A 27-year-old second gravida at 24 weeks is screened at a PHC with the national single-step test: 75 g oral glucose regardless of the last meal, giving plasma glucose 162 mg/dL at 2 hours. After two weeks of medical nutrition therapy and exercise, her fasting glucose is 104 mg/dL and 2-hour post-meal glucose 138 mg/dL (targets: fasting 95 mg/dL or less, 2-hour post-meal 120 mg/dL or less). What is the most appropriate next step?

Start insulin and continue the diet

Plan induction of labour at 34 weeks

Continue diet alone for four more weeks

Repeat the 75 g test at 32 weeks

A 28-year-old with epilepsy, on phenytoin for 6 years, is 26 weeks pregnant with twins. She did not take any supplements in the first trimester. Haemoglobin is 8.8 g/dL with MCV 108 fL, and the smear shows hypersegmented neutrophils and macro-ovalocytes. Serum vitamin B12 is 410 pg/mL (200-900). What is the most appropriate treatment?

Stop phenytoin, start valproate

Intramuscular vitamin B12 alone

A 26-year-old primigravida with mitral stenosis, NYHA class II on metoprolol, is at 39 weeks in spontaneous labour with a cephalic fetus, an adequate pelvis and a normal fetal heart. What is the best plan for delivery?

Vaginal delivery, epidural, assisted second stage

Vaginal delivery with prolonged active pushing

Emergency caesarean section under general anaesthesia

Augment with rapid oxytocin and IV fluids

A 30-year-old with gestational diabetes was controlled on insulin, 6 units before breakfast and 10 units before dinner, from 30 weeks. She has a normal vaginal delivery at 39 weeks in a district hospital and wants to breastfeed. What should be done with her insulin?

