UWise Questions UMKC OBGYN (Modules 11-24) NOT COMPLETE
A 19-year-old G1 woman at 36 weeks gestation presents for her first prenatal visit. She was recently diagnosed with HIV after her former partner tested positive. The HIV Western Blot is positive. The CD4 count is 612 cells/ul. The viral load is 9873 viral particles per ml of patient serum. Which of the management options would best decrease the risk for perinatal transmission of HIV? A) Treatment with intravenous zidovudine at the time of delivery B)Prophylactic treatment of the newborn with oral zidovudine C)One week of maternal treatment with zidovudine now D)Cesarean delivery in second stage of labor E) Single drug therapy to minimize drug resistance
A
A 23-year-old G1PO woman presents with cramping and vaginal bleeding. Her last menstrual period occurred seven weeks ago. On physical examination, vital signs are: blood pressure 110/74, pulse 82 beats/minute, respiratory rate 18/minute, and temperature 99.4°F (37.4°C). Abdominal examination shows mild right lower quadrant tenderness. On pelvic examination, she has scant old blood in the vagina and a normal appearing cervix. Her uterus is normal size and slightly tender. On bimanual examination, there is no cervical motion tenderness, and she has slight tenderness in right adnexae. Quantitative beta hCG is 2500 mlU/mL, progesterone 6.2 ng/mL, hematocrit 34%. The transvaginal ultrasound shows an empty uterus with endometrial thickening, a mass in the right ovary measuring 3 cm x 2 cm and a small amount of free fluid in the pelvis. Which of the following is the most appropriate next step in the management of this pat
A
A 24-year-old G1P0 woman at 22 weeks gestation with systemic lupus erythematosus (SLE) presents with malaise, joint aches, and fever. Physical examination reveals the following: pulse 88 beats/minute, temperature 98.6°F (37.0°C), respiratory rate 22/minute, and BP 130/80. Laboratory analysis reveals 1 + proteinuria, AST 35, and ALT 28. Which of the following is the most appropriate initial therapy for the treatment of this patient? Corticosteroids Nonsteroidal anti-inflammatory drugs (NSAIDs) Azathioprine Cyclophosphamide Magnesium Sulfate
A
A 24-year-old G1P0 woman has just delivered 37 week male twins. On initial assessment, twin A is noted to be large and plethoric, and twin B is small and pale. A complete blood count (CBC) is obtained on both twins. Which of the following findings would support the most likely diagnosis? A)Twin A with polycythemia B)Twin A with thrombocytopenia C)Twin B with thrombocytopenia D)Twin B with ascites E)Twin B with hyperbilirubinemia
A
A 24-year-old G1PO woman at 12 weeks gestation presents for prenatal care. She is 5 feet 4 inches fall and weighs 220 pounds (BMI: 37.8 kg/m2). She wants to know if her weight might cause any increased risks during this pregnancy. Which of the following is the most likely potential complication of pregnancy in this patient? A) Hypertension B) Preterm labor C) Post-term pregnancy D) Small for gestational age E) Malpresentation
A
A 27-year-old G1P0 woman at six weeks gestation presents with a two-month history of insomnia, feeling depressed, and unintentional weight loss. The symptoms began after the unexpected death of her father. She is not excited about this pregnancy and reports no suicidal ideation. Physical examination reveals a woman of stated age with a flat affect. In addition to psychotherapy, which of the following therapies is the most appropriate for this patient? A) Sertraline B) Amitriptyline C) Phenelzine D) Quetiapine E) Electroconvulsive therapy
A
A 27-year-old G2P2 woman presents for her annual health maintenance visit. She has a history of depression and is currently taking sertraline. She had preeclampsia with her last pregnancy. Her family history is significant for breast cancer in her mother. Her father died of a heart attack at age 52. Her BMI is 35 kg/m2. She states she is planning for a pregnancy next year. What is the most appropriate next step in counseling of this patient? A)Counsel on healthy diet and exercise B)Refer her to a bariatric surgeon C)Begin 81 mg aspirin daily D)Stress EKG E)Discontinue sertraline
A
A 28-year-old GO woman presents for preconception counseling. She has a history of type 1 diabetes, which was diagnosed at age six. Her only medication is insulin. She has a history of proliferative retinopathy treated with laser. Her last ophthalmologic examination was three months ago. Her last hemoglobin A1C (glycosylated hemoglobin level) six months ago was 9.2 percent. Which of the following complications is of most concern for her planned pregnancy? A) Fetal growth restriction B) Fetal cardiac arrhythmia C) Chromosome abnormality D) Oligohydramnios E) Macrosomia
A
A 29-year-old G1P0 woman presents for counseling after being diagnosed with a six-week embryonic demise. She is counseled about her options for expectant management, surgical management with suction dilation and curettage, and medical management with vaginal misoprostol. She would like to avoid surgical treatment, if possible. Which of the following is the main benefit of medical management for this patient? A) Shorten the time to expulsion B) Guarantees that she may avoid surgery C) Shortens the time to completion of treatment D) Decreases the likelihood of subsequent pregnancy loss E) It is less painful than surgery
A
A 30-year-old G1P0 woman with type 1 diabetes mellitus presents at 10 weeks gestation for a routine visit. She smokes a half pack of cigarettes per day. Her hemoglobin A1C level is 9.7. What structural anomaly is the fetus at highest risk of developing? A)Cardiac anomalies B)Caudal regression malformation C)Hydrocephalus D)Microcephaly E)Limb reductions
A
A 32-year-old G2P2 woman has just had a spontaneous vaginal delivery. She is concerned that no breast milk is yet being produced when she tries to feed her baby. The nurse reassures her that colostrum is rich in protein and nutrients and that her breast milk will come in two to three days. Which of her hormones must decrease to initiate lactogenesis? A)Estrogen and progesterone B)Estrogen and oxytocin C)Human placental lactogen and prolactin D)Progesterone and prolactin E)Growth hormone and GnRH
A
A 34-year-old G4P3 woman at 19 weeks gestation presents to the Emergency Department with chest pain, palpitations, and sweating, which began two to three hours ago. On further questioning, she states that she has been very anxious lately and is not sleeping well, which she attributes to the pregnancy She reports that she has no known medical problems, but she has lost 40 pounds in the last year without trying. On examination, the patient appears diaphoretic and anxious, her eyes are wide open, prominent, with easily visible sclera surrounding the pupil. Vital signs are: temperature 100.2°F (37.9°C), pulse 132 beats/minute, and blood pressure 162/84. Her height is 5 feet 10 inches and weight is 128 pounds. Her thyroid is palpably enlarged, with an audible bruit. Electrocardiogram shows sinus tachycardia. Remaining labs are pending. Which of the following therapies is contraindicated at this time? A) Radioactive iodi
A
A 35-year-old G1P0 woman presents to the Emergency Department with heavy vaginal bleeding at seven weeks gestation. On examination, she has a dilated cervix with blood and tissue present at the cervical os. Which of the following is the most likely cause of her current medical condition? A) Autosomal trisomy B) Triploidy C) Tetraploidy D)_ Monosomy X (45Х,0) E) Fragile X mutation
A
