OB/GYN APGO Test Bank Questions & Answers 2025
(All Correct)
A 34-year-old G1 woman at eight weeks gestation presents for prenatal care. She is
healthy and takes no medications. Family history reveals type 2 diabetes in her parents
and brothers. She is 5 feet 2 inches tall and weighs 220 pounds (BMI 40.2 kg/m2).
Which of the following is the best recommendation to screen her for gestational
diabetes?
A. No screening required
B. Screen at 24 - 28 weeks with a 50-g oral glucose challenge test
C. Screen at 16 - 20 weeks with a 50-g oral glucose challenge test
D. Screen now with a 50-g oral glucose challenge test
E. Begin an oral hypoglycemic agent now - ANSWER-D. Screening should be
performed between 24 and 28 weeks in those women not known to have glucose
intolerance earlier in pregnancy. This evaluation can be done in two steps: a 50-g oral
glucose challenge test is followed by a diagnostic 100-g oral glucose tolerance test
(OGTT) if initial results exceed a predetermined plasma glucose concentration. Patients
at low risk are not routinely screened. For those patients of average risk screening is
performed at 24 - 28 weeks while those at high risk (severe obesity and strong family
history) screening should be done as soon as feasible.
A 22-year-old G4P1 woman at 26 weeks gestation presents with a postcoital musty
odor and increased milky, gray-white discharge for the last week. This was an
unplanned pregnancy. She had her first pregnancy at age 15. She reports that she has
no new sex partners, but the father of the baby may not be monogamous. On
examination, there is a profuse discharge in the vaginal vault, which covers the cervix.
Pertinent labs: wet mount pH >4.5 and whiff test positive. Microscopic exam reveals
clue cells, but no trichomonads or hyphae. Which of the following is the most
appropriate next step in the management of this patient?
A. Delay treatment until postpartum
B. Treat her now and again during labor
C. Treat her now
D. Treat her and her partner
E. No treatment necessary - ANSWER-C. The patient has bacterial vaginosis. All
symptomatic pregnant women should be tested and treatment should be not be delayed
because treatment has reduced the incidence of preterm delivery. The optimal regimen
for women during pregnancy is not known, but the oral metronidazole regimens are
probably equally effective. Once treated antepartum, there is no need to treat during
labor unless she is reinfected.
,A 33-year-old G2P1 woman at eight weeks presents to the clinic. This is an unplanned
pregnancy. She had planned a tubal ligation six years ago when she was diagnosed
with pulmonary hypertension, but was unable to have the procedure. She states her
pulmonary hypertension has been stable, but she gets short of breath when climbing
stairs. She sleeps on one pillow at night. What is the concern for her during this
pregnancy?
A. There are no additional concerns compared to a normal pregnancy
B. She will need a Cesarean section at delivery
C. Her baby is at increased risk for pulmonary hypoplasia
D. The mother's mortality rate is above 25%
E. Epidural analgesia is contraindicated - ANSWER-D. Among women with cardiac
disease, patients with pulmonary hypertension are among the highest risk for mortality
during pregnancy, a 25-50% risk for death. Management of labor and delivery is
particularly problematic. These women are at greatest risk when there is diminished
venous return and right ventricular filling which is associated with most maternal deaths.
Similar mortality rates are seen in aortic coarctation with valve involvement and Marfan
syndrome with aortic involvement. The baby is not at increased risk of pulmonary
hypoplasia or Marfan's due to the mother's condition.
An 18-year-old G1P0 woman is seen in the clinic for a routine prenatal visit at 28 weeks
gestation. Her prenatal course has been unremarkable. She has not been taking
prenatal vitamins. Her pre-pregnancy weight was 120 pounds. Initial hemoglobin at the
first visit at eight weeks gestation was 12.3 g/dL. Current weight is 138 pounds. After
performing a screening complete blood count (CBC), the results are notable for a white
blood count 9,700/mL, hemoglobin 10.6 g/dL, mean corpuscular volume 88.2 fL (80.8 -
96.4) and platelets 215,000/mcL. The patient denies vaginal or rectal bleeding. Which of
the following is the best explanation for this patient's anemia?
