Maternal-Fetal Medicine Practice Questions

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: 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: Oxytocin challenge test for assessing fetal well-being is contraindicated in all of the following except:

Breech presentation. The **Oxytocin Challenge Test (OCT)**, also known as the Contraction Stress Test (CST), evaluates the fetal heart rate response to uterine contractions. The goal is to identify uteroplacental insufficiency. Because the test involves inducing contractions, it is contraindicated in any condition where labor or strong uterine activity poses a risk to the mother or fetus. ### Why Breech Presentation is the Correct Answer **Breech presentation** is a **relative contraindication** for vaginal delivery, but it is **not a contraindication** for an OCT. Inducing mild contractions to assess fetal well-being does not inherently increase the risk of complications in a breech fetus, provided other contraindications (like placenta previa) are absent. If the OCT is reactive, the clinician can then decide on the mode of delivery. ### Explanation of Incorrect Options (Contraindications) * **Placenta Previa:** Contractions can cause cervical effacement and dilatation, leading to massive maternal hemorrhage from the low-lying placenta. * **Previous Two LSCS:** Multiple prior uterine scars increase the risk of **uterine rupture** during induced contractions. (Note: A single prior LSCS is a relative contraindication, but two or more are absolute). * **Premature Labor:** Inducing contractions in a patient at risk for preterm birth can trigger active labor, leading to the delivery of a premature infant. ### High-Yield Clinical Pearls for NEET-PG * **Mechanism:** A positive OCT (Abnormal) shows **late decelerations** following 50% or more of contractions, indicating fetal hypoxia. * **Prerequisites:** Requires at least 3 contractions in 10 minutes, each lasting 40–60 seconds. * **Absolute Contraindications:** Placenta previa, vasa previa, previous classical CS, and prior uterine rupture. * **Interpretation:** A **Negative** result (no late decelerations) is highly reassuring and predicts fetal survival for 1 week (High Negative Predictive Value).

Q: A 28-week pregnant patient presents with a blood pressure of 140/90 mm Hg during a prenatal visit. Urine analysis is performed to detect the presence of proteins. Which of the following is a risk factor for progressing to pre-eclampsia in this patient?

All of the above. ### Explanation The correct answer is **D. All of the above**. Pre-eclampsia is a multisystem disorder characterized by new-onset hypertension (≥140/90 mmHg) and proteinuria (or end-organ dysfunction) after 20 weeks of gestation. The pathogenesis involves abnormal placentation leading to endothelial dysfunction. Identifying risk factors is crucial for early screening and prophylaxis (e.g., low-dose Aspirin). **Why the options are correct:** * **Family History (Option A):** Pre-eclampsia has a strong genetic component. A woman with a family history (mother or sister) has a 2- to 4-fold increased risk of developing the condition. * **Age (Option B):** Maternal age is a significant risk factor. Both extremes of reproductive age—**nulliparous teenagers** (due to an immature immune response to paternal antigens) and **women >35–40 years** (due to underlying vascular aging)—are at higher risk. * **Hydatidiform Mole (Option C):** This is a classic high-yield association. Molar pregnancies involve excessive trophoblastic proliferation, leading to early-onset pre-eclampsia (often occurring **before 20 weeks**). **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Risk Factor:** A prior history of pre-eclampsia is the strongest individual predictor for recurrence. * **Nulliparity:** Being a "primigravida" is a classic risk factor (often called the "disease of theories" or "disease of primigravida"). * **Other Risk Factors:** Obesity (BMI >30), Multiple pregnancy, Pre-existing medical conditions (Chronic HTN, Diabetes, SLE, Antiphospholipid syndrome), and IVF pregnancies. * **Prophylaxis:** Low-dose Aspirin (75–150 mg) is recommended starting from 12–16 weeks for high-risk patients.

Q: When does the first trimester of pregnancy complete?

14 completed weeks. **Explanation:** The division of pregnancy into trimesters is a clinical convention used to monitor fetal development and maternal changes. According to the standard obstetric definitions followed by major international bodies (such as ACOG and WHO) and standard textbooks like **Williams Obstetrics**, the first trimester extends from the first day of the last menstrual period (LMP) through **13 weeks and 6 days**. Therefore, the first trimester is considered over once **14 completed weeks** have begun. **Analysis of Options:** * **14 completed weeks (Correct):** This marks the transition into the second trimester (14–27 weeks). In clinical practice and exams, the first trimester is defined as 0–13+6 weeks; thus, completion occurs at the 14-week mark. * **12 completed weeks (Incorrect):** While many older texts and lay resources use 12 weeks as a milestone (as the uterus becomes an abdominal organ and the risk of miscarriage drops), it is not the formal obstetric definition for the end of the first trimester. * **13 completed weeks (Incorrect):** This is a common distractor. While the 13th week is the final week of the trimester, the trimester is not "complete" until the end of that week (13 weeks 6 days). * **16 completed weeks (Incorrect):** This is well into the second trimester and does not correspond to any major trimester transition. **High-Yield Clinical Pearls for NEET-PG:** * **Trimester Divisions:** * 1st Trimester: 0 to 13+6 weeks. * 2nd Trimester: 14 to 27+6 weeks. * 3rd Trimester: 28 weeks until delivery. * **NT Scan Timing:** The Nuchal Translucency (NT) scan, a crucial first-trimester screening, must be performed between **11 and 13+6 weeks**. * **Uterine Position:** The uterus remains a pelvic organ until **12 weeks**, after which it becomes palpable per abdomen.

Question 1

The maternal side of the mature placenta is covered by which structure?

Accepted Answer

Amnion

Answer

Chorion

Answer

Decidua

Answer

Amniotic membrane

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

Which of the following indicates the most severe form of fetal distress?

Accepted Answer

Reversal of diastolic flow

Answer

Decreased S/D ratio

Answer

Absent diastolic flow

Answer

Increased S/D ratio

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

In which of the following conditions can normal pregnancy be continued?

Accepted Answer

Wolf-Parkinson-White syndrome

Answer

Primary pulmonary hypertension

Answer

Eisenmenger syndrome

Answer

Marfan syndrome with dilated aortic root

Question 7

Oxytocin challenge test for assessing fetal well-being is contraindicated in all of the following except:

Accepted Answer

Breech presentation

Answer

Placenta previa

Answer

Previous two lower segment Caesarean sections (LSCS)

Answer

Premature labor

Question 8

A 28-week pregnant patient presents with a blood pressure of 140/90 mm Hg during a prenatal visit. Urine analysis is performed to detect the presence of proteins. Which of the following is a risk factor for progressing to pre-eclampsia in this patient?

Accepted Answer

All of the above

Answer

Family history of pre-eclampsia

Answer

Age

Answer

Hydatidiform mole

Question 9

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 10

When does the first trimester of pregnancy complete?

Accepted Answer

14 completed weeks

Answer

12 completed weeks

Answer

13 completed weeks

Answer

16 completed weeks

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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