A 36-year-old G1P1 woman presents eight weeks postpartum for evaluation of a breast mass. She noted the mass in her right breast two weeks ago while in the shower. She had an uncomplicated vaginal delivery and has been exclusively breastfeeding her infant. She reports no breast pain, fever, or chills. Vitals signs are temperature 98.6° F (37° C), and pulse 72 beats/minute. Physical examination demonstrates a firm, well circumscribed 3cm mass in the upper outer quadrant of the right breast. There is no erythema or lymphadenopathy. What is the next step in the evaluation of this patient? A) Order breast ultrasound B)Order mammogram C) Prescribe antibiotics D)Reassurance E)Perform needle aspiration
A
A 37-year-old G3P2 woman at 14 weeks gestation presents for prenatal care. She had an uncomplicated first pregnancy, and gestational diabetes and preeclampsia at term with the second pregnancy. Her blood pressure today is 138/88. Her fundal height is 12 cm and her cervix is closed. The fetal heart rate is 140 beats/minute. Which of the following is the next best step in the management of this pregnancy? A) Low dose aspirin therapy B) Fish oil supplementation C) Folic acid supplementation D) Vitamin C supplementation E) Bedrest
A
A 40-year-old G1 woman at 34 weeks gestation was observed at work having a grand mal seizure. Her airway was secured. Blood pressure in the ambulance was 140/90. Fetal heart rate is 120 beats/minute. What is the initial treatment for her condition? A) Magnesium sulfate B)Valium C)Phenobarbital D)Hydralazine E)Observation
A
A 17-year-old G2PO female presents with severe right lower quadrant pain. Her last menstrual period was seven weeks ago. She reports that last night she began having suprapubic pain that radiated to her right lower quadrant. This morning the pain awoke her from sleep. She has not had vaginal bleeding,nausea, or vomiting. Her history is notable for two first trimester elective pregnancy terminations and a history of chlamydia treated twice. Vital signs are blood pressure 90/60, pulse 99 beats/minute, respiratory rate 22/minute, and temperature 98.6°F (37.0°C). On physical examination, she is curled on a stretcher in a fetal position and says she hurts too much to move. She has rebound and voluntary guarding on abdominal examination. Pelvic examination demonstrates cervical motion tenderness and rectal tenderness. Her beta-hCG level is 2500 miU/mL, hematocrit 24%, and urinalysis negative. Ultrasound shows no intraute
B
A 19-year-old G1PO woman at 18 weeks gestation presents with a three-month history of palpitations and intermittent chest pain. She feels anxious at times. Physical examination reveals a pulse of 96 beats/minute and grade II/VI systolic ejection murmur with a click. The EKG shows normal rate and rhythm, and an echocardiogram is ordered. Which of the following is the best treatment in the management of this patient? A) Anxiolytics B) ß-blockers C) Calcium-channel blockers D) Digitalis No treatment needed at this time
B
A 19-year-old G2P1 woman presents with a three-day history of vaginal spotting and cramping. Her last menstrual period was six weeks ago. She has no history of sexually transmitted infections. Her vital signs are blood pressure 120/70, pulse 78 beats/minute, respiratory rate 20/minute, and temperature 98.6°F (37.0°C). On pelvic examination, she has no cervical motion tenderness, her uterus is normal size and non-tender, and no adnexal masses are palpable. Quantitative beta-hCG 48 hours ago was 1500 mlU/mL. Currently, beta-hCG is 3100 mlU/mL. Progesterone is 26 ng/mL, hematocrit is 38%, and urinalysis is normal. What is the most likely finding on transvaginal ultrasound? A) Blood clot in the uterus B) Viable intrauterine pregnancy C) Adnexal mass, empty uterus D) No adnexal mass, empty uterus E) Non-viable intrauterine pregnancy
B
A 24-year-old G3P0 woman at 26 weeks gestation was brought to the Emergency Department by paramedics. Her husband found her shivering and barely responsive. Two days prior, the patient noted that she was feeling sick, with a slight cough and back pain, but thought it was probably normal for pregnancy. Her pregnancy has been complicated by the recent diagnosis of gestational diabetes. Vital signs are: temperature 102.0°F (38.9°C), pulse 160 beats/minute, blood pressure 68/32, respiratory rate 32/minute, oxygen saturation 82 percent on room air. On examination, there is no fundal tenderness or vaginal bleeding, and her extremities are cool to touch. There is tenderness with percussion of the right back. Laboratory studies include leukocyte count 24,000/mL, hemoglobin 9.5 g/dL, hematocrit 27%. Urine microscopic analysis shows many white blood cells. What is the most likely etiology for this patient's clinica presentat
B
A 25-year-old G1 woman at 40 weeks gestation presents to labor and delivery with contractions. Her cervix is 6 cm dilated and 100% effaced. The fetus is in the occiput anterior presentation at +1 station. The fetal heart tracing is Category I. The patient had a fetal ultrasound three days ago which reported an estimated fetal weight (EFW) of 2900 g. The patient's older sister had a forceps-assisted vaginal delivery and has fecal incontinence. The patient would like to avoid having this same complication. Which of the following management plans is most appropriate for this patient? A)Cesarean delivery B)Vaginal delivery with no episiotomy C)Vaginal delivery with a small, controlled episiotomy D)Forceps assisted delivery with no episiotomy E)Vacuum assisted delivery with no episiotomy
B
A 25-year-old GO woman presents for follow-up after having a first trimester early pregnancy loss. She has no medical problems and really wants to get pregnant again soon. She is concerned because she had a urinary tract infection that was treated with nitrofurantoin before she knew she was pregnant. She wants to discuss the cause of this event. Which of the following factors is most likely to be the cause of her miscarriage? A) Medication induced B) Conceptus genetic anomalies C ) Maternal genetic anomalies D) Structural Uterine anomalies E) Infections
B
A 26-year-old Black G1PO woman presents at seven weeks gestation with her husband, who is also Black. The patient's brother has sickle cell anemia, and has been hospitalized on numerous occasions with painful crises requiring narcotic pain medication and blood transfusions. What are the odds that this couple will have a child with sickle cell anemia, if the carrier rate for sickle cell disease in the Black population is 1/10? 1 in 15 1 in 60 1 in 100 1 in 160 1 in 400
B
A 26-year-old G2P1 woman at 27 weeks gestation presents for her routine prenatal appointment. Her past medical history is notable for moderate persistent asthma for which she takes fluticasone, montelukast, and an albuterol inhaler for use as needed. She is allergic to cats. The patient has missed her last two appointments due to lack of transportation and has required two visits to the Emergency Department for asthma exacerbations. The patient recently lost her job and needed to move in with her sister. The household consists of three adults, five children, and two cats. Which of the following is the most likely factor contributing to her asthma exacerbations? A) Pregnancy B) The Cats C) Crowded Household D) Mold E) The New Neighborhood
B
A 28-year-old G2P2 presents twelve weeks following an unremarkable vaginal delivery for evaluation of pain with intercourse. She had a first-degree laceration that was repaired at the time of delivery. She is breastfeeding her infant. On physical examination, her vital signs are normal. Her uterus is firm and nontender. Vaginal examination reveals a well healed vagina with mild erythema and a small amount of discharge. Which of the following is the most likely cause of dyspareunia in this patient? A)Laceration B)Atrophic vaginitis C)Vaginismus D) Endometritis E)Vaginal Discharge
B
