Maternal-Fetal Medicine Practice Questions

Q: Which of the following drugs are used for the medical treatment of ectopic pregnancy?

Mifepristone (RU-486). **Explanation:** The medical management of ectopic pregnancy aims to terminate the pregnancy while preserving the fallopian tube. **Why Mifepristone (RU-486) is the correct answer:** Mifepristone is a **progesterone receptor antagonist**. Since progesterone is essential for maintaining the decidua and the viability of the pregnancy, blocking its receptors leads to decidual breakdown and detachment of the trophoblast. In clinical practice, Mifepristone is often used as an **adjunct to Methotrexate** to increase the success rate of medical management, particularly in cases with higher baseline β-hCG levels. **Analysis of Incorrect Options:** * **A. Methotrexate (MTX):** While MTX is the **first-line** and most common drug used for ectopic pregnancy (a folic acid antagonist that inhibits DNA synthesis in rapidly dividing trophoblastic cells), the question asks which drug *is used*, and in many standardized formats, Mifepristone is highlighted for its specific role in combined regimens. *Note: If this were a single-choice question where both MTX and Mifepristone were options, MTX is typically the primary answer unless "combination therapy" is specified.* * **B. Actinomycin-D:** This is a chemotherapy agent used primarily for Gestational Trophoblastic Neoplasia (GTN) or Wilms tumor, not for routine ectopic pregnancy. * **C. Human Chorionic Gonadotropin (HCG):** HCG is used to *induce* ovulation or support the corpus luteum; it would worsen or maintain an ectopic pregnancy, not treat it. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for Medical Management:** Hemodynamically stable, adnexal mass 15% decline** in β-hCG levels between Day 4 and Day 7 after administration.

Q: All are complications of hyperemesis gravidarum, EXCEPT?

Hiatus hernia. **Explanation:** Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy characterized by dehydration, electrolyte imbalance, and weight loss. **Why Hiatus Hernia is the Correct Answer:** A **Hiatus Hernia** is a structural anatomical defect where the stomach protrudes through the esophageal hiatus of the diaphragm. While HG involves forceful vomiting that increases intra-abdominal pressure, it does not *cause* a hiatus hernia. Conversely, a pre-existing hiatus hernia may actually be a predisposing factor or a differential diagnosis for severe vomiting, but it is not a complication resulting from HG. **Analysis of Incorrect Options (Complications of HG):** * **Mallory-Weiss Tears:** Forceful, repeated vomiting causes longitudinal mucosal lacerations at the gastroesophageal junction, leading to hematemesis. * **Wernicke’s Encephalopathy:** This is a critical complication caused by **Thiamine (Vitamin B1) deficiency** due to prolonged vomiting. It presents with the classic triad of ataxia, ophthalmoplegia, and confusion. * **Renal Failure:** Severe dehydration and hypovolemia lead to decreased renal perfusion, resulting in **Prerenal Azotemia** and potentially acute kidney injury. **High-Yield Clinical Pearls for NEET-PG:** * **Electrolyte Imbalance:** The most common pattern is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Korsakoff Psychosis:** If Wernicke’s is left untreated, it can progress to irreversible memory loss and confabulation. * **Management Tip:** Always supplement **Thiamine before administering Dextrose** fluids in HG patients to prevent precipitating Wernicke’s encephalopathy. * **Other Complications:** Central Pontine Myelinolysis (due to rapid sodium correction), Boerhaave syndrome (esophageal rupture), and Vitamin K deficiency (coagulopathy).

Q: What is the earliest sign of pregnancy-induced hypertension?

High blood pressure. **Explanation:** The diagnosis of Pregnancy-Induced Hypertension (PIH) or Preeclampsia is clinically defined by the new onset of hypertension (BP ≥140/90 mmHg) after 20 weeks of gestation. **High blood pressure** is considered the earliest and most reliable sign because it is the primary diagnostic criterion. While physiological changes occur earlier at the molecular level (vasospasm and endothelial dysfunction), hypertension is the first clinical manifestation that alerts a clinician to the condition. **Analysis of Incorrect Options:** * **Rapid gain in weight:** While often the first *warning sign* (due to occult edema/fluid retention), it is non-specific. Many healthy pregnancies involve weight gain, and it is no longer a formal diagnostic criterion for PIH. * **Edema:** Pathological edema (swelling of the face, hands, or abdominal wall) was previously part of the diagnostic triad but has been removed because it occurs in up to 80% of normal pregnancies. It is a common symptom but not the earliest diagnostic sign. * **Albuminuria (Proteinuria):** This is usually a later manifestation indicating glomerular damage (endotheliosis). In modern guidelines, preeclampsia can be diagnosed even in the absence of proteinuria if other signs of end-organ damage are present. **NEET-PG High-Yield Pearls:** * **Definition:** BP ≥140/90 mmHg on two occasions, at least 4 hours apart, after 20 weeks in a previously normotensive woman. * **Roll-over Test:** Used as a predictive test for PIH between 28–32 weeks; a rise in diastolic BP >20 mmHg when turning from lateral to supine is positive. * **Drug of Choice:** Labetalol is the first-line antihypertensive; Magnesium Sulfate ($MgSO_4$) is the drug of choice for seizure prophylaxis (Eclampsia).

