Maternal-Fetal Medicine Practice Questions

Q: Biophysical profile includes all except?

Acetylcholine level. The **Biophysical Profile (BPP)**, also known as Manning’s score, is a critical ultrasound-based assessment used to evaluate fetal well-being and identify fetal hypoxia. It consists of five specific parameters, each reflecting the integrity of the fetal central nervous system. ### Why Acetylcholine level is the correct answer: **Acetylcholine level** is not a component of the BPP. While biochemical markers like Alpha-fetoprotein or Acetylcholinesterase are measured in amniotic fluid to screen for neural tube defects, they play no role in the acute assessment of fetal oxygenation or behavioral states. ### Explanation of BPP Components (The Incorrect Options): The BPP evaluates five parameters, scoring each as either 2 (normal) or 0 (abnormal): 1. **Non-stress test (NST):** Assesses fetal heart rate reactivity (the only "non-ultrasound" component). 2. **Fetal muscle tone:** At least one episode of active extension with return to flexion of fetal limbs or trunk. 3. **Amniotic fluid volume:** A marker of chronic fetal well-being (at least one pocket of $2 \text{ cm} \times 2 \text{ cm}$). 4. **Fetal breathing movements:** At least one episode of $\geq 30$ seconds duration within 30 minutes. 5. **Gross body movements:** At least three discrete body or limb movements in 30 minutes. ### High-Yield Clinical Pearls for NEET-PG: * **Modified BPP:** Consists of only two parameters: **NST** (acute indicator) and **Amniotic Fluid Index** (chronic indicator). * **Sequence of Loss:** In progressive fetal acidemia, the first parameter to disappear is the **NST (reactivity)**, followed by breathing, then movement, and finally **tone** (the last to disappear). * **Scoring:** A score of **8–10** is normal; **4 or less** is strongly suggestive of fetal asphyxia and usually warrants immediate delivery.

Q: Which of the following agents is used for neuroprotection in preterm deliveries?

Magnesium sulphate. **Explanation:** **Magnesium Sulphate (MgSO₄)** is the drug of choice for fetal neuroprotection in anticipated preterm deliveries. When administered to mothers at risk of delivery before 32 weeks of gestation, it significantly reduces the risk of **cerebral palsy** and severe motor dysfunction in the offspring. The underlying mechanism involves stabilizing neuronal membranes, reducing pro-inflammatory cytokines, and inhibiting excitatory neurotransmitters like glutamate by blocking NMDA receptors. **Analysis of Incorrect Options:** * **Betamethasone & Dexamethasone (Options A & B):** These are antenatal corticosteroids used to accelerate **fetal lung maturity**. While they reduce the incidence of Respiratory Distress Syndrome (RDS), Intraventricular Hemorrhage (IVH), and Necrotizing Enterocolitis (NEC), they are not primarily classified as neuroprotective agents for cerebral palsy. * **Indomethacin (Option D):** This is a non-steroidal anti-inflammatory drug (NSAID) used as a **tocolytic** to delay preterm labor. It acts by inhibiting prostaglandin synthesis. It is generally avoided after 32 weeks due to the risk of premature closure of the ductus arteriosus. **High-Yield Clinical Pearls for NEET-PG:** * **Gestational Age:** MgSO₄ for neuroprotection is typically recommended for deliveries **<32 weeks** (some protocols say <30 weeks). * **Dosing:** Usually a 4g IV loading dose followed by a 1g/hour maintenance infusion for 24 hours or until delivery. * **Monitoring:** Always monitor for **Magnesium toxicity** (loss of patellar reflex is the first sign, followed by respiratory depression). * **Antidote:** Calcium Gluconate (10ml of 10% solution IV).

Q: A 25-year-old woman complains of abdominal pain of rapid onset in the right lower quadrant. She subsequently undergoes surgery for suspected acute appendicitis. At surgery, however, a tubal pregnancy is discovered. What is the most frequent predisposing factor for this condition?

