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uWise OBGYN QUESTIONS WITH
VERIFIED ANSWERS
A 28-year-old G2P2 woman returns today for follow up on her abnormal pap smear which reveals atypical squamous cells of undetermined significance (ASCUS). Reflex HPV testing is positive for high risk type. She has never had a prior abnormal pap smear, and has been following the recommended screening guidelines. She is asymptomatic. Her pelvic exam reveals a normal cervix with a small amount of cervical mucous. What is the next best step in the management of this patient? A. Routine screening B. Repeat Pap smear in one year C. Repeat HPV testing in one year D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy - CORRECT ANSWER_ -E. Colposcopy
A 17-year-old G0 high school student is brought in by her mother for her first gynecologic examination. She began her menses at age 12 and has had regular periods for the past three years. Her last menstrual period was one week ago. For privacy, you ask to examine the patient without her mother. Further history is obtained in the examination room. She admits that she has been sexually active with her boyfriend for the past three years. She uses condoms occasionally and is fearful about possible pregnancy. She requests that her mother not be informed about her sexual activity. On physical examination, she is anxious, but normally developed. Her pelvic examination reveals no vulvar lesions, minimal non-malodorous discharge, and a nulliparous appearing cervix. The bimanual examination reveals a normal size uterus, and her adnexa are non-tender and not enlarged. Urine pregnancy test is
negative. In addition to discussing - CORRECT ANSWER_ -C
Counseling about and screening for sexually transmitted infections is the best next step. This patient does not require treatment due to a lack of diagnostic criteria. A serum Beta-hCG is not indicated in the setting of normal menstrual cycles with last menstrual period a week ago and a negative urine pregnancy test. Guidelines for initiation of cervical cancer screening is recommended at age 21
regardless of coitarche. A pelvic ultrasound would not be indicated at this time especially since the pregnancy test is negative and given her lack of menstrual or pelvic symptoms. A 68-year-old G2P2 woman who has recently moved in with her daughter (a long-standing patient of yours) comes in for a health maintenance examination. A vaginal hysterectomy was done in her fifties for uterine prolapse. She is not sure if her ovaries were removed. She has never had an abnormal mammogram or Pap smear and has had yearly exams. She stopped hormone replacement therapy 10 years ago. She was recently widowed after being married for 50 years. She does not smoke or drink. Her diabetes is well-controlled with Metformin; she takes a daily baby aspirin and is on a lipid-lowering agent. On examination, she is a thin elderly woman with a dowager's hump. Her breast exam is unremarkable. Her lower genital tract is notable for atrophy. No masses are noted on bimanual and recto-vaginal exam. A fecal occult blood test is negative. Which of the following tests is not necessary? A. Bone density B. Colonoscopy
C. Pap sme - CORRECT ANSWER_ -C
Pap smear screening is not indicated in patients who have had a hysterectomy, unless it was done for cervical cancer or a high-grade cervical dyspalsia. Patients with a uterus can discontinue cervical cancer screening between the ages of 65 - 70 if they have had three consecutive negative smears or two negative consecutive cotesting in the last 10 years and no history of high-grade cervical intraepithelial neoplasia or cancer. Patients still need yearly bimanual and rectovaginal exam. Mammograms are done annually, as breast cancer increases with age. Colon cancer screening is recommended at age fifty. The patient has an exaggerated thoracic spine curvature, termed a dowager's hump, likely secondary to thoracic compression fractures secondary to osteoporosis. If this is confirmed on a bone density test, she may benefit from the addition of bisphosphonates. A 32-year-old G2P2 woman presents for a health maintenance examination. She is in good health and has no concerns. She does not have a history of abnormal Pap smears and her last one was three years ago. Her examination is normal including her pelvic exam. A Pap smear is performed and returns as normal with HPV negative. What is the most appropriate screening recommendation for cervical cancer in this patient? A. Pap smear and HPV testing in one year B. Pap smear and HPV testing in three years
A 19-year-old G0 woman presents with lower abdominal cramping. The pain started with her menses and has persisted, despite resolution of the bleeding. She thinks she may have a fever, but has not taken her temperature. No urinary frequency or dysuria are present. Her bowel habits are regular. She denies vomiting, but has mild nausea. A yellow blood-tinged vaginal discharge preceded her menses. No pruritus or odor was noted. She is sexually active, uses oral contraceptives and states that her partner does not like condoms. On examination: temperature is 100.2°F (37.9°C); pulse 90; blood pressure 110/60. She is well-developed and nourished and in mild distress. No flank pain is elicited. Her abdomen has normal bowel sounds, but is very tender with guarding in the lower quadrants. No rebound is present. Pelvic examination reveals a moderate amount of thick yellow discharge. The cervix is friable
