OB Physiology
Hemoglobin 10.5 g/dL in pregnancy is often normal because of:
A. Iron deficiency
B. Hemolysis
C. Plasma volume expansion
D. Bone marrow suppression
C. Plasma volume expansion
10-week pregnant patient with UTI. Best choice?
A. Ciprofloxacin
B. Nitrofurantoin
C. TMP-SMX
D. Doxycycline
B. Nitrofurantoin
WBC count in pregnancy:
A. Decreases
B. No change
C. Increases
D. Drops in 3rd trimester
C. Increases
A 29-year-old BMI 34 presents at 10 weeks.
What is the correct screening approach?
A. No screening until 24–28 weeks
B. HbA1c only
C. Early diabetes screening now and repeat at 24–28 weeks
D. Random glucose only
E. Fasting insulin level
C. Early diabetes screening now and repeat at 24–28 weeks
A 25-year-old primigravida at 32 weeks’ gestation comes to the emergency department due to severe headaches that began a month ago and now occur once or twice a week. The headaches are unilateral, throbbing, and associated with light sensitivity and nausea. She has tried massage and relaxation techniques with no symptom relief. The patient had similar headaches prior to pregnancy that usually improved with ibuprofen and bed rest. Vital signs and physical examination are normal.
Which of the following is the most appropriate therapy for this patient?
A. Acetaminophen
B. Ergotamine
C. Naproxen
D. Sumatriptan
E. Topiramate
A. Acetaminophen
Management of Migraines in Pregnancy
1-Non-pharmacologic therapy: rest, hydration, heat
2-Acetaminophen
3-Antiemetics (eg, promethazine), codeine, caffeine/butalbital
4-Non-steroidal anti-inflammatory drugs (eg, naproxen) (2nd trimester only)
5-Opioids (eg, oxycodone)
Which hormone causes reflux, constipation, and urinary stasis?
A. Estrogen
B. hCG
C. Progesterone
D. Prolactin
C. Progesterone
Preferred anticoagulant in pregnancy:
A. Warfarin
B. Rivaroxaban
C. LMWH
D. Aspirin alone
C. LMWH
Pregnancy causes thrombosis risk primarily because of:
A. Increased protein S
B. Increased fibrinolysis
C. Decreased fibrinogen
D. Increased procoagulant factors + reduced fibrinolysis
E. Platelet destruction
D. Increased procoagulant factors + reduced fibrinolysis
A pregnant patient with no risk factors asks about hepatitis C screening.
Best answer?
A. Not needed
B. Only if abnormal LFTs
C. Universal screening during pregnancy
D. Screen postpartum
E. Screen only IV drug users
C. Universal screening during pregnancy
Guidelines recommend universal HCV screening in pregnancy.
A 33-year-old woman comes to the office for an initial prenatal visit at 10 weeks’ gestation. Three years ago, the patient underwent gastric bypass surgery for morbid obesity, after which she lost 50 kg (110 lb). Her only chronic medical condition is hypertension. The patient jogs 6 miles a day and is training for a half marathon. Blood pressure is 140/80 mm Hg and pulse is 70/min. BMI is 24 kg/m². The physical examination is unremarkable.
Which of the following is the most significant risk factor for intrauterine fetal demise in this patient?
A. Body mass index
B. Chronic hypertension
C. Maternal age
D. Prior bariatric surgery
E. Regular exercise regimen
B. Chronic hypertension
Why do pregnant patients develop mild respiratory alkalosis?
A. Increased RR
B. Decreased oxygen demand
C. Increased tidal volume
D. CO₂ retention
C. Increased tidal volume
First-line for nausea and vomiting of pregnancy:
A. Ondansetron
B. Metoclopramide
C. Pyridoxine + doxylamine
D. Promethazine
C. Pyridoxine + doxylamine
Which pregnant patient most warrants urgent hematology evaluation?
A. Hb 10.4 g/dL at 24 weeks
B. Hb 10.9 g/dL at 34 weeks
C. Hb 11.2 g/dL at 10 weeks
D. Hb 16.3 g/dL at 18 weeks
E. Hb 10.8 g/dL at 30 weeks
D. Hb 16.3 g/dL at 18 weeks
Best timing for fetal anatomy scan?
