AEMCA Obstetrics and Neonatology 4 — Questions and Answers
Question 1: A postpartum patient delivered 20 minutes ago and now has BP of 84/60, HR of 128, and ongoing vaginal bleeding. After uterine massage and oxytocin, bleeding continues. This is BEST described as:
- Refractory postpartum hemorrhage requiring ALS-level intervention and rapid transport (Correct answer)
- Normal lochia rubra within the first hour
- Secondary postpartum hemorrhage unrelated to uterine atony
- Hypovolemic shock from placenta previa
Correct answer: Refractory postpartum hemorrhage requiring ALS-level intervention and rapid transport
Persistent hemorrhage with hemodynamic instability despite uterotonic therapy constitutes refractory PPH requiring advanced interventions and immediate transport.
Question 2: During assessment of a pregnant trauma patient, fetal heart tones are found to be 90 bpm. This finding suggests:
- Fetal bradycardia indicating possible fetal distress (Correct answer)
- Normal fetal heart rate for the third trimester
- Maternal pulse being detected rather than fetal
- Fetal tachycardia requiring immediate intervention
Correct answer: Fetal bradycardia indicating possible fetal distress
A fetal heart rate below 110 bpm is bradycardia and indicates possible fetal compromise, warranting emergent transport.
Question 3: Which of the following is the MOST common cause of neonatal resuscitation being required at delivery?
- Failure to breathe adequately at birth requiring ventilatory support (Correct answer)
- Neonatal sepsis from maternal infection
- Congenital cardiac defects
- Meconium aspiration syndrome
Correct answer: Failure to breathe adequately at birth requiring ventilatory support
The vast majority of neonates requiring resuscitation need only stimulation and/or positive-pressure ventilation to establish effective breathing.
Question 4: A woman at 39 weeks presents with contractions every 2 minutes lasting 90 seconds. She states she feels the urge to push. On visual inspection, you see the fetal head crowning. You should:
- Prepare for immediate field delivery; do not attempt transport (Correct answer)
- Apply gentle pressure to the head and attempt to delay delivery
- Transport immediately in left lateral position
- Tell the patient to resist the urge to push until you arrive at the hospital
Correct answer: Prepare for immediate field delivery; do not attempt transport
Crowning indicates imminent delivery; attempting transport at this stage risks delivery en route without proper preparation and is unsafe for mother and infant.
Question 5: Magnesium sulfate is given to a patient with eclampsia. Which sign indicates magnesium toxicity?
- Loss of deep tendon reflexes (Correct answer)
- Hypertension above baseline
- Tachycardia with palpitations
- Increased respiratory rate
Correct answer: Loss of deep tendon reflexes
Loss of the patellar (knee-jerk) reflex is the earliest clinical sign of magnesium toxicity and precedes respiratory depression.
Question 6: A neonate's APGAR score is assessed at 1 minute. Which component is NOT part of the APGAR scoring system?
- Blood glucose level (Correct answer)
- Heart rate
- Respiratory effort
- Muscle tone
Correct answer: Blood glucose level
APGAR scores assess Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — glucose is not included.
Question 7: A patient at 22 weeks gestation reports painless, blood-tinged mucus discharge after a vaginal exam. She has no contractions. This MOST likely represents:
- Bloody show signaling cervical changes (Correct answer)
- Placenta previa hemorrhage
- Active labor requiring immediate delivery
- Amniotic fluid mixed with blood
Correct answer: Bloody show signaling cervical changes
Blood-tinged mucus plug discharge (bloody show) reflects cervical effacement and dilation and does not necessarily indicate an emergency by itself.
AEMCA Obstetrics and Neonatology 4
A postpartum patient delivered 20 minutes ago and now has BP of 84/60, HR of 128, and ongoing vaginal bleeding.
After uterine massage and oxytocin, bleeding continues.
This is BEST described as: