Past CMS OB/GYN Things to Remember

Form 5

• Everyone gets flu vaccine; during pregnancy, the vaccine is the inactivated one

• Because pregnancy is a hypercoagulation state, it increases the risk of developing PE

• If the patient is not immune to Hep B during pregnancy, they get the Hep B vaccine as well

• Amniocentesis mixes maternal blood with fetal blood; if the patient is Rh(D) negative, they need the RhoGAM injection

• If mother has Kell antibodies against RBC antigens, it is likely the fetus will have the RBC antigen, but to know for sure, test the father’s blood; if the father is heterozygous or homozygous for the RBC antigen, further monitoring of the fetus may be necessary to assess for hemolytic disease.

• Severe bleeding from placenta previa can lead to hemorrhagic shock; in such cases, immediate medical intervention is required to stabilize the mother and prepare for potential preterm delivery.

• A patient with achondroplasia has high risk of needing C-section

• If the difference between gestational age and fundal height is greater than normal, ultrasound is the solution; this will help evaluate fetal growth and rule out potential complications such as intrauterine growth restriction (IUGR) or multiple gestation.

• Inadequate contractions lead to arrested labor; contractions should be 200 units over 10 minutes

• In uterine rupture, there is increasing abdominal pain and fetal bradycardia; this is due to lack of necessary blood flow to the fetus as the rupture compromises the uterine and placental integrity, leading to emergency intervention.

• Succenturiate placental lobes = placental accessory lobes connected to the main placenta; non tapering vessels extending to the margin of the membrane

• Maternal fever leads to fetal tachycardia, so it isn’t specific to chorioamnionitis; exquisite tenderness to right lower quadrant = appendicitis

• The best treatment for MSSA mastitis is dicloxacillin

• Not all breast cancers are masses; they can go to the lymph nodes too; if mammography doesn’t reveal anything, the next step is lymph node biopsy

• PID’s main suspects (Chlamydia and gonorrhea) are sexually transmitted, so in addition to treating those two, screenings for other STIs like HIV should be done as well

• Candida is gonna have the branching hyphae; use fluconazole or miconazole

• If leiomyomata uteri is present but patient is asymptomatic (she isn’t complaining of anything), all that is needed is observation; the different treatments like OCPs are used if there is the bleeding/other symptoms

• Chronic anovulation is one of the strongest risk factors for endometrial carcinoma because of much more exposure to estrogen compared to early menarche

• Mature cystic teratomas occur in ages 10 to 30 and show up as echogenic

• Depot medroxyprogresterone is a highly effective contraceptive and can be used if OCPs can’t (DVT history) or IUDs can’t (history of active/recent STI)

• If an adolescent patient wants contraceptives and isn’t symptomatic for STIs, you don’t have to test them, you can go straight to prescribing them low dose contraceptives

• If a patient has AUB and doesn’t wish to be fertile anymore, endometrial ablation is done

• If there is a postmenopausal patient who bleeds heavily, suspect endometrial carcinoma like you would with pregnancy for amenorrhea and go straight for the biopsy assuming the patient is comfortable with it

Form 6

• The best management for GDM is tighter glucose control; that has the greatest impact on pregnancy success

• Indirect Coombs test is done early in pregnancy for Rh negative mothers

• At 28 weeks, RhD Ig is given

• Normal FHR includes 110-160 bpm, minimal variability, and spontaneous accelerations

• Choriocarcinoma has really high values of b-hCG and very severe symptoms; it requires prompt diagnosis and aggressive treatment due to its potential for metastasis.

• When treated properly, hyperemesis gravidarum has no significant adverse effects; however, it is essential to monitor the mother closely for dehydration and electrolyte imbalances.

• Amniotic fluid embolism can lead to coagulation defects and DIC; it will be immediate compared to PE

• Premature rupture of membranes can lead to chorioamnionitis; treatment is antibiotics, but if there is any evidence of distress, immediate C-section

• Puerperal sepsis occurs right after delivery, and C-sections can be a risk factor for this

• In instances of fetal demise (when there is no detectable heartbeat), the next step is urgent delivery, whether that be vaginal or  cesarean removal of fetus, to prevent DIC

• Postpartum endometritis suspects are polymicrobial (same with Bartholin cysts)

• Hemorrhagic or ruptured corpus luteum cysts can cause severe, rapid-onset pelvic pain in hemodynamically stable patients

• Pelvic radiation, retinoblastoma, and tamoxifen (excessive estrogen) cause uterine sarcoma; if the estrogen is balanced by progesterone, the risk decreases

• Even if CIN3 was resected, because it was there, patients will needed Pap smears every year

• There are no contraindications for using the levonorgestrel emergency contraception

• Lethargy, hoarse cry, hypotonia, large fontanelles, dry skin, and constipation are some of the symptoms for congenital hypothyroid; routine screening would help prevent this

• There will be rectal and vaginal bleeding along with vulvar lacerations

Form 8

• The first prenatal appointment’s routine testing includes genetic testing

• The surgery for large ectopic pregnancies is laparoscopy

• If a patient is amenorrheic, unless it already says it, no matter what they present with, all amenorrhea needs to have the pregnancy test first; even if they show menopause early like in this case, you need to rule out pregnancy

• All breast cysts need to be drained with FNA

• If the length of the cervix is less than 25 cm, there is increased risk of cervical insufficiency

• If you can’t see SCJ on colposcopy, go for cone biopsy

• If a patient doesn’t want HIV testing, it helps to explore her reasons and offer again in 6 weeks time; HIV testing should be done at least once during pregnancy

• Pregestational/gestational diabetes can lead to uteroplacental insufficiency, which can lead to stillbirth/IUFD; if there’s an extensive history of diabetes, screening for blood glucose needs to be done

• If there’s multiple bilateral breast cysts, it’s fibrocystic breast changes and should resolve on its own, so have them come back

• Symptoms of hydatidiform moles include first trimester bleeding, abdominal pain, uterine gestational enlargement, persistent nausea and vomiting, and jittery feeling with palpitations (hyperthyroid)

• Nipple excoriation can increase the risk for mastitis

• They won’t always tell you bleeding and pain for uterine rupture, but if they talk about loss of fetal station, this is one of the major symptoms of uterine rupture and is treated with laparotomy

• Corpus luteum must enlarge to support intrauterine pregnancy, meaning corpus luteum cysts will enlarge and can rupture; when it does, its onset is rapid and severe on one side in the lower quadrant; will have the patient come back and give analgesics that are not NSAIDs

• Chronic endometritis will show plasma cells on biopsy

• Ovarian cancer causes GI symptoms

• Of the megaloblastic anemias, folic acid deficiency is more common in pregnancy

• Complete procidentia is severe prolapse of all components of all vaginal compartments, meaning a pretty large mass will be seen and the patient will complain that something is falling out