Pelvic inflammatory disease. **Explanation:** The clinical presentation describes an **Ectopic Pregnancy**, which often mimics acute appendicitis when it occurs in the right fallopian tube. **1. Why Pelvic Inflammatory Disease (PID) is Correct:** PID is the **most common risk factor** for ectopic pregnancy. Infections (primarily *Chlamydia trachomatis* or *Neisseria gonorrhoeae*) lead to salpingitis, causing structural damage to the tubal mucosa, loss of ciliary action, and the formation of intratubal adhesions (endosalpingeal folds). This mechanical and functional impairment hinders the transport of the fertilized ovum, leading to implantation within the tube. **2. Analysis of Incorrect Options:** * **Endometriosis (A):** While pelvic endometriosis can cause adhesions that distort tubal anatomy, it is a much less frequent cause compared to PID. * **Intrauterine Device (B):** IUDs do not *cause* ectopic pregnancy; they are highly effective at preventing all pregnancies. However, if a woman becomes pregnant with an IUD in situ, the *proportion* of those pregnancies being ectopic is higher, but the absolute risk is lower than in non-contraceptive users. * **Leiomyomas (C):** Uterine fibroids may cause infertility or miscarriage by distorting the uterine cavity, but they are rarely implicated in the pathogenesis of tubal pregnancies. **3. NEET-PG High-Yield Pearls:** * **Most common site of Ectopic Pregnancy:** Ampulla of the Fallopian tube (70%). * **Most common site for Tubal Rupture:** Isthmus (occurs early, around 6–8 weeks). * **Strongest Risk Factor:** Prior history of ectopic pregnancy (highest odds ratio). * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on histology, characteristic of (but not pathognomonic for) ectopic pregnancy.

Q: What type of seizures are characteristic of eclampsia?

Generalised Tonic-Clonic Seizures. **Explanation:** **Eclampsia** is defined as the onset of seizures in a woman with pre-eclampsia that cannot be attributed to other causes. The characteristic seizure type in eclampsia is **Generalised Tonic-Clonic Seizures (GTCS)**. **Why GTCS is the correct answer:** The pathophysiology involves cerebral vasospasm, edema, and loss of cerebral autoregulation (often termed Posterior Reversible Encephalopathy Syndrome or PRES). This leads to widespread cortical irritability, resulting in a classic four-stage seizure: 1. **Invasion:** Facial twitching. 2. **Tonic phase:** Generalized muscular rigidity (lasts ~20 seconds). 3. **Clonic phase:** Violent rhythmic contractions and tongue biting (lasts ~1-2 minutes). 4. **Coma:** A period of unconsciousness and post-ictal confusion. **Why other options are incorrect:** * **Focal seizures:** These involve a specific area of the brain. While eclampsia can occasionally present with focal neurological deficits, the hallmark seizure is generalized. * **Absence seizures:** These involve brief lapses in consciousness without motor activity, typical of childhood epilepsy, not the violent convulsions of eclampsia. * **Myoclonic seizures:** These are brief, shock-like jerks of a muscle group, which do not follow the tonic-clonic progression seen in eclamptic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Magnesium Sulfate ($MgSO_4$) is the DOC for both prophylaxis and treatment of eclamptic seizures (Pritchard Regimen). * **Antidote for $MgSO_4$:** Calcium Gluconate (10 ml of 10% solution). * **Timing:** Eclampsia most commonly occurs **antepartum** (50%), followed by intrapartum (25%) and postpartum (25%). * **Definitive Treatment:** Delivery of the fetus, regardless of gestational age, once the mother is stabilized.

Q: Which of the following is a pathognomonic feature of ectopic pregnancy?

Decidual casts. ### Explanation **Correct Answer: B. Decidual casts** In ectopic pregnancy, the high levels of progesterone produced by the corpus luteum cause the uterine endometrium to undergo a **decidual reaction** (thickening and vascularization) to prepare for an embryo that never arrives in the uterus. When the ectopic pregnancy begins to fail or the hormonal support drops, the entire decidualized lining sloughs off and is expelled through the cervix in one piece, mimicking the shape of the uterine cavity. This is known as a **decidual cast**. While not present in every case, it is considered a classic, pathognomonic sign of ectopic pregnancy when it occurs. **Analysis of Incorrect Options:** * **A. Purple hemorrhagic mass in the lower vagina:** This is a characteristic finding of **Gestational Trophoblastic Neoplasia (Choriocarcinoma)**, representing vaginal metastasis. * **C. Chadwick sign:** This refers to the bluish discoloration of the cervix, vagina, and labia due to increased vascularity. It is a **presumptive sign of pregnancy** (both intrauterine and ectopic) but is not specific to ectopic pregnancy. * **D. Postcoital hemorrhage:** This is most commonly associated with **cervical pathology**, such as cervical polyps, cervicitis, or cervical cancer. **NEET-PG High-Yield Pearls:** * **Arias-Stella Reaction:** A microscopic finding in the endometrium (hypersecretory glands with enlarged nuclei) seen in ectopic pregnancy; it is suggestive but not pathognomonic as it can also occur in intrauterine pregnancies. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serum β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Most Common Site:** Ampulla of the Fallopian tube.

Q: Which of the following conditions is considered least dangerous in pregnancy?

