Beckmann and Ling's Obstetrics and Gynecology Nursing 8th Edition - Test Bank

Beckmann and Ling's Obstetrics and Gynecology / Edition 8/ 8th edition TESTBANK Chapter 1: Women’s Health Examination and Women’s Health Care Management 1: Elevating the head of the examining table approximately 30 degrees facilitates a: the observation of the patient's responses b: the ability of the patient to comfortably look around to distract her from the examination c: the contraction of the abdominal wall muscle groups, making the examination easier d: comfortable blood pressure measurement e: the physician not being distracted by eye contact with the patient 2: Which of the following uterine positions is most associated with dyspareunia? a: Midposition, retroflexed b: Retroverted, anteflexed c: Anteverted, anteflexed d: Retroverted, retroflexed e: Midpostion, anteflexed 3: Inquiry concerning adult and child history of sexual abuse should be included in the sexual history a: if time permits b: in visits where there are suspicious physical findings but not otherwise c: in visits where sufficient time is allotted d: in all new patient visits e: in visits where a specific indication is noted 4: Peau d'orange change in the breast is associated with a: edema of the lymphatics b: jaundice c: too vigorous breastfeeding d: overly tight undergarments e: galactorrhea 5: Which kind of speculum is often most suitable for examination of the nulliparous patient? a: Morgan's speculum b: Endoscopic speculum c: Ling speculum d: Graves speculum e: Pederson speculum 6: Which uterine configuration is most difficult to assess for size, shape, configuration, and mobility? a: Midposition b: Anteverted c: There is no difference in difficulty d: Retroverted 7: Which type of speculum is most appropriate for the examination of a parous menstrual woman? a: Ling speculum b: Graves speculum c: Pederson speculum d: Endoscopic speculum e: Morgan's speculum 8: Menopause is defined as the cessation of menses for greater than a: 9 months b: 36 months c: 12 months d: 18 months e: 24 months 9: In a woman describing sufficiently frequent sexual encounters, infertility typically is described as a failure to conceive after a: 3 months b: 9 months c: 12 months d: 18 months e: 6 months 10: During bimanual examination of the adnexa in normal premenopausal women, the ovaries are palpable a: all the time b: almost never c: about one-half of the time d: about thee-quarters/most of the time e: about one-quarter of the time 11: If a patient becomes uncomfortable with a topic during a history-taking session, the best response of the physician is to a: address the patient's discomfort in a positive and supportive manner b: discontinue discussion of the topic to avoid further patient discomfort c: discontinue discussion to avoid damage to the patient-physician relationship d: continue after making a joke to relieve tension e: ignore the discomfort and proceed with questioning 12: Which of the following statements about the steps in the breast examination is correct? a: Palpation is done first b: Palpation and inspection are done simultaneously c: Palpation is only done if inspection is abnormal d: Palpation may be done with detailed inspection if a woman is especially modest e: Inspection is done first 13: Questions that promote the physician's fullest understanding of the patient's situation are best characterized as a: compassionate b: chronological c: sympathetic d: emphatic e: evidence based 14: The last menstrual period is dated from the a: first day of the last normal period b: last day of the last normal period c: first day of the last bleeding episode d: last day of the last bleeding episode 15: The passage of clots during menstruation a: is always abnormal b: may be either normal or abnormal c: is always normal d: is extremely rare 16: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"1" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 17: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"2" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 18: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"3" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 19: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"4" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 20: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"5" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 21: Tanner's classification with respect to the breast relates to changes in the breast a: before and after lactation b: associated with malignancy c: associated with maturation d: associated with galactorrhea e: associated with fibrocystic changes 22: The rectovaginal examination should be performed a: after 52 years of age b: at the initial patient visit c: only for the evaluation of chronic pelvic pain d: only when there are symptoms of pelvic relaxation e: at intervals of 5 years 23: In the gynecologic history, it is often possible to distinguish between vaginitis and pelvic inflammatory disease by inquiring about a: the duration of the pain b: the symptoms present (fever/chills, itching) c: the timing of pain in relation to menses d: the association of pain with body position e: the use of topical medications 24: The most common reason for failure to visualize the cervix during the speculum examination is a: failure to use lubricant b: a full bladder c: failure to fully insert the speculum d: use of a speculum that has not been warmed e: use of the wrong speculum 25: Prehypertension is defined as a blood pressure range of a: 80-90/120-139 b: 90-100/120-139 c: 80-90/110-129 d: 70-80/110-129 e: 70-80/120-139 Chapter 2: The Obstetrician–Gynecologist’s Role in Screening and Preventive Care 1: The sensitivity of a screening test is defined as the proportion of a: unaffected individuals that test positive b: affected individuals that test positive c: unaffected individuals that test negative d: affected individuals that test negative 2: The specificity of a screening test is defined as the proportion of a: affected individuals that test negative b: unaffected individuals that test positive c: affected individuals that test positive d: unaffected individuals that test negative 3: Counseling an obese patient to lose weight is an example of a: secondary prevention b: primary prevention c: empathy d: engagement 4: In women, the thyroid-stimulating hormone screening test should be performed at what interval? a: Every 1-2 years from age 40 years, then yearly after age 50 years b: Every 5 years after age 50 years c: Annually from puberty or from the onset of sexual activity d: Every 5 years from age 19 years, then every 3-5 years after age 65 years 5: The Pap smear for cervical dysplasia should be performed at what interval? a: Every 2-3 years after age 30 years if three consecutive annual tests are negative b: Every 5 years from age 19 years, then every 3-5 years after age 65 years c: Every 1-2 years beginning at age 65 years d: Every 1-2 years from age 40 years, then yearly after age 50 years 6: A cholesterol/lipid profile should be performed for women without risk factors at what interval? a: Every other year from age 40 years, then yearly after age 50 years b: Every 5 years after age 45 years c: Every 3-5 years after age 65 years d: Every 5 years from age 19 years, then every 3-4 years after age 65 years 7: A mammography to detect breast cancer should be performed at what interval in women at average risk? a: Every 1-2 years after age 65 years b: Every 5 years after age 19 years, then every 3-4 years after age 65 years c: Every other year from age 40 years, then yearly after age 50 years d: Every 3-5 years after age 45 years 8: A colonoscopy to detect