A woman with a diagnosis of invasive ductal carcinoma of the breast is found to have a mass measuring 6 cm on palpation at its greatest diameter and no palpable lymph nodes. Further there is no evidence of any metastases. In which stage of the
American Joint Committee on Cancer (AJCC) staging
would she be placed?
A 33-year-old woman, gravida 3, para 3, comes to the physician for an annual examination. She has no complaints. Past medical history is significant for two episodes of Chlamydia and one episode of gonorrhea. Obstetric history is significant for three normal spontaneous vaginal deliveries with gestational diabetes during the last two pregnancies. She takes no medications. Family history is significant for paternal coronary artery disease. Physical examination is unremarkable. Which of the following interventions should this patient most likely have?
A. Chest x-ray every 3 years
B. Coronary angiography every 3 years
C. Fasting glucose testing every 3 years
D. Mammography every 3 years
E. Pap testing every 3 years
AnswerTags:
MCQ, Obstetrics, High risk Pregnancy, Gestational Diabetes
A 39-year-old woman, gravida 2, para 1, at 30-weeks gestation comes to the physician for a prenatal visit. The patient's due date was determined by a 7-week ultrasound. Her prenatal course has been unremarkable. She has no complaints of contractions, loss of fluid, or bleeding from the vagina, and her baby is moving well. Examination demonstrates a fetal heart rate of 150 and a fundal height of 27 centimeters, which is the same measurement as that determined 4 weeks ago. This patient's fundal height measurement is most suggestive of which of the following?
A. Inaccurate estimated date of delivery (due date)
B. Intrauterine growth restriction
C. Premature labor
D. Twin gestation
E. Uterine cancer
AnswerTags:
MCQ, Obstetrics, IUGR
A 39-year-old woman, gravida 4, para 3, comes to the physician for a prenatal visit. Her last menstrual period was 8 weeks ago. She has had no abdominal pain or vaginal bleeding. She has no medical problems. Examination is unremarkable except for an 8-week sized, nontender uterus. Prenatal labs are sent. The rapid plasma reagin (RPR) test comes back as positive and a confirmatory microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) test also comes back as positive. Which of the following is the most appropriate pharmacotherapy?
A. Erythromycin
B. Levofloxacin
C. Metronidazole
D. Penicillin
E. Tetracycline
AnswerTags:
MCQ, Obstetrics, Antenatal Infections
A 22-year-old primigravid woman at term comes to the labor and delivery ward because of painful contractions every 2 minutes. She has had no gush of fluid and no bleeding from the vagina. Her prenatal course was unremarkable. She takes no medications and has no allergies to medications. Examination shows that her cervix is 6 cm dilated and 100% effaced; the fetus is at 0 station. The fetal heart rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally shortly before the epidural is placed?
A. Antacid
B. Antibiotic
C. Aspirin
D. Clear liquid meal
E. Regular "house" meal
AnswerTags:
MCQ, Obstetrics, Obstetric Analgesia
A 39-year-old woman, gravida 3, para 2, at term comes to the labor and delivery ward complaining of a gush of fluid. Examination shows her to be grossly ruptured, and ultrasound reveals that the fetus is in vertex presentation. The fetal heart rate is in the 120s and reactive. After a few hours, with no contractions present, oxytocin is started. Three hours later, the tocodynamometer shows the patient to be having contractions every minute and lasting for approximately 1 minute with almost no rest in between contractions. The fetal heart rate changes from 120s and reactive to a bradycardia to the 80s. Sterile vaginal examination shows that the cervix is 6 cm dilated. Which of the following is the most appropriate next step in management?
