WH Quiz 3

A 25-year-old Caucasian female G1P0 who is 20 weeks pregnant presents to the obstetrical clinic for a prenatal visit. She is concerned about her newborn getting a Group B streptococcal infection. She "hates being uninformed" and wants you to tell her how a Group B streptococcal infection could impact her baby. Which of the following is a newborn manifestation that you could mention to your patient? A. Pneumonia B. Nonimmune hydrops fetalis C. Microcephaly D. Congenital heart disease

A

A 25-year-old G1P0 female presents to your clinic with spotting after a positive home pregnancy test. She has been feeling a bit nauseous but denies cramping or any additional symptoms. She states her last menstrual period was exactly 4 weeks ago from today. After a thorough history and physical, you confirm her pregnancy with a beta human chorionic gonadotropin level of 3,080 mIU/mL and suspect implantation bleeding. Which of the following would help confirm the patient's pregnancy is not threatened? A. Repeat a quantitative beta human chorionic gonadotropin test 48 hours later. Her level should double by the next test. B. Perform a transvaginal ultrasound. The fetus should be clearly visible. C. Perform a type and screen for the fetus. An Rh positive fetus could induce a response from the maternal immune system, causing the bleeding. D. Measure the fetal heart rate. Normal rate is 120-160 beats per minute.

A

A 26 year old, caucasian, G1P0 female is 40 weeks pregnant and is currently in labor. An epidural has already been performed and the patient has been given pitocin. While monitoring fetal heart tone (FHT) tracing you begin to notice abnormal tracings as it correlates with the mother's uterine contractions. You also notice the mother is hypotensive (100/90). You noticed these abnormalities in FHT tracing began after the peak of uterine contraction had ended. Based on this information you conclude these abnormalities are due to uteroplacental insufficiency and deem intervention to be necessary. You begin the mother on oxygen, augmentation is turned off, and an IVF bolus is started. You treat the patient's hypotension and now are closely monitoring the patient. Based on the scenario described, what was seen on FHT tracing that prompted your intervention? A: Late FHT Deceleration B: Variable FHT Deceleration C: Sinusoidal FHT D: Early FHT Deceleration

A

A 28 year-old G2P0010 Hispanic female presents to clinic complaining of lesions on her vagina. She is 31 weeks pregnant. After performing a Venereal Disease Research Laboratory (VDRL) test and a Fluorescent Treponemal Antibody Absorption Blood Serum Screening (FTA-ABS), the patient is diagnosed with syphilis. Although congenital syphilis is readily preventable if mom is treated appropriately and promptly, mom is concerned that her baby may develop syphilis. What early symptoms could the baby present with if born with congenital syphilis? a. Jaundice, maculopapular rash, nasal discharge, and hepatosplenomegaly b. Fetal non-immune hydrops fetalis c. Congenital heart disease, deafness, and cataracts d. Epilepsy, hydrocephalus, blindness, and severe neurodevelopmental delays

A

A 28-year-old G1P0 Caucasian female presents for routine prenatal visit at 12 weeks gestation. She has no complaints and her physical examination is unremarkable. At her previous visit she completed all the initial routine obstetrical diagnostic tests and the results indicated a Rh negative maternal blood type. While reviewing these results with the patient, which of the following should be discussed? A. The mother will need to be given RhoGAM at 28 weeks and at delivery barring any complications B. The paternal blood type will need to be determined in order to assess the risk of a Rh positive fetal blood type C. The fetal blood type will need to be assessed via amniocentesis D. The baby has a potentially fatal disease known as fetal erythroblastosis

A

A 31 year old G2P0101, 18 weeks gravida female brings her 4 year old son into the pediatrician's office for a bright red rash across his cheeks with an additional lacy rash on his trunk, both arms, and hands. The mother states the rash showed up a couple of days after her son had had a fever and she is concerned about what is causing it. You are concerned about her son's rash, but you are also concerned about what this disease can mean for the mother and her fetus. You recommend that she go to her OB/GYN as soon as possible and explain that her son's infection is contagious and could have negative outcomes for her pregnancy. What negative fetal outcomes could result from this infection? A. Spontaneous abortion and fetal nonimmune hydrops fetalis B. Microcephaly, intrauterine growth restriction (IUGR), and stillbirth C. Skin scarring, limb hypoplasia, chorioretinitis, and microcephaly D. Maculopapular rash, mucous patches on the oropharynx, Hutchinson teeth, saddle nose

A

A 32-year-old female G3P2002 who is 39 weeks pregnant presents to the hospital in labor. Her past medical history is significant for diabetes and hypertension. When examining the fetal heart tracing, you notice some early decelerations. You need to decide what to do next, which of the following is the best choice? A. No intervention needed B. Amnioinfusion C. Emergent cesarean D. Tocolytics

A

A G5P4004 African American female presents today complaining of excessive nausea and vomiting. She is 11 weeks pregnant. You examine her abdomen and discover that the fundus of her uterus is at 14 cm. Next, you perform an ultrasound and see that she has a monochorionic-diamniotic pregnancy. How do you explain this type of pregnancy to the patient? A. 1 sperm fertilized 1 egg, and the egg split into 1 placenta with 2 sacs containing 2 genetically identical babies B. 1 sperm fertilized 1 egg, and the egg split into 2 placentas with 2 genetically identical babies C. 2 sperm fertilized 2 eggs with 2 genetically identical babies D. 1 sperm fertilized 2 eggs with 2 genetically different babies

