Maternal-Fetal Medicine Practice Questions

Q: Anencephaly is best diagnosed using which of the following methods?

Ultrasound (USG). **Explanation:** **Anencephaly** is a lethal neural tube defect (NTD) characterized by the absence of the cranial vault (acrania) and the cerebral hemispheres. **Why Ultrasound (USG) is the Correct Answer:** Ultrasound is the **gold standard and investigation of choice** for diagnosing anencephaly. It can reliably detect the condition as early as the late first trimester (11–14 weeks). The classic sonographic findings include the **"Frog-eye appearance"** (Mickey Mouse sign) due to prominent orbits and the absence of the calvarium above the level of the orbits. USG is preferred because it is non-invasive, provides real-time visualization, and has nearly 100% sensitivity for this condition after the first trimester. **Analysis of Incorrect Options:** * **Maternal Serum Alpha-Fetoprotein (MSAFP):** While MSAFP is a screening tool for NTDs (levels are elevated), it is not diagnostic. High levels require confirmation via ultrasound. * **Amniotic Fluid Alpha-Fetoprotein (AFAFP):** This is an invasive procedure (amniocentesis). While it shows elevated AFP and Acetylcholinesterase, it is rarely used for diagnosis today because USG provides a definitive diagnosis non-invasively. * **X-ray:** Historically used to show the absence of the skull vault, but it is now obsolete due to radiation risks to the fetus and the superior resolution of USG. **Clinical Pearls for NEET-PG:** * **Earliest Diagnosis:** Can be suspected at 10-14 weeks (Acrania-Anencephaly sequence). * **Associated Finding:** **Polyhydramnios** is common in the second trimester because the fetus lacks the swallowing reflex. * **Key Sign:** "Frog-eye" or "Mickey Mouse" appearance on coronal/axial views. * **Screening:** Elevated MSAFP (>2.5 MoM) is the first step in screening for open NTDs.

Q: A 6-week pregnant primigravida presents with severe, acute abdominal pain. Ultrasound confirms an ectopic pregnancy. Which of the following has the least risk of ectopic pregnancy?

Condoms. **Explanation:** The risk of ectopic pregnancy is assessed in two ways: the **absolute risk** (the chance of any pregnancy occurring) and the **relative risk** (the chance that, if a pregnancy occurs, it will be ectopic). **1. Why Condoms are the Correct Answer:** Condoms are a barrier method of contraception. They prevent pregnancy by preventing sperm from reaching the egg. Because they significantly reduce the overall (absolute) risk of conception without altering the anatomy or physiology of the fallopian tubes, they carry the **least risk** of ectopic pregnancy among the given options. **2. Analysis of Incorrect Options:** * **Tubectomy:** While it is a highly effective permanent sterilization method, if a pregnancy *does* occur (due to recanalization or fistula), there is a very high relative risk (approx. 30-50%) that it will be ectopic. * **Infertility (>1 year):** Infertility is often caused by Pelvic Inflammatory Disease (PID) or endometriosis, both of which cause tubal scarring and ciliary dysfunction. This significantly increases the risk of an ectopic gestation. * **Copper T (IUD):** IUDs are excellent at preventing intrauterine pregnancies. However, they do not prevent ovulation. If the IUD fails, the relative risk of the pregnancy being ectopic is higher than in the general population because the device prevents implantation in the uterus more effectively than in the tube. **Clinical Pearls for NEET-PG:** * **Highest Risk Factor:** Previous history of ectopic pregnancy (10-fold increase). * **Most Common Site:** Ampulla of the fallopian tube. * **Most Common Site for Rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) + Serial β-hCG levels. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases).

Q: What is the recommended daily dose of folic acid for treating megaloblastic anemia during pregnancy?

