Www.goppert.org



Review Questions (if there are errors or outdated questions, please let me know and I will edit) A 23yo female comes to your office 6 days after giving birth to her first child by CSect. Her pregnancy was complicated by preeclampsia. During the history she reports brief crying spells, irritability, poor sleep, and nervousness. Her husband notes that “even the littlest thing can set her off.” She has a h/o major depression 2 years ago that resolved with psychotherapy and SSRI treatment. She and her husband are concerned that she may be suffering from postpartum depression. Which one of the following is the greatest risk factor for postpartum depression in this patient?Operative deliveryFirst pregnancy and deliveryPreeclampsiaA previous h/o depressionD-Baby blues is differentiated from postpartum depression by the severity and duration of symptoms. Baby blues occur in 80% of population and are associated with mild dysfunction. Baby blues usually resolves within 10-14 days. A 23yo female becomes pregnant while using copper T IUD for contraception. US indicates an EGA of 8wks and confirms the IUD within the uterus. A speculum exam shows the string coming through the cervix. Which one of the following is the best management strategy?Remove the IUD nowRemove the IUD during 2nd semesterRemove the IUD after 37wks EGARemove the IUD when patient goes into laborLeave the IUD in place until the deliveryA- Remove the IUD now. Increases risk of SAB, but decreases preterm labor and sepsis Which of the following are true regarding postpartum depression?It has no effect on cognitive development of the childIt is directly related to the desired gender of the infantIt is usually transient lasting about 10 daysThyroid function should always be assessed in women with postpartum depressionA male infant is delivered by CSect because of dystocia due to macrosomia. Apgar scores were 8 and 10. However, at about 1 hour of age he begins to have tachypnea without hypoxemia. ACXR shows diffuse parenchymal infiltrates and fluid in the pulmonary fissures . The symptoms resolve without treatment within 24 hrs.The most likely diagnosis is. Transient tachypnea of the newbornIntracranial hemorrhageLaryngotracheomalaciaMeconium aspiration syndromeHyaline membrane disease Which of the following fetal US measurements gives the most accurate estimate of EGA in the first trimester?Femur lengthBiparietal diameterAbdominal circumferenceCrown-rump lengthScapula-sacral length A mother is being discharged from hospital exclusively breas feeding . Which one of the following would you recommend for the infant at this time in addition to continued breast feeding?Iron supplementationVitamin D supplementationA Multivitamin8 oz water daily4 oz cereal daily A 2 day old female infant developed a rash today that has continued to progress and spread. The infant was born at term after an uncomplicated pregnancy and delivery to a healthy mother following excellent prenatal care. The infant does not appear to be irritable or in distress. She is afebrile and feeding well. On examination, abnormal findings are confined to the skin, including her face trunk , and proximal extremities which have macules papules, and pustules that are all 2-3 mm in diameter. Her palms and soles are spared. A stain shows numerous eosinophils.Which one of the following is the most likely diagnosis? Staphlococcal pyodermaHerpes simplexAcne neonatorumErythema toxicum neonatoromRocky Mountain spotted fever A 39 yo AA multip. At 36 weeks EGA presents with a temp of 40 degrees C (104 degrees F), chills, bachache, and vomiting. On physical exam, the uterus is noted to be nontender, but there is a slight bilateral costovertebral angle tenderness. A UA shows many leukocytes, some in clumps, as well as numerous bacteria. Of the following, the most appropriate therapy at this time would be? Oral trimethoprim/sulfamethoxazole (Bactrim)Oral nitrofurantoin (Macrodantin)Oral levofloxacin (Levaquin)IV doxycycline IV ceftriaxone (Rocephin) In neonatal resuscitation chest compressions should begin if the heart rate drops below a threshold of?120 beats/min100 beats/min80 beats/min60 beats/min40 beats/min A 21 yo G1 with an EGA 12 wks presents to your office. A UA shows evidence of bacteriuria. She is completely asymptomatic. Appropriate management at this time includes which of the following?No treatment at this time; repeat UA at next visitReassure the patient that anitibiotics administration is not necessary unless she should develop symptomsNo antibiotic treatment; ask the patient to drink more fluids and cranberry juice dailyDiscontinue UA at OB visits because of the high false positive rateTreat the patient with 7 day course of amoxicillin Preterm labor is defined as regular contractions with cervical change before 40 wks EGA39 wks EGA38 wks EGA37 wks EGA36 wks EGAWhich of the following bacterial infections is not generally associated with preterm labor?Ureaplasma urealyticumGardenella vaginalisMycoplasma hominisBacteroides speciesAll are associated with preterm labor Which of the following tests has been shown to be a good predictor of preterm birth (in woman presenting with symptomatic preterm uterine contractions, and thus help guide the pharmacologic management of preterm labor patients?Screening for genitourinary infectionsMeasurement of salivary estriolCervical length measurementFetal fibronectin measurementBoth C and D Which of the following sports is contraindicated in pregnancyWalkingStationary bicycleLow-impact aerobicsSnow skiingSwimming During pregnancy it is important to counsel patient to add an additional ____calories to their dietary intake for normal activity15030050010001500 Which of the following is not a contraindication to aerobic exercise during pregnancy?Pregnancy induced hypertensionIncompetent cervixPreterm labor during a prior pregnancyPlacenta previaTwin gestation Maternal temperature elevations above __________can be detrimental to the fetus in the first trimester of pregnancy.37 degree C (98.6F)37.8 degreeC(100.0F)38.3 degree C (101.0F)38.8 degree C (102F)Maternal temp has no detrimental effects on fetus During labor, the FHT shows repeated late decelerations. You suspectUteroplacental insufficiencyAbnormal