Welcome to your MRCOG Part One (1)

Name

Which of the following features is NOT a characteristic of partial hydatid form molar pregnancies?

triploid karyotype

positive p57Kip2 immunostaining

Focal villous edema

Fifteen percent risk of post molar malignant sequelae

None

A 35-year-old woman presents with a missed abortion at 14 weeks gestation. Ultrasound reveals a cystic mass with scant fetal parts. Histopathological examination demonstrates hydropic degeneration of the villi. Immunohistochemical staining shows strong expression of p57. Karyotyping reveals a 46,XX karyotype. Given these findings, which of the following statements is MOST accurate regarding the most likely diagnosis and the role of p57 staining in this case?

Complete mole with a false-positive p57 stain due to technical error.

Partial mole with p57 expression confirming the diagnosis

Non-molar hydropic abortion with a paternally derived p57 allele contributing to the hydropic changes

Triploid complete mole with p57 expression due to mosaicism with a maternal cell line

Missed abortion with superimposed partial mole; p57 staining is not diagnostically helpful in this scenario

None

A 35-year-year-old woman presents with a history of evacuation of a complete molar pregnancy two months ago This finding, if found bilaterally in her adnexa she is at increasesd risk of which of the following?

Preeclampsia

Thyroid storm

Hyperemesis gravidarum

Gestational trophoblastic neoplasia

None

A surgeon is planning a skin incision on the anterior abdominal wall for a surgical procedure. To minimize scar visibility post-operatively which of the following contribute to the Wide scars that often develop following vertical midline incisions ?

Surgical technique

Poorly developed Camper fascia

Inferior epigastric artery injury

tension in the Langer lines of skin

None

A patient present in early pregnanncy with vaginal bleeding, her ultrasound shown below shows no fetal part, which of the following is the possible karyotype?

69XXX

69XXY

69XYY

46XX

None

A 52-year-old postmenopausal woman with a history of obesity and nulliparity presents with abnormal uterine bleeding. She denies ever using any form of hormonal therapy. Which of the following risk factors is MOST LIKELY associated with her developing endometrial carcinoma?

Early menarche

History of breast cancer

Long-term use of oral contraceptives

Use of tamoxifen

Chronic anovulation

None

A large-scale study is investigating the risk factors for endometrial hyperplasia. Which of the following research designs would be MOST appropriate to determine the causal relationship between obesity and endometrial hyperplasia?

A retrospective case-control study comparing medical records of women with and without hyperplasia.

A cross-sectional study analyzing the prevalence of obesity and hyperplasia in a specific population.

A randomized controlled trial comparing the effectiveness of various treatment options in obese participants.

A prospective cohort study following a group of women with and without obesity for development of hyperplasia.

None

Which of the following is FALSE regarding measurement of CA 125 as a tumor marker ?

Non-malignant gynaecological conditions such as pelvic inflammatory disease, fibroids, acute events in benign cysts (e.g. torsion or haemorrhage) and endometriosis can all result in an increased CA 125 level

Higher values are reported in African or Asian women as compared to Caucasian

Caffeine intake, hysterectomy and smoking have been associated with lower CA 125 levels

Numerous benign nongynaecological conditions that cause peritoneal irritation (tuberculosis, cirrhosis, ascites, hepatitis, pancreatitis, peritonitis, pleuritis) can cause elevated CA 125

None

A 28-year-old G3P2 woman presents at 36 weeks gestation with decreased fetal movement. Ultrasound reveals a hypoechoic mass in the umbilical cord, without detectable blood flow on Doppler. Which of the following complications is most likely associated with this finding, and what is the recommended management?

Umbilical artery aneurysm; expectant management and close surveillance

Cord hematoma; immediate cesarean delivery to prevent stillbirth

Umbilical vein thrombosis; prompt delivery of a viable-aged fetus

Funisitis; administration of antibiotics and continuation of pregnancy

Umbilical vein varix; weekly Doppler assessments until delivery

None

10.

A 29-year-old G2P1 woman presents at 38 weeks gestation with decreased fetal movement. A nonstress test is performed, which shows moderate variable decelerations. Ultrasound reveals a nuchal cord with two loops around the fetal neck. Which of the following factors is most likely associated with the presence of a nuchal cord?