colorectal cancer should be performed at what interval for women at average risk? a: Every 10 years starting at age 50 years b: Every 1-2 years starting at age 40 years c: Every 10 years starting at age 65 years d: Every 10 years from age 19 years, then every 3-4 years after age 65 years 9: Which of the following is the most appropriate screening mechanism for cervical dysplasia? a: Pap smear b: Serum HPV titer c: HPV-DNA testing d: Colposcopy of suspicious lesions 10: Which of the following is the most appropriate screening mechanism for colorectal cancer? a: Hemogram b: Colonoscopy c: Physical examination of suspicious lesions d: CT scan 11: Which of the following is the most appropriate screening mechanism for thyroid disease? a: Thyroid-stimulating hormone b: Free thyroxine c: Yearly physician examination d: Thyroid-binding globulin 12: What is the appropriate interval for Pap testing in women who have had a total hysterectomy for reasons other than cervical dysplasia? a: Every 2 years following the hysterectomy b: Every 5 years following the hysterectomy c: No additional Pap testing is needed d: Every year following the hysterectomy 13: In sexually active women age 25 or younger, regular screening for Chlamydia should occur a: only if the woman is at high risk for infection b: every 3-5 years c: annually d: every 2 years 14: Bone mineral density testing is recommended for women without risk factors for osteoporosis beginning at what age? a: 40 years b: 65 years c: 50 years d: Testing is not recommended for women with no risk factors 15: A 40-year-old woman comes for an initial visit. Her BMI is 30 and she had previously given birth to an infant weighing 9.5lb. Which of the following initial screening tests is indicated for this patient? a: Fasting blood glucose b: Colonoscopy c: TSH level d: Bone mineral density testing Chapter 3: Ethics, Liability, and Patient Safety in Obstetrics and Gynecology 1: The principle that the patient should be given what is "due" most closely matches the principle of a: justice b: nonmaleficence c: beneficence d: autonomy 2: The principle that there should be respect for the patient's right to make choices based on her beliefs and values best matches the principle of a: beneficence b: nonmaleficence c: justice d: autonomy 3: The principle that there is a duty not to inflict harm or injury best matches the principle of a: nonmaleficence b: autonomy c: justice d: beneficence 4: The principle that there is a duty to promote the well-being of the patient best matches the principle of a: justice b: autonomy c: beneficence d: nonmaleficence 5: A 32-year-old patient has delivered at 23 weeks of gestation, 3 days after premature rupture of the membranes. She has discussed the circumstances with her obstetrician and requests that no attempts at resuscitation should be made. At delivery there are rare gasping, breathing movements. The pediatrician recommends that intubation be done. In this case, the individual with the clearest primary responsibility for this decision is the a: obstetrician b: pediatrician c: hospital risk manager d: mother e: hospital attorney 6: Respect for patient wishes (autonomy) primarily requires that there be assessment of which of the following? a: Cost of the proposed treatment b: The legal risk to the physician and hospital c: Patient's ability to consider information d: Physician's concurrence with the patient's wishes e: Standards of care 7: A 62-year-old woman with newly diagnosed stage III ovarian cancer refuses chemotherapy. She wants to "go home to die." The next step in evaluating this patient is to a: determine insurance coverage for this action b: call the family for a conference c: accept the patient's wishes and discharge her from the hospital d: call the state medical licensing board and hospital attorney e: assess the patient's comprehension and look for evidence of impaired decision making 8: If a pregnant woman rejects medical recommendations, relying on care given in similar cases would be an example of a: principle-based ethics b: virtue-based ethics c: feminist ethics d: communication-based ethics e: case-based ethics 9: The concept of informed consent best relates to the principle of a: autonomy b: justice c: beneficence d: nonmaleficence 10: Paternalism violates the ethical principle of a: nonmaleficence b: beneficence c: standard of care d: justice e: autonomy 11: The person with primary responsibility to providing informed consent is a: the person or physician's staff assigned the task b: the patient c: the social worker assigned to the patient d: the hospital administrator e: the physician 12: In medical liability cases the complaint comes from the a: defendant b: judge c: jury d: attorney e: plaintiff 13: Most medical errors are associated with a: the use of care guidelines b: the use of medications c: the use of standards of care d: the use of hospital regulations e: the use of improper surgical technique Chapter 4: Embryology and Anatomy 1: The genital system develops from the embryonic a: yolk sac b: endoderm c: mesoderm d: ectoderm e: cytotrophoblast 2: The urogenital ridges give rise to elements of the a: cardiovascular system b: reproductive system c: muscular system d: skeletal system e: gastrointestinal system 3: Congenital adrenal hyperplasia ultimately affects the development of the genitalia of female fetuses through the a: stimulation of cortisol production b: stimulation of cortisone production c: stimulation of androgen production d: inhibition of the SRY gene e: inhibition of the WNT4 gene 4: Primary oocytes first appear at what stage of development a: In the primordial follicles b: At puberty c: In the primary sex cords d: At birth e: In the embryonic yolk sac 5: Primordial germ cells can be identified during the third week of development in the a: vaginal plate b: urogenital sinus c: cortical cords d: gonadal ridge e: yolk sac 6: In the female, which of the following persists to form the major parts of the reproductive tract? a: Mesonephric (wolffian) ducts b: Prmary sex cords c: Paramesonephric (Mullerian) ducts d: Gubernaculum 7: Gartner cysts result from remnants of the a: tunica albuginea b: primary sex cords c: Mullerian ducts d: mesonephric ducts 8: Transverse ultrasonography can begin to reliably distinguish between the two sexes at about how many weeks of gestation a: 15 weeks b: 5 weeks c: 10 weeks d: 20 weeks e: 25 weeks 9: Which of the following results in the absence of the uterus? a: Degeneration of the Mullerian ducts b: Degeneration of the mesonephric ducts c: Lack of fusion of the inferior parts of the paramesonephric ducts d: Failure of migration of the primordial germ cells 10: Which of the following results in the formation of a double uterus (uterus didelphys)? a: Lack of fusion of the inferior parts of the Mullerian ducts b: Failure of migration of the primordial germ cells c: Degeneration of the mesonephric ducts d: Degeneration of the Mullerian ducts 11: The labia minora develop from the a: urogenital folds b: labioscrotal swellings c: urogenital sinus d: genital tubercle 12: The labia majora develp from the a: labioscrotal swellings b: urogenital sinus c: genital tubercle d: urogenital folds 13: The clitoris develops from the a: urogenital folds b: genital tubercle c: labioscrotal swellings d: urogenital sinus 14: In the female, the embryologic homologue of the penis is the a: frenulum b: labia majora c: labia minora d: clitoris 15: The false pelvis and the true pelvis are separated by the a: linea terminalis b: acetabulum c: obturator membrane d: pelvic outlet e: sacrospinous ligament 16: The diagonal conjugate is defined as the distance a: between