Prenatal Care — MCQs

A 33-year-old woman presents with nausea and vomiting that has been worsening over the past 2 weeks, with two episodes of vomiting in the past 2 days. She also reports increased fatigue but denies abdominal pain or vaginal bleeding. Her past medical history includes occasional migraines, for which she takes acetaminophen as needed. She has no known drug allergies and no surgical history. Vital signs are stable. Examination reveals a bluish-appearing cervix on speculum examination, with a benign abdominal examination. Laboratory evaluation shows a positive urine hCG, leukocytes 9,000/mm3, hematocrit 41%, and platelets 250,000/mm3. Pelvic ultrasound demonstrates a gestational sac with a yolk sac and fetal pole surrounded by myometrium, with a fetal heart rate of 154 beats per minute. Which of the following is the MOST likely diagnosis?

Q27Medium

A 12-week anomaly scan of a 29-year-old lady revealed fetal malformation. Further investigation revealed she had taken vitamin supplements. Which of the following vitamins is most likely responsible for the fetal defects?

Q28Medium

A woman, 14 weeks pregnant, was exposed to chickenpox 2 days ago and has no history of chickenpox. What is the next step?

Q29Easy

A 23-year-old female presents with a 5-week history of amenorrhea. Her pregnancy test is positive, and on examination, Palmer's sign is present. What does Palmer's sign indicate?

Q30Easy

What is the recommended total number of iron and folic acid tablets to be given to a pregnant woman by a health worker?

Prenatal Care Indian Medical PG Practice Questions and MCQs

Question 21: In pregnancy, calculation of EDD (expected date of delivery) considers which of the following?

A. First day of last menstruation (Correct Answer)
B. Last day of last menstruation period
C. Mid-time of last menstrual period
D. Day of coitus

Explanation: The calculation of the **Expected Date of Delivery (EDD)** is a fundamental aspect of prenatal care, used to determine gestational age and guide clinical management. ### **Explanation of the Correct Answer** The correct answer is **A. First day of last menstruation**. Standard obstetric practice utilizes **Naegele’s Rule** to calculate the EDD. This rule is based on the assumption that a human pregnancy lasts approximately 280 days (40 weeks) from the **first day** of the Last Menstrual Period (LMP). This specific date is used because it is a discrete, objective event that most patients can recall more accurately than the date of ovulation or conception. ### **Why Other Options are Incorrect** * **B & C (Last day/Mid-time of LMP):** The duration of menstrual flow varies significantly between women (3–7 days). Using the last day or mid-point would introduce unnecessary variability and inaccuracy in dating. * **D (Day of coitus):** While conception occurs following coitus, the exact date of fertilization is often unknown. Sperm can survive in the female reproductive tract for up to 5 days, meaning the date of intercourse does not necessarily align with the start of gestation. ### **High-Yield Clinical Pearls for NEET-PG** * **Naegele’s Rule Formula:** EDD = [First day of LMP + 7 days] – [3 months] + [1 year]. * **Prerequisite:** Naegele’s rule assumes a standard **28-day cycle** with ovulation occurring on day 14. * **Irregular Cycles:** If a patient has a longer cycle (e.g., 35 days), add the extra days to the EDD (35 - 28 = 7 days extra). * **Gold Standard:** If the LMP is unknown or cycles are irregular, **First Trimester Ultrasound (Crown-Rump Length)** is the most accurate method for dating pregnancy.

Question 22: Which of the following diseases cannot be diagnosed by amniocentesis?