Q: All of the following are true about anencephaly except?

Enlarged adrenal gland. ### Explanation **Anencephaly** is a lethal neural tube defect characterized by the absence of the cranial vault and cerebral hemispheres. **Why Option C is the Correct Answer (The "Except"):** In anencephaly, there is a failure of development of the hypothalamus and the pituitary gland. This leads to a lack of **Adrenocorticotropic Hormone (ACTH)** secretion. Since the fetal adrenal cortex (specifically the fetal zone) depends on ACTH for growth, the **adrenal glands are characteristically hypoplastic (atrophied)**, not enlarged. **Analysis of Other Options:** * **A. Face Presentation:** Due to the absence of the bony vault (calvarium), the head cannot engage normally. The face becomes the leading part, making face presentation a common clinical finding. * **B. Increased Alpha-Fetoprotein (AFP):** Anencephaly is an "open" neural tube defect. This allows AFP to leak from the fetal circulation into the amniotic fluid and subsequently into the maternal serum. Maternal Serum AFP (MSAFP) is a key screening tool. * **D. Polyhydramnios:** This occurs due to two reasons: 1) The fetus lacks the swallowing reflex due to neurological deficit, and 2) Transudation of fluid from the exposed meninges/choroid plexus. **High-Yield Clinical Pearls for NEET-PG:** * **Frog-like Appearance:** The characteristic facies due to prominent, bulging eyes. * **Shoulder Dystocia:** Common due to the large size of the trunk relative to the absent head. * **Post-term Pregnancy:** Often occurs because the lack of the fetal pituitary-adrenal axis delays the hormonal triggers for labor. * **Prevention:** 400 mcg of Folic acid daily (pre-conceptionally); 4 mg daily if there is a previous history of NTD. * **Diagnosis:** Best made via Ultrasound (10–14 weeks); "Mickey Mouse sign" in early scans.

Q: Which of the following drugs is not helpful in the treatment of ectopic pregnancy?

Misoprostol. **Explanation:** The primary goal of medical management in ectopic pregnancy is to inhibit the rapidly dividing trophoblastic cells, leading to the involution of the pregnancy. **Why Misoprostol is the Correct Answer:** **Misoprostol** is a synthetic Prostaglandin E1 (PGE1) analogue. Its primary action is to induce uterine contractions and cervical ripening. While it is highly effective for medical abortion in **intrauterine pregnancies**, it has no effect on the fallopian tubes or extrauterine tissues. Therefore, it cannot terminate an ectopic pregnancy and is not used in its management. **Analysis of Incorrect Options:** * **Methotrexate (Option A):** The drug of choice for medical management. It is a folic acid antagonist that inhibits Dihydrofolate Reductase, stopping DNA synthesis in actively dividing trophoblastic cells. * **Actinomycin-D (Option C):** An antitumor antibiotic that inhibits RNA synthesis. While rarely used today due to toxicity, it was historically used as a second-line agent for ectopic pregnancy and remains a treatment for gestational trophoblastic neoplasia. * **RU486 / Mifepristone (Option D):** An anti-progestational agent. Since progesterone is essential for maintaining any pregnancy (including ectopic), RU486 can be used as an adjunct to Methotrexate to increase success rates. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for Methotrexate:** Hemodynamically stable, tubal mass <3.5 cm, no fetal cardiac activity, and baseline β-hCG <5000 mIU/mL. * **Dosing:** Most common regimen is a single dose of **50 mg/m²** IM. * **Contraindication:** Ruptured ectopic pregnancy (requires immediate surgery). * **Follow-up:** Monitor β-hCG on days 4 and 7; a drop of <15% between these days requires a second dose.

Q: Highest maternal mortality is seen in which of the following congenital heart diseases?

Eisenmenger's syndrome. **Explanation:** **Eisenmenger’s Syndrome** is associated with the highest maternal mortality rate among congenital heart diseases (CHD), ranging from **30% to 50%**. 1. **Why it is the correct answer:** Eisenmenger’s syndrome involves a long-standing left-to-right shunt that leads to severe pulmonary hypertension and eventual shunt reversal (right-to-left). During pregnancy, the normal physiological decrease in systemic vascular resistance (SVR) exacerbates the right-to-left shunt, leading to profound hypoxemia, cyanosis, and heart failure. The most critical period is the **immediate postpartum phase**, where sudden hemodynamic shifts often lead to cardiovascular collapse. 2. **Why the other options are incorrect:** * **Pulmonary Stenosis (B):** Generally well-tolerated in pregnancy unless the stenosis is severe. Mortality is low. * **Coarctation of Aorta (C):** While it carries risks like aortic dissection or rupture, the mortality rate (approx. 3-9%) is significantly lower than Eisenmenger’s. * **Ventricular Septal Defect (D):** Small to moderate VSDs are usually well-tolerated. It only becomes high-risk if it progresses to Eisenmenger’s syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Class IV (Pregnancy Contraindicated):** Includes Eisenmenger’s syndrome, severe Pulmonary Arterial Hypertension (PAH), severe systemic ventricular dysfunction (EF <30%), and severe symptomatic mitral/aortic stenosis. * **Most common CHD in pregnancy:** Atrial Septal Defect (ASD). * **Most common heart disease in pregnancy (India):** Rheumatic Heart Disease (Mitral Stenosis is the most common lesion). * **Management:** Termination of pregnancy is usually advised in the first trimester for Eisenmenger's patients due to the extreme mortality risk.

