Prenatal Care Practice Questions

Q: Nuchal translucency in USG can be detected at_____weeks of gestation.

11-13 weeks. ***11-13 weeks*** - Nuchal translucency (NT) is a **first-trimester ultrasound marker** used for screening for chromosomal abnormalities like **Down syndrome**. - The optimal window for accurate measurement is between **11 weeks 0 days and 13 weeks 6 days** of gestation, or when the crown-rump length (CRL) is between 45 mm and 84 mm. *18-20 weeks* - This period is typically dedicated to the **anomaly scan** or **mid-pregnancy scan**, which focuses on detecting structural abnormalities in the fetus. - While other markers like **nuchal fold thickness** can be assessed later, the diagnostic value of Nuchal Translucency is decreased by this time. *8-10 weeks* - At this early stage, the fetus is generally **too small** for accurate and consistent measurement of the nuchal translucency. - The nuchal translucency itself might not be fully developed or easily distinguishable for precise measurement. *20-22 weeks* - By this gestational age, the **nuchal translucency has usually resolved** or is no longer a reliable marker for chromosomal screening. - This period is well beyond the recommended window for NT measurement, making it unsuitable for this specific screening test.

Q: A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Continue the pregnancy with monitoring. ***Continue the pregnancy with monitoring*** - The risk of **fetal malformation** and **intellectual disability** from a single diagnostic X-ray exposure is generally considered very low, often below the threshold for clinical concern. - Current guidelines typically recommend continuing pregnancy with routine monitoring unless the estimated fetal dose exceeds a certain threshold (e.g., 50-100 mGy), which is unlikely with a single accidental exposure. *Perform chromosome analysis if needed* - **Chromosome analysis** is generally reserved for cases with suspected genetic anomalies or significant fetal exposure to radiation at doses known to induce chromosomal damage. - A single, accidental X-ray exposure is unlikely to cause clinically significant chromosomal aberrations requiring such invasive testing. *Conduct pre-invasive diagnostic testing if indicated* - **Pre-invasive diagnostic testing**, such as nuchal translucency scans or maternal serum screening, assesses risks for common aneuploidies and neural tube defects, not typically direct radiation effects. - While these tests are part of routine prenatal care, a single X-ray exposure does not, by itself, create a specific indication for additional pre-invasive testing beyond standard recommendations. *Consider termination of pregnancy* - **Termination of pregnancy** is usually considered only in cases of significant, confirmed fetal harm or very high radiation doses that unequivocally increase the risk of severe birth defects or intellectual disability. - A single accidental X-ray exposure almost certainly does not meet this threshold, as the associated risks to the fetus are minimal.

Q: A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

G2P1. ***G2P1*** - **Gravida (G)** refers to the total number of pregnancies, including the current one, so the current pregnancy (1) plus the previous twin delivery (1) equals **G2**. - **Parity (P)** refers to the number of times a woman has given birth to a fetus (or fetuses) beyond 20 weeks gestation, irrespective of whether the baby was born alive or is now living. A **twin delivery counts as one parity event** because it was one pregnancy that resulted in a delivery. *G2P2* - This option incorrectly counts the twin delivery as two separate parity events, whereas **parity is counted per pregnancy event** resulting in live birth or stillbirth beyond 20 weeks. - While G2 is correct (current pregnancy + previous pregnancy), P2 incorrectly implies two separate delivery events. *G3P2* - This option correctly identifies the parity as P2, but incorrectly states the gravida as G3. - **Gravida is 2** (current pregnancy + previous twin pregnancy), not 3. *G3P3* - This option is incorrect for both gravida and parity. - The patient has had **two pregnancies** (G2) and **one delivery event** (P1).

Q: Which of the following is the MOST significant physiological change that occurs during pregnancy?

Increase cardiac output. ***Increase cardiac output*** - **Cardiac output** significantly increases during pregnancy, starting in the first trimester and peaking in the third trimester. This is to meet the increased metabolic demands of the growing fetus, placenta, and maternal organs. - This increase is primarily due to an increase in **stroke volume** and **heart rate**, crucial for maintaining adequate uteroplacental perfusion. *Increase total protein* - While total blood volume increases during pregnancy, **plasma volume** increases disproportionately more than red blood cell mass, leading to hemodilution. - This hemodilution generally causes a *decrease* in total serum protein concentration and albumin levels, rather than an increase. *Increase residual volume* - **Residual volume** (the volume of air remaining in the lungs after maximal exhalation) actually *decreases* during pregnancy. - This decrease is due to the upward displacement of the diaphragm by the gravid uterus and an increase in inspiratory capacity, not an increase in residual volume. *Increase GFR* - **Glomerular filtration rate (GFR)** does significantly increase during pregnancy, often by 30-50% by the second trimester, in response to increased renal blood flow. - While important, the increase in GFR is a consequence of the systemic hemodynamic changes (including increased cardiac output) and is not as *overall* physiologically significant as the **fundamental increase in cardiac output** that drives many other physiological adaptations.

