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145 Cards in this Set
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- Back
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A 32 yo woman, G2P2, presents to your clinic reporting chronic abdominal and pelvic pain. The pain is intermittent, 6/10, worse on left side, nonradiating, occurs at different times throughout her menstrual cycle. PMHx uneventful, appendectomy 4 y ago. ABD: small linear scar in RLQ, active bowel sounds, diffusely tender to palpation, especially in lower quadrants. No masses. Pelvic exam unremarkable. Most likely dx:
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C. Adhesive disease
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19 yo female, G0P0, has had increasingly severe menstrual cramps since menarche. Her pain is worse around time of menses, also c/o dyspareunia, and pain is worse w/ movement. Denies N/V/D/C, otherwise healthy, no PSHx. Cause of pelvic pain most likely to be:
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E. Gynecologic, urologic, MSK
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An 18 yo G0P0 woman presents to your office because she has painful periods. She says she only has pain during the first 2 days of her periods, which are regular. The pain is always midline and 2 cm below the level of the umbilicus. She says Motrin helps ease the pain. She has no other medical or surgical history. Her pain is transmitted via:
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B. Sympathetic fibers to T11
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A 33 yo woman, G5P4 TAB 1, presents to the clinic with LLQ pain for 2 days. She describes the pain as intermittent initially but now constant, 7/10, nonradiating. Her LMP was 2 months ago. BTL 3 y ago, chole 7 y ago. Physical ex: T=98.5, BP=118/76, P=89, R=18. Abd exam: scar on RUQ, smal scar in umbilicus, + BS, tenderness in LLQ, no rebound tenderness, no guarding. Pelvic: uterus WNL, no adenexal masses appreciated. Next step?
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E. Serum B-hCG
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A 25 yo woman, G4P3, SAB1, presents c/o pelvic pain. She has had pain for 10 years, has seen several physicians. Pain: continuous and dull, 4/10 with intermittent exacerbations 10/10. The pain occasionally radiates to lower back and down her thighs. Nothing helps. PMHx asthma, peptic ulcer dz, MDD. Postpartum BTL, 3 suicide attempts. Hx of sexual abuse as a child. Using an albuterol inhaler, histamine receptor blocker, SSRI. Pelvic exam = diffuse pain, esp right posterior cul de sac. Most likely cause:
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E. Psychogenic cause
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A 26 yo presents to the ER c/o severe RLQ pain. She is taken to the OR for presumed appendicitis. At the time of her surgery her appendix is normal. The surgeon sees a large mass on her R ovary and removes the ovary. Frozen section on the mass shows a corpus luteum. Immediately after, her pregnancy test is found to be positive. She is by dates 6 weeks pregnant. Your main concern is:
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C. Removing the corpus luteum will affect the pregnancy
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A 36 yo woman, G6P2, at 8 weeks gestation, presents with painless vaginal bleeding. Her vital signs: T=99.9, BP=162/94, P=100, and R=18. Her uterus is consistent with 14 weeks pregnancy. Her serum hCG is 320,000 IU/L. Which of the following endocrine glands is most likely to be affected by hCG?
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E. Thyroid
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A 29 yo woman who is pregnant calls you for advice. She has just found out that her hCG level is elevated. Which of the following is true?
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D. A high level of hCG is the most sensitive marker for Down syndrome.
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Estrogens are produced by the mother, fetus, and placenta. Which of the following is true?
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B. Estriol is produced primarily by the placenta.
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Match the hormone: Increases myometrial gap junction formation
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E. Estriol
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Match the hormone: Suppresses maternal lymphocyte activity
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D. Progesterone
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Match the hormone: Necessary for development of male external genitalia
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A. hCG
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Match the hormone: Most sensitive marker for abnormal karyotype
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A. hCG
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Match the hormone: Elevates ketone levels
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B. hPL
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Match the hormone: Produced by the uterus
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C. Prolactin
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Match the hormone: Inhibits lactation during pregnancy
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E. Estriol
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Match the hormone: Lack of this hormone can cause spontaneous abortion in the first trimester
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D. Progesterone
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Match the hormone: Lack of this hormone is associated with an enzyme deficiency in the placenta
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E. Estriol
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Match the hormone: Elevated levels of this hormone are associated with twin pregnancy
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A. hCG
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Match the hormone: Anencephaly causes lack of production of this hormone
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E. Estriol
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A 24 yo woman, G4P3 receives an US to confirm her "due date"....long stem...Using ultrasound, which structure would you see leading into and out of the ductus venosus, respectively?
