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.
Adnexal Masses in Adolescents – May 2009
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.
Cerebral Palsy – July 2009
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.
Complications of Gynecologic Laparoscopic Surgery – September 2009
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.
Contraceptive Choices for Women With Common Medical Problems – August 2009
Obstetrician-gynecologists are frequently asked to provide contraceptive counseling for women with medical problems that complicate decision-making and may limit choices.
Dyslipidemia and Metabolic Syndrome in Women – November 2009
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.
Fecal Incontinence – February 2010
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.
Fetal Infections - Parvovirus – October 2008
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.
Fetal Ventral Abdominal Wall Defects – March 2009
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.
Management of a Thyroid Nodule – January 2010
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.
Nonimmune hydrops fetalis – January 2009
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.
Postmenopausal Ovarian Mass – February 2009
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?
Post Menopausal Vulvar Lesions – April 2009
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).
Postoperative Urinary Fistulae – December 2009
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.
Postpartum Perineal Pain – October 2009
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.
Pregnant Women with an Adnexal Mass – June 2009
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 centimeter s in diameter but almost always they disappear by the 14 week of gestation.
Surgical Management of the Obese Patient with Endometrial Cancer – December 2008
A 65 year old patient with a BMI of 55 is diagnosed with endometrial cancer. She presents now for opinions as to appropriate therapy.
Venous Thromboembolism Prophylaxis – November 2008
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.