A

Alexis is a G1P1001 27-year-old female who just delivered her first child last night in a taxi cab and is recovering in your hospital. She never went to the doctor during her pregnancy, and she says that she is an occasional IV drug abuser but hasn't gotten a hit in almost a year. The last time she got tested for sexually transmitted diseases (STDs) was 3 years ago, and the results came back normal. She says she has never had any rash or pain in her genital area. On physical exam, you don't notice anything out of the ordinary for a post-partum mother. You recommend she get a full STD panel, but she insists on only getting tested for what is necessary. What screening recommendations should you give her now that she is post-partum? a. HIV, Syphilis, Hepatitis B b. HIV, Syphilis, Chlamydia, Gonorrhea, Group B Streptococcus c. HIV, Syphilis, Hepatitis C, Hepatitis B, Herpes Simplex Virus (HSV), Chlamydia, Gonorrhea d. HIV, Hepatitis B, Hepatitis D, Group B Streptococcus

A

Anna, a 25-year-old G1P0 female currently 35 weeks gestation, presents to your clinic because she is very concerned about some changes she has noticed in her breast. Her primary care provider has always told her that when she is doing her breast self-exams, to look for any scabbing, crusting around the nipples and to note any abnormal discharge. She has now noticed crusting and abnormal white discharge from both breasts and is concerned that she has breast cancer. How would you advise this patient after performing an unremarkable breast exam? A. The breast changes that Anna is seeing are appropriate for her pregnancy stage. She has begun to produce colostrum, which may slightly leak from the breasts and form crusting on nipples. B. Anna likely has breast cancer and should be immediately referred to oncology. C. Anna's breasts are likely infected and she should be placed on antibiotics. D. Anna's breasts are likely infected; she should apply a warm compress to the area a few times a day.

A

Which of the following mothers have the BEST chance of success for a trial of labor after cesarean section (TOLAC), assuming none of them have contraindications for vaginal delivery and they are in a facility capable of such a procedure? A. A 31-year-old G3P2 with a history of a vaginal delivery with her first child (4 years old) and an emergency C-section with her second (2 years old), who was breech. B. A 26-year-old diabetic G2P1 with a fetal weight of 4300g. C. A 37-year-old G4P3 who has been induced at 40 weeks 6 days and has a fetal weight of 3500g. She required induction of labor with her 3 other children, and the first 2 were able to be vaginally delivered. D. A 21 year-old G2P1 whose 18 month-old son was delivered via C-section at 39 weeks because he was complete breech.

A

A 26-year-old G2P0101 patient presents to her monthly appointment at the clinic. She is currently 18 weeks pregnant. Towards the end of the exam she tells you that she is nervous and scared about having another "preemie" baby. What treatment would be beneficial for this patient to help prevent her from having another premature delivery? a. Magnesium Sulfate b. Vaginal Progesterone c.17 alpha hydroxy progesterone caproate d. Bedrest and hydration

C

A 22-year-old female G1P0010 gives birth to a stillborn baby that presents with microabscesses and delivers a placenta with macroabscesses. You suspect that this patient had an infection during pregnancy. Based on the information provided, which of the following is responsible for this fetal outcome? A. Toxoplasma gondii B. Listeria monocytogenes C. Treponema pallidum D. E. coli

B

A 25 year old G1P0 female that is at 27 weeks gestation comes in complaining of regular contractions for the past 2 hours. Upon examination she is found to have cervical dilation of 3 cm and you are concerned that she is at risk for delivery. Which of the following should be given to the patient? A Bedrest and hydration B Betamethasone C Vaginal progesterone D 17α-hydroxyprogesterone caproate

B

A 26 y/o female G2P1001 presents to the Emergency Room complaining of urinary frequency. Pt reported that her symptoms started 2 days ago and have been constant since onset. Associated symptoms include dysuria and urgency. Pt reported that she would not normally have come to the ER and would drink cranberry juice for her symptoms instead, but decided to come because she noticed her toilet paper was blood-tinged after using the restroom. She reported being very concerned since she is in her first trimester of pregnancy. Based on the patients presenting symptoms and history of current pregnancy, the physician ordered a hCG & UA with reflex culture. The results of the patient's hCG showed that the patient was pregnant in the 1st trimester, and the UA with reflex culture was positive as it showed greater than 100,000 cfu/mL of E. Coli in the voided catch. What is the best treatment for the patient's UTI? A Nitrofurantoin B Amoxicillin- Clavulanate C Bactrim D Doxycycline

B

A 26-year-old G2P2002 Caucasian female presents for a prenatal visit at 32 weeks gestation. She has no complaints, but she does tell her PA that she recently got a kitten. Upon obtaining further history, the PA discovers that the patient has been cleaning the litter box every other day for the last 3 weeks. The PA then decides to order an US, which reveals ventriculomegaly. What should the patient be treated with based upon the US findings? A. Spiramycin B.Pyrimethamine & Sulfadiazine C. Acyclovir D. Zidovudine

B

A 27 year-old gravida female presents to your OB clinic for her initial visit. While performing the pelvic exam you notice vascular congestion and a bluish color of her vagina and cervix. Following the exam, what early sign of pregnancy do you document this finding as? A. Goodell's sign B. Chadwick's sign C. McDonald's sign D. Hegar's sign

B

A 28 year old Caucasian G2P1001 is currently 20 weeks pregnant with her second child. No abnormalities and/or complications of her current pregnancy have been reported/documented. She is uncertain of her blood type, and verification of her blood type could not be obtained through her medical records. A blood type and screen was performed, and this patient was found to be blood type O negative. She states she is uncertain of the father's blood type. What, if any, would be the proper next step for prevention of fetal erythroblastosis? A: Administer RhoGAM today in clinic B: Inform the mother she will need a RhoGAM injection, but at a later date C: No prevention necessary, fetal erythroblastosis is only associated with Rh positive mothers D: Chorionic villus sampling to obtain fetal blood type

B

A 28 year old G1P0000 patient comes to the clinic for her 39 week visit where you tell your patient her cervix is not effaced or dilated yet. You discuss inducing labor if she does not go into spontaneous labor by 41 weeks. One of the risks that you are trying to avoid by inducing your patient include which of the following? A Polyhydramnios B NICU admissions C The baby becoming hyperglycemic D Microsomia

B

A 28-year-old G2P1001 female currently 36 weeks gestation presents in the emergency department today concerned about fluid "leaking" out of her. The provider performs a sterile speculum exam and notes that there is a pooling of fluid from the cervical os. Nitrazine paper testing reveals the amniotic fluid has a pH of 7.2 and the paper turns blue. Ferning of the amniotic fluid was also noted under the microscope. You diagnose the patient with premature rupture of membranes. What is the best management of this patient? A. Give magnesium sulfate for neuroprotection of the fetus. B. Proceed to delivery. Give steroids for fetal lung maturity and antibiotics for Group B Streptococcus prophylaxis. C, Tell the patient that they are on strict bed rest and can go home. D. Tell the patient that this is a normal finding and not to be worried.

