Prenatal Care Practice Questions

Q: All are cardiovascular system changes in pregnancy except.

Increase in peripheral resistance. ***Increase in peripheral resistance*** - During normal pregnancy, **peripheral vascular resistance actually decreases** due to the effects of hormones like progesterone and the presence of the low-resistance uteroplacental circulation. - This decrease in resistance helps accommodate the increased blood volume and cardiac output. *Increase in cardiac output* - **Cardiac output increases significantly** during pregnancy (by 30-50%) to meet the metabolic demands of the growing fetus and maternal tissues. - This is primarily achieved through an increase in both stroke volume and heart rate. *Increase in blood volume* - **Blood volume increases substantially** (by 30-50%) during pregnancy, with plasma volume increasing more than red blood cell mass. - This expansion supports the increased cardiac output and placental perfusion. *Increase in heart rate* - **Heart rate increases** during pregnancy, typically by 10-20 beats per minute, contributing to the overall increase in cardiac output. - This physiological adaptation helps maintain adequate circulation.

Q: A woman attends an antenatal clinic with a complaint of mild pain in the lower abdomen on the left side, her periods are regular, and a urine pregnancy test was positive at home. A transvaginal ultrasound was performed, revealing an empty uterine cavity and no adnexal mass. Her serum beta human chorionic gonadotropin (hCG) level is 700 IU/L. What is the next step?

Perform serum beta HCG after 48 hr. ***Perform serum beta HCG after 48 hr*** - An **empty uterine cavity** with a **hCG level of 700 IU/L** and no adnexal mass is inconclusive for a definitive diagnosis of ectopic pregnancy or intrauterine pregnancy. - Repeating the **hCG level after 48 hours** is crucial to assess its doubling time, which helps differentiate between a normal intrauterine pregnancy, failed pregnancy, or ectopic pregnancy. *Give single dose of methotrexate* - Administering methotrexate requires a **definitive diagnosis of ectopic pregnancy**, which is not yet established given the inconclusive ultrasound and hCG level. - Giving methotrexate prior to a definitive diagnosis would be **premature and potentially harmful** if the pregnancy were intrauterine or a failed pregnancy. *Perform laparoscopy* - **Laparoscopy is an invasive procedure** typically reserved for cases where ectopic pregnancy is strongly suspected or rupture is a concern, or when medical management fails. - At this stage, with an **unclear diagnosis and stable patient**, less invasive diagnostic steps are warranted first. *Perform serum Beta HCG after 7 days* - Waiting 7 days to re-check hCG levels would be **too long** in a potentially developing abnormal pregnancy or ectopic pregnancy. - A **48-hour interval** provides more timely information to guide management and detect rapid changes in hCG, which is critical for early diagnosis and intervention.

Q: According to Naegele's rule, what is the estimated date of delivery (EDD) for a patient with a last menstrual period (LMP) of 1st September 2017? (Dates given in DD/MM/YYYY format)

08/06/2018. ***08/06/2018*** - Naegele's rule: Add **7 days** to the LMP, subtract **3 months**, and add **1 year**. - For an LMP of 1st September 2017: (1 Sept 2017 + 7 days) = 8 Sept 2017; (8 Sept 2017 - 3 months) = 8 June 2017; (8 June 2017 + 1 year) = **8 June 2018**. - In DD/MM/YYYY format: **08/06/2018** is the correct EDD. *16/05/2018* - This represents 16th May 2018, which is incorrect. - The error involves miscalculating both the month (May instead of June) and the day (16th instead of 8th). - Subtracting 3 months from September yields June, not May. *16/07/2018* - This represents 16th July 2018, which is incorrect. - This reflects errors in both adding the days (resulting in 16th instead of 8th) and the month calculation (July instead of June). - Subtracting 3 months from September yields June, not July. *16/06/2018* - This represents 16th June 2018, which has the correct month but wrong day. - The error is in adding days: adding 7 days to the 1st gives the 8th, not the 16th. - This is a common calculation error when applying Naegele's rule.

Q: Most appropriate time for chorionic villus sampling in pregnancy is:

10-13 weeks. ***10-13 weeks*** - Chorionic villus sampling (CVS) is optimally performed between **10 and 13 completed weeks of gestation**. - This timing allows for **earlier diagnosis** of chromosomal abnormalities compared to amniocentesis, enabling more time for decision-making. *16-18 weeks* - This timeframe is typically used for **amniocentesis**, which is performed later in pregnancy. - Performing CVS at this stage is **outside the optimal window** and carries a higher risk profile for CVS specifically. *16-20 weeks* - This period is also generally recommended for **amniocentesis**, not chorionic villus sampling. - Delaying CVS until this point **reduces the advantage** of early diagnosis and may increase procedural risks. *8-10 weeks* - Performing CVS **before 10 weeks of gestation** is associated with a **higher risk of limb reduction defects** in the fetus. - Due to this significant risk, CVS is generally **contraindicated** before 10 weeks.

Q: Which of the following is a component of the triple test for Down syndrome?

