FHEA Study UPDATED ACTUAL
Questions and CORRECT Answers
First stage of labor is defined as lasting from the onset of:
AContractions until active cervical dilation occurs.
B Regular contractions with cervical change until complete dilation.
C Regular contractions with cervical change until transition.
D Cervical change until the delivery of the infant. - CORRECT ANSWER -Feedback
Correct answer: Regular contractions with cervical change until complete dilation.
Childbirth occurs in three stages. The first stage of labor is usually the longest and lasts from the
time of onset of labor (i.e., regular contractions) until the cervix is completely dilated to 10 cm.
The second stage comprises the period after the cervix is fully dilated until the baby is delivered.
The third stage involves the delivery of the placenta.
Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal uterine
bleeding resulting from: (Select all that apply.)
Endometriosis.
Progesterone deficiency.
Sexually transmitted infections.
Congenital abnormalities in the uterine structure.
,Estrogen excess. - CORRECT ANSWER -Correct answer:
Progesterone deficiency
Estrogen excess
Dysfunctional uterine bleeding (DUB) refers to irregular bleeding that occurs in the absence of
pelvic disease, general medical issues, or pregnancy. DUB results from a disruption in the
normal cyclic pattern of ovulatory stimulation to the endometrial lining. About 90% of DUB
cases are anovulatory and bleeding in these patients is unpredictable (heavy or light, short or
prolonged, frequent or random). As a result of cyclic disruption, patients have constant, non-
cycling estrogen levels along with progesterone deficiency (normally released during the luteal
phase) that stimulates endometrial growth.
The diagnosis of irritable bowel syndrome (IBS) is defined by Rome II criteria, which includes
the following symptoms except:
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months and
symptoms relieved with defecation plus a history of childhood sexual or physical abuse.
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months
with a change in the frequency of bowel movements (constipation or diarrhea) and symptoms
relieved with defecation.
Abdominopelvic pain for 12 weeks (not consecutive) over the past 12 months associated with an
onset of a change in the frequency of bowel movements (diarrhea or constipation) and a change
in the form of stool (loose, watery, with mucus, or pellet-like) and no history of bloody stools.
Abdominopelvic pain for 12 weeks (not consecutive) over the past 12 months associated with an
onset of a change in the frequen - CORRECT ANSWER -Correct answer:
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months and
symptoms relieved with defecation plus a history of childhood sexual or physical abuse.
The Rome II criteria for IBS include abdominal discomfort or pain lasting at least 12 weeks,
which need not be consecutive, in the preceding 12 months that has 2 of the following 3 features:
,1) relieved with defecation, and/or 2) onset associated with a change in frequency of stool,
and/or 3) onset associated with a change in form (appearance) of stool. A history of childhood
sexual or physical abuse is not required for the diagnosis.
A 29-year-old well woman of Mediterranean ancestry presents for her first healthcare visit in
many years. She relocated to North America from Italy after marrying a member of the Armed
Forces. A routine CBC reveals the following results:
-Hgb=9.6 g/dL (12-14 g/dL) (96 g/L {120-140 g/L})
-Hct=30% (36-42%) (.30 proportion {.36-.40 proportion})
-MCV=66 fL (80-96 fL)
-RDW=12% (<15%) (.12 proportion) (<.15 proportion)
-RBC=5.9 million cells/mm3 (3.2-4.3 million cells/mm³)
These findings are most consistent with:
Acute blood loss.
Beta thalassemia minor.
Iron deficiency anemia.
Cooley's anemia. - CORRECT ANSWER -Feedback
Correct answer: Beta thalassemia minor.
The mean cell volume (MCV) of 66 fL indicates microcytic anemia (normal MCV=80-96 fL).
Iron deficiency anemia and thalassemia are the two most common microcytic anemias
encountered in primary care and represent the leading differential diagnoses. Iron deficiency is
most commonly a consequence of slow, steady blood loss and resulting depletion of iron,
whereas thalassemia is a genetic disorder and not related to iron or any micronutrient deficiency.
The normal red blood cell distribution width (RDW) indicates a stable anemia of long duration.
Mediterranean ancestry is a risk factor for thalassemia, and the fact that the patient is a 29-year-
, old well woman suggests that this is a thalassemia minor form, with no impact on health.
Consideration should be given to providing genetic counseling prior to pregnancy.
A 36-year-old woman presents with a 12-h history of anorexia, nausea, and right lower quadrant
abdominal pain. A white blood cell count with differential demonstrates:
-Total WBC=16,500 cells/mm³
-Neutrophils=66%
-Bands=8%
-Lymphocytes=22%
Expected physical examination findings include:
Murphy's sign.
A palpable left lower quadrant mass.
Periumbilical ecchymosis.
A positive obturator sign. - CORRECT ANSWER -Feedback
Correct answer: A positive obturator sign.
This constellation of clinical symptoms is highly suggestive of appendicitis. The obturator and
psoas signs are both consistent with pain during peritoneal stretch in the region of the appendix
and are closely associated with appendicitis; the coincident abdominal pain, anorexia, and nausea
strengthen the diagnosis. Consequently, the white blood cell (WBC) count will likely
demonstrate an increase characterized by elevated neutrophils and bands; this pattern is
commonly referred to as the "left shift".
A 27-year-old G2 P1 had a C-section with her last delivery because of a transverse lie. She
relates that they told her that the baby "was stuck" in the top part of her uterus and they had to
Questions and CORRECT Answers
First stage of labor is defined as lasting from the onset of:
AContractions until active cervical dilation occurs.
