Maternal-Fetal Medicine Practice Questions

Q: Caudal regression syndrome is seen in which of the following maternal conditions?

Gestational diabetes. **Explanation:** **Caudal Regression Syndrome (CRS)** is a rare congenital defect characterized by varying degrees of developmental failure involving the lower spine (sacrum/lumbar), spinal cord, and corresponding lower limbs. **Why Gestational Diabetes is the Correct Answer:** While the question uses the term "Gestational Diabetes," it is crucial to note that CRS is most strongly associated with **Pre-gestational Diabetes (Type 1 or Type 2)** where hyperglycemia is present during the period of organogenesis (first 8 weeks). Maternal hyperglycemia leads to oxidative stress and altered gene expression in the developing embryo. Although rare, CRS is considered the **most specific** (pathognomonic) fetal malformation associated with maternal diabetes, occurring at a rate 200 times higher than in the general population. **Why Other Options are Incorrect:** * **Preeclampsia:** This is a hypertensive disorder of pregnancy. It is associated with placental insufficiency, IUGR, and abruption, but not specific structural malformations like CRS. * **Sickle-Cell Anemia:** This maternal hematological condition increases the risk of preterm labor and low birth weight but is not teratogenic. * **Systemic Lupus Erythematosus (SLE):** Maternal SLE is classically associated with **Congenital Heart Block** in the fetus (due to anti-Ro/SSA and anti-La/SSB antibodies), not skeletal defects like CRS. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Malformation in Diabetes:** Congenital Heart Defects (specifically **Ventricular Septal Defect**). * **Most Specific Malformation in Diabetes:** Caudal Regression Syndrome (Sacral Agenesis). * **Cardiac Pathognomonic Sign:** Hypertrophic Cardiomyopathy (asymmetric septal hypertrophy). * **HbA1c Correlation:** The risk of malformations increases significantly if maternal HbA1c is >8.5% during the first trimester.

Q: What is the most reliable method for diagnosing fetal wellbeing?

Ultrasound. **Explanation:** The assessment of fetal wellbeing has evolved from biochemical markers to real-time biophysical evaluation. **Ultrasound** is currently the most reliable method because it allows for a comprehensive, non-invasive, and immediate assessment of the fetus. It forms the basis of the **Biophysical Profile (BPP)** and **Doppler velocimetry**, which evaluate acute markers (fetal breathing, movements, tone, and heart rate) and chronic markers (amniotic fluid index and placental perfusion). **Analysis of Options:** * **A. L:S Ratio (Lecithin-Sphingomyelin):** This is a marker of **fetal lung maturity**, not overall wellbeing. While it predicts the risk of Respiratory Distress Syndrome (RDS), it does not provide information regarding acute fetal distress or placental function. * **B. HPL (Human Placental Lactogen) levels:** Formerly used as a "placental function test," HPL levels are no longer considered reliable. They have a wide range of normal values and poor sensitivity in predicting acute fetal compromise. * **C. Kick Test (Daily Fetal Movement Count):** While a valuable screening tool for mothers to monitor at home, it is **subjective** and can be influenced by maternal perception, obesity, or fetal sleep cycles. It is less reliable than objective ultrasound findings. **High-Yield Clinical Pearls for NEET-PG:** * **Modified BPP:** Combines the Non-Stress Test (NST) (acute indicator) and Amniotic Fluid Index (AFI) (chronic indicator). * **Umbilical Artery Doppler:** The most sensitive tool for monitoring growth-restricted (IUGR) fetuses; "Absent or Reversed End-Diastolic Flow" is a critical sign of impending compromise. * **First sign to disappear in fetal distress:** Fetal breathing movements. * **Last sign to disappear:** Fetal tone (indicates severe acidemia).

Q: A pregnant patient at 20 weeks gestation presents with fever and dysuria, leading to a preliminary diagnosis of cystitis. Which of the following antibiotics is safe to use for this patient?

