Gyneco (378)

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  • 1/100 Questions

    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. Tetracycline
    • B. Streptomycin
    • C. Nitrofurantoin
    • D. Chloramphenicol
    • E. Sulfonamides
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About This Quiz

The 'Gyneco (378)' quiz assesses knowledge in obstetrics and gynecology, focusing on medication impacts during pregnancy and appropriate treatments for various conditions affecting pregnant women. This quiz is crucial for medical students and professionals specializing in gynecology.

Obstetrics And Gynecology Quizzes & Trivia

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  • 2. 

    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. It is a very common finding and is insignificant.

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

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

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

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

    Correct Answer
    A. 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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  • 3. 

    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. Fetal hydrocephaly

    • B. Uterine fibroids

    • C. Polyhydramnios

    • D. Breech presentation

    • E. Undiagnosed twin gestation

    Correct Answer
    A. 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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  • 4. 

    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. Ruptured ectopic pregnancy

    • B. Hydatidiform mole

    • C. Incomplete abortion d. Missed abortion

    • 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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  • 5. 

    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. Previous cervical conization

    • B. Pelvic inflammatory disease (PID)

    • C. Use of a contraceptive uterine device (IUD)

    • D. Induction of ovulation

    • E. Exposure in utero to diethylstilbestrol (DES)

    Correct Answer
    A. 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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  • 6. 

    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. Multiple gestation

    • B. Hydramnios

    • C. Fetal growth restriction

    • D. The presence of fibroid tumors in the uterus

    • E. Large ovarian mass

    Correct Answer
    A. 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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  • 7. 

    You are following a 38-year-old G2P1 at 39 weeks in labor. She has had one prior vaginal delivery of a 3800-g infant. One week ago, the esti- mated fetal weight was 3200 g by ultrasound. Over the past 3 hours her cervical examination remains unchanged at 6 cm. Fetal heart rate tracing is reactive. An intrauterine pressure catheter (IUPC) reveals two contractions in 10 minutes with amplitude of 40 mm Hg each. Which of the following is the best management for this patient?

    • A. Ambulation

    • B. Sedation

    • C. Administration of oxytocin

    • D. Cesarean section

    • E. Expectant

    Correct Answer
    A. C. Administration of oxytocin
    Explanation
    In this scenario, the patient is in labor at 39 weeks with a history of one prior vaginal delivery. The estimated fetal weight one week ago was 3200 g, but the current cervical examination remains unchanged at 6 cm over the past 3 hours. The fetal heart rate tracing is reactive, indicating that the baby is tolerating labor well. The intrauterine pressure catheter reveals two contractions in 10 minutes with an amplitude of 40 mm Hg each. Given these findings, the best management for this patient would be the administration of oxytocin to augment labor progress and help the patient achieve cervical dilation and fetal descent.

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  • 8. 

    A nulliparous woman has had arrest of descent for the past 2 hours and arrest of dilation for the past 3 hours. The cervix is dilated to 7 cm and the vertex is at +1 station. Monitoring shows a normal pattern and adequate contractions. Fetal weight is estimated at 7.5 lb. Select the most appropriate treatment for above clinical situation.

    • A. Epidural block

    • B. Meperidine (Demerol) 100 mg intramuscularly

    • C. Oxytocin intravenously

    • D. Midforceps delivery

    • E. Cesarean section

    Correct Answer
    A. E. Cesarean section
    Explanation
    The given clinical situation describes a nulliparous woman who has been experiencing arrest of descent and dilation during labor. The cervix is dilated to 7 cm and the vertex is at +1 station. Despite normal monitoring and adequate contractions, the labor has not progressed for several hours. Additionally, the estimated fetal weight is 7.5 lb. Given these factors, the most appropriate treatment would be a cesarean section. This is because the prolonged arrest of descent and dilation, along with the estimated fetal weight, suggest that a vaginal delivery may not be successful or safe for the mother and baby.

