Complicated Pregnancy Practice Questions
A 28-year-old gravida 2 para 1 woman presents to her obstetrician at 28 weeks gestation for a routine prenatal visit. She has a history of Rh-negative blood type. Her first pregnancy resulted in the birth of a healthy Rh-positive baby. Her current pregnancy has been uncomplicated thus far. What is the most appropriate recommendation regarding Rhogam administration for this patient? A) Patinet requires administration of Rhogam intramuscularly B) Delay Rhogam administration until after delivery. C) Administer Rhogam only if she experiences vaginal bleeding or trauma during pregnancy. D) Administer Rhogam intramuscularly within 72 hours postpartum.
A
A 28-year-old pregnant woman in her second trimester presents for a routine prenatal visit. She denies any urinary symptoms such as dysuria, frequency, urgency, or hematuria. However, a urine dipstick test reveals the presence of leukocyte esterase and nitrites. What is the most appropriate next step in management? A) Initiate antibiotic therapy with amoxicillin B) Repeat urine culture in one week D) Advise increased fluid intake and repeat urine dipstick in 48 hours E) Start intravenous ceftriaxone therapy immediately
A
A 28-year-old pregnant woman presents for routine prenatal care at 28 weeks gestation. She has no significant past medical history. She undergoes a 3-hour glucose tolerance test (GTT) for screening of gestational diabetes mellitus (GDM). The results are as follows: Fasting glucose: 87 mg/dL 1-hour glucose: 160 mg/dL 2-hour glucose: 120 mg/dL 3-hour glucose: 100 mg/dL Which of the following is the most appropriate interpretation of these results? A) Normal glucose tolerance, no further action needed. B) Impaired glucose tolerance, recommend dietary modification and exercise. C) Gestational diabetes mellitus, initiate dietary modification and insulin therapy. D) Borderline results, repeat GTT in two weeks. E) Severe hyperglycemia, initiate immediate insulin therapy.
A
A 28-year-old pregnant woman presents to her obstetrician's office for a routine prenatal check-up at 32 weeks gestation. During her examination, her blood pressure is measured at 150/95 mmHg. She has no history of hypertension prior to pregnancy and has not experienced any symptoms related to high blood pressure. Her urine dipstick is negative for proteinuria. Fetal ultrasound shows appropriate growth for gestational age with no signs of intrauterine growth restriction. Which of the following is the most appropriate initial step in managing this patient's condition? A) Initiation of Methyldopa B) Lifestyle modifications and close blood pressure monitoring C) Initiation of low dose aspirin D) Immediate induction of labor to prevent complications
A
A 28-year-old pregnant woman presents to the emergency department complaining of severe nausea and vomiting for the past 2 weeks. She states that she is unable to keep any food or fluids down and has lost approximately 5 pounds during this time. Urinalysis reveals ketonuria. A diagnosis of hyperemesis gravidarum is made, and the patient is started on pyridoxine (vitamin B6) therapy. However, her symptoms persist despite treatment. Which of the following medications is most appropriate to add to her regimen? A) Diphenhydramine B) Loratadine C) Ranitidine D) Ondansetron
A
A 30-year-old pregnant woman in her 28th week of gestation is diagnosed with gestational diabetes mellitus during a routine prenatal visit. She has been managing her blood glucose levels through diet and exercise but continues to exhibit elevated fasting blood glucose levels despite these measures. Her current fasting blood glucose levels consistently range between 105-110 mg/dL. Which of the following is the most appropriate next step in managing her condition? A) Initiate insulin therapy to control her blood glucose levels. B) Counsel patient to increase her daily protein intake and start high intensity exercise. C) Advise her to continue with diet and exercise therapy alone. D) Wait until her fasting blood glucose levels consistently exceed 110 mg/dL before considering insulin therapy.
A
A 32-year-old G2P1 woman presents to the labor and delivery unit in active labor at 39 weeks gestation. Her first delivery was uncomplicated. During the second stage of labor, the fetal head delivers but the shoulders are impacted behind the pubic symphysis. After applying McRoberts maneuver and suprapubic pressure, the shoulders are released, and the baby is delivered. Which of the following describes the delivery complication described above? A) Turtle sign B) Footling Presentation C) Frank Position D) Overt Prolapse
A
A 32-year-old pregnant woman, at 36 weeks gestation, presents to the obstetric clinic with a breech presentation confirmed on ultrasound. She expresses her desire for a vaginal delivery but acknowledges concern for the safety of her and her baby. After counseling on the risks and benefits, she opts for an external cephalic version to attempt to reposition the baby. However, despite two attempts, ECV fails to convert the baby to a cephalic presentation. What is the most appropriate next step in the management of this patient? A) Schedule an elective cesarean section for delivery at 39 weeks gestation. B) Administer tocolytic therapy and attempt ECV again after 48 hours. C) Proceed with a trial of vaginal breech delivery under close fetal monitoring. D) Continue expectant management and reevaluate fetal presentation at 38 weeks gestation.
A
A 32-year-old pregnant woman, gravida 2, para 1, at 35 weeks of gestation presents to the emergency department with complaints of severe headache, epigastric pain, and visual disturbances. On examination, her blood pressure is 160/110 mmHg, and she has edema in her lower extremities. Laboratory investigations reveal elevated liver enzymes, thrombocytopenia, and proteinuria. Subsequent diagnosis confirms the presence of HELLP syndrome. Which of the following complications is most likely to be associated with this condition? A) Acute Kidney Injury (AKI) B) Hypoglycemia C) Preeclampsia D) Fetal Growth Restriction
A
A 32-year-old woman presents to the emergency department at 30 weeks gestation with symptoms suggestive of preterm labor. Upon evaluation, the obstetrician decides to perform a fetal fibronectin (fFN) test. Which of the following statements regarding fetal fibronectin in premature labor is most accurate? A) A positive fetal fibronectin test result is predictive of preterm labor due to being a sign of amniotic sac breaking from uterus B) Fetal fibronectin testing is primarily used for diagnosing congenital anomalies in the fetus rather than assessing the risk of preterm birth. C) A negative fetal fibronectin test result effectively rules out the risk of preterm labor, regardless of other clinical indicators. D) Fetal fibronectin levels remain constant throughout the gestational period and are not influenced by the onset of preterm labor.
