Maternal-Fetal Medicine Practice Questions

Q: What procedure is being demonstrated in the image?

Amniocentesis. ***Amniocentesis*** - The image clearly depicts a needle being inserted through the maternal abdomen into the **amniotic sac** to withdraw **amniotic fluid**, which is the procedure for amniocentesis. - This procedure is typically performed for prenatal diagnosis of genetic conditions, **fetal lung maturity assessment**, or to evaluate for uterine infections. *Artificial rupture of membranes* - This procedure involves using a specialized instrument (amniohook) to **break the amniotic sac** through the cervix during active labor to facilitate delivery, which is not what is shown. - The image shows an abdominal approach and aspiration of fluid, not membrane rupture through the vagina. *Fetal scalp pH monitoring* - Fetal scalp pH monitoring involves taking a small **blood sample from the fetal scalp** during labor to assess for fetal acidosis, typically done vaginally and not via abdominal puncture. - The instrument shown is a needle for fluid aspiration, not a blood sampling device or pH electrode. *Paracervical block* - A paracervical block is a regional anesthetic procedure involving injections into the **cervical tissue** to relieve pain during labor, which is not depicted in the image. - The image shows a procedure involving access to the amniotic fluid, not local anesthesia of the cervix.

Q: Increased nuchal translucency is a feature of:

Aneuploidy. ***Aneuploidy*** - Increased nuchal translucency (NT) is a well-established sonographic marker for fetal **aneuploidies**, particularly **Down syndrome (Trisomy 21)**. - The thickened NT reflects underlying fluid accumulation in the fetal neck due to various factors associated with aneuploidy, such as cardiac defects or altered lymphatic drainage. *Hyperploidy* - **Hyperploidy** refers to having more than the normal diploid number of chromosomes; it is a general term that includes aneuploidy. - While increased NT is a feature of conditions under the umbrella of hyperploidy, the term **aneuploidy** is more specific and commonly used in the context of NT screening for chromosomal abnormalities like trisomies. *Hypoploidy* - **Hypoploidy** refers to having fewer than the normal diploid number of chromosomes, such as **monosomy**. - While some hypoploid conditions (e.g., Turner syndrome, which is monosomy X) can be associated with increased NT, it is not the primary or most common genetic abnormality linked to significantly elevated NT measurements compared to aneuploidy in general. *Cystic fibrosis* - **Cystic fibrosis** is an autosomal recessive genetic disorder affecting exocrine glands, leading to mucus build-up in various organs. - It is **not directly associated with increased nuchal translucency** as a primary diagnostic marker; NT is a marker for chromosomal abnormalities and certain structural defects, not single-gene disorders like cystic fibrosis.

Q: A 21-year-old G2P1 presents to OPD at 20 weeks of gestation for a second opinion since her family physician had told her that the foetus had some problem. Her obstetric USG is given below. What is the diagnosis? (AIIMS May 2016)

Anencephaly. ***Anencephaly*** - The ultrasound images clearly show the **absence of the cranial vault** and the **cerebral hemispheres**, which is characteristic of anencephaly. The upper arrow in the right image points to the irregular brain tissue that is exposed, not covered by bone. - The "frog-like" appearance of the fetal head, with exposed brain tissue, is a classic sonographic finding for this neural tube defect. *Cystic hygroma* - A cystic hygroma would appear as a **multiloculated cystic mass**, typically in the posterior neck region, often associated with chromosomal abnormalities. - The image does not show such a cystic mass; instead, it shows a defect in the fetal skull. *Omphalocele* - An omphalocele involves the **protrusion of abdominal organs** into the umbilical cord base, covered by a membrane. - This condition affects the abdominal wall, not the fetal head or brain, and would appear as an abdominal mass rather than a cranial defect. *Encephalocele* - Encephalocele is characterized by the **protrusion of brain tissue and/or meninges** through a defect in the skull, typically covered by skin or a membrane. - In encephalocele, while some brain tissue might protrude, the **cranial vault is still visible**, unlike the complete absence seen in anencephaly.

Q: Which of the following maternal complications can be seen in hyperemesis gravidarum? I. Wernicke's encephalopathy II. Hepatic failure III. Hypoprothrombinemia IV. Convulsions Select the correct answer using the code given below :

I, III and IV only. ***Correct Option: I, III and IV only*** - **Hyperemesis gravidarum** can lead to severe metabolic derangements and nutrient deficiencies, resulting in multiple maternal complications. - **Wernicke's encephalopathy** occurs due to **thiamine (vitamin B1) deficiency** from prolonged vomiting and malnutrition, presenting with confusion, ataxia, and ophthalmoplegia. - **Hypoprothrombinemia** develops due to **vitamin K deficiency**, which can lead to coagulopathy and bleeding complications. - **Convulsions** can occur secondary to severe **electrolyte imbalances** (particularly hyponatremia, hypocalcemia) or metabolic derangements. *Incorrect Option: I, II, III and IV* - This option incorrectly includes **hepatic failure** as a complication of hyperemesis gravidarum. - While **mild transient elevation of liver enzymes** (transaminitis) can occur in hyperemesis gravidarum, **true hepatic failure does NOT occur**. - Hepatic failure in pregnancy is associated with other distinct conditions like **acute fatty liver of pregnancy (AFLP)** or **HELLP syndrome**, not hyperemesis gravidarum. *Incorrect Option: I, II and IV only* - This option incorrectly includes **hepatic failure**, which is not a recognized complication of hyperemesis gravidarum. - It also incorrectly excludes **hypoprothrombinemia**, which can occur due to vitamin K deficiency in severe cases. *Incorrect Option: II and III only* - This option is incorrect as it includes **hepatic failure** (which does not occur in hyperemesis gravidarum). - It also incorrectly excludes **Wernicke's encephalopathy** and **convulsions**, which are well-recognized severe complications of hyperemesis gravidarum.

