428 Obstetrics and Gynecology Board Review •••
❍ True or False: Benzodiazepines and sedative hypnotics should never be combined when being used as
chemical restraints.
False. Benzodiazepines may be given in combination with sedative hypnotics (specifically the ones listed in the
previous question) to both hasten and potentiate each other’s effect. Ultimately, titrate to effective dose and
monitor appropriately.
❍ What may occur when ethanol is combined with a benzodiazepine?
Severe respiratory depression, possibly leading to death.
❍ In a patient with bipolar disorder who now presents with polyuria, what medication is the patient most
likely taking?
Lithium. Long-term use can result in nephrogenic diabetes insipidus.
❍ What is Munchausen syndrome?
A factitious disorder in which the patient fabricates their symptoms or causes injury to themselves in order to
achieve the 1° gain of the “sick role.”
Commonly seen in health-care workers.
❍ What is Munchausen syndrome by proxy?
A factitious disorder with the same characteristics as Munchausen syndrome, but instead of the patient playing the
“sick role,” he/she projects this role onto an individual that he/she is caring for. This is considered a form of abuse.
❍ What is somatization disorder?
Multiple, chronic somatic symptoms from different body systems including GI, neurologic, pain, and sexual
complaint that do not have a medical explanation; seen more often in women. The complaints are very real to the
patients, and they have no control over these symptoms (no 1° gain).
Criteria:
(1) Eight or more symptoms
(2) At least four pain symptoms
(3) At least one gynecologic/sexual complaint
❍ A 30-year-old woman complains of calf pain, a headache, shooting pain when flexing her right wrist,
epigastric pain and bloating, and irregular menses. The physician is unable to find a medical condition to
explain this constellation of symptoms. What is a possible diagnosis?
Somatization disorder.
❍ What are the four phases of the female sexual response cycle and possible abnormalities of each of them?
(1) Excitement phase → Hypoactive sexual desire disorder
(2) Plateau → Female sexual arousal disorder
(3) Orgasmic phase → Female orgasmic disorder
(4) Resolution phase → Postcoital dysphoria/Postcoital headache
❍ What is dyspareunia?
Painful sexual intercourse due to medical/psychological cause.