OBGYN APGO UWise Exam Latest 2025
Questions and Answers Graded A+
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
D. Maternal systemic vascular resistance increa - CORRECT 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
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 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:
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
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 ANSWER-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
Questions and Answers Graded A+
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
D. Maternal systemic vascular resistance increa - CORRECT 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
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 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:
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
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 ANSWER-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
