ANSWER KEY

PAPER-II, MOCK 5 (PHYSIOLOGICAL CHANGES IN PREGNANCY & PLACENTAL

HARMONES)
1. A pregnant woman in her second trimester complains of feeling dizzy when lying on her
back. What is the most likely cause?
 A. Increased blood volume
 B. Compression of the inferior vena cava
 C. Increased cardiac output
 D. Decreased hemoglobin levels
Explanation: Lying supine can compress the inferior vena cava, reducing venous return
and causing dizziness (supine hypotensive syndrome).
2. A woman in her third trimester presents with dyspnea but no signs of respiratory
distress. What is the likely cause?
 A. Pulmonary embolism
 B. Asthma exacerbation
 C. Increased diaphragm elevation due to the growing uterus
 D. Cardiomyopathy
Explanation: As the uterus enlarges, it pushes the diaphragm upward, reducing lung
expansion and causing mild dyspnea.
3. A pregnant woman at 30 weeks gestation has a hemoglobin level of 11 g/dL. What is the
most likely reason for this finding?
 A. Physiologic anemia due to hemodilution
 B. Iron deficiency anemia
 C. Vitamin B12 deficiency
 D. Folate deficiency
Explanation: Increased plasma volume during pregnancy leads to dilution of red blood
cells, causing physiologic anemia.
4. A 28-week pregnant woman presents with mild ankle edema. Which physiological
change is responsible for this?
 A. Increased urinary sodium retention
 B. Reduced cardiac output
 C. Increased capillary permeability and venous pressure
  D. Proteinuria
Explanation: Venous return is impaired due to uterine pressure, leading to increased
capillary permeability and fluid retention.
5. A pregnant woman has an increase in her tidal volume. This is due to:
 A. Progesterone increasing respiratory drive
 B. Decreased alveolar surface area
 C. Decreased lung compliance
 D. Increased oxygen consumption by the fetus
Explanation: Progesterone increases respiratory drive, leading to increased tidal volume.
6. Which cardiovascular change occurs during pregnancy?
 A. Decreased heart rate
 B. Increased cardiac output
 C. Decreased stroke volume
 D. Increased systemic vascular resistance
Explanation: Cardiac output increases during pregnancy to meet the metabolic demands
of the mother and fetus.
7. A pregnant woman experiences hyperpigmentation. Which hormone is most likely
responsible?
 A. Estrogen
 B. Melanocyte-stimulating hormone (MSH)
 C. Progesterone
 D. Prolactin
Explanation: Elevated MSH during pregnancy causes hyperpigmentation (e.g., linea
nigra, melasma).
8. A pregnant woman develops shortness of breath. What respiratory change is expected
during pregnancy?
 A. Decreased minute ventilation
 B. Increased tidal volume
 C. Decreased respiratory rate
 D. Increased residual lung volume
Explanation: Tidal volume increases during pregnancy to meet higher oxygen demands.
9. A woman in her first trimester reports frequent urination. This is most likely due to:
  A. Increased renal tubular reabsorption
 B. Increased glomerular filtration rate (GFR)
 C. Increased aldosterone secretion
 D. Pressure from the enlarging uterus
Explanation: The GFR increases in early pregnancy, leading to more urine formation.
10. What change in blood pressure is typically seen during mid-pregnancy?
 A. Increase in systolic pressure
 B. Increase in diastolic pressure
 C. Decrease in diastolic pressure
 D. No change in blood pressure
Explanation: Diastolic pressure usually decreases during the second trimester due to
decreased systemic vascular resistance.
11. Which of the following increases during pregnancy?
 A. Hematocrit
 B. Plasma volume
 C. Systemic vascular resistance
 D. Diastolic blood pressure
Explanation: Plasma volume increases by about 50%, while hematocrit decreases due to
dilution.
12. A pregnant woman experiences increased thirst. What hormone is likely causing this
sensation?
