Free Printable BluePrint6 Pregnancy and Prenatal Care

1.

Vignette 1

A 27-year-old woman comes to your practice desiring pregnancy. She has a history of regular, 28-day cycles and has been using oral birth control pills for contraception. She has had two pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal delivery at 39 weeks. Her last Pap smear was 10 months ago and she has never

had an irregular Pap. She is not taking any medications and has no known medical allergies

1. On the basis of this woman’s obstetrical history, find out what is her TPAL designation?

a)

G3P1011

b)

G3P2001

c)

G2P1011

d)

G2P1101

e)

G1P1001

2.

Vignette 1

A 27-year-old woman comes to your practice desiring pregnancy. She has a history of regular, 28-day cycles and has been using oral birth control pills for contraception. She has had two pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal delivery at 39 weeks. Her last Pap smear was 10 months ago and she has never

had an irregular Pap. She is not taking any medications and has no known medical allergies

2. Nutritional supplements she should begin before she gets pregnant include which of the following:

a)

Folate to reduce neural tube defects

b)

Vitamin B12 to increase RBC production prior to pregnancy

c)

Vitamin B1 to reduce beriberi

d)

Vitamin C to reduce scurvy

e)

No supplementation is necessary until pregnancy is

confirmed

3.

Vignette 1

A 27-year-old woman comes to your practice desiring pregnancy. She has a history of regular, 28-day cycles and has been using oral birth control pills for contraception. She has had two pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal delivery at 39 weeks. Her last Pap smear was 10 months ago and she has never

had an irregular Pap. She is not taking any medications and has no known medical allergies

3. Before leaving your office, she asks how reliable over-the-counter (OTC) pregnancy tests are and how quickly after conceiving she should expect to test positive. You inform her that:

a)

urine pregnancy tests are notoriously unreliable and that

she should come in for blood tests if she thinks she is

pregnant

b)

OTC tests have high sensitivity for human placental lactogen

(hPL) and will be positive around the time of the missed

menstrual cycle

c)

OTC tests have high sensitivity for β-hCG and will be positive

around the time of the missed period

d)

OTC tests have high specificity, but low sensitivity, so she

should repeat the test twice at home to confirm the results

e)

OTC tests are typically positive the day after conception

4.

Vignette 1

A 27-year-old woman comes to your practice desiring pregnancy. She has a history of regular, 28-day cycles and has been using oral birth control pills for contraception. She has had two pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal delivery at 39 weeks. Her last Pap smear was 10 months ago and she has never

had an irregular Pap. She is not taking any medications and has no known medical allergies

4. She returns to your office 2 months later pregnant. Her initial prenatal visit should include:

a)

quad screen

b)

abdominal ultrasound

c)

pelvic examination

d)

titer for herpes simplex virus (HSV)

e)

Leopold maneuvers

5.

Vignette 2

33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested positive with two home pregnancy tests and has been experiencing breast tenderness and mild nausea for a few weeks. She has a history of regular menstrual periods occurring every 28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.

1. Your patient was actively tracking her menstrual cycle and is certain that the first day of her last menstrual period (LMP) was 12/2/11. Using Nägele rule, estimate her date of delivery.

a)

7/5/12

b)

9/2/12

c)

9/16/12

d)

9/9/12

e)

8/26/12

6.

Vignette 2

33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested positive with two home pregnancy tests and has been experiencing breast tenderness and mild nausea for a few weeks. She has a history of regular menstrual periods occurring every 28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.

2. As her pregnancy continues, you would expect her cardiac

output to increase by which of the following mechanisms:

a)

First an increase in stroke volume, then an increase in heart

rate

b)

A decrease in systemic vascular resistance

c)

Cardiac output would not change significantly until the third

trimester

d)

An increase in systemic vascular resistance facilitated by

elevated progesterone levels

e)

Increased heart rate alone

7.

Vignette 2

33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested positive with two home pregnancy tests and has been experiencing breast tenderness and mild nausea for a few weeks. She has a history of regular menstrual periods occurring every 28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.

3. Which of the following is true regarding the physiologic changes she might expect during her pregnancy?

a)

Gastric emptying and large bowel motility are increased in

pregnancy

b)

BUN and creatinine will decrease by 25% as a result of an

increase in glomerular filtration rate (GFR), which will be

maintained until delivery

c)

An overall decrease in the number of WBC and platelets

d)

Nausea and vomiting that should be treated aggressively

with antiemetics and intravenous hydration

e)

An increase in the tidal volume along with an increase in

total lung capacity (TLC)

8.

Vignette 2

33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested positive with two home pregnancy tests and has been experiencing breast tenderness and mild nausea for a few weeks. She has a history of regular menstrual periods occurring every 28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.

4. Which of the following is true regarding hCG in your patient?

a)

The corpus luteum produces hCG throughout pregnancy

b)

It is composed of two dissimilar alpha and beta units

c)

Levels double every 3 to 4 days in early pregnancy

d)

Levels peak after 24 weeks of pregnancy

e)

The alpha subunits are identical to subunits of prolactin and

human growth hormone

9.

