quiz 2 repro

A 29-year-old nulligravid woman reports to her physician because of a 10-dayhistory of blood-tinged discharge from her left nipple. She has been healthy andthere is no family history of serious illness. She has a 10 pack-year history ofsmoking. LMP was 12 days ago. She is sexually active and uses condomsinconsistently. On exam she has scant serosanguinous fluid expressible from theleft nipple. There is no palpable breast mass or axillary lymphadenopathy. Which ofthe following is the most appropriate next step in management?

Subareolar ultrasound

Which of the following sexually transmitted microbes can be transmitted from the mother to the fetus transplancentally (antepartum transmission)?

1. Cytomegalovirus 2. Herpes simplex virus 3. Treponema pallidum

Which of the following best describes a woman's lifetime risk of breast cancer by age 80 years?

10%

Which of the following is the recommended total weight gain during pregnancy for a woman with a normal pre-pregnancy BMI?

15-35 pounds

A neonate born at 34 weeks' gestation is noted to have the following shortly after birth: Arms and legs flexed, no spontaneous movement Pulse 140/minute Grimace and weak flexion of extremities when stimulated Body pink, extremities blue Vigorous cry Which of the following is this baby's APGAR score?

7

Which of the following represents typical maternal blood loss associated with most spontaneous vaginal deliveries?

< 500 mL

A neonate exhibits microcephaly, hepatosplenomegaly, and jaundice. Intracerebral calcification is noted on the radiograph. The mother had symptoms similar to mononucleosis during the second trimester of her pregnancy. Which antiviral drug is appropriate for treatment of the neonate?

Ganciclovir

Which of the following hormones is involved in lung maturation in a fetus? A. ACTH B. 1,25 - cholecalciferol C. calcitonin D. PTH E .PTH-rp

A. ACTH

What is the most important function of a fetus' digestive system? A. Remove excess amniotic fluid for water balance B. Concentrate ingested waste products in the colon C. Secrete stomach acid for pH balance D. Digest and absorb macromolecules from swallowed waste products

A. Remove excess amniotic fluid for water balance

Which of the following is NOT a risk factor for complicated pregnancy?

ABO incompatibility

A 39-year-old G3P2 woman at 32 weeks' gestation reports to the ED 1 hour after suddenonset of severe abdominal pain and nausea. She has vomited once. Pregnancy has beenuncomplicated except for a blood pressure measurement of 150/90 mm Hg at her lastprenatal visit. Her second child was delivered by lower segment transverse cesareansection because of nonreassuring heart rate. Patient appears anxious and pale. T is 37degrees C, HR is 115/min, BP is 88/44 mm Hg. Skin is cool and clammy. Abdominal examshows a rigid tender uterus. Cervix is 30% effaced and 1 cm dilated, vertex is -1 station.Fetal heart rate is 100/min. What is the most likely diagnosis?

Abruptio placenta

A previously healthy 29-year-old woman, gravida 1, para 0, at 35 weeks' gestation comes to the physician for a routine prenatal visit. Current medications include folic acid and a multivitamin. A rectovaginal swab culture grows bacitracin-resistant colonies of gram-positive cocci with surrounding areas of clear hemolysis. Which of the following is the most appropriate intervention to decrease vertical transmission of this organism?

Administer ampicillin intrapartum

Which of the following is a common "mimic" of Paget disease of the breast?

Allergic contact dermatitis of the nipple-areola complex

Which of the following hormonal drugs inhibits peripheral conversion of androgens to estrogen?

Anastrozole

A 53-year-old woman is treated for triple negative breast cancer with right-sidedmodified radical mastectomy and adjuvant chemotherapy. A year later, sheexperiences increasing shortness of breath and exercise intolerance. Cardiacexamination shows a laterally displaced apical impulse. Coarse inspiratory cracklesare audible over both lung fields. Echocardiography shows a left ventricularejection fraction of 30%. The physician informs the patient that her symptoms aremost likely due to an adverse effect of her chemotherapy. The drug most likelyresponsible for her current symptoms belongs to which of the following groups ofagents?

Anthracyclines

Trastuzumab is also used in the treatment for which of the following conditions?

