OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
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A 24-year-old G1P0 woman at 28 weeks gestation reports difficulty breathing, cough and frothy sputum.
She was admitted for preterm labor 24 hours ago. She is a non-smoker. She has received 6 liters of
Lactated Ringers solution since admission. She is receiving magnesium sulfate and nifedipine. Vital signs
are: 100.2°F (37.9°C); respiratory rate 24; heart rate 110; blood pressure 132/85; pulse oximetry is 97%
on a non-rebreather mask. She appears in distress. Lungs reveal bibasilar crackles. Uterine contractions
are regular every three minutes. The fetal heart rate is 140 beats/minute. Labs show white blood cell
count 17,500/mL with 94% segmented neutrophils. Potassium and sodium are normal. Which of the
following has most likely contributed to this patient's respiratory symptoms?
A. Increased plasma osmolality
B. Use of tocolytics
C. Chorioamnionitis
D. Preterm labor
E. Increased systemic vascular resistance - CORRECT ANSWERS B. Use of tocolytics
his patient has pulmonary edema. Plasma osmolality is decreased during pregnancy which increases the
susceptibility to pulmonary edema. Common causes of acute pulmonary edema in pregnancy include
tocolytic use, cardiac disease, fluid overload and preeclampsia. Use of multiple tocolytics increases the
susceptibility of pulmonary edema, especially with the use of isotonic fluids. Systemic vascular
resistance is decreased during pregnancy. Women with chorioamnionitis are also more likely to develop
pulmonary edema, but this is not usually the main cause unless the patient is in septic shock and this
patient does not have chorioamnionitis.
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
,OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
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D. Maternal systemic vascular resistance increa - CORRECT ANSWERS 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
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 - CORRECT ANSWERS 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:
,OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
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 - CORRECT ANSWERS A. Continue routine prenatal care
Thyroid binding globulin (TBG) is increased due to increased circulating estrogens with a concomitant
increase in the total thyroxine. Free thyroxine (T4) remains relatively constant. Total triiodothyroxine
(T3) levels also increase in pregnancy while free T3 levels do not change. In a pregnant patient without
iodine deficiency, the thyroid gland may increase in size up to 10%. This patient's thyroid function is
normal for pregnancy, and her symptoms of fatigue can be explained by other physiologic changes in
pregnancy, including anemia, difficulty with sleep, and increase metabolic demand.
An 18-year-old G1P0 woman at 12 weeks gestation reports nausea, vomiting, scant vaginal bleeding and
a "racing heart." These symptoms have been present on and off for the past four weeks. The patient has
no significant past medical, surgical or family history. Vital signs are: temperature 98.6°F (37°C); heart
rate 120; blood pressure 128/78. On physical examination: uterine fundus is 4 cm below the umbilicus;
no fetal heart tones obtained by fetal Doppler device; cervix is 1 cm dilated with pinkish/purple "fleshy"
tissue protruding through the os. Labs show: hemoglobin 8.2 gm/dL, quantitative Beta-hCG 1.0 Million
IU/mL; thyroid-stimulating hormone (TSH) undetectable; free T4 3.2 (normal 0.7 - 2.5). An ultrasound
, OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
reveals heterogeneous cystic tissue in the uterus (snowstorm pattern). Which of the following is the
most appropriate next step in the management of this patient?
A. Repeat quantitative Beta-hCG
B. Repeat - CORRECT ANSWERS D. Chest x-ray
Classic presentation for molar pregnancy
- BhCG 1mil (never this high in normal preg)
CXR needed because gest. trophoblastic disease mets to lungs
Afterwards, repeat BhCG weekly
An 18-year-old G1P0 woman is seen in the clinic for a routine prenatal visit at 28 weeks gestation. Her
prenatal course has been unremarkable. She has not been taking prenatal vitamins. Her pre-pregnancy
weight was 120 pounds. Initial hemoglobin at the first visit at eight weeks gestation was 12.3 g/dL.
Current weight is 138 pounds. After performing a screening complete blood count (CBC), the results are
notable for a white blood count 9,700/mL, hemoglobin 10.6 g/dL, mean corpuscular volume 88.2 fL
(80.8 - 96.4) and platelets 215,000/mcL. The patient denies vaginal or rectal bleeding. Which of the
following is the best explanation for this patient's anemia?
A. Folate deficiency
B. Relative hemodilution of pregnancy
C. Iron deficiency
D. Beta thalassemia trait
E. Alpha thalassemia trait - CORRECT ANSWERS B. Relative hemodilution of pregnancy
There is normally a 36% increase in maternal blood volume; the maximum is reached around 34 weeks.
The plasma volume increases 47% and the RBC mass increases only 17%. This relative dilutional effect
lowers the hemoglobin, but causes no change in the MCV. Folate deficiency results in a macrocytic
anemia. Iron deficiency and thalassemias are associated with microcytic anemia.
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
A 24-year-old G1P0 woman at 28 weeks gestation reports difficulty breathing, cough and frothy sputum.
