Module 4 Kelsey Chapter 7 Flashcards
A patient has reached week 39 of her pregnancy. On abdominal exam, you measure a fundal height of 42 cm. Leopold’s maneuvers provide you with an EFW of 4200 g. What factors would help to ease your mind about the fetal size?
A) The patient has wide hips and will have no problem with a big baby.
B) The patient is 5 ft 10 in. with an anthropoid pelvis and her husband is 6 ft 4 in.
C) The patient is totally unconcerned and knows this baby will fit.
D) The fetus is not yet engaged, so the height is greater than expected.
B) The patient is 5 ft 10 in. with an anthropoid pelvis and her husband is 6 ft 4 in.
The patient’s anthropoid pelvis shape favors a posterior position of the fetus and is adequate for a vaginal birth of a large infant.
Symmetric growth restriction is more likely than asymmetric growth restriction to:
A) be related to multiple gestation.
B) become apparent first in late pregnancy.
C) occur as a result of maternal medical illness.
D) result from maternal cigarette smoking.
D) result from maternal cigarette smoking.
Symmetric growth restriction is associated with maternal use of drugs such as tobacco, alcohol, Dilantin (phenytoin), cocaine, and heroin.
A patient returns for the reading of the PPD injection that was placed during the first prenatal visit. You read the result as 10 mm of induration. The patient is American-born and healthy, and has no known history of contact with the disease. How do you interpret this result?
A) It is positive and the patient needs referral to an infectious disease specialist.
B) It is unclear and the patient should have a chest radiograph to be certain.
C) It is positive and you should give the patient a prescription for INH.
D) It is negative because the patient has no high-risk characteristics for the disease.
D) It is negative because the patient has no high-risk characteristics for the disease.
PPD test interpretation is based on risk factors:
* Induration of 5 mm is positive for very-high-risk individuals—HIV positive, with abnormal chest radiograph, recent contact with active case.
* Induration of 10 mm is positive for high-risk individuals— foreign born, HIV negative, IV drug user, low-income populations, associated medical problems.
* Induration of 15 mm is positive for patients with none of these risks.
Which of the following is considered a severe feature of preeclampsia?
A) Abdominal pain
B) Blood pressure of 140/90 mm Hg
C) Light sensitivity
D) Thrombocytopenia
D) Thrombocytopenia
Severe features of preeclampsia include thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and cerebral or visual symptoms.
Loss of a fetus in the second trimester is most frequently related to:
A) hydatidiform mole.
B) inevitable abortion.
C) ectopic pregnancy.
D) incompetent cervix.
D) incompetent cervix.
Second-trimester fetal loss is most likely due to an incompetent cervix. The other stated causes of fetal loss—hydatidiform mole, inevitable abortion, and ectopic pregnancy—are related to first-trimester loss.
Preventive strategies against toxoplasmosis infection include:
A) fully cooking meat to at least 98.6°F.
B) avoiding pasteurized milk and cheeses.
C) avoiding handling kitty litter.
D) fully cooking poultry to 72.5°F.
C) avoiding handling kitty litter.
Preventive strategies against toxoplasmosis infection include the following:
* Fully cook meat to at least 145°F (63°C) and poultry to 160°F (71°C).
* Do not drink unpasteurized milk or eat unpasteurized cheese.
* Avoid handling and/or changing kitty litter.
* Avoid drinking untreated water.
* Perform good handwashing following gardening or wear gloves while gardening because soil might be contaminated with cat feces.
Which of the following is a risk factor for hypertensive disorders of pregnancy?
A) Adolescence
B) Multiparity
C) Singleton pregnancy
D) Thyroid disorder
A) Adolescence
The following are risk factors for hypertensive disorders of pregnancy: nulliparity, adolescent or advanced maternal age (> 35 years), multiple gestation, family history of preeclampsia or eclampsia, obesity and insulin resistance, chronic hypertension, limited exposure to father of baby’s sperm (new partner), donor insemination, and antiphospholipid antibody syndrome and thrombophilia.
