FiltersDone

Question type

Essay

Multiple Choice

Short Answer

True False

Matching

Exam 5: Obstetrics & Gynecology

Show Answer

Share

---

All types

Filters

Study FlashcardsPractice ExamLearn

Question 31

Multiple Choice

Review LaterAdd Note

Review Later

A 30-year-old woman, gravida 1 para 0, is admitted to the hospital in active labor and undergoes a forceps-assisted vaginal delivery due to recurrent late fetal heart rate decelerations.  The patient delivers a 4.2 kg (9.3 lb) infant with Apgar scores of 7 and 9 at 1 and 5 minutes, respectively.  An hour after delivery, the patient begins to feel dizzy and lightheaded.  She has no chest pain or shortness of breath and has had no loss of consciousness.  Temperature is 37.2 C (99 F) , blood pressure is 90/50 mm Hg, and pulse is 120/min.  The patient appears pale and is diaphoretic.  Cardiac examination shows sinus tachycardia but no rubs or murmurs.  The lungs are clear to auscultation.  The uterus is firm, nontender, and palpable at the umbilicus.  On pelvic examination, there is minimal blood on the perineal pad.  A large, purple mass protrudes medially into the vagina.  Which of the following is the most likely diagnosis in this patient?

A) Amniotic fluid embolism
B) Cervical laceration
C) Retained placenta
D) Uterine inversion
E) Uterine rupture
F) Vaginal hematoma

G) A) and D)
H) A) and E)

Correct Answer

verified

Show Answer

Question 32

Multiple Choice

Review LaterAdd Note

Review Later

A 36-year-old woman comes to the office due to vaginal spotting for the past 4 days.  The patient has a history of heavy menstrual bleeding for which she had a progestin-containing intrauterine device placed 3 years ago.  She has been amenorrhoeic for the past 2 years but started having vaginal spotting a few days ago and some mild pelvic cramping.  The patient has no significant medical history and has never been pregnant.  She has no prior sexually transmitted infections.  BMI is 30 kg/m².  Temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, pulse is 80/min, and respirations are 18/min.  Physical examination shows right adnexal tenderness and a closed cervix.  Urine pregnancy test is positive.  Transabdominal ultrasound shows a small uterus with a thin endometrium and an intrauterine device in place.  Which of the following is the best next step in management of this patient?

A) Diagnostic laparoscopy
B) Endometrial biopsy
C) FSH, TSH, and prolactin levels
D) Intrauterine device removal
E) Transvaginal ultrasound

F) D) and E)
G) B) and D)

Correct Answer

verified

Show Answer

Question 33

Multiple Choice

Review LaterAdd Note

A 32-year-old woman, gravida 4 para 4, comes to the office for a routine checkup 6 weeks after an uncomplicated vaginal delivery of a healthy boy.  The patient has no concerns and would like to discuss contraception options.  She heard from a friend that some options can make losing weight challenging.  Prior to this pregnancy, the patient had a history of increasingly heavy menses and was found to be mildly anemic.  Iron was prescribed, but she often forgot to take it; she often forgot her prenatal vitamins too.  The patient is breastfeeding exclusively.  Pelvic examination shows a small, mobile uterus with no abnormalities.  Breast examination shows no masses, tenderness, or nipple injury.  Which of the following is the preferred method of contraception for this patient?

A 29-year-old nulligravid woman comes to the office because she has not menstruated since stopping her birth control.  Menarche was at age 14, and she had irregular, heavy menstrual periods from age 14-16.  The patient then took combination oral contraceptives until 6 months ago.  Since stopping her medication, she has had more frequent headaches and increasing acne but has had no weight changes, pelvic pain, or abnormal hair loss or growth.  The patient is a high school teacher and coaches the cross-country and track teams.  She runs recreationally and eats a well-balanced diet.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs are normal and BMI is 22 kg/m².  A few open comedones are seen on the forehead.  The remainder of the physical examination, including pelvic examination, is normal.  Urine pregnancy test is negative and pelvic ultrasound is normal.  Which of the following is the best next step in evaluation of this patient?

