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10: Issues in Women s Health
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and must be supported by proof of causation Damages constitute demonstrable injuries and can either be purely economic (eg, lost wages) or noneconomic (eg, pain and suffering) Identify the elements needed to prove malpractice in a wrongful birth and wrongful conception claim In a wrongful birth claim, a clinician interviewing a pregnant couple (duty) omits the family history and fails to recognize a serious disability that has a hereditary or genetic basis (breach of duty) Consequently, a baby with appreciable disabilities is born (damages) to parents who would have sought termination, but for the clinician s failure which prevented proper counseling In a wrongful conception claim, a clinician treating a nonpregnant couple (duty) fails to provide histologic evidence of sterilization during a tubal ligation or provides improper contraceptive counseling or techniques (breach of duty) Consequently, a normal but unwanted child is born (damages) to the couple seeking sterilization or effective contraception
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SECTION V
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Review Questions and Answers
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(1) At which of the following time Answer: d periods of zygotic division does the formation of dichorionic, diamnionic twins occur following fertilization (a) >264 hours (b) >120 and 240 hours (c) >72 and 120 hours (d) 72 hours (2) Which surgical procedure is most commonly performed in the second trimester of pregnancy (a) Ovarian cystectomy (b) Cholecystectomy (c) Laparoscopy (d) Appendectomy (3) A 21-year-old female presents to the Answer: a emergency room (ER) stating that she was raped Which medications should she be given for prevention of sexually transmitted diseases (STDs) in this situation (a) Ceftriaxone, azithromycin, and metronidazole (b) Ceftriaxone plus cefixime (c) Ceftriaxone plus azithromycin (d) Ceftriaxone plus penicillin Answer: d
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Section V: Review Questions and Answers
(4) Maternal obesity is a risk factor for all of the fetal complications except: (a) fetal macrosomia (b) neural-tube defects (c) dizygotic twinning (d) stillbirth (5) Your pregnant patient has mitral stenosis and is New York Heart Association functional class II Which of the following sets of vaccinations, cultures, and antibiotics is indicated during her pregnancy (a) Influenza, pneumococcal, intrapartum bacterial endocarditis prophylaxis (b) Influenza, pneumococcal, group B streptococcal vaginal and rectal culture at 36 weeks (c) Influenza, pneumococcal, intrapartum bacterial endocarditis prophylaxis, group B streptococcal vaginal and rectal culture at 36 weeks (d) Influenza and pneumococcal vaccine
Answer: c
Answer: b
(6) Your patient states that she is Answer: b comfortable at rest but begins to experience shortness of breath and chest pain after walking three blocks What New York Heart Association classification would you assign her (a) I (b) II (c) III (d) IV (7) Which of the following analgesics is a non histamine-releasing narcotic and therefore should be used for asthmatics (a) Fentanyl (b) Codeine
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Answer: c
11: Review Questions and Answers
(c) Morphine (d) Meperidine (8) Your current patient is pregnant and Answer: c has a history of deep vein thrombosis (DVT) in her previous pregnancy How should she be managed during this pregnancy (a) Low-dose aspirin (b) Careful observation (c) Mini-dose subcutaneous heparin or LMWH (d) Full prophylactic dose subcutaneous heparin or LMWH (9) Your patient is 18 weeks pregnant and presents with idiopathic hematuria Which of the following outcomes is she at increased risk of developing (a) Preeclampsia (b) Pyelonephritis (c) Chronic renal disease (d) Preterm labor (10) Which of the following pregnancy complications is most common in women with chronic renal insufficiency (a) Fetal growth restriction (b) Anemia (c) Preeclampsia (d) Preterm delivery (11) During a first trimester surgical abortion, signs of complete evacuation include all of the following except: (a) Gritty sensation (b) Contraction around the uterus (c) Bubbles in the cannula and hose (d) Bleeding from the os Answer: d Answer: b Answer: a
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Section V: Review Questions and Answers
(12) Typically, postabortal infections present: (a) within the first 24 36 hours (b) within the first 48 96 hours (c) within the first 6 days (d) after at least 1 week post-procedure (13) During a suction dilation and curettage (D & C), the surgeons note a midline perforation If the uterus is not completely evacuated, all of the following options may be indicated except: (a) continue with the same procedure (b) exploratory laparotomy (c) perform ultrasound (d) exploratory laparoscopy (14) The method of abortion at 15 weeks gestation with the least psychologic and emotional impact on the patient is: (a) intra-amniotic hypertonic saline (b) intra-amniotic prostaglandin (c) dilation and evacuation
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