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  • 9. 

    A 20-year-old G1 at 41 weeks has been pushing for 21/2 hours. The fetal head is at the introitus and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact. How should you classify this type of episiotomy?

    • A. First-degree

    • B. Second-degree

    • C. Third-degree

    • D. Fourth-degree

    • E. Mediolateral episiotomy

    Correct Answer
    A. C. Third-degree
    Explanation
    The tear extending through the sphincter of the rectum indicates that this episiotomy is a third-degree tear. A first-degree tear involves only the perineal skin, a second-degree tear involves the perineal muscles, and a third-degree tear involves the anal sphincter. A fourth-degree tear would involve the anal sphincter and rectal mucosa, but in this case, the rectal mucosa is intact. Mediolateral episiotomy is not relevant to the classification of the tear.

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  • 10. 

    Which one do you like?

    • Option 1

    • Option 2

    • Option 3

    • Option 4

    Correct Answer
    A. Option 1
  • 11. 

    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. Hepatitis A

    • B. Tetanus

    • C. Typhoid

    • D. Hepatitis B

    • E. Measles

    Correct Answer
    A. 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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  • 12. 

    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. Doxycycline

    • B. Chloramphenicol

    • C. Tetracycline

    • D. Minocycline

    • E. Ceftriaxone

    Correct Answer
    A. 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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  • 13. 

    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. Complete abortion

    • B. Incomplete abortion

    • C. Threatened abortion

    • D. Missed abortion

    • 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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  • 14. 

    A 27-year-old G2P1 at 38 weeks gestation was admitted in active labor at 4 cm dilated; spontaneous rupture of membranes occurred prior to admission. She has had one prior uncomplicated vaginal delivery and denies any medical problems or past surgery. She reports an allergy to sulfa drugs. Currently, her vital signs are normal and the fetal heart rate tracing is reactive. Her prenatal record indicates that her Group B streptococcus (GBS) culture at 36 weeks was positive. What is the recommended antibiotic for prophylaxis during labor?

    • A. Cefazolin

    • B. Clindamycin

    • C. Erythromycin

    • D. Penicillin

    • E. Vancomycin

    Correct Answer
    A. D. Penicillin
    Explanation
    Penicillin is the recommended antibiotic for prophylaxis during labor in a patient who is GBS positive. GBS is a common bacterium that can be found in the vagina or rectum of about 25% of all healthy adult women. It can be transmitted to the newborn during delivery and can cause serious infections. Penicillin is effective in preventing GBS transmission to the newborn and is the first-line antibiotic for prophylaxis. Cefazolin is an alternative for patients with a penicillin allergy, but this patient does not have a penicillin allergy. Clindamycin, erythromycin, and vancomycin are not recommended for GBS prophylaxis.

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  • 15. 

    A 32-year-old G3P2 at 39 weeks gestation presented to the hospital with ruptured membranes and 4 cm dilated. She has a history of two prior vaginal deliveries, with her largest child weighing 3800 g at birth. Over the next 2 hours she progresses to 7 cm dilated. Two hours later, she remains 7 cm dilated. The estimated fetal weight by ultrasound is 3200 g. Which of the following labor abnormalities best describes this patient?

    • A. Prolonged latent phase

    • B. Protracted active-phase dilation

    • C. Hypertonic dysfunction

    • D. Secondary arrest of dilation

    • E. Primary dysfunction

    Correct Answer
    A. D. Secondary arrest of dilation
    Explanation
    This patient is experiencing a secondary arrest of dilation. This is indicated by the fact that she progressed from 4 cm to 7 cm in 2 hours, but then did not progress any further despite an additional 2 hours passing. This is considered a secondary arrest because there was initial progress in dilation, but it then stopped. The estimated fetal weight being lower than her largest previous child's weight suggests that fetal size is not the cause of the arrest.

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  • 16. 

