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West Coast University Practice MCQs for Obstetrics (Gynecology) APGO uWise to Score 98%
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West Coast University Practice MCQs for Obstetrics (Gynecology) APGO uWise to Score 98%
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West Coast University Practice MCQs forObstetrics (Gynecology) APGO uWise to
Score 98%
An 18-year-old G1P0 Asian woman is seen in the clinic for a routine
prenatal visit at 28 weeks’ gestation. Her prenatal course has been
unremarkable but she has been reporting increased fatigue. 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 cell count 9,700/mL; hemoglobin 10.6 g/dL; mean
corpuscular volume 88.2 fL (80.8 - 96.4); and platelet count
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
Verified 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
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
Verified Answer -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 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. W
Verified 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
had 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; temperature
98.6°F (37°C); 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: inspiratory
capacity (IC) increased; tidal volume (TV) increased; minute
ventilation increased; functional reserve capacity (FRC) decreased;
expiratory reserve capacity (ERC) decreased; residual volume (RV)
decreased. 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
Verified 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
bibasilar crackles. Uterine contractions are regular every three
minutes. The fetal heart rate is 140 beats/minute. Labs show white
blood cell count 127,500/mL. 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 magnesium sulfate and nifedipine
C. Chorioamnionitis
D. Preterm labor
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