Thank you so much! Could you please help me with these qs?
42 yo gravida 2, para 1 at 20 wks gestation comes to the physician for a routine prenatal visit. she has tested positive for factor V Leiden mutation. her 1st pregnancy was uncomplicated, and she delivered at term by c section for breech presentation. she has smoked one pack of cigarette daily for 20 yrs and has continued to smoke during pregnancy. she does not drink alcohol. she maintains a vega diet, and owns/manages a vegetarian restaurant. lives at home with her partner and son. temp is 37C, pulse is 80/min, resp 16, bp 100/60 mm Hg. physical exam shows no abnormalities. ultrasound shows a fetus consistent in size with a 20 wk gestation with normal amniotic fluid volume. placenta is anterior, and the distal portion covers the internal cervical os. which of the following is the greatest predisposing factor for this pt's findings on ultrasonsography?
A. maternal age
B. nutritional status
C. previous cesarean delivery
D. smoking hx
E. thrombophilia
--> So this sounds like placenta previa right? I chose A and got it wrong. I really have no clue with this.
19 yo female comes to the ER b/c of moderate lower abdominal pain and vaginal spotting that began after her last menstrual period 2 wks ago. menses occur at regular 28 day intervals. she underwent a first trimester elective abortion 8 months ago and has been using an oral contraceptive since then. she has been sexually active with one male partner for 1 year. her temp is 37.6C, other vital signs are within normal limits. abdominal exam shows no tenderness. pelvic exam shows blood tinged discharge at the cervical os. there is cervical motion and mild uterine tenderness. urine pregnancy test is negative. which of the following is the most likely cause of this pt's symptoms?
A. chlamydia trachomatis infection
B. endometrial polyp
C. levonorgestrel induced endometrial atrophy
D. retained products of conception
E. trichomoniasis
--> So I chose B and got wrong, so she has cervical motion and uterine tenderness so PID? A is the answer perhaps?
22 yo primigravid at 39 wks gestation has had ruptured membrane for 5 hours w/o contraction. her prenatal course was uncomplicated. her cervix is 80% effaced and 2 cm dilated. the fetal position is right occipitoposterior. fetal HR is 160 with little variation. which of the following is the most likely explanation for this pattern?
A. chorioamnionitis
B. fetal sleep state
C. occipitoposterior position
D. umbilical cord compression
E. uteroplacental insufficiency
--> I chose A and got it wrong, any idea?
27 yo female gravida 3, para 3, had the sudden onset of severe, sharp pain in the Rt. lower quadrant of the abdomen, pain the Rt. shoulder, light headedness, nausea, and rectal pressure 6 hrs ago. she uses diaphragm for contraception, and her last menstrual period was 24 days ago. her bp is 120/70, and pulse is 80 with no orthostatic changes. there is moderate tenderness of the Rt. lower quadrant of the abdomen w/o guarding or rebound tenderness, bowel sounds are active. culdocentesis shows 15 mL of nonclotting, serosanquineous fluid with a hematocrit of 5%. pregnancy test is negative
A. adenomyosis
B. adnexal torsion
C. appendicitis
D. diverticulitis
E. ectopic pregnancy
F. endometriosis
G. endometritis
H. inflammatory bowel dz
I. leiomyomata uteri
J. ovarian carcinoma
K. pelvic inflammatory dz
L. primary dysmenorrhea
M. renal calculus
N. ruptured corpus luteum cyst
O. spontaneous abortion
--> chose K and was wrong. what gives "pain the Rt. shoulder, light headedness, nausea, and rectal pressure ?"
36 yo female gravida 2, para 1, 41 wks has had ruptured membranes w/o contractions for 8 hrs. her first infant weighed 4422g at birth. this pregnancy has been uncomplicated except for gestational diabetes, which was diagnosed at 26 wks gestation and has been well controlled with diet. initial assessment shows a fundal height of 40 cm. on ultrasonography, the estimated fetal weight is 3714 g. the cervix is 2 cm dilated and 50% effaced. the fetal heart rate is within normal limits. labor is induced with intravenous oxytocin. 4 hrs later, her cervic is 4 cm dilated and completely effaced. continuous epidural anesthesia is administered. 2 hours later, the fetal heart rate pattern demonstrates late decelerations with each contraction. the contractions occur every minute, last 45 seconds, and are 75 mm Hg at their peak. which of the following is the most likely explanation for this pattern?
A. epidural anesthesia
B. fetal macrosomia
C. gestational diabetes
D. oxytocin administration
E. postdates pregnancy
--> I chose B and it was wrong
Sure! This is actually quite helpful for my step 2 review, so it's win-win.
Which of the following is the greatest predisposing factor for this pt's findings on ultrasonsography?
A. maternal age
B. nutritional status
C. previous cesarean delivery
D. smoking hx
E. thrombophilia
--> So this sounds like placenta previa right? I chose A and got it wrong. I really have no clue with this.
Answer = C. You're correct in thinking this is a previa. Prior cesarean is a risk for abnormal placentation due to the scar tissue it creates.
Which of the following is the most likely cause of this pt's symptoms?
A. chlamydia trachomatis infection
B. endometrial polyp
C. levonorgestrel induced endometrial atrophy
D. retained products of conception
E. trichomoniasis
--> So I chose B and got wrong, so she has cervical motion and uterine tenderness so PID? A is the answer perhaps?
Answer = A. You're correct again, this is PID, which can be due to Chlamydia infection. The cervical motion tenderness and uterine tenderness was key. Polyps aren't painful to my knowledge and it tends to occur in an older age group.
Which of the following is the most likely explanation for this pattern?
A. chorioamnionitis
B. fetal sleep state
C. occipitoposterior position
D. umbilical cord compression
E. uteroplacental insufficiency
--> I chose A and got it wrong, any idea?
Answer = B (probably). I also got this one wrong and had to look it up, but B is what my notes say. The other answers just don't make sense and a non-reactive stress test is frequently due to a sleep state.
Most likely explanation for pain:
A. adenomyosis
B. adnexal torsion
C. appendicitis
D. diverticulitis
E. ectopic pregnancy
F. endometriosis
G. endometritis
H. inflammatory bowel dz
I. leiomyomata uteri
J. ovarian carcinoma
K. pelvic inflammatory dz
L. primary dysmenorrhea
M. renal calculus
N. ruptured corpus luteum cyst
O. spontaneous abortion
--> chose K and was wrong. what gives "pain the Rt. shoulder, light headedness, nausea, and rectal pressure ?"
Answer = N. The keys here are the acuity of onset and where she is in her cycle. The severe onset of RLQ pain with light headedness is consistent with ruptured cyst, and the fact that she is in the luteal phase (24 days post period) points to a corpus luteum cyst. The cyst is fluid filled, so when it ruptures, the fluid goes into the abdominal cavity and annoys it, which I believe is what's causing some of the symptoms you mentioned.
Which of the following is the most likely explanation for this pattern?
A. epidural anesthesia
B. fetal macrosomia
C. gestational diabetes
D. oxytocin administration
E. postdates pregnancy
--> I chose B and it was wrong
Answer = D. The baby is certainly huge, but that doesn't explain the contraction pattern and late decels. Contractions every minute = tachysystole (>5 contractions in 10 min over 30 minute period), which is a side effect of too much oxytocin. This stresses out baby, which is causing the late decels.
