Psychosocial Aspects of Pregnancy — MCQs
A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
Which of the following is a criterion for infant at risk?
A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______
A 29 year old lady came to psychiatry OPD with symptoms of hypomania. She has a past history of manic episode. Now, she is planning to conceive. Which drug should be avoided for being highly teratogenic to the fetus?
In which of the following conditions is behavior therapy considered most effective?
Which of the following are individual indicators of fetal distress?
What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
Which of the following represents the current recommendation for offering screening for Down's syndrome during pregnancy?
Psychosocial Aspects of Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
- A. Postpartum depression
- B. Postpartum blues (Correct Answer)
- C. Postpartum psychosis
- D. Postpartum anxiety
Explanation: ***Postpartum blues*** - This condition presents with mild, transient symptoms like **tearfulness**, **mood swings**, and **insomnia** typically peaking around **4-5 days postpartum** and resolving within two weeks. - It is a very common, self-limiting condition impacting up to 80% of new mothers, attributed to drastic **hormonal shifts** post-delivery. *Postpartum depression* - Symptoms are similar to postpartum blues but are more **severe**, last longer (typically **beyond two weeks**), and significantly impair functioning. - It often includes feelings of **hopelessness**, pervasive sadness, loss of pleasure, and sometimes thoughts of harming oneself or the baby. *Postpartum psychosis* - This is a severe psychiatric emergency characterized by **hallucinations**, delusions, disorganized thinking, and bizarre behavior, usually within the first 2-3 weeks postpartum. - It is a rare condition requiring **urgent medical intervention** due to the high risk of harm to mother and baby. *Postpartum anxiety* - While anxiety can co-occur with postpartum blues or depression, primary postpartum anxiety specifically involves excessive and **uncontrollable worry** or fear, often about the baby's health or safety. - It does not typically present with the prominent **tearfulness** and **mood swings** characteristic of blues or depression.
Question 2: Which of the following is a criterion for infant at risk?
- A. Preeclampsia in pregnancy (Correct Answer)
- B. Has not taken 100 days folic acid
- C. Malpresentation during birth
- D. Working mothers
Explanation: ***Preeclampsia in pregnancy*** - **Preeclampsia** is a serious pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. - Infants born to mothers with preeclampsia are at **significantly higher risk** for complications including **preterm birth**, **intrauterine growth restriction (IUGR)**, low birth weight, respiratory distress syndrome, and perinatal mortality. - This is a **universally recognized criterion** for identifying high-risk infants in maternal-child health programs and NICU protocols. - Such infants require close monitoring and specialized care from birth. *Has not taken 100 days folic acid* - Periconceptional **folic acid supplementation** (ideally starting 3 months before conception and continuing through early pregnancy) reduces the risk of **neural tube defects** in the fetus. - While lack of folic acid supplementation increases the risk of congenital anomalies during pregnancy, this historical factor alone does not classify the infant as "at risk" after birth unless an actual neural tube defect or other complication is present. - This is primarily a **pregnancy risk factor** rather than a postnatal infant risk criterion. *Malpresentation during birth* - **Malpresentation** (e.g., breech, transverse lie, face presentation) increases the risk of birth complications such as **birth asphyxia**, **birth trauma**, cord prolapse, and difficult delivery. - While malpresentation is recognized as a risk factor during delivery and such infants may require closer initial monitoring, **preeclampsia** represents a more comprehensive and persistent risk affecting multiple organ systems and long-term outcomes. - In the context of identifying high-risk infants for follow-up programs, maternal preeclampsia is a more significant criterion than malpresentation alone (assuming no birth complications occurred). *Working mothers* - A mother's employment status does not inherently classify an infant as "at risk" from a medical or developmental standpoint. - While **socioeconomic factors** and access to care can impact infant health, simply being a working mother is not a direct medical criterion for defining an infant as high-risk.
