Nutrition in pregnancy US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Nutrition in pregnancy. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nutrition in pregnancy US Medical PG Question 1: You are counseling a pregnant woman who plans to breast-feed exclusively regarding her newborn's nutritional requirements. The child was born at home and the mother only plans for her newborn to receive vaccinations but no other routine medical care. Which vitamins should be given to the newborn?
- A. Vitamin B6
- B. Vitamin K and Vitamin D (Correct Answer)
- C. Vitamin K
- D. Folic acid
- E. Vitamin D
Nutrition in pregnancy Explanation: ***Vitamin K and Vitamin D***
- All newborns should receive a prophylactic dose of **Vitamin K** to prevent **Vitamin K Deficiency Bleeding (VKDB)**, as placental transfer is poor and breast milk contains low levels.
- Breastfed infants, especially those exclusively breastfed, require **Vitamin D** supplementation (400 IU daily) to prevent **rickets**, as breast milk Vitamin D levels are often insufficient.
*Vitamin B6*
- While essential for development, **Vitamin B6** supplementation is not routinely recommended for all healthy newborns, especially those exclusively breastfed by a healthy mother.
- Deficiency in newborns is rare and typically associated with specific metabolic disorders or maternal malnutrition, which are not suggested here.
*Vitamin K*
- While **Vitamin K** is critically important for all newborns, it is only one of the essential vitamins needed for breastfed infants.
- Exclusive breastfeeding also necessitates **Vitamin D** supplementation, making this option incomplete.
*Folic acid*
- **Folic acid** (Vitamin B9) is crucial during pregnancy for preventing neural tube defects and is found in adequate amounts in breast milk for a healthy full-term infant.
- Routine supplementation of folic acid is not recommended for healthy newborns, as deficiency is rare.
*Vitamin D*
- While **Vitamin D** supplementation is essential for exclusively breastfed infants, this option is incomplete as it misses the critical need for **Vitamin K** prophylaxis at birth.
- Both vitamins are critical for newborn health in this scenario.
Nutrition in pregnancy US Medical PG Question 2: A 24-year-old woman visits her physician to seek preconception advice. She is recently married and plans to have a child soon. Menses occur at regular 28-day intervals and last 5 days. She has sexual intercourse only with her husband and, at this time, they consistently use condoms for birth control. The patient consumes a well-balanced diet with moderate intake of meat and dairy products. She has no history of serious illness and takes no medications currently. She does not smoke or drink alcohol. The patient’s history reveals no birth defects or severe genetic abnormalities in the family. Physical examination shows no abnormalities. Pelvic examination indicates a normal vagina, cervix, uterus, and adnexa. To decrease the likelihood of fetal neural-tube defects in her future pregnancy, which of the following is the most appropriate recommendation for initiation of folic acid supplementation?
- A. As soon as her pregnancy is confirmed
- B. No folic acid supplement is required as nutritional sources are adequate
- C. As soon as possible (Correct Answer)
- D. When off contraception
- E. In the second half of pregnancy
Nutrition in pregnancy Explanation: ***As soon as possible***
- Folic acid supplementation is crucial for preventing **neural tube defects (NTDs)**, which occur very early in pregnancy, often before a woman even knows she is pregnant.
- To be effective, supplementation should begin at least **one month prior to conception** and continue through the first trimester.
*As soon as her pregnancy is confirmed*
- This timing is too late because **neurulation** (the formation of the neural tube) is completed by the **28th day post-conception**, often before a pregnancy is confirmed.
- Delaying supplementation until confirmation significantly reduces its preventative effect against neural tube defects.
*No folic acid supplement is required as nutritional sources are adequate*
- While a balanced diet contains some folic acid, it is generally **insufficient** to reach the protective levels needed to prevent NTDs.
- The Centers for Disease Control and Prevention (CDC) and other health organizations recommend universal folic acid supplementation for all women of childbearing age, regardless of diet.
*When off contraception*
- Although discontinuing contraception indicates an intent to conceive, starting folic acid *only* at this point might still be too late.
