MCCQE Part I Pregnancy and antenatal care Questions: 10 Free Practice MCQs

Ten MCCQE Part I-style pregnancy and antenatal care questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 29 pregnancy and antenatal care questions and many more across every topic.

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1. 1 / 10

   A 29-year-old pregnant woman has an inconclusive Rh D blood type on routine testing. RHD genotyping identifies weak D type 1. She asks what this means for anti-D immune globulin during the pregnancy.

   What is the correct interpretation?

   • A. She needs anti-D immune globulin at 28 weeks because any weak D variant carries risk
   • B. Weak D types 1, 2 and 3 carry no risk of alloimmunization, so prophylaxis is not recommended
   • C. The genotype should be repeated in the third trimester before a decision is made
   • D. She should receive anti-D immune globulin only if the baby is Rh D-positive
   Show answer

   Answer: B. Weak D types 1, 2 and 3 carry no risk of alloimmunization, so prophylaxis is not recommended

   Why: Guideline 448 states that weak D types 1, 2 and 3 carry no risk of alloimmunization and that prophylaxis is not recommended for these individuals, so this patient does not need antenatal immune globulin on account of her genotype. Not every D variant behaves in the same way: other weak D variants and partial D do carry a risk, which is why genotyping is performed when routine typing is inconclusive. Repeating the genotype or waiting for the blood type of the baby would not change the management.

   • A. Only some D variants carry risk; types 1, 2 and 3 are in the group that does not, so prophylaxis is not indicated.
   • C. Genotyping has already answered the question, so repeating it later does not change management.
   • D. Prophylaxis is withheld on the basis of her genotype rather than the blood type of the baby.

   Sources: SOGC Clinical Practice Guideline No. 448: Prevention of Rh D Alloimmunization, 2024

2. 2 / 10

   A 31-year-old woman at 18 weeks of pregnancy has read news reports linking acetaminophen use in pregnancy to neurodevelopmental disorders in children, including autism spectrum disorder. She has taken acetaminophen twice for a headache.

   What is the position of the Society of Obstetricians and Gynaecologists of Canada?

   • A. Practice should change until the association is disproved
   • B. The evidence for causality is weak, and the studies claiming a causal link should not alter current practice
   • C. Acetaminophen should be used only in the third trimester
   • D. Acetaminophen is now considered unsafe at any dose in pregnancy, and other analgesics should be used
   Show answer

   Answer: B. The evidence for causality is weak, and the studies claiming a causal link should not alter current practice

   Why: The SOGC reviewed the evidence and re-affirmed its recommendation. It states that available studies were critically analysed by scientific and regulatory bodies whose reviews concluded that the evidence for causality is weak and that the results of studies claiming a causal link should not alter current clinical practice. Restricting acetaminophen to one trimester, changing practice until the association is disproved, or declaring the drug unsafe at any dose does not reflect the position statement.

   • A. The SOGC reviewed the evidence and re-affirmed its recommendation rather than changing practice, so this option misstates the position.
   • C. The position statement does not restrict use to one trimester; it addresses use for fever and pain when medically indicated.
   • D. The SOGC re-affirmed acetaminophen as a first-line option rather than calling the drug unsafe.

   Sources: SOGC Position Statement on the Use of Acetaminophen for Analgesia and Fever in Pregnancy, 2025

3. 3 / 10

   A 30-year-old woman at 20 weeks gestation complains of tiredness. Her haemoglobin is 105 g/L and she takes a prenatal vitamin. She has no bleeding and her diet is varied.

   What is the most appropriate next step?

   • A. Reassure her that haemoglobin falls normally in pregnancy and repeat at 36 weeks
   • B. Measure ferritin as well and treat the anaemia and iron deficiency before 28 weeks
   • C. Arrange an immediate blood transfusion
   • D. Repeat the haemoglobin in 4 weeks without further tests
   Show answer

   Answer: B. Measure ferritin as well and treat the anaemia and iron deficiency before 28 weeks

   Why: Both haemoglobin and ferritin should be measured antenatally, and anaemia and iron deficiency should be assessed and treated at or before 28 weeks gestation. A Toronto study found that most pregnant women screened were iron deficient even when only a minority had a haemoglobin below 110 g/L, so repeating the haemoglobin alone, or reassuring without treatment, misses the diagnosis.

   • A. A level of 105 g/L with symptoms warrants assessment, and iron deficiency is common even when the haemoglobin is only mildly reduced.
   • C. Transfusion is not the first step for a mildly reduced haemoglobin in a stable antenatal patient.
   • D. Measuring ferritin is also needed, because iron deficiency is common even when the haemoglobin is normal or only slightly low.

   Sources: SOGC CPG No. 431 - Postpartum haemorrhage and haemorrhagic shock

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5. 4 / 10

   A 26-year-old woman at 26 weeks gestation is Rh D negative with a negative antibody screen. The father's blood type is unknown and the fetus has not been genotyped.

   When should routine antenatal anti-D prophylaxis be given?

