Maternal Physiology During Pregnancy Extra Questions

1. Most state-of-the-art serum pregnancy tests have a sensitivity for detection of β-human chorionic gonadotropin (β-hCG) of 25 mLU/ mL. Such tests would diagnose pregnancy as early as which of the following?

2. A 35-year-old G5P4004 patient is found to have ASCUS on her Pap smear done at her new obstetrics (OB) visit. In your counseling of the patient as to what this result means, you note that the hormonal changes of pregnancy will cause changes in the cervix. Which of the following cervical changes may be found more frequently in the pregnant state than in the nonpregnant state?

3. A 16-year-old G1P0 patient is brought for an examination due to a probable pregnancy. The patient says that she became sexually active approximately 5 months ago. To estimate her gestational age, you palpate the abdomen. At approximately 20 weeks’ estimated gestational age, which of the following best describes the uterus in a normal pregnancy?

4. A 21-year-old G1 now P1 just delivered after a prolonged induction of labor due to being postdates. After the placental delivery she continues to bleed excessively. Your initial intervention to address this bleeding is to activate the normal physiologic mechanisms. Which of the following is the most important hemostatic mechanism in combating postpartum hemorrhage?

5. The uterus must increase its volume over the course of a pregnancy from less than 20 cc to over 5 L. This is accomplished while still maintaining the ability for the uterine muscles to contract with enough force to expel the infant during labor. The uterine muscle mass enlarges during pregnancy primarily because of which of the following?

6. During a pelvic examination on a patient that is approximately 8 weeks’ gestation by dates and pelvic examination, one adnexa is found to be slightly enlarged. This is most commonly due to which of the following?

7. A patient presents for her new obstetrical (OB) examination. She is 23 years of age and G1PO at 10 weeks without problems. Her prepregnant body mass index (BMI) was 22. As part of her pregnancybased education, you inform her that she should follow a balanced diet with a recommended weight gain of approximately how many pounds?

8. A patient presents for her routine prenatal visit at 34 weeks’ estimated gestational age (EGA). She is complaining to the nurse of back pain. Her pulse and temperature are normal as well as her urine dip. After the examination you determine that it is due to exaggerate posture caused by her weight (BMI 35) and her pregnancy. Which of the following is a characteristic posture of pregnancy?

9. A pregnant patient presents very concerned about some skin lesions/changes she is seeing that are just like her uncle’s who has liver cirrhosis from hepatitis C. What lesions or changes are she likely referring to?

10. The physiologic changes of pregnancy can alter many of the common laboratory tests. During the evaluation of a patient with tachycardia, hypertension, and headache you are considering both hyperthyroidism versus an atypical preeclampsia and draw the following laboratory tests. To correctly interpret the results, it is necessary to distinguish between normal versus abnormal changes during pregnancy. Which of the following would normally be expected to increase during pregnancy?

11. A patient presents complaining of a friable painful local buildup of her gums around the base of a number of teeth. This is starting to interfere with eating due to pain and bleeding. She has not seen a dentist for some time due to finances. The remainder of the pregnancy has been uncomplicated. These changes are likely due to which of the following?

12. A patient at 19 weeks’ EGA is evaluated for vague gastrointestinal/abdominal complaints, and there is concern for possible appendicitis. She notes diffuse abdominal pain, some nausea, and temperature of 37.3°C. She is not particularly hungry but lacks anorexia. She does have new onset nausea. She has positive bowel sounds. There is a negative psoas sign and only diffuse periumbilical tenderness without rebound. Her white blood cell (WBC) count is 11,000 and remainder of liver functions and pancreatic laboratories are within normal limits. Considerations in the evaluation are sensitive to the changes in the gastrointestinal (GI) tract during pregnancy include which of the following?

13. A patient at 19 weeks’ EGA is evaluated for vague gastrointestinal/abdominal complaints, and there is concern for possible appendicitis. She notes diffuse abdominal pain, some nausea, and temperature of 37.3°C. She is not particularly hungry but lacks anorexia. She does have new onset nausea. She has positive bowel sounds. There is a negative psoas sign and only diffuse periumbilical tenderness without rebound. Her white blood cell (WBC) count is 11,000 and remainder of liver functions and pancreatic laboratories are within normal limits. Given her presenting complaints and initial physical and laboratory testing, which one of the following represents an abnormal value?

