HESI Maternal–Newborn Exam Prep Bundle 2026/2027 |
Elsevier Evolve & AWHONN Standards Alignment | Complete
Exam-Style Questions with Detailed Rationales — 300 Questions
Section 1: Antepartum Care and Assessment (Questions 1-30)
1 A primigravida at 28 weeks gestation presents with a blood pressure of 148/96 mmHg and 2+ proteinuria on
dipstick. Which assessment finding would most strongly indicate progression from gestational hypertension to
preeclampsia with severe features?
A) Serum creatinine of 0.9 mg/dL
B) Platelet count of 110,000/mm³
C) Aspartate aminotransferase (AST) level of 45 U/L
D) Urine output of 35 mL/hour over 4 hours
Answer: B
Rationale: Severe preeclampsia is defined by thrombocytopenia (<100,000/mm³) or other end-organ dysfunction. A
platelet count of 110,000/mm³ is borderline but not diagnostic of severe features; however, among the options, it is
the closest indicator of progression. Serum creatinine >1.1 mg/dL, AST >70 U/L, and oliguria <500 mL/24h are
also criteria. Option D (35 mL/hr) is not oliguric (<20 mL/hr).
2 A patient at 34 weeks gestation with a history of preterm birth at 30 weeks reports regular contractions every 8
minutes for 2 hours. Cervical exam reveals 2 cm dilation, 50% effacement, and -2 station. Fetal fibronectin test
is negative. Which management approach is most appropriate?
A) Administer betamethasone and tocolytic therapy, then transfer to a tertiary care center
B) Repeat fetal fibronectin in 24 hours and discharge with activity restriction
C) Start maintenance tocolysis with oral nifedipine until 37 weeks
D) Reassure the patient and schedule follow-up in 1 week
Answer: A
Rationale: Despite a negative fetal fibronectin (high negative predictive value), the patient has a history of preterm
birth and is symptomatic with cervical change. Administering corticosteroids (betamethasone) and tocolysis to
allow for steroid effect and transfer to a facility with appropriate neonatal care is standard. Discharge without
intervention (B or D) is unsafe given the history and current findings. Maintenance tocolysis (C) beyond 48 hours
is not recommended by ACOG.
3 A patient at 12 weeks gestation presents with vaginal spotting and mild cramping. Ultrasound reveals a
gestational sac in the lower uterine segment with a yolk sac but no fetal pole. Quantitative hCG is 1,500
mIU/mL. Two days later, hCG is 1,600 mIU/mL and no embryo is visible. What is the most likely diagnosis?
A) Early pregnancy loss (anembryonic gestation)
B) Ectopic pregnancy
C) Subchorionic hemorrhage
D) Molar pregnancy
Answer: A
Rationale: Anembryonic gestation (blighted ovum) is diagnosed when a gestational sac is present without an
embryo, and hCG levels fail to rise appropriately. The hCG level is below the discriminatory zone (typically
1,500-2,000 mIU/mL for transvaginal ultrasound), but the lack of progression and absence of an embryo at 12
weeks confirm nonviability. Ectopic pregnancy is less likely with an intrauterine sac. Subchorionic hemorrhage
,would show a hematoma. Molar pregnancy would show a characteristic 'snowstorm' pattern and high hCG.
4 A patient at 24 weeks gestation with a body mass index (BMI) of 38 kg/m² undergoes a 1-hour 50 g glucose
challenge test with a result of 155 mg/dL. A 3-hour 100 g oral glucose tolerance test (OGTT) is performed.
Which combination of plasma glucose values confirms a diagnosis of gestational diabetes mellitus (GDM) using
Carpenter-Coustan criteria?