Gastric cancer

A 32-year-old woman, gravida 1 para 1, presents to the clinic with a chief complaint of possible difficulty in breastfeeding for several days. She is a new mother and is unsure if her 4-day-old newborn is getting enough breast milk. She says that her breasts are engorged, and she estimates that she has been able to express one ounce of breast milk from each side. When asked for more details, she states that she puts the baby to breast, and he falls asleep 20 minutes after latching on and nursing from both breasts. 2 hours later he was hungry again. She says he has 3-4 wet diapers per day. Upon examination, the neonate is already back to his birth weight. The stool present in his diaper is yellow and seedy. Which of the following statements is correct?

Babies typically lose up to 10% of their birth weight safely

Which of the following best explains the finding of desmoplasia in ductal carcinoma of the breast?

Benign stroma induced to produce collagen

A baby boy is born at 38 weeks' gestation at a 3000 gm. His Apgar scores are 7 and 9 at 1 and 5 minutes, respectively. At his first newborn visit with the pediatrician at 5 days of age, he weighs in at 2900 gm. Mother reports that she will have to return to work at 6 weeks due to lack of maternity leave. She reports that she is considering switching to formula as she feels it might work better when her baby is at daycare. Which of the following statements is best to advise this mother?

Breastmilk will be beneficial to the baby's respiratory and gastrointestinal tract due to secretory IgA

A pregnant patient in her third trimester presents with blisters on her labia. Treatment with acyclovir is started. How does acyclovir slow down HSV-2 replication?

By inhibiting viral DNA replication

Which of the following best explains why administration of glucocorticoids to a mother at 28 weeks' gestation, lowers maternal estriol circulation?

Glucocorticoids inhibit fetal ACTH which drives fetal-placental estrogen production

The Gram-stained smear of urethral exudate from a male shown in the image is diagnostic for which disease?

Gonorrhea

What is the most important function of a fetus' kidneys? Produce the liquid component of amniotic fluid A. Eliminate metabolic waste products from the fetal blood B. Concentrate urine for water balance C. Produce the liquid component of amniotic fluid D. Concentrate bile for lipid processing E. Eliminate excess calcium ions from the fetal blood

C. Produce the liquid component of amniotic fluid

A 22-year-old woman presents to her physician at 20 weeks gestation. Past medical history is positive for two elective pregnancy terminations, one by medical abortion at 12 weeks and the second by surgical abortion at 15 weeks. Vaginal examination is performed at this visit because the patient is experiencing an itchy, white, curdled appearing vaginal discharge. The physician notes 2 cm dilation of the cervical os with no presenting membranes or fetal parts. Transvaginal US confirms a short cervical length. Which of the following is the likely diagnosis?

Cervical incompetence

Which of the following is the most common risk factor for postpartum metritis?

Cesarean delivery

Which of the following intrapartum infections is NOT reliably managed by antibiotic prophylaxis?

Chlamydia ophthalmia neonatorum

A 3000-g (6.6-lb) female newborn is delivered at term to a 23-year-old primigravid woman. The mother has had no prenatal care. Immunization records are not available. Cardiac examination shows a continuous heart murmur. There are several bluish macules on the skin that do not blanch with pressure. Slit lamp examination shows cloudy lenses in both eyes. The newborn does not pass auditory screening tests. Which of the following is the most likely diagnosis?

Congenital rubella infection

A 26-year-old woman reports to her obstetrician for a first obstetric visit at 10 weeks' gestation. She has a longstanding seizure disorder and is taking carbamazepine to manage her focal complex seizures. Which of the following is a potential teratogenic effect of this medication?

Neural tube defect

Which of the following accounts for most of the breast volume in a non-pregnant non-lactating woman?

Perilobular fat

A 45-year-old woman sees her physician because of a right breast lump and 10 lb.weight loss over the past 2 months. Past medical history is unremarkable. Palpation ofthe breast shows a 3 cm firm nontender mass with well defined margins lateral to theright nipple. There is dimpling of the overlying skin, but no rash is present. The leftbreast is normal. Mammography shows a density with calcifications in a star-shapedformation in the same location as the palpable mass. Which of the following is mostlikely to be seen on microscopic examination of breast biopsy tissue?

