ABOG OB/GYN Qualifying Exam cheat sheet

Hypertensive disorders: preeclampsia = BP ≥140/90 on two occasions ≥4 h apart after 20 weeks plus proteinuria (≥300 mg/24 h or P:Cr ≥0.3) or end-organ dysfunction; severe features include BP ≥160/110, platelets <100,000, AST/ALT >2× normal, creatinine >1.1, pulmonary edema, or new cerebral/visual symptoms.

Postpartum hemorrhage: most common cause is uterine atony; treat with uterine massage, oxytocin, then methylergonovine (avoid in hypertension), carboprost (avoid in asthma), and misoprostol; tranexamic acid 1 g IV within 3 h of onset reduces mortality.

Shoulder dystocia maneuvers in sequence: McRoberts positioning, suprapubic pressure, then internal rotation (Rubin II, Woods screw), delivery of posterior arm, and Gaskin all-fours; avoid fundal pressure.

Magnesium sulfate for eclampsia prophylaxis: 4-6 g IV loading dose then 1-2 g/h; monitor deep tendon reflexes, respiratory rate, and urine output; antidote is calcium gluconate 1 g IV.

Fetal heart rate category III includes absent variability with recurrent late or variable decelerations, bradycardia, or sinusoidal pattern; requires immediate evaluation and intrauterine resuscitation.

Gestational diabetes screening: 50-g glucose challenge at 24-28 weeks; diagnostic 100-g 3-hour OGTT uses Carpenter-Coustan thresholds (fasting 95, 1 h 180, 2 h 155, 3 h 140 mg/dL), with ≥2 abnormal values confirming diagnosis.

Group B streptococcus prophylaxis: intrapartum penicillin G is first-line; use cefazolin for non-anaphylactic penicillin allergy and clindamycin (with susceptibility testing) or vancomycin for anaphylaxis.

RhD immune globulin 300 mcg at 28 weeks and within 72 hours postpartum for Rh-negative unsensitized patients; a Kleihauer-Betke result guides additional dosing for large fetomaternal hemorrhage.

Preterm birth: antenatal corticosteroids (betamethasone 12 mg IM ×2, 24 h apart) between 24 and 34 weeks; magnesium sulfate before 32 weeks for fetal neuroprotection.

Abnormal uterine bleeding is classified by PALM-COEIN: structural causes (Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia) and nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified).

Endometrial cancer: postmenopausal bleeding warrants endometrial sampling; type I is estrogen-driven and endometrioid; risk factors include obesity, nulliparity, unopposed estrogen, and tamoxifen.

Cervical cancer screening: begin at 21 years with cytology every 3 years, or co-testing every 5 years from age 30; stop at 65 if adequate prior negative screening; HPV 16/18-positive results warrant colposcopy.

Ovarian torsion presents with sudden unilateral pelvic pain and nausea; Doppler flow may be normal, and definitive treatment is laparoscopic detorsion with ovarian preservation.

Ectopic pregnancy: discriminatory hCG zone is 3,500 mIU/mL for transvaginal ultrasound; methotrexate is contraindicated with hepatic/renal disease, breastfeeding, or adnexal mass >3.5-4 cm.

Fibroids: GnRH agonists shrink leiomyomas preoperatively; ulipristal and tranexamic acid manage bleeding; hysteroscopy is appropriate for submucosal fibroids.

Endometriosis: first-line diagnosis is clinical; laparoscopy is definitive; hormonal suppression (combined contraceptives, progestins, GnRH agonists) reduces pain but does not improve fertility.

Cervical cancer staging is clinical (FIGO), not surgical; parametrial involvement is stage IIB; para-aortic nodal spread is stage IIIC2.

Contraception: combined hormonal contraceptives are contraindicated with migraine with aura, smoking over age 35, hypertension, VTE history, and breast cancer; progestin-only methods are preferred in many of these.

Emergency contraception: copper IUD is most effective and can be placed up to 5 days after unprotected intercourse; ulipristal and levonorgestrel efficacy decline with time and higher BMI.

Osteoporosis screening: DXA at age 65 for all women, or earlier with risk factors; FRAX guides treatment thresholds; bisphosphonates are first-line pharmacotherapy.

Abnormal cervical cytology management: ASC-US with negative HPV returns to routine screening; ASC-US with positive HPV or LSIL warrants colposcopy; HSIL warrants colposcopy with excision.

Bacterial vaginosis: Amsel criteria (≥3 of homogeneous discharge, clue cells, pH >4.5, positive whiff test); treat with metronidazole or clindamycin; partner treatment is not indicated.

Breast cancer risk: BRCA1/2 carriers have markedly elevated lifetime risk; MRI screening is recommended in addition to mammography for high-risk patients, typically from age 30.