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D. portal vein; inferior vena cava
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A 37 yo woman, G1P1....long stem...Which event(s) is/are directly responsible for the most efficient oxygenation of the lungs?
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C. Closure of foramen ovale and ductus arteriosus
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You are listening to a discussion...The cardiac output and oxygen consumption is a fetus are approximately what multiple / fraction of that compared with an adult, respectively?
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B. 3; 3
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The most oxygenated blood is found in which part of the fetal circulation?
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A. Ductus venosus
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For each substance, select its route of transfer across the placenta: glucose
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B. Facilitated transport
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For each substance, select its route of transfer across the placenta: Iron
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A. Endocytosis
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For each substance, select its route of transfer across the placenta: Amino acids
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D. Active transport
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For each substance, select its route of transfer across the placenta: Carbon dioxide
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C. Passive diffusion
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Match the trimester during which the event occurs: Highest concentration of hemoglobin containing two a and two B chains
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D. Third trimester
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Match the trimester during which the event occurs: Amniotic fluid volume derived from transudation
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A. First trimester
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Match the trimester during which the event occurs: Significant amniotic fluid volume contribution from the lung
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B. Early 2nd trimester
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Match the trimester during which the event occurs: Production of red blood cells by the spleen
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A. First trimester
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Match the trimester during which the event occurs: Thyroxine levels first detectable in serum
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A. First trimester
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A 23 yo G1P1 just delivered an infant weighing 4350g by SVD. Placenta delivered. Massage fundus, deliver 20 U of pit in 1000mL LR. Repair 2nd degree lac but is difficult due to brisk bleeding from above. PE= soft boggy uterus. VS: 98.9, BP=164/92, P=130, R=18. What is next best step?
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C. Prostaglandin F2a 0.25 IM
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40 hours ago, 19 yo G1P1 delivered 3600 g infant 40 hours ago, APGARs 9/9. Pt is breastfeeding, minimal lochia. AROM 7 hours before delivery. VS=T=100.8, P=105,BP=100/70, R=16. PE = slight tenderness in area of uterus, nonerythematous nontender firm breasts, nontender calves. Which is best initial step before tmt with ABX?
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A. Urinalysis and culture
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A 27 yo woman, G2P1 presents for 1st prenatal after +hcg. Reports 35 day cycles. Denies contraceptive use. FDLMP = April 1, 2007 - April 5, 2007, normally 4 -5 days. What is best estimate of EDD?
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D. January 15, 2008
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A 16 yo primip presents to L&D with reports of abd pain, constant and located in RLQ and LLQ. No radiation, no asso symptoms other than constipation. VS:T=97.8, BP=108/74, P=96, R=14. PE= bilateral tenderness in lower abdomen. No rebound tenderness or guarding, no CVA tenderness. Cervix closed and uneffaced, fetal vertex is high. U/A=unimpressive. Blood work w/in normal range, CBC in normal range. Best explanation?
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B. Round ligament pain
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a 20 yo woman presents to L & D in labor. No prenatal care. Cervical exam: bulging membrane, no fetal parts at 4 cm dilation. U/S = head in fundus, fetal spine is parallel to mother's spine, knees and hips flexed, arms flexed at elbows. Which is best description of lie?
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A. Complete breech
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39 yo woman, G3P3 is contemplating pregnancy. 1st pregnancy: low birth weight. 2nd pregnancy = unremarkable. Third = 3rd degree lac extended from midline episiotomy. PMHx = 3 to 4 asthma exacerbation / month. What i sshe at highest risk for in subsequent pregnancy?
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D. Twins
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A 34 yo primip woman is seeing you because she is considering a 2nd pregnancy. She tells you she is afraid bc 1st pregnancy had term infant with Down syndrome. Had a 2nd trimester multiple marker screen been performed, which of the following results would have been helpful?
