Gyneco (378)

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Gynecology Quizzes & Trivia

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Questions and Answers
  • 1. 

    A 20-year-old female presents to your office for routine well-woman examination. She has a history of acne, for which she takes minocycline and isotretinoin on a daily basis. She also has a history of epilepsy that is well controlled on valproic acid. She also takes a combined oral contracep- tive birth control pill containing norethindrone acetate and ethinyl estra- diol. She is a nonsmoker but drinks alcohol on a daily basis. She is concerned about the effectiveness of her birth control pill, given all the medications that she takes. She is particularly worried about the effects of her medications on a developing fetus in the event of an unintended preg- nancy. Which of the following drugs has the lowest potential to cause birth defects?

    • A.

      A. Alcohol

    • B.

      B. Isotretinoin (Accutane)

    • C.

      C. Tetracyclines

    • D.

      D. Progesterone

    • E.

      E. Valproic acid (Depakote)

    Correct Answer
    D. D. Progesterone
    Explanation
    Progesterone is a hormone that is naturally produced in the body and is essential for maintaining pregnancy. It is commonly used in birth control pills to prevent pregnancy. Unlike the other options, progesterone does not have a known association with causing birth defects. However, it is important to note that no medication is completely risk-free during pregnancy, and it is always recommended to consult with a healthcare provider for personalized advice.

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  • 2. 

    A patient presents for prenatal care in the second trimester. She was born outside the United States and has never had any routine vaccinations. Which of the following vaccines is contraindicated in pregnancy?

    • A.

      A. Hepatitis A

    • B.

      B. Tetanus

    • C.

      C. Typhoid

    • D.

      D. Hepatitis B

    • E.

      E. Measles

    Correct Answer
    E. E. Measles
    Explanation
    Measles vaccine is contraindicated in pregnancy because it is a live attenuated vaccine. Live vaccines are generally avoided during pregnancy due to the theoretical risk of transmission of the live virus to the fetus. In the case of the measles vaccine, there is a small risk of developing measles infection from the vaccine, which could potentially harm the fetus. Therefore, it is recommended to administer the measles vaccine either before pregnancy or after delivery to ensure the safety of both the mother and the baby.

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  • 3. 

    Your 25-year-old patient is pregnant at 36 weeks gestation. She has an acute urinary tract infection (UTI). Which of the following medications is contraindicated in the treatment of the UTI in this patient?

    • A.

      A. Ampicillin

    • B.

      B. Nitrofurantoin

    • C.

      C. Trimethoprim/sulfamethoxazole

    • D.

      D. Cephalexin

    • E.

      E. Amoxicillin/clavulanate

    Correct Answer
    C. C. Trimethoprim/sulfamethoxazole
    Explanation
    Trimethoprim/sulfamethoxazole is contraindicated in pregnant women at 36 weeks gestation because it can cause kernicterus in the newborn. Kernicterus is a condition characterized by the accumulation of bilirubin in the brain, leading to neurological damage. Ampicillin, Nitrofurantoin, Cephalexin, and Amoxicillin/clavulanate are all considered safe to use in pregnant women and are commonly used to treat UTIs.

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  • 4. 

    You diagnose a 21-year-old woman at 12 weeks gestation with gonorrhea cervicitis. Which of the following is the most appropriate treatment for her infection?

    • A.

      A. Doxycycline

    • B.

      B. Chloramphenicol

    • C.

      C. Tetracycline

    • D.

      D. Minocycline

    • E.

      E. Ceftriaxone

    Correct Answer
    E. E. Ceftriaxone
    Explanation
    Ceftriaxone is the most appropriate treatment for gonorrhea cervicitis in a 21-year-old woman at 12 weeks gestation. Ceftriaxone is a third-generation cephalosporin antibiotic that is effective against Neisseria gonorrhoeae, the bacterium that causes gonorrhea. It is considered the treatment of choice for uncomplicated gonorrhea infections due to its high efficacy and low risk of resistance. Additionally, it is safe to use during pregnancy, making it an appropriate choice for this patient. Doxycycline, chloramphenicol, tetracycline, and minocycline are not recommended for the treatment of gonorrhea cervicitis.

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  • 5. 

    A 36-year-old G0 who has been epileptic for many years is contem- plating pregnancy. She wants to go off her phenytoin because she is con- cerned about the adverse effects that this medication may have on her unborn fetus. She has not had a seizure in the past 5 years. Which of the following is the most appropriate statement to make to the patient?

    • A.

      A. Babies born to epileptic mothers have an increased risk of structural       anomalies even in the absence of anticonvulsant medications.

    • B.

      B. She should see her neurologist to change from phenytoin to valproic acid       because valproic acid is not associated with fetal anomalies.

    • C.

      C. She should discontinue her phenytoin because it is associated with a 1% to       2 % risk of spina bifida.

    • D.

      D. Vitamin C supplementation reduces the risk of congenital anomalies in       fetuses of epileptic women taking anticonvulsants.

    • E.

      E. The most frequently reported congenital anomalies in fetuses of epileptic      women are limb defects.

    Correct Answer
    A. A. Babies born to epileptic mothers have an increased risk of structural       anomalies even in the absence of anticonvulsant medications.
    Explanation
    The correct answer is A because it addresses the patient's concern about the adverse effects of phenytoin on her unborn fetus. It explains that even without anticonvulsant medications, babies born to epileptic mothers have an increased risk of structural anomalies. This statement acknowledges the patient's worries and provides accurate information about the risks associated with epilepsy and pregnancy.

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  • 6. 

    At 1 year of age, a child has six deciduous teeth, which are discolored and have hypoplasia of the enamel. Match the appropriate scenario with the antibiotic most likely responsible for the clinical findings presented.

    • A.

      A. Tetracycline

    • B.

      B. Streptomycin

    • C.

      C. Nitrofurantoin

    • D.

      D. Chloramphenicol

    • E.

      E. Sulfonamides

    Correct Answer
    A. A. Tetracycline
    Explanation
    Tetracycline is known to cause discoloration and hypoplasia of the enamel in developing teeth. This is because tetracycline binds to calcium ions in the developing teeth, leading to the deposition of the drug in the enamel and dentin. This can result in a yellow-brown discoloration of the teeth and enamel hypoplasia. The other antibiotics listed do not typically cause these specific dental findings.

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  • 7. 

    During routine auditory testing of a 2-day-old baby, the baby failed to respond to high-pitched tones. Match the appropriate scenario with the antibiotic most likely responsible for the clinical findings presented.

    • A.

      A. Tetracycline

    • B.

      B. Streptomycin

    • C.

      C. Nitrofurantoin

    • D.

      D. Chloramphenicol

    • E.

      E. Sulfonamides

    Correct Answer
    B. B. Streptomycin
    Explanation
    Streptomycin is an aminoglycoside antibiotic that can cause ototoxicity, which is damage to the inner ear resulting in hearing loss. In this scenario, the 2-day-old baby failed to respond to high-pitched tones, suggesting a potential hearing impairment. Streptomycin is known to be ototoxic and can cause hearing loss, making it the most likely antibiotic responsible for the clinical findings presented.