Ebstein's anomaly. **Explanation:** In maternal-fetal medicine, cardiac diseases are categorized by their risk of maternal mortality. **Ebstein’s anomaly** is generally well-tolerated during pregnancy, provided there is no significant right-to-left shunting or severe heart failure. In this condition, the tricuspid valve is displaced downward into the right ventricle; however, unless accompanied by severe cyanosis or arrhythmias (like WPW syndrome), most women have successful obstetric outcomes. **Why the other options are more dangerous:** * **Pulmonary Hypertension (Option B):** This is the most lethal condition in pregnancy (mortality rates of 30-50%). The inability of the right ventricle to increase cardiac output against fixed pulmonary resistance leads to sudden cardiovascular collapse, especially during labor or the immediate postpartum period. * **Cyanotic Heart Disease (Option C):** Conditions like Eisenmenger syndrome or uncorrected Tetralogy of Fallot carry a high risk (mortality >25%). Pregnancy-induced systemic vasodilation increases right-to-left shunting, worsening hypoxia for both mother and fetus. * **Marfan Syndrome (Option D):** Pregnancy increases the risk of life-threatening **aortic dissection** or rupture due to hypervolemia and hormonal changes (estrogen/progesterone) affecting the aortic wall integrity, especially if the aortic root diameter exceeds 4 cm. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Class IV (Pregnancy Contraindicated):** Pulmonary hypertension, severe systemic ventricular dysfunction (EF 45mm. * **Most common heart disease in pregnancy:** Mitral Stenosis (Rheumatic). * **Most common congenital heart disease in pregnancy:** ASD (Atrial Septal Defect). * **Ebstein’s Anomaly** is uniquely associated with maternal **Lithium** intake during the first trimester.

Q: A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Bed rest, Nifedipine, and Dexamethasone. **Explanation:** The management of Placenta Previa depends on the gestational age, the severity of bleeding, and the maternal/fetal status. This patient is at **32 weeks (preterm)** with **mild contractions** and stable vitals, indicating a candidate for **Expectant Management (Macafee-Johnson Regime)**. 1. **Why Option B is Correct:** * **Bed Rest:** Essential to reduce pressure on the lower uterine segment and minimize bleeding. * **Nifedipine (Tocolysis):** The patient is experiencing contractions. Tocolytics are used to arrest preterm labor, providing a window (48 hours) for steroid action. * **Dexamethasone (Corticosteroids):** Crucial at 32 weeks to promote fetal lung maturity and reduce the risk of Respiratory Distress Syndrome (RDS), Intraventricular Hemorrhage, and Necrotizing Enterocolitis. 2. **Why Other Options are Incorrect:** * **Option A:** Lacks the tocolytic (Nifedipine) needed to stop the contractions that could lead to further placental separation. * **Option C:** Sedation may provide rest but does not address fetal lung maturity or the physiological process of preterm labor. * **Option D:** Immediate C-section is reserved for patients with heavy, life-threatening hemorrhage, fetal distress, or those who have reached 37 weeks. At 32 weeks with stable vitals, the goal is to prolong the pregnancy. **Clinical Pearls for NEET-PG:** * **Macafee-Johnson Regime:** Aimed at carrying the pregnancy to **37 weeks** to avoid prematurity. * **Contraindication:** Digital vaginal examination is strictly contraindicated in suspected placenta previa as it can provoke torrential hemorrhage. * **Type III/IV Previa:** Always requires a Cesarean Section for delivery. * **Tocolytic of Choice:** Nifedipine is preferred over Beta-mimetics (like Ritodrine) in previa because Beta-mimetics cause tachycardia, which can mask signs of hypovolemic shock.

Q: All are true about ectopic pregnancy EXCEPT:

A negative pregnancy test excludes the diagnosis.. **Explanation:** The correct answer is **C (A negative pregnancy test excludes the diagnosis)** because this statement is clinically inaccurate. While a urine pregnancy test (UPT) is highly sensitive, it has a threshold (usually 20–25 mIU/mL). In cases of chronic ectopic pregnancy or very early gestations, the hCG levels may fall below this threshold, leading to a "false negative" UPT. Therefore, a negative urine test cannot 100% exclude an ectopic pregnancy; a serum beta-hCG test is the gold standard for confirmation. **Analysis of other options:** * **Option A:** Pelvic Inflammatory Disease (PID), specifically caused by *Chlamydia trachomatis*, is the **most common risk factor** because it causes tubal scarring and cilia dysfunction. * **Option B:** Serial hCG levels are crucial for diagnosis. In a normal pregnancy, hCG doubles every 48 hours; a suboptimal rise (less than 35-53%) suggests an ectopic or failing intrauterine pregnancy. * **Option D:** Methotrexate (a folate antagonist) is the standard medical management for hemodynamically stable patients meeting specific criteria (e.g., hCG <5000 mIU/mL, no fetal heart tone, mass <4cm). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to narrow lumen). * **Discriminatory Zone:** The serum hCG level (usually 1500–2000 mIU/mL) at which a gestational sac should be visible on Transvaginal Sonography (TVS). If hCG is above this and the uterus is empty, suspect ectopic pregnancy. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, which is suggestive of pregnancy but not specific to ectopic.