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C. Low MSAFP, low estriol, high hCG, high inhibin A
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A 28 yo woman, G6P1, presents w/ + urine hCG. FDLMP 40 days ago. Cycle = 28 days, regular. 1st pregnancy = preterm infant at 17 yo. Since has had 3 miscarriages and one ectopic. Denies PMHx but admits chlamydia concurrent with ectopic, was treated. Which is the most important initial step?
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E. Transvaginal ultrasound
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A 33 yo woman, G3P2, 32 weeks gestation, present for routine prenatal care. She delivered 1st baby by cesarean section due to fetal distress. 2nd baby = ERC. Low classical incisions. Currently, interested in VBAC. What is the best advice you can give her?
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A. VBAC is not recommended bc the risk of uterine rupture approaches 8%.
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A 41 yo woamn, G8P4, at 18 weeks gestation, presents for 1st prenatal. She has history of 3 TAB as a teenager. 2 32 week babies, 2 at 37 weeks. PMHx = pyelonephritis, partial bicornuate uterus. What is greatest risk in PMHx?
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B. Delivery history
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A 25 yo woman, G2P1, at 8 weeks gest, presents to the high-risk clinic for prenatal care. 1st pregnancy: complicated by delivery of a premature infant with respiratory problems. PMHx = severe asthma (20 exacerbations / week), uses albuterol and steroid inhalers. She has DMII, treated with oral hypoglycemic agents. Hx of Hep C and former IV heroin use. She is 5 ft 5, 90 lbs. BP = 180/98, U/A is negative. Which predisposes her to infant with congenital anomalies?
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C. Diabetes mellitus
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A woman presents to your office for prenatal care. 2 abortions, 2 second trim miscarraiges, one ectopic, one 37 week fetal demise, 2 live births. two living children, one delivered at 34 weeks and ones a 38 weeks. What is her G/P with TPAL?
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C G9P3; G9P2142 - this is actually the wrong answer, but this is what is marked
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A 34 yo woman, G2P1, 32 weeks gest, presents for routine prenatal care. PMHx nonremarkable. BP=108/73, T=96.8, fundus = 33 weeks, 5'4" tall, has gained 15 lbs. Infxs disease workup is negative. What is best next step?
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D. Follow up in 2 weeks
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A 28 yo woman, G3P2, at 5 wks gestation, presents for prenatal care. Hx of babies born includes 34 wk delivery of baby with myelomeningocele. What is the most appropriate advice during this prenatal session?
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C. Increase your folic acid intake to 10 times your prepregnancy amount.
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Long stem...Aside from the weight of the fetus, what is the largest contributor to weight gain during pregnancy?
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A. Blood volume
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A 24 yo woman, G2P1, 27 wks gestation, presents for routine prenatal care. C/o vaginal discharge, white to yellow in color, distinct odor. Speculum exam: yellow white adherent homogenous d/c in posterior fornix and cervix. KOH test is non diagnostic but has a strong odor. pH = 5.5, wet mount displays 30% clue cells. Which of the following is the best dx / treatment?
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C. Bacterial vaginosis and clindimycin
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Which combination of markers is suggestive of Down syndrome?
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D. AFP ↓, hCG ↑, estriol ↓, inhibin A ↑
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Which of the following cannot be detected on a second-trimester ultrasound examination?
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C. Tay-Sachs disease
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A 32 yo woman, G1P1, comes to see you for genetic counseling. Her first child was born with sickle cell disease. She has since remarried. Which of the following is appropriate to offer the patient first?
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D. Paternal hemoglobin electrophoresis
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Which of the following procedures poses the lowest risk for fetal loss?
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B. Fetal echocardiography
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Which of the following is NOT an indication for prenatal diagnosis?
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A. Paternal age 45 years
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Stem includes 23 yo presents to ER with superficial gunshot wound, has + b-hCG test. On day 23 of cycle, always 28 days and regular. Denies PMHx, no smoking, no alcohol She does take megadoses of vitamins, which include 20,000 IU of vit. A daily. Above which dose of vitamin A has teratogenicity been noted?
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B. 8,000 IU
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A 28 yo woman, G2P1 at 11 weeks gestation, just moved from another state for initial prenatal visit. Has idiopathic respiratory disease, has received several radiographs recently. Radiologist estimates radiation exposure at approximately 260 mrad. Which of the following is the likely possible outcome of this pregnancy?
