TESTS MODUL 2
1. Chronic hypertension is:
А. Hypertension which arises up after 20 weeks of pregnancy but proteinuria doesn’t occur.
В. Hypertension which arises up after 12 weeks of pregnancy.
С. Hypertension, which arises up to pregnancy, or first to 20 weeks of pregnancy.
D. Hypertension which arises up after 12 weeks of pregnancy and urinary protein is more than 0,3 g/l.
Е. Hypertension which arises up after 20 weeks of pregnancy and urinary protein is more than 0,3 g/l.
2. Criteria for diagnosis of mild preeclampsia are:
А. Diastolic BP 100-109 mm Hg., proteinuria <3,0 g/24 h., edema (face and/or hands).
В. Diastolic BP 100-109 mm Hg., proteinuria 3,0-0,5 g/24 h., edema (face and/or hands).
С. Diastolic BP 90-100 mm Hg., proteinuria <3,0 g/24 h., edema (face and/or hands).
D. Diastolic BP 100-109 mm Hg., proteinuria <3,0 g/24 h.
Е. Diastolic BP 110 mm Hg., proteinuria >5,0 g/24 h., generalized edema.
3. Criteria of severe preeclampsia are all the following, except:
А. Seizure.
В. Headache.
С. Visual changes.
D. Generalized, gross edema.
Е. Oliguria.
4. The name of operation of cutting of one or both clavicles for decrease of brachial size is:
А. Cleidotomy.
В. Excerabration.
С. Cranioclasy.
D. Spondilotomy.
Е. Craniotomy.
5. Contraindications for caesarean section is:
А. Diabetes mellitus.
В. Deflexed fetal head.
С. Іnfections in mother.
D. Waterless period is till 6 hours.
Е. Macrosomia.
6. The main symptom of placenta praevia is:
А. Fetal chronic distress.
В. Decrease of hemoglobin level and erythrocytes.
С. Repeated blood discharges from vagina.
D. Arterial hypotension.
Е. Threatened premature labor.
7. What is not typical for diabetes fetopathy by ultrasound examination:
А. Double contour of fetal head.
В. Decrease of fetal movements.
С. Double contour of fetal body.
D. Polyhydramnion.
Е. Macrosomia.
8. Direct diagnostic methods of intrauterine infections are the following except:
А. Chorion villous samples.
В. Investigation of amniotic fluid.
С. Investigation of fetal blood.
D. Investigation of pharyngeal aspirate in moment of fetal birth.
Е. Identification of microorganisms in cervical and vaginal discharges of pregnant woman.
9. Patients with wound infections, or episiotomy infections, have all the following except:
А. Erythema.
В. Edema.
С. Tenderness,.
D. General malaise.
Е. Discharge from the wound or episiotomy site.
10. The treatment of the primary inertia include all the following, except:
А. Caesarean section.
В. Prophylactic antibiotics in prolonged labor particularly if the membranes are ruptured.
С. Forceps delivery.
D. Oxytocin.
Е. Amniotomy.
11. The diagnosis of the preterm labor include all the following, except:
А. Uterine contractions of frequency every 10 minutes or less.
В. The internal os of the cervix is closed.
С. Cervical dilatation ≥3 cm in primigravida.
D. Rupture of membranes.
Е. Uterine contractions of duration at least 30 seconds.
12. The drug of choice of the long anti-hypertensive therapy of preeclampsia is:
А. Hydrochlorthiazide.
В. Captopril.
С. Alpha methyldopa.
D. Labetalol..
Е. Hydralazine
13. All the following drugs are use in treatment of chronic hypertension during pregnancy, except:
А. Central α2 - adrenergic agonist.
В. Calcium channel blockers.
С. Angiotensin-converting enzyme inhibitors.
D. Beta blockers.
Е. Arteriolar vasodilator.
14. Pre-existing raised BP before pregnancy or in the early pregnancy may be due to the following,
except:
А. Essential hypertension.
В. Preeclampsia.
С. Renal artery stenosis.
D. Pheochromocytoma.
Е. Coarctation of the aorta.
