CompTIA
Checkpoint
ISC
HP
Dell
EC-Council
EXIN
Fortinet
ITIL®
Juniper
PMI
Microsoft
VMware
Avaya
Google
Salesforce
Amazon
Palo Alto Networks
Certiport
ISC2
All Vendors
  2. Home
  3. Exams
  4. USMLE
  5. STEP2

Free STEP2 Exam Braindumps (page: 54)

Page 53 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.

A21-year-old woman last menstruated 6 weeks ago. Her menses are usually every 2830 days. She has a past history of chlamydia. One week ago she had a positive home pregnancy test. She complains of mild left lower quadrant pain. Quantitative serum chorionic gonadotropin (hCG) concentrations 2 days ago and today are 6850 and 7685 mIU/mL, respectively. No intrauterine pregnancy is identified by transvaginal 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): K

Explanation:

Vaginal spotting accompanied by pelvic discomfort in a woman with a prior sexually transmitted infection suggests the diagnosis of an ectopic (tubal) pregnancy. Serum hCG concentrations should increase by at least 67% in 2 days during the first 68 weeks of pregnancy. The subnormal increase in this woman's serum hCG concentrations increases the probability of an ectopic pregnancy. However, approximately 15% of women with a normal intrauterine pregnancy will have a subnormal rise in hCG concentrations. Also, approximately 15% of women with an ectopic pregnancy will have a 48-hour rise in serum hCG concentrations greater than 67%. At hCG concentrations over 5000 mIU/mL, the absence of an intrauterine pregnancy by transvaginal ultrasound provides additional evidence for the diagnosis of an ectopic pregnancy.



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 29-year-old pregnant woman at 38 weeks' gestation presents to your labor and delivery unit complaining of dizziness, heavy vaginal bleeding, and loss of fetal movement. She had been having uterine contractions for approximately 4 hours, but these stopped when the bleeding began. Her previous pregnancy was delivered by classical cesarean section because of a transverse lie.

  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): F

Explanation:

The clinical features that make uterine rupture the most likely diagnosis are profuse bleeding coincident with cessation of uterine contractions and labor in a woman with a prior classical cesarean section (vertical incision in the uterine fundus). Uterine rupture is uncommon in women with a prior low transverse cesarean section and rare in women with no scar on her uterus. The standard of care is that all women with a previous classical cesarean section be delivered by repeat cesarean section at term before the onset of labor.



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 31-year-old woman has an uncomplicated labor and vaginal delivery of a healthy 3400-g male infant. However, her placenta has not yet delivered 2 hours after the delivery of her child. Under appropriate anesthesia manual extraction of the placenta is attempted, but the placenta is removed in fragments. She continues to have excessive vaginal bleeding after manual removal of her placenta. Her first child was delivered by a low transverse cesarean section because of fetal distress.

  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): G

Explanation:

Placenta accreta is suggested by the difficulty with manual removal of the placenta in a woman with a prior cesarean section. Placenta accrete is also more common over any previous uterine incision, such as a myomectomy. Placenta accrete is also more common in women with placenta previa and there is greater than an eightfold increase in women with an AFP higher than 2.5 MOM. The safest and most appropriate treatment is a hysterectomy.



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.

A34-year-old woman, gravida 5, has a 17-hour first stage, a 3.5-hour second stage ending with a spontaneous vaginal delivery of a 4400-g infant, and a 15-minute third stage of labor. Immediately after the placenta delivers, she has profuse vaginal bleeding. On examination, her perineum is intact and there are no vaginal or cervical lacerations. Her uterus is soft and the uterine fundus is 45 cm above her 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): I

Explanation:

Prolonged labor with delivery of a macrosomic fetus (greater than 4000 g) in a highly parous woman are the risk factors for uterine atony. The diagnosis is confirmed by a boggy, noncontracted uterus that is larger than expected after a normal delivery. Treatment is a combination of manual massage of the uterus, oxytocin, blood transfusion to maintain hemodynamic stability, and careful inspection of the vagina, cervix, and uterus to exclude a vaginal or cervical laceration or retained placental fragments. Ergot derivatives or prostaglandins should be administered if the above measures fail to cause the myometrium to contract.
Uterine artery embolization is an unproven therapy. Ahysterectomy is necessary if all measures fail to stop the postpartum hemorrhage






Post your Comments and Discuss USMLE STEP2 exam with other Community members:

STEP2 Discussions & Posts