A 28-year-old at 22 weeks has 1+ glucose on urine dipstick at an ANC visit. Her 75 g oral glucose test, fasting plasma glucose and HbA1c are all normal. What is the most likely mechanism of the glycosuria?

Filtered glucose exceeds tubular reabsorption

Proximal tubular damage from pregnancy

Placental hormones raise plasma glucose

Lactose excretion from the breasts

A 29-year-old at 32 weeks has an arterial blood gas sampled during a pre-anaesthetic work-up for a breast lump: pH 7.44, PaCO2 30 mm Hg, PaO2 104 mm Hg, HCO3- 20 mEq/L. She is well and not breathless. How should the gas be interpreted?

Compensated respiratory alkalosis of pregnancy

Mixed metabolic and respiratory alkalosis

Acute respiratory alkalosis from embolism

Metabolic acidosis with respiratory compensation

A 19-year-old primigravida at 16 weeks attends the ANC clinic at a PHC. She has no record of any tetanus or Td vaccination in the past. What schedule of Td should she receive in this pregnancy?

Td now and a second dose 4 weeks later

One Td dose now and one at delivery

Td now, at 1 month and at 6 months

A 38-year-old woman at 11 weeks had a cell-free DNA test (NIPT) at a private laboratory, which reports a high risk of trisomy 21. Her ultrasound is otherwise normal. She asks whether she should terminate the pregnancy. What is the most appropriate next step?

