Prenatal Care Practice Questions

Q: Identify the sign.

Hegar's sign. ***Hegar's sign*** - This sign is demonstrated during a **bimanual pelvic examination** where the lower uterine segment (isthmus) feels extremely soft and compressible, almost as if the cervix and the body of the uterus are separate structures. - It is a **probable sign of pregnancy**, typically appearing between 6 to 12 weeks of gestation, caused by hormonal changes leading to increased vascularity and softening of the uterine isthmus. *Chadwick's sign* - This is a visual finding, not a palpable one, characterized by a **bluish or purplish discoloration** of the cervix, vagina, and vulva. - It is an early, **presumptive sign** of pregnancy caused by increased blood flow (**venous congestion**) to the area, usually visible from about 6-8 weeks of gestation. *Goodell's sign* - This refers to the marked **softening of the cervix** itself, which changes from a consistency similar to the tip of the nose to that of lips. - While it is a probable sign of pregnancy also appearing around 6-8 weeks, it is distinct from Hegar's sign, which involves the softening of the **uterine isthmus** above the cervix. *Piskacek's sign* - This is the palpable **asymmetric enlargement** and softening of the uterus, where the area of implantation feels like a bulge or tumor. - It occurs when the embryo implants near one of the uterine cornua, leading to an uneven shape of the uterus, and is not what is depicted in the image.

Q: Which of the following CVS changes are not seen in pregnancy?

Diastolic murmur. ***Diastolic murmur***- Diastolic murmurs are generally **pathologic** and are *not* considered normal physiological findings resulting from the changes of pregnancy.- Their presence often indicates significant underlying structural heart disease, such as **mitral stenosis** or **aortic regurgitation**, requiring comprehensive cardiac evaluation.*Soft Systolic murmur*- A low-grade, transient, **ejection systolic murmur** is very common (up to 90% of cases) due to the **hyperdynamic circulatory state**.- This flow murmur results from increased **cardiac output** and elevated stroke volume across normal valves.*S3*- A pronounceable **third heart sound (S3)** is frequently heard due to the large increase in circulating plasma volume leading to **volume overload**.- This sound is caused by the **rapid filling** of the ventricle during early diastole, a common finding in high-output states.*Loud S1 splitting*- The first heart sound (**S1**) often becomes noticeably **louder** during pregnancy due to the **hyperdynamic circulation** and elevated heart rate.- The increased heart rate and fluid volume can enhance the audibility and sometimes the perception of splitting due to the closure of the **mitral and tricuspid valves**.

Q: What is the earliest sign of pregnancy on TVS?

G sac. ***G sac***- The **gestational sac** (G sac) is the first definitive sonographic sign of an intrauterine pregnancy (IUP) visible on TVS, typically appearing between **4.5 to 5 weeks** of gestation. - It is seen as a small, **anechoic** (fluid-filled) structure surrounded by a highly **echogenic rim** (trophoblastic tissue), often demonstrating the **double decidual sign**. *Yolk sac* - The **yolk sac** is visualized *after* the gestational sac, typically around **5 to 5.5 weeks** of gestation, located eccentrically within the gestational sac. - Its presence is crucial but is not the earliest structure seen on TVS. *Cardiac activity* - **Fetal cardiac activity** is usually first detectable by TVS comparatively later, generally around **6 to 6.5 weeks** of gestation. - The detection of cardiac activity requires the presence of a viable **fetal pole** (embryo). *Fetal pole* - The **fetal pole** (representing the early embryo) is generally first visualized by TVS around **5.5 to 6 weeks** of gestation. - While a very early finding, it appears slightly *after* the initial visualization of the **gestational sac** itself.

Q: Which of the following drugs is not given for hypertension in pregnancy?

Enalapril. ***Correct: Enalapril*** - **Enalapril** is an **Angiotensin-Converting Enzyme (ACE) inhibitor** which is strictly **contraindicated** throughout pregnancy, particularly during the second and third trimesters - The use of ACE inhibitors is associated with severe **fetal renal dysfunction**, resulting in **oligohydramnios**, **pulmonary hypoplasia**, and **fetal death** - ACE inhibitors are **NOT given** for hypertension in pregnancy due to these serious teratogenic effects *Incorrect: Methyldopa* - **Methyldopa**, a centrally acting **alpha-2 agonist**, is historically considered the first-line and safest drug for treating chronic hypertension during pregnancy - Its extensive use has demonstrated a favorable long-term safety profile for the development of the child - It operates by reducing **sympathetic outflow** from the central nervous system, thereby lowering peripheral vascular resistance *Incorrect: Labetalol* - **Labetalol** is a combined **alpha-1 and non-selective beta-blocker** and is a primary first-line choice for treating both chronic and **acute severe hypertension** in pregnant women - It is rapidly effective and safe, maintaining adequate **placental perfusion** - It exerts its antihypertensive effects by acting as a competitive antagonist at both adrenergic receptors *Incorrect: Nifedipine* - **Nifedipine** is a **dihydropyridine calcium channel blocker** frequently used for managing chronic hypertension and treating acute severe hypertension or **preeclampsia** in pregnancy - It is generally considered safe and effective - Its most common use is often an alternative first-line agent to Labetalol or for the management of hypertensive crises via its extended-release formulation