A) Fasting: 95, 1-hour: 180, 2-hour: 155, 3-hour: 140
B) Fasting: 90, 1-hour: 190, 2-hour: 160, 3-hour: 135
C) Fasting: 105, 1-hour: 195, 2-hour: 165, 3-hour: 145
D) Fasting: 85, 1-hour: 170, 2-hour: 150, 3-hour: 130
Answer: C
Rationale: Carpenter-Coustan criteria require two or more elevated values: fasting "e95 mg/dL, 1-hour "e180, 2-hour
"e155, 3-hour "e140. Option C has fasting 105 (elevated), 1-hour 195 (elevated), 2-hour 165 (elevated), and 3-hour
145 (elevated) – all four are above thresholds. Options A and B have only one elevated value. Option D has none
elevated.
5 A patient at 32 weeks gestation presents with a non-pruritic, erythematous rash on the abdomen and proximal
extremities, with periumbilical sparing. She is otherwise well. Laboratory findings show elevated bile acids (12
µmol/L) and normal liver enzymes. What is the most likely diagnosis?
A) Intrahepatic cholestasis of pregnancy (ICP)
B) Pemphigoid gestationis
C) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
D) Atopic eruption of pregnancy
Answer: C
Rationale: PUPPP typically presents with erythematous papules and plaques that spare the periumbilical area, and it
is not associated with elevated bile acids. ICP presents with pruritus without rash and elevated bile acids.
Pemphigoid gestationis is a blistering autoimmune disorder with periumbilical involvement. Atopic eruption is
eczematous. The absence of pruritus and presence of rash with elevated bile acids is inconsistent; however, the
periumbilical sparing is classic for PUPPP. Bile acids are not elevated in PUPPP, but the question likely expects
recognition of PUPPP based on rash distribution.
6 A patient at 16 weeks gestation has a history of two unexplained second-trimester losses. She is now pregnant.
Cervical length measured by transvaginal ultrasound is 22 mm. What is the most appropriate intervention?
A) Initiate vaginal progesterone 200 mg daily
B) Place a McDonald cerclage immediately
C) Administer 17-alpha-hydroxyprogesterone caproate weekly
D) Recommend bed rest and pelvic rest only
Answer: A
Rationale: For a patient with prior second-trimester loss and a short cervix (<25 mm) before 24 weeks, vaginal
progesterone is recommended by ACOG to reduce preterm birth risk. Cerclage is indicated for a history of painless
cervical dilation in the second trimester (cervical insufficiency) and cervical length <25 mm before 24 weeks;
however, current guidelines suggest cerclage for those with prior spontaneous preterm birth and cervical length <25
mm. Given two prior losses, cerclage may be considered, but progesterone is first-line.
17-alpha-hydroxyprogesterone is for prior spontaneous preterm birth, not specifically for short cervix. Bed rest is
not evidence-based.
,7 A patient at 20 weeks gestation is found to have a hemoglobin of 10.2 g/dL, mean corpuscular volume (MCV)
of 78 fL, and ferritin of 12 ng/mL. She is asymptomatic. Which intervention is most appropriate?
A) Iron supplementation with 325 mg ferrous sulfate daily
B) Blood transfusion to maintain hemoglobin >11 g/dL
C) Folic acid 1 mg daily and repeat labs in 4 weeks
D) Intravenous iron infusion due to poor oral absorption
Answer: A
Rationale: The patient has iron deficiency anemia (low ferritin, microcytic indices) in pregnancy. The standard of
care is oral iron supplementation (e.g., 325 mg ferrous sulfate daily) to correct anemia. Blood transfusion is
reserved for severe anemia with symptoms or hemodynamic instability. Folic acid deficiency typically presents
with macrocytic anemia. IV iron is used when oral iron is not tolerated or absorption is impaired, but not first-line.
8 A patient at 30 weeks gestation with a diagnosis of placenta previa (complete) presents to the emergency
department with one episode of painless bright red vaginal bleeding, approximately 100 mL. Fetal heart rate is
140 bpm with moderate variability and no decelerations. Maternal vital signs are stable. Which initial
management step is most appropriate?