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  • 8. 

    A 24-year-old primigravida with twins presents for routine ultra- sonography at 20 weeks gestation. Based on the ultrasound findings, the patient is diagnosed with dizygotic twins. Which of the following is true regarding the membranes and placentas of dizygotic twins?

    • A.

      A. They are dichorionic and monoamniotic only if the fetuses are of the same       sex.

    • B.

      B. They are dichorionic and monoamniotic regardless of the sex of the fetuses.

    • C.

      C. They are monochorionic and monoamniotic if they are conjoined twins.

    • D.

      D. They are dichorionic and diamniotic regardless of the sex of the twins.

    • E.

      E. They are monochorionic and diamniotic if they are of the same sex.

    Correct Answer
    D. D. They are dichorionic and diamniotic regardless of the sex of the twins.
    Explanation
    Dizygotic twins, also known as fraternal twins, result from the fertilization of two separate eggs by two separate sperm. As a result, they have different genetic material and are not identical. Dizygotic twins are typically dichorionic and diamniotic, meaning they have two separate chorions (outer fetal membranes) and two separate amniotic sacs. This is true regardless of the sex of the twins. Monochorionic and monoamniotic twins are typically seen in identical twins, where a single fertilized egg splits into two embryos. Conjoined twins may also be monochorionic and monoamniotic, but this is not the case for dizygotic twins.

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  • 9. 

    After delivery of a term infant with Apgar scores of 2 at 1 minute and 7 at 5 minutes, you ask that umbilical cord blood be collected for pH. The umbilical arteries carry which of the following?

    • A.

      A. Oxygenated blood to the placenta

    • B.

      B. Oxygenated blood from the placenta

    • C.

      C. Deoxygenated blood to the placenta

    • D.

      D. Deoxygenated blood from the placenta

    Correct Answer
    C. C. Deoxygenated blood to the placenta
    Explanation
    The umbilical arteries carry deoxygenated blood from the fetus to the placenta. This blood is rich in waste products and carbon dioxide, which are then exchanged for oxygen and nutrients in the placenta. The oxygenated blood is then returned to the fetus through the umbilical vein. In this case, collecting umbilical cord blood for pH would provide information about the acid-base status of the deoxygenated blood that was delivered to the placenta during the delivery.

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  • 10. 

    During the routine examination of the umbilical cord and placenta after a spontaneous vaginal delivery, you notice that the baby had only one umbilical artery. Which of the following is true regarding the finding of a single umbilical artery?

    • A.

      A. It is a very common finding and is insignificant.

    • B.

      B. It is a rare finding in singleton pregnancies and is therefore not significant.

    • C.

      C. It is an indicator of an increased incidence of congenital anomalies of the      fetus.

    • D.

      D. It is equally common in newborns of diabetic and nondiabetic mothers.

    • E.

      E. It is present in 5% of all births.

    Correct Answer
    C. C. It is an indicator of an increased incidence of congenital anomalies of the      fetus.
    Explanation
    A single umbilical artery is associated with an increased incidence of congenital anomalies in the fetus. This finding is not considered common or insignificant, as it suggests that further evaluation may be necessary to identify any potential abnormalities or malformations in the baby. The presence of a single umbilical artery is not related to the mother's diabetic status and is not present in a specific percentage of all births.

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  • 11. 

    A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining of decreased fetal movement. She has had no pre- natal care. On the fetal monitor there are no contractions. The fetal heart rate is 150 beats per minute and reactive. There are no decelerations in the fetal heart tracing. An ultrasound is performed in the radiology department and shows a 28-week fetus with normal-appearing anatomy and size con- sistent with dates. The placenta is implanted on the posterior uterine wall and its margin is well away from the cervix. A succenturiate lobe of the pla- centa is seen implanted low on the anterior wall of the uterus. Doppler flow studies indicate a blood vessel is traversing the cervix connecting the two lobes. This patient is most at risk for which of the following?

    • A.

      A. Premature rupture of the membranes

    • B.

      B. Fetal exsanguination after rupture of the membranes

    • C.

      C. Torsion of the umbilical cord caused by velamentous insertion of the umbilical       cord

    • D.

      D. Amniotic fluid embolism

    • E.

      E. Placenta accreta

    Correct Answer
    B. B. Fetal exsanguination after rupture of the membranes
    Explanation
    The presence of a succenturiate lobe of the placenta implanted low on the anterior wall of the uterus, with a blood vessel traversing the cervix connecting the two lobes, puts the patient at risk for fetal exsanguination after rupture of the membranes. This is because the blood vessel connecting the two lobes can be torn during the rupture of the membranes, leading to significant bleeding and potential fetal exsanguination. The other options (premature rupture of the membranes, torsion of the umbilical cord, amniotic fluid embolism, and placenta accreta) are not directly related to the specific findings in this patient.

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  • 12. 

    Healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12 weeks gestational age. She tells you that she has stopped taking her prenatal vitamins with iron supplements because they make her sick and she has trouble remembering to take a pill every day. A review of her prenatal labs reveals that her hematocrit is 39%. Which of the following statements is the best way to counsel this patient?

    • A.

      A. Tell the patient that she does not need to take her iron supplements because       her prenatal labs indicate that she is not anemic and therefore she will not       absorb the iron supplied in prenatal vitamins

    • B.

      B. Tell the patient that if she consumes a diet rich in iron, she does not need to       take any iron supplements

    • C.

      C. Tell the patient that if she fails to take her iron supplements, her fetus will be       anemic

    • D.

      D. Tell the patient that she needs to take the iron supplements even though she        is not anemic in order to meet the demands of pregnancy

    • E.

      E. Tell the patient that she needs to start retaking her iron supplements when       her hemoglobin falls below 11 g/dL

    Correct Answer
    D. D. Tell the patient that she needs to take the iron supplements even though she        is not anemic in order to meet the demands of pregnancy
    Explanation
    The correct answer is D because iron supplements are recommended during pregnancy to meet the increased demands of the growing fetus and placenta. Iron is essential for the production of red blood cells and to prevent iron deficiency anemia, which can have negative effects on both the mother and the baby. Even though the patient's hematocrit is within normal range, it is important for her to continue taking iron supplements to ensure an adequate supply of iron throughout her pregnancy.

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  • 13. 

    A pregnant patient of yours goes to the emergency room at 20 weeks gestational age with complaints of hematuria and back pain. The emer- gency room physician orders an intravenous pyelogram (IVP) as part of a workup for a possible kidney stone. The radiologist indicates the absence of nephrolithiasis but reports the presence of bilateral hydronephrosis and hydroureter, which is greater on the right side than on the left. Which of the following statements is true regarding this IVP finding?

    • A.

      A. The bilateral hydronephrosis is of concern, and renal function tests, including      BUN and creatinine, should be run and closely monitored.

    • B.

      B. These findings are consistent with normal pregnancy and are not of concern.

    • C.

      C. The bilateral hydronephrosis is of concern, and a renal sonogram should be         ordered emergently.

    • D.