B

A 29 year old G2P1001 female who is 39 weeks pregnant goes into labor and is delivering the baby vaginally. During the delivery, the baby's shoulder gets lodged behind the pubic symphysis after the head was delivered. There was also failure to deliver the shoulder after traction was placed on the head of the baby. Therefore, the McRobert's maneuver was performed, and the baby was then successfully delivered. What neonatal complications is the baby at risk for? A. Hypoglycemia B. Brachial plexus injury C. Head entrapment D. The baby is not at risk for any complications

B

A 30 year old, African-American, G1P1001 female has just vaginally delivered after a 40 week non-complicated pregnancy. Immediately following delivery you begin examining the newborn and notice the following: the newborn is blue at the extremities, has a heart rate of 120bpm, coughs and pulls away when stimulated, is moving actively, and is breathing regularly and strongly. What is this newborn's APGAR score and should you be concerned? A: 3; No, this is not a concerning score B: 9; No, this is not a concerning score C: 9; Yes, this is a concerning score D: 3; Yes, this is a concerning score

B

A 30-year-old female G2P1001 presents to your clinic with past medical history significant for diabetes, body mass index (BMI) of 33 for the past 2 years, and is a current smoker. Her first baby was 4600 grams and delivered via cesarean section. While discussing her current pregnancy, which of the following is important to educate your patient about? A. Smoking increases her risk for macrosomia. B. She is at risk for macrosomia which increases her risk of cesarean section. C. She is at risk for macrosomia and therefore will likely need to be induced with labor early. D. Primary cesarean section will be offered only if the estimated fetal weight is greater than 5000 grams.

B

A 31-year-old female G2P2002 presents to your clinic complaining of breast changes and nausea for the past 4 weeks. Her last menstrual period was 8 weeks ago, and she tells you her periods were always regular before that. She is worried that she is pregnant. You order a urine pregnancy test that comes back positive. You also order an ultrasound and determine that she is 6 weeks pregnant. Which of the following is a presumptive manifestation of pregnancy in this patient A. Positive urine pregnancy test B. Breast changes C. Ultrasound findings consistent with the 6th week of pregnancy D. Consistent, regular menstrual cycles

B

A 34-year-old African American G2P0101 patient who is currently 16 weeks pregnant presents to your office with concerns of having another preterm pregnancy. The patient is a smoker and you advise her to stop because this increases the risk of health problems for the baby and the chances of a preterm birth. Furthermore, you perform a physical exam and diagnostic tests. The physical exam was unremarkable, but a transvaginal ultrasound reveals a shortened cervix. This patient has many risk factors for preterm birth including: race, a previous preterm birth, smoking status, and a shortened cervix. Which of the following treatment options is the best to prevent preterm labor? A Vaginal progesterone B Weekly injections of 17a-hydroxyprogesterone caproate and continued until 36 weeks C Mifepristone D Bedrest and hydration

B

A 34-year-old G3P2002 women presents to the ER because her water broke, and she is in labor with her third girl. She is 35 weeks along in her pregnancy and has a history or leiomyomas. She has experienced subcostal discomfort and says the baby's kicks have felt lower than her previous children. An ultrasound is preformed, and it is noted that both of the fetus's hips are flexed with both knees extended at the birth canal. What type of breeched position is this describing? a. Complete b. Frank c. This is a normal presentation of the fetus and is not a breeched position. d. Incomplete

B

A 36 year old G2P0101 woman comes into the clinic today concerned that her baby may have Down's Syndrome. She read online that the risk for Down's Syndrome increases significantly after the age of 35. She has had one healthy child previously, with no abnormalities. She is currently 10 weeks pregnant, but she is wanting to get tested as soon as possible. What test would you recommend for her? A Amniocentesis B Chorionic villus sampling C Noninvasive Prenatal Testing D Ultrasound

B

A G0P0 27 y/o female presents to your clinic with a blood pressure of 160/90. She states she is not currently taking any anti-hypertensive medications and has never been diagnosed with hypertension. You decide to start her on an anti-hypertensive medication in order to minimize the sequelae that having a high blood pressure during pregnancy can cause. What medication is contraindicated in this patient? a. Hydrochlorothiazide b. Lisinopril c. Amlodipine d. Esmolol

B

A G2P1001 female who is 38 weeks pregnant presents to the clinic today complaining of very painful contractions. She claims the contractions are "frequent" and reports no noticeable vaginal bleeding, but is scared that she might be in labor. You see in her chart that she has a history of uncontrolled hypertension and smoking (though she stopped during her pregnancies). Upon inspection you note slight vaginal bleeding, and the fetal heart rate monitor shows non-reassuring fetal heart tracings. On ultrasound you see a retroplacental hematoma. After you confirm your top differential with your supervising physician, what is your next step in treating this patient? A. admit to the hospital and administer IV Pitocin immediately B. admit to the hospital for IV fluids, replacing her blood products, giving oxygen and proceeding to vaginal delivery C. expectant management ("watch and wait") D. give steroids and avoid tocolytics