presentationHead engagementRapid descent of fetusNormal progression of labor Repetitive variable decelerations noted on FHT suggestPlacenta PreviaUterine rupturePolyhydraminosNormal progression of laborA 26 yo G1 pushed effectively during a 2hr second stage with subsequent delivery of the infant’s head followed by a “turtle sign” with inability to deliver the infant’s shoulders with the normal amount of downward traction and maternal expulsive efforts. You diagnose shoulder dystocia and ask the mother to stop pushing and alert staff to this emergency. The next appropriate step is Place the mother in the left lateral positionPerform McRoberts’ maneuverApply fundal pressureUse a rotational maneuver, either the Rubin II or Wood’s corkscrewPerform a CSectThe drug of choice for controlling eclamptic seizures isHydralazinePhenobarbitalDiazepamMagnesium sulfate The current diagnosis of preeclampsia consists of which of the following?Elevated BP and proteinuriaElevated BP, proteinuria, and edemaElevated BP, proteinuria,edema, and seizuresElevated BP, proteinuria,edema, seizure,and headache The most common cause of postpartum bleeding isRetained placentaVaginal lacerationsUterine atonyCoagulopathyHELLP syndromeAn 18 yr old Gi is in the second stage of labor. She begins to complain of abdominal pain between uterine contractions. You suspectPosterior presentationBreech presentationAbruptionVasa previaUterine atonyA 25 yr old present to your office c/o abnormal vaginal bleeding. Your first diagnosis is InfectionTraumaForeign bodyPregnancyCoagulopathyAll patients undergoing CSect shouldAlways receive a preoperative antibiotic within 1 hr of start of surgeryNot receive antibiotics because of the risk of resistant infectionReceive antibiotics only if the surgery is prolonged (.1.5 hrs)Not receive antibiotics if they are considered low riskReceive antibiotics only if infection is suspectedIn discussing the risk of placing an epidural during labor, you explain to your patient thatThe ACOG recommends that epidural anesthesia in nulliparous women is not recommended until cervical dilation has reached 4-5 cm regardless of mother requestEarly epidural anesthesia increases the risk of CSectEpidural anesthesia my increase the rate of vacuum extractionEpidural anesthesia has no effect on the length of the second stage of laborEpidural anesthesia is of little help with pain management in early labor When using a vacuum extractor the procedure should be abandoned after3 disengagements “pop-offs” of vacuum head20 minutes3 consecutive pulls to not produce any progress3 consecutive pulls to not produce infants deliveryAny of the above Proper placement of the vacuum extractor isPlaced as far anteriorly as possibleOver the sagittal suture extending to the posterior fontanelleCovering the posterior fontanelOver the sagittal suture and 3 cm in front of the posterior fontanelAnywhere on the exposed cranium Pregnant patients with established HIV infectionShould avoid all antiviral medications because of their teratogenic potentialShould receive only zidovudine at the time of deliveryDo not need to switch off efavirenz if taking it when pregnancy is diagnosedShould avoid zidovudine because of its limited effectivenessShould receive only zidovudine if their CD4+ counts are unacceptably low.When repairing perineal lacerations , it has been shown that Skin sutures may increase the incidence of perineal painSkin sutures are required for adequate skin approximationInterrupted transcutaneous sutures are superior to running subcuticular suturesSutures should begin at the anterior point of the skin lacerationRepair with skin sutures leads to better outcomes A 39yr old mother presents to your office for preconception counseling. She has one child affected with neural tube defect. Appropriate counseling concerning folic acid supplementation should include _________ daily.100mcg400mcg1 mg4mg None needed on the basis of her current ageA 36yr old woman has a history of a prior DVT. She is pregnant for the first time. In view of her prior h/o DVT, you should recommendWarfarinHeparinAspirinClopidogrel (Plavix)No prophylaxis necessary When advising mothers concerning antiseizure medications during pregnancy , which of the following statements is trueMultiple medications are preferred to maintain lower levels of medicationAntiseizure medications should be discontinued at the time pregnancy is determinedSeizure activity in mothers has no impact on fetal outcomesMost antiseizure medications are considered safe (Category B)Single agents are preferred to multiple medicationsWhich of the following statements is true regarding smoking during pregnancy?Smoking increases the risk of ADD in the childNicotine patches are a safe alternative during pregnancyBupropion should be avoided during pregnancyRegardless of when she stops smoking infants born to mothers with a smoking history are more at risk for neonatal complicationsWhen compared with total abstinence reducing the number of cigarettes smoked has no effect on fetal outcomesThe use of benzodiazepines during pregnancy has been associated withPolydactlyCleft lipSpina bifidaGrowth retardationDevelopmental delayWhich of the following is not associated with maternal obesity during pregnancy?HydrocephalusMaternal hypertensionPreeclampsiaMaternal diabetesMacrosomic infantA 26yr old G1 present to you office. She is pregnant with twins and is in her 3rd trimester. She c/o pruritic, vesicular skin lesions that have developed on her abdomen. He face palms, and soles are spared. You suspectVaricellaScabiesPruritic urticarial papules and plaques of pregnancyHerpes zosterHyperbilirubinemiaWhat is the correct response to a Category III FHT?Expectant managementAttempt fetal scalp stimulation and if increase in FHR is not observed , continue to watch the patient closely and reattempt scalp stimulation in 30minutesBegin in utero resuscitation and proceed to CSECT within 30minutes if FHR tracing does not improveProceed to CSect immediatelyIncrease Pitocin to vaginal delivery more rapidlyA 26 yr old woman with an 30 wk EGA is involved in a MVA. She suspected neck trauma and is in need of transport. You suggest placing herIn the left lateral decubitus positionIn the