      D. The findings indicate that a urology consult is needed to obtain       recommendations for further workup and evaluation.

    • E.

      E. The findings are consistent with ureteral obstruction, and the patient should      be referred for stent placement.

    Correct Answer
    B. B. These findings are consistent with normal pregnancy and are not of concern.
    Explanation
    The presence of bilateral hydronephrosis and hydroureter, which is greater on the right side than on the left, is a common finding in pregnant patients and is considered normal during pregnancy. It is caused by the compression of the ureters by the growing uterus. This finding does not indicate any abnormalities or complications and does not require further intervention or monitoring. Therefore, the correct answer is B. These findings are consistent with normal pregnancy and are not of concern.

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  • 14. 

    During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks gestational age undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace glucosuria. All other parameters of the urine test are normal. Which of the following is the most likely etiology of the increased sugar detected in the urine?

    • A.

      A. The patient has diabetes.

    • B.

      B. The patient has a urine infection.

    • C.

      C. The patient’s urinalysis is consistent with normal pregnancy.

    • D.

      D. The patient’s urine sample is contaminated.

    • E.

      E. The patient has kidney disease.

    Correct Answer
    C. C. The patient’s urinalysis is consistent with normal pregnancy.
    Explanation
    Glucosuria, or the presence of glucose in the urine, is a common finding in pregnant women. During pregnancy, there is an increased demand for glucose by the fetus, which can lead to increased glucose in the maternal blood. Some of this excess glucose may be excreted in the urine, resulting in glucosuria. In the absence of any other abnormal parameters in the urine test and considering the patient's gestational age, it is likely that the glucosuria is a normal finding in pregnancy. Therefore, option C, "The patient's urinalysis is consistent with normal pregnancy," is the most likely explanation for the increased sugar detected in the urine.

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  • 15. 

    A 33-year-old G2P1 is undergoing an elective repeat cesarean section at term. The infant is delivered without any difficulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. This is followed by uterine atony and hemorrhage. Match the descriptions with the appropriate placenta type.

    • A.

      A. Succenturiate placenta

    • B.

      B. Vasa previa

    • C.

      C. Placenta previa

    • D.

      D. Membranaceous placenta

    • E.

      E. Placenta accreta

    Correct Answer
    E. E. Placenta accreta
    Explanation
    In this scenario, the difficulty in removing the placenta and the subsequent uterine atony and hemorrhage suggest the presence of placenta accreta. Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall, making it difficult to separate during delivery. This can lead to complications such as retained placenta and postpartum hemorrhage. The description provided matches the characteristics of placenta accreta, making it the correct answer.

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  • 16. 

    The shortest distance between the sacral promontory and the symphysis pubis is called which of the following?

    • A.

      A. Interspinous diameter

    • B.

      B. True conjugate

    • C.

      C. Diagonal conjugate

    • D.

      D. Obstetric (OB) conjugate

    • E.

      E. Biparietal diameter

    Correct Answer
    D. D. Obstetric (OB) conjugate
    Explanation
    The correct answer is D. Obstetric (OB) conjugate. The obstetric conjugate is the shortest distance between the sacral promontory and the symphysis pubis. It is an important measurement in obstetrics as it helps determine the adequacy of the pelvis for childbirth. The other options are not correct because they refer to different measurements or diameters in the pelvis.

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  • 17. 

    A patient presents in labor at term. Clinical pelvimetry is performed. She has an oval-shaped pelvis with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter. The baby is occiput posterior. The patient most likely has what kind of pelvis?

    • A.

      A. A gynecoid pelvis

    • B.

      B. An android pelvis

    • C.

      C. An anthropoid pelvis

    • D.

      D. A platypelloid pelvis

    • E.

      E. An androgenous pelvis

    Correct Answer
    C. C. An anthropoid pelvis
    Explanation
    The patient's pelvis is described as oval-shaped with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter. This is characteristic of an anthropoid pelvis, which is a type of pelvis with a long anteroposterior diameter and a narrow transverse diameter. This type of pelvis is more common in certain populations and may be associated with a higher risk of occiput posterior position of the baby during labor.

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  • 18. 

    On pelvic examination of a patient in labor at 34 weeks, the patient is noted to be 6 cm dilated, completely effaced with the fetal nose and mouth palpable. The chin is pointing toward the maternal left hip. This is an example of which of the following?

    • A.

      A. Transverse lie

    • B.

      B. Mentum transverse position

    • C.

      C. Occiput transverse position

    • D.

      D. Brow presentation

    • E.

      E. Vertex presentation

    Correct Answer
    B. B. Mentum transverse position
    Explanation
    In a mentum transverse position, the chin of the baby is pointing towards the maternal left or right hip. This is different from a vertex presentation where the baby's head is fully flexed and the occiput is presenting. In a transverse lie, the baby is lying horizontally across the uterus. In a brow presentation, the baby's head is partially extended. Therefore, the given scenario describes a mentum transverse position.

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  • 19. 

    A patient comes to your office with her last menstrual period 4 weeks ago. She denies any symptoms such as nausea, fatigue, urinary frequency, or breast tenderness. She thinks that she may be pregnant because she has not had her period yet. She is very anxious to find out because she has a history of a previous ectopic pregnancy and wants to be sure to get early prenatal care. Which of the following actions is most appropriate at this time?

    • A.

      A. No action is needed because the patient is asymptomatic, has not missed her       period, and cannot be pregnant.

    • B.

      B. Order a serum quantitative pregnancy test.

    • C.

      C. Listen for fetal heart tones by Doppler equipment.

    • D.

      D. Perform an abdominal ultrasound.

    • E.

      E. Perform a bimanual pelvic examination to assess uterine size

    Correct Answer
    A. A. No action is needed because the patient is asymptomatic, has not missed her       period, and cannot be pregnant.
    Explanation
    The patient has not missed her period yet, so it is too early to determine if she is pregnant or not. Additionally, she denies any symptoms of pregnancy such as nausea, fatigue, urinary frequency, or breast tenderness. Since she is asymptomatic and has not missed her period, it is unlikely that she is pregnant at this time. Therefore, no action is needed and it would be appropriate to reassure the patient that she does not need to be concerned about pregnancy at this point.

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  • 20. 

    A patient presents for her first initial OB visit after performing a home pregnancy test and gives a last menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates, however, because she has a long history of irregular menses. Which of the following is the most accurate way of dating the pregnancy?

    • A.

      A. Determination of uterine size on pelvic examination

    • B.

      B. Quantitative serum human chorionic gonadotropin (HCG) level

    • C.

      C. Crown-rump length on abdominal or vaginal ultrasound

    • D.

      D. Determination of progesterone level along with serum HCG level

    • E.

      E. Quantification of a serum estradiol level

    Correct Answer
    C. C. Crown-rump length on abdominal or vaginal ultrasound
    Explanation
    The most accurate way of dating the pregnancy in this patient with irregular menses is by measuring the crown-rump length on abdominal or vaginal ultrasound. This method allows for the estimation of gestational age based on the size of the fetus. Since the patient is unsure of her dates, using uterine size on pelvic examination may not be reliable. Quantitative serum HCG level and determination of progesterone level along with serum HCG level can indicate pregnancy but do not provide accurate dating information. Quantification of a serum estradiol level is not relevant for dating the pregnancy.