Which of the following is associated with the most severe neonatal outcome?
A) Impetigo
B) Primary herpes simplex virus
C) Pruritis gravidarum
D) PUPPP
B) Primary herpes simplex virus
A primary infection with HSV-2 during pregnancy is associated with preterm birth, low birth weight, and neonatal sequelae including local or disseminated infection and encephalopathy.
An elevated maternal AFP result is associated with which of the following?
A) Down syndrome
B) Neural tube defect
C) An autosomal recessive gene
D) X-linked recessive inheritance
B) Neural tube defect
An elevated maternal serum alpha-fetoprotein (AFP) is associated with neural tube defects, multiple gestation, and placental abruption.
Infants born to a pregnant person infected with the Zika virus may have:
A) microcephaly.
B) rebound hypoglycemia.
C) hydrocephaly.
D) vesicular lesions.
A) microcephaly.
Infants born to a pregnant person infected with Zika may have microcephaly and severe fetal brain damage.
A pregnant patient at 34 weeks’ gestation tells you that she noticed a small amount of blood on her underwear this morning about an hour after having sexual intercourse. She is not having any pain or contractions. Your initial differential diagnosis for this patient would include:
A) cervicitis.
B) incompetent cervix.
C) placental abruption.
D) premature rupture of membranes.
A) cervicitis.
Painless bleeding after sexual intercourse at 34 weeks’ gestation may be due to irritation of the cervix from cervicitis. Placental abruption is usually associated with painful bleeding, whereas premature rupture of membranes is typically characterized by loss of fluid.
In the management of anemia following placental abruption, which of the following is the most appropriate treatment strategy?
A) Administration of anticoagulant
B) Replacement of platelets
C) Restoration of volume and blood cells
D) Transfusion of iron
C) Restoration of volume and blood cells
Massive hemorrhage requires restoration of volume and cells to maintain perfusion of vital organs.
A pregnant nurse who had previously received the varicella vaccine works at a nursing home caring for older adults. The nurse was exposed to one of the nursing home residents who had shingles. What next steps should this pregnant nurse take?
A) Obtain an obstetric ultrasound as soon as possible.
B) Ask the provider to be swabbed for varicella.
C) Get a varicella vaccine within 72 hours of exposure.
D) Use universal precautions only since shingles poses little risk to the pregnant patient or baby.
D) Use universal precautions only since shingles poses little risk to the pregnant patient or baby.
There is no reason to be alarmed given that shingles poses little risk to the pregnant patient or baby.
Risks to the fetus in a post-term pregnancy are related to all of the following except:
A) fetal macrosomia.
B) meconium aspiration.
C) polyhydramnios.
D) uteroplacental insufficiency.
C) polyhydramnios.
Post-term pregnancy is typically associated with decreased amniotic fluid, rather than an excess of such fluid.
A woman receiving the varicella vaccine should wait how many weeks before attempting pregnancy?
A) There is no waiting period.
B) 1 week
C) 4 weeks
D) 12 weeks
C) 4 weeks
Varicella vaccination is recommended for all susceptible reproductive-age women prior to conception (at least 4 weeks before attempting pregnancy) or postpartum.
Correct information concerning pregnancies with first-trimester bleeding includes which of the following?
A) Approximately 10% of women have some bleeding in the first trimester.
B) Bleeding that occurs between 10 and 12 weeks is often caused by implantation.
C) Cervical incompetence is a common cause of first-trimester bleeding.
D) Approximately 90% of pregnancies in which FHT are heard will continue to term after early bleeding.
D) Approximately 90% of pregnancies in which FHT are heard will continue to term after early bleeding.
Approximately 90% of pregnancies with bleeding will continue to term after FHTs are observed. Other information to discuss with the patient includes the following: 40% of women have some bleeding in the first trimester, and 80% of spontaneous abortions occur in the first 12 weeks of pregnancy.