Trendelenberg positionProne position on a backboardSupine on a backboard with her right hip elevatedSupine on a backboard Which of the following conditions is characterized by infarction of the pituitary gland during labor and delivery?Asherman’s syndromeStein-Leventhal syndromeSheehan’s syndromeCushings diseaseNelson’s syndromeWhich of the following is NOT a risk factor for early-onset neonatal sepsis?Preterm birthMaternal Group B Strep colonizationMacrosomiaProlonged ROM >18hrsLow socioeconomic statusWhich of the following statements is true regarding seat belt use in pregnancy?The use of correctly positioned seat belts can increase the risk of fetal injuryThe lap belt should be placed under the gravid uterus and over the thighs with the shoulder harness placed between the breast and over the uterusThe air bag should be disabledSeat belt restrained woman who are in MVA have the same fetal mortality rate as woman who are not in a MVAThe shoulder harness should not be used during pregnancyA patient presenting for care in the first trimester of pregnancy request information on what types of noninvasive testing that are available to detect Down’s syndrome in her fetus at an early stage of pregnancy . You inform her thatA combo of an US (fetal nuchal translucency) done in the first trimester measuring a specific anatomical area of her fetus and maternal blood testing(PAPA) on the dame day will help identify if she is at increased risk for Down’s syndromeOnly an amniocintesis done in the early 2nd trimester can give her the information that she is looking forShe should wait until the 2nd trimester to have maternal quad screen and an US to look at fetal anatomyOnly patients who wish to terminate their pregnancies for abnormal fetuses should pursue genetic testingThere are now too many prenatal tests available for this indication and she will need to meet with a genetic councelor to help decide what testing she would like to have Pregnant women should avoid contact with cat litter because of the risk of developing CryptococcusCytomegalovirusToxoplasmosisCoccidioidomycosisErythema infectiosumWhat percentage of babies born to HIV positive mothers is HIV positive?0-1%20-30%50-75%90-100%100%The most appropriate management for intrauterine fetal demise in the 3rd trimester includesObservation for up to 4 weeks until mother goes into laborImmediate CSectAdministration of IV Pitocin after serial misoprostol 25 to 50 mcg every 4 hrs until cervix ripenedHigh dose misoprostol (200-400mcg every 4 hrs)Heparin plus antibiotic prophylaxis and observation for up to 4 weeksA standard dose of Rh immune globulin (300ug) prevents sensitization from feto maternal hemorrhage of up to 30ml of whole blood60ml of whole blood 100ml of whole blood500ml of whole bloodAny amount of whole bloodWhich of the following statements regarding varicella during pregnancy is true?If a pregnant woman has no h/o varicella and test negative for antibodies, she should be immunized as soon as possible.Varicella vaccination should be avoided in breast feeding womenSusceptible pregnant women who are exposed to varicella are candidates for varicella zoster immune globulinPregnancy should be delayed 6 months after varicella vaccinationA Single dose of varicella vaccine is safe during pregnancy and can be administered to help protect the fetusRho (D) immune globulin (RhoGAM) is indicated when The mother has type AB bloodThe father is Rh negativeThe mother is Rh positiveNone of the aboveWhen there is first trimester bleeding, fetal viability can be definitely determined by which of the following tests?Qualitative B-HCG determinationSerial quantitative B-HCG measurementsTransvaginal USSerum progesterone levelsBoth B and CA 29 yo woman G1 is 14 wks EGA and develops an initial outbreak of genital herpes. You explain to her HSV is a STD that can be treated in such a way as to prevent future recurrencesThe risk for transmission to the neonate is high among women who newly acquire genital HSV near term and low among women who acquire genital HSV during the first half of pregnancyTermination of the pregnancy should be consideredCsect will be needed for her delivery, irrespective of whether she has recurrent herpetic lesions at that time or notAntiviral medications such as acyclovir cannot be used in pregnancy if she develops recurrent attacksWhich of the following is not a risk factor for group B streptococcal infection of the neonateTwin gestation<37weeks gestationProlonged rupture of membranesMaternal feverMaternal GBS anogenital colonizationWhich of the following is the drug of choice for use in GBS colonized pregnant women in labor for the prevention of GBS infection of the neonate?IM ceftriaxoneOral ciprofloxacinIV penicillin GIV vancomycinOral amoxicillinIn the management of a pregnant patient , medications are classified based on their risk to the fetus. Category C medicationsShould never be given during pregnancyAre considered safe during pregnancy Should only be given in life threatening situationsHave unknown risk to the fetusAre associated with teratogenicity in animalsWhich of the following medications can be safely used for cervical ripening for term pregnancies?TerbutalineMethotrexateThalidomideMisoprostolBromocriptineWhich of the following is NOT true of oxytocin administration?The drug must be given through a controlled infusion deviceOxytocin must be administered as a continuous infusion or in “pulsed” dosesThe medication can have a diuretic effect with high dosesHyperstimulation can result from oxytocin administrationWhich of the following medications has been used with success in gestational DM?Glipizide (Glucotrol)Glyburide(micronase,diabeta)Glimepiride (amaryl)Rosiglitazone (Avandia)Repaglinide (Prandin)A 33yr old woman who delivered last week presents to your office with questions about her gestational diabetes that developed during the first trimester. You explainHer risk of developing type 2 DM in the future is no different from anyone elseShe should be screened for DM with either fasting blood glucose measurements on two occasions or a 2hr GTT 6 weeks postpartum and yearly thereafterNo further monitoring is necessary unless she develops symptoms of DMShe should test for diabetes 6 months after