High-risk pregnancies Practice Questions

Question 1

You have been entrusted with the task of finding the causes of low birth weight in infants born in the health jurisdiction for which you are responsible. In 2017, there were 1,500 live births and, upon further inspection of the birth certificates, 108 of these children had a low birth weight (i.e. lower than 2,500 g), while 237 had mothers who smoked continuously during pregnancy. Further calculations have shown that the risk of low birth weight in smokers was 14% and in non-smokers, it was 7%, while the relative risk of low birth weight linked to cigarette smoking during pregnancy was 2%. In other words, women who smoked during pregnancy were twice as likely as those who did not smoke to deliver a low-weight infant. Using this data, you are also asked to calculate how much of the excess risk for low birth weight, in percentage terms, can be attributed to smoking. What is the attributable risk percentage for smoking leading to low birth weight?

Accepted Answer

50%

Answer

40%

Answer

30%

Answer

20%

Answer

10%

Question 2

A 26-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and delivery of her first child were uncomplicated. Her temperature is 37.2°C (99°F) and blood pressure is 163/105 mm Hg. Her blood pressure 10 weeks ago was 128/84 mm Hg. At her last visit two weeks ago, her blood pressure was 142/92 mm Hg. Pelvic examination shows a uterus consistent in size with a 28-week gestation. A complete blood count and serum concentrations of electrolytes, creatinine, and hepatic transaminases are within the reference range. A urinalysis is within normal limits. Which of the following is the most appropriate next step in management?

Accepted Answer

Oral labetalol therapy

Answer

Lisinopril therapy

Answer

Magnesium sulfate therapy

Answer

Complete bed rest

Answer

Dietary salt restriction

Question 3

A 27-year-old P1G1 who has had minimal prenatal care delivers a newborn female infant. Exam reveals a dusky child who appears to be in distress. Her neck veins are distended and you note an enlarged v wave. She has a holosystolic murmur. Following echocardiogram, immediate surgery is recommended.

For which of the following conditions was the mother likely receiving treatment during pregnancy?

Accepted Answer

Bipolar disorder

Answer

Hypothyroidism

Answer

Depression

Answer

Hypertension

Answer

Diabetes

Question 4

A 35-year-old woman, gravida 2, para 1, at 16 weeks' gestation comes to the office for a prenatal visit. She reports increased urinary frequency but otherwise feels well. Pregnancy and delivery of her first child were uncomplicated. Her vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 16-week gestation. Urinalysis shows mild glucosuria. Laboratory studies show a non-fasting serum glucose concentration of 110 mg/dL. Which of the following is the most likely explanation for this patient's glucosuria?

Accepted Answer

Increased glomerular filtration rate

Answer

Decreased SGLT2 expression

Answer

Increased glomerular filtration barrier permeability

Answer

Decreased insulin production

Answer

Decreased insulin sensitivity

Question 5

A 35-year-old G1 is brought to the emergency department because of sharp pains in her abdomen. She is at 30 weeks gestation based on ultrasound. She complains of  feeling a little uneasy during the last 3 weeks of her pregnancy. She mentions that her abdomen has not been enlarging as expected and her baby is not moving as much as during the earlier part of the pregnancy. If anything, she noticed her abdomen has decreased in size. While she is giving her history, the emergency medicine physician notices that she is restless and is sweating profusely. An ultrasound is performed and her blood is sent for type and match. The blood pressure is 90/60 mm Hg, the pulse is 120/min, and the respiratory rate  is 18/min. The fetal ultrasound is significant for no fetal heart motion or fetal movement. Her blood work shows the following: hemoglobin, 10.3 g/dL; platelet count, 1.1*10(5)/ml; bleeding time, 10 minutes; PT, 25 seconds; and PTT, 45 seconds. Which of the following would be the best immediate course of management for this patient?

Accepted Answer

IV fluids

Answer

Low-molecular-weight heparin

Answer

Fresh frozen plasma

Answer

Initiation of labor

Answer

D-dimer assay

Question 6

A 42-year-old G1P0 woman presents to an obstetrician for her first prenatal visit. She has been pregnant for about 10 weeks and is concerned about how pregnancy will affect her health. Specifically, she is afraid that her complicated medical history will be adversely affected by her pregnancy. Her past medical history is significant for mild polycythemia, obesity hypoventilation syndrome, easy bleeding, multiple sclerosis, and aortic regurgitation. Which of these disorders is most likely to increase in severity during the course of the pregnancy?

