Oral Board Prep

Question 1

Bleeding in early pregnancy: what 6 DDX do you consider?

Answer 1

1. Pregnancy loss (Ectopic, SAB)
2. UTI/Vaginal Infection
3. Subchorionic hematoma/hemorrhage
4. Cervical Abnormalities
5. Molar Pregnancy
6. Vaginal Trauma

Question 2

How much should HCG rise in a viable pregnancy?

Answer 2

At least 33% if over 3000
48% if over 1500

Question 3

Choices of management in an ectopic pregnancy

Answer 3

Medical: Methotrexate 50mg IM. Follow hCG on day 4 and 7. Rise on day 4 is expected, however must be at least 15% decrease on day 7. If not, follow with second dose of 50mg MTX. F/u weekly until hCG is neg.

Surgical: always offer. Go-to if bleeding or hemo unstable.

Question 4

Patient teaching with methotrexate use?

Answer 4

No folic acid no NSAIDS
Decreased activity and pelvic rest
Wait 3 months before trying agin for pregnancy

Question 5

SAB: definitation and management?

Answer 5

CRL >= 7mm and no heart beat
Gestational sac >= 25mm with no embryo.
Expectant management (may take up to 30 days)
Medical management: Mifepristone 200mg PO and then Misoprostol 800mcg vaginally. May repeat w/in 7 days if needed.
Surgical: D+C. Pelvic rest 1-2 weeks post SAB to prevent infection and promote healing. May try immediately for another pregnancy or immediately for BC.

Question 6

RF for ectopic pregnancy?

Answer 6

IUD, previous ectopic. Hx of damage to FTs, smoking, hx of infertility, AMA, endometriosis.

Question 7

RF for SAB?

Answer 7

Prior SAB, maternal chronic disease, toxins, substance use, infection, uterine anomaly, AMA

Question 8

UTI in pregnancy. 2 medication options for 1st TM

Answer 8

Cephalexin (Keflex) - 250-500mg Q6hr for 5-7 days
Augmentin 875mg q12hr 5-7 days.
2nd TM? Nitrofurantoin 100mg q12hr 5-7 days.

Question 9

BV treatment in pregnancy
Yeast tx in pregnancy

Answer 9

Metronidazole 500mg BID for 7 days

No PO azoles. Miconazole topical vaginally x7 days

Question 10

Tx of G/C in pregnancy

Answer 10

G - x1 IM Ceftriaxone 500mg
C - 1G Azithromycin PO x1

Question 11

Pt education and return precautions regarding Subchorionic hematoma/hemorrhag.

Answer 11

Most resolve on their own within a few weeks.
Beware for increased bleeding and s/s of labor (cramping, LBP, etc)
May decrease activity, pelvic rest, rhogam, serial US. If viable fetus, may do fetal surveillance?

Question 12

RF for SCH?

Answer 12

Uterine irregularity, Hx of uterine infx, trauma, hx of EPL, IVF pregnancy or hypertension.

Question 13

3 possible cervical abnormalities that could cause bleeding in early pregnancy

Answer 13

Friability - increased vascularity in pregnancy
Polyp
Malignancy

Question 14

Molar pregnancy - RF, management

Answer 14

RF: very young or very old maternal, hx of molar pregnancy,
Tx with D+C. Monitor hCG at 48hrs and then every 1-2 weeks until neg.
WAIT 12mo to get pregnant again.