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MRCOG MedExamExpert > OHSS MedExamExpert > Flashcards

OHSS MedExamExpert Flashcards

1
Q

In cycles of conventional IVF, mild OHSS affects how many of cases?

A. 1/2
B. 1/3
C. 1/4
D. 1/10

A

B. 1/3

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2
Q

In cycles of conventional IVF, what is the incidence of mild or severe OHSS?

A. 3-8%
B. 9-11%
C. 15-20%
D. 30%

A

A. 3-8%

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3
Q

Abdominal bloating is a feature of:

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

A. Mild OHSS

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4
Q

Mild abdominal pain is a feature of:

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

A. Mild OHSS

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5
Q

Ovarian size <8cm3 is a feature of:

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

A. Mild OHSS

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6
Q

Moderate abdominal pain

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

B. Moderate OHSS

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7
Q

Nausea +/- vomiting

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

B. Moderate OHSS

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8
Q

USG evidence of ascites

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

B. Moderate OHSS

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9
Q

Ovarian size 8-12cm3

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

B. Moderate OHSS

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10
Q

Clinical ascites +/- hydrothorax

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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11
Q

Oliguria: <300cc/day or <30cc/h

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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12
Q

HCT >0.45

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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13
Q

Hypo Osmolality <282mOsm/kg

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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14
Q

HypoNat <135 mmol/l

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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15
Q

HypoAlb <35g/l

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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16
Q

HykerK >5 mmol/l

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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17
Q

Ovarian size >12cm3

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

C. Severe OHSS

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18
Q

Tense ascites, large hydrothorax

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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19
Q

HCT >0.55

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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20
Q

TWC >25k

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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21
Q

ARDS

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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22
Q

Oliguria/Anuria

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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23
Q

VTE is a feature of

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

D. Critical OHSS

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24
Q

When is outpatient monitoring suitable in OHSS?

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS
D. Critical

A

A. Mild OHSS
B. Moderate OHSS
C. Severe OHSS: selected cases

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25
Q

In OHSS, how is paracentesis performed?

A

Abdominal or Vaginal

Under USG

26
Q

In OHSS what are the additional tests that can be performed?

A 
ADECC
ABG
D-dimer
ECG
CXR
CT
27
Q

In OHSS, what do you look for on General examination?

A

Hydration, edema (pedal, vulval, sacral) HR, BP, BW.

28
Q

In OHSS, what do you look for on abdominal examination?

A

Ascites, palpable mass, AG

29
Q

In OHSS, what do you look for on respiratory examination?

A

pleural effusion, pneumonia, pulmonary edema

30
Q

In OHSS, what are the initial investigations to order?

A 
FBC Hct
CUE: CRP (severity), Urea, Electrolytes
Osm
LFT
Coag
HCG (determines outcome of tx cycle) 
USG: ovarian size, pelvic and abdominal FF, doppler if ?torsion
31
Q

What is the feature of outpatient monitoring of OHSS?

A

I/O chart
Contact details
Access advise
AVOID NSAIDS

32
Q

What is the main difference in outpatient monitoring of mild-mod and severe OHSS?

A

LMWH for severe. Duration indivualised as per risk factors and whether conception occurs.

33
Q

When should outpatient OHSS patients be reviewed if they develop signs of worsening OHSS?

A

Reviewed urgently

34
Q

When should outpatient OHSS patients be reviewed if they don’t develop signs of worsening OHSS?

A

2-3 days

35
Q

What is the single best guide to the depletion of intravascular volume in OHSS?

A

HCT

36
Q

Inpatient management should be considered for which of the following?

A. Mild ascites
B. Severe OHSS
C. Inadequate pain control
D. mild nausea and vomiting

A

C. Inadequate pain control

37
Q

Inpatient management should be considered for which of the following?

A. Mild ascites
B. Severe OHSS
C. mild nausea and vomiting
D. unable to maintain adequate oral intake

A

D. unable to maintain adequate oral intake

38
Q

Inpatient management should be considered for which of the following?

A. Worsening ssx despite outpatient mgt
B. Mild ascites
C. Severe OHSS
D. mild nausea and vomiting

A

A. Worsening ssx despite outpatient mgt

39
Q

Inpatient management should be considered for which of the following?

A. Severe OHSS
B. Mild ascites
C. Unable to attend outpt follow up
D. mild nausea and vomiting

A

C. Unable to attend outpt follow up

40
Q

Inpatient management should be considered for which of the following?