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  • 21. 

    A healthy 31-year-old G3P2002 patient presents to the obstetrician’s office at 34 weeks gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her baseline blood pressures were 100 to 110/60 to70, and she has gained a total of 20 lb so far. During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the office is currently 115/75. She denies any other symptoms or complaints. On physical examination, there is pitting edema of both legs without any calf tenderness. Which of the following is the most appropriate response to the patient’s concern?

    • A.

      A. Prescribe Lasix to relieve the painful swelling.

    • B.

      B. Immediately send the patient to the radiology department to have venous.      Doppler studies done to rule out deep vein thromboses.

    • C.

      C. Admit the patient to L and D to rule out preeclampsia.

    • D.

      D. Reassure the patient that this is a normal finding of pregnancy and no         treatment is needed.

    • E.

      E. Tell the patient that her leg swelling is caused by too much salt intake and       instruct her to go on a low-sodium diet.

    Correct Answer
    D. D. Reassure the patient that this is a normal finding of pregnancy and no         treatment is needed.
    Explanation
    The patient in this scenario is a healthy 31-year-old with an uneventful pregnancy. She presents with bilateral pedal edema, trace protein in her urine, and a blood pressure of 115/75. These findings are consistent with normal physiological changes that occur during pregnancy. The absence of calf tenderness and other symptoms suggests that deep vein thrombosis is unlikely. Therefore, the most appropriate response is to reassure the patient that this is a normal finding of pregnancy and no treatment is needed.

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  • 22. 

    A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit secondary to right-sided groin pain. She describes the pain as sharp and occurring with movement and exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The application of a heating pad helps alleviate the discomfort. As her obstetrician, what should you tell this patient is the most likely etiology of this pain?

    • A.

      A. Round ligament pain

    • B.

      B. Appendicitis

    • C.

      C. Preterm labor

    • D.

      D. Kidney stone

    • E.

      E. Urinary tract infection

    Correct Answer
    A. A. Round ligament pain
    Explanation
    The most likely etiology of the patient's pain is round ligament pain. Round ligament pain is a common cause of groin pain in pregnant women. It is caused by stretching and pulling of the round ligaments that support the uterus. The pain is typically sharp and occurs with movement and exercise. The absence of other symptoms such as fever, change in urinary or bowel habits, and the relief of pain with a heating pad further supports this diagnosis. Appendicitis, preterm labor, kidney stone, and urinary tract infection are less likely causes of the patient's symptoms based on the information provided.

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  • 23. 

    A 19-year-old G1P0 presents to her obstetrician’s office for a routine OB visit at 32 weeks gestation. Her pregnancy has been complicated by gestational diabetes requiring insulin for control. She has been noncompli- ant with diet and insulin therapy. She has had two prior normal ultra- sounds at 20 and 28 weeks gestation. She has no other significant past medical or surgical history. During the visit, her fundal height measures 38 cm. Which of the following is the most likely explanation for the discrepancy between the fundal height and the gestational age?

    • A.

      A. Fetal hydrocephaly

    • B.

      B. Uterine fibroids

    • C.

      C. Polyhydramnios

    • D.

      D. Breech presentation

    • E.

      E. Undiagnosed twin gestation

    Correct Answer
    C. C. Polyhydramnios
    Explanation
    The most likely explanation for the discrepancy between the fundal height and the gestational age in this case is polyhydramnios. Polyhydramnios refers to an excessive amount of amniotic fluid surrounding the fetus. In this scenario, the fundal height measurement is larger than expected for the gestational age, suggesting that there is more amniotic fluid present. This can be caused by various factors, including gestational diabetes, which the patient has been diagnosed with. Noncompliance with diet and insulin therapy may have contributed to the development of polyhydramnios in this case.

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  • 24. 

    A 30-year-old G2P1001 patient comes to see you in the office at 37 weeks gestational age for her routine OB visit. Her first pregnancy resulted in a vagi- nal delivery of a 9-lb 8-oz baby boy after 30 minutes of pushing. On doing Leopold maneuvers during this office visit, you determine that the fetus is breech. Vaginal examination demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The esti- mated fetal weight is about 7 lb. The patient denies having any contractions. You send the patient for a sonogram, which confirms a fetus with a double footling breech presentation. There is a normal amount of amniotic fluid present and the head is hyperextended in the “stargazer” position. Which of the following is the best next step in the management of this patient?

    • A.

      A. Allow the patient to undergo a vaginal breech delivery whenever she goes into       labor.

    • B.

      B. Send the patient to labor and delivery immediately for an emergent cesarean       section.

    • C.

      C. Schedule a cesarean section at or after 41 weeks gestational age.

    • D.

      D. Schedule an external cephalic version in the next few days.

    • E.

      E. Allow the patient to go into labor and do an external cephalic version at that       time if the fetus is still in the double footling breech presentation.

    Correct Answer
    D. D. Schedule an external cephalic version in the next few days.
    Explanation
    The best next step in the management of this patient is to schedule an external cephalic version in the next few days. An external cephalic version is a procedure in which the healthcare provider attempts to manually turn the fetus from a breech position to a head-down position. In this case, since the patient is at 37 weeks gestational age and the fetus is in a double footling breech presentation, an external cephalic version can be attempted to try and reposition the fetus. This is a safe and effective method to increase the chance of a successful vaginal delivery.

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  • 25. 

    A 29-year-old G1P0 presents to the obstetrician’s office at 41 weeks gestation. On physical examination, her cervix is 1 centimeter dilated, 0% effaced, firm, and posterior in position. The vertex is presenting at –3 station. Which of the following is the best next step in the management of this patient?

    • A.

      A. Send the patient to the hospital for induction of labor since she has a       favorable Bishop score.

    • B.

      B. Teach the patient to measure fetal kick counts and deliver her if at any time       there are less than 20 perceived fetal movements in 3 hours.

    • C.

      C. Order BPP testing for the same or next day.

    • D.

      D. Schedule the patient for induction of labor at 43 weeks gestation.

    • E.

      E. Schedule cesarean delivery for the following day since it is unlikely that the       patient will go into labor.

    Correct Answer
    C. C. Order BPP testing for the same or next day.
    Explanation
    The best next step in the management of this patient is to order BPP (biophysical profile) testing for the same or next day. This is because the patient is at 41 weeks gestation and her cervix is only 1 centimeter dilated, 0% effaced, firm, and posterior in position. These findings suggest that she is not yet in active labor. BPP testing is a noninvasive assessment that evaluates fetal well-being, including fetal movement, fetal tone, amniotic fluid volume, and fetal heart rate. It is important to assess the well-being of the fetus in this situation to ensure that it is not at risk and to determine the need for further management.

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  • 26. 