A. Folate deficiency
B. Relative hemodilution of pregnancy
C. Iron deficiency
D. Beta thalassemia trait
E. Alpha thalassemia trait - ANSWER-B. There is normally a 36% increase in maternal
blood volume; the maximum is reached around 34 weeks. The plasma volume
increases 47% and the RBC mass increases only 17%. This relative dilutional effect
lowers the hemoglobin, but causes no change in the MCV. Folate deficiency results in a
macrocytic anemia. Iron deficiency and thalassemias are associated with microcytic
anemia.
A 34-year-old G3P1 woman at 26 weeks gestation reports "difficulty catching her
breath," especially after exertion for the last two months. She is a non-smoker. She
does not have any history of pulmonary or cardiac disease. She denies fever, sputum,
cough or any recent illnesses. On physical examination, her vital signs are: blood
pressure 108/64, pulse 88, respiratory rate 15, and she is afebrile. Pulse oximeter is
98% on room air. Lungs are clear to auscultation. Heart is regular rate and rhythm with
,II/VI systolic murmur heard at the upper left sternal border. She has no lower extremity
edema. A complete blood count reveals a hemoglobin of 10.0 g/dL. What is the most
likely explanation for this woman's symptoms?
A. Pulmonary embolism
B. Mitral valve stenosis
C. Physiologic dyspnea of pregnancy
D. Peripartum cardiomyopathy
E. Anemia - ANSWER-Correct answer is C. Physical examination findings are not
consistent with pulmonary embolus (e.g tachycardia, tachypnea, hypoxia, chest pain,
signs of a DVT) or mitral stenosis (diastolic murmur, signs of heart failure). Physiologic
dyspnea of pregnancy is present in up to 75% of women by the third trimester.
Peripartum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart
failure secondary to left ventricular systolic function towards the end of pregnancy or in
the several months following delivery. Symptoms include fatigue, shortness of breath,
palpitations, and edema. The history and physical do not suggest a pathologic process,
nor does her hemoglobin level.
A 24-year-old G4P2 woman at 34 weeks gestation complains of a cough and whitish
sputum for the last three days. She reports that everyone in the family has been sick.
She reports a high fever last night up to 102°F (38.9°C). She denies chest pain. She
smokes a half-pack of cigarettes per day. She has a history of asthma with no previous
intubations. She uses an albuterol inhaler, although she has not used it this week. Vital
signs are: temperature 98.6°F (37°C); respiratory rate 16; pulse 94; blood pressure
114/78; peak expiratory flow rate 430 L/min (baseline documented in the outpatient
chart = 425 L/min). On physical examination, pharyngeal mucosa is erythematous and
injected. Lungs are clear to auscultation. White blood cell count 8,700; arterial blood
gases on room air (normal ranges in parentheses): pH 7.44 (7.36 - 7.44); PO2 103 mm
Hg (>100), PCO2 26 mm Hg (28 - 32), HCO3 19 mm Hg (22 - 26). Chest x-ray is nor -
ANSWER-B. The increased minute ventilation during pregnancy causes a compensated
respiratory alkalosis. Hypoventilation results in increased PCO2 and the PO2 would be
decreased if she was hypoxic. A metabolic acidosis would have a decreased pH and a
low HCO3. The patient's symptoms are most consistent with a viral upper respiratory
infection
A 28-year-old G1P0 internal medicine resident at 34 weeks gestation wants to discuss
the values on her pulmonary function tests performed two days ago because she was
feeling slightly short of breath. She is a non-smoker, and has no personal or family
history of cardiac or respiratory disease. Vital signs are: respiratory rate 16; pulse 90,
blood pressure 112/70; oxygen saturation is 99% on room air. On physical examination:
lungs are clear; abdomen non-tender; fundal height is 34 cm. The results of the
pulmonary function tests are:
Inspiratory Capacity (IC) increased
Tidal volume (TV) increased
Minute ventilation increased
Functional reserve capacity (FRC) decreased
, Expiratory reserve capacity (ERC) decreased
Residual volume (RV) decreased
What is the next best step in the evaluation of this patient?
