Maternal-Fetal Medicine Practice Questions

Q: Which of the following dietary supplements is recommended for a pregnant patient receiving Heparin therapy?

Calcium. **Explanation:** **Correct Option: B (Calcium)** The primary reason for recommending Calcium supplementation in pregnant patients on long-term Heparin therapy is to mitigate the risk of **Heparin-Induced Osteoporosis**. Heparin increases osteoclast activity and decreases osteoblast function, leading to a reduction in bone mineral density. Since pregnancy itself increases calcium demands for fetal skeletal development, the addition of Heparin significantly elevates the risk of maternal bone loss and vertebral fractures. Therefore, patients on Heparin (either Unfractionated Heparin or LMWH) should receive supplemental Calcium (1000–1500 mg/day) and Vitamin D. **Incorrect Options:** * **A. Folic acid:** While Folic acid is routinely supplemented in all pregnancies to prevent Neural Tube Defects (NTDs), its requirement is not specifically linked to Heparin therapy. * **C & D. Zinc and Copper:** These are trace elements. While they are present in standard prenatal multivitamins, there is no specific clinical indication or increased requirement for them necessitated by Heparin administration. **NEET-PG High-Yield Pearls:** * **Heparin vs. Warfarin:** Heparin is the anticoagulant of choice in pregnancy because it is a large molecule that **does not cross the placenta**, unlike Warfarin, which is teratogenic (causing Fetal Warfarin Syndrome). * **LMWH vs. UFH:** Low Molecular Weight Heparin (LMWH), such as Enoxaparin, is preferred over Unfractionated Heparin (UFH) due to a lower risk of osteoporosis and Heparin-Induced Thrombocytopenia (HIT). * **Monitoring:** UFH is monitored using **aPTT**, whereas LMWH usually does not require monitoring (though **Anti-Xa levels** are used if necessary).

Q: Which of the following is NOT a cause of antepartum hemorrhage?

Atonic uterus. **Explanation:** **Antepartum Hemorrhage (APH)** is defined as bleeding from or into the genital tract occurring from the 28th week of pregnancy until the birth of the baby. The core concept here is the timing of the bleeding relative to delivery. **Why Atonic Uterus is the correct answer:** Uterine atony (failure of the uterus to contract after delivery) is the most common cause of **Postpartum Hemorrhage (PPH)**, not antepartum hemorrhage. Since the bleeding occurs *after* the expulsion of the placenta, it does not fall under the definition of APH. **Analysis of Incorrect Options:** * **Placenta Previa:** This is a leading cause of APH. It occurs when the placenta is implanted in the lower uterine segment, leading to painless, causative, and recurrent bleeding as the lower segment stretches. * **Abruptio Placenta:** This refers to the premature separation of a normally situated placenta. It is a major cause of APH and typically presents with painful vaginal bleeding and uterine tenderness. * **Circumvallate Placenta:** This is a morphological variation where the chorionic plate is smaller than the basal plate. It is a known placental cause of APH, often leading to intermittent bleeding and hydrorrhea. **NEET-PG High-Yield Pearls:** * **Most common cause of APH:** Abruptio Placenta (though Placenta Previa is a close second). * **Most common cause of PPH:** Uterine Atony (accounts for ~80% of cases). * **Vasa Previa:** A rare but critical cause of APH where fetal vessels run over the internal os; it is associated with high fetal mortality. * **Warning Hemorrhage:** Specifically refers to the initial small bouts of painless bleeding seen in Placenta Previa.

Q: For antenatal fetal monitoring in a diabetic pregnancy, all of the following are useful except?