B

This is a 33 year old female G3P1102 at 28 weeks gestation who presents to the Emergency department after a trip and fall. She denies any abdominal pain, bruising, rupture of membranes, or vaginal bleeding. She reports she is only here to make sure the babies are okay, although she doesn't think her abdomen ever hit anything as her husband was able to catch her before she hit the ground. While getting her history she informs you that she is currently pregnant with twins, she states "they each have their own sac, but I guess they are sharing the placenta part. My OB says this is what happens to most people who have identical twins." With this information you decipher that her monozygotic cleavage at what time? a. days 0-4 b. days 4-8 c. days 8-12 d. days 13-16

B

You are a PA who has been seeing a 28-year-old female patient through her first pregnancy. She is in her third trimester and all her routine screenings came back normal. She has been compliant with all prenatal care that was recommended to her, but present to your clinic today saying she felt feverish. She does not recall any change in her normal routine, but on questioning admits to have "completely forgotten" about your warnings to avoid tending to her cat's litter box during her pregnancy. Her vital signs are as follows: T 103.2, P 80, R 16, BP 132/70. A blood titer is drawn and is positive for both IgG and IgM antibodies. Physical exam findings are normal except for slight cervical lymphadenopathy. Amniocentesis and PCR of the amniotic fluid is ordered, but the results are pending. What would you prescribe, given the patient's history and clinical presentation today? A Penicillin G B Spiramycin C IV Acyclovir D Nitrofurantoin

B

Your pregnant patient presents to the office today complaining of nausea, vomiting, and diarrhea. She is a 27-year-old G3P2 female. You diagnosis her with listeriosis and ask her what she has recently had to eat. You find out she had a BLT with cheddar cheese fries at a local restaurant. What part of her meal is most likely responsible for causing her infection? a.The bread b. The vegetables (lettuce and tomato) c. The cheddar cheese on the fries d. The bacon

B

A 26-year-old female G1P0 who is 36 weeks pregnant presents to the emergency department (ED) panicking that she is in labor, stating she "feels like her water just broke" about 30 minutes ago. She denies any contractions or pain. You conduct a sterile speculum exam, which reveals a closed external cervical os without any signs of dilation or effacement. However, you notice fluid leaking from the cervical os with pooling in the vaginal vault. There is no blood in the vaginal vault and no signs of infection of the genitalia. You collect some clear fluid from the posterior vaginal vault, which turns the pH nitrazine paper blue. You then view the fluid with a microscope, which reveals a ferning pattern. Which of the following BEST describes what this patient is experiencing? A. Preterm labor B. Premature rupture of membranes C. Preterm premature rupture of membranes D. Prolonged rupture of membranes

C

A 27 year-old G1P0000 patient presents for her 16-week gestational checkup. She denies any bleeding, discharge, or other symptoms, aside from expected fatigue. Her vital signs are unremarkable, and a urine human chorionic gonadotropin (hCG) test measures her hCG level at 50,000. A speculum exam is completed with normal findings of a bluish, closed cervical os with no blood or discharge present. On ultrasound, the baby's heart rate is determined to be 124 beats per minute (bpm). What interpretation of this fetal heart rate do you give to the mother? A. The baby's heart rate is tachycardic- it should be between 90-100 bpm B. The baby's heart rate is bradycardic- it should be between 160-220 bpm C. This is a normal fetal heart rate D. There is not enough information provided to come to a conclusion

C

A G1P0000 women who is 7 weeks pregnant comes to clinic for her first ultrasound and gets the standard testing including a urinalysis with reflex urine culture. The urine culture shows 121,000 cfu/mL of E. coli. What would be the best treatment option for this patient at this time? A. Educate the patient on wiping from front to back after urinating B. Nitrofurantoin C. Amoxicillin D. IV Penicillin

C

A 20 year old Caucasian G1P0 female presents to your clinic as a new patient. She is 7 weeks pregnant and showing up today for her first prenatal visit. She is enthusiastic about her pregnancy, but admits she has no idea what to expect when it comes to all of the changes that her body will go through. She states, "I obviously know I'm going to gain weight and probably have cankles at some point..(deep sigh)," but she wants to know more about some other common changes. Which of the physiological changes below are true about pregnancy? A. Gums may become dry due to decreased salivation and she may also experience gastroesophageal reflux disease (GERD). B. She may develop a systolic murmur (most likely a Mitral valve prolapse) and hepatosplenomegaly that resolves post-partum. C. Throughout her pregnancy, she may have an increased risk of constipation, hemorrhoids and potential blood clots in her legs. In the beginning of her pregnancy, it is normal if she has a slight decreased (6-10 mmHg) in her blood pressure. D. She may develop brown patches (melasma) on her face along with hair and nail thickening. Connective tissue may start to remodel, and an exaggerated kyphosis (hunchback) of her spine is normal and back pain can ensue.

C

A 25-year-old G1P0 female who is 35 weeks pregnant presents for a routine check-up and asks, "Is my baby in the right position?" She is concerned that the baby may be in the wrong position since she has been experiencing some subcostal discomfort and feels "kicking" in her lower abdomen. You perform Leopold's maneuvers and suspect a breech fetus. Ultrasound reveals the fetal head in the fundus and both fetal hips not completely flexed. What type of breech presentation is this? A. Frank breech B. Complete breech C. Incomplete breech D. This is a normal position. Answer: A. This is incorrect. A frank breech occurs when the fetus has both hips flexed and both knees extended so that the feet are adjacent to the fetal head. B. This is incorrect. A complete breech occurs when the fetus has both hips and both knees flexed. C. This is the correct answer. Incomplete breech occurs when the fetus has one or both hips not completely flexed. During labor, this position can cause one or both feet or knees to pass through the incompletely dilated cervix. This position also has a higher risk of cord prolapse. D. This is incorrect. This is not a normal position. The fetal head should not be in the fundus of the uterus; the fetal head should be below the umbilicus.