A 28-year-old G4P3 woman with last menstrual period eight weeks ago presents with pelvic pain and vaginal bleeding. This was an unplanned pregnancy, and she does not desire future fertility. Initial labs show quantitative beta-hCG 1200 mlU/m and hematocrit 30%. Ultrasound shows an empty uterus, a 3 cm left adnexal mass, and a large amount of blood in the cul-de-sac. Her vital signs show a pulse of 110 beats/minute and blood pressure 80/50. Based on these findings, she is suspected of having a ruptured ectopic pregnancy and is taken to the operating room for a diagnostic laparoscopy. The findings at laparoscopy confirm a ruptured left tubal ectopic pregnancy with a large amount of blood in the pelvis. What is the best surgical option for treatment of this patient's findings? A)Left salpingostomy B)Left salpingectomy C)Left salpingo-oophorectomy D)Removal of the ectopic pregnancy and repair of the Fallopian tube E)Hyst
B
A 29-year-old G1P1 lactating woman presents for evaluation of bleeding and cracked nipples. She had an uncomplicated cesarean delivery for breech presentation five days ago. She began breastfeeding immediately postpartum, and is breastfeeding every two to four hours while laying on her side. She iswearing a supportive nursing bra day and night. Her only other concern is incisional pain. Which of the following is the most likely cause of her bleeding and cracked nipples? A) Feedings not frequent enough B)Poor positioning of infant C)Feedings too frequent D)Inadequate milk production E)Irritation from her bra
B
A 29-year-old G3PO woman presents for prenatal care at eight weeks gestation. Her two prior pregnancies ended in early pregnancy losses at 19 and 18 weeks, respectively. Records corroborate the patient's history of an uncomplicated gestation until the evening of the losses, which is when she experienced a pink-tinged discharge that prompted her to go to labor and delivery for evaluation. In both cases, the obstetrician noted that her cervix had dilated completely with the amnionic sac bulging into the vagina to the level of the introitus. The patient was afebrile and there was no uterine tenderness on examination. She spontaneously delivered the fetus and placenta in both cases. A sonohysterogram confirmed normal uterine anatomy several weeks later. What is the most appropriate next step in the management of this patient? A) Begin weekly fetal fibronectin testing B) Placement of a cervical cerclage at 14 weeks gestat
B
A 31-year-old G3P0 woman at 27 weeks gestation is managed expectantly for preeclampsia with severe features. Her blood pressure is 155/100 on oral labetolol. Her recent 24-hour urine had 6.6 g of protein. An ultrasound revealed a fetus with adequate growth, having an estimated fetal weight in the 10th percentile, and fetal heart rate is 144 beats/minute. Her labs are normal, except for a uric acid of 8.0 mg/dL, hematocrit 42% (increased from 37%), and platelet count 77,000. Which of her findings indicates delivery is needed at this time? A) Elevated uric acid B) Thrombocytopenia C) Proteinuria D) Poorly controlled blood pressures E) Hemoconcentration
B
A 32-year-old G3P1 woman at 39 weeks gestation is admitted to labor and delivery for a scheduled repeat cesarean delivery. Maternal labs show HIV positive, blood type B+, RPR non-reactive, HBAg negative, GBS negative, PPD positive, CXR negative. She received adequate antiretroviral therapy prior to and during the pregnancy. Her viral load was undetectable throughout the second and third trimester. A live male infant is delivered with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. Which of the following is the most appropriate next step in the management of the newborn? A)Order HIV testing on the infant immediately on admission to the nursery B)Treat the infant with zidovudine (AZT) immediately after delivery C)Encourage breastfeeding D)Start zidovudine at 24 hours of life E)Isolate the infant from the other infants in the nursery
B
A 34-year-old G3P2 woman presents for her first prenatal visit at six weeks gestation. Her history is significant for a gastric bypass two years ago, after which she lost 60 pounds. She is otherwise healthy. Her examination is unremarkable, and her BMI is 28 kg/m2. In addition to a prenatal vitamin, which of the following medications should be recommended for this patient? A) Double dose prenatal vitamin B) Iron C) Calcium D) Fish oil E) Vitamin A
B
A 35yo G2P1 woman presents for a new obstetrics visit at eight weeks gestation. Her history is significant for a pulmonary embolism during her first pregnancy five years ago. She was treated with heparin during her pregnancy and had an uncomplicated vaginal delivery. Postpartum, she was treated with ora warfarin for several months. Which of the following is the best next step in the management of this patient? A) Observation B) Begin anticoagulation now C) Begin anticoagulation in the second trimester D) Begin anticoagulation in the third trimester E) Begin anticoagulation postpartum
B
A 41-year-old G3P2 woman presents with cramping, vaginal bleeding, and right lower quadrant pain for five days which has progressively worsened. Her last menstrual period occurred seven weeks ago. Her surgical history is notable for a bilateral tubal interruption following her last vaginal delivery. On physical examination, vital signs are: blood pressure 110/74, pulse 82 beats/minute, respiratory rate 18/minute, temperature 98.6°F (37.0°C). On abdominal examination, she has right lower quadrant tenderness with rebound and bilateral guarding. On pelvic examination, she has scant old blood in the vagina and a normal appearing cervix. On bimanual examination, her uterus is normal size and slightly tender, and she has cervical motion tenderness and rectal tenderness. Her quantitative beta-hCG is 4000 mlU/mL, progesterone 6.2 ng/mL, hematocrit 34%, and leukocyte count 15400/mm3, with 88% segmented neutrophils and no ba
B
A 24-year-old G1P1 woman delivered a full term baby boy. He is doing well, his newborn examinations are normal, and he has been cleared for discharge home. She is seen on postpartum rounds and is interested in circumcising her son; however her husband is not circumcised and is resistant. Which of the following is an effect of circumcision that might guide their decision? A)Increased risk of penile cancer B)Higher risk of STI C)Fewer UTls compared to uncircumcised D)Higher acquisition of HIV E)Higher risk of HPV
C
A 24-year-old G2P1 woman at 18 weeks gestation with a history of asthma presents to the office with worsening symptoms. The symptoms began with the pregnancy and have gradually increased to the point where she has a persistent cough. She is using her albuterol inhaler more frequently, recently three times a day. She reports no illness or fever. On examination, the patient appears comfortable. Her temperature is 100.2°F (37.9°C) and respiratory rate is 18/minute. Auscultation of the lungs shows good air movement with mild scattered end expiratory wheezes. There are no rales or bronchial breath sounds. Which of the following is the most appropriate next step in the management of this patient? A) Oral theophylline B) Oral corticosteroids C) Inhaled corticosteroids D) Oral zafirlukast (leukotriene inhibitor) E) Antibiotic treatment
C
A 26-year-old G2P1 woman at 41 weeks gestation is brought in by ambulance. The emergency medical technician reports that a pelvic examination performed 20 minutes ago when the patient had a severe urge to push revealed that she was fully dilated and the fetal station was +2. Fetal heart tones were confirmed to be 150 BPMwith no audible decelerations. When the patient is placed on the fetal monitor, the heart rate is noted to be 60 beats/minute. The maternal heart rate is recorded as 100 BPM Without pushing, the fetal scalp is visible at the introitus. A repeat pelvic examination shows that the fetus is in the occiput anterior position. Which of the following is the most appropriate next step in the management of this patient? A) Emergent cesarean delivery B) Amnioinfusion C) Operative vaginal delivery D)Confirm the fetal heart rate with an internal fetal scalp electrode E)Use ultrasound to assess the fetal heart rate
