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Free STEP2 Exam Braindumps (page: 53)

Page 52 of 185
PDF with 738 Questions

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.

A 23-year-old pregnant woman at 16 weeks' gestation begins to have light vaginal bleeding several hours after sexual intercourse. She has no abdominal discomfort. Her prenatal course has been uneventful and fetal heart tones were heard at 12 weeks. Her uterus is midway between her symphysis pubis and umbilicus, and is soft and nontender. Fetal heart tones are now 148 BPM. Her cervix is undilated.

  1. threatened abortion
  2. gestational trophoblastic disease
  3. cervicitis
  4. placenta previa
  5. placental abruption
  6. uterine rupture
  7. placenta accreta
  8. uterine inversion
  9. uterine atony
  10. vaginal laceration
  11. tubal pregnancy

Answer(s): C

Explanation:

Light vaginal bleeding following sexual intercourse is likely of cervical origin because of the increased blood flow to the pelvic organs in pregnancy and eversion of the endocervix that occurs as a result of the increased estrogen production. The absence of abdominal pain and tenderness, the appropriate size of the uterus and the spotting rather than overt bleeding tend to exclude threatened abortion as the cause of this woman's bleeding.



Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.

A 15-year-old girl began her last menstrual period (LMP) 14 weeks ago. She had a positive pregnancy test 6 weeks ago. On examination, her uterine fundus is at the level of the umbilicus. Fetal heart tones are not heard and no fetus is seen by abdominal ultrasound.

  1. threatened abortion
  2. gestational trophoblastic disease
  3. cervicitis
  4. placenta previa
  5. placental abruption
  6. uterine rupture
  7. placenta accreta
  8. uterine inversion
  9. uterine atony
  10. vaginal laceration
  11. tubal pregnancy

Answer(s): B

Explanation:

Gestational trophoblastic disease is more common in women at the extremes of reproductive age. Uterine size larger than her gestational age calculated from her last menses, the absence of fetal heart tones, and the absence of a fetus by ultrasound confirm the diagnosis. Treatment is evacuation of the uterus.



Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.

A 39-year-old pregnant woman with chronic hypertension at 37 weeks' gestation presents with heavy vaginal bleeding and complains of lower abdominal pain. She also has noted diminished fetal movement since the bleeding began 3 hours previously. On physical examination her uterus is firm (rock hard) and very tender. Fetal heart tones are in the range of 160170 BPM.

  1. threatened abortion
  2. gestational trophoblastic disease
  3. cervicitis
  4. placenta previa
  5. placental abruption
  6. uterine rupture
  7. placenta accreta
  8. uterine inversion
  9. uterine atony
  10. vaginal laceration
  11. tubal pregnancy

Answer(s): E

Explanation:

The features that make placental abruption the most likely diagnosis are the amount of bleeding, chronic hypertension, and an excessively firm (even titanic) uterus that is tender to palpation. Women with a placental abruption may have no bleeding if placental separation occurs only in the center of the placenta.
The other signs of pain and tenderness will be present.



Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all.

A 32-year-old pregnant woman has a low forceps vaginal delivery after a 3-hour second stage of labor. One hour later the nurse informs you she has excessive vaginal bleeding. On examination, her uterus is firm and nontender, and the uterine fundus is at the umbilicus.

  1. threatened abortion
  2. gestational trophoblastic disease
  3. cervicitis
  4. placenta previa
  5. placental abruption
  6. uterine rupture
  7. placenta accreta
  8. uterine inversion
  9. uterine atony
  10. vaginal laceration
  11. tubal pregnancy

Answer(s): J

Explanation:

The use of forceps and the presence of a firm, nontender uterus of appropriate size suggest vaginal laceration as the cause of postpartum bleeding. The diagnosis is confirmed by a speculum examination. A cervical laceration should also be considered and the cervix carefully inspected at the time of the speculum examination






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