1 set

Question 1

A 24-year-old primigravid woman, at term, has been in labor for 16 hours and has been dilated to 9 cm for 3 hours. The fetal vertex is in the right occiput posterior position, at +1 station, and molded. There have been mild late decelerations for the past 30 minutes. Twenty minutes ago, the fetal scalp pH was 7.27; it is now 7.20. What is the most appropriate procedure?
A. External version
B. Internal version
C. Midforceps rotation
D. Low transverse cesarean section
E. Classic cesarean section

Answer 1

D. Low transverse cesarean section

Question 2

A 34-year-old G3P2 delivers a baby by spontaneous vaginal delivery. She had scant prenatal care and no ultrasound, so she is anxious to know the sex of the baby. At first glance you notice female genitalia, but on closer examination the genitalia are ambiguous. Which of the following is the best next step in the evaluation of this infant?
A. Chromosomal analysis
B. Evaluation at 1 month of age
C. Pelvic ultrasound
D. Thorough physical examination
E. Laparotomy for gonadectomy

Answer 2

D. Thorough physical examination

Question 3

A pregnant woman who is 7 weeks from her LMP comes in to the office for her first prenatal visit. Her previous pregnancy ended in a missed abortion in the first trimester. The patient therefore is very anxious about the well-being of this pregnancy. Which of the following modalities will allow you to best document fetal heart action?
A. Regular stethoscope
B. Fetoscope
C. Special fetal Doppler equipment
D. Transvaginal sonogram
E. Transabdominal pelvic sonogram

Answer 3

D. Transvaginal sonogram

Question 4

A patient presents in labor at term. Clinical pelvimetry is performed. She has an oval-shaped pelvis with the anteroposterior diameter at the pelvic inlet greater than the transverse diameter. The baby is occiput posterior. The patient most likely has what kind of pelvis?
A. A gynecoid pelvis
B. An android pelvis
C. An anthropoid pelvis
D. A platypelloid pelvis
E. An androgenous pelvis

Answer 4

C. An anthropoid pelvis

Question 5

A 23-year-old G1 at 38 weeks gestation presents in active labor at 6 cm dilated with ruptured membranes. On cervical examination the fetal nose, eyes, and lips can be palpated. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. The patient’s pelvis is adequate. Which of the following is the most appropriate management for this patient?
A. Perform immediate cesarean section without labor.
B. Allow spontaneous labor with vaginal delivery.
C. Perform forceps rotation in the second stage of labor to convert mentum posterior to mentum anterior and to allow vaginal delivery.
D. Allow patient to labor spontaneously until complete cervical dilation is achieved and then perform an internal podalic version with breech extraction.
E. Attempt manual conversion of the face to vertex in the second stage of labor.

Answer 5

B. Allow spontaneous labor with vaginal delivery.

Question 6

Match this ethical concern or principal with the appropriate definition: giving the patient his or her due
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual issues
H. Justice

Answer 6

H. Justice

Question 7

A 23-year-old G2P2 requires a cesarean delivery for arrest of active phase. During labor she develops chorioamnionitis and is started on ampicillin and gentamicin. The antibiotics are continued after the cesarean delivery. On postoperative day 3, the patient remains febrile and symptomatic with uterine fundal tenderness. No masses are appreciated by pelvic examination. She is successfully breast-feeding and her breast examination is normal. Which antibiotic should be initiated to provide better coverage?
A. Cephalothin
B. Polymixin
C. Levofloxacin
D. Vancomycin
E. Clindamycin

Answer 7

E. Clindamycin

Question 8

What type of obstetric anesthesia may be complicated by profound hypotension?
A. Paracervical block
B. Pudendal block
C. Spinal block
D. Epidural block

Answer 8

C. Spinal block

Question 9

A 32-year-old G2P0101 presents to labor and delivery at 34 weeks of gestation, complaining of regular uterine contractions about every 5 minutes for the past several hours. She has also noticed the passage of a clear fluid per vagina. A nurse places the patient on an external fetal monitor and calls you to evaluate her status. The external fetal monitor demonstrates a reactive fetal heart rate tracing, with regular uterine contractions occurring about every 3 to 4 minutes. On sterile speculum examination, the cervix is visually closed. A sample of pooled amniotic fluid seen in the vaginal vault is fern and nitrazine-positive. The patient has a temperature of 38.8°C, pulse 102 beats per minute, blood pressure 100/60 mm Hg, and her fundus is tender to deep palpation. Her admission blood work comes back indicating a WBC of 19,000. The patient is very concerned because she had previously delivered a baby at 35 weeks who suffered from respiratory distress syndrome (RDS). You perform a bedside sonogram, which indicates oligohydramnios and a fetus whose size is appropriate for gestational age and with a cephalic presentation. Which of the following is the most appropriate next step in the management of this patient?
A. Administer betamethasone
B. Administer tocolytics
C. Place a cervical cerclage
D. Administer antibiotics
E. Perform emergent cesarean section

Answer 9

D. Administer antibiotics

Question 10

A 24-year-old woman appears at 8 weeks of pregnancy and reveals a history of pulmonary embolism 7 years ago during her first pregnancy. She was treated with intravenous heparin followed by several months of oral warfarin (Coumadin) and has had no further evidence of thromboembolic disease for more than 6 years. Which of the following statements about her current condition is true?
A. Having no evidence of disease for more than 5 years means that the risk of thromboembolism is not greater than normal.
B. Impedance plethysmography is not a useful study to evaluate for deep-venous thrombosis in pregnancy.
C. Doppler ultrasonography is not a useful technique to evaluate for deep-venous thrombosis in pregnancy.
D. The patient should be placed on low-dose heparin therapy throughout pregnancy and puerperium.
E. The patient is at highest risk for recurrent thromboembolism during the second trimester of pregnancy.