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A. No adverse outcome
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A 28 yo woman had + urine hCG, uses condoms for BC regularly. FDLMP was 36 days ago. Cycle = 30 days. PMHx and social history noncontributory. She received a Rubella vax 3 weeks ago and was told not to get pregnant for a month.
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D. Pregnancy outcome is usually favorable even after exposure to this vaccine.
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A 19 yo woman, G1P0 presents at 7 weeks gestation for prenatal care. PMHx noncontributory. She states she has a stressful job and likes to use the hot tub at least several times a day in excess of four hours. What is the best advice to give this patient?
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C. Minimize hot tub use in the first trimester because it may cause malformations.
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Match the statement below with the teratogenic agent that best describes it: Persistent patent ductus arteriosus
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A. Rubella
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Match the statement below with the teratogenic agent that best describes it: Endocardial fibroelastosis
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E. Mumps
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Match the statement below with the teratogenic agent that best describes it: Triad of heart, eye and ear defects or malformations
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A. Rubella
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Match the statement below with the teratogenic agent that best describes it: Skin scarring and shortened limbs
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D. Varicella zoster
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Match the statement below with the teratogenic agent that best describes it: Aplastic anemia
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B. Parvovirus
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Exposure to ___ rad may have some adverse fetal effects.
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C. 10
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After week ___, exposure to radioactive iodine iodine may affect fetal thyroid development.
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C. 10
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Baseline risk of major congenital anomaly is ____.
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A. 3
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Intrauterine fetal growth retardation is increased ___ times in excessive drinkers.
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A. 3
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Infants born to epileptic mothers have ____% incidence of congenital abnormalities.
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B. 6
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Rate of congenital anomalies in pregnant women taking antipsychotic medications is ___
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B. 6
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An 18 yo student enjoys drinking once or twice a week...10 drinks each time...gets a severe"hangover" each time...used to only drink 4 drinks to get the same "buzz"...Her pattern of alcohol consumption is best described as:
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B. Abuse
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A 30 yo woman, G2P1, at 8 weeks GA, likes to drink one glass of red wine at night with dinner and doesn't believe it will harm her developing fetus...When performing her ultrasound at 18 weeks of gestation, the ultrasonographer should pay close attention to the anatomy of the baby's
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C. Heart
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A 20 yo woman, G4P3, presents at 22 weeks GA...has missed last two appts., all previous pregnancies were preterm labor, SGA with RDS. She had an MI last year. She appears anxious. VS: T =99, BP=170/96,P=135, R=18. She has "stretch marks" on her antecubital fossa. Which of the following obstetric complications s most likely to occur during this pregnancy?
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D. Placental abruption
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A 25 yo woman, G1P0, at 13 weeks GA...you smell alcohol on her breath. She fails the finger-to-nose test...What is the initial best step?
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D. Confront her with your findings
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A 35 yo woman, G3P2, 20 weeksGA, routine prenatal visit...She admits to smoking marijuana several times a week for relaxation and says she has read several papers that show no increased risk of congenital abnormalities. VS: T=97.9, BP=108/68, P=100, R=16. Doppler: FHR=156 bpm. What is the best course of action during this prenatal visit?
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A. Educate her about the possibility of delivering a small infant.
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A 25 yo woman, G2P1, at 36 4/7 GA with a history of prior cesarean presents with abdominal pain and vaginal bleeding. She admits to using cocaine. Her VS: T=99.9, HR=120, BP=170/100. FHR baseline = 160s, minimal variability, late decels. Blood work: Hgb 7.5, platelets of 110,000, fibrinogen = 250 mg/dL. The most likely diagnosis is:
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D. Placental abruption
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A 39 yo woman, G54 presents at 38 weeks with complaints of severe headache, abdominal pain, and vaginal bleeding. Had previous placental abruption, chronic hypertension, tobacco use. VS: P=105, BP:=180/105...The following are all risk factors for placental abruption except:
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D. History of previous cesarean section
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A 20 yo woman, G1P0, at 28 weeks GA, presents with continuous vaginal bleeding and back pain. BPP and VS are WNL. Examination reveals about 100 mL of blood in the vaginal vault. Her cervix is closed upon examination. Which of the following medications would you definitely administer?
