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OBGYN APGO UWise Questions with 100% Correct
Answers | Latest Version 2024 | Expert Verified

An f18-year-old fG1P0 fwoman fis fseen fin fthe fclinic ffor fa froutine fprenatal fvisit fat f28 fweeks fgestation.
fHer fprenatal fcourse fhas fbeen funremarkable. fShe fhas fnot fbeen ftaking fprenatal fvitamins. fHer fpre-
pregnancy fweight fwas f120 fpounds. fInitial fhemoglobin fat fthe ffirst fvisit fat feight fweeks fgestation fwas
f12.3 fg/dL. fCurrent fweight fis f138 fpounds. fAfter fperforming fa fscreening fcomplete fblood fcount
f(CBC), fthe fresults fare fnotable ffor fa fwhite fblood fcount f9,700/mL, fhemoglobin f10.6 fg/dL, fmean
fcorpuscular fvolume f88.2 ffL f(80.8 f- f96.4) fand fplatelets f215,000/mcL. fThe fpatient fdenies fvaginal for
frectal fbleeding. fWhich fof fthe ffollowing fis fthe fbest fexplanation ffor fthis fpatient's fanemia?


fA. fFolate fdeficiency


fB. fRelative fhemodilution fof fpregnancy


fC. fIron fdeficiency


fD. fBeta fthalassemia ftrait


fE. fAlpha fthalassemia ftrait f- fCorrect f fAnswer f- fB. fRelative fhemodilution fof fpregnancy




There fis fnormally fa f36% fincrease fin fmaternal fblood fvolume; fthe fmaximum fis freached faround f34
fweeks. fThe fplasma fvolume fincreases f47% fand fthe fRBC fmass fincreases fonly f17%. fThis frelative
fdilutional feffect flowers fthe fhemoglobin, fbut fcauses fno fchange fin fthe fMCV. fFolate fdeficiency
fresults fin fa fmacrocytic fanemia. fIron fdeficiency fand fthalassemias fare fassociated fwith fmicrocytic
fanemia.


A f34-year-old fG3P1 fwoman fat f26 fweeks fgestation freports f"difficulty fcatching fher fbreath,"
fespecially fafter fexertion ffor fthe flast ftwo fmonths. fShe fis fa fnon-smoker. fShe fdoes fnot fhave fany
fhistory fof fpulmonary for fcardiac fdisease. fShe fdenies ffever, fsputum, fcough for fany frecent fillnesses.
fOn fphysical fexamination, fher fvital fsigns fare: fblood fpressure f108/64, fpulse f88, frespiratory frate f15,
fand fshe fis fafebrile. fPulse foximeter fis f98% fon froom fair. fLungs fare fclear fto fauscultation. fHeart fis
fregular frate fand frhythm fwith fII/VI fsystolic fmurmur fheard fat fthe fupper fleft fsternal fborder. fShe fhas
fno flower fextremity fedema. fA fcomplete fblood fcount freveals fa fhemoglobin fof f10.0 fg/dL. fWhat fis
fthe fmost flikely fexplanation ffor fthis fwoman's fsymptoms?


fA. fPulmonary fembolism

,fB. fMitral fvalve fstenosis


fC. fPhysiologic fdyspnea fof fpregnancy


fD. fPeripartum fcardiomyopathy


fE. fAnemia f- fCorrect f fAnswer f- fC. fPhysiologic fdyspnea fof fpregnancy




fPhysical fexamination ffindings fare fnot fconsistent fwith fpulmonary fembolus f(e.g ftachycardia,
ftachypnea, fhypoxia, fchest fpain, fsigns fof fa fDVT) for fmitral fstenosis f(diastolic fmurmur, fsigns fof fheart
ffailure). fPhysiologic fdyspnea fof fpregnancy fis fpresent fin fup fto f75% fof fwomen fby fthe fthird
ftrimester. fPeripartum fcardiomyopathy fis fan fidiopathic fcardiomyopathy fthat fpresents fwith fheart
ffailure fsecondary fto fleft fventricular fsystolic ffunction ftowards fthe fend fof fpregnancy for fin fthe
fseveral fmonths ffollowing fdelivery. fSymptoms finclude ffatigue, fshortness fof fbreath, fpalpitations, fand
fedema. fThe fhistory fand fphysical fdo fnot fsuggest fa fpathologic fprocess, fnor fdoes fher fhemoglobin
flevel.