Answer 10

D. The patient should be placed on low-dose heparin therapy throughout pregnancy and puerperium.

Question 11

Your patient complains of decreased fetal movement at term. You recommend a modified BPP test. Nonstress testing (NST) in your office was reactive. The next part of the modified BPP is which of the following?
A. Contraction stress testing
B. Amniotic fluid index evaluation
C. Ultrasound assessment of fetal movement
D. Ultrasound assessment of fetal breathing movements
E. Ultrasound assessment of fetal tone

Answer 11

B. Amniotic fluid index evaluation

Question 12

You are called in to evaluate the heart of a 19-year-old primigravida at term. Listening carefully to the heart, you determine that there is a split S 1 , normal S 2, S 3 easily audible with a 2/6 systolic ejection murmur greater during inspiration, and a soft diastolic murmur. You immediately recognize which of the following?
A. The presence of the S3 is abnormal.
B. The systolic ejection murmur is unusual in a pregnant woman at term.
C. Diastolic murmurs are rare in pregnant women.
D. The combination of a prominent S3 and soft diastolic murmur is a significant abnormality.
E. All findings recorded are normal changes in pregnancy.

Answer 12

E. All findings recorded are normal changes in pregnancy.

Question 13

A 27-year-old G2P1 at 29 weeks gestational age, who is being followed for Rh isoimmunization presents for her OB visit. The fundal height is noted to be 33 cm. An ultrasound reveals fetal ascites and a pericardial effusion. Which of the following can be another finding in fetal hydrops?
A. Oligohydramnios
B. Hydrocephalus
C. Hydronephrosis
D. Subcutaneous edema
E. Over-distended fetal bladder

Answer 13

D. Subcutaneous edema

Question 14

An 18-year-old G1 has asymptomatic bacteriuria (ASB) at her first prenatal visit at 15 weeks gestation. Which of the following statements is true?
A. The prevalence of ASB during pregnancy may be as great as 30%.
B. There is a decreased incidence of ASB in women with sickle cell trait.
C. Fifteen percent of women develop a urinary tract infection after an initial negative urine culture.
D. Twenty-five percent of women with ASB subsequently develop an acute symptomatic urinary infection during the same pregnancy and should be treated with antibiotics.
E. ASB is highly associated with adverse pregnancy outcomes.

Answer 14

D. Twenty-five percent of women with ASB subsequently develop an acute symptomatic urinary infection during the same pregnancy and should be treated with antibiotics.

Question 15

What type of obstetric anesthesia may be associated with increased need for augmentation of labor with oxytocin and for instrument-assisted delivery?
A. Paracervical block
B. Pudendal block
C. Spinal block
D. Epidural block

Answer 15

D. Epidural block

Question 16

Match this ethical concern or principal with the appropriate definition: what does the patient want?
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual issues
H. Justice

Answer 16

A. Patient preferences

Question 17

A 23-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of contractions. She states they are occurring every 4 to 8 minutes and each lasts approximately 1 minute. She reports good fetal movement and denies any leakage of fluid or vaginal bleeding. The nurse places an external tocometer and fetal monitor and reports that the patient is having contractions every 2 to 10 minutes. The nurse states that the contractions are mild to palpation. On examination the cervix is 2 cm dilated, 50% effaced, and the vertex is at - 1 station. The patient had the same cervical examination in your office last week. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. Which of the following stages of labor is this patient in?
A. Active labor
B. Latent labor
C. False labor
D. Stage 1 of labor
E. Stage 2 of labor

Answer 17

C. False labor

Question 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

Answer 18

C. Perform an emergent cesarean section

Question 19

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.

Answer 19

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

Question 20

Match this ethical concern or principal with the appropriate definition: what is the best treatment?
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual

Answer 20

F. Medical indication

Question 21

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 vaginal delivery of a 9-Ib 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 estimated 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.

Answer 21

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

Question 22

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 estimated 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

Answer 22

C. Administration of oxytocin

Question 23

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. What is the most appropriate treatment for this clinical situation?
A. Epidural block
B. Meperidine (Demerol) 100 mg intramuscularly
C. Oxytocin intravenously
D. Midforceps delivery
E. Cesarean section

Answer 23

E. Cesarean section

Question 24

Your patient is a 44-year-old G4P4 with symptomatic uterine fibroids that are unresponsive to medical therapy. The patient has severe menorrhagia to the point that when she menstruates, she cannot leave the house. You recommend to her that she undergo a total abdominal hysterectomy. You counsel her that she may need a blood transfusion if she has a large blood loss during the surgical procedure. Her current hematocrit is 25.0. The patient is a Jehovah’s Witness who adamantly refuses to have a blood transfusion, even if it results in her death. The patient’s insurance company refuses to pay for the surgical procedure. Which of the following ethical areas is involved?
A. Autonomy
B. Justice
C. Contextual issue
D. Patient preference
E. Quality of life

Answer 24

B. Justice

Question 25

A 22-year-old G1 at 34 weeks is tested for tuberculosis because her father, with whom she lives, was recently diagnosed with tuberculosis. Her skin test is positive and her chest x-ray reveals a granuloma in the upper left lobe. Which of the following is true concerning infants born to mothers with active tuberculosis?
A. The risk of active disease during the first year of life may approach 90% without prophylaxis.
B. Bacille Calmette-Guérin (BCG) vaccination of the newborn infant without evidence of active disease is not appropriate.
C. Future ability for tuberculin skin testing is lost after BCG administration to the newborn.
D. Neonatal infection is most likely acquired by aspiration of infected amniotic fluid.
E. Congenital infection is common despite therapy.

