ABFM + KSA
OBGYN
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,A 40-year-old primigravida who recently moved to your area sees you for an initial
visit at 18 weeks gestation. Her pregnancy is the result of an intrauterine insemination,
and she had an ultrasound evaluation at 6 weeks gestation. Your medical assistant
alerts you that her initial blood pressure is 164/104 mm Hg, with a repeat reading of
166/105 mm Hg 10 minutes later. The patient is on no medications other than prenatal
vitamins and feels well. Although she knows her blood pressure was measured at her
previous physician's office, she is unaware of the readings and does not remember
being told she has high blood pressure. Which of the following would be appropriate
in the management of this patient at this time? (Mark all that are true.)
A. 24-hour urine collection to assess for proteinuria
B. Lisinopril (Prinivil, Zestril), 20 mg daily
C. Atenolol (Tenormin), 50 mg daily
D. Nifedipine (Procardia), 60 mg daily
E. Bed rest
F. A and D
**Answer:** A and D
**Rationale:**
Hypertension that is detected prior to 20 weeks gestation or is known to have existed
prior to the pregnancy is considered chronic hypertension during pregnancy. It is
classified as mild (systolic blood pressure 140-159 mm Hg or diastolic blood pressure
90-109 mm Hg) or severe (systolic >160 mm Hg or diastolic >110 mm Hg). Because
,this patient is at less than 20 weeks gestation and has a blood pressure approaching
the severe range, it is appropriate to treat her blood pressure to decrease the risk of
maternal stroke. Chronic hypertension is also a risk factor for the development of
preeclampsia. It is therefore appropriate to order a 24-hour urine collection to
establish a baseline amount of protein. Elevated proteinuria above this baseline level
later in pregnancy could indicate the development of superimposed preeclampsia.
Certain illicit substances such as cocaine and methamphetamine can cause
hypertension in addition to causing adverse fetal outcomes, and a hypertensive
pregnant woman should be screened for these drugs. Chronic hypertension affects
fetal growth, and it is recommended that these patients have baseline anatomic
ultrasonography at 18-20 weeks gestation followed by serial ultrasound evaluations to
monitor fetal growth. ACE inhibitors and angiotensin receptor blockers (ARBs) are
contraindicated in all trimesters of pregnancy. ACE inhibitors have been associated
with teratogenicity, including severely underdeveloped calvarial bone, renal dysgenesis,
and pulmonary hypoplasia, as well as adverse fetal outcomes including intrauterine
growth restriction, fetal death, neonatal renal failure, oligohydramnios, anuria, and
neonatal death. ARBs have been associated with renal abnormalities, dysmorphia, and
stillbirth. While atenolol, a pure β-blocker, has been associated with fetal growth
restriction, labetalol, a combination α- and β-blocker, is considered safe in pregnancy.
Nifedipine is the most commonly studied calcium channel blocker in pregnancy and is
also an appropriate treatment of hypertension. There is no evidence that bed rest
confers any benefit in these patients.
---
, You are called to attend the precipitous delivery of a patient you have not previously
seen. When you arrive, the patient has just delivered the infant's head to the level of
the nose, but further pushing yields no progress. You apply gentle traction on the
infant's head, and deliver the remainder of the head, but not the anterior shoulder.
Appropriate measures at this point include which of the following? (Mark all that are
true.)
A. Call for additional help
B. Ask a nurse to apply fundal pressure while the patient pushes
C. Have the patient flex and abduct her hips with assistance
D. Provide supplemental oxygen to the mother
E. Attempt to rotate the infant's anterior shoulder into an oblique position
F. A, C, and E
**Answer:** A, C, and E
**Rationale:**
Shoulder dystocia is defined as a delivery in which gentle downward traction fails to
deliver the anterior shoulder, which has impacted against the symphysis pubis. The
overall incidence of shoulder dystocia increases as fetal weight increases, with an
incidence of 0.6%-1.4% in infants weighing between 2500 g and 4000 g, and 5%-9%
in infants weighing between 4000 g and 4500 g. The incidence is increased in
gestations complicated by diabetes, macrosomia, assisted vaginal delivery, abnormal
pelvic anatomy, and a protracted active first or second stage of labor. Complications
OBGYN
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,A 40-year-old primigravida who recently moved to your area sees you for an initial
visit at 18 weeks gestation. Her pregnancy is the result of an intrauterine insemination,
and she had an ultrasound evaluation at 6 weeks gestation. Your medical assistant
alerts you that her initial blood pressure is 164/104 mm Hg, with a repeat reading of
166/105 mm Hg 10 minutes later. The patient is on no medications other than prenatal
vitamins and feels well. Although she knows her blood pressure was measured at her
previous physician's office, she is unaware of the readings and does not remember
being told she has high blood pressure. Which of the following would be appropriate
in the management of this patient at this time? (Mark all that are true.)