1 mg. **Explanation:** **1. Why Option C (1 mg) is Correct:** Megaloblastic anemia in pregnancy is most commonly caused by **folic acid deficiency**. While the physiological requirement for folate increases during pregnancy, the therapeutic dose required to treat established megaloblastic anemia is **1 mg of folic acid daily**. This dose is sufficient to induce a reticulocyte response and restore hemoglobin levels, provided there is no concurrent Vitamin B12 deficiency or malabsorption. **2. Why Other Options are Incorrect:** * **Option A (400 mg):** This is an erroneously high value. The standard prophylactic dose for low-risk pregnancies is 400 **micrograms** (0.4 mg), not milligrams. * **Option B (5 mg):** This is the high-dose prophylaxis recommended for women at **high risk of Neural Tube Defects (NTDs)** (e.g., previous child with NTD, maternal diabetes, or anti-epileptic drug use). While often used in clinical practice for anemia, 1 mg is the standard textbook recommendation for treatment. * **Option D (2 mg):** This is not a standard recommended dose in international or national guidelines for the treatment of nutritional anemia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Prophylaxis (Low Risk):** 400 mcg (0.4 mg) daily, starting 1 month preconception until 12 weeks of gestation. * **Prophylaxis (High Risk):** 5 mg daily to prevent NTD recurrence. * **Iron + Folic Acid (IFA) Program:** Under the *Anemia Mukt Bharat* guidelines, pregnant women receive **60 mg elemental iron + 500 mcg (0.5 mg) folic acid** daily for 180 days. * **Diagnosis:** Megaloblastic anemia is characterized by a **Mean Corpuscular Volume (MCV) > 100 fL** and hypersegmented neutrophils on peripheral smear. Always rule out Vitamin B12 deficiency before starting high-dose folate to avoid masking neurological symptoms.

Q: What is the most valuable diagnostic test in a case of suspected ectopic pregnancy?

Transvaginal ultrasound. **Explanation:** The diagnosis of ectopic pregnancy relies on the "Discriminatory Zone" concept—the level of serum beta-hCG at which an intrauterine pregnancy (IUP) should be visible. **1. Why Transvaginal Ultrasound (TVS) is the correct answer:** TVS is the **most valuable diagnostic tool** because it provides direct anatomical evidence. It can confirm an IUP (ruling out ectopic via the principle of exclusivity, except in rare heterotopic cases) or visualize an adnexal mass/gestational sac. TVS is superior to transabdominal ultrasound as it can detect an IUP at lower hCG levels (1,500–2,000 mIU/mL). Finding an empty uterus with an adnexal mass in a patient with a positive pregnancy test is highly diagnostic. **2. Why other options are incorrect:** * **Serial beta-hCG levels:** While crucial for monitoring viability and determining the discriminatory zone, a single or serial level cannot pinpoint the *location* of the pregnancy. It is a supportive biochemical test, not a definitive diagnostic one. * **Progesterone measurement:** Levels <5 ng/mL suggest a non-viable pregnancy but do not distinguish between a miscarriage and an ectopic pregnancy. It is rarely used in modern clinical practice. * **Culdocentesis:** Historically used to detect hemoperitoneum (ruptured ectopic), it has been largely replaced by the non-invasive and more accurate TVS. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy (allows for both diagnosis and immediate surgical management). * **Most common site:** Ampulla of the Fallopian tube. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy; it is suggestive of pregnancy but not specific to ectopic. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases).

Q: Raised beta-hCG levels are seen in which of the following conditions?

Rh incompatibility. **Explanation:** The correct answer is **Rh incompatibility**. **1. Why Rh Incompatibility is Correct:** In Rh-isoimmunization, maternal antibodies cross the placenta and cause fetal hemolysis. To compensate for the resulting fetal anemia, the placenta undergoes **hypertrophic changes (placentomegaly)**. The increased mass of the cytotrophoblasts and syncytiotrophoblasts leads to an overproduction of human chorionic gonadotropin (hCG). Therefore, raised maternal serum beta-hCG levels are a characteristic finding in severe Rh-isoimmunization and hydrops fetalis. **2. Analysis of Incorrect Options:** * **Diabetes Mellitus:** While DM is associated with large placentas, beta-hCG levels are typically **normal** or only slightly altered; they are not a diagnostic or characteristic marker for the condition. * **Preeclampsia:** This condition is associated with placental ischemia and "placental aging." While some studies show elevated hCG in severe cases due to trophoblastic hyperproliferation, it is **not** the classic association compared to Rh incompatibility in standard textbooks. * **Ectopic Pregnancy:** This is a high-yield distractor. In ectopic pregnancy, beta-hCG levels are **lower than expected** for the period of gestation and fail to show the normal doubling (at least 66% increase) every 48 hours. **3. NEET-PG High-Yield Pearls:** * **Conditions with Raised beta-hCG:** Molar pregnancy (highest levels), Multiple pregnancy, Rh-isoimmunization, Down Syndrome (Triple/Quadruple screen), and Choriocarcinoma. * **Conditions with Low beta-hCG:** Ectopic pregnancy, Threatened/Spontaneous abortion, and Edwards Syndrome (Trisomy 18). * **Doubling Time:** In a healthy intrauterine pregnancy, beta-hCG doubles every 48–72 hours until it peaks at 8–11 weeks.