C
A 27-year-old G1 woman at 36 weeks gestation is undergoing an induction of labor for preeclampsia. has a headache, right upper quadrant pain, and seeing spots. Admission vital signs are: blood pressure 180/120, respiratory rate 20/minute, pulse 92 beats/minute. Fetal heart rate is 144 beats/minute. In addition to 10 hours of oxytocin, she is receiving intravenous magnesium sulfate 2 g/hour. During the past two hours, her urine output has decreased to 15 mL per hour (down from 40 mL/h), and her respiratory rate is now 10/minute. Pulse oximetry is 88%. The fundal height is 36 and the cervi is dilated 5 and completely effaced with a vertex presentation. The fetal heart rate tracing is a Category I. What is the next best step in the management of this patient? A) Continue magnesium sulfate B) Decrease magnesium sulfate to 1 g/hour C) Administer calcium gluconate D) Increase oxytocin drip E) Cesarean delivery now
C
A 27-year-old G2P0 woman is diagnosed with a first trimester pregnancy loss. She has a history of type 1 diabetes mellitus, chronic hypertension, and one prior elective termination of pregnancy. Which of the following is the most likely cause of this early pregnancy loss? A) Prior elective termination of pregnancy B) Chronic hypertension C) Diabetes mellitus D) Intrauterine adhesions E) Infection
C
A 28-year-old G1P0 woman is at 15 weeks gestation. Her husband's cousin has moderate intellectual disability. Which of the following would be the most common cause of inherited intellectual disability in this patient's child? A)Undiagnosed phenylketonuria (PKU) B)Neonatal hypothyroidism C)Fragile X syndrome D) Down syndrome E)Autism
C
A 30-year-old G2P1 presents with amenorrhea. Her last menstrual period (LMP) was five weeks ago. Her periods are usually irregular, but she is concerned because she has a history of a previous ectopic pregnancy, which was treated with methotrexate. She feels well other than having some breast tenderness, and has no major medical problems. What is the best next step in the evaluation of this patient? A) Listen for fetal heart tones with Doppler B) Observation C) Order a serum beta-hCG D) Perform a bimanual examination E)Perform an abdominal ultrasound
C
A 30-year-old G2P1 woman at 39 weeks has had an uncomplicated pregnancy. She is admitted to labor and delivery and delivers a vigorous infant with good tone and cry. Immediately after the body delivers, which of the following would be the most appropriate next step? A)Perform DeLee suctioning on the infant B)Move the infant to the warmer C)Initiate skin to skin contact with mother D)Flick the soles of the feet to stimulate the infant E)Clamp and cut the umbilical cord
C
A 30-year-old G3P2 woman, whose last menstrual period was eight weeks ago, began spotting three days ago and developed cramping this morning. She has a history of a chlamydia infection treated two years ago, and she smokes one pack of cigarettes per day. Otherwise, her medical history is unremarkable. On physical examination, her blood pressure is 120/70, pulse 82 beats/minute, respiratory rate 20/minute, and temperature 98.6°F (37.0°C). Abdominal examination is normal. Pelvic examination reveals old blood in the vaginal vault, closed cervix without lesions, slightly enlarged uterus, and no adnexal tenderness. Pertinent labs: quantitative beta-hCG is 1000 mlU/mL, urinalysis normal, hematocrit 32%. Transvaginal ultrasound shows no intrauterine pregnancy, no adnexal masses, and no free fluid in pelvis. Which of the following is the most appropriate next step in the management of this patient? A)Treat with methotrexat
C
A 38-year-old G1P1 woman presents with concerns that her baby is not getting enough milk. She underwent a cesarean delivery three weeks ago. She reports that she is feeding on demand every two to four hours, and is not supplementing with formula, but her infant son is still fussy. Which of the following is indicative that her baby is getting adequate milk? A) Sleeps through the night B) Spits up a small amount of milk after feeding C) Three to four stools in 24 hours D) Three to four wet diapers in 24 hours E) Coverage of the entire areola with his mouth when he breastfeeds
C
A 42-year-old G5P4 woman who is exclusively breastfeeding her two-month-old infant presents with left breast pain, and fever. On examination, her temperature is 100.2°F (37.9°C). Breast examination demonstrates a red, tender, wedge-shaped area on the outer quadrant of her left breast. Which of thefollowing is the most appropriate next step in the management of this condition? Gentian violet treatment of the nipples and the baby's mouth Cessation of breastfeeding until afebrile Antibiotics Warm compresses Incision and drainage
C
A 45-year-old G2P2 woman presents for a six-week postpartum visit. She reports crying spells, difficulty sleeping, and a feeling of low self-worth that began one week after her delivery. She is frustrated because she has not been able to breastfeed and feels that she is a bad mother. She has been getting up every 2-3 hours to feed her baby. She has a previous history of anxiety. Which of the following is the most likely diagnosis in this patient? A) Normal puerperium B)Postpartum blues C)Postpartum depression D)Anxiety disorder E)Bipolar disorder
C
A full-term infant is born to a healthy mother by normal vaginal delivery after a three-hour second stage. At one minute of life, the infant is noted to have poor respiratory effort and remains cyanotic while on the mother's chest. The heart rate remains at 125 beats/minute. Which of the following is the most appropriate next step in management? A)Administer naloxone B)Administer positive pressure ventilation C)Clear airway and administer supplemental oxygen D Continue skin-to-skin contact with mother E)Intubate infant
C
A 23-year-old G1P0 woman at 38 weeks gestation presents to labor and delivery with a one-day history of lower abdominal pain and mild nausea. Her pregnancy has been uncomplicated and fetal kick counts are appropriate. Her review of symptoms is otherwise negative. Vital signs are: temperature 98.6°F (37.0°C), blood pressure 100/60, pulse 79 beats/minute, respiratory rate 14/minute. The fetal heart tracing is Category I and the tocometer shows irregular contractions every 2 to 8 minutes. On examination, the abdomen is nontender, the fundal height is 36 cm, and the cervix is firm, long, closed and posterior. A repeat cervical examination two hours later is unchanged. A urine dipstick is notable for 1+ glucose with negative ketones. Which of the following is the next best step in management for this patient? A)General surgery consult B)Hemoglobin A1c C)Discharge home with labor precautions D)Admit to labor and deliver
C She is having Braxton Hicks contractions
A 34-year-old G1PO woman at 39 weeks gestation presents in active labor. Her cervical examination an hour ago was 5 cm dilated, 90 percent effaced and 0 station. She just had spontaneous rupture of membranes and is found to be completely dilated with the fetal head at +3 station. The fetal heart rate tracing is shown below. What is the most likely etiology for these findings? A)Oligohydramnios B)Rapid change in descent C)Umbilical cord compression D)Uteroplacental insufficiency E)Head compression
D This patient is having late decelerations. Late decelerations are associated with uteroplacental insufficiency. The onset, nadir, and recovery of the decelerations occur, respectively, after the beginning, peak, and end of the contraction. A rapid change in cervical dilation and descent are not associated with late decelerations. Umbilical cord compression is associated with variable ndecelerations. Oligohydramnios can increase a patient's risk of having umbilical cord compression; however, it does not cause late decelerations. Head compression is associated with early decelerations.