Answer 25

C. Future ability for tuberculin skin testing is lost after BCG administration to the newborn.

Question 26

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

Answer 26

E. Less extension of the incision

Question 27

A 29-year-old Caucasian primigravid patient is 20 weeks pregnant with twins. She found out today on her routine ultrasound for fetal anatomy that she is carrying two boys. In this patient’s case, which of the following statements about twinning is true?
A. The twins must be monozygotic since they are both males.
B. If division of these twins occurred after formation of the embryonic disk, the twins will be conjoined.
C. She has a higher incidence of having monozygotic twins since she is Caucasian.
D. If the ultrasound showed two separate placentas, the twins must be dizygotic.
E. Twinning causes no appreciable increase in maternal morbidity and mortality over singleton pregnancies.

Answer 27

B. If division of these twins occurred after formation of the embryonic disk, the twins will be conjoined.

Question 28

A 16-year-old primigravida presents to your office at 35 weeks gestation. 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 uneffaced. 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.

Answer 28

E. Admit her to the hospital for cesarean delivery.

Question 29

A 19-year-old woman comes to the emergency department and reports that she fainted at work earlier in the day. She has mild vaginal bleeding. Her abdomen is diffusely tender and distended. In addition, she complains of shoulder and abdominal pain. Her temperature is 37.2°C, pulse rate is 120 beats per minute, and blood pressure is 80/42 mm Hg. Which of the following is the best diagnostic procedure to quickly confirm your diagnosis?
A. Computed tomography of the abdomen and pelvis
B. Culdocentesis
C. Dilation and curettage
D. Posterior colpotomy
E. Quantitative B-human chorionic gonadotropin (B-hCG)

Answer 29

B. Culdocentesis

Question 30

A 30-year-old G1 at 28 weeks gestation with a twin pregnancy is admitted to the hospital for preterm labor with regular painful contractions every 2 minutes. She is 3 cm dilated with membranes intact and a small amount of bloody show. Ultrasound reveals growth restriction of twin A and oligohydramnios, otherwise normal anatomy. Twin B has normal anatomy and has appropriate-for-gestational-age weight. Which of the following is a contraindication to the use of indomethacin as a tocolytic in this patient?
A. Twin gestation
B. Gestational age greater than 26 weeks
C. Vaginal bleeding
D. Oligohydramnios
E. Fetal growth restriction

Answer 30

D. Oligohydramnios

Question 31

A 33-year-old woman at 10 weeks presents for her first prenatal examination. Routine labs are drawn and her hepatitis B surface antigen is positive. Liver function tests are normal and her hepatitis B core and surface antibody tests are negative. Which of the following is the best way to prevent neonatal infection?
A. Provide immune globulin to the mother.
B. Provide hepatitis B vaccine to the mother.
C. Perform a cesarean delivery at term.
D. Provide hepatitis B vaccine to the neonate.
E. Provide immune globulin and the hepatitis B vaccine to the neonate.

Answer 31

E. Provide immune globulin and the hepatitis B vaccine to the neonate.

Question 32

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

Answer 32

C. Deoxygenated blood to the placenta

Question 33

A 20-year-old G1P0 at 30 weeks gestation with a known placenta previa is delivered by cesarean section under general anesthesia for vaginal bleeding and nonreassuring fetal heart rate tracing. The baby is easily delivered, but the placenta is adherent to the uterus and cannot be completely removed, and heavy uterine bleeding is noted. Which of the following is the best next step in the management of this patient?
A. Administer methylergonovine (Methergine) intramuscularly
B. Administer misoprostol (Cytotec) suppositories per rectum
C. Administer prostaglandin F2a (Hemabate) intramuscularly
D. Perform hysterectomy
E. Close the uterine incision and perform curettage

Answer 33

D. Perform hysterectomy

Question 34

A 29-year-old G2P1 at 40 weeks is in active labor. Her cervix is 5 cm dilated, completely effaced, and the vertex is at 0 station. She is on oxytocin to augment her labor and she has just received an epidural for pain management. The nurse calls you to the room because the fetal heart rate has been in the 70s for the past 3 minutes. The contraction pattern is noted to be every 3 minutes, each lasting 60 seconds, with return to normal tone in between contractions. The patient’s vital signs are blood pressure 90/40 mm Hg, pulse 105 beats per minute, respiratory rate 18 breaths per minute, and temperature 36.1°C (97.6°F). On repeat cervical examination, the vertex is well applied to the cervix and the patient remains 5 cm dilated and at 0 station, and no vaginal bleeding is noted. Which of the following is the most likely cause for the deceleration?
A. Cord prolapse
B. Epidural analgesia
C. Pitocin
D. Placental abruption
E. Uterine hyperstimulation

Answer 34

B. Epidural analgesia

Question 35

You have just delivered an infant weighing 2.5 kg (5.5 lb) at 39 weeks gestation. Because the uterus still feels large, you do a vaginal examination. A second set of membranes is bulging through a fully dilated cervix, and you feel a small part presenting in the sac. A fetal heart is auscultated at 60 beats per minute. What is the most appropriate procedure?
A. External version
B. Internal version
C. Midforceps rotation
D. Low transverse cesarean section
E. Classic cesarean section

Answer 35

B. Internal version

Question 36

A 21-year-old has a positive purified protein derivative (PPD) and is about to be treated with rifampin, isoniazid, and pyridoxine for tuberculosis. She can be reassured that her risk of which of the following is minimal?
A. A flulike syndrome caused by rifampin
B. A peripheral neuropathy caused by isoniazid
C. Optic neuritis caused by isoniazid
D. Ototoxicity as a side effect of streptomycin
E. A positive antinuclear antibody (ANA) titer with INH therapy

Answer 36

C. Optic neuritis caused by isoniazid

Question 37

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 nontender 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 nontender. 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. ß-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