- It's recommended to start supplementation at least **1 month before attempting conception** to ensure adequate folate levels at the critical time of neural tube closure.
*In the second half of pregnancy*
- Supplementing in the second half of pregnancy is **too late** to prevent neural tube defects.
- By this stage, the neural tube has already fully developed or failed to close, and supplementation will not reverse any existing defects.
Nutrition in pregnancy US Medical PG Question 3: A 28-year-old female in the 2nd trimester of pregnancy is diagnosed with primary Toxoplasma gondii infection. Her physician fears that the fetus may be infected in utero. Which of the following are associated with T. gondii infection in neonates?
- A. Hutchinson’s teeth, saddle nose, short maxilla
- B. Deafness, seizures, petechial rash
- C. Hydrocephalus, chorioretinitis, intracranial calcifications (Correct Answer)
- D. Patent ductus arteriosus, cataracts, deafness
- E. Temporal encephalitis, vesicular lesions
Nutrition in pregnancy Explanation: ***Hydrocephalus, chorioretinitis, intracranial calcifications***
- These are the classic triad of symptoms (known as the **Sabin triad**) often associated with **congenital toxoplasmosis**.
- **Hydrocephalus** results from obstruction of cerebrospinal fluid flow, **chorioretinitis** can lead to vision loss, and **intracranial calcifications** are a hallmark of the infection's impact on the brain.
*Hutchinson’s teeth, saddle nose, short maxilla*
- These are characteristic features of **congenital syphilis**, not *Toxoplasma gondii* infection.
- **Hutchinson's triad** includes Hutchinson's teeth, interstitial keratitis, and sensorineural hearing loss in congenital syphilis.
*Deafness, seizures, petechial rash*
- While seizures can occur with severe congenital infections, this combination is more suggestive of **cytomegalovirus (CMV)** infection or **rubella**, which can cause petechial rash (blueberry muffin baby) and profound sensorineural deafness.
- *Toxoplasma gondii* does not typically cause a petechial rash as a primary symptom.
*Patent ductus arteriosus, cataracts, deafness*
- This constellation of symptoms is highly characteristic of **congenital rubella syndrome**.
- **Cardiac defects** (like patent ductus arteriosus), **ocular abnormalities** (cataracts), and **sensorineural deafness** are classical signs of rubella.
*Temporal encephalitis, vesicular lesions*
- **Temporal encephalitis** with vesicular lesions, particularly in a neonatal context, is a classic presentation of **congenital herpes simplex virus (HSV) infection**.
- *Toxoplasma gondii* can cause encephalitis, but not typically with vesicular lesions or a primary predilection for the temporal lobe in this specific clinical presentation.
Nutrition in pregnancy US Medical PG Question 4: A 32-year-old primigravid woman with a history of seizures comes to the physician because she had a positive pregnancy test at home. Medications include valproic acid and a multivitamin. Physical examination shows no abnormalities. A urine pregnancy test is positive. Her baby is at increased risk for requiring which of the following interventions?
- A. Lower spinal surgery (Correct Answer)
- B. Kidney transplantation
- C. Arm surgery
- D. Cochlear implantation
- E. Respiratory support
Nutrition in pregnancy Explanation: ***Lower spinal surgery***
- Maternal use of **valproic acid** during pregnancy significantly increases the risk of neural tube defects, particularly **spina bifida**, which often requires surgical correction of the lower spine in affected infants.
- **Spina bifida** results from the incomplete closure of the neural tube, leading to exposed spinal cord or meninges, and frequently necessitates surgical intervention to prevent further neurological damage and infection.
*Kidney transplantation*
- While some fetal anomalies can involve the kidneys, **valproic acid** exposure is not primarily associated with renal agenesis or severe kidney malformations requiring transplantation.
- Birth defects affecting the kidneys are more commonly linked to genetic syndromes or other teratogens, not specifically valproic acid.
*Arm surgery*
- **Valproic acid** has been associated with limb defects, but these are typically minor and do not usually directly necessitate extensive arm surgery.
- **Phocomelia** (shortened or absent limbs) is more typically associated with **thalidomide** exposure, not valproic acid.
