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55309 Gynaecology & Obstetrics

A 32-year-old G2P1 woman at 34 weeks’ gestation presents to the labor and delivery floor with the chief complaint of regular contractions, bloody show, and a gush of fluids. A 2.3 kg (5 Ib 1 oz) boy is delivered by spontaneous vaginal delivery without further complication 1 hour after presentation. Twenty-four hours later, the infant has developed irritability, fever, and respiratory distress. He is diagnosed with sepsis secondary to pneumonia. The mother has no complaints other than anxiety regarding the condition of her child. She denies rigors, chills, sweats, nausea, or vomiting. The mother’s pulse is 60/min, blood pressure is 125/80 mm Hg, and temperature is 37degC (98.6degF). Physical examination reveals lungs that are clear to auscultation bilaterally, and no murmurs, rubs, or gallops are present on cardiac examination. The suprapubic region is not tender to palpation. Vaginal and cervical examination reveals no significant tears or bleeds.Which prenatal test would have provided the most useful information in preventing this condition:

ACervical chlamydia culture
BCervical gonorrhea culture
CELISA for HIV
DRectovaginal group B streptococcal culture
Gynaecology & Obstetrics
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55310 Surgery

During the treatment of septic shock, a 28-year- old male remains hypotensive despite adequate volume replacement; PA occlusion pressure is 18 mm Hg. When dopamine is started, ventricular tachycardia develops and this is unresponsive to lidocaine. The V-tach converts back to sinus rhythm once the dopamine is stopped. At this point, which of the following treatments are most appropriate for this hypotensive patient?

AAmrinone
BDobutamine
CEpinephrine
DPhenylephrine
Surgery
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