37-year-old woman, gravida 7 para 2 aborta 4, comes to the hospital with labor pains The patient received care at another clinic, but her medical records are unavailable. She delivered her first child vaginally at age 16 after an uncomplicated, full-term pregnancy The patient subsequently had 4 elective terminations followed by a cesarean delivery at term for breech presentation On physical examination, her cervix is 6 cm dilated and 90% effaced with the fetal head at +1 station. She i s hospitalized, dilates quickly to 10 cm, and vaginally delivers a healthy 4540-g (10-lb) boy The umbilical cord avulses from the placenta, necessitating a manual extraction. The placenta is extracted in pieces During placental removal, the patient develops profuse vaginal bleeding. Her uterus is firm, and the bleeding is unresponsive to uterine massage and uterotonic medications. Which of the following is the most likely cause of her bleeding?
- QA Abruptio placentae
- 0 B. Placenta accreta
- 0 C. Placenta previa
- 0 D. Uterine atony
- 0 E. Uterine inversion
- 0 F. Vasa previa
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63-year-old Asian American woman comes to the emergency department for a severe right-sided headache that started 2 hours ago. The pain is located all around the eye. She has vomited once since the pain began. She is also seeing “halos” around lights. She has never had a headache like this before. She has a history of hypertension and urinary incontinence. Her medications include valsartan and tolterodine. She has been taking trimethoprim-sulfamethoxazole for the last 2 days for a urinary tract infection. Her mother has a history of migraine headaches.She does not use tobacco, alcohol, or illicit drugs. Her vital signs are within normal limits. Physical examination shows a nonreactive, dilated right pupil and erythematous right eye. Excessive lacrimation is present. Visual acuity is decreased. Laboratory studies show an erythrocyte sedimentation rate of 35 mm/h. Which of the following is the most likely diagnosis?
- QA Acute angle-closure glaucoma
- 0 B. Cluster headache
- 0 C. Herpes zoster ophthalmicus
- 0 D. lntracranial tumor
- 0 E. Meningitis
- 0 F Migraine
- 0 G. Optic neuritis
- 0 H. Subarachnoid hemorrhage
- 0 I. Temporal arteritis
- 0 J. Tension-type headache
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