Prenatal Care — MCQs

A 23-year-old woman presents to the emergency department with burning and increased urinary frequency. The patient states that her symptoms started yesterday and have been worsening despite hydrating well. The patient is generally healthy, does not smoke or drink alcohol, and is 10 weeks pregnant. She is currently taking folate, iron, and a multivitamin. Her temperature is 98.1°F (36.7°C), blood pressure is 122/83 mmHg, pulse is 83/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for an absence of costovertebral angle tenderness and mild discomfort to palpation of the lower abdomen. An initial urine dipstick is notable for the presence of leukocytes, bacteria, and nitrates. Which of the following is the best treatment for this patient?

A 29-year-old, gravida 1 para 0, at 10 weeks' gestation comes to the physician for progressively worsening emesis, nausea, and a 2-kg (4.7-lb) weight loss over the past 2 weeks. The most recent bouts of vomiting occur around 3–4 times a day, and she is stressed that she had to take a sick leave from work the last 2 days. She is currently taking ginger and vitamin B6 with limited relief. Her pulse is 80/min, blood pressure is 100/60 mmHg, and respiratory rate is 13/min. Orthostatic vital signs are within normal limits. The patient is alert and oriented. Her abdomen is soft and nontender. Urinalysis shows no abnormalities. Her hematocrit is 40%. Venous blood gas shows: pH 7.43 pO2 42 mmHg pCO2 54 mmHg HCO3- 31 mEq/L SO2 80% In addition to oral fluid resuscitation, which of the following is the most appropriate next step in management?

A 31-year-old G2P1001 presents to the labor floor for external cephalic version (ECV) due to breech presentation at 37 weeks gestation. Her pregnancy has been complicated by an episode of pyelonephritis at 14 weeks gestation, treated with intravenous ceftriaxone. The patient has not had urinary symptoms since that time. Otherwise, her prenatal care has been routine and she tested Rh-negative with negative antibodies at her first prenatal visit. She has a history of one prior spontaneous vaginal delivery without complications. She also has a medical history of anemia. Current medications include nitrofurantoin for urinary tract infection suppression and iron supplementation. The patient’s temperature is 98.5°F (36.9°C), pulse is 75/min, blood pressure is 122/76 mmHg, and respirations are 13/min. Physical exam is notable for a fundal height of 37 centimeters and mild pitting edema in both lower extremities. Cardiopulmonary exams are unremarkable. Bedside ultrasound confirms that the fetus is still in breech presentation. Which of the following should be performed in this patient as a result of her upcoming external cephalic version?

A 15-year-old girl is brought to the clinic by her mother for an annual well-exam. She is relatively healthy with an unremarkable birth history. She reports no specific concerns except for the fact that her friends “already got their periods and I still haven’t gotten mine.” Her mom reports that she also had her menarche late and told her not to worry. When alone, the patient denies any pain, fevers, weight changes, vaginal discharge, or psychosocial stressors. Physical examination demonstrates a healthy female with a Tanner 4 stage of development of breast, genitalia, and pubic hair. What findings would you expect in this patient?

A 54-year-old woman comes to the office complaining of increased urinary frequency and dysuria. She is accompanied by her husband. The patient reports that she goes to the bathroom 6-8 times a day. Additionally, she complains of pain at the end of her urinary stream. She denies fever, abdominal pain, vaginal discharge, or hematuria. Her husband adds, “we also don’t have sex as much as we used to.” The patient reports that even when she is “in the mood,” sex is “no longer pleasurable.” She admits feeling guilty about this. The patient’s last menstrual period was 15 months ago. Her medical history is significant for hyperlipidemia and coronary artery disease. She had a non-ST elevation myocardial infarction (NSTEMI) 3 months ago, and she has had multiple urinary tract infections (UTIs) in the past year. She smokes 1 pack of cigarettes a day and denies alcohol or illicit drug use. Body mass index is 32 kg/m^2. Pelvic examination reveals vaginal dryness and vulvar tissue thinning. A urinalysis is obtained as shown below: Urinalysis Glucose: Negative WBC: 25/hpf Bacterial: Many Leukocyte esterase: Positive Nitrites: Positive The patient is prescribed a 5-day course of nitrofurantoin. Which of the following is the most appropriate additional management for the patient’s symptoms?

A 27-year-old G1P0 at 12 weeks gestation presents to her obstetrician for her first prenatal visit. She and her husband both have achondroplasia, and she is curious what are the chances that they will have a child of average height. What percent of pregnancies between two individuals with achondroplasia that result in a live birth will be expected to be offspring that are unaffected by this condition?

A 16-year-old girl comes to the physician for a regular health visit. She feels healthy. She lives with her parents at home. She says that the relationship with her parents has been strained lately because they ""do not approve"" of her new boyfriend. She recently became sexually active with her boyfriend and requests a prescription for an oral contraception. She does not want her parents to know. She smokes half-a-pack of cigarettes per day and does not drink alcohol. She appears well-nourished. Physical examination shows no abnormalities. Urine pregnancy test is negative. Which of the following is the most appropriate next step in management?

A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?

A 27-year-old woman comes to the physician because of a 1-month history of progressive shortness of breath. She can no longer walk one block without stopping to catch her breath. Her last menstrual period was 3 months ago. Menarche occurred at the age of 12 years, and menses had occurred at regular 28-day intervals. Cardiac examination shows a grade 3/6, rumbling diastolic murmur at the apex. Laboratory studies show an elevated β-hCG concentration. Which of the following is the most likely explanation for this patient's worsening dyspnea?

A 21-year-old woman, gravida 1, para 0, at 39 weeks' gestation comes to the physician for a prenatal visit. She has some mild edema and tiredness but generally feels well. She recently had a nephew visiting for 1 week who became ill and was diagnosed with the chickenpox. She has no history of chickenpox and is not vaccinated against the varicella zoster virus. Current medications include folic acid supplements and a prenatal vitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 15/min, and blood pressure is 116/64 mm Hg. Pelvic examination shows a uterus consistent in size with 39 weeks' gestation. IgG antibody titers for varicella zoster virus are negative. Which of the following is the most appropriate next step in management?