Prenatal Care Practice Questions

Q: At what stage of pregnancy is quickening typically felt?

Fifth month. **Explanation:** **Quickening** refers to the first perception of active fetal movements by the mother. It is a subjective clinical sign used to assess fetal well-being and estimate gestational age. 1. **Why Option B is correct:** In clinical practice, quickening typically occurs between **18 to 20 weeks** of gestation in primigravida (first-time mothers) and slightly earlier, around **16 to 18 weeks**, in multigravida (due to prior experience). Since the fifth month of pregnancy spans from 17 to 20 weeks, it is the most accurate timeframe for the onset of these movements. 2. **Why other options are incorrect:** * **Option A (Second month):** At 8 weeks, the embryo is just becoming a fetus; movements are microscopic and cannot be felt. * **Option C & D (10 & 12 weeks):** While fetal movements can be visualized on ultrasound as early as 8–10 weeks, the fetus is too small and the muscular contractions too weak for the mother to perceive them through the uterine wall and abdominal layers at this stage. **High-Yield Clinical Pearls for NEET-PG:** * **Primigravida:** Quickening at **18–20 weeks**. * **Multigravida:** Quickening at **16–18 weeks**. * **Significance:** Quickening is a "presumptive" sign of pregnancy. It helps in calculating the Expected Date of Delivery (EDD) if the Last Menstrual Period (LMP) is unknown (Add 22 weeks for primigravida; 24 weeks for multigravida). * **Differential Diagnosis:** Intestinal peristalsis or gas bubbles can sometimes be mistaken for quickening (pseudocyesis).

Q: What is the recommended dose of anti-D immunoglobulin for antenatal prophylaxis in Rh-negative, non-immunized females?

1500 IU at 28 weeks. **Explanation:** The primary goal of antenatal prophylaxis in Rh-negative, non-immunized (indirect Coombs test negative) women is to prevent **Rh isoimmunization** caused by silent feto-maternal hemorrhages that typically occur in the third trimester. **Why Option B is Correct:** Current international guidelines (RCOG and NICE) and standard obstetric practice recommend a dose of **1500 IU (300 mcg)** of anti-D immunoglobulin. This is ideally administered at **28 weeks of gestation** because the risk of sensitization increases significantly after this period, and the half-life of the immunoglobulin ensures protection until delivery. This single-dose regimen is highly effective in reducing the incidence of maternal sensitization from ~1.5% to 0.2%. **Analysis of Incorrect Options:** * **Option A (1000 IU):** This is an insufficient dose for standard single-dose prophylaxis. While some protocols use two doses of 500 IU (at 28 and 34 weeks), 1000 IU as a single dose is not the standard recommendation. * **Option C (500 IU):** This dose is typically reserved for first-trimester sensitizing events (e.g., miscarriage or ectopic pregnancy before 12-20 weeks) but is inadequate for routine third-trimester prophylaxis. * **Option D (32 weeks):** Waiting until 32 weeks leaves a "window of vulnerability" between 28 and 32 weeks where sensitization could occur. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Dose:** 300 mcg = 1500 IU (Conversion: 1 mcg = 5 IU). * **Postpartum Dose:** 1500 IU must be given within **72 hours** of delivery if the newborn is Rh-positive. * **Kleihauer-Betke Test:** Used to quantify feto-maternal hemorrhage to determine if additional anti-D doses are required (10 mcg covers 0.5 ml of fetal red cells or 1 ml of whole blood). * **Indirect Coombs Test (ICT):** Must be negative before administering prophylaxis; if ICT is positive, the woman is already sensitized, and anti-D is of no use.

Q: What is the recommended treatment for Chlamydia infection during pregnancy?