*Cochlear implantation*
- Although **valproic acid** exposure has been occasionally linked to some congenital anomalies, it is not a primary risk factor for **severe hearing loss** requiring cochlear implantation.
- Hearing loss requiring such intervention is more often due to genetic factors, congenital infections, or other specific teratogens.
*Respiratory support*
- While a variety of congenital conditions can lead to respiratory compromise, **valproic acid** exposure does not specifically cause severe pulmonary hypoplasia or other defects that commonly necessitate prolonged or intense neonatal respiratory support.
- Respiratory distress in neonates is often related to prematurity, meconium aspiration, or other direct pulmonary issues.
Nutrition in pregnancy US Medical PG Question 5: A 21-year-old female presents to her primary care doctor for prenatal counseling before attempting to become pregnant for the first time. She is an avid runner, and the physician notes her BMI of 17.5. The patient complains of chronic fatigue, which she attributes to her busy lifestyle. The physician orders a complete blood count that reveals a Hgb 10.2 g/dL (normal 12.1 to 15.1 g/dL) with an MCV 102 µm^3 (normal 78 to 98 µm^3). A serum measurement of a catabolic derivative of methionine returns elevated. Which of the following complications is the patient at most risk for if she becomes pregnant?
- A. Placenta abruptio (Correct Answer)
- B. Placenta previa
- C. Placenta accreta
- D. Neural tube defects
- E. Gestational diabetes
Nutrition in pregnancy Explanation: **Placenta abruptio**
* The patient presents with several risk factors for **placental abruption**, including **low BMI**, **anemia** (Hgb 10.2), and **elevated homocysteine** (indicated by elevated catabolic derivative of methionine, implying **folate or B12 deficiency**, which leads to high homocysteine).
* **Anemia** and **folate deficiency** are associated with an increased risk of placental abruption.
*Placenta previa*
* **Placenta previa** is characterized by the placenta covering the cervical os, typically associated with risk factors like **previous C-section**, **multiparity**, and **advanced maternal age**.
* The patient's profile (first pregnancy, young) does not align with the typical risk factors for placenta previa.
*Placenta accreta*
* **Placenta accreta** involves abnormal placental adherence to the uterine wall, most commonly linked to **prior uterine surgery** (especially C-sections) and **placenta previa**.
* The patient has no history of uterine surgery, making placenta accreta an unlikely primary risk.
*Neural tube defects*
* **Neural tube defects** are associated with **folate deficiency**, which is likely present given the **macrocytic anemia** (MCV 102) and elevated homocysteine.
* However, the question asks for the complication the patient is *most* at risk for due to her overall profile including her low BMI and anemia, and while NTDs are a risk, the combination of factors points more strongly to placental abruption.
*Gestational diabetes*
* **Gestational diabetes** is linked to risk factors like **obesity**, **family history of diabetes**, and **advanced maternal age**.
* The patient's **low BMI** (17.5) and young age make gestational diabetes an unlikely significant risk.
Nutrition in pregnancy US Medical PG Question 6: A 19-year-old African female refugee has been granted asylum in Stockholm, Sweden and has been living there for the past month. She arrived in Sweden with her 2-month-old infant, whom she exclusively breast feeds. Which of the following deficiencies is the infant most likely to develop?
- A. Vitamin E
- B. Vitamin A
- C. Vitamin C
- D. Vitamin B1
- E. Vitamin D (Correct Answer)
Nutrition in pregnancy Explanation: ***Vitamin D***
- The combination of exclusive breastfeeding, a 2-month-old infant, being of African heritage (darker skin), and living in a high-latitude region like Stockholm, Sweden, significantly increases the risk of **vitamin D deficiency**. Darker skin pigmentation reduces the efficiency of **cutaneous vitamin D synthesis** from sunlight, and insufficient sun exposure in northern latitudes further exacerbates this.
- Breast milk is a relatively poor source of **vitamin D**, and infants specifically require supplementation, especially when they have risk factors for deficiency such as being of African descent and living in an area with limited sunshine.
*Vitamin E*
- **Vitamin E deficiency** in infants is rare and typically seen in premature infants or those with severe malabsorption, neither of which is indicated in this scenario.