A. Trisomy 21
B. Duchenne's muscular dystrophy
C. Lesch-Nyhan syndrome
D. Cleft lip (Correct Answer)

Explanation: **Explanation:** Amniocentesis is a procedure used to obtain amniotic fluid, which contains desquamated fetal cells (amniocytes) and biochemical substances. These cells are used for **karyotyping, DNA analysis, and enzyme assays**. **Why Cleft Lip is the correct answer:** Cleft lip (with or without cleft palate) is a **structural/anatomical malformation**. While it can sometimes be associated with genetic syndromes, isolated cleft lip cannot be diagnosed via chromosomal or biochemical analysis of amniotic fluid. Structural defects are primarily diagnosed using **Targeted Imaging for Fetal Anomalies (TIFFA)** or a Level II Ultrasound scan, usually performed between 18–20 weeks of gestation. **Analysis of Incorrect Options:** * **Trisomy 21 (Down Syndrome):** This is a chromosomal numerical abnormality. Amniocytes are cultured and subjected to **karyotyping** or FISH (Fluorescence In Situ Hybridization) to confirm the presence of an extra chromosome 21. * **Duchenne’s Muscular Dystrophy (DMD):** This is an X-linked recessive genetic disorder. It can be diagnosed by performing **DNA analysis** (PCR for dystrophin gene deletions) on the fetal cells obtained. * **Lesch-Nyhan Syndrome:** This is an inborn error of purine metabolism (HGPRT deficiency). It can be diagnosed via **biochemical enzyme assays** or molecular genetic testing of the amniotic fluid. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Amniocentesis is ideally performed between **15–20 weeks** of gestation. * **Alpha-Fetoprotein (AFP):** Elevated amniotic fluid AFP is a marker for **Neural Tube Defects (NTDs)** like anencephaly and spina bifida. * **L/S Ratio:** Amniocentesis is also used to assess fetal lung maturity by measuring the Lecithin/Sphingomyelin ratio (Normal > 2:1). * **Risk:** The procedure-related risk of miscarriage is approximately **0.5%**.

Question 23: Which drug is given as a single dose to prevent mother-to-child HIV transmission?

A. Didanosine
B. Nevirapine (Correct Answer)
C. Acyclovir
D. Nelfinavir

Explanation: **Explanation:** The correct answer is **Nevirapine**. **Why Nevirapine is correct:** Nevirapine is a Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) characterized by a long half-life and rapid placental transfer. In the landmark **HIVNET 012 protocol**, a single dose of Nevirapine (200 mg) given to the mother at the onset of labor, followed by a single dose (2 mg/kg) to the newborn within 72 hours, was shown to significantly reduce vertical transmission. While current WHO and National guidelines (NACO) have shifted toward **Option B+ (Lifelong ART with TLE regimen: Tenofovir + Lamivudine + Efavirenz)**, single-dose Nevirapine remains a classic high-yield fact for its historical role in resource-limited settings. **Why the other options are incorrect:** * **Didanosine (A):** A Nucleoside Reverse Transcriptase Inhibitor (NRTI) that is not used as a single-dose monotherapy for prophylaxis due to its side effect profile (pancreatitis) and lower efficacy compared to modern regimens. * **Acyclovir (C):** An antiviral used for Herpes Simplex Virus (HSV), not HIV. It inhibits DNA polymerase but has no effect on the HIV reverse transcriptase enzyme. * **Nelfinavir (D):** A Protease Inhibitor (PI). While used in some multidrug HIV regimens, it is never used as a single-dose treatment and has been largely replaced by more potent PIs like Lopinavir/Ritonavir. **High-Yield Clinical Pearls for NEET-PG:** * **Current NACO Guideline:** All pregnant women living with HIV should be started on a fixed-dose combination of **Tenofovir (300mg) + Lamivudine (300mg) + Efavirenz (600mg)** regardless of CD4 count or clinical stage. * **Infant Prophylaxis:** Nevirapine syrup is given to the infant for at least **6 weeks**. * **Breastfeeding:** In India, exclusive breastfeeding for the first 6 months is recommended even if the mother is HIV positive, provided she is on ART. * **Mode of Delivery:** Routine elective Cesarean Section is no longer mandatory if the viral load is <1000 copies/ml.

Question 24: Which of the following is the drug of choice for Toxoplasmosis in pregnancy?

A. Metronidazole
B. Pyrimethamine
C. Sulfadiazine
D. Spiramycin (Correct Answer)

Explanation: **Explanation:** **Toxoplasmosis in pregnancy** is a critical topic for NEET-PG due to its potential for congenital transmission. The management depends on whether the fetus is infected. **Why Spiramycin is the Correct Answer:** Spiramycin is a macrolide antibiotic and is the **drug of choice for primary prophylaxis** in a pregnant woman with documented acute Toxoplasmosis where fetal infection is not yet confirmed. Its primary mechanism is to concentrate in the placenta, thereby reducing the risk of vertical transmission from mother to fetus by approximately 60%. Importantly, it does not cross the placenta in significant amounts, making it safe for the fetus but ineffective if the fetus is already infected. **Analysis of Incorrect Options:** * **A. Metronidazole:** This is an antiprotozoal/antibiotic used for Trichomoniasis, Bacterial Vaginosis, and anaerobic infections; it has no role in treating Toxoplasmosis. * **B & C. Pyrimethamine and Sulfadiazine:** This combination is the **treatment of choice if fetal infection is confirmed** (via positive amniotic fluid PCR) or if the mother is infected late in the third trimester. However, Pyrimethamine is potentially teratogenic (folate antagonist) and is generally avoided in the first trimester. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad of Congenital Toxoplasmosis:** Chorioretinitis, Hydrocephalus, and Intracranial calcifications (typically diffuse/scattered). * **Transmission Risk:** The risk of transmission increases with gestational age (highest in the 3rd trimester), but the **severity** of fetal damage is greatest if infected in the 1st trimester. * **Diagnosis:** Sabin-Feldman Dye test is the gold standard (though rarely used now); IgM and IgG avidity tests are used clinically. * **Folinic Acid (Leucovorin):** Always co-administer with Pyrimethamine to prevent bone marrow suppression.