Hypertension in pregnancy vs chronic: chronic hypertension predates 20 weeks or persists postpartum; treat with labetalol, nifedipine, or methyldopa; ACE inhibitors and ARBs are teratogenic.

Thyroid disease in pregnancy: levothyroxine requirements increase; TSH targets are trimester-specific, generally <2.5-3.0 mIU/L in the first trimester.

Reproductive endocrinology: PCOS uses Rotterdam criteria (≥2 of oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries); letrozole is preferred for ovulation induction in PCOS.

Infertility workup: semen analysis, ovulation assessment, tubal patency (HSG), and ovarian reserve testing; define infertility as 12 months of unprotected intercourse (6 months if age ≥35).

Urogynecology: stress incontinence is treated first with pelvic floor muscle training; midurethral sling or Burch colposuspension for surgical cases; pessaries are non-surgical options.

Gynecologic oncology: high-risk endometrial cancer (grade 3, deep invasion, LVSI) may require lymph node assessment; carboplatin/paclitaxel is standard for advanced disease.

Maternal-fetal medicine: monoamniotic twins require close surveillance due to cord entanglement; dichorionic twins are monitored differently from monochorionic; TTTS occurs in monochorionic-diamniotic twins.

Reproductive infectious disease: pelvic inflammatory disease is treated with ceftriaxone plus doxycycline plus metronidazole; tubo-ovarian abscess may require drainage.

Minimally invasive surgery: laparoscopic entry options include Veress needle and Hasson (open) technique; convert to laparotomy for uncontrolled bleeding or inability to proceed safely.

Genetic screening: cell-free DNA screening is best for trisomy 21, 18, 13; it is a screening test, and diagnostic confirmation requires amniocentesis or CVS.

Labor: first stage ends at full dilation; second stage is delivery; third stage is placental delivery; active management of third stage reduces hemorrhage.

Fetal monitoring: category I is normal with baseline 110-160, moderate variability, no late/variable decelerations; category II is indeterminate and requires continued surveillance.

Preeclampsia with severe features at ≥34 weeks warrants delivery; before 34 weeks, expectant management may be considered if stable.

Gestational hypertension without proteinuria or severe features: monitor closely; progression to preeclampsia warrants reassessment.

Postpartum endometritis: treat with clindamycin plus gentamicin; add ampicillin if enterococcus is suspected.

Induction of labor: Bishop score predicts success; cervical ripening with misoprostol, dinoprostone, or mechanical methods.

VBAC: candidates should have one prior low-transverse cesarean; risks include uterine rupture; continuous monitoring is required.

Menopause: diagnosis is clinical; hormone therapy is the most effective treatment for vasomotor symptoms; use the lowest effective dose for the shortest duration.

Postmenopausal bleeding: evaluate with transvaginal ultrasound and endometrial biopsy; endometrial stripe >4 mm warrants sampling.

Ovarian cancer: most are epithelial; CA-125 is not a screening test; surgery with staging is primary treatment.

Cervical cancer prevention: HPV vaccination reduces risk; screening and treatment of precancerous lesions are key.

Contraceptive counseling: long-acting reversible contraceptives (IUDs, implants) are highly effective; discuss risks and benefits.

Sexually transmitted infections: screen for chlamydia and gonorrhea in at-risk women; treat partners.

Uterine fibroids: symptoms include heavy bleeding and bulk symptoms; treatment options include medical, surgical, and minimally invasive approaches.

Depression screening: use validated tools; treatment options include psychotherapy and antidepressants; SSRIs are commonly used.

Diabetes screening: screen adults with risk factors; lifestyle modification and metformin are first-line for prediabetes.

Vaccination: recommend HPV, influenza, and Tdap vaccines per guidelines; pregnancy-specific recommendations apply.

Obesity: calculate BMI; lifestyle intervention is first-line; consider pharmacotherapy or bariatric surgery for eligible patients.

Sexual health: take a sexual history; offer STI testing and contraception counseling.

Substance use: screen with validated tools; brief intervention and referral to treatment.

Breast health: clinical breast exam and mammography per age and risk; evaluate palpable masses with imaging and biopsy as needed.

Gynecologic oncology: ovarian cancer staging includes cytoreductive surgery; chemotherapy is platinum-based.

Reproductive endocrinology: evaluate infertility with semen analysis, ovulation testing, and tubal assessment.

Urogynecology: pelvic organ prolapse can be managed with pessary or surgery; discuss options.

Maternal-fetal medicine: manage preterm labor with corticosteroids and magnesium sulfate for neuroprotection.

Infectious disease: PID treatment covers gonorrhea, chlamydia, and anaerobes.

Minimally invasive surgery: consider laparoscopic approaches for appropriate candidates; convert if needed.

Genetics: offer carrier screening and prenatal diagnostic testing options.