Routine prenatal visit schedule US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Routine prenatal visit schedule. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Routine prenatal visit schedule US Medical PG Question 1: A 25-year-old G1P0000 presents to her obstetrician’s office for her first prenatal visit. She had a positive pregnancy test 6 weeks ago, and her last period was about two months ago, though at baseline her periods are irregular. Aside from some slight nausea in the mornings, she feels well. Which of the following measurements would provide the most accurate dating of this patient’s pregnancy?
- A. Crown-rump length (Correct Answer)
- B. Femur length
- C. Abdominal circumference
- D. Biparietal diameter
- E. Serum beta-hCG
Routine prenatal visit schedule Explanation: ***Crown-rump length***
- This measurement, typically obtained via **transvaginal ultrasound** in the first trimester (up to 13 weeks 6 days), provides the **most accurate gestational age dating**.
- It's highly precise because fetal growth is very consistent during this early period, minimizing variability.
*Femur length*
- This is a biometric measurement typically used for dating in the **second and third trimesters**.
- Its accuracy for dating is lower than CRL in the first trimester and becomes more variable in later pregnancy due to individual fetal growth differences.
*Abdominal circumference*
- This measurement is primarily used in the **late second and third trimetes**r to assess fetal growth and weight, rather than for accurate dating.
- It is highly susceptible to variations based on fetal nutrition and health, making it a poor choice for initial dating.
*Biparietal diameter*
- This is a reliable measurement for dating from the **late first trimester through the second trimester**, but it is less accurate than CRL in the very early first trimester.
- After the first trimester, its accuracy declines compared to earlier measurements as individual variations in head size become more prominent.
*Serum beta-hCG*
- While a **positive beta-hCG test** confirms pregnancy and quantitative levels can suggest gestational age ranges, it's not a precise dating tool.
- Levels vary widely among individuals and with different types of pregnancies (e.g., multiples), making it unsuitable for accurate dating.
Routine prenatal visit schedule US Medical PG Question 2: A 40-year-old woman in her 18th week of pregnancy based on the last menstrual period (LMP) presents to her obstetrician for an antenatal check-up.
The antenatal testing is normal, except the quadruple screen results which are given below:
Maternal serum alpha-fetoprotein (MS-AFP) low
Unconjugated estriol low
Human chorionic gonadotropin (hCG) high
Inhibin-A high
Which of the following conditions is the most likely the cause of the abnormal quadruple screen?
- A. Fetal alcohol syndrome
- B. Spina bifida
- C. Gastroschisis
- D. Trisomy 21 (Correct Answer)
- E. Omphalocele
Routine prenatal visit schedule Explanation: ***Trisomy 21***
- The classic quadruple screen pattern for **Trisomy 21 (Down syndrome)** includes **low MS-AFP**, **low unconjugated estriol**, **high hCG**, and **high inhibin-A**.
- This pattern reflects specific placental and fetal biochemical changes associated with the chromosomal abnormality.
*Fetal alcohol syndrome*
- **Fetal alcohol syndrome** is caused by maternal alcohol consumption during pregnancy and is not detectable by a quadruple screen.
- It is characterized by specific facial features, growth restriction, and central nervous system abnormalities.
*Spina bifida*
- **Spina bifida**, an **open neural tube defect**, would typically present with a **high MS-AFP** due to leakage of fetal AFP from the open defect into the amniotic fluid and then into maternal circulation.
- This contradicts the **low MS-AFP** finding in the current case.
*Gastroschisis*
- **Gastroschisis**, an abdominal wall defect where intestines are outside the body, also results in a significantly **elevated MS-AFP** due to direct exposure of fetal blood vessels to the amniotic fluid.
- This condition is not associated with the pattern of unconjugated estriol, hCG, and inhibin-A seen in this quadruple screen.
*Omphalocele*
- **Omphalocele**, another abdominal wall defect where abdominal contents are covered by a membrane, usually presents with a **high MS-AFP**, though often less elevated than in gastroschisis or spina bifida.
- It is not associated with the specific pattern of low estriol, high hCG, and high inhibin-A seen in Trisomy 21.