A 32-year-old woman comes to the emergency department due to abdominal pain and nausea that began 2 days earlier but has become increasingly severe over the last 3 hours.  The patient has passed several vaginal blood clots in the last hour.  She has a history of irregular menstrual cycles and is not sure of the date of her last period.  She was diagnosed with a bicornuate uterus 2 years ago during an infertility evaluation.  The patient has no other medical conditions and has had no surgeries.  BMI is 28 kg/m².  Blood pressure is 90/56 mm Hg and pulse is 120/min.  Abdominal examination shows guarding with decreased bowel sounds.  Speculum examination shows moderate bleeding with clots from the cervix.  A urine pregnancy test is positive.  Transvaginal ultrasound reveals a gestational sac at the upper left uterine cornu and free fluid in the posterior cul-de-sac of the pelvis.  Which of the following is the best next step in management of this patient?

A 29-year-old woman comes to the emergency department due to fever, chills, and lower abdominal pain.  Two days ago, the patient underwent dilation and curettage for a 9-week missed abortion.  After the procedure, she initially had light spotting, but the bleeding has become increasingly heavy and malodorous within the last few hours.  She has also developed increasing abdominal pain and a fever unrelieved by acetaminophen.  The patient has no chronic medical conditions and has had no other surgeries.  Temperature is 39.4 C (103 F) , blood pressure is 88/50 mm Hg, and pulse is 118/min.  On speculum examination, the cervix is visibly 1 cm dilated and has purulent discharge at the os.  The uterus is enlarged and has cervical motion tenderness.  Transvaginal ultrasound shows a thickened endometrial stripe.  Urine pregnancy test is positive.  The patient is started on broad-spectrum intravenous antibiotics and undergoes a suction dilation and sharp curettage.  This patient is at increased risk for which of the following conditions?

A 36-year-old woman, gravida 1 para 0, at 26 weeks gestation comes to the office for routine prenatal care.  The patient reports good fetal movement and has no concerns.  She initiated prenatal care at 12 weeks gestation and an ultrasound at that time was consistent with her last menstrual period.  She declined all genetic testing.  Anatomy ultrasound performed at 19 weeks revealed an estimated fetal weight consistent with 18 weeks gestation and an atrial septal defect.  The patient has a history of depression for which she takes citalopram.  She quit smoking cigarettes prior to conception and does not use alcohol or illicit drugs.  Prepregnancy BMI was 23 kg/m² and her weight gain has been appropriate.  Blood pressure is 138/89 mm Hg.  Fundal height is 22 cm and fetal heart tones are heard by Doppler.  An ultrasound reveals fetal head circumference, abdominal circumference, and estimated fetal weight at the 4th percentile.  Normal amniotic fluid level and a fundal placenta are present.  A biophysical profile is 8/8.  Umbilical artery Dopplers are normal.  Which of the following is the most likely cause of these fetal findings?

A 31-year-old woman, gravida 1 para 0, at 28 weeks gestation comes to the office for an initial prenatal visit.  The patient reports fatigue but otherwise feels well.  She has no contractions, vaginal bleeding, or leakage of vaginal fluid.  Fetal movement is normal.  The patient had a vaginal yeast infection 6 weeks ago that she treated with an over-the-counter suppository.  Her only other medication is a prenatal vitamin.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 37.2 C (99 F) and blood pressure is 100/70 mm Hg.  BMI is 24 kg/m².  Fetal heart rate is 155/min on Doppler ultrasound.  Fundal height is appropriate for gestational age.  A 1-hour, 50-g oral glucose challenge test reveals a blood glucose level of 120 mg/dL (normal: <140 mg/dL) .  A urine culture grows >100,000 colony-forming units/mL of Escherichia coli.  If left untreated, this patient is at greatest risk for which of the following complications?

A 28-year-old woman comes to the office for evaluation of nipple discharge.  The patient has had bilateral yellow nipple discharge for the past month.  She has gained 5 lb (2.3 kg) in the past year.  The patient has had no missed menses, and her last menstrual period was 2 weeks ago.  She takes sertraline for anxiety and depression.  The patient's mother had breast cancer at age 59.  She does not use tobacco, alcohol, or illicit drugs.  BMI is 29 kg/m².  Blood pressure is 122/74 mm Hg and pulse is 78 /min.  On examination, there is dense breast tissue with no palpable dominant masses.  The breasts are nontender and the nipples have bilateral white-yellow crusting.  There is no axillary or clavicular lymphadenopathy.  The remainder of the physical examination is unremarkable.  Urine pregnancy test is negative.  Laboratory results are as follows: Which of the following is the best next step in management of this patient?

