OB/GYN APGO Exam Questions and Detailed Answers | Actual Exam | Already Verified Answers

A 42-year-old G5P4 woman at eight weeks gestation presents for her first prenatal appointment. She has glycosuria noted on urine dipstick in the office. She has a history of four prior vaginal deliveries at full-term with birth weights ranging from 9 to 10.5 pounds. Family history is positive for type 2 diabetes in her mother and two siblings. Weight is 265 pounds and height is 5 feet 4 inches (BMI is 45.5 kg/m2). Which of the following recommendations concerning weight gain during this pregnancy is most appropriate? A. Maintain current weight B. Gain 11 - 20 pounds C. Gain 15 - 25 pounds D. Gain 25 - 35 pounds E. Gain 28 - 40 pounds ----CORRECT ANSWER-------B. The Institute of Medicine (IOM) has developed guidelines (2009) on weight gain in pregnancy. Historical data show that women who gained within the IOM guidelines experienced better outcomes of pregnancy than those who did not. The recommendations are: underweight (BMI 18.5 kg/m2) total weight gain 28 - 40 pounds; normal weight (BMI 18.5 - 24.9 kg/m2) total weight gain 25 - 35 pounds; overweight (BMI 25 - 29.9 kg/m2) total weight gain 15 - 25 pounds; and obese (BMI 30 kg/m2) total weight gain 11 - 20 pounds. A 17-year-old G2P0 female has severe right lower quadrant pain. Her last normal menstrual period seven weeks ago. She notes that last night she began having suprapubic pain that radiated to her right lower quadrant. This morning, the pain awoke her from sleep. She has had no vaginal bleeding, no nausea or vomiting. The patient's history is notable for two first trimester elective abortions and a history of Chlamydia treated twice. Vital signs are: blood pressure 90/60; pulse 99; respirations 22; and temperature 98.6°F (37°C). On physical exam, the patient is noted to be curled on a stretcher in a fetal position and says she hurts too much to move. She has rebound and voluntary guarding on abdominal examination. She has profound cervical motion tenderness and rectal tenderness. Her Beta-hCG level is 2500 mIU/ml; hematocrit 24%; and urinalysis negative. Ultrasound shows no intrauterine pregnancy, a right adnexal mass that measures 6 x 2 cm, and a moderate amount of free fluid. Which of the following is the most appropriate next step in the management of this patient? A. Admit for serial examinations B. Exploratory surgery C. Recheck Beta-hCG level in 48 hours D. Administer methotrexate E. Dilation and curettage ----CORRECT ANSWER-------B. This patient has a ruptured ectopic pregnancy until proven otherwise. Her vital signs, examination and anemia are consistent with an intra-abdominal bleed. Exploratory laparoscopy/laparotomy is indicated at this point. Conservative management with observation, serial examinations or repeat Beta-hCG testing could be dangerous in a patient suspected of having a ruptured ectopic pregnancy. Medical management (methotrexate) is not used in a patient with an acute surgical abdomen. Dilation and curettage would not be the next step in management and might only be considered in this scenario after the patient's abdomen was explored.