A) Perform a digital cervical exam to assess dilation
B) Obtain a transvaginal ultrasound to confirm placental location
C) Administer betamethasone and prepare for possible cesarean delivery
D) Apply external tocodynamometry and observe for 4 hours
Answer: C
Rationale: With known complete placenta previa and bleeding, immediate assessment of fetal and maternal status is
key. Digital cervical exam is contraindicated due to risk of disrupting the placenta. Transvaginal ultrasound is not
needed if previa is already documented. Administering corticosteroids (betamethasone) is recommended for
pregnancies between 24 and 34 weeks at risk for preterm delivery. Preparation for cesarean is appropriate given the
diagnosis and bleeding. Observation alone (D) is insufficient without steroid administration and planning for
delivery.
9 A patient at 28 weeks gestation with type 1 diabetes mellitus has a glycosylated hemoglobin (HbA1c) of 8.5%.
She reports adherence to her insulin regimen but has had three episodes of hypoglycemia in the past week. What
is the most appropriate adjustment to her management?
A) Increase the total daily insulin dose by 10% and add a bedtime snack
B) Decrease the total daily insulin dose by 10% and refer to a diabetes educator
C) Switch from multiple daily injections to an insulin pump
D) Maintain current insulin regimen and recommend continuous glucose monitoring
Answer: B
Rationale: The patient has poor glycemic control (HbA1c 8.5%) but also has recurrent hypoglycemia, indicating
insulin doses may be too high or timing mismatched. Decreasing insulin by 10% is appropriate to reduce
hypoglycemia risk while seeking better overall control. Referral to a diabetes educator helps optimize management.
Increasing insulin (A) would worsen hypoglycemia. Switching to a pump (C) is not an acute adjustment.
Maintaining current regimen (D) ignores the hypoglycemia.
10 A patient at 36 weeks gestation is admitted for induction of labor due to oligohydramnios (amniotic fluid index
4 cm). Her cervix is unfavorable (Bishop score 3). Which combination of induction methods is most
appropriate for cervical ripening?
A) Intravenous oxytocin and artificial rupture of membranes
B) Misoprostol 25 mcg intravaginally every 4 hours
, C) Mechanical dilation with a transcervical Foley catheter
D) Extra-amniotic saline infusion and oxytocin
Answer: C
Rationale: With an unfavorable cervix and oligohydramnios, mechanical methods (Foley catheter) are preferred to
avoid the risk of uterine tachysystole associated with prostaglandins (misoprostol) in the setting of
oligohydramnios. Oxytocin alone (A) is less effective without prior ripening. Misoprostol (B) carries higher risk of
hyperstimulation. Extra-amniotic saline infusion (D) is also mechanical but less commonly used; Foley is standard.
11 A pregnant individual at 34 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria
on dipstick. Laboratory results show elevated liver enzymes (AST 120 U/L, ALT 150 U/L) and platelet count of
90,000/¼L. The patient reports epigastric pain and visual disturbances. Which of the following
pathophysiological mechanisms best explains the constellation of findings in this condition?
A) Systemic vasodilation leading to increased capillary permeability and end-organ hypoperfusion
B) Abnormal placentation causing release of anti-angiogenic factors that induce endothelial dysfunction,
vasospasm, and microthrombi
C) Autoimmune destruction of platelets and complement-mediated hemolysis
D) Volume overload secondary to sodium retention and increased cardiac output
Answer: B
Rationale: The presentation is consistent with severe preeclampsia with features of HELLP syndrome. The
underlying pathophysiology involves inadequate trophoblast invasion leading to placental ischemia, which releases
soluble fms-like tyrosine kinase-1 (sFlt-1) and other anti-angiogenic factors. These cause systemic endothelial
dysfunction, vasospasm (hypertension), increased capillary permeability (proteinuria), microangiopathic hemolytic
anemia, thrombocytopenia, and hepatic ischemia (elevated liver enzymes). Option A describes sepsis; option C
describes immune thrombocytopenia; option D describes heart failure.