A
A 32-year-old woman presents to the emergency department complaining of severe abdominal pain and profuse vaginal bleeding following childbirth. Upon examination, her vital signs are stable, but she appears pale and diaphoretic. Pelvic examination reveals a mass protruding from the vagina that is consistent with uterine inversion. Which of the following symptoms would the patient most likely exhibit in addition to abdominal pain and vaginal bleeding? A) Urinary retention B) Constipation C) Fever D) Shoulder pain
A
What is an adverse outcome associated with shoulder dystocia? A) Erbs Palsy B) Cerebral Palsy C) Developmental Delays D) Umbilical vein occlusion
A
A 28-year-old female presents with vaginal bleeding and passage of prune-like discharge. She has a PMH of a molar pregnancy. You notice that her uterus is larger than expected for her gestational age. Which of the following is something that you should for sure initially do with this patients PMH history and symptoms? A) Pelvic Exam B) Uterine Evacuation C) Chest X-Ray D) MMS exam
A - diagnosis is hydatidiform mole, pelvic exam is important initial physical exam to not miss passage of material / adnexal masses
A pregnant patient at 38 weeks gestation is admitted to the labor and delivery unit with progressing contractions. Upon continuous fetal heart rate monitoring, late decelerations are noted. The nurse assesses the patient's vital signs, finding maternal blood pressure within normal limits, but the fetal heart rate remains between 110-120 beats per minute with late decelerations occurring after the peak of contractions. Which of the following interventions is the priority action for the nurse to take? A) Administer oxygen to the mother via face mask at 8-10 liters per minute. B) Increase the rate of the intravenous infusion of normal saline. C) Prepare the patient for immediate cesarean delivery. D) Change the mother's position to a lateral tilt.
A - fetal distress - oxygen to mom means more oxygen to baby
A 29-year-old pregnant woman at 31 weeks of gestation presents to the emergency department with severe epigastric pain, nausea, and malaise. Laboratory tests reveal thrombocytopenia, elevated liver enzymes, and hemolysis. The diagnosis of HELLP syndrome is made. The mother is given magnesium sulfate and stabilized. What should be given prior to delivery? A) Betamethasone B) Empiric Antibiotics C) Terbutaline D) IV fluids
A - give in HELLP if delivery prior to 34 weeks gestation
A 28-year-old pregnant woman, currently at 10 weeks gestation, presents to the emergency department complaining of persistent nausea and vomiting for the past three days. She states that she now weighs less than she weighed before she became pregnant. She denies any other symptoms such as fever, abdominal pain, or vaginal bleeding. Her vital signs are stable and laboratory studies reveal no signs of dehydration at this point. Urinalysis is negative for ketones. The patient is diagnosed with hyperemesis gravidarum. Which of the following treatment options is the most appropriate initial management for this patient's condition? A) Prescribe doxylamine-pyrodoxine and suggest dietary changes B) Advise patient to watch diet and take Benadryl when feeling nauseous C) Prescription of metoclopramide D) Initiation of glucocorticoid therapy
A - hyperemesis gravidarum just persistent nausea and vomiting
A 32-year-old woman, G3P3, presents to the emergency department with excessive bleeding following childbirth. Physical examination reveals a uterus that is boggy and larger than expected for the postpartum period. She is tachycardic with a heart rate of 110 bpm and hypotensive with a blood pressure of 90/60 mmHg. Which of the following pathophysiological mechanisms primarily contributes to postpartum hemorrhage in this patient? A) Uterine atony B) Coagulopathy C) Trauma to birth canal D) Retained placental tissue E) Uterine rupture
A - large and boggy uterus
A 37-year-old female presents to her OBGYN complaining of vaginal bleeding and pelvic pain. She reports that her last menstrual period was 10 weeks ago. On PE, her uterus is enlarged to the size consistent with a 14-week gestation. Serum β-hCG levels are markedly elevated. A transvaginal ultrasound reveals a grape-like cluster of structures within the uterus and no fetal heartbeat. A diagnosis of gestational trophoblastic disease (GTD) is suspected. Which of the following regarding GTD is most accurate? A) GTD's are benign in nature but can be premalignant giving rise to choriocarcinoma B) Complete or partial hydatidiform moles do not contain any fetal tissue and do not carry any risk for malignancy C) Treatment of GTD involves observation for passage of material and beta HCG monitoring D) Treatment of GTD typically involves hysterectomy as first-line therapy due to malignant transformation.
A - notice age of pregnancy, increased maternal age is a risk factor
A 28-year-old female presents to the emergency department complaining of vaginal bleeding and lower abdominal cramping. She is 8 weeks pregnant by her last menstrual period. Upon examination, her vital signs are stable, and she appears anxious. Pelvic examination reveals a closed cervical os with mild uterine tenderness. Fetal heart tones are detected. Ultrasound confirms a viable intrauterine pregnancy. What kind of abortion is this? A) Threatened B) Inevitable C) Complete D) Incomplete E) Septic
A - threatened spontaneous abortion = baby is still alive and has a chance of survival - cervical os is closed and no fetal tissue has been passed
A 32-year-old pregnant woman presents to the emergency department at 34 weeks gestation complaining of epigastric pain, nausea, and malaise for the past 24 hours. She denies any history of hypertension prior to her pregnancy. On examination, her blood pressure is 160/100 mmHg, and she has tenderness over the right upper quadrant of the abdomen. Laboratory studies reveal hemoglobin of 10.5 g/dL, platelet count of 85,000/μL, and elevated liver enzymes. Which of the following criteria is most consistent with this diagnosis? A) Hemoglobin < 9 g/dL, platelet count < 100,000/μL, elevated liver enzymes, elevated LDH, elevated bilirubin B) Hemoglobin < 12 g/dL, platelet count < 150,000/μL, low liver enzymes, low LDH, elevated bilirubin C) Hemoglobin < 12 g/dL, platelet count < 100,000/μL, elevated liver enzymes, decreased bilirubin D) Hemoglobin < 13 g/dL, platelet count < 50,000/μL, low liver enzymes, normal blood smea
A - we dont need to know a # for hemoglobin in hellp syndrome just showing a significant drop + elevated bilirubin (need two signs of hemolysis) , AST or ALT 2x upper limit, LDH 2x upper limit, platelet less than 100,000