A. Discontinue oxytocin
B. Start magnesium sulfate
C. Perform forceps assisted vaginal delivery
D. Perform vacuum assisted vaginal delivery
E. Perform cesarean delivery
Answer
A 32-year-old woman comes to the hospital for an elective repeat cesarean delivery. Four years ago she had a primary cesarean delivery for a nonreassuring fetal heart rate tracing. Two years ago she chose to have an elective repeat cesarean delivery rather than attempt a vaginal birth after cesarean (VBAC). Her prenatal course was uncomplicated except that she has mitral valve prolapse. An echocardiograph demonstrated the mitral valve prolapse, but no other structural cardiac disease. Which of the following is the correct management of this patient?
A. Administer intravenous antibiotics 30 minutes prior to the procedure
B. Administer intravenous antibiotics immediately after the procedure
C. Administer intravenous antibiotics for 24 hours after the procedure
D. Administer oral antibiotics 6 hours after the procedure
E. No antibiotics are needed
Answer with ExplanationTags:
MCQ, Obstetrics, High Risk Pregnancy
A 31-year-old primigravid woman comes to the physician for a prenatal visit. She is known to be HIV positive. She also has asthma, for which she uses an inhaler. She had a diagnostic laparoscopy at age 20 for pelvic pain and has had no other surgeries. She has no known drug allergies. Extensive counseling is given to the patient regarding vertical transmission of HIV to the fetus. It is recommended to her that she take antiretroviral therapy during the pregnancy to decrease the vertical transmission rate. It is also recommended to her that she have a scheduled cesarean delivery. After consideration of these options, the patient chooses not to take the antiretrovirals and opts for a vaginal delivery. Which of the following represents the approximate risk of vertical transmission (from the mother to the fetus) for this patient?
A. 2%
B. 8%
C. 25%
D. 50%
E. 100%
AnswerTags:
MCQ, Obstetrics, HIV, Vertical Transmission
A 29-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the labor and delivery ward with frequent painful contractions. Her prenatal course was significant for a urine culture that showed 100,000 colony-forming units/milliliter of Group-B streptococci and asthma, for which she uses an albuterol inhaler. Examination shows that she is contracting every 2 minutes and her cervix is 5 centimeters dilated and 100% effaced. Which of the following medications should this patient be treated with during labor and delivery?
A. Betamethasone
B. Folic acid
C. Magnesium sulfate
D. Oxytocin
E. Penicillin
AnswerTags:
MCQ, Obstetrics, Group B Streptococcus
A 27-year-old primigravid woman at 39 weeks' gestation comes to the labor and delivery ward with a gush of fluid and regular contractions. Examination shows that she is grossly ruptured, contracting every 2 minutes, and that her cervix is dilated to 4 cm. The fetal heart rate tracing is in the 140s and reactive. She is admitted to labor and delivery, and over the following 4 hours she progresses to 9 cm dilation. Over the past hour, the fetal heart rate has increased from a baseline of 140 to a baseline of 160. Furthermore, moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not respond to scalp stimulation. The decision is made to proceed with cesarean delivery. Which of the following is the reason for the cesarean delivery and the preoperative diagnosis?
A. Fetal acidemia
B. Fetal distress
C. Fetal hypoxic encephalopathy
D. Low neonatal APGAR scores
E. Non-reassuring fetal heart rate tracing
AnswerTags:
MCQ, Obstetrics, Fetal Acidemia, Electronic fetal monitoring
A 34-year-old woman comes the physician because of lower abdominal cramping. The cramping started 2 days ago. Examination is unremarkable except for a pelvic examination that reveals a 10-week sized uterus. Urine hCG is positive, and pelvic ultrasound reveals a 10-week intrauterine pregnancy with a fetal heart rate of 160. The patient states that she is not sure whether to keep the pregnancy. Which of the following is the most appropriate next step in management?
A. Counsel the patient or refer to an appropriate counselor
B. Notify the patient's parents
C. Notify the patient's partner
D. Schedule a termination of pregnancy
E. Tell the patient that she is likely to have a miscarriage
Answer
A 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is started on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closed. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal heart rate monitoring is continued. In approximately 60 minutes, the fetal heart rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions. Which of the following was most likely the cause of the uterine hyperstimulation?
