Module 4 BBB Practice Questions

Question 1

A patient’s 1h glucose tolerance was 128, how do we interpret this?

Answer 1

WNL

Question 2

What does a normal early 1-h glucose tolerance signify?

Answer 2

She likely did not have DM II prior to the pregnancy

Question 3

A choroid plexus cyst was noted on U/S. What is the association with aneuploidies?

Answer 3

If it is an isolated finding, it is very unlikely to be associated with aneuploidy

Question 4

Your patient had an early U/S and an LMP with sure dates. Should this patient’s EDB be changed based on her U/S in the second trimester?

Answer 4

No-if there is a discrepancy in EDB it is likely because something is off with the pregnancy

Question 5

How often do we change dates on second-trimester U/S on a patient who had a first-trimester U/S?

Answer 5

Almost never

Question 6

A patient at 22 6/7 has trace protein in her urine. Should we be concerned?

Answer 6

No, especially if her BP is WNL.

Question 7

A patient at 27 1/7 presents for an OB visit with a BP of 108/68. Her pre-pregnancy BP is typically 120-130/70s. When should we expect her BP to return to a prepregnant level?

Answer 7

About 32 weeks

Question 8

You’re reviewing your patient’s weight gain during pregnancy. Prepregnancy 130lb (BMI 22):
9w 127
13w 134
18w 140
22w 141
27w 150 (current appointment).

What is your overall assessment of her weight gain?

Answer 8

She has gained about the right amount of weight

1st trim: 4lb
2nd trim: 16lb in 14 wks (recommended is 1 lb/w)
Total 25-35lb (she is at 20lb with 13 wks left)

Question 9

27 w 1/7 OB appointment, the patient has leukocyte esterase without nitrates on her urine dip. What may be occurring?

Answer 9

Leukorrhea or vaginitis.

Question 10

What may nitrites in a urine dip indicate?

Answer 10

Bacteria growth=UTI

Question 11

What does the evidence about routine urine dips for (protein, glucose, and ketones) indicate?

Answer 11

In the absence of risk factors and symptoms for conditions like Pre-E, evidence shows no benefit in routine urine dips.

Question 12

Your patient has positive leukocytes without nitrites in her urine. You ask her about vaginal odor, irritation, itching, or burning. She denies all and only reports an increased amount of pale yellow discharge. She is in a mutually monogamous relationship. What is your assessment?

Answer 12

She probably has normal leukorrhea or pregnancy.

Question 13

A patient at 27w states that her baby moves every day but not in a predictable pattern. Is this a normal description of movement for this gestation?

Answer 13

Yes

Question 14

Your patient at 27w’s fundus measures 29cm. What is your assessment?

Answer 14

WNL

22+= GA+/- 2 cm

Question 15

27w patients FHR is 146. She is concerned that it is lower than normal. How should you respond?

Answer 15

That’s expected because the FHR usually gets lower as pregnancy progresses

Question 16

Why do we assess the baby’s presentation in 2nd trimester?

Answer 16

To help determine where to doppler

Question 17

What labs may need to be done at a 27w appointment?

Answer 17

1h GTT, CBC, Antibody screen

Question 18

A patient’s initial OB H/H was 12.8/34.6. What would you expect to see for her 27-week H/H?

Answer 18

WNL= >10.5 and 32%
Example: 11.9/33.1

RBC volume increases, plasma volume increases, and maximum hemodilution occur in 2nd trimester

Question 19

Is it important to know our patient’s race when assessing her H/H?

Answer 19

No!

Question 20

Our patient is O-. At her 27-week appointment, we decide to give her rhogam. How much should she get?

Answer 20

300mcg

Note: some practices give rhogam and draw antibodies simultaneously, and some wait for the result to give it.

Question 21

What should be your response if a patient has a positive antibody?

Answer 21

A positive antibody requires immediate referral to MFM.

Question 22

Does it harm the patient if you give rhogam and their antibody drawn the same day comes back positive?

Answer 22

No, but it may make it more complicated for MFM

Question 23

We tell our patient that we recommend a Tdap vaccine between 27 and 36 weeks. This visit is at the ideal end of that range. What would we think if she told us she doesn’t believe she needs it because she got it during her last pregnancy?

