OB GYN Exam Questions

Based on the American Board of Obstetrics and Gynecology format.

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  • Just like you'll see on the actual exam
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Sample Stem:

A 20-year-old gravida 1 para 0 woman presents to you at 20 weeks of gestation with complaints of fever, dysuria, and right flank pain since yesterday. She is having shaking chills and her extremities are cool and clammy.

Her temperature is 38.5 °C, heart rate is 120 beats/minute, blood pressure is 80/50 mm Hg (mean arterial pressure [MAP] 60 mm Hg), respiration rate is 24 breaths/minute, and her oxygen saturation is 99% on room air.

Her physical examination is notable for moderate right costovertebral angle tenderness. Fetal heart tracing (FHT) is in the 170s on Doppler ultrasonography. White blood cell count is 24,000/mm3.

Which of the following is the most appropriate initial step in this patient’s care?

Answers

Challenging distractors are one of the most important features of a high quality OB GYN practice question.

Highlights

  • Challenging distractors (incorrect answer options)
  • Practice Modes for self-testing instant feedback
  • Review Modes for read-friendly questions & answers

Answer Options:

 volume resuscitation with blood products
 volume resuscitation with crystalloids
 intravenous ampicillin 2 g every 6 hours
 norepinephrine infusion

Explanations

Understanding why an answer choice is incorrect is just as important as knowing why it is correct for a truly effective OB GYN board review course.

Highlights

  • Detailed explanation for the correct and incorrect answer choices
  • Integrated media for visual learning
  • Key points link associated concepts and practice guidelines

Correct Answer:

volume resuscitation with crystalloids

Educational Objective:

Characterize the initial management of suspected sepsis.

Key Point:

Early recognition of suspected sepsis or suspected septic shock along with prompt, early, goal-directed treatments can reduce mortality and improve outcomes in the general population; these recommendations have also been applied to obstetric patients. Goals of therapy for sepsis are the initiation of broad-spectrum antibiotics within 1 hour of presentation, initial volume resuscitation of 30 mL/kg within 3 hours, source identification, and source control.

Explanation:

This patient’s clinical scenario is suspicious for sepsis. Her symptoms are most consistent with acute pyelonephritis, which is one of the most common causes for sepsis during pregnancy. She is hypotensive, which indicates her illness is significant enough to provoke a decrease in systemic vascular resistance. Preload is decreased due to increased fluid loss from fever, vasodilation, and increased vascular permeability. The most appropriate initial step to treat her hypovolemia and hypotension is intravenous fluid resuscitation with either lactated Ringer solution or 0.9% normal saline.

The intravascular volume depletion associated with sepsis is due to fever and free-spacing, not blood loss, so transfusion is inappropriate at this time. Blood component replacement would be appropriate if significant coagulopathy with bleeding or anticipated bleeding is found.

Empiric, broad-spectrum antibiotics should be started within 1 hour of presentation of suspected sepsis. Ideally, blood cultures should be obtained prior to the initiation of antibiotics, but they should not delay administration of therapy beyond 1 hour. For obstetric patients, gram-positive, gram-negative, and anaerobic coverage is needed. One recommended regimen is penicillin 5 million units every 6 hours (or ampicillin 2 g every 6 hours) plus clindamycin 900 mg every 8 hours (or metronidazole 500 mg every 12 hours) plus gentamycin 7 mg/kg every 24 hours.

Ampicillin alone is inadequate for empiric treatment. Historically ampicillin was used as a sole agent to treat acute pyelonephritis, but increasing Escherichia coli resistance has necessitated the use of combination treatment with ampicillin and gentamycin. Although pyelonephritis is the suspected source, results of urine and other cultures are necessary for actual source identification.

Vasopressors may be needed to maintain MAP of at least 65 mm Hg in adequately volume-resuscitated patients with sepsis. This patient has hypotension but has not begun intravenous fluids. Therefore, norepinephrine infusion, the first-line vasopressor used in cases of septic shock, is not appropriate at this time.

References:

Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120:689-706.

Resnik R, et al. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed., 2019.

Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304-377.

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OB GYN Board Review Topics

Blueprint-based Exam Simulation

ABOG publishes a content blueprint of the material that will appear on the exam.

This is how we determine which material appears in OBGYN exam simulations.