Answer 37

E. Dilation and curettage

Question 38

A 32-year-old G1 at 10 weeks gestation presents for her routine OB visit. She is worried about her pregnancy because she has a history of insulin-requiring diabetes since the age of 18. Prior to becoming pregnant, her endocrinologist diagnosed her with microalbuminuria. She has had photo laser ablation of retinopathy in the past. Which diabetic complication is most likely to be worsened by pregnancy?
A. Benign retinopathy
B. Gastroparesis
C. Nephropathy
D. Neuropathy
E. Proliferative retinopathy

Answer 38

E. Proliferative retinopathy

Question 39

Your patient is a 44-year-old G4P4 with symptomatic uterine fibroids that are unresponsive to medical therapy. The patient has severe menorrhagia to the point that when she menstruates, she cannot leave the house. You recommend to her that she undergo a total abdominal hysterectomy. You counsel her that she may need a blood transfusion if she has a large blood loss during the surgical procedure. Her current hematocrit is 25.0. The patient is a Jehovah’s Witness who adamantly refuses to have a blood transfusion, even if it results in her death. Which of the following is not an ethical concern that needs to be considered when working through this case?
A. Legal issues
B. Patient preferences
C. Quality-of-life issues
D. Medical indications

Answer 39

A. Legal issues

Question 40

A 24-year-old patient who you have been seeing for routine gynecological care reports that she is considering becoming a surrogate mother for a couple she knows at work. As her physician, what is your responsibility to her in preparing her to become a surrogate?
A. Contact the intended parents so that you can provide care for them also.
B. Explain to her that you will require an additional fee to care for her pregnancy since she will be a surrogate.
C. Recommend that she utilize the same legal counsel as the intended parents.
D. Refer her to mental health counseling.
E. Review the surrogate contract to ensure that she is being fully compensated.

Answer 40

D. Refer her to mental health counseling.

Question 41

A 19-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of contractions. She states they are very painful and occurring every 3 to 5 minutes. She reports good fetal movement and denies any leakage of fluid or vaginal bleeding. The nurse places an external tocometer and fetal monitor and reports that the patient is having contractions every 4 to 12 minutes. The nurse states that the contractions are mild to moderate to palpation. On examination the cervix is 1 cm dilated, 60% effaced, and the vertex is at -1 station. The patient had the same cervical examination in your office last week. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. Which of the following is the most appropriate next step in the management of this patient?
A. Send her home
B. Admit her for an epidural for pain control
C. Rupture membranes
D. Administer terbutaline
E. Augment labor with Pitocin

Answer 41

A. Send her home

Question 42

A 27-year-old G4P3 at 37 weeks presents to the hospital with heavy vaginal bleeding and painful uterine contractions. Quick bedside ultrasound reveals a fundal placenta. The patient’s vital signs are blood pressure 140/92 mm Hg, pulse 118 beats per minute, respiratory rate 20 breaths per minute, and temperature 37°C (98.6°F). The fetal heart rate tracing reveals tachycardia with decreased variability and a few late decelerations. An emergency cesarean section delivers a male infant with Apgar scores of 4 and 9. With delivery of the placenta, a large retroplacental clot is noted. The patient becomes hypotensive, and bleeding is noted from the wound edges and her IV catheter sites. She requires 12 units of packed red blood cells and fresh frozen plasma for resuscitation. After a short stay in the intensive care unit the patient recovers. When can long-term complications related to sequela of postpartum hemorrhage first be noted?
A. 6 hours postpartum
B. 1 week postpartum
C. 1 month postpartum
D. 6 month postpartum
E. 1 year postpartum

Answer 42

B. 1 week postpartum

Question 43

A 32-year-old G5P1 presents for her first prenatal visit. A complete obstetrical, gynecological, and medical history and physical examination is done. Which of the following would be an indication for elective cerclage placement?
A. Three spontaneous first-trimester abortions
B. Twin pregnancy
C. Three second-trimester pregnancy losses without evidence of labor or abruption
D. History of loop electrosurgical excision procedure for cervical dysplasia
E. Cervical length of 35 mm by ultrasound at 18 weeks

Answer 43

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

Question 44

What is the recommendation regarding influenza vaccination in pregnancy?
A. Recommended if the underlying disease is serious
B. Recommended after exposure or before travel to endemic areas
C. Not routinely recommended, but mandatory during an epidemic
D. Contraindicated unless exposure to the disease is unavoidable
E. Contraindicated

Answer 44

A. Recommended if the underlying disease is serious

Question 45

A 26-year-old G1P1 is now postoperative day (POD) 6 after a low transverse cesarean delivery for arrest of active phase. On POD 2, the patient developed a fever of 39°C (102.2°F) and was noted to have uterine tenderness and foul-smelling lochia. She was started on broad-spectrum antibiotic coverage for endometritis. The patient states she feels fine now and wants to go home, but continues to spike fevers each evening.
Her lung, breast, and cardiac examinations are normal. Her abdomen is nontender with firm, nontender uterus below the umbilicus. On pelvic examination her uterus is appropriately enlarged, but nontender. The adnexa are nontender without masses. Her lochia is normal. Her white blood cell count is 12 with a normal differential. Blood, sputum, and urine cultures are all negative for growth after 3 days. Her chest x-ray is negative. Which of the following statements is true regarding this patient’s condition?
A. It usually involves both the iliofemoral and ovarian veins.
B. Antimicrobial therapy is usually ineffective.
C. Fever spikes are rare.
D. Heparin therapy is always needed for resolution of fever.
E. Vena caval thrombosis may accompany either ovarian or iliofemoral thrombophlebitis.