Answer 23

We would still recommend it now because the CDC recommends it with each pregnancy

Question 24

You have a new OB appointment for a patient who may be “4-5 months along.” What is the best practice for establishing EDB?

Answer 24

Ask memory-triggering questions to see if she can remember her LMP.
Get a U/S to compare to the LMP EB

Question 25

How could closely spaced pregnancies affect anemia risk?

Answer 25

Could increase risk of anemia

Question 26

You have a new OB appointment for a patient who may be “4-5 months along.” What type of U/S do we need, and what information are we looking for?

Answer 26

Abdominal U/S
Measure BPD, AC, HC, FL; anatomy scan

Question 27

Your new OB patient has a GA of 20 weeks; what genetic screening can we offer?

Answer 27

Amniocentesis, cfDNA, Quad screen (may be inaccurate due to unsure dates), carrier screening

Cannot offer an integrated/sequential screen because it is the second trimester already, and we cannot obtain the first-trimester portion. Cannot offer CVS.

Question 28

What conditions does a quad screen test for?

Answer 28

Both trisomies and neural tube defects

Question 29

Your new OB patient was about 160 lb prepregnancy with a BMI of 26.4 at that time. She is determined to be 20 weeks and is 175 today. How should you respond?

Answer 29

This is on the lower end of the total pregnancy weight gain for her weight class of 15-25 lb. She is halfway through the pregnancy and on track to gain 30lb total.

Question 30

A patient has a prepregnant BMI in the overweight category. According to the current evidence, what is the most likely reason?

Answer 30

Genetics and complex factors

Question 31

What is a good way to address weight gain during pregnancy?

Answer 31

“I’d like to talk about weight gain as it relates to the health of your pregnancy. Would you be open to talking about that?”

Question 32

What does current evidence suggest about the importance of physical activity during pregnancy?

Answer 32

Physical activity directly improves cardiovascular health but does not meaningfully affect weight gain.

Question 33

Your patient has gained more weight than recommended in the second trimester. Should we tell them to avoid weight gain over the next month?

Answer 33

No, focus on future weight gain patterns rather than worrying about weight gain in the past.

Question 34

What patients should be screened for G/C according to the CDC?

Answer 34

<25 years old and high risk

Question 35

Your patient in the second trimester complains of groin pain. What common discomfort could this be?

Answer 35

Round ligament pain

Question 36

If your patient with groin pain does not have round ligament pain, what should we consider?

Answer 36

Inguinal hernia, preterm labor, appendicitis

Question 37

What question should you ask if you suspect round ligament pain?

Answer 37

When does it hurt/what makes it worse? How long does it last?
Describe the pain. Does it resolve with rest?

Question 38

How do patients describe round ligament pain? How long does it last?

Answer 38

Knife life stabbing pain
Sudden and lasts seconds

Question 39

When does round ligament pain occur?

Answer 39

With movement

Question 40

What can we suggest to help a patient with round ligament pain?

Answer 40

Support belt, move slowly, gently bend sideways toward the painful side, education/reassurance

Question 41

What is the calcium intake recommendation during pregnancy?

Answer 41

1000 mg/day (1300 for teens)

Question 42

What can we tell a patient to expect regarding the fetal movement in the next month at 20 weeks gestation?

Answer 42

You will be able to identify defined sleep-wake patterns during the next 4 weeks.

Question 43

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

Answer 43

A blood draw for a quad screen

Question 44

If a patient chooses not to have the second-trimester portion of the sequential screen, what has not been tested for?

Answer 44

A screen for neural tube defects

Question 45

The sequential screen results show no increased risk for aneuploidies or open neural tube defects. How do we interpret this?

Answer 45

The predicted risk for aneuploidies and open neural tube defects is lower after the screening.

Question 46

We are reviewing labs done at 28w. The 1h GTT result is 148. What is the significance, and how do we respond?

Answer 46

This means the gestational diabetes screen is positive. A diagnostic test, a 3h GTT should be done next.