L3-ObGyn™ OB/GYN Residents 2011- 2012 - BOOK 2 Please visit our website under Programs of Exxcellence for PEARLS OF EXXCELLENCE to review the most challenging topics from the oral certification exams. Copyright 2011, The Foundation for Exxcellence in Women's Health Care 2915 Vine Street, Dallas, Texas 75204 http://www.exxcellence.org
USE OF LIFE-LONG LEARNING (L3-ObGyn™) PROGRAM
The Foundation for Exxcellence in Women's Health Care (Foundation) has prepared this reference book to introduce residents and their Program Director to the concept and importance of "life-long learning." The references included have been selected to provide residents with new, recent or review material to supplement their didactic foundation in the practice of obstetrics and gynecology. The inclusion of a reference does not constitute acceptance or endorsement by the Foundation or any individual employed by or associated with it, of any opinions expressed or of the accuracy of the data or case studies included therein.
THE FOUNDATION FOR EXXCELLENCE IN WOMEN'S HEALTH CARE L3-ObGyn™ Ob/Gyn Residents November 2011 Reading Assignment List Question Gynecology
Handa VL, Blomquist JL, Knoepp LR, et al: Pelvic floor disorders 5-10 years
after vaginal or cesarean childbirth, Obstet Gynecol 2011(Oct);118(4):777-
84 Gariepy AM, Creinin MD, Schwarz EB, Smith KJ: Reliability of laparoscopic
compared with hysteroscopic sterilization at 1 year: a decision analysis, Obstet Gynecol 2011(Aug);118(2 Pt 1):273-9 Selk A, Kroft J: Misoprostol in operative hysteroscopy: a systematic review
and meta-analysis, Obstet Gynecol 2011(Oct);118(4):941-9
Obstetrics
Melamed N, Pardo J, Milstein R, et al: Perinatal outcome in pregnancies
complicated by isolated oligohydramnios diagnosed before 37 weeks of gestation, Am J Obstet Gynecol 2011(Sep);205(3):241.e1-6 Chamarthi B, Greene MF, Dluhy RG: A problem in gestation, N Engl J Med
2011(Sep);365(9):843-8 Lamont RF, Sobel JD, Carrington D, et al: Varicella-zoster virus (chicken-
pox) infection in pregnancy, BJOG 2011(Sep);118(10):1155-62Office Practice
Mozaffarian D, Hao T, Rimm EB, et al: Changes in diet and lifestyle and
long-term weight gain in women and men, N Engl J Med 2011(Jun);364(25):
2392-404 Hoover RN, Hyer M, Pfeiffer RM, et al: Adverse health outcomes in women
exposed in utero to diethylstilbestrol, N Engl J Med 2011(Oct);365(14): 1304-14 ACOG Comm Opin #503: Tobacco use and women’s health, Obstet
THE FOUNDATION FOR EXXCELLENCE IN WOMEN'S HEALTH CARE L3-ObGyn™
Directions: Each of the questions or incomplete statements below is followed by suggested answers or completions. Select the ONE THAT IS BEST in each case and then blacken the corresponding space on the answer sheet. IF CHOICE "D or E" CONTAINS DASHES ONLY, DO NOT CHOOSE IT AS AN ANSWER.
L3-ObGyn™ — Gynecology
Handa VL, Blomquist JL, Knoepp LR, et al: Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth, Obstet Gynecol 2011(Oct);118(4):777-84
1. What was the reference group used for comparison in this study?
A. Women who delivered all their children by unlabored cesarean delivery B. Women who delivered at least one child by operative vaginal birth C. Women who delivered by spontaneous vaginal birth D. Women who delivered by cesarean delivery after the onset of labor E. ---
2. Which of the following was NOT considered to be a confounder?
B. Obesity C. Parity D. Maternal age at the time of first delivery E. ---
3. How were women classified as having objective evidence of prolapse?
A. Any descent of the vaginal wall or cervix into the vagina B. Descent of the cervix only beyond the hymen C. Descent of the vaginal wall or cervix to or beyond the hymen D. Improvement in symptoms after insertion of a pessary E. ---