Question 3: A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______
- A. Major depression
- B. Mania
- C. Postpartum psychosis
- D. Postpartum blues (Correct Answer)
Explanation: ***Postpartum blues*** - **Mild depressive symptoms** that onset a few days after delivery and resolve within **two weeks postpartum** are characteristic of postpartum blues. - This condition is very common, affecting 50-80% of new mothers, and is thought to be due to **hormonal shifts** and **sleep deprivation**. *Major depression* - **Major depression** involves more severe and persistent symptoms that last for **at least two weeks** and significantly impair functioning, often requiring intervention. - While it can occur postpartum (postpartum depression), the **mild nature** and rapid resolution of symptoms in this case make it less likely. *Mania* - **Mania** is characterized by elevated mood, increased energy, racing thoughts, and decreased need for sleep, which are not described here. - This condition is typically associated with **bipolar disorder** and represents a distinct mood disturbance from the mild depressive symptoms described. *Postpartum psychosis* - **Postpartum psychosis** is a severe and rare psychiatric emergency characterized by **hallucinations, delusions, and disorganized behavior**. - Its rapid onset, severe symptoms, and high risk of harm to mother and baby are distinct from the mild, self-resolving symptoms presented.
Question 4: A 29 year old lady came to psychiatry OPD with symptoms of hypomania. She has a past history of manic episode. Now, she is planning to conceive. Which drug should be avoided for being highly teratogenic to the fetus?
- A. Oxcarbazepine
- B. Lithium
- C. Olanzapine
- D. Valproate (Correct Answer)
Explanation: ***Valproate*** - **Valproate** is highly **teratogenic** and is associated with multiple birth defects, including **neural tube defects** (e.g., spina bifida), cardiac anomalies, and craniofacial defects. - Due to its significant risks, it is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other suitable alternatives exist. *Oxcarbazepine* - While it has some teratogenic risk (e.g., cleft palate), the risk is generally considered **lower than valproate**. - It is often favored over valproate in pregnant women requiring mood stabilizers, but still requires careful risk-benefit assessment. *Lithium* - **Lithium** is associated with an increased risk of **Ebstein's anomaly**, a specific cardiac defect, if used during the first trimester. - However, the overall risk of major malformations is still **lower than valproate**, and it can be used with careful monitoring if other options are not viable. *Olanzapine* - **Olanzapine** is an **atypical antipsychotic** that can be used as a mood stabilizer and is considered to have a **relatively lower teratogenic risk** compared to anticonvulsants like valproate. - While it's not entirely risk-free (associated with gestational diabetes and fetal growth issues), it's often a safer option in pregnancy for bipolar disorder than valproate.
Question 5: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 6: Which of the following are individual indicators of fetal distress?
- A. Meconium staining
- B. Late deceleration of heart rate
- C. Decrease in fetal scalp blood pH
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Meconium staining** of the amniotic fluid, **late decelerations of fetal heart rate**, and a **decrease in fetal scalp blood pH** are all recognized individual indicators of fetal distress. - These signs individually or collectively suggest that the fetus is experiencing **hypoxia** or other adverse conditions. *Meconium staining* - Refers to the presence of **meconium** (the first stool of a newborn) in the **amniotic fluid**, which can indicate fetal stress leading to gasping and passage of meconium. - While concerning, it's not always indicative of severe hypoxia but warrants further assessment. - **Mechanism**: Fetal hypoxia → vagal stimulation → relaxation of anal sphincter → meconium passage. *Late deceleration of heart rate* - **Late decelerations** are symmetric drops in fetal heart rate that begin after the peak of the contraction and return to baseline after the contraction has ended. - They are associated with **uteroplacental insufficiency** and **fetal hypoxia**, reflecting inadequate oxygen delivery to the fetus. - **Significance**: Indicates fetal compromise requiring immediate evaluation and potential intervention. *Decrease in fetal scalp blood pH* - A **low fetal scalp blood pH** (typically below 7.20) indicates **fetal acidosis**, which is a direct sign of **fetal hypoxemia** and distress. - It suggests that the fetus is undergoing anaerobic metabolism due to insufficient oxygen supply. - **Clinical utility**: Provides objective biochemical evidence of fetal compromise when CTG is non-reassuring.
