Prenatal Care Practice Questions

Q: Match List-I with List-II and select the correct answer using the code given below the Lists:

A→4 B→2 C→3 D→1. ***A→4 B→2 C→3 D→1*** - **Palmer's sign** refers to **rhythmic uterine contractions** felt by bimanual examination in the **first trimester** of pregnancy. This is often an early sign used to detect pregnancy. - **Braxton Hicks contractions** are characterized by **rhythmic, painless uterine contractions** that are felt per abdomen and typically occur in the **second and third trimesters** of pregnancy. They are often called "practice contractions." - **Goodell's sign** describes the **softening of the cervix** in early pregnancy due to increased vascularity and edema. - **Chadwick's sign** is the **bluish coloration of the vagina and cervix** in pregnancy, also due to increased vascularity and blood flow. *A→1 B→2 C→3 D→4* - This option incorrectly matches Palmer's sign with bluish coloration of the vagina, which is **Chadwick's sign**. - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester, which is **Palmer's sign**. *A→3 B→2 C→1 D→4* - This option incorrectly matches Palmer's sign with softening of the cervix (**Goodell's sign**) and Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**). - It also incorrectly matches Chadwick's sign with rhythmic uterine contractions in the first trimester (**Palmer's sign**). *A→2 B→3 C→1 D→4* - This option incorrectly matches Palmer's sign with Braxton Hicks contractions and Braxton Hicks sign with softening of the cervix, which is **Goodell's sign**. - It also incorrectly matches Goodell's sign with bluish coloration of the vagina (**Chadwick's sign**) and Chadwick's sign with rhythmic contractions in the first trimester (**Palmer's sign**).

Q: Abnormally low alpha-fetoprotein in maternal serum indicates:

Down's syndrome. ***Down's syndrome*** - Abnormally **low alpha-fetoprotein (AFP)** levels in maternal serum are a key indicator for increased risk of **Down's syndrome (Trisomy 21)**. - This is often part of a quad screen (AFP, hCG, unconjugated estriol, inhibin A) used for **prenatal screening** for chromosomal abnormalities. *Meningocele* - This is a type of **spina bifida** where the meninges protrude through a defect in the vertebrae. - While a neural tube defect, it typically results in **elevated AFP** levels in maternal serum due to leakage of fetal protein. *Encephalocele* - An encephalocele is a **neural tube defect** where a sac-like protrusion of the brain and its surrounding membranes occurs through an opening in the skull. - Similar to other open neural tube defects, it is usually associated with **elevated levels of AFP** in maternal serum. *Anencephaly* - This is a severe **neural tube defect** characterized by the absence of a major portion of the brain, skull, and scalp. - Anencephaly invariably leads to very **high levels of AFP** in maternal serum due to direct leakage from exposed neural tissue.

Q: Which one of the following is NOT done as screening test in pregnancy?

Serum cholesterol. ***Serum cholesterol*** - **Serum cholesterol** levels are not routinely measured as a screening test during pregnancy. - While lipid metabolism changes during pregnancy, monitoring cholesterol levels specifically for screening purposes is not standard practice. *Neural tube defects (NTDs)* - Screening for **neural tube defects** is a crucial part of antenatal care, typically involving maternal serum alpha-fetoprotein (**MSAFP**) screening and targeted ultrasound. - Early detection allows for counseling and management options for the pregnancy due to conditions like **spina bifida** or **anencephaly**. *Syphilis-VDRL* - Screening for **syphilis** using tests like **VDRL** (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) is a mandatory part of antenatal screening in many regions. - This is done to prevent congenital syphilis, which can cause severe fetal and neonatal complications. *Diabetes* - All pregnant women are screened for **gestational diabetes mellitus (GDM)**, typically between 24 and 28 weeks of gestation, using a **glucose challenge test** followed by an oral glucose tolerance test if screening is positive. - Undiagnosed and untreated GDM can lead to adverse maternal and fetal outcomes, including macrosomia, pre-eclampsia, and neonatal hypoglycemia.

Q: The most common cause of early spontaneous abortion is:

Chromosomal abnormality. ***Chromosomal abnormality*** - **Chromosomal abnormalities**, such as aneuploidy (e.g., trisomy, monosomy), are responsible for approximately 50-70% of all **early spontaneous abortions**. - These abnormalities often result in **non-viable embryos** or fetuses, leading to pregnancy loss before 12-20 weeks of gestation. *Teratogens* - **Teratogens** are agents that can cause birth defects, but they are a less common cause of **early spontaneous abortion** compared to chromosomal abnormalities. - While they can lead to fetal demise, their primary impact is often on **fetal development** rather than embryonic non-viability. *Endocrine disorder* - **Endocrine disorders** like uncontrolled diabetes or thyroid disease can increase the risk of spontaneous abortion, but they are not the **most common cause**. - These factors tend to contribute to a smaller percentage of **early pregnancy losses** compared to genetic errors. *Infection* - Certain **infections** (e.g., TORCH infections, bacterial vaginosis) can cause spontaneous abortion, especially if systemic or severe. - However, similar to endocrine disorders, infections are a less frequent cause of **early spontaneous abortion** than chromosomal abnormalities.