Increased risk of stillbirth and fetal growth restriction

Increased cesarean delivery rates due to fetal distress during labor

Higher risk of moderate to severe variable decelerations during labor

Higher risk of adverse perinatal outcomes requiring immediate delivery

None

11.

A 28-year-old woman with sickle cell disease (SCD) is 6 weeks postpartum and seeks advice regarding contraception. Which of the following methods would be most appropriate for her, considering her condition?

A. Combined oral contraceptive pill

B. Copper intrauterine device (IUD)

C. Depot medroxyprogesterone acetate (DMPA) injection

Levonorgestrel intrauterine device (IUD)

None

12.

A 30-year-old woman presents for preconception counseling. She has a family history of congenital heart defects and is concerned about her risk of having a child with a similar condition. Which of the following statements best describes the pattern of inheritance and risk assessment for multifactorial diseases such as congenital heart defects?

The risk of recurrence is higher for dizygotic twins compared to monozygotic twins

The risk of recurrence in siblings is 50%, consistent with autosomal dominant inheritance

The risk of recurrence is approximately 3-5% after having one affected child, and the risk declines with more distant relatives

The risk of recurrence is independent of environmental factors, and only genetic factors contribute to disease causation.

None

13.

A 35-year-old woman and her partner are undergoing genetic counseling after a spontaneous abortion. Karyotype analysis reveals the woman is a balanced Robertsonian translocation carrier with a translocation between chromosomes 13 and 14. Which of the following statements best explains the reproductive risks associated with her chromosomal abnormality?

The risk of having an affected child is higher if the Robertsonian translocation is carried by the father.

The woman’s translocation will result in recurrent miscarriages due to increased risk of monosomy or trisomy.

The risk of an affected child is 15% if the translocation carrier is the mother, and unbalanced gametes are likely to result in trisomy or monosomy.

Since the translocation is balanced, the woman will have no difficulty producing viable offspring.

None

14.

A 25-year-old woman with known phenylketonuria (PKU) presents for preconception counseling. She has been following a low-phenylalanine diet, but her most recent serum phenylalanine level is 8 mg/dL. What is the most appropriate management to reduce fetal risk in a potential pregnancy?

Initiate sapropterin therapy immediately, as dietary therapy alone is insufficient.

Recommend increased dietary protein intake to lower phenylalanine levels.

Advise phenylalanine restriction to achieve serum levels between 2-6 mg/dL before conception and throughout pregnancy.

Reassure the patient that as long as she remains asymptomatic, the fetal risk is minimal.

None

15.

A 30-year-old pregnant woman with poorly controlled PKU is referred for obstetric care. Her serum phenylalanine levels have been consistently above 10 mg/dL throughout the first trimester. Which of the following is the most likely fetal outcome associated with her condition?

Increased risk of consanguinity-related genetic disorders

Intellectual disability and microcephaly, despite the fetus being heterozygous for the PAH mutation

Phenotypically normal fetus, as the mother’s condition is recessive and the fetus is heterozygous

Fetal survival is unlikely due to the high risk of early miscarriage

None

16.

A 28-year-old woman with PKU and her partner, who is unaffected, are planning a pregnancy. Genetic testing shows that the woman is homozygous for a PAH mutation, and her partner is not a carrier. What is the probability that their child will inherit phenylketonuria?

0% chance of PKU, as the partner is not a carrier

25% chance of PKU, following an autosomal recessive pattern

50% chance of PKU, since the woman is homozygous

100% chance of being a carrier, but no risk of PKU

None

17.

A 34-year-old woman at 20 weeks gestation is referred for a detailed anomaly scan after a second-trimester aneuploidy screening indicates an increased risk of Trisomy 18 (Edwards Syndrome). The ultrasound reveals a strawberry-shaped cranium, clenched hands with overlapping digits, and choroid plexus cysts. Which of the following is the most appropriate next step in confirming the diagnosis?

Repeat ultrasound in the third trimester to assess fetal growth

Perform amniocentesis for karyotyping

Conduct a non-invasive prenatal test (NIPT)

Offer perinatal palliative care consultation without further diagnostic testing

None

18.

A 30-year-old woman at 18 weeks of gestation undergoes amniocentesis due to abnormal second-trimester aneuploidy screening. The cytogenetic analysis reveals an unbalanced structural chromosomal rearrangement involving chromosome 18. Which of the following best describes the next step in genetic testing to provide more detailed characterization of the chromosomal abnormality?