C

A 26 year old Caucasian G2P0101 female who is 32 weeks pregnant presents to clinic today because "her water broke". She denies any bleeding or contractions. She used to smoke 1 pack of cigarettes daily but stopped when she became pregnant. Her last child was delivered prematurely at 30 weeks. You perform a pelvic exam with a sterile speculum and note fluid pooling from the cervical os. You apply cervical mucus to a glass slide and note a ferning pattern. Because you know that may be indicative of premature rupture of membranes, you also check the cervical pH with nitrazine paper and it turned blue. Due to these findings, and the gestational age of the fetus, you decide to proceed with a specific treatment plan. Which of the following is not an appropriate option at this time? A: Administer a tocolytic like magnesium sulfate B: Administer IV Ampicillin and Erythromycin x2 days C: Allow the patient to proceed to delivery of the baby so he or she may be cared for in the NICU D: Give steroids so that the baby's lungs will mature more quickly

C

A 26 year old female is currently in phase 2 labor and the doctor notices that the head is presenting, but the fetal shoulder is lodged. The next step is doing additional obstetric maneuvers in order to avoid maternal and neonatal complications. Which of the following is not a neonatal complication that the doctor is worried about preventing? A Erb's Palsy B Klumpke Palsy C Cleft foot D Fracture of the clavicle

C

A 26 year-old G1P0 mother presents today for her initial OB visit. You decide to get her blood type and Rh status and determine that she is Rh negative. Which of the following is true regarding the management of Rh negative mothers? A. Rhogam should be administered today, at 28 weeks, and within 72 hours after delivery of a Rh positive baby. B. Rhogam should be administered IM every week until delivery. C. Rhogam should be administered at 28 weeks, within 72 hours after delivery of a Rh positive baby, or after any potential mixing of blood. D. Rhogam does not needed to be administered until confirmation that the fetus is Rh positive.

C

A 27-year-old G1P0 Caucasian female that is 30 weeks pregnant presents to your clinic for her routine prenatal visit. However she has complaints of congestion, yellowish-green nasal discharge when she blows her nose, and "pain in her face" when she leans forward. Her symptoms have not improved over the past 10 days. You diagnose her with acute bacterial rhinosinusitis and are trying to decide which antibiotic to prescribe her. Which antibiotic is the most appropriate and safest for her to take at this time? A. Doxycycline (Doryx) B. Levofloxacin (Levaquin) C. Amoxicillin Clavulanate (Augmentin) D. Gentamicin (Gentak)

C

A 27-year-old G2P1001 female presents to her OB/GYN at 26 weeks pregnant for her follow-up 3-hour glucose tolerance test (the 1-hour GTT revealed a level of 145 mg/dL). After receiving the results of the 3-hour test, the PA informs the patient that she has gestational diabetes. Which of the following is consistent with a diagnosis of gestational diabetes? a. At least one elevated glucose level after drinking a 100 g glucose solution. b. Two or more elevated glucose levels after drinking a 50 g glucose solution. c. Two or more elevated glucose levels after drinking a 100 g glucose solution. d. All glucose levels must be elevated after drinking a 50 g glucose solution.

C

A 27-year-old G3P3003 Caucasian female presents to the clinic complaining of excessive nausea and vomiting. Upon examination, you discover the patient is pregnant. Upon learning of the pregnancy, she expresses concern that she has not been screened for any kind of STD. After reviewing her medical records you discover that she has never had any kind of screening at all, even during her previous pregnancies but that she does not have further risk factors. During this visit you would inform her of which of the following? A. That no further testing is warranted at this time B. That because her previous pregnancies have been healthy, she only needs to be screened for HIV C. That she needs to have a full panel of tests run, including screens for HIV, Syphillis, Hepatitis C, and chlamydia D. That she needs to be screened for chlamydia alone

C

A 28 year old female, G2P1, presents to your clinic and is currently 11 weeks pregnant with her second child. She complains of changes in urinary frequency, signs of hematuria, and painful urination. During her most recent OB/GYN appointment, the urinary analysis with reflex urine culture results came back positive for bacteriuria with > 100,000 cfu/mL of the same bacterial strain. You diagnose the patient with a UTI in pregnancy and discuss the appropriate treatment regimen for her bacterial infection. Which of the following pairs indicates the most likely pathogen and the best treatment? A. Toxoplasma gondii; IV Penicillin and 48 hours of observation of the baby B. Streptococcus agalactiae; Ampicillin plus gentamicin C. E. Coli; Amoxicillin or Cephalexin D. E. Coli; Nitrofurantoin 100 mg BID for 5-7 days

C

A 29 year old G2P1001 female patient presents to your clinic during her first trimester of pregnancy saying that she is certain that she was exposed to Erythema Infectiosum because some children in her son's class had it, and she has been helping out with lunch at the school. You obtain B19-specific IgM and IgG serologic testing for which she tests positive for IgM but not IgG. You follow her accordingly with ultrasound every 1-2 weeks for 8-12 weeks and note an enlarged placenta, hydrops, and growth disturbances. Which of the following (as a whole) are the possible fetal outcomes you should inform your patient about? A. Skin scarring, limb hypoplasia, chorioretinitis, and microcephaly B. Microcephaly, intrauterine growth retardation, and stillbirth C. Spontaneous abortion, fetal nonimmune hydrops fetalis (ascites and edema), death D. Maculopapular rash, "snuffles" (nasal discharge), mucous patches on the oropharynx, hepatosplenomegaly, and chorioretinitis

C

A 29 year-old G2P2002 caucasian female presents to your clinic for a follow-up appointment after just delivering her 2nd child. Within the first 18 hours of delivery, she mentions that she had lost a total of almost 1100 mL of blood, and had an overall prolonged labor. She admits that she also bled heavily during her first delivery, and that she wishes it didn't happen to her because she hates how she feels several hours after. She describes that she gets really dizzy, her heart starts beating very quickly, she has quick/shallow breaths, and her skin gets really cold and clammy. The patient states that she wants to have a few more children within the next couple of years, and asks if there is something that can be done to prevent or decrease the bleeding in the future. What is a preventative measure that can be implemented during her future deliveries to reduce the rate of bleeding for this condition? a. Vaginal progesterone b. Magnesium Sulfate c. Prophylactic oxytocin d. Corticosteroids

