354 Obstetrics and Gynecology Board Review •••
❍ How should a deep venous thrombosis be managed in the postoperative patient?
Intravenous heparin for 7 to 10 days, then oral Coumadin for at least 3 months.
❍ What is the most definitive method of diagnosing pulmonary embolism?
Pulmonary angiography.
❍ What is the most common sign associated with pulmonary embolism?
Tachypnea, present over 90% of the time.
❍ What percentage of acute iliofemoral thrombosis will lead to pulmonary embolus?
40% of these patients will develop pulmonary embolism.
❍ What is the initial procedure of choice for diagnosing deep venous thrombosis?
Duplex ultrasonography.
❍ What is Virchow triad?
Stasis, coagulability, and endothelial wall damage.
❍ How do intermittent compression devices help in preventing deep venous thrombosis?
Decreasing venous stasis, and also decreasing coagulability (increasing fibrinolysis).
❍ How can postoperative pneumonia be differentiated from atelectasis?
Pneumonia usually presents with a purulent productive cough, higher fever, and coarse rales over the infected area.
❍ How is adult respiratory distress syndrome (ARDS) distinguished from congestive heart failure or
pulmonary edema?
A Swan-Ganz catheter is helpful showing a low pulmonary capillary wedge pressure.
❍ Which blood product is the most volume efficient method of increasing fibrinogen?
Cryoprecipitate has a volume of 40 mL versus fresh frozen plasma (200 mL).
❍ What is the most sensitive indicator of decreased volume status due to intraperitoneal hemorrhage?
Decreased urine output, which precedes tachycardia and hypotension.
❍ What is the primary goal in the management of a patient in hypovolemic shock?
Adequate oxygenation and ventilation, followed by fluid replacement.
❍ How much blood must be lost for a young woman to demonstrate signs of shock?
At least 20% of blood volume.
❍ What are the risk factors associated with femoral neuropathy following gynecological surgery?
Thin patient, self-retained retractor with deep blades, and a transverse skin incision.