Q: Fundal height is more than the period of gestation in all conditions except:

Intrauterine death (IUD). **Explanation:** In clinical obstetrics, the symphysis-fundal height (SFH) is a crucial screening tool. When the **fundal height is less than the period of gestation**, it indicates a decrease in the contents of the uterus (fetus, placenta, or liquor). **1. Why Intrauterine Death (IUD) is the Correct Answer:** In IUD, the cessation of fetal growth, the loss of fetal muscle tone (leading to collapse of the fetal body), and the subsequent absorption of amniotic fluid (liquor) cause the uterus to shrink. Consequently, the fundal height becomes **less than** the expected period of gestation. **2. Analysis of Incorrect Options (Conditions where SFH > Gestational Age):** * **Twin Pregnancy:** The presence of two fetuses and two placentas increases the total intrauterine volume. * **Hydatidiform Mole:** This is characterized by the rapid proliferation of chorionic villi and the accumulation of concealed hemorrhage, often making the uterus "doughy" and larger than dates. * **Hydramnios (Polyhydramnios):** An excessive accumulation of amniotic fluid directly increases the uterine size beyond what is expected for the fetal age. **Clinical Pearls for NEET-PG:** * **Other causes of SFH > Dates:** Large for gestational age (LGA) fetus, uterine fibroids, and maternal obesity or full bladder during examination. * **Other causes of SFH 2 cm** between SFH and gestational age warrants further investigation via ultrasound. * **McDonald's Rule:** SFH in cm = Gestational age in weeks (applicable between 20–36 weeks).

Question 1

What is the first step in managing a patient presenting with a post-dated pregnancy?

Accepted Answer

Review menstrual history for accuracy

Answer

Perform Ultrasound (USG)

Answer

Conduct Non-stress Test (NST)

Answer

Obtain X-ray of the abdomen

Question 2

Anencephaly is best diagnosed using which of the following methods?

Accepted Answer

Ultrasound (USG)

Answer

Maternal serum alpha-fetoprotein

Answer

Amniotic fluid alpha-fetoprotein

Answer

X-ray

Question 3

An elderly gravida (G6P5) became disoriented, lightheaded, breathless, and cyanotic 20 minutes after an uncomplicated spontaneous vaginal term delivery. Her blood pressure is 80/40 mm Hg, pulse is 110/min, and respiratory rate is 30/min. O2 saturation is 75% on face mask. A generalized purpuric rash and bleeding from the I.V line site are seen. Which of the following is the most appropriate next step in management of this patient?

Accepted Answer

Intubation and mechanical ventilation

Answer

Abdominal ultrasound

Answer

Intramuscular magnesium sulfate

Answer

Intravenous heparin

Question 4

A 6-week pregnant primigravida presents with severe, acute abdominal pain. Ultrasound confirms an ectopic pregnancy. Which of the following has the least risk of ectopic pregnancy?

Accepted Answer

Condoms

Answer

Tubectomy

Answer

Infertility for more than 1 year

Answer

Copper T (Intrauterine Device)

Question 5

An ovarian cyst is detected in a pregnant woman; what is the recommended management?

Accepted Answer

Removal by laparotomy in the second trimester

Answer

Immediate removal by laparotomy

Answer

Wait and watch

Answer

Removal at the time of cesarean section

Question 6

What is the recommended daily dose of folic acid for treating megaloblastic anemia during pregnancy?

Accepted Answer

1 mg

Answer

400 mg

Answer

5 mg

Answer

2 mg

Question 7

What is the most valuable diagnostic test in a case of suspected ectopic pregnancy?

Accepted Answer

Transvaginal ultrasound

Answer

Serial beta-hCG levels

Answer

Progesterone measurement

Answer

Culdocentesis

Question 8

Raised beta-hCG levels are seen in which of the following conditions?

Accepted Answer

Rh incompatibility

Answer

Diabetes Mellitus

Answer

Preeclampsia

Answer

Ectopic pregnancy

Question 9

Which of the following statements is true regarding the management of labor in an HIV-positive mother?

Accepted Answer

Routine suctioning of the newborn should be avoided.

Answer

Cesarean delivery is the preferred method of delivery.

Answer

Early artificial rupture of membranes should be performed to detect meconium, as these patients are at high risk of fetal distress.

Answer

If instrumental delivery is required, vacuum extraction is preferable to forceps.

Question 10

Fundal height is more than the period of gestation in all conditions except:

Accepted Answer

Intrauterine death (IUD)

Answer

Twin pregnancy

Answer

Hydatidiform mole

Answer

Hydramnios

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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