the true and false pelvis b: between the lower border of the pubis anteriorly and the lower sacrum at the level of the ischial spines c: between the upper border of the pubis anteriorly and the lower sacrum at the level of the ischial spines d: measured at the greatest width of the superior aperture e: between the ischial spines 17: Which of the following contains the uterine arteries and veins and the ureters? a: Infundibulopelvic ligament b: Broad ligament c: Uterosacral ligament d: Sacrospinal ligament e: Cardinal ligament 18: The ligament that provides primary support to the uterus is the a: uterosacral ligament b: infundibulopelvic ligament c: broad ligament d: sacrospinal ligament e: cardinal ligament 19: The epithelial lining of the fallopian tube is a: Columnar b: Transitional c: Simple squamous d: Stratified columnar e: Stratified squamous 20: The fallopian tubes enter into which part of the uterus a: Fundus b: Cornu c: SQ junction d: Lower uterine segment e: Mesosalpinx 21: The two main anatomic divisions of the uterus are the corpus and the a: uterotubal junction b: cornu c: fundus d: isthmus e: cervix Chapter 5: Maternal–Fetal Physiology 1: Oxygen crosses the placenta by a: pinocytosis b: facilitated diffusion c: simple diffusion d: active transport e: phgocytosis 2: Glucose crosses the placenta by a: facilitated diffusion b: simple diffusion c: active transport d: phagocytosis e: pinocytosis 3: Amino acids cross the placenta by a: facilitated diffusion b: active transport c: pinocyctosis d: simple diffusion e: phagocytosis 4: Pregnancy has what effect on gastric motility? a: Gastric motility typically remains the same b: The effect on gastric motility is unpredictable c: Gastric motility typically increases d: Gastric motility typically decreases 5: Pregnancy has what effect on gastric reflux? a: The effect on gastric reflux is unpredictable b: Gastric reflux is typically unaffected c: Gastric reflux typically decreases d: Gastric reflux typically increases 6: "Morning sickness" typically begins during which weeks of pregnancy? a: 1-3 weeks b: 16-22 weeks c: 10-12 weeks d: 14-18 weeks e: 4-8 weeks 7: Changes in gastrointestinal motility during pregnancy are related to increased levels of a: thyrotropin-releasing factor b: human chorionic gonadotropin c: estrogen d: oxytocin e: progesterone 8: Transit time in the stomach and small bowel increases by what percent in the second and third trimesters of pregnancy? a: 60%-70% b: 1%-15% c: 45%-60% d: 30%-45% e: 15%-30% 9: Epulis is a pregnancy-related vascular swelling of the a: larynx b: pharynx c: nares d: gums e: epiglottis 10: Which of the following pulmonary measurements is decreased in pregnancy? a: Carbon dioxide pressure b: Tidal volume c: Oxygen pressure d: Oxygen requirement e: Residual volume 11: During pregnancy, total body oxygen consumption a: decreases by 50% from nonpregnant levels b: increases by 20% from nonpregnant levels c: increases by 50% from nonpregnant levels d: decreases by 20% from nonpregnant levels e: increases by 70% from nonpregnant levels 12: By term in a normal pregnancy, maternal blood volume a: increases by 15% b: increases by 50% c: decreases by 15% d: decreases by 35% e: increases by 35% 13: Iron supplementation in pregnancy is mainly used to a: maintain fetal hemoglobin concentration b: prevent iron deficiency in the mother c: maintain maternal hemoglobin concentration d: prevent iron deficiency in both the mother and the fetus e: prevent iron deficiency in the fetus 14: Which of the following measures of pulmonary function decreases in late pregnancy? a: Tidal volume b: Residual volume c: Respiratory rate d: Expiratory volume e: Inspiratory capacity 15: The increased nasal stuffiness and perception of increased nasal secretions during prenancy are associated with a: increased immunoglobulin production b: increased interluminal production of mast cell toxins c: increased airway conductance d: decreased airway conductance e: mucosal hyperemia 16: Maternal arterial blood gas analysis during pregnancy would show a: mild metabolic acidosis b: mild respiratory alkalosis c: mild metabolic alkalosis d: mild respiratory acidosis e: moderate metabolic alkalosis 17: As compared with the nonpregnant state, the risk of thromboembolism during pregnancy a: is not effected by pregnancy b: is increased during pregnancy and in the puerperium c: is decreased during prengnancy and in the puerperium d: is increased during pregnancy and decreased in the puerperium e: is decreased during pregnancy and increased in the puerperium 18: Displacement of the maternal heart during pregnancy is caused by a: constriction of the anteroposterior diameter of the thorax b: enlargement of the liver c: elevation of the diaphragm d: widening of the mediastinum e: increased lung volume 19: Which of the following best describes the change in position of the maternal heart during pregnancy? a: Displaced downward and to the right into a more vertical position b: Displaced upward and to the left into a more horizontal position c: Displaced upward and to the right into a more horizontal position d: Displaced downward and to the left into a more vertical position e: Displaced further into the thoracic cavity 20: When do changes in maternal cardiac output begin during pregnancy? a: Early second trimester b: First trimester c: Late first trimester d: Third trimester e: Late second trimester 21: As compared with the nonpregnant state, the overall increase in maternal cardiac output during pregnancy is approximately a: 30%-50% b: 10%-20% c: 5%-10% d: 50%-60% e: 60%-80% 22: Which of the following factors contributes to the changed maternal cardiac output during pregnancy? a: Increased peripheral vascular resistance b: Decreased maternal heart rate c: Increased stroke volume d: Decreased stroke volume e: Increased venous return 23: During pregnancy, maternal ciculating blood volume increases about how much over nonpregnant levels? a: 30% b: 60% c: 45% d: 5% e: 15% 24: When does the increase in circulating maternal blood volume reach its peak during pregnancy? a: 18 weeks b: 32 weeks c: 12 weeks d: 38 weeks e: 24 weeks 25: What percent of cardiac output does the uterus receive at term? a: 10% b: 30% c: 20% d: 40% e: 50% 26: Occlusion of the vena cava by the gravid uterus results in shunting of venous return from the lower extremities primarily through the a: mesenteric circulation b: portal vein circulation c: paravertebral circulation d: ovarian circulation e: renal circulation Chapter 6: Preconception and Antepartum Care 1: A 22-year-old primigravida patient who is approximately 3 months' pregnant expresses concern that she has not felt the baby move yet. She should be informed that "quickening" generally occurs at how many weeks of gestation? a: 12-14 b: 8-10 c: 22-24 d: 18-20 2: Congestion and a bluish color of the vagina in early pregnancy is called a: Stoppard sign b: Newman sign c: Hegar sign d: Chadwick sign 3: A softening of the cervix on physical examination in early pregnancy is referred to as a: Doderlein sign b: Hegar sign c: Naegele sign d: Chadwick sign 4: Fetal heart tones in a normal, viable pregnancy may routinely be heard by simple, nonelectrically amplified auscultation at or beyond how many weeks of gestational age? a: 12-14 b: 18-20 c: 21-23 d: 15-17 5: Commonly used electronic Doppler devices will usually detect fetal heart tones initially at approximately how many weeks of gestation? a: 12 b: 10 c: 8 d: 14 6: A 21-year-old patient whose last menstrual period started 3 weeks ago calls the doctor's office because she is concerned that she might be pregnant. She should be informed that home urine pregnancy