A 17-year-old G1 female at 39 weeks gestation presents with increased swelling in her face and hands over the last two days. Her blood pressure is 155/99. Fetal heart rate is 144 beats/minute. She has 2+ pitting edema of the lower extremities. A 24-hour urine collection shows 440 mg of protein. What is the next best step in the management of this patient? Fluid restriction low-dose aspirin Furosemide Hydralazine Delivery
E
A 19-year-old G1PO woman at 41 weeks gestation, with two prior prenatal visits at 35 weeks and 40 weeks, presents in active labor. Review of available maternal labs shows blood type 0+; RPR non-reactive, HBsAg negative, and HIV negative. She delivers a small female infant who cries spontaneously. On examination, the the infant has a slightly flattened nasal bridge. Her ears are small and slightly rotated. What is the most appropriate next step in the management of this patient? A)Tell the mother the infant will be fine B)Tell the mother that her newborn has Down syndrome C)Send placental tissue for karyotype D)Further examine the infant for wide-spaced nipples and lymphedema E)Further examine the infant for sandal gap toes and hypotonia
E
A 20-year-old GO Malaysian woman presents for prenatal care at six weeks gestation. She reports a one week history of vaginal spotting, and is otherwise healthy with no medical problems. Prenatal labs reveal a hemoglobin of 9.1 g/dL with the following indices: MCV (mean corpuscular volume) 72 femtoliter MCH (mean corpuscular hemoglobin) 22 picograms/cell, Serum ferritin 108 mcq/L, Hemoglobin A2 normal, Hemoglobin F normal, Hemoglobin electrophoresis normal. What is the most likely cause of anemia in this patient? A) Acute blood loss B) Iron deficiency anemia C) Hemoglobin H disease D) Beta thalassemia E) Alpha thalassemia trait
E
A 21-year-old G1PO woman delivered a 4000 g infant by a low-forceps delivery after a prolonged labor course that included a three-hour second stage. Her prenatal course was notable for anemia, poor weight gain and maternal obesity. Following the delivery, she required extensive repair of a vaginal sulcus laceration and a second-degree perineal laceration. Her hematocrit was 30% on postpartum day one. Which of the following factors places this patient at greatest risk for developing a puerperal infection? A) Second-degree perineal laceration B) poor Nutrition C) Obesity D) Anemia E) Prolonged Labor
E
A 22-year-old G2P1 woman presents to clinic with her three-month-old daughter. She was breastfeeding without problems until two weeks ago, when she developed sore nipples and burning pain in the breasts. The pain is worse when breastfeeding. On physical examination, she is afebrile. The breasts appear normal except for the tips of the nipples, which are pink and shiny with peeling noted at the periphery. Which of the following organisms is the most likely cause of these findings? A) • Group A streptrococcocus B) Group B streptrococcocus C) Staphylococcus aureus D) Staphylococcus epidermidis E) Candida
E
A 24-year-old G1PO woman presents in active labor at 39 weeks gestation. She reports leaking fluid for the last two days. She develops a temperature of 102.0°F (38.9°C), and fetal heart rate tracing is Category I| with heart rate 180 beats/minute and minimal variability. Maternal labs show blood type O+, RPR non-reactive, HBsAg negative, HIV negative, and GBS unknown. What will be the expected appearance of the baby at delivery? A) Vigorous, pink with normal temperature B) Vigorous, pale with low temperature C Lethargic, pink with high temperature D Lethargic, pale with low temperature E)Lethargic, pale with high temperature
E
A 25-year-old G3P2 woman delivered a healthy infant with Apgars of 9 at one minute and 9 at five minutes 40 minutes ago. She sustained no lacerations and had no episiotomy. Her placenta has not delivered, despite active management of her third stage. Her EBL is 350cc. Vital signs are temperature 98.6°F (37.0°C) blood pressure 100/60, pulse 79 beats/minute, respiratory rate 14/minute. Which of the following best describes this patient's condition? A) Postpartum hemorrhage B)Placenta percreta C) Normal third stage of labor D)Prolonged second stage of labor E)Retained placenta
E
A 25-year-old GO woman presents for a preconception consultation. Her medical history is notable for a seizure disorder. She has been well-controlled on lamotrigine and she has been seizure free for nine months. Her BMI is 26 kg/m2 and her blood pressure is 120/80. Which of the following is the next best step in the management of this patient? A) Discontinue her anticonvulsant medication B)Increase her medication dose C)Initiate 81 mg of aspirin D)Initiate a prenatal vitamin E)Initiate additional folate supplementation
E
A 27-year-old G1P1 woman delivered her first baby two days ago. Her pregnancy and delivery were unremarkable. She is healthy with no major medical problems. She wants to begin postpartum contraception immediately. Which of the following should be avoided in this patient? A)Oral progesterone-only pills B)Depot medroxyprogesterone acetate C)Etonogestrel implant D)Levonorgestrel IUD E)Estrogen-progesterone oral contraceptive
E
A 27-year-old G2P1 woman at 14 weeks gestation presents to the Emergency Department with a 24-hour history of fever, nausea, vomiting, and mid-abdominal pain. She has had no appetite for the last 12 hours. She has been healthy, but reports that her three-year-old son has had diarrhea for two days. Physical examination reveals a blood pressure of 100/60, pulse 88 beats/minute, respiratory rate 18/minute, and temperature 102.0°F (38.9°C). Abdominal examination reveals decreased bowel sounds and tenderness more pronounced on the right than the left. Which of the following is the next best step in the management of this patient? A) Right upper quadrant ultrasound B) X-ray of the abdomen C) CT of the abdomen and pelvis D) MRI of the abdomen and pelvis E) Graded compression ultrasound
E
A 30-year-old G1P1 woman is exclusively breastfeeding her baby, but is concerned that she is not making enough milk. She is pumping in order to improve the supply of milk. The nurse tells her that more frequent suckling would be better as it will stimulate which of the following hormones? A)Progesterone B) Dopamine C) Cortisol D)Prolactin E) Oxytocin
E
A 32-year-old G2P1 woman is at 20 weeks gestation. Her prior pregnancy was complicated by postpartum endometritis and her son was diagnosed with early-onset neonatal sepsis due to group B streptococcus. Which of the following management options regarding group B streptococcus is most appropriate for this patient? A)Recto-vaginal culture at 35 to 37 weeks and antibiotic treatment during labor ifpositive B)Recto-vaginal culture at 35 to 37 weeks and antibiotic treatment at the time theculture result returns if positive C)Recto-vaginal culture at 24 to 28 weeks and antibiotic treatment during labor ifpositive D)Recto-vaginal culture at 24 to 28 weeks and antibiotic treatment at the time theculture result returns if positive E)Do not perform recto-vaginal cultures and treat with antibiotics during labor
E
A 34-year-old G2P1 woman at 40 weeks gestation was admitted to labor and delivery in active labor two hours ago. Her cervix was 4 cm dilated and 100% effaced on admission. Her fetus was vertex and -3 station. After she experiences spontaneous rupture of membranes, she is examined and found to be 9 cm dilated, and the fetal head is occiput anterior (OA) at + 1 station. A 5 cm long section of umbilical cord is palpated in the patient's vagina. The fetal heart tracing is Category I. The patient is having regular uterine contractions every two to three minutes. She has an epidural and is not feeling the contractions. What is the most appropriate next step in the management of this patient? A) Allow for passive descent of the fetal head with continuous fetal monitoring B)Have the patient start pushing with the contractions C)Gently attempt to replace the umbilical cord segment back up into the uterus D)Perform a forceps
