Maternal-Fetal Medicine Practice Questions

Q: Which of the following complications is usually not observed in gestational diabetes mellitus?

Oligohydramnios. **Explanation:** In **Gestational Diabetes Mellitus (GDM)**, the hallmark pathophysiology is maternal hyperglycemia leading to fetal hyperglycemia. This triggers **fetal osmotic diuresis**, resulting in **polyhydramnios** (excess amniotic fluid), not oligohydramnios. **Why Oligohydramnios is the correct answer:** Oligohydramnios is typically associated with conditions causing placental insufficiency or fetal renal anomalies. In GDM, the increased glucose load in the fetus leads to polyuria, which increases the amniotic fluid volume. Therefore, oligohydramnios is an "atypical" finding in GDM and is usually not observed unless there is co-existing fetal growth restriction (FGR) or premature rupture of membranes. **Analysis of Incorrect Options:** * **Abortion:** While more common in pre-gestational diabetes with poor glycemic control during organogenesis, poorly controlled GDM still carries a slightly increased risk of spontaneous pregnancy loss. * **Preeclampsia:** There is a strong clinical association between GDM and hypertensive disorders. Hyperinsulinemia and insulin resistance contribute to endothelial dysfunction, increasing the risk of preeclampsia. * **Infection:** Hyperglycemia impairs neutrophil function and provides a culture medium for pathogens, making GDM patients prone to monilial vaginitis and urinary tract infections (UTIs). **NEET-PG High-Yield Pearls:** * **Most common fetal complication in GDM:** Macrosomia (due to fetal hyperinsulinemia). * **Most common malformation (Pre-gestational DM):** Cardiac defects (VSD). * **Most specific malformation (Pre-gestational DM):** Caudal Regression Syndrome. * **Amniotic Fluid Index (AFI):** In GDM, look for Polyhydramnios (AFI >24-25 cm).

Q: A hemodynamically stable nulliparous patient with ectopic pregnancy has an adnexal mass of 2.5 x 3 cms and a Beta HCG titer of 1500 miu/ml. What modality of treatment is suitable for her?

Medical management. ### Explanation The management of ectopic pregnancy is determined by the patient's hemodynamic stability, the size of the adnexal mass, and Beta-HCG levels. **Why Medical Management is Correct:** This patient is a prime candidate for medical management with **Methotrexate** because she meets the standard inclusion criteria: 1. **Hemodynamic stability:** No signs of rupture or active bleeding. 2. **Size of adnexal mass:** The mass is $\leq$ 3.5 cm (this patient’s mass is 3 cm). 3. **Beta-HCG levels:** Titer is < 5000 mIU/ml (this patient’s titer is 1500 mIU/ml). 4. **Desire for fertility:** As a nulliparous patient, medical management avoids the surgical risks of tubal scarring. **Analysis of Incorrect Options:** * **A. Conservative (Expectant) Management:** This is generally reserved for patients with very low, spontaneously declining Beta-HCG levels (usually < 1000 mIU/ml) and no symptoms. A titer of 1500 mIU/ml requires active intervention. * **C. Laparoscopic Surgery:** This is the gold standard for **ruptured** ectopic pregnancies in stable patients or when medical management is contraindicated/fails. Since this patient is stable and meets medical criteria, surgery is unnecessarily invasive. * **D. Laparotomy:** Reserved for hemodynamically **unstable** patients (shock) with a ruptured ectopic pregnancy where immediate life-saving intervention is required. **High-Yield Clinical Pearls for NEET-PG:** * **Methotrexate Dose:** 50 mg/m² BSA (intramuscular). * **Contraindications to Medical Management:** Breastfeeding, immunodeficiency, active pulmonary/renal/hepatic disease, and the presence of **fetal cardiac activity** (relative contraindication). * **Monitoring:** Beta-HCG levels are measured on Day 4 and Day 7. A decline of $\geq$ 15% between Day 4 and Day 7 indicates successful treatment. * **Most common site of ectopic:** Ampulla (Fallopian tube). * **Most common site of rupture:** Isthmus (occurs earliest).

Q: What is the recommended concentration of MgSO4 in meq/L for the treatment of eclampsia?