with yellow mucoid disch - CORRECT ANSWER_ -B
This patient has findings suggestive of acute salpingitis (pelvic inflammatory disease) including lower abdominal pain, adnexal tenderness, fever, cervical motion tenderness, and vaginal discharge. Mucopurulent cervicitis with exacerbation in the symptoms during and after menstruation is classically gonorrhea. Chlamydia is frequently associated with gonorrhea and also causes cervicitis and pelvic inflammatory disease. Cervicitis alone would not explain this patient's constellation of findings. Trichomonas may cause a yellow frothy discharge, and Candida may cause a thick white cottage cheese like discharge, but neither would cause fever and abdominal pain. A 39-year-old G0 woman presents to the clinic reporting non-tender spots on her vulva for about a week. No pruritus or pain is present. She also notes a brownish rash on the palms of her hands. She admits to IV drug abuse. She was diagnosed as HIV-positive two years ago, but has not been compliant with suggested treatment. On examination, three elevated plaques with rolled edges are noted on the vulva. They are non-tender. A brown macular rash is noted on the palms of her hands and the soles of her feet. What is the most appropriate next step in the management of this patient? A. Obtain a treponemal-specific test B. Biopsy of the lesion C. Colposcopic evaluation of the vulvar lesions D. Culture the base of the lesion
E. Initiate empiric treatment with doxycycline and ceftriaxone - CORRECT ANSWER_ -A
The diagnosis of syphilis is often established by serologic testing. Non-treponemal tests (VDRL or RPR) are non-specific. In this patient with high suspicion for syphilis, specific testing with treponemal antibody
can confirm infection. The classic coiled spirochete is easily seen with dark-field microscopy but availability is limited. A characteristic finding is a macular rash on the palms and soles that are often described as copper penny lesions. Colposcopy would not be diagnostic, but certainly is helpful to evaluate for any vulvar lesions thought to be dysplastic. Biopsies can be stained for spirochetes and may show a necrotizing vasculitis, but certainly would not be the most expedient way to make the diagnosis. Penicillin G is the preferred drug for treating all stages of syphilis. A 24-year-old G0 woman presents with multiple painful ulcers involving the vulva. The sores initially were fluid filled, but are now open, weeping and crusted. She reports a fever and is having difficulty voiding due to pain. She uses a vaginal ring for contraception. She has multiple sexual partners and uses condoms for vaginal intercourse. She is distraught that she may have a sexually transmitted infection. She is healthy and does not smoke or use drugs. On physical exam, she is in obvious distress. Temperature is 100.2°F (37.9°C), pulse 100. Examination of the genital tract is limited due to her discomfort. Multiple ulcers and erosions of variable size are localized to the perineum, labia minora and vestibule. Swelling is diffuse. The lesions are eroded, some with a purulent eschar. There is exquisite tenderness to touch. What further testing should be offered to this patient? A. RPR (rapid plasma regain)
B. HIV - CORRECT ANSWER_ -E
This patient has classic primary herpes with painful genital ulcerations, fever and dysuria. Given the presence of one sexually transmitted infection, screening should be offered for other STIs. Resolution of the acute episode is required before a speculum can be inserted to allow endocervical sampling for gonorrhea and chlamydia. If it was a high-risk exposure, prophylactic empiric treatment could be offered to cover gonorrhea and chlamydia. The patient should be counseled that primary herpes can be acquired despite condoms and even by oral-genital inoculation. Hepatitis B vaccination should be offered to protect her against any future exposures. She should be encouraged to discuss her diagnosis with all sexual partners and to continue to reliably use latex condoms. A 38-year-old G0 woman comes to the office because she noted a persistent yellow, frothy discharge associated with mild external vulvar irritation. She denies any odor. She tried over the counter anti- fungal medication without success. The discharge has been present for over three months, gradually increasing in amount. Douching has resulted in temporary relief, but the symptoms always recur. Pelvic examination reveals mild erythema at the introitus and a copious yellow frothy discharge fills the vagina. The cervix has erythematous patches on the ectocervix. A sample of the discharge is examined under the microscope. What is the most likely finding?