    Your patient had an ultrasound examination today at 39 weeks gestation for size less than dates.The ultrasound showed oligohydramnios with an amniotic fluid index of 1.5 centimeters. The patient’s cervix is unfavorable. Which of the following is the best next step in the management of this patient?

    • A.

      A. Admit her to the hospital for cesarean delivery.

    • B.

      B. Admit her to the hospital for cervical ripening then induction of labor.

    • C.

      C. Write her a prescription for misoprostol to take at home orally every 4 hours       until she goes into labor.

    • D.

      D. Perform stripping of the fetal membranes and perform a BPP in 2 days.

    • E.

      E. Administer a cervical ripening agent in your office and have the patient    ​​​  present to the hospital in the morning for induction with oxytocin.

    Correct Answer
    B. B. Admit her to the hospital for cervical ripening then induction of labor.
    Explanation
    The patient is at 39 weeks gestation with oligohydramnios and an unfavorable cervix. The best next step in management would be to admit her to the hospital for cervical ripening, followed by induction of labor. Cervical ripening helps to soften and thin the cervix, making it more favorable for labor induction. Induction of labor is necessary in this case to prevent further complications related to oligohydramnios and ensure a safe delivery for both the mother and the baby.

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  • 27. 

    An 18-year-old G2P1001 with the first day of her last menstrual period of May 7 presents for her first OB visit at 10 weeks. What is this patient’s estimated date of delivery?

    • A.

      A. February 10 of the next year

    • B.

      B. February 14 of the next year

    • C.

      C. December 10 of the same year

    • D.

      D. December 14 of the same year

    • E.

      E. December 21of the same year

    Correct Answer
    B. B. February 14 of the next year
    Explanation
    The estimated date of delivery (EDD) is calculated by adding 280 days (40 weeks) to the first day of the last menstrual period (LMP). In this case, the LMP is May 7. Adding 280 days to May 7 brings us to February 12. However, since the patient is presenting for her first OB visit at 10 weeks, we subtract 14 days from the EDD. Therefore, the estimated date of delivery is February 14 of the next year.

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  • 28. 

    A new patient presents to your office for her first prenatal visit. By her last menstrual period she is 11 weeks pregnant. This is the first pregnancy for this 36-year-old woman. She has no medical problems. At this visit you observe that her uterus is palpable midway between the pubic symphysis and the umbilicus. No fetal heart tones are audible with the Doppler stethoscope. Which of the following is the best next step in the manage- ment of this patient?

    • A.

      A. Reassure her that fetal heart tones are not yet audible with the Doppler       stetho- scope at this gestational age.

    • B.

      B. Tell her the uterine size is appropriate for her gestational age and schedule       her for routine ultrasonography at 20 weeks.

    • C.

      C. Schedule genetic amniocentesis right away because of her advanced maternal       age.

    • D.

      D. Schedule her for a dilation and curettage because she has a molar pregnancy       since her uterus is too large and the fetal heart tones are not audible.

    • E.

      E. Schedule an ultrasound as soon as possible to determine the gestational age       and viability of the fetus.

    Correct Answer
    E. E. Schedule an ultrasound as soon as possible to determine the gestational age       and viability of the fetus.
    Explanation
    The best next step in the management of this patient is to schedule an ultrasound as soon as possible to determine the gestational age and viability of the fetus. This is because the patient is 11 weeks pregnant and her uterus is palpable midway between the pubic symphysis and the umbilicus, which is not consistent with the expected uterine size for this gestational age. Additionally, no fetal heart tones are audible with the Doppler stethoscope, which raises concerns about the viability of the fetus. Therefore, an ultrasound is necessary to assess the gestational age and determine if there are any abnormalities or complications.

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  • 29. 

    A 16-year-old primigravida presents to your office at 35 weeks gesta- tion. Her blood pressure is 170/110 mm Hg and she has 4+ proteinuria on a clean catch specimen of urine. She has significant swelling of her face and extremities. She denies having contractions. Her cervix is closed and unef- faced. The baby is breech by bedside ultrasonography. She says the baby’s movements have decreased in the past 24 hours. Which of the following is the best next step in the management of this patient?

    • A.

      A. Send her to labor and delivery for a BPP.

    • B.

      B. Send her home with instructions to stay on strict bed rest until her swelling       and blood pressure improve.

    • C.

      C. Admit her to the hospital for enforced bed rest and diuretic therapy to       improve her swelling and blood pressure.

    • D.

      D. Admit her to the hospital for induction of labor.

    • E.

      E. Admit her to the hospital for cesarean delivery.

    Correct Answer
    E. E. Admit her to the hospital for cesarean delivery.
    Explanation
    The patient in this scenario is presenting with severe preeclampsia, which is characterized by hypertension, proteinuria, and edema. Additionally, the decreased fetal movements may indicate fetal distress. In this case, the best next step in management would be to admit the patient to the hospital for cesarean delivery. This is because severe preeclampsia poses a significant risk to both the mother and the baby, and delivery is the only definitive treatment for this condition. Cesarean delivery is chosen in this case due to the breech presentation of the baby.

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  • 30. 

    A 29-year-old G3P2 presents to the emergency center with com- plaints of abdominal discomfort for 2 weeks. Her vital signs are: blood pressure 120/70 mm Hg, pulse 90 beats per minute, temperature 36.94°C, respiratory rate 18 breaths per minute. A pregnancy test is positive and an ultrasound of the abdomen and pelvis reveals a viable 16-week gestation located behind a normal-appearing 10 × 6 × 5.5 cm uterus. Both ovaries appear normal. No free fluid is noted. Which of the following is the most likely cause of these findings?

    • A.

      A. Ectopic ovarian tissue

    • B.

      B. Fistula between the peritoneum and uterine cavity

    • C.

      C. Primary peritoneal implantation of the fertilized ovum

    • D.

      D. Tubal abortion

    • E.

      E. Uterine rupture of prior cesarean section scar

    Correct Answer
    D. D. Tubal abortion
    Explanation
    The most likely cause of the findings described in the question is a tubal abortion. This is indicated by the patient's positive pregnancy test, the presence of a viable 16-week gestation, and the ultrasound findings of a normal-appearing uterus with no free fluid. A tubal abortion occurs when a pregnancy implants in the fallopian tube and subsequently aborts. This can cause abdominal discomfort and may present with similar symptoms to a normal intrauterine pregnancy.

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  • 31. 

    A 32-year-old G2P1 at 28 weeks gestation presents to labor and delivery with the complaint of vaginal bleeding. Her vital signs are: blood pressure 115/67 mm Hg, pulse 87 beats per minute, temperature 37.0°C, respiratory rate 18 breaths per minute. She denies any contraction and states that the baby is moving normally. On ultrasound the placenta is anteriorly located and completely covers the internal cervical os. Which of the following would most increase her risk for hysterectomy?

    • A.

      A. Desire for sterilization

    • B.

      B. Development of disseminated intravascular coagulopathy (DIC)

    • C.

      C. Placenta accreta

    • D.

      D. Prior vaginal delivery

    • E.

