ABFM + KSA
OBGYN
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,A 40-year-old primigravida who recently moved to your area sees you for an
ini al visit at 18 weeks gesta on. Her pregnancy is the result of an intrauterine
insemina on, and she had an ultrasound evalua on at 6 weeks gesta on. Your
medical assistant alerts you that her ini al blood pressure is 164/104 mm Hg,
with a repeat reading of 166/105 mm Hg 10 minutes later. The pa ent is on no
medica ons other than prenatal vitamins and feels well. Although she knows
her blood pressure was measured at her previous physician's office, she is
unaware of the readings and does not remember being told she has high blood
pressure. Which of the following would be appropriate in the management of
this pa ent at this me? (Mark all that are true.)
A. 24-hour urine collec on to assess for proteinuria
B. Lisinopril (Prinivil, Zestril), 20 mg daily
C. Atenolol (Tenormin), 50 mg daily
D. Nifedipine (Procardia), 60 mg daily
E. Bed rest
F. A and D
**Answer:** A and D
**Ra onale:**
Hypertension that is detected prior to 20 weeks gesta on or is known to have
existed prior to the pregnancy is considered chronic hypertension during
pregnancy. It is classified as mild (systolic blood pressure 140-159 mm Hg or
diastolic blood pressure 90-109 mm Hg) or severe (systolic >160 mm Hg or
diastolic >110 mm Hg). Because this pa ent is at less than 20 weeks gesta on and
has a blood pressure approaching the severe range, it is appropriate to treat her
blood pressure to decrease the risk of maternal stroke. Chronic hypertension is
,also a risk factor for the development of preeclampsia. It is therefore appropriate
to order a 24-hour urine collec on to establish a baseline amount of protein.
Elevated proteinuria above this baseline level later in pregnancy could indicate the
development of superimposed preeclampsia. Certain illicit substances such as
cocaine and methamphetamine can cause hypertension in addi on to causing
adverse fetal outcomes, and a hypertensive pregnant woman should be screened
for these drugs. Chronic hypertension affects fetal growth, and it is recommended
that these pa ents have baseline anatomic ultrasonography at 18-20 weeks
gesta on followed by serial ultrasound evalua ons to monitor fetal growth. ACE
inhibitors and angiotensin receptor blockers (ARBs) are contraindicated in all
trimesters of pregnancy. ACE inhibitors have been associated with teratogenicity,
including severely underdeveloped calvarial bone, renal dysgenesis, and
pulmonary hypoplasia, as well as adverse fetal outcomes including intrauterine
growth restric on, fetal death, neonatal renal failure, oligohydramnios, anuria,
and neonatal death. ARBs have been associated with renal abnormali es,
dysmorphia, and s llbirth. While atenolol, a pure β-blocker, has been associated
with fetal growth restric on, labetalol, a combina on α- and β-blocker, is
considered safe in pregnancy. Nifedipine is the most commonly studied calcium
channel blocker in pregnancy and is also an appropriate treatment of
hypertension. There is no evidence that bed rest confers any benefit in these
pa ents.
---
You are called to a.end the precipitous delivery of a pa ent you have not
previously seen. When you arrive, the pa ent has just delivered the infant's
head to the level of the nose, but further pushing yields no progress. You apply
gentle trac on on the infant's head, and deliver the remainder of the head, but
not the anterior shoulder. Appropriate measures at this point include which of
the following? (Mark all that are true.)
, A. Call for addi onal help
B. Ask a nurse to apply fundal pressure while the pa ent pushes
C. Have the pa ent flex and abduct her hips with assistance
D. Provide supplemental oxygen to the mother
E. A>empt to rotate the infant's anterior shoulder into an oblique posi on
F. A, C, and E
**Answer:** A, C, and E
**Ra onale:**
Shoulder dystocia is defined as a delivery in which gentle downward trac on fails
to deliver the anterior shoulder, which has impacted against the symphysis pubis.
The overall incidence of shoulder dystocia increases as fetal weight increases, with
an incidence of 0.6%-1.4% in infants weighing between 2500 g and 4000 g, and
5%-9% in infants weighing between 4000 g and 4500 g. The incidence is increased
in gesta ons complicated by diabetes, macrosomia, assisted vaginal delivery,
abnormal pelvic anatomy, and a protracted ac ve first or second stage of labor.
Complica ons of shoulder dystocia can occur in both the mother and the infant.