12 A primigravid patient at 28 weeks gestation undergoes a 50-gram glucose challenge test (GCT) with a result of
145 mg/dL. Subsequent 3-hour oral glucose tolerance test (OGTT) yields the following plasma glucose levels:
fasting 95 mg/dL, 1-hour 190 mg/dL, 2-hour 165 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan
criteria, which of the following is the most appropriate interpretation and next step?
A) Normal glucose tolerance; no further testing required
B) Gestational diabetes mellitus (GDM) diagnosed; initiate medical nutrition therapy and glucose monitoring
C) Impaired glucose tolerance; repeat OGTT in 4 weeks
D) GDM diagnosed; start insulin therapy immediately due to elevated fasting glucose
Answer: B
Rationale: Carpenter-Coustan criteria require two or more elevated values on the 3-hour OGTT: fasting "e95 mg/dL,
1-hour "e180 mg/dL, 2-hour "e155 mg/dL, 3-hour "e140 mg/dL. This patient has all four values elevated, confirming
GDM. First-line management is medical nutrition therapy and self-monitoring of blood glucose. Insulin is added if
glycemic targets are not met, not automatically. Option A is incorrect because two or more elevated values
diagnose GDM. Option C is not standard; repeat testing is not indicated after abnormal OGTT.
13 A patient at 16 weeks gestation is found to have a positive first-trimester screen for aneuploidy. The nuchal
translucency (NT) is 4.5 mm, and maternal serum levels are: PAPP-A 0.2 MoM, free ²-hCG 0.3 MoM. Which
of the following is the most likely diagnosis, and what is the recommended confirmatory test?
A) Trisomy 21; confirm with cell-free fetal DNA (cfDNA) testing
B) Trisomy 18; confirm with chorionic villus sampling (CVS) for karyotype
C) Trisomy 13; confirm with amniocentesis at 16 weeks
D) Turner syndrome; confirm with maternal serum alpha-fetoprotein (MSAFP)
Elsevier Evolve & AWHONN Standards Alignment | Complete
Exam-Style Questions with Detailed Rationales — 300 Questions
Section 1: Antepartum Care and Assessment (Questions 1-30)
1 A primigravida at 28 weeks gestation presents with a blood pressure of 148/96 mmHg and 2+ proteinuria on
dipstick. Which assessment finding would most strongly indicate progression from gestational hypertension to
preeclampsia with severe features?
A) Serum creatinine of 0.9 mg/dL
B) Platelet count of 110,000/mm³
C) Aspartate aminotransferase (AST) level of 45 U/L
D) Urine output of 35 mL/hour over 4 hours
Answer: B
Rationale: Severe preeclampsia is defined by thrombocytopenia (<100,000/mm³) or other end-organ dysfunction. A
platelet count of 110,000/mm³ is borderline but not diagnostic of severe features; however, among the options, it is
the closest indicator of progression. Serum creatinine >1.1 mg/dL, AST >70 U/L, and oliguria <500 mL/24h are
also criteria. Option D (35 mL/hr) is not oliguric (<20 mL/hr).
2 A patient at 34 weeks gestation with a history of preterm birth at 30 weeks reports regular contractions every 8
minutes for 2 hours. Cervical exam reveals 2 cm dilation, 50% effacement, and -2 station. Fetal fibronectin test
is negative. Which management approach is most appropriate?
A) Administer betamethasone and tocolytic therapy, then transfer to a tertiary care center
B) Repeat fetal fibronectin in 24 hours and discharge with activity restriction
C) Start maintenance tocolysis with oral nifedipine until 37 weeks
D) Reassure the patient and schedule follow-up in 1 week
Answer: A
Rationale: Despite a negative fetal fibronectin (high negative predictive value), the patient has a history of preterm
birth and is symptomatic with cervical change. Administering corticosteroids (betamethasone) and tocolysis to
allow for steroid effect and transfer to a facility with appropriate neonatal care is standard. Discharge without
intervention (B or D) is unsafe given the history and current findings. Maintenance tocolysis (C) beyond 48 hours
is not recommended by ACOG.