15. Gestosis of the early terms of pregnancy include all the following, except:
А. Vomiting.
В. Hypersalivation.
С. Dermatosis of pregnancy.
D. Osteomalacia.
Е. Preeclampsia.
16. Abortion is:
А. The termination of pregnancy before viability of the fetus before 28 weeks or if the fetal weight is
less than 1000 gm.
В. The termination of pregnancy before viability of the fetus before 24 weeks or if the fetal weight
less than 800 gm.
С. The termination of pregnancy before viability of the fetus before 22 weeks or if the fetal weight
less than 500 gm.
D. The termination of pregnancy before viability of the fetus before 26 weeks or if the fetal weight
less than 600 gm.
Е. The termination of pregnancy before viability of the fetus before 32 weeks or if the fetal weight
less than 1000 gm.
17. The treatment of the complete abortion include:
А. Rest in bed until one week after stoppage of bleeding.
В. Progestogens, gonadotrophins.
С. Curettage the cavity of uterus.
D. Sympathomimetics, antiprostaglandins.
Е. Folic acid.
18. The clinical picture of the incomplete abortion include all the following, except:
А. The patient usually noticed the passage of a part of the conception products.
В. Bleeding is continuous.
С. The cervix is closed.
D. The cervix is opened and retained contents may be felt through it.
Е. On examination, the uterus is less than the period of amenorrhoea but still large in size.
19. Preterm labor is:
А. Onset of labor from 24 before completed 37 weeks of pregnancy.
В. Onset of labor from 28 before completed 37 weeks of pregnancy.
С. Onset of labor from 24 before completed 38 weeks of pregnancy.
D. Onset of labor from 22 before completed 38 weeks of pregnancy.
Е. Onset of labor from 22 before completed 37 weeks of pregnancy.
20. The preventive management of the preterm labor include all the following, except:
А. Sedatives.
В. Progestogens.
С. Sympathomimetics, antiprostaglandins.
D. Oxytocin.
Е. Betamethazone for the acceleration of fetal lung maturity.
21. The classification of the abortion include:
А. Threatened abortion.
В. Inevitable abortion.
С. Incomplete abortion.
D. Complete abortion.
Е. All above mentioned is right.
22. Precipitate labor is:
А. A labor lasting less than 3 hours.
В. A labor lasting less than 5 hours.
С. A labor lasting more than 3 hours.
D. A labor lasting less than 1 hour.
Е. A labor lasting more than 8 hours.
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23. The etiology of hypotonic uterine inertia include all the following, except:
А. Overdistension of the uterus.
В. Anomalies of the uterus.
С. Myomas of the uterus.
D. Precipitate labor.
Е. Cephalopelvic disproportion.
24. The clinical symptoms of the hypotonic uterine inertia include all the following, except:
А. The fetus and mother are exhausted.
В. Slow cervical dilatation.
С. Uterine contractions are infrequent, weak and of short duration.
D. A labor lasting 8 hours.
Е. Labor is prolonged.
25. The drug for the stimulation of the labor is:
А. 5 units of oxytocin in 500 ml glucose 5% is given by IV infusion starting with 6-8 drops per minute.
В. 12 mg Betamethazone IM every 12 hours.
С. 10 units of oxytocin in 500 ml glucose 5% is given by IV infusion starting with 6-8 drops per
minute.
D. 5 units of oxytocin in 500 ml glucose 5% is given by IV infusion starting with 20 drops per minute.
Е. 6 mg Progestogen IM every 12 hours.
26. The complications of the premature rupture of membranes include all the following, except:
А. Lacerations of the cervix.
В. Abnormal uterine action.
С. Chorio-amnionitis.
D. Fetal distress.
Е. Preterm labor.
27. The clinical picture of the puerperal endometritis include all the following except:
А. Symptoms of intoxication.
В. Uterus is subinvoluted.
С. Uterus is soft and painful.
D. Foul-smelling excessive lochia.
Е. Uterus is well involuted.
28. The intrapartum factors of puerperal sepsis include all the following except:
А. Premature rupture of membranes.