    A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, which of the following is an advantage of mediolateral episiotomy?

    • A. Ease of repair

    • B. Fewer breakdowns

    • C. Less blood loss

    • D. Less dyspareunia

    • E. Less extension of the incision

    Correct Answer
    A. E. Less extension of the incision
    Explanation
    Mediolateral episiotomy is advantageous compared to midline episiotomy because it is less likely to extend further during the healing process. This means that the incision is less likely to cause additional trauma and damage to the surrounding tissues, resulting in better healing and less complications.

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  • 17. 

    A 24-year-old woman (G3P2) is at 40 weeks gestation. The fetus is in the transverse lie presentation. For above clinical description, select the most appropriate procedure.

    • A. External version

    • B. Internal version

    • C. Midforceps rotation

    • D. Low transverse cesarean section

    • E. Classic cesarean section

    Correct Answer
    A. A. External version
    Explanation
    External version is the most appropriate procedure for a 24-year-old woman at 40 weeks gestation with a fetus in the transverse lie presentation. External version involves manually manipulating the fetus from a transverse lie position to a head-down position externally on the mother's abdomen. This procedure is typically done to avoid a cesarean section and allow for a vaginal delivery. Internal version, midforceps rotation, low transverse cesarean section, and classic cesarean section are not appropriate procedures for a transverse lie presentation.

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  • 18. 

    A 25-year-old G1P0 patient at 41 weeks presents to labor and delivery complaining of gross rupture of membranes and painful uterine contractions every 2 to 3 minutes. On digital examination, her cervix is 3 cm dilated and completely effaced with fetal feet palpable through the cervix. The estimated weight of the fetus is about 6 lb, and the fetal heart rate tracing is reactive. Which of the following is the best method to achieve delivery?

    • A. Deliver the fetus vaginally by breech extraction

    • B. Deliver the baby vaginally after external cephalic version

    • C. Perform an emergent cesarean section

    • D. Perform an internal podalic version

    • E. Perform a forceps-assisted vaginal delivery

    Correct Answer
    A. C. Perform an emergent cesarean section
    Explanation
    Performing an emergent cesarean section is the best method to achieve delivery in this case. The patient is at term (41 weeks) with ruptured membranes and regular painful contractions, indicating active labor. The cervix is already dilated to 3 cm and completely effaced, with fetal feet palpable through the cervix. These findings suggest a footling breech presentation, which is a contraindication for vaginal delivery due to the increased risk of cord prolapse and compression. Therefore, an emergent cesarean section is the safest option to ensure a successful delivery and minimize the risk to both the mother and the fetus.

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  • 19. 

    A 25-year-old G1 at 37 weeks presents to labor and delivery with gross rupture of membranes. The fluid is noted to be clear and the patient is noted to have regular painful contractions every 2 to 3 minutes lasting for 60 seconds each. The fetal heart rate tracing is reactive. On cervical examination she is noted to be 4 cm dilated, 90% effaced with the presenting part a −3 station. The presenting part is soft and felt to be the fetal buttock. A quick bedside ultrasound reveals a breech presentation with both hips flexed and knees extended. What type of breech presentation is described?

    • A. Frank

    • B. Incomplete, single footling

    • C. Complete

    • D. Double footling

    Correct Answer
    A. A. Frank
    Explanation
    The given scenario describes a breech presentation with both hips flexed and knees extended. This is characteristic of a Frank breech presentation, which is the most common type of breech presentation. In a Frank breech, the baby's buttocks are the presenting part, with the legs extended up towards the head. This presentation is associated with a higher risk of complications during delivery compared to other types of breech presentations.

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  • 20. 

    A 38-year-old G3P3 begins to breast-feed her 5-day-old infant. The baby latches on appropriately and begins to suckle. In the mother, which of the following is a response to suckling?