Question 25: Chorionic villus sampling (CVS) performed at 9-10 weeks gestation is associated with an increased risk of which of the following complications?

A. Neural tube defects
B. Fetal loss
C. Limb defects (Correct Answer)
D. Vaginal bleeding

Explanation: **Explanation:** **Chorionic Villus Sampling (CVS)** is a prenatal diagnostic procedure typically performed between **10 and 13 weeks** of gestation. When performed earlier than this window (specifically before 9–10 weeks), it is strongly associated with **Limb Reduction Defects (LRD)**, such as oromandibular-limb hypogenesis. **1. Why Limb Defects?** The underlying mechanism is believed to be **vascular disruption**. Early instrumentation of the developing placenta can cause subchorionic hematomas or placental trauma, leading to distal limb ischemia and subsequent malformation. The risk is significantly higher when CVS is performed before 9 weeks; therefore, it is clinically recommended to wait until at least 10 weeks of gestation. **2. Analysis of Incorrect Options:** * **A. Neural Tube Defects (NTDs):** These are caused by failure of the neural tube to close (around week 4) and are associated with folic acid deficiency, not invasive procedures. * **B. Fetal Loss:** While CVS does carry a risk of miscarriage (approx. 0.5–1%), this risk is present regardless of the timing within the first trimester. Limb defects are the specific *teratogenic* complication associated with early timing (9-10 weeks). * **D. Vaginal Bleeding:** This is a common immediate side effect of transcervical CVS (occurring in ~10% of cases) but is considered a minor complication rather than a developmental malformation. **High-Yield Facts for NEET-PG:** * **Optimal Timing:** CVS (10–13 weeks) vs. Amniocentesis (15–20 weeks). * **Advantage of CVS:** Provides earlier diagnosis compared to amniocentesis, allowing for safer termination if needed. * **Disadvantage:** CVS cannot test for **Alpha-fetoprotein (AFP)**; therefore, it cannot diagnose Neural Tube Defects. * **Rh Isoimmunization:** Anti-D immunoglobulin must be administered to Rh-negative unsensitized women following the procedure.

Question 26: A 33-year-old woman presents with nausea and vomiting that has been worsening over the past 2 weeks, with two episodes of vomiting in the past 2 days. She also reports increased fatigue but denies abdominal pain or vaginal bleeding. Her past medical history includes occasional migraines, for which she takes acetaminophen as needed. She has no known drug allergies and no surgical history. Vital signs are stable. Examination reveals a bluish-appearing cervix on speculum examination, with a benign abdominal examination. Laboratory evaluation shows a positive urine hCG, leukocytes 9,000/mm3, hematocrit 41%, and platelets 250,000/mm3. Pelvic ultrasound demonstrates a gestational sac with a yolk sac and fetal pole surrounded by myometrium, with a fetal heart rate of 154 beats per minute. Which of the following is the MOST likely diagnosis?

A. Appendicitis
B. Complete hydatidiform mole
C. Ectopic pregnancy
D. Intrauterine pregnancy (Correct Answer)

Explanation: **Explanation:** The patient presents with classic signs and symptoms of early pregnancy: amenorrhea, nausea, vomiting (morning sickness), fatigue, and a positive urine hCG. The physical examination finding of a **bluish-appearing cervix** is known as **Chadwick’s sign**, a presumptive sign of pregnancy caused by increased vascularity of the pelvic organs. The definitive diagnosis is confirmed via **pelvic ultrasound**, which shows a gestational sac, yolk sac, and fetal pole located within the **myometrium** (intrauterine) with a documented fetal heart rate. This confirms a viable **Intrauterine Pregnancy (IUP)**. **Analysis of Incorrect Options:** * **Appendicitis:** While nausea and vomiting occur, the absence of fever, leukocytosis, or right lower quadrant pain, combined with a benign abdominal exam and a confirmed IUP, makes this unlikely. * **Complete Hydatidiform Mole:** This usually presents with "snowstorm" appearance on ultrasound, abnormally high hCG levels, and the absence of a fetus or fetal heart rate. * **Ectopic Pregnancy:** Ultrasound would show an empty uterus and an adnexal mass. This patient’s ultrasound explicitly confirms the pregnancy is surrounded by myometrium (intrauterine). **NEET-PG Clinical Pearls:** * **Chadwick’s Sign:** Bluish discoloration of cervix/vagina (appears at ~6–8 weeks). * **Goodell’s Sign:** Softening of the cervix (appears at ~4–6 weeks). * **Ladin’s Sign:** Softening of the uterine midline (appears at ~6 weeks). * **Ultrasound Milestones:** Gestational sac is visible at 4.5–5 weeks; Yolk sac at 5–5.5 weeks; Fetal pole with cardiac activity at 6 weeks (transvaginal).