Q: What can Doppler ultrasound in pregnancy detect?

IUGR. **Explanation:** **Why IUGR is the correct answer:** Doppler ultrasound is a functional imaging modality used to assess feto-placental hemodynamics. In **Intrauterine Growth Restriction (IUGR)**, there is often placental insufficiency. Doppler allows for the evaluation of blood flow in the **Umbilical Artery (UA)**, **Middle Cerebral Artery (MCA)**, and **Ductus Venosus**. * **Key Finding:** A high-resistance pattern in the Umbilical Artery (decreased, absent, or reversed end-diastolic flow) indicates placental resistance. * **Brain Sparing Effect:** Increased flow in the MCA suggests the fetus is redirecting blood to the brain due to hypoxia. This makes Doppler the gold standard for monitoring the timing of delivery in growth-restricted fetuses. **Why the other options are incorrect:** * **A, B, & C (Cardiovascular malformations, Neural tube defects, Abdominal masses):** These are **structural/anatomical abnormalities**. They are primarily diagnosed using **Routine Morphological Ultrasound (Level II scan/Anomaly scan)** between 18–22 weeks, which uses 2D/3D B-mode grayscale imaging to visualize anatomy rather than blood flow velocity. **High-Yield Clinical Pearls for NEET-PG:** * **Umbilical Artery:** The most common vessel studied; **Absent End Diastolic Velocity (AEDV)** or **Reversed End Diastolic Velocity (REDV)** are critical indicators of fetal distress. * **Uterine Artery Doppler:** Used at 11–14 weeks to screen for the risk of developing **Pre-eclampsia**. * **Ductus Venosus:** Abnormal (reversed) 'a' wave is a late sign of fetal cardiac failure and an indication for immediate delivery. * **MCA Doppler:** The investigation of choice for detecting **Fetal Anemia** (e.g., in Rh isoimmunization) by measuring Peak Systolic Velocity (PSV).

Question 1

Biophysical profile includes all except?

Accepted Answer

Acetylcholine level

Answer

Non-stress test (NST)

Answer

Fetal muscle tone

Answer

Amniotic fluid volume

Question 2

Which of the following agents is used for neuroprotection in preterm deliveries?

Accepted Answer

Magnesium sulphate

Answer

Betamethasone

Answer

Dexamethasone

Answer

Indomethacin

Question 3

A 25-year-old woman complains of abdominal pain of rapid onset in the right lower quadrant. She subsequently undergoes surgery for suspected acute appendicitis. At surgery, however, a tubal pregnancy is discovered. What is the most frequent predisposing factor for this condition?

Accepted Answer

Pelvic inflammatory disease

Answer

Endometriosis

Answer

An intrauterine device

Answer

Leiomyomas of the uterus

Question 4

What type of seizures are characteristic of eclampsia?

Accepted Answer

Generalised Tonic-Clonic Seizures

Answer

Focal seizures

Answer

Absence seizures

Answer

Myoclonic seizures

Question 5

Which of the following is a pathognomonic feature of ectopic pregnancy?

Accepted Answer

Decidual casts

Answer

Purple hemorrhagic mass in the lower vagina

Answer

Chadwick sign

Answer

Postcoital hemorrhage

Question 6

A patient in shock is diagnosed with ectopic pregnancy in the right fallopian tube. What is the postulated cause of fetal death in ectopic pregnancy?

Accepted Answer

Vascular accident

Answer

Nutritional adequacy

Answer

Endocrine insufficiency

Answer

Immune response of mother

Question 7

Which of the following conditions is considered least dangerous in pregnancy?

Accepted Answer

Ebstein's anomaly

Answer

Pulmonary hypertension

Answer

Cyanotic heart disease

Answer

Marfan syndrome

Question 8

A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Accepted Answer

Bed rest, Nifedipine, and Dexamethasone

Answer

Bed rest and Dexamethasone

Answer

Bed rest and Sedation

Answer

Immediate caesarean section

Question 9

All are true about ectopic pregnancy EXCEPT:

Accepted Answer

A negative pregnancy test excludes the diagnosis.

Answer

The most common cause is pelvic inflammatory disease.

Answer

It can be diagnosed by human chorionic gonadotropin (hCG) levels.

Answer

Methotrexate is used as a part of medical management.

Question 10

What can Doppler ultrasound in pregnancy detect?

Accepted Answer

IUGR

Answer

Cardiovascular malformation

Answer

Neural tube defect

Answer

Abdominal masses

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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