Q: The image depicts which of the following early signs of pregnancy?

Hegar sign. ***Hegar Sign*** - The image demonstrates a bimanual examination where the lower uterine segment (isthmus) is compressed between the internal and external fingers, which is the classic maneuver to elicit **Hegar sign**. - This is a probable sign of pregnancy, characterized by the softening and compressibility of the uterine isthmus, typically detectable between **6 to 8 weeks** of gestation. *Goodell Sign* - **Goodell sign** refers to the significant softening of the **cervix** due to increased vascularity and edema, which feels like the consistency of lips rather than the tip of the nose. - The examination shown in the image is focused on palpating the **uterine isthmus**, which is located superior to the cervix. *Osiander sign* - **Osiander sign** is the detection of an increased **pulsation** in the **lateral vaginal fornices**, which is a result of increased blood flow through the uterine artery. - The image depicts the assessment of tissue consistency and compressibility, not the detection of arterial pulsations. *Palmer sign* - **Palmer sign** is characterized by regular, rhythmic **uterine contractions** that can be palpated during a bimanual examination in early pregnancy. - The maneuver shown is assessing the static compressibility of the uterine isthmus, not its dynamic contractile activity.

Q: Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Crown rump length. ***Crown rump length*** - The **Crown Rump Length (CRL)** is the most accurate parameter for estimating gestational age during the **first trimester** (up to 12 weeks of gestation). - This is because biological variation between fetuses is minimal during early development, providing a narrow range of error (typically ±5-7 days). *Biparietal Diameter* - **Biparietal Diameter (BPD)** becomes the primary parameter for dating in the **second trimester** (after 12 weeks of gestation). - Its accuracy in the first trimester is significantly lower than CRL due to difficulty in obtaining standardized measurements and higher potential for measurement variability. *Head circumference* - **Head circumference (HC)** is highly utilized, often alongside BPD, for fetal growth assessment and dating near the mid-to-late second trimester. - Like BPD, HC is not the most precise measure for dating during the **first trimester** when CRL dominates. *Abdominal circumference* - **Abdominal circumference (AC)** is mainly used to assess **fetal weight** and growth, often becoming inaccurate for dating due to high biological variability later in gestation. - It is the least accurate parameter for establishing gestational age in the **first trimester** compared to CRL, BPD, and HC.

Q: Which of the following is the most common location of implantation in ectopic pregnancy? ![img-40.jpeg](img-40.jpeg)

A. ***A*** - Label A points to the **fallopian tube**, which is the site of over 95% of all ectopic pregnancies. The most common specific location within the tube is the **ampulla** (approximately 80% of tubal ectopics). - Risk factors such as **pelvic inflammatory disease (PID)**, previous tubal surgery, or endometriosis can damage the fallopian tube, impeding the transit of the fertilized ovum to the uterus. *D* - Label D indicates the **uterus**, which is the normal site for implantation in a healthy, **intrauterine pregnancy**. - By definition, an ectopic pregnancy is one that implants *outside* the uterine cavity, making this location incorrect. *B* - Label B indicates the **ovary**. An **ovarian ectopic pregnancy** is a rare form of ectopic implantation, constituting about 3% of cases. - This occurs if the egg is fertilized and implants on or within the ovary itself, before it enters the fallopian tube. *C* - Label C points to the **cervix**. A **cervical pregnancy** is a very rare type of ectopic pregnancy, accounting for less than 1% of cases. - This location is particularly dangerous due to a high risk of life-threatening **hemorrhage** because of the cervix's rich vascular supply.