A. Severe OHSS
B. Ovarian size 8-12cm3
C. nausea and vomiting
D. critical OHSS

A

D. critical OHSS

41
Q

When should MDT be considered in the management of OHSS?

A. Severe OHSS
B. Ovarian size 8-12cm3
C. nausea and vomiting
D. critical OHSS

A

D. critical OHSS

42
Q

When should MDT be considered in the management of OHSS?

A. Severe OHSS with persistent hemoconcentration and dehydration
B. Ovarian size 8-12cm3
C. nausea and vomiting
D. Hydrothorax

A

A. Severe OHSS with persistent hemoconcentration and dehydration

43
Q

How often should inpatient OHSS be monitored?

A

At least once daily

44
Q

How often should inpatient critical OHSS be monitored?

A

More than once daily

45
Q

How often should inpatient OHSS with complications be monitored?

A

More than once daily

46
Q

What medication is avoided in OHSS?

A

NSAID and those contraindicated in pregnancy.

47
Q

What is the most physiological approach to correcting IV dehydration?

A. Paracentesis
B. Full IVD
C. Oral hydration, drinking to thirst
D. TPN

A

C. Oral hydration, drinking to thirst

48
Q

When should the management of OHSS require anesthetic input?

A. Critical OHSS
B. Persistent hemoconcentration despite volume replacement s and continuous colloids, may requiring invasive monitoring
C. Paracentesis
D. VTE

A

B. Persistent hemoconcentration despite volume replacement s and continuous colloids, may requiring invasive monitoring

49
Q

When should diuretics be considered in the management of OHSS?

A. Critical OHSS
B. Paracentesis
C. Persistent oliguria despite adequate fluid replacement and ascetic drainage.
D. VTE

A

C. Persistent oliguria despite adequate fluid replacement and ascetic drainage.

50
Q

What are the indications for paracentesis?

A. Mild abdominal pain
B. Mild abdominal distension
C. Abdominal distension
D. Severe abdominal pain and distension secondary to ascites

A

D. Severe abdominal pain and distension secondary to ascites

51
Q

What are the indications for paracentesis?

A. Mild abdominal pain
B. Mild abdominal distension
C. SOB secondary to abdominal distension and increased AP
D. Severe abdominal pain

A

C. SOB secondary to abdominal distension and increased AP

52
Q

What are the indications for paracentesis?

A. Mild abdominal pain
B. Mild abdominal distension
C. Severe abdominal pain
D. Oliguria despite adequate volume, secondary to increased IAP causing reduced renal perfusion.

A

D. Oliguria despite adequate volume, secondary to increased IAP causing reduced renal perfusion.

53
Q

When is IV Colloids indicated in the management of OHSS?

A. Gross hydrothorax
B. Large amounts of fluids removed by paracentesis
C. Severe ascites
D. Severe dehydration

A

B. Large amounts of fluids removed by paracentesis

54
Q

When is LMWH indicated in the management of OHSS?

A. Severe OHSS
B. ARDS
C. Severe ascites
D. Severe dehydration

A

A. Severe OHSS

55
Q

When is LMWH indicated in the management of OHSS?

A. ARDS
B. Critical OHSS
C. Severe ascites
D. Severe dehydration

A

B. Critical OHSS

56
Q

When is LMWH indicated in the management of OHSS?

A. ARDS
B. Severe ascites
C. Inpatient management
D. Severe dehydration

A

C. Inpatient management

57
Q

How should VTE prophylaxis in women with mod OHSS be?

A. LMWH
B. TEDS
C. As per risk factors LMWH +/- TEDS
D. Ambulation and hydration

A

C. As per risk factors LMWH +/- TEDS

58
Q

A woman with OHSS several weeks ago presents with neurological ssx. What are the considerations?

A. SAH
B. ICB
C. VTE
D. ARDS

A

C. VTE

59
Q

When is surgery indicated in OHSS?

A

Concurrent pathology: ovarian torsion, ovarian rupture, ectopic pregnancy.

60
Q

Pregnancies complicated with OHSS maybe at increased risk for:

A. Hyperthyroidism
B. PE
C. GDM
D. PP

A

B. PE

61
Q

Pregnancies complicated with OHSS maybe at increased risk for:

A. Hyperthyroidism
B. GDM
C. PTL
D. PP

A

C. PTL

MRCOG MedExamExpert (4 decks)

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