Prenatal Care Practice Questions

Q: Vaccines that can be safely given during pregnancy are the following except

Rubella. ***Rubella*** - The **rubella vaccine** is a **live attenuated vaccine** and is **contraindicated in pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported from vaccination during pregnancy. - Women should be vaccinated *before* pregnancy or postpartum, and advised to avoid conception for at least four weeks after vaccination. *Influenza* - The **inactivated influenza vaccine** is highly recommended during **any trimester of pregnancy** to protect both the mother and the newborn from severe influenza-related complications. - Pregnancy alters the immune system and cardiopulmonary function, increasing the risk of severe illness from influenza. *Pneumococcus* - The **pneumococcal polysaccharide vaccine (PPSV23)** and **pneumococcal conjugate vaccine (PCV13)** are considered **safe for pregnant women** who meet the indications for vaccination (e.g., chronic medical conditions). - These vaccines provide protection against serious invasive pneumococcal diseases. *Tetanus* - The **tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine** is **recommended during each pregnancy**, preferably between 27 and 36 weeks gestation. - It provides critical protection against **pertussis** for the newborn and tetanus immunity for the mother.

Q: During pregnancy, vaccination can be given against all these diseases except :

Mumps. ***Mumps*** - The **mumps vaccine** is a **live attenuated vaccine**, meaning it contains a weakened form of the virus. - Live attenuated vaccines are generally **contraindicated in pregnancy** due to the theoretical risk of transmitting the vaccine virus to the fetus. *Hepatitis A* - The **Hepatitis A vaccine** is an **inactivated (killed) vaccine**. - Inactivated vaccines are generally considered **safe during pregnancy** if there's a significant risk of exposure. *Tetanus* - The **tetanus toxoid vaccine (Tdap)** is recommended during every pregnancy to protect the newborn from **pertussis (whooping cough)** and provide maternal protection against tetanus. - It is an **inactivated vaccine** and is very safe for both mother and fetus. *Hepatitis B* - The **Hepatitis B vaccine** is a **recombinant vaccine**, meaning it's made from a component of the virus. - It is considered **safe in pregnancy** and is recommended for pregnant women at risk of acquiring hepatitis B.

Q: The daily requirement of calcium during normal pregnancy is

1000 mg. ***1000 mg*** - This is the daily calcium requirement for **pregnant women aged 19 years and above** according to **ACOG** and many international guidelines. - Some guidelines, including **ICMR (2020)**, recommend **1200 mg/day** for all pregnant women, making both 1000-1200 mg acceptable ranges. - Adequate calcium intake supports **fetal skeletal development** and helps prevent complications such as **gestational hypertension** and **preeclampsia**. - This answer is accepted as the standard recommendation for normal pregnancy in most textbooks. *500 mg* - This amount is the recommended daily intake for **pre-school children**, not pregnant women. - Grossly insufficient during pregnancy, as the **fetus requires approximately 200-300 mg/day** for skeletal development, primarily drawn from maternal calcium stores. - Would lead to **maternal bone demineralization** and increased risk of pregnancy complications. *2000 mg* - This represents the **tolerable upper intake level (UL)** for calcium during pregnancy. - While not harmful in most cases, this higher dose is **unnecessarily excessive** for routine supplementation. - May cause side effects including **constipation, kidney stones**, and interference with absorption of other minerals like iron and zinc. *250 mg* - This is **significantly below the requirement** for both pregnant and non-pregnant adults (who need ~600-800 mg/day). - Such severe deficiency would result in **mobilization of maternal bone calcium** to meet fetal demands. - Would increase risk of **osteoporosis, pre-eclampsia**, and impaired fetal bone development.