- While breast milk contains vitamin E, deficiency is not directly linked to geographic location, skin color, or a 2-month-old infant.
*Vitamin A*
- **Vitamin A deficiency** can be a concern in developing countries, but it is less likely to be the primary concern under these specific circumstances in a 2-month-old exclusively breastfed infant unless the mother herself is severely deficient.
- Breast milk usually provides adequate **vitamin A** if the mother's nutritional status is sufficient.
*Vitamin C*
- **Vitamin C deficiency** (scurvy) is rare in breastfed infants because breast milk typically contains adequate vitamin C if the mother has adequate dietary intake.
- Scurvy would be more likely in infants fed with improperly prepared formula or after 6 months if complementary foods lack vitamin C.
*Vitamin B1*
- **Vitamin B1 (thiamine) deficiency** is uncommon in exclusively breastfed infants in developed countries.
- It is often associated with maternal malnutrition in endemic areas or specific genetic disorders, which are not suggested here.
Nutrition in pregnancy US Medical PG Question 7: A 45-year-old woman comes to the emergency department because of abdominal cramping, vomiting, and watery diarrhea for the past 4 hours. One day ago, she went to a seafood restaurant with her family to celebrate her birthday. Three of the attendees have developed similar symptoms. The patient appears lethargic. Her temperature is 38.8°C (101.8°F). Which of the following organisms is most likely responsible for this patient's current symptoms?
- A. Vibrio parahaemolyticus (Correct Answer)
- B. Staphylococcus aureus
- C. Salmonella enterica
- D. Campylobacter jejuni
- E. Listeria monocytogenes
Nutrition in pregnancy Explanation: ***Vibrio parahaemolyticus***
- This organism is commonly associated with the consumption of **raw or undercooked seafood** and causes **acute gastroenteritis** with vomiting, watery diarrhea, and abdominal cramps.
- The **24-hour incubation period** (symptoms began 4 hours ago after eating seafood 1 day ago) fits well with *V. parahaemolyticus*, which typically has an incubation of **12-24 hours** (range 4-96 hours).
- The involvement of multiple individuals who ate at the same seafood restaurant strongly points to a **foodborne infection** from contaminated seafood.
- The presence of fever (38.8°C) is consistent with *V. parahaemolyticus* gastroenteritis.
*Staphylococcus aureus*
- *S. aureus* causes food poisoning with a very **short incubation period (1-6 hours)** due to preformed enterotoxin, which does **not** match the 24-hour timeline in this case.
- While it can cause rapid-onset vomiting and diarrhea, it is more commonly associated with contaminated **dairy products, mayonnaise salads, or meats**, not typically seafood.
- Fever is uncommon in *S. aureus* enterotoxin-mediated food poisoning.
*Salmonella enterica*
- *Salmonella* infections typically have an incubation period of **6-72 hours** (often 12-36 hours) and could fit the timeline, but are more commonly associated with **poultry, eggs, or contaminated produce** rather than seafood as the primary source.
- While it causes fever, vomiting, and diarrhea, the **seafood exposure** makes *Vibrio parahaemolyticus* the more likely pathogen.
*Campylobacter jejuni*
- *Campylobacter jejuni* usually causes **inflammatory diarrhea** (often bloody) with an incubation period of **2-5 days**, which is longer than the 24-hour period in this case.
- It is commonly linked to **undercooked poultry or unpasteurized milk**, not typically seafood.
- The watery (non-bloody) diarrhea presentation also makes this less likely.
*Listeria monocytogenes*
- *Listeria monocytogenes* is associated with **deli meats, soft cheeses, and unpasteurized dairy products**, and has a much longer and highly variable incubation period **(1-70 days, median ~3 weeks)**.
- While it can cause gastroenteritis, its primary concern is severe invasive disease in immunocompromised individuals, pregnant women, and the elderly.
- The rapid 24-hour onset with seafood exposure does not fit *Listeria*.