She was admitted for preterm labor 24 hours ago. She is a non-smoker. She has received 6 liters of
Lactated Ringers solution since admission. She is receiving magnesium sulfate and nifedipine. Vital signs
are: 100.2°F (37.9°C); respiratory rate 24; heart rate 110; blood pressure 132/85; pulse oximetry is 97%
on a non-rebreather mask. She appears in distress. Lungs reveal bibasilar crackles. Uterine contractions
are regular every three minutes. The fetal heart rate is 140 beats/minute. Labs show white blood cell
count 17,500/mL with 94% segmented neutrophils. Potassium and sodium are normal. Which of the
following has most likely contributed to this patient's respiratory symptoms?
A. Increased plasma osmolality
B. Use of tocolytics
C. Chorioamnionitis
D. Preterm labor
E. Increased systemic vascular resistance - CORRECT ANSWERS B. Use of tocolytics
his patient has pulmonary edema. Plasma osmolality is decreased during pregnancy which increases the
susceptibility to pulmonary edema. Common causes of acute pulmonary edema in pregnancy include
tocolytic use, cardiac disease, fluid overload and preeclampsia. Use of multiple tocolytics increases the
susceptibility of pulmonary edema, especially with the use of isotonic fluids. Systemic vascular
resistance is decreased during pregnancy. Women with chorioamnionitis are also more likely to develop
pulmonary edema, but this is not usually the main cause unless the patient is in septic shock and this
patient does not have chorioamnionitis.
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
,OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
D. Maternal systemic vascular resistance increa - CORRECT ANSWERS 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
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 - CORRECT ANSWERS 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:
,OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
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 - CORRECT ANSWERS A. Continue routine prenatal care
Thyroid binding globulin (TBG) is increased due to increased circulating estrogens with a concomitant
increase in the total thyroxine. Free thyroxine (T4) remains relatively constant. Total triiodothyroxine
(T3) levels also increase in pregnancy while free T3 levels do not change. In a pregnant patient without
iodine deficiency, the thyroid gland may increase in size up to 10%. This patient's thyroid function is
normal for pregnancy, and her symptoms of fatigue can be explained by other physiologic changes in
pregnancy, including anemia, difficulty with sleep, and increase metabolic demand.
An 18-year-old G1P0 woman at 12 weeks gestation reports nausea, vomiting, scant vaginal bleeding and
a "racing heart." These symptoms have been present on and off for the past four weeks. The patient has
no significant past medical, surgical or family history. Vital signs are: temperature 98.6°F (37°C); heart
rate 120; blood pressure 128/78. On physical examination: uterine fundus is 4 cm below the umbilicus;
no fetal heart tones obtained by fetal Doppler device; cervix is 1 cm dilated with pinkish/purple "fleshy"
tissue protruding through the os. Labs show: hemoglobin 8.2 gm/dL, quantitative Beta-hCG 1.0 Million
IU/mL; thyroid-stimulating hormone (TSH) undetectable; free T4 3.2 (normal 0.7 - 2.5). An ultrasound
, OBGYN APGO UWISE QUESTIONS AND ANSWERS UPDATED
2024/2025 A COMPLETE SOLUTION ALL ANSWERS 100% GET IT
CORRECT DETAILED BEST RATED A+ FOR SUCCESS
reveals heterogeneous cystic tissue in the uterus (snowstorm pattern). Which of the following is the
most appropriate next step in the management of this patient?
A. Repeat quantitative Beta-hCG
B. Repeat - CORRECT ANSWERS D. Chest x-ray
Classic presentation for molar pregnancy
- BhCG 1mil (never this high in normal preg)
CXR needed because gest. trophoblastic disease mets to lungs
Afterwards, repeat BhCG weekly
An 18-year-old G1P0 woman is seen in the clinic for a routine prenatal visit at 28 weeks gestation. Her
prenatal course has been unremarkable. She has not been taking prenatal vitamins. Her pre-pregnancy
weight was 120 pounds. Initial hemoglobin at the first visit at eight weeks gestation was 12.3 g/dL.
Current weight is 138 pounds. After performing a screening complete blood count (CBC), the results are
notable for a white blood count 9,700/mL, hemoglobin 10.6 g/dL, mean corpuscular volume 88.2 fL
(80.8 - 96.4) and platelets 215,000/mcL. The patient denies vaginal or rectal bleeding. Which of the
following is the best explanation for this patient's anemia?
A. Folate deficiency
B. Relative hemodilution of pregnancy
C. Iron deficiency
D. Beta thalassemia trait
E. Alpha thalassemia trait - CORRECT ANSWERS B. Relative hemodilution of pregnancy
There is normally a 36% increase in maternal blood volume; the maximum is reached around 34 weeks.
The plasma volume increases 47% and the RBC mass increases only 17%. This relative dilutional effect
lowers the hemoglobin, but causes no change in the MCV. Folate deficiency results in a macrocytic
anemia. Iron deficiency and thalassemias are associated with microcytic anemia.