E
A 34-year-old G4P4 woman presents with a fever three days after a cesarean delivery. Her vital signs are: temperature 102.0°F (38.9° C), pulse 88 beats/minute, respiratory rate 20/minute. On examination, her incision is healing well without erythema or drainage, and she has notable fundal tenderness. Whichof the following is the most likely cause of her symptoms? A)Aerobic streptococcus B)Anaerobic streptococcus C)Aerobic staphylococcus D)Anaerobic staphylococcus E)Aerobic and anaerobic bacteria
E
At one minute of life, a newborn infant has a heart rate greater than 120 beats/minute, is crying, has acrocyanosis, gags when suctioned and is vigorously moving all four extremities. What is the Apgar score for this infant? A)5 B)6 C)7 D)8 E)9
E
A healthy 25-year-old G6P2 woman presents in early labor and is given mepiridine for pain relief. She unexpectedly progresses from 4 cm to fully dilated in one hour, followed by a 15-minute second stage. A limp unresponsive infant is delivered. Heart rate is 90 beats/minute. The infant has no respiratory effort. Which of the following is the most appropriate medication to administer in the management of the neonate? Ampicillin Atropine Epinephrine Nalbuphine Naloxone
Naloxone
A 25-year-old G2P1 woman at eight weeks gestation is diagnosed with an early pregnancy loss. Her husband is 35 years old. The patient's past medical history is remarkable only for smoking two packs of cigarettes a day. She is a runner who was training for a half marathon. Three years ago, she had a full term delivery that was complicated by preeclampsia. Which of the following factors is the most likely cause of this early pregnancy loss? Paternal age Vigorous exercise Smoking Uterine anomaly (i.e. unicornuate uterus) History of preeclampsia Submit Answer
Smoking
A 30-year-old GO woman presents with her husband for preconception counseling. The patient is of Ashkenazi Jewish descent. Her husband is white and of Irish descent. Which of the following genetic diseases is the most likely to affect their future children? A)Canavan disease B)Maple syrup urine disease C)Cystic fibrosis D)Tay-Sachs disease E)Gaucher's disease
c
A 34-year-old G1P0 woman whose last menstrual period was 6 weeks ago presents with vaginal spotting. On physical examination, vital signs are: blood pressure 120/70, pulse 82 beats/minute, respiratory rate 20/minute, and temperature 98.6°F (37.0°C). An ultrasound confirms a non-viable intrauterine pregnancy. She is otherwise healthy. Her partner accompanies her and is supportive. The patient wishes to avoid any unnecessary medical interventions and asks whether she can safely let nature take its course. What is the best next step in the management of this patient? A)Immediate dilation and suction curettage B) Dilation and suction curettage in one week C) Immediate treatment with misoprostol D) Treatment with misoprostol in one week E) Expectant management
e
A 25-year-old G1PO woman at 24 weeks gestation presents for a new OB visit. She reports that she is currently homeless and lives at the local shelter. She has no known medical problems and feels well. She smokes ½ pack of cigarettes per day. Which of the following pregnancy complications is this patien most likely to experience during her pregnancy? Preterm delivery Urinary tract infection Gestation diabetes preeclampsia Intrauterine fetal demise
preterm delivery
A 20-year-old G1 woman presents with a three-day history of vaginal spotting and mild cramping. Her last menstrual period was approximately nine weeks ago. She had a positive home pregnancy test. Vital signs are: blood pressure 120/72, pulse 64 beats/minute, respiratory rate 18/minute, temperature 98.6°F (37.0°C). On pelvic examination, she has scant old blood in the vagina, with a normal appearing cervix. On bimanual examination, her uterus is nontender and small, and there are no adnexal masses palpable. Quantitative beta-hCG 48 hours ago was 750 mlU/mL. Her current beta-hCG is 500 mlU/mL, progesterone 3.2 ng/mL, hematocrit 37%. Transvaginal ultrasound shows a gestational sac in the uterus with a yolk sac. A 3 cm x 3 cm simple cyst is seen on the left ovary. There is no free fluid in the pelvis. Which of the following is the most appropriate next step in the management of this patient? A)Diagnostic laparoscopy B)
D
A 22-year-old G2P1 woman at 39 weeks gestation was admitted to labor and delivery in spontaneous labor. Her initial cervical examination was 6 cm dilated and 90% effaced. Four hours later she is 7 cm dilated and 90% effaced. On external tocometer, she is having painful contractions every two to three minutes. The fetal heart rate tracing is Category I. Which of the following is the most appropriate next step in management of this patient? A) Placement of an intrauterine pressure catheter B) Placement of a fetal scalp electrode C) Cesarean delivery D) Oxytocin augmentation E)Expectant management
D
A 23-year-old G2P1 woman presents with spotting and pelvic pain. She had a positive home pregnancy test six weeks ago. She has a history of a prior cesarean delivery and is otherwise healthy. Labs show quantitative beta-hCG 5000 mlU/mL and hematocrit 34%. Ultrasound shows an enlarged area in the anterior uterine wall with a gestational sac and small embryo with cardiac activity. There is a small amount of blood in the cul de sac. Her vital signs show a pulse of 110 beats/minute and blood pressure 80/50. What is the most likely diagnosis in this patient? A) Normal intrauterine pregnancy B)Placenta accreta C)Placenta increta D)Cesarean scar ectopic pregnancy E)Cervical ectopic pregnancy
D
A 23-year-old G3P2 woman presents for a new obstetrics visit at eight weeks gestation. After delivery, she wants to exclusively breastfeed her baby. She is researching hospital policies to decide at which hospital she will plan to deliver. Which of the following hospital policies most strongly promotes breastfeeding? A) Uninterrupted sleep for the mother on her first night in the hospital B)Use of a breast pump to help increase the milk supply C)Use of pacifiers to prevent sore nipples D)Unlimited access of mother to baby E)Use of metoclopramide to increase the milk supply
D
A 24-year-old GO woman presents for preconception counseling. Her medical history is notable for type 1 diabetes mellitus, hypertension, epilepsy, and hypothyroidism. Her medications include insulin, labetalol, valproic acid, and levothyroxine. Based on her medication exposure, her infant is at greatest risk of which of the following anatomical defects? A) Hypoplastic left heart syndrome B) Skeletal anomalies C) Renal tubular dysgenesis D) Neural tube defects E) Gastroschisis
D
A 25-year-old G1P1 woman presents with a fever six days after undergoing a cesarean delivery for arrest of descent. Her surgery was complicated by a postpartum hemorrhage that required a blood transfusion. Her past medical history is significant for obesity, type 2 diabetes, and chronic hypertension. Her vital signs are: temperature 102.0°F (38.9° C), pulse 100 beats/minute, respiratory rate 20/minute, and her BMI is 50 kg/m2. Physical examination demonstrates tenderness around her incision with erythema and yellowish drainage from the middle of the incision. Which of the following is the greatest risk factor in this patient for a wound infection? A)Blood Transfusion B)Diabetes C)Hypertension D)Obesity E)Surgery after onset of labor
D
A 26-year-old GO woman and her husband present for preconception counseling. They both identify as Black and do not have any significant family or genetic history. Which of the following blood tests are recommended? A)MCV (mean corpuscular volume) and CB B)Sickle cell preparation and CBC C)Peripheral blood smear and CBC D)Hemoglobin electrophoresis and СВС E)Sickle cell preparation with a hemoglobin electrophoresis, if the sickle preparation isabnormal
D