A. 10–12 weeks
B. 14–16 weeks
C. 18–22 weeks
D. 24–28 weeks
E. 30–32 weeks
C. 18–22 weeks
A 26-year-old primigravida at 11 weeks’ gestation comes to the clinic for her first prenatal visit. She is up to date on vaccinations. Vital signs and physical examination are unremarkable. Ultrasound confirms a normal intrauterine pregnancy. Routine prenatal laboratory studies show a negative titer for rubella; all other results are normal.
Which of the following is the best next step in management of this patient?
A. Administer measles-mumps-rubella vaccine now
B. Administer prophylactic rubella immune globulin
C. Collect amniotic fluid PCR to evaluate for fetal rubella infection
D. Recommend the measles-mumps-rubella vaccine after delivery
E. Repeat rubella titers during the second trimester
D. Recommend the measles-mumps-rubella vaccine after delivery
Which lab normally decreases due to increased GFR?
A. BUN
B. Creatinine
C. Sodium
D. Potassium
B. Creatinine
Safe antihypertensive in pregnancy:
A. Lisinopril
B. Losartan
C. Labetalol
D. Enalapril
C. Labetalol
Most common platelet count in GT:
A. 50–80K
B. 80–99K
C. 100–149K
D. 150–200K
E. >500K
C. 100–149K
A 33-year-old at 36 weeks had GBS bacteriuria earlier in pregnancy.
What is the next step?
A. Repeat GBS culture
B. No further testing
C. Plan intrapartum antibiotics
D. Give oral antibiotics now
E. Repeat urine culture
C. Plan intrapartum antibiotics
GBS bacteriuria at any time means intrapartum prophylaxis.
A 32-year-old primigravid woman comes to the office during the fall to establish prenatal care after a positive home pregnancy test. Her last menstrual period was 7 weeks ago. The patient is healthy and takes no medications. Ultrasound shows a viable intrauterine gestation. Prenatal laboratory results reveal susceptibility to rubella and varicella. She is up to date on vaccinations.
Which of the following vaccines is recommended during this patient's pregnancy?
A-Intranasal influenza
B-Measles-mumps-rubella
C-Pneumococcal
D-Tetanus-reduced diphtheria-acellular pertussis
E-Varicella
D-Tetanus-reduced diphtheria-acellular pertussis
A Cr of 1.0 mg/dL at 24 weeks most suggests:
A. Normal pregnancy
B. Mild renal insufficiency
C. Lab variation
D. Hemodilution
B. Mild renal insufficiency
High-risk patient at 14 weeks (chronic HTN). Intervention shown to reduce preeclampsia risk?
A. Bed rest
B. LMWH
C. Low-dose aspirin
D. Calcium restriction
C. Low-dose aspirin
At which gestational window is hemoglobin typically at its lowest in a normal pregnancy?
A. 8–12 weeks
B. 16–20 weeks
C. 28–36 weeks
D. 37–40 weeks
E. Immediately postpartum
C. 28–36 weeks
Max plasma expansion is more than RBC rise
A 38-year-old at 11 weeks wants the most sensitive noninvasive test for trisomy 21.
Best test?
A. First-trimester combined screening
B. Quad screen
C. Nuchal translucency alone
D. Cell-free DNA testing (NIPS)
E. Amniocentesis
D. Cell-free DNA testing (NIPS)
A 27-year-old primigravida comes to the office for a routine prenatal visit at 36 weeks gestation. The patient began having shortness of breath at the beginning of the second trimester, but her symptoms always resolved after rest. However, for the past few weeks, she has had worsening dyspnea and fatigue with minimal exertion. Blood pressure is 120/76 mm Hg, pulse is 84/min, and respirations are 20/min. Lungs are clear to auscultation bilaterally. Bilateral lower extremities have 2+ pitting edema to the midcalf. Hemoglobin is 11.1 g/dL.
Which of the following is the most likely diagnosis in this patient?
A-Iron deficiency anemia
B-Peripartum cardiomyopathy
C-Physiologic dyspnea
D-Pulmonary edema
E-Pulmonary embolism
C-Physiologic dyspnea