Q: The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Down syndrome. ***Down syndrome*** - In **Down syndrome (Trisomy 21)**, the maternal serum **alpha-fetoprotein (MSAFP) level is typically decreased**, not elevated. - This characteristic **low MSAFP** is a key marker used in screening for Down syndrome in the second trimester. *Omphalocele* - **Omphalocele** involves the protrusion of abdominal organs through an umbilical defect, covered by a membrane. - Due to the **exposed fetal gut**, there is leakage of **alpha-fetoprotein** into the amniotic fluid and maternal circulation, leading to **elevated MSAFP**. *Intra uterine death* - In cases of **intrauterine fetal death**, there can be a release of fetal alpha-fetoprotein into the maternal circulation due to **fetal tissue breakdown**. - This often results in a **transient elevation of MSAFP levels**. *Neural tube defect* - **Neural tube defects (NTDs)**, such as **anencephaly** and **spina bifida**, are characterized by incomplete closure of the neural tube. - The **exposed neural tissue** allows **alpha-fetoprotein** to leak directly into the amniotic fluid and then into the maternal bloodstream, causing a significant **elevation of MSAFP**.

Q: In pregnancy with Down syndrome consider the following biomarkers: 1. β HCG is raised 2. α FP is raised 3. Inhibin A is decreased Which of the above statements is/are correct?

1 only. ***1 only*** - In pregnancies affected by **Down syndrome (Trisomy 21)**, the levels of **β-hCG** (human chorionic gonadotropin) are typically found to be **elevated**. This is a well-established biochemical marker used in prenatal screening. - The increased production of β-hCG is thought to be from the **placenta**, which may be functioning differently in pregnancies with Down syndrome. *1, 2 and 3* - This option is incorrect because while **β-hCG is raised**, **α-fetoprotein (αFP)** is typically **decreased** in pregnancies with Down syndrome, not raised. - Furthermore, **inhibin A** is usually **raised**, not decreased, making both statements 2 and 3 false for Down syndrome. *1 and 2 only* - This option is incorrect because although **β-hCG is raised**, **α-fetoprotein (αFP)** is characteristically **decreased** in pregnancies with Down syndrome, making statement 2 inaccurate. - The elevated αFP is usually associated with **neural tube defects** or other fetal anomalies. *2 and 3 only* - This option is incorrect as both statements 2 and 3 are factually wrong for Down syndrome. **α-fetoprotein (αFP)** is typically **decreased**, not raised, in pregnancies with Down syndrome. - Similarly, **inhibin A** levels are typically **raised**, not decreased, in such pregnancies, often incorporated into the quad screen for prenatal screening.

Q: Which one of the following statements regarding pre-conceptional counseling is NOT correct?

It is needed only in selected complicated pregnancies. ***It is needed only in selected complicated pregnancies*** - Pre-conceptional counseling is important for **all women of reproductive age**, especially those planning a pregnancy, not just for complicated cases. - Its purpose is to **optimize maternal health before conception** to prevent adverse outcomes, regardless of initial perceived risk. *It helps in early detection of risk factors* - Pre-conceptional counseling identifies **maternal and fetal risk factors** such as chronic medical conditions, genetic predisposition, and lifestyle choices before pregnancy. - Early detection allows for ** timely interventions** to mitigate these risks. *It is a part of preventive medicine* - Counseling before pregnancy focuses on **prevention of adverse pregnancy outcomes** by optimizing health and addressing potential issues. - This proactive approach aligns directly with the principles of **preventive healthcare**. *It helps in reducing maternal morbidity and mortality* - By addressing risk factors, optimizing health, and educating women about healthy behaviors, pre-conceptional counseling can significantly **lower the incidence of complications** during pregnancy. - This ultimately contributes to a **reduction in maternal illness and death**.

Q: A 23-year-old woman presents at 10 weeks gestation with a positive rapid plasma reagin (RPR) titer of 1:64 and positive TPHA. She was treated for primary syphilis 2 years ago with appropriate penicillin therapy, after which her RPR declined to 1:2. She denies any new symptoms or sexual contacts since then. What is the most appropriate management?