A 27-year-old G1P0 woman at 32 weeks gestation presents with cough, fever, chest pain, and dyspnea. Vital signs are: pulse 108 beats/minute, temperature 102.0° F (38.9° C), respiratory rate 22/minute. Physical examination reveals an ill-appearing woman in mild distress. Lung examination demonstrates right lower lobe bronchial breath sounds. Which of the following tests would be most appropriate for making a diagnosis in this patient? A) Blood cultures B) Sputum culture C) Lower extremity Dopplers D) Chest X-ray E) Chest CT
D
A 27-year-old G2P1 woman presents to the Emergency Department with increasing lower abdominal pain, nausea, scant bleeding, and fever. She is two days posi-op from a suction dilation and curettage for an incomplete pregnancy termination. Vital signs are: blood pressure 120/80, pulse 110 beats/minute, respiratory rate 20/minute, and temperature 100.2°F (38.0°C). Physical examination reveals rebound tenderness and abdominal guarding. Pelvic examination shows a soft and slightly tender uterus. Pelvic ultrasound demonstrates an 6mm endometrial stripe, normal ovaries, and a moderate amount of fluid in the cul-de-sac. Which of the following is the most likely cause of the symptoms in this patient? A) Normal recovery symptoms B) Retained products of conception C) Hematometra D) Perforated uterus E) Cervical laceration
D
A 28-year-old G1P1 woman delivered three days ago and desires to exclusively breastfeed her infant. She is having problems since her milk came in with full, engorged, tender breasts. She is very uncomfortable but reports no fever or chills. Which of the following strategies is proven to best help relieve her symptoms? A)Discontinue breastfeeding for 24 hours B)Switch to exclusive pumping of breast milk C)Increase the interval between breastfeeding sessions D)Nurse every 1.5 to 3 hours around the clock E)Avoid wearing a bra until the engorgement subsides
D
A 28-year-old G3P0 woman presents with her husband for preconception counseling. She has a history of three prior early first-trimester pregnancy losses, all confirmed with ultrasound and managed expectantly. She had a normal hysterosalpingogram (HSG). She reports no medical problems and has never had surgery. She does not take any medications and she does not smoke. Which of the following tests is the best next step in the evaluation of this patient? A) MRI of pelvis B)Ultrasound for cervical length C)Semen analysis D)Parental karyotype analysis E Anti-mullerian hormone (AMH)
D
A 29-year-old G1P0 woman at 37 weeks gestation presents to labor and delivery with decreased fetal movement for two days. The nurse is unable to find fetal heart tones. Ultrasound confirms absent fetal cardiac activity and an intrauterine fetal demise (IUFD) is diagnosed. Examination shows the cervix is closed, 20% effaced, and the presenting part is at -2 station. The patient is understandably devastated, and condolences are offered. What is the best next step in the management of this patient? A) Begin oxytocin induction immediately B) Begin oxytocin induction when the patient is ready C)Begin misoprostol induction immediately D Begin misoprostol induction when the patient is ready E Await spontaneous labor
D
A 32-year-old G5P3 woman presents with left-sided abdominal pain. Her last menstrual period was eight weeks ago. She began having pain early this morning and it has increased to a severity of 8/10. She does not have nausea, vomiting, or vaginal bleeding. Her gynecologic history is significant for a right sided ectopic pregnancy four years ago that was treated with a right salpingectomy and she had a left tubal interruption for sterilization. On physical examination, blood pressure is 90/54, pulse 108 beats/minute, respiratory rate 22/minute, and temperature 98.6°F (37.0°C). On abdominal examination, she has rebound and guarding in all quadrants, and on pelvic examination, there is left adnexal fullness and tenderness. Urine pregnancy test is positive. A transvaginal ultrasound shows a thickened endometrium, left pelvic mass with a gestational sac and fetal pole and a large amount of free fluid in the pelvis. Her he
D
A 33-year-old G1P1 woman delivered a healthy infant two days ago. She has had difficulty breastfeeding despite multiple attempts. Her nipples are sore and cracked and she is thinking about exclusively bottle-feeding. Her pregnancy was complicated by gestational diabetes, chronic hypertension, and a history of an abnormal Pap test. She had a cone biopsy two years ago and had a normal Pap test with the current pregnancy. The patient's mother has a history of endometrial and colon cancer, and her maternal grandmother and grandfather both had fatal heart attacks in their early 60s. Breastfeeding decreases the risk of which of the following for this patient? A) Type 2 diabetes B) Coronary artery disease C) Cervical cancer D) Ovarian cancer E) Colon cancer
D
A 33-year-old G5P4 woman just delivered her fourth baby without complications. She gained 50 pounds during this pregnancy and would like to begin a weight loss program as soon as possible. She desires long-term effective contraception but she and her husband are not sure if they want more children. She also desires to breastfeed exclusively for six months and has had trouble with this in the past. Which of the following is the most appropriate contraceptive choice for this patient? A) Depot medroxyprogesterone B) Combined estrogen-progestin oral contraceptives C) Contraceptive patch D) Intrauterine device (IUD) E) Vasectomy
D
A 34-year-old G1 woman at eight weeks gestation presents for her first prenatal visit. She is healthy and takes no medications. Family history reveals type 2 diabetes in her parents and brothers. She is 5 feet 2 inches tall and weighs 220 pounds (BMI 40.2 kg/m2). Which of the following is the best recommendation to screen her for gestational diabetes? A) Screen at 24 to 28 weeks with a 50-g oral glucose challenge test B) Check a fasting glucose now C) Screen at 12 weeks with a 50-g oral glucose challenge test D) Screen now with a 50-g oral glucose challenge test E) Check a hemoglobin A1c now
D
A 34-year-old G1P0 woman at 39 weeks gestation presents with increased swelling in her face and hands over the last four days. She has no prior history of hypertension. Blood pressure is 150/94 and a 24-hour urine sample for protein is 140 mg. BMilis 29 kg/m2. Creatinine is 1.2 mg/dL. The fundal height is 37 and the cervix is dilated 1 and 50% effaced with a vertex presentation. Which of the following is the next best step in the management of this patient? A) Repeat the blood pressure B) Collect a 24 hour urine for protein C) Observation D) Initiate oxytocin E) Cesarean delivery
D
A 35-year old G2P1 woman is at 11 weeks gestation. She had a triple screen with her last pregnancy which was positive, but the follow up amniocentesis was normal. She requests to have the most reliable aneuploidy screening test. Which of the following screening tests should be recommended for this patient? A)First trimester combined test B)Sequential screen C)Quad screen D)Cell-free DNA screen E)Serum integrated screen
D
A 35-year-old G3P2 Black woman presents for a prenatal visit at 20 weeks gestation. She reports intermittent heart palpitations. She feels anxious when this happens. Her pregnancy has otherwise been unremarkable, and she reports no medical problems. On examinaton, she appears well. Vital signs are: BM 36 kg/m2, blood pressure 125/70, pulse 70 beats/minute, respirations 25/minute. Her lung and heart examinations are normal. What is the best next step in the management of this patient? A)Provide reassurance that her symptoms are normal in pregnancy B)Prescribe an anxiolytic medication C)Prescribe a beta-blocker D) Order EKG E)Check a TSH
D
A 36-year-old G2P 1 woman presents for her first prenatal visit at nine weeks gestation. Her history is significant for chronic hypertension that is well controlled with lisinopril and labetalol, hypothyroidism treated with levothyroxine with recent normal labs, recurrent herpes genitalis managed with chronic acyclovi suppressive therapy, and migraine headaches managed with butalbital. What adjustments to her current medication regimen should be recommended in this patient? A) Decrease levothyroxine dose B) Decrease labetalol dose C) Change acyclovir to valacyclovir D) Discontinue lisinopril E) Discontinue butalbital
