OBGYN COMAT EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2025-2026
Young Mother 32 weeks pregnant presents with normal EKG but abnormally positioned heart,
how should this be handled? - Answers This sounds like normal physiologic displacement of the
maternal heart in pregnancy.
The earliest and most dramatic physiologic changes in the mother in pregnancy are? - Answers
Cardiovascular
Aim to improve fetal oxygenation and nutrition
Maternal heart moves more lateral due to diaphragm elevation
Left ventricle and atrium muscle mass increases in relation to blood volume increase.
Cardiac Output increases 30-50% By about 8 weeks
Systemic Vascular Resistance Decreases due to Progesterone.
Young Mother in late pregnancy presents with huge decrease in CO due to obstruction, explain?
- Answers Most likely Vena Caval syndrome
Enlarging uterus has compressed the inferior Vena Cava.
In the supine station, the obstruction can be close to 100%
1/10 women can present with dizziness and light-headedness and syncopy.
At term what percent of the CO goes to the uterus? - Answers About 20%, thus increasing the
risk of postpartum hemorrhage.
Normal cardiac findings during pregnancy? - Answers Increased Splitting of the second heart
sound with inspiration, distended neck veins and low grade ejection systolic murmurs
( Increased blood flow across the aortic and mitral valves.
What heart findings are not normal and need to be evaluated? - Answers Diastolic murmurs
100% are not good in pregnancy
Young Mother weeks pregnant presents with recurrent "Flu Like Symptoms", Explain this? -
Answers This could be something completely normal. Allergy, due to mucosal hypermeia like
symptoms nasal stuffiness and secretions.
Hematologic changes during pregnancy? - Answers Maternal blood volume increases about
35% by term.
Can Cause a physiologic anemia. but all anemia needs to be treated.
Fe needs to be supplemented during pregnancy becasue the fetus will leach the Fe from the
,mother.
Non-anemic women needs 60mg Fe/day.
60mg of Fe is a dosage of 325mg.
Anemia pt needs about 60 - 120 mg Fe/day
Clotting Factors are increased VII, VIII, IX and X. Inhibitors of clotting like C and S are decreased.
Oxygen carrying capacity changes? - Answers Maternal increase in Hbg and the mild respiratory
alkalosis cause a left shift in the dissociation curve meaning the maternal Hbg has an increases
affinity for O2 in the lungs but not in the tissues so more O2 is given of to the placenta.
Renal physiologic changes? - Answers There is increased renal plasma flow and thus increased
GFR.
This means that Trace amount of Glucose is normal and most likely doesn't mean glycemia
pathology. But it should be watched fro a trend.
There should not be any increase in urinary protein loss.
There is also a decrease in the Cr normal is about 0.4 to 0.8, any higher and I might get
suspicious.
Gastrointestinal Functional Changes - Answers Generalized Smooth muscle relaxation meaning
the LES tone, decreased GI motility and increased Gal Bladder tone DUE TO PROGESTERONE.
GI Diagnostic test alterations in pregnancy - Answers ALK PHOS x 2
Cholesterol increased
Pregnancy induced Thyroid function? - Answers Overall its a Euthyroid state despite the
changes.
Glad enlarges but not goiter like
hCG in the first trimester is like Thyrotropin and stimulates T4 but hCG declines and normalizes
T4
Estrogen induces the levels of Thyroxine binding globulin which binds free t3 and t4, this could
alter the free amount of hormone.
Changes of Metabolism during pregnancy? - Answers hPL acts as a diabetagenic that reduces
the body's sensitivity to insulin, which can cause hyperglycemia after meals.
Skin changes in pregnancy? - Answers All are due to the hunge increase in Estrogen
, Palmar Erythema
Striae gravidarum
Skin darkening lina alba
Skin Nevi can also increase in size and color but should regress after pregnancy. You should
still consider removing them due to risk of malignancy.
Increased Acne due to increased Sebum production.
Loss of hair that will return to normal 6 months post delivery.
What Disease screen should always be performed on a pregnant female unless she declines? -
Answers HIV
It should also be offered to women who think they will become pregnant.
What is the best type of urine for a urine pregnancy test? - Answers Early morning urine will have
the highest hCG.
The Naegele rule - Answers Way to calculate the EDD
Add 7 days to the first day of the last normal menstrual flow and subtract 3 months
Normal fetal HR range? - Answers 110 to 160 bpm
What is the best lab test to determine premature labor, and what physical exam finding helps
determine premature labor? - Answers Fetal Fibronectin
pt with a negative fFN have less than 1% chance of going into labor within two weeks.
The physical exam finding is Cervical change, ie a decrease in cervical length.
Rotterdam Criteria for diagnosing PCOS? - Answers 2 of the 3 are needed
1. Multiple follicles on each ovary ( About 12) via US
2. Oligo/ An ovulation
3. Signs of increased androgens.
24 -28 week glucose tolerance test results - Answers 1hr 50g should be <140
or two of the following
3hr 100g
1hr >180
Young Mother 32 weeks pregnant presents with normal EKG but abnormally positioned heart,
how should this be handled? - Answers This sounds like normal physiologic displacement of the
maternal heart in pregnancy.
