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167 questions
Apreviously healthy 28-year-old woman develops significant postpartum hemorrhage, with a rapid drop in hematocrit to 18%. Despite aggressive IV fluid resuscitation, the patient has a persistent tachycardia, labile systolic blood pressure, and poor urine output. Ongoing resuscitation includes emergency transfusion with 2 units of O-negative packed red blood cells. During transfusion of the second unit, the patient develops chills, fever, vomiting, and hypertension. These symptoms are most likely the result of which of the following?
A65-year-old White female presents to the office for her annual gynecologic examination. She has been a patient of yours for many years. She also sees you on a routine basis for treatment of hypertension and hypothyroidism. Her last pap smear was 5 years ago and she has never had an abnormal pap smear. She had a mammogram 1 year ago that was normal. She does not perform self- breast examination. She is without complaint today. Past medical 1. Hypertension for 15 years history: 2. Graves' disease, treated with radioactive iodine thyroid ablation at age 50 OB/GYN history: 1. Menarche at age 14 Four term pregnancies with vaginal deliveries (at age 22, 25, 27, and 32) Total abdominal hysterectomy and bilateral salpingo oophorectomy (TAH/BSO) age 47 for fibroids On estrogen replacement therapy from age 47 to 55 Past surgical 1. Appendectomy at age 16 history: 2. TAH/BSO as noted above Medications: 1. Hydrochlorothiazide 25 mg daily 2. Levothyroxine 0.1 mg daily 3. Potassium chloride 20 meq daily Allergies: None Family history: Parents, siblings unknown as patient was adopted Children are alive and well without known chronic medical conditions Social history: Widowed for 5 years, has not been involved in a sexual relationship since the death of her husband; retired school teacher; college educated; does not smoke cigarettes, drink alcohol, or use drugs; walks 3045 min a day for exercise Which of the following conditions results in the most deaths of American women over the age of 65?
A 23-year-old G1P0010 woman complains of severe dysmenorrhea (i.e., pain with menses). She misses work for the first 3 days of her menstrual cycle almost every month and states that this has been a problem for about 3 years, now getting worse. She is not currently sexually active and is not using any hormonal contraception. She complains of occasional deep abdominal pain after bowel movements. Subsequent laparoscopic evaluation reveals endometriosis. Which of the following is a true statement regarding this condition?
A 24-year-old woman has a MSAFP of 0.5 MOM (multiples of the median) at 17 weeks' gestation. Which of the following fetal abnormalities is most likely to occur with this MSAFP?
Which of the following statements regarding vaccinations of pregnant women is true?
A 34-year-old woman with a history of type 1 diabetes mellitus presents to your office for a routine follow-up visit. She is feeling well and has no complaints. Her fasting blood sugars usually run 140 160 and her HgbA1C was recently measured at 8.2. She tells you that she would like to become pregnant but wants to know if there are any risks for her and a baby due to her diabetes. Which of the following statements about the risk to offspring of diabetic mothers is true?
A meta-analysis of randomized-controlled trials was published comparing two methods of managing postterm pregnancies. The question studied was whether the routine induction of labor at 41 weeks' gestation would result in improved maternal or fetal outcomes compared with expectant management. The authors reported that the odds ratio for caesarian delivery rate in the induction group compared to the expectant management group was 0.88 with a 95% confidence interval (CI) of 0.780.99. A second outcome studied was perinatal mortality. For this outcome, the odds ratio for the induction group compared to the expectant management group was 0.41 with a 95% CI of 0.141.18. Which of the following statements is true?
A 34-year-old woman with a history of type 1 diabetes mellitus presents to your office for a routine follow-up visit. She is feeling well and has no complaints. Her fasting blood sugars usually run 140 160 and her HgbA1C was recently measured at 8.2. She tells you that she would like to become pregnant but wants to know if there are any risks for her and a baby due to her diabetes. Which of the following preconception counseling statements is true?
A 19-year-old woman comes in for a routine obstetrical follow-up visit at 24 weeks' gestation. She is here with her boyfriend, who is the father of the baby. She is wearing dark sunglasses in the examination room. When you ask her to remove the glasses, you see that she has a bruise around her left eye. Her boyfriend quickly states that she accidentally bumped into a door and she quietly nods in agreement. Which of the following would be the most appropriate intervention at this time?
