OB/GYN APGO EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ WITH RATIONALES
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OB/GYN APGO EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ WITH RATIONALES
OB/GYN APGO EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ WITH RATIONALES
OB/GYN APGO EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ WITH RATIONALES
OB/GYN APGO EXAM ACTUAL EXAM 2023-
2024 QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A+ WITH
RATIONALES
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 - ANSWER-B. 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.
A 34-year-old G3P1 woman at 26 weeks gestation reports "difficulty catching her
breath," especially after exertion for the last two months. She is a non-smoker.
She does not have any history of pulmonary or cardiac disease. She denies fever,
sputum, cough or any recent illnesses. On physical examination, her vital signs
are: blood pressure 108/64, pulse 88, respiratory rate 15, and she is afebrile.
Pulse oximeter is 98% on room air. Lungs are clear to auscultation. Heart is
,OB/GYN APGO EXAM ACTUAL EXAM 2023-
2024 QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A+ WITH
RATIONALES
regular rate and rhythm with II/VI systolic murmur heard at the upper left sternal
border. She has no lower extremity edema. A complete blood count reveals a
hemoglobin of 10.0 g/dL. What is the most likely explanation for this woman's
symptoms?
A. Pulmonary embolism
B. Mitral valve stenosis
C. Physiologic dyspnea of pregnancy
D. Peripartum cardiomyopathy
E. Anemia - ANSWER-Correct answer is C. Physical examination findings are not
consistent with pulmonary embolus (e.g tachycardia, tachypnea, hypoxia, chest
pain, signs of a DVT) or mitral stenosis (diastolic murmur, signs of heart failure).
Physiologic dyspnea of pregnancy is present in up to 75% of women by the third
trimester. Peripartum cardiomyopathy is an idiopathic cardiomyopathy that
presents with heart failure secondary to left ventricular systolic function
towards the end of pregnancy or in the several months following delivery.
Symptoms include fatigue, shortness of breath, palpitations, and edema. The
history and physical do not suggest a pathologic process, nor does her
hemoglobin level.
A 24-year-old G4P2 woman at 34 weeks gestation complains of a cough and
whitish sputum for the last three days. She reports that everyone in the family has
been sick. She reports a high fever last night up to 102°F (38.9°C). She denies
chest pain. She smokes a half-pack of cigarettes per day. She has a history of
asthma with no previous intubations. She uses an albuterol inhaler, although she
has not used it this week. Vital signs are: temperature 98.6°F (37°C); respiratory
rate 16; pulse 94; blood pressure 114/78; peak expiratory flow rate 430 L/min
(baseline documented in the outpatient chart = 425 L/min). On physical
examination, pharyngeal mucosa is erythematous and injected. Lungs are clear to
,OB/GYN APGO EXAM ACTUAL EXAM 2023-
2024 QUESTIONS AND CORRECT
ANSWERS ALREADY GRADED A+ WITH
RATIONALES
auscultation. White blood cell count 8,700; arterial blood gases on room air
(normal ranges in parentheses): pH 7.44 (7.36 - 7.44); PO2 103 mm Hg (>100),
PCO2 26 mm Hg (28 - 32), HCO3 19 mm Hg (22 - 26). Chest x-ray is normal. What
is the correct interpretation of this arterial blood gas?
A. Acute metabolic acidosis
B. Compensated respiratory alkalosis
C. Compensated metabolic alkalosis
D. Hypoventilation
E. Hyperventilation - ANSWER-B. The increased minute ventilation during
pregnancy causes a compensated respiratory alkalosis. Hypoventilation results
in increased PCO2 and the PO2 would be decreased if she was hypoxic. A
metabolic acidosis would have a decreased pH and a low HCO3. The patient's
symptoms are most consistent with a viral upper respiratory infection
A 28-year-old G1P0 internal medicine resident at 34 weeks gestation wants to
discuss the values on her pulmonary function tests performed two days ago
because she was feeling slightly short of breath. She is a non-smoker, and has no
personal or family history of cardiac or respiratory disease. Vital signs are:
respiratory rate 16; pulse 90, blood pressure 112/70; oxygen saturation is 99% on
room air. On physical examination: lungs are clear; abdomen non-tender; fundal
height is 34 cm. The results of the pulmonary function tests are:
What is the next best step in the evaluation of this patient?
A. Routine antenatal care
B. Chest x-ray
C. Arterial blood gas
D. Spiral CT of the lungs
E. Echocardiogram - ANSWER-A. The results of her PFT are consistent with
normal physiologic changes in pregnancy. Inspiratory capacity increases by 15%
during the third trimester because of increases in tidal volume and inspiratory
reserve volume. The respiratory rate does not change during pregnancy, but the
TV is increased which increases the minute ventilation, which is responsible for
the respiratory alkalosis in pregnancy. Functional residual capacity is reduced to
80% of the non-pregnant volume by term. These combined lead to subjective
shortness of breath during pregnancy.
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
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