4. Which of the following was found in this study?
A. There was no increase in urinary incontinence after operative vaginal delivery B. There was no association between active labor and pelvic floor disorders among women delivering by
C. Most women with prolapse to or beyond the hymen were significantly symptomatic D. All of the above E. ---
Gariepy AM, Creinin MD, Schwarz EB, Smith KJ: Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year: a decision analysis, Obstet Gynecol 2011(Aug);118(2 Pt 1):273-9
5. A woman has an unsuccessful hysteroscopic sterilization procedure and then has a successful
laparoscopic sterilization procedure. In the model described by the authors, how would this particular case be counted? A. Hysteroscopic
C. Hysteroscopic sterilization failure D. Hysteroscopic and laparoscopic sterilization successes E. ---
6. Regarding outcome data from studies relating to success of hysteroscopic sterilization, what was required
of these studies in order to be included in this analysis? A. The studies must have been randomized B. At least 2 years of patient follow-up C. Success documented by hysterosalpingogram D. There were no special requirements E. ---
7. If one uses the highest probability of success for laparoscopic sterilization and the lowest probability of
success for hysteroscopic sterilization, what is the difference in successful sterilization procedures within 1 year? A. 2% B. 5% C. 7% D. 10% E. ---
8. How are this model and its findings limited?
A. Small numbers of participants in each study B. Few studies have been done C. Uncertainty of the data they are based on D. All of the above E. ---
Selk A, Kroft J: Misoprostol in operative hysteroscopy: a systematic review and meta-analysis, Obstet Gynecol 2011(Oct);118(4):941-9
9. What was the primary measure of treatment effect for misoprostol in this study?
A. Need for cervical dilation B. Number of dilators used to effect sufficient cervical dilation C. Mean difference in cervical diameter at the start of surgery D. Complication rate E. ---
10. Seven studies formed the basis of this paper. Which of the following is NOT true of the studies reviewed
by the authors? A. All studies used operative hysteroscopes of at least 9 mm diameter B. Both premenopausal and postmenopausal women were included C. Dosing, route, and timing of misoprostol had to be uniform D. All studies used a placebo control E. ---
11. Data on preoperative pain were reported in 3 studies. In the pooled analysis, how did misoprostol
A. There was no difference between misoprostol and placebo B. There was significantly more pain experienced in the misoprostol group C. There was significantly more pain experienced in the placebo group D. No conclusions could be drawn E. ---
12. Which of the following is a conclusion reached by the authors of this study?
A. Existing evidence does not support routine use of preoperative misoprostol for operative hysteroscopy B. Existing evidence does not demonstrate that misoprostol reduces operative complications C. Existing evidence shows that misoprostol increases side effects D. All of the above E. ---
L3-ObGyn™ — Obstetrics
Melamed N, Pardo J, Milstein R, et al: Perinatal outcome in pregnancies complicated by isolated oligohydramnios diagnosed before 37 weeks of gestation, Am J Obstet Gynecol 2011(Sep);205(3): 241.e1-6
13. Which of the following conditions were excluded by the authors in this report?
A. Chronic hypertension B. Suspected fetal growth restriction C. Premature rupture of membranes D. All of the above E. ---
14. Compared to the control group, which of the characteristics listed below was statistically significantly
different in the group with isolated oligohydramnios?
A. Gestational age at time of initial ultrasound B. Maternal
C. Nulliparity D. None of the above E. ---
15. What percent of all cases of oligohydramnios before 37 weeks were defined as isolated oligohydramnios?
A. 0.5% B. 4.5% C. 10.9% D. None of the above E. ---
16. When isolated oligohydramnios is diagnosed preterm (<37 weeks), which of the following is TRUE?
A. Indicated preterm delivery occurs more frequently B. The risk of induction failure is decreased C. The cesarean delivery rate is decreased D. None of the above E. ---
17. Regarding management of preterm isolated oligohydramnios, which statement is FALSE?
A. 1/3 of MFM specialists would consider labor induction B. 21% of MFM specialists believed that labor induction decreases perinatal morbidity C. Active management decreases perinatal morbidity D. There were no fetal deaths in the expectant management group E. ---
Chamarthi B, Greene MF, Dluhy RG: A problem in gestation, N Engl J Med 2011(Sep);365(9):843-8
18. Which of the following laboratory values is normally increased during pregnancy?
A. Creatinine B. Calcium C. Triglycerides D. Albumin E. ---
19. What does the article state was the most likely cause of pancreatitis in this patient?
A. Gallstones B. Alcohol C. Hyperparathyroidism D. Hyperlipidemia E. ---
20. Which of the following maternal adaptations occurs in response to the increased fetal calcium demand?
A. Increased urinary calcium excretion B. Increased intestinal absorption of calcium C. Increased PTH secretion D. All of the above E. ---