delivery via fasting blood glucose measurements on two occasions or a 2hr GTT-75 gmWhich of the following medications is contraindicated for the management of hypertension in pregnancyMethyldopaHydralazineLabetalolNifedipine XLLosartanPainless and profuse vaginal bleeding in the third trimester is most likely Placenta acredaPlacenta previaVaso previaBloody show Cervical ripeningThe normal amount of blood loss for a vaginal delivery is less than 250ml500ml1000ml1500ml2000mlWhich of the following statements about epidural anesthesia is true?It provides anesthesia only for lumbar and sacral nerve rootsIt should only be used for multigravida womenIt can be used in hemophiliacs It can be associated with hypotensionPlacement of the catheter should be at the L2-L3 levelWhich of the following statements regarding anencephaly is trueIntracerebral shunts can be used effectively in preventing CNS complicationsThe condition should be suspected with elevations in alpha-fetoprotein levelsChildren who are affected may need additional tutoring during schoolNicotinic acid may help prevent anencephaly when given antepartumUTI’s are common in those affectedWhich of the following medication is not used in the treatment of preterm labor?RitodrineMagnesium sulfateTerbutalinePropranololNifedipeneWhich of the following statements about neural tube defects is true?Laboratory testing is not useful in the diagnosis of neural tube defectsElevated alpha-fetoprotein levels should be further evaluated by OB USNicotinic acid has been shown to help prevent neural tube defectsAlpha fetoprotein testing should be done at 24-28 wks EGAElevated alpha-fetoprotein levels are not associated with normal pregnanciesA 27yr old asymptomatic pregnant woman at 8 weeks EGA is found to have hyperthyroidism. Which of the following medications is the drug of choice for treatment in the first trimester?Propylthiouracil (PTU)Radioactive iodineMethimazolePropranololLevothyroxineThe maximum acceptable cumulative dose of ionizing radiation during pregnancy is100 rads50 rads10 rads5 rads1 radLive virus vaccines such as measles, mumps, and rubella should be administered to pregnant women At the first prenatal visit following conceptionAt least 3 months before conceptionDuring the second trimesterDuring the third trimesterAt 18-20 weeks gestationWhen testing fetal well –being which of the following factors is not measured with biophysical profile?Fetal toneAmniotic fluidFHRFetal sizeBody movementsWhich of the following is an absolute contraindication of tocolysis?Chorioamnionitis4cm cervical dilatationBPP of 8OligohydraminosHyperthyroidismWhen testing fetal well being which of the following statements about the non stress test is true?Two or more fetal heart accelerations (at least 15 beats above baseline) that last for 15 sec in a 20min period are reassuringLate decelerations are usually noted with fetal movementsAn abnormal nonstress test should be followed by a contraction stress testThe presence of oligohydraminos is accurately predicted with the results of a NSTNST should be routinely performed beginning at 38 weeks until deliveryRhogam should be given to Rh-negative mothers atFirst prenatal visit and at delivery12 and 36weeks16 weeks gestation and after delivery, depending on Rh status of newborn28 weeks gestation and after delivery depending on Rh status of newborn28 and 36wks gestationThe most appropriate medication for the treatment of pyelonephritis in pregnancy isAmpicillin + gentamicinTrimethoprim-sulfamethoxazoleTetracyclineNitrofurantoinCiprofloxacinWhich of the following tests is indicated at the time of the first prenatal visit in a healthy mother?Alpha-fetoprotein testingQuantitative B-HCGAntibody test (indirect Coombs’ test)Glucose tolerance testFree T4Which of the following is associated with preeclampsiaBP>140/90Trace proteinuriaMild edemaSeizuresScotomataGestational DM screening during pregnancy for women without risk factors for DM should take place At the first prenatal visitAt 12-16 weeks EGAAt 24-28 weeks EGAAt 30-34 weeks EGARandomly throughout pregnancyWhich of the following test results are associated with pregnancy?Increased WBCDecreased alkaline phosphataseIncreased hemoglobulinDecreased lactic dehydrogenaseDecreased fibrinogen levelWhich of the following is a contraindication for external cephalic version36weeks EGAMaternal age of 35PolyhydramniosMaternal diabetesObesityWhich of the following is not considered appropriate tocolysis for preterm labor at 32 weeks gestation?Magnesium sulfate IV for 48 hrsMagnesium sulfate until 34 wks EGARitrodrine for 48hrsIndomethacin for 48hrsNifedipine for 48 hrsGestational hypertension is associated withBP>140/90ProteinuriaThrombocytopeniaDecreased UOSeizuresWhich of the following statements about sexual intercourse and uncomplicated pregnancy is trueIntercourse should be avoided until 36 weeks because of the risk of preterm laborIntercourse should be avoided 2 weeks before the EDC because of the risk of infectionIntercourse is safe during pregnancy, however organsm should be avoided because of the risk of preterm laborIntercourse is not considered dangerous during normal pregnancyIntercourse should be avoided during pregnancy because of the risk for placental abruptionWhich of the following statements is true regarding BV during pregnancy?Studies have shown that BV is associated with adverse pregnancy outcomesSymptomatic women should be treatedRoutine screening is recommended for all pregnant patientsOral metronidazole should be avoided in pregnancy due to potential teratogenic effectsVaginal clindamycin or vaginal metronidazole are both good choices for treatment of BV during pregnancyThe most common cause of first trimester spontaneous abortion isIncompetent cervixChromosomal abnormalitiesIncreased maternal ageInadequate levels of progesterone during luteal phaseLupus anticoagulantOligohydramnios (in the absence of ruptured membranes) is NOT correlated with an increased risk for IUGRFetal gastrointestinal abnormalitiesInduction of laborMeconium stained fluidAbnormal FHR patterns Rubella infection during pregnancy Rarely affects the fetusHas its most devastating effects during the third trimesterIs associated with cataracts, cardiac defects, and