    • A. Decrease of oxytocin

    • B. Increase of prolactin-inhibiting factor

    • C. Increase of hypothalamic dopamine

    • D. Increase of hypothalamic prolactin

    • E. Increase of luteinizing hormone—releasing factor

    Correct Answer
    A. D. Increase of hypothalamic prolactin
    Explanation
    When a mother begins to breast-feed her infant, suckling stimulates the release of hypothalamic prolactin. Prolactin is responsible for milk production and secretion in the mammary glands. Therefore, an increase in hypothalamic prolactin is a normal response to suckling and is necessary for the mother to produce and supply milk for her baby.

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  • 21. 

    A 21-year-old G2P2 calls her physician 7 days postpartum because she is concerned that she is still bleeding from the vagina. She describes the bleeding as light pink to bright red and less heavy than the first few days postdelivery. She denies fever or any cramping pain. On examination she is afebrile and has an appropriately sized, nontender uterus. The vagina con- tains about 10 cc of old, dark blood. The cervix is closed. Which of the fol- lowing is the most appropriate treatment?

    • A. Antibiotics for endometritis

    • B. High-dose oral estrogen for placental subinvolution

    • C. Oxytocin for uterine atony

    • D. Suction dilation and curettage for retained placenta

    • E. Reassurance

    Correct Answer
    A. E. Reassurance
    Explanation
    The patient in this scenario is 7 days postpartum and experiencing light pink to bright red bleeding, which is normal after delivery. The bleeding is also less heavy than the first few days postdelivery, indicating a normal progression of postpartum bleeding. The absence of fever, cramping pain, and the presence of an appropriately sized, nontender uterus suggest that there are no signs of infection or uterine atony. The small amount of old, dark blood in the vagina is likely residual blood from the delivery. Therefore, the most appropriate treatment in this case is reassurance, as the patient's symptoms are consistent with normal postpartum bleeding.

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  • 22. 

    A 28-year-old G2P2 presents to the hospital 2 weeks after vaginal delivery with the complaint of heavy vaginal bleeding that soaks a sanitary napkin every hour. Her pulse is 89 beats per minute, blood pressure 120/76 mm Hg, and temperature 37.1°C (98.9°F). Her abdomen is non- tender and her fundus is located above the symphysis pubis. On pelvic examination, her vagina contained small blood clots and no active bleeding is noted from the cervix. Her uterus is about 12 to 14 weeks size and non- tender. Her cervix is closed. An ultrasound reveals an 8-mm endometrial stripe. Her hemoglobin is 10.9, unchanged from the one at her vaginal delivery. β-hCG is negative. Which of the following potential treatments would be contraindicated?

    • A. Methylergonovine maleate (Methergine)

    • B. Oxytocin injection (Pitocin)

    • C. Ergonovine maleate (Ergotrate)

    • D. Prostaglandins

    • E. Dilation and curettage

    Correct Answer
    A. E. Dilation and curettage
    Explanation
    Dilation and curettage (D&C) is a surgical procedure in which the cervix is dilated and the uterine lining is scraped or suctioned. It is commonly used to treat heavy vaginal bleeding after delivery. However, in this case, the patient has a closed cervix and no active bleeding. Additionally, her hemoglobin level is stable and there is no evidence of retained products of conception. Therefore, D&C would not be indicated and is contraindicated in this situation.

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  • 23. 

    A 30-year-old G3P3, who is 8 weeks postpartum and regularly breast-feeding calls you and is very concerned because she is having pain with intercourse secondary to vaginal dryness. Which of the following should you recommend to help her with this problem?

    • A. Instruct her to stop breast-feeding

    • B. Apply hydrocortisone cream to the perineum

    • C. Apply testosterone cream to the vulva and vagina

    • D. Apply estrogen cream to the vagina and vulva

    • E. Apply petroleum jelly to the perineum

    Correct Answer
    A. D. Apply estrogen cream to the vagina and vulva
    Explanation
    Postpartum women often experience vaginal dryness due to hormonal changes. Estrogen cream is a recommended treatment as it helps to restore moisture and elasticity to the vaginal tissues. It is safe to use while breastfeeding and can provide relief from pain during intercourse. Applying hydrocortisone cream or petroleum jelly is not effective for treating vaginal dryness. Testosterone cream is not recommended for women as it can have masculinizing effects. Stopping breastfeeding is not necessary to address this issue.