 A. Progesterone
 B. Vasopressin (ADH)
 C. Oxytocin
 D. Cortisol
Explanation: ADH secretion increases during pregnancy, promoting water retention and
increasing thirst.
13. A woman in her third trimester has elevated alkaline phosphatase levels. What is the
cause?
 A. Liver disease
 B. Placental production
  C. Biliary obstruction
 D. Bone demineralization
Explanation: The placenta produces alkaline phosphatase, leading to higher levels
during pregnancy.
14. During pregnancy, a woman's respiratory rate:
 A. Remains unchanged
 B. Increases significantly
 C. Decreases slightly
 D. Is variable depending on body position
Explanation: Respiratory rate typically remains unchanged, but tidal volume increases.
15. A pregnant woman reports varicose veins. What is the main contributing factor?
 A. Hormonal changes
 B. Increased venous pressure from the uterus
 C. Decreased blood volume
 D. Increased arterial pressure
Explanation: The expanding uterus increases venous pressure, leading to varicose veins.
16. What gastrointestinal change is common in pregnancy?
 A. Increased gastric emptying
 B. Decreased motility
 C. Increased acid production
 D. Increased bile secretion
Explanation: Progesterone slows gastrointestinal motility, leading to constipation and
delayed gastric emptying.
17. A pregnant woman experiences heartburn. This is most likely due to:
 A. Increased gastric acidity
 B. Relaxation of the lower esophageal sphincter
 C. Increased intra-abdominal pressure
 D. Decreased gastric volume
Explanation: Progesterone causes relaxation of the lower esophageal sphincter, allowing
acid reflux.
18. A pregnant woman has a resting heart rate 15 beats per minute higher than her
baseline. This increase is primarily due to:
 A. Anxiety
 B. Increased cardiac output
 C. Decreased oxygenation
 D. Increased systemic vascular resistance
Explanation: Cardiac output increases during pregnancy, which elevates the resting
heart rate.
19. A pregnant woman is found to have a decrease in systemic vascular resistance. This is
due to:
 A. Increased aldosterone
 B. Progesterone-mediated smooth muscle relaxation
 C. Increased cardiac output
 D. Increased blood viscosity
Explanation: Progesterone causes vasodilation, leading to decreased systemic vascular
resistance.
20. Which hormone increases insulin resistance during pregnancy?
 A. Human placental lactogen (hPL)
 B. Progesterone
 C. Estrogen
 D. Prolactin
Explanation: hPL is responsible for increasing insulin resistance to ensure adequate
glucose supply for the fetus.
21. A pregnant woman’s oxygen demand increases. What compensatory change occurs?
 A. Increased respiratory rate
 B. Increased tidal volume
 C. Increased residual volume
 D. Decreased diaphragm movement
Explanation: Increased tidal volume helps meet the increased oxygen demand during
pregnancy.
22. A pregnant woman has increased urinary frequency. What is a likely cause in the third
trimester?
 A. Increased renal function
 B. Pressure from the gravid uterus on the bladder
 C. Progesterone effect on bladder tone
 D. Decreased bladder capacity
Explanation: The expanding uterus exerts pressure on the bladder, causing frequent
urination.
23. What is the expected change in thyroid function during pregnancy?
 A. Increased total thyroid hormone levels
 B. Decreased thyroid hormone-binding globulin
 C. Decreased free thyroid hormones
 D. Decreased thyroid-stimulating hormone (TSH)
Explanation: Estrogen increases thyroid-binding globulin, leading to higher total thyroid
hormone levels.
24. A pregnant woman presents with mild gingival bleeding. What is the likely cause?
 A. Vitamin C deficiency
 B. Increased blood flow to mucous membranes
 C. Poor oral hygiene
 D. Platelet dysfunction
Explanation: Increased blood flow and vascularity of the gums during pregnancy can
cause gingival bleeding.
25. A woman in her third trimester has a slight increase in blood pressure. What might
contribute to this?