tests typically become positive approximately how many weeks following the first day of the last normal menstrual period? a: 6 b: 2 c: 4 d: 8 7: A 30-year-old patient with a history of ectopic pregnancy presents with 5 weeks of amenorrhea and a positive home pregnancy test. Intrauterine pregnancy is generally detectable by transvaginal ultrasonography when the beta-human chorionic gonadotropin concentration is greater than a: 5,000-6,000 mIU/mL b: 3,000-4,000 mIU/mL c: 1,000-2,000 mIU/mL d: 500-750 mIU/mL 8: "Normal" pregnancy lasts 40 weeks from the first day of the last menstrual period with a margin of error of how many weeks? a: 1 b: 4 c: 3 d: 2 9: A woman comes for her initial prenatal visit and wants to know her estimated date of delivery (EDD). Her last menstrual period began January 14. According to Naegele's rule, her EDD will be a: October 1 b: October 14 c: October 21 d: October 28 10: In normal singleton pregnancy, from 18 weeks of gestation until 36 weeks of gestation, the fundal height in centimeters is roughly equal to a: one-half the number of weeks of gestational age b: the number of weeks of gestational age minus 5 c: the number of weeks of gestational age d: twice the number of weeks of gestational age 11: In a woman with a BMI in the normal range, the generally prescribed recommendation for weight gain during pregnancy is a: 15-20 lb b: 25-35 lb c: 50-55 lb d: 40-45 lb 12: A 25-year-old primigravida patient at 24 weeks of gestation has gained 8 lb since her last prenatal visit a month ago. What is the most appropriate initial intervention? a: Insulin b: Dietary counseling c: Hospitalization d: Metformin 13: A 25-year-old G2P1 patient at 20 weeks of gestation is concerned that her child will be breech like her first child was. She can be informed that cephalic presentation occurs in what percentage of deliveries? a: 15% b: 3.5% c: 95% d: 1% 14: At 36 weeks of gestation, examination in the office reveals that the fetus is in breech presentation. Breech presentation occurs in what percentage of deliveries? a: 3.5% b: 1% c: 95% d: 15% 15: An ultrasound performed at 30 weeks of gestation shows the fetus to be lying transverse. An explanation of the implications of this finding may include the reassurance that shoulder presentation occurs in what percentage of deliveries? a: 3.5% b: 95% c: 1% d: 15% 16: An abnormal contraction stress test includes which of the following fetal heart rate findings? a: Decreases in response to maternal respirations b: Increases in response to maternal position change c: Decreases in response to a uterine contraction d: Increases in response to fetal movement 17: A biophysical profile in which there is one or more episodes of fetal breathing in 30 minutes, three or more discrete movements in 30 minutes, opening/closing of the fetal hand, a nonreactive nonstress test, and no pockets of amniotic fluid greater than 1 cm would have a total score of a: 4 b: 8 c: 2 d: 6 18: Exclusive of the fetal heart rate reactivity, which of the following elements of the biophysical profile is generally considered most important? a: Fetal breathing b: Qualitative amniotic fluid volume c: Fetal tone d: Gross body movement 19: Repetitive decelerations following each contraction when three contractions occur in a 10-minute window is generally an indication of a: fetal well-being b: nonreassuring fetal status c: increased placental blood flow d: reduced amniotic fluid 20: At how many weeks of gestational age does phospholipid production increase, resulting in a positive phosphatidylglycerol test? a: 33 b: 31 c: 35 d: 29 21: In counseling a patient about activities during the antepartum period, which of the following activities is generally contraindicated? a: Regular, non-weight-bearing activity on a three-times-per-week schedule b: Bathtub bathing c: Supine exercises d: Air travel after 28 weeks 22: A 20-year-old pregnant patient requests information about food cravings in pregnancy. She should be informed that pica is often associated with which of the following? a: Hyperthyroidism b: Anemia c: Substance abuse d: Diabetes 23: At the initial prenatal visit, a 30-year-old primigravida woman asks about traveling for business purposes. Which of the following recommendations is appropriate? a: Limit air travel to the first two trimesters b: Avoid travel of any kind after 36 weeks c: Avoid extended periods of inactivity d: Use seat belts up to 20 weeks of gestation 24: The FDA category PRF X carries what important clinical implication? a: Animal reproduction studies have demonstrated an adverse fetal effect and there are no controlled human studies b: Controlled human studies demonstrate no evidence of risk in pregnancy in any trimester c: Adequate studies have demonstrated positive evidence of fetal risk d: Animal reproduction studies have not demonstrated fetal risk and there are no controlled human studies 25: A 24-year-old pregnant woman asks about the use of medications given prior to pregnancy by her other physicians. Which FDA pregnancy risk factor category is characterized by the presence of human studies in which there is no demonstrable fetal risk during pregnancy? a: D b: C c: B d: A 26: Which of the following effects to the fetus is associated with maternal ingestion of tetracyclines? a: Hemolytic anemia b: Irreversible arthropathies c: Discoloration of deciduous teeth d: Hyperbilirubinemia 27: Fetal abnormal facies, cleft lip or palate, and microcephaly are associated with maternal ingestion of which of the following drugs during pregnancy? a: Heparin b: Thiazide diuretics c: Sulfonamides d: Phenytoin 28: A 23-year-old pregnant woman who complains of constipation should be informed that physiologic constipation in pregnancy is associated with a: increased bulk b: decreased water absorption c: decreased blood flow to the gut d: increased transit time 29: Due to the position of the fetus, round ligament pain is often more pronounced a: in the center b: on the right side c: on the left side d: in the fundus 30: For which of the following conditions should all pregnant women be tested? a: Tay-Sachs b: Sickle cell disease c: Tuberculosis d: HIV Chapter 7: Genetics and Genetic Disorders in Obstetrics and Gynecology 1: A DNA replication error that results in one amino acid being substituted for another is termed a(n) a: Missense mutation b: Deletion mutation c: Nonsense mutation d: Insertion mutation 2: During which phase of meiosis is an error most likely? a: Anaphase I b: Meiosis II c: Metahase I d: Prophase I 3: Which of the following is an example of euploidy? a: 47, XXY b: 46, XX c: 45, X d: 69, XXX 4: Trisomy 21 is an example of which type of chromosomal anomaly? a: Ring chromosome b: Aneuploidy c: Euploidy d: Deletion mutation 5: A Robertsonian translocation in the mother increases the risks to her fetus of which of the following conditions? a: Spina bifida b: Anencephaly c: Fragile X syndrome d: Down syndrome 6: Which of the following conditions is inherited through autosomal dominant inheritance? a: Tay-Sachs disease b: Huntington disease c: Phenylketonuria d: Cystic fibrosis 7: The parents of a child found to have Marfan syndrome are planning to conceive in the future, and inquire about the inheritance pattern of this condition. They should be informed that the inheritance pattern is a: multifactorial b: autosomal dominant c: X-linked d: autosomal recessive 8: In autosomal dominant inheritance, the affected parent passes the disease to a: twice as many male offspring as females b: one-half of the offspring c: twice as many female offspring as males d: one-half of female offspring 9: First trimester screening tests are performed to determine