Question bank

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 29-year-old pregnant woman at 38 weeks' gestation presents to your labor and delivery unit complaining of dizziness, heavy vaginal bleeding, and loss of fetal movement. She had been having uterine contractions for approximately 4 hours, but these stopped when the bleeding began. Her previous pregnancy was delivered by classical cesarean section because of a transverse lie. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 31-year-old woman has an uncomplicated labor and vaginal delivery of a healthy 3400-g male infant. However, her placenta has not yet delivered 2 hours after the delivery of her child. Under appropriate anesthesia manual extraction of the placenta is attempted, but the placenta is removed in fragments. She continues to have excessive vaginal bleeding after manual removal of her placenta. Her first child was delivered by a low transverse cesarean section because of fetal distress. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A34-year-old woman, gravida 5, has a 17-hour first stage, a 3.5-hour second stage ending with a spontaneous vaginal delivery of a 4400-g infant, and a 15-minute third stage of labor. Immediately after the placenta delivers, she has profuse vaginal bleeding. On examination, her perineum is intact and there are no vaginal or cervical lacerations. Her uterus is soft and the uterine fundus is 45 cm above her umbilicus. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

A newborn infant requires repeated resuscitation in the delivery room because of failure to breathe and cyanosis. During spells of crying, which appear to alleviate the cyanosis, his breath and heart sounds are normal, as is direct laryngoscopy. Vigorous respiratory movements appear ineffectual. Immediate management of this infant consists of which of the following? obtaining a chest x-ray

A specific pattern of abnormalities has been identified among infants born to mothers who consume moderate-to-large amounts of alcohol during their pregnancies. Which of the following abnormalities is characteristic of these infants? cataracts

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 39-year-old pregnant woman with chronic hypertension at 37 weeks' gestation presents with heavy vaginal bleeding and complains of lower abdominal pain. She also has noted diminished fetal movement since the bleeding began 3 hours previously. On physical examination her uterus is firm (rock hard) and very tender. Fetal heart tones are in the range of 160170 BPM. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 15-year-old girl began her last menstrual period (LMP) 14 weeks ago. She had a positive pregnancy test 6 weeks ago. On examination, her uterine fundus is at the level of the umbilicus. Fetal heart tones are not heard and no fetus is seen by abdominal ultrasound. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

A 4-day-old infant presents with yellow discoloration of the skin and sclera. The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast-fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg/dL (all unconjugated), the hematocrit is 45%, and the Coombs test is negative. Which of the following is the most likely diagnosis?

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 32-year-old pregnant woman has a low forceps vaginal delivery after a 3-hour second stage of labor. One hour later the nurse informs you she has excessive vaginal bleeding. On examination, her uterus is firm and nontender, and the uterine fundus is at the umbilicus. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture placenta accreta

A 25-year-old woman presents to your office complaining of cold hands. She describes them turning white as she reaches for orange juice in the frozen food section of the supermarket. It seems to be getting worse lately. She has no other symptoms but does note that she and her husband are contemplating pregnancy. Her examination today is unremarkable. What condition is she describing?

At a follow-up routine prenatal visit, the uterine fundus of a healthy 23-year-old pregnant woman is palpated halfway between her symphysis pubis and umbilicus. Which of the following is the most appropriate test to order at this stage of her pregnancy? serum human immunodeficiency virus (HIV) titer

A woman at 31 weeks' gestation complains of feeling dizzy and lightheaded when she lies on her back. She is Rh negative but denies vaginal bleeding, abdominal trauma, or abdominal pain. The diagnosis is probably the supine hypotensive syndrome. This results in which of the following?

A37-year-old White executive secretary comes to you after she found a lump in her right breast while she was showering. She describes a lesion beneath her right nipple. You question her about her personal and family history. She began menarche at age 12, and she is still having regular menstrual periods. She has had two children; the first was born when she was 25 years old. She has no family history of breast, ovarian, or colon cancer on either her maternal or paternal side. You perform a physical examination including a careful examination of her breasts. You note that her breasts contain many small cysts bilaterally. However, you also palpate a localized, firm, nontender mass below the right areola. You also describe a peau d'orange appearance of the areola. What should you advise her?

A1-cm carcinoma of the breast is diagnosed by an excisional biopsy in a 36-year-old woman at 14 weeks' gestation. The axillary nodes are negative. Which of the following is the best management of this patient?

A 35-year-old woman at 30 weeks' gestation discovers a lump in her left breast. Examination reveals a 23 cm, firm nodule in the upper outer quadrant. Which of the following is the most appropriate next step in the management of this patient?

A 39-year-old pregnant woman with chronic hypertension and one prior pregnancy is now at 38 weeks' gestation. She comes to labor and delivery with profuse vaginal bleeding and abdominal pain of sudden onset. This patient has an external fetal monitor placed. Uterine tone seems to be increased, and there are occasional variable decelerations of the fetal heart to 90 BPM. Which of the following is the most appropriate management?

A 39-year-old pregnant woman with chronic hypertension and one prior pregnancy is now at 38 weeks' gestation. She comes to labor and delivery with profuse vaginal bleeding and abdominal pain of sudden onset. Which of the following is the most likely diagnosis?

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. You advise this woman to do which of the following?

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. You tell her that the conceptus is most susceptible to teratogenesis at what stage of pregnancy?

A 37-year-old pregnant woman has a genetic amniocentesis at 16 weeks' gestation. Aconcurrent ultrasound shows normal fetal anatomy. Her prenatal course has been unremarkable. Her prenatal laboratory tests include a B-negative blood type, a negative rubella antibody titer, a negative hepatitis B surface antigen, and a hematocrit of 31%. Which of the following is the most appropriate management for this woman?