Retreatment with three doses of benzathine penicillin G. **Retreatment with three doses of benzathine penicillin G** - The significant **fourfold or greater increase in RPR titer (from 1:2 to 1:64)** indicates **reinfection or treatment failure**, even in the absence of symptoms or reported new exposures. - Given the **2-year interval since initial treatment** and **uncertain timing of reinfection**, this should be managed as **late latent syphilis or syphilis of unknown duration**, which requires **three weekly doses of benzathine penicillin G 2.4 million units IM**. - In pregnant women, this approach is critical to **prevent congenital syphilis** and ensure adequate treponemacidal levels throughout pregnancy. *HIV testing followed by treatment decision* - While **HIV testing is crucial for all pregnant women** and those with syphilis, it is **not the primary determinant** of treatment for syphilis reinfection. - The need for syphilis treatment is established by the **rising RPR titer**, irrespective of HIV status. - Treatment should **not be delayed** pending HIV test results. *No treatment needed as this represents serological scar* - A **serological scar** would typically involve low, stable non-treponemal titers (e.g., 1:1 or 1:2) without a significant rise. - The **1:64 RPR titer** represents a **32-fold increase** from the previous 1:2, indicating **active infection**, not a serological scar. - Serological scars remain stable and do not show such dramatic increases. *Retreatment with one dose of benzathine penicillin G* - A **single dose of benzathine penicillin G** is appropriate for **early syphilis (primary, secondary, or early latent <1 year duration)**. - In this case, the **2-year interval** since original treatment and **uncertain timing of reinfection** necessitate treating as **late latent syphilis**, which requires **three doses**. - During pregnancy, the more conservative approach is essential to prevent congenital syphilis.

Q: What is the most appropriate topical treatment for external genital warts in pregnancy?

Trichloroacetic acid (TCA). ***Trichloroacetic acid (TCA)*** - **TCA** is a caustic agent that **chemically ablates** warts and is considered safe for use in **pregnancy** as it is not systemically absorbed. - It works by **denaturing proteins** and causing necrosis of the wart tissue, leading to its destruction. *5-Fluorouracil cream* - **5-Fluorouracil** is an **antineoplastic agent** that inhibits cell proliferation and DNA synthesis. - It is **contraindicated in pregnancy** due to potential **teratogenic effects** on the fetus. *Imiquimod cream* - **Imiquimod** is an **immune response modifier** that stimulates interferon and cytokine production. - It is **not recommended in pregnancy** due to **insufficient safety data** regarding its systemic absorption and potential effects on fetal development. *Podophyllin resin* - **Podophyllin** is a **cytotoxic agent** that inhibits cell division and causes tissue necrosis. - It is **contraindicated in pregnancy** due to significant **systemic absorption** and high risk of **fetal toxicity and teratogenicity**.

Question 1

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→4  B→2  C→3  D→1

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→1  D→4

Answer

A→2  B→3  C→1  D→4

Question 2

Abnormally low alpha-fetoprotein in maternal serum indicates:

Accepted Answer

Down's syndrome

Answer

Meningocele

Answer

Encephalocele

Answer

Anencephaly

Question 3

Which one of the following is NOT done as screening test in pregnancy?

Accepted Answer

Serum cholesterol

Answer

Neural tube defects

Answer

Syphilis-VDRL

Answer

Diabetes

Question 4

The most common cause of early spontaneous abortion is:

Accepted Answer

Chromosomal abnormality

Answer

Teratogens

Answer

Endocrine disorder

Answer

Infection

Question 5

The Maternal serum α-fetoprotein level is elevated in all EXCEPT:

Accepted Answer

Down syndrome

Answer

Omphalocele

Answer

Intra uterine death

Answer

Neural tube defect

Question 6

In pregnancy with Down syndrome consider the following biomarkers:

1. β HCG is raised
2. α FP is raised
3. Inhibin A is decreased
Which of the above statements is/are correct?

Accepted Answer

1 only

Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Question 7

Which one of the following statements regarding pre-conceptional counseling is NOT correct?

Accepted Answer

It is needed only in selected complicated pregnancies

Answer

It helps in early detection of risk factors

Answer

It is a part of preventive medicine

Answer

It helps in reducing maternal morbidity and mortality

Question 8

A 23-year-old woman presents at 10 weeks gestation with a positive rapid plasma reagin (RPR) titer of 1:64 and positive TPHA. She was treated for primary syphilis 2 years ago with appropriate penicillin therapy, after which her RPR declined to 1:2. She denies any new symptoms or sexual contacts since then. What is the most appropriate management?

Accepted Answer

Retreatment with three doses of benzathine penicillin G

Answer

HIV testing followed by treatment decision

Answer

No treatment needed as this represents serological scar

Answer

Retreatment with one dose of benzathine penicillin G

Question 9

What is the most appropriate topical treatment for external genital warts in pregnancy?

Accepted Answer

Trichloroacetic acid (TCA)

Answer

5-Fluorouracil cream

Answer

Imiquimod cream

Answer

Podophyllin resin

Question 10

A 34-year-old pregnant woman at 28 weeks gestation is found to have a positive treponemal test (TPHA) but negative non-treponemal test (VDRL) during routine antenatal screening. She has no history of syphilis treatment. What is the most appropriate interpretation and management?

Accepted Answer

Latent syphilis cannot be ruled out - treat with benzathine penicillin

Answer

Successfully treated past infection - no treatment needed

Answer

Biological false positive - repeat testing in 4 weeks

Answer

False positive TPHA - no treatment needed

Prenatal Care — MCQs

Prenatal Care — MCQs

On this page

Practice by Chapter

Want unlimited practice?