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Introduction
Obstetrics
Preconception
Counseling, Genetics, and Prenatal Diagnosis
You should tell her that she has an increased risk of having a child with Down syndrome under which of the following circumstances. Which of the following medications is contraindicated in the treatment of UTI in this patient.
Maternal-Fetal Physiology and
Placentation
Which of the following is the most appropriate next step to pursue in the management of this patient. The answer is d. (Cunningham, p. 1145.) The amount of iron that can be mobilized from maternal stores and obtained from the diet is insufficient to meet the requirements of pregnancy.
Antepartum Care and Fetal Surveillance
Instruct the patient to return to the office in 1 week for her next routine visit. Send the patient to the hospital for induction of labor as she has a favorable Bishop score. Schedule a cesarean section for the next day, as the patient is unlikely to go into labor.
Administer a cervical ripening agent in your office and have the patient come to the hospital in the morning for induction with oxytocin. Admit the patient and schedule a C-section in the morning, after the patient has been NPO for 12 hours. Which of the following is the best advice for the attending physician to give the patient.
Inform the patient that the baby is probably asleep and that she should continue to monitor fetal kicks. Pelvic examination shows that the patient is 7 cm dilated with the fetal apex at +1 station.
Fetal Surveillance
The answer is d. (Cunningham, pp 381-385.) The BPP is based on FHR monitoring (usually NST) in addition to four parameters observed on real-time ultrasound: amniotic fluid volume, fetal breathing, fetal body movements and fetal body colors. The answer is d. (Cunningham, pp 570-572. Gabbe, pp 560-562.) The patient who has a fetus with a breech presentation has the option of scheduling an external cephalic version, an elective cesarean section at or after 39 weeks, or can choose to have a vaginal breech delivery if certain conditions are met. It is not recommended to perform an elective section without a trial of labour, due to the risks of major surgery.
BPP allows assessment of fetal heart rate tracking and amniotic fluid level, which in this case is the next best step in the management of this patient. As mentioned above, it is not recommended to perform an elective section without a proof of birth due to the risks of major surgery. The answer is b. (Cunningham, p. 208.) The expected delivery date can be estimated using Naegele's rule.
Dilation and curettage are not indicated until the patient is assessed by ultrasound for gestational age and fetal viability. The answer is: (Cunningham, pp. 607-617.) The desire for sterilization is not an indication for an optional repeat cesarean section.
Obstetrical
Complications of Pregnancy
Which of the following is the most appropriate next step in the management of this patient. Which of the following is the most appropriate first step in evaluating vaginal bleeding in this patient? Which of the following is the most appropriate next step in the management of this patient.
Which of the following is the best next step in treating this patient? Which of the following is the most appropriate next step in the management of this patient? The answer is c. (ACOG, Practice Bulletin No. 48.) The diagnosis of cervical insufficiency or incompetence is based on the presence of painless cervical dilation with a history of pregnancy loss in the second trimester or preterm labor in the third trimester.
The answer is a. (Katz, pp 894-898.) The condition of women who have hydatidiform moles but no evidence of metastatic disease should be routinely monitored by hCG titers after uterine evacuation. The answer is b. (Katz, pp 153-155.) The clinical history presented in this question is classic for a ruptured fallopian tube pregnancy accompanied by hemoperitoneum.
Medical and Surgical Complications of
Pregnancy
She can be sure that which of the following risks is the same for her as for the general population. Which of the following statements should be included in your consultation with the patient. The patient denies any recent illness, but some of the children at her school have been sick recently.
Acute appendicitis during pregnancy is one of the more common non-obstetric causes of abdominal pain. Patients with pancreatitis are usually in acute distress - the classic finding is a person rocking with knees drawn up and trunk flexed in pain. The answer is d. (Cunningham, pp Beckmann, pp 178-179.) The term asymptomatic bacteriuria is used to indicate persistent, actively multiplying bacteria within the urinary tract without symptoms of a.
It should also be avoided in late pregnancy because of the risk of hemolysis caused by a deficiency of erythrocyte phosphate dehydrogenase in the newborn. Gestational diabetes—when a mother who does not have diabetes develops a resistance to insulin due to the hormones of pregnancy.
Normal and Abnormal Labor and Delivery
An IUPC is placed and the patient is noted to have 280 Montevideo units (MUV) of the IUPC. After another 2 hours of labor, the patient is noted to still be 5 cm dilated. Which of the following is the best next step in handling this work.