B Regular contractions with cervical change until complete dilation.
C Regular contractions with cervical change until transition.
D Cervical change until the delivery of the infant. - CORRECT ANSWER -Feedback
Correct answer: Regular contractions with cervical change until complete dilation.
Childbirth occurs in three stages. The first stage of labor is usually the longest and lasts from the
time of onset of labor (i.e., regular contractions) until the cervix is completely dilated to 10 cm.
The second stage comprises the period after the cervix is fully dilated until the baby is delivered.
The third stage involves the delivery of the placenta.
Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is abnormal uterine
bleeding resulting from: (Select all that apply.)
Endometriosis.
Progesterone deficiency.
Sexually transmitted infections.
Congenital abnormalities in the uterine structure.
,Estrogen excess. - CORRECT ANSWER -Correct answer:
Progesterone deficiency
Estrogen excess
Dysfunctional uterine bleeding (DUB) refers to irregular bleeding that occurs in the absence of
pelvic disease, general medical issues, or pregnancy. DUB results from a disruption in the
normal cyclic pattern of ovulatory stimulation to the endometrial lining. About 90% of DUB
cases are anovulatory and bleeding in these patients is unpredictable (heavy or light, short or
prolonged, frequent or random). As a result of cyclic disruption, patients have constant, non-
cycling estrogen levels along with progesterone deficiency (normally released during the luteal
phase) that stimulates endometrial growth.
The diagnosis of irritable bowel syndrome (IBS) is defined by Rome II criteria, which includes
the following symptoms except:
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months and
symptoms relieved with defecation plus a history of childhood sexual or physical abuse.
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months
with a change in the frequency of bowel movements (constipation or diarrhea) and symptoms
relieved with defecation.
Abdominopelvic pain for 12 weeks (not consecutive) over the past 12 months associated with an
onset of a change in the frequency of bowel movements (diarrhea or constipation) and a change
in the form of stool (loose, watery, with mucus, or pellet-like) and no history of bloody stools.
Abdominopelvic pain for 12 weeks (not consecutive) over the past 12 months associated with an
onset of a change in the frequen - CORRECT ANSWER -Correct answer:
Abdominopelvic pain for 12 weeks (not necessarily consecutive) in the preceding 12 months and
symptoms relieved with defecation plus a history of childhood sexual or physical abuse.
The Rome II criteria for IBS include abdominal discomfort or pain lasting at least 12 weeks,
which need not be consecutive, in the preceding 12 months that has 2 of the following 3 features:
,1) relieved with defecation, and/or 2) onset associated with a change in frequency of stool,
and/or 3) onset associated with a change in form (appearance) of stool. A history of childhood
sexual or physical abuse is not required for the diagnosis.
A 29-year-old well woman of Mediterranean ancestry presents for her first healthcare visit in
many years. She relocated to North America from Italy after marrying a member of the Armed
Forces. A routine CBC reveals the following results:
-Hgb=9.6 g/dL (12-14 g/dL) (96 g/L {120-140 g/L})
-Hct=30% (36-42%) (.30 proportion {.36-.40 proportion})
-MCV=66 fL (80-96 fL)
-RDW=12% (<15%) (.12 proportion) (<.15 proportion)
-RBC=5.9 million cells/mm3 (3.2-4.3 million cells/mm³)
These findings are most consistent with:
Acute blood loss.
Beta thalassemia minor.
Iron deficiency anemia.
Cooley's anemia. - CORRECT ANSWER -Feedback
Correct answer: Beta thalassemia minor.
The mean cell volume (MCV) of 66 fL indicates microcytic anemia (normal MCV=80-96 fL).
Iron deficiency anemia and thalassemia are the two most common microcytic anemias
encountered in primary care and represent the leading differential diagnoses. Iron deficiency is
most commonly a consequence of slow, steady blood loss and resulting depletion of iron,
whereas thalassemia is a genetic disorder and not related to iron or any micronutrient deficiency.
The normal red blood cell distribution width (RDW) indicates a stable anemia of long duration.
Mediterranean ancestry is a risk factor for thalassemia, and the fact that the patient is a 29-year-
, old well woman suggests that this is a thalassemia minor form, with no impact on health.
Consideration should be given to providing genetic counseling prior to pregnancy.
A 36-year-old woman presents with a 12-h history of anorexia, nausea, and right lower quadrant
abdominal pain. A white blood cell count with differential demonstrates:
-Total WBC=16,500 cells/mm³
-Neutrophils=66%
-Bands=8%
-Lymphocytes=22%
Expected physical examination findings include:
Murphy's sign.
A palpable left lower quadrant mass.
Periumbilical ecchymosis.
A positive obturator sign. - CORRECT ANSWER -Feedback
Correct answer: A positive obturator sign.
This constellation of clinical symptoms is highly suggestive of appendicitis. The obturator and
psoas signs are both consistent with pain during peritoneal stretch in the region of the appendix
and are closely associated with appendicitis; the coincident abdominal pain, anorexia, and nausea
strengthen the diagnosis. Consequently, the white blood cell (WBC) count will likely
demonstrate an increase characterized by elevated neutrophils and bands; this pattern is
commonly referred to as the "left shift".
A 27-year-old G2 P1 had a C-section with her last delivery because of a transverse lie. She
relates that they told her that the baby "was stuck" in the top part of her uterus and they had to