В. Prolonged labor.
С. Pretem labor.
D. Instrumental delivery.
Е. Lacerations.
29. The clinical picture of the puerperal mastitis include all the following except:
А. General malaise.
В. Well lactation.
С. Tender swelling in one quadrant of the breast.
D. Redness of the skin.
Е. Local pain.
30. The third stage of spreading the puerperal infectious process is:
А. Progressing thrombophlebitis.
В. Puerperal ulcer.
С. Endometritis.
D. Salpingo-ophritis.
Е. General sepsis.
31. The symptoms of superficial thrombophlebitis are all the following except:
А. Skin redness or inflammation along a vein that's just below the skin.
В. Symptoms of intoxication.
С. Tenderness or pain along a vein that's just below the skin.
D. Hardening of a the vein.
Е. Limb pain.
32. Indications for caesarean section by diabetes mellitus are:
А. Giant fetus.
В. Labile diabetes with tendency ketoacidosis
С. Progress of fetal distress.
D. Severe preeclampsia.
Е. All above mentioned.
33. Chronic hypertension is:
А. Hypertension appeared before pregnancy or appeared till 20 weeks of pregnancy.
В. Hypertension appeared before pregnancy.
С. Hypertension appeared till 20 weeks of pregnancy.
D. Hypertension appeared after 20 weeks of pregnancy.
Е. Hypertension appeared till 12 weeks of pregnancy.
34. Pregnant women with chronic hypertension form a risk group of development of the following
pathology except:
А. Preeclampsia.
В. Placenta abrupture.
С. Intrauterine growth retardation.
D. Anemia of pregnancy.
Е. Antenatal fetal death.
35. What is not indicate to interrupt late pregnancy by chronic hypertension?
А. Early preeclampsia which is difficult to correct.
В. Acute disorders of brain circulation.
С. Intrauterine growth retardation.
D. Malignant course of arterial hypertension.
Е. Dissecting aortic aneurism.
36. Multipara pregnant woman, 25 years old, was hospitalized to gynecology department. The pregnancy
is 8 weeks of gestation, active form of rheumatism, combined mitral valvul disease with prevalence of
stenos, circulatory insufficiency IIA degree were diagnosed. In anamnesis – 4 rheumatic attacks during
the last year, nonstable compensation with inconsiderable effect of treatment. What is management?
А. Treatment of circulation insufficiency, prolong the pregnancy and cesarean section in 36-37 weeks
of gestation.
В. Treatment of circulation insufficiency, prolong the pregnancy and deliver with forceps.
С. Interruption of pregnancy be medical indications and treatment of basis disease.
D. Prolongation of pregnancy and treatment of basis disease.
Е. Hospitalization to Cardiology department.
37. Indications for organ’s reservative operations of tube pregnancy are the following except:
А. Middle intraabdomenal bleeding.
В. Nonfunctional reproductive system.
С. Progressive tube pregnancy.
D. Absence of adhesions in abdomen.
Е. Severe inflammatory changes of uterine tubes.
38. Treatment of initial abortion includes the following except:
А. Spasmolytics.
В. Instrumental removal of fetal egg.
С. Hemostatics.
D. Tocolysis.
Е. Hormonal therapy.
39.
The first step to stop the pathological bleeding in early postpartum period is:
А. To press aorta.
В. Manual examination of uterine cavity.
С. Putting clamps on cervix by Baksheev method.
D. Examination of maternal passages.
Е. External uterine massage.
40. Placenta accreta growths into uterine wall in membrane:
А. Basal membrane.
В. Myometrium.
С. Compact layer of mucous.
D. Spongy layer of mucous.
Е. All layer of uterus.
41. Differential-diagnostic signs of inevitable abortion are:
А. Repeated cramp-like pain in low abdomen, constant dark blood discharges, sizes of uterus are less
than term of pregnancy, cervix is closed.
В. Cramp-like or dull pain in low abdomen and loin, poor blood discharges, softness of cervix, light
uterine hypertonus, sizes of uterus are in accordance with the term of pregnancy.
