Operational OB-GYN Practical Knowledge Test

1
Operational OB-GYN Practical Knowledge Test

• Test your knowledge of operational medicine
  against the Undersea Medical Officers and Surface
  Warfare Medical Officers.

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Operational OB-GYN Practical Knowledge Test

• These questions are from material presented at
  the Surface Warfare Medical Officer
  Indoctrination Course (SWMOIC) and Undersea
  Medical Officer Candidate (UMOC) Course.
• After answering each question, the Medical
  Officers engage in a discussion, justifying their
  answers.

3
LTJG Decatur started her first pack of OCPs 9
days ago.

• She complains of nausea, depression, tender
  breasts, and thinks she may be pregnant.
• Your ship left Norfolk yesterday for exercises
  off Guantanamo before a 6-month deployment to
  Italy.

4
You Should

• A. Obtain a Pregnancy Test
• B. Stop the OCPs
• C. MEDEVAC for a mammogram
• D. Continue the OCPs if the pregnancy test is
  negative and the symptoms mild
• (A and D are the correct)

5
Discussion

• You should always obtain a pregnancy test
  whenever a woman believes she may be pregnant.
  She is often right.
• It is not necessary to stop the BCPs. The
  side-effects shes experiencing are common in the
  first month and should disappear.
• The first few days or weeks of a deployment can
  be very stressful, particularly for junior
  personnel on their first deployment.

6
LTJG Decatur returns 3 days later

• The nausea and depression are gone.
• Her breast tenderness is improved.
• Her Division Officer complimented her on her good
  performance while underway.
• She noticed a tiny amount of spotting after
  exercise yesterday.

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Your Advice to LTJG Decatur

• A.Transfer off the ship because of these endless
  gynecologic problems.
• B. Bedrest for 4 days.
• C. GYN consultation at Guantanamo
• D. Spotting during the 1st cycle of OCPs is
  common and not dangerous.
• (D is correct)

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Discussion

• 80 of women starting OCPs have no side effects.
• The other 20 may have spotting, nausea, breast
  tenderness, and headaches.
• These usually disappear after the first month.
• If they dont, switching to a different OCP from
  a different manufacturer, will generally solve
  the problem.

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LCDR Dewey

• Positive pregnancy test
• LMP 6 weeks ago
• C/O mild cramping and spotting
• Uterus enlarged, sl. tender, cervix closed
• Your ship is underway from Guam to Yokosuka,
  Japan, and due to arrive in 23 hours. It is a
  dark and stormy night.

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Your Plans for LCDR Dewey

• A. Helo MEDEVAC to USNH Yokosuka
• B. Bedrest. Advise Yokosuka of your situation and
  ETA.
• C. Give Methergine.
• D. Give IV antibiotics
• (B is correct)

11
LCDR Dewey Discussion

• She has a threatened abortion which can likely be
  postponed by having her lie still. Antibiotics
  will not be helpful and Methergine may worsen
  it.
• You are only 23 hours away from a safe, pier-side
  transfer of LCDR Dewey to an ambulance. Helo OPS
  at night in bad weather are very dangerous and
  not justified here.

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SN Bainbridge

• C/O urinary frequency, urgency, dysuria and
  hematuria x 10 hours
• Bladder is tender, flanks are not
• Temp 98.6
• Similar episode 3 years ago
• Her division is cleaning the CHT system today.

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Your Plan for SN Bainbridge

• A. Obtain urine culture and await results
• B. Begin IV antibiotics
• C. Begin oral antibiotics
• D. Call for MEDEVAC
• E. Caution her about malingering and send her
  back to her division
• (C is correct)

14
Discussion of SN Bainbridge

• She has symptoms of lower urinary tract infection
  and should be given oral antibiotics, regardless
  of any laboratory findings.
• Aboard a ship at sea, the biggest risk is that a
  simple, lower tract infection will become
  pyelonephritis, which you are ill-equipped to
  treat.
• In the absence of more tangible evidence, I would
  keep my thoughts about malingering to myself.
  While cleaning the CHT system is not a popular
  task, she has symptoms and physical findings of a
  UTI.

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BM1 Perry

• Severe RLQ pain for the 12 hours
• Marked rebound tenderness and rigidity
• Negative pregnancy test
• Temp 103.4
• Your ship is off Mexico, 2 days from Acapulco and
  7 days from Pearl Harbor. You have started IV
  antibiotics. The operating room aboard your
  Submarine Tender is currently in use and an
  office.

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Your Plan for BM1 Perry

• A. Restore the OR and begin surgery
• B. Wait for a response to the IV antibiotics
• C. Call for MEDEVAC
• D. Using battle lanterns over the wardroom
  table, perform an emergency appendectomy and
  receive the Navy Cross.
• (C is correct)

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Discussion of BM1 Perry

• While you may have removed an appendix or two in
  medical school, you do not have an
  anesthesiologist, recovery room, ICU, nurses, or
  any other supporting services.
• Considering your skills and the absence of
  support, the safest course for this patient is IV
  antibiotics and prompt MEDEVAC.
• Should you decide to operate, dont count on a
  Navy Cross, even if things go reasonably well.

18
LT Isherwood

• Found unconscious in the Officers Head.
• BP 60/0, P150, RR30
• Positive Pregnancy Test
• Vaginal bleeding, distended abdomen
• Your ship is in the Indian Ocean, 2 days from
  Diego Garcia

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Your Plan for LT Isherwood

• A. 2 Large-bore IVs
• B. Oxygen
• C. MAST Suit
• D. Call for MEDEVAC
• E. Prepare for blood transfusion
• F. All of these
• (F is correct)

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Discussion of LT Isherwood

• She is in shock, due to a ruptured ectopic
  pregnancy.
• Blood can be life-saving, particularly fresh,
  whole blood, full of platelets, coagulation
  factors, serum, and healthy RBCs.
• Your approach is supportive therapy until
  surgical intervention can be accomplished.

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However, two days ago...

• You saw LT Isherwood in Sick Call, complaining of
  LLQ pains, positive pregnancy test, and left
  adnexal tenderness.
• You advised her to get more rest and see you next
  week.

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Dont you wish you would have

• A. Placed her on strict bedrest
• B. Called for a MEDEVAC 2 days ago
• C. Kept an IV line open
• D. Prepared for blood transfusion
• E. Told her to have someone else teach the daily,
  high-impact, aerobic dance class on the Helo
  Deck.
• F. All of the above

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Further Discussion of LT Isherwood

• You cannot prevent an ectopic pregnancy, but you
  often can prevent them from rupturing in adverse
  circumstances.
• Unlike in a teaching hospital, operational
  medicine settings are typically unforgiving of
  errors in judgement or lack of foresight.

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