      E. Smoking

    Correct Answer
    C. C. Placenta accreta
    Explanation
    Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall, increasing the risk of severe bleeding during delivery. In this case, the patient has an anteriorly located placenta that completely covers the internal cervical os, which is a risk factor for placenta accreta. Placenta accreta can lead to significant bleeding during delivery, which may necessitate a hysterectomy to control the bleeding and prevent further complications. The other options, such as desire for sterilization, disseminated intravascular coagulopathy (DIC), prior vaginal delivery, and smoking, are not directly associated with an increased risk of hysterectomy in this scenario.

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  • 32. 

    A patient at 17 weeks gestation is diagnosed as having an intrauter- ine fetal demise. She returns to your office 5 weeks later and her vital signs are: blood pressure 110/72 mm Hg, pulse 93 beats per minute, tempera- ture 36.38°C, respiratory rate 16 breaths per minute. She has not had a miscarriage, although she has had some occasional spotting. Her cervix is closed on examination. This patient is at increased risk for which of the following?

    • A.

      A. Septic abortion

    • B.

      B. Recurrent abortion

    • C.

      C. Consumptive coagulopathy with hypofibrinogenemia

    • D.

      D. Future infertility

    • E.

      E. Ectopic pregnancies

    Correct Answer
    C. C. Consumptive coagulopathy with hypofibrinogenemia
    Explanation
    This patient is at increased risk for consumptive coagulopathy with hypofibrinogenemia. Intrauterine fetal demise refers to the death of the fetus inside the uterus, which can lead to the release of tissue thromboplastin and activation of the coagulation cascade. This can result in disseminated intravascular coagulation (DIC), a consumptive coagulopathy characterized by widespread clotting and subsequent depletion of clotting factors, including fibrinogen. The patient's history of occasional spotting suggests that there may be ongoing placental abruption, which further increases the risk of DIC.

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  • 33. 

    A 24-year-old presents at 30 weeks with a fundal height of 50 cm. Which of the following statements concerning polyhydramnios is true?

    • A.

      A. Acute polyhydramnios rarely leads to labor prior to 28 weeks.

    • B.

      B. The incidence of associated malformations is approximately 3%.

    • C.

      C. Maternal edema, especially of the lower extremities and vulva, is rare.

    • D.

      D. Esophageal atresia is accompanied by polyhydramnios in nearly 10% of cases.

    • E.

      E. Complications include placental abruption, uterine dysfunction, and       postpartum hemorrhage

    Correct Answer
    E. E. Complications include placental abruption, uterine dysfunction, and       postpartum hemorrhage
    Explanation
    Polyhydramnios is a condition characterized by excessive amniotic fluid. In this case, the fundal height of 50 cm at 30 weeks suggests polyhydramnios. The correct answer, E, states that complications of polyhydramnios include placental abruption, uterine dysfunction, and postpartum hemorrhage. This is true because the increased volume of amniotic fluid can put pressure on the placenta, leading to its separation from the uterine wall (placental abruption). The excessive fluid can also interfere with uterine contractions (uterine dysfunction) and increase the risk of postpartum bleeding (postpartum hemorrhage).

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  • 34. 

    A 20-year-old G1 at 32 weeks presents for her routine obstetric (OB) visit. She has no medical problems. She is noted to have a blood pressure of 150/96 mm Hg, and her urine dip shows 1+ protein. She complains of a constant headache and vision changes that are not relieved with rest or a pain reliever. The patient is sent to the hospital for further management. At the hospital, her blood pressure is 158/98 mm Hg and she is noted to have tonic-clonic seizure. Which of the following is indicated in the manage- ment of this patient?

    • A.

      A. Low-dose aspirin

    • B.

      B. Dilantin (phenytoin)

    • C.

      C. Antihypertensive therapy

    • D.

      D. Magnesium sulfate

    • E.

      E. Cesarean delivery

    Correct Answer
    C. C. Antihypertensive therapy
    Explanation
    The patient in this scenario is presenting with symptoms of severe preeclampsia, including high blood pressure, proteinuria, headache, and seizures. Antihypertensive therapy is indicated to lower her blood pressure and reduce the risk of complications such as stroke and organ damage. Low-dose aspirin is typically used for prevention of preeclampsia in high-risk patients, but it is not appropriate for managing severe preeclampsia. Dilantin (phenytoin) is an antiepileptic medication and would not address the underlying issue of high blood pressure. Magnesium sulfate is used for seizure prophylaxis and is indicated in this patient to prevent further seizures. Cesarean delivery may be considered in severe cases, but antihypertensive therapy should be initiated first to stabilize the patient.

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  • 35. 

    Uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage of tissue. Match above description with the correct type of abortion.

    • A.

      A. Complete abortion

    • B.

      B. Incomplete abortion

    • C.

      C. Threatened abortion

    • D.

      D. Missed abortion

    • E.

      E. Inevitable abortion

    Correct Answer
    E. E. Inevitable abortion
    Explanation
    The given description of uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage of tissue matches the definition of an inevitable abortion. In an inevitable abortion, the cervix begins to dilate, and there is bleeding, but the pregnancy cannot be saved, and eventually, the fetus and placenta will be expelled from the uterus. This is different from a complete abortion, where all the products of conception are expelled, and an incomplete abortion, where some but not all of the products of conception are expelled. It is also different from a threatened abortion, where there is bleeding but the cervix remains closed, and a missed abortion, where the fetus has died but is not expelled from the uterus.

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  • 36. 

    Passage of some but not all placental tissue through the cervix at 9 weeks gestation. Match above description with the correct type of abortion.

    • A.

      A. Complete abortion

    • B.

      B. Incomplete abortion

    • C.

      C. Threatened abortion

    • D.

      D. Missed abortion

    • E.

      E. Inevitable abortion

    Correct Answer
    B. B. Incomplete abortion
    Explanation
    An incomplete abortion is the correct type of abortion that matches the given description. In an incomplete abortion, only some of the placental tissue passes through the cervix, while some remains in the uterus. This can result in bleeding and may require medical intervention to remove the remaining tissue.

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  • 37. 

    Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks. Match above description with the correct type of abortion.

    • A.

      A. Complete abortion

    • B.

      B. Incomplete abortion

    • C.

      C. Threatened abortion

    • D.

      D. Missed abortion

    • E.

      E. Inevitable abortion

    Correct Answer
    D. D. Missed abortion
    Explanation
    A missed abortion refers to a situation where the fetus dies in utero, but is not expelled from the uterus for at least 8 weeks. This means that the pregnancy is no longer viable, but the body does not recognize the loss and does not initiate the process of expelling the fetal or maternal tissue. This is different from a complete abortion, where all fetal and maternal tissue is expelled, and from an incomplete abortion, where some but not all of the tissue is expelled. In a missed abortion, there is a delay in the recognition and expulsion of the nonviable pregnancy.

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  • 38. 

    Uterine bleeding at 7 weeks gestation without any cervical dilation. Match above description with the correct type of abortion.

    • A.

      A. Complete abortion

    • B.

      B. Incomplete abortion

    • C.

      C. Threatened abortion

    • D.

      D. Missed abortion

    • E.