С. Cramp-like pain in low abdomen, bright blood discharges, shortness and dilatation of cervix.
D. Attack of violet pain in low abdomen with irradiation in rectum and right arm, sizes of uterus are
less than term of pregnancy, progressive anemia.
42. The most spread method of cesarean section is:
А. Cesarean section in low segment of uterus by transverse incision.
В. Classic (corporal) caesarean section.
С. Extraperitoneal caesarean section.
D. Vaginal caesarean section.
Е. Caesarean section in low segment of uterus by vertical incision.
43. Indications for caesarean section are the following except:
А. Defective cicatrix on uterus.
В. Cetral placenta praevia.
С. Threatened uterus rupture.
D. Placenta abrupture in the I period of labor.
Е. Cervical erosion.
44. What is necessary to do for prevention of defective cicatrix after caesarean section:
А. To provide hermetization of uterine cavity by suture of uterus.
В. To choose correct sutural material for suture of incision on uterus.
С. To provide development of invective complications in postpartum period.
D. To provide aseptic and antiseptic during operation.
Е. All above mentioned.
45. Indications for corporal caesarean section are the following except:
А. Severe commissures in low segment of uterus.
В. Placenta abrupture.
С. Big sizes of uterus myoma in low segment.
D. Transverse fetal lie with back down.
Е. Fetal defects (conjoined twins).
46. Contraindications for forceps delivery are the following except:
А. Endometritis in labor.
В. Fetal death.
С. Immature fetus.
D. Anatomical contracted pelvis of III degree.
Е. Brow fetal presentation.
47. Risk factors for preeclampsia are all the following, except:
А. Chronic hypertension.
В. Obesity.
С. Maternal age (<20 or >35).
D. Multiparity.
Е. Multiple gestation.
48. The etiology of spontaneous abortions are:
А. Immunological causes.
В. Maternal infections.
С. Maternal anoxia and malnutrition.
D. Endocrine causes.
Е. All above mentioned is right.
49. The drug for the prophylactic of the fetal distress is:
А. 12 mg Betamethazone IM every 12 hours.
В. 6 mg Betamethazone IM every 12 hours.
С. 12 mg Betamethazone IM every 6 hours.
D. 12 mg Progestogen IM every 12 hours.
Е. 6 mg Progestogen IM every 12 hours.
50. The diagnosis of the postterm pregnancy include all the following, except:
А. Calculation of gestational age.
В. Abdomal examination: larger baby size.
С. Ultrasonography.
D. Rupture of membranes.
Е. Tests for placental function.
51. The clinical symptoms of the uncoordinated uterine action include all the following, except:
А. Labor is prolonged.
В. Fast cervical dilatation.
С. Fetal and maternal distress.
D. Slow cervical dilatation.
Е. Uterine contractions are irregular and very painful.
52. The first stage of spreading the puerperal infectious process is:
А. Pelvic thrombophlebitis.
В. Puerperal ulcer.
С. Salpingo-ophritis.
D. Parametritis.
Е. Pelvic peritonitis.
53. Mastitis treatment include all the following except:
А. The mother should be told to stop to breastfeed the baby,.
В. Use local measures, such as ice packs, analgesics, and breast support.
С. Administer a penicillinase-resistant antibiotic such as cephalexin, dicloxacillin or cloxacillin, or
clindamycin in penicillin-allergic patients.
D. Mastitis could lead to abscess formation, which may require surgical drainage.
Е. Continued breastfeeding prevents breast engorgement and subsequent pain.
54. The basis of diagnostic of iron deficiency anemia:
А. Special complaints of pregnant woman.
В. Laboratory results.
С. Appearance of heart diseases.
D. Presence of trophic disorders.
Е. Disturbance of intrauterine fetal development.
55. What syndrome by chronic hepatitis has the following sings: decrease of appetite, nausea, sometimes
vomiting, eructation, abdominal distention, constipations, fat food intolerance:
А. Hepatolienal.
В. Dyspeptic.
С. Asthenovegetative.
D. Cholestatic.
Е. Hemorrhagic.