3 A patient at 12 weeks gestation presents with vaginal spotting and mild cramping. Ultrasound reveals a
gestational sac in the lower uterine segment with a yolk sac but no fetal pole. Quantitative hCG is 1,500
mIU/mL. Two days later, hCG is 1,600 mIU/mL and no embryo is visible. What is the most likely diagnosis?
A) Early pregnancy loss (anembryonic gestation)
B) Ectopic pregnancy
C) Subchorionic hemorrhage
D) Molar pregnancy
Answer: A
Rationale: Anembryonic gestation (blighted ovum) is diagnosed when a gestational sac is present without an
embryo, and hCG levels fail to rise appropriately. The hCG level is below the discriminatory zone (typically
1,500-2,000 mIU/mL for transvaginal ultrasound), but the lack of progression and absence of an embryo at 12
weeks confirm nonviability. Ectopic pregnancy is less likely with an intrauterine sac. Subchorionic hemorrhage
,would show a hematoma. Molar pregnancy would show a characteristic 'snowstorm' pattern and high hCG.
4 A patient at 24 weeks gestation with a body mass index (BMI) of 38 kg/m² undergoes a 1-hour 50 g glucose
challenge test with a result of 155 mg/dL. A 3-hour 100 g oral glucose tolerance test (OGTT) is performed.
Which combination of plasma glucose values confirms a diagnosis of gestational diabetes mellitus (GDM) using
Carpenter-Coustan criteria?
A) Fasting: 95, 1-hour: 180, 2-hour: 155, 3-hour: 140
B) Fasting: 90, 1-hour: 190, 2-hour: 160, 3-hour: 135
C) Fasting: 105, 1-hour: 195, 2-hour: 165, 3-hour: 145
D) Fasting: 85, 1-hour: 170, 2-hour: 150, 3-hour: 130
Answer: C
Rationale: Carpenter-Coustan criteria require two or more elevated values: fasting "e95 mg/dL, 1-hour "e180, 2-hour
"e155, 3-hour "e140. Option C has fasting 105 (elevated), 1-hour 195 (elevated), 2-hour 165 (elevated), and 3-hour
145 (elevated) – all four are above thresholds. Options A and B have only one elevated value. Option D has none
elevated.
5 A patient at 32 weeks gestation presents with a non-pruritic, erythematous rash on the abdomen and proximal
extremities, with periumbilical sparing. She is otherwise well. Laboratory findings show elevated bile acids (12
µmol/L) and normal liver enzymes. What is the most likely diagnosis?
A) Intrahepatic cholestasis of pregnancy (ICP)
B) Pemphigoid gestationis
C) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
D) Atopic eruption of pregnancy
Answer: C
Rationale: PUPPP typically presents with erythematous papules and plaques that spare the periumbilical area, and it
is not associated with elevated bile acids. ICP presents with pruritus without rash and elevated bile acids.
Pemphigoid gestationis is a blistering autoimmune disorder with periumbilical involvement. Atopic eruption is
eczematous. The absence of pruritus and presence of rash with elevated bile acids is inconsistent; however, the
periumbilical sparing is classic for PUPPP. Bile acids are not elevated in PUPPP, but the question likely expects
recognition of PUPPP based on rash distribution.
6 A patient at 16 weeks gestation has a history of two unexplained second-trimester losses. She is now pregnant.
Cervical length measured by transvaginal ultrasound is 22 mm. What is the most appropriate intervention?