4 7 meq/L. **Explanation:** Magnesium Sulfate ($MgSO_4$) is the drug of choice for both the prophylaxis and treatment of seizures in eclampsia. The therapeutic goal is to maintain a specific serum concentration that is high enough to prevent seizures but low enough to avoid systemic toxicity. **1. Why 4–7 mEq/L is correct:** The therapeutic window for $MgSO_4$ in eclampsia is **4–7 mEq/L** (equivalent to 4.8–8.4 mg/dL). At this concentration, magnesium acts as a CNS depressant and a vasodilator, effectively raising the seizure threshold without compromising vital functions. **2. Analysis of Incorrect Options:** * **2–4 mEq/L (Option C):** This is below the therapeutic range. While normal physiological magnesium levels are 1.5–2.5 mEq/L, concentrations in this range are insufficient to prevent eclamptic convulsions. * **7–10 mEq/L (Option A):** This range approaches the threshold of toxicity. Loss of patellar reflexes (knee jerk) typically occurs when levels exceed **7–10 mEq/L** (or >10 mg/dL). * **10–15 mEq/L (Option B):** This is a dangerously toxic range. Respiratory depression and narcosis generally occur at **12–15 mEq/L**, and cardiac arrest is imminent when levels exceed **25–30 mEq/L**. **High-Yield Clinical Pearls for NEET-PG:** * **Monitoring:** Always check for the presence of the **Patellar reflex**, Respiratory rate (>12-14/min), and Urine output (>30 ml/hr or 100 ml/4hrs) before administering repeat doses. * **Antidote:** If toxicity occurs, the immediate treatment is **10 ml of 10% Calcium Gluconate** IV, administered slowly over 10 minutes. * **Excretion:** Magnesium is almost exclusively excreted by the kidneys; hence, dose adjustment is mandatory in renal impairment.

Q: A 21-year-old female presents with 8 weeks of amenorrhea and is now in shock. What is the most likely diagnosis?

Ruptured ectopic pregnancy. **Explanation:** The clinical presentation of **amenorrhea (8 weeks)** followed by **sudden shock** in a woman of reproductive age is a classic medical emergency. **1. Why Ruptured Ectopic Pregnancy is Correct:** An ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the **ampulla** of the fallopian tube. As the embryo grows, it distends the tube, eventually leading to rupture (typically between 6–10 weeks). Rupture causes massive **intraperitoneal hemorrhage (hemoperitoneum)**, leading to hypovolemic shock (tachycardia, hypotension, and pallor). In NEET-PG, the triad of amenorrhea, abdominal pain, and vaginal bleeding/shock should always be considered a ruptured ectopic pregnancy until proven otherwise. **2. Why Other Options are Incorrect:** * **Incarcerated Amnion:** This is not a standard clinical term. An incarcerated gravid uterus (usually at 12–16 weeks) causes urinary retention, not sudden shock. * **Torsed Ovarian Cyst:** While this causes acute pelvic pain and potentially localized peritonitis, it rarely causes systemic shock unless it leads to secondary rupture and massive internal bleeding, which is far less common than ectopic rupture. * **Threatened Abortion:** This presents with vaginal bleeding and mild cramping while the cervix remains closed. It does not cause hemodynamic instability or shock. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) + Serum β-hCG. * **Picket Fence Temperature:** Often seen in ruptured ectopic due to blood irritating the peritoneum. * **Management of Shock:** Immediate resuscitation with IV fluids/blood followed by **emergency laparotomy** (Salpingectomy). Do not wait for an ultrasound if the patient is hemodynamically unstable. * **Arias-Stella Reaction:** A characteristic endometrial change seen in ectopic pregnancy (hypersecretory glands with pleomorphic nuclei).

Q: Which drug is given to reduce uterine contractions during preterm labor with the least side effects?

