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Women's Health EOR Exam Questions with Verified Answers.
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Women's Health EOR Exam Questions with Verified Answers.Women's Health EOR Exam Questions with Verified Answers.
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Women's Health EOR Exam Questions with VerifiedAnswers.
4 abnormal patterns of labor - Correct Answer 1) Prolonged latent phase
2) Protraction
3) Arrest
4) Precipitate labor
A normal umbilical cord has ___ arteries, ___ veins - Correct Answer 2 arteries and 1
vein,
Single artery is most common abnormality, can be a sign of other congenital
abnormalities in 25% of these cases
Abnormal fetal lie in delivery - Correct Answer transverse of oblique
20 times greater incidence of cord prolapse
Prompt cesarean is MANDATORY with onset of labor or rupture of membranes
Prolapsed extremity constitutes Compound presentation
-do not attempt to reposition fetal extremity other than pinching digits
Abnormal labor pattern - Arrest - Correct Answer dilatation none for 2 hours or more,
descent none for 1 hour or more
-if NO fetopelvic disproportion and contractions not optimal, then oxytocin used
Abnormal labor pattern - Precipitate labor - Correct Answer delivery in less than 3 hours
from onset of contractions,
-precipitate dilation - 5 cm/hr in primi, 10 cm/hr in multi
-lateral position to prevent compression of IVC
-if FHR abnormal with uterine activity persists despite no oxytocin, admin beta-mimetic
Abnormal labor pattern - Prolonged latent phase - Correct Answer more than 20 hrs in
null, 14 hours in multi
-oxytocin TOC for immediate delivery
Abnormal Labor pattern - Protraction - Correct Answer dilatation less than 1.2 cm/h in
null, 1.5 cm/h multi
-descent less than 1 cm/h null, 2 cm/h multi
-second stage longer than 2 hrs null, 1 hrs multi, (3/2 with anesthesia)
-does NOT respond to oxytocin if adequate contractions already, cesarean if fetopelvic
disproportion
abnormalities of pelvic structure for labor - pelvis types - Correct Answer 1) Gynecoid -
most common (50%), pelvic inlet oval, transverse slightly greater than AP
2) Android - 33% white, 15% black, inlet wedge shaped, persistent OP and transverse
arrest
3) Anthropoid - half of blacks 20% of whites, inlet is oval but AP greater than transverse
,4) Platypelloid (3%) - transverse much wider than AP, deep transverse arrests
ABO hemolytic dz of newborn - Correct Answer much milder than Rh incompatibily
-those affected are almost always group A or B infants of Group O mothers
-neonatal DIRECT coombs may be positive or negative
40-50% can occur in first born infant (vs 1-2% for Rh)
early onset of neonatal jaundice (at < 24hrs), variable elevation of indirect bilirubin
-kernicterus almost never occurs with ABO
abruptio placenta essentials of dx - Correct Answer unremitting abdominal (uterine) or
back pain
irritable, tender, and often hypertonic uterus
visible or concealed hemorrhage
evidence of fetal distress may or may not be present, depending on the severity of the
process
absolute contraindications for induction of labor - Correct Answer contracted pelvis
placenta previa
uterine scar from previous classical c-section, myomectomy, hysterotomy, or unification
surgery
transverse lie
abx for PROM - Correct Answer ampicillin 2g and erythromycin 250mg IV q6h for 48
hours then
amoxicillin 250mg and erythromycin 333mg PO q8h for 7 days
ACS guidelines for the testing for CIN and cervical cancer - Correct Answer all women
21 years old or 3 yrs after coitarche
-once 30 and 3 consecutive negative, can be q3yr
-dc at age 70 if 3 neg in preceding 10yr
adenocarcinoma in situ of cervix - Correct Answer 25% of all cervical cancers
-conization is required to make dx
-hysterectomy in all except young pts with negative margins who wish to remain fertile
adenomyosis definition and essentials of dx - Correct Answer the presence of
endometrial glands and stoma within the myometrium of the uterus, beneath the
basement membrane
-premenstrual and comenstrual dysmenorrhea
-uniform and symmetric uterine enlargement
-menorrhagia
common 20-65%
adenomyosis physical exam and clinical findings - Correct Answer uterus is uniformly
enlarged and boggy
fundus is generally the site
