TrueLearn Question of the Month for July!
I am happy to announce a new partnership with a great new sponsor, TrueLearn. TrueLearn is a web based platform for learning material to improve performance on standardized medical exams, with platforms for specific specialties as well as general medical boards. In OB/GYN TrueLearn offers question banks for CREOGS, ABOG boards, as well as general OB/GYN question banks. In each case, the online questions exactly simulate the computer environment you will see when you actually take the test as well.
TrueLearn also allows you to track your performance over time, as well as compare you performance to other doctors and students preparing for the same exam, both on a global level and specific to each question. It’s a great too that will no doubt be of tremendous use to the thousands of students and physicians who take OB/GYN related exams each year.
Each month, we will be doing TrueLearn Question of the Month, both on the blog and on the soon to relaunch Academic OB/GYN Podcast.
Academic OB/GYN readers and listeners can also get a 10% discount on the product by using the promo code “ACADEMICOBGYN” when they order.
This month’s question from the OB/GYN MOC Series:
A 37 year old Gravida 1 presents in labor at 39 weeks gestation. Her past medical history is significant for SLE. Which of the following in her history would be LEAST indicative for stress dose steroids in labor?
A. Cushingoid appearance
B. Recent use of methyprednisolone taper for seven days just prior to labor
C. Use of dexamethasone 0.75 mg twice a day for the past month
D. Use of hydrocortisone 40mg /day for her entire pregnancy
E. Use of prednisone 10 mg/day for her last trimester of pregnancy.
The correct answer is B
Patients who have taken glucocorticoids for less than three weeks, or who have taken chronic alternate-day therapy, are unlikely to have a suppressed hypothalamic-pituitary-adrenal (HPA) axis and should continue usual dose of glucocorticoids during labor and/or when undergoing surgery such as cesarean delivery. Typically patients who have been taking glucocorticoidsin a dose equivalent to prednisone 5mg or more daily for more than three weeks may have HPA axis suppression and should receive stress done steroids during labor and delivery.
Answer A: Women who exhibit a Cushingoid appearance (moon face, red cheeks, excessive striae) should eb assumed to have HPA axis suppression and stress dose steroids are indicated
Answer C: The dose dexamethasone 0.75 mg twice day is equivalent to 10mg prednisone daily. Since the patient has been taking therapy for greater than 3 weeks, stress doing steroids are indicated.
Answer D: The dose of hydrocortisone 40mg/day is equivalent to 10mg prednisone daily. Since the patient has been taking therapy for greater than 3 weeks, stress doing steroids are indicated.
Answer E: Patients who have been taking glucocorticoids in a dose equivalent to prednisone 5 mg or more daily for more than three weeks may have a HPA axis suppression and should be given stress dose steroids in labor and delivery.