Final Exam Review

Question 1

Describe the GTPALM

Answer 1

Gravida
Term
Preterm
Abortion
Living
Multiples

Question 2

You have a patient come in for a new OB appointment. Her first pregnancy was a miscarriage at 8 weeks in 2008. Her next was a 19 week IUFD in 2009. She gave birth in 2010 at 38.6 by NSVD who is living. She then had twin girls by C/S at 36w in 2013 who are both alive and well. What is her GTPALM?

Answer 2

G5T11231

Question 3

A patient has the following lab results from their new OB visit. Which results need a follow up?
H/H: 9.8/29.9
Blood Type: A+
Antibody: Negative
RPR: Non-Reactive
HBsAg: Negative
HCV: Negative
HIV: Negative
Rubella: Immune
Urine Culture: 100,000 cfu of e coli
1-hour glucose tolerance: 112

Answer 3

H/H: 9.8/29.9
Urine Culture: 100,000 cfu of e coli (UTI needing treatment)

Question 4

Your patient has a LMP EDC of 11/30, the U/S shows CRL of 9w2d and EDC of 11/21. Which EDC should be used?

Answer 4

11/21 (this is a 9 week gestation that differs more than 7 days)

Question 5

Your patient had a U/S yesterday that shows an embryo of 5w1d without visible cardiac activity. How should we proceed?

Answer 5

Recommend a repeat U/S in 1 week. It may have been to early to see cardiac activity

Question 6

Your first trimester patient at 11w4d has a positive nuchal translucency. The nuchal fold is thicker than the cutoff measurement and one of the serum analytes is lower than normal. What is our next step?

Answer 6

Offer/facilitate referral to a genetic counselor

Question 7

A patient trying to get pregnant calls to ask for advice. According to their usual cycle length, they should have started their period yesterday but did not. They took a home pregnancy test this morning, and it’s negative. The person isn’t having any pain or other concerns. How should we advise this person to follow up?

Answer 7

Repeat a urine pregnancy test at home later this week

Question 8

A person seen for a new OB last week at 9 weeks initially decided to forego genetic testing. Since that visit, they’ve changed their mind and would like chorionic villus sampling (CVS). Is there time to refer the patient to your physician colleague who performs CVS?

Answer 8

Yes, CVS are usually done 10-13 weeks

Question 9

A pregnant patient called, worried about a news report she heard about a listeriosis warning from the CDC. She heard that it could be dangerous for pregnant people but didn’t hear which foods are risky. What should we tell this patient about the foods that are most concerning for listeriosis?

Answer 9

Cold deli meat, soft cheeses, and raw sprouts

Question 10

G4P2012: How many living children?

Answer 10

2

Question 11

G4P012: For the pregnancies that resulted in living children, were they term or preterm?

Answer 11

Term

Question 12

What is included in the cfDNA/NIPS?

Answer 12

Screens for trisomies 13,18,21 but not neural tube defects

Question 13

Patient has LMP with regular cycles with LMP 11/3=EDB 8/10
Early U/S on 12/20 CRL of 7w1d=EDB 8/6
How should we respond?

Answer 13

Keep the LMP EDB

Question 14

A new OB patient had a TSH result of 4.24 (Non-pregnant range 0.35-4.45). How should we proceed?

Answer 14

Look up the trimester-specific reference range; decide what to do based on that

Question 15

A new OB patient had a TSH result of 4.24 (Non-pregnant range 0.35-4.45; first trimester 0.6-3.4). How should we proceed?

Answer 15

Additional labs and physician consultation are needed

Question 16

A patient who is 11 weeks calls and reports SOB during normal activities. When this occurs related to normal pregnancy physiology rather than due to pathological problems, what is the cause?

Answer 16

Hyperventilation and decreased CO2

Question 17

A patient who was having light bleeding 3 days ago without cramping at approximately 6 weeks post-LMP. U/S showed intrauterine gest. Sac and yolk sack but no embryonic pole or cardiac motion. Her beta hCG was 980. Was would be your top differential?

Answer 17

Dates earlier than expected

Question 18

A patient who was having light bleeding 3 days ago without cramping at approximately 6 weeks post-LMP. U/S showed intrauterine gest. Sac and yolk sack but no embryonic pole or cardiac motion. Her beta hCG was 980. Her beta hCG from yesterday was 1220. What should we conclude?

Answer 18

The level did not rise as expected so the pregnancy may not be healthy

Question 19

A patient who was having light bleeding 3 days ago without cramping at approximately 6 weeks post-LMP. U/S showed intrauterine gest. Sac and yolk sack but no embryonic pole or cardiac motion. Her beta hCG was 980. Her beta hCG from yesterday was 1220. What should we offer to this patient?

Answer 19

Follow up hCG, U/S in 1-2 weeks, watch and wait

Question 20

Your patient has come in for a new OB visit. She has had a NSVD at 40 weeks, a twin pregnancy delivered by C/S at 38 weeks, a SAB at 6 weeks, and a VBAC at 32 weeks. Aside from the SAB all are living well. What is her GTPALM?

Answer 20

G5P21141

Question 21

What does the first-trimester portion of the sequential screen consist of?

Answer 21

A nuchal translucency U/S and blood draw for several serum analytes

Question 22

A preconception patient’s rubella result comes back non-immune. How do we respond?

Answer 22

Recommend the patient get a rubella vaccine now and then postpone pregnancy for one month.

Question 23

We sent a patient to U/S for early pregnancy bleeding and right-sided pelvic pain. The U/S report shows an intrauterine gestational sac without a yolk sac or embryo. How should we interpret these results regarding a differential of ectopic pregnancy?

Answer 23

Ectopic pregnancy is very unlikely. We cannot rule out ectopic pregnancy completely due to the risk of heterotopic pregnancy.

Question 24

A patient seen recently at 8 weeks asks about fetoscopes. She wants to know if we can use a fetoscope for all her visits, beginning with her next one. How should we respond?

Answer 24

It will be too early to use a fetoscope at the next visit at 12 weeks, but it’s possible that we could begin using one at the following visit at 16 weeks.