Accepted Answer

Hypoventilation

Answer

Easy bleeding

Answer

Multiple sclerosis

Answer

Polycythemia

Answer

Heart murmur

Question 7

A 24-year-old woman, gravida 1, at 35 weeks gestation is admitted to the hospital with regular contractions and pelvic pressure for the last 5 hours. Her pregnancy has been uncomplicated and she has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. She has had no history of fluid leakage or bleeding. At the hospital, her temperature is 37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respirations are 16/min. Cervical examination shows 60% effacement and 5 cm dilation with intact membranes. Cardiotocography shows a contraction amplitude of 220 MVU in 10 minutes. Which of the following is the most appropriate pharmacotherapy at this time?

Accepted Answer

No pharmacotherapy at this time

Answer

Magnesium sulfate

Answer

Dexamethasone

Answer

Oxytocin

Answer

Terbutaline

Question 8

A 21-year-old primigravida presents to her physician for a prenatal visit. She has a positive pregnancy test 1 week ago. The estimated gestational age is 16 weeks. She has no complaints. She has a history of type 1 diabetes mellitus and takes insulin for glucose control. The urine dipstick test shows 3+ glucose and negative for protein. The blood tests ordered at the last visit 1 week ago are as follows:
Fasting glucose 110 mg/dL
HbA1c 8.3%
Which of the following tests should be highly recommended for this patient?

Accepted Answer

Triple test

Answer

Chorionic villus sampling

Answer

Serum creatinine

Answer

C-peptide assessment

Answer

Oral glucose tolerance test

Question 9

A 32-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the physician for a prenatal visit. She reports that she has had frequent headaches and dizziness recently. Pregnancy and delivery of her first child were uncomplicated. There is no personal or family history of serious illness. Medications include folic acid and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 170/100 mm Hg. Pelvic examination shows a uterus consistent in size with a 32-week gestation. Physical examination shows 2+ edema in the lower extremities. Laboratory studies show:
Hematocrit 37%
Leukocyte count 9000/mm3
Platelet count 60,000/mm3
Serum
Na+ 140 mEq/L
Cl- 104 mEq/L
K+ 4.4 mEq/L
Creatinine 1.0 mg/dL
Aspartate aminotransferase 20 U/L
Alanine aminotransferase 20 U/L
Which of the following is the most appropriate next step in management?

Accepted Answer

Magnesium sulfate and labetalol therapy

Answer

Lisinopril therapy

Answer

Platelet transfusion

Answer

Perform C-section

Answer

Admit the patient to the ICU

Question 10

A 36-year-old primigravid woman at 34 weeks' gestation comes to the physician because of a 1-week history of upper abdominal discomfort, nausea, and malaise. She had a mild upper respiratory tract infection a week ago. She has a 10-year history of polycystic ovarian syndrome and a 3-year history of hypertension. Her medications include metformin, labetalol, folic acid, and a multivitamin. Her pulse is 92/min, respirations are 18/min, and blood pressure is 147/84 mm Hg. Examination shows a nontender uterus consistent in size with a 34-week gestation. There is mild tenderness of the right upper quadrant of the abdomen. The fetal heart rate is reactive with no decelerations. Which of the following is the most appropriate next step in management?

Accepted Answer

Serum transaminase levels and platelet count

Answer

Reassurance and follow-up

Answer

Serum bile acid levels

Answer

HBsAg and IgM anti-HBc serology

Answer

Stool antigen assay for H. pylori

High-risk pregnancies

Study Resources

Lessons

Questions

Flashcards

Lessons

Advanced maternal age

Multiple gestation management

Pregestational diabetes

Chronic hypertension in pregnancy

Thyroid disorders in pregnancy

Autoimmune disorders in pregnancy

Cardiac disease in pregnancy

Renal disease in pregnancy

Obesity in pregnancy

Substance use in pregnancy

Prior preterm birth management

Prior cesarean delivery management

Maternal cancer in pregnancy

Practice Questions

Flashcards

About High-risk pregnancies for USMLE

Lessons in High-risk pregnancies

Master High-risk pregnancies