Confirm with chorionic villus sampling

Terminate on the basis of the result

Do a quadruple test at 16 weeks

Antenatal care, screening and physiology of pregnancy

24 NEET-PG practice questions on Antenatal care, screening and physiology of pregnancy, part of Obstetrics & Gynaecology. The first 24 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 28-year-old at 22 weeks has 1+ glucose on urine dipstick at an ANC visit. Her 75 g oral glucose test, fasting plasma glucose and HbA1c are all normal. What is the most likely mechanism of the glycosuria?
1. AProximal tubular damage from pregnancy
2. BFiltered glucose exceeds tubular reabsorption
3. CPlacental hormones raise plasma glucose
4. DLactose excretion from the breasts
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Answer: B · Filtered glucose exceeds tubular reabsorption
Renal plasma flow and GFR rise by about 50% in pregnancy, so more glucose is filtered, while the tubules do not raise their reabsorption to match; glucose can therefore appear in urine at normal blood levels. This is why urine glucose is a poor screening test for diabetes in pregnancy and blood tests are used instead. The same rise in GFR lowers serum creatinine and urea, so a creatinine that would be normal outside pregnancy may be abnormal in it. Lactosuria can occur late in pregnancy and in lactation, but a glucose-specific dipstick does not detect lactose.
- A: Pregnancy does not damage the tubules; this is a normal change.
- C: Her blood glucose tests are normal, so this is not hyperglycaemia.
- D: Glucose oxidase dipsticks do not react with lactose.
Question 2 · Medium
A 29-year-old at 32 weeks has an arterial blood gas sampled during a pre-anaesthetic work-up for a breast lump: pH 7.44, PaCO2 30 mm Hg, PaO2 104 mm Hg, HCO3- 20 mEq/L. She is well and not breathless. How should the gas be interpreted?
1. AMixed metabolic and respiratory alkalosis
2. BCompensated respiratory alkalosis of pregnancy
3. CAcute respiratory alkalosis from embolism
4. DMetabolic acidosis with respiratory compensation
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Answer: B · Compensated respiratory alkalosis of pregnancy
Progesterone stimulates the respiratory centre, so minute ventilation rises by about 40-50%, mainly through a larger tidal volume. PaCO2 falls to about 30 mm Hg and the kidneys excrete bicarbonate to about 20 mEq/L, keeping pH slightly alkaline: a compensated respiratory alkalosis that is normal in pregnancy. The low PaCO2 also helps carbon dioxide pass from fetus to mother. Her pH above 7.40 and normal PaO2 exclude the other options.
- A: Bicarbonate is low, so there is no metabolic alkalosis.
- C: Embolism would cause symptoms and a lower PaO2.
- D: A primary metabolic acidosis would give a pH below 7.40.
Question 3 · Easy
A 22-year-old primigravida registers at a sub-centre at 10 weeks and is told she should have at least four antenatal check-ups. Under MoHFW guidance, in which period should her third visit fall?
1. A28 to 34 weeks
2. BWithin 12 weeks
3. C14 to 26 weeks
4. D36 weeks to term
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Answer: A · 28 to 34 weeks
MoHFW recommends a minimum of four antenatal visits: the first within 12 weeks (ideally as soon as pregnancy is suspected), the second between 14 and 26 weeks, the third between 28 and 34 weeks and the fourth between 36 weeks and term. Early registration allows dating, baseline tests and the start of Td and iron-folic acid. The third-trimester visits are timed to pick up pre-eclampsia, anaemia, malpresentation and growth problems before labour. WHO's 2016 model goes further, with eight contacts.
- B: The first visit, not the third, should be within 12 weeks.
- C: 14 to 26 weeks is the window for the second visit.
- D: 36 weeks to term is the window for the fourth visit.
Question 4 · Easy
A 19-year-old primigravida at 16 weeks attends the ANC clinic at a PHC. She has no record of any tetanus or Td vaccination in the past. What schedule of Td should she receive in this pregnancy?
1. ATd now and a second dose 4 weeks later
2. BOne Td dose now and one at delivery
3. CA single dose of Td now
4. DTd now, at 1 month and at 6 months
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Answer: A · Td now and a second dose 4 weeks later
Under the Universal Immunisation Programme, a pregnant woman who has not been immunised gets two doses of Td: the first early in pregnancy and the second 4 weeks later, ideally finished well before delivery. Antibodies cross the placenta and protect the newborn against neonatal tetanus. A single booster dose is enough only if she received two doses in a pregnancy within the last 3 years. Td replaced TT in the programme to also boost protection against diphtheria.
- B: A dose at delivery comes too late to protect the newborn.
- C: A single booster suits women immunised in a pregnancy within 3 years.
- D: Three doses is a primary series for unimmunised adults outside pregnancy.
Question 5 · Medium
