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OBGYN APGO UWise EXAM || MOST RECENT EXAM
ACTUAL COMPLETE REAL VERIFIED EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ | GUARANTEED
SUCCESS!! | BRAND NEW!!!
A 25-year-old G1P0 woman is seen for an initial obstetrical
appointment at eight weeks gestation. She has had a
small ventricular septal defect (VSD) since birth. She has
no surgical history and no limitations on her activity. Vital
signs are: respiratory rate 12; heart rate 88; blood
pressure 112/68. On physical examination: her skin
appears normal; lungs are clear to auscultation; heart is a
regular rate and rhythm. There is a grade IV/VI coarse
pansystolic murmur at the left sternal border, with a thrill.
Chest x-ray and ECG are normal. Which of the following is
the correct statement regarding cardiovascular adaptation
in this patient?
A. Approximately 2% of women will normally have a
diastolic murmur
B. Maternal pulmonary vascular resistance is normally
less than systemic vascular resistance
C. The maternal cardiac output will increase up to 33%
during pregnancy
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D. Maternal systemic vascular resistance increase -
Answer-C. The maternal cardiac output will increase up to
33% during pregnancy
The cardiac output increases up to 33% due to increases
in both the heart rate and stroke volume. The SVR falls
during pregnancy. Up to 95% of women will have a systolic
murmur due to the increased volume. Diastolic murmurs
are always abnormal. The systemic vascular resistance
(SVR) is normally greater than the pulmonary vascular
resistance. If the pulmonary vascular resistance exceeds
the SVR, right to left shunt will develop in the setting of a
VSD, and cyanosis will develop.
A 17-year-old G1P0 woman at 32 weeks gestation
complains of right flank pain that is "colicky" in nature and
has been present for two weeks. She denies fever, dysuria
and hematuria. Physical examination is notable for
moderate right costovertebral angle tenderness. White
blood cell count 8,800/mL, urine analysis negative. A renal
ultrasound reveals no signs of urinary calculi, but there is
moderate (15 mm) right hydronephrosis. Which of the
following is the most likely cause of these findings?
A. Smooth muscle relaxation due to declining levels of
progesterone
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B. Smooth muscle relaxation due to increasing levels of
estrogen
C. Compression by the uterus and right ovarian vein
D. Elevation of the bladder in the second trimester
E. Iliac artery compression of the ureter - Answer-C.
Compression by the uterus and right ovarian vein
Some degree of dilation in the ureters and renal pelvis
occurs in the majority of pregnant women. The dilation is
unequal (R > L) due to cushioning provided by the sigmoid
colon to the left ureter and from greater compression of
the right ureter due to dextrorotation of the uterus. The
right ovarian vein complex, which is remarkably dilated
during pregnancy, lies obliquely over the right ureter and
may contribute significantly to right ureteral dilatation. High
levels of progesterone likely have some effect but
estrogen has no effect on the smooth muscle of the ureter.
A 34-year-old G4P2 woman at 18 weeks gestation
presents with fatigue and occasional headache. She has a
sister with Grave's disease. On physical exam, vital signs
are normal. BMI is 27. Thyroid is difficult to palpate due to
her body habitus. The remainder of her exam is
unremarkable. Thyroid function studies show:
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Results Reference Range
TSH 1.8 mU/L 0.30 -5.5 mU/L
Free T4 1.22 ng/dL 0.76 - 1.70 ng/dL
Total T4 14.2 ng /dL 4.9 - 12.0 ng /dL
Free T3 3.4 ng/dL 2.8 - 4.2 ng/dL
Total T3 200 ng/dL 80 - 175 ng/dL
What is the next best step in the management of this
patient?
A. Continue routine prenatal care
B. Check anti-thyroid antibody levels
C. Obtain a thyroid ultrasound
D. Initiate propylthiouracil
E. Initiate methimazole - Answer-A. Continue routine
prenatal care
Thyroid binding globulin (TBG) is increased due to
increased circulating estrogens with a concomitant
OBGYN APGO UWise EXAM || MOST RECENT EXAM
ACTUAL COMPLETE REAL VERIFIED EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ | GUARANTEED
SUCCESS!! | BRAND NEW!!!