Maternal Alpha-fetoprotein. ***Maternal Alpha-fetoprotein*** - The **triple test** for Down syndrome assesses **maternal serum levels** of alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG). - In pregnancies affected by **Down syndrome**, **maternal AFP levels** are typically lower than normal. *Maternal PAPP-A* - **Pregnancy-associated plasma protein A (PAPP-A)** is a component of the **first-trimester screening** (dual test), not the second-trimester triple test. - Low levels of **PAPP-A** in the first trimester are associated with an increased risk of Down syndrome. *Maternal Progesterone* - **Progesterone** is a hormone crucial for maintaining pregnancy and is not typically used as a marker in routine **screening tests for Down syndrome**. - Its levels can be monitored in cases of threatened miscarriage or to assess corpus luteum function. *Maternal Inhibin A* - **Inhibin A** is a component of the **quad screen** (which includes AFP, uE3, hCG, and Inhibin A), not the triple test. - Elevated **Inhibin A levels** are associated with an increased risk of Down syndrome in the second trimester.

Q: Increased nuchal translucency at 14 weeks is most commonly associated with:

Down syndrome. ***Down syndrome*** - **Increased nuchal translucency (NT)** in the first trimester is a significant marker for **chromosomal abnormalities**, with **Down syndrome (Trisomy 21)** being the most common. - This finding, especially at 14 weeks, indicates a higher risk, warranting further diagnostic testing like **chorionic villus sampling (CVS)** or **amniocentesis**. *Esophageal atresia* - This is a **structural anomaly** affecting the esophagus; it is typically identified by an **absent stomach bubble** or sometimes polyhydramnios on later ultrasound, not primarily by increased nuchal translucency. - While it can be associated with some chromosomal anomalies, **increased NT** is not its primary diagnostic marker. *Trisomy 18* - While **increased nuchal translucency** can be a feature of **Trisomy 18 (Edwards syndrome)**, it often presents with additional distinct anatomical findings such as choroid plexus cysts, clenched hands, and a small jaw. - Given the sole finding of increased NT, **Down syndrome** is generally a more common association, although this would still raise suspicion for other aneuploidies including Trisomy 18. *Foregut duplication cyst* - This is a **rare congenital malformation** of the digestive tract, typically appearing as a fluid-filled mass. - It is a **structural anomaly** and is not directly indicated by **increased nuchal translucency**.

Q: Which of the following statements about alpha-fetoprotein (AFP) is NOT true?

MSAFP is unrelated to the period of gestation. ***MSAFP is unrelated to the period of gestation*** - This is the correct answer because this statement is **NOT true** (i.e., it is FALSE). - **Maternal serum alpha-fetoprotein (MSAFP) levels are highly dependent on gestational age**, rising steadily during the second trimester and peaking around 15-18 weeks of gestation. - **Accurate gestational dating is crucial** for proper interpretation of MSAFP levels, as values must be adjusted for gestational age. *Decreased AFP levels are seen in Down syndrome* - This statement is **TRUE** and therefore not the answer to this "NOT true" question. - **Down syndrome (Trisomy 21)** is characterized by **decreased MSAFP levels**, along with increased hCG and decreased unconjugated estriol (the "triple screen"). - This biochemical pattern helps in prenatal screening for chromosomal abnormalities. *Diabetic patients have decreased AFP levels* - This statement is **TRUE** and therefore not the answer to this "NOT true" question. - **Diabetic patients**, especially those with pre-gestational diabetes, typically exhibit **decreased MSAFP levels**. - This reduction can be significant enough to mask neural tube defects even if present, making interpretation more challenging in diabetic pregnancies. *AFP is produced by the fetal liver and yolk sac* - This statement is **TRUE** and therefore not the answer to this "NOT true" question. - **Alpha-fetoprotein is synthesized primarily by the fetal liver and yolk sac** during fetal development. - It is the fetal equivalent of albumin and reaches maternal circulation through the placenta, which is why it can be measured in maternal serum.

Q: The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?

24 weeks. ***24 weeks*** - The **MTP (Medical Termination of Pregnancy) Act** was amended in 2021 to extend the gestational limit for termination of pregnancy from 20 to **24 weeks** for certain categories of women. - This extension applies to vulnerable groups such as survivors of **sexual assault**, minors, and women with disabilities. *12 weeks* - This was the initial gestational limit under the original MTP Act where the opinion of **one registered medical practitioner (RMP)** was sufficient. - The current amendment has significantly expanded this limit for various circumstances. *16 weeks* - This gestational period is **not explicitly a termination limit** under the MTP Act, either in its original form or its amendments. - The Act generally focuses on limits of 12, 20, and 24 weeks. *20 weeks* - This was the previous upper gestational limit for termination requiring the opinion of **two registered medical practitioners (RMPs)** under the MTP Act before the 2021 amendment. - Beyond this, termination was only permitted under very specific circumstances related to fetal abnormalities or risk to the mother's life.