C

A 29 yo, African-American, G2P1001 female is currently 30 weeks gravid and complains of contractions. She has previously been diagnosed with an incompetent cervix and is extremely anxious that she is going to have her baby girl today. Upon exam, she is dilated 2 cm upon presentation with contractions. What is the best management of this patient? A: Bedrest and hydration B: Vaginal progesterone C: Corticosteroids, Magnesium Sulfate, and Antibiotics D: 17-alpha-hydroxyprogesterone caproate

C

A 29-year old patient (G2P1001) presents to your clinic for her initial prenatal visit after taking two home pregnancy tests that were positive. She recently immigrated to the United States and does not have any vaccination records from her home country. She lives in community housing, and she reports the area around her building is littered with drug paraphernalia. You decide to do a full work-up, including titers, to assess her immunization status. If her titers come back showing no immunization, what vaccinations will you do while she is pregnant? A. Rubella, Varicella, and Hepatitis A and B B. Rubella, Hepatitis B and Hepatitis D C. Hepatitis A and Hepatitis B D. Hepatitis B and Hepatitis D

C

A 29-year-old G1P0 female presents post-term at 43 weeks. The provider is concerned about postmaturity syndrome and induces labor hoping to avoid this and other adverse outcomes associated with post-term births. Which of the following is NOT an expected finding in a neonate with postmaturity syndrome? A. Long fingernails B. Long, thin body with loss of subcutaneous fat C. Hyperglycemia D. Dry, peeling, wrinkled skin

C

A 30 year-old G2P1001 African American female presents to her gynecologist after finding out that she is pregnant with her second child. Her first baby was carried to term and was delivered by cesarean section. She has a past medical history of hypertension and Marfan syndrome. Which of the above aspects put her at risk for having a placenta previa? A. Hypertension B. Race C. Prior cesarean delivery D. Marfan Syndrome

C

A 31 year-old primagravida female presents to your OB clinic today at 28 weeks gestation. Early this morning she started feeling contractions, but denies any bleeding as part of your thorough history and review of systems for today's visit. She has been compliant with the regular protocol of prenatal examinations and screenings for STIs and other infections, and was previously confirmed to have a singleton gestation. Physical and sonographic findings for today's visit include a fundal height of 28cm, no placental abnormalities or rupture of membranes, and a cervical length of 20mm with 2cm dilation. Tocometry confirms the presence of regular contractions. Given the above history and exam findings, which of the following would be most appropriate as one component of her treatment going forward? A. Injections of 17 alpha-hydroxyprogesterone caproate to prevent preterm labor B. Vaginal progesterone to prevent preterm labor C. Antibiotics for Group B Streptococcus (GBS) prophylaxis and Magnesium Sulfate D. Cervical cerclage

C

A 32-year-old African American female G3P0202 who is currently 14 weeks pregnant presents to the clinic for a prenatal appointment and is complaining of abdominal pain. She gave birth to her first child at 36 weeks and her second child at 35 weeks. An ultrasound is performed in which leiomyomas are identified and the cervix length is 20mm. What is the best treatment option to prevent preterm labor in her current pregnancy? A. Vaginal progesterone B. Oxytocin C. 17α-hydroxyprogesterone caproate D. Penicillin

C

A 32-year-old G1P0 female at 22 weeks gestation presents to the emergency department after a motor vehicle accident. After checking the airway, breathing and circulation, you measure her vitals. Her temperature is 99.4 degrees Fahrenheit, blood pressure 90/48 mm Hg, pulse 122/min, and respirations 25/min. You immediately give supplemental oxygen, administer IV fluids, and continue monitoring vital signs. After stabilizing the mother who is crying out in pain and telling you that she has felt a few contractions, you palpate the fundal height to begin an assessment of the baby. You inspect the vaginal area and note vaginal bleeding. Your most likely diagnosis at this time is ___. A. Uterine rupture B. Placenta previa C. Placental abruption D. Toxic shock syndrome

C

A 32-year-old G1P0000 woman recently delivered a baby who is seen to have skin scarring, hypoplasia, chorioretinitis, and slight microcephaly. After asking the mother if she has been around any young children recently she admits to spending time with her niece four days ago whom recently got over a viral infection that caused tiny vesicles appear on her skin. Which of the following is the best treatment for her child? A Acyclovir IM B Spiramycin C Varicella Zoster Ig D There is no treatment for such condition

C

A 36 year-old G3P1102 Asian female presents to your OB/GYN clinic for a regular OB check. She is currently 29 weeks pregnant and has had no complications thus far. During the visit she does have a complaint of subcostal pain and is concerned that the "baby is kicking differently than she is used to." When you ask her to clarify, she says that she now feels the kicks in her lower abdomen. Uterine size is approximately 29 cm and the fetal heart rate is 152. While performing the physical exam, and doing the Leopold maneuver, you note that the head appears to be occupying the fundus. You order a transabdominal ultrasound and note that the head is in the fundus, both hips are flexed, both knees are extended, and that the feet are adjacent to the fetal head. What type of fetal presentation is displayed on the ultrasound? a. Incomplete Breech b. Compound presentation c. Frank Breech d. Complete Breech

C

A 37 year old G6P3205 Caucasian female presents to Labor and Delivery through the emergency department 30 minutes after her water broke while at home. She states that she is not having contractions and was 1 cm dilated at her appointment with her obstetrician 3 days ago. She is 37 weeks pregnant and is concerned about the baby coming early as her 5 other children "came right on time." Four of her children were vaginal deliveries, and her most recent was a cesarean delivery 2 years ago. As the PA on call, you monitor the fetal heart rate as well as the contractions, order labs, and perform a pelvic exam. The patient's obstetrician left for vacation, so you relay the progress to the obstetrician on-call. You are told to prep the patient for an emergency cesarean section and scrub in as first assist. Which of the following conditions would an emergency cesarean be indicated: a. Early fetal heart tone deceleration noted on tocometry. b. Cervix is dilated to 6 cm and tocometry indicates normal fetal heart tones. c. Cervix is dilated to 3 cm and tocometry indicates sinusoidal fetal heart tones. d. Previous low transverse cesarean delivery.

