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OB/GYN APGO Test Bank Questions & Answers 2022. (All Correct)
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OB/GYN APGO Test Bank Questions & Answers 2022. (All Correct) 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. Initi...

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  • 19 september 2022
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  • obgyn apgo test bank questions amp answers 2022 all correct 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 unr

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OB/GYN APGO Test Bank Questions & Answers 2022.
(All Correct)

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
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
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 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
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:

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
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 17,500/mL with
94% segmented neutrophils. 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 tocolytics
C. Chorioamnionitis
D. Preterm labor
E. Increased systemic vascular resistance
B. This patient has pulmonary edema. Plasma osmolality is decreased during
pregnancy which increases the susceptibility to pulmonary edema. Common causes of
acute pulmonary edema in pregnancy include tocolytic use, cardiac disease, fluid
overload and preeclampsia. Use of multiple tocolytics increases the susceptibility of
pulmonary edema, especially with the use of isotonic fluids. Systemic vascular
resistance is decreased during pregnancy. Women with chorioamnionitis are also more
likely to develop pulmonary edema, but this is not usually the main cause unless the
patient is in septic shock and this patient does not have chorioamnionitis.
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 increases throughout pregnancy

, E. The increase in cardiac output is only due to the increase in the maternal
stroke volume
C. 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
C. 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

What is the next best step in the management of this patient?

A. Continue routine prenatal care
B. Check anti-thyroid antibody levels
C. Obtain a thyroid ultrasound

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