimulation until there are 3 contractions for every 10 min.

** Don’t do CST if placenta previa or h/o of myomectomy.

Question 9

Why is pulmonary edema a likely consequence of severe preeclampsia?

Answer 9

Preeclamptic patients have generalized vasospasm&raquo_space; ^ SVR and ^ cardiac afterload. Heart becomes hyperdynamic to overcome systemic HTN. Preeclamptic patients also have decreased renal function, decreased serum albumin, and endothelial damage&raquo_space; ^ capillary permeability.

Manage with supplemental O2, fluid restriction, and gentle diuresis.

Question 10

Multiseptated bilateral cystic masses in a young woman:

Answer 10

Theca lutein cysts. Form due to ovarian stimulation by B-HCG from molar pregnancy and resolve after b-HCG levels decrease.

Question 11

MCC of arrested 2nd stage of labor:

Answer 11

Fetal malpresentation. Arrested second stage of labor occurs when there is no fetal descent after pushing >3 hrs (nulliparous) (2hrs in multi).

Optimal fetal position = occiput anterior (back of head faces pubic symphysis)

Question 12

Shoulder dystocia in a newborn. Kid now has forearm supinated, wrist extended, MCP joints hyperextended and interphalangeal joints flexed. What’s the Dx?

Answer 12

Klumpke palsy (“claw hand”). C8-T1 affected.

Question 13

Shoulder dystocia in a newborn. Kid now has upper arm abducted and internally rotated, elbow extended, forearm supinated with wrist and fingers flexed. What’s the Dx?

Answer 13

Erb Duchenne palsy (waiter’s tip). C5-C6 affected.

Question 14

Rx for endometrial adenocarcinoma:

Answer 14

TAH + BSO. Endometrial AdenoCa is due to prolonged unopposed estrogen exposure.