A. Routine antenatal care
B. Chest x-ray
C. Arterial blood gas
D. Spiral CT of the lungs
E. Echocardiogram - ANSWER-A. The results of her PFT are consistent with normal
physiologic changes in pregnancy. Inspiratory capacity increases by 15% during the
third trimester because of increases in tidal volume and inspiratory reserve volume. The
respiratory rate does not change during pregnancy, but the TV is increased which
increases the minute ventilation, which is responsible for the respiratory alkalosis in
pregnancy. Functional residual capacity is reduced to 80% of the non-pregnant volume
by term. These combined lead to subjective shortness of breath during pregnancy.
A 24-year-old G1P0 woman at 28 weeks gestation reports difficulty breathing, cough
and frothy sputum. She was admitted for preterm labor 24 hours ago. She is a non-
smoker. She has received 6 liters of Lactated Ringers solution since admission. She is
receiving magnesium sulfate and nifedipine. Vital signs are: 100.2°F (37.9°C);
respiratory rate 24; heart rate 110; blood pressure 132/85; pulse oximetry is 97% on a
non-rebreather mask. She appears in distress. Lungs reveal bibasilar crackles. Uterine
contractions are regular every three minutes. The fetal heart rate is 140 beats/minute.
Labs show white blood cell count 17,500/mL with 94% segmented neutrophils.
Potassium and sodium are normal. Which of the following has most likely contributed to
this patient's respiratory symptoms?
A. Increased plasma osmolality
B. Use of tocolytics
C. Chorioamnionitis
D. Preterm labor
E. Increased systemic vascular resistance - ANSWER-B. This patient has pulmonary
edema. Plasma osmolality is decreased during pregnancy which increases the
susceptibility to pulmonary edema. Common causes of acute pulmonary edema in
pregnancy include tocolytic use, cardiac disease, fluid overload and preeclampsia. Use
of multiple tocolytics increases the susceptibility of pulmonary edema, especially with
the use of isotonic fluids. Systemic vascular resistance is decreased during pregnancy.
Women with chorioamnionitis are also more likely to develop pulmonary edema, but this
is not usually the main cause unless the patient is in septic shock and this patient does
not have chorioamnionitis.
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
(All Correct)
A 34-year-old G1 woman at eight weeks gestation presents for prenatal care. She is
healthy and takes no medications. Family history reveals type 2 diabetes in her parents
and brothers. She is 5 feet 2 inches tall and weighs 220 pounds (BMI 40.2 kg/m2).
Which of the following is the best recommendation to screen her for gestational
diabetes?
A. No screening required
B. Screen at 24 - 28 weeks with a 50-g oral glucose challenge test
C. Screen at 16 - 20 weeks with a 50-g oral glucose challenge test
D. Screen now with a 50-g oral glucose challenge test
E. Begin an oral hypoglycemic agent now - ANSWER-D. Screening should be
performed between 24 and 28 weeks in those women not known to have glucose
intolerance earlier in pregnancy. This evaluation can be done in two steps: a 50-g oral
glucose challenge test is followed by a diagnostic 100-g oral glucose tolerance test
(OGTT) if initial results exceed a predetermined plasma glucose concentration. Patients
at low risk are not routinely screened. For those patients of average risk screening is
performed at 24 - 28 weeks while those at high risk (severe obesity and strong family
history) screening should be done as soon as feasible.
A 22-year-old G4P1 woman at 26 weeks gestation presents with a postcoital musty
odor and increased milky, gray-white discharge for the last week. This was an
unplanned pregnancy. She had her first pregnancy at age 15. She reports that she has
no new sex partners, but the father of the baby may not be monogamous. On
examination, there is a profuse discharge in the vaginal vault, which covers the cervix.
Pertinent labs: wet mount pH >4.5 and whiff test positive. Microscopic exam reveals
clue cells, but no trichomonads or hyphae. Which of the following is the most
appropriate next step in the management of this patient?
A. Delay treatment until postpartum
B. Treat her now and again during labor
C. Treat her now
D. Treat her and her partner
E. No treatment necessary - ANSWER-C. The patient has bacterial vaginosis. All
symptomatic pregnant women should be tested and treatment should be not be delayed
because treatment has reduced the incidence of preterm delivery. The optimal regimen
for women during pregnancy is not known, but the oral metronidazole regimens are
probably equally effective. Once treated antepartum, there is no need to treat during
labor unless she is reinfected.