Disorganized nests of glandular cells with surrounding fibrosis

A 32-year-old woman, gravida 1 para 1, presents to the clinic with a chief complaint of possible difficulty in breastfeeding for several days. She is a new mother and is unsure if her 4-day-old newborn is getting enough breast milk. She says that her breasts are engorged, and she estimates that she has been able to express one ounce of breast milk from each side. When asked for more details, she states that she puts the baby to breast, and he falls asleep 20 minutes after latching on and nursing from both breasts. 2 hours later he was hungry again. She says he has 3-4 wet diapers per day. Upon examination, the neonate is already back to his birth weight. The stool present in his diaper is yellow and seedy. In this mother, as part of her feedback loops, the secretion of which hormones or neurotransmitters are most likely decreased during suckling?

Dopamine

Which of the following may be associated with bloody nipple discharge?

Ductal papilloma

A 59-year-old woman sees her physician because of a mass in her leftbreast. Examination shows a firm, nontender mass close to the nipple.Mammography confirms an irregular calcified mass. Core needle biopsyshows invasive ductal carcinoma. Genetic analysis of this patient's cancercells shows overexpression of a particular gene. Which of the following isthe most likely gene culprit?

HER2

A 35-year-old G2P1 woman reports for a prenatal visit at 16 weeks'gestation. She has noted increased urinary frequency but otherwisefeels well. Her first pregnancy and delivery were both uncomplicated.Vital signs are normal. Pelvic examination reveals a uterus consistentwith a 16-week gestation. UA shows 1+ glucosuria. Non-fasting serumglucose is 100 mg/dL. Which of the following is the most likelyexplanation for this patient's glucosuria?

Increased glomerular filtration rate

A 35-year-old G6P5 at 35 weeks' gestation reports to the ED because of painlessvaginal bleeding for 2 hours, her second episode in the past 2 days. She has had noprenatal care. All of her children were delivered vaginally without complications.Her pulse is 122/min, RR is 20/min and BP is 88/59. Abdomen is nontender and nocontractions are felt. There is bright red vaginal bleeding. Fetal heart rate is110/min. Two large bore peripheral IV cannulas are inserted, and IV fluids areadministered which she is typed and cross-matched for 3 units of blood. Which ofthe following is the most appropriate next step in management?

Emergency cesarean delivery

Which of the following is considered definitive treatment for actively bleeding placenta previa?

Emergency cesarean delivery

All of the following oral medications can be used to manage hypertension in pregnancy except which?

Enalapril

A 3-day-old girl is brought to the physician by his mother because of irritability and feeding intolerance for 1 day. His temperature is 39.2°C (102.6°F). PCR reveals presence of a naked, ss plus (+) strand RNA virus. Which of the following is the most likely causal pathogen?

Enterovirus

A 3-day-old girl is brought to the physician by his mother because of irritability and feeding intolerance for 1 day. His temperature is 39.2°C (102.6°F). Physical examination shows a bulging anterior fontanelle. A Gram negative organism that expresses the K1 capsular polysaccharide is isolated from the cerebrospinal fluid. Which of the following is the most likely causal pathogen?

Escherichia coli

Which of the following best describes the mechanism of tamoxifen in the treatment of hormone-positive breast cancer?

Estrogen receptor antagonist in breast tissue

A 27-year-old woman reports to the physician with a 1-month historyof increasing shortness of breath. Her LMP was 3 months ago.Menarche occurred at age 12 years and menses have been regularevery 28 days. Cardiac examination shows a grade 3/6, rumblingdiastolic murmur at the apex. Lab studies confirm elevated β hCG.Which of the following is the most likely explanation for this patient'sworsening dyspnea?

Increased intravascular volume

Which of the following is NOT a maternal adaptation to pregnancy?

Increased total lung capacity

Which of the following best explains the increased vulnerability of the anterior pituitary to hypotensive events during parturition?

Increasing estrogen in pregnancy stimulates enlargement of the anterior pituitary with no increase in vascularization

An investigator studying patients with symptoms of arthritis detects a nonenveloped virus with a single-stranded DNA genome in the serum of a pregnant patient. Fetal infection with this pathogen is most likely to cause which of the following manifestations?