Q: During a normal pregnancy, the changes occurring in the urinary tract include the following except

Hypertonicity of the ureteric smooth muscle. ***Hypertonicity of the ureteric smooth muscle*** - Ureteric smooth muscle actually exhibits **reduced tone** and **hypoactivity** during pregnancy due to the relaxing effects of **progesterone**. - This **hypoactivity** contributes to ureteral dilatation and urinary stasis, making **hypertonicity** an incorrect statement. *Dilatation of the ureters* - **Progesterone** causes relaxation of smooth muscle throughout the body, including the ureters, leading to their **dilatation** and hydronephrosis. - Mechanical compression of the ureters by the gravid uterus, especially the right ureter, also contributes to this dilatation. *Elevation and thickening of the trigone* - The increased vascularity and hormonal influences during pregnancy cause the bladder trigone to become **edematous and elevated**. - This anatomical change can make the trigone more prominent during cystoscopic examination. *Increase in the Glomerular filtration rate* - Renal blood flow and GFR **increase by 30-50%** during pregnancy, primarily due to increased cardiac output and renal vasodilation. - This physiological adaptation is crucial for excreting fetal and maternal waste products.

Q: A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

Injectable iron therapy. ***Injectable iron therapy*** - With a hemoglobin of **7 gm%** at **28 weeks of gestation**, the patient has **severe anemia** that requires a rapid increase in hemoglobin. - **Injectable iron therapy** provides a swift and effective way to replenish iron stores and improve hemoglobin levels, especially when oral iron absorption is insufficient or time is critical. *Blood transfusion* - While blood transfusions rapidly increase hemoglobin, they are generally reserved for **acute hemodynamic instability**, severe symptomatic anemia, or when immediate delivery is anticipated. - This patient, though severely anemic, does not present with criteria for **immediate transfusion**. *Oral iron and folic acid therapy* - **Oral iron therapy** is the standard treatment for moderate anemia, but for a hemoglobin of **7 gm%**, it may be too slow to raise hemoglobin levels quickly enough. - While folic acid is important in pregnancy, it doesn't directly address the **iron deficiency** indicated by microcytic hypochromic anemia. *Oral iron therapy* - **Oral iron therapy** is usually the first-line treatment for **iron deficiency anemia**. - However, at **7 gm% hemoglobin** in the **third trimester**, oral iron may not increase hemoglobin levels fast enough, and compliance or absorption issues could further delay recovery.

Q: Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

A→3 B→4 C→2 D→1. ***A→3 B→4 C→2 D→1*** This question has inherent issues as the anatomical sites in List-II do not perfectly correspond to the signs in List-I. Based on the image provided and available options: - **A (Jacquemier's sign) → 3**: Jacquemier's sign refers to the **bluish-purple discoloration of the vagina and cervix** due to increased vascularity. While primarily a vaginal/cervical sign, if the list groups this under broader "uterine/pelvic" changes, this may be the intended match, though medically it is most specific to the vagina (which would be option 4). - **B (Chloasma gravidarum) → 4**: Chloasma gravidarum is the **hyperpigmentation of facial skin** (mask of pregnancy). This does NOT occur on the vagina. This matching appears incorrect unless List-II's option 4 refers to something other than "vagina" in the original source. - **C (Striae gravidarum) → 2**: Striae gravidarum are **stretch marks that typically appear on the abdomen** (also breasts, thighs). This match is **correct**. - **D (Montgomery's tubercles) → 1**: Montgomery's tubercles are **enlarged sebaceous glands on the areola of the breast**. This match is **correct**. *Other options are incorrect as they mismatch the anatomical sites for these well-established signs of pregnancy. The correct answer reflects the intended matching from the original UPSC-CMS 2010 examination, though some matches may not align perfectly with anatomical specificity.*

Q: Which of the following vaccines is/are contraindicated in pregnancy? 1. Rubella 2. Hepatitis-B 3. Diphtheria 4. Mumps 5. Measles Select the correct answer using the code given below:

1, 4 and 5 only. ***1, 4 and 5 only*** - **Rubella, Mumps, and Measles** vaccines are **live attenuated vaccines**, which are **contraindicated during pregnancy** due to the theoretical risk of congenital infection. - The live viral components could potentially cross the placenta and cause fetal harm or **congenital anomalies**. *1, 2, 3, 4 and 5* - This option incorrectly includes **Hepatitis B** and **Diphtheria** vaccines as contraindicated during pregnancy. - Both **Hepatitis B** (inactivated) and **Diphtheria** (toxoid) vaccines are considered safe and often recommended during pregnancy if indicated. *1 only* - This option is incomplete as it only lists **Rubella** as contraindicated, while **Mumps and Measles** are also **live attenuated vaccines** and thus contraindicated. - It misses other important live vaccines also contraindicated in pregnancy. *2 and 3 only* - This option is incorrect because **Hepatitis B** and **Diphtheria** vaccines are generally considered **safe during pregnancy** and are not contraindicated. - **Hepatitis B** is an inactivated vaccine, and **Diphtheria** is a toxoid vaccine, both of which do not pose a risk of active infection to the fetus.

Question 1

Which of the following best defines gestational hypertension?

Accepted Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 20 weeks of gestation in a previously normotensive woman

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on two occasions 4-6 hours apart with proteinuria after 20 weeks of gestation

Answer

Sustained rise of blood pressure to 140/90 mmHg or more on at least two occasions 4-6 hours apart after 12 weeks of gestation

Answer

Sustained rise of blood pressure to 150/100 mmHg or more on at least two occasions 2 hours apart after 20 weeks of gestation

Question 2

Vaccines that can be safely given during pregnancy are the following except

Accepted Answer

Rubella

Answer

Influenza

Answer

Pneumococcus

Answer

Tetanus

Question 3

During pregnancy, vaccination can be given against all these diseases except :

Accepted Answer

Mumps

Answer

Hepatitis A

Answer

Tetanus

Answer

Hepatitis B

Question 4

The daily requirement of calcium during normal pregnancy is

Accepted Answer

1000 mg

Answer

500 mg

Answer

2000 mg

Answer

250 mg

Question 5

During a normal pregnancy, the changes occurring in the urinary tract include the following except

Accepted Answer

Hypertonicity of the ureteric smooth muscle

Answer

Dilatation of the ureters

Answer

Elevation and thickening of the trigone

Answer

Increase in the Glomerular filtration rate

Question 6

A pregnant woman presents at 28 weeks of gestation with haemoglobin level of 7 gm%; and peripheral smear reveals it to be of microcytic hypochromic type. What would be the correct option of therapy?

Accepted Answer

Injectable iron therapy

Answer

Blood transfusion

Answer

Oral iron and folic acid therapy

Answer

Oral iron therapy

Question 7

Match List-I (Signs of pregnancy) with List-II (Anatomical sites) and select the correct answer using the code given below the Lists:

Accepted Answer

A→3  B→4  C→2  D→1

Answer

A→3  B→5  C→2  D→1

Answer

A→3  B→1  C→4  D→2

Answer

A→2  B→4  C→1  D→3

Question 8

A pregnant woman visits a medical officer for an antenatal check up. The woman mentions that she had received two doses of Tetanus Toxoid vaccine four years ago. Which of the following steps should the medical officer take with regard to administration of Tetanus Toxoid vaccine as per the Government of India recommended schedule?

Accepted Answer

Two doses of Tetanus Toxoid vaccine should be administered with an interval of four weeks between the two doses

Answer

No Tetanus Toxoid vaccine is required

Answer

Only one dose of Tetanus Toxoid vaccine is required

Answer

Tetanus Immunoglobulin should be administered in the third trimester of pregnancy

Question 9

Which of the following statements is false?

Accepted Answer

Gestational diabetes is always transient and cured after delivery.

Answer

Gestational diabetes is a risk factor for diabetes in children born to mothers with GDM.

Answer

Screening for gestational diabetes should be included in antenatal care.

Answer

Gestational diabetes can lead to Type-II diabetes after delivery.

Question 10

Which of the following vaccines is/are contraindicated in pregnancy?

1. Rubella

2. Hepatitis-B

3. Diphtheria

4. Mumps

5. Measles
Select the correct answer using the code given below:

Accepted Answer

1, 4 and 5 only

Answer

1, 2, 3, 4 and 5

Answer

1 only

Answer

2 and 3 only

Prenatal Care — MCQs

Prenatal Care — MCQs

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