CHAPTER 1

Vignette 1
A 27-year-old woman comes to your
practice desiring pregnancy. She has a
history of regular, 28-day cycles and has
been using oral birth control pills for
contraception. She has had two
pregnancies in the past, one ending in
miscarriage at 9 weeks and one vaginal
delivery at 39 weeks. Her last Pap smear
was 10 months ago and she has never had
an irregular Pap. She is not taking any
medications and has no known medical
allergies.
1. On the basis of this womans obstetrical
history, find out what is her TPAL
designation?
a. G3P1011 b. G3P2001
c. G2P1011 d. G2P1101
e. G1P1001
2. Nutritional supplements she should
begin before she gets pregnant include
which of the following:
a. Folate to reduce neural tube defects
b. Vitamin B12 to increase RBC production
prior to pregnancy
c. Vitamin B1 to reduce beriberi
d. Vitamin C to reduce scurvy
e. No supplementation is necessary until
pregnancy is confirmed
3. Before leaving your office, she asks how
reliable over-the-counter (OTC) pregnancy
tests are and how quickly after conceiving
she should expect to test positive. You
inform her that:
a. urine pregnancy tests are notoriously
unreliable and that she should come in for
blood tests if she thinks she is pregnant
b. OTC tests have high sensitivity for
human placental lactogen (hPL) and will
be positive around the time of the missed
menstrual cycle

c. OTC tests have high sensitivity for hCG and will be positive around the time
of the missed period
d. OTC tests have high specificity, but low
sensitivity, so she should repeat the test
twice at home to confirm the results
e. OTC tests are typically positive the day
after conception
4. She returns to your office 2 months
later pregnant. Her initial prenatal visit
should include:
a. quad screen
b. abdominal
ultrasound
c. pelvic examination d. titer for herpes
simplex e. Leopold maneuvers
virus
(HSV)
Vignette 2
A 33-year-old G0P0 woman comes to your
office for her initial prenatal visit. She
tested positive with two home pregnancy
tests and has been experiencing breast
tenderness and mild nausea for a few
weeks. She has a history of regular
menstrual periods occurring every 28 to
30 days. This was a planned pregnancy
and is the first child for her and for her
partner.
1. Your patient was actively tracking her
menstrual cycle and is certain that the
first day of her last menstrual period (LMP)
was 12/2/11. Using Nagele rule, estimate
her date of delivery.
a. 7/5/12
b. 9/2/12
c. 9/16/12
d. 9/9/12
e. 8/26/12
2. As her pregnancy continues, you would
expect her cardiac output to increase by
which of the following mechanisms:
a. First an increase in stroke volume, then
an increase in heart rate
b. A decrease in systemic vascular
resistance
c. Cardiac output would not change
significantly until the third trimester

d. An increase in systemic vascular

resistance facilitated by elevated
progesterone levels
e. Increased heart rate alone
3. Which of the following is true regarding
the physiologic changes she might expect
during her pregnancy?
a. Gastric emptying and large bowel
motility are increased in pregnancy
b. BUN and creatinine will decrease by
25% as a result of an increase in
glomerular filtration rate (GFR), which will
be maintained until delivery
c. An overall decrease in the number of
WBC and platelets
d. Nausea and vomiting that should be
treated aggressively with antiemetics and
intravenous hydration
e. An increase in the tidal volume along
with an increase in total lung capacity
(TLC)
4. Which of the following is true regarding
hCG in your patient?
a. The corpus luteum produces hCG
throughout pregnancy
b. It is composed of two dissimilar alpha
and beta units
c. Levels double every 3 to 4 days in early
pregnancy
d. Levels peak after 24 weeks of
pregnancy
e. The alpha subunits are identical to
subunits of prolactin and human growth
hormone
5. The major function of human placental
lactogen is:
a. To cause a diuretic effect
b. To cause relaxation of smooth muscle
c. To maintain the corpus luteum in early
pregnancy
d. To act as an insulin agonist
e. To induce lipolysis and protein synthesis
leading to a constant nutrient supply to
the fetus

Vignette 3
A 36-year-old G1P0 is 31 weeks and 5
days by LMP and is sure of her dates. Her
pregnancy has been complicated by
persistent nausea and vomiting, back
pain, and lower extremity swelling. She
comes to you for a routine prenatal visit.
She had a quad screen at 16 weeks that
was normal. She is having a girl.
1. On this visit her urine is assessed for
the presence of protein, glucose, blood,
and leukocyte esterase. Which of the
following results would be most
concerning?
a. Absent leukocyte esterase
b. Negative glucose
c. Trace blood
d. 4+ protein
e. Leukocyte esterase positive
2. Her low back pain is no longer relieved
with a heating pad and she finds that she
needs pain relief to make it through each
work day. Which of the following options
would be safest for her?
a. Ibuprofen
c. Oxycodone
e. Tylenol

b. Aspirin
d. Flexeril

3. Her nausea and vomiting has extended

past the first trimester when most women
stop experiencing these symptoms. What
would suggest that she has hyperemesis
gravidarum?
a. Less than 5% loss of prepregnancy
weight
b. Jaundice
c. Syncopal episodes
d. Ketonuria
e. Metabolic acidosis
4. She has started experiencing lower
abdominal pain and tightening that occurs
infrequently (1 to 2 times per hour) and
irregularly. This is most likely:
a. a preterm labor
b. round ligament pain
c. Braxton Hicks contractions
d. an indication of fetal distress
e. related to constipation

Vignette 4
A G3P2002 woman at 35 weeks is seen in
your office for her prenatal visit. She is
concerned because she has not felt her
baby moving as much as she used to. Her
pregnancy has been uncomplicated and
her past two pregnancies ended in full
term, normal spontaneous vaginal
deliveries.
1. A biophysical profile (BPP) is done to
assess which of the following?
a. Diastolic flow in the umbilical artery
b. Lung maturity
c. Blood flow in the middle cerebral artery
d. Fetal well-being
e. Genetic abnormalities
2. An indication for early delivery is
identified, but first a test for fetal lung
maturity is done. Which of the following is
true?
a. Type I pneumocytes secrete surfactant

b. A lecithin to sphingomyelin (L/S) ratio

greater than 2 is ideal if an early delivery
is indicated
c. A low L/S ratio is associated with fewer
cases of respiratory distress syndrome
(RDS)
d. Typically, lecithin decreases as the lung
matures
e. Sphingomyelin decreases beyond 24
weeks
3. When formal antenatal testing is done,
which of the following is most reassuring?
a. Late decelerations on fetal monitoring
b. A contraction stress test (CST) with
variable fetal heart rate (FHR)
decelerations with contractions, but
moderate variability
c. A nonstress test (NST) with two
accelerations of the FHR in 20 minutes
that are at least 15 beats above baseline
and last for at least 15 seconds
d. An increase in the systolic to diastolic
ratio in the umbilical artery blood flow
e. A score of 6 on a BPP