Which of the following is the best next step in treating this patient. The patient's cervix is completely dilated and effaced and the fetal head is in the direct OA position and is visible at the introitus between thrusts. On the patient's final push, the fetal heart rate showed a prolonged deceleration to the 80s for 3 minutes.
It is now Sunday evening at 8pm and the patient returns to labor and delivery with increasing pain. The estimated weight of the fetus is about 6 lb and the fetal heart rate is reactive.
Labor and Delivery
The answer is b. (Cunningham, pp. 506-508.) In the case of facial presentation, there will be a successful vaginal delivery; most of the time with a proper pelvis. The answer is d. (Scott, pp. 438-444.) The labor shown is characteristic of secondary arrest of dilation. The answer is c. (Scott, pp. 438-444.) The best available evidence suggests that this labor is hypotonic and that the contractions are inadequate.
The answer is d. (Cunningham, pp. 817-819.) The patient described in the question has a classic history of abruption—that is, the sudden onset of abdominal pain accompanied by bleeding. Local anesthetic is injected at the level of the L4-5 interspace while the patient is sitting. The second stage of labor begins with the full dilation of the cervix and ends with the delivery of the baby.
The answer is d. (Cunningham, pp. 477-491.) The most appropriate way to control pain in this patient is to use an epidural block. In the case of Klumpke's palsy, the lower nerves of the brachial plexus (C7-T1) are affected and the arm is paralyzed.
The Puerperium, Lactation, and
A triangular area of erythema is located in the upper outer quadrant of the left breast. Bacille Calmette-Guérin (BCG) vaccination of the newborn without evidence of active disease is not appropriate. Which of the following bacteria is resistant to these antibiotics and is most likely responsible for this woman's infection.
Which of the following is the most appropriate antibiotic to initially treat this patient. In counseling this patient, you tell her which of the following recommendations from the American Pediatric Association. Shortly after birth, you examine the infant at the pediatrician and note the following on physical examination: a small amount of cartilage in the earlobe, occasional wrinkles over the front two-thirds of the soles of the feet, breast nodule diameter 4 mm. , thin and fuzzy head hair, and a scrotum with some but not extensive rugae.
After the birth of the fetus, you send an umbilical gas, which comes back with the following arterial blood values: pH 7.29, Pco250 and Po220. Her midline vertical skin incision is erythematous and has a foul-smelling purulent discharge from the lower segment of the wound.
Lactation, and Immediate Care
The answer is d. (Cunningham, pp 699-704.) The normal sequence of events caused by breastfeeding is as follows: through a reaction of the central nervous system, dopamine is lowered in the hypothalamus. The answer is d. (Beckmann, pp 148-152. Cunningham, pp 712-715.) Metritis, or infection of the uterus, is the most common infection that occurs after a caesarean section. The answer is d. (ACOG, Committee Opinion 260. Cunningham, pp 643-644.) The American Academy of Pediatrics and the American College of Obstetrics and Gynecology do not recommend that routine circumcision procedures be performed on newborn male infants. .
The answer is d. (Cunningham, p 642.) An estimate of the gestational age of a newborn baby can be quickly made by a physical examination immediately after delivery. The answer is b. (Cunningham, pp. 637-638.) The Apgar scoring system, applied at 1 minute and again at 5 minutes, was developed as a tool to evaluate infants requiring resuscitation. The answer is c. (Cunningham, pp. 641-642.) The Centers for Disease Control recommends that all newborns receive routine immunization against hepatitis B before they are discharged from the hospital.
The answer is c. (Cunningham, p. 697. Beckmann, p. 148, 451.) The uterus reaches its previous nonpregnant size about four weeks after delivery. The answer is 249-c, 250-c. (Cunningham, p. 716. Beckmann, p. 150.) The incidence of incision wound infection after cesarean section is approximately 6%.
Gynecology
Preventive Care and Health Maintenance
She had her last well-woman check-up 20 years earlier when she had a hysterectomy for fibroids. Which of the following is the most appropriate set of laboratory tests to order for this patient. You are following up the results of routine testing of a 68-year-old G4P3 for her well-woman examination.
Based on this patient's history, which of the following medical conditions should be this patient's greatest concern. She denies any family history of medical problems, but says her 80-year-old grandmother was recently diagnosed with breast cancer. Based on this patient's history, what would be the most likely cause of death if she were to die at age 16?
A 15-year-old female arrives at your office for her first well-woman exam while on summer break from school. Which of the following is the best frequency and time to perform breast self-examinations?
