Challenging Exam Topics for Ob/Gyn Certification

The Pearls of Exxcellence are provided for the reinforcement in education of Ob/Gyn practitioners. Annually, the Exxcellence Foundation will review the data from the three oral certification exams, and compile a list of the ten to twelve most challenging topics. A short review and references will periodically be posted.

Date	Title
Sep 2010	Management of Adnexal Cysts A 35 year-old G.P. complains of a constant dull ache in her left lower pelvis over one week. Her medical history and review of systems is not significant. Pelvic exam is suspicious for an enlarged left ovary. An ultrasound reveals a 5 cm simple ovarian cyst.
Aug 2010	Contraceptive Choices for Women With Common Medical Problems Obstetrician-gynecologists are frequently asked to provide contraceptive counseling for women with medical problems that complicate decision-making and may limit choices. As the medical condition becomes more serious, it sometimes becomes imperative to avoid pregnancy, as it might threaten the life of the woman.
Jul 2010	Neonatal Encephalopathy The advent of fetal heart rate monitoring fueled optimism that the incidence of cerebral palsy and mental retardation could be reduced by 50%. This hope, however, never came to fruition. The incidence of cerebral palsy has remained at approximately 2 per 100 births while the incidence of mental retardation is about twice as frequent. Clearly, the rising cesarean section rate over recent decades cannot be defended by any recognized improvement in neonatal neurologic outcome.
Jun 2010	Elevated Maternal Serum AFP (MSAFP) at 16 Weeks Alpha-fetoprotein is produced by the fetal liver. Levels of maternal serum alpha-fetoprotein (MSAFP) rise during the second trimester of pregnancy. Values are expressed as MoMs (multiples of the median) for each specific week of gestation. Values greater than 2.5 MoMs are generally considered elevated.
May 2010	Management of Paget Disease of the Vulva Extramammary Paget disease (EMPD) of the vulva is a rare malignant neoplasm of the vulva skin presenting mostly commonly with a compliant of pruritus.
Apr 2010	Anemia in Pregnancy with Normal Iron Studies The most common cause of a microcytic anemia in a pregnant patient who is not iron deficient is the presence of a thalassemia mutation in one of her hemoglobin genes.
Mar 2010	Management of Postoperative Ileus Ileus (intestinal paralysis) is most common following abdominal surgery. The pathophysiology of the condition is poorly understood. Atony of the stomach, colon and sometimes also the small bowel is the usual presentation and usually spontaneously resolves in a few days. In most cases the small bowel recovers first (within 24 hours) followed by the stomach and colon in 3-4 days.
Feb 2010	Fecal Incontinence Fecal incontinence (FI) is defined as the involuntary loss of liquid or solid stool whereas anal incontinence includes the loss of gas. The best estimate of the prevalence of FI in the non-institutionalized adult population in the U.S, provided by the National Health and Nutrition Examination Survey of over 5000 Americans, was 8.9% of women and 7.7% of men. The biggest identified risk factor was age, with 15% of those older than 70 affected.
Jan 2010	Management of a Thyroid Nodule Case Presentation: Ms. X is a 58 year old woman who presents for a well woman examination. She has a BP of 130/85 and a BMI of 23 kg/m2. On examination of the neck, a small, firm 1.5 cm nodularity is felt within the thyroid gland.
Dec 2009	Postoperative Urinary Fistulae A 38-year-old patient presents seven days following a difficult hysterectomy and bilateral adnexectomy for severe endometriosis with the complaint of having continuous urinary incontinence.
Nov 2009	Dyslipidemia and Metabolic Syndrome in Women The metabolic syndrome is a common problem in the population, with one recent community-base study demonstrating a prevalence of 16% of mid-life women.
Oct 2009	Postpartum Perineal Pain The correct diagnosis and management scheme for pain in this anatomic region after a delivery are dependent far more on physical examination than on history.
Sep 2009	Complications of Gynecologic Laparoscopic Surgery Complications of laparoscopy in gynecologic patients are reported to occur in 0.1 to 10 percent of all cases. Over one-half of these occur at entry in to the abdominal cavity.
Aug 2009	Contraceptive Choices for Women With Common Medical Problems Obstetrician-gynecologists are frequently asked to provide contraceptive counseling for women with medical problems that complicate decision-making and may limit choices.
Jul 2009	Cerebral Palsy Cerebral palsy is a non-progressive muscular disability (or spasticity) of early onset. Cerebral palsy complicates approximately 2 per 1000 births, and this incidence has not changed over decades.
Jun 2009	Pregnant Women with an Adnexal Mass Essentially every pregnant woman has an adnexal mass during pregnancy. Usually it is a 3-5 centimeter corpus luteum. These functional cysts can get as large as 11 centimeters in diameter but almost always they disappear by the 14 week of gestation.
May 2009	Adnexal Masses in Adolescents The prevalence of adnexal masses in adolescents is unknown, but they are relatively uncommon. Only about 6% of ovarian neoplasms are found in adolescents and less than 25% of these are malignant. Non-neoplastic lesions account for 75-98% of adolescent adnexal masses detected by ultrasound.
Apr 2009	Post Menopausal Vulvar Lesions In the post menopausal period the vulvar skin may undergo changes which are grouped together under the heading of dystrophies or dysplasia sometimes termed vulvar intraepithelial neoplasia (VIN).
Mar 2009	Fetal Ventral Abdominal Wall Defects Fetal ventral abdominal wall defects include the more common gastroschisis and omphalocoele and the less common ectopis cordis, limb-body wall complex, cloacal exstrophy and urachal cyst. By the 6th week (8 weeks from the last menstrual period) of development, the abdominal cavity is not large enough to accommodate all its contents.
Feb 2009	Postmenopausal Ovarian Mass A 72 year old woman presents with a CT scan report indicating that she has a 2.5cm ovarian mass. She is concerned that she may have cancer. What is the appropriate way to evaluate this patient?
Jan 2009	Nonimmune hydrops fetalis Hydrops fetalis is defined as the presence of excessive fluid in two or more fetal compartments and includes: skin edema, pleural effusion, pericardial effusion, ascites and polyhydramnios. Fetal hydrops can be immune or nonimmune.
Dec 2008	Surgical Management of the Obese Patient with Endometrial Cancer A 65 year old patient with a BMI of 55 is diagnosed with endometrial cancer. She presents now for opinions as to appropriate therapy.
Nov 2008	Venous Thromboembolism Prophylaxis A 37 year old woman, G2P2, who has a BMI of 23 kg/m2, is taking hormonal contraception and is scheduled for a cholecystectomy. She requests instructions on stopping her oral contraceptive pills pre-operatively.
Oct 2008	Fetal Infections - Parvovirus Parvovirus B19 is a single stranded DNA virus which causes erythema infectiosum, also known as fifth disease. Clinical manifestations include flu-like signs and symptoms, low-grade fever, malaise, arthralgia, and a classic "slapped cheek" rash.