A 28-year-old pregnant woman presents to the obstetric clinic at 34 weeks gestation with complaints of fluid leakage from the vaginal canal for the past 12 hours. She denies any associated pain or contractions. On examination, the amniotic fluid pooling is noted in the posterior fornix upon speculum examination. Which of the following tests is the most appropriate next step in confirming the diagnosis of premature rupture of membranes? A) Nitrazine paper test B) Ultrasound examination C) Fetal fibronectin (fFN) test D) Amniotic fluid culture What would this results of this test show? A) Fluid in arborization pattern B) Orange to dark blue in color C) Absent fetal heartbeat D) Amniotic sac detachment
A and B - premature rupture of membranes can use nitrazine paper test, amniotic fluid would turn nitrazine paper from orange to dark blue
A 27-year-old pregnant woman at 36 weeks gestation presents to the labor and delivery unit with complaints of fluid leakage per vagina. She reports a sudden gush of clear fluid approximately 2 hours ago while she was at home. On examination, there is a suspicion of premature rupture of membranes. Which of the following test would you perform with a sterile speculum exam? A) Pooling test B) Ferning Test C) Nitrazine Test What does this look for? A) Amniotic fluid interaction with nitrazine B) Collection of amniotic fluid in vaginal fornex C) Pattern of aminiotic fluid
A and B - sterile speculum exam allows you to do pooling test to look for pooling of amniotic fluid in vaginal fornix
A 32-year-old gravida 2 para 1 woman presents to the emergency department at 8 weeks gestation with vaginal bleeding and abdominal cramping. Ultrasound reveals a live intrauterine pregnancy with evidence of a subchorionic hemorrhage. Which of the following statements regarding subchorionic hemorrhage is most accurate? (can be more than one) A) Subchorionic hemorrhage is commonly associated with an increased risk of miscarriage. B) Subchorionic hemorrhage is usually resolves spontaneously without intervention. C) Subchorionic hemorrhage is typically seen as a collection of blood between the uterine wall and the chorionic membrane. D) Subchorionic hemorrhage is not related to spontaneous abortion
A and C
A 32-year-old woman, gravida 2 para 2, presents to the emergency department complaining of severe pelvic pain and profuse vaginal bleeding after delivering her second child at home. On examination, her vital signs are stable, but she appears pale and diaphoretic. Pelvic examination reveals a large, smooth, rounded mass protruding from the vagina. On further assessment, the uterus is palpable as a firm, inverted mass above the symphysis pubis. Which of the following is the most appropriate initial management for this patient? A) Attempt manual replacement of the uterus B) Administer intravenous antibiotics C) Perform exploratory laparotomy D) Administer uterotonic medications Next? A) Attempt manual replacement of the uterus B) Administer intravenous antibiotics C) Perform exploratory laparotomy D) Administer uterotonic medications
A and D First try to manually reposition the uterus and then if successful give uterotonic drugs
A pregnant client is in labor to deliver her baby. The mother is 39 weeks' gestation and has had gestational diabetes during pregnancy. The mother has missed many prenatal appointments and admits that she has not checked her blood glucose levels or controlled her diet well, despite her diagnosis. Which of the following are risks to the infant as a result of uncontrolled gestational diabetes? Select all that apply. A) Low blood glucose after birth B) Macrosomia C) Increased episodes of apnea D) Low blood pressure E) Shoulder Dystocia F) Hypercalcemia
A, B, C, E -hypoglycemia -macrosomia -respiratory distress -Shoulder dystocia, technically listed under mom in our powerpoint but is something that can hurt baby -HypOcalcemia
A 28-year-old pregnant woman at 32 weeks gestation presents to the clinic with complaints of headache, blurry vision, and swelling in her hands and face. Her blood pressure is 161/112 mmHg. Her urine dipstick shows 2+ proteinuria. She has no significant past medical history. Which of the following is the most likely diagnosis? A) Chronic hypertension exacerbation B) Preeclampsia C) Gestational hypertension D) Essential hypertension E) Renal artery stenosis
B
A 28-year-old pregnant woman at 36 weeks gestation presents to the emergency department with sudden onset of intense abdominal pain and vaginal bleeding. Upon examination, her cervix is found to be dilated at 5 cm with fetal presenting part palpable. Fetal heart rate monitoring reveals variable decelerations. An umbilical cord prolapse is suspected. Which of the following is the most appropriate initial management for umbilical cord prolapse in this patient? A) Immediate administration of tocolytics B) Emergent cesarean delivery C) Application of sterile saline-soaked gauze to the exposed cord
B
A 28-year-old pregnant woman presents at 34 weeks gestation with a blood pressure reading of 150/95 mmHg. She has a history of gestational hypertension and has been on methyldopa 500 mg twice daily for the past 2 weeks. Despite compliance with methyldopa, her blood pressure remains elevated. Which of the following is the most appropriate next step in her management? A) Increase the dose of methyldopa B) Add hydralazine to her current regimen C) Switch methyldopa to nifedipine D) Initiate labetalol therapy E) Continue monitoring without medication adjustment
B
A 28-year-old primigravid woman at 39 weeks gestation presents to the labor and delivery unit with prolonged labor. She has been in active labor for the past 6 hours with inadequate cervical dilation despite regular contractions. Upon examination, her cervix is dilated to 4 cm and effaced at 50%. Fetal heart rate monitoring is reassuring. Which of the following is the most appropriate next step in the management of this patient's dystocia? A) Immediate cesarean delivery B) Augmentation with oxytocin C) Maternal hydration and position change D) Vacuum-assisted delivery E) Administration of tocolytic therapy
B
A 29-year-old female presents to the emergency department with severe abdominal pain and vaginal bleeding. She reports a positive pregnancy test two weeks ago and denies any prior medical history. Transvaginal ultrasound reveals an empty uterus and the presence of a left adnexal mass consistent with an ectopic pregnancy. The patient is counseled on the management options. Which of the following regarding the course of an ectopic pregnancy is most accurate? A) The body typically absorbs fetal tissue within 2-3 weeks, eliminating the need for surgical intervention. B) Fetal tissue is usually absorbed by the body within 4-6 weeks, and if not, surgical intervention is necessary. C) Surgical intervention is always necessary within 24-48 hours of diagnosis to prevent life-threatening complications. D) Ectopic pregnancies can spontaneously resolve without medical or surgical intervention in the majority of cases.