,A 33-year-old G2P1 woman at eight weeks presents to the clinic. This is an unplanned
pregnancy. She had planned a tubal ligation six years ago when she was diagnosed
with pulmonary hypertension, but was unable to have the procedure. She states her
pulmonary hypertension has been stable, but she gets short of breath when climbing
stairs. She sleeps on one pillow at night. What is the concern for her during this
pregnancy?
A. There are no additional concerns compared to a normal pregnancy
B. She will need a Cesarean section at delivery
C. Her baby is at increased risk for pulmonary hypoplasia
D. The mother's mortality rate is above 25%
E. Epidural analgesia is contraindicated - ANSWER-D. Among women with cardiac
disease, patients with pulmonary hypertension are among the highest risk for mortality
during pregnancy, a 25-50% risk for death. Management of labor and delivery is
particularly problematic. These women are at greatest risk when there is diminished
venous return and right ventricular filling which is associated with most maternal deaths.
Similar mortality rates are seen in aortic coarctation with valve involvement and Marfan
syndrome with aortic involvement. The baby is not at increased risk of pulmonary
hypoplasia or Marfan's due to the mother's condition.
An 18-year-old G1P0 woman is seen in the clinic for a routine prenatal visit at 28 weeks
gestation. Her prenatal course has been unremarkable. She has not been taking
prenatal vitamins. Her pre-pregnancy weight was 120 pounds. Initial hemoglobin at the
first visit at eight weeks gestation was 12.3 g/dL. Current weight is 138 pounds. After
performing a screening complete blood count (CBC), the results are notable for a white
blood count 9,700/mL, hemoglobin 10.6 g/dL, mean corpuscular volume 88.2 fL (80.8 -
96.4) and platelets 215,000/mcL. The patient denies vaginal or rectal bleeding. Which of
the following is the best explanation for this patient's anemia?
A. Folate deficiency
B. Relative hemodilution of pregnancy
C. Iron deficiency
D. Beta thalassemia trait
E. Alpha thalassemia trait - ANSWER-B. There is normally a 36% increase in maternal
blood volume; the maximum is reached around 34 weeks. The plasma volume
increases 47% and the RBC mass increases only 17%. This relative dilutional effect
lowers the hemoglobin, but causes no change in the MCV. Folate deficiency results in a
macrocytic anemia. Iron deficiency and thalassemias are associated with microcytic
anemia.
A 34-year-old G3P1 woman at 26 weeks gestation reports "difficulty catching her
breath," especially after exertion for the last two months. She is a non-smoker. She
does not have any history of pulmonary or cardiac disease. She denies fever, sputum,
cough or any recent illnesses. On physical examination, her vital signs are: blood
pressure 108/64, pulse 88, respiratory rate 15, and she is afebrile. Pulse oximeter is
98% on room air. Lungs are clear to auscultation. Heart is regular rate and rhythm with
,II/VI systolic murmur heard at the upper left sternal border. She has no lower extremity
edema. A complete blood count reveals a hemoglobin of 10.0 g/dL. What is the most
likely explanation for this woman's symptoms?
A. Pulmonary embolism
B. Mitral valve stenosis
C. Physiologic dyspnea of pregnancy
D. Peripartum cardiomyopathy
E. Anemia - ANSWER-Correct answer is C. Physical examination findings are not
consistent with pulmonary embolus (e.g tachycardia, tachypnea, hypoxia, chest pain,
signs of a DVT) or mitral stenosis (diastolic murmur, signs of heart failure). Physiologic
dyspnea of pregnancy is present in up to 75% of women by the third trimester.
Peripartum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart
failure secondary to left ventricular systolic function towards the end of pregnancy or in
the several months following delivery. Symptoms include fatigue, shortness of breath,
palpitations, and edema. The history and physical do not suggest a pathologic process,
nor does her hemoglobin level.
A 24-year-old G4P2 woman at 34 weeks gestation complains of a cough and whitish
sputum for the last three days. She reports that everyone in the family has been sick.