A 24-year-old woman, gravida 2 para 0 aborta 1, at 26 weeks gestation comes to the office for an initial prenatal visit.  Prior to this, the patient's only prenatal care was a visit to the emergency department due to 2 days of persistent vomiting.  At that time, a first trimester ultrasound was performed and was consistent with gestational age.  Her previous pregnancy was a spontaneous abortion at 8 weeks gestation.  Blood pressure is 120/70 mm Hg and pulse is 72/min.  Fundal height is 32 cm.  Maternal blood type is O, Rh negative.  Indirect Coombs test is negative.  Transabdominal ultrasound shows a female fetus with a biparietal diameter and head circumference that are consistent with 26 weeks gestation.  Abdominal circumference measures at 34 weeks gestation.  Fetal heart rate is 180/min.  A pericardial effusion, bilateral pleural effusions, and polyhydramnios are noted.  Which of the following factors most likely contributed to this fetal presentation?

A 33-year-old woman, gravida 3 para 2, at 31 weeks gestation comes to the emergency department due to fever, nausea, vomiting, and right flank pain.  The patient has no chronic medical conditions and her pregnancy has been uncomplicated.  She is admitted to the hospital for acute pyelonephritis and started on intravenous ceftriaxone.  Forty-eight hours later, the patient feels better and has become afebrile.  She is able to eat a normal diet and has had no nausea or vomiting for the past day.  Current temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, and pulse is 76/min.  Fetal heart tones are 130/min.  The abdomen is nontender and there is no costovertebral angle tenderness.  Urine culture from the day of hospital admission grows Escherichia coli with the following sensitivities: Which of the following is the most appropriate oral antibiotic therapy for this patient at this time?

A 19-year-old nulligravid woman comes to the office for a routine checkup.  She is concerned about having gained 4.5 kg (10 lb) over the last year and believes it is related to her oral contraceptive pills.  The patient takes low-dose ethinyl estradiol/norethindrone daily.  Prior to starting the pills, she had regular, heavy periods lasting 4-5 days.  The patient missed school every month due to severe cramping on the first day of her period.  Her pain symptoms resolved after 3 months on the pills.  She takes no other medications.  Coitarche was at age 18 and she has had 2 partners since then.  The patient and her current partner use condoms inconsistently.  Vital signs are normal.  Her BMI is 27 kg/m².  Physical examination is unremarkable.  Which of the following is the most appropriate advice for this patient?

A 35-year-old woman, gravida 4 para 3, at 37 weeks gestation comes to the hospital due to leakage of fluid and painful contractions.  The patient has had continuous vaginal leakage of clear fluid for the past 2 days and now the fluid appears green.  Her prior 3 pregnancies were uncomplicated term vaginal deliveries, and she has not received prenatal care with this pregnancy.  The patient has no chronic medical conditions and no known drug allergies.  Temperature is 36.1 C (97 F) , blood pressure is 120/80 mm Hg, and pulse is 76/min.  Speculum examination shows a pool of meconium-stained fluid in the posterior fornix of the vagina.  The cervix is 6 cm dilated, 60% effaced, and the fetal vertex is at +1 station.  Fetal heart tracing reveals moderate variability and early decelerations with each contraction.  Contractions occur every 2-3 minutes.  Which of the following is the best next step in management of this patient?

A 36-year-old woman, gravida 1 para 0, at 32 weeks gestation comes to the emergency department due to right upper quadrant pain.  For the past week, the patient has had intermittent right upper quadrant pain that radiates to the back and resolves within a few hours.  The pain has become progressively worse and is now occurring multiple times a day.  She has also had increasing dyspnea and fatigue but has had no fever, cough, or headaches.  The patient has no chronic medical conditions and has had no surgeries.  Temperature is 36.7 C (98 F) , blood pressure is 136/84 mm Hg, and pulse is 88/min.  BMI is 40 kg/m².  Fetal heart rate tracing shows a baseline of 150/min with moderate variability and no decelerations.  Cardiac examination reveals a 2/6 midsystolic murmur.  The lungs are clear bilaterally.  There is tenderness to deep palpation in the right upper quadrant and epigastrium but no palpable mass.  The uterus is nontender.  Bilateral lower extremities have 1+ pitting edema to the midcalves.  Which of the following is the most likely cause of this patient's symptoms?

A 24-year-old woman, gravida 1 para 0, at 31 weeks gestation comes to urgent care due to a rash on her back.  Her mother first noticed a small rash on the patient's back a week ago, and it has spread despite the use of a topical cream.  The patient has had no prenatal care.  Vital signs are normal.  Fetal heart rate is 150 /min.  Fundal height is 28 cm.  The rash extends across her trunk and extremities, including the palms of the hands and the soles of the feet.  The lesions do not bleed, and there are no excoriations.  The rash is seen in the image below: Which of the following is the most likely diagnosis in this patient?