Answer 45

E. Vena caval thrombosis may accompany either ovarian or iliofemoral thrombophlebitis.

Question 46

A 32-year-old G1PO reports to your office for a routine OB visit at 14 weeks gestational age. Labs drawn at her first prenatal visit 4 weeks ago reveal a platelet count of 60,000, a normal PT, PTT and bleeding time. All her other labs were within normal limits. During the present visit, the patient has a blood pressure of 120/70 mm Hg. Her urine dip reveals the presence of trace protein. The patient denies any complaints. The only medication she is currently taking is a prenatal vitamin. On taking a more in-depth history you learn that, prior to pregnancy, your patient had a history of occasional nose and gum bleeds, but no serious bleeding episodes. She has considered herself to be a person who just bruises easily. Which of the following is the most likely diagnosis?
A. Alloimmune thrombocytopenia
B. Gestational thrombocytopenia
C. Idiopathic thrombocytopenic purpura
D. HELLP syndrome
E. Pregnancy-induced hypertension

Answer 46

C. Idiopathic thrombocytopenic purpura

Question 47

A 28-year-old G1 presents to your office at 8 weeks gestation. She has a history of diabetes since the age of 14. She uses insulin and denies any complications related to her diabetes. Which of the following is the most common birth defect associated with diabetes?
A. Anencephaly
B. Encephalocele
C. Meningomyelocele
D. Sacral agenesis
E. Ventricular septal defect

Answer 47

E. Ventricular septal defect

Question 48

A 27-year-old G3P2002, who is 34 weeks gestational age, calls the on-call obstetrician on a Saturday night at 10:00 PM complaining of decreased fetal movement. She says that yesterday her baby has moved only once per hour. For the past 6 hours she has felt no movement. She is healthy, has had regular prenatal care, and denies any complications so far during the pregnancy. Which of the following is the best advice for the on-call physician to give the patient?
A. Instruct the patient to go to labor and delivery for a contraction stress test.
B. Reassure the patient that one fetal movement per hour is within normal limits and she does not need to worry.
C. Recommend the patient be admitted to the hospital for delivery.
D. Counsel the patient that the baby is probably sleeping and that she should continue to monitor fetal kicks. If she continues to experience less than five kicks per hour by morning, she should call you back for further instructions.
E. Instruct the patient to go to labor and delivery for a nonstress test.

Answer 48

E. Instruct the patient to go to labor and delivery for a nonstress test.

Question 49

Your 36-year-old patient is admitted to the hospital for induction of labor at 42 weeks gestation. She provides the hospital with her living will at the time of her admission. She signed the will 5 years ago, but she says to her nurse that she still wants to abide by the will. She has also signed an organ donor card allowing the harvesting of her organs in the event of her death. Why is her living will not valid for this hospitalization?
A. In the event that she becomes delirious during labor, she will be unable to change her mind.
B. She is pregnant.
C. It has been too many years since the signing of the will.
D. Signing an organ donor card automatically invalidates a living will.
E. Her husband may decide later on that he disagrees with her living will.

Answer 49

B. She is pregnant.

Question 50

A healthy 30-year-old G1P0 at 41 weeks gestational age presents to labor and delivery at 11:00 PM because she is concerned that her baby has not been moving as much as normal for the past 24 hours. She denies any complications during the pregnancy. She denies any rupture of membranes, regular uterine contractions, or vaginal bleeding. On arrival to labor and delivery, her blood pressure is initially 140/90 but decreases with rest to 120/75. Her prenatal chart indicates that her baseline blood pressures are 100 to 120/60 to 70 mm Hg. The patient is placed on an external fetal monitor. The fetal heart rate baseline is 180 beats per minute with absent variability. There are uterine contractions every 3 minutes accompanied by late fetal heart rate decelerations. Physical examination indicates that the cervix is long/closed/-2. Which of the following is the appropriate plan of management for this patient?
A. Proceed with emergent cesarean section.
B. Administer intravenous MgSO4 and induce labor with Pitocin.
C. Ripen cervix overnight with prostaglandin E2 (Cervidil) and proceed with Pitocin induction in the morning.
D. Admit the patient and schedule a cesarean section in the morning, after the patient has been NPO for 12 hours.
E. Induce labor with misoprostol (Cytotec).

Answer 50

A. Proceed with emergent cesarean section.

Question 51

A 38-year-old G1PO presents to the obstetrician’s office at 37 weeks gestational age complaining of a rash on her abdomen that is becoming increasingly pruritic. The rash started on her abdomen, and the patient notes that it is starting to spread downward to her thighs. The patient reports no previous history of any skin disorders or problems. She denies any malaise or fever. On physical examination, she is afebrile and her physician notes that her abdomen, and most notably her stretch marks, is covered with red papules and plaques. No excoriations or bullae are present. The patient’s face, arms, and legs are unaffected by the rash. Which of the following is this patient’s most likely diagnosis?
A. Herpes gestationis
B. Pruritic urticarial papules and plaques of pregnancy
C. Prurigo gravidarum
D. Intrahepatic cholestasis of pregnancy
E. Impetigo herpetiformis

Answer 51

B. Pruritic urticarial papules and plaques of pregnancy

Question 52

A 40-year-old G3P2 obese patient at 37 weeks presents for her routine OB visit. She has gestational diabetes that is controlled with diet. She reports that her fasting and postprandial sugars have all been within the normal range. Her fetus has an estimated fetal weight of 6½ Ib by Leopold maneuvers. Which of the following is the best next step in her management?
A. Administration of insulin to prevent macrosomia
B. Cesarean delivery at 39 weeks to prevent shoulder dystocia
C. Induction of labor at 38 weeks
D. Kick counts and routine return OB visit in 1 week
E. Weekly biophysical profile

Answer 52

D. Kick counts and routine return OB visit in 1 week

Question 53

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 incision this morning. She has been experiencing general malaise and reports a fever of 38.8°C (102°F). Physical examination indicates that the Pfannenstiel 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 tenderness 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