Azithromycin. **Explanation:** The primary goal of treating Chlamydia trachomatis during pregnancy is to prevent maternal complications (pelvic inflammatory disease, preterm labor) and neonatal transmission (ophthalmia neonatorum, pneumonia). **Why Azithromycin is correct:** **Azithromycin (1g orally in a single dose)** is the first-line treatment recommended by the WHO and CDC for chlamydial infection in pregnancy. It is highly effective, has a high safety profile (Category B), and the single-dose regimen ensures 100% compliance, which is crucial in prenatal care. Amoxicillin is considered an alternative if Azithromycin is contraindicated. **Why other options are incorrect:** * **Doxycycline and Tetracycline:** These are the first-line treatments in non-pregnant adults. However, they are **contraindicated in pregnancy** (Category D) because they cross the placenta and can cause permanent yellow-brown discoloration of the deciduous teeth and inhibit fetal bone growth. * **Penicillin:** While safe in pregnancy, Penicillin is ineffective against *Chlamydia trachomatis* because Chlamydia is an obligate intracellular bacterium that lacks a typical peptidoglycan cell wall, making it resistant to beta-lactam antibiotics. **Clinical Pearls for NEET-PG:** * **Screening:** All pregnant women should be screened for Chlamydia at the first prenatal visit. * **Test of Cure (TOC):** Unlike in non-pregnant patients, a TOC (via Nucleic Acid Amplification Test - NAAT) is mandatory **3–4 weeks after treatment** in pregnancy to ensure eradication. * **Partner Treatment:** To prevent reinfection, the partner must be treated simultaneously (Expedited Partner Therapy). * **Neonatal Impact:** Chlamydial conjunctivitis typically appears 5–14 days after birth (later than Gonococcal conjunctivitis, which appears in 2–5 days).

Q: Elevated maternal serum alpha-fetoprotein (AFP) is seen in which of the following conditions?

Trisomy 21 (Down syndrome). **Explanation:** The question asks for conditions associated with **elevated** maternal serum alpha-fetoprotein (MSAFP). However, there is a discrepancy in the provided key: **Trisomy 21 (Down syndrome) is actually associated with LOW MSAFP levels.** **1. Understanding the Correct Answer (Correction):** In clinical practice and for NEET-PG, it is crucial to remember that **Trisomy 21** is characterized by a "Low AFP, Low Estriol, and High hCG" pattern in the triple screen. If the question intended to identify a condition with *elevated* AFP, options A, C, and D would all be correct. If the question asks which condition is associated with *low* AFP, then **Option B (Trisomy 21)** is the only correct answer. **2. Analysis of Options (Causes of Elevated AFP):** * **Open Neural Tube Defects (C):** This is the most common cause of pathological elevation. Failure of neural tube closure allows AFP to leak from the fetal cerebrospinal fluid into the amniotic fluid and maternal circulation. * **Multiple Pregnancy (A):** More than one fetus produces a higher cumulative volume of AFP, leading to elevated maternal levels. * **Intrauterine Fetal Demise (D):** Fetal death leads to a breakdown of the fetal-maternal barrier, causing a massive release of AFP into the maternal blood. * **Other causes:** Omphalocele, Gastroschisis, and Renal anomalies (Finnish-type nephrosis). **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of elevated MSAFP:** Under-estimation of gestational age (wrong dates). * **Down Syndrome Marker Pattern:** Low AFP, Low uE3 (Estriol), High hCG, and High Inhibin A ("HI" for High = hCG and Inhibin). * **Trisomy 18 (Edwards Syndrome):** All markers (AFP, hCG, uE3) are **decreased**. * **Timing:** MSAFP screening is ideally performed between **15–20 weeks** of gestation.

Q: Increased nuchal fold thickness is a feature of which condition?

Down's syndrome. **Explanation:** **Down’s Syndrome (Trisomy 21)** is the most common chromosomal disorder and is frequently associated with specific ultrasound markers during pregnancy. **Increased nuchal fold thickness** (measured in the second trimester, typically between 15–20 weeks) is a highly sensitive soft marker for Down’s syndrome. It is defined as a measurement of **≥6 mm**. This is distinct from *nuchal translucency*, which is measured in the first trimester (11–13.6 weeks). The increased thickness is thought to result from lymphatic obstruction or delayed development of the lymphatic system in the cervical region. **Analysis of Incorrect Options:** * **Paul–Bunnel Syndrome:** This is not a congenital or chromosomal disorder; the Paul–Bunnell test is a heterophile antibody test used to diagnose **Infectious Mononucleosis** (EBV). * **De–pan Syndrome:** This is not a recognized clinical entity in standard pediatric or genetic literature. It may be a distractor or a misspelling of other rare syndromes, but it is not associated with nuchal thickening. * **Cri–du-chat Syndrome (5p deletion):** While this syndrome presents with microcephaly, a cat-like cry, and epicanthal folds, it is not classically associated with increased nuchal fold thickness as a primary diagnostic marker. **High-Yield Clinical Pearls for NEET-PG:** * **Nuchal Translucency (NT):** Measured in the 1st trimester; >3 mm is considered abnormal and suggests Trisomy 21, 18, 13, or Turner syndrome. * **Other USG markers for Down’s:** Hypoplastic/absent nasal bone, echogenic intracardiac focus, "double bubble" sign (duodenal atresia), and short femur/humerus. * **Quadruple Marker Test:** In Down’s syndrome, **AFP and Estriol are LOW**, while **hCG and Inhibin-A are HIGH** (Mnemonic: **HI**gh = **H**cg & **I**nhibin).