Doppler flow study. **Explanation:** The primary goal of antenatal fetal monitoring in diabetic pregnancies is to prevent stillbirth caused by **fetal acidemia and hyperglycemia-induced hypoxia**. **Why Doppler flow study is the correct answer:** Umbilical artery Doppler flow studies are primarily used to monitor pregnancies complicated by **Intrauterine Growth Restriction (IUGR)** and **Placental Insufficiency** (e.g., Preeclampsia). In a typical diabetic pregnancy (especially Gestational Diabetes or Type 2), the pathophysiology involves fetal hyperinsulinemia and increased metabolic demand rather than primary placental vascular resistance. Therefore, Doppler studies are **not** routinely recommended for monitoring fetal well-being in diabetic patients unless there is concurrent hypertension or suspected growth restriction. **Why the other options are used:** * **Fetal Kick Count (D):** A simple, cost-effective screening tool for all high-risk pregnancies to assess fetal alertness. * **Non-Stress Test (NST) (A):** The most common surveillance tool used (usually starting at 32–34 weeks) to assess fetal heart rate reactivity, which reflects an intact central nervous system. * **Biophysical Profile (BPP) (B):** Combines NST with ultrasound parameters (breathing, movements, tone, and liquor). It is highly sensitive for detecting acute and chronic fetal hypoxia in diabetic mothers. **High-Yield Clinical Pearls for NEET-PG:** * **Target:** The most common cause of fetal demise in poorly controlled diabetes is **fetal acidemia**. * **Polyhydramnios:** Common in diabetes; if present, BPP is often preferred over NST. * **Timing:** For well-controlled GDM, monitoring usually starts at **32–34 weeks**; if poorly controlled, it may start earlier. * **Doppler Exception:** Use Doppler in diabetics **only** if there is associated **Pre-eclampsia** or **Small for Gestational Age (SGA)** fetus.

Q: Which of the following statements regarding monozygotic twins is not true?

They are always monochorionic. **Explanation:** **1. Why Option C is the Correct Answer (The "False" Statement):** Monozygotic (MZ) twins are not always monochorionic. The chorionicity and amnionicity depend entirely on the **timing of the zygotic split**. If the split occurs early (within the first 3 days post-fertilization, at the morula stage), the twins will be **Dichorionic Diamniotic (DCDA)**, just like dizygotic twins. Approximately 25–30% of monozygotic twins are DCDA. **2. Analysis of Other Options:** * **Option A:** Ultrasound is indeed more useful in the first half (specifically the first trimester) for determining chorionicity. Signs like the **'Lambda' (T-sign)** are most accurate before 14 weeks. * **Option B:** While MZ twins are genetically identical, sex discordance can occur rarely due to **post-zygotic non-disjunction** (e.g., one twin is 46,XY and the other is 45,X Turner syndrome) or in cases of phenotypic discordance in disorders of sexual development. * **Option C:** Assisted Reproductive Technology (ART) and ovulation induction are known risk factors that increase the incidence of monozygotic twinning, likely due to micromanipulation of the zona pellucida. **3. High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Split":** * 0–3 days: DCDA (25-30%) * 4–8 days: Monochorionic Diamniotic (MCDA) — **Most common (70-75%)** * 8–13 days: Monochorionic Monoamniotic (MCMA) — High risk (1-2%) * >13 days: Conjoined twins (Rare) * **T-sign vs. Lambda sign:** Lambda (λ) sign indicates Dichorionic; T-sign indicates Monochorionic. * **Twin-to-Twin Transfusion Syndrome (TTTS):** Occurs only in monochorionic pregnancies.

Q: Which of the following is NOT helpful in the diagnosis of a tubal mass in ectopic pregnancy?

Hysterosalpingography. **Explanation:** The diagnosis of ectopic pregnancy relies on a combination of clinical assessment, biochemical markers, and imaging. **Why Hysterosalpingography (HSG) is the Correct Answer:** HSG is a radiologic procedure used primarily to assess tubal patency in infertility workups. It involves injecting radiopaque contrast into the uterine cavity and tubes under pressure. In a suspected ectopic pregnancy, HSG is **contraindicated** and not helpful because: 1. It carries a high risk of **rupturing** the ectopic gestation. 2. It can cause severe infection or introduce contrast into the peritoneal cavity. 3. It provides no diagnostic value compared to non-invasive imaging. **Analysis of Other Options:** * **Beta-HCG Estimation:** This is the "gold standard" biochemical marker. A positive pregnancy test confirms gestation, and serial titers (looking for a sub-optimal doubling time) help differentiate an ectopic pregnancy from a viable intrauterine one. * **Transvaginal Ultrasound (TVS):** This is the imaging modality of choice. It can visualize an adnexal mass (e.g., "bagel sign" or "blob sign"), a gestational sac outside the uterus, or free fluid in the Pouch of Douglas. * **Pelvic Examination:** Clinical examination is essential. Findings such as cervical motion tenderness (Chandelier sign) and a palpable, tender adnexal mass are classic indicators of a tubal pregnancy. **NEET-PG High-Yield Pearls:** * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Discriminatory Zone:** The level of β-hCG (usually 1500–2000 mIU/mL) at which a gestational sac should be visible on TVS. If β-hCG is above this and the uterus is empty, suspect ectopic pregnancy. * **Most Common Site:** The **Ampulla** of the fallopian tube. * **Most Common Site for Rupture:** The **Isthmus** (due to its narrow lumen).