   • A. At 20 weeks gestation
   • B. At 28 weeks gestation
   • C. At 34 weeks gestation
   • D. Only after delivery, if the newborn is Rh D positive
   Show answer

   Answer: B. At 28 weeks gestation

   Why: For non-sensitised Rh D-negative pregnant individuals, administration of Rho(D) immune globulin at 28 weeks is recommended when the fetal blood type is unknown or known to be Rh D positive, with an alternative two dose regimen at 28 and 34 weeks. Postpartum prophylaxis for an Rh D positive newborn is given in addition to, not instead of, antenatal prophylaxis.

   • A. Prophylaxis at this gestation is not the recommendation for a non-sensitised Rh D-negative patient.
   • C. 34 weeks is the timing of the second dose in the two dose regimen, not the single routine dose.
   • D. Postpartum prophylaxis is given as well, but antenatal prophylaxis at 28 weeks is also recommended.

   Sources: SOGC CPG No. 448 - Prevention of Rh D alloimmunization (antenatal care, anti-D prophylaxis)

6. 5 / 10

   A 27-year-old woman at 30 weeks of pregnancy asks whether there is a safer alternative to acetaminophen for fever, since she would prefer to avoid it entirely. She has no allergies.

   What does the SOGC position statement say about alternatives?

   • A. Several safer analgesics are available for use in pregnancy
   • B. Acetaminophen should be replaced by a non-drug approach for fever
   • C. The benefits of acetaminophen are well recognized, and there is a lack of safer alternatives in pregnancy
   • D. Acetaminophen should be used only when fever is caused by infection, and other causes treated without drugs
   Show answer

   Answer: C. The benefits of acetaminophen are well recognized, and there is a lack of safer alternatives in pregnancy

   Why: The SOGC position statement states that the benefits of acetaminophen for fever or pain in pregnancy are well recognized, as is the lack of safer alternatives in pregnancy. Patients can therefore be reassured that acetaminophen remains the first-line option when treatment is medically indicated at recommended doses for the shortest duration required. The statement does not suggest that safer analgesics are available, that non-drug measures replace treatment of fever, or that use depends on the cause of the fever.

   • A. The statement notes a lack of safer alternatives rather than the availability of safer drugs.
   • B. Non-drug measures are not presented as a substitute for treating fever and pain when treatment is medically indicated.
   • D. The statement does not limit use by the cause of the fever; it addresses fever and pain that are medically indicated for treatment.

   Sources: SOGC Position Statement on the Use of Acetaminophen for Analgesia and Fever in Pregnancy, 2025

7. 6 / 10

   A 29-year-old woman at 24 weeks of pregnancy has a headache and a temperature of 38.2 degrees Celsius. She has no allergies and no other medical problems. She asks which medication she can take for the pain and fever.

   What is the most appropriate recommendation?

   • A. Acetaminophen at the recommended dose for the shortest duration needed
   • B. No medication, because fever and pain should be managed without treatment
   • C. Acetaminophen only if the temperature rises above 39 degrees Celsius
   • D. Acetaminophen at a higher dose to shorten the treatment course
   Show answer

   Answer: A. Acetaminophen at the recommended dose for the shortest duration needed

   Why: The SOGC recommends acetaminophen as a first-line therapeutic option for fever and pain in pregnancy when medically indicated, at recommended doses, for the shortest duration required. Untreated fever has been associated with miscarriage and other pregnancy complications, so avoiding all treatment is not the preferred approach. There is no recommendation to reserve acetaminophen for a higher temperature threshold, and taking more than the recommended dose is not supported.

   • B. Leaving fever untreated carries its own risks, so the SOGC position statement supports treating fever and pain when medically indicated.
   • C. The statement does not set a temperature threshold below which treatment should be withheld.
   • D. The recommendation specifies recommended doses rather than higher doses, with the shortest duration that is needed.

   Sources: SOGC Position Statement on the Use of Acetaminophen for Analgesia and Fever in Pregnancy, 2025

8. 7 / 10

   A 29-year-old woman at 14 weeks of pregnancy in British Columbia is overdue for cervical screening. She dislikes speculum examinations and asks whether she can take a self-collected vaginal swab home instead.

   How should her request be handled?

   • A. Provide the self-collection kit, because self-collected samples are equivalent in pregnancy
   • B. Defer all screening until 6 weeks postpartum regardless of her history
   • C. Collect a sample with an endocervical brush to avoid a speculum
   • D. Offer a provider-collected cervical sample or vaginal HPV swab at the visit
   Show answer

   Answer: D. Offer a provider-collected cervical sample or vaginal HPV swab at the visit

   Why: During pregnancy the sample should be collected by the provider, either as a cervical liquid-based cytology sample or as a vaginal HPV swab. Self-screening is not recommended when screening is done during pregnancy, even though a self-collected sample is as effective as a provider-collected sample outside pregnancy. The endocervical brush or cytobrush should not be used in pregnancy because of the risk of bleeding. This patient is overdue, so screening should be offered now as a provider-collected sample rather than deferred.

   • A. BC guidance states that self-screening is not recommended when screening is performed during pregnancy, even though it is as effective outside pregnancy.
   • B. Deferral suits patients who are up to date, but this patient is overdue and can reasonably be screened during the pregnancy.
   • C. The endocervical brush or cytobrush should not be used during pregnancy because of the risk of bleeding, which can cause distress for the patient.

