Answers.
A 26 year-old gravida 2 para 1 female at 9 weeks' estimated gestational age (by last normal
menstrual period) presents to the Emergency Department complaining of heavy vaginal bleeding
which began two hours earlier. She denies having any sexual intercourse in the past seven days. Her
vital signs are stable. A quantitative serum hCG returns at a value of 3200 mIU/mL and a
transvaginal ultrasound reveals a mean gestational sac diameter of 30mm and no embryo. She
reports passing no tissue and a speculum examination reveals the cervix is visually closed. In
counseling the patient about her options, which of the following statements is true? - Correct
Answer ✔✔ - Medical management with misoprostol is more effective than expectant management
Correct
Whichryofrytheryfollowingryisryarycontraindicationryforrymedicalrymanagementryofryanryectopicrypregnancyr
ywithrymethotrexate?ry-ryCorrectryryAnswerry✔✔ry-ryPresenceryofryembryonicrycardiacryactivityryCorrect
Ary19-
yoryprimigravidaryatryapproximatelyry40ryweeks'ryestimatedrygestationalryagerycomesrytorytheryhospitalry
withrypainfulrycontractions.rySheryhasryreceivedrynoryprenatalrycare.ryExamination:ryCervixryisry4rycmrydila
tedryandry80%ryeffacedryatrystationry-
1.ryBloodrypressureryisry164/111rymmryHg,ryandryaryurinerydipstickryshowsry3+ryprotein.rySheryreportsryhav
ingryhadrysevereryheadachesryforrythreerydaysryandryhasrynoticedryswellingryinryherryhandsryandryfeet.ryMo
mentsryafterryherrybloodryisrydrawnryandryIVryaccessryisryobtained,rysheryhasryarygeneralizedrytonic-
clonicryseizure.ryWhichryofrytheryfollowingryisrytherymostryappropriateryimmediaterycourseryofryaction?ry-
ryCorrectryryAnswerry✔✔ry-ryAdministerrymagnesiumrysulfaterysixrygramsryIVryoverry15-
20ryminutesryCorrect
Ary29ryyear-
oldrygravidary3ryparary2ryfemaleryatry28ryweeks'ryestimatedrygestationalryageryisryfoundrytoryhaveryarypulmo
naryryembolus.rySheryisryhemodynamicallyrystableryandryyouryarerydiscussingrytherapeuticryanticoagulati
onrywithryher.ryAccordingrytorythery2012ryAmericanryCollegeryofryChestryPhysiciansryGuidelines,rytherytreat
, mentryofrychoiceryforryvenousrythromboembolismryinrypregnancyryisrywhichryoneryofrytheryfollowing?ry-
ryCorrectryryAnswerry✔✔ry-ryLow-molecularryweight ryheparinryCorrect
AccordingrytorytheryNICHDryFetalryHeartryRateryClassificationrySystem,rywhichrycategoryrytracingryrequire
srypromptryevaluationryandryexpedientryinterventionsrytoryaddressrytherypatternry(asrytherytracingryinrythis
rycategoryryisryconsidered ryabnormalryandrypredictiveryofryabnormalryfetalryacid-
baserystatusryatrytherytimeryofryobservation)?ry-ryCorrectryryAnswerry✔✔ry-
ryCategoryryIIIryelectronicryfetalrymonitoringrytracingryCorrect
Arycesareanrydeliveryrymayryberyconsideredryduerytoryfailedryinductionryafterryarrestryofrylaborryinrywhichry
ofrytheryfollowingryprimiparousrylaborryscenarios?ry-ryCorrectryryAnswerry✔✔ry-
ryAfterrymaximumryoxytocinrydosingryforrysixryhoursrywithryrupturedrymembranes,rythereryisryfailurerytoryg
enerateryadequaterycontractionsryorryprogressryatry7rycmryCorrect
Whichryofrytheryfollowingrydefinesryanryocciputryposteriorryposition?ry-ryCorrectryryAnswerry✔✔ry-
ryFetalryocciputrytoward rytherymaternalryspineryCorrect
AllryofrytheryfollowingryarerytruerystatementsryregardingrymultiplerygestationrypregnanciesryEXCEPT:ry-
ryCorrectryryAnswerry✔✔ry-ryThereryisryarydecreased ryincidenceryofrycongenitalryanomaliesryCorrect
Ary32-year-
oldrygravidary2ryparary1ryfemaleryatry40ry6/7ryweeks'ryestimatedrygestationalryageryhasrybeenryfullyrydilated
ryforryfourryhours,ryandryhasrynowrybeenrypushingryforrytworyhours.rySheryisryphysicallyryandryemotionallyry
exhausted,rysoryyouryhaveryarydiscussionrywithryherryregardingryassistedryvaginalrydelivery.ryWhichryofryth
eryfollowingryareryprerequisitesrytoryanryinstrumentedrydelivery?ry-ryCorrectryryAnswerry✔✔ry-
ryLackryofrysuspicionryofrysevererycephalopelvicrydisproportion ryCorrect
Whichryofrytheryfollowingryisryanryantenatalryriskryfactorryforryshoulderrydystocia?ry-ryCorrectryryAnswerry✔
✔ry-ryMaternalryobesityryCorrect
Documentationryinrytherymedicalryrecordryafterryarydeliveryrywithryaryshoulderrydystociaryisryanryessentialr
yriskrymanagement rytool.ryWhichryofrytheryfollowingryshouldryberydocumentedryinrytherymedicalryrecordryp
ertainingrytorytherycircumstancesrythatrytookryplaceryduringrytheryshoulderrydystocia?ry-