Hydrops fetalis

During the transition from fetal to neonatal life, which event occurs FIRST after delivery? A. Activation of inspiratory centers in the brainstem B. Closure of the ductus arteriosus C. Closure of the foramen ovale D. Defecation of meconium E. Replacement of HbF with HbA F. Shutdown of umbilical vein

F. Shutdown of umbilical vein

A 28-year-old woman finds a 1.5 cm, discrete, mobile, firm nodule in the upper outer quadrant of her right breast. Which of the following is the most likely diagnosis?

Fibroadenoma

A 36-year-old woman is brought to the ED after slipping on the ice andhitting her head, which resulted in about 6 minutes ofunconsciousness. LMP was 6 months ago; she has gained 10 # over thelast 6 months. Menses were previously regular at 28-day intervals. BMIis 33 kg/m2. She has a bleeding laceration on the back of her scalp.Serum beta hCG is elevated. MRI of her brain shows no evidence ofintracranial bleed, but her pituitary gland is enlarged. Which of thefollowing best explains her MR findings?

Functional hyperplasia

A 36-year-old woman, gravida 2 para 2, comes into the clinic with complaints of feeling ill for 2 days. She reports that her left breast is painful, red, and swollen. She has been breastfeeding her 4-week-old infant well prior to these symptoms. Three days ago, she noted the onset of pain in her left nipple with latching on; her left breast became sore 2 days ago. She is worried that she is going to have to stop nursing. Upon examination, the temperature is 38.3° C, and the left breast is warm to touch. Which of the following is the most appropriate clinical advice for this patient?

Her baby should continue to breastfeed from both breasts while she takes antibiotics

A 36-year-old woman, G2P2, comes into the clinic with complaints of feeling ill for 2 days.She reports that her left breast is painful, red, and swollen. She has been breastfeeding her4-week-old infant without difficulties prior to these symptoms. Three days ago, she notedonset of pain in her left nipple with latching on; her left breast became sore 2 days ago.She is worried that she is going to have to stop nursing. Upon examination, temperature is38.3° C, and the left breast is red, firm and warm to touch. Which of the following is themost appropriate clinical advice for this patient?

Her baby should continue to breastfeed from both breasts while she takesantibiotics

A 16-year-old girl reports to the physician because of a 3-week historyof nausea, increased urinary frequency and breast tenderness. She hasnever had a menstrual period. She is actively competing on her school'strack and field team. BMI is 18 kg/m2. Breast and pubic hairdevelopment are Tanner stage 5. Which of the following serum assaysis most the most appropriate next step in the diagnosis of this patient?

Human chorionic gonadotropin

Which of the following best explains the underlying cause of the "peau d'orange" finding in ductal carcinoma?

Invasion of dermal lymphatics causes local edema around insertions of Cooper ligaments

Which of the following is NOT an accepted method of ascertaining whether ruture of membranes has occurred?

Leakage of vaginal fluid with fundal compression

A 65-year-old woman is diagnosed with breast cancer after a screening mammogram reveals an abnormality. Her family history is positive for stomach cancer in her father. Her breast biopsy reveals cells with large amounts of mucin invading between collagen fibers in single strands ("Indian filing"). Which of the following is the correct diagnosis?

Lobular carcinoma

A 35-year-old woman comes to the physician because of a rapidly growing lump inher right breast. 8 months ago, she underwent excision of a liposarcoma from thedorsum of her right forearm. Her brother was diagnosed with osteosarcoma ofthe maxilla at the age of 22 years. Her mother died at age 43 years fromcomplications of acute myeloid leukemia. The patient has a 20 pack-year historyof cigarette smoking and continues to smoke 1 pack/day. Examination shows afixed, firm mass in the right breast with axillary lymphadenopathy. Biopsy of themass confirms an invasive ductal carcinoma. Which of the following geneticprinciples is most likely responsible for this patient's condition?

Loss of heterozygosity in tumor suppressor gene

Which of the following has a nearly identical chemical structure to hCG?