scraped. The herpes virus can theoretically be isolated from both primary and recurrent infections. This patient very likely presented too late in the course for a useful culture. Oral contraceptives do not affect the growth of viruses. While serum antibody screening can be performed, it indicates lifetime exposure and would not answer the question as to the etiology of the specific lesion. Alternatively, DNA studies such as the polymerase chain reaction can be done, if available. A 27-year-old G1P0 at 34 weeks gestation is brought in by ambulance after a motor vehicle accident. Although restrained in the car with a safety belt, she suffers a significant head laceration. When she arrives in the emergency room, her initial trauma survey is completed. On her secondary survey, there is bright red blood coming from the vagina. Her abdomen is noted to be tense. Subsequent documentation of the fetal heart tones reveals fetal tachycardia. Abruption is suspected and the patient is rushed to the operating room for an emergent Cesarean section. After delivery, the nurse notes that an informed surgical consent was never signed. Which of the following is true? a. Informed consent is valid if the doctor-patient discussion occurred soon after the patient received intravenous morphine for pain relief b. Informed consent is unnecessary in an emergency situation if a delay in treatment would risk the
patient's - CORRECT ANSWER_ -B
Informed consent needs to be obtained for all procedures while patient is fully alert and has not received any narcotics or other medications that may affect her decision-making. The only exception is in true emergency situations that would risk the patient's life. Obtaining informed consent does not necessarily protect the provider from lawsuits and should never be signed after a procedure is already completed. A 36-year-old G3P2 presents in active labor at full term with a known placenta previa. She reports brisk vaginal bleeding. Evaluation shows that fetus and patient are currently hemodynamically stable. She has had two normal vaginal deliveries in the past. She declines your recommendation to undergo Cesarean section. Which of the following is not advisable during your initial management of this patient? a. Soliciting her reasons for not undergoing a Cesarean section b. Obtaining hospital Ethics Committee recommendation c. Proceeding with an emergency Cesarean section d. Explaining your reasons for recommending a Cesarean section
e. Informing risk management of the situation that has developed - CORRECT ANSWER_ -C
You should not perform any procedure on the patient without her consent. It is best in these situations to explain your reasons for the recommended Cesarean section and elicit the patient's reasons for not wanting to undergo the procedure. A court order should only be obtained as a last resort. A 27-year-old G1 at 12 weeks gestation presents for first prenatal care visit. She is previously healthy and takes no medications. An ultrasound is performed and a viable pregnancy is confirmed. At the end of the visit, the patient discusses with you her desire to have a Cesarean section for delivery, as she does not wish to go through the pain of labor. Her husband, an orthopedic surgeon, expresses concerns as they desire to have at least three children and he is worried about potential complications with repeated Cesarean sections. What is the most appropriate next step in the counseling of this patient? a. Agree with her decision after proper counseling and perform a Cesarean section at 39 weeks gestation b. Agree with her decision after proper counseling and perform a Cesarean section at 41 weeks gestation if she has not gone into labor by then
c. Advise her that it is not possible to plan a Cesarean section for - CORRECT ANSWER_ -A
Elective cesarean section on demand has been getting more popular among women for a variety of reasons. Although, it might sound unreasonable to undergo a Cesarean section for being afraid of pain, the patient has the right to request it and the physician's duty is to make sure she understands all the risks and potential complications associated with such a decision. Her husband is appropriately concerned but it is up to her to make the decision regarding an elective procedure. A 25-year-old G3P2, who had recently undergone a primary Cesarean section, had her HIV status revealed to her mother when a nurse left her chart open in the recovery room. She speaks to patient relations and is thinking about seeking damages through legal avenues. When trying to explain the concept of patient privacy, which of the following statements is correct? a. Patient privacy is based on the ethical principle of justice b. Patient privacy is protected by federal law, primarily with the Federal Emergency Medical Treatment and Labor Act (EMTALA) statute c. Patient privacy is the responsibility of physicians; physicians may be fined and/or assessed criminal penalties for violating the privacy of a patient's protected health information