B
A 32-year-old G2P1 woman presents to the emergency department in active labor at 39 weeks gestation. She has a history of a previous vaginal delivery without complications. During the second stage of labor, the obstetric team encounters shoulder dystocia. Which of the following maneuvers should be performed initially to resolve the shoulder dystocia? A) Suprapubic pressure B) McRoberts maneuver C) External Cephalic Version D) Woods' maneuver
B
A 32-year-old pregnant woman at 28 weeks gestation presents to her OB with elevated blood pressure readings consistently above 140/90 mmHg. She has a past medical history significant for asthma, for which she occasionally uses an albuterol inhaler. Her obstetrician diagnoses her with gestational hypertension and prescribes labetalol to manage her blood pressure. However, after initiating labetalol therapy, the patient reports worsening shortness of breath and increased wheezing. Which of the following is the most appropriate next step in managing this patient's hypertension? A) Increase the dose of labetalol to achieve better blood pressure control. B) Switch labetalol to Methyldopa C) Discontinue labetalol and initiate treatment with a beta-1 selective blocker. D) Continue labetalol, it has no association with asthma
B
A 32-year-old pregnant woman at 28 weeks gestation presents to the emergency department with painless vaginal bleeding. She denies any abdominal pain or uterine contractions. Her prenatal history is significant for a prior cesarean section. On examination, her vital signs are stable, and she has no abdominal tenderness. On physical examination you see bright red vaginal bleeding. Which of the following is the most likely diagnosis? A) Placental abruption B) Placenta previa C) Premature Rupture of membranes D) Uterine rupture
B
A 32-year-old pregnant woman at 36 weeks gestation presents to the clinic for a routine prenatal visit. On physical examination, the healthcare provider palpates the fetal head in the fundus and the fetal buttocks in the lower abdomen. The fetus is in a breech presentation. Which of the following complications is the fetus at increased risk for due to this presentation? A) Umbilical cord prolapse B) Torticollis C) Shoulder dystocia D) Cerebral Palsy
B
A 32-year-old pregnant woman presents to the labor and delivery unit at 38 weeks gestation with severe abdominal pain and prolonged labor. Her prenatal history is unremarkable, and she has had regular prenatal care visits with no complications noted. On examination, her cervix is fully dilated, but despite strong uterine contractions, fetal descent is minimal. Which of the following is the most likely cause of this presentation? A) Maternal infection B) Fetal macrosomia C) Placental abruption D) Uterine rupture
B
A 32-year-old pregnant woman, G3P2, presents to the emergency department at 36 weeks gestation with sudden onset of severe abdominal pain. Upon examination, the obstetrician notes a visible umbilical cord protruding through the cervix. The woman is immediately placed in the Trendelenburg position and a sterile gloved hand is inserted into the vagina to alleviate pressure on the cord. Which of the following complications is most likely to occur as a result of umbilical cord prolapse in this patient? A) Maternal hypotension B) Fetal hypoxia C) Placental abruption D) Uterine rupture
B
A 32-year-old woman who is 28 weeks pregnant presents to the emergency department with complaints of severe epigastric pain, nausea, vomiting, and malaise. Laboratory studies reveal thrombocytopenia, elevated liver enzymes, and hemolysis. She is diagnosed with HELLP syndrome. Which of the following complications is she most at risk for developing? A) Placenta Previa B) Abruptio Placentae C) Uterine Rupture D) Eclampsia E) Intrauterine growth restriction
B
A 32-year-old woman, G2P1, presents to the labor and delivery unit at 38 weeks gestation with complaints of severe lower abdominal pain and decreased fetal movements. She has a history of a previous cesarean delivery due to fetal distress. On examination, her vital signs are within normal limits, and the fetal heart rate tracing shows variable decelerations. Vaginal examination reveals no cervical dilation, effacement, or descent of the presenting part. Ultrasound confirms the presence of a live fetus in a frank position. What is the most appropriate next step in management? A) Immediate cesarean delivery B) External cephalic version C) Administer tocolytic therapy D) Induction of labor with oxytocin E) Continuous fetal heart rate monitoring and observation
B
A 32-year-old woman, G3P2, presents to the emergency department 12 hours postpartum complaining of heavy vaginal bleeding. She delivered a healthy infant vaginally without complications. On examination, her vital signs show signs of hypovolemia and she has ongoing bleeding estimated at 500 mL over the past hour. Uterine massage and bimanual compression have been ineffective in controlling the bleeding. Considering the management of postpartum hemorrhage, which of the following statements regarding oxytocin is correct? A) Oxytocin administration is contraindicated in postpartum hemorrhage B) Oxytocin should be administered to promote uterine contractions and reduce bleeding C) Oxytocin is only effective in cases of mild postpartum hemorrhage
B
Abortion is termination of pregnancy before ___ weeks of gestation that can be spontaneous or induced. A) 16 B) 20 C) 30 D)35
B
Which of the following does not carry a risk of postpartum hemorrhage? A) Spontaneous Abortion B) Dystocia C) Uterine Inversion D) Placenta Previa E) Ectopic Pregnancy
B
Which of the following statements regarding the management of placenta previa is most accurate? A) Digital pelvic examination is preferred over ultrasonography in assessing placenta previa due to its higher accuracy. B) Ultrasonography is preferred over digital pelvic examination in assessing placenta previa due to the risk of hemorrhage associated with digital examination. C) Both digital pelvic examination and ultrasonography are equally effective in assessing placenta previa and carry similar risks of hemorrhage. D) Digital pelvic examination should be performed first, followed by ultrasonography, to confirm the diagnosis of placenta previa and minimize the risk of hemorrhage.
B
A 32-year-old pregnant woman presents to her obstetrician for a routine prenatal check-up at 28 weeks gestation. She has a history of hypertension prior to pregnancy, which was well-controlled with medication. On examination, her blood pressure is 150/100 mmHg. She denies any associated symptoms. Which of the following statements best differentiates chronic HTN from pregnancy-induced gestational HTN? A) Chronic HTN often presents with proteinuria, whereas gestational HTN typically does not. B) Chronic HTN is typically first diagnosed before 20 weeks gestation, whereas gestational HTN typically occurs after 20 weeks gestation. C) Chronic HTN is associated with a higher risk of preterm delivery and fetal growth restriction compared to gestational HTN. D) Chronic HTN is more likely to resolve within 6 weeks postpartum, whereas gestational HTN may persist beyond the postpartum period.
B -pregnancy induced HTN is typically resolved 6 weeks post partum and is diagnosed >20 weeks gestation -chronic HTN is HTN identified <20 weeks gestation and aslo if someone had HTN prior to pregnancy
A 30-year-old pregnant woman at 34 weeks of gestation presents with symptoms of nausea, epigastric pain, and malaise. Laboratory findings reveal thrombocytopenia, elevated liver enzymes, and hemolysis consistent with HELLP syndrome. Which of the following is the most appropriate initial treatment for this patient? A) Immediate induction of labor B) Administration of magnesium sulfate C) Intravenous corticosteroids D) Platelet transfusion
B - first thing you do after diagnosis is administer mag sulfate for seizure prophylaxis (also treat HTN if present with methyldopa / labetalol)
A 28-year-old pregnant woman presents to the emergency department at 8 weeks gestation with vaginal bleeding and abdominal cramping. She reports noticing a decrease in fetal movement. On examination, her cervix is dilated and open. Fetal heart sounds are absent. You find that no fetal tissue has been passed. Which of the following is the most likely diagnosis? A) Threatened abortion B) Inevitable abortion C) Incomplete abortion D) Complete abortion
B - inevitable spontaneous abortion = baby has passed away, cervical os is open but no fetal tissue has passed
A 35-year-old female presents to the emergency department with complaints of shortness of breath and hemoptysis. Her medical history is significant for a recent diagnosis of GTD, specifically choriocarcinoma, for which she underwent treatment and uterine evacuation was perfromed. On examination, she appears pale, tachypneic, and diaphoretic. Which of the following is the most appropriate next step in management for this patient? A) Do a pelvic exam B) Obtain a chest X-Ray C) Check Rh and blood type D) Perform uterine vacuum aspiration
B - metastasizes to the lungs
A 28-year-old pregnant woman at 20 weeks gestation presents to the emergency department with fever, flank pain, and dysuria. Her temperature is 38.5°C (101.3°F). She reports no history of urinary tract infections (UTIs) prior to pregnancy. Urinalysis reveals pyuria, bacteriuria, and leukocyte esterase positivity. Blood cultures are pending. Fetal ultrasound shows no abnormalities. Which of the following is the most appropriate initial management for this patient? A) Ciprofloxacin B) Ceftriaxone C) Amoxicillin-clavulanate D) Oral nitrofurantoin E) Piperacillin-Tazobactam
B - mild to moderate pyelonephritis
A 28-year-old woman, gravida 2 para 1, presents to the labor and delivery unit at 38 weeks gestation with spontaneous rupture of membranes. The amniotic fluid is noted to be heavily stained with thick greenish-black material. Fetal heart rate monitoring reveals tachycardia. The patient has a fever of 101.3°F and uterine tenderness. Which of the following is the most likely diagnosis? A) Meconium aspiration syndrome B) Chorioamnionitis C) Umbilical cord prolapse D) Fetal distress E) Placental abruption What is the treatment for this diagnosis? A) IV Vancomycin B) Ceftriaxone C) Ampicillin and gentamicin D) Ciprofloxacin
B and C
A 26-year-old pregnant woman presents to her obstetrician for her routine prenatal visit at 32 weeks gestation. She has had an uncomplicated pregnancy thus far. During the visit, the obstetrician discusses the risk of infections to the fetus during pregnancy. Which of the following statements regarding in utero infections versus intrapartum infections is accurate? A) In utero infections include illnesses like Group B strep, Hepatitis B and HIV B) In utero infections result from infections caught during the birthing process and risk can be decreased through having a C-Section C) Rubella, cytomegalovirus and HSV are examples of in utero infections. D) Intrapartum infections are typically transmitted to the fetus through transplacental transmission.
