Answer 35

35.  Choice D is the correct answer.  Premature rupture of membranes typically does not have blood in it.  It is usually a sudden onset of a gush of clear or pale yellow fluid leaking from the vagina.  The Nitrazine and Fern test tests the pH of the vagina.  Amniotic fluid is usually a pH of 7.0-7.3 and typical vaginal pH is 3.8-4.2.  Palpating the fundus while examining the cervix and cause some of the amniotic fluid to be pushed out through the cervix.  

Question 35

35.  All of the following are useful tests are useful on physical exam for assessment of premature rupture of membranes except:

A.  Nitrazine Test

B.  Fern Test

C.  Palpating the fundus while examining the cervix

D.  Vaginal occult blood test

Answer 34

34.  Choice B is the correct answer.  This patient has life threatening post partum hemorrhage and needs to have her heparin reversed.  The antidote for this is protamine.  Fresh frozen plasma and Vitamin K is the antidote for coumadin.  This patient is afebrile and it is not likely that the patient is septic.  There is no reason to be suspicious for thrombocytopenia and a platelet transfusion is not indicated.  

Question 34

34.  Your patient is a 31 year old female that has just delivered a 6 pound 8 ounce boy via vaginal delivery 6 hours ago.  She is on heparin because of a DVT in her right leg that was diagnosed when she was 24 weeks gestation.  She suddenly starts having severe vaginal bleeding and becomes dizzy and tachycardic.  Her vital signs are as follows:  HR 141, BP 79/47, Sat 95% Temp 97.7.  Which of the following is the best therapeutic intervention at this time?

A.  Fresh Frozen Plasma
B.  Protamine
C.  Start Vancomycin and Zosyn, with a fluid bolus for empiric treatment of Sepsis
D.  Transfuse a 6 pack of platelets

Answer 33

33.  Choice B is the correct answer.  Microsomia is not a complication of gestational diabetes.  There is increased growth hormone secreted and this causes macrosomia.  Infants of diabetic mothers can have a complication of hypoglycemia after delivery.

Question 33

33.  Which of the following is not a complication of gestational diabetes:

A.  Macrosomia
B.  Microsomia
C.  Preclampsia
D.  Neonatal morbidity

Answer 32

32.  Choice D is the correct answer.  Microsomia is not an indication for a C-Section.  All of the following are indications for a C-Section:  failure to progress, non reassuring fetal status, fetal malpresentation, abnormal placenta, multiple gestation, fetal bleeding diathesis, cord prolapse, suspected macrosomia, uterine rupture, and mechanical obstruction to vaginal birth.