Question 27: A 12-week anomaly scan of a 29-year-old lady revealed fetal malformation. Further investigation revealed she had taken vitamin supplements. Which of the following vitamins is most likely responsible for the fetal defects?

A. Vitamin A (Correct Answer)
B. Vitamin B
C. Vitamin E
D. Vitamin C

Explanation: **Explanation:** The correct answer is **Vitamin A (Option A)**. While essential for vision and immune function, Vitamin A is a known **teratogen** when consumed in excessive amounts during the first trimester of pregnancy. **Why Vitamin A is the correct answer:** Preformed Vitamin A (Retinol) and its derivatives (Retinoids) are highly teratogenic in high doses (typically >10,000 IU/day). They interfere with **neural crest cell** migration and homeobox (HOX) gene expression. This leads to a specific pattern of malformations known as **"Retinoic Acid Embryopathy,"** characterized by: * **Craniofacial defects:** Cleft palate, microtia (small ears), or anotia. * **Cardiac defects:** Transposition of great arteries, Fallot’s tetralogy. * **CNS anomalies:** Hydrocephalus or microcephaly. * **Thymic hypoplasia.** **Why other options are incorrect:** * **Vitamin B (Option B):** Most B-complex vitamins are water-soluble and safe. Specifically, **Vitamin B9 (Folic Acid)** is mandatory in early pregnancy to *prevent* neural tube defects. * **Vitamin E (Option C) & Vitamin C (Option D):** These are water-soluble (C) or safe fat-soluble (E) antioxidants. There is no documented evidence linking standard or even slightly elevated doses of these vitamins to structural fetal malformations. **High-Yield Clinical Pearls for NEET-PG:** * **Safe Source:** Beta-carotene (provitamin A) found in vegetables is NOT teratogenic. * **Isotretinoin:** A Vitamin A derivative used for acne is strictly contraindicated in pregnancy (Category X). A pregnancy test and effective contraception are mandatory before prescription. * **WHO Recommendation:** In routine prenatal care, Vitamin A supplementation is generally avoided unless the mother is in an area with endemic deficiency. * **Critical Period:** The period of maximum sensitivity to Vitamin A teratogenicity is **2–5 weeks** post-conception.

Question 28: A woman, 14 weeks pregnant, was exposed to chickenpox 2 days ago and has no history of chickenpox. What is the next step?

A. Administer varicella vaccine
B. Administer varicella immunoglobulin
C. Administer varicella immunoglobulin and vaccine
D. Test mother for antibodies against varicella (Correct Answer)

Explanation: **Explanation:** The management of varicella exposure in pregnancy depends on the mother’s immune status. Varicella infection during pregnancy poses risks of maternal pneumonia and **Congenital Varicella Syndrome** (highest risk between 13–20 weeks). **1. Why Option D is Correct:** The first step in an exposed pregnant woman with a negative or uncertain history of chickenpox is to **test for Varicella-Zoster Virus (VZV) IgG antibodies**. Up to 80–90% of adults with an uncertain history are actually immune due to prior subclinical infection. If the IgG test is positive, the mother is immune, and no further action is required. **2. Why Other Options are Incorrect:** * **Option A & C:** The varicella vaccine is a **live-attenuated vaccine** and is strictly **contraindicated** during pregnancy due to the theoretical risk of transmission to the fetus. It should be given postpartum to non-immune women. * **Option B:** Varicella-Zoster Immunoglobulin (VZIG) is indicated only if the mother is confirmed to be **seronegative (IgG negative)**. Administering it before testing is not cost-effective and unnecessary if she is already immune. VZIG should ideally be given within 96 hours (up to 10 days) of exposure. **High-Yield Clinical Pearls for NEET-PG:** * **Incubation Period:** 10–21 days. * **Congenital Varicella Syndrome:** Characterized by skin scarring (cicatricial), limb hypoplasia, chorioretinitis, and microcephaly. * **Neonatal Varicella:** Occurs if the mother develops a rash 5 days before to 2 days after delivery. This is a medical emergency requiring VZIG for the newborn. * **Treatment:** If a pregnant woman develops the rash, oral **Acyclovir** is the drug of choice to reduce maternal complications.