C

A 38 year old G4P3013 African American female comes to the emergency department complaining of contractions. She is 35 weeks pregnant with a past medical history of type 1 diabetes, leiomyomas of the uterus and smoking. On examination you notice her cervix is 3cm dilated with no abnormal bleeding. Which of the following is NOT a risk factor for preterm labor in this patient? a. Her race b. Her age c. Her history of type 1 diabetes d. Her history of smoking

C

A 38-year-old African American female G1P0 who is 10 weeks pregnant presents to the obstetrical clinic for her first prenatal check-up. She has had multiple sex partners in the past and was an intravenous drug user for ten years. Due to this high-risk history, you send a sample of her blood to the laboratory for hepatitis B serologic testing. The results are positive for hepatitis B surface antigen (HBsAg) and total hepatitis B core antibody (anti-HBc) and are negative for immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc) and hepatitis B surface antibody (anti-HBs). You submit a second sample to the laboratory to confirm the viral load. The viral load is 9 log10 copies/mL. Based on these results, you conclude that she is chronically infected with the hepatitis B virus and currently has a high viral load. Which of the following is the next best step in this situation? A. Offer hepatitis B vaccination during pregnancy B. Administer hepatitis B immunoglobulin and begin the hepatitis B vaccination series to the newborn within 12 hours of birth C. Start the mom on Tenofovir D. Wait between 2 days to 2 months after delivery to administer the hepatitis B vaccination to the baby

C

A G1P0000 26 year old female presents to the clinic for her initial visit. She states that her last menstrual period was approximately 13 weeks ago and she had a positive at home urine pregnancy test about 2 weeks after her last menstrual period. She complains of severe morning sickness that "really lasts all day" and breast tenderness. Upon physical exam, you palpate a fundal height that is greater than expected for her estimated gestational age. During the ultrasound, 1 placenta and 2 amniotic sacs are visualized. Which of the following is a complication you would discuss with your patient when educating her about her pregnancy? A. Post-term delivery B. Macrosomia C. Twin-Twin Transfusion Syndrome D. Decreased perinatal morbidity

C

Penicillin G 1g IM x1 25-year-old G2P1 female patient presents to clinic complaining of a fever for the past few days. On physical exam, she has no rash, ulceration, conjunctivitis, or arthralgia noted. You ask the patient if she has been vaccinated and she confirms receiving the Varicella and Rubella vaccinations 3 months before she became pregnant with her first child. You decide to do further testing to confirm your suspicions, especially since the potential infection can cause significant complications in her pregnancy. What is the best treatment option for the infection most likely causing her fever? a. IV acyclovir b. IgG Rubella Antibody c .Acetaminophen (if fever persists) d. Penicillin G 1g IM x1

C

Ruby, a 29-year-old African American female G1P0 who is 10 weeks pregnant, presents to the obstetric clinic for a routine prenatal visit. You are a physician assistant student (PA-S) out on rotations and will be the one conducting her pelvic exam. While performing the exam, your preceptor tells you to appreciate the blue hue of the cervix. She wants you to tell her the technical term for this physical exam finding. What should you tell her it is? A. Goodell's sign B. Hegar's sign C. Chadwick's sign D. Von Fernwald's sign

C

A 22 year old female G1P0000 presents to the office for her first prenatal visit. Her last menstrual period was 10 weeks ago. She recently moved to Texas from France last year for graduate school. She has no family members nearby and is still trying to make new friends. She tells you she is starting to feel anxious about her pregnancy because she is having issues with the father of the baby, and she feels alone. She has no past medical history and has completed all of her vaccinations. She has read many online articles and is really concerned about contracting Listeria because of her French diet. What types of food would you recommend to avoid? A. Cooked sushi B. Pasteurized soft cheeses C. Well cooked meats D. Unpasteurized soft cheeses

D

A 23-year-old G1P0 non-diabetic female presents to her prenatal visit at 40-4/7 weeks gestation. She is not experiencing regular contractions and her cervix is not dilated. You perform an ultrasound and obtain fetal measurements. The estimated fetal weight is 4650 grams. What is the most appropriate next step? A. Induce labor the following day B. Schedule a cesarean delivery for the following day C. Schedule a cesarean delivery at 42 weeks if patient has not entered labor and estimated fetal weight remains below 5000 grams D. Plan to induce labor at 42 weeks if patient has not entered labor and estimated fetal weight remains below 5000 grams

D

A 24 yo gravida female presents today via ambulance following a MVA. She appears in no acute distress and is able to tell you that she is 30 months pregnant. Being the great PA student you are you know that even though the patient received minor trauma you will want to observe her for 4 hours unless: A. She was a passenger and therefore does not need to be observed and can be discharged. B. She experiences abdominal pain and should then be observed for 8 hours. C. Her spouse is with her and can drive her home. D. She has vaginal spotting and should then be observed for 24 hours.