A 38-year-old woman at 11 weeks had a cell-free DNA test (NIPT) at a private laboratory, which reports a high risk of trisomy 21. Her ultrasound is otherwise normal. She asks whether she should terminate the pregnancy. What is the most appropriate next step?
1. ATerminate on the basis of the result
2. BDo a quadruple test at 16 weeks
3. CConfirm with chorionic villus sampling
4. DRepeat the cell-free DNA test
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Answer: C · Confirm with chorionic villus sampling
Cell-free DNA in maternal blood comes mainly from the placenta (trophoblast), not the fetus itself, so confined placental mosaicism and other causes can give false-positive results. NIPT is therefore a screening test, however good its detection rate, and a positive result must be confirmed by a diagnostic test (CVS now, or amniocentesis from 15 weeks) before any decision on termination. Repeating the screening test or adding serum screening does not give a diagnosis. Counselling should be non-directive, and the decision remains hers once the diagnosis is confirmed.
- A: A screening result alone must not decide termination.
- B: Serum screening is less accurate than NIPT and still not diagnostic.
- D: A repeat screen still cannot give a diagnosis.
Question 6 · Medium
A 36-year-old second gravida has first-trimester combined screening at 12 weeks 3 days. The crown-rump length is 62 mm and nuchal translucency is 3.4 mm. Which serum pattern would most raise her risk of trisomy 21?
1. ARaised free beta-hCG, raised PAPP-A
2. BRaised free beta-hCG, low PAPP-A
3. CNormal free beta-hCG, raised PAPP-A
4. DLow free beta-hCG, low PAPP-A
Answer and explanation in LearnFree account
Question 7 · Easy
A 27-year-old woman at her first ANC visit cannot recall the date of her last period because she was breastfeeding her first child. A transvaginal scan shows a single live intrauterine fetus of about 9 weeks. Which ultrasound measurement dates this pregnancy most accurately?
1. ABiparietal diameter
2. BCrown-rump length
3. CGestational sac diameter
4. DFemur length
Answer and explanation in LearnFree account
Question 8 · Medium
A 26-year-old at 30 weeks is referred from the ANC clinic because the doctor heard a murmur. Four findings are noted: 1. A third heart sound. 2. A soft ejection systolic murmur at the left sternal edge. 3. A mid-diastolic murmur at the apex. 4. Left axis shift of the QRS on ECG. Which of these can be explained by normal pregnancy?
1. A1, 2, 3 and 4
2. B1, 2 and 4 only
3. C1 and 2 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 9 · Hard
A 34-year-old at 12 weeks had a nuchal translucency of 4.0 mm, and chorionic villus sampling showed a normal 46,XX karyotype with a normal microarray. She is relieved and asks whether any further tests are needed. What additional evaluation should be planned?
1. AMaternal TORCH serology this week
2. BFetal echocardiography at about 20 weeks
3. CRepeat CVS for mosaicism at 14 weeks
4. DNo further tests beyond routine care
Answer and explanation in LearnFree account
Question 10 · Hard
A 29-year-old at 17 weeks, who booked late, has a quadruple test: AFP 0.55 MoM, unconjugated oestriol 0.35 MoM, hCG 0.30 MoM and inhibin A 1.0 MoM. Her dates are confirmed by an early scan, and she is not diabetic. Which condition does this pattern most suggest?
1. ATurner syndrome with hydrops
2. BOpen neural tube defect
3. CTrisomy 21
4. DTrisomy 18
Answer and explanation in LearnFree account
Question 11 · Easy
A 25-year-old had a normal 75 g glucose test at her booking visit at 10 weeks. At 26 weeks the PHC doctor asks her to repeat it, and she asks why. Which placental hormone mainly drives the rising insulin resistance of the second half of pregnancy?
1. AHuman chorionic gonadotropin
2. BHuman placental lactogen
3. COxytocin
4. DRelaxin
Answer and explanation in LearnFree account
Question 12 · Medium
During a growth scan at 34 weeks, a 27-year-old lying flat on her back for 15 minutes becomes pale, sweaty and dizzy. Her BP is 84/50 mm Hg and pulse 112/min. What is the immediate step?
1. AGive IV phenylephrine at once
2. BTurn her onto her left side
3. CGive an IV fluid bolus of 1 L
4. DRaise the legs with her flat
Answer and explanation in LearnFree account
Question 13 · Hard
A 26-year-old at 30 weeks with known asthma is brought to casualty with acute breathlessness. After three salbutamol nebulisations and IV hydrocortisone she still speaks in short phrases. Pulse is 124/min, respiratory rate 30/min, SpO2 93% on oxygen. ABG: pH 7.38, PaCO2 40 mm Hg, PaO2 72 mm Hg, HCO3- 23 mEq/L. The resident notes that the PaCO2 is 'normal'. How should this gas be read, and what follows?
1. AMetabolic acidosis; give IV sodium bicarbonate
2. BImpending respiratory failure; escalate to ICU care
3. CAnxiety hyperventilation; reassure her
4. DNormal for pregnancy; continue ward treatment
Answer and explanation in LearnFree account
Question 14 · Medium
A 28-year-old at 28 weeks has a routine growth scan that also reports mild dilatation of the right renal pelvis and ureter down to the pelvic brim; the left side is less affected. She has no pain or fever, and urine microscopy and culture are normal. What best explains this finding?