Answer 53

C. Probe the fascia

Question 54

A 22-year-old G3P2 undergoes a normal spontaneous vaginal delivery without complications. The placenta is spontaneously delivered and appears intact. The patient is brought to the postpartum floor, where she starts to bleed profusely. Physical examination reveals a boggy uterus, and a bedside sonogram indicates the presence of placental tissue. What is the placenta type?
A. Fenestrated placenta
B. Succenturiate placenta
C. Vasa previa
D. Placenta previa
E. Membranaceous placenta
F. Placenta accrete

Answer 54

B. Succenturiate placenta

Question 55

A 32-year-old G3P2 at 39 weeks gestation with an epidural has been pushing for 30 minutes with good descent. The presenting fetal head is left occiput anterior with less than 45° of rotation with a station of +3 of 5. The fetal heart rate has been in the 90s for the past 5 minutes and the delivery is expedited with forceps. Which of the following best describes the type of forceps delivery performed?
A. Outlet forceps
B. Low forceps
C. Midforceps
D. High forceps
E. Rotational forceps

Answer 55

B. Low forceps

Question 56

A 24-year-old presents at 30 weeks with a fundal height of 50 cm. Which of the following statements concerning polyhydramnios is true?
A. Acute polyhydramnios rarely leads to labor prior to 28 weeks.
B. The incidence of associated malformations is approximately 3%.
C. Maternal edema, especially of the lower extremities and vulva, is rare.
D. Esophageal atresia is accompanied by polyhydramnios in nearly 10% of cases.
E. Complications include placental abruption, uterine dysfunction, and postpartum hemorrhage.

Answer 56

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

Question 57

A Jewish couple comes in to see you for preconception counseling. They are concerned that they might be at an increased risk of certain genetic diseases because of their ethnic background. The woman is 38 years old and tells you that in neither side of the family is there a family history of any genetic disorders. Which one of the following statements is the best advice for this couple?
A. They are at an increased risk of having a -thalassemia.
B. They are at an increased risk of having a baby born with a neural tube defect associated with advanced maternal age.
C. They do not need to undergo additional screening if there is no history of affected children in their families.
D. All Jewish couples should be screened for cystic fibrosis.
E. Tay-Sachs disease has a carrier frequency of 1 in 30 in the Jewish population, and the couple therefore should be screened for this genetic disease.

Answer 57

E. Tay-Sachs disease has a carrier frequency of 1 in 30 in the Jewish population, and the couple therefore should be screened for this genetic disease.

Question 58

Your patient is a 44-year-old G4P4 with symptomatic uterine fibroids that are unresponsive to medical therapy. The patient has severe menorrhagia to the point that when she menstruates, she cannot leave the house. You recommend to her that she undergo a total abdominal hysterectomy. You counsel her that she may need a blood transfusion if she has a large blood loss during the surgical procedure. Her current hematocrit is 25.0. The patient is a Jehovah’s Witness who adamantly refuses to have a blood transfusion, even if it results in her death. Prior to performing the abdominal hysterectomy, you must obtain the patient’s informed consent. Which of the following is not a key element of informed consent?
A. The patient must have the ability to comprehend medical information.
B. Alternatives to the procedure must be presented.
C. If the patient is incapable of providing consent, the procedure cannot be performed.
D. The risks of the procedure must be presented.
E. The benefits of the procedure must be presented.

Answer 58

C. If the patient is incapable of providing consent, the procedure cannot be performed.

Question 59

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

Answer 59

B. Mentum transverse position

Question 60

A 38-year-old G3P2 at 40 weeks gestation presents to labor and delivery with gross rupture of membranes occurring 1 hour prior to arrival. The patient is having contraction every 3 to 4 minutes on the external tocometer, and each contraction lasts 60 seconds. The fetal heart rate tracing is 120 beats per minute with accelerations and no decelerations. The patient has a history of rapid vaginal deliveries, and her largest baby was 3200 g. On cervical examination she is 5 cm dilated and completely effaced, with the vertex at -2 station. The estimated fetal weight is 3300 g. The patient is in a lot of pain and requesting medication. Which of the following is the most appropriate method of pain control for this patient?
A. Intramuscular Demerol
B. Pudendal block
C. Local block
D. Epidural block
E. General anesthesia

Answer 60

D. Epidural block

Question 61

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 tocodynamometer 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 negative 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

Answer 61

E. Gestational hypertension

Question 62

A 38-year-old G4P3 at 33 weeks gestation is noted to have a fundal height of 29 cm on routine obstetrical visit. An ultrasound is performed by the maternal-fetal medicine specialist. The estimated fetal weight is determined to be in the fifth percentile for the estimated gestational age. The biparietal diameter and abdominal circumference are concordant in size. Which of the following is associated with symmetric growth restriction?
A. Nutritional deficiencies
B. Chromosome abnormalities
C. Hypertension
D. Uteroplacental insufficiency
E. Gestational diabetes

Answer 62

B. Chromosome abnormalities

Question 63

A 25-year-old G3P2 at 39 weeks is admitted in labor at 5 cm dilated. The fetal heart rate tracing is reactive. Two hours later, she is reexamined and her cervix is unchanged at 5 cm dilated. An IUPC is placed and the patient is noted to have 280 Montevideo units (MUV) by the IUPC. After an additional 2 hours of labor, the patient is noted to still be 5 cm dilated. The fetal heart rate tracing remains reactive. Which of the following is the best next step in the management of this labor?
A. Perform a cesarean section
B. Continue to wait and observe the patient
C. Augment labor with Pitocin
D. Attempt delivery via vacuum extraction
E. Perform an operative delivery with forceps