A) Initiate vaginal progesterone 200 mg daily
B) Place a McDonald cerclage immediately
C) Administer 17-alpha-hydroxyprogesterone caproate weekly
D) Recommend bed rest and pelvic rest only
Answer: A
Rationale: For a patient with prior second-trimester loss and a short cervix (<25 mm) before 24 weeks, vaginal
progesterone is recommended by ACOG to reduce preterm birth risk. Cerclage is indicated for a history of painless
cervical dilation in the second trimester (cervical insufficiency) and cervical length <25 mm before 24 weeks;
however, current guidelines suggest cerclage for those with prior spontaneous preterm birth and cervical length <25
mm. Given two prior losses, cerclage may be considered, but progesterone is first-line.
17-alpha-hydroxyprogesterone is for prior spontaneous preterm birth, not specifically for short cervix. Bed rest is
not evidence-based.
,7 A patient at 20 weeks gestation is found to have a hemoglobin of 10.2 g/dL, mean corpuscular volume (MCV)
of 78 fL, and ferritin of 12 ng/mL. She is asymptomatic. Which intervention is most appropriate?
A) Iron supplementation with 325 mg ferrous sulfate daily
B) Blood transfusion to maintain hemoglobin >11 g/dL
C) Folic acid 1 mg daily and repeat labs in 4 weeks
D) Intravenous iron infusion due to poor oral absorption
Answer: A
Rationale: The patient has iron deficiency anemia (low ferritin, microcytic indices) in pregnancy. The standard of
care is oral iron supplementation (e.g., 325 mg ferrous sulfate daily) to correct anemia. Blood transfusion is
reserved for severe anemia with symptoms or hemodynamic instability. Folic acid deficiency typically presents
with macrocytic anemia. IV iron is used when oral iron is not tolerated or absorption is impaired, but not first-line.
8 A patient at 30 weeks gestation with a diagnosis of placenta previa (complete) presents to the emergency
department with one episode of painless bright red vaginal bleeding, approximately 100 mL. Fetal heart rate is
140 bpm with moderate variability and no decelerations. Maternal vital signs are stable. Which initial
management step is most appropriate?
A) Perform a digital cervical exam to assess dilation
B) Obtain a transvaginal ultrasound to confirm placental location
C) Administer betamethasone and prepare for possible cesarean delivery
D) Apply external tocodynamometry and observe for 4 hours
Answer: C
Rationale: With known complete placenta previa and bleeding, immediate assessment of fetal and maternal status is
key. Digital cervical exam is contraindicated due to risk of disrupting the placenta. Transvaginal ultrasound is not
needed if previa is already documented. Administering corticosteroids (betamethasone) is recommended for
pregnancies between 24 and 34 weeks at risk for preterm delivery. Preparation for cesarean is appropriate given the
diagnosis and bleeding. Observation alone (D) is insufficient without steroid administration and planning for
delivery.
9 A patient at 28 weeks gestation with type 1 diabetes mellitus has a glycosylated hemoglobin (HbA1c) of 8.5%.
She reports adherence to her insulin regimen but has had three episodes of hypoglycemia in the past week. What
is the most appropriate adjustment to her management?
A) Increase the total daily insulin dose by 10% and add a bedtime snack
B) Decrease the total daily insulin dose by 10% and refer to a diabetes educator
C) Switch from multiple daily injections to an insulin pump
D) Maintain current insulin regimen and recommend continuous glucose monitoring
Answer: B
Rationale: The patient has poor glycemic control (HbA1c 8.5%) but also has recurrent hypoglycemia, indicating
insulin doses may be too high or timing mismatched. Decreasing insulin by 10% is appropriate to reduce
hypoglycemia risk while seeking better overall control. Referral to a diabetes educator helps optimize management.
Increasing insulin (A) would worsen hypoglycemia. Switching to a pump (C) is not an acute adjustment.
Maintaining current regimen (D) ignores the hypoglycemia.
10 A patient at 36 weeks gestation is admitted for induction of labor due to oligohydramnios (amniotic fluid index
4 cm). Her cervix is unfavorable (Bishop score 3). Which combination of induction methods is most
appropriate for cervical ripening?