the risk of what abnormality in addition to trisomy 13 and trisomy18? a: Hemophilia b: Klinefelter syndrome c: Turner syndrome d: Down syndrome 10: A woman who has previously had a child with a neural tube defect should take a daily prenatal vitamin in subsequent pregnancies that contains how much folic acid? a: 40 mg b: 0.04 mg c: 0.4 mg d: 4 mg 11: An ultrasound confirms a 7-week intrauterine gestation. If nuchal transparency measurement is to be used to aid in the detection of Down syndrome, the next ultrasound should be performed in how many weeks? a: 8 b: 2 c: 4 d: 12 12: Trisomy 16 is characterized by which of the following clinical scenarios? a: Rarely survives to 3 years of age b: Multisystem failure within a year of birth c: Cardiac arrest within 3 days of birth d: No live births 13: Which of the following is more common than trisomy 18 (Edwards syndrome)? a: Turner syndrome b: Trisomy 21 (Down syndrome) c: Trisomy 13 (Patau syndrome) d: Cridu chat syndrome 14: Individuals with which of the following chromosomal abnormalities are most likely to live into adulthood? a: Trisomy 21 b: Trisomy 16 c: Trisomy 13 d: Trisomy 18 15: First trimester screening reveals that a woman is at increased risk for carrying a fetus with Down syndrome. She elects to undergo amniocentesis. This is typically performed between what weeks of gestation? a: 8 and 10 weeks b: 15 and 20 weeks c: 22 and 26 weeks d: 30 and 34 weeks 16: During her initial visit for this pregnancy, a couple inquires about the potential value of chorionic villus sampling. Which of the following conditions cannot be diagnosed by this technique? a: Down syndrome b: Trisomy 13 c: Trisomy 18 d: Neural tube defects 17: A 33-year-old patient comes to you for her annual gynecologic exam. In the course of obtaining her history, she tells you that her aunt was diagnosed with breast cancer at age 49 and that her grandfather had lung cancer. She is not of Ashkenazi Jewish origin. You tell her that you recommend which of the following? a: HPNCC testing b: BRCA 1 and BRCA 2 testing c: Annual clinical breast exams and no further testing at this time d: BRCA 1 testing only 18: The level of alpha-fetoprotein in amniotic fluid is normal in which of the following conditions? a: Anencephaly b: Spina bifida c: Omphalocele d: Postmaturity 19: The increased availability of what test has resulted in a declining reliance on PUBS? a: FISH b: Early amniocentesis c: Fetoscopy d: CVS 20: Which of the following is an accurate description of a germ cell? a: Two sets of chromosomes b: Gamete c: 2n d: Diploid 21: Which of the following karyotypes is an example of mosaicism? a: 46, XX/XY b: 47, XXY c: 47, XXX d: 45, X 22: In autosomal recessive disorders, which parent(s) is/are usually affected? a: Father always b: Both c: Mother usually d: Neither 23: Color blindness has what kind of inheritance pattern? a: Autosomal dominant b: X-linked c: Multifactorial d: Autosomal recessive 24: In counseling a couple about the role of first trimester screening, the difference between the "triple screen" and the "quadruple screen" should be described as the addition of which marker? a: hCG b: Estriol c: MSAFP d: Inhibin A 25: In obtaining informed consent regarding chorionic villlus sampling (CVS), the provider should inform the patient that which of the following is the most common complication? a: Infection b: Bleeding c: Pregnancy loss d: Limb reduction Chapter 8: Intrapartum Care A 22-year-old primigravid patient at 38 weeks gestation calls the office stating that she has had "bloody show." She should be informed that this is related to which of the following? a: Quickening b: Effacement of the cervix c: Braxton Hicks contractions d: Lightening 2: True labor is associated with contractions that the patient feels in what area? a: Low abdomen b: Bilateral round ligaments c: Low back d: Uterine fundus 3: A 23-year-old primigravid patient at 36 weeks of gestation asks under what circumstances she should call the office. Which of the following would warrant a phone call? a: Loss of the mucus plug b: Back pain c: Contractions every 10 minutes d: Decreased fetal movement 4: When is the optimal time for auscultation of fetal heart tones during labor? a: At the peak of a contraction b: Immediately following a contraction c: Halfway between contractions d: Immediately prior to a contraction 5: The portion of the fetus that is lowest in the birth canal is defined by what term? a: Lie b: Position c: Attitude d: Presentation 6: Which of the following accurately describes the uterine wall during a true contraction? a: Not easily indented b: Expuisitely tender to palpation c: Changes shape d: Indents by itself 7: In a vertex presentation, if the anterior fontanel is palpated on the maternal left and the posterior fontanel is felt on the maternal right, what is the position? a: ROT b: LOT c: OA d: OP 8: Fetal station is defined by the relationship of the presenting part and by which maternal anatomic landmark? a: Pubic symphysis b: Ischial spines c: Coccyx d: Sacral promontory 9: Engagement of the fetal head in labor can be misinterpreted under what circumstances? a: Maternal obesity b: Epidural anesthesia c: Molding d: Ruptured membranes 10: A 30-year-old multiparous patient at 37 weeks of gestation presents to the hospital completely dilated. Which of the following describes this stage of labor? a: First b: Third c: Second d: Fourth 11: The third stage of labor is marked by which of the following events? a: Delivery of placenta b: Removal of epidural catheter c: Repair of episiotomy d: Inspection for lacerations 12: Which of the cardinal movements of labor best reflects the adequacy of the bony pelvis? a: Flexion b: Expulsion c: Internal rotation d: Engagement 13: When does the greatest rate of descent occur? a: Latent phase of first stage of labor b: Second stage of labor c: Prior to the onset of labor d: During extension of the fetal head 14: Oral intake in labor is restricted due to what concern? a: Diarrhea b: Reflux c: Decreased gastrointestinal peristalsis d: Nausea 15: A 25-year-old primigravid patient verbalizes a desire to avoid electronic fetal monitoring while in labor. She should be informed that intermittent auscultation of fetal heart tones is appropriate in which of the following clinical circumstances? a: Maternal temperature of 101 degrees F b: Third trimester bleeding c: Low-risk term pregnancy d: Intrauterine growth restriction 16: Pain during the first stage of labor is due to which of the following event? a: Maternal position b: Dilation of cervix c: Effacement of cervix d: Descent of fetal presenting part 17: A 29-year-old primigravid patient at term presents complaining of labor contractions. She is found to be 4 cm dilated with reassuring fetal rate tracings. The most appropriate anesthetic technique to provide pain relief during labor and delivery for this patient is which of the following? a: Epidural b: Spinal c: Pudendal d: General 18: Maternal "pushing" efforts prior to the second stage of labor are associated with which of the following outcome? a: Abruptio placentae b: Swelling of the cervix c: Uterine prolapse d: Fetal compromise 19: What finding at the time of rupture of membranes is most likely to represent an emergent situation? a: Meconium staining of fluid b: Blood-tinged fluid c: Potential for infection d: Prolapsed umbilical cord 20: The presence of molding and/or caput succedaneum prior to the second stage of labor is suggestive of which significant finding? a: Fetal anomaly b: Inadequate anesthesia c: Birth canal insufficient to allow passage of fetus d: Excessive uterine contractions 21: If an episiotomy is needed, when should