cleft palateIs associated with neural tube defectsCan be prevented with immunization during the pregnancyA major risk factor for shoulder dystocia includes which of the following?Young maternal ageGestational diabetesPrecipitous deliveryPreterm deliveryThin body habitusWhich laboratory test would best support lung maturity in a fetus whose mother has shown signs of premature labor?Lecithin-sphingomyelin (l/S0 ratio of 1.75L/S ratio of 1.5Absence of phosphatidylinositolAbsence of phosphatidyl glycerolL/S ratio of 2.2 with a positive PG levelWhich of the following statements about striae distensae are true?They usually respond to topical corticosteroidsThey rarely fade after pregnancy They may be related to excessive corticosteroids that are produced during pregnancyThe condition is secondary to excessive weight gain (>40lbs) during pregnancyNone of the aboveAt what month during pregnancy does the mother’s appendix move upward to a level above the iliac crest?3rd month6th month9th monthThe appendix does not change location When the fetal head engages in the pelvisWhich of the following is the most important risk factor in the transmission of HIV from an infected mother to her newborn?Preterm delivery (<34 weeks)Low birth weightLow maternal CD4 countProlonged ROM (>4hrs)IV drug use during pregnancyAt a routine prenatal visit, a patient says she has been having headaches. Which one of the following statements about analgesic use during pregnancy is correctAspirin is considered safe during the third trimesterAcetaminophen as a single agent is generally safe during pregnancyAcetaminophen is contraindicated if the patient is febrileNSAIDs are the analgesic of choice Which one of the following types of over the counter medications should be used with caution during pregnancy?AntihistaminesTopical antifungalsSelective histamine H2 blockersDecongestants Although few studies support the safety of herbals and dietary supplements during pregnancy which one of the following is generally considered safe and effective for treating nausea in pregnancy?St Johns WortBlack CohoshGingerMugwort A 22yo pregnant woman at 32 wks gestation is driving home when she is rear-ended at a stoplight. She is wearing her seatbelt, and the airbag does not deploy. She denies experiencing abdominal pain, vaginal bleeding, loss of fluid, or decreased fetal movement. Which one of the following statements is correct?Seat belt use increases during pregnancyAir bag deployment increases the risk of adverse pregnancy outcomesPlacing the lap belt over the dome of the uterus has been associated with uterine and fetal injuryShe should be monitored by TOCO for a minimum of 12 hours Which one of the following statements about major trauma in pregnancy is correct?Placental abruption can occur up to 72 hours following traumaTransportation to a hospital for timely trauma evaluation is recommendedAll patients with major trauma should be monitored with TOCO for a minimum of 24 hours regardless of evaluation findingsRh-positive patients with abdominal trauma should receive Rh immune globulin therapy Opthalmia neonatorum is diagnosed in a 3-day old newborn after purulent conjunctivitis is noted. Which one of the following is the most likely etiology?Chemical irritantGonoccocal infectionChlamydia infectionHSV infectionAn examination of a seemingly healthy newborn reveals bounding pulses bilarterally. This is most likely indicative of which one of the following?Poor cardiac output (eg cardiac stenosis)Cyanotic heart disease (eg truncus arteriosus)Left heart failureHigh Cardiac output (eg patent ductus arteriosus)Scheduled glucose screening is recommended for newborns in which of the following categories?Large for gestational ageSmall for gestational ageLate preterm (34-36 6/7)Newborns of mother with DMAll of the aboveDuring a newborn exam a “clunk” is felt while performing the Ortalani maneuver. This finding combined with which of the following characteristics put the newborn at the highest risk of hip dysplasiaA male newborn with a family history of developmental dysplasia of hipA male newborn born in a breech positionA female newborn with a family h/o dysplasia of the hipA female newborn born in a breech position A mother is concerned after noticing flesh-colored papules with an ertythematous base on her newborns face and trunk. Which one of the following courses are these skin lesions likely to take?Rupture and leave hyperpigmented macules that may persist for monthsSpontaneously rupture within the first few weeks of lifeResolve within the first week of lifeResolve with warmthWhich of the following are characteristics of a simple sacral dimple?< 0.5cm in diameterLocated within 2.5 cm of the anal vergeLocated more than 3cm from the anal verge Not associated with cutaneous markersA,B &DWhich of the following is an absolute contraindication for trial of labor after CSECT?Twin gestation2 prior low cervical transverse CSectPrevious C Sect with unknown scarH/O classical uterine incision during prior CSECTPregnant women wo empty cat litter boxes are at increased risk for which one of the following?ToxoplasmosisToxocara mystax (Toxocara cati) infectionChagas diseaseCysticercosisAspergillosisA 25-year-old primigravida at 33 weeks gestation presents to the labor suite with a complaint of painful uterine contractions every 3 minutes for the last 2 hours. A fetal monitor confirms the contraction pattern, and the fetal heart rate pattern is category 1. A fetal fibronectin test is ordered.Thirty minutes later the contractions have stopped, but the results of the fetal fibronectin test are positive. A speculum examination shows no indication of ruptured membranes. The cervix is closed and thick to palpation. The positive result on this patient’s fetal fibronectin testHas a low positive predictive value for preterm deliveryIndicates a high likelihood of delivery before termIndicates a high likelihood of delivery within the next weekIndicates occult rupture of membranesIs diagnostic of preterm laborBoth the AAFP and ACOG recommend that non-medically indicated (elective) inductions of labor or cesarean deliveries should be scheduled after what gestational age?37 weeks, 0 days39 weeks, 0 days40 weeks, 0 days41 weeks, 0 days42 