236 Obstetrics and Gynecology Board Review •••
❍ Define osteopenia and osteoporosis.
Osteopenia is classified as having a bone mineral density between 1 and 2.5 standard deviations below the mean
value for a reference population of young women.
Osteoporosis is defined as a bone mineral density of 2.5 or more standard deviations below the mean for the
reference population.
❍ When does ACOG recommend screening for osteoporosis?
All women starting at age 65. Starting at age 60 for women with an increased risk of osteoporotic fractures, no
more frequently than every 2 years. Risk factors include, white race, history of a fracture, family history, poor
nutrition, smoking, low BMI, early menopause (prior to age 45), and inadequate physical activity.)
❍ What factor is predictive of 80% of a woman’s peak bone mass?
Genetics, with ethnic background also being highly predictive. Caucasian women are at highest risk of
osteoporosis, followed by Asian women, Mexican women, and African American women.
❍ What type of exercise is most effective at slowing the rate of bone loss?
Weight bearing exercise.
❍ What percentage of women is likely to have subclinical hypothyroidism?
Up to 5%. The prevalence increases with age and is more common in white women than African Americans.
❍ What is the ACOG recommendation for screening for thyroid dysfunction?
ACOG recommends checking a TSH every 5 years, beginning at age 50.
❍ A PPD is considered positive with what amount of induration in a given population?
Millimeters of induration populations
>5 mm HIV positive
Other immunosuppressed populations—ie, organ donor recipients
Those in close contact with a person known to be infected with
tuberculosis (TB)
Those who have had TB in the past
Patients with fibrotic changes on chest X-ray indicative of TB infection
>10 mm Immigrants from high prevalence area within the past 5 years
Intravenous drug users
Residents and employees of prisons, homeless shelters, nursing homes,
hospitals, or other long-term care facilities.
Patients with medical conditions that increase their risk of TB, eg,
diabetes, silicosis, or chronic renal failure.
>15 mm Patients with no risk factors.