   Sources: BC Guidelines: Cervical Cancer Prevention and Screening, BC Ministry of Health

9. 8 / 10

   A 24-year-old woman at 14 weeks gestation has a positive test for Chlamydia trachomatis. She has no allergies and is otherwise well.

   According to the Public Health Agency of Canada guidelines, which treatment is recommended in pregnancy?

   • A. Azithromycin 1 g orally in a single dose
   • B. Doxycycline 100 mg orally twice daily for 7 days
   • C. Levofloxacin 500 mg orally once daily for 7 days
   • D. Metronidazole 500 mg orally twice daily for 7 days
   Show answer

   Answer: A. Azithromycin 1 g orally in a single dose

   Why: The Public Health Agency of Canada chlamydia guide recommends azithromycin 1 g PO in a single dose for pregnant and lactating people, with amoxicillin or erythromycin as alternatives. Doxycycline and quinolones are contraindicated in pregnancy and in lactating people, and metronidazole is not a chlamydia regimen. Treatment in pregnancy matters because of the risk of transmission to the infant and the possibility of persistent infection.

   • B. Doxycycline is contraindicated in pregnancy and in lactating people, so it is not the recommended choice here.
   • C. Quinolones such as levofloxacin are contraindicated in pregnancy and lactation.
   • D. Metronidazole is not part of the recommended chlamydia treatment regimens for pregnancy in this guide.

   Sources: Public Health Agency of Canada (PHAC). PHAC Canadian STI guidelines - Chlamydia/LGV treatment and follow-up (incl. pregnancy regimens).

10. 9 / 10

    A 28-year-old woman at 32 weeks gestation presents with a blood pressure of 160/100 mmHg and proteinuria. She has no prior history of hypertension. Her labs show a platelet count of 100,000/μL and AST of 50 U/L. She is diagnosed with severe preeclampsia.

    What is the most appropriate next step in managing this patient's condition?

    • A. Administer IV MgSO4 for seizure prophylaxis and IV hydralazine for blood pressure control, and plan for delivery within 24-48 hours
    • B. Administer IV labetalol and plan for immediate delivery
    • C. Administer oral nifedipine and plan for delivery in 1 week
    • D. Discharge the patient with instructions to monitor blood pressure at home and return in one week for repeat labs
    Show answer

    Answer: A. Administer IV MgSO4 for seizure prophylaxis and IV hydralazine for blood pressure control, and plan for delivery within 24-48 hours

    Why: The management of severe preeclampsia involves stabilizing the patient with seizure prophylaxis using MgSO4 and controlling blood pressure, typically with IV hydralazine or labetalol, before planning delivery. The SOGC guidelines recommend delivery within 24-48 hours of stabilization for severe preeclampsia at or beyond 32 weeks gestation, considering both maternal and fetal well-being.

    • B. While labetalol is used for blood pressure control, immediate delivery may not be necessary without considering fetal well-being and gestational age.
    • C. Nifedipine is not the first-line treatment for acute severe hypertension in pregnancy, and delaying delivery for 1 week may increase maternal and fetal risk.
    • D. Severe preeclampsia requires immediate hospital management due to the high risk of complications.

    Sources: SOGC Clinical Practice Guideline

11. 10 / 10

    A 29-year-old woman at 20 weeks gestation asks about pain relief for a persistent headache and low back pain. A friend advised her to avoid acetaminophen because of reports linking it to autism in children.

    According to the Society of Obstetricians and Gynaecologists of Canada position statement, what should be advised?

    • A. Avoid acetaminophen for the remainder of pregnancy and use non-drug measures
    • B. Acetaminophen is the first-line option for fever and pain in pregnancy when medically indicated, at recommended doses for the shortest duration required
    • C. Use a non-steroidal anti-inflammatory drug instead, at the lowest effective dose for the shortest time throughout pregnancy
    • D. Use acetaminophen only in the third trimester
    Show answer

    Answer: B. Acetaminophen is the first-line option for fever and pain in pregnancy when medically indicated, at recommended doses for the shortest duration required

    Why: The Society of Obstetricians and Gynaecologists of Canada re-affirmed its recommendation that acetaminophen be used as a first-line therapeutic option for fever and pain in pregnancy when medically indicated, at recommended doses for the shortest duration required. The statement notes that the evidence for a causal link with neurodevelopmental disorders is weak and that there is a lack of safer alternatives in pregnancy. Untreated fever and pain also carry risks.

    • A. The SOGC re-affirmed its 2021 recommendation supporting acetaminophen as a first-line option, so avoiding it for the rest of pregnancy is not advised.
    • C. The statement notes the lack of safer alternatives in pregnancy rather than recommending another drug class.
    • D. The statement does not limit acetaminophen to the third trimester, and it supports use at recommended doses when medically indicated.

    Sources: Society of Obstetricians and Gynaecologists of Canada (SOGC). SOGC Position Statement on the use of Acetaminophen for Analgesia and Fever in Pregnancy (2025).

Exam-style questions written by MedHub for practice. They are not official exam questions.