Quiz 12 Name: ____________Florence Yip_______________

Question 1:
An 18 year old G1P0 woman at 12 weeks gestation reports nausea, vomiting, scant vaginal
bleeding and a “racing heart.” These symptoms have been present on and off for the past four
weeks. The patient has no significant past medical, surgical or family history. Vital signs are:
temperature 98.6˚F (37˚C); heart rate 120; blood pressure 128/78. On physical examination:
uterine fundus is 4 cm below the umbilicus; no fetal heart tones obtained by fetal Doppler
device; cervix is 1 cm dilated with pinkish/purple “fleshy” tissue protruding through the os. Labs
show: hemoglobin 8.2 gm/dL, quantitative Beta-hCG 1.0 Million IU/mL; thyroid-stimulating
hormone (TSH) undetectable; free T4 3.2 (normal 0.7-2.5). An ultrasound reveals
heterogeneous cystic tissue in the uterus (snowstorm pattern). Which of the following is the
most appropriate next step in the management of this patient?
A. Repeat quantitative Beta-hCG
B. Repeat transvaginal ultrasound
C. PET scan
D. Chest x-ray
E. CBC

Question 2:
You are asked to give a lecture on a new chemotherapy drug that has demonstrated a
reasonable efficacy in woman with advanced cervical cancer. The day before giving the lecture,
you realize that you own stock in the company that makes the drug. Which of the following
statements about conflict of interest is true?
A. Pharmaceutical companies can support the costs of medical conferences in which
physicians receive continuing medical education credits.
B. Physicians should engage in agreements in which companies make a substantial
donation to an educational activity, when the donation is contingent on the physician’s
use or advocacy of a product.
C. The hospital may not interfere with a physician’s decision to use a new surgical device.
D. An investigator may not own stock in a company if he/she does research for that
company.
E. Physicians are not required to disclose any potential conflict of interest before speaking
in a national forum.
Question 3:
A 19 year old G1P0 woman notes vaginal spotting. Her last normal menstrual period occurred
six weeks ago. She began having spotting early this morning and it has increased only slightly.
She has no pain and denies other symptoms. Her medical history is noncontributory. Vital signs
are: blood 120/69; pulse 68; respirations 20; and temperature 98.6˚F (37.0˚C). On pelvic exam,
her cervix is normal; uterus is small and non-tender; and no masses are palpable. Initial labs
show quantitative Beta- hCG 2000 mIU/mI and hematocrit 38%. A repeat Beta-hCG level 48
hours later is 2100 mIU/mI. A transvaginal ultrasound shows an empty uterus with a thin
endometrial stripe and no adnexal masses. What is the best next step in the management of
this patient?
A. Dilation and curettage
B. Treat with methotrexate
C. Exploratory laparotomy
D. Repeat Beta-hCG level in 48 hours
E. Repeat ultrasound in 24 hours

Question 4:
A 35 year old G3P2 woman presents foe her initial prenatal care visit at 15 weeks gestation,
according to her last menstrual period. She reports that a home pregnancy test was positive
about five weeks ago. Review of her history is unremarkable and her entire family is in good
health. Physical examination reveals a ten week size uterus. Which of the following is the most
appropriate next step in establishing this pregnancy’s gestational age?
A. Checking fetal heart tones
B. Hysterosonogram
C. Quantitative Beta-hCG
D. Obstetrical ultrasound
E. Quadruple screen

Question 5:
A 23 year old G1P0 woman presents with cramping, vaginal bleeding and right lower quadrant
pain. Her last normal menstrual period occurred seven weeks ago. On physical exam, vital signs
are: blood pressure 110/74; pulse 82; respirations 18; and temperature 99.4˚F (37.4˚C). On
abdominal exam, she has very mild right lower quadrant tenderness. On pelvic exam, she has
scant old blood in the vagina and a normal appearing cervix. Her uterus is normal size and
slightly tender. On bimanual exam, there is no cervical motion tenderness, and she has slight
tenderness in the right lower quadrant. Quantitative Beta-hCG is 2500 mIU/mI; progesterone
6.2 ng/mI; hematocrit 34%. The transvaginal ultrasound shows an empty uterus with
endometrial thickening, a mass in the right ovary measuring 3 x 2 cm and a small amount of
free fluid in the pelvis. Which of the following is the most appropriate next step in the
management of this patient?
A. Methotrexate
B. Antibiotics
C. Observation
D. Dilation and curettage
E. Culdocentesis

Question 6:
A 16 year old G1P0 woman at 39 weeks gestation presents to labor and delivery reporting a
gush of blood-tinged fluid approximately five hours ago and the onset of uterine contractions
shortly thereafter. She reports contractions have become stronger and closer together over the
past hour. The fetal heart rate is 140 to 150 with accelerations and no decelerations. Uterine
contractions are recorded every 2-3 minutes. A pelvic exam reveals that the cervix is 4 cm
dilated and 100 percent effaced. Fetal station is 0. After walking around for 30 minutes the
patient is put back in bed after complaining of further discomfort. She requests an epidural.
However, obtaining the fetal heart rate externally has become difficult because the patient
cannot lie still. What is the most appropriate next step in the management of this patient?
A. Place the epidural
B. Apply a fetal scalp electrode
C. Perform a fetal ultrasound to assess the fetal heart rate
D. Place an intrauterine pressure catheter (IUPC)
E. Recommend a Cesarean delivery

Question 7:
A 23 year old G1P0 woman at 24 weeks gestation requires treatment for depression. She has no
other pregnancy complications. In addition to counseling, she begins therapy with fluoxetine
(Prozac). Which of the following symptoms is the most common side effect of her therapy?
A. Increased libido
B. Sleep disturbance
C. Hypertension
D. Dyspepsia
E. Flatulence
Question 8:
A 32 year old G3P1 woman at 37 weeks gestation is admitted to labor and delivery for a
scheduled repeat Cesarean delivery. Maternal labs show: HIV positive; blood type B+; RPR non-
reactive; HBsAg negative; GBS negative; PPD positive; CXR negative. She received adequate
antiretroviral therapy prior to and during the pregnancy. Her viral load was undetectable
throughout the second and third trimester. A live male infant is delivered with Apgar scores of 9
and 9 at 1 and 5 minutes, respectively. Which of the following is the most appropriate next step
in the management of the newborn?
A. Order HIV testing on the infant on admission to the nursery
B. Treat the infant with zidovudine (AZT) immediately after delivery
C. Encourage breastfeeding
D. Start zidovudine at 24 hours of life
E. Isolate the infant from the other infants in the nursery

Question 9:
A 35 year old woman presents to the emergency department with heavy vaginal bleeding at
seven weeks gestation. On examination, she has a dilated cervix with blood and tissue present
at the cervical os. Which of the following is the most likely chromosomal abnormality to be
found in the karyotypic evaluation of the products of conception?
A. Autosomal trisomy
B. Triploidy
C. Tetraploidy
D. Monosomy X (45X,0)
E. Fragile X mutation