For the mother, there is an increased incidence of postpartum hemorrhage and
lacera ons of the genital tract, including fourth-degree lacera ons; for the infant,
there is an increased incidence of brachial plexus injuries, clavicle or humerus
fracture, hypoxic brain injury, and death. This emergency should be managed
rapidly and in a fashion that maximizes the likelihood of safe vaginal delivery while
minimizing maternal and newborn complica ons. Several maneuvers have been
proposed and studied for management of shoulder dystocia. For the family
physician, an appropriate considera on, depending on the seFng of the delivery,
includes obtaining addi onal assistance for management of the mother, the baby,
OBGYN
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,A 40-year-old primigravida who recently moved to your area sees you for an
ini al visit at 18 weeks gesta on. Her pregnancy is the result of an intrauterine
insemina on, and she had an ultrasound evalua on at 6 weeks gesta on. Your
medical assistant alerts you that her ini al blood pressure is 164/104 mm Hg,
with a repeat reading of 166/105 mm Hg 10 minutes later. The pa ent is on no
medica ons other than prenatal vitamins and feels well. Although she knows
her blood pressure was measured at her previous physician's office, she is
unaware of the readings and does not remember being told she has high blood
pressure. Which of the following would be appropriate in the management of
this pa ent at this me? (Mark all that are true.)
A. 24-hour urine collec on to assess for proteinuria
B. Lisinopril (Prinivil, Zestril), 20 mg daily
C. Atenolol (Tenormin), 50 mg daily
D. Nifedipine (Procardia), 60 mg daily
E. Bed rest
F. A and D
**Answer:** A and D
**Ra onale:**
Hypertension that is detected prior to 20 weeks gesta on or is known to have
existed prior to the pregnancy is considered chronic hypertension during
pregnancy. It is classified as mild (systolic blood pressure 140-159 mm Hg or
diastolic blood pressure 90-109 mm Hg) or severe (systolic >160 mm Hg or
diastolic >110 mm Hg). Because this pa ent is at less than 20 weeks gesta on and
has a blood pressure approaching the severe range, it is appropriate to treat her
blood pressure to decrease the risk of maternal stroke. Chronic hypertension is
,also a risk factor for the development of preeclampsia. It is therefore appropriate
to order a 24-hour urine collec on to establish a baseline amount of protein.
Elevated proteinuria above this baseline level later in pregnancy could indicate the
development of superimposed preeclampsia. Certain illicit substances such as
cocaine and methamphetamine can cause hypertension in addi on to causing
adverse fetal outcomes, and a hypertensive pregnant woman should be screened
for these drugs. Chronic hypertension affects fetal growth, and it is recommended
that these pa ents have baseline anatomic ultrasonography at 18-20 weeks
gesta on followed by serial ultrasound evalua ons to monitor fetal growth. ACE
inhibitors and angiotensin receptor blockers (ARBs) are contraindicated in all
trimesters of pregnancy. ACE inhibitors have been associated with teratogenicity,
including severely underdeveloped calvarial bone, renal dysgenesis, and
pulmonary hypoplasia, as well as adverse fetal outcomes including intrauterine
growth restric on, fetal death, neonatal renal failure, oligohydramnios, anuria,
and neonatal death. ARBs have been associated with renal abnormali es,
dysmorphia, and s llbirth. While atenolol, a pure β-blocker, has been associated
with fetal growth restric on, labetalol, a combina on α- and β-blocker, is
considered safe in pregnancy. Nifedipine is the most commonly studied calcium
channel blocker in pregnancy and is also an appropriate treatment of
hypertension. There is no evidence that bed rest confers any benefit in these
pa ents.
---
You are called to a.end the precipitous delivery of a pa ent you have not
previously seen. When you arrive, the pa ent has just delivered the infant's
head to the level of the nose, but further pushing yields no progress. You apply
gentle trac on on the infant's head, and deliver the remainder of the head, but
not the anterior shoulder. Appropriate measures at this point include which of
the following? (Mark all that are true.)
, A. Call for addi onal help
B. Ask a nurse to apply fundal pressure while the pa ent pushes
C. Have the pa ent flex and abduct her hips with assistance
D. Provide supplemental oxygen to the mother
E. A>empt to rotate the infant's anterior shoulder into an oblique posi on
F. A, C, and E
**Answer:** A, C, and E
**Ra onale:**
Shoulder dystocia is defined as a delivery in which gentle downward trac on fails
to deliver the anterior shoulder, which has impacted against the symphysis pubis.
The overall incidence of shoulder dystocia increases as fetal weight increases, with
an incidence of 0.6%-1.4% in infants weighing between 2500 g and 4000 g, and
5%-9% in infants weighing between 4000 g and 4500 g. The incidence is increased
in gesta ons complicated by diabetes, macrosomia, assisted vaginal delivery,
abnormal pelvic anatomy, and a protracted ac ve first or second stage of labor.
Complica ons of shoulder dystocia can occur in both the mother and the infant.
For the mother, there is an increased incidence of postpartum hemorrhage and
lacera ons of the genital tract, including fourth-degree lacera ons; for the infant,
there is an increased incidence of brachial plexus injuries, clavicle or humerus
fracture, hypoxic brain injury, and death. This emergency should be managed
rapidly and in a fashion that maximizes the likelihood of safe vaginal delivery while
minimizing maternal and newborn complica ons. Several maneuvers have been
proposed and studied for management of shoulder dystocia. For the family
physician, an appropriate considera on, depending on the seFng of the delivery,
includes obtaining addi onal assistance for management of the mother, the baby,