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  • 24. 

    A 39-year-old G3P3 comes to see you on day 5 after a second repeat cesarean delivery. She is concerned because her incision has become very red and tender and pus started draining from a small opening in the inci- sion this morning. She has been experiencing general malaise and reports a fever of 38.8°C (102°F). Physical examination indicates that the Pfan- nenstiel incision is indeed erythematous and is open about 1 cm at the left corner, and is draining a small amount of purulent liquid. There is tender- ness along the wound edges. Which of the following is the best next step in the management of this patient?

    • A. Apply Steri-Strips to close the wound

    • B. Administer antifungal medication

    • C. Probe the fascia

    • D. Take the patient to the OR for debridement and closure of the skin

    • E. Reapproximate the wound edge under local analgesia

    Correct Answer
    A. C. Probe the fascia
    Explanation
    The patient's symptoms of redness, tenderness, purulent drainage, malaise, and fever suggest an infection at the incision site. The best next step in management would be to probe the fascia to assess the depth and extent of the infection. This will help determine the appropriate course of action, such as initiating antibiotics, wound care, or surgical intervention. Applying Steri-Strips, administering antifungal medication, or reapproximating the wound edge would not address the underlying infection. Taking the patient to the operating room for debridement and closure of the skin may be necessary if the infection is severe or extensive.

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  • 25. 

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

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

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

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

    • 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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  • 26. 

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

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

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

    Correct Answer
    A. 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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  • 27. 

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

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

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

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

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

    Correct Answer
    A. 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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  • 28. 

    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. Succenturiate placenta

    • B. Vasa previa

    • C. Placenta previa

    • D. Membranaceous placenta

    • E. Placenta accreta

    Correct Answer
    A. 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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  • 29. 

    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. Transverse lie

    • B. Mentum transverse position

    • C. Occiput transverse position

    • D. Brow presentation

    • E. Vertex presentation

    Correct Answer
    A. 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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  • 30. 

    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. Round ligament pain

    • B. Appendicitis

    • C. Preterm labor

    • D. Kidney stone

    • 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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  • 31. 

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

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

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

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

    • 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
    A. 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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  • 32. 

    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. February 10 of the next year

    • B. February 14 of the next year

    • C. December 10 of the same year

    • D. December 14 of the same year

    • E. December 21of the same year

    Correct Answer
    A. 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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  • 33. 

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

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

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

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

    Correct Answer
    A. 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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  • 34. 

    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. Send her to labor and delivery for a BPP.

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

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

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

    • E. Admit her to the hospital for cesarean delivery.

    Correct Answer
    A. 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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  • 35. 

    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. Desire for sterilization

    • B. Development of disseminated intravascular coagulopathy (DIC)

    • C. Placenta accreta

    • D. Prior vaginal delivery

    • E. Smoking

    Correct Answer
    A. 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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  • 36. 

    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. Hyperglycemia

    • B. Fever

    • C. Hypertension

    • D. Anemia

    • E. Hypoxia

    Correct Answer
    A. 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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  • 37. 

    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. Preeclampsia

    • B. Chronic hypertension

    • C. Chronic hypertension with superimposed preeclampsia

    • D. Eclampsia

    • E. Gestational hypertension

    Correct Answer
    A. 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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  • 38. 

    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. Hydralazine

    • B. Magnesium sulfate

    • C. Labetalol

    • D. Pitocin

    • E. Nifedipine

    Correct Answer
    A. 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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  • 39. 