14. A patient at 19 weeks’ EGA is evaluated for vague gastrointestinal/abdominal complaints, and there is concern for possible appendicitis. She notes diffuse abdominal pain, some nausea, and temperature of 37.3°C. She is not particularly hungry but lacks anorexia. She does have new onset nausea. She has positive bowel sounds. There is a negative psoas sign and only diffuse periumbilical tenderness without rebound. Her white blood cell (WBC) count is 11,000 and remainder of liver functions and pancreatic laboratories are within normal limits. It is determined that imaging is needed to evaluate the pain further. What is the best imaging test to order?

15. A patient presents to OB triage unit with complaints of back pain and fever. She is 30 weeks’ EGA. She had asymptomatic bacteria at her initial OB visit that was treated. Her temperature is 38.5°C and she has CVA tenderness. Because of changes in the urinary tract during pregnancy, patients are at greater risk for urinary tract infections.Changes in the urinary tract during normal pregnancy include which of the following?

16. A patient presents to OB triage unit with complaints of back pain and fever. She is 30 weeks’ EGA. She had asymptomatic bacteria at her initial OB visit that was treated. Her temperature is 38.5°C and she has CVA tenderness. Because of changes in the urinary tract during pregnancy, patients are at greater risk for urinary tract infections. On further questioning, a concern for renal stones possibly contributing to the infection is raised. It is decided to perform a one shot intravenous pyelogram (IVP) to evaluate for renal obstruction. If an IVP were performed in the third trimester, normal findings in pregnancy would include which of the following?

17. At the initial OB visit your patients receive nutritional information. Iron supplementation is recommended in pregnancy in order to do which of the following?

18.  A 22-year-old G3P2002 who had a hematocrit of 36% at her initial obstetrical examination at 12 weeks is found to have a hematocrit of 30% at 28 weeks when checked along with her 1 hour glucola. Based on the indices of the red blood cells on the CBC, you diagnose iron deficiency. She asks why that occurred since she has been taking her prenatal vitamins. As part of the explanation, you note that which of the following maternal measurements or findings is first decreased by the iron requirements of pregnancy?

19. During pregnancy the blood volume increases by 40%. The increase in blood volume in normal pregnancy is made up of which of the following?

20.  In response to the increased vascular volume, the maternal cardiovascular system undergoes great change during pregnancy. During prenatal care, which of the following findings is part of the cardiovascular response to this increase in preload?

21. During pregnancy, the hormonal system of a woman is markedly altered since the fetus and placenta add their production to the maternal hormone production. This impacts maternal physiology and some of the findings of pregnancy. Estrogen is such a hormone that increases markedly. Most of this estrogen is produced by which of the following?

22. A patient presents for preconceptive counseling. Her history is complicated by significant mitral stenosis.You tell her that this may be problematic at times of high cardiac output in pregnancy. Because of the fixed outflow, she could experience heart failure. The time at which cardiac output is highest is during which phase of pregnancy?

23. A patient presents for preconceptive counseling. Her history is complicated by significant mitral stenosis.You tell her that this may be problematic at times of high cardiac output in pregnancy. Because of the fixed outflow, she could experience heart failure. Which of the following factors contribute to the increase in cardiac output in pregnancy?

24. A 24-year-old nurse at 32 weeks’ gestation complains of shortness of breath during her pregnancy, especially with physical exertion. She has no prior medical history. Her respiratory rate is 16; her lungs are clear to auscultation; and your office oxygen saturation monitor reveals her oxygen saturation to be 98% on room air. You reassure her that this sensation is normal and explain which of the following?

25. A 24-year-old nurse at 32 weeks’ gestation complains of shortness of breath during her pregnancy, especially with physical exertion. She has no prior medical history. Her respiratory rate is 16; her lungs are clear to auscultation; and your office oxygen saturation monitor reveals her oxygen saturation to be 98% on room air. She urges you to perform pulmonary function tests. Assuming that your medical judgment is correct, these tests should show which of the following?

26. A 25-year-old G3P2 in her sixth week of pregnancy, by last menstrual period (LMP) calculation, has an endovaginal ultrasound examination because of vaginal bleeding. The ultrasound confirms an intrauterine pregnancy with fetal cardiac activity present and fetal pole length consistent with 6 weeks’ gestation. Scan of the adnexae reveals a 5-cm simple cyst on the left ovary. Which of the following statements is true?

27. Most obstetrical providers screen pregnant women for gestational diabetes around 28 weeks’ gestation. The increased risk of developing diabetes in pregnancy is due to which of the following?