A6-month-old boy is brought to the office for a routine check-up by his mother. They have recently moved to the area and are new to your practice. He is the product of an uncomplicated term pregnancy, has grown and developed appropriately for his age, and is up-to-date on his immunizations. He has had two cases of otitis media in his life. Neither of his parents has been diagnosed with any chronic medical conditions. Both of his parents smoke cigarettes, but "not in the same room" as the child. What information about secondhand smoke could you provide to the parents? The health risks of secondhand smoke are lower because it has a significantly different chemical
A 6-month-old male infant presents to your clinic because the mother is concerned that he is not eating well and he has been constipated. The mother tells you that her prenatal course and delivery were uneventful. On physical examination, the infant has a puffy face, large tongue, and persistent nasal drainage The above condition can be caused by a deficiency of which of the following?
A27-year-old nulligravid single White female presents to your office for an annual examination. In taking her history, you learn that her mother died of ovarian cancer at the age of 63. There is no other family history ofbreast or ovarian cancer. The patient asks you to tell her what she can do to reduce her own ovarian cancer risk. What is the most effective strategy appropriate for this patient to reduce her risk?
A 6-month-old male infant presents to your clinic because the mother is concerned that he is not eating well and he has been constipated. The mother tells you that her prenatal course and delivery were uneventful. On physical examination, the infant has a puffy face, large tongue, and persistent nasal drainage. Which of the following conditions is most likely to present with these findings?
A 62-year-old female with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IIIC epithelial ovarian cancer is without evidence of visible remaining disease following a total abdominal hysterectomy, bilateral salpingo-oophorectomy, complete omentectomy, bilateral pelvic and paraaortic lymph node sampling, and rectosigmoid resection with reanastomosis. She is seen now for further treatment planning. The appropriate adjuvant therapy indicated in this setting is which of the following?
A 16-year-old nulligravid high school student is on your afternoon office schedule for a "talk visit." She was seen last year by one of your colleagues for an initial GYN evaluation. She is healthy and has no medical problems. Today she tells you that she and her new boyfriend had intercourse the night before, and the condom they were using broke. Your initial course of action should include which of the following?
A 26-year-old G2P1 female comes to your office for her initial obstetric visit. The first day of her last menstrual period was 6 weeks ago. Other than some mild morning sickness, she is feeling fine. Her first pregnancy was 40 weeks in gestation and uncomplicated. She has no significant medical history. The result of the test that you ordered in question 60 is positive. What would be appropriate management for the neonate to reduce the risk of perinatal transmission of the hepatitis B virus?
A 19-year-old newly married female presents to the emergency room, accompanied by her spouse. She states that she awoke this morning to find that she could not move her legs. She denies any pain but claims that she is unable to feel anything below her abdomen. She denies any trauma or past medical history. She is 24 weeks' pregnant, has had an uneventful pregnancy, and only takes prenatal vitamins. She is concerned if her symptoms will get better and wonders whether the "baby is pulling on my spinal cord." Her neurologic examination is remarkable for 0/5 motor strength in her lower extremities bilaterally, with decreased sensation to light touch and pinprick below the level of her umbilicus. Her cranial nerves and reflexes are normal, and she does not display any upper motor neuron signs. A STAT MRI performed is read as normal. Which of the following is the most appropriate approach for this patient?
A healthy 38-year-old G4P3003 presents for amniocentesis. The karyotype returns as shown in the Figure. What is the diagnosis?
A 19-year-old newly married female presents to the emergency room, accompanied by her spouse. She states that she awoke this morning to find that she could not move her legs. She denies any pain but claims that she is unable to feel anything below her abdomen. She denies any trauma or past medical history. She is 24 weeks' pregnant, has had an uneventful pregnancy, and only takes prenatal vitamins. She is concerned if her symptoms will get better and wonders whether the "baby is pulling on my spinal cord." Her neurologic examination is remarkable for 0/5 motor strength in her lower extremities bilaterally, with decreased sensation to light touch and pinprick below the level of her umbilicus. Her cranial nerves and reflexes are normal, and she does not display any upper motor neuron signs. A STAT MRI performed is read as normal. Which of the following is the most likely explanation for her current symptoms?
A 23-year-old pregnant woman at 5 postmenstrual weeks took coumadin until about 3 days after her menses was due. She has monthly menses. A home pregnancy test was positive on the day she took coumadin. She takes coumadin because of a history of deep vein thrombosis and pulmonary embolism. She is concerned that the coumadin will cause birth defects. Which of the following is the treatment of choice during pregnancy for this woman?