CEN Obstetric and Gynecologic Emergencies 3

Question 1

A patient presents with severe unilateral pelvic pain that started suddenly, and ultrasound shows an enlarged ovary with absence of blood flow on Doppler. What is the diagnosis?

Accepted Answer

Ovarian torsion

Answer

Absent ovarian blood flow on Doppler ultrasound combined with an enlarged ovary and acute onset pelvic pain confirms ovarian torsion.

Question 2

A woman at 38 weeks presents in active labor and the fetal head is delivered but shoulders cannot be delivered. The obstetrician calls for help. What maneuver is performed first?

Accepted Answer

McRoberts maneuver with suprapubic pressure

Answer

McRoberts maneuver (hyperflexion of the maternal thighs onto the abdomen) combined with suprapubic pressure is the first-line intervention for shoulder dystocia.

Question 3

A 22-year-old sexually active woman presents with a right adnexal mass, acute pelvic pain, and a negative pregnancy test. Doppler shows absent blood flow to the right ovary. What is the next step?

Accepted Answer

Emergency surgical consultation for ovarian torsion

Answer

Absent ovarian blood flow on Doppler in the setting of acute pain indicates ovarian torsion requiring emergency surgical consultation and operative detorsion.

Question 4

In a patient with severe preeclampsia, which antihypertensive agent is most commonly used IV to acutely lower blood pressure?

Accepted Answer

Labetalol IV or hydralazine IV

Answer

IV labetalol or IV hydralazine are the most commonly used agents for acute severe hypertension in pregnancy; ACE inhibitors are contraindicated.

Question 5

A 28-year-old presents with amenorrhea for 8 weeks, sudden lower abdominal pain, and a positive urine pregnancy test. A beta-hCG is 2500 mIU/mL with no intrauterine pregnancy on transvaginal ultrasound. What is the management?

Accepted Answer

Methotrexate or surgical treatment for ectopic pregnancy

Answer

An hCG of 2500 mIU/mL above the discriminatory zone with no IUP on TVUS is presumptive ectopic pregnancy requiring definitive treatment with methotrexate (if stable) or surgery.

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Obstetric and Gynecologic Emergencies 3