Stop insulin and check her blood glucose

Replace insulin with glibenclamide

Halve the doses until the postnatal OGTT

Continue the same doses for six weeks

Diabetes, anaemia and medical disorders in pregnancy

33 NEET-PG practice questions on Diabetes, anaemia and medical disorders in pregnancy, part of Obstetrics & Gynaecology. The first 25 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 · Hard
A 27-year-old second gravida at 24 weeks is screened at a PHC with the national single-step test: 75 g oral glucose regardless of the last meal, giving plasma glucose 162 mg/dL at 2 hours. After two weeks of medical nutrition therapy and exercise, her fasting glucose is 104 mg/dL and 2-hour post-meal glucose 138 mg/dL (targets: fasting 95 mg/dL or less, 2-hour post-meal 120 mg/dL or less). What is the most appropriate next step?
1. AStart insulin and continue the diet
2. BPlan induction of labour at 34 weeks
3. CContinue diet alone for four more weeks
4. DRepeat the 75 g test at 32 weeks
Show answerHide answer
Answer: A · Start insulin and continue the diet
The single-step (DIPSI) test used in India diagnoses gestational diabetes when the 2-hour plasma glucose after 75 g of glucose, taken fasting or not, is 140 mg/dL or more, so 162 mg/dL confirms GDM. Diet and exercise are tried first for about two weeks; her fasting and post-meal values are both above target, so insulin is added while she continues the diet. Insulin does not cross the placenta and is the standard drug in the national guideline. Uncontrolled hyperglycaemia causes fetal hyperinsulinaemia, macrosomia, shoulder dystocia and neonatal hypoglycaemia, and she needs a repeat glucose test after delivery because of her later risk of type 2 diabetes.
- B: Well-controlled GDM does not need preterm delivery.
- C: Two weeks of diet has failed; waiting longer exposes the fetus to hyperglycaemia.
- D: The diagnosis is already made; retesting delays treatment.
Question 2 · Medium
A 27-year-old with moderate rheumatic mitral stenosis, NYHA class II, has a normal vaginal delivery in a district hospital labour room. The duty doctor plans active management of the third stage. Which drug should be avoided?
1. AMethylergometrine
2. BMisoprostol
3. CTranexamic acid
4. DOxytocin by slow infusion
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Answer: A · Methylergometrine
Ergometrine causes sustained contraction of the uterus and of vascular smooth muscle, squeezing a large volume of blood into the circulation and raising blood pressure. In a woman with mitral stenosis, this sudden preload can precipitate pulmonary oedema, already a risk just after delivery, when uterine contraction returns blood to the circulation. Oxytocin given as a slow, dilute infusion, not as a rapid IV bolus, is the uterotonic of choice. She also needs close monitoring for the first hours after delivery, the most dangerous period for cardiac decompensation.
- B: Misoprostol does not cause the vasoconstriction ergometrine does.
- C: Tranexamic acid reduces bleeding without raising preload.
- D: Oxytocin by slow infusion is the safe uterotonic here.
Question 3 · Medium
A 28-year-old with epilepsy, on phenytoin for 6 years, is 26 weeks pregnant with twins. She did not take any supplements in the first trimester. Haemoglobin is 8.8 g/dL with MCV 108 fL, and the smear shows hypersegmented neutrophils and macro-ovalocytes. Serum vitamin B12 is 410 pg/mL (200-900). What is the most appropriate treatment?
1. AStop phenytoin, start valproate
2. BIntravenous iron sucrose
3. COral folic acid 5 mg daily
4. DIntramuscular vitamin B12 alone
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Answer: C · Oral folic acid 5 mg daily
Macrocytosis with hypersegmented neutrophils is megaloblastic anaemia, and with a normal B12 the cause is folate deficiency. Pregnancy raises folate needs, more so with twins, and phenytoin lowers folate further by impairing its absorption and increasing its metabolism. The treatment is oral folic acid, 5 mg daily, given only after B12 deficiency has been excluded, as here, because folate alone can let the neurological damage of B12 deficiency progress. Women on enzyme-inducing antiepileptics should take folic acid before conception to reduce neural tube defects.
- A: Valproate is the most teratogenic antiepileptic and also lowers folate.
- B: This anaemia is macrocytic, not iron deficient.
- D: B12 is normal; injecting it alone will not correct folate deficiency.
Question 4 · Medium
A 26-year-old primigravida with mitral stenosis, NYHA class II on metoprolol, is at 39 weeks in spontaneous labour with a cephalic fetus, an adequate pelvis and a normal fetal heart. What is the best plan for delivery?
1. AVaginal delivery with prolonged active pushing
2. BEmergency caesarean section under general anaesthesia
3. CVaginal delivery, epidural, assisted second stage
4. DAugment with rapid oxytocin and IV fluids
Show answerHide answer
Answer: C · Vaginal delivery, epidural, assisted second stage
In most women with heart disease, vaginal delivery is safer than caesarean, which adds blood loss, fluid shifts, infection and thromboembolism; caesarean is kept for obstetric reasons and a few cardiac ones. Epidural analgesia blunts the pain-driven rise in heart rate and cardiac output, and she labours propped up or on her side. Prolonged bearing down is avoided, so the second stage is shortened by outlet forceps or vacuum. Fluids are restricted, and she is watched closely after delivery, when preload rises suddenly.
- A: Prolonged pushing strains the heart; the second stage is shortened.
- B: Heart disease alone is not an indication for caesarean section.
- D: Rapid fluids and oxytocin boluses can precipitate pulmonary oedema.
Question 5 · Medium
A 30-year-old with gestational diabetes was controlled on insulin, 6 units before breakfast and 10 units before dinner, from 30 weeks. She has a normal vaginal delivery at 39 weeks in a district hospital and wants to breastfeed. What should be done with her insulin?
1. AStop insulin and check her blood glucose
2. BReplace insulin with glibenclamide
3. CHalve the doses until the postnatal OGTT
4. DContinue the same doses for six weeks
Show answerHide answer
Answer: A · Stop insulin and check her blood glucose
In gestational diabetes the insulin resistance is caused by placental hormones, so it disappears once the placenta is delivered and insulin is stopped after birth. Blood glucose is checked for a day or two to pick up the few women who actually had undiagnosed pre-existing diabetes. Continuing insulin risks hypoglycaemia, particularly while breastfeeding. She needs a 75 g OGTT some weeks after delivery and lifelong screening, because she has a high risk of type 2 diabetes later.
- B: She needs no glucose-lowering drug after delivery.
- C: A reduced dose is still unnecessary and can cause hypoglycaemia.
- D: Insulin resistance resolves with the placenta, so continuing risks hypoglycaemia.
Question 6 · Medium
A 4.1 kg baby is born at 38 weeks to a mother whose gestational diabetes was poorly controlled. At 2 hours of age the baby is jittery and the blood glucose is 30 mg/dL. What is the main mechanism of this hypoglycaemia?
1. ADeficient neonatal cortisol response
2. BFetal islet hyperplasia with excess insulin
3. CPoor glycogen stores from growth restriction
4. DMaternal insulin crossing the placenta
Answer and explanation in LearnFree account
Question 7 · Easy
A 22-year-old primigravida at 10 weeks has her first antenatal visit at a PHC. She is given 75 g of oral glucose without regard to her last meal, and her plasma glucose at 2 hours is 126 mg/dL. According to the national GDM guideline, what should be done next?
1. ANo further glucose testing this pregnancy
2. BRepeat the same test at 24-28 weeks
3. CConfirm with a 100 g three-hour OGTT
4. DStart medical nutrition therapy now
Answer and explanation in LearnFree account
Question 8 · Medium
A 30-year-old at 37 weeks from a tribal block comes to the district hospital breathless on walking. Pulse is 112/min, BP 110/70 mm Hg, there are no basal crepitations, and the fetal heart rate is 144/min. Haemoglobin is 6.1 g/dL with a microcytic picture. What is the most appropriate management?
1. ARapid whole blood transfusion
2. BDouble-dose oral iron until labour
3. CIV ferric carboxymaltose alone
4. DSlow packed red cell transfusion
Answer and explanation in LearnFree account
Question 9 · Medium
In a NICU, a resident caring for the 37-week baby of a mother with poorly controlled pre-gestational diabetes lists the problems to watch for: 1. Hypoglycaemia in the first hours after birth. 2. Polycythaemia and hyperbilirubinaemia. 3. Respiratory distress from delayed surfactant maturation. 4. Hypermagnesaemia causing floppiness. Which of these are expected in this baby?
1. A1, 3 and 4 only
2. B1 and 2 only
3. C1, 2 and 3 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 10 · Medium
A 32-year-old with gestational diabetes on insulin is admitted at 31 weeks with threatened preterm labour and receives the first dose of intramuscular betamethasone. Twelve hours later her capillary glucose values are 220-250 mg/dL, and urine ketones are negative. What is the most appropriate step?
1. AIncrease insulin with close glucose monitoring
2. BSwitch from insulin to glibenclamide
3. CMake no change, as the rise is transient
4. DWithhold the second dose of betamethasone
Answer and explanation in LearnFree account
Question 11 · Medium
A 22-year-old tea plantation worker at 20 weeks has haemoglobin 8.8 g/dL with a microcytic hypochromic picture. She walks barefoot, and stool examination shows hookworm ova. She is started on iron-folic acid. What else should she receive?
1. AAlbendazole 400 mg as a single dose now
2. BPraziquantel as a single dose now
3. CIvermectin as a single dose now
4. DDeworming deferred until after delivery
Answer and explanation in LearnFree account
Question 12 · Easy
A 23-year-old at 24 weeks, given iron-folic acid and calcium tablets at a PHC, has a haemoglobin of 9.8 g/dL, unchanged in 6 weeks. She takes the IFA tablet with her calcium tablet and a cup of tea after breakfast every morning. What is the most appropriate advice?
1. ATake IFA together with milk to reduce nausea
2. BTake IFA apart from tea and the calcium tablet
3. CStop IFA and switch to intramuscular iron
4. DTake IFA only once a week instead of daily
Answer and explanation in LearnFree account
Question 13 · Hard
A 24-year-old with type 1 diabetes at 30 weeks comes to casualty after 2 days of vomiting and missing insulin doses. She is drowsy, breathing deeply, pulse 118/min, BP 100/64 mm Hg. Results: plasma glucose 230 mg/dL, arterial pH 7.12, bicarbonate 8 mmol/L, potassium 4.1 mmol/L and urine ketones 3+. The CTG shows reduced variability with late decelerations. What is the most appropriate next step?
1. ATreat the ketoacidosis first, then reassess the fetus
2. BCorticosteroids and delivery after 48 hours
3. CIV sodium bicarbonate, then caesarean section
4. DEmergency caesarean section for fetal distress
Answer and explanation in LearnFree account
