OB/GYN APGO Test Bank. Newest
2025-2026. Questions & Correct
Verified Answers. Graded A
A 16-year-old G1P0 woman at 39 weeks gestation presents to labor and
delivery reporting a gush of blood-tinged fluid approximately five hours ago
and the onset of uterine contractions shortly thereafter. She reports
contractions have become stronger and closer together over the past hour.
The fetal heart rate is 140 to 150 with accelerations and no decelerations.
Uterine contractions are recorded every 2-3 minutes. A pelvic exam reveals
that the cervix is 4 cm dilated and 100 percent effaced. Fetal station is 0.
After walking around for 30 minutes the patient is put back in bed after
complaining of further discomfort. She requests an epidural. However,
obtaining the fetal heart rate externally has become difficult because the
patient cannot lie still. What is the most appropriate next step in the
management of this patient?
A. Place the epidural
B. Apply a fetal scalp electrode
C. Perform a fetal ultrasound to asses - ANSB. If the fetal heart rate cannot
be confirmed using external methods, then the most reliable way to
document fetal well-being is to apply a fetal scalp electrode. Putting in an
epidural without confirming fetal status might be dangerous. Although
ultrasound will provide information regarding the fetal heart rate, it is not
practical to use this to monitor the fetus continuously while the epidural is
,placed. An intrauterine pressure catheter will provide information about the
strength and frequency of the patient's contractions, but will not provide
information regarding the fetal status. Closer fetal monitoring via a fetal
scalp electrode should be performed.
A 17-year-old G1P0 woman at 32 weeks gestation complains of right flank
pain that is "colicky" in nature and has been present for two weeks. She
denies fever, dysuria and hematuria. Physical examination is notable for
moderate right costovertebral angle tenderness. White blood cell count
8,800/mL, urine analysis negative. A renal ultrasound reveals no signs of
urinary calculi, but there is moderate (15 mm) right hydronephrosis. Which
of the following is the most likely cause of these findings?
A. Smooth muscle relaxation due to declining levels of progesterone
B. Smooth muscle relaxation due to increasing levels of estrogen
C. Compression by the uterus and right ovarian vein
D. Elevation of the bladder in the second trimester
E. Iliac artery compression of the ureter - ANSC. Some degree of dilation
in the ureters and renal pelvis occurs in the majority of pregnant women.
The dilation is unequal (R > L) due to cushioning provided by the sigmoid
colon to the left ureter and from greater compression of the right ureter due
to dextrorotation of the uterus. The right ovarian vein complex, which is
remarkably dilated during pregnancy, lies obliquely over the right ureter and
may contribute significantly to right ureteral dilatation. High levels of
progesterone likely have some effect but estrogen has no effect on the
smooth muscle of the ureter.
,A 17-year-old G1P1 woman delivered a term infant two days ago. She is
not interested in breastfeeding and she asks for something to suppress
lactation. Which of the following is the safest method of lactation
suppression in this patient?
A. Bromocriptine
B. Breast binding, ice packs and analgesics
C. Medroxyprogesterone acetate
D. Oral contraceptives
E. Manual milk expression - ANSB. Hormonal interventions for preventing
lactation appear to predispose to thromboembolic events, as well as a
significant risk of rebound engorgement. Bromocriptine, in particular, is
associated with hypertension, stroke and seizures. The safest method to
suppress lactation is breast binding, ice packs and analgesics. The patient
should avoid breast stimulation or other means of milk expression, so that
the natural inhibition of prolactin secretion will result in breast involution
A 17-year-old G2P0 female has severe right lower quadrant pain. Her last
normal menstrual period seven weeks ago. She notes that last night she
began having suprapubic pain that radiated to her right lower quadrant.
This morning, the pain awoke her from sleep. She has had no vaginal
bleeding, no nausea or vomiting. The patient's history is notable for two first
trimester elective abortions and a history of Chlamydia treated twice. Vital
signs are: blood pressure 90/60; pulse 99; respirations 22; and temperature
98.6°F (37°C). On physical exam, the patient is noted to be curled on a
stretcher in a fetal position and says she hurts too much to move. She has
rebound and voluntary guarding on abdominal examination. She has
profound cervical motion tenderness and rectal tenderness. Her Beta-hCG
, level is 2500 mIU/ml; hematocrit 24%; and urinalysis negative. Ultrasound
shows no intrauterine pregnancy, a right adnexal mass t - ANSB. This
patient has a ruptured ectopic pregnancy until proven otherwise. Her vital
signs, examination and anemia are consistent with an intra-abdominal
bleed. Exploratory laparoscopy/laparotomy is indicated at this point.
Conservative management with observation, serial examinations or repeat
Beta-hCG testing could be dangerous in a patient suspected of having a
ruptured ectopic pregnancy. Medical management (methotrexate) is not
used in a patient with an acute surgical abdomen. Dilation and curettage
would not be the next step in management and might only be considered in
this scenario after the patient's abdomen was explored.