Q: Alpha-fetoprotein levels are increased in all EXCEPT:

Down syndrome. **Explanation:** Alpha-fetoprotein (AFP) is a glycoprotein synthesized initially by the yolk sac and later by the fetal liver. It is the fetal equivalent of albumin. Understanding its levels is crucial for prenatal screening. **Why Down Syndrome is the correct answer:** In **Down Syndrome (Trisomy 21)**, maternal serum AFP (MSAFP) levels are characteristically **decreased** (usually <0.5 MoM). The exact mechanism is not fully understood, but it is attributed to reduced synthesis by the fetal liver and a smaller-than-normal yolk sac. In a "Triple Test" for Down Syndrome, you typically see **Low AFP, Low Estriol (uE3), and High hCG.** **Why the other options are incorrect (Causes of Increased AFP):** * **Open Neural Tube Defects (ONTDs):** Conditions like anencephaly or spina bifida allow AFP to leak directly from the fetal cerebrospinal fluid into the amniotic fluid and maternal circulation, causing a significant rise. * **Twin Pregnancy:** AFP levels are roughly proportional to the number of fetuses; more fetal liver mass results in higher cumulative MSAFP. * **Intrauterine Death (IUD):** Fetal demise leads to the breakdown of fetal tissues and increased permeability of the skin/vessels, allowing massive amounts of AFP to diffuse into the maternal blood. **NEET-PG High-Yield Pearls:** * **Most common cause of increased MSAFP:** Underestimation of gestational age (wrong dates). * **Other causes of High AFP:** Omphalocele, Gastroschisis, Turner Syndrome (with cystic hygroma), and Renal anomalies (Finnish-type nephrosis). * **Low AFP is also seen in:** Trisomy 18 (Edwards Syndrome), Gestational Trophoblastic Disease (Molar pregnancy), and Maternal Obesity. * **Amniotic Fluid Acetylcholinesterase (AChE):** This is the confirmatory test used if AFP is elevated to differentiate between a true NTD and other causes.

Q: In which type of abortion does the gestational age correspond to the uterine size?

Threatened. In clinical practice, comparing uterine size to the period of amenorrhea (POA) is a high-yield diagnostic tool for differentiating types of abortion. **Explanation of the Correct Answer:** In **Threatened Abortion**, the pregnancy is still viable and the products of conception (POC) are entirely intact within the uterus. The cervical os remains closed. Because the gestational sac and fetus continue to develop normally despite the vaginal bleeding, the **uterine size corresponds to the gestational age.** **Analysis of Incorrect Options:** * **Inevitable Abortion:** While the POC are still inside, the cervical os is dilated and heavy bleeding/rupture of membranes often occurs. While the size may initially correspond, it is often slightly **less than or equal to** gestational age due to the impending expulsion and loss of liquor. * **Complete Abortion:** All products of conception have been expelled. Consequently, the uterus is empty and contracted, making the **uterine size significantly smaller** than the gestational age. * **Missed Abortion:** The fetus has died in utero but is retained. Over time, the amniotic fluid is absorbed and the POC macerate, leading to a **uterine size that is less than** the period of amenorrhea. **High-Yield Clinical Pearls for NEET-PG:** * **Uterine Size > POA:** Think of Molar Pregnancy, Multiple Gestation, or Polyhydramnios. * **Uterine Size < POA:** Think of Missed Abortion, Complete Abortion, or IUGR. * **Internal Os Status:** It is **Closed** in Threatened and Missed abortions; it is **Open** in Inevitable and Incomplete abortions. * **Management:** Threatened abortion is managed conservatively (bed rest and progesterone), whereas Inevitable/Missed abortions require medical or surgical evacuation.

Q: A 28-year-old primigravida has a pre-pregnancy BMI of 30 kg/m². What is the recommended weight gain for her during pregnancy?

