PBL: Obstetrics Answer Key and Tips
Day 1
Questions
1. What are some of the interventions you plan to do during the initial visit?
Check urine for pregnancy
Comprehensive health history. Because Mary is established in your clinic, you may just need to
review some of her medical health hx, and focus on her obstetric history:
o Previous OB hx
o Family genetic hx
o Psychiatric disorders
o Contraceptive hx
o Medications taken since LMP, menstrual hx
o Social habits, environmental exposures, domestic abuse
o Sources of social support and health promotion
Depending on time, the PE may also be performed. Many practitioners have the pt return in 2
weeks to perform a PE d/t the time taken for history and blood tests.
o CBC, rubella titer, HIV (with pt’s consent), syphilis (rapid plasma reagin or RPR), Hepatitis B
surface antigen (HBSAg), blood type and Rh factor, antibody screen, tuberculosis testing,
urine culture and sensitivity and BV screening.
o Optional labs: HgbA1c, thyroid profile and Hepatitis C
o This is also the time to advise Mary on the pregnancy – health promotion, dietary
recommendation, exercise, smoking, etc. This includes normal changes, discomforts, and
concerns during pregnancy. Even if this is not her first pregnancy, Mary should have a review
of these items.
2. What physical exam would you do on this visit? Include your rationale for performing a specific PE, if
any.
Depending on time, the PE may not necessarily be performed during this initial visit. However, if
time permits, other tests can be performed with the PE.
PE: VS, note postural hypotension and tachycardia
o Inspect general appearance, examine peri-pad to determine amt of bldng
o Palpate abd (rebound, signs of internal hemorrhage, uterine size (measure fundal ht))
o Check iliopsoas and obturator muscle tests.
o Auscultate heart, lungs, and bowel sounds
o Pelvic exam – Assess for Chadwick’s sign, look for vaginitis/cervicitis and other s/s of
infections that could be causing the bldng.
Bimanual exam: Check Hegar’s sign, evaluate cervical dilatation, CMT (often present with ectopic
pregnancy), and bulging cul-de-sac (represents hemoperitoneum); adnexal mass is present in
50% of ectopic pregnancy.
3. What are some of the questions you would ask Mary that is specific to a pregnant pt?
This study source was downloaded by 100000840275362 from CourseHero.com on 06-13-2022 15:36:54 GMT -05:00
https://www.coursehero.com/file/46798810/N675-PBL-Obstetrics-Answer-Key-and-Tips-w8docx/
Day 1
Questions
1. What are some of the interventions you plan to do during the initial visit?
Check urine for pregnancy
Comprehensive health history. Because Mary is established in your clinic, you may just need to
review some of her medical health hx, and focus on her obstetric history:
o Previous OB hx
o Family genetic hx
o Psychiatric disorders
o Contraceptive hx
o Medications taken since LMP, menstrual hx
o Social habits, environmental exposures, domestic abuse
o Sources of social support and health promotion
Depending on time, the PE may also be performed. Many practitioners have the pt return in 2
weeks to perform a PE d/t the time taken for history and blood tests.
o CBC, rubella titer, HIV (with pt’s consent), syphilis (rapid plasma reagin or RPR), Hepatitis B
surface antigen (HBSAg), blood type and Rh factor, antibody screen, tuberculosis testing,
urine culture and sensitivity and BV screening.
o Optional labs: HgbA1c, thyroid profile and Hepatitis C
o This is also the time to advise Mary on the pregnancy – health promotion, dietary
recommendation, exercise, smoking, etc. This includes normal changes, discomforts, and
concerns during pregnancy. Even if this is not her first pregnancy, Mary should have a review
of these items.
2. What physical exam would you do on this visit? Include your rationale for performing a specific PE, if
any.
Depending on time, the PE may not necessarily be performed during this initial visit. However, if
time permits, other tests can be performed with the PE.
PE: VS, note postural hypotension and tachycardia
o Inspect general appearance, examine peri-pad to determine amt of bldng
o Palpate abd (rebound, signs of internal hemorrhage, uterine size (measure fundal ht))
o Check iliopsoas and obturator muscle tests.
o Auscultate heart, lungs, and bowel sounds
o Pelvic exam – Assess for Chadwick’s sign, look for vaginitis/cervicitis and other s/s of
infections that could be causing the bldng.
Bimanual exam: Check Hegar’s sign, evaluate cervical dilatation, CMT (often present with ectopic
pregnancy), and bulging cul-de-sac (represents hemoperitoneum); adnexal mass is present in
50% of ectopic pregnancy.
3. What are some of the questions you would ask Mary that is specific to a pregnant pt?
This study source was downloaded by 100000840275362 from CourseHero.com on 06-13-2022 15:36:54 GMT -05:00
https://www.coursehero.com/file/46798810/N675-PBL-Obstetrics-Answer-Key-and-Tips-w8docx/