      E. Inevitable abortion

    Correct Answer
    C. C. Threatened abortion
    Explanation
    A threatened abortion refers to vaginal bleeding during the first half of pregnancy, without any cervical dilation or tissue passing from the uterus. In this case, the description states that there is uterine bleeding at 7 weeks gestation without cervical dilation, which aligns with the characteristics of a threatened abortion. This means that there is a possibility of the pregnancy continuing, but there is also a risk of miscarriage.

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  • 39. 

    Expulsion of all fetal and placental tissue from the uterine cavity at 10 weeks gestation. Match above description with the correct type of abortion.

    • A.

      A. Complete abortion

    • B.

      B. Incomplete abortion

    • C.

      C. Threatened abortion

    • D.

      D. Missed abortion

    • E.

      E. Inevitable abortion

    Correct Answer
    A. A. Complete abortion
    Explanation
    A complete abortion refers to the expulsion of all fetal and placental tissue from the uterine cavity. In this case, the description states that all fetal and placental tissue is expelled at 10 weeks gestation, which aligns with the definition of a complete abortion.

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  • 40. 

    A 32-year-old G5P1 presents for her first prenatal visit. A complete obstetrical, gynecological, and medical history and physical examination is done. Which of the following would be an indication for elective cerclage placement?

    • A.

      A. Three spontaneous first-trimester abortions

    • B.

      B. Twin pregnancy

    • C.

      C. Three second-trimester pregnancy losses without evidence of labor or       abruption

    • D.

      D. History of loop electrosurgical excision procedure for cervical dysplasia

    • E.

      E. Cervical length of 35 mm by ultrasound at 18 weeks

    Correct Answer
    C. C. Three second-trimester pregnancy losses without evidence of labor or       abruption
    Explanation
    An indication for elective cerclage placement is when a woman has experienced three second-trimester pregnancy losses without evidence of labor or abruption. This suggests a potential issue with cervical insufficiency, where the cervix is unable to support the growing fetus and may lead to premature birth. Cerclage placement involves stitching the cervix closed to provide additional support and prevent premature labor.

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  • 41. 

    A 20-year-old G1P0 presents to your clinic for follow-up for a suc- tion dilation and curettage for an incomplete abortion. She is asymptomatic without any vaginal bleeding, fever, or chills. Her examination is normal. The pathology report reveals trophoblastic proliferation and hydropic degenera- tion with the absence of vasculature; no fetal tissue is identified. A chest x-ray is negative for any evidence of metastatic disease. Which of the following is the best next step in her management?

    • A.

      A. Weekly human chorionic gonadotropin (hCG) titers

    • B.

      B. Hysterectomy

    • C.

      C. Single-agent chemotherapy

    • D.

      D. Combination chemotherapy

    • E.

      E. Radiation therapy

    Correct Answer
    A. A. Weekly human chorionic gonadotropin (hCG) titers
    Explanation
    The patient's presentation, along with the pathology report findings and negative chest x-ray, are consistent with a diagnosis of gestational trophoblastic disease (GTD), specifically a complete hydatidiform mole. The best next step in management is to monitor the patient's hCG levels weekly to assess for resolution of the disease. This is because GTD has the potential to develop into persistent or metastatic disease, and monitoring hCG levels allows for early detection and intervention if needed. Hysterectomy, chemotherapy, and radiation therapy are not indicated in this case as the patient is asymptomatic and there is no evidence of metastatic disease.

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  • 42. 

    A 22-year-old G1P0 presents to your clinic for follow-up of evacuation of a complete hydatidiform mole. She is asymptomatic and her examination is normal. Which of the following would be an indication to start single-agent chemotherapy?

    • A.

      A. A rise in hCG titers

    • B.

      B. A plateau of hCG titers for 1 week

    • C.

      C. Return of hCG titer to normal at 6 weeks after evacuation

    • D.

      D. Appearance of liver metastasis

    • E.

      E. Appearance of brain metastasis

    Correct Answer
    A. A. A rise in hCG titers
    Explanation
    A rise in hCG titers would be an indication to start single-agent chemotherapy in this patient. After the evacuation of a complete hydatidiform mole, it is important to monitor hCG levels to assess for persistent or recurrent disease. A rise in hCG titers suggests the presence of persistent or recurrent disease, which may require treatment with chemotherapy. A plateau of hCG titers for 1 week or the return of hCG titer to normal at 6 weeks after evacuation indicates a favorable response to treatment and does not require chemotherapy. The appearance of liver or brain metastasis would also indicate the need for chemotherapy, but the question specifically asks for an indication before the development of metastasis.

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  • 43. 

    A 32-year-old female presents to the emergency department with abdominal pain and vaginal bleeding. Her last menstrual period was 8 weeks ago and her pregnancy test is positive. On examination she is tachycardic and hypotensive and her abdominal examination findings reveal peritoneal signs, a bedside abdominal ultrasound shows free fluid within the abdominal cavity. The decision is made to take the patient to the operating room for emergency exploratory laparotomy. Which of the following is the most likely diagnosis?

    • A.

      A. Ruptured ectopic pregnancy

    • B.

      B. Hydatidiform mole

    • C.

      C. Incomplete abortion d. Missed abortion

    • D.

      D. Torsed ovarian corpus luteal cyst

    Correct Answer
    A. A. Ruptured ectopic pregnancy
    Explanation
    The patient's presentation of abdominal pain, vaginal bleeding, positive pregnancy test, tachycardia, hypotension, peritoneal signs, and free fluid on abdominal ultrasound are all consistent with a ruptured ectopic pregnancy. Ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, commonly in the fallopian tubes. Rupture of the ectopic pregnancy can lead to internal bleeding, which can cause the patient's symptoms of abdominal pain and hypotension. Emergency exploratory laparotomy is necessary to address the life-threatening condition.

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  • 44. 

    A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?

    • A.

      A. Previous cervical conization

    • B.

      B. Pelvic inflammatory disease (PID)

    • C.

      C. Use of a contraceptive uterine device (IUD)

    • D.

      D. Induction of ovulation

    • E.

      E. Exposure in utero to diethylstilbestrol (DES)

    Correct Answer
    B. B. Pelvic inflammatory disease (PID)
    Explanation
    Pelvic inflammatory disease (PID) would be most likely to predispose to ectopic pregnancy because it can cause scarring and damage to the fallopian tubes, making it more difficult for a fertilized egg to pass through and implant in the uterus. This increases the risk of the egg implanting in the fallopian tube instead, resulting in an ectopic pregnancy. Previous cervical conization, use of a contraceptive uterine device (IUD), induction of ovulation, and exposure in utero to diethylstilbestrol (DES) are not directly associated with an increased risk of ectopic pregnancy.

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  • 45. 

    A 34-year-old G2P1 at 31 weeks gestation presents to labor and delivery with complaints of vaginal bleeding earlier in the day that resolved on its own. She denies any leakage of fluid or uterine contractions. She reports good fetal movement. In her last pregnancy, she had a low trans- verse cesarean delivery for breech presentation at term. She denies any medical problems. Her vital signs are normal and electronic external monitoring reveals a reactive fetal heart rate tracing and no uterine contractions. Which of the following is the most appropriate next step in the management of this patient?