D
A 36-year-old G5P4 woman with no prenatal care presents with painful contractions every one to two minutes. She has a history of four prior vaginal deliveries. The patient reports having bright red vaginal bleeding for the past hour. Her blood pressure is 170/105 and she has 3+ proteinuria. Fetal heart tones are 170 beats/minute with no baseline variability and a sinusoidal pattern (Category III). Fundal height is 28 cm. Ultrasound demonstrates a fundal placenta. Based on this history, what is the most likely etiology of her vaginal bleeding? A) Uterine rupture B Placenta previa C Bloody show D Placental abruption E Vasa previa
D
A 40-year-old G3P2 woman at 12 weeks gestation presents for prenatal care. She was seen in the Emergency Department one week ago because of spotting. Ultrasound revealed an 11-week viable gestation and the nuchal translucency was 2.5 mm. She has chronic hypertension controlled with labetalol and nifedipine, and type 2 diabetes controlled with insulin. Her blood pressure today is 138/88 and her BMI is 34 kg/m2. The uterus measures 13 cm. Which is the next best step in the management of this pregnancy? A) Discontinue insulin and start oral hypoglycemic agent B) Discontinue all antihypertensives C) Repeat ultrasound D) Serum aneuploidy screen E) Glucose screening for gestational diabetes
D
An 18-year-old G1P0 woman presents at 32 weeks for a routine prenatal visit. She reports intense itching for the past two weeks and cannot stop scratching her arms, legs, and soles of her feet. She has tried over-the-counter lotions and antihistamines with no relief. Her vital signs are normal, and there are scattered excoriations over her arms and legs. Which of the following is the best treatment in the management of this patient? A) Aggressive hydration B) High dose topical steroids C) Antihistamines D) Ursodeoxycholic acid E) Oral steroids
D
A 17-year-old G1P1 female delivered a term infant two days ago. She is not interested in breastfeeding and is experiencing painful breast engorgement. She asks for something to suppress lactation. Which of the following is the safest method of lactation suppression in this patient? A) Bromocriptine B)Breast binding, ice packs, and analgesics С)Medroxyprogesterone acetate D) Oral contraceptives E)Manual milk expression
B
A 22-year-old G1PO woman presents to the Emergency Department at eight weeks gestation with heavy vaginal bleeding. On physical examination, vital signs are blood pressure 94/60, pulse 108 beats/minute, respiratory rate 20/minute, and temperature 98.6°F (37.0°C). Pelvic examination demonstrates brisk bleeding through a dilated cervical os. The patient's hemoglobin is 7 g/dL (hematocrit 21%). Which of the following is the most appropriate next step in the management of this patient? A) Administration of intravaginal misoprostol B) Administration of oral misoprostol C) Dilation and suction curettage D) Endometrial ablation Observation
C
A 16-year-old G1PO female at 39 weeks gestation presents to labor and delivery reporting a gush of blood-tinged fluid approximately five hours ago, followed by the onset of uterine contractions shortly thereafter. She reports that contractions have become stronger and closer together over the past hour. The fetal heart rate tracing is Category I. Uterine contractions are recorded every two to three minutes. A pelvic examination reveals that the cervix is 4 cm dilated and 100% effaced. Fetal station is 0. After walking around for 30 min, the patient returns reporting further discomfort and requests an epidural. However, obtaining the fetal HR externally has become difficult because the patient cannot lie still. What is the most appropriate next step in the management of this patient? A) Place the epidural B) Apply a fetal scalp electrode C)Perform a fetal ultrasound to assess the fetal heart rate D) Place an intraute
B
A 22-year-old G4P1 woman at 26 weeks gestation presents with a one-week history of a postcoital vaginal odor and increased milky, gray-white discharge. She reports that she has no new sexual partners, but the father of the baby may not be monogamous. On examination, there is a profuse discharge in the vaginal vault, which covers the cervix. Pertinent labs: wet mount pH greater than 4.5 and whiff test positive. Microscopic examination reveals vaginal epithelial cells studded with adherent coccobacilli that are best appreciated at the edge of the cell. There are no motile trichomonads or branching hyphae. Whic of the following is the most appropriate next step in the management of this patient? A) Delay treatment until postpartum B) Treat her now and again during labor C) Treat her now D) Treat her and her partner E) No treatment necessary
C
A 23-year-old G1P1 woman presents with a fever on the third day after an uncomplicated cesarean delivery that was performed secondary to arrest of descent. Her vital signs are: temperature 102.0°F (38.9° C), pulse 88 beats/minute, respiratory rate 22/minute. Physical examination demonstrates an ill-appearing woman with bilateral breast engorgement and tenderness and mild uterine fundal tenderness. Which of the following is the most likely diagnosis in this patient? A) Urinary tract infection B)Mastitis C)Endometritis D)Wound infection E) Septic pelvic thrombophlebitis
C
A 23-year-old G2PO woman at 33 weeks gestation presents to labor and delivery with acute nausea, vomiting, and epigastric pain. Her blood pressure is 145/90; she has 1+ protein on a urinalysis. Her labs are shown below: Hematocrit: 42% Leukocyte count: 11,000/mm3 Bilirubin: 1.4 mg/dL Platelets 42,000/mm3 Lipase: 11 U/L Aspartate aminotransferase (AST): 391 U/L Creatinine: 0.8 mg/dL Alanine aminotransferase (ALT): 444 U/L Uric acid: 7.7 mg/dL Glucose: 100 mg/dL Fibrinogen: 405 mg/dL What of the following is the most likely diagnosis in this patient? A) Preeclampsia without severe features B) Immune thrombocytopenic purpura (ITP) C) HELLP syndrome D) Cholecystitis E) Acute Fatty Liver
C
A 21-year-old G1P1 woman presents with amenorrhea since the birth of her one-year-old daughter. She reports extreme fatigue, forgetfulness, and depression. She was unable to breastfeed because her milk never came in, and she feels guilty about this. She notes hair loss including under her arms and in her pubic area. Her delivery was complicated by a postpartum hemorrhage requiring aggressive resuscitation and dilation and curettage. She is afebrile. Vital signs are: blood pressure 90/50, pulse 84 beats/minute. The patient appears tired. Her examination is normal, but she is noted to have dry skin. A urine pregnancy test is negative. Which of the following is the most likely diagnosis in this patient? A)Hyperprolactinemia B)Hyperthyroidism C)Sheehan's syndrome D)Asherman syndrome E)Major depressive disorder
C
A 22-year-old G1 woman is undergoing treatment with magnesium sulfate for preeclampsia with severe features. She had a cesarean delivery 10 hours ago for a Category Ill fetal heart rate tracing. She now has oliguria and appears lethargic. On examination, no deep tendon reflexes are elicited. Her magnesium level is 11 mEq/L. Which of the following conditions is most likely to occur in this patient? A) Seizures B)Muscle weakness C) Respiratory depression D) Pulmonary edema E) Cardiac arrest
C
A 30-year-old G2P0 woman at 38 weeks gestation has just delivered a male infant. She has a history of type 1 diabetes since age 11. Maternal labs show blood type B+, RPR non-reactive, HBsAg negative, HIV negative, and GBS negative. She had poor control of blood sugar during her pregnancy. For which of the following conditions must the pediatrics team monitor the newborn? Hypoxemia Hyperglycemia Hypoglycemia Hypoinsulinemia Anemia
Hypoglycemia