Question 14 · Medium
A 28-year-old with type 1 diabetes, well controlled on basal-bolus insulin, finds that her insulin requirement climbs steadily from about 24 weeks of pregnancy and has nearly doubled by 34 weeks. Which placental hormone is chiefly responsible for this rise?
1. ARelaxin
2. BOestriol
3. CHuman chorionic gonadotropin
4. DHuman placental lactogen
Answer and explanation in LearnFree account
Question 15 · Medium
A 24-year-old had a haemoglobin of 12.6 g/dL at booking. At 30 weeks it is 11.2 g/dL, with normal red cell indices and a normal serum ferritin, and she feels well. What explains the fall in haemoglobin?
1. APlasma volume rises more than red cell mass
2. BOestrogen shortens the red cell lifespan
3. CIron is diverted to the fetus and placenta
4. DRed cell production is suppressed in pregnancy
Answer and explanation in LearnFree account
Question 16 · Easy
A 26-year-old at 7 weeks is diagnosed with Graves' disease: she has a diffuse goitre, proptosis, a suppressed TSH, a high free T4 and positive TSH receptor antibodies. Which antithyroid drug is preferred at this stage of pregnancy?
1. APotassium iodide
2. BCarbimazole
3. CPropylthiouracil
4. DRadioactive iodine
Answer and explanation in LearnFree account
Question 17 · Medium
A 25-year-old at 14 weeks has these results at booking: haemoglobin 9.6 g/dL, MCV 64 fL, MCH 20 pg, RBC count 5.8 million/µL, RDW 13.2% (11.5-14.5) and serum ferritin 82 ng/mL (15-150). The smear shows microcytes and target cells. Which investigation should be done next?
1. ASerum vitamin B12 and folate
2. BBone marrow iron stain
3. CHaemoglobin HPLC for HbA2
4. DTherapeutic trial of oral iron
Answer and explanation in LearnFree account
Question 18 · Hard
A 31-year-old second gravida with a BMI of 31 kg/m2 books at 8 weeks in an urban ANC clinic. Her mother has type 2 diabetes. Fasting plasma glucose is 138 mg/dL and HbA1c is 7.4%; a repeat fasting value two days later is 134 mg/dL. Insulin is started and she is referred to the high-risk clinic. Besides glucose control, which assessment is most important for the fetus in this pregnancy?
1. AWeekly non-stress tests from 20 weeks
2. BRepeat 75 g OGTT at 24-28 weeks
3. CDetailed anomaly scan with fetal echocardiography
4. DSerial middle cerebral artery Doppler
Answer and explanation in LearnFree account
Question 19 · Easy
A 25-year-old primigravida at 30 weeks is examined in the ANC clinic. She is asymptomatic. Which finding needs echocardiography because it is not explained by normal pregnancy?
1. AMid-diastolic murmur at the apex
2. BAudible third heart sound
3. CMild bilateral ankle oedema
4. DSoft ejection systolic murmur
Answer and explanation in LearnFree account
Question 20 · Easy
A 23-year-old at 26 weeks attends an ANC clinic with tiredness. Her haemoglobin is 8.2 g/dL. How is her anaemia graded by the WHO criteria used in India for pregnant women?
1. APhysiological anaemia of pregnancy
2. BSevere anaemia
3. CMild anaemia
4. DModerate anaemia
Answer and explanation in LearnFree account
Question 21 · Easy
In the NICU, a term newborn of a mother with poorly controlled type 1 diabetes has flat buttocks, short wasted lower limbs with flexion contractures and absent ankle jerks. An X-ray shows absence of the sacrum and lower lumbar vertebrae. This anomaly is:
1. ALumbosacral meningomyelocele
2. BCaudal regression syndrome
3. CSacrococcygeal teratoma
4. DPotter sequence
Answer and explanation in LearnFree account
Question 22 · Medium
A 27-year-old who is breastfeeding comes to the OPD 3 months after delivery with palpitations, anxiety and weight loss. There is a small, painless goitre and no eye signs. TSH is below 0.01 mU/L, free T4 is raised, anti-TPO antibodies are strongly positive and TSH receptor antibodies are negative. What is the most appropriate management?
1. ARadioactive iodine ablation
2. BCarbimazole for 18 months
3. CTotal thyroidectomy
4. DPropranolol and repeat thyroid tests
Answer and explanation in LearnFree account
Question 23 · Medium
A 27-year-old at 28 weeks has haemoglobin 8.4 g/dL, MCV 70 fL and serum ferritin 8 ng/mL. She stopped oral iron after 4 weeks because of repeated vomiting and constipation, and her haemoglobin has not risen. She has no breathlessness and the fetus is growing normally. What is the most appropriate treatment?
1. ARecombinant erythropoietin injections
2. BPacked red cell transfusion
3. CIntravenous ferric carboxymaltose
4. DDouble the dose of oral iron
Answer and explanation in LearnFree account
Question 24 · Medium
A 29-year-old with no previous heart disease presents 6 weeks after a twin delivery with breathlessness on lying flat and swollen legs. BP is 116/76 mm Hg and there is no proteinuria. Echocardiography shows a dilated left ventricle with an ejection fraction of 30% and normal valves; CT pulmonary angiography is normal. What is the most likely diagnosis?
1. ARheumatic mitral stenosis
2. BPulmonary thromboembolism
3. CPeripartum cardiomyopathy
4. DPostpartum pre-eclampsia
Answer and explanation in LearnFree account
Question 25 · Medium
A 29-year-old with primary hypothyroidism, well controlled on levothyroxine 75 µg daily with a recent TSH of 1.8 mU/L, has a positive urine pregnancy test at 5 weeks and comes to the gynae OPD. What is the most appropriate advice?
1. ARaise the dose by about 25-30% and recheck TSH in 4 weeks
2. BKeep the same dose and check TSH at 20 weeks
3. CStop levothyroxine until the first trimester ends
4. DChange levothyroxine to liothyronine
Answer and explanation in LearnFree account

