OBGYN APGO UWise Practice MCQs sha2507 Exam | Questions & 100% Correct Answers (Verified) | Latest Update | Grade A+

A 23-year-old G1P0 woman presents with cramping, vaginal bleeding and right lower quadrant pain. Her last normal menstrual period occurred seven weeks ago. On physical exam, vital signs are: blood pressure 110/74; pulse 82; respirations 18; and temperature 99.4°F (37.4°C). On abdominal exam, she has very mild right lower quadrant tenderness. On pelvic exam, she has scant old blood in the vagina and a normal appearing cervix. Her uterus is normal size and slightly tender. On bimanual exam, there is no cervical motion tenderness, and she has slight tenderness in right lower quadrant. Quantitative Beta-hCG is 2500 mIU/ml; progesterone 6.2 ng/ml; hematocrit 34%. The transvaginal ultrasound shows an empty uterus with endometrial thickening, a mass in the right ovary measuring 3 x 2 cm and a small amount of free fluid in the pelvis. Which of the following is the most appropriate next step in the management of this patien : A. The next best step in management is methotrexate administration. Certain conditions must be met prior to initiating methotrexate therapy for treatment of an ectopic pregnancy. These include: hemodynamic stability; non-ruptured ectopic 2 | P a g e pregnancy; size of ectopic mass 4 cm without a fetal heart rate or 3.5 cm in the presence of a fetal heart rate; normal liver enzymes and renal function; normal white cell count; and the ability of the patient to follow up rapidly (reliable transportation, etc.) if her condition changes. There is no indication for antibiotics in this scenario. Offering observation delays treatment and pain control would not address the underlying cause of the patient's problem. Culdocentesis is not indicated and would not change the management of this patient. A 32-year-old G5P3 woman presents with left-sided abdominal pain. Her last normal menstrual period was eight weeks ago. She began having pain early this morning and it has increased to a severity of 8/10. She denies nausea or vomiting or vaginal bleeding. Her gynecological history is notable for a right-sided ectopic pregnancy four years ago. At that time, she had a right salpingectomy and a left tubal ligation. On physical examination: blood pressure is 90/54; pulse 108; respirations 22; and temperature 98.6°F (37.0°C). On abdominal examination, she has rebound and guarding in all quadrants, and on pelvic exam, her uterus is very tender and there is left adnexal fullness. Urine pregnancy test is positive. A transvaginal ultrasound shows a thickened endometrium, left pelvic mass with a gestational sac and fetal pole, and a large amount of free fluid in the pelvis. Her hematocrit is 26%. What would be the next best : D. This scenario is consistent with the patient having a ruptured ectopic pregnancy. Signs of hypovolemia (tachycardia, hypotension) with peritoneal signs 3 | P a g e (rebound, guarding and severe abdominal tenderness) and a positive pregnancy test lead to the diagnosis of ruptured ectopic pregnancy. Conservative management, with observation and repeating the Beta-hCG level in 48 hours is not indicated since a diagnosis is clear and delaying surgery can potentially be dangerous to the patient. Dilation and curettage would only be considered after laparoscopy, if needed. A 19-year-old G1P0 woman with a desired pregnancy notes vaginal spotting early this morning and it has slightly increased. Her last normal menstrual period occurred six weeks ago. She has no pain or other symptoms. Her medical history is noncontributory. Vital signs are: blood pressure 120/68; pulse 68; respirations 20; and temperature 98.6°F (37.0°C). On pelvic exam, her cervix is normal; her uterus is small and nontender; there are no masses palpable. Labs show: quantitative Beta-hCG 750 mIU/ml; progesterone 3.8 ng/ml; hematocrit 38%. Which of the following is the most appropriate next step in the management of this patient? A. Order a transvaginal ultrasound B. Repeat Beta-hCG level in 24 hours C. Repeat Beta-hCG level in 48 hours D. Dilation and curettage E. Bed rest 4 | P a g e : C. Repeating the Beta-hCG level will show whether the pregnancy is viable or failing. The appropriate time interval for repeating the initial level is 48 hours, since during the first 42 days of gestation levels increase by approximately 50% every 48 hours in most viable pregnancies. Ordering an ultrasound would not be helpful, since the patient's Beta-hCG level is lower than the discriminatory zone (the level at which an intrauterine pregnancy should be seen on ultrasound, usually 2000 mIU/ml). There is no need to repeat the progesterone level. Dilation and curettage or treatment with methotrexate are both inappropriate without a diagnosis, since both could interrupt a viable pregnancy. Bedrest is not indicated in this patient. A 19-year-old G1P0 woman notes vaginal spotting. Her last normal menstrual period occurred six weeks ago. She began having spotting early this morning and it has increased only slightly. She has no pain and denies other symptoms. Her medical history is noncontributory. Vital signs are: blood pressure 120/68; pulse 68; respirations 20; and temperature 98.6°F (37.0°C). On pelvic exam, her cervix is normal; uterus is small and nontender; and no masses are palpable. Initial labs show quantitative BetahCG 2000 mIU/ml and hematocrit 38%. A repeat Beta-hCG level 48 hours later is 2100 mIU/ml. A transvaginal ultrasound shows an empty uterus with a thin endometrial stripe and no adnexal masses. What is the next best step in the management of this patient? A. Dilation and curettag