Answer 63

A. Perform a cesarean section

Question 64

A 34-year-old G2P1 at 31 weeks gestation with a known placenta previa is admitted to the hospital for vaginal bleeding. The patient continues to bleed heavily and you observe persistent late decelerations on the fetal heart monitor with loss of variability in the baseline. Her blood pressure and pulse are normal. You explain to the patient that she needs to be delivered. The patient is delivered by cesarean section under general anesthesia. The baby and placenta are easily delivered, but the uterus is noted to be boggy and atonic despite intravenous infusion of Pitocin. Which of the following is contraindicated in this patient for the treatment of uterine atony?
A. Methylergonovine (Methergine) administered intramuscularly
B. Prostaglandin F2a (Hemabate) suppositories
C. Misoprostol (Cytotec) suppositories
D. Terbutaline administered intravenously
E. Prostaglandin E2 suppositories

Answer 64

D. Terbutaline administered intravenously

Question 65

A 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

Answer 65

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

Question 66

A 23-year-old G3P1011 at 6 weeks presents for routine prenatal care. She had a cesarean delivery 3 years ago for breech presentation after a failed external cephalic version. Her daughter is Rh-negative. She also had an elective termination of pregnancy 1 year ago. She is Rh-negative and is found to have a positive anti-D titer of 1:8 on routine prenatal labs. Failure to administer RhoGAM at which time is the most likely cause of her sensitization?
A. After elective termination
B. At the time of cesarean delivery
C. At the time of external cephalic version
D. Within 3 days of delivering an Rh-negative fetus
E. At 28 weeks in the pregnancy for which she had a cesarean delivery

Answer 66

A. After elective termination

Question 67

A 36-year-old G1P1 comes to see you for a routine postpartum examination 6 weeks after an uncomplicated vaginal delivery. She is currently nursing her baby without any major problems and wants to continue to do so for at least 9 months. She is ready to resume sexual activity and wants to know what her options are for birth control. She does not have any medical problems. She is a nonsmoker and is not taking any medications except for her prenatal vitamins. Which of the following methods may decrease her milk supply?
A. Intrauterine device
B. Progestin only pill
C. Depo-Provera
D. Combination oral contraceptives
E. Foam and condoms

Answer 67

D. Combination oral contraceptives

Question 68

A 36-year-old G1P0 at 35 weeks gestation presents to labor and delivery complaining of a several-day history of generalized malaise, anorexia, nausea, and emesis. She denies any headache or visual changes. Her fetal movement has been good, and she denies any regular uterine contractions, vaginal bleeding, or rupture of membranes. On physical examination, you notice that she is mildly jaundiced and appears to be a little confused. Her vital signs indicate a temperature of 37.7°C (99.9°F), pulse of 70 beats per minute, and blood pressure of 100/62 mm Hg. Blood is drawn and the following results are obtained: WBC=25,000, Hct=42.0, platelets=51,000, SGOT/PT=287/350, glucose=43, creatinine=2.0, fibrinogen=135, PT/PTT=16/50 s, serum ammonia level=90 mmol/L (nl=11-35). Urinalysis is positive for 3+ protein and large ketones. Which of the following is the most likely diagnosis?
A. Hepatitis B
B. Acute fatty liver of pregnancy
C. Intrahepatic cholestasis of pregnancy
D. Severe preeclampsia
E. Hyperemesis gravidarum

Answer 68

B. Acute fatty liver of pregnancy

Question 69

You are called to see a 37-year-old G4P4 for a fever to 38.7°C (101.8°F). She is postoperative day 3 after cesarean delivery for arrest of active-phase labor. She underwent a long induction for postdate pregnancy and had rupture of membranes for more than 18 hours. Her other vital signs include pulse 118 beats per minute, respiratory rate 16 breaths per minute, and blood pressure 120/80 mm Hg. She complains of some incisional and abdominal pain, but is otherwise fine. HEENT, lung, breast, and cardiac examinations are within normal limits. On abdominal examination she has uterine fundal tenderness. Her incision has mild erythema around the staple edges and serous drainage along the left side. Pelvic examination reveals a tender uterus, but no adnexal masses. Which of the following is the most appropriate antibiotic to treat this patient with initially?
A. Oral Bactrim
B. Oral dicloxacillin
C. Oral ciprofloxacin
D. Intravenous gentamicin
E. Intravenous cefotetan

Answer 69

E. Intravenous cefotetan

Question 70

A 28-year-old G1 at 38 weeks had a normal progression of her labor. She has an epidural and has been pushing for 2 hours. The fetal head is direct occiput anterior at +3 station. The fetal heart rate tracing is 150 beats per minute with variable decelerations. With the patient’s last push the fetal heart rate had a prolonged deceleration to the 80s for 3 minutes. You recommend forceps to assist the delivery owing to the nonreassuring fetal heart rate tracing. Compared to the use of the vacuum extractor, forceps are associated with an increased risk of which of the following neonatal complications?
A. Cephalohematoma
B. Retinal hemorrhage
C. Jaundice
D. Intracranial hemorrhage
E. Corneal abrasions

Answer 70

E. Corneal abrasions

Question 71

A 32-year-old G2P1 at 41 weeks is undergoing an induction of oligohydramnios. During the course of her labor, the fetal heart rate tracing demonstrates severe variable decelerations that do not respond to oxygen, fluid, or amnioinfusion. The patient’s cervix is dilated to 4 cm. A low-transverse cesarean delivery is performed for nonreassuring fetal heart tones. After delivery of the fetus you send a cord gas, which comes back with the following arterial blood values: pH 7.29, PCO 2 50, and PO 2 20. What condition does the cord blood gas indicate?
A. Normal fetal status
B. Fetal acidemia
C. Fetal hypoxia
D. Fetal asphyxia
E. Fetal metabolic acidosis

Answer 71

A. Normal fetal status

Question 72

A 17-year-old woman at 22 weeks gestation presents to the emergency center with a 3-day history of nausea, vomiting, and abdominal pain. The pain started in the middle of the abdomen and is now located along her mid to upper right side. She is noted to have a temperature of 38.4°C (101.1°F). She denies any past medical problems or surgeries. How does pregnancy alter the diagnosis and treatment of the disease?
A. Owing to anatomical and physiological changes in pregnancy, diagnosis is easier to make.
B. Surgical treatment should be delayed since the patient is pregnant.
C. Fetal outcome is improved with delayed diagnosis.
D. The incidence is unchanged in pregnancy.
E. The incidence is higher in pregnancy.

