Obstetrics and Gynecology Knowledge Quiz

1. A 28-year-old G1P0 at 39 weeks gestation presents for routine outpatient obstetric care and is found to have a blood pressure of 145/95 mm Hg. A complete ROS is notable only for chronic low back pain causing poor sleep. The physical examination is normal, including a nontender, gravid uterus and a fetal heart rate of 150 beats/min. The cervical examinations reveals firm consistency, 1 cm dilation, 50% effacement, and -3 station. The patient’s blood pressure is checked 5 hours later and is 142/94 mm Hg. Based on the 2013 ACOG guidelines for management of hypertension in pregnancy, which one of the following should be the next step in management?

2. A 32-year-old primigravida at 20 weeks gestation presents with a 5-day history of gradually worsening left calf pain and swelling. She was placed in a walking boot 3 weeks ago to immobilize a left foot fracture. She feels well otherwise, and she specifically denies any chest pain, cough, palpitations, dyspnea, fever, chills, easy bruising, or bleeding. Her examination is notable only for posterior tenderness and swelling of the left calf. A CBC, PT, PTT are all normal. Duplex Doppler US of the left leg is consistent with deep vein thrombosis. Which one fo the following do you recommend at this point?

3. A 28-year-old G2P1 visits your office for routine prenatal care at 36 weeks gestation. Today she reports some mildly increased lower extremity edema without associated headache, visual changes, or right upper quadrant pain. She has not noticed any leaking amniotic fluid and has only had occasional mild uterine contractions. Her blood pressure has been normal at past visits, but on examination today it is 144/92 mm Hg. Repeat measurement confirms the blood pressure reading, and urine dipstick shows trace protein. Her fundal height measures 36 cm, fetal heart tones have a rate of 134 beats/min, and Leopold’s maneuvers indicate that her fetus is in a cephalic position. Laboratory tests reveal a normal platelet count, normal transaminase and creatinine levels, and a normal urine protein/creatinine ratio. Your plan at this time should include which one of the following?

4. How many arteries and veins are normally found in the umbilical cord on a newborn examination?

5. A 22-year-old G1P0 with a history of homelessness and recent IV drug use presents for prenatal care. Mantoux tuberculin testing is performed and produces 20 mm of induration. She had a negative tuberculin test 1 year ago. A chest radiograph is normal. You decide to treat her with isoniazid for latent tuberculosis infection. Which one of the following should also be given to prevent the development of peripheral neuropathy?

6. A 25-year-old primigravida at 33 weeks gestation presents to the labor suite with a complaint of painful uterine contractions every 3 minutes for the last 2 hours. A fetal monitor confirms the contraction pattern, and the fetal heart rate pattern is category 1. A fetal fibronectin test is ordered. Thirty minutes later the contractions have stopped, but results of the fetal fibronectin test are positive. A speculum examination shows no indication of ruptured membranes. The cervix is closed and thick to palpation. The positive result on this patient’s fetal fibronectin test:

7. A 28-year-old female just delivered a male infant over an intact perineum. She has had polyhydramnios during this pregnancy, but her prenatal course has otherwise been normal. Her only significant chronic medical problem is asthma, treated with a long-acting beta-agonist/corticosteroid combination inhaler. Vital signs were stable throughout the labor. After delivery of the placenta, bleeding becomes brisk and you note a soft, boggy, uterus. Which one of the following medications is contraindicated in this patient?

8. A 32-year-old female at 12 weeks gestation presents with an itchy vulvar lesion, which you diagnose as external genital warts. Which one of the following would be accurate advice regarding treatment?

9. A 37-year-old female who smokes 1 pack of cigarettes per day has just had her third child and requests contraception. She does not intend to have any more children. Which one of the following is the safest option for this patient?