G-banded karyotype to detect subtle chromosomal rearrangements

Chromosomal microarray (CMA) for higher resolution analysis

Fluorescence in situ hybridization (FISH) for rapid detection of aneuploidy

Fetal blood sampling for faster karyotyping results

None

19.

A stillborn fetus is evaluated postmortem, and cytogenetic analysis is requested. However, the cytogenetics laboratory reports difficulty in stimulating the growth of fetal skin fibroblasts. Which of the following statements best explains the delay in obtaining results and the current preferred method for postmortem genetic analysis?

Fetal skin fibroblasts are difficult to culture, and cytogenetic analysis typically takes longer postmortem

Cytogenetic analysis requires dividing cells, and amniocytes would have provided faster results

Fetal blood sampling would yield results within 48 hours, but postmortem samples are not suitable

Chromosomal microarray (CMA) has largely replaced cytogenetic analysis for postmortem testing due to faster turnaround

None

Comment

20.

A 32-year-old woman with a family history of intellectual disability is seeking preconception genetic counseling. Testing reveals that she has a fragile X premutation with 110 CGG repeats. Based on this finding, which of the following statements is most accurate regarding her reproductive risk?

She has less than a 5% chance of having a child with full mutation fragile X syndrome

She has a greater than 95% chance of transmitting a full mutation to her offspring

She is unlikely to experience any personal health consequences related to the premutation

Her male offspring are more likely to have FXTAS due to expansion of the premutation

None

Comment

21.

A 40-year-old man is diagnosed with fragile X tremor ataxia syndrome (FXTAS) and is found to have a fragile X premutation. Which of the following is most accurate regarding the inheritance and transmission of his fragile X premutation?

His sons are at risk of developing FXTAS

He is at risk of passing a full mutation to his children

His daughters will inherit the fragile X premutation

He cannot transmit the premutation to his offspring

None

Comment

22.

A 32-year-old G2P1 woman presents at 28 weeks of gestation with concerns about reduced fetal movements. Her obstetric history is significant for a previous stillbirth at 34 weeks gestation. Prenatal sonography shows a thickened basal plate, but no other significant findings. Which of the following conditions most likely explains her current placental pathology, and what mechanism is implicated in its pathogenesis?

Maternal floor infarction; maternal autoimmune or alloimmune response

Placental abruption; excessive fibrin deposition due to increased thrombin activity

Chorioamnionitis; ascending bacterial infection causing villous necrosis

Intervillous thrombus; mixing of maternal and fetal blood with villous damage

Vasa previa; rupture of fetal vessels causing hemorrhage into the intervillous space

None

23.

A 35-year-old pregnant woman at 36 weeks gestation is undergoing a routine ultrasound, which reveals focal sonolucencies in the placenta. These findings are consistent with subchorionic and perivillous fibrin deposition. Histological examination reveals that more than 30% of placental villi are affected. Which of the following complications is most likely associated with these findings?

Chorioangioma formation

Marginal placental hematoma

Fetal-growth restriction

Maternal floor infarction

None

24.

A 28-year-old woman at 34 weeks gestation presents with concerns about decreased fetal movement. Ultrasound reveals thickened placental basal plate with areas of sonolucency. Based on these findings and her history of antiphospholipid syndrome, which of the following placental lesions is most likely implicated, and what is the potential recurrence risk in future pregnancies?

Intervillous thrombus with minimal recurrence risk

Maternal floor infarction with a high recurrence risk

Subchorionic hematoma with no recurrence risk

Fetal vascular malperfusion with moderate recurrence risk

None

25.

A histological examination of a placenta from a stillbirth at 38 weeks gestation reveals multiple thrombi in the fetal vessels, with many terminal villi showing decreased vascularity. Which of the following ultrasound or Doppler findings would most likely correlate with these histopathological findings, and what is the underlying pathophysiology?

Absent umbilical artery end-diastolic flow; fetal vascular malperfusion

Increased placental thickness; subchorionic hematoma

Elevated maternal serum alpha-fetoprotein (MSAFP); intervillous thrombus

Hyperechoic placental areas; chorangiosis

None

26.

A 28-year-old woman is diagnosed with myoclonic epilepsy with ragged red fibers (MERRF), a mitochondrial disorder. She is concerned about the risk of passing this condition to her children. Which of the following best explains why her male offspring, even if affected, cannot transmit MERRF to their children?

