Maternal-Fetal Medicine Practice Questions

Q: What is the drug of choice to control convulsions in eclampsia?

Magnesium sulphate. **Explanation:** **Magnesium Sulphate ($MgSO_4$)** is the gold standard and drug of choice for both the prevention and control of seizures in eclampsia. Its superiority over other anticonvulsants was established by the landmark **Collaborative Eclampsia Trial**. **Why it is the Correct Choice:** $MgSO_4$ acts primarily by blocking **NMDA receptors** in the brain, which raises the seizure threshold. It also acts as a potent cerebral vasodilator, reversing the vasospasm associated with eclampsia. Additionally, it inhibits acetylcholine release at the neuromuscular junction, providing a mild muscle-relaxant effect. Unlike other anticonvulsants, it effectively prevents recurrent seizures without causing significant maternal CNS depression. **Why Other Options are Incorrect:** * **Pethidine (A):** This is an opioid analgesic used for pain relief during labor. It has no anticonvulsant properties and can cause respiratory depression in the neonate. * **Diazepam (B):** While a potent benzodiazepine for status epilepticus, it is associated with a higher rate of seizure recurrence in eclampsia and can cause "Floppy Infant Syndrome" (neonatal hypotonia and respiratory depression). * **Phenytoin (C):** It is less effective than $MgSO_4$ in preventing recurrent eclamptic fits and requires slow intravenous infusion to avoid cardiac arrhythmias. **High-Yield Clinical Pearls for NEET-PG:** * **Regimens:** Pritchard (IM) and Zuspan (IV) are the standard protocols. * **Therapeutic Window:** 4–7 mEq/L. * **Monitoring:** Always check for **Patellar reflex** (earliest sign of toxicity), **Respiratory rate** (>12/min), and **Urine output** (>30 ml/hr). * **Antidote:** 10 ml of 10% **Calcium Gluconate** (IV) administered over 10 minutes.

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 and 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 **11–14 weeks** (late first trimester). Key sonographic features include the absence of the calvarium above the orbits (the **"Frog-eye appearance"** or "Mickey Mouse sign") and the presence of a vascular stroma instead of brain tissue (*Area cerebrovasculosa*). Its high sensitivity (nearly 100%), non-invasive nature, and real-time visualization make it superior to biochemical markers. **Analysis of Incorrect Options:** * **Maternal Serum Alpha-Fetoprotein (MSAFP):** This is a **screening tool**, not a diagnostic one. While MSAFP is elevated in 80-90% of open NTDs, it requires confirmation via USG due to high false-positive rates (e.g., multiple gestations, incorrect dating). * **Amniotic Fluid Alpha-Fetoprotein (AFAFP):** This is more specific than MSAFP but requires an invasive procedure (amniocentesis). With the advancement of high-resolution USG, invasive testing for anencephaly is rarely necessary. * **X-ray:** Historically used to see the absence of the skull vault, it is now **obsolete** due to radiation risks and the superior diagnostic accuracy of USG. **Clinical Pearls for NEET-PG:** * **Earliest Diagnosis:** 11 weeks by USG. * **Associated Finding:** **Polyhydramnios** is common in the third trimester due to the fetus's inability to swallow amniotic fluid. * **Prevention:** Periconceptional **Folic Acid (400 mcg/day)** reduces the risk of NTDs. For women with a previous affected pregnancy, the dose is increased to **4 mg/day**. * **Management:** Since it is a lethal anomaly, termination of pregnancy is offered regardless of gestational age.

Q: A young lady presents with acute abdominal pain and a history of 1.5 months of amenorrhea. Ultrasonography reveals a collection of fluid in the pouch of Douglas and an empty uterine cavity. What is the most likely diagnosis?

