Case 1 Presentation

20-year-old female presented to OB triage with c/o abdominal cramping and clear fluid draining from her vagina since last night. She notes that her last menstrual period (LMP) was 6 months ago. A pregnancy test at her primary care physician’s (PCP) office had confirmed her pregnancy, and her 200 mg/dl blood glucose levels suggested gestational diabetes. She used to live in a shelter but was able to recently secure low-cost housing. She reports that she hadn’t visited her PCP since the first visit. On review of systems, it was noted that she has “increased urge to use the bathroom” and “her stomach hurts”. On examination, her BMI was 18; vitals were Temp- 40 ° C, HR - 92, RR - 20, BP – 123/82, SpO2 – 98% on room air. She was noted to have B/L pedal edema, regular uterine contractions and her cervix was 5 cm dilated with ruptured membranes. She was noted to have anemia with hemoglobin of 8 gm/dl. Emergency ultrasound determined the pregnancy age at 32 weeks. The patient was given antenatal steroids, but she delivered the child two hours later.

The baby was stabilized in the delivery room but was sent to neonatal intensive care unit (NICU) receiving 30% O2 through continuous positive airway pressure (CPAP).

NICU vital signs
SpO2 = 92%, temperature = 36° C, heart rate = 200 bpm, respiratory rate = 70

NICU physical exam findings
Neonate is pale in color and shows increased breathing effort with chest wall retractions. The capillary refill time is 4 seconds, and a heart murmur is present.

Which of the following findings is most suggestive of the etiology of the infant’s condition?

A.Body temperature
B.Chest wall retractions
C.Heart murmur
D.Tachypnea
E.Tachycardia

INSTRUCTIONS

• Step 1: Answer the question, providing medical reasoning to back up your answer. Your answer should be at least 3-5 sentences in order to explain your reasoning in full. DO NOT REFRESH YOUR BROWSER UNTIL YOU HAVE FINISHED YOUR ANSWER.
• Step 2: Now, refresh your browser, and respond to as many others in your team as you can. Responses should provide evidence of your thinking processes (not just "I agree", or "answer is X"). Regularly refresh your browser as others' responses come in.
• Step 3: Based on the discussion recorded in CGScholar, your team reporter should now enter your team's answer in Benware. The whole-class discussion of this application exercise will take place verbally as usual.