A. 24-hour urine collection to assess for proteinuria
B. Lisinopril (Prinivil, Zestril), 20 mg daily
C. Atenolol (Tenormin), 50 mg daily
D. Nifedipine (Procardia), 60 mg daily
E. Bed rest
F. A and D
**Answer:** A and D
**Rationale:**
Hypertension that is detected prior to 20 weeks gestation or is known to have existed
prior to the pregnancy is considered chronic hypertension during pregnancy. It is
classified as mild (systolic blood pressure 140-159 mm Hg or diastolic blood pressure
90-109 mm Hg) or severe (systolic >160 mm Hg or diastolic >110 mm Hg). Because
,this patient is at less than 20 weeks gestation and has a blood pressure approaching
the severe range, it is appropriate to treat her blood pressure to decrease the risk of
maternal stroke. Chronic hypertension is also a risk factor for the development of
preeclampsia. It is therefore appropriate to order a 24-hour urine collection to
establish a baseline amount of protein. Elevated proteinuria above this baseline level
later in pregnancy could indicate the development of superimposed preeclampsia.
Certain illicit substances such as cocaine and methamphetamine can cause
hypertension in addition to causing adverse fetal outcomes, and a hypertensive
pregnant woman should be screened for these drugs. Chronic hypertension affects
fetal growth, and it is recommended that these patients have baseline anatomic
ultrasonography at 18-20 weeks gestation followed by serial ultrasound evaluations to
monitor fetal growth. ACE inhibitors and angiotensin receptor blockers (ARBs) are
contraindicated in all trimesters of pregnancy. ACE inhibitors have been associated
with teratogenicity, including severely underdeveloped calvarial bone, renal dysgenesis,
and pulmonary hypoplasia, as well as adverse fetal outcomes including intrauterine
growth restriction, fetal death, neonatal renal failure, oligohydramnios, anuria, and
neonatal death. ARBs have been associated with renal abnormalities, dysmorphia, and
stillbirth. While atenolol, a pure β-blocker, has been associated with fetal growth
restriction, labetalol, a combination α- and β-blocker, is considered safe in pregnancy.
Nifedipine is the most commonly studied calcium channel blocker in pregnancy and is
also an appropriate treatment of hypertension. There is no evidence that bed rest
confers any benefit in these patients.
---
, You are called to attend the precipitous delivery of a patient you have not previously
seen. When you arrive, the patient has just delivered the infant's head to the level of
the nose, but further pushing yields no progress. You apply gentle traction on the
infant's head, and deliver the remainder of the head, but not the anterior shoulder.
Appropriate measures at this point include which of the following? (Mark all that are
true.)
A. Call for additional help
B. Ask a nurse to apply fundal pressure while the patient pushes
C. Have the patient flex and abduct her hips with assistance
D. Provide supplemental oxygen to the mother
E. Attempt to rotate the infant's anterior shoulder into an oblique position
F. A, C, and E
**Answer:** A, C, and E
**Rationale:**
Shoulder dystocia is defined as a delivery in which gentle downward traction fails to
deliver the anterior shoulder, which has impacted against the symphysis pubis. The
overall incidence of shoulder dystocia increases as fetal weight increases, with an
incidence of 0.6%-1.4% in infants weighing between 2500 g and 4000 g, and 5%-9%
in infants weighing between 4000 g and 4500 g. The incidence is increased in
gestations complicated by diabetes, macrosomia, assisted vaginal delivery, abnormal
pelvic anatomy, and a protracted active first or second stage of labor. Complications
