Genitourinary, Gynecology, and Obstetrical Emergencies practice questions

Answer: A) Dry the newborn and place them skin-to-skin on the mother, covered with a warm blanket

For a vigorous newborn, the first step is drying and keeping them warm (skin-to-skin). Routine suctioning isn't recommended, and cord clamping and prophylaxis can wait.

• ACorrect. For a stable newborn, the first step is to dry them and keep them warm, ideally skin-to-skin. This prevents heat loss, and drying also stimulates breathing.
• BIncorrect. Routine suctioning is not recommended for a vigorous newborn. Suction only if the airway is blocked.
• CIncorrect. For a stable newborn, cord clamping should be delayed when appropriate, and the newborn can stay skin-to-skin with the mother.
• DIncorrect. Vitamin K can be given within 6 hours of birth and eye prophylaxis within 24 hours. Neither comes before keeping the newborn warm.

Answer: A) Some pregnancy tissue remains in the uterus

• ACorrect. Bleeding may continue.
• BIncorrect. That's complete.
• CIncorrect. That's threatened.
• DIncorrect. That isn't incomplete.

Answer: A) It is most likely ischemic priapism, a urologic emergency usually managed with corporal aspiration and intracavernosal phenylephrine

A painful erection lasting more than 4 hours in sickle cell disease is ischemic priapism, a urologic emergency. Treatment is prompt corporal aspiration and intracavernosal phenylephrine, along with supportive sickle cell care.

• ACorrect. More than 95% of priapism in sickle cell disease is ischemic (low-flow). It is a true emergency, and first-line treatment is aspiration and irrigation with intracavernosal phenylephrine, with a surgical shunt if these fail.
• BIncorrect. Nonischemic priapism is usually painless and follows arterial injury. A painful, rigid erection in a patient with sickle cell disease points to ischemic priapism, which needs prompt intervention.
• CIncorrect. Supportive sickle cell measures are added to aspiration and phenylephrine; they do not replace them. Waiting for urology risks permanent erectile dysfunction.
• DIncorrect. Ischemic changes begin around 6 hours and structural changes around 14 hours. Permanent damage occurs after 24 hours, so a delayed referral is unsafe.

Answer: A) Renal calculi

• ACorrect. Treat pain and strain the urine.
• BIncorrect. This doesn't cause hematuria typically.
• CIncorrect. This involves the scrotum.
• DIncorrect. This affects infants.

Answer: B) Rh(D) immune globulin given within 72 hours of the sensitizing event

An unsensitized Rh-negative pregnant patient with a potentially sensitizing event, such as bleeding or abdominal trauma, should receive Rh(D) immune globulin within 72 hours to prevent anti-D alloimmunization.

• AIncorrect. Vitamin K treats coagulopathy, such as from warfarin or vitamin K deficiency. It has no effect on anti-D antibody formation after fetomaternal hemorrhage.
• BCorrect. Bleeding and trauma in pregnancy are potentially sensitizing events. An unsensitized Rh-negative patient (negative antibody screen) should get RhIG within 72 hours. If a large hemorrhage is suspected, a Kleihauer-Betke test can guide extra dosing.
• CIncorrect. Methylergonovine is a uterotonic for postpartum hemorrhage and is not used during an ongoing pregnancy. It does not prevent alloimmunization.
• DIncorrect. A postpartum dose is given if the newborn is Rh-positive, but the current sensitizing event needs its own coverage within 72 hours. Waiting allows anti-D antibodies to form.

Answer: B) Molar pregnancy

• AIncorrect. The findings are abnormal.
• BCorrect. hCG is often very high.
• CIncorrect. That usually has a smaller uterus.
• DIncorrect. That occurs later.

Answer: D) Threatened abortion

A threatened abortion is vaginal bleeding before 20 weeks with a closed cervical os and a viable intrauterine pregnancy. No tissue has passed, and the pregnancy may continue.

• AIncorrect. In an incomplete abortion, some of the pregnancy tissue has already passed, usually through an open os. Here no tissue has passed and the os is closed.
• BIncorrect. An inevitable abortion means the loss cannot be stopped, usually with a dilated cervix. Here the os is closed.
• CIncorrect. In a missed abortion, the pregnancy has failed but the tissue stays in the uterus. Here fetal cardiac activity shows the pregnancy is still viable.
• DCorrect. Bleeding before 20 weeks with a closed os, no tissue passed, and a viable intrauterine pregnancy is a threatened abortion. Many of these pregnancies continue normally.

Answer: A) Postpartum preeclampsia

• ACorrect. It can occur up to about 6 weeks after delivery.
• BIncorrect. The BP and headache are red flags.
• CIncorrect. Preeclampsia must be ruled out.
• DIncorrect. That causes breast pain and fever.

Answer: D) Uterine rupture

Sudden tearing pain, fetal bradycardia, and loss of fetal station during a trial of labor after cesarean suggest uterine rupture, which needs an emergency cesarean by laparotomy. Previa causes painless bleeding, and abruption and cord prolapse don't cause loss of station.

• AIncorrect. Abruption can cause painful bleeding and fetal distress, but it is more linked to tetanic uterine activity. It does not make the presenting part move back up. Loss of station in a scarred uterus points to rupture.
• BIncorrect. Placenta previa typically causes painless vaginal bleeding. It does not cause sudden tearing pain or loss of fetal station.
• CIncorrect. Cord prolapse can cause sudden fetal bradycardia, but the cord is seen or felt at or through the cervix. It does not cause tearing abdominal pain or make the presenting part move away from the pelvis.
• DCorrect. In a patient with a prior uterine incision, sudden severe 'ripping' pain, fetal bradycardia (the most common FHR abnormality), and loss of fetal station are classic signs of uterine rupture. It needs an emergency laparotomy for delivery and hemorrhage control.

Answer: B) Postpartum endometritis

• AIncorrect. Fever and odor are abnormal.
• BCorrect. It needs antibiotics.
• CIncorrect. The symptoms point to the uterus.
• DIncorrect. The symptoms point to the uterus.