1. A G3P2 comes into the Emergency Room complaining of painful contractions happening every 1 - 2
minutes. On exam, she is dilated 8 cm and 50% effaced. What stage of labor is she in?
A. Stage V
B. Stage IV
C. Stage III
D. Stage II
E. Stage I
This was taken from Williams Obstetrics 22nd edition.
2. A 29 year old woman presents to the emergency department presenting with shortness of breath,
chest pain, and coughing. After taking an extensive history, you find she has recently traveled 10 hours
on a plane only getting up once to use the restroom. She is also currently taking oral contraceptives. You
order a D-dimer test that comes back positive. Which of the following would be the next step in
diagnosing the patient?
A. CT scan
B. MRI
C. V/Q lung scan
D. CBC
E. Ultrasound
The correct answer is A.
Citation: CURRENT MEDICAL DIAGNOSIS & TREATMENT - 49th Ed. (2010)
3. A 54 year old alcoholic presents to your emergency with lethargy, fever 101F, productive cough and
moderate SOB. The patient has a past med hx positive for HTN, DM, and chronic alcoholism. A portable
chest xray reveals hazy opacity to the RLL but otherwise no other abnormalities are noted. What is the
most likely organism responsible for the changes seen?
A. Psedomonas
B. Staphylococcus
C. Streptococcus
D. Klebsiella
E. Moraxella
Answer is D.
4. A 43 year old G1P0 Caucasian female is very excited about her first pregnancy and presents to her
obstetrician at 8 weeks for her initial prenatal visit. Unfortunately, her doctor tells her that due to her
age her child is at an increased risk for Down Syndrome. What is the overall incidence of Down
Syndrome in newborns, regardless of maternal age?
A)
B)
C)
D)
E)
1 in 30
1 in 700
1 in 8,000
1 in 15,000
1 in 1,000,000
The correct answer is “B” 1 in 700. Overall, 1 in 700 live births will have Down Syndrome. Along with
the cognitive impairment, these patients will be at increased risk for congenital heart defects,
Alzheimer’s disease, recurrent infections, and acute leukemias. Answer choice “C” is the incidence for
Edwards Syndrome, and answer choice “D” is the incidence for Patau Syndrome. Answers “A” and “E”
are too high and too low, respectively.
5. A 34 year old G2P1 female presents to the ER in labor. She was planning to have a vaginal delivery
although her prior pregnancy was delivered via cesarean section. Which of the following circumstances
would indicate a subsequent cesarean section delivery during this pregnancy?
A. Positive Group B Strep culture
B. Prior history of thromboembolism
C. Rh-negative gravida
D. Previous full-thickness, nontransverse incision through the myometrium
E. Abnormal pap smear
Answer: D
An absolute indication for a cesarean delivery is a previous full-thickness, nontransverse incision
through the myometrium. This occurs in all classic cesarean deliveries and some myomectomy
surgeries
Source: Hacker and Moore’s Essentials of Obstetrics and Gynecology
Elsevier Inc, 2010
Part 2, Chapter 17 (Obstetric Procedures)
Page 226
6. A 42 year old female presents to the ER with shortness of breath. Vital signs and ECG are obtained:
Temp: 98.6
Pulse: 96
BP: 138/90
Respirations: 26
ECG shows nonspecific changes and a spiral CT detects acute pulmonary embolism. The patients is
stabilized and later found to have right ventricular hypertrophy and lower extremity edema. What is the
most likely cause of these findings?
A. Lung cavitation
B. Secondary Pulmonary infection
C. Recurrent Pulmonary Embolism
D. Pneumothorax
E. LMWH treatment
Answer: C
Secondary pulmonary hypertension is a common complication of recurrent pulmonary
embolisms. Mechanical obstruction of one-half to two-thirds of the pulmonary vascular bed by
emboli is necessary for this complication to develop.
Source: Mayo Clinic Internal Medicine Board Review
Oxford University Press, 2010
Chapter 23 (Pulmonary Diseases: neoplastic and vascular diseases)
Page 836 (Complications of PE)
7. A 16 year old female presents to your office with a history significant for trisomy 21 and seizures. She
complains of dyspnea, cough, fever, weight loss and production of a large amount of foul smelling
sputum that has worsened over the past 3 weeks. Her oxygen saturation is 96% on room air. Blood
pressure is 110/70, temperature 102 F, and pulse is 112 per minute. Which of the following is the best
initial test?
A. Chest CT Scan
B. Chest x-ray
C. Lung Biopsy
D. Sputum Culture
E. Sweat Chloride Test
Answer: B. The patients history and presentation lead to a high probability of aspiration pneumonia with
possible lung abscess. Aspiration pneumonia typically happens in the upper lobe when lying flat. A chest
x-ray is the best initial test and will show a cavity, possibly with an air fluid level. Chest CT is more
accurate than a chest x-ray but cost and radiation exposure keep it from being the best initial test. Lung
biopsy would be used to establish the specific pathogen. Sputum culture cannot be used to diagnose a
lung abscess due to the fact that everybody's sputum has anaerobes from mouth flora. Sweat chloride
test is associated with cystic fibrosis which is not applicable here. Clindamycin or penicillin are the best
antibiotics to cover a lung abscess.
Andreoli and Carpenter's Cecil Essentials of Medicine 8th Edition pg 254-255.
8. Immediately after vaginal delivery of a newborn at 33 wks of gestation, a 42 yr old woman
experiences heavy bleeding. Examination reveals an inseparable placenta to the uterine wall. Placental
tissues are found to be invading the myometrium. Which of the following is the most likely diagnosis?
a)abruptio placentae
b)placenta arreta
c)placenta percreta
d)placenta previa
e)placental infarction
ans: b
Source: First aid 2012 pg: 541
9. A mother brings her 1 yr old child for a wellness child examination. During the interview, it is revealed
that the mother and the father both smoke. The child is at increased risk of developing:
a)eczema
b)cystic fibrosis
c)asthma
d)cirrhosis
e)ureteral reflux
ans: c
Source: First aid 2012 pg: 568
10. A 4 year old male is brought to the ED by his parents because he suddenly started having difficulty
breathing, after the parents found him 45min ago laying down in their garage workshop. Physical exam
reveals a low grade fever, crackles in both lungs and cyanosis around his mouth. A chest x-ray reveals
diffuse infiltrates in the lower lobes bilaterally. If further pulmonary studies were done they would most
likely reveal which of the following:
A.
B.
C.
D.
E.
Interstitial fibrous with an increase in FEV1
Decrease in surfactant due to neutrophil damage to pneumocytes
Hyaline membrane formation with increased pulmonary compliance
Dilated pulmonary vasculature in the areas of the diffuse infiltrates
Lymphocytic infiltration of pneumocytes in response to alveolar macrophage cytokines
Answer: B
Source: Goljan Rapid Path Review