Question 7: What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
- A. Lamotrigine (Correct Answer)
- B. CBZ
- C. Levetiracetam
- D. Valproate
Explanation: ***Lamotrigine*** - **Lamotrigine** is considered **one of the preferred drugs** for managing epilepsy during pregnancy due to its relatively **low teratogenic risk** compared to older antiepileptic drugs. - Its established safety profile in pregnancy makes it a preferred option to balance seizure control and **fetal well-being**. - **Important Note:** For **GTCS specifically**, lamotrigine and levetiracetam are both considered appropriate first-line choices, with selection depending on individual patient factors and seizure control history. - Lamotrigine levels **decrease during pregnancy** and require monitoring and dose adjustments. *CBZ* - **Carbamazepine (CBZ)** is associated with an increased risk of **neural tube defects** and other congenital malformations when used during pregnancy, making it less favorable. - While effective for GTCS, its teratogenicity often leads to avoidance or careful consideration of alternatives in pregnant women. *Levetiracetam* - **Levetiracetam** is increasingly recognized as an **excellent choice for GTCS in pregnancy** with a favorable safety profile and growing evidence base. - Many recent guidelines and clinical practices favor levetiracetam as **first-line for GTCS** due to its low risk of major congenital malformations and good efficacy. - It is a **medically appropriate alternative** to lamotrigine, and in some contexts may be preferred, particularly for primary generalized epilepsy. *Valproate* - **Valproate** has the highest risk of **teratogenicity** among common antiepileptic drugs, including a significant risk of **neural tube defects**, developmental delay, autism spectrum disorder, and other anomalies. - Due to these significant risks, valproate is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other effective and safer alternative exists.
Question 8: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 9: What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
- A. G2P1L2 (2 live births) (Correct Answer)
- B. G3P2L2 (3 pregnancies, 2 live births)
- C. G2P2L2 (2 pregnancies, 2 live births)
- D. G3P3L2
Explanation: ***G2P1L2 (2 live births)*** - **Gravida (G)** refers to the total number of pregnancies, including the current one. This woman is currently pregnant and has had one previous pregnancy, making her G2. - **Parity (P)** refers to the number of pregnancies that reached viability (>20 weeks gestation or >500g), *regardless of the number of fetuses*. She had one previous delivery (twins) that reached viability, so her P is 1. The current pregnancy is not included in parity until after delivery. - **Live births (L)** refers to the number of live children delivered. Her previous pregnancy resulted in twins, meaning 2 live births. *G3P2L2 (3 pregnancies, 2 live births)* - This option incorrectly counts the number of pregnancies (**G**) as 3. She has had one previous pregnancy and is currently pregnant, totaling 2 pregnancies. - It also incorrectly counts the parity (**P**) as 2. Parity refers to the number of deliveries that reached viability, not the number of fetuses. Her previous delivery was a single event, making P1. *G2P2L2 (2 pregnancies, 2 live births)* - While the Gravida (G2) and Live births (L2) are correct, the Parity (**P**) is incorrectly stated as 2. Parity refers to the number of viable pregnancies delivered, and she has only had one previous delivery. - The number of fetuses (twins) does not increase the parity count for a single delivery event. *G3P3L2 (3 pregnancies, 3 live births)* - This option incorrectly states the number of pregnancies (**G**) as 3 and the parity (**P**) as 3. - The woman has only had one previous pregnancy and is currently pregnant, for a total of G2 and P1.
Question 10: Which of the following represents the current recommendation for offering screening for Down's syndrome during pregnancy?
- A. 35
- B. No screening necessary
- C. 30
- D. All in the reproductive age group (Correct Answer)
Explanation: ***All in the reproductive age group*** - The American College of Obstetricians and Gynecologists (ACOG) and other major medical bodies recommend that **all pregnant women**, regardless of age, be offered **screening for Down syndrome** and other aneuploidies. - This recommendation reflects the principle of **patient autonomy** and the availability of safe and effective screening methods for all pregnancies, not just those considered high-risk based on maternal age. *30* - While the risk of Down syndrome increases with maternal age, **screening is not exclusively recommended for women aged 30**; rather, it is offered to all pregnant women. - Focusing only on this age group would **miss cases** in younger women and limit informed decision-making. *35* - Historically, **maternal age 35** was considered the threshold for offering invasive diagnostic testing due to the significantly increased risk of Down syndrome. - However, current guidelines emphasize universal screening, as a substantial number of babies with Down syndrome are born to women **younger than 35** due to higher birth rates in this group. *No screening necessary* - This option is incorrect as **screening is routinely offered** to all pregnant women to provide information about the risk of conditions like Down syndrome. - Deciding to forgo screening or diagnostic testing is a personal choice, but the **option to screen should always be available** to the patient.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free