Nutrition in pregnancy US Medical PG Question 8: A 23-year-old nulligravida presents for evaluation 5 weeks after her last menstrual period. Her previous menstruation cycle was regular, and her medical history is benign. She is sexually active with one partner and does not use contraception. A urine dipstick pregnancy test is negative. The vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 71/min, respiratory rate 13/min, and temperature 36.8°C (98.2°F). The physical examination is notable for breast engorgement, increased pigmentation of the nipples, and linea nigra. The gynecologic examination demonstrates cervical and vaginal cyanosis.
Measurement of which of the following substances is most appropriate in this case?
- A. Blood estriol
- B. Blood human chorionic gonadotropin (Correct Answer)
- C. Urinary estrogen metabolites
- D. Urinary human chorionic gonadotropin
- E. Blood progesterone
Nutrition in pregnancy Explanation: ***Blood human chorionic gonadotropin***
- The patient exhibits classic signs of early pregnancy, including **breast engorgement**, **nipple hyperpigmentation**, **linea nigra**, and **cervical and vaginal cyanosis** (Chadwick's sign). These signs, combined with a missed menstrual period and unprotected intercourse, strongly indicate pregnancy despite the negative urine dipstick.
- A **blood human chorionic gonadotropin (hCG)** test is more sensitive than a urine test, detecting lower levels of hCG earlier in pregnancy, and is therefore the most appropriate next step to confirm pregnancy.
*Blood estriol*
- **Estriol** levels are used to assess fetal well-being in the late second and third trimesters, typically as part of the **triple or quadruple screen**, not for early pregnancy detection.
- Its levels become significantly elevated much later in pregnancy, making it unsuitable for confirming a pregnancy at 5 weeks.
*Urinary estrogen metabolites*
- **Urinary estrogen metabolites** are primarily used to assess ovarian function and fertility, or to monitor hormone replacement therapy.
- They are not a reliable or standard method for the early detection or confirmation of pregnancy.
*Urinary human chorionic gonadotropin*
- While **urinary hCG** is used for pregnancy detection (e.g., home pregnancy tests), a negative result at 5 weeks, especially in the presence of strong clinical signs of pregnancy, suggests that the levels might be below the detection threshold of the urine test.
- A **quantitative blood hCG** test is superior in sensitivity and can detect very low levels of hCG, confirming or ruling out early pregnancy more definitively.
*Blood progesterone*
- **Progesterone** levels are necessary to maintain a pregnancy, but they do not confirm a pregnancy itself. High progesterone can indicate ovulation and potential luteal phase support.
- While useful for assessing the viability of a confirmed early pregnancy or diagnosing conditions like ectopic pregnancy, it's not the primary test to confirm the presence of pregnancy.
Nutrition in pregnancy US Medical PG Question 9: A 29-year-old woman presents to a medical office complaining of fatigue, nausea, and vomiting for 1 week. Recently, the smell of certain foods makes her nauseous. Her symptoms are more pronounced in the mornings. The emesis is clear-to-yellow without blood. She has had no recent travel out of the country. The medical history is significant for peptic ulcer, for which she takes pantoprazole. The blood pressure is 100/60 mm Hg, the pulse is 70/min, and the respiratory rate is 12/min. The physical examination reveals pale mucosa and conjunctiva, and bilateral breast tenderness. The LMP was 9 weeks ago. What is the most appropriate next step in the management of this patient?
- A. Beta-HCG levels and a transvaginal ultrasound (Correct Answer)
- B. Beta-HCG levels and a transabdominal ultrasound
- C. Beta-HCG levels and a pelvic CT
- D. Abdominal x-ray
- E. Abdominal CT with contrast
Nutrition in pregnancy Explanation: ***Beta-HCG levels and a transvaginal ultrasound***
- The patient's symptoms (fatigue, nausea, vomiting, morning sickness, breast tenderness, and **amenorrhea** for 9 weeks) strongly suggest **early pregnancy**.
- **Urine or serum beta-HCG** confirms pregnancy, and a **transvaginal ultrasound** is crucial for confirming an **intrauterine pregnancy**, estimating gestational age, and ruling out complications like ectopic pregnancy, especially at this early stage when transabdominal ultrasound might not provide clear images.