it be performed? a: After the perineum is thinned b: Prior to the fetal head reaching the perineum c: Just after a contraction d: After a perineal laceration has started forming 22: Excessive traction to the neck during a vaginal delivery can be associated with injury to which of the following structure(s)? a: Strap muscles b: Trachea c: Thyroid gland d: Brachial plexus 23: Uterine inversion is associated with what aspect of postpartum management? a: Inspection of the birth canal b: Exploration of the uterine cavity c: Traction on the umbilical cord d: Manual removal of placenta 24: What degree is an obstetric laceration that extends to the rectal sphincter but not the mucosa? a: Third b: First c: Fourth d: Second 25: Which technique of labor induction allows for the greatest variability in dosing? a: Amniotomy b: Membrane stripping c: Oxytocin d: Prostaglandins 26: A 36-year-old pregnant woman with a history of previous classical cesarean delivery requests a trial of labor after cesarean delivery. She should be informed of which of the following? a: TOLAC is available if the fetus is not breech b: TOLAC is contraindicated c: TOLAC is available if epidural anesthesia is not used d: TOLAC can be done if no oxytocin is used Chapter 9: Abnormal Labor and Intrapartum Fetal Surveillance 1: Which of the following is the best predictor of successful vaginal birth? a: Clinical pelvimetry b: Radiographic pelvimetry c: Descent of the presenting part during labor d: CT pelvimetry 2: A 30-year-old primigravid patient at term progresses from 4 cm dilation to 7 cm in 5 hours. How would this labor be described? a: A protraction disorder b: An arrest disorder c: A normal labor d: A prolonged latent phase 3: A 22-year-old multiparous patient has been pushing for 2 hours resulting in no descent of the presenting part. This would be classified as a: a normal labor b: a prolonged latent phase c: an arrest disorder d: a protraction disorder 4: Which of the following maternal factors can prevent accurate clinical assessment of uterine contractions? a: Preeclampsia b: Obesity c: Epidural anesthesia d: Third trimester bleeding 5: For a patient in active labor, which of the following provides a quantitative measurement of the strength of her uterine contractions? a: "Indentation" of uterus on palpation during contraction b: Intrauterine pressure catheter c: Manual palpation of maternal abdomen d: Tocodynamometer 6: For a labor pattern to be considered optimal, contractions must generate peak intrauterine pressures of at least how many mm Hg? a: 15 b: 25 c: 45 d: 35 7: The incidence of shoulder dystocia and possible need for cesarean delivery increase markedly if the fetus has an estimated weight of at least a: 3,000 g b: 3,500 g c: 4,000 g d: 2,500 g 8: Which of the following presentations typically coverts to either a vertex or face presentation? a: Shoulder b: Brow c: Breech d: Compound 9: Normal fetal heart rate variability is characterized by an amplitude range that is a: 6-25 bpm b: detectable but at 5 bpm or less c: greater than 25 bpm d: undetectable 10: Marked fetal heart rate variability is characterized by an amplitude range that is a: >25 bpm b: undetectable c: detectable but at 5 bpm or less d: 6-25 bpm 11: Which of the following presentations usually resolves spontaneously as labor continues? a: Breech b: Vertex c: Compound d: Shoulder 12: A 22-year-old G1P0 patient at term presents with complaints of contractinos for many hours. Her cervix is 100% effaced and dilated to 3cm. In a nulliparous patient, the latent phase of labor is defined as prolonged if it lasts longer than a: 10 hours b: 20 hours c: 25 hours d: 15 hours 13: A 37-year-old G4P3 patient reports having contractions "all day." In multiparous patients, the latent phase is defined as prolonged if it lasts more than a: 10 hours b: 20 hours c: 24 hours d: 14 hours 14: A 30-year-old G2P1 at term is in adequate active labor with the cervical dilation unchanged at 6 cm as documented by several examiners. There has been secondary arrest of dilation when cervical dilation during the active phase of labor stops for at least a: 2 hours b: 4 hours c: 1 hour d: 3 hours 15: Which of the following is the appropriate management of a prolonged latent phase? a: Cesarean delivery b: Forceps delivery c: Vacuum extraction d: Sedation 16: A 25-year-old G1P0 patient at 32 weeks of gestation has a fetus in the breech position. She inquires about the likelihood of her fetus being in the breech position at the time of term delivery. What percent of singleton term deliveries are breech presentations? a: 2% b: 7% c: 0.5% d: 5% 17: Which of the following is a selection criterion that would allow for external cephalic version? a: No uterine surgical scars b: Fetus less than 35 weeks of gestation c: Presenting part in the pelvis d: Oligohydramnios 18: Outlet forceps-assisted vaginal delivery is appropriately considered with the fetal head at what station? a: Above the +2 station b: At the +2 station c: Outside the perineum d: At the pelvic floor 19: Low forceps-assisted vaginal delivery occurs with the fetal head at what station? a: Outside the perineum b: At the +2 station c: At the pelvic floor d: Above the +2 station 20: A patient has been in the second stage of labor for 2.5 hours. Fetal heart tones are reassuring and there is no clinical evidence of cephalopelvic disproportion. The next step in the management of this patient should be a: forceps delivery b: immediate cesarean delivery c: oxytocin administration if uterine contractions are inadequate d: vacuum extraction 21: Vibroacoustic stimulation is used to elicit what type of fetal heart rate response? a: Late deceleration b: Acceleration c: Variable deceleration d: Early deceleration 22: Amnioinfusion to relieve umbilical cord compression is useful in cases of a: fetal heart rate acceleration b: early fetal heart rate deceleration c: late fetal heart rate deceleration d: variable fetal heart rate deceleration 23: If a fetus experiences progressive and sustained hypoxia, the mixed metabolic and respiratory acidosis that may ensue typically results from a: aerobic gluconeogenesis b: anaerobic glycolysis c: aerobic glycolysis d: anaerobic gluconeogenesis 24: In high-risk cases, intermittent fetal heart rate auscultation to monitor fetal well-being should be employed at least how often during the active phase of labor? a: Every 30 minutes b: Every 10 minutes c: Every 5 minutes d: Every 15 minutes 25: In high-risk cases, intermittent fetal heart rate auscultation to monitor fetal well-being should be employed at least how often in the second stage of labor? a: Every 5 minutes b: Every 10 minutes c: Every 1 minute d: Every 20 minutes 26: Baseline fetal tachycardia is defined as a heart rate greater than how many beats per minute? a: 120 b: 200 c: 160 d: 180 27: The most common cause of fetal tachycardia is a: maternal hypothermia b: maternal anemia c: chorioamnionitis d: cord compression 28: Baseline fetal bradycardia is defined as a heart rate of less than how many beats per minute? a: 110 b: 80 c: 100 d: 140 29: A fetal heart rate below how many beats per minute is an ominous sign that may presage fetal death? a: 60 b: 100 c: 80 d: 120 30: Fetal heart rate accelerations are associated with a: reassuring fetal status b: fetal sleep c: hypoxia d: acidemia Chapter 10: Immediate Care of the Newborn Following an emergency cesarean section for prolonged bradycardia, you delivered a viable infant. At 1 minute, the heart rate is less than 100 bpm, there is a weak cry, limp muscle tone, a grimace, and blue color throughout. 