A f24-year-old fG4P2 fwoman fat f34 fweeks fgestation fcomplains fof fa fcough fand fwhitish fsputum ffor
fthe flast fthree fdays. fShe freports fthat feveryone fin fthe ffamily fhas fbeen fsick. fShe freports fa fhigh
ffever flast fnight fup fto f102°F f(38.9°C). fShe fdenies fchest fpain. fShe fsmokes fa fhalf-pack fof fcigarettes
fper fday. fShe fhas fa fhistory fof fasthma fwith fno fprevious fintubations. fShe fuses fan falbuterol finhaler,
falthough fshe fhas fnot fused fit fthis fweek. fVital fsigns fare: ftemperature f98.6°F f(37°C); frespiratory frate
f16; fpulse f94; fblood fpressure f114/78; fpeak fexpiratory fflow frate f430 fL/min f(baseline fdocumented fin
fthe foutpatient fchart f= f425 fL/min). fOn fphysical fexamination, fpharyngeal fmucosa fis ferythematous
fand finjected. fLungs fare fclear fto fauscultation. fWhite fblood fcell fcount f8,700; farterial fblood fgases fon
froom fair f(normal franges fin fparentheses): fpH f7.44 f(7.36 f- f7.44); fPO2 f103 fmm fHg f(>100), fPCO2 f26
fmm fHg f(28 f- f32), fHCO3 f19 fmm fHg f(22 f- f26). fChest fx-ray fis fnor f- fCorrect f fAnswer f- fB.
fCompensated frespiratory falkalosis f




The fincreased fminute fventilation fduring fpregnancy fcauses fa fcompensated frespiratory falkalosis.
fHypoventilation fresults fin fincreased fPCO2 fand fthe fPO2 fwould fbe fdecreased fif fshe fwas fhypoxic. fA
fmetabolic facidosis fwould fhave fa fdecreased fpH fand fa flow fHCO3. fThe fpatient's fsymptoms fare fmost
fconsistent fwith fa fviral fupper frespiratory finfection.


A f28-year-old fG1P0 finternal fmedicine fresident fat f34 fweeks fgestation fwants fto fdiscuss fthe fvalues
fon fher fpulmonary ffunction ftests fperformed ftwo fdays fago fbecause fshe fwas ffeeling fslightly fshort fof
fbreath. fShe fis fa fnon-smoker, fand fhas fno fpersonal for ffamily fhistory fof fcardiac for frespiratory
fdisease. fVital fsigns fare: frespiratory frate f16; fpulse f90, fblood fpressure f112/70; foxygen fsaturation fis
f99% fon froom fair. fOn fphysical fexamination: flungs fare fclear; fabdomen fnon-tender; ffundal fheight fis
f34 fcm. fThe fresults fof fthe fpulmonary ffunction ftests fare:

,Inspiratory fCapacity f(IC) fincreased

Tidal fvolume f(TV) fincreased

Minute fventilation fincreased

Functional freserve fcapacity f(FRC) fdecreased

Expiratory freserve fcapacity f(ERC) fdecreased

Residual fvolume f(RV) fdecreased

f




What fis fthe fnext fbest fstep fin fthe fevaluation fof fthis fpatient?



fA. fRoutine fantenatal fcare


fB. fChest fx-ray


fC. fArterial fblood fgas


fD. fSpiral fCT fof fthe flungs


fE. fEchocardiogram f- fCorrect f fAnswer f- fA. fRoutine fantenatal fcare f




The fresults fof fher fPFT fare fconsistent fwith fnormal fphysiologic fchanges fin fpregnancy. fInspiratory
fcapacity fincreases fby f15% fduring fthe fthird ftrimester fbecause fof fincreases fin ftidal fvolume fand
finspiratory freserve fvolume. fThe frespiratory frate fdoes fnot fchange fduring fpregnancy, fbut fthe fTV fis
fincreased fwhich fincreases fthe fminute fventilation, fwhich fis fresponsible ffor fthe frespiratory falkalosis
fin fpregnancy. fFunctional fresidual fcapacity fis freduced fto f80% fof fthe fnon-pregnant fvolume fby fterm.
fThese fcombined flead fto fsubjective fshortness fof fbreath fduring fpregnancy.