Luteinizing hormone

A 6-day-old female infant is brought to the emergency department because of poor feeding and irritability for two days. She was born at 39 weeks' gestation, and the pregnancy and delivery were uncomplicated. Her temperature is 39.2°C (102.6°F). She appears lethargic and makes occasional twitching movements in both upper extremities. The anterior fontanelle is soft and full. A lumbar puncture is performed and analysis of the cerebrospinal fluid shows increased protein and decreased glucose. Cerebrospinal fluid culture shows gram-positive, intracellular rods with tumbling motility. Infection of a healthy adult with the pathogen affecting this infant would most likely present with which of the following clinical conditions?

Meningitis

A 65-year-old woman is diagnosed with advanced estrogen receptor negative breast cancer. Which of the following findings is least likely based upon this diagnosis?

Metastasis to bone

Which of the following is effective treatment for choriocarcinoma?

Methotrexate and hysterectomy

Which of the following causes a natural rise in oxytocin during parturition?

Movement of the fetus into the birth canal

A 24-year-old primigravid woman reports for a routine prenatal visit at 24 weeks'gestation. She has a bit of decreased exercise tolerance compared to 6 months ago,and she is tired, but she has otherwise been well. Weight gain has been normal.Medical history is unremarkable. She is taking prenatal vitamins and no othermedication. Vital signs are normal. Fundal height is consistent with a 24-weekgestation. Lab studies and ABGs are shown below. Oral GTT test is within referencerange. US shows a male fetus in a transverse lie. Which of the following is the mostappropriate next step in management?

No further action is indicated

A 56-year-old woman see her physician after finding a mass in her right breast 1 week ago.Menarche was at age 14 and LMP was at age 51. Vital signs are normal. A nontender, firm,hard mass is palpable in the upper outer quadrant of the right breast. Mammographyshows dense breasts with a 1.7 cm mass in the right upper quadrant. The patientundergoes outer quadrant lumpectomy and sentinel node biopsy, which revealsmoderately differentiated invasive ductal carcinoma and micrometastasis to one axillarylymph node. There is no evidence of extranodal metastasis. The tumor tests positive forboth ER and PR but is HER2 negative. Flow cytometry reveals aneuploid tumor cells. Whichof the following has the greatest effect on this patient's prognosis?

Nodal status

Which of the following is NOT a complication of premature rupture of membranes?

Nuchal umbilical cord

A 55-year-old woman reports to her physician with concerns about swellingand pain in her right breast. Physical examination shows erythema andprominent pitting of the hair follicles overlying the upper and lower outerquadrants of the right breast. There are no nipple changes or discharge. Acore needle biopsy shows invasive carcinoma of the breast. Which of thefollowing is the most likely explanation for this patient's skin findings?

Obstruction of lymphatic channels

A 32-year-old G2P1 woman at 24 weeks' gestation is seen for a routineprenatal visit. Her pregnancy has been uncomplicated, and she feelswell. Her first baby was born via cesarean delivery because of fetalmacrosomia causing arrest of labor in the 2nd stage. The patient has nohistory of serious illness. She is taking a prenatal vitamin only. Pre-pregnancy BMI was 30 kg/m2. Fundal height is 28 cm at today's visitand transvaginal US shows an amniotic fluid index of 27 cm and noevidence of fetal anomalies. Which of the following is the mostappropriate next step?

Oral glucose challenge test

An otherwise healthy 45-year-old woman sees her physician because of a 2-week history of an itchy rash on her left nipple. The rash began as smallvesicles on the nipple and spread to the areola. The area is now a painfululcer with yellow, watery discharge that is occasionally blood-tinged.Examination shows a weeping ulcerated lesion involving the entire leftnipple-areolar complex. There are no palpable masses, dimpling or palpableaxillary lymphadenopathy. Remainder of her examination is normal. Whichof the following is the likely diagnosis?

Paget disease of the breast

Which of the following is NOT a finding in Potter Sequence?

Polycythemia

Which of the following is NOT associated with HER2 overamplification in breast cancers?