C
A 28-year-old female presents to the emergency department with severe lower abdominal pain and vaginal bleeding. She reports a positive pregnancy test at home. On examination, she appears pale and diaphoretic. Pelvic examination reveals cervical motion tenderness and adnexal tenderness on the right side. Transvaginal ultrasound shows an empty uterine cavity with a complex adnexal mass consistent with an ectopic pregnancy. Which of the following complications is she at highest risk of developing if not promptly treated? A) Ovarian torsion B) Uterine rupture C) Tubal Rupture D) Endometriosis
C
A 28-year-old pregnant woman presents to the emergency department complaining of a sudden gush of fluid from her vagina. She is at 32 weeks gestation and has no significant medical history. Upon examination, it is confirmed that her membranes have ruptured prematurely. Which of the following complications is she at increased risk for due to this condition? A) Placenta previa B) Abruptio placenta C) Umbilical cord prolapse D) Uterine Inversion
C
A 28-year-old pregnant woman presents to the obstetrics clinic at 32 weeks gestation with complaints of sudden onset hypertension, proteinuria, and swelling of the hands and face. She has a PMH of deep vein thrombosis. Laboratory findings reveal elevated AST, ALT and fibrinogen. As well as elevated levels of anticardilopin antibodies. She is diagnosed with pre-eclampsia. Which of the following is the most likely explanation for her current presentation? A) Gestational diabetes B) HELLP syndrome C) Antiphospholipid syndrome D) Cholestasis of pregnancy E) Maternal hypothyroidism
C
A 28-year-old pregnant woman, G3P2, presents to her obstetrician's office for routine prenatal care at 28 weeks gestation. She has no significant past medical history and her previous pregnancies were uncomplicated. Her body mass index (BMI) is 28 kg/m². During the initial prenatal visit, she underwent a screening test for gestational diabetes mellitus (GDM). The results showed elevated glucose levels, prompting further evaluation. Which of the following glucose levels on a 3-hour glucose tolerance test would confirm the diagnosis of gestational diabetes in this patient? A) Fasting glucose ≥ 92 mg/dL B) 1-hour glucose 165 mg/dL C) 2-hour glucose 160 mg/dL D) 3-hour glucose 138 mg/dL
C
A 29-year-old woman presents to the emergency department complaining of heavy vaginal bleeding and severe abdominal pain. She reports a history of amenorrhea for the past 10 weeks, followed by irregular vaginal bleeding. On physical examination, her vital signs are stable but she appears pale. Pelvic examination reveals a significantly enlarged uterus consistent with gestational size. Serum beta-hCG levels are markedly elevated. Ultrasonography demonstrates a uterine mass with cystic spaces resembling a "bunch of grapes." Which of the following is the most appropriate next step in management? A) Immediate administration of antibiotics B) Initiation of high-dose oral contraceptive pills C) Uterine evacuation using suction curettage D) Administration of methotrexate therapy
C
A 29-year-old woman presents to the emergency department complaining of sudden-onset severe lower abdominal pain on the right side. She also reports experiencing some vaginal bleeding. Upon further questioning, she mentions a missed period and a positive pregnancy test. Physical examination reveals unilateral adnexal pain and cervical motion tenderness. Transvaginal ultrasound demonstrates an empty uterus with a right adnexal mass. Which of the following is the best initial treatment for this diagnosis? A) Misoprostal B) Uterine evacuation C) Methotextrate D) Pyridoxine
C
A 32-year-old pregnant woman at 34 weeks gestation presents to the emergency department with sudden-onset severe abdominal pain. She describes the pain as constant and located mainly in her abdomen, with occasional radiation to her lower back. She denies any vaginal bleeding but reports a sensation of tightness in her abdomen. Upon examination, her abdomen is tender to palpation, and uterine contractions are noted every 3-5 minutes. Fetal heart rate monitoring shows persistent late decelerations. Which of the following conditions is most likely causing the patient's symptoms? A) Placenta previa B) Uterine rupture C) Abruptio placentae D) Preeclampsia
C
A 32-year-old pregnant woman at 35 weeks gestation presents to the emergency department with severe abdominal and back pain. Transvaginal ultrasound is performed, revealing evidence of separation between the placenta and uterine wall consistent with abruptio placentae. Which of the following findings is most likely to be observed on transvaginal ultrasound in cases of abruptio placentae? A) Covered cervical os B) Polyhydramnios C) Retroplacental hematoma D) Fetal heart rate tracing showing reassuring patterns
C
A 32-year-old pregnant woman presents at 34 weeks gestation with complaints of premature rupture of membranes (PROM) that occurred 12 hours ago. She has no contractions or signs of infection. On examination, the fetal heart rate is normal, and there are no signs of meconium staining. What is the most appropriate next step in the management of this patient? A) Immediate induction of labor with oxytocin B) Admit and administer betamethasone C) Admit and initiate antibiotic and tocolytic therapy D) Perform a cesarean section
C
A 32-year-old pregnant woman presents to the emergency department at 34 weeks gestation complaining of sudden onset of intense abdominal pain and vaginal bleeding. Upon examination, her abdomen is tender to palpation with evidence of uterine tachysystole noted on the fetal monitor. Which of the following conditions is most likely to be associated with this presentation? A) Placenta previa B) Ectopic pregnancy C) Abruptio placentae D) Uterine rupture
C
A 32-year-old pregnant woman presents to the emergency department complaining of severe abdominal pain, nausea, and vomiting. She is 34 weeks pregnant and has a history of hypertension during this pregnancy. On physical examination, she appears jaundiced and has right upper quadrant tenderness. Laboratory studies reveal thrombocytopenia, elevated liver enzymes, and hemolysis. Which of the following conditions is most likely to be associated with these findings? A) Cholecystitis B) Eclampsia C) HELLP syndrome D) Acute fatty liver of pregnancy E) Placental abruption
C
A 32-year-old pregnant woman, G3P2, with a history of gestational diabetes presents to the labor and delivery unit at 38 weeks gestation. She has been managing her diabetes with diet and exercise. During labor, the fetal head delivers but the shoulders fail to follow. Despite proper maneuvers, the shoulders remain impacted. Which of the following maternal risk factors is most likely contributing to this obstetric emergency? A) Hypertension B) Advanced maternal age C) Gestational diabetes D) Previous cesarean section E) Multiparity
C
A 32-year-old woman, G2P1, presents to the emergency department complaining of vaginal bleeding and lower abdominal pain. She reports that she is approximately 8 weeks pregnant according to her last menstrual period. On examination, her vital signs are stable, but she appears distressed. Pelvic examination reveals a boggy and tender fundus of the uterus with a uterine size inconsistent with her reported gestational age. Which of the following is the most likely diagnosis? A) Ectopic pregnancy B) Placental abruption C) Spontaneous abortion D) Pelvic inflammatory disease
C
A 35-year-old gravida 3, para 2 woman presents to the emergency department in active labor at 36 weeks gestation. She has a history of two previous cesarean deliveries. Upon examination, she appears distressed and complains of severe abdominal pain. Fetal heart rate monitoring reveals bradycardia. Upon further evaluation, the obstetrician suspects uterine rupture. Which of the following statements regarding uterine rupture is true? A) Uterine rupture is more common in singletons. B) Uterine rupture is less likely to occur in women with a history of previous cesarean deliveries. C) Fetal expulsion into the peritoneal cavity can be a complication of uterine rupture. D) Immediate surgical intervention is not necessary in cases of suspected uterine rupture.