Amoxicillin. **Explanation:** **Correct Answer: D. Amoxicillin** **Why Amoxicillin is correct:** Amoxicillin is a penicillin-group antibiotic and is classified as **FDA Pregnancy Category B**. It is considered safe and effective for treating Urinary Tract Infections (UTIs) in pregnancy because it does not cross the placental barrier in harmful concentrations and lacks teratogenic potential. In pregnant patients, asymptomatic bacteriuria and cystitis must be treated promptly to prevent progression to pyelonephritis, which is associated with preterm labor. **Why the other options are incorrect:** * **A. Ciprofloxacin:** Fluoroquinolones are generally avoided in pregnancy (Category C) as they have a high affinity for bone and cartilage, potentially causing **arthropathy** and permanent cartilage damage in the developing fetus. * **B. Gentamicin:** Aminoglycosides are associated with **ototoxicity** (damage to the 8th cranial nerve) and potential nephrotoxicity in the fetus. They are reserved for life-threatening infections like severe pyelonephritis where no safer alternative exists. * **C. Cotrimoxazole:** This is a combination of Sulfamethoxazole and Trimethoprim. Trimethoprim is a **folate antagonist** (risk of neural tube defects in the 1st trimester), and Sulfonamides can displace bilirubin from albumin, leading to **kernicterus** in the newborn if used near term. **NEET-PG High-Yield Pearls:** * **Drug of Choice for UTI in Pregnancy:** Nitrofurantoin (avoided only at term/near labor due to risk of neonatal hemolysis) or Amoxicillin/Cephalosporins. * **Safe Antibiotics (Category B):** Penicillins, Cephalosporins, Erythromycin (except estolate form), and Azithromycin. * **Teratogenic mnemonic:** "**T**atty **C**ats **A**re **G**reedy" (**T**etracycline - stained teeth; **C**hloramphenicol - Gray baby syndrome; **A**minoglycosides - Ototoxicity; **G**luoroquinolones - Cartilage damage).

Q: What does the following ultrasound show?

Ectopic pregnancy. ***Ectopic pregnancy*** - Classic **transvaginal ultrasound** findings include the **adnexal ring sign** (hyperechoic ring in the fallopian tube) and an **empty uterine cavity** despite positive pregnancy test. - Often shows **free fluid** in the **pouch of Douglas** indicating potential tubal rupture or bleeding. *Normal pregnancy* - Shows a **gestational sac** within the **uterine cavity** with appropriate size for gestational age. - **Fetal pole** and **cardiac activity** are visible in viable intrauterine pregnancies after 6-7 weeks. *Hydatidiform mole* - Characteristic **"snowstorm appearance"** with multiple **cystic spaces** and **echogenic material** filling the uterine cavity. - Absence of **normal fetal structures** and markedly elevated **β-hCG levels** compared to gestational age. *Ovarian cyst* - Appears as a **simple fluid-filled structure** with **thin walls** and **anechoic contents** in the ovary. - **Uterine cavity** would show normal intrauterine pregnancy if patient is pregnant, not the empty uterus seen in ectopic pregnancy.

Q: Which of the following physiological changes is NOT true in pregnancy?

Blood volume is maximum at 36 weeks gestation.. ### Explanation **1. Why Option A is the Correct Answer (The "Not True" Statement):** In pregnancy, blood volume begins to increase at 6 weeks, rises rapidly until the mid-trimester, and reaches its **peak at 30–32 weeks gestation**. After this peak, it remains relatively plateaued until term. The statement that it is maximum at 36 weeks is physiologically incorrect and a common trap in NEET-PG questions. **2. Analysis of Incorrect Options (True Statements):** * **Option B:** Cardiac output increases by 40–50%. It reaches its maximum at **30–32 weeks** (paralleling blood volume). Note: It also spikes significantly during the second stage of labor and immediately postpartum. * **Option C:** Progesterone causes smooth muscle relaxation, and the enlarging uterus causes mechanical compression. This leads to physiological hydroureter and hydronephrosis, which is most pronounced in **mid-pregnancy** (around 20–24 weeks) and is more common on the right side. * **Option D:** Pregnancy is a state of "physiological hyperlipidemia." Serum cholesterol and triglycerides rise significantly to provide nutrients for the fetus and precursors for steroid hormones, peaking around **32 weeks**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Plasma vs. RBC Mass:** Plasma volume increases (50%) more than RBC mass (20–30%), leading to **physiological anemia** of pregnancy (hemodilution). * **Heart Sounds:** A loud S1 and a physiological S3 are common; however, a **diastolic murmur is always pathological**. * **Blood Pressure:** Diastolic BP decreases more than systolic BP, reaching its nadir at 24–28 weeks. * **Positioning:** Cardiac output is highest in the **left lateral position** due to the relief of aortocaval compression.

Q: A pregnant mother is treated with oral anticoagulant. What is the likely congenital malformation that may result in the fetus?