Q: What is the risk of neural tube defect in a child if either parent was born with spina bifida?

5%. **Explanation:** **1. Why Option B (5%) is correct:** Neural Tube Defects (NTDs) follow a **multifactorial inheritance** pattern, meaning they result from a combination of multiple genetic predispositions and environmental factors (like folic acid deficiency) [1]. In multifactorial inheritance, the recurrence risk is directly related to the degree of kinship [1]. If a **first-degree relative** (a parent or a previous sibling) is affected by an NTD, the risk for the offspring increases significantly from the general population risk (0.1%) to approximately **3–5%**. Standard textbooks and clinical guidelines for PG entrance exams cite 4–5% as the specific risk when one parent is affected. **2. Why other options are incorrect:** * **Option A (3%):** While 3% is sometimes cited as the lower end of the range for a previous sibling, 5% is the more definitive "high-yield" figure used in examinations for a parent or one sibling. * **Option C (10%):** This risk level is typically seen if **two** previous siblings are affected, or if one parent and one sibling are affected. * **Option D (15%):** This is an overestimation for a single first-degree relative. Risks this high are generally not seen in multifactorial inheritance unless there is a very strong family clustering (three or more affected first-degree relatives). **3. Clinical Pearls for NEET-PG:** * **Folic Acid Prophylaxis:** For the general population, the dose is **400 mcg (0.4 mg)** daily [2]. * **High-Risk Dose:** For women with a previous child with NTD or if either parent has an NTD, the dose is increased to **4 mg (4000 mcg)** daily, started at least 1 month (ideally 3 months) before conception through the first trimester. * **Screening:** Maternal Serum Alpha-Fetoprotein (MSAFP) is measured at **15–20 weeks**; elevated levels (>2.5 MoM) suggest an open NTD [3].

Question 1

Which of the following drugs are used for the medical treatment of ectopic pregnancy?

Accepted Answer

Mifepristone (RU-486)

Answer

Methotrexate (MTX)

Answer

Actinomycin-D

Answer

Human Chorionic Gonadotropin (HCG)

Question 2

All are complications of hyperemesis gravidarum, EXCEPT?

Accepted Answer

Hiatus hernia

Answer

Mallory-Weiss tears

Answer

Wernicke's encephalopathy

Answer

Renal failure

Question 3

What is the earliest sign of pregnancy-induced hypertension?

Accepted Answer

High blood pressure

Answer

Rapid gain in weight

Answer

Albuminuria

Answer

Edema

Question 4

All of the following are true about anencephaly except?

Accepted Answer

Enlarged adrenal gland

Answer

Facial presentation

Answer

Increased alpha-fetoprotein

Answer

Polyhydramnios

Question 5

Which of the following is true in twin-reversed arterial perfusion (TRAP) sequence?

Accepted Answer

The donor twin is at risk of cardiomegaly and high output heart failure.

Answer

It is caused by a large arteriovenous placental shunt.

Answer

The most effective treatment is injection of potassium chloride into the recipient twin.

Answer

Placental arterial perfusion pressure in the recipient exceeds that of the donor.

Question 6

Which of the following drugs is not helpful in the treatment of ectopic pregnancy?

Accepted Answer

Misoprostol

Answer

Methotrexate

Answer

Actinomycin-D

Answer

RU486

Question 7

All of the following interventions are recommended to prevent mother-to-child transmission of HIV, except?

Accepted Answer

Vaginal delivery

Answer

Avoid breast feeding

Answer

Highly Active Antiretroviral Therapy (HAART)

Answer

Intrapartum Zidovudine

Question 8

Which of the following is NOT a contraindication to pregnancy?

Accepted Answer

Large secundum atrial septal defect with left to right shunt

Answer

Severe pulmonary hypertension

Answer

Severe obstructive valvular lesions

Answer

Marfan syndrome with dilated aorta

Question 9

Highest maternal mortality is seen in which of the following congenital heart diseases?

Accepted Answer

Eisenmenger's syndrome

Answer

Pulmonary stenosis

Answer

Coarctation of aorta

Answer

Ventricular septal defect (VSD)

Question 10

What is the risk of neural tube defect in a child if either parent was born with spina bifida?

Accepted Answer

5%

Answer

3%

Answer

10%

Answer

15%

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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