Maternal-Fetal Medicine Practice Questions

Q: What is the standard dose regimen of betamethasone for fetal lung maturation?

Two doses of 12mg, IM administered 24 hours apart. **Explanation:** Antenatal corticosteroids (ACS) are administered to women at risk of preterm delivery (24 to 34 weeks of gestation) to accelerate fetal lung maturation and reduce the incidence of Respiratory Distress Syndrome (RDS), intraventricular hemorrhage, and necrotizing enterocolitis. **1. Why Option B is Correct:** The standard, evidence-based regimen for **Betamethasone** is **12 mg intramuscularly (IM), given in two doses, 24 hours apart**. This regimen ensures optimal plasma concentrations to induce the production of surfactant by Type II pneumocytes in the fetal lungs. The maximum benefit is seen if delivery occurs between 24 hours and 7 days after the first dose. **2. Why Other Options are Incorrect:** * **Option A:** 6 mg of Betamethasone is an under-dose; the standard single dose is 12 mg. * **Option C:** This describes the standard regimen for **Dexamethasone** (6 mg IM, 4 doses, 12 hours apart). While both drugs are used, their dosing schedules are distinct. * **Option D:** This dosage is excessive and not supported by clinical guidelines, increasing the risk of maternal and fetal side effects without added benefit. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Betamethasone is often preferred over Dexamethasone because it is associated with a lower risk of periventricular leukomalacia. * **Mechanism:** Corticosteroids induce surfactant-associated proteins and improve lung compliance. * **Timing:** The "Rescue Dose" (a single repeat dose) may be considered if the initial course was given >7 days ago and the patient is still <34 weeks pregnant. * **Contraindications:** Systemic fungal infections or active maternal tuberculosis.

Q: A 27-year-old woman at 34 weeks' gestation presents to the emergency department following a motor vehicle collision. Her heart rate is 130/min and blood pressure is 150/90 mm Hg. She is alert and oriented. She complains of severe abdominal pain that began immediately after the collision. Physical examination reveals bruising over her abdomen, along with a hypertonic uterus and dark vaginal bleeding. A sonogram reveals a placental abruption, and the fetal heart tracing reveals some decelerations. Emergency laboratory tests reveal an International Normalized Ratio of 2.5, with elevated fibrin degradation products. Which of the following is the most appropriate first step in management?

Administer fresh frozen plasma.. ### Explanation The patient presents with classic signs of **Placental Abruption** (painful vaginal bleeding, hypertonic uterus) following trauma. The critical finding here is the laboratory evidence of **Disseminated Intravascular Coagulation (DIC)**: an elevated INR (2.5) and elevated fibrin degradation products (FDPs). **1. Why Fresh Frozen Plasma (FFP) is the Correct Answer:** In cases of placental abruption complicated by DIC, the immediate priority is **hemodynamic stabilization and correction of coagulopathy** before surgical intervention. Administering FFP provides necessary clotting factors to stabilize the patient. Proceeding directly to surgery (LSCS) in a patient with an INR of 2.5 without correcting the coagulopathy would lead to uncontrollable intraoperative hemorrhage and maternal mortality. **2. Why Other Options are Incorrect:** * **A. Tocolytics:** These are strictly contraindicated in placental abruption, as they can worsen maternal hemorrhage and delay necessary delivery. * **B. Corticosteroids:** While indicated for fetal lung maturity at 34 weeks, they are not the *first* step in an unstable patient with active DIC and fetal distress. * **D. Immediate LSCS:** While delivery is the definitive treatment for abruption with fetal distress, the maternal coagulopathy must be addressed first (or concurrently with blood products) to ensure the mother survives the procedure. **Clinical Pearls for NEET-PG:** * **Placental Abruption** is the most common cause of DIC in pregnancy. * **Pathophysiology:** Release of tissue thromboplastin from the damaged placenta into maternal circulation triggers the extrinsic clotting pathway. * **Management Rule:** Always stabilize the mother (ABC + Coagulopathy correction) before addressing the fetus. * **Target:** In DIC, aim to keep Fibrinogen >150 mg/dL and Platelets >50,000/µL.

Q: A young woman with six weeks amenorrhoea presents with an abdominal mass. Ultrasound shows an empty uterus. What is the most likely diagnosis?

