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Procedures (2)
Medical Conditions in Pregnancy (2)
Heart and Lungs (related to OB of course)
Counseling
Miscellaneous
100
41 yr old G1 at 36wks comes in for routine visit. She conceived with IVF. Ultrasounds have shown normal growth and anatomy. She desires a cesarean delivery although she has no medical indication and would like a BTL at the time. You inform her that compared with planned vaginal delivery, planned cesarean delivery is associated with higher risk of A)PPH B)longer hospital stay C)urinary incontinence D) sexual dysfunction E)neonatal mortality
What is B) longer hospital stay
100
24 year old G1 had a successful Roux-en-Y gastric bypass surgery approximately 2 years ago. Her BMI is 24. She comes to your office for prenatal counseling on pregnancy complications associated with gastric bypass. You tell her the most likely pregnancy complication for gastric bypass surgery A)GDM B)Gestational HTN C)macrosomia D)cesarean delivery E)vitamin deficiency
What is E)vitamin deficiency
100
28 year old G2P1 at 32 wks has been admitted to the hospital and is on bed rest for PTL for 2 weeks. She develops sudden onset of SOB and chest pain. RR is 36. ABG shows PO2 of 52. The best diagnosistic test for her condition is A)D-dimer B)EKG C)spiral CT D)pulmonary angiography E)chest radiography
What is C)spiral CT
100
23 year old African American G1 comes to the office at 9wks for her first prenatal visit. With regard to screening her for cystic fibrosis, the most appropriate recommendation is that carrier testing should A)not be offered B) be offered C)be offered only if there is positive family history D)be offered only in the presence of an abnormal fetal US
What is B) be offered
100
A healthy primigravid African-American woman comes to the office for PNC. IN addition to doing a CBC, the best test to screen for hemoglobinopathies is A)solubility test for hemoglobin S B)high-performance liquid chromatography to detect abnormal hemoglobin C)hemoglobin electrophoresis D)DNA-based test for hemoglobin chain gene deletions
What is C)hemoglobin electrophoresis
200
25 year old has a normal labor and a SVD of the fetal head. On expulsion of the head, a shoulder dystocia is recognized. Before instituting manuevers, the next step is to: A) Tell the patient not to push B)apply fundal pressure C)increase or initiate oxytocin D)cut a large episiotomy
What is A) Tell the patient not to push
200
26 year old G3P1 at 28.6 reports abdominal pain x 12hrs. She reports nausea and emesis x2. Her POBHx is significant for c-section at term for transverse position. Vitals: BP 98/56, P 92, T 98.9. PE significant for diffuse abd pain with rebound and guarding especially in right mid to lower quadrant. EFM shows 165 baseline, reassuring. US reveals vtx presentation, AFI 9cm. UA negative for glucose, protein, blood. HCT 38 WBC, 16 with 84% neutrophils. The most likely diagnosis is: A) uterine rupture B)renal stones C)abruption D)appendicitis E) diverticulitis
What is D)appendicitis
200
28 year old with PMHx of mild intermittent asthma presents at 24 wks with increasing SOB over the past 3 weeks. She currently needs to use her abluterol metered dose inhaler two or three times per day. She does not report fever, productive cough or malaise. The best treatment strategy for improving her asthma control is to A)increase the albuterol dose B)change to a low-dose inhaled corticosteroid C)add inhaled cromolyn sodium D)add a leukotriene receptor antagonist E)add theophylline
What is B)change to a low-dose inhaled corticosteroid
200
44 year old G1 at 8wks comes for first prenatal visit and inquires about risks to her pregnancy. You tell her that there are genetic risks associated with AMA. You inform her that in addition to the increased risk of csection, PreE, GDM, and placenta previa, her age puts her at increased risk for A)midtrimester loss B)postterm pregnancy C)stillbirth D)postpartum depression
What is C)stillbirth
200
28 year old G1 at 38 wks of gestation is in teh first hour of the second stage of labor. Uterine contractions occur every 3 minutes, lasting 50 seconds. You note mild variable decelerations, minimal variability, a baseline FHR of 170 and accelerations. Usually, a fetal cord pH of 7.2 or more is assured due to the presence of A) accelerations B) variable decelerations C)minimal variability D) baseline FHR of 170
What is A)accelerations
300
A G1 in labor with EFW of 3600g has been pushing for 3 hours. She has adequate epidural analgesia. Her bony pelvis is felt to be adequate and bony part of the head is at +4 station, OA. The fetal heart tracing which previously was Category 1 has begun to show significant variable decelerations and minimal variability. The major reason to perform an episiotomy in this patient is: A) it is routine intrapartum care B) to avoid a 3rd or 4th degree laceration C) to reduce the incidence of urinary or fecal incontinence D)to expedite delivery
What is D) to expedite delivery
300
One week after treatment for a UTI with nitrofurantoin, a 19 year old of mediterranean descent returns to your office because she has been feeling week, dizzy and lightheaded and has back pain. She is at 22wks and on questioning, she recalls that she was instructed as a child to avoid eating fava beans. A CBC was sent with hemoglobin at 6.0. The test that is most diagnostic is to to obtain a: A) G6PD enzyme activity level B)reticulocyte count C)prothrombin time D)ferritin E)hemoglobin electrophoresis
What is A) G6PD enzyme activity level
300
33 year old G4P3 at 22wks with a 4-day history of fever, shaking chills, and cough productive of yellow sputum. She has a 12-pack-per-year smoking history and has chronic active hepatitis C. A cxray shows scattered bibasilar infiltrates. The patient is admitted to the hospital. The initial antibiotic treatment should be IV: A)ceftriaxone and azithromycin B)levofloxacin C)doxycycline D)clindamycin and vancomycin E)ampicillin
What is A)ceftriaxone and azithromycin
300