Progesterone. **Explanation:** The correct answer is **Progesterone**. In the context of preterm labor management, it is crucial to distinguish between **prevention** and **acute tocolysis**. **Why Progesterone is Correct:** Progesterone is primarily used for the **prevention** of preterm birth in high-risk women (e.g., those with a short cervix or prior history). It maintains "uterine quiescence" by inhibiting pro-inflammatory cytokines and decreasing oxytocin receptors. Among all drugs listed, it has the **least systemic side effect profile**, as it mimics a natural pregnancy hormone. While not used to stop active, advanced labor, it is the drug of choice for long-term reduction of uterine irritability with minimal maternal-fetal risks. **Analysis of Incorrect Options:** * **Ritodrine:** A Beta-2 agonist. It is notorious for severe side effects, including maternal tachycardia, pulmonary edema, and hyperglycemia. It is now rarely used due to these safety concerns. * **Nifedipine:** A Calcium Channel Blocker. While it is the **first-line agent for acute tocolysis** due to better efficacy and fewer side effects than Ritodrine, it can still cause maternal hypotension, flushing, and headaches. * **Magnesium Sulfate:** Primarily used for **fetal neuroprotection** (if <32 weeks) rather than as a primary tocolytic. It carries risks of respiratory depression and loss of deep tendon reflexes at toxic levels. **NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC) for Acute Tocolysis:** Nifedipine. * **DOC for Fetal Neuroprotection:** Magnesium Sulfate. * **Progesterone Formulations:** Vaginal progesterone is preferred for "short cervix," while IM 17-OHP is used for a history of prior preterm birth. * **Tocolytic Contraindication:** Do not give tocolytics if there is evidence of chorioamnionitis or abruption.

Question 1

An elderly multiparous woman with intrauterine fetal death was admitted with strong labor pains. The patient suddenly goes into shock with cyanosis, respiratory disturbances, and pulmonary edema. What is the most likely clinical diagnosis?

Accepted Answer

Amniotic fluid embolism

Answer

Rupture of uterus

Answer

Congestive heart failure

Answer

Concealed accidental hemorrhage

Question 2

A 19-year-old primigravida presents with 8 weeks of amenorrhea, light bleeding, and pain. On examination, the uterine size corresponds to the period of gestation, and the os is closed. Ultrasound reveals an intrauterine pregnancy. What is the preferred management in this case?

Accepted Answer

Bed rest and Progesterone

Answer

Estrogen plus Progesterone therapy

Answer

Dilatation and Curettage

Answer

Beta hCG

Question 3

A 24-year-old woman presents with mildly painful swelling of her right leg and acute shortness of breath. She is 32 weeks pregnant with her second child and has no other medical history. Which of the following statements is NOT true regarding this condition?

Accepted Answer

D-Dimer assay could be an important diagnostic tool.

Answer

Deep vein thrombosis and venous obstruction by the pregnant uterus are likeliest causes.

Answer

An ultrasound of the deep veins of the right leg should be performed.

Answer

A V/Q scan can be helpful in this condition.

Question 4

Which of the following complications is usually not observed in gestational diabetes mellitus?

Accepted Answer

Oligohydramnios

Answer

Abortion

Answer

Preeclampsia

Answer

Infection

Question 5

A hemodynamically stable nulliparous patient with ectopic pregnancy has an adnexal mass of 2.5 x 3 cms and a Beta HCG titer of 1500 miu/ml. What modality of treatment is suitable for her?

Accepted Answer

Medical management

Answer

Conservative management

Answer

Laparoscopic surgery

Answer

Laparotomy

Question 6

What is the recommended concentration of MgSO4 in meq/L for the treatment of eclampsia?

Accepted Answer

4 
 7 meq/L

Answer

7 
 10 meq/L

Answer

10 
 15 meq/L

Answer

2 
 4 meq/L

Question 7

Contraction stress test is used to detect which of the following fetal conditions?

Accepted Answer

Fetal hypoxia

Answer

Placenta previa

Answer

Hydramnios

Answer

Cord prolapse

Question 8

Embryo reduction of a multiple pregnancy is typically performed at which gestational age?

Accepted Answer

11-13 weeks

Answer

8-10 weeks

Answer

13-15 weeks

Answer

16-18 weeks

Question 9

A 21-year-old female presents with 8 weeks of amenorrhea and is now in shock. What is the most likely diagnosis?

Accepted Answer

Ruptured ectopic pregnancy

Answer

Incarcerated amnion

Answer

Torsed ovarian cyst

Answer

Threatened abortion

Question 10

Which drug is given to reduce uterine contractions during preterm labor with the least side effects?

Accepted Answer

Progesterone

Answer

Ritodrine

Answer

Nifedipine

Answer

Magnesium sulfate

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?