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Section V: Review Questions and Answers
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(49) A 17-year-old female presents to her gynecologist with complaints of cramping lower abdominal pain that begins with menstruation She also admits to mild nausea and diarrhea around the same time Her physical examination is unremarkable What should be used as first-line therapy (a) NSAIDs (b) Oral contraceptive pills (c) Presacral neurectomy (d) Antispasmodic agents (50) A 28-year-old female presents with increasing pelvic pain with menstruation that is not relieved with NSAIDs Physical examination reveals some uterine immobility as well as tender nodularities in the posterior cul-de-sac What is the most likely diagnosis (a) Primary dysmenorrhea (b) Endometriosis (c) Leiomyomas (d) Adenomyosis (51) Match each of the following terms to their correct description (1) Prolonged, irregular menstrual bleeding (2) Prolonged, regular menstrual bleeding (3) Irregular menstrual bleeding
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11: Review Questions and Answers
(52) What is the fetal lie, presentation, and position if the head is down, flexed, and the fetal back is near the left maternal pelvis Additionally, on sterile vaginal examination a diamond fontanel is noted near the right ischial spine, a triangular fontanel is the leading edge, and the sagittal suture is not parallel with the floor (a) Longitudinal lie and left occiput anterior (LOA) (b) Longitudinal lie and right occiput anterior (ROA) (c) Transverse lie and left occiput anterior (LOA) (d) Transverse lie and right occiput anterior (ROA) (53) On examination, the sagittal suture is deflected toward the sacrum, which allows more of the parietal bone to be palpated anteriorly What is the term that describes this physical finding (a) Transverse diagonal (b) Posterior diagonal (c) Posterior asynclitism (d) Anterior asynclitism (54) How is zero station determined on sterile vaginal examination (a) The leading fetal edge is flush with the introitus (b) The leading fetal edge is parallel with the maternal ischial spines (c) The leading fetal edge is engaged in the maternal pelvis (d) The leading fetal edge is engaged in a fully dilated cervix
Answer: a
Answer: d
Answer: b
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Section V: Review Questions and Answers
(55) A multigravid mother has a history of previous group B streptococcus (GBS)-negative pregnancies, a GBS-positive urinary tract infection during the current pregnancy, and a negative GBS culture at 36 weeks She presents to labor and delivery with spontaneous rupture of membranes and contractions every 5 minutes Which of the following is indicated (a) Immediate urinalysis for signs of current infection (b) Immediate urine culture and rectal swab for identification of GBS status (c) Empiric treatment for unknown GBS status (d) Antibiotics immediately due to history of GBS colonization (56) A group B Streptococcus-positive G2P1 with a penicillin allergy presents at 38 weeks with loss of fluid for 3 hours and contractions every 5 minutes What is the next step in management (a) Place the mother and infant on cardiac monitors (b) Assess for rupture of membranes (c) Begin ampicillin prophylaxis (d) Desensitize patient to penicillin (57) How often is meconium noted during labor and what does it signify (a) Rarely, and only in the presence of anoxic brain injury (b) Often, without any significance (c) Half of the time with variable outcomes (d) Occasionally, and it is suggestive of some degree of fetal stress
Answer: d
Answer: b
Answer: d
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11: Review Questions and Answers
(58) Your patient, a 21-year-old G2P1 with a prior cesarean delivery and currently with a singleton gestation, is found to have placenta previa Which of the following is not associated with an increased incidence of placenta previa (a) Advanced maternal age (b) Grand multiparity (c) Prior cesarean delivery (d) Singleton gestation (59) Your patient presents at 30 weeks with complaints of vaginal bleeding There is currently no active vaginal bleeding She is admitted to a labor room for evaluation A fetal heart strip is obtained and reveals an FHR of 130 bpm with no accelerations or decelerations An ultrasound is obtained and reveals a partial previa What is the next step in management (a) Observation in labor and delivery (L&D) (b) Assessment of fetal lung maturity (c) Cesarean delivery (d) Gentle cervical examination to assess dilation and amnionic membrane status (60) During the third stage of labor, your patient s uterus inverts and the placenta becomes detached from the uterus Which of the following is the next best step in management (a) Prompt oxytocin administration (b) Attempt to manually replace the uterus (c) Prompt hysterectomy (d) Administration of inhalation anesthetics prior to manual replacement
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