1. Prego’s, Hoo-ha’s and Beans (oh my!)
Board Review for Ob/Gyn and Renal
Tracie Shea, MD
January 17, 2008

2. What is Chadwick’s sign and when does it develop?

3. Chadwick’s sign is a bluish discoloration of the cervix
Chadwick’s sign is a bluish discoloration of the cervix. It is a sign of pregnancy that develops at 6-8 weeks.

4. What is the normal pCO2 in pregnancy?

5. 30 mmHg
Decreases due to the increases in minute volume.

6. Physiologic Changes of Pregnancy
Pulmonary
 RR and VT
Cardiovascular
 CO and HR
 BP
Renal
 BUN and Cr
 GFR
Heme
 Volume, WBC, D-dimer
 Hgb and platelet

7. Name one physiologic parameter that decreases in pregnancy
Name one physiologic parameter that decreases in pregnancy? (hint: on previous slide)

8. FRC BP
BUN and Cr
Hgb
Platelets

9. What immunization is contraindicated in pregnancy?

10. Any live immunizations.
MMR
Smallpox

11. What is the most common cause of spontaneous abortions?

12. Chromosomal abnormalities Then:
Autoimmune disease
Drugs
Maternal illness
Increased maternal age
Conception early in post partum period

13. What are the general landmarks for gestational height?

14. 12 weeks – Pubic Symphysis
20 weeks – Umbilicus
36 weeks – Costal Margin

15. What is the discriminatory zone for transabdominal ultrasound?
And at what week should a gestational sac be visualized?

16. ß-HCG > 6500 mIU
6 weeks

17. Endovaginal ultrasound?

18. ß- HCG >1500 mIU
5 weeks

19. Name a risk factor for ectopic pregnancy that is not PID or previous ectopic?

20. IUD
Pelvic surgery
Infertility treatments

21. What is the mechanism of methotrexate?

22. Inhibits the formation of nucleosides

23. What are the contraindications for methotrexate use?

24. ß- HCG > 5,000
Evidence of rupture
Active renal or liver disease
Inability to provide/obtain adequate follow up

25. What is the criteria for hyperemesis gravidarum?

26. Ketonemia
Electrolyte disturbance
Loss of >5% of pre-pregnancy weight

27. Ultrasound findings of a molar pregnancy?

28. Snowstorm appearance

29. What is the difference between a complete and partial molar pregnancy?

30. Complete mole- 46 XX- both paternal in origin, no fetal tissue.
Partial mole- 69 XXY- may have viable fetus
ß-HCG higher than expected

31. What is the most sensitive indicator for placental abruption?

32. Fetal distress
Not ultrasound or vaginal bleeding

33. What are the indications for Rh immunoprophylaxis?

34. Any Rh-negative mother who is/may be carrying a Rh-positive baby and are exposed to any event, which puts them at risk for developing isoimmunization.

35. What are the dosings for Rho-GAM and when does it need to be administered?

36. 50 mcg IM < 12 weeks gestation
Must be administered within 72 hours of the event.

37. What is the leading cause of maternal death in preeclampsia?

38. Intracranial hemorrhage

39. What is the treatment for preterm labor?

40. MgSO4 – 6g IV then 2g/hour
Terbutaline 0.25 – 5 mg SQ
Steroids if pt < 34 weeks

41. Signs of amniotic fluid vs. vaginal fluid?

42. “pooling” of fluid in vaginal vault
“ferning” on glass slide
 pH (nitrazine paper turns blue)

43. Define mild preeclampsia

44. BP > 140/90 with proteinuria

45. Define sever preeclampsia

46. BP > 160/90 Or
ANY symptom: oliguria, cerebral or visual disturbances, pulmonary edema, epigastric RUQ pain, impaired LFTs, thrombocytopenia, fetal growth restriction.

47. Treatment for preeclampsia

48. MgSO4 4g IV then 1-2 g per hour
Benzos for seizures
Hydralazine 5mg IV or labetalol 20-40mg IV for BP
Delivery of fetus

49. What is a normal fetal heart rate?

50. bpm

51. Name the 5 measurements of the APGAR score?

52. Appearance (color)
Pulse
Grimace (reflex)
Activity (tone)
Respiration

53. Define HELPP syndrome

54. Hemolysis
Elevated liver enzymes
Low platelets
Address coag deficits

55. How many weeks following the last menses do ectopic pregnancies most commonly present?

56. 5-8 weeks

57. What is the next approach if a nuchal cord is unable to be reduced?

58. The cord should be cut prior to delivery
and the child quickly delivered.

59. What is the treatment for mastitis?

60. Dicloxacillin 500 mg qid x 1 week
1st generation cephalosporin
I&D if necessary

61. POINT TALLY!!!

62. What is the treatment for a bartholin’s abscess?

63. I & D
Place Word catheter
GC/Chlamydia cultures
F/u Ob/Gyn

64. For what length of time should a ward catheter be placed for a Bartholin Abscess?

65. 4-6 weeks

66. What is the 2nd line treatment for GC?

67. Cefixime 400mg PO
1st line- Ceftriaxone 125mg IM

68. What is the 2nd line treatment for Chlamydia?

69. Doxycycline 100mg PO BID x 7d
1st line- Azithromycin 1 gm PO

70. What are the indications for hospitalization for PID?

71. Cannot exclude surgical abdomen
Pregnancy
Failed outpatient treatment
Severe illness (N/V/high fever)
Tubo-ovarian abscess
Inadequate follow-up.

72. What is the inflammation of the liver capsule resulting in adhesions secondary to PID?
What is it commonly caused by?

