ABOG OB/GYN Qualifying Exam flashcards

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Preeclampsia severe features

BP ≥160/110, platelets <100,000, AST/ALT >2× normal, creatinine >1.1 mg/dL, pulmonary edema, or new cerebral or visual symptoms; delivery is indicated at ≥34 weeks.

Postpartum hemorrhage first-line

Uterine atony is the most common cause; initial management is uterine massage and oxytocin, followed by methylergonovine (avoid in hypertension) and carboprost (avoid in asthma).

Magnesium sulfate antidote

Calcium gluconate 1 g IV is the antidote for magnesium toxicity; monitor deep tendon reflexes, respiratory rate, and urine output during infusion.

Shoulder dystocia sequence

McRoberts positioning and suprapubic pressure first, then internal rotation maneuvers, posterior arm delivery, and all-fours position; avoid fundal pressure.

Gestational diabetes diagnosis

Carpenter-Coustan 100-g OGTT thresholds are fasting 95, 1 h 180, 2 h 155, 3 h 140 mg/dL; two or more abnormal values confirm gestational diabetes.

Group B strep prophylaxis

Intrapartum penicillin G is first-line; cefazolin for non-anaphylactic penicillin allergy; clindamycin (with susceptibility) or vancomycin for anaphylaxis.

RhD immune globulin timing

Give 300 mcg at 28 weeks and within 72 hours postpartum for Rh-negative unsensitized patients; Kleihauer-Betke testing guides additional dosing for large fetomaternal hemorrhage.

Antenatal corticosteroids

Betamethasone 12 mg IM twice, 24 hours apart, between 24 and 34 weeks gestation reduces neonatal respiratory distress and other complications of prematurity.

PALM-COEIN classification

Structural causes are Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia; nonstructural causes are Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified.

Postmenopausal bleeding evaluation

Endometrial stripe >4 mm on transvaginal ultrasound or persistent bleeding warrants endometrial sampling to exclude hyperplasia or carcinoma.

Cervical cancer screening ages

Begin cytology at age 21 every 3 years; co-testing every 5 years from age 30; stop at 65 with adequate prior negative screening.

Ovarian torsion management

Sudden unilateral pelvic pain with nausea suggests torsion; Doppler flow may be normal; treatment is laparoscopic detorsion with ovarian preservation.

Ectopic pregnancy methotrexate

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

Endometrial cancer risk factors

Obesity, nulliparity, unopposed estrogen, tamoxifen, and chronic anovulation increase risk; type I is estrogen-driven endometrioid carcinoma.

Fibroid treatment options

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

Endometriosis treatment goals

Hormonal suppression (combined contraceptives, progestins, GnRH agonists) reduces pain but does not improve fertility; laparoscopy is diagnostic.

Combined contraceptive contraindications

Migraine with aura, smoking over age 35, hypertension, VTE history, and breast cancer are contraindications; progestin-only methods are often preferred.

Emergency contraception efficacy

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; bisphosphonates are first-line pharmacotherapy.

Bacterial vaginosis criteria

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

Abnormal cervical cytology

ASC-US with negative HPV returns to routine screening; ASC-US with positive HPV or LSIL warrants colposcopy; HSIL warrants colposcopy with excision.

Hypertension in pregnancy treatment

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.

Breast cancer high-risk screening

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

PCOS diagnostic criteria

Rotterdam criteria require ≥2 of oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries; letrozole is preferred for ovulation induction.

Infertility workup

Infertility is 12 months of unprotected intercourse (6 months if age ≥35); workup includes semen analysis, ovulation assessment, tubal patency, and ovarian reserve testing.

Stress incontinence treatment

Pelvic floor muscle training is first-line; midurethral sling or Burch colposuspension for surgical cases; pessaries are non-surgical options.

Pelvic inflammatory disease

Treat with ceftriaxone plus doxycycline plus metronidazole; tubo-ovarian abscess may require drainage.

Cell-free DNA screening

Best for trisomy 21, 18, and 13; it is a screening test, and diagnostic confirmation requires amniocentesis or chorionic villus sampling.

Twin pregnancy surveillance

Monoamniotic twins require close surveillance due to cord entanglement; TTTS occurs in monochorionic-diamniotic twins.

High-risk endometrial cancer

Grade 3, deep myometrial invasion, and LVSI may require lymph node assessment; carboplatin/paclitaxel is standard for advanced disease.

Laparoscopic entry techniques

Options include Veress needle and Hasson (open) technique; convert to laparotomy for uncontrolled bleeding or inability to proceed safely.