on the ventilator because the doctor has said that Mary may never wean off of the ventilator again. Who should make the decision about whether to put Mary back on the ventilator? a. Jim b. All of them together c. Mary's doctor in consultation with Jim d. Mary
e. If Jim and Mary cannot agree, consult the hospital ethic - CORRECT ANSWER_ -D
Since Mary is still competent, she can make her own decisions despite the fact that her husband has power of attorney. A 72-year-old G3P1 has progressive ovarian cancer. She and her husband have already completed a medical power of attorney form. However, the patient did not complete a living will or any other documents expressing her wishes for the initiation of mechanical ventilation or cardioversion in the event of a respiratory or cardiac arrest. Unfortunately, the patient is brought into the hospital after suffering an incapacitating seizure. She is not arousable when she reaches the oncology unit. Her husband Jim is present and willing to act as Mary's surrogate decision-maker. When he decides on the proper course of care, the husband should make decisions based primarily on which of the following? a. What Mary would have chosen b. Mary's best interest c. Hospital Ethics Committee's recommendation d. The family's wishes
e. His own wishes - CORRECT ANSWER_ -A
A person who has power of attorney should make decisions based on what the patient would have wanted for herself, regardless of what they think her best interests might be. A 26-year-old G0 presents to the reproductive endocrinology clinic seeking an infertility evaluation for failing to conceive after 14 months of unprotected intercourse with her boyfriend, who has fathered two
other children. She works as a janitor in a nearby elementary school and currently has Medicaid for her health insurance. The physician discourages her from pursuing treatment because she will likely have to pay for her visit with cash, check or charge, and is told that treatment for infertility often involves procedures and technology that are very expensive. She is also informed that, in most states, many of these therapies are not paid by insurance or Medicaid. This situation violates which of the following ethical principles? a. Patient autonomy b. Beneficence c. Justice d. Physician autonomy
e. A patient's right to privacy - CORRECT ANSWER_ -C
Justice requires that we treat like cases alike. It is the physician's duty to educate the patient about all her treatment options in a non-judgmental way regardless of the nature of the treatment and her socioeconomic status. You are asked to give a lecture on a new chemotherapy drug that has demonstrated a reasonable efficacy in women with advanced cervical cancer. The day before giving the lecture, you realize that you own stock in the company that makes the drug. Which of the following statements about conflict of interest is true? a. Pharmaceutical companies can support the costs of medical conferences in which physicians receive continuing medical education credits b. Physicians should engage in agreements in which companies make a substantial donation to an educational activity, when the donation is contingent on the physician's use or advocacy of a product c. The hospital may not interfere with a physician's decision to use a new surgical device d. An investigator may not own stock in a company if he/she does research for that company e. Physicians are not required to disclose any potential conflict of interest before speaking in a -
CORRECT ANSWER_ -A
A. Pap smear at age 21 B. Pap smear at this visit and then annually C. Pap smear now and every 3 years D. Pap smear now and then every other year
E. Pap smear at age 18 - CORRECT ANSWER_ -A
The American Congress of Obstetricians and Gynecologists (ACOG) recommendation from 2009 is for patients to have an annual Pap smear starting at 21 years of age regardless of history of sexual activity. Cervical neoplasia develops in susceptible individuals in response to a sexually transmitted infection with a high-risk type of HPV (Human papillomavirus). HPV causes carcinogenesis in the transformation zone of the cervix, where the process of squamous metaplasia replaces columnar with squamous epithelium. Squamous metaplasia is active in the cervix during adolescence and early adulthood. Human papillomavirus infections are commonly acquired by young women shortly after the initiation of vaginal intercourse, but, in most, they are cleared by the immune system within one to two years without producing neoplastic changes. The recommendation to start screening at age 21 years regardless of the age of onset of sexual intercourse