Q: What is a common cause of recurrent second-trimester fetal loss?

Abnormality of cervix and uterus. **Explanation:** Recurrent pregnancy loss (RPL) is etiologically distinct depending on the gestational age. **Abnormalities of the cervix and uterus** are the most common causes of recurrent **second-trimester** losses. Specifically, **Cervical Insufficiency** (painless cervical dilation) and structural uterine anomalies (such as a septate or bicornuate uterus) or acquired lesions (like submucosal fibroids or intrauterine synechiae) compromise the structural integrity required to hold a growing fetus, leading to mid-trimester expulsions. **Analysis of Options:** * **A. Chromosomal anomaly:** This is the most common cause of **first-trimester** sporadic and recurrent abortions (approx. 50-60%). Their incidence decreases significantly as pregnancy advances into the second trimester. * **B. Intrauterine infection:** While infections (e.g., TORCH, bacterial vaginosis) can cause sporadic mid-trimester loss or preterm labor, they are rarely responsible for *recurrent* losses. * **D. Hormonal imbalance:** Conditions like Luteal Phase Defect (LPD) or uncontrolled diabetes are primarily associated with implantation failure or early first-trimester losses. **High-Yield Clinical Pearls for NEET-PG:** * **Cervical Insufficiency:** Characterized by painless cervical ripening and spontaneous mid-trimester abortion. The gold standard treatment is **McDonald’s or Shirodkar’s Cerclage**, typically performed at 12–14 weeks. * **Uterine Septum:** The most common uterine anomaly associated with recurrent pregnancy loss. * **Antiphospholipid Syndrome (APS):** The most important *treatable* autoimmune cause of recurrent second-trimester loss due to placental thrombosis. * **Rule of Thumb:** 1st Trimester = Genetic/Chromosomal; 2nd Trimester = Anatomic/Structural.

Q: True about abruptio placentae, all are correct except?

Placenta lying in the lower segment.. **Explanation:** Abruptio placentae is defined as the premature separation of a **normally situated placenta** from the uterine wall before the birth of the fetus. **Why Option B is the Correct Answer (The Exception):** The hallmark of abruptio placentae is that the placenta is located in the **upper uterine segment**. If the placenta is implanted in the **lower uterine segment**, the condition is termed **Placenta Previa**. Therefore, Option B is factually incorrect regarding abruption and is the correct choice for this "except" question. **Analysis of Other Options:** * **Option A:** Chronic hypertension and Preeclampsia are the most significant predisposing risk factors for abruption due to maternal vascular degenerative changes. * **Option C:** In abruption, blood often extravasates into the myometrium (Couvelaire uterus), leading to uterine irritability. This manifests clinically as a **woody-hard, board-like, and tender uterus**. * **Option D:** Unlike the episodic, painless bleeding of placenta previa, the bleeding in abruption is typically **continuous** and associated with abdominal pain. **NEET-PG High-Yield Pearls:** * **Most common cause of DIC in obstetrics:** Abruptio Placentae. * **Couvelaire Uterus:** Utero-placental apoplexy where blood seeps into the myometrium (diagnosed via laparotomy). * **Classification:** Revealed (blood escapes), Concealed (blood trapped behind placenta), and Mixed (most common). * **Key Clinical Triad:** Abdominal pain, uterine tenderness, and vaginal bleeding (in revealed/mixed types).

Q: A 31-year-old woman in her second trimester of pregnancy presents with dyspnea on exertion. She has no history of chest pain, cough, or fever, and no known cardiac disease. Physical examination reveals a pulse of 75/min, BP of 110/70 mmHg, and SpO2 of 96%. Chest and cardiovascular examinations are unremarkable. What is the most probable cause of this patient's clinical presentation?