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
2025-2026. Questions & Correct
Verified Answers. Graded A
A 16-year-old G1P0 woman at 39 weeks gestation presents to labor and
delivery reporting a gush of blood-tinged fluid approximately five hours ago
and the onset of uterine contractions shortly thereafter. She reports
contractions have become stronger and closer together over the past hour.
The fetal heart rate is 140 to 150 with accelerations and no decelerations.
Uterine contractions are recorded every 2-3 minutes. A pelvic exam reveals
that the cervix is 4 cm dilated and 100 percent effaced. Fetal station is 0.
After walking around for 30 minutes the patient is put back in bed after
complaining of further discomfort. She requests an epidural. However,
obtaining the fetal heart rate externally has become difficult because the
patient cannot lie still. What is the most appropriate next step in the
management of this patient?
A. Place the epidural
B. Apply a fetal scalp electrode
C. Perform a fetal ultrasound to asses - ANSB. If the fetal heart rate cannot
be confirmed using external methods, then the most reliable way to
document fetal well-being is to apply a fetal scalp electrode. Putting in an
epidural without confirming fetal status might be dangerous. Although
ultrasound will provide information regarding the fetal heart rate, it is not
practical to use this to monitor the fetus continuously while the epidural is
,placed. An intrauterine pressure catheter will provide information about the
strength and frequency of the patient's contractions, but will not provide
information regarding the fetal status. Closer fetal monitoring via a fetal
scalp electrode should be performed.
A 17-year-old G1P0 woman at 32 weeks gestation complains of right flank
pain that is "colicky" in nature and has been present for two weeks. She
denies fever, dysuria and hematuria. Physical examination is notable for
moderate right costovertebral angle tenderness. White blood cell count
8,800/mL, urine analysis negative. A renal ultrasound reveals no signs of
urinary calculi, but there is moderate (15 mm) right hydronephrosis. Which
of the following is the most likely cause of these findings?
A. Smooth muscle relaxation due to declining levels of progesterone
B. Smooth muscle relaxation due to increasing levels of estrogen
C. Compression by the uterus and right ovarian vein
D. Elevation of the bladder in the second trimester
E. Iliac artery compression of the ureter - ANSC. Some degree of dilation
in the ureters and renal pelvis occurs in the majority of pregnant women.
The dilation is unequal (R > L) due to cushioning provided by the sigmoid
colon to the left ureter and from greater compression of the right ureter due
to dextrorotation of the uterus. The right ovarian vein complex, which is
remarkably dilated during pregnancy, lies obliquely over the right ureter and
may contribute significantly to right ureteral dilatation. High levels of
progesterone likely have some effect but estrogen has no effect on the
smooth muscle of the ureter.
,A 17-year-old G1P1 woman delivered a term infant two days ago. She is
not interested in breastfeeding and she asks for something to suppress
lactation. Which of the following is the safest method of lactation
suppression in this patient?
A. Bromocriptine
B. Breast binding, ice packs and analgesics
C. Medroxyprogesterone acetate
D. Oral contraceptives
E. Manual milk expression - ANSB. Hormonal interventions for preventing
lactation appear to predispose to thromboembolic events, as well as a
significant risk of rebound engorgement. Bromocriptine, in particular, is
associated with hypertension, stroke and seizures. The safest method to
suppress lactation is breast binding, ice packs and analgesics. The patient
should avoid breast stimulation or other means of milk expression, so that
the natural inhibition of prolactin secretion will result in breast involution
A 17-year-old G2P0 female has severe right lower quadrant pain. Her last
normal menstrual period seven weeks ago. She notes that last night she
began having suprapubic pain that radiated to her right lower quadrant.
This morning, the pain awoke her from sleep. She has had no vaginal
bleeding, no nausea or vomiting. The patient's history is notable for two first
trimester elective abortions and a history of Chlamydia treated twice. Vital
signs are: blood pressure 90/60; pulse 99; respirations 22; and temperature
98.6°F (37°C). On physical exam, the patient is noted to be curled on a
stretcher in a fetal position and says she hurts too much to move. She has
rebound and voluntary guarding on abdominal examination. She has
profound cervical motion tenderness and rectal tenderness. Her Beta-hCG
, level is 2500 mIU/ml; hematocrit 24%; and urinalysis negative. Ultrasound
shows no intrauterine pregnancy, a right adnexal mass t - ANSB. This
patient has a ruptured ectopic pregnancy until proven otherwise. Her vital
signs, examination and anemia are consistent with an intra-abdominal
bleed. Exploratory laparoscopy/laparotomy is indicated at this point.
Conservative management with observation, serial examinations or repeat
Beta-hCG testing could be dangerous in a patient suspected of having a
ruptured ectopic pregnancy. Medical management (methotrexate) is not
used in a patient with an acute surgical abdomen. Dilation and curettage
would not be the next step in management and might only be considered in
this scenario after the patient's abdomen was explored.
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
