OBGYN Shelf Exam (uWISE) Test
Bank. Newest 2025-2026. Questions &
Correct Verified Answers. Graded A
19-year-old G1 woman at 36 weeks gestation presents for her first prenatal
visit, stating she was recently diagnosed with HIV after her former partner
tested positive. The HIV Western Blot is positive. The CD4 count is 612
cells/µl. The viral load is 9,873 viral particles per ml of patient serum. Which
of the management options would best decrease the risk for perinatal
transmission of HIV?
A. Treatment with intravenous zidovudine at the time of delivery
B. Treatment of the newborn with oral zidovudine only if HIV-positive
C. One week maternal treatment with zidovudine now
D. Cesarean section in second stage of labor
E. Single drug therapy to minimize drug resistance - ANSA. Antiretroviral
therapy should be offered to all HIV-infected pregnant women to begin
maternal treatment as well as to reduce the risk of perinatal transmission
regardless of CD4+ T-cell count or HIV RNA level. The baseline
transmission rate of HIV to newborns can be reduced from about 25% to
2% with the HAART (highly active antiretroviral therapy) protocol
antepartum and continuing through delivery with intravenous zidovudine in
labor and zidovudine treatment for the neonate. Cesarean section prior to
labor can reduce this rate to 2% (although the benefit is less clear in
women with viral loads).
,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 - ANSE. 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 - ANSC. 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 -
ANSE. 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?
Bank. Newest 2025-2026. Questions &
Correct Verified Answers. Graded A
19-year-old G1 woman at 36 weeks gestation presents for her first prenatal
visit, stating she was recently diagnosed with HIV after her former partner
tested positive. The HIV Western Blot is positive. The CD4 count is 612
cells/µl. The viral load is 9,873 viral particles per ml of patient serum. Which
of the management options would best decrease the risk for perinatal
transmission of HIV?
A. Treatment with intravenous zidovudine at the time of delivery
B. Treatment of the newborn with oral zidovudine only if HIV-positive
C. One week maternal treatment with zidovudine now
D. Cesarean section in second stage of labor
E. Single drug therapy to minimize drug resistance - ANSA. Antiretroviral
therapy should be offered to all HIV-infected pregnant women to begin
maternal treatment as well as to reduce the risk of perinatal transmission
regardless of CD4+ T-cell count or HIV RNA level. The baseline
transmission rate of HIV to newborns can be reduced from about 25% to
2% with the HAART (highly active antiretroviral therapy) protocol
antepartum and continuing through delivery with intravenous zidovudine in
labor and zidovudine treatment for the neonate. Cesarean section prior to
labor can reduce this rate to 2% (although the benefit is less clear in
women with viral loads).
,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 - ANSE. 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 - ANSC. 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 -
ANSE. 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?