73. Fitz-Hugh-Curtis Syndrome
N. gonorrhea

74. What should we always consider in older women with tubo-ovarian abscess?

75. Always consider malignancy or diverticular disease.

76. Name some predisposing factors for adnexal (ovarian) torsion.

77. Cyst
Hyperstimulation
Tumor
Pregnancy
PID
Pelvic surgery

78. What is the gold standard for diagnosing ovarian torsion?

79. Laparoscopy
U/S lacks sensitivity and normal blood flow does NOT r/o torsion

80. Most ovarian tumors are derived from what tissue?

81. Epithelial

82. Name some causes of dysfunctional uterine bleeding.

83. Anovulatory states
Polycystic ovarian disease
Weight gain or loss
Eating disorders
Hypothyroidism
Fibroids (leiomyomata)
Exogenous gonadal steroids
IUD
Cervicitis
Coagulopathies
Endometrial hyperplasia/malignancy

84. POINT TALLY!!!

85. In which of the causes of acute renal failure (prerenal, renal or postrenal) is the microscopic urinalysis abnormal?

86. Renal

87. Prerenal vs. Renal (ATN)
Urine sodium > 40 mEq/L
Dilute urine

88. Renal (ATN)

89. Prerenal vs. Renal
Urine/plasma creatinine ratio < 20

90. Prerenal vs. Renal PreRenal Renal < 20 > 40 > 40 < 20
Urine Sodium
Urine/plasma Cr
PreRenal
< 20
> 40
Renal
> 40
< 20

91. What are the indications for emergency dialysis?

92. A – acidosis (pronounced)
E – electrolyte imbalance (esp. hyper K)
I – intoxication (methanol, ethylene glycol)
O – overload (fluid)
U - uremia

93. What is the most common cause of renal azotemia?

94. Acute Tubular Necrosis

95. What is the most immediate life-threatening complication of acute renal failure (ARF)?

96. Hyperkalemia

97. What is the most sensitive test for detecting rhabdomyolysis?

98. Serum creatnine kinase (CK)

99. What are the most important electrolyte abnormality occuring in association with rhabdomyolysis?

100. Hyperkalemia and hypocalcemia

101. Which type of kidney stone occurs in association with chronic UTI’s due to urea-splitting organisms?

102. Struvite Stones

103. Name 2 diseases that produce uric acid stones.

104. Myeloproliferative disease or leukemia
Gout

105. What type of renal stones are radiolucent?

106. Uric acid and xanthine stones

107. What is the most common cause of infection of vascular access in hemodialysis patients?

108. Staphylococcal

109. Most UTI’s are caused by which organism?

110. E. coli

111. What is the definitive diagnosis of UTI based on?

112. Isolating 105 colony-forming units on bacterial culture.
Associated with > 10 WBC per hpf

113. What is the most common cause of nongonococcal urethritis?

114. Chlamydia

115. If a gram stain from a painless penile ulcer reveals Donovan bodies it is indicative of what disease?

116. Granuloma inguinale

117. What is the treatment for granuloma inguinale?

118. Bactrim or doxycycline for a minimum of 3 weeks.

119. What are the predominant causative organisms of Fournier’s Gangrene?

120. Bacteroides fragilis
E. coli

121. Which of the following urologic conditions requires emergency treatment?
Phimosis
Paraphimosis
Peyronie’s disease

122. Paraphimosis

123. Phimosis- inability to retract foreskin
Paraphimosis- inability to replace retracted foreskin back over the glans
Peyronie’s- penile fibromatosis

124. POINT TALLY!!!

125. What is the initial treatment of choice for both reversible and irreversible priapism?

126. Sub Q terbutaline
Along with hydration, oxygen, pain control.
Also can try alpha-agonists, aspiration of corpus cavernosum, HBO
Rarely requires surgery; urology should be consulted

127. What are the most common ages for testicular torsion to occur?

128. First few days of life
Between years

129. What are the “classic” exam findings for testicular torsion?

130. Swollen, firm, high-riding testicle with a transverse lie.
NO cremasteric reflex

131. A positive Tzank smear confirms the diagnosis of what?

132. Herpes simplex
Although this is no longer done. Diagnosis is usually clinical or with PCR testing.

133. What is the organism most likely to cause prostatitis?

134. E. coli Followed by GC/Chlamydia Klebsiella Enterobacter Proteus
Pseudomonas

135. Name the systemic diseases that are associated with orchitis?

136. Syphillis
Mumps
Viral illness
Bacterial spread of epididymitis

137. What are the presenting signs/symptoms of polycystic kidney disease?

138. Pain
Hematuria
Nocturia (due to concentrating deficit)
HTN (renal insufficiency)
UTI’s and pyelonephritis
Family history

139. What is the major cause of staghorn calculi?

140. Urea splitting organism (struvite stones)

141. What imaging modality should be used to diagnose polycystic kidney disease?

142. Ultrasound

143. What is the most common testicular tumor?

144. Seminomas

145. What organism must be considered in patients with recent or indwelling foley catheters with UTIs?

146. Pseudomonas

147. What is the leading cause of perinephric abscess?

148. Pyelonephritis

149. What causes painful penile ulcers?

150. Herpes
Haemophilus ducreyi

151. What is the treatment for H. ducreyi?

152. Single dose:
Azithromycin
Ceftriaxone

153. What is Prehn’s sign and what does it distinguish?

154. Elevation of painful testicle decreases pain
Seen in epididymitis

155. What are some causes of nontraumatic hematuria?

156. GU tumors
Vigorous exercise
Renal disease/infection
Bleeding disorders
Dyes

157. What is the triad of HUS?

158. Hemolytic anemia
Thrombocytopenia
Renal insufficiency

159. Do we treat HUS or TTP with plasma exchange, FFP or Steroids?

160. TTP
Treat HUS with supportive care.

161. POINT TALLY!!!

162. The End