A 25-year-old G1P0 woman is seen for an initial obstetrical
appointment at eight weeks gestation. She has had a
small ventricular septal defect (VSD) since birth. She has
no surgical history and no limitations on her activity. Vital
signs are: respiratory rate 12; heart rate 88; blood
pressure 112/68. On physical examination: her skin
appears normal; lungs are clear to auscultation; heart is a
regular rate and rhythm. There is a grade IV/VI coarse
pansystolic murmur at the left sternal border, with a thrill.
Chest x-ray and ECG are normal. Which of the following is
the correct statement regarding cardiovascular adaptation
in this patient?
A. Approximately 2% of women will normally have a
diastolic murmur
B. Maternal pulmonary vascular resistance is normally
less than systemic vascular resistance
C. The maternal cardiac output will increase up to 33%
during pregnancy
,2|Page
D. Maternal systemic vascular resistance increase -
Answer-C. The maternal cardiac output will increase up to
33% during pregnancy
The cardiac output increases up to 33% due to increases
in both the heart rate and stroke volume. The SVR falls
during pregnancy. Up to 95% of women will have a systolic
murmur due to the increased volume. Diastolic murmurs
are always abnormal. The systemic vascular resistance
(SVR) is normally greater than the pulmonary vascular
resistance. If the pulmonary vascular resistance exceeds
the SVR, right to left shunt will develop in the setting of a
VSD, and cyanosis will develop.
A 17-year-old G1P0 woman at 32 weeks gestation
complains of right flank pain that is "colicky" in nature and
has been present for two weeks. She denies fever, dysuria
and hematuria. Physical examination is notable for
moderate right costovertebral angle tenderness. White
blood cell count 8,800/mL, urine analysis negative. A renal
ultrasound reveals no signs of urinary calculi, but there is
moderate (15 mm) right hydronephrosis. Which of the
following is the most likely cause of these findings?
A. Smooth muscle relaxation due to declining levels of
progesterone
,3|Page
B. Smooth muscle relaxation due to increasing levels of
estrogen
C. Compression by the uterus and right ovarian vein
D. Elevation of the bladder in the second trimester
E. Iliac artery compression of the ureter - Answer-C.
Compression by the uterus and right ovarian vein
Some degree of dilation in the ureters and renal pelvis
occurs in the majority of pregnant women. The dilation is
unequal (R > L) due to cushioning provided by the sigmoid
colon to the left ureter and from greater compression of
the right ureter due to dextrorotation of the uterus. The
right ovarian vein complex, which is remarkably dilated
during pregnancy, lies obliquely over the right ureter and
may contribute significantly to right ureteral dilatation. High
levels of progesterone likely have some effect but
estrogen has no effect on the smooth muscle of the ureter.
A 34-year-old G4P2 woman at 18 weeks gestation
presents with fatigue and occasional headache. She has a
sister with Grave's disease. On physical exam, vital signs
are normal. BMI is 27. Thyroid is difficult to palpate due to
her body habitus. The remainder of her exam is
unremarkable. Thyroid function studies show:
, 4|Page
Results Reference Range
TSH 1.8 mU/L 0.30 -5.5 mU/L
Free T4 1.22 ng/dL 0.76 - 1.70 ng/dL
Total T4 14.2 ng /dL 4.9 - 12.0 ng /dL
Free T3 3.4 ng/dL 2.8 - 4.2 ng/dL
Total T3 200 ng/dL 80 - 175 ng/dL
What is the next best step in the management of this
patient?
A. Continue routine prenatal care
B. Check anti-thyroid antibody levels
C. Obtain a thyroid ultrasound
D. Initiate propylthiouracil
E. Initiate methimazole - Answer-A. Continue routine
prenatal care
Thyroid binding globulin (TBG) is increased due to
increased circulating estrogens with a concomitant
