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+--- Thread: sugesstion needed - dr_usmle2012 (/showthread.php?tid=796072)
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0 - ArchivalUser - 09-04-2015
A 23-year-old African American woman, gravida 3, para 2, comes to the office at 35 weeks' gestation for follow-up after having been treated in the emergency department 18 hours ago following a motor vehicle collision. At the time of the collision, the patient was not wearing a seatbelt and her chest and abdomen struck the dashboard. Obstetric ultrasonography and nonstress testing were obtained in the emergency department and disclosed no abnormalities. The patient had several superficial lacerations over her upper extremities that required suturing. Her prenatal course has been otherwise unremarkable. Her blood type is A, Rh-negative. The patient now reports light vaginal bleeding and decreased fetal movement. Vital signs are temperature 36.7°C (98.0°F), pulse 88/min, respirations 24/min, and blood pressure 100/68 mm Hg. Fetal heart tones are 140/min. Fundal height is 35 cm. Pelvic examination shows dark red blood at the cervical os. The cervix is long and closed. A repeat nonstress test is done and shows irregular painless contractions with repetitive late decelerations. At one point, three contractions are observed in a 10-minute interval. The office is located in a rural area, and while there are general surgeons 5 to 10 minutes away at the local hospital who do cesarean deliveries, the nearest obstetrician is 1 hour away. Which of the following is the most appropriate next step?
A) Order Kleihauer-Betke testing
B) Refer the patient to a surgeon for immediate cesarean delivery
C) Refer the patient to an obstetrician
D) Repeat nonstress testing in 24 hours
E) Repeat obstetric ultrasonography
0 - ArchivalUser - 09-08-2015
b cesarean
0 - ArchivalUser - 09-09-2015
bbbb
3 - ArchivalUser - 09-10-2015
cc
0 - ArchivalUser - 09-10-2015
bbb
0 - ArchivalUser - 09-10-2015
plz post answers
0 - ArchivalUser - 09-10-2015
correct answer is B
0 - ArchivalUser - 09-11-2015
thank you
0 - ArchivalUser - 09-11-2015
A 15-year-old girl comes to the office because of a 6-month history of episodes of sharp pain on either side of her lower abdomen that occur each month. The last episode occurred 18 days ago. A watery vaginal discharge usually accompanies the discomfort. She is concerned that the symptoms may be a sign of a tumor. Menarche occurred at age 13 years and the patient's menses were initially painless. Since that time, menstrual periods have occurred every 28 days; her last menstrual period was 4 days ago. For the past 6 months, she has had cramping pain associated with menstruation that has been relieved by nonsteroidal anti-inflammatory drugs. She is sexually active with two partners and uses nonlubricated condoms sometimes. Medical history is otherwise unremarkable and she takes no medications. She is 157 cm (5 ft 2 in) tall and weighs 63 kg (140 lb); BMI is 26 kg/m2. Physical examination shows normal development and no abnormalities. Pelvic examination discloses a normal-sized, anteverted uterus. There are no adnexal masses or tenderness. Which of the following is the most appropriate recommendation to the patient at this time?
A) Application of a heating pad to the abdomen
B) Danazol therapy
C) Hydrocodone-acetaminophen therapy
D) Nitrofurantoin therapy
E) Oral contraceptive therapy
0 - ArchivalUser - 09-12-2015
EE