1: A. The 1 minute Apgar score is _____. a: 3 b: 5 c: 4 d: 1 e: 2 2: B. An Apgar score of less than _____ is suggestive of a severely depressed infant who requires immediate resusucitative efforts. a: 6 b: 5 c: 8 d: 7 e: 4 3: C. A newborn who is apneic or gasping and has a heart rate of less than _____ bpm usually requires positive pressure ventilation, which may be done with a face mask after clearing the airway. a: 40 b: 80 c: 100 d: 60 e: 120 4: D. At 5 minutes, after vigorous resuscitation, the baby has a heart rate of more than 100 bpm, good respiratory effort, active muscular activity, a cry, and acrocyanosis. The 5-minute Apgar is a: 6 b: 8 c: 10 d: 9 e: 7 5: E. The 5-minute Apgar score can appropriately be used to a: identify an infant who needs further evaluation and management b: identify an infant at high risk for neurologic problems c: identify an infant with metabolic acidosis d: identify an infant with birth asphyxia e: identify an infant at risk for low IQ at 6 to 8 years of age 6: F. During resuscitation of the newborn, metabolic well-being is best assessed by measurement of a: umbilical cord blood gases b: heart rate c: blood urea nitrogen levels d: blood glucose levels e: respiratory rate 7: G. Acidemia is generally accepted as an increase in hydrogen ion concentration in an umbilical arterial sample resulting in a pH of _____. a: <7.2 b: <7.0 c: <7.1 d: 7.4 e: 7.3 8: H. Fetal asphyxia is defined as a condition of impaired blood gas exchange leading to progressive hypoxemia and hypercapnia with a significant metabolic acidosis with a base deficit of _____. a: 12 mmol/L b: 16 mmol/L c: 14 mmol/L d: 18 mmol/L e: 10 mmol/L A young woman presents to your clinic for an incision check. She is a 21-year-old G1P1 who had a primary cesarean section 2 weeks ago at 35 weeks for severe preeclampsia and breech presentation. Upon entering the room you notice the baby has a distinct jaundiced appearance. She comments that the baby's bilirubin is being followed in the Pedi Clinic. 9: A. Jaundice that persists for _____ weeks requires further investigation, including measurement of both total and direct bilirubin concentrations. a: 1 b: 3 c: 4 d: 5 e: 2 10: B. Which of the following statements about jaundice in the newborn is correct? a: Jaundice typically poses a serious threat to the infant b: Jaundice that persists for more than 4 days requires immediate treatment c: Jaundice that persists for more than 2 days requires immediate treatment d: Elevation of direct serum bilirubin always requires further investigation e: Term infants are at a higher risk for hyperbilirubinemia than late preterm infants 11: C. Acute bilirubin encephalopathy or kernicterus is associated with total serum bilirubin levels greater than _____. a: 30 mg/dL b: 10 mg/dL c: 20 mg/dL d: 40 mg/dL e: 50 mg/dL You are making morning rounds on a 16-year-old G1P1 who underwent a spontaneous vaginal delivery at 36 weeks. She had a history of an unknown and untreated sexually transmitted infection. She had no prenatal care or prenatal classes. She is concerned about all the events following her delivery last night. What were they doing to her baby and why? What wes the cream they rubbed in her baby's eyes? 12: A. Which of the following newborn infants should receive prophylactic antibiotic ointment in both eyes to prevent gonococcal opththalmia neonatorum? a: Only infants delivered vaginally b: Only preterm infants c: Only macrosomic infants d: Only infants delivered vaginally e: All infants 13: B. The prophylactic application of antibiotic ointment (containing erythromycin [0.5%] or tetracycline [1%]) to both eyes to prevent the development of gonococcal ophthalmia neonatorum may be delayed up to _____ hour(s) to allow for breastfeeding. a: 1 b: 3 c: 2 d: 5 e: 4 Why didn't they just leave her and the baby alone? They kept checking the baby all the time. 14: A. After delivery, infant vitals signs should be taken at what interval? a: Every 30 minutes for the next 2 hours b: Every 2 hours for the first 24 hours c: Every 5 minutes for the next 2 hours d: Every 2 hours until the signs are stable for 8 hours e: Every 30 minutes until the signs are stable for 2 hours 15: B. Following the initial assessment and routine care of a healthy neonate, continued close observation is necessary for the subsequent stabilization-transition period(the first _____ hours after birth) to identify any problems that may arise. a: 1-3 b: 8-16 c: 6-12 d: 3-8 e: 10-18 The pediatrics resident came by and told her about having to take blood from the baby's heel to check for some diseases. Is this routine? 16: A. If a heel-stick initial blood sample is collected before 12-24 hours delivery, a second sample should be collected at ____ of age to decrease the probability that phenyketonuria and other disorders with metabolite accumulation are missed as a result of early testing. a: 1-2 weeks b: 7-8 weeks c: 4-6 days d: 4-5 weeks e: 3--4 weeks 17: B. Premature infants, neonates receiving parenteral feeding, or those treated for illness should have a newborn screening test performed at or near _____ days of age, regardless of feeding status. a: 3 b: 1 c: 7 d: 5 e: 9 She was also concerned because her baby, now 12 hours old, had not had a bowel movement. 18: What percent of newborns pass stool within 24 hours? a: 50% b: 10% c: 30% d: 70% e: 90% Chapter 11: Postpartum Care Your clinic nurse warns you that your next patient may take some time. Upon entering the room you find a tearful 16-year-old G1P1 who presents for her 6-week postpartum visit. 1: The puerperium, the period following birth during which the reproductive tract returns to its normal, nonpregnant state, lasts approximately a: 14-16 weeks b: 10-12 weeks c: 6-8 weeks d: 2-4 weeks e: 18-20 weeks During your interview the patient expresses concern that she and her partner attempted intercourse several weeks ago. It was painful and she is afraid there may be something wrong. 2: The best treatment for dyspareunia in the post partum period is a: analgesic b: antidepressant c: oral estrogen d: lubricant e: topical estrogen Is it possible that she could get pregnant? She is not breast-feeding. 3: A. The mean time to ovulation in the nonlactating postpartum woman is approximately a: 75 days b: 45 days c: 60 days d: 15 days e: 30 days 4: B. Approximately _____ of non-nursing women are fertile at 6-week postpartum. a: 10% b: 15% c: 20% d: 25% e: 5% The patient's crying escalates. This was an unplanned pregnancy and she is terrified of being pregnant again. She is grouchy and moody all day and things just get worse at night with the baby getting colicky after the formula, her boyfriend just watching TV, and her mother giving unwanted advice. She has not slept in days. 5: A. The incidence of postpartum blues is approximately _____. a: 50%-60% b: 70%-80% c: 90%-99% d: 30%-40% e: 10%-20% 6: B. Approximately what percent of new mothers experience postpartum depression? a: 20%-25% b: 1%-5% c: 10%-15% d: 30%-45% e: 50%-65% 7: C. The incidence of postpartum psychosis is approximately a: 0.05%-0.1% b: 0.7%-0.8% c: 0.1%-0.2% d: 0.5%-0.6% e: 0.3%-0.4% During your review of systems she admits to leaking urine during coughing or sneezing. 8: A. The best treatment fo postpartum stress incontinence is a: topical estrogen medication b: empirical antibiotic treatment for cystitis c: anticholinergic medication d: tricyclic antidepressant medication e: reassurance and re-evaluation in 2 months 9: B. The return of normal tone to the pelvic floor muscles postpartum may be enhanced by a: exogenous estrogen supplementation b: Kegel exercises c: avoiding coitus fo 3 to 6 months d: endogenous estrogen supplementation e: endogenous progesterone supplementation On continuation of your review of systems she also admits to bleeding with bowel movements and she thinks it is due to the hemorrhoids she developed during her 2 hours of pushing. 