5-7 kg. ### Explanation The recommended weight gain during pregnancy is strictly determined by the patient’s **pre-pregnancy Body Mass Index (BMI)**. This guideline ensures optimal fetal growth while minimizing maternal complications like gestational diabetes, pre-eclampsia, and macrosomia. **1. Why Option A is Correct:** The patient is a primigravida with a BMI of **30 kg/m²**, which classifies her as **Obese** (BMI ≥ 30). According to the Institute of Medicine (IOM) and ACOG guidelines: * **Obese (BMI ≥ 30):** Recommended weight gain is **5–9 kg** (often simplified to 5–7 kg in Indian clinical contexts and exams). * The goal for obese women is to limit gain to the minimum required for fetal and placental development to avoid postpartum weight retention and metabolic risks. **2. Why Other Options are Incorrect:** * **Option B (8–11 kg):** This is the recommendation for **Overweight** women (BMI 25–29.9 kg/m²), where the range is 7–11.5 kg. * **Option C (10–13 kg):** This is the standard recommendation for women with a **Normal BMI** (18.5–24.9 kg/m²), where the range is 11.5–16 kg. * **Option D (14–16 kg):** This is recommended for **Underweight** women (BMI < 18.5 kg/m²), who require a higher gain of 12.5–18 kg to ensure adequate birth weight. **3. High-Yield Clinical Pearls for NEET-PG:** * **Twin Pregnancy:** Recommended gain is 17–25 kg for normal BMI, 14–23 kg for overweight, and 11–19 kg for obese. * **Rate of Gain:** In the 2nd and 3rd trimesters, a woman with a normal BMI should gain roughly **0.45 kg/week**, while an obese woman should gain only **0.22 kg/week**. * **Weight Loss:** Intentional weight loss during pregnancy is **never** recommended, even for morbidly obese patients.

Question 1

At what stage of pregnancy is quickening typically felt?

Accepted Answer

Fifth month

Answer

Second month

Answer

10 weeks

Answer

12 weeks

Question 2

What is the recommended dose of anti-D immunoglobulin for antenatal prophylaxis in Rh-negative, non-immunized females?

Accepted Answer

1500 IU at 28 weeks

Answer

1000 IU at 28 weeks

Answer

500 IU at 28 weeks

Answer

1500 IU at 32 weeks

Question 3

What is the recommended treatment for Chlamydia infection during pregnancy?

Accepted Answer

Azithromycin

Answer

Doxycycline

Answer

Tetracycline

Answer

Penicillin

Question 4

Elevated maternal serum alpha-fetoprotein (AFP) is seen in which of the following conditions?

Accepted Answer

Trisomy 21 (Down syndrome)

Answer

Multiple pregnancy

Answer

Open neural tube defect

Answer

Intrauterine fetal demise (IUD)

Question 5

The triple test for Down syndrome screening includes which of the following biochemical markers?

Accepted Answer

Maternal Alpha-fetoprotein (AFP), Human Chorionic Gonadotropin (HCG), and Estriol

Answer

Maternal Alpha-fetoprotein (AFP), Pregnancy-Associated Plasma Protein-A (PAPPA), and Human Chorionic Gonadotropin (HCG)

Answer

Maternal Alpha-fetoprotein (AFP), Pregnancy-Associated Plasma Protein-A (PAPPA), and Estriol

Answer

Thyroid-Stimulating Hormone (TSH), Human Chorionic Gonadotropin (HCG), and Estriol

Question 6

A 38-year-old G3 P2 presents with 10 weeks of amenorrhea. Her serum β-hCG level is 25,000 mIU/mL, and her internal cervical os is closed. On USG, an anechoic intrauterine area measures 40mm, and the adnexa are normal. What is the diagnosis?

Accepted Answer

Missed abortion

Answer

Complete abortion

Answer

Threatened abortion

Answer

Complete Hydatidiform mole

Question 7

Increased nuchal fold thickness is a feature of which condition?

Accepted Answer

Down's syndrome

Answer

Paul–Bunnel syndrome

Answer

De–pan syndrome

Answer

Cri–du chat syndrome

Question 8

Alpha-fetoprotein levels are increased in all EXCEPT:

Accepted Answer

Down syndrome

Answer

Open neural tube defects

Answer

Twin pregnancy

Answer

Intrauterine death

Question 9

In which type of abortion does the gestational age correspond to the uterine size?

Accepted Answer

Threatened

Answer

Inevitable

Answer

Complete

Answer

Missed

Question 10

A 28-year-old primigravida has a pre-pregnancy BMI of 30 kg/m². What is the recommended weight gain for her during pregnancy?

Accepted Answer

5-7 kg

Answer

8-11 kg

Answer

10-13 kg

Answer

14-16 kg

Prenatal Care — MCQs

Prenatal Care — MCQs

On this page

Practice by Chapter

Want unlimited practice?