Answer 72

D. The incidence is unchanged in pregnancy.

Question 73

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

Answer 73

A. Breast binder

Question 74

A healthy 42-year-old G2P1001 presents to labor and delivery at 30 weeks gestation complaining of a small amount of bright red blood per vagina which occurred shortly after intercourse. It started off as spotting and then progressed to a light bleeding. By the time the patient arrived at labor and delivery, the bleeding had completely resolved. The patient denies any regular uterine contractions but admits to occasional abdominal cramping. She reports no pregnancy complications and a normal ultrasound done at 14 weeks of gestation. Her obstetrical history is significant for a previous low transverse cesarean section at term. Which of the following can be ruled out as a cause for her vaginal bleeding?
A. Cervicitis
B. Preterm labor
C. Placental abruption
D. Placenta previa
E. Subserous pedunculated uterine fibroid
F. Uterine rupture

Answer 74

E. Subserous pedunculated uterine fibroid

Question 75

A 36-year-old G0 who has been epileptic for many years is contemplating pregnancy. She wants to go off her phenytoin because she is concerned 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.

Answer 75

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

Question 76

A 32-year-old G2P2 develops fever and uterine tenderness 2 days after cesarean delivery for nonreassuring fetal heart tones. She is placed on intravenous penicillin and gentamicin for her infection. After 48 hours of antibiotics she remains febrile, and on examination she continues to have uterine tenderness. Which of the following bacteria is resistant to these antibiotics and is most likely to be responsible for this woman’s infection?
A. Proteus mirabilis
B. Bacteroides fragilis
C. Escherichia coli
D. A-Streptococci
E. Anaerobic streptococci

Answer 76

B. Bacteroides fragilis

Question 77

A 23-year-old G3P2002 presents for a routine obstetric (OB) visit at 34 weeks. She reports a history of genital herpes for 5 years. She reports that she has had only two outbreaks during the pregnancy, but is very concerned about the possibility of transmitting this infection to her baby. Which of the following statements is accurate regarding how this patient should be counseled?
A. There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor.
B. The patient should be scheduled for an elective cesarean section at 39 weeks of gestation to avoid neonatal infection.
C. Starting at 36 weeks, weekly genital herpes cultures should be done.
D. The herpes virus is commonly transmitted across the placenta in a patient with a history of herpes.
E. Suppressive antiviral therapy can be started at 36 weeks to help prevent an outbreak from occurring at the time of delivery

Answer 77

E. Suppressive antiviral therapy can be started at 36 weeks to help prevent an outbreak from occurring at the time of delivery

Question 78

A 20-year-old female at 34 weeks of gestation develops a lower urinary tract infection. Which of the following is the best choice for treatment?
A. Cephalosporin
B. Tetracycline
C. Sulfonamide
D. Nitrofurantoin
E. Ciprofloxacin

Answer 78

A. Cephalosporin

Question 79

The labor nurse calls you in your office regarding your patient who is 30 weeks pregnant and complaining of decreased fetal movement. The fetus is known to have a ventricular septal defect of the heart. The nurse has performed a nonstress test on the fetus. No contractions are seen. She thinks the tracing shows either a sinusoidal or saltatory fetal heart rate (FHR) pattern. Without actually reviewing the FHR tracing what can you tell the nurse?
A. The FHR tracing is probably not a sinusoidal FHR pattern because this pattern can be diagnosed only if the patient is in labor.
B. The FHR tracing is probably not a saltatory FHR pattern because this pattern is almost always seen during rather than before labor.
C. The FHR tracing of the premature fetus should be analyzed by different criteria than tracings obtained at term.
D. Fetuses with congenital anomalies of the heart will invariably exhibit abnormal FHR patterns.
E. Neither sinusoidal nor saltatory fetal heart rate patterns are seen in premature fetuses because of the immaturity of their autonomic nervous systems.

Answer 79

B. The FHR tracing is probably not a saltatory FHR pattern because this pattern is almost always seen during rather than before labor.

Question 80

Your patient is a healthy 28-year-old G2P1001 at 20 weeks gestational age. Two years ago, she vaginally delivered at term a healthy baby boy weighing 6 lb 8 oz. This pregnancy, she had a prepregnancy weight of 130 lb. She is 5 ft 4 in tall. She now weighs 140 lb and is extremely nervous that she is gaining too much weight. She is worried that the baby will be too big and require her to have a cesarean section. What is the best counsel for this patient?
A. Her weight gain is excessive, and she needs to be referred for nutritional counseling to slow down her rate of weight gain.
B. Her weight gain is excessive, and you recommend that she undergo early glucola screening to rule out gestational diabetes.
She is gaining weight at a less than normal rate, and, with her history of a small-for-gestational-age baby, she should supplement her diet with extra calories.
C. During the pregnancy, she should consume an additional 300 kcal/day versus prepregnancy, and her weight gain so far is appropriate for her gestational age.
D. During the pregnancy she should consume an additional 600 kcal/day versus prepregnancy, and her weight gain is appropriate for her gestational age.

Answer 80

C. During the pregnancy, she should consume an additional 300 kcal/day versus prepregnancy, and her weight gain so far is appropriate for her gestational age.