Routine prenatal visit schedule US Medical PG Question 3: A 27-year-old woman, gravida 2, para 1, at 37 weeks' gestation is admitted to the hospital in active labor. She has received routine prenatal care, but she has not been tested for group B streptococcal (GBS) colonization. Pregnancy and delivery of her first child were complicated by an infection with GBS that resulted in sepsis in the newborn. Current medications include folic acid and a multivitamin. Vital signs are within normal limits. The abdomen is nontender and contractions are felt every 4 minutes. There is clear amniotic fluid pooling in the vagina. The fetus is in a cephalic presentation. The fetal heart rate is 140/min. Which of the following is the most appropriate next step in management?
- A. Obtain vaginal-rectal swab for nucleic acid amplification testing
- B. Obtain vaginal-rectal swab for GBS culture
- C. Administer intrapartum intravenous penicillin (Correct Answer)
- D. Reassurance
- E. Obtain vaginal-rectal swab for GBS culture and nucleic acid amplification testing
Routine prenatal visit schedule Explanation: ***Administer intrapartum intravenous penicillin***
- This patient has a **previous infant with invasive GBS disease**, which is a strong indication for **intrapartum antibiotic prophylaxis (IAP)** regardless of current GBS colonization status.
- Penicillin is the **first-line agent** for GBS prophylaxis during labor to prevent vertical transmission to the newborn.
*Obtain vaginal-rectal swab for nucleic acid amplification testing*
- While **NAAT** can provide rapid results, the presence of a prior infant with invasive GBS disease is an **absolute indication** for IAP, making testing unnecessary.
- Waiting for NAAT results would **delay necessary antibiotic administration**, increasing the risk of GBS transmission.
*Obtain vaginal-rectal swab for GBS culture*
- A **GBS culture** typically takes 24-48 hours for results, which is too long given the patient is in active labor and requires immediate management.
- As with NAAT, a prior affected infant means that **IAP is indicated regardless of current culture results**.
*Reassurance*
- Reassurance alone is **insufficient** given the patient's history of a previous infant with GBS sepsis, which places her current fetus at high risk.
- **Active intervention** with antibiotics is crucial to prevent recurrence of GBS disease in the newborn.
*Obtain vaginal-rectal swab for GBS culture and nucleic acid amplification testing*
- Performing both tests is **unnecessary and delays treatment** in a patient with a clear indication for intrapartum antibiotics.
- The patient's history of a prior infant with GBS sepsis is classified as a **high-risk factor, necessitating immediate antibiotic prophylaxis** without waiting for test results.
Routine prenatal visit schedule US Medical PG Question 4: A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?
- A. After 28 weeks gestation, administration of RhoGAM will have no benefit
- B. If mother is Rh-positive and father is Rh-negative then administer RhoGAM
- C. If mother is Rh-negative and father is Rh-negative then administer RhoGAM
- D. If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed
- E. If mother is Rh-negative and father is Rh-positive then administer RhoGAM (Correct Answer)
Routine prenatal visit schedule Explanation: ***If mother is Rh-negative and father is Rh-positive then administer RhoGAM***
- This combination creates a risk for **Rh incompatibility**, meaning the fetus could be Rh-positive and the mother's immune system could form antibodies against fetal red blood cells, which can harm the fetus in future pregnancies.
- **RhoGAM (Rh immunoglobulin)** administration prevents the mother from forming these antibodies when there's a risk of maternal-fetal blood mixing, as indicated by vaginal bleeding.
*After 28 weeks gestation, administration of RhoGAM will have no benefit*
- This statement is incorrect; **RhoGAM is routinely administered around 28 weeks gestation** as prophylaxis in Rh-negative mothers, even without bleeding episodes, to prevent sensitization.
- In cases of potential fetal-maternal hemorrhage, such as vaginal bleeding, RhoGAM is indicated regardless of gestational age beyond the first trimester.
*If mother is Rh-positive and father is Rh-negative then administer RhoGAM*
- This scenario does not pose a risk for **Rh incompatibility hemolytic disease of the newborn**, as the mother already possesses the Rh antigen.
- RhoGAM is specifically given to Rh-negative mothers to prevent their immune system from reacting to an Rh-positive fetus.
*If mother is Rh-negative and father is Rh-negative then administer RhoGAM*
- In this case, both parents are **Rh-negative**, meaning the fetus will also be Rh-negative.
- There is no risk of **Rh incompatibility** or sensitization, so RhoGAM administration is not indicated.
*If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed*
- This statement is incorrect and represents a critical misunderstanding of **Rh incompatibility prophylaxis**.
