operational ob-gyn practical knowledge test

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1

Operational OB-GYN Practical Knowledge Test

Test your knowledge of operational medicine against the Undersea Medical Officers and

Surface Warfare Medical Officers.


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.


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.


You Should:

A. Obtain a Pregnancy TestB. Stop the OCPsC. MEDEVAC for a mammogramD. Continue the OCPs if the

pregnancy test is negative and the symptoms mild

(A and D are the correct)


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 she’s 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.


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.


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)


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 don’t, switching to a different OCP from a different manufacturer, will generally solve the problem.


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.


Your Plans for LCDR Dewey:A. Helo MEDEVAC to USNH

YokosukaB. Bedrest. Advise Yokosuka of

your situation and ETA.C. Give Methergine.D. Give IV antibiotics

(B is correct)


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.


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.


Your Plan for SN Bainbridge:A. Obtain urine culture and await

resultsB. Begin IV antibioticsC. Begin oral antibioticsD. Call for MEDEVACE. Caution her about malingering

and send her back to her division

(C is correct)


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.


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.


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)


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, don’t count on a Navy Cross, even if things go reasonably well.


LT Isherwood:• Found unconscious in the Officer’s

Head.

• BP 60/0, P=150, RR=30

• Positive Pregnancy Test

• Vaginal bleeding, distended abdomen

• Your ship is in the Indian Ocean, 2 days from Diego Garcia


Your Plan for LT Isherwood:A. 2 Large-bore IV’sB. OxygenC. MAST SuitD. Call for MEDEVACE. Prepare for blood

transfusionF. All of these

(F is correct)


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.


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.


Don’t 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


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.

operational ob-gyn practical knowledge test

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