56. The following signs are typical for extrauterine pregnancy as tube rupture except:
А. Pang pain in ilioinguinal region.
В. Lose consciousness or syncope.
С. Aching pain in low abdomen.
D. Progressive anemia.
Е. Excentric pain in arm and rectum.
57. Modern treatment of progressive tube pregnancy is:
А. Laparoscopy, salpingotomy.
В. Laparotomy, segmental resection of tube isthmus, anastomosis end-to-end.
С. Introduction of cytostatics into fetal egg by laparoscopy or transvaginal echography.
D. Laparotomy, removal of uterine tube.
Е. All above mentioned.
58. Management of neglected transverse lie of alive mature fetus, its satisfactory state, absence of
infection in mother:
А. External obstetrical version of fetus on head.
В. Combined obstetrical version of fetus on head with extraction.
С. Caesarean section.
D. Stimulation by oxytocin with combined obstetrical version of fetus on head with extraction.
Е. Stimulation by oxytocin with combined obstetrical version of fetus on head with forceps. 9.
59. Moments of operation of obstetrical forceps:
А. Application of blades.
В. The location of the branches.
С. Trial traction.
D. Tractions.
Е. Removing of forceps.
F. All above mentioned.
60. Complications of preeclampsia are all the following, except:
А. Seizure.
В. Cerebral hemorrhage.
С. Placental abruption.
D. Gestational diabetes.
Е. Uteroplacental insufficiency.
61. Symptoms and signs of imminent eclampsia are all the following, except:
А. Headache.
В. Epigastric pain.
С. Hyperreflexia.
D. Sacral edema.
Е. Visual disturbances.
62. The clinical picture of the threatened abortion include all the following, except:
А. Pregnancy test is positive.
В. Cervix is closed.
С. Vaginal bleeding slight or mild.
D. Pain is absent or slight.
Е. Pain is colicky felt in the suprapubic region radiating to the back.
63. The complications of the of the precipitate labor include all the following, except:
А. Lacerations of the cervix, vagina and perineum.
В. Shock.
С. Postpartum haemorrage.
D. Fetal asphyxia.
Е. Uterine exhaustion.
64. The contraindications for the stimulation of the labor are the following, except:
А. Functionally contracted pelvis.
В. Placenta previa.
С. Malpresentations and malpositions.
D. Uterine contractions are infrequent, weak and of short duration.
Е. Abruption of placenta.
65. Medications to treat superficial thrombophlebitis may include all the following except :
А. Anticoagulants.
В. Nonsteroidal anti-inflammatory drugs.
С. Steroidal drugs.
D. Analgesics.
Е. Antibiotics.
66. Indication for treatment of chronic hypertension by pregnancy is:
А. Ingibitors of angiotensine transforming factor.
В. Calcium antagonists.
С. ß-adrenoblockers.
D. Central a2-adrenoagonists.
Е. Diuretics.
67. The typical signs of inevitable abortion are (some answers are correct):
А. Intensive cramp-like pains in low abdomen.
В. Severe blood discharges from vagina.
С. The sizes of uterus are more than term of pregnancy.
D. Cervix is opened, elements of fetal egg are in cervix.
Е. Cervix is soft, external os is closed.
68. A multipara pregnant woman was hospitalized with complaints on blood discharges with vesicles
from vagina during last 2 weeks, mild cramp-like pain in low abdomen. Last menses – 4,5 months
ago. The uterine fundus is located near umbilicus, fetal heart beating is absent, small parts of fetus are
not palpated, uterus is soft. Diagnosis.
А. Disturbed tube pregnancy.
В. Inevitable abortion.
С. Molar pregnancy.
D. Symptomatic myoma.
Е. Initial abortion.
69. Conditions of caesarean section are the following except:
А. Alive fetus.
В. Intact amnion.
С. Waterless period is till 6 hours.
D. Waterless period is till 24 hours.
Е. Absence of fever in mother.