Q: Which of the following is shown in the given image? ![img-35.jpeg](img-35.jpeg)

Linea nigra. ***Linea nigra*** - The image shows a dark, vertical line running down the midline of a pregnant woman's abdomen, which is the classic presentation of **linea nigra**. - This hyperpigmentation of the **linea alba** is a normal physiological change during pregnancy, caused by increased levels of hormones such as **melanocyte-stimulating hormone (MSH)** and **estrogen**. *Striae gravidarum* - **Striae gravidarum**, commonly known as stretch marks, are atrophic linear bands that result from the rapid stretching of the skin. They are not represented by the single, dark vertical line shown. - Initially, they appear as reddish or purplish lines (**striae rubrae**) and later fade to a silvery-white color (**striae albicantes**). *Chloasma* - **Chloasma**, or melasma, is a form of hyperpigmentation that appears on the face, particularly on the cheeks, forehead, and upper lip, often referred to as the "mask of pregnancy". - This condition affects facial skin and does not present as a line on the abdomen. *Linea alba* - The **linea alba** ("white line") is the fibrous connective tissue that runs down the midline of the abdomen in all individuals. It is typically pale and not easily visible. - During pregnancy, the **linea alba** darkens due to hormonal influences, transforming into the **linea nigra**. Therefore, the image shows the pigmented version, not the original linea alba.

Q: A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?

Urine dipstick. ***Urine dipstick***- The initial requirement for diagnosing **preeclampsia** is the presence of new-onset hypertension (BP > 140/90) plus **proteinuria** (or signs of end-organ damage).- The urine dipstick is the quickest and easiest initial test to rapidly screen for the presence of **proteinuria** and establish the correct diagnostic category (Gestational Hypertension vs. Preeclampsia).*Uric acid*- Elevated **serum uric acid** is often associated with preeclampsia severity, correlating with increased poor maternal and fetal outcomes.- However, it is not the standard *initial* diagnostic screening test needed to define the condition itself, which primarily requires checking for proteinuria.*Liver function test*- LFTs (AST and ALT) are performed to evaluate for signs of **severe preeclampsia** or **HELLP syndrome**, indicated by elevated transaminases.- While crucial for assessing severity, the initial step after noting hypertension is to screen for **proteinuria**, not necessarily end-organ damage markers.*Complete blood count*- A CBC is necessary to check for signs of severity, specifically **thrombocytopenia** (platelet count < 100,000/µL), which defines severe preeclampsia or HELLP syndrome.- Like LFTs, this is part of the workup for *severity* or *end-organ damage*, but the priority after detecting hypertension is confirming proteinuria via an initial screening test.

Question 1

Identify the sign.

Accepted Answer

Hegar's sign

Answer

Goodell's sign

Answer

Piskacek's sign

Answer

Chadwick's sign

Question 2

Which of the following CVS changes are not seen in pregnancy?

Accepted Answer

Diastolic murmur

Answer

S3

Answer

Loud S1 splitting

Answer

Soft Systolic murmur

Question 3

What is the earliest sign of pregnancy on TVS?

Accepted Answer

G sac

Answer

Fetal pole

Answer

Cardiac activity

Answer

Yolk sac

Question 4

A 32 y/o pregnant woman presents for her routine antenatal check-up at 28 weeks gestation. She has a history of obesity but no previous history of diabetes. Her fasting plasma glucose level is 104 mg/dL, and her 2-hour plasma glucose level after a 75g Oral Glucose Tolerance Test (OGTT) is 167 mg/dL. Based on these findings, what is the most appropriate next step?

Accepted Answer

Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.

Answer

Start lifestyle modifications and repeat OGTT at 32 weeks gestation.

Answer

Monitor her closely without intervention since her glucose levels are borderline.

Answer

Diagnose her with pre-existing diabetes and initiate insulin therapy.

Question 5

Which of the following drugs is not given for hypertension in pregnancy?

Accepted Answer

Enalapril

Answer

Nifedipine

Answer

Methyldopa

Answer

Labetalol

Question 6

The image depicts which of the following early signs of pregnancy?

Accepted Answer

Hegar sign

Answer

Osiander sign

Answer

Palmer sign

Answer

Goodell sign

Question 7

Which of the following is the best parameter for estimation of fetal age by ultrasound in 1st trimester?

Accepted Answer

Crown rump length

Answer

Biparietal Diameter

Answer

Abdominal circumference

Answer

Head circumference

Question 8

Which of the following is the most common location of implantation in ectopic pregnancy? ![img-40.jpeg](img-40.jpeg)

Accepted Answer

A

Answer

D

Answer

B

Answer

C

Question 9

Which of the following is shown in the given image? ![img-35.jpeg](img-35.jpeg)

Accepted Answer

Linea nigra

Answer

Striae gravidarum

Answer

Chloasma

Answer

Linea alba

Question 10

A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?

Accepted Answer

Urine dipstick

Answer

Uric acid

Answer

Liver function test

Answer

Complete blood count

Prenatal Care — MCQs

Prenatal Care — MCQs

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