Question 29: A 23-year-old female presents with a 5-week history of amenorrhea. Her pregnancy test is positive, and on examination, Palmer's sign is present. What does Palmer's sign indicate?

A. Pulsation in the lateral fornix
B. Softening of the uterus
C. Rhythmic contraction of the uterus (Correct Answer)
D. Bluish coloration of the vagina

Explanation: **Explanation:** **Palmer’s sign** refers to the **rhythmic, regular, and painless contractions** of the uterus that can be felt during a bimanual examination as early as 4 to 8 weeks of gestation. These contractions are a result of increased uterine irritability and vascularity during early pregnancy. **Analysis of Options:** * **Option C (Correct):** Palmer’s sign is specifically defined as these early rhythmic contractions. It is one of the "probable" signs of pregnancy. * **Option A (Incorrect):** Pulsations felt in the lateral fornices due to increased vascularity is known as **Osiander’s sign**. * **Option B (Incorrect):** Softening of the uterine isthmus (the portion between the cervix and the body of the uterus) is known as **Hegar’s sign**. General softening of the cervix itself is called **Goodell’s sign**. * **Option D (Incorrect):** Bluish discoloration of the vagina and cervix due to venous congestion is known as **Chadwick’s sign** (or Jacquemier’s sign). **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Palmer’s sign is typically detectable between **4–8 weeks** of gestation. * **Probable vs. Positive Signs:** Signs like Palmer’s, Hegar’s, and Chadwick’s are "probable" signs. "Positive" (diagnostic) signs include visualization of the fetus on ultrasound, fetal heart sound detection, and palpation of fetal movements by the clinician. * **Piskacek’s Sign:** Asymmetrical enlargement of the uterus if implantation occurs near one of the cornua.

Question 30: What is the recommended total number of iron and folic acid tablets to be given to a pregnant woman by a health worker?

A. 70
B. 90
C. 100 (Correct Answer)
D. 150

Explanation: **Explanation:** The correct answer is **100 tablets (Option C)**. This recommendation is based on the guidelines set by the Ministry of Health and Family Welfare (MoHFW), India, under the **Anemia Mukt Bharat** (formerly NIPI) strategy. **1. Why 100 is correct:** To prevent nutritional anemia during pregnancy, every pregnant woman is advised to consume **one tablet daily** of Iron and Folic Acid (IFA) for a minimum of **100 days**, starting from the second trimester (after the first 12-13 weeks). Each tablet contains **60 mg of elemental iron** and **500 mcg (0.5 mg) of folic acid**. If a woman is diagnosed with clinical anemia (Hb <11 g/dL), the dose is doubled to two tablets daily for 100 days (therapeutic dose). **2. Why other options are incorrect:** * **70 & 90 (Options A & B):** These numbers do not align with any standard national health program guidelines for prenatal care in India. * **150 (Option D):** While some updated WHO guidelines and specific high-risk protocols suggest longer durations (up to 180 days), the standard benchmark for public health examinations like NEET-PG remains the 100-day requirement as per the National Health Mission (NHM). **3. High-Yield Clinical Pearls for NEET-PG:** * **Prophylactic Dose:** 60 mg Iron + 500 mcg Folic Acid for 100 days. * **Therapeutic Dose:** 120 mg Iron + 1000 mcg Folic Acid (2 tablets/day) for 100 days. * **Postpartum Care:** The same 100-day regimen is recommended during the **lactation period** (postpartum) to replenish iron stores. * **Timing:** IFA should be started after the first trimester to avoid aggravating nausea and because organogenesis is complete. * **Calcium Interaction:** Advise patients not to take Calcium and Iron tablets together, as calcium inhibits iron absorption.

Practice by Chapter

Preconception Counseling

Practice Questions

Pregnancy Diagnosis and Dating

Practice Questions

Routine Antenatal Assessments

Practice Questions

Maternal Physiological Changes

Practice Questions

Nutrition in Pregnancy

Practice Questions

Screening Tests in Pregnancy

Practice Questions

Fetal Growth Assessment

Practice Questions

High-Risk Pregnancy Identification

Practice Questions

Antenatal Complications Management

Practice Questions

Psychosocial Aspects of Pregnancy

Practice Questions

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