Ectopic pregnancy. ### Explanation **Correct Answer: B. Ectopic pregnancy** The clinical triad of **amenorrhea, abdominal pain, and an empty uterus on ultrasound** in a woman of reproductive age is highly suggestive of an ectopic pregnancy until proven otherwise. At six weeks of gestation, an intrauterine gestational sac should typically be visible via transvaginal sonography (TVS). The presence of an "empty uterus" in a patient with a positive pregnancy test (implied by amenorrhea) and an adnexal/abdominal mass indicates that the blastocyst has implanted outside the uterine cavity—most commonly in the fallopian tube (95%). The "abdominal mass" in this context often represents the ectopic sac, a hematoma, or a ruptured tubal pregnancy with localized collection. **Why other options are incorrect:** * **A. Ovarian cyst:** While an ovarian cyst presents as an abdominal mass, it does not typically cause amenorrhea unless it is a functional corpus luteum cyst of pregnancy. However, the combination of amenorrhea and a mass in a clinical vignette is a classic "red flag" for ectopic pregnancy in exams. * **C. Complete abortion:** In a complete abortion, the uterus would be empty, but there would be a history of heavy vaginal bleeding and passage of products of conception. Crucially, a complete abortion would not present with a persistent abdominal mass. **NEET-PG High-Yield Pearls:** * **Discriminatory Zone:** The serum β-hCG level at which an intrauterine sac should be seen is **1500–2000 mIU/ml** (TVS) or **6500 mIU/ml** (TAS). If the uterus is empty above these levels, suspect ectopic pregnancy. * **Most common site:** Ampulla of the Fallopian tube. * **Gold Standard Diagnosis:** Laparoscopy. * **Classic Sign:** "Ring of Fire" sign (hypervascularity around the adnexal mass) on Doppler ultrasound.

Q: What is the most common site of ectopic pregnancy in the fallopian tube?

Ampulla. **Explanation:** Ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. The **Fallopian tube** is the most common site for ectopic pregnancy, accounting for approximately **95-97%** of all cases. **1. Why Ampulla is Correct:** The **Ampulla** is the widest and longest part of the fallopian tube, making it the most frequent site for fertilization. Consequently, it is the most common site for ectopic implantation, accounting for approximately **70-80%** of tubal pregnancies. **2. Analysis of Incorrect Options:** * **Infundibulum (approx. 5%):** This is the distal, funnel-shaped portion. Implantation here is less common and often results in tubal abortion. * **Isthmus (approx. 12%):** This is the narrow, muscular portion. While less common than the ampulla, pregnancies here are more likely to result in early rupture (usually by 6-8 weeks) due to the lack of distensibility. * **Interstitium (approx. 2-3%):** This is the segment within the uterine wall. Though the least common tubal site, it is the **most dangerous**. Because the area is highly vascular (near the uterine and ovarian artery anastomosis), rupture here occurs later (12-16 weeks) and can lead to massive, life-threatening hemorrhage. **High-Yield Clinical Pearls for NEET-PG:** * **Overall Most Common Site:** Ampulla of the Fallopian tube. * **Most Common Site for Rupture:** Isthmus (earliest rupture) vs. Interstitial (latest/most severe rupture). * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) + Serum β-hCG (Correlation with the "Discriminatory Zone"). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, which is suggestive of pregnancy but not specific to ectopic.

Q: Which of the following is NOT a cause of acute abdomen in pregnancy?

