OBGYN Clinical mastery series form 1 help
Having trouble with a couple questions, any help would be appreciated.
1. A 23 y/o primigravid woman at 32 weeks' gestation is admitted to the hospital because of irregular uterine contractions for 3 hrs. Her temperature is 38.2. The uterus is moderately tender to palpation. The fetal heart rate is 170/min. The cervix is 80% effaced and 2cm dilated; the vertex is at -1 station. Fundal height is 31cm. There is a watery vaginal discharge that tests positive to nitrazine.
A. Abruptio placentae
D. Fetal anomaly
E. Idiopathic preterm labor
F. Incompetent cervix
G. Placenta previa
I guessed E which was incorrect
2. A 26 y/o woman, gravida 3, para 0, aborta 3, comes to a physician because of three spontaneous first-trimester abortions during the past 4 years. She has had no previous evaluation. She has a history of recurrent UTIs since childhood. An intravenous pyelography 16 years ago showed a single left kidney. Pelvic examination today shows a palpable uterus and an easily palpable left ovary. Which of the following is the most likely diagnosis?
A. autoimmune disorder
B. Congenital uterine anomalies
C. Intrauterine synechiae
D. Mullerian agenesis
E. Polycystic ovarian syndrome
F. Premature ovarian failure
G. Prolacin-secreting adenoma
H. Short luteal phase
I. Submucosal leiomyomata uteri
J. Tuberculous salpingitis
I guessed A which was incorrect, no idea what's wrong w/ this lady @@
3. A previously healthy 27 y/o woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician because of a 2hr history of intermittent vaginal bleeding. She has received no prenatal care. The fundal height is 35cm. The fetal heart rate is 135/min. Examination of the lower genital tract and cervix shows the bleeding to be of uterine origin. Laboratory studies are w/in the reference range. Her blood group is O, Rh-negative, and antibody screening is negative. Fetal nonstress test is reactive, and fetal biophysical profile score is 8/8. Which of the following is the most appropriate next step in management?
A. Coagulation studies
B. Measurement of fetal hemoglobin concentration
C. Contraction stress test
D. Administration of betamethasone
E. Administration of Rh0(D) immune globulin
I chose B, thinking I should quantify fetal Hb first to determine the amount of Rho(D) immune globulin (E.) needed to administor for the mother, but that wasn't right.
Is the answer D?
4. A 27 year old Filipino at 10 weeks' gestation comes for her first prenatal visit. Her pregnancy has been complicated by fatigue and nausea. She has not had fever bleeding, or rashes. She has a 15-year history of anemia. Her hematocrit has remained 28% to 29% during the past 7 years despite iron supplementation. She has never been hospitalized. Menarche was at the age of 13 years. Menses occur at regular 28 day intervals, last 5 days, and diminish in flow after the first day. Five years ago, she visited her family in Manila and remembers becoming ill w/ flu-like symptoms during that visit. Examination shows a uterus consistent in size with a 10-week gestation. Which of the following is the most appropriate next step in management?
A. Test stool for occult blood
B. Hb electrophoresis
C. Triple screening
D. Erythropoietin therapy
E. Interferon alfa therapy
F. Chorionic villus sampling
I chose F thinking she has thalassemia so could probably check the baby w/ it but I guess not. Is the answer B? If it is, is it saying I should "confirm" the mother has thalassemia w/ electrophoresis or is it saying I should check the baby's Hb? Thanks!
4. A 27 year old primigravid woman at 14 week's gestation comes to the ED because of a 24 hr history of nausea and right-sided abdominal pain. She also has had loss of appetite for the past 2 days She has not had vomiting, and pregnancy had been uncomplicated. Her temperature is 38.2, pulse is 94/min, respirations are 20/min, and blood pressure is 120/80 mmHg. Fetal heart tones are heard. Abdominal examination shows RLQ tenderness w/ no rigidty or rebound. Laboratory studies show:
Leukocyte count 16500
Seg neutrophils 80%
Which is the most likely diagnosis?
I guessed D and got it wrong, is it appendicitis?
Thanks in advance!
Although I am open to subsequent corrections and discussion, here's how I would answer them:
Q1: She is having Chorioamnionitis. Fever, Uterine tenderness, PeudoLabour, and PPROM (evidenced on clear amniotic vaginal vault fluid).
Q2: This lady I think is having Congenital Uterine Abnormalities (Didelphus Uteri), along with Congenital Genitourinary Abnormalities (Double Ureter....Incr UTIs). Although genetic and chromosomal defects are the leading causes, yet the Etiology is broad.
Q3: This lady has nothing abnormal, I mean all the parameters being in reference ranges. However, her time(36 weeks)for Rhogam has come ( since she is negative for the antibody). I am surprise, why wil you give betamethasone? She is past fetal lung maturation timing (33-34 weeks).
Q4: This lady has been having Low Hct and therefore Anemia, unresponsive to meds, therefore needs to be investigated. More common cause is Iron deficiency, but it should have corrected with meds. Hence the work up for Thalassemia with Hb Electrophoresis is the likely next step.
Q5: The Diagnosis of Appendicitis presents more of a challenge in Pregnancy than in nonpregnants. Well, She has Nausea, Anorexia, RLQ pain (although this might be atypical as well). Fever, Marked Neutrophilic Leukocytosis. Absence of RBCs and pus in UA, and absence of CVA tenderness excludes Pyelonephritis.
I hope this answers the questions, discussion is invited however.
Last edited by Struggler; 04-21-2015 at 10:24 AM. Reason: missing word
Thanks a lot! your explanations were very helpful.
For Q5 though there urinalysis actually showed RBCs/numerous WBCs, which led me to choose pyelonephritis over appendicitis. I still don't get what makes appendicitis more likely given that fact @@
Also, for Q3, do you know when the "Kleihauer-Betke test" is used? In what situations do we have to quantify fetal hemoglobin levels to determine the amount of Rhogam to give?
Another Question on the Same Form
A 32-year-old nulligravid woman comes to the physician because she has not had a menstrual period since she stopped taking an oral contraceptive 6 months ago. Menses had occured at regular 28-day intervals. She also has had increased libido, increased facial acne, increased facial hair growth that requires shaving every other day, and scalp hair loss, especially on the crown. She has had an 11.3-kg (25-lb) weight gain during this period. She is sexually active with one partner, and they use condoms for contraception. She is 163 cm (5 ft 4 in) tall and weighs 86 kg (190); BMI is 33 kg/m2. Her vital signs are within normal limits. Physical examination shows increased development of upper shoulder muscles. There is hair between the breasts and above the umbilicus. Pelvic examination shows the clitoris protruding completely from the clitoral hood. US shows a 2-cm solid mass in the R ovary. Measurements of which of the following serum hormone concs is most likely to be abnormal?
B) DHEA Sulfate
I picked B, which was incorrect. Now that I've typed it out, I'm pretty sure it's D. I'd appreciate any input. Thank you!
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