*Beta-HCG levels and a transabdominal ultrasound*
- While beta-HCG levels are appropriate, a **transabdominal ultrasound** may not be sufficient to visualize an early intrauterine pregnancy at 9 weeks due to limited resolution compared to transvaginal ultrasound.
- A definitive confirmation of **intrauterine pregnancy** is critical to rule out an **ectopic pregnancy**, which is better achieved with transvaginal imaging in early gestation.
*Beta-HCG levels and a pelvic CT*
- **CT scans** expose the patient to significant **ionizing radiation**, which is **contraindicated in pregnancy** unless absolutely necessary for life-threatening conditions.
- While it could identify some pelvic pathologies, it is **not the primary imaging modality** for confirming or evaluating early pregnancy due to radiation risks and inferior soft tissue resolution for early gestational sacs compared to ultrasound.
*Abdominal x-ray*
- An **abdominal X-ray** involves **ionizing radiation** and offers very limited diagnostic value for early pregnancy, as it cannot visualize the gestational sac, fetus, or fetal heart activity.
- It is **contraindicated** in suspected pregnancy due to the risk of fetal harm.
*Abdominal CT with contrast*
- **Abdominal CT with contrast** involves both **ionizing radiation** and **contrast agents**, both of which pose significant risks to a developing fetus.
- It is an **inappropriate initial step** for suspected pregnancy and offers no specific diagnostic benefits for confirming or characterizing early gestation.
Nutrition in pregnancy US Medical PG Question 10: A 26-year-old woman presents to the women’s health clinic with a 9-week delay in menses. The patient has a history of grand mal seizures, and was recently diagnosed with acute sinusitis. She is prescribed lamotrigine and amoxicillin. The patient smokes one-half pack of cigarettes every day for 10 years, and drinks socially a few weekends every month. Her mother died of breast cancer when she was 61 years old. The vital signs are stable during the current office visit. Physical examination is grossly normal. The physician orders a urine beta-hCG that comes back positive. Abdominal ultrasound shows an embryo consistent in dates with the first day of last menstrual period. Given the history of the patient, which of the following would most likely decrease congenital malformations in the newborn?
- A. Decrease alcohol consumption
- B. Switching to cephalexin
- C. Folic acid supplementation (Correct Answer)
- D. Smoking cessation
- E. Switching to another antiepileptic medication
Nutrition in pregnancy Explanation: ***Folic acid supplementation***
- **Folic acid** (vitamin B9) is crucial in early pregnancy for **neural tube development** and significantly reduces the risk of **neural tube defects** and other congenital malformations.
- Given the patient’s history of **lamotrigine** use, which can increase the risk of neural tube defects, folic acid supplementation is even more critical.
*Decrease alcohol consumption*
- While **alcohol cessation** is important to prevent **fetal alcohol syndrome** and other alcohol-related developmental issues, it primarily affects neurological development and facial dysmorphology rather than primarily preventing
- The effects of alcohol are typically more pronounced with **chronic heavy consumption**, and while any reduction is beneficial, it is not the most likely intervention to decrease general congenital malformations.
*Switching to cephalexin*
- **Amoxicillin** is considered **safe in pregnancy** and is a penicillin-class antibiotic, while **cephalexin** is a cephalosporin.
- Switching antibiotics from one safe drug to another without a clear medical indication (e.g., allergy, resistance) would **not decrease the risk of congenital malformations**.
*Smoking cessation*
- **Smoking cessation** is vital during pregnancy as it reduces the risk of **low birth weight**, **preterm birth**, and other complications like placental abruption.
- However, the primary link of smoking is not directly with **congenital malformations** like neural tube defects, but rather with growth restriction and adverse perinatal outcomes.
*Switching to another antiepileptic medication*
- This patient is on **lamotrigine**, which is considered one of the **safer antiepileptic drugs (AEDs)** in pregnancy, especially compared to others like **valproic acid**.
- Switching to an alternative AED might even carry a **higher risk for congenital malformations** and is generally not recommended unless lamotrigine is ineffective or contraindicated.
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