1. APhysiological dilatation from progesterone and pressure
2. BCongenital pelviureteric junction obstruction
3. CEarly acute pyelonephritis
4. DObstruction by a stone at the pelvic brim
Answer and explanation in LearnFree account
Question 15 · Medium
A 23-year-old at 14 weeks has a routine urine culture at her first ANC visit that grows more than 10^5 CFU/mL of Escherichia coli sensitive to nitrofurantoin and cephalexin. She has no urinary symptoms. What is the best management?
1. ANo treatment unless symptoms develop
2. BTreat with oral ciprofloxacin
3. CAdmit for IV ceftriaxone
4. DTreat with oral nitrofurantoin
Answer and explanation in LearnFree account
Question 16 · Hard
A 32-year-old second gravida with regular 28-day cycles comes to the ANC clinic for her nuchal scan. By her last menstrual period she is 12 weeks 2 days, but the crown-rump length today is 36 mm, corresponding to 10 weeks 4 days. The fetus is alive and the scan is otherwise normal. What is the most appropriate step?
1. AKeep LMP dates and label the fetus growth-restricted
2. BRe-date by CRL and skip NT, offering the quadruple test
3. CKeep LMP dates and measure the NT today
4. DRe-date by CRL and repeat the NT scan in about a week
Answer and explanation in LearnFree account
Question 17 · Medium
A 24-year-old primigravida at 17 weeks has maternal serum AFP of 3.1 multiples of the median. Her dating was by last menstrual period only, and she has had no scan. What is the most appropriate next step?
1. ARepeat serum AFP after 2 weeks
2. BFetal karyotyping by amniocentesis
3. CTargeted ultrasound of the fetus
4. DAmniotic fluid acetylcholinesterase
Answer and explanation in LearnFree account
Question 18 · Hard
A 27-year-old at 24 weeks, sent from a PHC with palpitations, has these results: total T4 15.5 µg/dL (non-pregnant reference 5-12), free T4 1.2 ng/dL (0.8-1.8), TSH 1.6 mIU/L (second-trimester reference 0.2-3.0). Pulse is 92/min, she has no goitre, tremor or eye signs, and her weight gain is normal. The PHC doctor has suggested starting propylthiouracil. What is the best interpretation?
1. AT4 toxicosis needing beta-blockers
2. BRaised TBG from oestrogen; no treatment
3. CGestational transient thyrotoxicosis
4. DGraves disease needing antithyroid drugs
Answer and explanation in LearnFree account
Question 19 · Medium
During an inspection of a private ultrasound clinic, the district appropriate authority checks four practices: 1. A Form F is filled for every pregnant woman scanned. 2. The clinic is registered under the PCPNDT Act. 3. The sex of the fetus may be told to parents after 20 weeks. 4. A notice that sex determination is not done is displayed. Which practices are required by law?
1. A1, 2, 3 and 4
2. B1, 2 and 4 only
3. C1, 2 and 3 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 20 · Medium
A 30-year-old at 34 weeks has routine liver tests: total bilirubin 0.6 mg/dL, ALT 22 U/L, AST 25 U/L, GGT 18 U/L and alkaline phosphatase 290 U/L (non-pregnant reference 44-147 U/L). She has no itching, pain or other symptoms and her BP is normal. What is the most likely source of the raised alkaline phosphatase?
1. ABone disease
2. BThe placenta
3. CEarly HELLP syndrome
4. DIntrahepatic cholestasis
Answer and explanation in LearnFree account
Question 21 · Medium
A 35-year-old at 12 weeks has a first-trimester combined screening risk of 1 in 25 for trisomy 21. After counselling, she wants a definite answer as early as possible. Which test should be offered now?
1. AQuadruple serum test
2. BChorionic villus sampling
3. CCordocentesis
4. DAmniocentesis today
Answer and explanation in LearnFree account
Question 22 · Easy
At a village health and nutrition day, the ANM gives a woman at 16 weeks of pregnancy her iron and folic acid tablets under Anaemia Mukt Bharat. What is the prophylactic regimen for her?
1. A100 mg iron + 500 µg folic acid daily for 100 days
2. B60 mg iron + 500 µg folic acid daily for 180 days
3. C45 mg iron + 400 µg folic acid daily for 90 days
4. D60 mg iron + 500 µg folic acid weekly for 180 days
Answer and explanation in LearnFree account
Question 23 · Medium
A 26-year-old woman whose first baby was born with anencephaly comes to the gynae OPD because she plans another pregnancy in 3 months. She has no other illness. What folic acid advice is most appropriate?
1. A400 µg daily from the missed period
2. B4 mg daily from a month before conception
3. C4 mg daily starting at 12 weeks
4. D400 µg daily for the whole pregnancy
Answer and explanation in LearnFree account
Question 24 · Medium
A 30-year-old at 32 weeks asks why she was told to keep walking and drink water on a long train journey. Her routine tests show fibrinogen 480 mg/dL and a slightly short aPTT. Which pregnancy change contributes to her higher risk of venous thrombosis?
1. AA rise in antithrombin
2. BA rise in plasminogen activator
3. CA fall in free protein S
4. DA fall in factor VIII
Answer and explanation in LearnFree account