Male gametes lack mitochondria, preventing transmission of mitochondrial disorders.

Mitochondrial DNA undergoes mutations only in oocytes, and sperm mitochondria are excluded from the embryo after fertilization.

Only oocytes contribute mitochondria to the embryo, and sperm mitochondria are destroyed after fertilization, preventing paternal transmission of mitochondrial disorders like MERRF.

Sperm mitochondrial DNA is integrated into nuclear DNA and does not participate in mitochondrial inheritance.

Male gametes undergo replicative segregation during spermatogenesis, eliminating mutated mitochondrial DNA.

None

Comment

27.

A 43-year-old man and his 35-year-old wife present for genetic counseling regarding their risk of passing on genetic disorders to their future children. The man is concerned about his age and its impact on their offspring. Considering the concepts of autosomal dominant inheritance and paternal age effect disorders, which of the following statements is MOST accurate?

The offspring of older fathers are at increased risk for autosomal recessive conditions due to increased single base-pair mutations in sperm.

Paternal age older than 40 is associated with an increased risk of autosomal dominant conditions such as achondroplasia and neurofibromatosis.

Whole genome sequencing suggests a decrease in the rate of single nucleotide polymorphisms (SNPs) among offspring of older fathers.

Paternal age effect disorders such as multiple endocrine neoplasia are due to X-linked mutations that arise with increasing paternal age.

Autosomal dominant disorders are unaffected by paternal age, and advanced paternal age has no impact on offspring risk.

None

Comment

28.

A woman with a family history of an autosomal dominant disorder wants to understand her potential risk of passing the condition to her children. You explain that both penetrance and expressivity play a role in the inheritance and expression of autosomal dominant conditions. Which of the following scenarios BEST explains the combined influence of incomplete penetrance, variable expressivity, and advanced paternal age on the inheritance of an autosomal dominant disorder?

A gene that shows incomplete penetrance is always expressed in affected offspring, regardless of the father's age or the gene's expressivity.

A 42-year-old man with an autosomal dominant disorder and incomplete penetrance has a 100% chance of passing the disorder to his children, but they may express different severities of the condition due to variable expressivity.

The likelihood of passing an autosomal dominant disorder is 50%, but the severity of symptoms in offspring can vary due to expressivity, and some may not express the disorder at all due to incomplete penetrance.

Codominant inheritance plays a key role in determining the phenotypic expression of autosomal dominant conditions passed down from older fathers.

The risk of autosomal dominant conditions increases with paternal age but is not influenced by penetrance or expressivity, as these factors only apply to X-linked disorders.

None

Comment

29.

A 35-year-old pregnant woman undergoes chorionic villus sampling (CVS) at 12 weeks due to an increased risk of trisomy 21 on first-trimester screening. The clinician offers chromosomal microarray analysis (CMA) and karyotyping. The patient inquires about the benefits of CMA over traditional karyotyping. Which of the following correctly describes an advantage of CMA in this clinical scenario?

CMA can detect balanced chromosomal rearrangements missed by karyotyping.

CMA is able to detect aneuploidies, unbalanced translocations, and balanced translocations.

CMA can identify pathogenic microdeletions and microduplications that karyotyping may miss.

CMA should be avoided if structural abnormalities are suspected, as karyotyping is more sensitive.

CMA requires dividing cells for analysis, making it unsuitable for stillbirth evaluations.

None

Comment

30.

A patient with a history of consanguinity undergoes a chromosomal microarray analysis (CMA) as part of prenatal diagnosis. Which of the following results would CMA be uniquely capable of identifying, and what is the clinical implication?

Balanced chromosomal rearrangements leading to fetal growth restriction.

Uniparental disomy, which may result in autosomal recessive disorders.

Variants of uncertain significance, all of which are clinically benign.

Absence of heterozygosity, indicating balanced translocations.

Copy number variations that always predict severe congenital abnormalities.

None

Comment

31.

A 28-year-old woman is a carrier of hemophilia A and is pregnant with her first child. Which of the following statements accurately describes the genetic implications for her pregnancy?

The probability of her son inheriting hemophilia A is 50%, and the probability of her daughter being a carrier is 25%.

Her son has a 50% risk of inheriting hemophilia A, and her daughter has a 50% risk of being affected.

Both her son and daughter have a 50% chance of being carriers, but her son cannot be affected.