A pregnant 28-year-old woman who is a G1P0 presents at her first antenatal visit at 12 weeks’ gestation with a variable reddish brown rash on her torso, hands, and feet. The rash does not itch. The patient reports fatigue and a recent sore throat. Which of the following laboratory tests may be the most helpful in determining a diagnosis?
A) CBC
B) Quantiferon Gold
C) RPR
D) Serum bile acid
C) RPR
An RPR test is part of the standard initial antepartum visit lab set and will confirm a suspected diagnosis of secondary syphilis that aligns with this presentation
The fundal height for a pregnant patient at 20 weeks’ gestation was 1 cm below the umbilicus. At today’s 24-week visit, fundal height is at the umbilicus. The patient is feeling regular fetal movement, and the fetal heart rate is 140 bpm. The most appropriate management for this patient is:
A) ordering a biophysical profile.
B) ordering an ultrasound.
C) performing a nonstress test at this visit.
D) scheduling the next visit for 4 weeks from today.
B) ordering an ultrasound.
Ordering an ultrasound is the most appropriate management of the patient to evaluate fetal size and gestation. The patient is too early in gestation for a biophysical profile and a nonstress test. Waiting 4 weeks for an evaluation is too long to wait—the patient needs to be evaluated much sooner.
If a pregnant person with HIV and an undetectable viral load receives antiretroviral therapy during the pregnancy and intrapartum, the rate of transmission to the neonate is:
A) less than 1%.
B) between 5% and 15%.
C) between 15% and 25%.
D) more than 80%.
A) less than 1%.
2008 data from the United Kingdom and Ireland showed that pregnant women receiving ART had transmission rates of about 1%.
A woman receiving the rubella vaccine should wait how many weeks before attempting pregnancy?
A) There is no waiting period.
B) 1 week
C) 4 weeks
D) 12 weeks
C) 4 weeks
Although there are no documented cases of CRS from vaccine, the recommendation is to wait at least 4 weeks prior to attempting a pregnancy following rubella vaccination. The vaccine may be given to mothers postpartum and while breastfeeding.
Iron-deficiency anemia in the second trimester is most commonly due to:
A) blood volume expansion.
B) degradation of erythrocytes.
C) folate deficiency.
D) poor nutrition.
A) blood volume expansion.
Iron-deficiency anemia in the second trimester is most commonly a consequence of expansion of blood volume with inadequate expansion of maternal hemoglobin mass.
When IV access has not been established in the intrapartum setting and the need for immediate treatment related to preeclampsia exists, which of the following is the most appropriate therapy?
A) Hydralazine
B) Labetalol
C) Nifedipine
D) Nitroglycerine
C) Nifedipine
immediate-release nifedipine is most appropriate where IV access has not been established.
Which of the following is the most appropriate strategy for antepartum management of preeclampsia?
A) Fluid restriction
B) Increased physical activity
C) Referral to a registered dietician
D) Weekly fetal movement assessment
C) Referral to a registered dietician
Antepartum management may include dietary assessment, adequate hydration, restricted activity, monitoring (blood pressure, weight, edema, intake, output, DTRs, patient symptoms), and daily fetal movement assessment.
Rubella is spread through:
A) contaminated food.
B) cat feces.
C) respiratory secretions.
D) infected mosquitoes.
C) respiratory secretions.
Rubella is an acquired respiratory disease and can be spread through respiratory secretions.
A patient who is 32 weeks pregnant has had symptoms of preterm labor and has a history of preterm delivery at 34 weeks. A fetal fibronectin test is negative. You advise her that:
A) she has a 60% chance of going into labor within the next week.
B) it is really too early in the pregnancy for this test to be of much value.
C) the result offers some reassurance that the patient will not go into labor in the next 2 weeks.
D) it is really too late in the pregnancy for this test to be of much value.
C) the result offers some reassurance that the patient will not go into labor in the next 2 weeks.