    A 22-year-old G1 at 14 weeks gestation presents to your office with a history of recent exposure to her 3-year-old nephew who had a rubella viral infection. In which time period does maternal infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?

    • A. Preconception

    • B. First trimester

    • C. Second trimester

    • D. Third trimester

    • E. Postpartum

    Correct Answer
    A. B. First trimester
    Explanation
    Maternal infection with rubella virus during the first trimester carries the greatest risk for congenital rubella syndrome in the fetus. This is because organogenesis, the formation of organs and major structures, occurs during this time period. Rubella virus can cause significant damage to the developing fetus, leading to a variety of birth defects including hearing loss, heart abnormalities, and vision problems. Therefore, it is crucial for pregnant women to be vaccinated against rubella and to avoid contact with individuals who have active rubella infections, especially during the first trimester.

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  • 40. 

    Appears to lengthen the second stage of labor. Match above description with the most appropriate type of obstetric anesthesia.

    • A. Paracervical block

    • B. Pudendal block

    • C. Spinal block

    • D. Epidural block

    Correct Answer
    A. C. Spinal block
    Explanation
    A spinal block is the most appropriate type of obstetric anesthesia in this scenario because it appears to lengthen the second stage of labor. A spinal block is a type of regional anesthesia that is administered into the spinal fluid, numbing the lower half of the body. This can help to alleviate pain and discomfort during labor, but it may also affect the progress of labor by reducing the ability to push effectively, thus potentially lengthening the second stage.

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  • 41. 

    Following a vaginal delivery, a woman develops a fever, lower abdom- inal pain, and uterine tenderness. She is alert, and her blood pressure and urine output are good. Large gram-positive rods suggestive of clostridia are seen in a smear of the cervix. Which of the following is most closely tied to a decision to proceed with hysterectomy?

    • A. Close observation for renal failure or hemolysis

    • B. Immediate radiographic examination for hydrosalpinx

    • C. High-dose antibiotic therapy

    • D. Fever of 103°F

    • E. Gas gangrene

    Correct Answer
    A. E. Gas gangrene
    Explanation
    Following a vaginal delivery, the presence of large gram-positive rods suggestive of clostridia in a smear of the cervix indicates a potential infection with gas gangrene. Gas gangrene is a serious and life-threatening condition caused by Clostridium bacteria, which can rapidly spread and cause tissue destruction. Given the symptoms of fever, lower abdominal pain, and uterine tenderness, along with the presence of gas gangrene, the most appropriate course of action would be to proceed with a hysterectomy to remove the infected uterus and prevent further complications. Close observation for renal failure or hemolysis, immediate radiographic examination for hydrosalpinx, high-dose antibiotic therapy, and fever alone would not address the underlying infection and its potential complications.

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  • 42. 

    You are counseling a new mother and father on the risks and benefits of circumcision for their 1-day-old son. The parents ask if you will use analgesia during the circumcision. What do you tell them regarding the recommendations for administering pain medicine for circumcisions?

    • A. Analgesia is not recommended because there is no evidence that newborns      undergoing circumcision experience pain.

    • B. Analgesia is not recommended because it is unsafe in newborns.

    • C. Analgesia in the form of oral Tylenol is the pain medicine of choice recom-       mended for circumcisions.

    • D. Analgesia in the form of a penile block is recommended.

    • E. The administration of sugar orally during the procedure will keep the neonate       preoccupied and happy.

    Correct Answer
    A. D. Analgesia in the form of a penile block is recommended.
    Explanation
    The correct answer is D. Analgesia in the form of a penile block is recommended. This option is the most appropriate because it acknowledges the need for pain relief during circumcision and suggests the use of a penile block, which is a common method of providing local anesthesia to reduce pain and discomfort. It is important to address the parents' concerns about pain management for their newborn son, and recommending a penile block aligns with current medical guidelines for circumcision procedures.

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  • 43. 