Her son cannot inherit hemophilia A, and her daughter has a 50% risk of being a carrier.

None

Comment

32.

A 30-year-old woman with Duchenne muscular dystrophy has a 7-year-old son with cardiomyopathy. Which of the following best explains the relationship between this condition and the woman's carrier status?

The woman's carrier status is unrelated to her son’s cardiomyopathy, as it is not a feature of Duchenne muscular dystrophy.

The son's cardiomyopathy is a direct result of inherited X-linked Duchenne muscular dystrophy from his mother, affecting both his muscles and heart.

The woman's carrier status may have contributed to the son's cardiomyopathy, as female carriers of Duchenne muscular dystrophy are at increased risk for cardiac dysfunction.

The son's cardiomyopathy likely results from a Y-linked mutation, given the low prevalence of Y-linked disorders and their association with spermatogenesis.

None

33.

In autosomal recessive inheritance, a couple has already had one child diagnosed with an autosomal recessive disease. They now seek genetic counseling for their second pregnancy. What is the probability that their second child will be affected by the same condition, and what factors might influence the risk of recurrence?

50% probability of having an affected child; higher risk if the partner is a carrier or if there is consanguinity.

25% probability of having an affected child; no increase in risk unless there is consanguinity or the partner is a carrier.

75% probability of having an affected child; risk is unaffected by consanguinity or carrier status of the partner.

50% probability of having a carrier child; consanguinity increases the likelihood of the partner being a carrier.

None

Comment

34.

Which of the following placental variations is most likely associated with an increased risk of vasa previa and postpartum uterine hemorrhage, and may require careful monitoring due to the presence of vessels connecting a small accessory lobe to the main placental disc?

Bilobate placent

Succenturiate lobe

Placenta membranacea

Multilobate placenta

None

Comment

35.

A 32-week pregnant woman presents with thickened placental tissue on ultrasound, and the placental disc shows multiple cystic vesicles in a homogenous pattern. Genetic testing reveals a diploid chromosomal complement. What is the most likely diagnosis, and what underlying maternal condition might it be associated with?

Partial mole; associated with maternal hypertension

Placental mesenchymal dysplasia; associated with maternal diabetes

Placenta fenestrata; associated with maternal anemia

Placenta membranacea; associated with placenta previa

None

36.

Human chorionic gonadotropin (hCG) and luteinizing hormone (LH) share a significant degree of structural homology, but their functional distinctions are critical in clinical practice. Which of the following correctly describes the molecular and clinical relationship between hCG and LH?

Both hCG and LH are produced by the anterior pituitary and serve identical roles in steroidogenesis during early pregnancy.

The β-subunit of hCG contains an additional 24-amino-acid extension compared to LH, which allows it to be distinguished in assays, and hCG can stimulate hyperthyroidism in molar pregnancies by binding to thyroid-stimulating hormone (TSH) receptors.

The α-subunits of hCG and LH are encoded by separate genes, which contributes to their distinct roles in pregnancy and ovulation.

hCG is solely produced by the anterior pituitary, and elevated levels are used exclusively to diagnose germ cell tumors.

None

37.

In the context of gestational trophoblastic neoplasia (GTN) and pregnancy screening, the measurement of human chorionic gonadotropin (hCG) levels plays a critical role. Which of the following statements best integrates the understanding of hCG's role in pregnancy and pathology?

hCG levels peak during the third trimester of pregnancy and are predominantly useful for diagnosing ectopic pregnancies and trophoblastic tumors.

In normal early pregnancy, hCG levels increase steadily with a doubling time of approximately every 4 days, but in cases of GTN, hyperglycosylated hCG is commonly detected, which helps differentiate it from other neoplasms.

Serial measurements of hCG can differentiate between multifetal gestations and molar pregnancies, as both conditions are characterized by significantly elevated hCG levels.

hCG secreted by syncytiotrophoblasts in the early first trimester is critical for the luteal-placental shift, and its abnormal production in multifetal pregnancies is associated with poor placentation and miscarriage.

Elevated hCG levels in the first trimester are primarily associated with ectopic pregnancies and serve no role in screening for Down syndrome or molar pregnancies.

None

38.

Hormone-receptor interactions are essential in mediating the physiological effects of peptide and steroid hormones. Considering the mechanisms of action of peptide hormones like LH, FSH, and hCG, which of the following correctly describes their biosynthesis, receptor interactions, and potential clinical implications?

