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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
In OHSS, how is paracentesis performed?
Abdominal or Vaginal | Under USG
26
In OHSS what are the additional tests that can be performed?
``` ADECC ABG D-dimer ECG CXR CT ```
27
In OHSS, what do you look for on General examination?
Hydration, edema (pedal, vulval, sacral) HR, BP, BW.
28
In OHSS, what do you look for on abdominal examination?
Ascites, palpable mass, AG
29
In OHSS, what do you look for on respiratory examination?
pleural effusion, pneumonia, pulmonary edema
30
In OHSS, what are the initial investigations to order?
``` 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
What is the feature of outpatient monitoring of OHSS?
I/O chart Contact details Access advise AVOID NSAIDS
32
What is the main difference in outpatient monitoring of mild-mod and severe OHSS?
LMWH for severe. Duration indivualised as per risk factors and whether conception occurs.
33
When should outpatient OHSS patients be reviewed if they develop signs of worsening OHSS?
Reviewed urgently
34
When should outpatient OHSS patients be reviewed if they don't develop signs of worsening OHSS?
2-3 days
35
What is the single best guide to the depletion of intravascular volume in OHSS?
HCT
36
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
C. Inadequate pain control
37
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
D. unable to maintain adequate oral intake
38
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. Worsening ssx despite outpatient mgt
39
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
C. Unable to attend outpt follow up
40
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
D. critical OHSS
41
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
D. critical OHSS
42
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. Severe OHSS with persistent hemoconcentration and dehydration
43
How often should inpatient OHSS be monitored?
At least once daily
44
How often should inpatient critical OHSS be monitored?
More than once daily
45
How often should inpatient OHSS with complications be monitored?
More than once daily
46
What medication is avoided in OHSS?
NSAID and those contraindicated in pregnancy.
47
What is the most physiological approach to correcting IV dehydration? A. Paracentesis B. Full IVD C. Oral hydration, drinking to thirst D. TPN
C. Oral hydration, drinking to thirst
48
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
B. Persistent hemoconcentration despite volume replacement s and continuous colloids, may requiring invasive monitoring
49
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
C. Persistent oliguria despite adequate fluid replacement and ascetic drainage.
50
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
D. Severe abdominal pain and distension secondary to ascites
51
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
C. SOB secondary to abdominal distension and increased AP
52
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.
D. Oliguria despite adequate volume, secondary to increased IAP causing reduced renal perfusion.
53
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
B. Large amounts of fluids removed by paracentesis
54
When is LMWH indicated in the management of OHSS? A. Severe OHSS B. ARDS C. Severe ascites D. Severe dehydration
A. Severe OHSS
55
When is LMWH indicated in the management of OHSS? A. ARDS B. Critical OHSS C. Severe ascites D. Severe dehydration
B. Critical OHSS
56
When is LMWH indicated in the management of OHSS? A. ARDS B. Severe ascites C. Inpatient management D. Severe dehydration
C. Inpatient management
57
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
C. As per risk factors LMWH +/- TEDS
58
A woman with OHSS several weeks ago presents with neurological ssx. What are the considerations? A. SAH B. ICB C. VTE D. ARDS
C. VTE
59
When is surgery indicated in OHSS?
Concurrent pathology: ovarian torsion, ovarian rupture, ectopic pregnancy.
60
Pregnancies complicated with OHSS maybe at increased risk for: A. Hyperthyroidism B. PE C. GDM D. PP
B. PE
61
Pregnancies complicated with OHSS maybe at increased risk for: A. Hyperthyroidism B. GDM C. PTL D. PP
C. PTL

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