OB/GYN APGO LATEST EXAM 2025
QUESTIONS AND DETAILED CORRECT
ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) | A+ GRADE
STUDY GUIDE
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 increa Correct
Answer 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 Correct Answer
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
D. Initiate propylthiouracil
E. Initiate methimazole Correct Answer A. Thyroid
binding globulin (TBG) is increased due to increased
circulating estrogens with a concomitant increase in
the total thyroxine. Free thyroxine (T4) remains
, relatively constant. Total triiodothyroxine (T3) levels
also increase in pregnancy while free T3 levels do not
change. In a pregnant patient without iodine
deficiency, the thyroid gland may increase in size up
to 10%. This patient's thyroid function is normal for
pregnancy, and her symptoms of fatigue can be
explained by other physiologic changes in pregnancy,
including anemia, difficulty with sleep, and increase
metabolic demand.
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;
QUESTIONS AND DETAILED CORRECT
ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) | A+ GRADE
STUDY GUIDE
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 increa Correct
Answer 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 Correct Answer
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
D. Initiate propylthiouracil
E. Initiate methimazole Correct Answer A. Thyroid
binding globulin (TBG) is increased due to increased
circulating estrogens with a concomitant increase in
the total thyroxine. Free thyroxine (T4) remains
, relatively constant. Total triiodothyroxine (T3) levels
also increase in pregnancy while free T3 levels do not
change. In a pregnant patient without iodine
deficiency, the thyroid gland may increase in size up
to 10%. This patient's thyroid function is normal for
pregnancy, and her symptoms of fatigue can be
explained by other physiologic changes in pregnancy,
including anemia, difficulty with sleep, and increase
metabolic demand.
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;