A 29-year-old primigravida at 12 weeks gestation comes to the office for a prenatal visit.  The patient feels some pelvic pressure but has no vaginal bleeding or discharge.  She completed a course of antibiotics at 10 weeks gestation after a urine culture grew ≥100,000 colony-forming units of Escherichia coli.  The patient has had some urinary frequency but no dysuria, urgency, or hematuria.  She has no chronic medical conditions and has had no surgeries.  Temperature is 98.6 F (37 C) , blood pressure is 96/68 mm Hg, and pulse is 90/min.  Fetal heart rate is 170/min on Doppler ultrasound.  The uterus is nontender and palpable just above the pubic symphysis.  Which of the following is the best next step in management of this patient?

A 27-year-old woman, gravida 2 para 1, at 37 weeks gestation is admitted to the labor and delivery unit in active labor.  The patient has had no vaginal bleeding or leakage of fluid.  She has no chronic medical conditions but has not received prenatal care during this pregnancy.  Her only surgery was a prior cesarean delivery for an uncomplicated twin gestation at term.  Temperature is 36.7 C (98 F) , blood pressure is 120/70 mm Hg, and pulse is 88/min.  Ultrasound reveals an anterior placenta and a breech fetus with a heart rate of 140/min.  The patient undergoes a repeat cesarean delivery.  After delivery of the infant, there is moderate bleeding from the uterine hysterotomy site.  The uterine fundus is firm, and the placenta cannot be removed due to dense adhesions to the anterior uterine wall.  Vital signs are repeated, and temperature is 36.7 C (98 F) , blood pressure is 114/66 mm Hg, and pulse is 83/min.  Which of the following is the best next step in management for this patient?

A 33-year-old woman comes to the office due to new-onset pain with intercourse.  The patient has been in a relationship with a male partner for the past 6 months and is using condoms for contraception.  For the past 3 months, she has had worsening dyspareunia and vaginal dryness, which has made her limit sexual activity despite no changes in libido.  She has had 6 lifetime partners and has not had this problem before.  The patient has had no postcoital spotting or abnormal vaginal discharge.  Family history is significant for a sister with infertility due to 45,X mosaicism.  Vital signs are normal.  Bilateral breasts are atrophic.  On pelvic examination, the vulvae are pale and thin, and the clitoris protrudes from the clitoral hood.  There is no tenderness to palpation over the perineum.  The vagina has minimal rugation, and a large, mildly tender adnexal mass is palpated.  Pregnancy test is negative.  Pelvic ultrasound reveals a 9-cm, solid adnexal mass.  Which of the following is the most likely etiology of this patient's presentation?

A 36-year-old primigravida at 26 weeks gestation comes to the office for evaluation of painful urination.  She has had urinary frequency since her first month of pregnancy, but a week ago she developed dysuria.  The patient has also had chills and fatigue for the past 2 days.  She has intermittent, nonpainful contractions but no vaginal bleeding or leakage of fluid.  Fetal movement is normal.  Three years ago, the patient was treated for pyelonephritis.  She has no chronic medical conditions and has had no surgeries.  Temperature is 100.4 F (38 C) , blood pressure is 110/60 mm Hg, and pulse is 110/min.  Fundal height is 26 cm and fetal heart tones are 170/min.  There is tenderness over the right costovertebral angle.  The uterus is nontender and the cervix is closed.  Urinalysis is positive for leukocyte esterase and blood; a urine culture is collected.  Which of the following is the best next step in management of this patient?

A 41-year-old woman comes to the office for evaluation of nipple discharge.  The patient has had 2 episodes of blood-tinged discharge from the right breast over the last 2 weeks.  She has no associated breast pain, palpable masses, or trauma.  On review of systems, the patient has had a slightly increased number of headaches; she takes ibuprofen at least twice a week for them.  She has no chronic medical conditions.  The patient takes combined estrogen/progestin oral contraceptives, and her last menstrual period was 2 weeks ago.  There is no family history of breast, endometrial, or colorectal cancer.  Vital signs are normal.  Examination of the right breast shows no palpable masses, skin changes, or lymph node enlargement.  There is scant discharge, which is guaiac positive, from the right nipple.  Examination of the left breast is normal.  Mammography is normal.  Which of the following is the best next step in management of this patient?