Review Practice Exercise 2

Antepartum Diagnostic Testing > Maternal Newborn

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Practice Exercise 2

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Total Questions : 5

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Question 1:

Which prenatal screening test measures the fluid accumulation at the back of the fetal neck?

A. Quadruple screen B. Nuchal translucency ultrasound C. Amniocentesis D. Chorionic villus sampling

Answer and Explanation

Choice A:

The quadruple screen is a maternal serum screening performed between 15–20 weeks measuring AFP, hCG, estriol, and inhibin A. It does not involve ultrasound or direct fetal measurements.

Choice B:

Nuchal translucency ultrasound specifically measures the subcutaneous fluid accumulation at the back of the fetal neck between 11–14 weeks gestation. Increased measurements are linked to chromosomal and structural abnormalities.

Choice C:

Amniocentesis is a diagnostic test done at 15–20 weeks where amniotic fluid is sampled to analyze fetal karyotype, not neck fluid.

Choice D:

Chorionic villus sampling is performed at 10–13 weeks to obtain placental tissue for genetic analysis. It provides a definitive diagnosis but does not measure nuchal translucency.

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Question 2:

A nurse is educating a patient about maternal serum screening. Which protein is measured in this test?

A. Alpha-fetoprotein B. Pregnancy-associated plasma protein-A C. Estriol D. Inhibin-A

Answer and Explanation

Choice A:

Alpha-fetoprotein is the protein measured in maternal serum screening. Its levels provide important information about risk for neural tube defects and chromosomal abnormalities.

Choice B:

Pregnancy-associated plasma protein-A (PAPP-A) is used in first-trimester screening, not the standard second-trimester maternal serum screen. Low levels may indicate increased risk of trisomy 21.

Choice C:

Estriol (unconjugated estriol, uE3) is a hormone included in the quadruple screen but is not classified as a protein. It reflects placental and fetal adrenal function.

Choice D:

Inhibin-A is a glycoprotein hormone also included in the quadruple screen, but it is not the main protein measured to detect neural tube defects.

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Question 3:

The nurse is explaining the components of the first-trimester combined screening to a client. Which two maternal serum markers are typically included in this screening?

A. Alpha-fetoprotein (AFP) and Unconjugated Estriol (uE3) B. Pregnancy-Associated Plasma Protein-A (PAPP-A) and free beta-human chorionic gonadotropin (free β-hCG) C. Inhibin-A and Alpha-fetoprotein (AFP) D. Unconjugated Estriol (uE3) and Inhibin-A

Answer and Explanation

Choice A:

Alpha-fetoprotein (AFP) and unconjugated estriol (uE3) are measured later, in second-trimester maternal serum screening (triple or quadruple screen), not in the first trimester.

Choice B:

PAPP-A and free β-hCG are the maternal serum markers included in first-trimester combined screening. When combined with nuchal translucency measurement, detection rates for trisomy 21 increase significantly.

Choice C:

Inhibin-A and AFP are both components of the quadruple screen done in the second trimester, not part of first-trimester combined screening.

Choice D:

Unconjugated estriol and inhibin-A are also part of second-trimester screening panels and not used in the first-trimester combined screening.

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Question 4:

Which of the following are components of the quadruple screen? Select all that apply

A. Alpha-fetoprotein B. Human chorionic gonadotropin C. Estriol D. Pregnancy-associated plasma protein-A E. Inhibin-A

Answer and Explanation

Choice A:

Alpha-fetoprotein is included; elevated levels suggest neural tube or abdominal wall defects, while low levels suggest trisomy 21 or 18.

Choice B:

Human chorionic gonadotropin is measured; elevated levels are associated with trisomy 21, while low levels may indicate trisomy 18.

Choice C:

Estriol (unconjugated) is included; low levels suggest trisomy 21 and 18 due to impaired placental and fetal steroid metabolism.

Choice D:

Pregnancy-associated plasma protein-A (PAPP-A) is not part of the quadruple screen. It is measured in first-trimester combined screening along with free β-hCG.

Choice E:

Inhibin-A is part of the quadruple screen; elevated levels are linked to trisomy 21.

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Question 5:

Which of the following are considered advantages of Non-Invasive Prenatal Testing (NIPT) over traditional serum screening methods? Select all that apply

A. Higher detection rates for common trisomies B. Can be performed earlier in pregnancy C. Non-invasive, requiring only a maternal blood draw D. Provides definitive diagnostic results E. Can screen for sex chromosome aneuploidies

Answer and Explanation

Choice A:

NIPT offers higher sensitivity and specificity (>99% for trisomy 21) compared to serum screening, which has lower detection rates.

Choice B:

NIPT can be performed as early as 10 weeks gestation, whereas some traditional serum screenings begin at 11–14 weeks or later.

Choice C:

NIPT is non-invasive, requiring only maternal venipuncture, eliminating risks associated with procedures like amniocentesis.

Choice D:

NIPT does not provide definitive diagnostic results. It is highly accurate but remains a screening test. Positive results must be confirmed with diagnostic methods such as CVS or amniocentesis.

Choice E:

NIPT can screen for sex chromosome abnormalities, including monosomy X and extra sex chromosomes, which traditional serum screening cannot detect.

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Practice Exercise 2

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