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Front

An 18-year-old pregnant woman is noted to have vaginal bleeding. She is bleeding from venipuncture sites, IV sites, and from her gums. What is the most likely underlying diagnosis?

Back

Placental abruption

Answer explanation

The patient's symptoms of vaginal bleeding and bleeding from venipuncture sites, IV sites, and gums suggest a coagulopathy, which is commonly associated with placental abruption. This condition can lead to significant maternal and fetal complications.

Front

Upon performing laparoscopy for a suspected ovarian torsion on an 18-year-old nulliparous woman, the surgeon sees that the ovarian vascular pedicle has twisted 1 to 1.5 times and that the ovary appears somewhat bluish. What is the best management at this point? Options: Oophorectomy with excision close to the ovary, Oophorectomy with excision of the vascular pedicle to prevent possible embolization of the thrombosis, Unwind the vascular pedicle to assess the viability of the ovary, Bilateral salpingo-oophorectomy, Intravenous heparin therapy.

Back

Unwind the vascular pedicle to assess the viability of the ovary.

Answer explanation

Unwinding the vascular pedicle allows assessment of the ovary's viability. If the ovary is still viable, it can be salvaged, whereas oophorectomy may be premature if there is a chance of recovery.

Front

A 24-year-old G2P1001 woman at 34 weeks’ gestation is icteric with nausea, vomiting, and malaise. A diagnosis of acute fatty liver of pregnancy is made. Which of the following is most consistent with acute fatty liver of pregnancy?
- Elevated serum bile acid levels
- Hypoglycemia requiring multiple D50 injections
- Proteinuria of 500 mg over 24 hours
- Oligohydramnios noted on ultrasound

Back

Hypoglycemia requiring multiple D50 injections

Answer explanation

Hypoglycemia is a common finding in acute fatty liver of pregnancy due to impaired fatty acid metabolism. This condition can lead to severe hypoglycemia, requiring interventions like D50 injections, making it the most consistent choice.

Front

Back

The most common sign of uterine rupture is a fetal heart rate abnormality.

Answer explanation

The most common sign of uterine rupture is indeed a fetal heart rate abnormality, such as bradycardia, which can occur due to compromised fetal oxygenation. This makes the correct choice accurate in this scenario.

Front

A 32-year-old G1P0 woman at 29 weeks’ gestation presents with severe midepigastric abdominal pain radiating to the back, nausea, and vomiting. Her BP is 100/60 mm Hg, HR is 110 bpm, and temperature is 99°F. Abdominal examination shows tenderness and diffuse rebound. Serum amylase level is markedly elevated. What is the next step? Options: Initiate a high-protein, low-fat diet, Immediate surgical excision of the inflamed aspect of the pancreas, Ultrasound imaging of the abdomen, Delivery of the infant

Back

Ultrasound imaging of the abdomen

Answer explanation

The patient's symptoms and elevated amylase suggest pancreatitis. Ultrasound imaging is the next step to assess for gallstones or other complications, guiding further management.