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Antenatal care, screening and physiology of pregnancy

A 28-year-old at 22 weeks has 1+ glucose on urine dipstick at an ANC visit. Her 75 g oral glucose test, fasting plasma glucose and HbA1c are all normal. What is the most likely mechanism of the glycosuria?

A 29-year-old at 32 weeks has an arterial blood gas sampled during a pre-anaesthetic work-up for a breast lump: pH 7.44, PaCO2 30 mm Hg, PaO2 104 mm Hg, HCO3- 20 mEq/L. She is well and not breathless. How should the gas be interpreted?

A 22-year-old primigravida registers at a sub-centre at 10 weeks and is told she should have at least four antenatal check-ups. Under MoHFW guidance, in which period should her third visit fall?

A 19-year-old primigravida at 16 weeks attends the ANC clinic at a PHC. She has no record of any tetanus or Td vaccination in the past. What schedule of Td should she receive in this pregnancy?

A 38-year-old woman at 11 weeks had a cell-free DNA test (NIPT) at a private laboratory, which reports a high risk of trisomy 21. Her ultrasound is otherwise normal. She asks whether she should terminate the pregnancy. What is the most appropriate next step?

A 36-year-old second gravida has first-trimester combined screening at 12 weeks 3 days. The crown-rump length is 62 mm and nuchal translucency is 3.4 mm. Which serum pattern would most raise her risk of trisomy 21?

A 27-year-old woman at her first ANC visit cannot recall the date of her last period because she was breastfeeding her first child. A transvaginal scan shows a single live intrauterine fetus of about 9 weeks. Which ultrasound measurement dates this pregnancy most accurately?

A 34-year-old at 12 weeks had a nuchal translucency of 4.0 mm, and chorionic villus sampling showed a normal 46,XX karyotype with a normal microarray. She is relieved and asks whether any further tests are needed. What additional evaluation should be planned?

A 29-year-old at 17 weeks, who booked late, has a quadruple test: AFP 0.55 MoM, unconjugated oestriol 0.35 MoM, hCG 0.30 MoM and inhibin A 1.0 MoM. Her dates are confirmed by an early scan, and she is not diabetic. Which condition does this pattern most suggest?

A 25-year-old had a normal 75 g glucose test at her booking visit at 10 weeks. At 26 weeks the PHC doctor asks her to repeat it, and she asks why. Which placental hormone mainly drives the rising insulin resistance of the second half of pregnancy?

During a growth scan at 34 weeks, a 27-year-old lying flat on her back for 15 minutes becomes pale, sweaty and dizzy. Her BP is 84/50 mm Hg and pulse 112/min. What is the immediate step?

A 28-year-old at 28 weeks has a routine growth scan that also reports mild dilatation of the right renal pelvis and ureter down to the pelvic brim; the left side is less affected. She has no pain or fever, and urine microscopy and culture are normal. What best explains this finding?

A 23-year-old at 14 weeks has a routine urine culture at her first ANC visit that grows more than 10^5 CFU/mL of Escherichia coli sensitive to nitrofurantoin and cephalexin. She has no urinary symptoms. What is the best management?

A 24-year-old primigravida at 17 weeks has maternal serum AFP of 3.1 multiples of the median. Her dating was by last menstrual period only, and she has had no scan. What is the most appropriate next step?

A 35-year-old at 12 weeks has a first-trimester combined screening risk of 1 in 25 for trisomy 21. After counselling, she wants a definite answer as early as possible. Which test should be offered now?

At a village health and nutrition day, the ANM gives a woman at 16 weeks of pregnancy her iron and folic acid tablets under Anaemia Mukt Bharat. What is the prophylactic regimen for her?

A 26-year-old woman whose first baby was born with anencephaly comes to the gynae OPD because she plans another pregnancy in 3 months. She has no other illness. What folic acid advice is most appropriate?

A 30-year-old at 32 weeks asks why she was told to keep walking and drink water on a long train journey. Her routine tests show fibrinogen 480 mg/dL and a slightly short aPTT. Which pregnancy change contributes to her higher risk of venous thrombosis?