This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Choriocarcinoma, Subject name: Gynaecology & Obstetrics
In Down's syndrome, 2nd trimester quadruple test includes all EXCEPT: 
Select and explain. 
A. Alpha fetoprotein, B. HCG, C. Inhibin A, D. PAPP
D: PAPP
Answer: D: PAPP 
Explanation: Ans. (d) PAPP* The triple test measures the following three levels in the maternal serum: (sensitivity 71%)# Alpha-fetoprotein (AFP)# Human chorionic gonadotropin (hCG)# Unconjugated estriol (UE3)* Quadruple test include: triple test + Inhibin A: increases sensitivity upto 80%The levels may indicate increased risk for certain conditions: hCGAssociated conditionsLowLowHighDown's syndromeLowLowLowTrisomy 18 (Edward's syndrome)High--NTD, omphalocoele, gastrochisis