A negative result on a fetal fibronectin test is useful in ruling out imminent (within 14 days) preterm birth before 37 weeks’ gestation; its predictive value can be as high as 94%.
Which of the following individuals is at the lowest risk for developing gestational diabetes in pregnancy?
A) A 17-year-old white woman with a BMI of 30
B) A 24-year-old white woman who is pregnant for the first time
C) A 25-year-old Latina woman with a history of PCOS
D) A 32-year-old African American woman who is a vegan
B) A 24-year-old white woman who is pregnant for the first time
The following are risk factors for gestational diabetes: overweight or obesity, physical inactivity, history of GDM, prior LGA infant, age > 25 years, strong family history of type 2 diabetes, race/ethnicity (African American, Hispanic, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander), hypertension, elevated HDL and triglycerides, PCOS, elevated HbA1c, being treated for HIV.
The result of a 1-hour 50-g GCT at 28 weeks for a 34-year-old G5 P4004 was 154 mg/dL. Follow-up 100-g glucose tolerance test produced the following results: 100, 192, 185, and 160 mg/dL. The plan for this patient should include:
A) obtaining fasting glucose tests at 32 and 36 weeks to ensure that levels stay at or below 100 mg/dL.
B) referring the patient to a nutritionist to help her limit further weight gain to no more than 10 lb.
C) referring the patient to a perinatologist for periumbilical blood sampling to determine fetal blood glucose levels.
D) screening for diabetes at 6–12 weeks postpartum.
D) screening for diabetes at 6–12 weeks postpartum.
The patient’s 1-hour OGTT results are abnormal, and a diagnosis for gestational diabetes can be made. Thus, a screening for pregestational diabetes at 6–12 weeks postpartum is necessary.
The neonatal condition in which an infant is in withdrawal from opioids at birth is called:
A) NAS.
B) gestational diabetes.
C) FASD.
D) Ballard’s score.
A) NAS.
NAS is a condition in an which infant goes through withdrawal at birth due to fetal exposure to opioids (prescription pain relievers or heroin), barbiturates, or benzodiazepines.
A pregnant patient presents for the 32-week visit with no complaints. All findings from previous visits have been normal. Today she has blood pressure of 145/95 mm Hg. An expected additional finding if she has mild preeclampsia would include:
A) lower-extremity edema.
B) serum creatinine > 1.1 mg/dL.
C) right upper epigastric pain.
D) elevated liver function tests.
B) serum creatinine > 1.1 mg/dL.
Preeclampsia is the development of blood pressure higher than or equal to 140/90 mm Hg on two occasions at least 4 hours apart after 20 weeks’ gestation, and proteinuria greater than or equal to 300 mg per 24-hour urine collection or protein/creatinine ratio greater than or equal to 0.3 or, if other quantitative methods are unavailable, a dipstick result of 1+. In the absence of proteinuria, diagnosis parameters for preeclampsia include new-onset hypertension with any of the following:
* Thrombocytopenia: platelet count < 100,000/mcL
* Renal insufficiency: serum creatinine > 1.1 mg/dL or doubling of serum creatinine concentration without renal disease
* Impaired liver function: doubling of normal levels of liver transaminases
* Pulmonary edema
* Cerebral or visual symptoms
An 18-year-old female patient is 16 weeks pregnant. She has a positive chlamydia test. Appropriate management includes:
A) erythromycin base 500 mg orally QID for 7 days and ceftriaxone 125 mg IM.
B) azithromycin 1 g orally in a single dose and perform a test of cure in 3 to 4 weeks.
C) ofloxacin 300 mg orally BID for 7 days and rescreen in the third trimester.
D) spectinomycin 2 g IM now and repeat in 1 week.
B) azithromycin 1 g orally in a single dose and perform a test of cure in 3 to 4 weeks.