A. Infection
B. IV fluids
C. Postdates pregnancy
D. Prostaglandin (PGE2) gel
E. Vaginal examination
Answer
A 22-year-old primigravid woman comes to the labor and delivery ward at term with regular, painful contractions. Her prenatal course was unremarkable. She has a past medical history significant for mitral valve prolapse with regurgitation demonstrated on echocardiography. She takes no medications and has no allergies to medications. Examination shows that her cervix is 4 centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring. Which of the following is the most appropriate management of this patient?
A. Administer intravenous antibiotics throughout labor.
B. Administer intravenous antibiotics 30 minutes prior to the delivery.
C. Administer intravenous antibiotics after the cord is clamped.
D. Administer intravenous antibiotics six hours after the delivery.
E. Antibiotic prophylaxis is not necessary
AnswerTags:
MCQ, Obstetrics, Endocarditis, Valvular Heart Disease
A 27-year-old woman, gravida 2, para 2, comes to the physician to have her staples removed after an elective repeat cesarean delivery. Her pregnancy course was uncomplicated. She states that she is doing well except that since the delivery she has noticed some episodes of sadness and tearfulness. She is eating and sleeping normally and has no strange thoughts or thoughts of hurting herself or others. Physical examination is within normal limits for a patient who is status post cesarean delivery. Which of the following is the most likely diagnosis?
A. Maternity blues
B. Postpartum depression
C. Postpartum mania
D. Postpartum psychosis
E. Poststerilization depression
Answer
Recognised associations with hypermesis gravidarum include:
- Hydatidiform mole
- Age More than 30 years
- Smoking
- Primiparous women under 20 years of age
- Pre-eclampsia
Answer
WHEN INITIATING TREATMENT WITH A PROGESTERONE ONLY CONTRACEPTIVE, THE FOLLOWING POINTS ARE TRUE.
A. Extra contraceptive precautions should be used if started on day 1 of the cycle.
B. They should not be taken for 4 weeks prior to surgery.
C. If switching from a combined oral contraceptive, they should be commenced after the 7 day break.
D. Post abortion they should be started on the day after the operation.
E. They are secreted in significant amounts in breast milk.
Answer
You see an 18-year-old obstetric patient late in her third trimester for mild dysuria and urinary urgency. Microscopic examination of the urinary sediment is notable for bacteria and you make a presumptive diagnosis of cystitis.
Which one of the following antibiotics would be CONTRAINDICATED?
A) Nitrofurantoin (Macrodantin)
B) Trimethoprim/sulfamethoxazole (Bactrim, Septra)
C) Amoxicillin/clavulanate (Augmentin)
D) Cephalexin (Keflex)
E) Amoxicillin (Amoxil)
Answer
5. Which one of the following is the most reliable clinical symptom of uterine rupture?
A) Sudden, tearing uterine pain
B) Vaginal bleeding
C) Loss of uterine tone
D) Fetal distress
E) Maternal bradycardia
Answer
Treating preterm labor with beta-adrenergic agonists has been shown to decrease the rate of which one of the following?
A.Perinatal deaths
B.Preterm delivery
C.Low birth weight infants
D.Delivery within 48 hours of treatment
Answer
You are called to attend the delivery of a 24-year-old primiparous female. After a prolonged 18-hour labor requiring oxytocin (Pitocin) agumentation, she delivered a 4200 gm (9lb 4 oz) male infant. A vacuum-assisted delivery was performed because of maternal exhaustion, and the mother required repair of a third degree perineal laceration. Thirty minutes after you leave the delivery room, there are no other physicians in the hospital, and the delivery nurse urgently reports to you that the mother’s blood pressure is 80 mmHg systolic and her bed is soaked with blood.
The most likely cause of this problem is:
A.occult cervical lacerations.
B.hematoma.
C.uterine atony.
D.uterine rupture.
E.disseminated intravascular coagulopathy (DIC).
Answer