Peptide hormones like LH and FSH bind to intracellular receptors, initiating gene transcription, and their β-subunits are crucial for distinguishing their specific functions in ovarian steroidogenesis.

The biosynthesis of LH and FSH occurs in the syncytiotrophoblast, and both hormones bind to steroid receptors, resulting in the maintenance of early pregnancy.

LH and hCG have nearly identical receptor interactions, but abnormal hCG production in molar pregnancies can result in hyperthyroidism due to hCG binding to TSH receptors, highlighting their overlapping glycoprotein subunits.

FSH and hCG act on nuclear receptors to mediate ovarian follicular development, and excess free α-subunits in circulation are indicative of functional pituitary adenomas.

The glycoprotein β-subunits of LH and hCG are completely interchangeable, leading to no clinical distinction in their receptor binding during pregnancy.

None

39.

A 32-year-old woman presents with signs of hirsutism and is found to have elevated levels of circulating androgens. Considering her condition, which enzyme would most likely be involved in the transformation of androgens to estrogens in peripheral tissues, and what additional tissue sources could contribute to her estrogen levels after menopause?

21-hydroxylase; adrenal cortex

5α-reductase; skin E. Desmolase; theca cells

Aromatase; adipose tissue

11β-hydroxylase; granulosa cells

None

40.

A patient is diagnosed with hyperandrogenism due to polycystic ovarian syndrome (PCOS). She has normal total testosterone levels, but clinically significant signs of hirsutism and acne. Which of the following mechanisms best explains her hyperandrogenic symptoms despite normal total testosterone?

Decreased activity of 21-hydroxylase in the adrenal cortex

Increased SHBG levels leading to higher testosterone bioavailability

Elevated free testosterone due to decreased SHBG levels

Increased 5α-reductase activity converting androstenedione to estrogen

Impaired estradiol metabolism in the liver

None

41.

A 45-year-old woman with a history of obesity presents with postmenopausal vaginal bleeding. Laboratory studies reveal elevated circulating levels of estrone. What is the most likely mechanism contributing to this patient’s elevated estrogen levels?

Increased aromatization of androgens in adipose tissue

Elevated activity of 17α-hydroxylase in the adrenal cortex

Increased ovarian production of estradiol through LH stimulation

Decreased hepatic metabolism of estrone to estriol

Overproduction of estradiol by the placenta

None

42.

A pregnant woman in her third trimester is taking lithium for bipolar disorder. Based on current recommendations, how should lithium be managed near the time of delivery to minimize neonatal complications?

Lithium should be continued at the same dose throughout pregnancy and postpartum to prevent maternal relapse.

Lithium should be discontinued 2 to 3 days before delivery to reduce the risk of neonatal cardiac arrhythmias, hypoglycemia, and respiratory distress.

Lithium should be discontinued in the first trimester to prevent Ebstein anomaly, but restarted in the third trimester to manage maternal symptoms.

Lithium should only be adjusted in the second trimester to minimize the risk of neonatal hypotonia and diabetes insipidus.

None

43.

A 32-year-old pregnant woman has been taking an SSRI for depression. She is concerned about the risks to her newborn. Which of the following outcomes is most likely associated with late-pregnancy SSRI exposure?

Severe congenital cardiac anomalies such as Ebstein anomaly.

Persistent pulmonary hypertension of the newborn (PPHN) with an attributable risk of 10-15 per 1000 births.

Neonatal behavioral syndrome characterized by transient symptoms like jitteriness, irritability, and respiratory abnormalities.

Prolonged hospitalization and the need for mechanical ventilation in neonates due to severe adaptation difficulties.

None

44.

Which of the following statements regarding corticosteroid use in pregnancy is correct?

Corticosteroid use in pregnancy is considered a major teratogenic risk, associated with a significantly increased rate of orofacial clefts.

Prednisolone, the active metabolite of prednisone, is thought to reach the fetus more effectively because it bypasses placental metabolism

Systemic corticosteroid use in pregnancy is associated with an increased rate of orofacial clefts, but the absolute risk remains small.

Mycophenolate mofetil and corticosteroids both carry equivalent teratogenic risks when used in the first trimester.

None

45.

A 32-year-old woman with lupus nephritis is planning a pregnancy. She is currently on mycophenolate mofetil. Which of the following is the most accurate statement regarding the teratogenic risks of mycophenolate?