 A. Increased systemic vascular resistance
 B. Increased blood volume
 C. Decreased cardiac output
 D. Progesterone-induced vasodilation
Explanation: Blood volume increases in the third trimester, which can slightly elevate
blood pressure.
26. A pregnant woman experiences mild respiratory alkalosis. What causes this?
 A. Increased metabolic rate
  B. Hyperventilation from increased progesterone
 C. Compression of the lungs by the uterus
 D. Increased carbon dioxide production
Explanation: Progesterone stimulates increased ventilation, causing mild respiratory
alkalosis.
27. Which of the following changes is expected in the renal system during pregnancy?
 A. Increased GFR
 B. Decreased renal blood flow
 C. Increased serum creatinine
 D. Decreased kidney size
Explanation: GFR increases significantly during pregnancy to accommodate the
increased metabolic load.
28. A pregnant woman develops carpal tunnel syndrome. The likely cause is:
 A. Decreased serum protein levels
 B. Fluid retention leading to compression of the median nerve
 C. Increased joint laxity
 D. Increased plasma calcium
Explanation: Fluid retention during pregnancy can cause compression of nerves, such as
the median nerve, leading to carpal tunnel syndrome.
29. A pregnant woman experiences difficulty sleeping due to nasal congestion. What is the
cause?
 A. Allergies
 B. Increased blood flow to the nasal mucosa
 C. Decreased respiratory rate
 D. Reduced lung compliance
Explanation: Increased vascularity and blood flow to mucous membranes can lead to
nasal congestion.
30. What cardiovascular change is common during pregnancy?
 A. Increased stroke volume
 B. Decreased heart rate
 C. Increased systemic vascular resistance
  D. Decreased cardiac output
Explanation: Stroke volume increases as part of the adaptation to the increased blood
volume during pregnancy.
31. In which trimester does hCG reach its peak concentration?
 A. First trimester
 B. Second trimester
 C. Third trimester
 D. Labor
Explanation: hCG peaks in the first trimester and then declines as the placenta takes
over hormone production.
32. Which placental hormone plays a significant role in increasing maternal fat stores to
support fetal growth?
 A. Progesterone
 B. Human placental lactogen (hPL)
 C. Estriol
 D. Relaxin
Explanation: hPL helps promote lipolysis, leading to increased fat stores for energy
during pregnancy.
33. A pregnant woman is told that her progesterone levels are essential for preventing
premature labor. How does progesterone achieve this?
 A. By relaxing uterine smooth muscle
 B. By stimulating uterine contractions
 C. By increasing estrogen production
 D. By increasing fetal cortisol levels
Explanation: Progesterone relaxes the uterine muscles, preventing premature
contractions and labor.
34. Which hormone increases maternal respiratory drive to accommodate the growing
oxygen needs of the fetus?
 A. Progesterone
 B. hCG
 C. Estriol
  D. hPL
Explanation: Progesterone increases respiratory sensitivity to CO₂, leading to increased
ventilation.
35. Which hormone is responsible for maintaining the endometrium during the early stages
of pregnancy until the placenta is fully developed?
 A. Estriol
 B. Progesterone
 C. hPL
 D. Relaxin
Explanation: Progesterone maintains the uterine lining during early pregnancy.
36. A pregnant woman has increased levels of estrogen. Which of the following is NOT a
typical effect of estrogen during pregnancy?
 A. Increased uterine blood flow
 B. Suppression of uterine contractions
 C. Breast development
 D. Promotion of fetal growth
Explanation: Estrogen promotes uterine blood flow and fetal growth but does not
suppress uterine contractions—that's the role of progesterone.
37. A pregnant woman develops hyperpigmentation (e.g., linea nigra). Which placental
hormone is most responsible for this change?
 A. Progesterone
 B. Estrogen
 C. hCG
 D. hPL
Explanation: Estrogen stimulates melanocytes, leading to hyperpigmentation.
38. A 24-week pregnant woman has elevated cortisol levels. Which placental hormone is
primarily responsible for stimulating this increase?