She reports a high fever last night up to 102°F (38.9°C). She denies chest pain. She
smokes a half-pack of cigarettes per day. She has a history of asthma with no previous
intubations. She uses an albuterol inhaler, although she has not used it this week. Vital
signs are: temperature 98.6°F (37°C); respiratory rate 16; pulse 94; blood pressure
114/78; peak expiratory flow rate 430 L/min (baseline documented in the outpatient
chart = 425 L/min). On physical examination, pharyngeal mucosa is erythematous and
injected. Lungs are clear to auscultation. White blood cell count 8,700; arterial blood
gases on room air (normal ranges in parentheses): pH 7.44 (7.36 - 7.44); PO2 103 mm
Hg (>100), PCO2 26 mm Hg (28 - 32), HCO3 19 mm Hg (22 - 26). Chest x-ray is nor -
ANSWER-B. The increased minute ventilation during pregnancy causes a compensated
respiratory alkalosis. Hypoventilation results in increased PCO2 and the PO2 would be
decreased if she was hypoxic. A metabolic acidosis would have a decreased pH and a
low HCO3. The patient's symptoms are most consistent with a viral upper respiratory
infection
A 28-year-old G1P0 internal medicine resident at 34 weeks gestation wants to discuss
the values on her pulmonary function tests performed two days ago because she was
feeling slightly short of breath. She is a non-smoker, and has no personal or family
history of cardiac or respiratory disease. Vital signs are: respiratory rate 16; pulse 90,
blood pressure 112/70; oxygen saturation is 99% on room air. On physical examination:
lungs are clear; abdomen non-tender; fundal height is 34 cm. The results of the
pulmonary function tests are:
Inspiratory Capacity (IC) increased
Tidal volume (TV) increased
Minute ventilation increased
Functional reserve capacity (FRC) decreased
, Expiratory reserve capacity (ERC) decreased
Residual volume (RV) decreased
What is the next best step in the evaluation of this patient?
A. Routine antenatal care
B. Chest x-ray
C. Arterial blood gas
D. Spiral CT of the lungs
E. Echocardiogram - ANSWER-A. The results of her PFT are consistent with normal
physiologic changes in pregnancy. Inspiratory capacity increases by 15% during the
third trimester because of increases in tidal volume and inspiratory reserve volume. The
respiratory rate does not change during pregnancy, but the TV is increased which
increases the minute ventilation, which is responsible for the respiratory alkalosis in
pregnancy. Functional residual capacity is reduced to 80% of the non-pregnant volume
by term. These combined lead to subjective shortness of breath during pregnancy.
A 24-year-old G1P0 woman at 28 weeks gestation reports difficulty breathing, cough
and frothy sputum. She was admitted for preterm labor 24 hours ago. She is a non-
smoker. She has received 6 liters of Lactated Ringers solution since admission. She is
receiving magnesium sulfate and nifedipine. Vital signs are: 100.2°F (37.9°C);
respiratory rate 24; heart rate 110; blood pressure 132/85; pulse oximetry is 97% on a
non-rebreather mask. She appears in distress. Lungs reveal bibasilar crackles. Uterine
contractions are regular every three minutes. The fetal heart rate is 140 beats/minute.
Labs show white blood cell count 17,500/mL with 94% segmented neutrophils.
Potassium and sodium are normal. Which of the following has most likely contributed to
this patient's respiratory symptoms?
A. Increased plasma osmolality
B. Use of tocolytics
C. Chorioamnionitis
D. Preterm labor
E. Increased systemic vascular resistance - ANSWER-B. This patient has pulmonary
edema. Plasma osmolality is decreased during pregnancy which increases the
susceptibility to pulmonary edema. Common causes of acute pulmonary edema in
pregnancy include tocolytic use, cardiac disease, fluid overload and preeclampsia. Use
of multiple tocolytics increases the susceptibility of pulmonary edema, especially with
the use of isotonic fluids. Systemic vascular resistance is decreased during pregnancy.
Women with chorioamnionitis are also more likely to develop pulmonary edema, but this
is not usually the main cause unless the patient is in septic shock and this patient does
not have chorioamnionitis.
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