Ectopic pregnancy. ### Explanation The clinical presentation of **acute abdominal pain** following a period of **amenorrhea** (1.5 months/6 weeks) is a classic triad for **Ectopic Pregnancy** until proven otherwise. **1. Why Ectopic Pregnancy is the correct answer:** The key diagnostic findings here are an **empty uterine cavity** on ultrasound despite a history of amenorrhea, combined with **fluid in the Pouch of Douglas (POD)**. In the context of a suspected pregnancy, fluid in the POD usually represents **hemoperitoneum** resulting from a ruptured or leaking tubal pregnancy. The "empty uterus" sign is crucial; if the β-hCG levels are above the discriminatory zone (usually 1500–2000 mIU/ml) and the uterus is empty, the diagnosis of ectopic pregnancy is highly probable. **2. Why other options are incorrect:** * **Pelvic Hematocele:** While a hematocele (a collection of blood) is often a *sequela* of a ruptured ectopic pregnancy, it is a clinical finding rather than the primary diagnosis. * **Threatened Abortion:** In this condition, the pregnancy is intrauterine. Ultrasound would show a gestational sac within the uterine cavity, not an empty uterus. * **Twisted Ovarian Cyst:** While this causes acute pain, it is usually not associated with amenorrhea. Ultrasound would typically show a cystic adnexal mass with compromised blood flow rather than an empty uterus with free fluid. ### Clinical Pearls for NEET-PG: * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (seen in only 50% of cases). * **Most common site:** Ampulla of the Fallopian tube. * **Gold Standard Diagnosis:** Laparoscopy (though TVS + Serial β-hCG is the standard initial approach). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on histology, characteristic of ectopic pregnancy. * **Pseudosac:** A fluid collection in the midline of the uterus (unlike an eccentric true gestational sac) seen in 10-20% of ectopic cases.

Q: All of the following drugs can be given to a mother with lupus after 35th week of gestation, except?

Methotrexate. **Explanation:** The correct answer is **Methotrexate (Option B)**. Methotrexate is a potent folic acid antagonist and is strictly **contraindicated** throughout pregnancy (FDA Category X). While its teratogenic effects (fetal hydantoin-like syndrome, cranial anomalies) are most concerning in the first trimester, it remains contraindicated in the third trimester due to its potential for neonatal myelosuppression and hepatotoxicity. **Analysis of Options:** * **Chloroquine (Option A):** Antimalarials (Hydroxychloroquine/Chloroquine) are considered the cornerstone of SLE management in pregnancy. They are safe and essential to prevent lupus flares and reduce the risk of neonatal heart block. * **Sulphadiazine / Sulphasalazine (Option C):** These are considered safe in pregnancy. While sulfonamides are generally avoided near term due to the theoretical risk of neonatal kernicterus (by displacing bilirubin from albumin), Sulphasalazine is frequently used in stable autoimmune patients and is not strictly contraindicated like Methotrexate. * **Prednisolone (Option D):** This is the steroid of choice for maternal indications (like SLE flares). It is metabolized by the placental enzyme **11-beta-hydroxysteroid dehydrogenase**, ensuring that less than 10% of the drug reaches the fetus, thus minimizing fetal side effects. **NEET-PG High-Yield Pearls:** * **Drug of Choice for SLE in Pregnancy:** Hydroxychloroquine (reduces flares). * **Steroids in Pregnancy:** Prednisolone is used for maternal SLE; **Betamethasone/Dexamethasone** are used for fetal lung maturity (as they cross the placenta). * **Lupus & Neonatal Heart Block:** Associated with Anti-Ro (SSA) and Anti-La (SSB) antibodies. * **Safe Immunosuppressants in Pregnancy:** Azathioprine, Cyclosporine, and Tacrolimus. * **Contraindicated in SLE Pregnancy:** Methotrexate, Mycophenolate Mofetil (MMF), and Cyclophosphamide.

Q: Which drug is used for the management of ectopic pregnancy?

Methotrexate. **Explanation:** **Methotrexate (Option A)** is the drug of choice for the medical management of unruptured ectopic pregnancy. It is a folic acid antagonist that inhibits the enzyme **dihydrofolate reductase**, thereby preventing the synthesis of DNA, RNA, and proteins. Since trophoblastic tissue is rapidly dividing, it is highly sensitive to methotrexate, which effectively halts the growth of the ectopic pregnancy and allows for gradual resorption. **Why other options are incorrect:** * **Mifepristone (Option B):** While it is an anti-progestogen used for medical abortion (in combination with Misoprostol), it is not the primary treatment for ectopic pregnancy. It acts on the decidua but is insufficient to reliably terminate a tubal pregnancy. * **Procarbazine (Option C):** This is an alkylating agent primarily used in the treatment of Hodgkin’s lymphoma, not in obstetric practice. * **Cytosine arabinoside (Option D):** Also known as Cytarabine, this is a chemotherapy agent used for leukemias and has no role in managing ectopic pregnancies. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Methotrexate:** Hemodynamically stable patient, unruptured mass <3.5–4 cm, no fetal cardiac activity, and baseline serum β-hCG <5000 mIU/mL. * **Contraindications:** Breastfeeding, immunodeficiency, ruptured ectopic pregnancy, or hepatic/renal dysfunction. * **Dosing:** Most commonly administered as a single intramuscular dose (50 mg/m²). * **Monitoring:** Success is defined by a ≥15% drop in β-hCG levels between Day 4 and Day 7 after administration.

