You see a 42-year-old patient in your office who is now 5 weeks pregnant with her fifth baby. She is very concerned regarding the risk of Down syndrome because of her advanced maternal age. After extensive genetic counseling, she has decided to undergo a second-trimester amniocentesis to determine the karyotype of her fetus. You must obtain informed consent prior to the procedure. During your discussion you should tell the patient which of the following?
a. Transient leakage of amniotic fluid is common after amniocentesis so she should not be concerned if she notices a watery vaginal discharge for a few days
b. Chorioamnionitis, although an uncommon complication of amniocentesis, can be treated with broad spectrum oral antibiotics
c. Fetal loss rate after amniocentesis is around 5%
d. Amniocentesis has not been associated with fetal limb reduction defects
e. Karyotyping may not be possible as cell culture failure of the amniocytes occurs frequently
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Amniocentesis has not been associated with fetal limb reduction defects.
Amniocentesis performed in the second trimester has been associated with a 1 to 2% risk of amniotic fluid leakage, a fetal loss rate of less than 0.5%, transient transvaginal spotting, a less than 0.1% risk of chorioamnionitis, and a rare risk of cell culture failure. There has not been an association of amniocentesis in the second trimester with fetal limb reduction defects. Chorionic villus sampling performed at a gestational age of less than 9 weeks has been associated with fetal limb reduction defects.