The recommended treatment for chlamydia is azithromycin 1 g PO × 1 or amoxicillin 500 mg orally TID × 7 days. Alternative regimens:
* Erythromycin base 500 mg PO QID × 7 days
* Erythromycin base 250 mg PO QID × 14 days
* Erythromycin ethylsuccinate 800 mg PO QID × 7 days
* Erythromycin ethylsuccinate 400 mg PO QID × 14 days
Magnesium toxicity is best managed by:
A) administering calcium gluconate.
B) dialysis.
C) administering diazepam.
D) observation.
A) administering calcium gluconate.
The antidote for magnesium toxicity is calcium gluconate 1 g intravenous.
The CDC’s recommended treatment for trichomoniasis during pregnancy is:
A) metronidazole 2 g orally.
B) clindamycin 300 mg orally BID × 7 days.
C) azithromycin 1 g orally.
D) ceftriaxone 125 mg IM.
A) metronidazole 2 g orally.
The treatment for trichomoniasis in pregnancy is metronidazole 2 g PO × 1 at any stage of pregnancy.
The varicella vaccine is recommended for:
A) all susceptible patients of reproductive age prior to conception.
B) all pregnant patients in their first trimester.
C) all pregnant patients in their last trimester.
D) all postpartum patients regardless of when their last varicella vaccine was given.
A) all susceptible patients of reproductive age prior to conception.
Varicella vaccination is recommended for all susceptible reproductive-age women prior to conception (at least 4 weeks before attempting pregnancy) or postpartum.
Ectopic pregnancy is consistent with no intrauterine sac on transvaginal ultrasound and an hCG titer of less than:
A) 100 IU/L.
B) 1500 IU/L.
C) 6500 IU/L.
D) 10,000 IU/L.
C) 6500 IU/L.
Ninety percent of ectopic pregnancies are associated with β-hCG levels less than 6500 IU/L.
Pregnancy-induced megaloblastic anemia can be treated with:
A) folic acid.
B) iron supplementation.
C) a protein-rich diet.
D) vitamin B12.
A) folic acid.
The underlying etiology in pregnancy-induced megaloblastic anemia is blood and bone marrow abnormalities caused by impaired DNA synthesis. Folic acid supplementation is necessary to correct this type of anemia.
Which of the following is the most appropriate screen for a woman who is at the end of the postpartum period and whose pregnancy was affected by gestational diabetes?
A) 50-g 1-hour oral glucose screen
B) 100-g 3-hour OGTT
C) 75-g 2-hour OGTT
D) Fasting glucose levels
C) 75-g 2-hour OGTT
A 75-g 2-hour OGTT should be drawn at 6–12 weeks postpartum to screen for diabetes, followed by subsequent screening for diabetes or prediabetes as part of routine primary care.
Hyperthyroidism in pregnancy is diagnosed by:
A) elevated FT4 levels.
B) low free T3 levels.
C) elevated TSH.
D) elevated TT4 levels.
A) elevated FT4 levels.
Elevated serum free thyroxine FT4or FTI levels indicate hyperthyroidism in pregnancy.
At an initial prenatal visit, a pregnant patient is diagnosed with bacterial vaginosis. She does not have any symptoms of vaginal infection. You tell the patient that:
A) all pregnant patients should be treated if they have asymptomatic bacterial vaginosis.
B) pregnant patients who are at risk for preterm delivery should be treated if they have asymptomatic bacterial vaginosis.
C) only pregnant patients at risk for preterm delivery should be treated for symptomatic bacterial vaginosis.
D) pregnant patients who are at risk for preterm delivery should be tested for asymptomatic bacterial vaginosis early in the third trimester.
B) pregnant patients who are at risk for preterm delivery should be treated if they have asymptomatic bacterial vaginosis.
The following treatment is recommended for all pregnant patients with symptoms of bacterial vaginosis: metronidazole 500 mg PO BID × 7 days or metronidazole 250 mg PO TID × 7 days or clindamycin 300 mg PO BID × 7 days.