Physiological dyspnea of pregnancy. **Explanation:** **Physiological dyspnea of pregnancy** is the most likely diagnosis. It affects approximately 60–75% of pregnant women, typically beginning in the first or second trimester. The underlying mechanism is primarily hormonal: increased levels of **progesterone** act as a direct respiratory stimulant, increasing the sensitivity of the respiratory center to CO2. This leads to **hyperventilation** (increased tidal volume), which results in a physiological state of mild respiratory alkalosis. Clinically, the patient remains comfortable at rest, and physical examination (vitals, chest auscultation) is characteristically normal. **Why other options are incorrect:** * **Asthma:** Usually presents with a history of atopy, cough, wheezing, or chest tightness. Physical exam would typically reveal expiratory wheeze. * **Pulmonary Embolism (PE):** While pregnancy is a hypercoagulable state, PE usually presents with sudden-onset dyspnea, tachycardia, tachypnea, and often pleuritic chest pain or hypoxia (SpO2 <95%). * **Left Heart Failure:** This would present with orthopnea, paroxysmal nocturnal dyspnea, and clinical signs like pulmonary crackles (rales), an S3 gallop, or peripheral edema. **High-Yield Clinical Pearls for NEET-PG:** * **Respiratory Changes:** Pregnancy increases **Tidal Volume** (by 40%) and **Minute Ventilation**, but **Functional Residual Capacity (FRC)** and **Residual Volume** decrease due to the elevating diaphragm. * **ABG Profile:** Normal pregnancy shows a compensated **respiratory alkalosis** (pH 7.40–7.45, pCO2 27–32 mmHg). * **Vital Signs:** A respiratory rate >20/min or SpO2 <95% is **never** physiological in pregnancy and warrants investigation for pathology.

Question 1

What are the most life-threatening complications of septic abortion?

Accepted Answer

Respiratory distress syndrome

Answer

Peritonitis

Answer

Renal failure

Answer

Septicemia

Question 2

Which of the following dietary supplements is recommended for a pregnant patient receiving Heparin therapy?

Accepted Answer

Calcium

Answer

Folic acid

Answer

Zinc

Answer

Copper

Question 3

Which of the following is NOT a cause of antepartum hemorrhage?

Accepted Answer

Atonic uterus

Answer

Placenta previa

Answer

Abruptio placenta

Answer

Circumvallate placenta

Question 4

For antenatal fetal monitoring in a diabetic pregnancy, all of the following are useful except?

Accepted Answer

Doppler flow study

Answer

Non-stress test

Answer

Biophysical profile

Answer

Fetal kick count

Question 5

Which of the following statements regarding monozygotic twins is not true?

Accepted Answer

They are always monochorionic

Answer

Ultrasound is more useful in the first half of pregnancy

Answer

Sex discordance can occur rarely

Answer

They are more common following ovulation induction

Question 6

Which of the following is NOT helpful in the diagnosis of a tubal mass in ectopic pregnancy?

Accepted Answer

Hysterosalpingography

Answer

Beta-HCG estimation

Answer

Transvaginal ultrasound

Answer

Pelvic examination

Question 7

A 23-year-old primigravida at 33 weeks gestation presented with jaundice for 2 days. On examination, her BP was 140/90 mmHg, serum bilirubin was 5 mg%, Hb was 8 gm%, platelet count was 90,000/cu.mm, TLC was 10,000/cu.mm, and blood sugar was 40 mg/dL. AST and ALT were 85 and 80 IU/L, respectively. What is the probable diagnosis?

Accepted Answer

Acute fatty liver in pregnancy

Answer

Acute Hepatitis A

Answer

HELLP syndrome

Answer

Acute hepatitis E

Question 8

What is a common cause of recurrent second-trimester fetal loss?

Accepted Answer

Abnormality of cervix and uterus

Answer

Chromosomal anomaly

Answer

Intrauterine infection

Answer

Hormonal imbalance

Question 9

True about abruptio placentae, all are correct except?

Accepted Answer

Placenta lying in the lower segment.

Answer

Hypertension in pregnancy is an important predisposing factor.

Answer

Tender and hard uterus.

Answer

Continuous bleeding per vaginum.

Question 10

A 31-year-old woman in her second trimester of pregnancy presents with dyspnea on exertion. She has no history of chest pain, cough, or fever, and no known cardiac disease. Physical examination reveals a pulse of 75/min, BP of 110/70 mmHg, and SpO2 of 96%. Chest and cardiovascular examinations are unremarkable. What is the most probable cause of this patient's clinical presentation?

Accepted Answer

Physiological dyspnea of pregnancy

Answer

Asthma

Answer

Pulmonary embolism

Answer

Left heart failure

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

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