Chondrodysplasia punctata. **Explanation:** The correct answer is **Chondrodysplasia punctata**. This condition is the hallmark of **Fetal Warfarin Syndrome (Warfarin Embryopathy)**, which occurs when oral anticoagulants (specifically Vitamin K antagonists like Warfarin) are administered during the first trimester (6–9 weeks of gestation). **Why it is correct:** Warfarin crosses the placenta and interferes with the γ-carboxylation of proteins required for bone and cartilage formation (such as osteocalcin). This leads to **Chondrodysplasia punctata**, characterized by "stippled epiphyses" (calcific punctate deposits in the ends of bones) on X-ray. Other classic features include **nasal hypoplasia** (depressed nasal bridge) and midface hypoplasia. **Why the other options are incorrect:** * **A. Long bones limb defect:** While Warfarin affects bone development, it typically causes stippling and shortening rather than gross limb reduction defects (which are more characteristic of Thalidomide). * **B. Cranial malformation:** Though CNS anomalies (like microcephaly or hydrocephalus) can occur if Warfarin is used in the 2nd or 3rd trimester due to fetal hemorrhage, they are not the primary "stippled" malformation associated with early exposure. * **C. Cardiovascular malformation:** These are more commonly associated with Lithium (Ebstein’s anomaly) or uncontrolled maternal diabetes, rather than oral anticoagulants. **High-Yield Clinical Pearls for NEET-PG:** * **Critical Period:** Exposure between **6–9 weeks** gestation is most teratogenic for bone defects. * **Safe Alternative:** **Heparin** (both UFH and LMWH) is the anticoagulant of choice in pregnancy because it is a large molecule and **does not cross the placenta**. * **Late Pregnancy Risk:** Warfarin in the 3rd trimester increases the risk of fetal intracranial hemorrhage during labor.

Question 1

Caudal regression syndrome is seen in which of the following maternal conditions?

Accepted Answer

Gestational diabetes

Answer

Preeclampsia

Answer

Sickle-Cell anemia

Answer

Systemic lupus erythematosus

Question 2

What is the most reliable method for diagnosing fetal wellbeing?

Accepted Answer

Ultrasound

Answer

L:S ratio

Answer

HPL levels

Answer

Kick test

Question 3

What is the specific gravity of amniotic fluid?

Accepted Answer

1.01

Answer

1.213

Answer

1.51

Answer

1.1

Question 4

A pregnant patient at 20 weeks gestation presents with fever and dysuria, leading to a preliminary diagnosis of cystitis. Which of the following antibiotics is safe to use for this patient?

Accepted Answer

Amoxicillin

Answer

Ciprofloxacin

Answer

Gentamicin

Answer

Cotrimoxazole

Question 5

What does the following ultrasound show?

Accepted Answer

Ectopic pregnancy

Answer

Normal pregnancy

Answer

Hydatidiform mole

Answer

Ovarian cyst

Question 6

Which of the following physiological changes is NOT true in pregnancy?

Accepted Answer

Blood volume is maximum at 36 weeks gestation.

Answer

Cardiac output is maximum at 30 weeks gestation.

Answer

Ureters dilate maximally in mid-pregnancy.

Answer

Serum cholesterol levels are maximum at 32 weeks gestation.

Question 7

What is the treatment of choice for intrahepatic cholestasis of pregnancy?

Accepted Answer

Ursodiol (Ursodeoxycholic acid)

Answer

Cholestyramine

Answer

Corticosteroids (Dexamethasone)

Answer

Antihistamines

Question 8

A 32-year-old primi gravida presents with deep vein thrombosis (DVT). There is a history of two episodes of DVT in the past and she was diagnosed to have antiphospholipid antibody syndrome. What is the next step in management?

Accepted Answer

Aspirin and heparin

Answer

Aspirin alone

Answer

Low molecular weight heparin (LMWH)

Answer

Warfarin for 6 months

Question 9

A pregnant mother is treated with oral anticoagulant. What is the likely congenital malformation that may result in the fetus?

Accepted Answer

Chondrodysplasia punctata

Answer

Long bones limb defect

Answer

Cranial malformation

Answer

Cardiovascular malformation

Question 10

Which of the following statements is NOT true regarding the amniotic fluid index (AFI)?

Accepted Answer

There is a steady increase in AFI after 36 weeks of gestation.

Answer

It is calculated by adding the vertical depths of the largest pocket in each of four equal uterine quadrants.

Answer

Fluid restriction may lead to a lower AFI.

Answer

Significant hydramnios is defined by an AFI greater than 24 cm.

Maternal-Fetal Medicine — MCQs

Maternal-Fetal Medicine — MCQs

On this page

Practice by Chapter

Want unlimited practice?