C
Which of the following conditions is considered a significant risk factor for the development of abruptio placentae in pregnant women? A) Placenta Previa B) Gestational diabetes mellitus C) Chorioamnionitis D) Fetal macrosomia
C
A 32-year-old pregnant woman presents for her routine prenatal visit at 28 weeks gestation. She has no significant past medical history and her pregnancy has been uneventful thus far. However, her 1 hour 50-g oral glucose challenge test results come back at 140. The patient completes a 3 hour 100-g glucose test and her results are as follows: 1 hour: 195 2 hour: 157 3 hour: 139 Which of the following is the most appropriate initial treatment for this patient? A) Initiation of insulin therapy B) Metformin C) Dietary modifications and exercise regimen D) Glyburide
C - diet and exercise first
A 29-year-old woman presents to the emergency department with sudden onset severe lower abdominal pain and vaginal bleeding. She reports a positive pregnancy test done 5 weeks ago. On examination, she appears pale and is tachycardic. Abdominal examination reveals tenderness and guarding in the lower abdomen, especially on the right side. Transvaginal ultrasound shows an adnexal mass measuring 4 cm with no intrauterine gestational sac. Beta-hCG levels are elevated. What is the most appropriate next step in management for this patient? A) Initiate medical management with methotrexate B) Repeat beta-hCG levels in 48 hours C) Perform exploratory laparoscopy D) Order magnetic resonance imaging (MRI) for further evaluation E) Discharge home with analgesics and schedule follow-up in one week
C - ectopic pregnancy over 3 cm = immediate surgery
A 32-year-old woman presents to the emergency department due to a syncopal episode with severe abdominal pain and dizziness. Upon further examination, she is found to be hypotensive and tachycardic. An ultrasound reveals an empty uterus. Her medical history is significant for a previous pelvic surgery due to endometriosis and infertility. She states that she has been using in vitro fertilization to try to conceive. On PE you note cervical motion tenderness. Laboratory findings include an elevated HCG. Which of the following mechanisms is most likely responsible for her current presentation? A) Ovulatory dysfunction B) Pelvic inflammatory disease C) Adhesion formation D) Intrauterine device (IUD) malfunction
C - ectopic pregnancy, these are due to adhesions
A 28-year-old pregnant woman presents to her obstetrician at 10 weeks gestation with complaints of severe nausea and vomiting. She reports that these symptoms began around 6 weeks gestation and have progressively worsened since then. She has lost approximately 5% of her pre-pregnancy body weight due to frequent vomiting and inability to tolerate food or fluids. On examination, she appears dehydrated with dry mucous membranes and orthostatic hypotension. Urinalysis reveals ketonuria. Which of the following is the most appropriate initial management for this patient? A) Prescribe Pyridoxine and advise bed rest B) Recommend dietary modifications and encourage frequent small meals C) Administer intravenous fluids and electrolyte replacement with IV ondansetron D) Perform a gastric emptying study
C - hyperemesis gravidarum with dehydration
A 28-year-old woman presents to the emergency department with vaginal bleeding and abdominal cramping. She reports a history of amenorrhea for 8 weeks followed by sudden onset of heavy vaginal bleeding with passage of tissue. On examination, her vital signs are stable, but she appears pale. Pelvic examination reveals an enlarged and tender uterus with the cervical os dilated (open) and fetal tissue is noted within the cervix. Which of the following is the most likely diagnosis? A) Threatened abortion B) Inevitable abortion C) Incomplete abortion D) Complete abortion
C - incomplete spontaneous abortion = cervical os is open and fetal tissue has passed but there is still fetal tissue left in the uterus
Which of the following clinical presentations is most indicative of postpartum hemorrhage? A) Decreased uterine size and firmness B) Bright red, odorless lochia C) Foul-smelling lochia D) Normal vital signs and stable hematocrit
C - lochia is vaginal discharge after birth and has a foul smell with postpartum hemorrhage
A 27-year-old primigravida at 38 weeks gestation presents to the labor and delivery unit in active labor. During delivery, the fetus experiences shoulder dystocia, and maneuvers are performed to facilitate delivery. Following delivery, examination of the newborn reveals asymmetry of the shoulders with decreased movement of the left arm. Physical examination further reveals crepitus over the left clavicle. Which of the following is the most likely diagnosis? A) Erb's palsy B) Cerebral Palsy C) Clavicle fracture D) Shoulder dislocation
C - most common fracture of neonates and most commonly due to shoulder dystocia
Which of the following diagnostic criteria is used to define postpartum hemorrhage (PPH)? A) Cumulative blood loss exceeding 500 mL within 24 hours of delivery. B) Cumulative blood loss exceeding 1000 mL within 48 hours of delivery. C) Cumulative blood loss exceeding 1000 mL within 24 hours of delivery. D) Cumulative blood loss exceeding 1500 mL within 24 hours of delivery.