Obstetrics
Preconception/Antenatal Care
Routine prenatal care (diet; life style; habits)
Counseling - Genetic
Counseling - Teratogenesis
Counseling - Exercise
Nausea and vomiting; hyperemesis
2nd and 3rd trimester losses
Multifetal gestation
Pre-eclampsia
Eclampsia
Infectious diseases - HIV
Infectious diseases - Group A streptococcus
Infectious diseases - Misc. (varicella, pyelonephritis, CMV, toxoplasmosis, parvovirus, etc.)
Coexistent medical diseases - Cardiovascular
Coexistent medical diseases - Chronic hypertension
Coexistent medical diseases - Pulmonary
Coexistent medical diseases - Renal
Coexistent medical diseases - Gastrointestinal
Coexistent medical diseases - Hematologic
Coexistent medical diseases - Endocrine (includes thyroid)
Coexistent medical diseases - Autoimmune (includes DM)
Coexistent medical diseases - Neoplastic
Coexistent medical diseases - Misc. (dermatologic, neurologic, etc.)
Surgical conditions (acute abdomen, adnexal & breast masses, etc.)
Psychiatric disorders
Abnormal fetal growth
Anomalies
Ultrasound
Abnormalities of AFV
Indications for testing
Isoimmunization

Intrapartum Care
Induction and augmentation
Fetal monitoring (normal)
Term ROM
Preterm labor and delivery
Post-term
Preterm ROM
Fetal monitoring (abnormal)
Dystocia
Malpresentations (breech, face, brow, etc.)
Cord problems (prolapse, know, entanglement, etc.)
Infections (chorioamnionitis, amnionitis, etc.)
Hemorrhage - Antepartum
Hemorrhage - Intrapartum
Hemorrhage - Postpartum
Hemorrhage - Coagulopathy (various causes)
Thrombosis/Embolism
Cesarean (primary, repeat, emergency, hysterectomy, VBAC)
Forceps
Vacuum
Wound complications
Complications of operative delivery
Episiotomy and tears (perineal, cervix, vagina, vulva, hematoma)
Placental complications - Abruption
Placental complications - Previa
Placental complications - Accreta/percreta
Anesthesia
Immediate care of the newborn

Postpartum care
Routine (includes lactation)
Endomyometritis
Other infections (mastitis, infected repairs, etc.)

Non-obstetric emergencies
Trauma (MVA, etc.)


Gynecology
Diagnostic
Ultrasonography
D&C
Diagnostic Laparoscopy
Diagnostic Hysteroscopy

Preoperative Evaluation
Routine evaluation
Co-existing medical conditions (DM, CV, Pulmonary, thrombophilia’s, etc.)
Psychiatric conditions
Geriatric

Surgical Management
Non-infectious conditions - Vulvovaginal/cervical (VIN, CIN, VAIN, masses, etc.)
Non-infectious conditions - Uterine (myomas, AUB, hyperplasia, etc.)
Non-infectious conditions - Tubal (ectopic, infertility, sterilization, etc.)
Non-infectious conditions - Adnexal masses
Non-infectious conditions - Pelvic relaxation (cystocele, rectocele, prolapse, etc.)
Non-infectious conditions - Fistulae (all)
Non-infectious conditions - Endometriosis and adenomyosis
Non-infectious conditions - Urinary and fecal incontinence
Non-infectious conditions - Acute Pelvic pain
Non-infectious conditions - Chronic Pelvic pain
Infectious conditions - PID (salpingitis, tubo-ovarian abscess, TB, etc.)
Infectious conditions - Abscesses
Spontaneous, complete, incomplete abortion (1st and 2nd trimester)
Benign trophoblastic disease
Congenital anomalies (reproductive tract)

Surgical Procedures
Minor - Operative Laparoscopy (including sterilization)
Minor - Operative Hysteroscopy
Minor - D&C
Major - Vaginal Hysterectomy
Major - Abdominal Hysterectomy
Major - Laparoscopic (total and LAVH) Hysterectomy
Major - Robotic Hysterectomy
Major - Prolapse Pelvic floor repair
Major - Incontinence Pelvic floor repair
Major - Laparotomy

Surgical complications
Hemorrhage
Bowel injury (small and large)
Urinary tract injury

Neoplasia
Vulva & vagina
Cervix
Uterus
Tube
Ovary
GTN
Breast

Postoperative care and complications
Routine (orders, diet, etc.)
Embolism (including prevention)
Gastrointestinal - Injury
Gastrointestinal - Ileus
Gastrointestinal - SBO
Necrotizing fasciitis
Wound - Normal care
Wound - Infection
Wound - Dehiscence
Urinary tract - UTI
Urinary tract - Fistulae
Neurologic
Fever
Pain
Emergency Care

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