 A. Progesterone
 B. Corticotropin-releasing hormone (CRH)
 C. hPL
 D. Relaxin
Explanation: The placenta produces CRH, which increases maternal cortisol levels.
39. Which hormone is essential for the softening of the pelvic ligaments in preparation for
childbirth?
 A. Relaxin
 B. Estrogen
 C. Progesterone
 D. hCG
Explanation: Relaxin softens the ligaments and cervix, allowing the pelvis to widen for
childbirth.
40. Which hormone increases significantly in late pregnancy and is thought to play a role in
the onset of labor by promoting uterine contractions?
 A. Progesterone
 B. Estrogen
 C. hCG
 D. hPL
Explanation: Estrogen increases towards the end of pregnancy and helps stimulate
uterine contractions.
41. Which hormone is critical for the development of the fetal adrenal glands during
pregnancy?
 A. Progesterone
 B. hPL
 C. Corticotropin-releasing hormone (CRH)
 D. Estrogen
Explanation: CRH is involved in the development of the fetal adrenal glands and the
regulation of fetal cortisol production.
42. Which hormone is responsible for stimulating milk production after delivery?
 A. Progesterone
 B. Prolactin
 C. Oxytocin
 D. hPL
Explanation: Prolactin stimulates milk production post-delivery.
43. A woman in her second trimester reports increased appetite and weight gain. Which
placental hormone is contributing to this change?
  A. Human placental lactogen (hPL)
 B. Progesterone
 C. Estrogen
 D. hCG
Explanation: hPL promotes fat storage and increases maternal appetite.
44. Which hormone helps increase blood flow to the placenta by promoting vasodilation
during pregnancy?
 A. Estrogen
 B. Progesterone
 C. hPL
 D. hCG
Explanation: Estrogen promotes vasodilation, increasing uterine and placental blood
flow.
45. Which hormone primarily stimulates the production of breast milk after childbirth?
 A. Estrogen
 B. Prolactin
 C. Oxytocin
 D. hCG
Explanation: Prolactin initiates milk production, while oxytocin is responsible for milk
ejection.
46. A woman is having a difficult time breastfeeding due to a low milk supply. Which
hormone is likely deficient?
 A. Oxytocin
 B. Prolactin
 C. Estrogen
 D. hCG
Explanation: Prolactin is essential for milk production.
47. Which hormone is involved in regulating glucose and lipid metabolism in the mother
during pregnancy?
 A. Human placental lactogen (hPL)
 B. Progesterone
  C. Estrogen
 D. Relaxin
Explanation: hPL regulates glucose and lipid metabolism, increasing maternal insulin
resistance to ensure glucose availability for the fetus.
48. Which hormone peaks in early pregnancy to maintain the corpus luteum, ensuring the
continued production of progesterone?
 A. Human chorionic gonadotropin (hCG)
 B. Estrogen
 C. Progesterone
 D. hPL
Explanation: hCG maintains the corpus luteum in early pregnancy, ensuring the
production of progesterone.
49. A woman at 38 weeks gestation has a high estrogen level. What is the role of this
hormone at this stage of pregnancy?
 A. Preparing the uterus for labor by stimulating contractions
 B. Preventing uterine contractions
 C. Supporting placental growth
 D. Maintaining the endometrium
Explanation: Estrogen helps prepare the uterus for labor by stimulating contractions and
increasing oxytocin receptor sensitivity.
50. Which hormone, secreted by the placenta, is involved in the maternal adaptation to
stress during pregnancy?
 A. Progesterone
 B. Estrogen
 C. Corticotropin-releasing hormone (CRH)
 D. hCG
Explanation: CRH increases maternal cortisol levels, helping the body adapt to stress.
51. A pregnant woman develops gestational diabetes. Which placental hormone is most
likely contributing to this condition?
 A. Estrogen
 B. Progesterone
 C. Human placental lactogen (hPL)
 D. Relaxin
Explanation: hPL contributes to gestational diabetes by increasing insulin resistance in
the mother.