D

A 25 year old female G1P0 presents to the clinic for her first ultrasound during her pregnancy. The ultrasound reveals one placenta and two uterine sacs. You diagnose the patient with a monochorionic-diamniotic pregnancy. You explain to the patient that there are risks associated with a twin pregnancy. Which is not a complication associated with twins? A Gestational diabetes B Fetal growth restriction C Hemorrhage D Late term pregnancy

D

A 25 year-old G1P0010 Caucasian female presents to the clinic today because she believes she may be pregnant. She took a pregnancy test at home last night and it was positive. She got pregnant last year, but had a miscarriage in the first trimester. She did not see an OBGYN for her first pregnancy, and she wants to make sure she does it right this time to avoid going through the heartbreak of another failed pregnancy. She states her last menstrual period was 7 weeks ago and that she has been feeling nauseated the last few days, which prompted her to take a pregnancy test. After doing a physical exam and drawing blood, you conclude the patient is pregnant and appears to be at roughly 6 weeks gestation. The patient states she did some research online and wants to know her blood type because she read that her Rh factor may have caused her first abortion. What should you tell this patient? a. This is her first real pregnancy so there is no chance that the Rh factor is a problem. However, if she wants another child, it may be an issue next time but we can screen for it then. b. Tell the patient that the Rh factor has no bearing on whether a patient has a miscarriage. c. Give the patient Rhogam because she is concerned and it will make her feel better. d. Explain to the patient the we will check for her Rh factor and administer Rhogam if necessary once the labs come back.

D

A 25 year-old patient G1P0000 is 12 weeks pregnant. She is out to eat with some of her friends and trying to decide what to order. She remembered her PA counseling her on certain foods to avoid while pregnant during her last prenatal visit. Which of the options below would be a safe choice for her and the baby? A. The Strawberry poppyseed salad with fresh made gorgonzola and chicken. B. The classic cold deli sub without the mayonnaise C. A raw sushi roll with sake D. The chicken fajitas

D

A 26 year-old G1P0000 patient who is 8 months pregnant comes into your emergency room after she starts experiencing contractions. An ultrasound is ordered to monitor the baby's position and amniotic fluid index. You notice that both of the baby's hips and knees are flexed and will pass through the birth canal simultaneously. What is the correct term for the position of this baby? A.Frank Breech B. Footling Breech C. Kneeling Breech D. Complete Breech

D

A 27 year old female, G2P1, who is 36 weeks pregnant is currently in labor and has chosen to deliver her twins vaginally. The first twin was delivered successfully. Upon delivery of the second twin, the baby now presents with an incomplete breech. The physician suspects that there is now a risk for cord prolapse and begins management of the delivery of the second twin as such. She calls for help and constantly monitors fetal heart tone tracings. What finding on a fetal heart tone tracing would confirm the physician's suspicion of a cord prolapse? A. Early Deceleration B. Acceleration C. Late deceleration D. Variable deceleration

D

A 28-year old G1P0 female in her second trimester presents to your clinic for her OB visit. She tells you that she thinks she might have a UTI. You order a urinalysis with reflex urine culture, which comes back positive for E. coli. You decide to treat her UTI with an antibiotic. Which of the following antibiotics can NOT be prescribed for this patient? A. Amoxicillin B. Nitrofurantoin C. Cephalexin D. Doxycycline

D

A 29 year old G2P1001 female comes in to your clinic feeling febrile and ill. She is 28 weeks pregnant with no history of complications. She complains of nausea and fatigue that started a day or two after her and her husband stopped at a sandwich shop for lunch. Her vital signs are: Temp: 100.6; HR: 87 RR: 17 BP: 131/74 After doing a full history and physical exam, the PA educates the patient that this condition may put her baby at risk for spontaneous abortion, neonatal sepsis, or a fetal infection that causes micro-abscesses and she wants to start her with treatment right away. Which of the following is the treatment of choice for this patient with the diagnosis described? a. Ampicillin plus doxycycline b. IV acyclovir c. Ampicillin and gentamicin, plus NSAIDs PRN for fever d. Ampicillin plus gentamicin

D

A 32 year old G3P2103 female patient has been told by her family that she cannot breastfeed her newborn that she delivered 14 hours ago. The patient's mother found out that the patient is a chronic carrier of hepatitis B and is worried that the baby might contract it. Her doctor made sure to start the newborn on the hepatitis B vaccination series within 12 hours of her birth and reassured the mother that it is now safe for her daughter to breastfeed. Based on the history and vaccination of the newborn, is it really safe for the patient to breastfeed her newborn? A. Yes, the baby is protected against hepatitis B with the beginning of the vaccination series and can be breastfed even if the patient is a chronic carrier. B. No, she cannot breastfeed her newborn due to the fact that she is a chronic carrier of hepatitis B. C. Yes, she can breastfeed her child as long as she has no signs of cracking or bleeding from her nipples. D. No, she cannot breastfeed her newborn due to the fact that the newborn did not also receive hepatitis B immunoglobulin injection along with the beginning of the hepatitis B vaccination series.

D

A 36 year-old G1P0 female presents to your clinic because she is nervous about the risk of genetic abnormalities in her baby after reading on Google her age increases her risk. The woman is 11 weeks pregnant and wants to know if there is any testing she can do to determine if her baby could have an increased risk of a genetic abnormality. Of the following options, which would be the most appropriate and least invasive option to recommend to your patient? A Penta screen B Blood type & screen C Amniocentesis D Nuchal translucency E Biophysical Profile (BPP)

D

A 37-year-old G3P1102 female presents to your clinic seeking prenatal care. She is currently at 11 weeks gestation and carrying twins. She has a history of 2 healthy vaginal deliveries at 38 and 36 weeks gestation, respectively. Based on her weight 3 months ago, you calculate that her pre-pregnancy BMI was 29.5. Upon questioning, she admits to a 12 pack-year history, and currently smokes 1 pack per day although she has been "trying to quit." Which of the following in her history does NOT increase her risk of preterm labor with this pregnancy? A. Multiple pregnancy B. Smoking status C. Prior vaginal delivery at 36 weeks D. Pre-pregnancy BMI

D

Libby, a 26-year-old G1P0 female who is currently 16 weeks gestation is super nervous considering this is her first pregnancy and wants to be sure she does everything right. Lucky for her, her best friend is in her 2nd year of PA school learning about the 'dos and don'ts' of pregnancy and has been giving her advice all along the way. Given the top notch education that her friend is receiving, she correctly tells Libby that the _______ vaccine is safe to get during pregnancy. A. Varicella B. Rubella C. Hepatitis D D. Hepatitis A

D