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D. Betamethasone
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A 34 yo an 2/7 GA, present, G2P1 at 34 and 2/7 weeks to L&D reporting painless vaginal bleeding. Transvaginal U/S: placenta completely covering internal os, fetus in cephalic presentation, AFI of 14. Cervical length appears closed on speculum exam. BP: 110/78, P=106. Slow, continuous bleeding from vagina. Fetal monitoring: 1 ctx per 30 minutes, FHR reactive. What is the next best step in management?
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B. Hospitalization
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A 28 yo woman, G3P1, at 37 weeks GA, presents to L&D for a scheduled repeat cesarean....long stem...cesarean complicated by hemorrhage and hypotension. The patient receives 20 units of PRBCs. Which of the following organs is most likely to malfunction?
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C. Kidney
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A 26 yo woman, G2P1, at 39 weeks GA, is admitted with ruptured membranes. Cervix is 5 cm dilated, 100% effaced, and fetal vertex is +1 station. Strip: 5 ctx in 10 minutes, each ctx is 50 mmHg of pressure. Three hours later, cervix is still at 5 cm, 100%, +1. What is the next best step in management?
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B. Cesarean section
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A 22 yo woman, G1P0, 40 wks GA, presents to L&D reporting regular ctxs for 2 hours. She denies ROM, + fetal movement. 2 cm / 50%/ 0. Strip: regular ctx every 2 - 3 minutes, FHR 154, reactive. What is the next step in management
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D. Walk for 1 to 2 hours, then return to check her cervix
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A 29 yo woman, G2P1, at 32 weeks gestation, presents to L&D c/o flank pain, fever, chills and cramping. Ctx every 3 -4 min., FHR baseline is 180. 3 cm/ 100% / floating. Dx: pyelonephritis, admitted for IV abx, magnesium sulfate, and steroids. Has trouble breathing, tachycardic and tachypnic, bilateral rales over lung bases. Abdomen: soft, gravid, nontender, + CVA tenderness. There is 2+ pedal edema. Which of the following is the most likely diagnosis?
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D. Pulmonary edema
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A 24 yo woman, G1P0, at 39 weeks GA, is crowning. The fetal head is not emerging from the vagina after two pushes. Blah blah episiotomy. What is the advantage of a mediolateral ?
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B. Avoids fourth-degree laceration
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Cardinal movements of labor: 1st - the greatest transverse diameter of fetal head passes through the pelvic inlet; 2nd - the fetal head descends; 3rd - fetal head brought close to fetal thorax; 4th - turning of occiput toward 12 o clock position; 5th - fetal vertex extended anteriorly. What is the next step?
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B. Rotation of occiput to transverse position
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A 25 yo woman, G1P0, 39 wks GA, has been laboring for a few hours. 6 cm / 80% / 0 station. ROM 20 minutes ago, labor is augmented by oxytocin. IUPC detects ctx every one to two minutes at 80 mmHg of pressure and lasting 2 minutes. FHR baseline is 90 bpm for last 2 minutes, 30 minutes ago was 140 bpm. What is the best next step in management?
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D. Discontinue oxytocin
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A 27 yo woman, G1P0 at 40 3/7 GA, middle of first stage of labor. 4 cm dilated, decide to place an epidural. Prehydrated with 500mL LR and has augmentation with oxytocin. VS: T = 99.1, BP=110/74, P=102, R = 18.The FHR baseline is 142 bpm, reactive. Ctx every 3 min. After epidural placement, FHR drops to 130 bpm, non reactive. Ctx every 2 to 3 minutes now. VS: T = 99.2, BP=78/56, P = 115, R=18. What is the best next step in management?
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D. Ephedrine
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22 yo owman, G2P1, 41 weeks GA, is laboring. 8 cm/ 100%/ +1. ROM >24 hrs, labor aug w/ oxytocin. Amnioinfusion running bc of 3 - 4+ meconium. FHR 138 bpm, some variability and mild variable decels. Then, nonreassuring strip. Toco: 6 ctx in 10 minutes, pressure of 70 mmHg, FHR is now 70 bpm for more than 3 minutes. She is placed in left lateral position, oxytocin is stopped, O2 by mask, IV fluids increased. FHR now 98 bpm. What is the best next step in management?
