A 32-year-old woman, gravida 2 para 1, at 12 weeks’ gestation is referred for chorionic villus sampling (CVS) due to an increased risk of chromosomal abnormalities noted during her first-trimester ultrasound and screening tests. She has no significant medical history and had a normal pregnancy with her first child. CVS Findings: Karyotype Results: Mosaic trisomy 16 detected in the placental sample. Interpretation: Confined placental mosaicism (CPM) suspected, but fetal involvement cannot be ruled out. What is the primary follow-up test to confirm whether the placental mosaicism detected on chorionic villus sampling (CVS) involves the fetus?
A 32-year-old pregnant woman (G2P1) presents for routine prenatal care at 17 weeks of gestation, confirmed by her last menstrual period and an earlier ultrasound. She has no significant medical or genetic history, and her first pregnancy was uncomplicated, resulting in the delivery of a healthy baby. Her family history is also unremarkable for genetic disorders or birth defects. During this visit, she undergoes a second-trimester maternal serum screening (quadruple screen) as part of routine prenatal care. What is the primary marker associated with neural tube defects in maternal serum screening?
A 25-year-old woman, G1P0, presents for her first prenatal visit at 10 weeks gestation. She has no significant past medical history and is generally healthy. The patient is counseled on the importance of vaccinations during pregnancy to protect both the mother and the fetus. Vaccines contraindicated during pregnancy, such as live vaccines like MMR, are also addressed. Which vaccine is contraindicated during pregnancy due to the risk of fetal infection?
Joanna is a 28-year-old woman, currently 20 weeks pregnant with her second pregnancy. Her first pregnancy ended in a miscarriage at 10 weeks. She presents for a routine prenatal care visit. Joanna has no history of chronic illnesses or allergies, and her current pregnancy has been uncomplicated so far. During the visit, Joanna is counseled about the importance of vaccinations during pregnancy. Which of the following vaccines is universally recommended during pregnancy to protect both the mother and the baby?
A 28-year-old Amish female comes to your office for vaccine counseling because she is 24 weeks pregnant. She has never received any vaccines but states, “For the sake of the baby, I would like to take any vaccines which are necessary.” Of the following, which vaccine is indicated for this patient? A) Varicella B) Measles, mumps, rubella C) Live attenuated intranasal influenza vaccine D) Tetanus, diphtheria, and pertussis (Tdap) E) Smallpox vaccine
A team of scientists is investigating whether high dietary fiber intake reduces the risk of colorectal cancer. Participants complete dietary questionnaires, and their fiber intake is categorized as low, moderate, or high. Researchers then monitor participants for 15 years to record colorectal cancer cases. Which of the following is a major limitation of this prospective cohort study?
Researchers are examining the relationship between smoking and lung cancer. They enroll 5,000 participants, categorize them based on smoking status (current smokers, former smokers, and non-smokers), and follow them for 20 years to record lung cancer incidence. What is a primary advantage of using a prospective cohort study for this research?
A research team wants to investigate whether regular physical activity reduces the risk of developing type 2 diabetes. They recruit a group of 10,000 diabetes-free participants, assess their physical activity levels at baseline, and follow them for 10 years to record the occurrence of new diabetes cases. Which of the following best describes the study design in this example?
A 62-year-old male comes to your primary care office with shortness of breath that has progressively worsened over the last three weeks. His medical history is significant for hypertension, diabetes and knee pains. He takes ibuprofen for his knee pains, he reports, ‘Without it, I can’t function’. He started on hydrochlorothiazide 6 months ago. Two months later, his doctor added one more ‘blue pill’ to control his blood pressure because the first pill was not completely effective. He can’t remember the name of the ‘blue pill’. Last month, he was started on a third pill because the first two medications could not bring his blood pressure to a normal level. His current medications are hydrochlorothiazide 25 mg, a blue pill, lisinopril 20 mg, insulin of unknown units per day and ibuprofen 800 mg three times a day. His temperature is 99 ⁰ F, heart rate is 62 beats per minute, respiratory rate is 17 breaths per minute, and blood pressure is 165/95 mm Hg. Physical examination reveals an anxious patient; on auscultation fine crackles at the bases of the lungs, audible bruit on both sides of his abdomen, and bilateral pitting edema. Laboratory tests show elevated serum creatinine, elevated renin, and hypokalemia. Chest x-ray shows increased interstitial markings, butterfly pattern of distribution of alveolar thickening, and increased blurriness of vascular outlines. Abdominal ultrasound revealed two small hyperechoic kidneys. What is the next best step in the management of this patient?
