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* CmS OBGYN Form 4
  honey123rich - 12/26/17 13:05
  1. Five weeks after the uncomplicated delivery of her newborn, 25 year old woman,G1 P1 comes to the physician with concerns about insomnia,restlessness,extreme fatigue,irritability and depression.She has not been eating well.She finds the baby's crying increasingly annoying and has been letting him cry alone in the crib for long periods of time. She is having difficulty with her memory and ability to concentrate.While her husband has been supportive,she has had difficulty involving him in the care of the baby.She is afraid that she may hurt her child and says that may be she "would be better off dead".Which of the following is the most appropriate initial step in management?
a.reassure the patient that her postpartum blues are normal
b.measure serum estradiol concentration
c. prescribe immediate antidepressant therapy (wrong)
d. refer the patient to a family therapist
e. arrange for an immediate psychiatric evaluation

2. 32 year old woman G5, P4 at 40 weeks gestation is brought to the emergency department because of bright red vaginal bleeding for 1 hour. Contractions have occurred every 2 to 3 minutes for 5 hours. Her pregnancy had been uncomplicated. Ultrasonography at 22 weeks gestation showed no evidence of placenta previa. Her temperature is 37'C (98.6'F), pulse is 120 mins , respirations are 18 mins and blood pressure is 90/60 mmHg. Physical examination shows a tender abdomen with a firm uterus.The fetal heart rate is 140 min. On speculum examination ,there is copious bright red bleeding from the external cervical os. The cervix is 4 cm dilated and 80% effaced. The physician informs the patient and her husband that emergency cesarean delivery is recommended. The patient and her husband state that because of their religious beliefs, the elders of their church must agree to a surgical delivery before they can give their consent.Which of the following is the most appropriate course of action?
a. ask the patient to convene a meeting of the church elders to discuss cesarean delivery
b.transfer the patient to another physician
c. appoint a guardian ad litem for the fetus to consent to cesarean delivery
d.obtain approval from the hospital administator to perform emergency cesarean delivery
e.obtain approval from the pediatric staff to perform emergency cesarean delivery
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* Re:CmS OBGYN Form 4
  amfyoyo - 12/26/17 18:26
  1. immediate psych evaluation. she is not stable and may hurt the child or herself.
2. d. she needs immediate c-section. parents can't withhold treatment for an child if it would be life saving, regardless of their beliefs
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* Re:CmS OBGYN Form 4
  honey123rich - 12/27/17 14:46
  thanks amfyoyo  
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* Re:CmS OBGYN Form 4
  honey123rich - 12/27/17 15:03
  1.An asymptomatic 52 year old nulligravid woman comes to the physician for a routine health maintenance examination.Her last visit to a physician was 4 years ago.Menses occur at regular 30 to 32 day intervals; there is no bleeding between menses.She smoked one pack of cigarettes daily but quit 5 years ago. She drinks one to two glasses of wine per week.In addition to a pap smear, mammography and cholesterol testing, which of the following tests is most appropriate at this time?
a. Xrays of the chest
b. Plevic ultrasonography
c. sputum cytology
d. bone densitometry (wrong)
e. colonosopy

2.A 25 year old woman comes to the physician because of a 4 week history of right sided pelvic pain.She has been sexually active with one partner for 3 years; they use condoms for contraception. Her last menstrual period was 3 weeks ago. She is afebrile. Pelvic examination shows a 12 cm, cystic, mobile, right adnexal mass. Her serum CA 125 concentration is 35 U/ml (normal is less than 35).Serum beta-hCG testing is negative.An xrays of the abdomen shows calcium deposits in the mass.Which of the following is the most likely diagnosis?
a. cystic teratoma
b.ectopic pregnancy
c. fallopian tube carcinoma
d. follicular cyst
e. leiomyomata uteri
f. ovarian carcinoma(wrong)

3. A 57 year old woman,G6,P6 comes to the physician because of 6 months history of immediate loss of urine when she coughs or exercises. Her children were born by vaginal delivery. Her last menstrual period was 10 years ago. and she has never received estrogen therapy. Pelvic examination shows a normal-sized uterus and ovaries. There is downward mobility of the urethral vesical junction with Valsalva maneuver.Which of the following is the most likely diagnosis?
a. cystocele
b.detrusor instability
c. stress incontienece
d. urethral prolapse
e. urethrocele
f. ulterovaginal prolapse (wrong)
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* Re:CmS OBGYN Form 4
  amfyoyo - 12/27/17 16:33
  1. colonoscopy starts age 50 in individuals with no family history
X-ray of chest would be correct if she was 55, she's 52

2. CALCIUM = teratoma
CA-125 is highly specific for postmenopausal women, not the case with premenopausal women

3. I would have gone for stress incontinence.
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