Aquifer FM Qs at end of case 1-40 Questions With Complete Solutions

*Case 30: Question 1* A 21-year-old G1P0 female present to clinic as a new patient to establish prenatal care. Which statement represents something that would not be expected to be a benefit of group prenatal care for this patient? A. Decreases the likelihood of preterm delivery B. Increases physician contact C. Increases support network D. Shared education between patients E. Increases adherence to techniques for pain management during labor correct answer: The correct Answer is E. E. Increases adherence to techniques for pain management during labor Clear, health literate communication about options for pain management are a benefit of group prenatal care, not adherence to a particular pain management plan. Answer choices A, B, C and D are benefits of group prenatal care. Advantages of group prenatal visits: increase prenatal knowledge, labor preparedness, support network, shared education between patients, and patient satisfaction provide more time for prenatal education and anticipatory guidance improve provider efficiency preterm delivery less likely (more significant for African-American women) -preterm birth is the number one cause for neonatal death in African-American infants increased birth weight of preterm infants (a significant survival determinant) combat racial disparities used for a variety of medical conditions, including diabetes and chronic pain. *Case 30: Question 2* A 24-year-old G1P0 female at 38 weeks gestation presents to ED complaining of strong lower abdominal contractions that are 10 minutes apart for the last hour. Subsequent cervical examination demonstrates that she is 2cm dilated. FHT are 140 and NST is non-reactive with early decelerations. What is the most appropriate management of this patient? A. Augment labor with Pitocin B. C-section C. Expectant management D. Immediate vacuum delivery E. Rupture membranes to increase labor correct answer: The correct answer is C. C. Expectant management Expectant management is the most appropriate management at this time. ** Patient is currently not in active labor. Active labor is defined as cervical dilation > 6 cm in the presence of contractions. Contractions are normally 3-5 minutes apart. Fetus is not in distress at this time. Early decelerations are indicative of head compression and are not especially concerning. It is not generally advised to induce patients prior to 39 weeks if there are no complications and fetus is not in distress. C-section would not be indicated in this case because neither mother and baby are stable and not in distress. Immediate vacuum delivery is not indicated in this case. Vacuum delivery is indicated only during the second stage of labor, which is the beginning of pushing to the delivery of the baby. *Case 30: Question 3* The NST tracing attached is most consistent with: A. Cord compression B. Head compression C. Uteroplacental insufficiency D. Fetal bradycardia E. Fetal tachycardia correct answer: The correct answer is B. B. Head compression The NST tracing shows early decelerations which indicate head compression. Early decelerations coincide with the beginning and end of a contraction. It is the characteristic "mirror image" of a contraction. Cord compression is indicated by variable decelerations which are a decrease in fetal heart rate that vary in timing, duration, and intensity. It often looks like the letter "V" and does not necessarily correspond to contractions. *Case 30: Question 4* A 32-year-old female at 33 weeks and 5 days gestation (G2P1) presents to the clinic with headache and RUQ abdominal pain. Blood pressure is 172/121 mmHg on examination while seated. No visual changes noted. Edema is present in the hands, bilaterally. Urine dipstick demonstrated 4+ protein. FHT are 117. Which of the following is the most appropriate next step in the management of this patient? A. Twice-weekly non-stress testing B. Daily aspirin C. Expedited delivery of the premature fetus D. Lisinopril E. Strict bed rest until 37 weeks correct answer: The correct answer is C. C. Expedited delivery of the premature fetus Expedited delivery of the fetus is the best treatment for severe pre-eclampsia. (Note: severe pre-eclampsia is not necessarily an indication for a C-section, however.) *Case 30: Question 5* A 28-year-old, G2P1 female delivers a 6lb 7oz baby boy at 39 weeks gestation. At one minute, baby has blue extremities and a pink body, his arms and legs are flexed. HR is 118 bpm and he is coughing and crying vigorously. What would his APGAR score be at one minute? A. 6 B. 8 C. 7 D. 9 E. 10 correct answer: The correct answer is B. B. 8 The APGAR scoring is done at one minute and 5 minutes of life. It is a tool that helps to predict early infant mortality. The scoring criteria is shown here. *Case 31: Question 1* Which of the following is not a risk factor for CAD? A. Hypertension B. Female sex C. Smoking D. Diabetes correct answer: The correct answer is B. B. Female sex Hypertension, smoking, and diabetes (along with elevated lipid levels, obesity, and sedentary lifestyle) are modifiable risk factors for CAD. Non-modifiable risk factors include older age (men>45 and women >55), family history of CAD in a first-degree relative at a young age, and male sex. *Case 31: Question 2* A 56-year-old male presents for care at the ED complaining of dry cough for the past three days. He notes that this problem started a few days after his family's annual fish fry and barbecue and has been worsening since. He has no known past medical history but mentions that he has not seen a doctor in years. He notes that the cough is worse at night often waking him from sleep. He is unable to lie flat on his back and has started using three to four pillows to sleep comfortably. He also reports increased swelling in his legs that worsens throughout the day. He denies having any chest pain or palpitations and also does not believe he has had any sick contacts. He does no