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18.A 32-year-old woman, gravida 3, para 2, at 14 weeks' gestation comes to the physician for a prenatal visit. She has some mild nausea, but otherwise no complaints. She has no significant medical problems and has never had surgery. She takes no medications and has no known drug allergies. She is concerned for two reasons. First, the "flu season" is coming, and she seems to get sick every year. Second, a child at her son's daycare center recently broke out with welts and was sent home. Which of the following vaccinations should this patient most likely be given?
a) Influenza
b)Measles
c)Mumps
d)Rubella
e)Varicella
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not very sure...probably varicella
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19.A 35-year-old woman, gravida 3, para 2, at 39 weeks' gestation, comes to the labor and delivery ward with contractions. Past obstetric history is significant for two normal spontaneous vaginal deliveries at term. Examination shows the cervix to be 4 centimeters dilated and 50% effaced. The patient is contracting every 4 minutes. Over the next 2 hours the patient progresses to 5 centimeters dilation. An epidural is placed. Artificial rupture of membranes is performed, demonstrating copious clear fluid. 2 hours later the patient is still at 5 centimeters dilation and the contractions have spaced out to every 10 minutes. Which of the following is the most appropriate next step in management?
a)Expectant management
b)Intravenous oxytocin
c)Cesarean delivery
d)Forceps-assisted vaginal delivery
e)Vacuum-assisted vaginal delivery
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arrest in active phase of labor......BBBBBBBBBBBBB
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20. A 27-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a prenatal visit. She has no complaints. Her obstetric history is significant for a primary low transverse cesarean delivery because of a non-reassuring fetal tracing 3 years ago. She has no medical problems. She takes prenatal vitamins and has no known drug allergies. She is debating whether to have an elective repeat cesarean delivery or to attempt a vaginal birth after cesarean (VBAC). She wants to know her chances for a successful VBAC. Which of the following most accurately represents the patient's likelihood of having a successful vaginal delivery?
a) 0%
b) 25%
c)50%
d)70%
e) 100%
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a good guess will be 70%...DDDDD
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21. A 62-year-old woman comes to the physician because of bleeding from the vagina. She states that her last menstrual period came 11 years ago and that she has had no bleeding since that time. She has hypertension and type 2 diabetes mellitus. Examination shows a mildly obese woman in no apparent distress. Pelvic examination is unremarkable. An endometrial biopsy is performed that shows grade I endometrial adenocarcinoma. Which of the following is the most appropriate next step in management?
a) Chemotherapy
b)Cone biopsy
c)Dilation and curettage
d)Hysteroscopy
e)Hysterectomy
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straight one...EEEEEEEEEEEEE
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22.A 35-year-old woman, gravida 4, para 3, at 38 weeks' gestation comes to the labor and delivery ward after a gush of clear fluid from the vagina. After the gush, she has had increasing contractions. Sterile speculum examination shows a pool of clear fluid in the vagina that is nitrazine positive. Cervical examination shows that the patient is 5 cm dilated, with the fetal face presenting in a mentum anterior position. External uterine monitoring shows that the patient is contracting every 2 minutes, and external fetal monitoring shows that the fetal heart rate is in the 140s and reactive. Which of the following is the most appropriate next step in management?
a)Expectant management
b)Oxytocin augmentation
c)Forceps delivery
d)Vacuum delivery
e)Cesarean section
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complicated labor.....EEEEEEEEEEE
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23.A 36-year-old woman, gravida 3, para 2, at 33 weeks' gestation comes to the physician for a prenatal visit. She has some fatigue but no other complaints. Her current pregnancy has been complicated by a Group B Streptococcus urine infection at 16 weeks. Her past obstetric history is significant for a primary, classic cesarean delivery 5 years ago for a non-reassuring fetal tracing. Two years ago, she had a repeat cesarean delivery. Past surgical history is significant for an appendectomy 10 years ago. Which of the following is the major contraindication to a vaginal birth after cesarean (VBAC) in this patient?
a) Classic uterine scar
b)Group B Streptococcus urine infection
c)Previous appendectomy
d)Prior cesarean delivery for non-reassuring fetal tracing
e)Two prior cesarean deliveries
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AAAAAAAAAA
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24.A patient who has been taking tamoxifen to prevent breast cancer for the past 6 months presents complaining of irregular vaginal bleeding. An endometrial biopsy is performed that demonstrates atypical hyperplasia. Which of the following is the most appropriate next step in management?
a)Discontinue the tamoxifen
b)Increase the tamoxifen dose
c)Repeat the endometrial biopsy
d)Schedule a pelvic ultrasound
e)Switch the patient to estrogen
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got to discontinue...AAAAAAAAAAA
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25.A 18-year-old woman comes to the physician for an annual examination. She has no complaints. She has been sexually active for the past 2 years. She uses the oral contraceptive pill for contraception. She has depression for which she takes fluoxetine. She takes no other medications and has no allergies to medications. Her family history is negative for cancer and cardiac disease. Examination is unremarkable. Which of the following screening tests should this patient most likely have?
a) Colonoscopy
b)Mammogram
c)Pap smear
d)Pelvic ultrasound
e)Sigmoidoscopy
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3yrs from since when sexually active or 18 yrs ..which ever is earlier....pap smear...AAAAAAAAAA
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1b,2e,3a,4d,5d,6e,7a,8b,9c,10a,11b,12d,13d,14d,15b,16a,17a,18a,19b,20d,21e,22c,23a,24a,25c------------
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