Q: Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following? I. Number of foetus II. Viability of foetus III. Chorionicity of twins IV. Malformation in either foetus Select the correct answer using the code given below :

I, II and III only. ***I, II and III only*** - A **first-trimester ultrasound** (10-13 weeks) in a twin pregnancy is essential for confirming the **number of fetuses**, assessing their **viability** (cardiac activity), and most importantly determining the **chorionicity of twins**. - **Chorionicity determination** is crucial at this stage as it guides the entire pregnancy management - monochorionic twins require more intensive surveillance due to higher risks. - While nuchal translucency screening for chromosomal abnormalities is performed at 11-13+6 weeks, **systematic structural malformation screening is NOT the primary objective** of the first-trimester scan and is typically performed at **18-22 weeks**. *I and III only* - While confirming the **number of fetuses** and **chorionicity** is essential, this option incorrectly omits the assessment of **fetal viability**. - Confirming cardiac activity and viability of both fetuses is a fundamental component of the first-trimester ultrasound examination. *II and IV only* - This option fails to include the most critical aspects of first-trimester twin ultrasound: confirming the **number of fetuses** and determining **chorionicity**. - Additionally, **malformation screening** is NOT a primary objective at 10-13 weeks; detailed anomaly scanning is performed in the second trimester (18-22 weeks). *I, II, III and IV* - While this option correctly includes fetal number, viability, and chorionicity determination, it incorrectly adds **malformation screening** as a primary objective. - **Structural anomaly scanning** is performed during the **mid-trimester ultrasound (18-22 weeks)**, not at 10-13 weeks, when organ development is more complete and detailed anatomical survey is possible.

Q: Which of the following is the primary surveillance tool in the growth-restricted fetus?

Umbilical artery Doppler. ***Umbilical artery Doppler*** - The **umbilical artery Doppler** is the primary tool for fetal surveillance in **growth-restricted fetuses** because it directly assesses **placental resistance** and **blood flow** to the fetus. - Abnormal findings, such as **increased resistance** or **absent/reversed end-diastolic flow**, indicate **placental insufficiency** and are key indicators for intervention. *Umbilical venous pulsation* - **Umbilical venous pulsation** can be a sign of **cardiac dysfunction** in the fetus but is considered a **late and severe sign** of fetal compromise, not a primary surveillance tool. - Its presence usually indicates significant **cardiac overload** or **venous congestion**, suggesting advanced stages of fetal distress. *Uterine artery Doppler* - **Uterine artery Doppler** is primarily used for **screening** for preeclampsia and fetal growth restriction in the **second trimester**, not as a primary surveillance tool once growth restriction is established. - It assesses **placental bed development** and **maternal uterine blood flow** but doesn't directly monitor the fetal response to placental insufficiency. *Middle cerebral artery Doppler* - **Middle cerebral artery (MCA) Doppler** is used to assess for **brain-sparing effect** in growth-restricted fetuses, indicating the fetus is shunting blood to the brain due to hypoxia. - While important for evaluating the severity of compromise, it is a **secondary surveillance tool** for brain perfusion, not the primary measure of placental function.

Q: A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?

Ectopic pregnancy. ***Ectopic pregnancy*** - This patient presents with **acute abdominal pain** and **vaginal bleeding** of short duration, with right adnexal tenderness and a closed os, highly suggestive of an ectopic pregnancy even after a tubal ligation. Tubal ligation does not provide 100% protection against pregnancy. - The history of **tubal ligation** increases the risk for ectopic pregnancy, as fertilization can still occur with the ovum implanting outside the uterus. *Complete abortion* - A complete abortion would typically involve the **passage of all products of conception**, after which the pain and bleeding would subside, and the os would generally be closed or closing. - This patient's symptoms are more acute and localized to the **adnexa**, which is less typical for a complete abortion occurring in a non-pregnant uterus (given the tubal ligation). *Pelvic inflammatory disease* - **Pelvic inflammatory disease (PID)** usually presents with **vaginal discharge/cervicitis**, **fever**, and bilateral abdominal pain. - While adnexal tenderness can be present, the acute onset with vaginal bleeding in a patient post-tubal ligation makes ectopic pregnancy a more concerning and probable diagnosis. *Appendicitis* - **Appendicitis** typically presents with **right lower quadrant pain** that often migrates from the periumbilical region, but usually lacks vaginal bleeding or adnexal tenderness. - The combination of **vaginal bleeding** and adnexal tenderness points away from appendicitis and more towards a gynecological origin.