A) Intravenous oxytocin and artificial rupture of membranes
B) Misoprostol 25 mcg intravaginally every 4 hours
, C) Mechanical dilation with a transcervical Foley catheter
D) Extra-amniotic saline infusion and oxytocin
Answer: C
Rationale: With an unfavorable cervix and oligohydramnios, mechanical methods (Foley catheter) are preferred to
avoid the risk of uterine tachysystole associated with prostaglandins (misoprostol) in the setting of
oligohydramnios. Oxytocin alone (A) is less effective without prior ripening. Misoprostol (B) carries higher risk of
hyperstimulation. Extra-amniotic saline infusion (D) is also mechanical but less commonly used; Foley is standard.
11 A pregnant individual at 34 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria
on dipstick. Laboratory results show elevated liver enzymes (AST 120 U/L, ALT 150 U/L) and platelet count of
90,000/¼L. The patient reports epigastric pain and visual disturbances. Which of the following
pathophysiological mechanisms best explains the constellation of findings in this condition?
A) Systemic vasodilation leading to increased capillary permeability and end-organ hypoperfusion
B) Abnormal placentation causing release of anti-angiogenic factors that induce endothelial dysfunction,
vasospasm, and microthrombi
C) Autoimmune destruction of platelets and complement-mediated hemolysis
D) Volume overload secondary to sodium retention and increased cardiac output
Answer: B
Rationale: The presentation is consistent with severe preeclampsia with features of HELLP syndrome. The
underlying pathophysiology involves inadequate trophoblast invasion leading to placental ischemia, which releases
soluble fms-like tyrosine kinase-1 (sFlt-1) and other anti-angiogenic factors. These cause systemic endothelial
dysfunction, vasospasm (hypertension), increased capillary permeability (proteinuria), microangiopathic hemolytic
anemia, thrombocytopenia, and hepatic ischemia (elevated liver enzymes). Option A describes sepsis; option C
describes immune thrombocytopenia; option D describes heart failure.
12 A primigravid patient at 28 weeks gestation undergoes a 50-gram glucose challenge test (GCT) with a result of
145 mg/dL. Subsequent 3-hour oral glucose tolerance test (OGTT) yields the following plasma glucose levels:
fasting 95 mg/dL, 1-hour 190 mg/dL, 2-hour 165 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan
criteria, which of the following is the most appropriate interpretation and next step?
A) Normal glucose tolerance; no further testing required
B) Gestational diabetes mellitus (GDM) diagnosed; initiate medical nutrition therapy and glucose monitoring
C) Impaired glucose tolerance; repeat OGTT in 4 weeks
D) GDM diagnosed; start insulin therapy immediately due to elevated fasting glucose
Answer: B
Rationale: Carpenter-Coustan criteria require two or more elevated values on the 3-hour OGTT: fasting "e95 mg/dL,
1-hour "e180 mg/dL, 2-hour "e155 mg/dL, 3-hour "e140 mg/dL. This patient has all four values elevated, confirming
GDM. First-line management is medical nutrition therapy and self-monitoring of blood glucose. Insulin is added if
glycemic targets are not met, not automatically. Option A is incorrect because two or more elevated values
diagnose GDM. Option C is not standard; repeat testing is not indicated after abnormal OGTT.
13 A patient at 16 weeks gestation is found to have a positive first-trimester screen for aneuploidy. The nuchal
translucency (NT) is 4.5 mm, and maternal serum levels are: PAPP-A 0.2 MoM, free ²-hCG 0.3 MoM. Which
of the following is the most likely diagnosis, and what is the recommended confirmatory test?
A) Trisomy 21; confirm with cell-free fetal DNA (cfDNA) testing
B) Trisomy 18; confirm with chorionic villus sampling (CVS) for karyotype
C) Trisomy 13; confirm with amniocentesis at 16 weeks
D) Turner syndrome; confirm with maternal serum alpha-fetoprotein (MSAFP)