Q: During which trimester is the double decidua sign typically observed?

First trimester. ***First trimester*** - The **double decidua sign** is a classic sonographic finding seen in the **first trimester** that helps confirm an intrauterine pregnancy. - It results from the visualization of the **decidua capsularis** and the **decidua parietalis** separated by a small amount of intrauterine fluid. *Early second trimester* - By the early second trimester, the **placenta** is usually well-formed, and the **chorion laeve** fuses with the decidua parietalis, causing the double decidua sign to no longer be clearly visible. - At this stage, other markers like **fetal anatomy** scans are more diagnostically relevant. *Late second trimester* - The late second trimester is well beyond the period when the double decidua sign is identifiable. - **Fetal growth** and **organ development** are the primary focus of sonography during this time. *Third trimester* - In the third trimester, the pregnancy is advanced, and the double decidua sign has long since disappeared. - Sonography focuses on **fetal well-being**, **growth**, and **placental position**.

Q: Best time to perform the quadruple test is:

15-20 weeks. ***15-20 weeks*** - The quadruple test measures levels of four substances (**alpha-fetoprotein**, **human chorionic gonadotropin**, **unconjugated estriol**, and **inhibin A**) in the mother's blood. - This window is optimal for detecting neural tube defects and chromosomal abnormalities like **Down syndrome** and **Trisomy 18**, allowing for timely counseling and further diagnostic testing if needed. *8-12 weeks* - This period is generally too early for the quadruple test to be accurate, as the levels of the markers would not be sufficiently distinct for reliable screening. - The **combined first-trimester screening** (nuchal translucency and blood tests for PAPP-A and hCG) is typically performed during this time. *11-15 weeks* - While some components might be detectable at the later end of this range, 15-20 weeks offers a more accurate window for all four markers of the quadruple test. - **Integrated screening**, which combines first and second-trimester markers, would involve blood draws around 10-14 weeks and then 15-20 weeks. *18-22 weeks* - This period is generally considered too late for optimal results of the quadruple test, as the fetal markers might be less indicative or diagnostic interventions options might be limited. - A **detailed ultrasound** for anatomical survey is usually performed around this time.

Q: Hydrocephalus is best detected antenatally by :

Ultrasonography. ***Ultrasonography*** - **Antenatal ultrasonography** is the primary and most effective method for detecting fetal hydrocephalus. - It allows direct visualization of **ventricular dilation**, the key diagnostic finding in hydrocephalus (lateral ventricles >10mm at atrium level). - USG is **safe, non-invasive**, and can be performed repeatedly without radiation exposure. - It also helps identify associated anomalies and determine the cause of hydrocephalus. *X-ray abdomen* - **X-rays** expose the fetus to **ionizing radiation**, posing risks and violating ALARA (As Low As Reasonably Achievable) principles. - They provide limited detail of **soft tissue structures** like brain ventricles, making them unsuitable for diagnosing hydrocephalus. - X-rays are not used for antenatal diagnosis of fetal brain abnormalities. *Amniocentesis* - **Amniocentesis** is primarily used for **chromosomal analysis** and genetic testing, not for direct visualization of brain anomalies. - While some genetic conditions can lead to hydrocephalus, amniocentesis doesn't directly detect the hydrocephalus itself. - It cannot visualize structural fetal abnormalities. *Clinical examination* - **Antenatal clinical examination** of the mother cannot directly assess fetal brain abnormalities. - It may suggest fetal issues if there is an abnormally large uterine size or polyhydramnios, but it **lacks the specificity and sensitivity** to diagnose hydrocephalus. - Clinical examination alone is inadequate for detecting structural fetal anomalies.

Q: A 45-year-old female with a history of G5P4A0L4 has her last menstrual period (LMP) on August 25, 2014. What is the gestational age in weeks on May 11, 2015?

37 weeks. ***37 weeks*** - Calculating from **LMP (August 25, 2014)** to assessment date **(May 11, 2015)**: Days remaining in August: 6 days (26th-31st), September through April: 242 days, Days in May: 11 days. - **Total: 259 days ÷ 7 = exactly 37 weeks** gestational age using standard **Naegele's rule** calculation method. *32 weeks* - This option would correspond to an assessment date in early April 2015, which is **too early** given the LMP and assessment date. - It suggests a **5-week shorter** pregnancy duration than the actual interval calculated. *35 weeks* - This option indicates an assessment around the third week of April 2015, which is still **earlier** than the May 11, 2015, date. - It implies a **2-week shorter** gestational period than the correct calculation shows. *40 weeks* - This option would correspond to an assessment date in early June 2015, **beyond** the May 11, 2015, assessment date. - This gestational age is **too long** for the specified dates and would suggest the patient is at **term** or past her due date.