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E. Terbutaline
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A 19 yo woman, G1P0, 38 weeks GA, in active labor. 5 cm / ?%/ +1. Toco: ctx q 2 -3 min, lasting 1 min, 50 mmHg. FHR= baseline of 140 bpm, random sharp decels to 70 bpm that return to baseline in 60 - 80 secs. When this type of decel occurs, what is the best description of the initial acid-base status of the fetus?
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A. Respiratory acidosis
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26 yo woman, G2P1, 20 wks GA, presents for prenatal care. FH=18 cm, unable to find FHR. Ultrasound confirms lack of fetal cardiac activity and lack of fetal movement. Last pregnancy: severe preeclampsia at 34 weeks, emergency cesarean...Reports one episode of spotting 4 weeks ago, no cramping, didn't pass any clots. Which of the following is the most descriptive diagnosis?
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E. Missed abortion
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Chromosomal abnormalities account for the majority of first-trimester abortions. If one was to analyze the chromosomal composition of the POC that are extruded in a SAB, which of the following would be the most common finding?
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D. Trisomy
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30 yo woman, G4P3, 12 weeks GA, presents for prenatal care. 1st pregnancy: SVD. 2nd pregnancy: CD for breech, low transverse incision. 3rd pregnancy: SVD. What is the best advice you can give this patient regarding VBAC?
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B. You are an excellent candidate for VBAC.
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Long stem...Given her protracted second stage of labor, you decide to perform a forceps delivery. What step is not necessary prior to proceeding?
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D. An additional obstetrician in the room
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Match the description below with the best range of numbers above: Risk of sensitization in Rh-negative woman after D&E if RhoGAM not given
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A. 0 -10%
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Match the description below with the best range of numbers above: Risk of uterine perforation after D&E
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A. 0 -10%
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Match the description below with the best range of numbers above: After 3 SABs, risk of SAB if no history of liveborn
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C. 35% - 45%
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Match the description below with the best range of numbers above: Annual percent of births by cesarean section in the US
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B. 25% - 30% (out of date!!)
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Match the description below with the best range of numbers above: Risk of endomyometritis after cesarean section
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C. 35% - 45%
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Match the description below with the best range of numbers above: Uterine atony as the indication for a cesarean hysterectomy
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C. 35% - 45%
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Match the description below with the best range of numbers above: Success rate for VBAC after one previous low transverse cesarean section for fetal distress and two previous successful VBACs
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E. 71% - 80%
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A 24 yo parturient is at 20 wks GA. Her PMHx is notable for mitral stenosis secondary to rheumatic heart disease as a child. What physiological change places her at risk for the development of heart failure during her pregnancy?
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B. Increase in stroke volume
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A parturient at 40 weeks' gestation is scheduled for a MRI to assess for placenta accreta. The radiologist is unable to complete the study due to nausea whenever the patient is supine. What do you recommend to the radiologist?
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D. Tilting the patient to the left
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A 24 yo parturient with severe preeclampsia requires urgent cesarean delivery for nonreassuring FHR. The anesthesiologist plans general anesthesia. Which of the following maneuvers would you recommend to increase the safety of airway management in this patient?
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B. Have small diameter endotracheal tubes available
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A 28 yo parturient at 40 weeks GA requires general anesthesia for cesarean delivery due to umbilical cord prolapse.With induction of anesthesia, there is a rapid decline of the oxygen saturation. This decline is a result of a decrease in which lung volume?
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D. Residual
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The pain of the second stage of labor is conveyed by which nerve?
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C. Pudendal
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A 25 yo woman requires cesarean section during epidural anesthesia. Prior to the injection of local anesthetic, the anesthesiologist administers a test does of 3 mL lidocaine 1.5% with epinephrine 1:200,000. The patient complains of tinnitus and a rapid heart rate. What is the most likely etiology of her symptoms?
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B. Intravascular injection
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A 24 yo parturient at 40 wks GA is in active labor and requests epidural analgesia. During epidural placement, the dura is punctured. The patient is at increased risk for the development of which of the following complications postoperatively?
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C. Headache
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A 21 yo parturient is considering epidural analgesia. Which of the following is increased in patients with epidural analgesia?