Placenta previa. **Explanation:** The core concept in evaluating an acute abdomen in pregnancy is the presence of **pain**. An "acute abdomen" refers to a sudden, severe abdominal pain that may require urgent surgical or medical intervention. **Why Placenta Previa is the correct answer:** Placenta previa is classically characterized by **painless, causeless, and recurrent** vaginal bleeding in the second half of pregnancy. Because the bleeding occurs from the separation of the placenta from the lower uterine segment without uterine contractions or concealed hemorrhage, it does not typically cause abdominal pain or peritoneal irritation. Therefore, it is not a cause of acute abdomen. **Analysis of incorrect options:** * **Abortion:** Threatened or inevitable abortions are associated with uterine contractions and cervical dilation, leading to significant pelvic pain and cramping. * **Preterm Labor:** This involves regular, painful uterine contractions leading to cervical changes before 37 weeks, presenting as acute abdominal/pelvic pain. * **Appendicitis:** This is the most common non-obstetric surgical emergency during pregnancy. It presents with acute right-sided abdominal pain (though the location may shift upward as the uterus grows). **NEET-PG High-Yield Pearls:** * **Abruptio Placentae vs. Placenta Previa:** Abruption is **painful** (due to retroplacental hematoma and uterine hypertonicity), whereas Previa is **painless**. * **Diagnosis:** Transvaginal Ultrasound (TVS) is the gold standard for diagnosing Placenta Previa. **Digital vaginal examination is strictly contraindicated** (the "Double Setup" rule) until previa is ruled out, as it can provoke torrential hemorrhage. * **Most common cause of acute abdomen in pregnancy:** Appendicitis. * **Most common obstetric cause of acute abdomen:** Ectopic pregnancy (1st trimester) or Abruptio placentae (3rd trimester).

Question 1

Anti-Rh immunoglobulin (A.R.M) is contraindicated in which of the following conditions?

Accepted Answer

When the fetus is dead

Answer

Pregnancy beyond 40 weeks

Answer

When the mother is Rh-negative

Answer

When the mother is diabetic

Question 2

What is the standard dose regimen of betamethasone for fetal lung maturation?

Accepted Answer

Two doses of 12mg, IM administered 24 hours apart

Answer

Two doses of 6mg, IM administered 24 hours apart

Answer

Four doses of 6mg, IM administered 12 hours apart

Answer

Four doses of 12mg, IM administered 12 hours apart

Question 3

A 27-year-old woman at 34 weeks' gestation presents to the emergency department following a motor vehicle collision. Her heart rate is 130/min and blood pressure is 150/90 mm Hg. She is alert and oriented. She complains of severe abdominal pain that began immediately after the collision. Physical examination reveals bruising over her abdomen, along with a hypertonic uterus and dark vaginal bleeding. A sonogram reveals a placental abruption, and the fetal heart tracing reveals some decelerations. Emergency laboratory tests reveal an International Normalized Ratio of 2.5, with elevated fibrin degradation products. Which of the following is the most appropriate first step in management?

Accepted Answer

Administer fresh frozen plasma.

Answer

Administer a tocolytic.

Answer

Administer a corticosteroid.

Answer

Deliver the fetus immediately by LSCS.

Question 4

A young woman with six weeks amenorrhoea presents with an abdominal mass. Ultrasound shows an empty uterus. What is the most likely diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Ovarian cyst

Answer

Complete abortion

Answer

None of the above

Question 5

Which scenario leads to the most severe Rh-isoimmunization in a fetus?

Accepted Answer

Rh negative mother and Rh positive fetus in the second pregnancy.

Answer

Rh positive mother and Rh negative fetus.

Answer

Rh positive mother and Rh negative fetus in the 15th pregnancy.

Answer

Rh positive mother and Rh positive fetus in the second pregnancy.

Question 6

Which of the following medications is the drug of choice for severe preeclampsia?

Accepted Answer

Labetalol

Answer

Metoprolol

Answer

Alpha-methyldopa

Answer

Nifedipine

Question 7

A 21-year-old female presents with painless vaginal bleeding at term. Her previous labor was normal. What is the next line of management?

Accepted Answer

Examination in the operating theatre followed by amniotomy

Answer

Lower segment cesarean section (LSCS)

Answer

Perineal examination in the emergency room

Answer

Hysterectomy

Question 8

What is the most common site of ectopic pregnancy in the fallopian tube?

Accepted Answer

Ampulla

Answer

Infundibulum

Answer

Isthmus

Answer

Interstitium

Question 9

Which of the following is NOT a cause of acute abdomen in pregnancy?

Accepted Answer

Placenta previa

Answer

Abortion

Answer

Preterm labor

Answer

Appendicitis

Question 10

Which of the following statements regarding epilepsy in pregnancy is true?

Accepted Answer

Folic acid supplementation helps prevent the risk of neural tube defects.

Answer

Sodium valproate is the drug of choice.

Answer

Therapeutic drug monitoring is not required.

Answer

Lamotrigine is the most teratogenic antiepileptic drug.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?