- This specific genetic combination creates the highest risk for **Rh sensitization** during pregnancy, especially with events like vaginal bleeding, making RhoGAM administration essential.
Routine prenatal visit schedule US Medical PG Question 5: A 35-year-old woman gravida 2, para 1, comes to the physician for her first prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She is not sure about the date of her last menstrual period. Pelvic examination shows a uterus consistent in size with a 10-week gestation. An ultrasound examination confirms the gestational age and shows one fetus with no indication of multiple gestations. During counseling on pregnancy risks and possible screening and diagnostic tests, the patient states she would like to undergo screening for Down syndrome. She would prefer immediate and secure screening with a low risk to herself and the fetus. Which of the following is the most appropriate next step in management at this time?
- A. Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin
- B. Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A
- C. Chorionic villus sampling
- D. Amniocentesis
- E. Cell-free fetal DNA testing (Correct Answer)
Routine prenatal visit schedule Explanation: ***Cell-free fetal DNA testing***
- This is the most appropriate choice given the patient's desire for **immediate and secure screening with low risk** because it is a **non-invasive prenatal screening (NIPS)** method offering high sensitivity and specificity for Down syndrome, particularly in higher-risk pregnancies.
- It involves a simple maternal blood draw and can be performed as early as **10 weeks of gestation**, perfectly aligning with the patient's current gestational age and desire for early screening.
*Nuchal translucency, pregnancy-associated plasma protein-A, human chorionic gonadotropin*
- This combination represents the **first-trimester combined screen**, which is typically performed between 11 and 14 weeks of gestation. While suitable for early screening, **cell-free DNA testing offers higher detection rates and lower false-positive rates** for Down syndrome.
- The patient specifically asked for the most **secure and least risky** screening, and NIPS outperforms the combined screen in terms of diagnostic accuracy for aneuploidies.
*Maternal serum α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A*
- This refers to the **quad screen**, which is typically performed in the **second trimester (15-20 weeks)**, making it too late for the patient's desire for immediate screening at 10 weeks gestational age.
- While a widely used screening tool, the quad screen has a **lower detection rate** for Down syndrome compared to cell-free DNA testing.
*Chorionic villus sampling*
- **Chorionic villus sampling (CVS)** is a **diagnostic, invasive procedure** that carries a small risk of miscarriage (approximately 1 in 455 or 0.22%) and is not a screening test.
- Although it can be performed earlier (typically between 10 and 13 weeks), the patient specifically requested a **low-risk screening** option, which CVS is not.
*Amniocentesis*
- **Amniocentesis** is also an **invasive diagnostic procedure** with a risk of miscarriage (approximately 1 in 900 or 0.11%) and is typically performed in the **second trimester (15-20 weeks)**.
- This option is unsuitable because the patient is at 10 weeks gestation and desires **immediate and low-risk screening**, not a diagnostic procedure with procedural risks a few weeks later.
Routine prenatal visit schedule US Medical PG Question 6: A 37-year-old primigravid woman comes to the physician at 13 weeks' gestation for a prenatal visit. She feels well. Her only medication is folic acid. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 13-week gestation. Ultrasonography shows a nuchal translucency above the 99th percentile. Maternal serum pregnancy-associated plasma protein A is decreased and human chorionic gonadotropin concentrations are elevated to 2 times the median level. Which of the following is most likely to confirm the diagnosis?
- A. Chorionic villus sampling (Correct Answer)
- B. Cell-free DNA testing
- C. Triple screening test
- D. Amniocentesis
- E. Quadruple marker test
Routine prenatal visit schedule Explanation: ***Chorionic villus sampling***
- This procedure can be performed between **10 to 13 weeks of gestation** to obtain fetal cells for genetic analysis, which is within the patient's gestational age.
- It provides a definitive diagnosis of **chromosomal abnormalities** by directly sampling placental tissue, which shares the same genetic material as the fetus.
*Cell-free DNA testing*
- While it has high sensitivity and specificity for various **aneuploidies**, it is a **screening test**, not a diagnostic one.
- An abnormal result from cell-free DNA testing still requires **confirmatory diagnostic testing** such as CVS or amniocentesis.
*Triple screening test*
- This test is typically performed between **15 and 20 weeks of gestation**, which is too late to confirm the findings presented at 13 weeks gestation.