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A. Prolonged labor
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A 33 yo woman, G2P1, in third trimester, presents for prenatal care. She is not sure of due date, been given different dates by different doctors. Periods: irregular. FDLMP July 19, 2006. U/S in ER on Sept. 5, 2007 showed her to be 8 0/7 GA. Last doctor did U/S on Dec. 22, 2007, 24 3/7 GA. Which one of the following is the best estimate of her due date?
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C. April 19, 2008
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A 22 yo woman, G1P0, 15 weeks GA by FDLMP, presents for U/S to confirm due date. Which of the following measurements on the fetus is the best at predicting her actual due date?
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B. Biparietal diameter
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A 25 yo woman, G3P0, 42 weeks GA, present for prenatal care. Has accurate dating and has had twice weekly NSTs for the last week. Underdevelopment of which structure in the fetus may contribute to prolongation of this woman's gestation.
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D. Adrenal cortex
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A 34 yo woman, G3P1, abortions 1, at 42 1/7 GA by week6 U/S, presents to your clinic. Her NST is reactive and AFI is 8.5. Her cervix is 0.5 cm dilated, 20% effaced, midposition, firm, and fetal vertex is at -4. Which is the best next step in management?
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B. Prostaglandin analog
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25 yo, G3P2, 30 weeks GA, presents to L & D c/o regular uterine ctx. 3 cm / 80%. Given corticosteroids and tocolytics. Ctx persist, despite second tocolytic. Amniocentesis reveals presence of bacteria on gram stain. The next best step is to:
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B. Discontinue the tocolytic therapy
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28 yo G3P2, 28 weeks GA, admitted to treat preterm labor. Cx dilated to 3 cm, 100%, MgSO4 started at 2.5 g/hr after blous over 30 minutes. Work up done, received antibiotics and steroids. Currently, 3 to 4 ctx per minute, barely feels on 2 g.hr. Treatment with MgSO4 is most likely to
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E. Delay delivery for 2 days
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22 yr old woman. G1P0, 33 wks GA, presents to L&D c/o cramping and lower back pain. Denies ROM. No S/S of ROM. Cervical cultures taken, placed on monitoring. Cervix changes from cosed, 50% to 2 - 3 cm / 80%. Next best step in management is
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D. Corticosteroids and tocolytics
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29 yr old G3P1, SAB 1, 30 weeks GA, in preterm labor. Has received initial bolus os 6 g MgSO4, on maintenance of 4 g/hr for the last 2 days to reduce ctx pattern to 1 every 15 min, barely noticeable. VS: P=88, BP=90/50, R=9, SaO2 = 95% on RA, Deep tendon reflexes are 0 B/L. She has crackles on her lung bases on deep inspiration. The next best step in management is
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D. Discontinue MgSO4
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It is important for a physician to _________ when counseling a couple who wishes artificial insemination.
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B. Explain that there is no guarantee of pregnancy if protocol is followed.
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An obstetrician is called at home by a woman who is in labor. Never been to him for a prenatal, wants him to deliver her infant. The obstetrician refuses. She subsequently delivers a healthy infant at home. If this woman sues the physician for negligence, which of the following would be his best defense?
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D. The physician never accepted the woman as his patient.
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A gynecologist has a long standing relationship with a patient. She becomes pregnant, does not inform him, and is not scheduled to see him until next annual visit. She calls to report N/V but is unable to reach the physician, who is on vacation with no coverage. Three months later she delivers a premature infant, who dies one month later. In a lawsuit, which is the physician's best defense?
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C. The premature delivery and fetal death was unrelated to the physician's time on vacation.
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A 34 yo woman delivers a boy with Tay Sachs disease.Eight years later, she and her husband obtain the services of a lawyer and sue the physician, alleging that he was remiss in genetic counseling, and because of this, a child with an irreversible neurologic disease had to be brought into the world. The best term to describe this lawsuit is:
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A. Wrongful birth
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Matching: Advanced cervical cancer can affect this structure by extension and pressure effects
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B. Ureter
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Matching: Advanced ovarian cancer often affects this structure by spread and encroachment
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D. Intestine
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HPV is associated with the development of cervical, vaginal, vulvar, and anal cancers. Which of the following is true?