weeks, 0 daysA 29-year-old female presents to your office for a routine prenatal visit at 30 weeks gestation. She received Tdap vaccine during her last pregnancy 3 years ago.Which one of the following should she receive today?Live attenuated influenza vaccineMMRTdapVaricella vaccineNo vaccineA 65-year-old female sees you for a routine health maintenance visit. She has a newborn granddaughter that she is planning to watch a few days a week and asks if there are any vaccines that she can get that will help protect the health of her granddaughter. She has not received any vaccines other than yearly influenza vaccine in the past 20 years. According to the CDC, which one of the following would be recommended for her to protect her infant grandchild from illness?Meningococcal vaccine (Menactra)13-valent pneumococcal conjugate vaccine (Prevnar 13)23-valent pneumococcal polysaccharide vaccine (Pneumovax 23)TdapVaricella vaccineWhich one of the following is the most common cause of hearing loss in the newborn?AminoglycosidesGenetic inheritanceHead traumaPrematurityRubellaThe American College of Obstetricians and Gynecologists and the American Academy of Pediatrics support the advance provision of emergency contraception to sexually active women. Evidence shows that this practiceDecreases pregnancy rates on a population levelDecreases the time from unprotected sex to use of emergency contraceptionDecreases contraception use by the patient prior to sexual activityIncreases the rates of sexually transmitted infectionsIncreases the rates of unprotected intercourseA 32-year-old primigravida at 20 weeks gestation presents with a 5-day history of gradually worsening left calf pain and swelling. She was placed in a walking boot 3 weeks ago to immobilize a left foot fracture. She feels well otherwise, and she specifically denies any chest pain, cough, palpitations, dyspnea, fever, chills, easy bruising, or bleeding. Her examination is notable only for posterior tenderness and swelling of the left calf. A CBC, prothrombin time, and partial thromboplastin time are all normal. Duplex Doppler ultrasonography of the left leg is consistent with deep vein thrombosis. Which one of the following do you recommend at this point?Low molecular weight heparin (Lovenox)Unfractionated heparinAspirin and clopidogrel (Plavix)Rivaroxaban (Xarelto) A 25-year-old gravida 1 para 0 presents for follow-up of gestational diabetes mellitus. She had a positive screening test at her 24-week visit last week and has been checking her blood glucose at home twice daily since that time. She is not currently on any diabetes medications and has a nutrition visit scheduled for later today. She is currently unclear on what her glucose level should be at various times throughout the day. Which one of the following is the goal fasting blood glucose in this patient?Less/equal to 75 mg/dLLess/equal to 95 mg/dLLess/equal to 120 mg/dLLess/equal to 140 mg/dLLess/equal to 180 mg/dLA newborn female is found to have constricted ear deformity (cup ears). Her mother had gestational diabetes mellitus. Which of the following studies would be most appropriate for this patient?A single-view chest radiographLong bone radiographsEchocardiographyRenal ultrasoundUnenhanced head CTA newborn male is brought to your office for his first examination after hospital discharge. He has been diagnosed with Down Syndrome. Which one of the following is indicated for all newborns with Down Syndrome? A cervical spine filmAn echocardiogramPolysomnographyUltrasonography of both hipsRisk factors for sudden infant death syndrome include which one of the following?Side sleepingBeing large for gestational age at birthA history of an apparent life-threatening eventPacifier useAsian or Pacific Islander ethnicityA 28-year-old gravida 2 para 1 visits your office for routine prenatal care at 36 weeks gestation. Today she reports some mildly increased lower extremity edema without associated headache, visual changes, or right upper quadrant pain. She has not noticed any leaking amniotic fluid and has only had occasional mild uterine contractions. Her blood pressure has been normal at past visits, but on examination today it is 144/92 mm Hg. Repeat measurement confirms the blood pressure reading, and a urine dipstick shows trace protein. Her fundal height measures 36 cm, fetal heart tones have a rate of 134 beats/min, and Leopold’s maneuvers indicate that her fetus is in a cephalic position. Laboratory tests reveal a normal platelet count, normal transaminase and creatinine levels, and a normal urine protein/creatinine ratio. Your plan at this time should include which one of the following?Immediate induction of laborHome blood pressure and symptom monitoring, and induction of labor a t 37 weeks gestationHome blood pressure and symptom monitoring, weekly office visits and laboratory evaluation, and induction of labor at 39 weeks gestationHome blood pressure and symptom monitoring, weekly office visits and laboratory evaluation and induction of labor at 40 weeksHome blood pressure and symptom monitoring, weekly office visits and laboratory evaluation, and induction of labor at 41 weeks. You see a 5-week-old female for a well child visit in December. She was delivered at 28 weeks gestation because of severe preeclampsia in the mother. Her parents state that she is doing well, feeding well, and growing. The physical examination is normal. At this time, you recommend immunoprophylaxis withInfluenza vaccinePalivizumab (synagis)Pertussis vaccineIntravenous immunoglobulinWhich one of the following is considered first-line therapy for nausea and vomiting of pregnancy?GingerBlue cohoshCranberry juiceVitamin B6Fenugreek A full-term newborn female develops respiratory distress 1 hour after an uncomplicated cesarean delivery. She has a respiratory rate of 70/min, and mild grunting and intercostal retractions are noted on examination. The remainder of the examination is within normal limits. A chest radiograph shows some hyperexpansion and fluid in the fissures. Which one of the following is the most likely cause of her symptoms?Respiratory distress syndrome of the newbornTransient tachypnea of the newbornPneumothoraxMeconium aspiration syndromeA 4-week-old white