OBGYN uwise Exam Part 1 Questions AND Correct Answers
19-year-old G1 woman presents at 28 weeks gestation for
prenatal care. Her past medical history is unremarkable
except for a splenectomy following a motor vehicle accident
four years ago. Prenatal labs today show a hemoglobin of 12
g/dL; blood type O positive; Rh negative with antibody screen
positive for Lewis (titer 1:16). What is the next best step in the
management of this pregnancy?
A. Check father of the baby's antibody status
B. Biophysical profile
C. Serial amniocentesis
D. Percutaneous umbilical blood sampling
E. Reassurance - ✔✔E. The patient should be reassured that
the fetus is not at risk even though the antibody titer is 1:16.
Lewis antibodies are IgM antibodies and do not cross the
placenta, therefore are not associated with isosensitization or
hemolytic disease of the fetus. The father of the baby does
not need to be tested nor does this unaffected fetus need a
biophysical profile. The other tests listed above are invasive
and used to monitor fetuses at risk for anemia, hydrops and
fetal death.
,29-year-old G1P0 woman at 42 weeks gestation presents in
labor. She denies ruptured membranes. Her prenatal course
was complicated by chronic hypertension. Her vital signs are:
blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2100 gm. Cervix is dilated to
4 cm, 100% effaced, +1 station. The fetal heart rate tracing is
shown below. What is the most likely diagnosis?
(fetal heart rate min after peak of CTX)
A. Normal fetal heart rate pattern
B. Sinusoidal rhythm
C. Late deceleration
D. Variable decelerations
E. Early decelerations - ✔✔C. Late decelerations are a
symmetric fall in the fetal heart rate, beginning at or after the
peak of the uterine contraction and returning to baseline only
after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable
decelerations show an acute fall in the FHR with a rapid down
slope and a variable recovery phase. They are
characteristically variable in duration, intensity, and timing,
and may not bear a constant relationship to uterine
contractions. Early decelerations are physiologic caused by
,fetal head compression during uterine contraction, resulting
in vagal stimulation and slowing of the heart rate. This type of
deceleration has a uniform shape, with a slow onset that
coincides with the start of the contraction and a slow return
to the baseline that coincides with the end of the contraction.
Thus, it has the characteristic mirror image of the contraction.
The true sinusoidal pattern is a regular, smooth, undulating
form typical of a sine wave that occurs with a frequency of
two to five cycles/minute and an amplitude range of five to 15
beats per minute. It is also characterized by a stable baseline
heart rate of 120 to 160 beats per minute and absent beat-to-
beat variability.
32-year-old G1P1 is status post uncomplicated normal
spontaneous vaginal delivery. She is taking sertraline (Zoloft),
a selective serotonin uptake inhibitor (SSRI) as an
antidepressant and wants to breastfeed. What is the next best
step in management of this patient?
A. Decrease her SSRI dose by 50%, since these drugs are
concentrated in the breast milk
B. Consult psychiatry about changing medications and discard
the expressed milk in the meantime
C. Discontinue the medications so she can breastfeed
, D. Increase her SSRI dose, since these drugs are not
concentrated in the breast milk and she is at great risk for
postpartum depression
E. Continue the medications, since there is negligible risk for
the newborn - ✔✔E. Breastfeeding is beneficial to both
mother and infant. Current recommendations state that SSRI
medications can be safely used during lactation. Several
studies show that SSRIs are secreted in breast milk, however
no detectable levels of the drug were found in the infants'
serum. In addition, no adverse effects were noted in the
infants by either their parents or pediatricians following the
infants.
A 12-year-old girl is brought to the office by her mother who
complains that her daughter has never been interested in
dolls and pretty dresses, but prefers to play with tools and
mechanical things. The mother also divulges that her brother
is gay and is worried that her daughter will grow up as a
lesbian and be stigmatized. A private conversation with the
girl reveals that she is starting to show an interest in boys, and
even has a "boyfriend." Examination reveals a normal pre-
pubertal phenotype. Which of the following is the most
appropriate course of action at this time?