1. A 30-year-old gravida 1 para 0 at 40 weeks' gestation delivered ambulance the maternal hospital. She is
nonexaminated. Three weeks ago edema on the legs was appeared. In the morning regular contractions
were started. There were several convulsions at home. The patient`s condition is severe. BP is 190/120
mm Hg. The fetal lie is longitudinal, the head is in the pelvic cavity. Fetal heart rate is 90-100 bpm. At
vaginal examination the cervix is fully dilated, the head is in midpelvis. What is the most likely
diagnosis?
2. A 27-year-old gravida 1 para 0, 37-38 weeks entered the maternity hospital with the complaints of
headache, nasal breathing difficulty, visual changes, swelling. She is sick for 2 weeks. BP is 180/110 mm
Hg, Ps 80 per min. Gross edema is on the legs, abdominal wall, and in the area of external genital organs.
The uterus is in a normal tonus. The fetus is in longitudinal lie, and head presentation. The fetal heart rate
is 100 bpm. Proteinuria - 5 g/l, hourly diuresis - 45 ml, platelet count in the blood - 160 th., fibrinogen B
(++), total protein in the blood - 50 g/l, creatinine 150 mcrmol/l. What is the most likely diagnosis?
3. A 25-year-old gravida 1 para 0 woman at 30 weeks' gestation entered in obstetric hospital with the
complaints of headache, right upper quadrant pain, visual disturbances. BP is 170/110 mm Hg, there is
edema of the face, hands, and abdominal wall. The uterus is in the normal tonus, fetal lie is longitudinal,
the fetal head is above the pelvic inlet. Fetal heart rate is 180 bpm. Proteinuria - 4 g/l. What is the most
likely diagnosis?
4. A 28-year-old gravida 2 para 1 woman with a history of a chronic hypertension presents at 36 weeks of
gestation with a complaint of vaginal bleeding, passing several clots. She notes frequent contractions that
began as menstrual cramps, but have increased over the past hour. What was the main risk factor for
placental abruption?
5. A 35-year-old woman at 8 weeks’ gestation complaints of crampy lower abdominal pain and vaginal
bleeding. She states that the pain was intense last night, and that some tissue passed per vagina. After that,
the pain subsided tremendously as did vaginal bleeding. On examination, her BP is 130/80, heart rate 90
bpm, and temperature 36,7ºC. Abdominal examination is unremarkable. Pelvic examination reveals
normal exernal female genitalia. The cervix is closed and nontender, and no adnexal masses are
appreciated. What is the most likely diagnosis?
6. A 35-year-old G 2 P 1 woman at 41 weeks gestation has been pushing for 3h without progress.
Throughout this time, her vaginal examination has remained completely dilated, completely effaced, and
0 station, with the head persistently in the occiput posterior position. The pelvic sizes are: d. spinarum –
23 cm, d. cristarum – 26 cm, d. trochanterica – 29 cm, c. exerna – 18 cm. What is the situation?
7. A 28-year-old G2 P1 woman with a history of a prior cesarean delivery presents at 36 weeks' gestation
with a complaint of vaginal bleeding. She notes no contractions, but awoke this morning with vaginal
bleeding equivalent to heavy menstrual flow. You obtain an ultrasound as part of her workup for thirdtrimester bleeding. Ultrasound is the primary diagnostic tool for which cause of third-trimester bleeding?
8. A 19-year-old G3 P1 patient with a history of a miscarriage in her last pregnancy presents to the
emergency department with some vaginal spotting. She reports that her last menstrual period occurred 6
weeks earlier. She has had no vaginal discharge other than the spotting, no cramping, and no abdominal
pain. Her physical examination reveals a slightly enlarged uterus, no tenderness, a closed cervical os, and
normal ovarian. What is the most likely diagnosis?
9. A 19-year-old G1 P0 at 38 weeks' gestation presents to labor and delivery. On arrival, she is having
contractions every 2 to 3 minutes and claims that her "water broke" 2 days earlier but that she didn't come
in because she hadn't reached her due date. She has a temperature of 38,9°C, heart rate of 110, blood
pressure of 116/72, and uterine tenderness on palpation. The fetal heart rate is in the 170s with small
accelerations and no decelerations. What is the most likely diagnosis?