- It measures **AFP, hCG, and unconjugated estriol**, and an abnormal result would indicate a need for further diagnostic testing.
*Amniocentesis*
- This procedure is generally performed later in pregnancy, typically between **15 and 20 weeks gestation**, so it would require waiting several more weeks.
- While it provides definitive genetic results, **chorionic villus sampling is preferred at 13 weeks** due to earlier diagnostic potential.
*Quadruple marker test*
- This test is also performed between **15 and 20 weeks of gestation** and measures **AFP, hCG, unconjugated estriol, and inhibin A**.
- It is a **screening test**, similar to the triple screen, and does not provide a definitive diagnosis, requiring further confirmatory testing if abnormal.
Routine prenatal visit schedule US Medical PG Question 7: A 27-year-old G1P0 female presents for her first prenatal visit. She is in a monogamous relationship with her husband, and has had two lifetime sexual partners. She has never had a blood transfusion and has never used injection drugs. Screening for which of the following infections is most appropriate to recommend this patient?
- A. Syphilis and HIV
- B. Syphilis, HIV, and HBV (Correct Answer)
- C. Syphilis, HIV, HBV, and chlamydia
- D. Syphilis, HIV, and chlamydia
- E. No routine screening is recommended for this patient
Routine prenatal visit schedule Explanation: ***Syphilis, HIV, and HBV***
- The **American College of Obstetricians and Gynecologists (ACOG)** and the **Centers for Disease Control and Prevention (CDC)** recommend universal screening for syphilis, HIV, and hepatitis B virus (HBV) in all pregnant women at the first prenatal visit.
- This **routine screening** is crucial due to the potential for vertical transmission and severe adverse outcomes for the neonate if untreated.
*Syphilis and HIV*
- While screening for syphilis and HIV is essential, it is **incomplete** as it omits HBV, which is also universally recommended for antenatal screening.
- This option does not align with the standard comprehensive screening guidelines for pregnancy.
*Syphilis, HIV, HBV, and chlamydia*
- Although syphilis, HIV, and HBV screening are appropriate, adding **chlamydia** to the universal prenatal screening for *all* pregnant women in the first trimester is not standard practice unless specific risk factors are present or local prevalence is high.
- Chlamydia screening is typically recommended for pregnant women who are **25 years or younger** or those with **risk factors** for sexually transmitted infections (STIs).
*Syphilis, HIV, and chlamydia*
- This option incorrectly includes chlamydia as a universal screen for all pregnant women while **omitting HBV**, which is universally recommended.
- Missing HBV screening leaves a critical gap in prenatal care, as it can be transmitted vertically and cause severe neonatal disease.
*No routine screening is recommended for this patient*
- This statement is incorrect as **universal screening** for syphilis, HIV, and HBV is recommended for all pregnant women, regardless of reported risk factors or monogamous relationships.
- Maternal infection can still occur, and screening helps prevent severe outcomes for both mother and child through timely detection and intervention.
Routine prenatal visit schedule US Medical PG Question 8: A 36-year-old primigravida presents to her obstetrician for antenatal care. She is at 24 weeks of gestation and does not have any current complaint except for occasional leg cramps. She does not smoke or drink alcohol. Family history is irrelevant. Her temperature is 36.9°C (98.42°F), blood pressure is 100/60 mm Hg, and pulse of 95/minute. Her body mass index is 21 kg/m² (46 pounds/m²). Physical examination reveals a palpable uterus above the umbilicus with no other abnormalities. Which of the following screening tests is suitable for this patient?
- A. Fasting and random glucose testing for gestational diabetes mellitus
- B. HbA1C for gestational diabetes mellitus
- C. Oral glucose tolerance test for gestational diabetes mellitus (Correct Answer)
- D. Complete blood count for iron deficiency anemia
- E. Wet mount microscopy of vaginal secretions for bacterial vaginosis
Routine prenatal visit schedule Explanation: ***Oral glucose tolerance test for gestational diabetes mellitus***
- The **oral glucose tolerance test (OGTT)**, typically performed between **24 and 28 weeks of gestation**, is the gold standard for screening and diagnosing **gestational diabetes mellitus (GDM)**. This patient is at 24 weeks, making it the appropriate time for this screening.
- GDM, if undiagnosed and untreated, can lead to significant maternal and fetal complications, including **macrosomia**, **preeclampsia**, **neonatal hypoglycemia**, and **shoulder dystocia**.
