OBGYN APGO UWISE EXAM LATEST
2024-2025 ACTUAL EXAM AND
PRACTICE EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS
(VERIFIED ANSWERS) WITH
RATIONALES
A 27-year-old G2P0 woman is diagnosed with an early first
trimester spontaneous abortion. She has a history of type 1
diabetes mellitus, mild chronic hypertension and one prior
termination of pregnancy. Which of the following is the most likely
cause of this spontaneous abortion?
A. Prior termination of pregnancy
B. Chronic hypertension
C. Diabetes mellitus
D. Intrauterine adhesions
E. Infection Correct Answer C. Systemic diseases such as
diabetes mellitus, chronic renal disease and lupus are
associated with early pregnancy loss. In women with insulin-
dependent diabetes, the rates of spontaneous abortion and
major congenital malformations are both increased. The risk
appears related to the degree of metabolic control in the first
trimester. There are many other causes of spontaneous
abortion, including genetic factors, endocrine abnormalities,
reproductive tract abnormalities, immunologic factors and
environmental factors. The patient's history of mild chronic
hypertension and one prior termination of pregnancy do not
increase her risk of a first trimester loss. Additionally, an
uncomplicated termination of pregnancy, intrauterine
,adhesions and infection are not likely causes in this
scenario.
A 25-year-old G2P1 woman at eight weeks gestation is diagnosed
with a spontaneous abortion. Her husband is 40 years old. The
patient's past medical history is noncontributory. She gets some
exercise regularly and smokes two packs of cigarettes a day.
Three years ago, she had a full-term delivery that was
complicated by mild preeclampsia. Which of the following factors
is most likely the cause of this spontaneous abortion?
A. Infection
B. Advanced paternal age
C. Environmental factors
D. Uterine anomaly (i.e. unicornuate uterus)
E. History of preeclampsia Correct Answer C. Environmental
factors, such as smoking, alcohol and radiation are causes
of spontaneous abortion. Although the risk increases with
infections, such as listeria, mycoplasma, ureaplasma,
toxoplasmosis and syphilis, advancing maternal or paternal
age, advancing parity and some mullerian anomalies, the
clinical scenario does not support these as possible causes.
An isolated history of preeclampsia confers no increase in
risk of spontaneous abortion.
A 22-year-old G1P0 woman presents to the emergency
department at eight weeks gestation experiencing heavy vaginal
bleeding. On physical exam: blood pressure 94/60; pulse 108;
respirations 20; and temperature 98.6°F (37.0°C). Pelvic
examination demonstrates brisk bleeding through a dilated
cervical os. The patient's hemoglobin is 7 g/dL (hematocrit 21%).
Which of the following is the most appropriate next step in the
management of this patient?
A. Administration of intravaginal misoprostol
, B. Administration of oral misoprostol
C. Dilation and suction curettage
D. Endometrial ablation
E. Expectant care to permit spontaneous abortion Correct
Answer C. This patient is actively bleeding and is anemic.
She, therefore, requires immediate surgical treatment
consisting of dilation and suction curettage. Although
clinicians increasingly utilize both expectant management
and various drug regimens to treat spontaneous abortion, a
prerequisite for either is that the patient is hemodynamically
stable and reliable for follow-up care. She is not
hemodynamically stable. Endometrial ablation will not work
in this case, as the products of conception need to be
evacuated to control the bleeding.
A 34-year-old G1P0 woman presents with vaginal spotting. On
physical exam: blood pressure 120/70; pulse 82; respirations 20;
and temperature 98.6°F (37.0°C). An ultrasound confirms a non-
viable intrauterine pregnancy. She is otherwise healthy. Her
partner accompanies her and is supportive. The patient wishes to
avoid any unnecessary medical interventions and asks whether
she can safely let nature take its course. What is the best next
step in the management of this patient?
A. Immediate dilation and suction curettage
B. Dilation and suction curettage in one week
C. Immediate treatment with misoprostol
D. Treatment with misoprostol in one week
E. Expectant management Correct Answer E. Patients
experiencing early pregnancy loss can safely consider
several different treatments, including expectant
management, medical treatment to assist with expulsion of
the pregnancy or surgical evacuation. Provided the patient is
hemodynamically stable and reliable for follow-up, expectant
management is appropriate therapy. At the gestational age
, described, expectant management portends no increase in
risk of either hemorrhage or infection compared with surgical
or medical evacuation. Regardless of method chosen, the
patient's blood type should be checked and rhogam
administered as indicated.
A 32-year-old G3P0 woman presents to the clinic for
preconception counseling. Her prior three pregnancies resulted in
first trimester losses. Which of the following tests should be
ordered for this patient?
A. Adrenal stimulation test
B. Clomiphene citrate-FSH challenge test
C. Lupus anticoagulant test
D. Pelvic MRI
E. CT scan of the pelvis Correct Answer C. It is important to
rule out systemic disease in a patient with recurrent abortion
(three successive first trimester losses). Testing for lupus
anticoagulant, diabetes mellitus and thyroid disease are
commonly performed. Maternal and paternal karyotypes
should also be obtained. Infectious causes should also be
considered. Uterine imaging to exclude a septum or other
anomaly is routinely done using hysteroscopy or
hysterography and not CT or MRI scanning. There is no role
for clomiphene citrate-FSH challenge in the evaluation of this
patient.
A 26-year-old G2P0 woman presents for counseling following
manual vacuum aspiration of an eight-week missed abortion. The
patient asks whether an uncomplicated first trimester pregnancy
termination three years ago might have predisposed her to the
subsequent spontaneous abortion. What are the patient's risks
associated with the prior surgical abortion in the first trimester?
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