    You are asked to assist in the well-born nursery with neonatal care. Which of the following is a part of routine care in a healthy infant?

    • A. Administration of ceftriaxone cream to the eyes for prophylaxis for       gonorrhea and chlamydia

    • B. Administration of vitamin A to prevent bleeding problems

    • C. Administration of hepatitis B vaccination for routine immunization

    • D. Cool-water bath to remove vernix

    • E. Placement of a computer chip in left buttock for identification purposes

    Correct Answer
    A. C. Administration of hepatitis B vaccination for routine immunization
    Explanation
    Routine care for a healthy infant includes the administration of hepatitis B vaccination for routine immunization. This vaccination is recommended for all infants to protect against hepatitis B virus infection. It is typically given within the first 24 hours after birth. The other options listed are not part of routine care for a healthy infant. Administration of ceftriaxone cream to the eyes is done to prevent eye infections caused by gonorrhea and chlamydia in newborns born to mothers with these infections. Administration of vitamin A is not a routine practice for healthy infants, and a cool-water bath to remove vernix is not necessary as vernix is a protective substance on the baby's skin. Placement of a computer chip for identification purposes is not a routine practice in neonatal care.

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  • 44. 

    A 22-year-old G1P1 who is postpartum day 2 and is bottle-feeding complains that her breasts are very engorged and tender. She wants you to give her something to make the engorgement go away. Which of the following is recommended to relieve her symptoms?

    • A. Breast binder

    • B. Bromocriptine

    • C. Estrogen-containing contraceptive pills

    • D. Pump her breasts

    • E. Use oral antibiotics

    Correct Answer
    A. A. Breast binder
    Explanation
    A breast binder is recommended to relieve the symptoms of engorgement in a postpartum woman who is bottle-feeding. A breast binder helps to provide support and compression to the breasts, which can help reduce engorgement and provide relief. This can be especially helpful for women who are not breastfeeding and need to suppress milk production. Bromocriptine is a medication used to suppress lactation but is not recommended as a first-line treatment for engorgement. Estrogen-containing contraceptive pills can increase the risk of blood clots and are not typically used for engorgement. Pumping breasts can help relieve engorgement, but may also stimulate more milk production. Oral antibiotics are not indicated for engorgement unless there is an underlying infection.

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  • 45. 

    A 25-year-old G1P1 comes to see you 6 weeks after an uncompli- cated vaginal delivery for a routine postpartum examination. She denies any problems and has been breast-feeding her newborn without any diffi- culties since leaving the hospital. During the bimanual examination, you note that her uterus is irregular, firm, nontender, and about a 15-week size. Which of the following is the most likely etiology for this enlarged uterus?

    • A. Subinvolution of the uterus

    • B. The uterus is appropriate size for 6 weeks postpartum

    • C. Fibroid uterus

    • D. Adenomyosis

    • E. Endometritis

    Correct Answer
    A. C. Fibroid uterus
    Explanation
    The most likely explanation for the enlarged uterus in this patient is a fibroid uterus. Fibroids are benign tumors that can cause uterine enlargement. The patient's symptoms and physical examination findings are consistent with this diagnosis. Subinvolution of the uterus, which is the failure of the uterus to return to its normal size after delivery, would typically present with a boggy, tender uterus. The uterus is not expected to be at a 15-week size 6 weeks postpartum, so option B is incorrect. Adenomyosis, which is the presence of endometrial tissue within the muscular wall of the uterus, would typically present with dysmenorrhea and an enlarged, boggy uterus. Endometritis, which is inflammation of the endometrium, would typically present with fever and uterine tenderness.

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  • 46. 