*Fasting and random glucose testing for gestational diabetes mellitus*
- While **fasting** or **random glucose** values can indicate hyperglycemia, they are **not sensitive or specific enough** on their own to reliably screen for or diagnose GDM.
- A single elevated reading might prompt further testing, but it's not the primary or most suitable screening method.
*HbA1C for gestational diabetes mellitus*
- **HbA1c** reflects **average blood glucose levels over the past 2-3 months** and is primarily used for diagnosing and monitoring **pre-existing diabetes** or assessing glycemic control in non-pregnant individuals.
- Due to the **physiological changes in red blood cell turnover during pregnancy** and the acute onset nature of GDM, HbA1c is **not recommended** as a first-line screening tool for GDM.
*Complete blood count for iron deficiency anemia*
- While **complete blood count (CBC)** is a routine prenatal screening test to check for **anemia**, it is typically done earlier in pregnancy and again in the third trimester. There are no specific symptoms in this patient that strongly suggest immediate concern for anemia beyond routine.
- The question specifically asks for the "most suitable" screening test at this gestational age, and the **GDM screening** takes precedence given the timing.
*Wet mount microscopy of vaginal secretions for bacterial vaginosis*
- There are **no symptoms of vaginal infection** (e.g., unusual discharge, itching, odor) mentioned in the patient's presentation that would warrant immediate screening for **bacterial vaginosis (BV)** at this visit.
- While BV can be associated with adverse pregnancy outcomes, routine asymptomatic screening by wet mount is **not universally recommended** at 24 weeks gestation without other indications.
Routine prenatal visit schedule US Medical PG Question 9: A 25-year-old G1P0 woman at 22 weeks’ gestation presents to the emergency department with persistent vomiting over the past 8 weeks which has resulted in 5.5 kg (12.1 lb) of unintentional weight loss. She has not received any routine prenatal care to this point. She reports having tried diet modification and over-the-counter remedies with no improvement. The patient's blood pressure is 103/75 mm Hg, pulse is 93/min, respiratory rate is 15/min, and temperature is 36.7°C (98.1°F). Physical examination reveals an anxious and fatigued-appearing young woman, but whose findings are otherwise within normal limits. What is the next and most important step in her management?
- A. Begin treatment with vitamin B6
- B. Begin treatment with metoclopramide
- C. Obtain a basic electrolyte panel
- D. Obtain a beta hCG and pelvic ultrasound
- E. Admit and begin intravenous rehydration (Correct Answer)
Routine prenatal visit schedule Explanation: ***Admit and begin intravenous rehydration***
- The patient exhibits signs of **hyperemesis gravidarum**, including persistent vomiting, **significant weight loss** (5.5 kg), and inability to maintain hydration orally.
- **Intravenous rehydration** is crucial to correct dehydration and electrolyte imbalances, which can lead to serious complications if left untreated.
*Begin treatment with vitamin B6*
- While **pyridoxine (vitamin B6)** is a first-line treatment for **mild to moderate nausea and vomiting of pregnancy**, it is insufficient for severe cases involving significant weight loss and dehydration.
- This patient's symptoms are beyond what can be effectively addressed with vitamin B6 alone and require more aggressive management.
*Begin treatment with metoclopramide*
- **Metoclopramide** is an antiemetic that can be used for nausea and vomiting in pregnancy, but it is typically reserved for cases where first-line therapies (like vitamin B6) are ineffective.
- Before starting medication, especially in a severely dehydrated patient, addressing the immediate fluid and electrolyte deficits is paramount.
*Obtain a basic electrolyte panel*
- While obtaining an **electrolyte panel** is an important diagnostic step to assess the degree of electrolyte disturbance, it is not the *most important first step* in management.
- The patient's clinical presentation of persistent vomiting and weight loss clearly indicates the need for immediate intravenous rehydration regardless of initial electrolyte results.
*Obtain a beta hCG and pelvic ultrasound*
- A **beta hCG level** and **pelvic ultrasound** might be indicated later to rule out other causes of hyperemesis, such as **multiple gestation** or **molar pregnancy**.
- However, given the patient's acute symptoms of dehydration and weight loss, immediate stabilization with intravenous fluids takes precedence over diagnostic imaging.
Routine prenatal visit schedule 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
Routine prenatal visit schedule 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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