Mycophenolate exposure in the first trimester carries a small risk of minor birth defects and is considered relatively safe for use in pregnancy.

Mycophenolate exposure in the first trimester is associated with a high risk of pregnancy loss and major congenital anomalies, including a specific pattern of defects called mycophenolate embryopathy.

Mycophenolate should be discontinued by the second trimester to avoid a significant risk of major congenital anomalies.

Mycophenolate is associated with neurodevelopmental delays in exposed fetuses but not with structural birth defects.

None

46.

Which of the following is the most appropriate recommendation regarding lead and mercury exposure in pregnancy?

Pregnant women should be routinely tested for lead exposure due to its significant neurodevelopmental risks to the fetus.

Mercury exposure during pregnancy is primarily due to consumption of large fish, and cooking these fish eliminates the risk of methylmercury accumulation in the fetus.

Pregnant women should avoid consuming specific types of large fish to minimize methylmercury exposure, as prenatal exposure can lead to severe neurodevelopmental delays and motor abnormalities in the fetus.

Lead and mercury exposure both cause orofacial clefts and should be avoided, especially in the first trimester.

None

47.

None

48.

A pregnant woman with hepatitis C is being considered for antiviral therapy. Which of the following antiviral medications is contraindicated in both women who are pregnant and men whose partners are pregnant due to its teratogenic effects?

Oseltamivir

Acyclovir

Ribavirin

Valacyclovir

Tenofovir

None

49.

A 29-year-old woman with a history of epilepsy is planning to conceive. She is currently on valproic acid monotherapy for seizure control. You are counseling her on the risks associated with antiepileptic medications during pregnancy. Which of the following statements best reflects the current understanding of fetal risks with antiepileptic medication?

Phenytoin monotherapy is associated with the highest risk of neural tube defects.

Valproic acid use in the first trimester is associated with a 9% risk of major malformations, including a 4% risk of neural tube defects

Lamotrigine monotherapy has been associated with an increased risk of orofacial clefts.

Levetiracetam has been linked to significantly lower cognitive development in children exposed in utero

The use of multiple antiepileptic drugs during pregnancy does not significantly increase the risk of fetal malformations compared to monotherapy.

None

50.

A 32-year-old woman with epilepsy is 8 weeks pregnant and is currently taking carbamazepine and lamotrigine for seizure control. She is concerned about the potential risks of these medications on her developing fetus. Which of the following statements is true regarding her antiepileptic therapy?

The combination of carbamazepine and lamotrigine is associated with a fourfold increase in fetal malformation risk compared to monotherapy

Carbamazepine use is associated with a risk of fetal hydantoin syndrome

Lamotrigine monotherapy is associated with an increased risk of neural tube defects and orofacial clefts.

Carbamazepine monotherapy carries a twofold increased risk of major fetal malformations

Levetiracetam is contraindicated in pregnancy due to a high risk of major malformations.

None

51.

A 28-year-old woman in her first trimester presents for her prenatal visit. She reports having consumed alcohol before she knew she was pregnant, including binge drinking on several occasions. She asks about the potential risks to her fetus. Which of the following statements is most accurate regarding fetal alcohol spectrum disorder (FASD) and its related conditions?

Fetal alcohol syndrome is the only form of fetal alcohol spectrum disorder associated with neurobehavioral deficits

The risk of fetal alcohol spectrum disorder is limited to the first trimester of pregnancy.

There are established sonographic criteria for diagnosing fetal alcohol syndrome in utero.

Prenatal alcohol exposure increases the risk for birth defects, including cardiac, renal, and orthopedic abnormalities

Alcohol-related neurodevelopmental disorder is associated only with binge drinking during the second and third trimesters.

None

52.

A 34-year-old pregnant woman at 26 weeks gestation is found to have been consuming alcohol regularly throughout her pregnancy. Which of the following factors is most likely to modify the risk of alcohol-related birth defects in the fetus?

Binge drinking is less harmful than chronic alcohol consumption.

Maternal nutritional status and coexisting maternal disease can influence the fetal effects of alcohol exposure

Genetic factors are not believed to play a role in fetal vulnerability to alcohol exposure.

The risk of alcohol-related birth defects decreases after the first trimester

There is no increased risk of structural birth defects after the first trimester, only neurodevelopmental issues.

None

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