10. A 30-year-old woman at 32 weeks gestation complains of significant bright-red bleeding. She denies
uterine contractions, leakage of fluid, or trauma. The patient states that, 4 weeks previously, she
experienced some vaginal spotting after engaging in sexual intercourse. On examination, her BP is
110/60, heart rate 80 bpm, and temperature 36,7ºC. Heart and lung examinations are normal. The
abdomen is soft and uterus nontender. Fetal heart tones range from 140 to 150 bpm. What is the most
likely diagnosis?
11. A 37-year-old G7 P6 with a dichorionic/diamnionic, vertex/ vertex twin gestation at 38 weeks
presents to labor and delivery for induction of labor. She is started on oxytocin and begins having
contractions after 2 hours. She delivers the babies vaginally 16 hours later. Right after delivery of the
second infant, there is a large, continuous hemorrhage from the vagina. What is the most likely cause of
this?
12. A 29-year-old gravida 3 para 2 at 38 weeks' gestation presents to labor and delivery complaining of
the sudden onset of abdominal pain and bright-red vaginal bleeding. On examination, her uterus is firm
and tender to palpation and the tocodynamometer reveals regular contractions every 1 to 2 minutes. The
fetal heart monitor shows no evidence of fetal distress. The patient had a normal ultrasound at week 34
that showed the infant in the vertex presentation. What is the most likely diagnosis in this patient?
13. A 23-year-old G1 P0 at week 38 is being managed with magnesium sulfate while she undergoes
induction of labor for severe preeclampsia. She received a 4-g bolus followed by a constant infusion of
1.0 g/hr. However, the nurse found the patient to have absent patellar reflexes and a respiratory rate of 6
breaths/minute. The patient can be aroused but is very drowsy. In addition to discontinuing the
magnesium, what should your next management step be?
14. A 22-year-old G3 P2 at 40 weeks’ gestation complains of strong uterine contractions. She denies
medical illnesses. Her antenatal history is unremarkable. On examination, her BP is 120/80, heart rate 85
bpm. The fetal heart rate ranges from 140 to 150 bpm. The cervix is 5 cm dilated, and the vertex is at -3
station. Upon rupture of membranes, fetal bradycardia ranging from 70 to 80 bpm is noted for 4 min
without recovery. What is your next step?
15. Your next patient is a 39-year-old G2 P1 at 19 weeks' gestation. You sent her for an anatomic fetal
survey that showed multiple fetal anomalies incompatible with life. The patient and her husband are
devastated. They have received genetic counseling and decided to terminate the pregnancy at this time.
Her gestational dating is very accurate and was confirmed on a first-trimester ultrasound. They would like
to know everything possible about what caused the anomalies and how to prevent a future problem. They
ask for your advice regarding methods of termination in their situation. Which method of termination of
pregnancy would be moist suitable for this couple's needs?
16. A 23-year-old G1 P0 at 35 weeks' gestation presents with a vaginal gush of fluid. On sterile speculum
examination, the patient has a pool of clear fluid in the vagina that is nitrazine and fern positive. She is
contracting every 3 to 4 minutes, and her cervix on visualization appears to be dilated 2 to 3 cm. What is
the best course of action?
17. A 22-year-old G2 P1 woman at 35 weeks gestation complains of abdomimal pain. She states that she
has been experiencing moderate vaginal bleeding, no leakage of fluid per vagina, and has no history of
trauma. On examination, her BP is 150/95, heart rate 110 bpm. The fundus reveals tenderness, and a
moderate amount of dark vaginal blood is noted in the vaginal vault. 2 days ago ultrasound examination
showed no placental abnormalities. The cervix is 1 cm dilated. Fetal heart tones range from 170 to 175
bpm. What is the most likely diagnosis? What is the best management of this condition?
18. A patient presents for her first initial OB visit after performing a home pregnancy test and gives a last
menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates, however, because
she has a long history of irregular menses. Which of the following is the most accurate way of dating the
pregnancy?