10: Surgical management of postpartum hemorrhoids may be considered how soon postpartum? a: 3 months b: 18 months c: 6 months d: 12 months e: Immediately Your physical exam is within normal limits, including normal thyroid, heart, lungs, and breast exam. On pelvic exam you find that vaginal mucosa is intact but moderately atrophic and her uterus is anteverted, small, and firm with minimal lochia. She is noted to have some nonthrombosed hemorrhoids. 11: A. Uterine involution is a result of a decrease in the a: size of the intercellular spaces in the uterine myometrium b: increased intravascular volume, especially venous space volume c: number of cells in the uterine myometrium d: number of intercellular spaces in the uterine myometrium e: size of cells in the uterine myometrium 12: B. How many weeks does it take for the uterus to return to its pre-pregnancy position in the true pelvis? a: 2 b: 4 c: 8 d: 10 e: 6 13: C. How many weeks does it take for the uterus to return to its pre-pregnancy size? a: 2 b: 6 c: 8 d: 10 e: 4 You receive a call from the Labor and Delivery nurse. The patient you delivered by forceps 3 hours ago is bleeding more than usual. Her pulse is now 110 bpm and she is rapidly soaking pads. 14: A. Immediate postpartum uterine hemostasis is maintained by a: primary clotting of blood in the uterine artery b: tamponade effect of clots c: scar formation within the uterine cavity d: contraction of the uterine smooth muscle e: decrease in myometrial cell volume 15: B. The elevated pulse rate characteristic of pregnancy a: decreases approxiamately 1 hour after delivery b: decreases approximately 6 hours after delivery c: persists for approximately 3 weeks postpartum d: decreases at the end of the third stage of labor e: persists for about 3 months postpartum On exam you notice that her bladder is full and she is unable to void spontaneously, so a Foley catheter is inserted and 600 mL of urine drained from the bladder. 16: Transitory urinary retention in the postpartum period following vaginal delivery is primarily related to a: peripartum cystitis b: periurethral edema c: parasympathomimetic discharge d: sympathomimetic discharge e: progesterone-associated loss of bladder contractility On exam, there are no cervical or vaginal lacerations and the bleeding responds to fundal massage and an increase in the Pitocin infusion rate. You recommend the patient to proceed with breast-feeding and assure the patient and nurse that you will follow-up in a few hours. 17: A. Postpartum uterine contractile pain is greater in breast-feeding women bcause suckling releases a: oxytocin b: estrogen c: progesterone d: prostaglandins e: inhibin 18: B. When is the endometrium re-established after delivery in most patients? a: First week b: Fourth week c: Third week d: Second week e: Fifth week You return later and find the bleeding has stabilized. The urine output is 100 to 200 mL per hour. 19: A. In a normal patient immediately after delivery, what is the weight of fluid lost through diuresis and loss of extravascular fluid? a: 3 kg b: 7 kg c: 9 kg d: 1 kg e: 5 kg 20: B. In the intrapartum and postpartum periods, the glomerular filtration rate decreases to normal a: 1-2 days after delivery b: at the time of delivery c: 3-5 days after delivery d: several weeks after delivery e: at the onset of labor Chapter 12: Postpartum Hemorrhage 1: A drop in hematocrit of at least what percent is an indication of postpartum hemorrhage? a: 5% b: 10% c: 20% d: 15% 2: You are called to evaluate heavy vaginal bleeding in a woman 30 minutes after delivery of her first child. Bleeding is brisk and ongoing. What is the first sign of significant blood loss that you are likely to observe? a: Tachycardia b: Shock c: Anuria d: Hypotension 3: A 23-year-old G2P1011 has delivered a healthy term infant without difficulty. Which of the following sets of actions are most likely to minimize her risk of hemorrhage? a: Fundal pressure, firm cord traction, and maternal pushing b: Uterine massage, gentle cord traction, and oxytocin after delivery c: Expectant management for placental delivery d: Oxytocin infusion and manual delivery of the placenta 4: A 33-year-old G2P2 just underwent a successful forceps-assisted vaginal delivery of a 4,552-g son, followed by spontaneous placental expulsion. Her pregnancy was complicated by gestational diabetes requiring insulin and by mild polyhydramnios. Labor was spontaneous, with delivery 9 hours after admission, including 2 hours of pushing. In this senario, the most significant risk factor for hemorrhage due to atony is a: multiparity b: prolonged labor c: excessive uterine distention d: use of forceps 5: The most common cause of postpartum hemorrhage is a: uterine atony b: genital tract trauma c: retained placenta d: coagulation disorder 6: The initial finding of a soft "boggy" consistency to the uterus in a patient with postpartum bleeding should lead to immediate a: temporary ligation of the uterine artery b: placement of a balloon compression device c: bimanual uterine massage d: administration of packed red blood cells 7: A 19-year-old G1P1 underwent induction of labor at 41 weeks of gestation. She required cervical ripening with a Foley balloon. Oxytocin was started at admission. Delivery occurred 39 hours after admission. Immediately following spontaneous delivery of a 3,119-g male, heavy vaginal bleeding is noted. No prior risk factors are found. The placenta was inspected and found to be intact. Uterine tone is soft despite vigorous bimanual massage and high-dose oxytocin. The next appropriate step in the management of this patient is a: ultrasound exam for retained products b: mobilization of the OB response team c: movement to the OR and prep for exploratory laparotomy d: inspection of the birth canal for trauma 8: Methylergonovine maleate is given intramuscularly because IV administration can directly lead to a: heart failure b: hypertension c: hypotension d: clotting disorder 9: To reduce the risk of postpartum hemorrhage, prophylactic oxytocin should first be administered when during the labor and delivery process? a: Second stage b: Fourth stage c: Third stage d: After completion of the fourth stage 10: In a patient with postpartum bleeding and a firm, contracted uterus, the first step in management should be to a: order a CAT scan to determine if there are retained placental fragments b: inspect the lower genital tract for laceration c: administer methylergonovine d: increase oxytocin infusion 11: Which of the following is a predisposing factor for retained placenta? a: Advanced maternal age b: Instrument delivery c: Excessive oxytocin administration during delivery d: Uterine leiomyomata 12: Penetration of placental villi into the uterine muscle is termed a: placenta accreta b: placenta percreta c: placenta increta d: placenta previa 13: The first finding in a patient with amniotic fluid embolism typically is a: cyanosis b: hemorrhage c: respiratory distress d: cardiovascular collapse 14: An opening between the uterine cavity and the abdominal cavity is termed a: uterine dehiscence b: uterine inversion c: uterine retroversion d: uterine rupture Chapter 13: Multifetal Gestation 1: What is the incidence in the general population of twinning? a: 1 in 50 pregnancies b: 1 in 20 pregnancies c: 1 in 90 pregnancies d: 1 in 250 pregnancies 2: What is the incidence in the general population of monozygotic twinning? a: 1 in 20 pregnancies b: 1 in 50 pregnancies c: 1 in 90 pregnancies d: 1 in 250 pregnancies 3: In twin-twin tran