A f24-year-old fG1P0 fwoman fat f28 fweeks fgestation freports fdifficulty fbreathing, fcough fand ffrothy
fsputum. fShe fwas fadmitted ffor fpreterm flabor f24 fhours fago. fShe fis fa fnon-smoker. fShe fhas freceived
f6 fliters fof fLactated fRingers fsolution fsince fadmission. fShe fis freceiving fmagnesium fsulfate fand
fnifedipine. fVital fsigns fare: f100.2°F f(37.9°C); frespiratory frate f24; fheart frate f110; fblood fpressure
f132/85; fpulse foximetry fis f97% fon fa fnon-rebreather fmask. fShe fappears fin fdistress. fLungs freveal
fbibasilar fcrackles. fUterine fcontractions fare fregular fevery fthree fminutes. fThe ffetal fheart frate fis f140
fbeats/minute. fLabs fshow fwhite fblood fcell fcount f17,500/mL fwith f94% fsegmented fneutrophils.

, fPotassium fand fsodium fare fnormal. fWhich fof fthe ffollowing fhas fmost flikely fcontributed fto fthis
fpatient's frespiratory fsymptoms?


fA. fIncreased fplasma fosmolality


fB. fUse fof ftocolytics


fC. fChorioamnionitis


fD. fPreterm flabor


fE. fIncreased fsystemic fvascular fresistance f- fCorrect f fAnswer f- fB. fUse fof ftocolytics




his fpatient fhas fpulmonary fedema. fPlasma fosmolality fis fdecreased fduring fpregnancy fwhich fincreases
fthe fsusceptibility fto fpulmonary fedema. fCommon fcauses fof facute fpulmonary fedema fin fpregnancy
finclude ftocolytic fuse, fcardiac fdisease, ffluid foverload fand fpreeclampsia. fUse fof fmultiple ftocolytics
fincreases fthe fsusceptibility fof fpulmonary fedema, fespecially fwith fthe fuse fof fisotonic ffluids.
fSystemic fvascular fresistance fis fdecreased fduring fpregnancy. fWomen fwith fchorioamnionitis fare falso
fmore flikely fto fdevelop fpulmonary fedema, fbut fthis fis fnot fusually fthe fmain fcause funless fthe fpatient
fis fin fseptic fshock fand fthis fpatient fdoes fnot fhave fchorioamnionitis.


A f25-year-old fG1P0 fwoman fis fseen ffor fan finitial fobstetrical fappointment fat feight fweeks fgestation.
fShe fhas fhad fa fsmall fventricular fseptal fdefect f(VSD) fsince fbirth. fShe fhas fno fsurgical fhistory fand fno
flimitations fon fher factivity. fVital fsigns fare: frespiratory frate f12; fheart frate f88; fblood fpressure
f112/68. fOn fphysical fexamination: fher fskin fappears fnormal; flungs fare fclear fto fauscultation; fheart fis
fa fregular frate fand frhythm. fThere fis fa fgrade fIV/VI fcoarse fpansystolic fmurmur fat fthe fleft fsternal
fborder, fwith fa fthrill. fChest fx-ray fand fECG fare fnormal. fWhich fof fthe ffollowing fis fthe fcorrect
fstatement fregarding fcardiovascular fadaptation fin fthis fpatient?


fA. fApproximately f2% fof fwomen fwill fnormally fhave fa fdiastolic fmurmur


fB. fMaternal fpulmonary fvascular fresistance fis fnormally fless fthan fsystemic fvascular fresistance


fC. fThe fmaternal fcardiac foutput fwill fincrease fup fto f33% fduring fpregnancy


fD. fMaternal fsystemic fvascular fresistance fincrea f- fCorrect f fAnswer f- fC. fThe fmaternal fcardiac
foutput fwill fincrease fup fto f33% fduring fpregnancy




The fcardiac foutput fincreases fup fto f33% fdue fto fincreases fin fboth fthe fheart frate fand fstroke
fvolume. fThe fSVR ffalls fduring fpregnancy. fUp fto f95% fof fwomen fwill fhave fa fsystolic fmurmur fdue fto
fthe fincreased fvolume. fDiastolic fmurmurs fare falways fabnormal. fThe fsystemic fvascular fresistance
f(SVR) fis fnormally fgreater fthan fthe fpulmonary fvascular fresistance. fIf fthe fpulmonary fvascular

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