,classic pt - middle aged with menorrhagia and dysmenorrhea with a symmetrically
enlarged uterus
uterus is tender and slightly sofened under bimanual exam performed premenstraully
(Halban's sign)
adolescents and young women with dysfunctional uterine bleeding - Correct Answer
physical exam (pelvic if possible) and US must be performed
oral estrogens should be adequate for most
for acute hemorrhage, high dose estrogen IV
OCPs at 3-4 times normal dose then titrated down
medroxyprogesterone acetate 10mg/d x 10d for proliferative endometrium
advantages of OCPs - Correct Answer reduction in risk of ovarian (40-80%) and
endometrial (50%) cancer, ectopic pregnancy, PID,
protection against BMD loss, development of colon CA, and RA
reduces menstrual blood loss and dysmenorrhea
30-50% decrease in fibrocystic dz of breast
agressive fibroadenoma - Correct Answer cystosarcoma phyllodes - grow rapidly
will reoccur if inadequately excised, must have clear margins
alcohol and pregnancy - Correct Answer precise level of alcohol consumption that
causes adverse effects has NOT yet been established
Fetal Alcohol Syndrome - growth retardation, facial dysmorphology (microcephaly and
microphthalmia), CNS deficit, other
NO exact dose-response relationship
-should be avoided completely
altered bladder function in pregnancy - Correct Answer vascular engorgement of the
pelvis and hormonal changes are responsible
-late in pregnancy when pressure on bladder by uterus and fetal presenting part
worsens
Dysuria or hematuria NEVER normal
amniotomy - Correct Answer should not be routinely performed,
discredited as means of induction when used alone
increases risk of chorioamniointis, need for antibiotics, and cord prolaspse
may provide information on amniotic fluid
may increase uterine contractility
used when internal fetal or uterine monitoring is required
helpful when enhancement of uterine contractility in the active phase of labor is
indicated
record fetal heart rate before during and immediately after the procedure
amniotomy - Correct Answer therapuetic rupture of membranes has been discreditied
as a means of induction with used alone
, -increases risk of chorioamnionitis and need for abx
-risk of cord prolapse if presenting part is not engaged
-should NOT be performed routinely
-used when internal fetal or uterine monitoring is required
-enhancement of uterine contractility in active phase
palpate for umblical cord and avoid dislodging fetal head
amniohook used
Anesthetic of choice for cesarean delivery - Correct Answer SPINAL - quicker than
epidural, immediate onset
absence of drug transmission to fetus
technique is NOT difficult, simpler than epidural
achieves good relaxation of pelvic floor and lower birth canal
(2.5mg bupivacaine and 25 ug fentanyl)
Disadvantages - more profound and rapid hypotension, more frequent N/V
GENERAL anesthesia is most suitable for URGENT cesarean
antepartum care of GDM - Correct Answer DM has triple the risk of asymptomatic
bacteriuria
end organ dz gets NST twice weekly or BPP starting at 32 weeks gestation
insulin use - same at 34 wks, diet only at 36 wks
assessment for fetal lung maturity for elected delivery at less than 38 wks, lung maturity
is delayed with poor glycemic control
tocolysis for 48 hrs for glucocorticoid to take effect (no terbutaline), should have insulin
infusion if necessary
antibodies L/D/K - Correct Answer Lewis lives
Duffy dies
Kelly kills
antiHTN therapy in pregnancy - Correct Answer 1) Methydopa - centrally acting alpha
agonist 500mg to 2g divided bid-qid
-may cause positive direct Coombs' and hemolytic anemia, dc
2) Labatelol - alpha1/nonselective beta blocker, 100mg BID to max of 2400mg daily,
titrate no more than 200mg BID
3) Nifedipine - 30mg qd initially, NTE 60-90mg, caution with mag sulfate
avoid diuretics, ACE are CI
appearance of PID on US - Correct Answer ACUTE - "cogwheel sign" - incomplete
septation of the tubal wall
CHRONIC - "beaded string" - thin tubal wall
ASC-US next step - Correct Answer treat underlying condition if present - vaginitis
ASC-US only (no HPV test) - repeat q6m until 2 neg
most cost effective to test for high risk HPV after ASC-US result
-ASC-US and high risk HPV pos - colpo
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