Q: What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?

4 mg. ***4 mg*** - For women with a prior history of a **neural tube defect (NTD)-affected pregnancy**, a higher dose of **4 mg of folic acid daily** is recommended to significantly reduce the risk of recurrence. - This increased dosage is crucial for achieving adequate maternal folate levels to prevent NTDs, starting at least one month before conception and continuing through the first trimester. *0.5 mg* - This dose is lower than the standard recommendation for women without a history of NTDs and is insufficient for high-risk individuals. - Suboptimal folic acid levels can still lead to a higher risk of NTD recurrence in patients with a history of NTD-affected pregnancies. *1 mg* - While 1 mg is higher than the general recommendation, it is still insufficient for women with a **history of NTD in a previous pregnancy**. - Current guidelines suggest a significantly higher dose for secondary prevention due to altered folate metabolism or higher requirements in these individuals. *2 mg* - This dose is also lower than the **established recommendation for high-risk women** who have had a previous NTD-affected pregnancy. - It does not provide the optimal level of protection required to reduce the risk of recurrence effectively.

Q: A pregnant woman at term presents with a symphysiofundal height of 40 cm. What is the most likely approximate fetal weight?

4 kg. ***4 kg*** - Using **Johnson's formula** for fetal weight estimation: Weight (g) = (SFH in cm - n) × 155, where n = 12 if fetal vertex is above ischial spines or n = 11 if at/below spines - For SFH of **40 cm**: (40 - 12) × 155 = **4,340 g ≈ 4 kg** or (40 - 11) × 155 = 4,495 g ≈ 4.5 kg - An approximate weight of **4 kg** is the most reasonable estimate for an SFH of 40 cm at term - This represents a larger than average fetus, which is consistent with the clinical measurement *3 kg* - While 3 kg is a common average birth weight, Johnson's formula calculation for an SFH of **40 cm** yields a significantly higher estimate - A weight of 3 kg would typically correlate with an SFH of approximately **32-33 cm**, not 40 cm - This option significantly underestimates the fetal weight for the given measurement *3.3 kg* - Although closer to average birth weight, this still **underestimates** the fetal weight suggested by an SFH of 40 cm - Using Johnson's formula, this measurement would correlate with an SFH of approximately **34-35 cm**, not 40 cm - The 40 cm measurement indicates a larger fetus than this estimate suggests *4.3 kg* - This represents the more **precise calculation** using Johnson's formula: (40 - 12) × 155 = 4,340 g - While mathematically accurate, **4 kg is the more commonly used approximation** in clinical practice for ease of communication - Both 4 kg and 4.3 kg are acceptable estimates, but 4 kg is the standard teaching answer for NEET-PG

Question 1

Nuchal translucency in USG can be detected at_____weeks of gestation.

Accepted Answer

11-13 weeks

Answer

18-20 weeks

Answer

8-10 weeks

Answer

20-22 weeks

Question 2

A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Accepted Answer

Continue the pregnancy with monitoring

Answer

Perform chromosome analysis if needed

Answer

Conduct pre-invasive diagnostic testing if indicated

Answer

Consider termination of pregnancy

Question 3

A 36-week pregnant lady with previous twin delivery. What is the Obstetric score?

Accepted Answer

G2P1

Answer

G2P2

Answer

G3P2

Answer

G3P3

Question 4

Which of the following is the MOST significant physiological change that occurs during pregnancy?

Accepted Answer

Increase cardiac output

Answer

Increase total protein

Answer

Increase GFR

Answer

Increase residual volume

Question 5

During which trimester is the double decidua sign typically observed?

Accepted Answer

First trimester

Answer

Early second trimester

Answer

Late second trimester

Answer

Third trimester

Question 6

Best time to perform the quadruple test is:

Accepted Answer

15-20 weeks

Answer

8-12 weeks

Answer

11-15 weeks

Answer

18-22 weeks

Question 7

Hydrocephalus is best detected antenatally by :

Accepted Answer

Ultrasonography

Answer

X-ray abdomen

Answer

Amniocentesis

Answer

Clinical examination

Question 8

A 45-year-old female with a history of G5P4A0L4 has her last menstrual period (LMP) on August 25, 2014. What is the gestational age in weeks on May 11, 2015?

Accepted Answer

37 weeks

Answer

32 weeks

Answer

35 weeks

Answer

40 weeks

Question 9

What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?

Accepted Answer

4 mg

Answer

0.5 mg

Answer

1 mg

Answer

2 mg

Question 10

A pregnant woman at term presents with a symphysiofundal height of 40 cm. What is the most likely approximate fetal weight?

Accepted Answer

4 kg

Answer

3 kg

Answer

3.3 kg

Answer

4.3 kg

Prenatal Care — MCQs

Prenatal Care — MCQs

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