    • A.

      A. Send her home, since the bleeding has completely resolved and she is       experiencing good fetal movements

    • B.

      B. Perform a sterile digital examination

    • C.

      C. Perform an amniocentesis to rule out infection

    • D.

      D. Perform a sterile speculum examination

    • E.

      E. Perform an ultrasound examination

    Correct Answer
    E. E. Perform an ultrasound examination
    Explanation
    The most appropriate next step in the management of this patient is to perform an ultrasound examination. This is because the patient is presenting with vaginal bleeding during pregnancy, which could indicate a potential complication. An ultrasound examination can help determine the cause of the bleeding and assess the well-being of the fetus. It is important to rule out any placental abnormalities or other issues that could be causing the bleeding. This will help guide further management and ensure the safety of both the mother and the baby.

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  • 46. 

    A 34-year-old G2P1 at 31 weeks gestation with a known placenta previa presents to the hospital with vaginal bleeding. On assessment, she has normal vital signs and the fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. No uterine contractions are demonstrated on external tocometer. Heavy vaginal bleeding is noted. Which of the following is the best next step in the management of this patient?

    • A.

      A. Administer intramuscular terbutaline

    • B.

      B. Administer methylergonovine

    • C.

      C. Admit and stabilize the patient

    • D.

      D. Perform cesarean delivery

    • E.

      E. Induce labor

    Correct Answer
    C. C. Admit and stabilize the patient
    Explanation
    The best next step in the management of this patient is to admit and stabilize the patient. This is because the patient is experiencing heavy vaginal bleeding, which is concerning for placenta previa. Admitting the patient allows for close monitoring and immediate access to necessary interventions if the bleeding worsens or if the patient's condition deteriorates. Stabilizing the patient involves ensuring her vital signs remain stable and addressing any potential complications that may arise from the bleeding. This step takes priority over other options such as administering medications or performing a cesarean delivery, as the patient's immediate safety is the primary concern.

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  • 47. 

    A 40-year-old G2P1001 presents to your office for a routine OB visit at 30 weeks gestational age. Her first pregnancy was delivered 10 years ago and was uncomplicated. She had a normal vaginal delivery at 40 weeks and the baby weighed 7 lb. During this present pregnancy, she has not had any complications, and she reports no significant medical history. She is a non- smoker and has gained about 25 lb to date. Despite being of advanced maternal age, she declined any screening or diagnostic testing for Down syndrome. Her blood pressure range has been 100 to 120/60 to 70. During her examination, you note that her fundal height measures only 25 cm. Which of the following is a likely explanation for this patient’s decreased fundal height?

    • A.

      A. Multiple gestation

    • B.

      B. Hydramnios

    • C.

      C. Fetal growth restriction

    • D.

      D. The presence of fibroid tumors in the uterus

    • E.

      E. Large ovarian mass

    Correct Answer
    C. C. Fetal growth restriction
    Explanation
    The likely explanation for this patient's decreased fundal height is fetal growth restriction. Fundal height is a measurement of the distance from the pubic bone to the top of the uterus, which typically corresponds to the number of weeks of gestation. In this case, the patient is 30 weeks gestational age, but her fundal height measures only 25 cm. Fetal growth restriction refers to a condition where the fetus is not growing at the expected rate. This can be caused by various factors, such as placental insufficiency or maternal medical conditions. In this patient, there are no reported complications or medical history, making fetal growth restriction a likely explanation for the decreased fundal height.

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  • 48. 

    A 26-year-old G1 at 37 weeks presents to the hospital in active labor. She has no medical problems and has a normal prenatal course except for fetal growth restriction. She undergoes an uncomplicated vaginal delivery of a female infant weighing 1950 g. The infant is at risk for which of the following complications?

    • A.

      A. Hyperglycemia

    • B.

      B. Fever

    • C.

      C. Hypertension

    • D.

      D. Anemia

    • E.

      E. Hypoxia

    Correct Answer
    E. E. Hypoxia
    Explanation
    The infant is at risk for hypoxia because fetal growth restriction can lead to decreased oxygen supply to the fetus. This can result in inadequate oxygenation during labor and delivery, increasing the risk of hypoxia for the newborn.

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  • 49. 

    A 39-year-old G1P0 at 39 weeks gestational age is sent to labor and delivery from her obstetrician’s office because of a blood pressure reading of 150/100 mm Hg obtained during a routine OB visit. Her baseline blood pressures during the pregnancy were 100 to 120/60 to 70. On arrival to labor and delivery, the patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. The heart rate strip is reactive and the toco- dynamometer indicates irregular uterine contractions. The patient’s cervix is 3 cm dilated. Her repeat blood pressure is 160/90 mm Hg. Hematocrit is 34.0, platelets are 160,000, SGOT is 22, SGPT is 15, and urinalysis is neg- ative for protein. Which of the following is the most likely diagnosis?

    • A.

      A. Preeclampsia

    • B.

      B. Chronic hypertension

    • C.

      C. Chronic hypertension with superimposed preeclampsia

    • D.

      D. Eclampsia

    • E.

      E. Gestational hypertension

    Correct Answer
    E. E. Gestational hypertension
    Explanation
    The patient's blood pressure reading of 150/100 mm Hg during a routine OB visit, along with the absence of other symptoms such as headache, visual changes, nausea, vomiting, or abdominal pain, suggests gestational hypertension. This diagnosis is further supported by the patient's baseline blood pressures during pregnancy being within normal range and the absence of proteinuria on urinalysis. Chronic hypertension and chronic hypertension with superimposed preeclampsia would be unlikely as the patient's blood pressure readings were normal during pregnancy. Preeclampsia and eclampsia are also unlikely as the patient does not exhibit the characteristic symptoms associated with these conditions.

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  • 50. 

    A 20-year-old G1 at 36 weeks is being monitored for preeclampsia; she rings the bell for the nurse because she is developing a headache and feels funny. As you and the nurse enter the room, you witness the patient undergoing a tonic-clonic seizure. You secure the patient’s airway, and within a few minutes the seizure is over. The patient’s blood pressure monitor indicates a pressure of 160/110 mm Hg. Which of the following medications is recommended for the prevention of a recurrent eclamptic seizure?

    • A.

      A. Hydralazine

    • B.

      B. Magnesium sulfate

    • C.

      C. Labetalol

    • D.

      D. Pitocin

    • E.

      E. Nifedipine

    Correct Answer
    B. B. Magnesium sulfate
    Explanation
    Magnesium sulfate is recommended for the prevention of recurrent eclamptic seizures in this patient. Eclampsia is a severe complication of preeclampsia characterized by the onset of seizures. Magnesium sulfate is the treatment of choice for preventing and treating eclamptic seizures. It works by acting as a central nervous system depressant and inhibiting neuromuscular transmission. It also has vasodilatory effects, which can help lower blood pressure. Hydralazine, labetalol, nifedipine, and pitocin are not indicated for the prevention of eclamptic seizures.

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