C - or blood loss with signs of hypovolemia within 24 hours of pregnancy
A 32-year-old pregnant woman, gravida 3, para 2, at 30 weeks gestation presents to the emergency department with sudden onset vaginal bleeding. She reports no preceding abdominal pain or trauma. On examination, she appears pale and anxious. Her blood pressure is 110/70 mmHg, pulse rate is 100 beats per minute, and respiratory rate is 20 breaths per minute. Abdominal examination reveals a fundal height consistent with gestational age, and the fetal heart rate is 140 beats per minute. Pelvic examination demonstrates bright red blood filling the vaginal vault. What should you do next in this scenario? A) IV fluids with fetal and maternal heart rate monitoring B) Magnesium sulfate and delivery after maternal stabilization C) Blood type, Rh status, blood transfusion (RhoGAM if needed) and plan for C-Section D) Stabilize and monitor with digital pelvic exams
C - placenta previa with acute bleeding this is an emergency needs blood transfusion
A 28-year-old woman presents to the emergency department complaining of abdominal pain and vaginal bleeding. She is 12 weeks pregnant by her LMP. On PE, she appears pale and diaphoretic. Her vital signs are as follows: temp 102°F, HR 120 bpm, BP 90/60 mmHg, and RR 22 breaths/min. Abdominal examination reveals diffuse tenderness with guarding in the lower abdomen. Pelvic examination demonstrates active vaginal bleeding with cervical dilation (open cervix) and purulent cervical discharge. Which of the following is the most likely diagnosis in this patient? A) Incomplete abortion B) Placental abruption C) Septic spontaneous abortion D) Ectopic pregnancy How would you treat this diagnosis? A) IV gentamicin B) IV Ampicillin C) IV clindamycin D) Uterine Evacuation E) All of the above F) A, C, & D only
C - septic spontaneous abortion = abortion with infection (fever chills), cervix is open with purulent discharge, uterus is tender, and there may or may not be passage of the fetal tissue E - treat septic abortion with IV gentamicin, ampicillin, adn clindamycin as well as uterine evacuation
A 28-year-old woman, gravida 3, para 2, presents to the emergency department complaining of severe abdominal pain and vaginal bleeding. She is currently at 38 weeks gestation and has a history of two previous cesarean sections. On examination, her vital signs are stable, but she appears distressed and is experiencing uterine tenderness. Fetal heart rate monitoring reveals variable decelerations. Fetal position is abnormal. Which of the following is the most likely diagnosis, and what immediate intervention is indicated? A) Placental abruption; administer tocolytics and betamethasone for fetal lung maturity B) Ectopic pregnancy; perform an urgent pelvic ultrasound C) Uterine rupture; prepare for emergent laparotomy with cesarean delivery D) Pelvic inflammatory disease; initiate broad-spectrum antibiotics
C - uterine rupture risk is prior c sections and symptoms can be abdominal pain and vaginal bleeding with baby having variable decelerations and loss of fetal position
A 28-year-old pregnant woman, gravida 1, para 0, presents for her initial obstetric visit at 10 weeks gestation. She has a history of chronic hypertension controlled with medication. Upon transvaginal ultrasound you find that the patient is pregnant with twins. What is this patient at highest risk for? A) Abruptio Placentae B) Placenta Previa C) Pre-eclampsia D) Uterine Rupture What is the most appropriate initial management strategy for this patient to mitigate the risk? A) Prescribe daily low-dose aspirin B) Initiate antihypertensive therapy with a calcium channel blocker C) Schedule more frequent prenatal visits for closer monitoring D) Perform a baseline 24-hour urine collection for protein measurement E) Order a renal function panel and urinalysis to assess baseline renal function
C and A chronic hypertension + pregnancy of twins
A 30-year-old pregnant woman presents to the emergency department at 32 weeks gestation with severe preeclampsia (BP 190/120, proteinuria 3+ on dipstick and serum creatinine 4.5). After assessment, it is determined that delivery within 48 hours is necessary due to the severity of her condition. Out of the following, which should be given in this scenario? A) Methotextrate B) Aspirin C) Betamethasone D) Tocolytics Which of the following statements regarding the use of this medication in this scenario is most accurate? A) Prevents progression to eclampsia B) Should be administered to the patient to accelerate fetal lung maturity. C) Primarily indicated for maternal blood pressure control in cases of severe preeclampsia. D) Has no significant impact on neonatal outcomes, used for mothers protection
C and B
A 28-year-old pregnant woman at 34 weeks gestation presents with hypertension (blood pressure of 160/100 mmHg), proteinuria, and edema. She is diagnosed with preeclampsia. Which of the following interventions is the most appropriate initial treatment option to manage her condition? A) Immediate induction of labor B) Oral antihypertensive medication C) Intravenous magnesium sulfate D) Corticosteroid administration E) Daily low-dose aspirin therapy What does this therapy prevent? A) Immaturity of fetal lungs B) Fetal bradycardia C) Abruptio placentae D) AKI
C and B -mag sulfate prevents maternal seizures - maternal seizures are dangerous to fetus due to causing fetal bradycardia for 3-5 minutes during and after seziure
A 28-year-old pregnant woman presents to her obstetrician's office for prenatal care at 16 weeks gestation. She is a smoker who has a history of preterm delivery at 32 weeks in her previous pregnancy. She is positive for Group B Streptococcus. Her weight prior to pregnancy was 97 pounds. What would you recommend for this patient due to her current risk factors? A) Begin terbutaline weekly until term B) Administer corticosteroids for fetal lung maturation C) Increasing caffeine intake to delay labor onset D) Weekly 17 alpha-hydroxyprogesterone caproate injections from 16 to 36 weeks gestation to reduce the risk of preterm labor
D
A 32-year-old female presents to the emergency department with heavy vaginal bleeding and abdominal cramping. She reports a positive pregnancy test and is approximately 8 weeks gestation. Upon examination, she appears pale and tachycardic with blood pressure of 90/60 mmHg. Transvaginal ultrasound confirms an incomplete spontaneous abortion. Which of the following is the most appropriate initial management for this patient to address her hemorrhage? A) Immediate administration of intravenous antibiotics B) Oral administration of misoprostol with IV antibiotics C) Dilation and curettage (D&C) D) Intravenous administration of crystalloid fluids and blood products and uterine aspiration
D
A 32-year-old pregnant woman presents at 28 weeks gestation with elevated blood pressure readings consistently above 140/90 mmHg. She has no prior history of hypertension or other medical conditions. After thorough evaluation, it is determined that she has gestational hypertension. Which of the following should be used for the initial treatment of gestational hypertension? A) Hydrochlorothiazide B) Hyrdralazine C) Magnesium Sulfate D) Labetalol
D
A 32-year-old pregnant woman presents to the labor and delivery unit in active labor. Upon delivery, shoulder dystocia is encountered. Which of the following best represents the primary goal in managing shoulder dystocia? A) Decreasing maternal anxiety during the delivery process. B) Ensuring immediate delivery of the placenta after birth. C) Reducing the duration of labor. D) Preventing fetal asphyxia and permanent injury to mother or baby
D