Vignette 2

33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested positive with two home pregnancy tests and has been experiencing breast tenderness and mild nausea for a few weeks. She has a history of regular menstrual periods occurring every 28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.

5. The major function of human placental lactogen is:

a)

To cause a diuretic effect

b)

To cause relaxation of smooth muscle

c)

To maintain the corpus luteum in early pregnancy

d)

To act as an insulin agonist

e)

To induce lipolysis and protein synthesis leading to a constant

nutrient supply to the fetus

10.

Vignette 3

A 36-year-old G1P0 is 31 weeks and 5 days by LMP and is sure of her dates. Her pregnancy has been complicated by persistent nausea and vomiting, back pain, and lower extremity swelling. She comes to you for a routine prenatal visit. She had a quad screen at 16 weeks that was normal. She is having a girl.

1. On this visit her urine is assessed for the presence of protein, glucose, blood, and leukocyte esterase. Which of the following results would be most concerning?

a)

Absent leukocyte esterase

b)

Negative glucose

c)

Trace blood

d)

4+ protein

e)

Leukocyte esterase positive

11.

Vignette 3

A 36-year-old G1P0 is 31 weeks and 5 days by LMP and is sure of her dates. Her pregnancy has been complicated by persistent nausea and vomiting, back pain, and lower extremity swelling. She comes to you for a routine prenatal visit. She had a quad screen at 16 weeks that was normal. She is having a girl.

2. Her low back pain is no longer relieved with a heating pad and she finds that she needs pain relief to make it through each work day. Which of the following options would be safest for her?

a)

Ibuprofen

b)

Aspirin

c)

Oxycodone

d)

Flexeril

e)

Tylenol

12.

Vignette 3

A 36-year-old G1P0 is 31 weeks and 5 days by LMP and is sure of her dates. Her pregnancy has been complicated by persistent nausea and vomiting, back pain, and lower extremity swelling. She comes to you for a routine prenatal visit. She had a quad screen at 16 weeks that was normal. She is having a girl.

3. Her nausea and vomiting has extended past the first trimester when most women stop experiencing these symptoms. What would suggest that she has hyperemesis gravidarum?

a)

Less than 5% loss of prepregnancy weight

b)

Jaundice

c)

Syncopal episodes

d)

Ketonuria

e)

Metabolic acidosis

13.

Vignette 3

A 36-year-old G1P0 is 31 weeks and 5 days by LMP and is sure of her dates. Her pregnancy has been complicated by persistent nausea and vomiting, back pain, and lower extremity swelling. She comes to you for a routine prenatal visit. She had a quad screen at 16 weeks that was normal. She is having a girl.

4. She has started experiencing lower abdominal pain and tightening that occurs infrequently (1 to 2 times per hour) and irregularly. This is most likely :

a)

a preterm labor

b)

round ligament pain

c)

Braxton Hicks contractions

d)

an indication of fetal distress

e)

related to constipation

14.

Vignette 4

A G3P2002 woman at 35 weeks is seen in your office for her prenatal visit. She is concerned because she has not felt her baby moving as much as she used to. Her pregnancy has been uncomplicated and her past two pregnancies ended in full term, normal spontaneous vaginal deliveries.

1. A biophysical profile (BPP) is done to assess which of the

following?

a)

Diastolic flow in the umbilical artery

b)

Lung maturity

c)

Blood flow in the middle cerebral artery

d)

Fetal well-being

e)

Genetic abnormalities

15.

Vignette 4

A G3P2002 woman at 35 weeks is seen in your office for her prenatal visit. She is concerned because she has not felt her baby moving as much as she used to. Her pregnancy has been uncomplicated and her past two pregnancies ended in full term, normal spontaneous vaginal deliveries.

2. An indication for early delivery is identified, but first a test for fetal lung maturity is done. Which of the following is true?

a)

Type I pneumocytes secrete surfactant

b)

A lecithin to sphingomyelin (L/S) ratio greater than 2 is ideal

if an early delivery is indicated

c)

A low L/S ratio is associated with fewer cases of respiratory

distress syndrome (RDS)

d)

Typically, lecithin decreases as the lung matures

e)

Sphingomyelin decreases beyond 24 weeks

16.

Vignette 4

A G3P2002 woman at 35 weeks is seen in your office for her prenatal visit. She is concerned because she has not felt her baby moving as much as she used to. Her pregnancy has been uncomplicated and her past two pregnancies ended in full term, normal spontaneous vaginal deliveries.

3. When formal antenatal testing is done, which of the following is most reassuring?

a)

Late decelerations on fetal monitoring

b)

A contraction stress test (CST) with variable fetal heart

rate (FHR) decelerations with contractions, but moderate

variability

c)

A nonstress test (NST) with two accelerations of the FHR in

20 minutes that are at least 15 beats above baseline and last

for at least 15 seconds

d)

An increase in the systolic to diastolic ratio in the umbilical

artery blood flow

e)

A score of 6 on a BPP

BluePrint6 Pregnancy and Prenatal Care

Total questions: 16

Worksheet time: 16mins

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