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B. The quadrivalent vaccine that is currently approved for prevention of HPV infection is over 95% effective in preventing HPV 16 and 18 related cervical cancers
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A 40 yo woman, G1P1, presents wanting to decrease her risk of ovarian cancer via prophylactic oophorectomy. Long stem of history...infertility, smoking, birth control pills, HPV, and mother and maternal grandmother with breast cancer and maternal aunt with ovarian cancer. Most significant risk factor for developing ovarian cancer is her:
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A. Family history
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A 23 yo woman, G1P0 SAB1, has undergone colposcopy for evaluation of a high-grade lesion found on Pap smear. The SC junction was visible in its entirety, and the endocervical curettage was normal. A directed biopsy of the cervix revealed a 1 mm focus of invasion. The next best step in management is
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C. Cold knife conization of cervix
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Matching: Most common histology for cervical cancer
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A. Squamous
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Matching: Subtype of endometrial cancer with very poor prognosis; is also type of borderline ovarian tumor
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G. Papillary serous
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Matching: Most common malignant germ cell tumor
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H. Dysgerminoma
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Matching: Uncommon, aggressive vulvar cancer that is known as the most common cancer to metastasize to the placenta
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N. Melanoma
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Matching: Most common endometrial cancer
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D. Endometrioid
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A 60 yo woman, G5P4 SAB 1, has been treated with vaginal estrogen therapy, various pelvic muscle rehabilitation therapies, and pessaries for symptoms of pelvic prolapse without incontinence for the past 2 years. She desires definitive therapy. Long stem...hx of vaginal deliveries, cystocele, no stress incontinence, etc. The next best step in management of this patient is
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C. Vaginal hysterectomy and anterior repair
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A 32 yo woman, G3P3, just delivered a baby via cesarean section. She received intrathecal (spinal) anesthetic and narcotic for pain relief during the procedure. Her Foley catheter is left in place for several hours after the cesarean section. This will prevent
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C. Overflow incontinence
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A 56 yo woman, G2P2, who reports leaking urine when she coughs and exercises, is dx with genuine urinary stress incontinence. Kegels do not improve her symptoms, and she desires more definitive treatment. Her doctor recommends laparoscopic retropubic urethropexy. When discussing risks and benefits, the doctor should mention:
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C. Risk of urinary retention
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A 67 yo woman, G3P3, presents reporting incontinence...long stem, reports voiding 40 times a day, only voiding small amounts of urine. The next best step in management of this patient is
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A. Urinalysis
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A 55 yo Caucasian woman, G3P3, all by cesarean prior to albor, has mild pelvic organ prolapse. Other history, including family hx of early osteoporosis...The strongest risk factor for pelvic relaxation in this patient is:
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D. Genetic
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Embryologic homolog in the male is the floor of the penile urethra
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B. Labia minora
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Embryologic homolog in the male is the Cowper gland(s)
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F. Bartholin gland
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Contains sebaceous glands but not hair follicles or sweat glands; is a paired structure
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B. Labia minora
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Source of vaginal lubrication during intercourse
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L. Cervical
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Azygous artery of the vagina
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L. Cervical
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A 23 yo woman, G2P1, at 10 GA, presents c/o increasing yellow vaginal d/c that has an odor. Vaginal smear reveals clue cells. She denies pruritis. The next step in management is
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B. Vaginal metronidazole
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25 yo woman G1P1, presents c/o 4 recurrent yeast infections within the last 2 months. Confirm presence of psuedohyphae, absence of clue cells or leukocytes. Not pregnant, not on OPCs, not sexually active for 7 months. What is next step in management?
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D. Screen for HIV
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Matching: A 19 yo woman c/o inreasing DC and odor. pH is 5.5, wet mount reveals lack of leukocytes and protozoa
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A. Bacterial vaginosis
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Matching: 24 yo woman who is 2 months postpartum, breastfeeding, c/o itching and dyspareunia. Speculum reveals pale, dry vaginal walls.
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E. Atrophic vaginitis
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A wet mount shows predominance of cells with large nuclei (parabasal cells)
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E. Atrophic vaginitis
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A 36 yo woman, G4P4, presents with bilateral white-colored nipple discharge for last 3 months. Suspended breastfeeding two years ago. Takes tricyclic antidepressants. Uses OPCs...Which of the following is the next best step in management?
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A. Obtain a prolactin
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