is based in part on the very low incidence of cancer in younger women. It is also based on the potential for adverse effects associated with follow-up of young women with abnormal cytology screening results. An 18-year-old woman comes to your office for her first gynecologic visit. Her 43-year-old stepmother was just diagnosed with breast cancer. She wants to discuss breast cancer screening and wants to have a mammogram. According to the American College of Obstetricians and Gynecologists (ACOG), which of the following is the most appropriate recommendation for this patient? A. Yearly starting at age 35 B. Every one to two years from 35-49, then yearly starting at age 50 C. Yearly starting at age 50 D. Yearly breast ultrasound at age 35, then yearly mammograms at age 50
e. Yearly breast ultrasound now, then yearly mammograms at age 40 - CORRECT ANSWER_ -C
Although the recommendation to initiate breast cancer screening timing with mammograms varies among different professional societies (American Cancer Society: yearly at age 40; American College of Obstetricians and Gynecologists (ACOG): yearly at age 40; United States Preventive Services Task Force [USPSTF]: every two years at age 50), none recommend routine screening prior to age 40 in a patient with no family history of breast cancer. A 40-year-old patient presents for her first health maintenance examination. She denies any new complaints or symptoms. She has no history of any gynecologic problems. Family history is significant for a father with hypertension and a mother, deceased, with breast cancer diagnosed at age 56. A paternal aunt has ovarian cancer which was diagnosed at age 83. A physical exam is unremarkable. What screening test should be offered to this patient next? A. Breast MRI B. Mammogram C. Transvaginal pelvic ultrasound D. Breast ultrasound
E. BRCA-1/BRCA-2 testing - CORRECT ANSWER_ -B
Presently, there are limitations in the ability to screen for cancer. The patient's family history of a first- degree relative with postmenopausal breast cancer means that she could be at increased risk and genetic counseling can be suggested for evaluation for BRCA testing. A combination of first and second- degree relatives on the same side of the family diagnosed with breast and ovarian cancer (one cancer type per person) increases the risk of BRCA mutation in non-Ashkenazi women. At present, transvaginal sonography and CA-125 testing are not recommended as first-line screening tools for the general population for ovarian cancer. Ultrasound and MRI are generally used as adjunctive studies when a patient has an abnormal or unsatisfactory mammogram. A 48-year-old G3P3 presents to the office for a health maintenance examination. Her past medical history, physical exam and labs are normal. Her body mass index (BMI) is normal. Her family history is significant for hypertension in her father and diabetes mellitus in her mother. Her grandfather passed away of colon cancer at the age of 82 and she is worried about getting colon cancer and desires to undergo screening. What is the most appropriate next step in the management of this patient? A. Recommend a colonoscopy at age 50 and, if normal, repeat every 10 years B. Recommend a colonoscopy at age 50 and then every two years
A. Obtain a DEXA scan now B. Obtain a DEXA scan now only if her blood pressure is not well controlled C. Obtain a DEXA scan at age 65 D. Bone density screening is only necessary if she presents with a fracture
E. Recommend bone density screening five years after the onset of menopause - CORRECT
ANSWER_ -C
CORRECT ANSWER_ is C. Bone density screening is recommended for women beginning at age
65 unless they have pre-existing risk factors which warrant earlier screening. Risk factors for osteoporosis are early menopause, glucocorticoid therapy, sedentary lifestyle, alcohol consumption, hyperthyroidism, hyperparathyroidism, anticonvulsant therapy, vitamin D deficiency, family history of early or severe osteoporosis, or chronic liver or renal disease. These factors would institute early screening in a patient for osteoporosis. A postmenopausal patient presenting with fractures should alert you to suspect osteoporosis. A 36-year-old health worker presents for a health maintenance examination. She is sexually active and not using contraception. She doesn't think she is pregnant, but would be happy if she were. As part of her general preventive care, you discuss immunizations. Which vaccination is contraindicated if this patient gets pregnant now? A. Measles-Mumps-Rubella (MMR) B. Pneumococcus C. Hepatitis B D. Polio
E. Influenza - CORRECT ANSWER_ -A
Pregnancy or the possibility of pregnancy within four weeks is a contraindication to the MMR and varicella vaccinations. Tetanus, Hepatitis B, Polio and Pneumococcal vaccinations would not be contraindicated.
