hCG and will be positive around the time Vignette 1 of the missed period A 27-year-old woman comes to your d. OTC tests have high specificity, but low practice desiring pregnancy. She has a sensitivity, so she should repeat the test history of regular, 28-day cycles and has twice at home to confirm the results been using oral birth control pills for e. OTC tests are typically positive the day contraception. She has had two after conception pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal 4. She returns to your office 2 months delivery at 39 weeks. Her last Pap smear later pregnant. Her initial prenatal visit was 10 months ago and she has never had should include: an irregular Pap. She is not taking any a. quad screen b. abdominal medications and has no known medical ultrasound allergies. c. pelvic examination d. titer for herpes 1. On the basis of this womans obstetrical simplex e. Leopold maneuvers virus history, find out what is her TPAL (HSV) designation? a. G3P1011 b. G3P2001 Vignette 2 c. G2P1011 d. G2P1101 A 33-year-old G0P0 woman comes to your e. G1P1001 office for her initial prenatal visit. She tested positive with two home pregnancy 2. Nutritional supplements she should tests and has been experiencing breast begin before she gets pregnant include tenderness and mild nausea for a few which of the following: weeks. She has a history of regular menstrual periods occurring every 28 to a. Folate to reduce neural tube defects 30 days. This was a planned pregnancy b. Vitamin B12 to increase RBC production and is the first child for her and for her prior to pregnancy partner. c. Vitamin B1 to reduce beriberi d. Vitamin C to reduce scurvy 1. Your patient was actively tracking her e. No supplementation is necessary until menstrual cycle and is certain that the pregnancy is confirmed first day of her last menstrual period (LMP) was 12/2/11. Using Nagele rule, estimate 3. Before leaving your office, she asks how her date of delivery. reliable over-the-counter (OTC) pregnancy a. 7/5/12 b. 9/2/12 tests are and how quickly after conceiving c. 9/16/12 d. 9/9/12 she should expect to test positive. You e. 8/26/12 inform her that: 2. As her pregnancy continues, you would a. urine pregnancy tests are notoriously expect her cardiac output to increase by unreliable and that she should come in for which of the following mechanisms: blood tests if she thinks she is pregnant a. First an increase in stroke volume, then b. OTC tests have high sensitivity for an increase in heart rate human placental lactogen (hPL) and will b. A decrease in systemic vascular be positive around the time of the missed resistance menstrual cycle c. Cardiac output would not change significantly until the third trimester d. An increase in systemic vascular resistance facilitated by elevated Vignette 3 progesterone levels A 36-year-old G1P0 is 31 weeks and 5 days by LMP and is sure of her dates. Her e. Increased heart rate alone pregnancy has been complicated by persistent nausea and vomiting, back 3. Which of the following is true regarding pain, and lower extremity swelling. She the physiologic changes she might expect comes to you for a routine prenatal visit. during her pregnancy? She had a quad screen at 16 weeks that was normal. She is having a girl. a. Gastric emptying and large bowel 1. On this visit her urine is assessed for motility are increased in pregnancy the presence of protein, glucose, blood, b. BUN and creatinine will decrease by and leukocyte esterase. Which of the 25% as a result of an increase in following results would be most glomerular filtration rate (GFR), which will concerning? be maintained until delivery c. An overall decrease in the number of a. Absent leukocyte esterase WBC and platelets b. Negative glucose c. Trace blood d. Nausea and vomiting that should be d. 4+ protein treated aggressively with antiemetics and e. Leukocyte esterase positive intravenous hydration 2. Her low back pain is no longer relieved e. An increase in the tidal volume along with a heating pad and she finds that she with an increase in total lung capacity needs pain relief to make it through each (TLC) work day. Which of the following options would be safest for her? 4. Which of the following is true regarding a. Ibuprofen b. Aspirin hCG in your patient? c. Oxycodone d. Flexeril e. Tylenol a. The corpus luteum produces hCG throughout pregnancy 3. Her nausea and vomiting has extended b. It is composed of two dissimilar alpha past the first trimester when most women and beta units stop experiencing these symptoms. What would suggest that she has hyperemesis c. Levels double every 3 to 4 days in early gravidarum? pregnancy d. Levels peak after 24 weeks of a. Less than 5% loss of prepregnancy pregnancy weight e. The alpha subunits are identical to b. Jaundice subunits of prolactin and human growth c. Syncopal episodes hormone d. Ketonuria e. Metabolic acidosis 5. The major function of human placental lactogen is: 4. She has started experiencing lower abdominal pain and tightening that occurs a. To cause a diuretic effect infrequently (1 to 2 times per hour) and b. To cause relaxation of smooth muscle irregularly. This is most likely: c. To maintain the corpus luteum in early pregnancy a. a preterm labor d. To act as an insulin agonist b. round ligament pain e. To induce lipolysis and protein synthesis c. Braxton Hicks contractions leading to a constant nutrient supply to d. an indication of fetal distress the fetus e. related to constipation b. A lecithin to sphingomyelin (L/S) ratio Vignette 4 greater than 2 is ideal if an early delivery is indicated A G3P2002 woman at 35 weeks is seen in c. A low L/S ratio is associated with fewer your office for her prenatal visit. She is cases of respiratory distress syndrome concerned because she has not felt her (RDS) baby moving as much as she used to. Her d. Typically, lecithin decreases as the lung pregnancy has been uncomplicated and matures her past two pregnancies ended in full e. Sphingomyelin decreases beyond 24 term, normal spontaneous vaginal weeks deliveries. 3. When formal antenatal testing is done, 1. A biophysical profile (BPP) is done to which of the following is most reassuring? assess which of the following? a. Late decelerations on fetal monitoring a. Diastolic flow in the umbilical artery b. A contraction stress test (CST) with b. Lung maturity variable fetal heart rate (FHR) c. Blood flow in the middle cerebral artery decelerations with contractions, but d. Fetal well-being moderate variability e. Genetic abnormalities c. A nonstress test (NST) with two accelerations of the FHR in 20 minutes 2. An indication for early delivery is that are at least 15 beats above baseline identified, but first a test for fetal lung and last for at least 15 seconds maturity is done. Which of the following is d. An increase in the systolic to diastolic true? ratio in the umbilical artery blood flow e. A score of 6 on a BPP a. Type I pneumocytes secrete surfactant