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(52) What is the fetal lie, presentation, and position if the head is down, flexed, and the fetal back is near the left maternal pelvis Additionally, on sterile vaginal examination a diamond fontanel is noted near the right ischial spine, a triangular fontanel is the leading edge, and the sagittal suture is not parallel with the floor (a) Longitudinal lie and left occiput anterior (LOA) (b) Longitudinal lie and right occiput anterior (ROA) (c) Transverse lie and left occiput anterior (LOA) (d) Transverse lie and right occiput anterior (ROA) (53) On examination, the sagittal suture is deflected toward the sacrum, which allows more of the parietal bone to be palpated anteriorly What is the term that describes this physical finding (a) Transverse diagonal (b) Posterior diagonal (c) Posterior asynclitism (d) Anterior asynclitism (54) How is zero station determined on sterile vaginal examination (a) The leading fetal edge is flush with the introitus (b) The leading fetal edge is parallel with the maternal ischial spines (c) The leading fetal edge is engaged in the maternal pelvis (d) The leading fetal edge is engaged in a fully dilated cervix

Don t accept a job offer on a handshake alone When you get an offer that you like, and you agree to take it, end the conversation with something like, So, I ll watch the mail for your offer letter If they look surprised or uncomfortable, be suspicious: any company with an ounce of professionalism mails out formal offer letters for full-time work they may even be required by state law An offer letter is the company s stated commitment to hire you at the salary and other terms you ve agreed upon It should also include your start date

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(55) A multigravid mother has a history of previous group B streptococcus (GBS)-negative pregnancies, a GBS-positive urinary tract infection during the current pregnancy, and a negative GBS culture at 36 weeks She presents to labor and delivery with spontaneous rupture of membranes and contractions every 5 minutes Which of the following is indicated (a) Immediate urinalysis for signs of current infection (b) Immediate urine culture and rectal swab for identification of GBS status (c) Empiric treatment for unknown GBS status (d) Antibiotics immediately due to history of GBS colonization (56) A group B Streptococcus-positive G2P1 with a penicillin allergy presents at 38 weeks with loss of fluid for 3 hours and contractions every 5 minutes What is the next step in management (a) Place the mother and infant on cardiac monitors (b) Assess for rupture of membranes (c) Begin ampicillin prophylaxis (d) Desensitize patient to penicillin (57) How often is meconium noted during labor and what does it signify (a) Rarely, and only in the presence of anoxic brain injury (b) Often, without any significance (c) Half of the time with variable outcomes (d) Occasionally, and it is suggestive of some degree of fetal stress

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In this section I m going to address some of the concerns that women, members of minority groups, gays and lesbians, and non-westerners (people from Asia, not people from New York!) might have about trying to find work in game development For the most part, the news is good Although the game industry is primarily an entertainment business, it was founded by engineers and to some extent their pragmatic ethos still pervades the workplace As with other high-tech industries, interactive entertainment is largely a meritocracy If you can write tight, bug-free software that does amazing things, you can be a three-headed alien from planet Zweeble for all that other programmers will care They ll be much more interested in your code than in you This attitude tends to spill over into art, music, writing, and the other development crafts as well: people respect performance

(58) Your patient, a 21-year-old G2P1 with a prior cesarean delivery and currently with a singleton gestation, is found to have placenta previa Which of the following is not associated with an increased incidence of placenta previa (a) Advanced maternal age (b) Grand multiparity (c) Prior cesarean delivery (d) Singleton gestation (59) Your patient presents at 30 weeks with complaints of vaginal bleeding There is currently no active vaginal bleeding She is admitted to a labor room for evaluation A fetal heart strip is obtained and reveals an FHR of 130 bpm with no accelerations or decelerations An ultrasound is obtained and reveals a partial previa What is the next step in management (a) Observation in labor and delivery (L&D) (b) Assessment of fetal lung maturity (c) Cesarean delivery (d) Gentle cervical examination to assess dilation and amnionic membrane status (60) During the third stage of labor, your patient s uterus inverts and the placenta becomes detached from the uterus Which of the following is the next best step in management (a) Prompt oxytocin administration (b) Attempt to manually replace the uterus (c) Prompt hysterectomy (d) Administration of inhalation anesthetics prior to manual replacement

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