Puerperium

Question 1

What is the likely diagnosis in an afebrile postpartum woman that presents with bilateral, symmetric warmth and tenderness of the breasts 3 days after delivery?

Answer 1

Breast engorgement

Question 2

What is the likely diagnosis in an exclusively breastfed infant that presents with craniotabes, widened wrists, Harrison’s subcostal groove, rachitic rosary, and genu varum?

Answer 2

Rickets (secondary to vitamin D deficiency

Question 3

Preterm infants that are exclusively breastfed should be initiated on _________in addition to vitamin D

Answer 3

iron supplementation

Question 4

What is the likely diagnosis in a woman that develops abdominal pain and hemorrhagic shock after failing to deliver the placenta? There is a smooth, round mass protruding through the vagina

Answer 4

Uterine inversion

Question 5

What is the next step in management after IV lines have been placed in a woman with uterine inversion with a retained placenta?

Answer 5

Manual replacement of the uterus

Question 6

What is the likely diagnosis in a pregnant patient at 35 weeks gestation that presents with abdominal pain, painful vaginal bleeding and a firm, tender uterus?

Answer 6

Placental abruption (abruptio placentae)

Question 7

Which gestational disorder may present with minimal vaginal bleeding, focal pain, and a distended uterus with high-frequency contractions?

Answer 7

Concealed placental abruption

Question 8

In a patient with placental abruption at ≥ 34 weeks gestation and no fetal distress, management is

Answer 8

vaginal delivery

Question 9

Uterine atony is managed with ______– AND _________

Answer 9

uterine massage and oxytocin

Question 10

What is the most common cause of postpartum hemorrhage?

Answer 10

Uterine atony

Question 11

What is the likely cause of postpartum hemorrhage with a soft, boggy, enlarged uterus on exam and thin endometrial stripe on ultrasound?

Answer 11

Uterine atony

Question 12

What is the recommended management for a pregnant patient at 37 weeks gestation that presents with placenta previa?

Answer 12

Immediate Cesarean delivery

Question 13

What is the likely diagnosis in a pregnant patient that presents with painless third-trimester bleeding with a normal fetal heart tracing?

Answer 13

Placenta previa

Question 14

• Painful bleeding = mom’s problems:
• Painless bleeding = baby’s problems:

Answer 14

• Placental abruption and uterine rupture
• Placenta previa and vasa previa

Question 15

What is the recommended management for a pregnant patient at 34 weeks gestation that presents with placenta previa?

Answer 15

Elective cesarean delivery at 36–37 weeks

Question 16

What is the likely diagnosis in a patient that is 6 hours postpartum that presents with inability to void, diffuse lower abdominal tenderness, and persistent urinary dribbling?

Answer 16

Postpartum urinary retention

Question 17

Treatment of postpartum urinary retention causing overflow incontinence is

Answer 17

urethral catheterization

Question 18

Patient’s involuntary loss of urine, abdominal distention, and tenderness after the administration of epidural analgesia for peripartal pain management suggest:

Answer 18

overflow incontinence.

Question 19

Progressive dyspnea on exertion, cough, reduced left ventricular ejection fraction and mitral regurgitation in late pregnancy is suggestive of:

Answer 19

peripartum cardiomyopathy

Question 20

What is the next step in management in a pregnant patient with progressive dyspnea on exertion, lower extremity edema, and S3 in late pregnancy?

Answer 20

Echocardiography

Question 21

Leukocytosis and persistent fever and pain despite antibiotic therapy in an early postpartum patient with a history of cesarean delivery and no clinical examination findings other than fever raise concern for:

Answer 21

Septic pelvic thrombophlebitis (SPT).

Question 22

What is the recommended treatment for septic pelvic thrombophlebitis?

Answer 22

• Antibiotics (e.g., clindamycin and gentamicin)
• Anticoagulation (e.g., low molecular weight heparin or unfractionated heparin).

Question 23

Patient with uterine atony whose bleeding continues despite bimanual uterine massage and administration of oxytocin. Which is the most appropriate next step in management?

Answer 23

• Additional uterotonic agents (e.g., intramuscular methylergonovine, sublingual or intracavitary misoprostol)
• Tranexamic acid (TXA).

Question 24

Next step in management in a patient with post-partum profuse bleeding due to uterine atony in whom conservative therapy has no effect within 30 minutes

Answer 24

Surgical interventions (e.g., hysterectomy)

Question 25

What is the second most common cause of PPH.

Answer 25

Genital tract injury

Question 26

What is the best next step in management of a pregnant patient with rectus abdominis diastasis?

Answer 26

Observation and reassurance ± exercise program

Question 27

In a newborn, white oral lesions that can be scraped off suggest neonatal oral thrush. This feature together with stabbing breast pain that is more severe than would be expected from examination findings and worsens with breastfeeding is characteristic of:

Answer 27

Mammary candidiasis.

Question 28

Treatment of mammary candidiasis:

Answer 28

Simultaneous treatment of mother and infant with Topical antifungal therapy

Question 29

Asymptomatic women who have placenta previa detected early on routine screening TVUS (often performed between 18 and 20 weeks' gestation) should undergo:

Answer 29

Follow-up TVUS at 32 weeks' gestation.

Question 30

Triad of Vasa previa

Answer 30

- Membrane rupture - Painless vaginal bleeding - Fetal bradycardia (< 110 beats/min

Question 31

True or false: Low‑grade fever, shivering, and leukocytosis may be present during the first 24 hours postpartum

Answer 31

True

Question 32

One hour following vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. Diagnosis

Answer 32

Placenta accreta

Question 33

What is the likely diagnosis in a postpartum patient on post-operative day 2 that presents with fever, uterine tenderness, and purulent lochia?

Answer 33

Postpartum endometritis

Question 34

What is the treatment of endometritis?

Answer 34

Gentamicin + clindamycin

Question 35

What is the likely diagnosis in a 5-day-old baby that presents with unconjugated hyperbilirubinemia and signs of dehydration after exclusively breastfeeding?

Answer 35

Breastfeeding jaundice

Question 36

What is the recommended management for infants with breastfeeding jaundice?

Answer 36

Increase the frequency and duration of feeds (q2h)

Question 37

What pregnancy complication is associated with painless third trimester bleeding without fetal bradycardia?

Answer 37

Placenta previa ( it is associated with maternal blood loss, which may lead to maternal tachycardia and hypotension)

Question 38

What pregnancy complication is associated with painless third trimester bleeding with fetal bradycardia?

Answer 38

Vasa previa

Question 39

Causes of hypertension (e.g. cocaine, smoking, and preeclampsia) all increase the risk for

Answer 39

placental abruption

Question 40

What is the next step in management for a macrosomic newborn with a clavicular fracture secondary to shoulder dystocia?

Answer 40

Reassurance / pin sleeve → chest

Question 41

What is the likely diagnosis in a macrosomic, vacuum-delivered newborn with crepitus over the clavicle and asymmetric Moro reflex?

Answer 41

Clavicular fracture (secondary to shoulder dystocia)

Question 42

Infant presents with ipsilateral head tilt and contralateral chin deviation with a neck mass that does not transilluminate on ultrasound - Diagnosis? - Treatment?

Answer 42

- Congenital muscular torticollis - Stretching