    A 30-year-old G3P3 is postoperative day 4 after a repeat cesarean delivery. During the surgery she received 2 units of packed red blood cells for a hemorrhage related to uterine atony. She is to be discharged home today. She complains of some yellowish drainage from her incision and redness that just started earlier in the day. She states that she feels feverish. She is breast-feeding. Her past medical history is significant for type 2 dia- betes mellitus and chronic hypertension. She weighs 110 kg. Her vital signs are temperature 37.8°C (100.1°F), pulse 69 beats per minute, respi- ratory rate 18 breaths per minute, and blood pressure is 143/92 mm Hg. Breast, lung, and cardiac examinations are normal. Her midline vertical skin incision is erythematous and has a foul-smelling purulent discharge from the lower segment of the wound. It is tender to touch. The uterine fundus is not tender. Which of the following is not a risk factor for her condition?

    • A. Diabetes

    • B. Corticosteroid therapy

    • C. Preoperative antibiotic administration

    • D. Anemia

    • E. Obesity

    Correct Answer
    A. C. Preoperative antibiotic administration
    Explanation
    The patient is presenting with signs and symptoms of a wound infection, including erythema, purulent discharge, tenderness, and fever. Risk factors for wound infection include diabetes, corticosteroid therapy, anemia, and obesity. However, preoperative antibiotic administration is not a risk factor for wound infection. In fact, it is a preventive measure that is commonly done to reduce the risk of surgical site infections. Therefore, the correct answer is C. Preoperative antibiotic administration.

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  • 47. 

    You are following up on the results of routine testing of a 68-year-old G4P3 for her well-woman examination. Her physical examination was nor- mal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram was normal, lipid profile was normal, and the urinalysis shows hematuria. Which of the following is the most appropriate next step in the management of this patient?

    • A. Colposcopy

    • B. Endometrial biopsy

    • C. Renal sonogram

    • D. Urine culture

    • E. No further treatment/evaluation is necessary if the patient is asymptomatic.

    Correct Answer
    A. D. Urine culture
    Explanation
    The patient's urinalysis shows hematuria, which indicates the presence of blood in the urine. The most appropriate next step in the management of this patient would be to perform a urine culture. This will help identify any potential infection that may be causing the hematuria. It is important to rule out urinary tract infection as a possible cause before considering other options.

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  • 48. 

    A 74-year-old woman presents to your office for well-woman exam- ination. Her last Pap smear and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and denies alcohol use. Based on this patient’s history which of the following medical conditions should be this patient’s biggest concern?

    • A. Alzheimer disease

    • B. Breast cancer

    • C. Cerebrovascular disease

    • D. Heart disease

    • E. Lung cancer

    Correct Answer
    A. D. Heart disease
    Explanation
    Based on the patient's history, her biggest concern should be heart disease. This is because she has hypertension, high cholesterol, and a history of smoking. These risk factors increase her chances of developing heart disease, which is a leading cause of morbidity and mortality in older adults. The other options, such as Alzheimer's disease, breast cancer, cerebrovascular disease, and lung cancer, may also be concerns but are not as directly related to her specific risk factors.

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  • 49. 

    A married 41-year-old G5P3114 presents to your office for a routine examination. She reports being healthy except for a history of migraine headaches. All her Pap smears have been normal. She developed gestational diabetes in her last pregnancy. She drinks alcohol socially, and admits to smoking occasionally. Her grandmother was diagnosed with ovarian cancer when she was in her fifties. Her blood pressure is 140/90 mm Hg; height is 5 ft 5 in; weight is 150 lb. Which of the following is the most common cause of death in women of this patient’s age?

    • A. HIV

    • B. Cardiac disease

    • C. Accidents

    • D. Suicide

    • E. Cancer

    Correct Answer
    A. E. Cancer
    Explanation
    The most common cause of death in women of this patient's age is cancer. This patient has multiple risk factors for cancer, including a family history of ovarian cancer and a history of gestational diabetes. Additionally, her age and gender put her at higher risk for certain types of cancer, such as breast and ovarian cancer. The other options, HIV, cardiac disease, accidents, and suicide, are less likely to be the most common cause of death in this patient's age group.

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