Free Obstetric Emergencies Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Obstetric Emergencies practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A pregnant patient with newly diagnosed opioid use disorder is ready to begin medication treatment. Which pair contains the recommended first-line medication options during pregnancy?

   1. A. Methadone and naltrexone
   2. B. Buprenorphine and naltrexone
   3. C. Methadone and buprenorphine
   4. D. Naltrexone and naloxone

   Answer: C

   Explanation: CDC states, "Methadone and buprenorphine are first-line therapy options for pregnant women with OUD." These are the two first-line treatment choices; naltrexone has limited pregnancy safety data, and naloxone reverses overdose rather than providing maintenance treatment.

   Reference: Treatment of Opioid Use Disorder Before, During, and After Pregnancy — Medication for opioid use disorder (MOUD) during pregnancy

2. 2A pregnant patient has confirmed acute deep vein thrombosis and no contraindication to heparin. Which anticoagulant approach does ASH prefer for treatment during pregnancy?

   1. A. Oral warfarin
   2. B. Low-molecular-weight heparin
   3. C. Oral rivaroxaban
   4. D. Oral apixaban

   Answer: B

   Explanation: ASH identifies "low molecular weight heparin (LMWH)" as the preferred agent for pregnancy-associated VTE. Oral vitamin K antagonists and direct-acting oral anticoagulants have pregnancy safety concerns and are not the preferred approach here.

   Reference: Venous Thromboembolism (VTE) in the Context of Pregnancy: A Pocket Guide for the Clinician — p.2, Prevention of VTE; p.3, Table 4 and footnote 1

3. 3An obstetric team reviews disproportionate maternal mortality and severe morbidity among Black, Indigenous, and Hispanic patients. Which contributor does the AIM severe hypertension bundle identify as the basis for mitigating bias and maintaining clinical vigilance?

   1. A. Inherited thrombophilia
   2. B. Systemic racism
   3. C. Maternal age distribution
   4. D. Pharmacogenetic variation

   Answer: B

   Explanation: The source states, "because of systemic racism, but not race itself" The bundle identifies systemic racism as the contributor to inequitable outcomes and calls for bias mitigation and clinical vigilance. It does not attribute these disparities to inherent racial physiology or medication response.

   Reference: Severe Hypertension in Pregnancy Patient Safety Bundle: Element Implementation Details — p.6, Respectful, Equitable, and Supportive Care

4. 4A patient stable on naltrexone before conception asks whether to continue treatment. Which pair of considerations should guide the shared decision during pregnancy?

   1. A. Extensive pregnancy safety evidence and the risk of relapse after discontinuation.
   2. B. Limited pregnancy safety evidence and the risk of relapse after discontinuation.
   3. C. Limited pregnancy safety evidence and the risk of opioid withdrawal from continuation.
   4. D. Extensive pregnancy safety evidence and the risk of opioid withdrawal from continuation.

   Answer: B

   Explanation: CDC recommends "weighing the limited safety data on naltrexone with the potential risk of relapse with discontinuation of treatment." A patient already stable on naltrexone needs an individualized discussion rather than an automatic continuation or discontinuation rule.

   Reference: Treatment of Opioid Use Disorder Before, During, and After Pregnancy — Medication for opioid use disorder (MOUD) during pregnancy, naltrexone paragraph

5. 5A pregnant patient is receiving therapeutic low-molecular-weight heparin for acute venous thromboembolism. Under ASH guidance, how should routine anti-factor Xa testing be used to adjust her dose?

   1. A. Obtain a level before each injection to select the next dose.
   2. B. Obtain a daily level until a pregnancy-specific range is reached.
   3. C. Avoid routine anti-factor Xa monitoring solely to guide dosing.
   4. D. Obtain a weekly level throughout every uncomplicated course.

   Answer: C

   Explanation: ASH "suggests against routine monitoring of anti-FXa levels to guide dosing." The recommendation concerns routine testing in pregnancy; it does not require assuming that a level is indicated for every patient receiving therapeutic LMWH.