Q: Intrauterine growth restriction (IUGR) is caused by all of the following except?

Diabetes. **Explanation:** The correct answer is **Diabetes (Option A)**. In the context of pregnancy, maternal diabetes (specifically pre-gestational or gestational diabetes) is classically associated with **fetal macrosomia** (birth weight >4000g or >90th percentile) rather than growth restriction. This occurs because maternal hyperglycemia leads to fetal hyperglycemia, which stimulates the fetal pancreas to secrete excess insulin. Since insulin is a potent anabolic growth factor, it results in excessive fetal growth and fat deposition. *Note: The only exception is long-standing diabetes with advanced vascular complications (White’s Class F or R), which can cause placental insufficiency and lead to IUGR. However, as a general rule for NEET-PG, diabetes is the "odd one out" as it primarily causes large-for-gestational-age (LGA) babies.* **Why other options are incorrect:** * **Alcohol (Option B):** Alcohol is a known teratogen and a leading cause of symmetric IUGR. It interferes with cell division and protein synthesis. * **Smoking (Option C):** Nicotine and carbon monoxide cause vasoconstriction and reduce the oxygen-carrying capacity of fetal blood, leading to placental insufficiency and asymmetric IUGR. * **Chronic Renal Failure (Option D):** Maternal chronic disease leads to systemic hypertension and impaired uteroplacental blood flow, which are major risk factors for growth restriction. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of IUGR:** Placental insufficiency (often due to maternal hypertension). * **Symmetric IUGR:** Occurs early in pregnancy (e.g., chromosomal anomalies, TORCH infections). * **Asymmetric IUGR:** Occurs later in pregnancy; "Head sparing" effect is seen (e.g., Preeclampsia, Smoking). * **Ponderal Index:** Used to differentiate between symmetric and asymmetric IUGR.

Question 1

A 32-week pregnant woman presents with mild uterine contractions. On examination, her vital signs are stable, and placenta previa type III is present. What is the best management?

Accepted Answer

Bed rest + Nifedipine and Dexamethasone

Answer

Bed rest + Dexamethasone

Answer

Bed rest + Sedation

Answer

Immediate cesarean section

Question 2

What is the drug of choice to control convulsions in eclampsia?

Accepted Answer

Magnesium sulphate

Answer

Pethidine

Answer

Diazepam

Answer

Phenytoin

Question 3

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 4

A young lady presents with acute abdominal pain and a history of 1.5 months of amenorrhea. Ultrasonography reveals a collection of fluid in the pouch of Douglas and an empty uterine cavity. What is the most likely diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Pelvic hematocele

Answer

Threatened abortion

Answer

Twisted ovarian cyst

Question 5

All of the following drugs can be given to a mother with lupus after 35th week of gestation, except?

Accepted Answer

Methotrexate

Answer

Chloroquine

Answer

Sulphadiazine / Sulphasalazine

Answer

Prednisolone

Question 6

The oxytocin challenge test for assessing fetal well-being is contraindicated in all except which of the following conditions?

Accepted Answer

Breech presentation

Answer

Placenta previa

Answer

Previous two lower segment caesarean sections

Answer

Premature labor

Question 7

What is considered a dangerously low-lying placenta?

Accepted Answer

Type II posterior placenta

Answer

Type I anterior placenta

Answer

Type II anterior placenta

Answer

Type I posterior placenta

Question 8

Which drug is used for the management of ectopic pregnancy?

Accepted Answer

Methotrexate

Answer

Mifepristone

Answer

Procarbazine

Answer

Cytosine arabinoside

Question 9

Intrauterine growth restriction (IUGR) is caused by all of the following except?

Accepted Answer

Diabetes

Answer

Alcohol

Answer

Smoking

Answer

Chronic renal failure

Question 10

Cholestasis of pregnancy is characterized by:

Accepted Answer

Increased perinatal mortality and recurrence in subsequent pregnancies

Answer

Commonly occurs in the 1st trimester of pregnancy, increased perinatal mortality, and recurrence in subsequent pregnancies

Answer

Increased maternal mortality, increased perinatal mortality, and recurrence in subsequent pregnancies

Answer

Commonly occurs in the 1st trimester of pregnancy and recurrence in subsequent pregnancies

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?