A 42-year-old patient presents for a health maintenance examination. Her past medical history, physical exam, and labs are normal. Her body mass index (BMI) is normal. Her family history is significant for hypertension and hypercholesterolemia in her father and diabetes mellitus in her mother. What lifestyle modification is most important for this patient? A. Starting a weight loss diet B. Starting a sugar-free and cholesterol-free diet C. Recording a daily blood pressure D. Starting an aerobic exercise program
E. Recording a weekly blood pressure - CORRECT ANSWER_ -D
Heart disease is the number one killer of women. Lifestyle modifications to reduce her risk, especially considering her family history, are important proactive changes that she can make. Studies show an inverse relationship between the level of physical activity and incidence of death from coronary disease. Exercise would be an appropriate first step with this patient. She does not need to lose weight (normal BMI) and does not need to be on a special diet (normal labs). Recording daily or weekly blood pressures is not necessary, but her blood pressure should be checked once a year. A 28-year-old patient presents to the office for a health maintenance examination. She is currently on oral contraceptive pills, but reports a history of irregular menses prior to starting them. Her past medical history is otherwise non-contributory. On physical examination, she is 5 feet 2 inches tall and weighs 180 pounds. She has an area of velvety, hyperpigmented skin on the back of her neck and under her arms. What is the next best step in the management of this patient? A. Complete blood count B. Diabetes screen C. Biopsy pigmented area D. Pelvic ultrasound
E. Lipid profile - CORRECT ANSWER_ -B
D. Beta thalassemia trait
E. Alpha thalassemia trait - CORRECT ANSWER_ -B
There is normally a 36% increase in maternal blood volume; the maximum is reached around 34 weeks. The plasma volume increases 47% and the RBC mass increases only 17%. This relative dilutional effect lowers the hemoglobin, but causes no change in the MCV. Folate deficiency results in a macrocytic anemia. Iron deficiency and thalassemias are associated with microcytic anemia. A 34-year-old G3P1 woman at 26 weeks gestation reports "difficulty catching her breath," especially after exertion for the last two months. She is a non-smoker. She does not have any history of pulmonary or cardiac disease. She denies fever, sputum, cough or any recent illnesses. On physical examination, her vital signs are: blood pressure 108/64, pulse 88, respiratory rate 15, and she is afebrile. Pulse oximeter is 98% on room air. Lungs are clear to auscultation. Heart is regular rate and rhythm with II/VI systolic murmur heard at the upper left sternal border. She has no lower extremity edema. A complete blood count reveals a hemoglobin of 10.0 g/dL. What is the most likely explanation for this woman's symptoms? A. Pulmonary embolism B. Mitral valve stenosis C. Physiologic dyspnea of pregnancy D. Peripartum cardiomyopathy
E. Anemia - CORRECT ANSWER_ -C
Physical examination findings are not consistent with pulmonary embolus (e.g tachycardia, tachypnea, hypoxia, chest pain, signs of a DVT) or mitral stenosis (diastolic murmur, signs of heart failure). Physiologic dyspnea of pregnancy is present in up to 75% of women by the third trimester. Peripartum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic function towards the end of pregnancy or in the several months following delivery. Symptoms include fatigue, shortness of breath, palpitations, and edema. The history and physical do not suggest a pathologic process, nor does her hemoglobin level. A 24-year-old G4P2 woman at 34 weeks gestation complains of a cough and whitish sputum for the last three days. She reports that everyone in the family has been sick. She reports a high fever last night up
to 102°F (38.9°C). She denies chest pain. She smokes a half-pack of cigarettes per day. She has a history of asthma with no previous intubations. She uses an albuterol inhaler, although she has not used it this week. Vital signs are: temperature 98.6°F (37°C); respiratory rate 16; pulse 94; blood pressure 114/78; peak expiratory flow rate 430 L/min (baseline documented in the outpatient chart = 425 L/min). On physical examination, pharyngeal mucosa is erythematous and injected. Lungs are clear to auscultation. White blood cell count 8,700; arterial blood gases on room air (normal ranges in parentheses): pH 7. (7.36 - 7.44); PO2 103 mm Hg (>100), PCO2 26 mm Hg (28 - 32), HCO3 19 mm Hg (22 - 26). Chest x-ray is
nor - CORRECT ANSWER_ -B
The increased minute ventilation during pregnancy causes a compensated respiratory alkalosis. Hypoventilation results in increased PCO2 and the PO2 would be decreased if she was hypoxic. A metabolic acidosis would have a decreased pH and a low HCO3. The patient's symptoms are most consistent with a viral upper respiratory infection. A 28-year-old G1P0 internal medicine resident at 34 weeks gestation wants to discuss the values on her pulmonary function tests performed two days ago because she was feeling slightly short of breath. She is a non-smoker, and has no personal or family history of cardiac or respiratory disease. Vital signs are: respiratory rate 16; pulse 90, blood pressure 112/70; oxygen saturation is 99% on room air. On physical examination: lungs are clear; abdomen non-tender; fundal height is 34 cm. The results of the pulmonary function tests are: Inspiratory Capacity (IC) = increased Tidal volume (TV) = increased Minute ventilation = increased Functional reserve capacity (FRC) = decreased Expiratory reserve capacity (ERC) = decreased Residual volume (RV) = decreased What is the next best step in the evaluation of this patient? A. Routine antenatal care B. Chest x-ray