Positive response to conventional chemotherapeutic agents

A 34-year-old G1P0 woman reports for her prenatal visit at 37 weeks' gestation.She has been having worsening back pain for the last 3 weeks. The pain is worsewith prolonged walking, standing and sitting. Family history is positive for RA in hermother. She denies radiation of the pain or any numbness in her legs or saddleregion. On exam, pain is elicited along the SI joint area when a posterior force isapplied through the femurs while the knees are flexed. She has trouble withactively raising either leg with the knee extended. Lower limb motor and sensoryexams are normal, as are deep tendon reflexes. Abdominal examination is normalat this visit. Which of the following is the most likely explanation for this patient'ssymptoms?

Relaxation of the pelvic girdle ligaments

Which of the following best describes the clinical presenation of early onset Group B streptococcus infecction in affected newborns?

Respiratory distress, apnea, and hypotension 6-12 hours after birth

A 30-year-old G4P3 woman at 39 weeks' gestation reports to the hospital 20minutes after the onset of vaginal bleeding. She has not received prenatal care. Herthird baby was delivered by cesarean section because of a breech presentation. HerHR is 86/min, RR is 18/min and BP is 132/74 mm Hg. Abdomen is nontender and nocontractions are palpable. The fetus is in a cephalic presentation. Fetal heart rate is96/min. Speculum examination discloses ruptured membranes and moderatebleeding from the external os. Which of the following is most likely

Ruptured vasa previa

Which of the following distinguishes eclampsia from pre-eclampsia?

Seizures

How does hCG production maintain early (up to 8 weeks) pregnancy?

Stimulation of LH receptors prevents loss of corpus luteum

A 21-year-old woman reports to the physician because of positive homepregnancy test. She is in her last year of college and plays on the varsitysoccer team. She lifts weights for strength training, 1 hour 3 X weekly. Shealso is an avid downhill skier and wants to renew her ski pass for theupcoming winter season. Physical examination is normal. After ascertainingthat the patient wants to keep the pregnancy, which of the following isappropriate advice concerning her physical activity?

Stop playing soccer, continue strength training, do not ski

A 26-year-old pregnant woman in her 32nd gestational week arrived at the emergency obstetrics and gynecology department due to the vaginal discharge of clear fluid (hydrorrhea), with no uterine contractions or bleeding. Following the protocol for PROM, antibiotherapy was started to prevent infection with which of the following:

Streptococcus agalactiae

A 2980-g (6.6-lb) female newborn is brought to the emergency department by her mother because of worsening lethargy. The newborn was delivered at home 10 hours ago. The mother has had no prenatal care. The newborn's temperature is 39.7°C (103.5°F). Physical examination shows scleral icterus. Her leukocyte count is 36,000/mm3 (85% segmented neutrophils). An organism is isolated from the blood. When grown together on sheep agar, the isolated organism enlarges the area of clear hemolysis formed by Staphylococcus aureus. Which of the following is the most likely causal organism?

Streptococcus agalactiae

Which of the following describes an endocrine complication of pathologically high hCG levels?

Thyrotoxicosis

A 49-year-old woman reports to her physician with a growing lump in her rightbreast that she first noticed 1 month ago. Physical examination of the right breastshows a 3.5 cm firm, fixed mass in the right upper quadrant with dimpling of theoverlying skin. Mammography shows a mass with poorly-defined margins andmicrocalcifications. Immunohistochemical analysis of a biopsy specimen showsmalignant cells that stain negative for estrogen and progesterone receptors andpositive for human epidermal growth factor receptor 2. Which of the following isthe drug that most specifically targets this patient's tumor?

Trastuzumab

A 23-year-old male presents with ulcerated lesions on the penis (see image) as well as marked unilateral inguinal lymphadenopathy. The lesions and lymph node, however, are not particularly painful to the touch. The patient denies abnormal discharge and any discomfort during intercourse. He is presently afebrile. Consistent with the presentation, what is the probably causative etiology?

Treponema pallidum

A newborn is brought to the ED with hepatomegaly, jaundice, and profuse nasal discharge. The mother had no prenatal care. Which of the following most likely causes the babies condition?

Treponema pallidum

Testing for nonspecific anti-cardiolipin antibodies is often the first test for diagnosing infection with which of the following microbes?

Treponema pallidum

Which of the following correctly describes the path by which the most-well-oxygenated blood in the fetus makes its way into the fetal aorta?