Q: Full-term denotes:

39 to 40+6 weeks. ***39 to 40+6 weeks*** - The **American College of Obstetricians and Gynecologists (ACOG)** redefined "term" classifications, establishing "full term" as 39 weeks 0 days through 40 weeks 6 days of gestation. - This classification aims to reduce elective deliveries before 39 weeks, as infants delivered within this period have optimal health outcomes. *41 to 41+6 weeks* - This period is classified as **late term**, indicating a pregnancy that has extended beyond the standard full-term window but is not yet post-term. - While generally safe, pregnancies in this range may require increased monitoring for potential complications. *42 completed weeks* - This gestational age is considered **post-term**, which carries an increased risk of complications for both the mother and the fetus. - Management often includes induction of labor due to concerns like **placental insufficiency** or **macrosomia**. *37 to 38+6 weeks* - This period is defined as **early term**, signifying that while the infant is generally mature, full development benefits from remaining in utero until at least 39 weeks. - Infants born during this time *may* still have slightly higher rates of respiratory, feeding, and temperature regulation issues compared to those born at full term.

Q: When treating urinary tract infection (UTI) in the third trimester, what is the antibiotic of choice?

Cephalosporin. ***Cephalosporin*** - **Cephalosporins** are generally considered safe and effective for treating UTIs during all trimesters of pregnancy, including the third trimester. - They have **low teratogenic risk** and broad-spectrum activity against common UTI pathogens. *Tetracycline* - **Tetracyclines** are contraindicated in the third trimester due to the risk of permanent **discoloration of fetal teeth** and inhibition of bone growth. - They readily cross the **placenta** and accumulate in the fetal skeletal system. *Sulfonamide* - **Sulfonamides** like trimethoprim-sulfamethoxazole should be avoided in the third trimester, especially near term, due to the risk of **kernicterus** in the neonate. - Sulfonamides compete with **bilirubin** for binding sites on albumin, potentially leading to elevated unconjugated bilirubin. *Nitrofurantoin* - **Nitrofurantoin** should be avoided in the third trimester (after 36 weeks of gestation) in pregnant patients with G6PD deficiency due to the risk of **hemolytic anemia** in the neonate. - It's generally considered safe in the first and second trimesters, but caution is advised in the late third trimester.

Question 1

All are cardiovascular system changes in pregnancy except.

Accepted Answer

Increase in peripheral resistance

Answer

Increase in blood volume

Answer

Increase in heart rate

Answer

Increase in cardiac output

Question 2

A woman attends an antenatal clinic with a complaint of mild pain in the lower abdomen on the left side, her periods are regular, and a urine pregnancy test was positive at home. A transvaginal ultrasound was performed, revealing an empty uterine cavity and no adnexal mass. Her serum beta human chorionic gonadotropin (hCG) level is 700 IU/L. What is the next step?

Accepted Answer

Perform serum beta HCG after 48 hr

Answer

Give single dose of methotrexate

Answer

Perform laparoscopy

Answer

Perform serum beta HCG after 7 days

Question 3

According to Naegele's rule, what is the estimated date of delivery (EDD) for a patient with a last menstrual period (LMP) of 1st September 2017? (Dates given in DD/MM/YYYY format)

Accepted Answer

08/06/2018

Answer

16/05/2018

Answer

16/07/2018

Answer

16/06/2018

Question 4

Most appropriate time for chorionic villus sampling in pregnancy is:

Accepted Answer

10-13 weeks

Answer

16-18 weeks

Answer

16-20 weeks

Answer

8-10 weeks

Question 5

Which of the following is a component of the triple test for Down syndrome?

Accepted Answer

Maternal Alpha-fetoprotein

Answer

Maternal PAPP-A

Answer

Maternal Progesterone

Answer

Maternal Inhibin A

Question 6

Increased nuchal translucency at 14 weeks is most commonly associated with:

Accepted Answer

Down syndrome

Answer

Esophageal atresia

Answer

Trisomy 18

Answer

Foregut duplication cyst

Question 7

Which of the following statements about alpha-fetoprotein (AFP) is NOT true?

Accepted Answer

MSAFP is unrelated to the period of gestation

Answer

Decreased AFP levels are seen in Down syndrome

Answer

Diabetic patients have decreased AFP levels

Answer

AFP is produced by the fetal liver and yolk sac

Question 8

The MTP Act (as currently amended) provides rules for termination of pregnancy till what number of weeks of pregnancy?

Accepted Answer

24 weeks

Answer

12 weeks

Answer

16 weeks

Answer

20 weeks

Question 9

Full-term denotes:

Accepted Answer

39 to 40+6 weeks

Answer

41 to 41+6 weeks

Answer

42 completed weeks

Answer

37 to 38+6 weeks

Question 10

When treating urinary tract infection (UTI) in the third trimester, what is the antibiotic of choice?

Accepted Answer

Cephalosporin

Answer

Tetracycline

Answer

Sulfonamide

Answer

Nitrofurantoin

Prenatal Care — MCQs

Prenatal Care — MCQs

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