21. What is the incidence of pancreatitis in pregnancy?
A. 3/100 B. 3/1,000 C. 3/10,000 D. 3/100,000 E. ---
22. Which of the following treatments is not recommended for hypercalcemia during pregnancy?
A. Bisphosphonates B. Isotonic saline plus furosemide C. IV calcitonin D. Parathyroidectomy E. ---
Lamont RF, Sobel JD, Carrington D, et al: Varicella-zoster virus (chickenpox) infection in pregnancy, BJOG 2011(Sep);118(10):1155-62
23. When is a person with chickenpox considered contagious?
A. Two days before the rash until crusting of vesicles B. Two days after the rash until crusting of vesicles C. Only when the rash has vesicles D. Not reported in the article E. ---
24. Which of the following statements is TRUE?
A. Chickenpox is associated with first-trimester spontaneous abortion. B. IUGR occurs in 23% of cases of chickenpox before 24 weeks of gestation. C. Only 13 cases of congenital varicella syndrome have been reported in the literature. D. None of the above. E. ---
25. What is the method of choice to determine whether a fetus has been infected with varicella zoster virus?
A. IgM in maternal serum B. Tzanck prep C. PCR of amniotic fluid D. Recombinant immunoblot assay E. ---
26. In the modern era, what is the mortality rate for neonatal chickenpox?
27. Within what period of time after exposure to chickenpox should a susceptible woman be given VZIG?
A. 12 hours B. 24 hours C. 48 hours D. 72 hours E. ---
L3-ObGyn™ — Office Practice
Mozaffarian D, Hao T, Rimm EB, et al: Changes in diet and lifestyle and long-term weight gain in women and men, N Engl J Med 2011(Jun);364(25):2392-404
28. In this study of diet, lifestyle and weight, which of the following was a reason for exclusion from the
B. Obesity C. Diabetes D. Daily average intake of 3000-3200kcal E. ---
29. Which cohort had the least weight gain on average during each 4 year period of the study?
B. Nurses’ Health Study II C. Health Professionals Follow-up Study D. --- E. ---
30. According to the results of this study, a person should sleep which number of hours each night to gain the
A. 5 B. 7 C. 9 D. No significance identified E. ---
31. Which of the following is a limitation of this study that prevents it from being generalized to the whole U.S.
A. Height and weight were not measured directly B. Exclusions are unsupportable C. Study participants were health care professionals D. Dietary intake was self-reported E. ---
32. The mean intake of which of the following was similar, on average, among the 3 cohorts?
C. Diet soda D. Unprocessed red meats E. ---
Hoover RN, Hyer M, Pfeiffer RM, et al: Adverse health outcomes in women exposed in utero to diethylstilbestrol, N Engl J Med 2011(Oct);365(14):1304-14
33. This work is an example of which of the following study designs?
B. Case-control C. Cohort D. Randomized trial E. ---
34. Which of the following potential confounders was identified as changing the hazard ratios by 10% or more?
B. Vaginal epithelial changes C. Original cohort D. Use of oral contraceptives E. ---
35. Which of the following adverse outcomes was associated with the highest hazard ratio among DES-
C. Early menopause D. Breast cancer E. ---
36. Which of the following adverse outcomes was associated with the highest cumulative risk among DES-
B. Preeclampsia C. CIN ≥2 D. Breast cancer E. ---
37. Which of the following is a strength of this study?
B. Yearly examinations during entire study period C. Pathologic verification of all adverse outcomes D. Self-reporting of reproductive outcomes E. --- ACOG Comm Opin #503: Tobacco use and women’s health, Obstet Gynecol 2011(Sep);118(3):746-50
38. According to the CDC, what percent of women over 18 years of age smoked in the United States in 2009?
39. Which of the following cancers is NOT increased among women who smoke?
A. Colon B. Bladder C. Pancreas D. Uterus E. ---
40. Which of the following is NOT one of the “5 A’s” in the clinical intervention model?
A. Ask B. Advise C. Admonish D. Arrange E. ---
41. A patient wants to stop smoking but is afraid that she will gain weight. Which of the following statements is
TRUE about this fear? A. 50% of women who stop smoking gain weight B. This is a myth propagated by manufacturers C. Use of bupropion while quitting causes more rapid weight gain D. Weight gain occurs primarily in adolescents E. ---
42. Active training in smoking cessation counseling finds that the training is especially useful in patients in all
but which one of the following categories?
A. Those in denial B. Ambivalent about quitting C. Relapsed D. None of the above E. ---
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