Umbilical vein -> Ductus venosus -> Inferior vena cava -> Right atrium -> Foramen ovale -> Left atrium -> Left ventricle -> Aorta

A 2900-g (6.4-lb) male newborn is delivered at term to a 29-year-old primigravid woman. His mother had no routine prenatal care. She reports that the pregnancy was uncomplicated apart from a 2-week episode of a low-grade fever and swollen lymph nodes during her early pregnancy. She has avoided all routine vaccinations because she believes that "natural immunity is better". The newborn is at the 35th percentile for height, 15th percentile for weight, and 90th percentile for head circumference. Fundoscopic examination shows inflammation of the choroid and the retina in both eyes. A CT scan of the head shows diffuse intracranial calcifications and mild ventriculomegaly. Prenatal avoidance of which of the following would have most likely prevented this newborn's condition?

Undercooked pork

A 26-year-old primigravid woman at 22 weeks' gestation comes to the emergency department because of vaginal bleeding and suprapubic pain for the last 2 hours. She has no history of medical illness. She takes folic acid and a multivitamin supplement. The patient works as a physician in a local clinic. She has no history of recent travel. Her husband works as a flight attendant for an international airline and frequently travels to South America and Southeast Asia. Ultrasonography shows absent fetal cardiac activity and detachment of the placenta from the uterus. Examination of the stillborn fetus shows microcephaly. A reverse transcriptase polymerase chain reaction test of placental tissue confirms infection with a flavivirus. Which of the following measures during pregnancy is most likely to have prevented this fetus's condition?

Use of condoms

A G2P1 woman at 40 week's gestation reports to labor and delivery in activelabor. Her pregnancy was uncomplicated. She delivers a 7lb 2oz baby girlafter 4 hours. She is in the third stage of labor for 1 hour before theobstetrician performs manual separation of the placenta. Significant uterinebleeding ensues. After uterine massage, bleeding diminishes, and the uterinefundus is noted to be firm and nontender at the level of the umbilicus.Which of the following is the likely diagnosis?

Uterine atony

Which of the following is NOT a clinical feature/finding in a patient with a complete hydatidiform mole?

Uterus small for gestational age

A 28-year-old woman comes to the physician because of a 5-day history of a painful rash in the genital area. She also developed mild nausea and decreased appetite during the last 4 weeks. She has not seen a physician in several years; her immunization records are unavailable. Her menstrual cycle is irregular, and she does not recall when her last menstrual period was. She drinks two to three beers daily and occasionally smokes cigarettes. Her usual diet consists of fast food, e.g., hamburgers, and processed carbohydrates, e.g., potato chips. She has several male sexual partners and uses condoms inconsistently. Her temperature is 37.5°C (99.5°F), pulse is 71/min, and blood pressure is 112/70 mm Hg. She is 168 cm (5 ft 6 in) tall and weighs 79 kg (174 lb); BMI is 28 kg/m2. The Pelvic examination shows a group of small vesicles on an erythematous base over the labia majora and minora with tender, bilateral inguinal lymphadenopathy. The urine pregnancy test was positive. Ultrasonography discloses an intrauterine pregnancy consistent with 14 weeks' gestation with no detectable heartbeat. The fetal cranial vault is absent, there is no visible brain tissue, and there is mild polyhydramnios. Which of the following is most likely to have prevented the defect in this fetus?

Vitamin supplementation

A 2500 gm male newborn is delivered at 35 weeks' gestation to a 25-year-oldG2P1 woman. The pregnancy was complicated by oligohydramnios. Newbornexam in the delivery room showed cyanosis, a weak cry and irregularbreathing with gasping. The infant is noted to have a flat nose, prominentepicanthal folds, low set ears and a lower jaw that is abnormally displacedbackwards. Right lower limb is shorter that the left. Breath sounds aredecreased bilaterally. Renal ultrasound of the baby shows bilateral dilation ofthe renal pelvis and ureters. Which of the following is likely to confirm theunderlying cause of this patient's condition?

Voiding cystourethrogram

Which of the following best describes when maternal hCG can be detected in a home pregnancy (urine) test?

Within 1 week of implantation