Q: If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid (which correlates with elevated maternal serum levels), which of the following conditions is likely to be present?

Neural tube defects. ***Neural tube defects*** - **Elevated alpha-fetoprotein (AFP)** in amniotic fluid and maternal serum is a key indicator of neural tube defects like **spina bifida** or **anencephaly**. - These defects result in an open neural tube, allowing AFP to leak directly into the amniotic fluid. *Duchenne muscular dystrophy* - This is an **X-linked recessive genetic disorder** causing progressive muscle degeneration. - While it can be detected prenatally through genetic testing, it is **not associated with elevated AFP** levels. *Cardiac septal defects* - These are **structural abnormalities of the heart** (e.g., ventricular septal defect, atrial septal defect). - They are typically diagnosed via **fetal echocardiography** and do not cause elevated AFP levels. *Galactosaemia* - This is an **autosomal recessive metabolic disorder** where the body cannot properly metabolize galactose. - It is diagnosed by detecting elevated galactose or genetic testing, and **AFP levels are unaffected**.

Q: Tongue bite occurs in eclampsia at :

Tonic stage. ***Tonic stage*** - During the **tonic stage** of an eclamptic seizure, there is a sudden, sustained contraction of all muscles, including the **masseter muscles** (jaw muscles). - This forceful, sustained jaw clenching causes the teeth to clench tightly, leading to involuntary **biting of the tongue**. - The tonic phase lasts 10-20 seconds and is the first phase of the eclamptic seizure, characterized by rigid muscle contraction. *Coma stage* - The coma stage occurs after the seizure activity has ceased, and the patient is unconscious. - While aspiration or other complications can occur during this stage, **tongue biting** specifically happens during the active tonic phase of the seizure, not afterward. *Clonic stage* - The clonic stage follows the tonic stage and is characterized by rhythmic, jerking movements of the limbs and body. - Although there is muscle activity, the severe, **sustained jaw clenching** that causes tongue bite is specific to the tonic phase. - In the clonic phase, the jaw may rhythmically open and close, but the initial tongue bite has already occurred. *Postictal stage* - The postictal stage is the period of recovery immediately following a seizure. - The patient may be confused, drowsy, or unresponsive, but the active seizure movements, including **tongue biting**, have already occurred in the tonic phase.

Question 1

What procedure is being demonstrated in the image?

Accepted Answer

Amniocentesis

Answer

Artificial rupture of membranes

Answer

Fetal scalp pH monitoring

Answer

Paracervical block

Question 2

Increased nuchal translucency is a feature of:

Accepted Answer

Aneuploidy

Answer

Hyperploidy

Answer

Hypoploidy

Answer

Cystic fibrosis

Question 3

A 21-year-old G2P1 presents to OPD at 20 weeks of gestation for a second opinion since her family physician had told her that the foetus had some problem. Her obstetric USG is given below. What is the diagnosis? (AIIMS May 2016)

Accepted Answer

Anencephaly

Answer

Cystic hygroma

Answer

Omphalocele

Answer

Encephalocele

Question 4

Which of the following maternal complications can be seen in hyperemesis gravidarum?
I. Wernicke's encephalopathy
II. Hepatic failure
III. Hypoprothrombinemia
IV. Convulsions

Select the correct answer using the code given below :

Accepted Answer

I, III and IV only

Answer

I, II, III and IV

Answer

I, II and IV only

Answer

II and III only

Question 5

Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following?
I. Number of foetus
II. Viability of foetus
III. Chorionicity of twins
IV. Malformation in either foetus

Select the correct answer using the code given below :

Accepted Answer

I, II and III only

Answer

I and III only

Answer

II and IV only

Answer

I, II, III and IV

Question 6

Which of the following is the primary surveillance tool in the growth-restricted fetus?

Accepted Answer

Umbilical artery Doppler

Answer

Umbilical venous pulsation

Answer

Uterine artery Doppler

Answer

Middle cerebral artery Doppler

Question 7

Which of the following are the predictive factors for Fetal Growth Restriction (FGR)?
I. Low level of maternal 1^st trimester Beta hCG
II. Abnormal uterine artery Doppler at 20-24 weeks of pregnancy
III. Fetal echogenic bowel on ultrasound
IV. Maternal medical disorder

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, III and IV

Answer

I, II and III

Answer

II, III and IV

Question 8

A 30-year-old P3L3 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Complete abortion

Answer

Pelvic inflammatory disease

Answer

Appendicitis

Question 9

If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid (which correlates with elevated maternal serum levels), which of the following conditions is likely to be present?

Accepted Answer

Neural tube defects

Answer

Duchenne muscular dystrophy

Answer

Cardiac septal defects

Answer

Galactosaemia

Question 10

Tongue bite occurs in eclampsia at :

Accepted Answer

Tonic stage

Answer

Coma stage

Answer

Clonic stage

Answer

Postictal stage

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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