A. Encourage mother to support more gender-appropriate
activities including dressing like and playing with other girls
19-year-old G1 woman presents at 28 weeks gestation for
prenatal care. Her past medical history is unremarkable
except for a splenectomy following a motor vehicle accident
four years ago. Prenatal labs today show a hemoglobin of 12
g/dL; blood type O positive; Rh negative with antibody screen
positive for Lewis (titer 1:16). What is the next best step in the
management of this pregnancy?
A. Check father of the baby's antibody status
B. Biophysical profile
C. Serial amniocentesis
D. Percutaneous umbilical blood sampling
E. Reassurance - ✔✔E. The patient should be reassured that
the fetus is not at risk even though the antibody titer is 1:16.
Lewis antibodies are IgM antibodies and do not cross the
placenta, therefore are not associated with isosensitization or
hemolytic disease of the fetus. The father of the baby does
not need to be tested nor does this unaffected fetus need a
biophysical profile. The other tests listed above are invasive
and used to monitor fetuses at risk for anemia, hydrops and
fetal death.
,29-year-old G1P0 woman at 42 weeks gestation presents in
labor. She denies ruptured membranes. Her prenatal course
was complicated by chronic hypertension. Her vital signs are:
blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2100 gm. Cervix is dilated to
4 cm, 100% effaced, +1 station. The fetal heart rate tracing is
shown below. What is the most likely diagnosis?
(fetal heart rate min after peak of CTX)
A. Normal fetal heart rate pattern
B. Sinusoidal rhythm
C. Late deceleration
D. Variable decelerations
E. Early decelerations - ✔✔C. Late decelerations are a
symmetric fall in the fetal heart rate, beginning at or after the
peak of the uterine contraction and returning to baseline only
after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable
decelerations show an acute fall in the FHR with a rapid down
slope and a variable recovery phase. They are
characteristically variable in duration, intensity, and timing,
and may not bear a constant relationship to uterine
contractions. Early decelerations are physiologic caused by
,fetal head compression during uterine contraction, resulting
in vagal stimulation and slowing of the heart rate. This type of
deceleration has a uniform shape, with a slow onset that
coincides with the start of the contraction and a slow return
to the baseline that coincides with the end of the contraction.
Thus, it has the characteristic mirror image of the contraction.
The true sinusoidal pattern is a regular, smooth, undulating
form typical of a sine wave that occurs with a frequency of
two to five cycles/minute and an amplitude range of five to 15
beats per minute. It is also characterized by a stable baseline
heart rate of 120 to 160 beats per minute and absent beat-to-
beat variability.
32-year-old G1P1 is status post uncomplicated normal
spontaneous vaginal delivery. She is taking sertraline (Zoloft),
a selective serotonin uptake inhibitor (SSRI) as an
antidepressant and wants to breastfeed. What is the next best
step in management of this patient?
A. Decrease her SSRI dose by 50%, since these drugs are
concentrated in the breast milk
B. Consult psychiatry about changing medications and discard
the expressed milk in the meantime
C. Discontinue the medications so she can breastfeed
, D. Increase her SSRI dose, since these drugs are not
concentrated in the breast milk and she is at great risk for
postpartum depression
E. Continue the medications, since there is negligible risk for
the newborn - ✔✔E. Breastfeeding is beneficial to both
mother and infant. Current recommendations state that SSRI
medications can be safely used during lactation. Several
studies show that SSRIs are secreted in breast milk, however
no detectable levels of the drug were found in the infants'
serum. In addition, no adverse effects were noted in the
infants by either their parents or pediatricians following the
infants.
A 12-year-old girl is brought to the office by her mother who
complains that her daughter has never been interested in
dolls and pretty dresses, but prefers to play with tools and
mechanical things. The mother also divulges that her brother
is gay and is worried that her daughter will grow up as a
lesbian and be stigmatized. A private conversation with the
girl reveals that she is starting to show an interest in boys, and
even has a "boyfriend." Examination reveals a normal pre-
pubertal phenotype. Which of the following is the most
appropriate course of action at this time?
A. Encourage mother to support more gender-appropriate
activities including dressing like and playing with other girls