The earliest and most dramatic physiologic changes in the mother in pregnancy are? - Answers
Cardiovascular
Aim to improve fetal oxygenation and nutrition
Maternal heart moves more lateral due to diaphragm elevation
Left ventricle and atrium muscle mass increases in relation to blood volume increase.
Cardiac Output increases 30-50% By about 8 weeks
Systemic Vascular Resistance Decreases due to Progesterone.
Young Mother in late pregnancy presents with huge decrease in CO due to obstruction, explain?
- Answers Most likely Vena Caval syndrome
Enlarging uterus has compressed the inferior Vena Cava.
In the supine station, the obstruction can be close to 100%
1/10 women can present with dizziness and light-headedness and syncopy.
At term what percent of the CO goes to the uterus? - Answers About 20%, thus increasing the
risk of postpartum hemorrhage.
Normal cardiac findings during pregnancy? - Answers Increased Splitting of the second heart
sound with inspiration, distended neck veins and low grade ejection systolic murmurs
( Increased blood flow across the aortic and mitral valves.
What heart findings are not normal and need to be evaluated? - Answers Diastolic murmurs
100% are not good in pregnancy
Young Mother weeks pregnant presents with recurrent "Flu Like Symptoms", Explain this? -
Answers This could be something completely normal. Allergy, due to mucosal hypermeia like
symptoms nasal stuffiness and secretions.
Hematologic changes during pregnancy? - Answers Maternal blood volume increases about
35% by term.
Can Cause a physiologic anemia. but all anemia needs to be treated.
Fe needs to be supplemented during pregnancy becasue the fetus will leach the Fe from the
,mother.
Non-anemic women needs 60mg Fe/day.
60mg of Fe is a dosage of 325mg.
Anemia pt needs about 60 - 120 mg Fe/day
Clotting Factors are increased VII, VIII, IX and X. Inhibitors of clotting like C and S are decreased.
Oxygen carrying capacity changes? - Answers Maternal increase in Hbg and the mild respiratory
alkalosis cause a left shift in the dissociation curve meaning the maternal Hbg has an increases
affinity for O2 in the lungs but not in the tissues so more O2 is given of to the placenta.
Renal physiologic changes? - Answers There is increased renal plasma flow and thus increased
GFR.
This means that Trace amount of Glucose is normal and most likely doesn't mean glycemia
pathology. But it should be watched fro a trend.
There should not be any increase in urinary protein loss.
There is also a decrease in the Cr normal is about 0.4 to 0.8, any higher and I might get
suspicious.
Gastrointestinal Functional Changes - Answers Generalized Smooth muscle relaxation meaning
the LES tone, decreased GI motility and increased Gal Bladder tone DUE TO PROGESTERONE.
GI Diagnostic test alterations in pregnancy - Answers ALK PHOS x 2
Cholesterol increased
Pregnancy induced Thyroid function? - Answers Overall its a Euthyroid state despite the
changes.
Glad enlarges but not goiter like
hCG in the first trimester is like Thyrotropin and stimulates T4 but hCG declines and normalizes
T4
Estrogen induces the levels of Thyroxine binding globulin which binds free t3 and t4, this could
alter the free amount of hormone.
Changes of Metabolism during pregnancy? - Answers hPL acts as a diabetagenic that reduces
the body's sensitivity to insulin, which can cause hyperglycemia after meals.
Skin changes in pregnancy? - Answers All are due to the hunge increase in Estrogen
, Palmar Erythema
Striae gravidarum
Skin darkening lina alba
Skin Nevi can also increase in size and color but should regress after pregnancy. You should
still consider removing them due to risk of malignancy.
Increased Acne due to increased Sebum production.
Loss of hair that will return to normal 6 months post delivery.
What Disease screen should always be performed on a pregnant female unless she declines? -
Answers HIV
It should also be offered to women who think they will become pregnant.
What is the best type of urine for a urine pregnancy test? - Answers Early morning urine will have
the highest hCG.
The Naegele rule - Answers Way to calculate the EDD
Add 7 days to the first day of the last normal menstrual flow and subtract 3 months
Normal fetal HR range? - Answers 110 to 160 bpm
What is the best lab test to determine premature labor, and what physical exam finding helps
determine premature labor? - Answers Fetal Fibronectin
pt with a negative fFN have less than 1% chance of going into labor within two weeks.
The physical exam finding is Cervical change, ie a decrease in cervical length.
Rotterdam Criteria for diagnosing PCOS? - Answers 2 of the 3 are needed
1. Multiple follicles on each ovary ( About 12) via US
2. Oligo/ An ovulation
3. Signs of increased androgens.
24 -28 week glucose tolerance test results - Answers 1hr 50g should be <140
or two of the following
3hr 100g
1hr >180
