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Category: Obstetrics & Gynecology--->Maternal-Fetal Physiology and Placentation
Page: 2

Question 6# Print Question

A healthy 25-year-old G1P0 at 37 weeks’ gestational age comes to your office to see you for a routine obstetric visit. She reports that on several occasions she has experienced dizziness, light-headedness, and feeling as if she is going to pass out when she lies down on her back to take a nap.

What is the most appropriate plan of management for this patient?

A. Perform an electrocardiogram
B. Monitor her for 24 hours with a Holter monitor to rule out an arrhythmia
C. Perform an arterial blood gas analysis
D. Refer her to a cardiologist
E. Reassure and encourage her not to lie flat on her back


Question 7# Print Question

A 22-year-old primigravida presents to your office for a routine OB visit at 34 weeks’ gestational age. She voices concern because she has noticed an increasing number of spidery veins appearing on her face, upper chest, and arms. She is upset with the unsightly appearance of these veins and wants to know what you recommend to get rid of them.

How should you counsel this patient?

A. Tell her that this is a condition which requires evaluation by a vascular surgeon
B. Tell her that you are concerned that she may have serious liver disease and order liver function tests
C. Tell her that you are going to refer her to a dermatologist for further workup and evaluation
D. Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy
E. Tell her to wear an abdominal binder


Question 8# Print Question

You are the third year medical student assigned to labor and delivery. A 29-year-old P3003 at 29 weeks with known placenta previa presents to the triage area with a report of vaginal bleeding. The fetal heart tracing is reactive and the bleeding is minimal. You take history and present her to your intern. You accompany the intern to triage to further evaluate the patient together. Your intern confirms the history and prepares to perform a digital cervical examination.

What should your next step be in this situation?

A. Watch the intern perform a digital cervical examination
B. Ask if you may also perform a digital cervical examination
C. Remind the intern that the patient has a placenta previa and should not have a digital cervical examination
D. Suggest that the intern perform an ultrasound to evaluate the placenta
E. Do not say anything at the time, but afterward remind the intern that the patient has a placenta previa and should not have a digital cervical examination


Question 9# Print Question

A healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12 weeks’ gestational age. She tells you that she has stopped taking her prenatal vitamins with iron supplements because they make her sick and she has trouble remembering to take a pill every day. A review of her prenatal laboratory tests reveals that her hematocrit is 39%.

Which of the following statements is the best way to counsel this patient?

A. Tell the patient that she is not anemic, and therefore she will not need the iron supplied in prenatal vitamins
B. Tell the patient that if she consumes a diet rich in iron, she does not need to take any iron supplements
C. Tell the patient that if she fails to take her iron supplements, her fetus will be anemic
D. Tell the patient that she needs to take the iron supplements, even though she is not currently anemic, in order to meet the iron demands of pregnancy
E. Tell the patient that she needs to start her iron supplements if her hematocrit falls below 36%


Question 10# Print Question

A 19-year-old P0 at 20 weeks’ gestation presents to the emergency department (ED) with complaints of right flank pain. The ED physician orders a renal sonogram as part of a workup for a possible kidney stone. The radiologist reports that no nephrolithiasis is present, but reports the presence of bilateral mild hydronephrosis and hydroureter, which is greater on the right side than on the left.

What is the most appropriate next step in management?

A. Order renal function tests, including BUN and creatinine, to evaluate the renal function
B. These findings are consistent with normal pregnancy and are not of concern. No further evaluation is required
C. Order an intravenous pyelogram to further evaluate the bilateral hydronephrosis
D. Request a urology consult to obtain recommendations for further workup and evaluation
E. The findings are concerning for bilateral ureteral obstruction, and the patient should be referred for stent placement




Category: Obstetrics & Gynecology--->Maternal-Fetal Physiology and Placentation
Page: 2 of 3