28 year old G2P1 at 20 wks reports spotting and no fetal movement. She has had a LTCS for FTP. On evaluation, no heart tones are found and US confirmed IUFD. YOu counsel the pt and because the cause of the demise is unknown, you suggest that autopsy would be desirable and pt agrees. When she asks about her options for terminating the pregnancy, you tell her that the best option is: A)await spontaneous labor B)intravaginal dinoprostone suppository C)misoprostol IOL D)hysterotomy E)IOL with pitocin
What is C)misoprostol IOL
300
The antepartum use of high-dose dexamethasone in the management of HELLP syndrome has been most consistently reported to A)hasten the rate of recovery B)increase the rate of regional anesthesia use C)reduce maternal mortality D)reduce the need for blood product transfusion
What is B)increase the rate of regional anesthesia use
400
40 year old G1 has been pushing adequately for 3 hrs. The vertex is at +5 station, OA. EFW 3629g and pelvis is adequate. The woman is exhausted and accepts operative delivery. In counseling regarding complications of forceps or vacuum, you advise that compared to vacuum, forceps delivery is associated with a higher incidence of A) maternal perineal laceration B) neonatal retinal hemorrhages C) shoulder dystocia D) PPH E)cephalohematoma
What is A) maternal perineal laceration
400
24 year old G1 seeks preconception counseling. She has a seizure disorder diagnosed in childhood and reports good control on lamotrigine. Her last seizure was 8 months ago. She is planning to attempt conception in teh next few months and wants to know if she should discontinue lamotrigine bc she has read it may harm the fetus. The best way to minimize risks to both mother and fetus is to: A)increase lamotrigine dose B)discontinue lamotrigine until after delivery C) add folic acid to current regimen D)add valproate sodium to current regimen E)add vitamin K to current regimen
What is C) add folic acid to current regimen
400
26 year old G2P1 at 37 wks reported decreased FM. EFM showed FHR at 80 beats per minute. Pt was counseled and underwent emergency c-section. Uterine atony was treated with IM methergine. In recovery, the pt became dyspneic, O2sat 85% while on room air and cxray showed bilateral lower lobe infiltrates. The most likely predisposing factor in the development of this clinical picture is A)preoperative oral administration of sodium citrate B)rapid sequence induction of anesthesia C)cricoid pressure during intubation D)intraoperative administration of IM methergine E)extubation before full emergence from the anesthetic
What is E)extubation before full emergence from the anesthetic
400
20 year old G1P1 is seen postpartum after the delivery of a fetus with a meningomyelocele. You advice her that the best recommendation to reduce the risk of future NTD is to start folic acid A)4mg at 12wks B)0.4mg after she conceives C)4mg after she conceives D)4mg at least 1 month before planned conception E)0.4mg at least 1 month before planned conception
What is D)4mg at least 1 month before planned conception
400
32 year old G5P4 at 34 with twins is found to be 6cm dilated with twin A at +1 station. US shows that twin A is vertex and twin B is transverse. The patient is counseled and accepts vaginal breech extraction of twin B. The most important factor to consider in this case for breech extraction of twin B is: A)EGA B)parity C)perform US to estimate fetal weights D) need for oxytocin
What is C)perform US to estimate fetal weights
500
34 year old with BMI of 41 is scheduled a RLTCS. IN addition to preoperative antibiotics, the approach most likely to reduce her risk of postoperative wound infection is: A)interruped Smead Jones closure B)drain placement through the surgical site C)closure of the peritoneum D)subcutaneous tissue closure E)continuation of antibiotics postoperatively
What is D)subcutaneous tissue closure
500
32 yoear old G2P2 with known relapsing MS for 4 years was treated with natalizumab 1 year before her pregnancy and high-dose prednisone during the antenatal period to reduce the incidence of relapses. Acute stress steroids and epidural analgesia were administered. On PPD4, she reported gait instability, bladder incontinence, fatigue and double vision. VSS and labs showed normal electrolytes and normal CBC. The most likely diagnosis is: A)epidural toxicity B)postpartum psychosis C)natalizumab-induced progressive multifocal leukoencephalopathy D)MS flare E)adrenal insufficiency
What is D)MS flare
500
23 year old G1 with mitral valve prolapse is in active labor. An echo in the 1st trimester confirmed this diagnosis but showed no evidence of mitral regurgitation or leaflet thickening. The appropriate managment of this patient is: A)amp and gent B)vanc and gent C)cefazolin D)no prophylaxis
What is D)no prophylaxis
500
26 year old G1 at 39 wks comes into the office for routine visit. Her pregnancy has been uncomplicated and US reveals normal growth. Her cervix is long, uneffaced, undilated and firm. Fetal head is floating. Due to a recent change in her home situation, she requests to have her labor induced in the next 2 days. In counseling this pt regarding her risk of csection, you advise her that A)Elective IOL increases her risk B)pharmacologic methods of labor induction reduce her risk C)mechanical methods of cervical ripening reduce her risk d)her risk would be similar if she presented in spontaneous labor
What is A)Elective IOL increases her risk
500
36 year old multiparous woman who had a cesarean delivery 3 years ago was told not to avoid spontaneous labor in future pregnancies. She now is seen at 36 wks of gestation for an amniocentesis to assess fetal lung maturity prior to a planned cesarean delivery. An anterior placenta is encountered and the amniotic fluid sample is bloody. The most appropriate test to assess fetal pulmonary maturity is A)lecithin-sphingomyelin ratio B)phosphatidylglycerol C)foam stability test D)fluorescence polarization E)lamellar bodies
What is B)phosphatidylglycerol