male is brought to your office with a 2-week history of increasing dyspnea, cough, and poor feeding. The child appears nontoxic and is afebrile. On examination you note conjunctivitis, and a chest examination reveals tachypnea and crackles. A chest film shows hyperinflation and diffuse infiltrates and a WBC count reveals eosinophilia. What is the most likely etiologic agent?Staphylococcus speciesChlamydia trachomatisRespiratory syncytial virusParainfluenza virusExamination of a 2-day-old infant reveals flesh-colored papules with an erythematous base located on the face and trunk, containing eosinophils. Which of the following would be the most appropriate at this time?An allergy evaluationLow-dose antihistaminesHydrocortisone cream 0.5%A sepsis workupObservation onlyA 21-year-old female comes to her family physician’s office with an unintended pregnancy and states that she wishes to have a medical abortion. Elective abortion is against the physician’s personally held moral principles. According to the AAFP, which one of the following would be the most appropriate course of action for the physician in this situation?Explaining the rationale for morally opposing medical abortionProviding no further assistance at this visitOffering to match the patient with prospective adoptive parentsAdvising the patient that it would be safer for her to continue with the pregnancyProviding resources that explain how to access a safe and legal medical abortionA 30-year-old female reports that she and her husband have not been able to conceive after trying for 15 months. She takes no medications, has regular menses, and has no history of headaches, pelvic infections, or heat/cold intolerance. Her physical examination is unremarkable. Her husband recently had a normal semen analysis. Which one of the following would be the most appropriate next step.Observation for 1 yearTSH, free T4 and prolactin levelsHysterosalpingographyAn estradiol levelA luteal-phase progesterone level How many arteries and veins are normally found in the umbilical cord on a newborn examination?1 artery, 1 vein1 artery, 2 veins2 arteries, 1 vein2 arteries, 2 veins2 arteries, 3 veinsA 25-year-old female who is 3 months post partum presents with multiple complaints, including increasing weakness and fatigue, intolerance to warm environments, a weight loss of 30 lbs despite and increased appetite, difficulty sleeping, awareness that her heart is beating faster and “pounding” in her chest, increasing restlessness and difficulty concentrating, increased tremulousness, and a significant swelling in her neck. She takes no medication, has experienced no recent trauma, and has not ingested large amounts of iodine. When you examine her you find no exophthalmos or lid lag and no pretibial edema, but her skin is warm, smooth and moist. You also find a smooth, non-nodular, nontender, enlarged thyroid gland, clear lungs, a resting tremor, and hyperactive reflexes. Laboratory testing reveals a low TSH level, elevated free T3 and T4, and high uptake on a radioactive iodine uptake scan. Which one of the following is the most likely diagnosis?Postpartum thyroiditisSilent thyroiditisSubacute thyroiditisGrave diseaseExogenous thyroid ingestion A 28-year-old gravida 1 para 0 at 39 weeks gestation presents for routine outpatient obstetric care and is found to have a blood pressure of 145/95mm Hg. A complete review of systems is notable only for chronic low back pain causing poor sleep. The physical examination is normal, including a nontender, gravid uterus and a fetal heart rate of 150 beats/min. The cervical examination reveals firm consistency, 1 cm dilation, 50% effacement, and -3 station. The patient’s blood pressure is checked 5 hours later and is 142/94 mm Hg. Based on the 2013 ACOG guidelines for management of hypertension in pregnancy, which one of the following should be the next step in management?Admit the patient for induction of laborMeasure 24-hour protein, with induction of labor if the level exceeds 300 mgBegin oral nifedipine (Procardia) and recheck her blood pressure in 24-48 hoursPlace the patient on strict bed rest and check her blood pressure twice a weekBegin twice-weekly office visits with assessment for preeclampsiaA 25-year-old gravida 1 para 0 sees you for a routine prenatal visit. This is a planned pregnancy and you calculate her to be at approximately 14 weeks gestation based on the dates of her last menstrual period. She is healthy without any medical problems, takes no medication, and does not use tobacco products. She is adopted and does not know her family history. She feels well today and has no specific concerns. Her vital signs are stable, her weight is normal, and fetal heart tones are auscultated with a Doppler stethoscope at approximately 140 beats/min. Which one of the following should be completed today?A 1-hour glucose tolerance testA group B Streptococcus screenA TSH levelA urinalysis and urine cultureEvaluation for bacterial vaginosisA 34-year-old G2P0101 at 11 weeks gestation comes to your office to establish care for her pregnancy. In reviewing her history you find that her first pregnancy was complicated by preeclampsia and she required induction of labor at 33 weeks. She also has chronic hypertension treated with chlorthalidone. Her blood pressure today is 128/78 mm Hg. Which one of the following medications, if started today, will lower her risk of preeclampsia in this pregnancy?AspirinCalciumLabetololNifedipine (Procardia)Vitamin EWhich one of the following immunizations is indicated for all pregnant women at any stage of pregnancy?MMRVaricellaInfluenzaHPVA 24-year-old gravida 2 para 1 at 9 weeks gestation sees you for a routine prenatal check. She complains of significant nausea, and recommended dietary modifications have not helped. She drives a school bus so she would like to avoid sedating medications. She appears well-hydrated and her examination is otherwise normal. Which one of the following would be best for relieving this patient’s nausea?Auricular acupressureA scopolamine patch (Transderm Scop)Vitamin B6 (pyridoxine)Methylprednisolone (Medrol)A 31-year-old gravida 1 para 0 presents for a routine visit at 32 weeks gestation. She has gestational diabetes mellitus (GDM) and has been following the dietary guidelines from her dietitian. However, her blood glucose is still elevated and you discuss starting medications for management of her GDM. She is adamant about not starting insulin but is willing to consider taking metformin (Glucophage). Before making a decision she would like to know the specific benefits to her baby. You would tell her that one benefit of treatment of GDM is a decreased risk forMaternal type 2 diabetes mellitus after deliveryMaternal preeclampsiaPerinatal deathA small-for-gestational-age infantA 28-year-old female just delivered a male infant over an intact perineum. She has had polyhydramnios during this pregnancy, but her prenatal course has otherwise been normal. Her only significant chronic medical problem is asthma, treated with a long-acting B-agonist/corticosteroid combination inhaler. Vital signs were stable throughout her labor. After delivery of the placenta, bleeding becomes brisk and you note a soft, boggy uterus. Which one of the following medications is contraindicated in this patient?Carboprost (Hemabate)MethylergonovineMisoprostol (Cytotec)Oxytocin (Pitocin)A pregnant 30-year-old female comes to your office in October and asks if she should receive influenza vaccine. She is at 12 weeks gestation by dates and has a past history of a severe egg allergy. Which one of the following would you recommend?No immunization, because of the pregnancyNo immunization, because of the egg allergyStandard inactivated seasonal vaccine nowHigh-dose inactivated seasonal vaccine nowImmunization during the second trimester A 23-year-old gravida 1 para 0 at 35 weeks gestation presents with a 2-day history of ankle swelling and headache. She denies any abdominal pain or visual disturbances. On examination, you note a fundal height of 35 cm, a fetal heart rate of 140 beats/min, 2+ lower extremity edema, and a blood pressure of 144/92 mm Hg. A urine dipstick shows 1+ proteinuria. A cervical examination reveals 2cm dilation, 90% effacement, and vertex presentation. You send her to labor and delivery and triage for further evaluation. Over the next 4 hours she has a reactive nonstress test and her blood pressure ranges from 142/90 mm Hg to 148/96 mm Hg. Laboratory results show a urine protein to creatinine ratio of 0.4 (N<0.3), normal BUN and creatinine levels, normal liver enzyme and LDH levels, normal hemoglobin and hematocrit levels, and a platelet count of 95,000/mm3 (N 150,000-350,000). Which one of the following would be the most appropriate next step in the management of this patient?A biophysical profileUltrasonography to check for fetal intrauterine growth restrictionInititiation of antihypertensive treatmentImmediate induction of laborImmediate cesarean deliveryA 22-year-old gravida 1 para 0 with a history of homelessness and recent intravenous drug use presents for prenatal care. Mantoux tuberculin testing is performed and produces 20mm of induration. She had a negative tuberculin test 1 year ago. A chest radiograph is normal. You decide to treat her with isoniazid for latent TB infection. Which one of the following should also be given to prevent the development of peripheral neuropathy?FolateVitamin B6Vitamin DDuloxetine (Cymbalta)Gabapentin (Neurontin) A pregnant 20-year-old female is diagnosed with Chlamydia infection. She is treated and the infection is cured, but she tests positive again at a follow-up visit. In this situation, contacting her sexual partners is considered a reasonable breach of confidentiality becauseThere is a public health riskThere is a risk to the fetusThe patient’s chlamydia infection has become resistant to antibioticsThere is a risk of pelvic inflammatory disease You are discharging a mother and her infant after delivery. The infant was born at 35 weeks gestation, is exclusively breastfed, and has a weight that is appropriate for her gestational age. No blood transfusions were necessary and all evaluations have been unremarkable. According to the guidelines of the American Academy of Pediatrics, at what age should you recommend initiation of iron supplementation for this infant?Now1 month3 months6 months9 months While you are examining a 3-day-old for a routine newborn checkup, his mother, who is also your patient, tells you that she has been crying very easily and feeling overwhelmed, and that some of her friends have suggested she ask about an antidepressant medication. She has no previous history of depression or other mood disorders. She does not have any thoughts of self-harm or intent to harm the baby or anyone else. She is breastfeeding and is otherwise healthy. Which one of the following would be most appropriate at this point?Reassurance that she likely has baby blues that will resolve in a few daysEncouraging her to make an appointment with a therapist if she does not feel better in 1 week.Referral to a counselor for psychotherapyUse of a validated screening tool to evaluate for postpartum depressionStarting an SSRI for postpartum depression Which one of the following populations should be screened for asymptomatic bacteriuria?Patients with diabetes mellitusPatients who are pregnantHospitalized patients who have an indwelling Foley catheterHospitalized patients at the time of removal of an indwelling Foley catheterResidents of long-term care facilitiesA 37-year-old female who smokes 1 pack of cigarettes per day has just had her third child and requests contraception. She does not intend to have any more children. Which one of the following is the safest option for this patient?Traditional combined oral contraceptive pillsExtended-cycle combined oral contraceptive pillsThe contraceptive patch (Ortho Evra)The contraceptive vaginal ring (NuvaRing)The etonogestrel implant (Nexplanon)A 36-year-old female sees you for a 6-week postpartum visit. Her pregnancy was complicated by gestational diabetes mellitus. Her BMI at this visit is 33 and she has a family history of diabetes. Which one of the following is this patient’s greatest risk factor for developing type 2 diabetes in the future?Her ageObesityThe history of a completed pregnancyThe history of gestational diabetesThe family history of diabetes ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download