Pregnancy: ACE inhibitors: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Pregnancy: ACE inhibitors

Sample item

A woman at 30 weeks of gestation, who continued enalapril for hypertension, has a fetal ultrasound showing oligohydramnios and small kidneys. What is the underlying mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Reduced angiotensin II lowering fetal glomerular filtration and urine output

Fetal glomerular filtration depends on angiotensin II-mediated efferent arteriolar tone. ACE inhibitors and ARBs cause fetal hypotension and renal failure, so little urine is produced, producing oligohydramnios, pulmonary hypoplasia, skull hypoplasia and neonatal anuria. The risk is mainly in the second and third trimesters.

Option by option

  • A. Reduced angiotensin II lowering fetal glomerular filtration and urine output (correct)

    Correct. Loss of angiotensin II effect reduces fetal renal perfusion and urine output.

  • B. Premature constriction of the ductus arteriosus

    Ductal constriction is a feature of NSAID exposure.

  • C. Direct toxicity impairing neural tube closure

    Neural tube defects are associated with valproate and carbamazepine, not with this mechanism.

  • D. Inhibition of fetal thyroid hormone synthesis

    Fetal goitre and hypothyroidism are related to iodides and antithyroid drugs.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Reduced angiotensin II lowering fetal glomerular filtration and urine output. Fetal glomerular filtration depends on angiotensin II-mediated efferent arteriolar tone.

Why is "Premature constriction of the ductus arteriosus" not the answer?

Ductal constriction is a feature of NSAID exposure.

Why is "Direct toxicity impairing neural tube closure" not the answer?

Neural tube defects are associated with valproate and carbamazepine, not with this mechanism.

Why is "Inhibition of fetal thyroid hormone synthesis" not the answer?

Fetal goitre and hypothyroidism are related to iodides and antithyroid drugs.

What concept does this question test?

It tests Pregnancy: ACE inhibitors in Pharmacology. ACE inhibitors and ARBs cause fetal hypotension and renal failure, so little urine is produced, producing oligohydramnios, pulmonary hypoplasia, skull hypoplasia and neonatal anuria. The risk is mainly in the second and third trimesters.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pregnancy: ACE inhibitors?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.