   Reference: Venous Thromboembolism (VTE) in the Context of Pregnancy: A Pocket Guide for the Clinician — p.3, Table 4, therapeutic LMWH comments

6. 6A postpartum clinician is deciding which patients should receive a trauma-informed approach to care. What scope of implementation does ACOG recommend?

   1. A. Patients with a positive standardized trauma screening result.
   2. B. Patients with a documented posttraumatic stress diagnosis.
   3. C. Patients with a disclosed history of interpersonal violence.
   4. D. Patients across the practice, regardless of documented trauma history.

   Answer: D

   Explanation: ACOG advises clinicians to "strive to universally implement a trauma-informed approach across all levels of their practice". Implementation is universal rather than restricted to the three specified groups, whose histories may remain undisclosed or undocumented.

   Reference: Caring for Patients Who Have Experienced Trauma — Committee Opinion 825, Abstract

7. 7A patient has remained stable on methadone throughout pregnancy and asks whether she should stop treatment after delivery. Which maintenance plan follows CDC's postpartum guidance?

   1. A. Taper the methadone when the placenta is delivered.
   2. B. Stop the methadone when the postpartum admission ends.
   3. C. Pause the methadone until postpartum cravings recur.
   4. D. Continue the methadone during the postpartum period.

   Answer: D

   Explanation: CDC states, "MOUD should be continued postpartum for women with OUD." Delivery does not end the indication for treatment; the postpartum period increases vulnerability to return to use.

   Reference: Opioid Use and Pregnancy — Treating OUD after pregnancy

8. 8For therapeutic LMWH treatment of acute VTE in pregnancy, what is the longest interval between scheduled doses among the daily regimens ASH considers acceptable?

   1. A. 24 hours
   2. B. 12 hours
   3. C. 8 hours
   4. D. 6 hours

   Answer: A

   Explanation: ASH accepts "either once-per-day or twice-perday dosing regimens." Once daily is every 24 hours and is the longest accepted interval in this recommendation. Every 12 hours is also accepted but is not the longest; 8- and 6-hour schedules are not the named LMWH regimens.

   Reference: Venous Thromboembolism (VTE) in the Context of Pregnancy: A Pocket Guide for the Clinician — p.3, Table 4, acute VTE dosing comments

9. 9A clinician reviewing maternal deaths uses the CDC Pregnancy Mortality Surveillance System definition. What is the latest postpartum interval included when a death is caused or aggravated by pregnancy?

   1. A. 28 days after pregnancy ends
   2. B. 42 days after pregnancy ends
   3. C. 1 year after pregnancy ends
   4. D. 90 days after pregnancy ends

   Answer: C

   Explanation: CDC defines a pregnancy-related death as "a death during or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy." This PMSS definition extends beyond the 42-day interval used in another maternal mortality definition.

   Reference: Data from the Pregnancy Mortality Surveillance System — About, PMSS definition

10. 10During postpartum feeding counseling, which maternal circumstance supports encouraging breastfeeding rather than withholding maternal milk under CDC guidance?

    1. A. Stable buprenorphine maintenance after stopping nonprescribed substance use.
    2. B. Current nonprescribed cocaine use after delivery despite substance-use treatment.
    3. C. Confirmed human T-cell lymphotropic virus type I infection during lactation.
    4. D. HIV infection after delivery without initiation of antiretroviral treatment.

    Answer: A

    Explanation: CDC states, "For mothers who discontinue illicit opioids or other substances and are on stable methadone or buprenorphine maintenance therapy, breastfeeding should be encouraged." Its contraindications include current illicit-drug use, HTLV-1/2 infection, and HIV without antiretroviral treatment. Stable treatment after discontinuation of nonprescribed use therefore supports breastfeeding.

    Reference: Contraindications to Breastfeeding — Reasons not to breastfeed, illicit-drug use and stable maintenance exception