8 more Diabetes, anaemia and medical disorders in pregnancy questions

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Diabetes, anaemia and medical disorders in pregnancy

A 27-year-old with moderate rheumatic mitral stenosis, NYHA class II, has a normal vaginal delivery in a district hospital labour room. The duty doctor plans active management of the third stage. Which drug should be avoided?

A 26-year-old primigravida with mitral stenosis, NYHA class II on metoprolol, is at 39 weeks in spontaneous labour with a cephalic fetus, an adequate pelvis and a normal fetal heart. What is the best plan for delivery?

A 30-year-old with gestational diabetes was controlled on insulin, 6 units before breakfast and 10 units before dinner, from 30 weeks. She has a normal vaginal delivery at 39 weeks in a district hospital and wants to breastfeed. What should be done with her insulin?

A 4.1 kg baby is born at 38 weeks to a mother whose gestational diabetes was poorly controlled. At 2 hours of age the baby is jittery and the blood glucose is 30 mg/dL. What is the main mechanism of this hypoglycaemia?

A 22-year-old primigravida at 10 weeks has her first antenatal visit at a PHC. She is given 75 g of oral glucose without regard to her last meal, and her plasma glucose at 2 hours is 126 mg/dL. According to the national GDM guideline, what should be done next?

A 30-year-old at 37 weeks from a tribal block comes to the district hospital breathless on walking. Pulse is 112/min, BP 110/70 mm Hg, there are no basal crepitations, and the fetal heart rate is 144/min. Haemoglobin is 6.1 g/dL with a microcytic picture. What is the most appropriate management?

A 32-year-old with gestational diabetes on insulin is admitted at 31 weeks with threatened preterm labour and receives the first dose of intramuscular betamethasone. Twelve hours later her capillary glucose values are 220-250 mg/dL, and urine ketones are negative. What is the most appropriate step?

A 22-year-old tea plantation worker at 20 weeks has haemoglobin 8.8 g/dL with a microcytic hypochromic picture. She walks barefoot, and stool examination shows hookworm ova. She is started on iron-folic acid. What else should she receive?

A 23-year-old at 24 weeks, given iron-folic acid and calcium tablets at a PHC, has a haemoglobin of 9.8 g/dL, unchanged in 6 weeks. She takes the IFA tablet with her calcium tablet and a cup of tea after breakfast every morning. What is the most appropriate advice?

A 28-year-old with type 1 diabetes, well controlled on basal-bolus insulin, finds that her insulin requirement climbs steadily from about 24 weeks of pregnancy and has nearly doubled by 34 weeks. Which placental hormone is chiefly responsible for this rise?

A 24-year-old had a haemoglobin of 12.6 g/dL at booking. At 30 weeks it is 11.2 g/dL, with normal red cell indices and a normal serum ferritin, and she feels well. What explains the fall in haemoglobin?

A 26-year-old at 7 weeks is diagnosed with Graves' disease: she has a diffuse goitre, proptosis, a suppressed TSH, a high free T4 and positive TSH receptor antibodies. Which antithyroid drug is preferred at this stage of pregnancy?

A 25-year-old at 14 weeks has these results at booking: haemoglobin 9.6 g/dL, MCV 64 fL, MCH 20 pg, RBC count 5.8 million/µL, RDW 13.2% (11.5-14.5) and serum ferritin 82 ng/mL (15-150). The smear shows microcytes and target cells. Which investigation should be done next?

A 25-year-old primigravida at 30 weeks is examined in the ANC clinic. She is asymptomatic. Which finding needs echocardiography because it is not explained by normal pregnancy?

A 23-year-old at 26 weeks attends an ANC clinic with tiredness. Her haemoglobin is 8.2 g/dL. How is her anaemia graded by the WHO criteria used in India for pregnant women?

In the NICU, a term newborn of a mother with poorly controlled type 1 diabetes has flat buttocks, short wasted lower limbs with flexion contractures and absent ankle jerks. An X-ray shows absence of the sacrum and lower lumbar vertebrae. This anomaly is:

A 29-year-old with primary hypothyroidism, well controlled on levothyroxine 75 µg daily with a recent TSH of 1.8 mU/L, has a positive urine pregnancy test at 5 weeks and comes to the gynae OPD. What is the most appropriate advice?