A 34-year-old pregnant woman at 34 weeks of gestation presents to the emergency department with sudden onset of severe abdominal pain and vaginal bleeding. She reports no history of trauma. On examination, her blood pressure is 150/100 mmHg, pulse is 110 bpm, and respiratory rate is 24 breaths per minute. Abdominal examination reveals tenderness and guarding. Fetal heart rate monitoring shows bradycardia. Which of the following is the most likely diagnosis? A) Placenta previa B) Ectopic pregnancy C) Uterine rupture D) Abruptio placentae
D
A pregnant patient at 34 weeks gestation presents to the emergency department complaining of sudden onset of intense abdominal pain and vaginal bleeding. On examination, you notice a prolapsed umbilical cord. The patient reports feeling a tightening sensation around her abdomen. Which of the following best describes the mechanism of complications that come with umbilical cord prolapse? A) Increased uterine contractility due to oxytocin administration B) Compression of the umbilical cord leading to decreased fetal perfusion C) Release of prostaglandins causing cervical ripening D) Umbilical artery vasospasm and umbilical vein occlusion resulting in reduced blood flow to the fetus
D
Which does not have risk to continue to occur postpartum? A) Pre-eclampsia B) HELLP syndrome C) Endometritis D) Abruptio Placentae
D
Which of the following complications is most commonly associated with abruptio placentae? A) Fetal Hydrops B) Fetal macrosomia C) Placenta previa D) Disseminated intravascular coagulation (DIC)
D
primarily concentrated in the lower abdominal region. Upon examination, the obstetrician observes that the fundal height is lower than expected for gestational age and notices palpable fetal parts in the lower abdomen. Which of the following presentations is most likely indicated by these findings? A) Abnormal position facing forward B) Transverse presentation C) Frank breech presentation D) Complete breech presentation
D
A 28-year-old female presents to the emergency department with pelvic pain and vaginal bleeding. She reports having missed her last menstrual period and experiencing cramping for the past 24 hours. On examination, she appears pale and uncomfortable. Pelvic examination reveals a closed cervical os with passage of products of conception. Ultrasound confirms an empty, contracted uterus. Vital signs are stable except for mild tachycardia. Which of the following is the most likely diagnosis? A) Threatened abortion B) Inevitable abortion C) Incomplete abortion D) Complete abortion
D - complete abortion = full abortion of fetus has occurred, cervical os has closed back and all parts of fetus and placenta have been passed - uterus is contracted
A 32-year-old pregnant woman, G3P2, presents to the clinic at 36 weeks gestation with complaints of headache, visual disturbances, and upper abdominal pain. Her blood pressure is 160/100 mmHg. Urinalysis reveals 2+ proteinuria. Which of the following laboratory findings is most consistent with the diagnosis of severe preeclampsia? A) Serum creatinine of 0.8 mg/dL B) Platelet count of 250,000/mm³ C) Alanine aminotransferase (ALT) of 35 U/L D) Serum uric acid of 7.5 mg/dL What can this be a sign of? A) Liver involvement B) Low birth weight C) Renal Crisis D) Fetal Hydrops
D - elevated uric acid is an additional sign of preeclampsia (other values are normal) B - uric acid is a predictor of low brith weight
A 32-year-old pregnant woman, who is immunocompromised due to HIV infection, presents to the emergency department with severe pyelonephritis. Her symptoms include fever, chills, flank pain, and dysuria. Laboratory investigations reveal leukocytosis and pyuria. Given her complex medical history, what is the most appropriate initial treatment for her condition? A) Oral amoxicillin B) Intravenous ceftriaxone C) Oral ciprofloxacin D) Intravenous piperacillin-tazobactam E) Intravenous vancomycin
D - severe pyelo and immunocompromised
A 28-year-old woman, G2P1, presents to the emergency department six weeks after an uncomplicated vaginal delivery. She complains of heavy vaginal bleeding for the past 3 days, associated with severe lower abdominal pain and fatigue. On PE, her vital signs are stable, but she appears pale. Pelvic examination reveals an enlarged, tender uterus consistent with retained placental tissue. Labs show a hemoglobin level of 7 g/dL. Which of the following is the most appropriate initial step in management? A) Immediate administration of oxytocin B) Surgical exploration with D&C to remove fetal tissue C) Initiation of broad-spectrum antibiotics D) Transfusion of packed red blood cells What next? A) Immediate administration of intravenous oxytocin B) Surgical exploration with D&C to remove fetal tissue C) Initiation of broad-spectrum antibiotics D) Transfusion of packed red blood cells
D and B -Postpartum hemorrhage, she first needs to be stabilized and with her Hgb needs a blood transfusion and then left over fetal tissue needs to be removed to fix the problem
A 28-year-old pregnant woman presents for her routine prenatal visit at 28 weeks gestation. She has had an uneventful pregnancy thus far with no complaints. On physical examination, her vital signs are stable and she appears well. Ultrasound reveals a low-lying placenta that completely covers the internal cervical os. However, the patient denies any vaginal bleeding or abdominal pain. What is the most appropriate next step in management for this patient? A) Immediate referral for emergent C-Section B) Administration of tocolytic therapy C) Scheduled elective cesarean section at 34 weeks gestation D) Rest with serial ultrasounds for monitoring until term What should be given prior to delivery in this scenerio? A) Tocolytics B) Blood Transfusion C) Corticosteroids D) Prophylactic antibiotics
D and C Asymptomatic placenta previa - needs monitoring, rest and corticosteroids prior to delivery -- depending on positioning of placenta vaginal delivery is possible
A 32-year-old woman, gravida 3, para 2, at 36 weeks gestation presents to the emergency department with sudden onset of severe abdominal pain. She reports feeling a sensation of something protruding from her vagina. On examination, you note a visible umbilical cord protruding from the cervical os. Fetal heart rate monitoring reveals fetal bradycardia. Which of the following is the most appropriate initial management step for this patient? A) Administer intravenous magnesium sulfate B) Perform an emergent cesarean section C) Place the patient in Trendelenburg position D) Administer tocolytic therapy with terbutaline E) Maternal knee to chest position
E
A 28-year-old pregnant woman at 36 weeks gestation presents to the labor and delivery unit with complaints of decreased fetal movement and persistent uterine contractions. Upon examination, fetal heart rate monitoring reveals late decelerations. The patient's vital signs are within normal limits. Which of the following is involved in the management of this patient? A) Administer terbutaline therapy B) Give patient oxygen C) Increase intravenous hydration D) Stop oxytocin E) All of the above
E - Late decelerations = fetal distress - also turn mom on her side and consider delivery if possible
Which is a prior C-Section not a risk factor for? A) Placenta Previa B) Abuptio Placentae C) Uterine Rupture D) PROM E) All of the above F) B and C only
F - Prior C-section is a risk factor for uterine rupture and placenta previa
Which of the following is a treatment option for preterm labor? A) Uterotonics (Oxcytocyin) B) Cervical Cerclage C) Corticosteroids D) IV fluids E) All of the above F) B, C, D
F - cervical cerclage is suturing the cervix if it wont stay closed / stop dilating
