Question: Best investigation to establish the diagnosis of endometriosis is

Ans. is a i.e. Laparoscopy Diagnostic laparoscopy is the gold standard for diagnosing endometriosis. Typical lesion : Powder burn / gun shot lesions (black, dark brown or bluish cysts with old hemorrhage surrounded by variable degree of fibrosis). Other non typical findings could be : - Red implantsdeg - Serous or clear vesicles White plaques / scarring] - Yellowish brown discolouration of peritoneumdeg Sub ovarian adhesionsdeg. Histological confirmation of laparoscopic impression is essential for diagnosis of endometriosis. Danazol By its multiple effects, produces a high androgen & low estrogen environment that does not suppo the growth of endometriosis. It inhibits pituitary gonadotropins & produces pseudo menopause like state. Danazol is not more effective than other available medications to treat endometriosis. Due to its androgenic propey has significant side effect like weight gain, fluid retention, acne oily skin, hirsutism, hot flashes, atrophic vaginitis, reduced breast-size. reduced libido, fatigue, muscle cramps. Deepening of voice is an rreversible side effect. Gestrinone It is a 19 noesto sterone derivative. It acts centrally & peripherally to increase free testosterone, reduce SHBG. serum estradiol & LH which inturn obliterates LH & FSH surge. Its actions are similar to Danazol but is longer acting. So, can be given twice weekly. Side effects - similar to Danazol but less intense. Gonadotropin releasing hormone agonist When given continously suppress pituitary gonadotropin. They are inactive orally; & have to be given intramuscular, intra nasal or subcutaneous. Side effects due to hypo estrogen are hot-flashes, vaginal dryness, reduced libido and osteoporosis. GnRH should not be prescribed to girls who have not yet attained their maximum bone density (i.e., in age < 16 years).


Question: The highest rate of transmission of toxoplasmosis in pregnancy is

The incidence and severity of fetal toxoplasmosis infection depend on gestational age at the time of maternal infection. Risks for fetal infection increase with pregnancy duration. A meta-analysis estimated the risk to be 15 percent at 13 weeks, 44 percent at 26 weeks, and 71 percent at 36 weeks (SYROCOT Study Group, 2007). Conversely, the severity of fetal infection is much greater in early pregnancy, and these fetuses are much more likely to have clinical findings of infection.Ref: William&;s obstetrics; 24th edition; Chapter 64; Infectious Diseases; Protozoal infections


Question: Predisposing factor to carcinoma endometrium is

i.e. (D M): (416-18-Shaw's 15th)PREDISPOSING FACTORS IN CARCINOMA ENDOMETRIUM* Un opposed and unsupervised administration of hormone replacement therapy (HRT) after menopause predispose to endometrial hyperplasia and cancer. Fortunately the malignancy is well-differentiated with good prognosis* Chronic non ovulatory cycle as seen in DUB* In some families, a strong familial predispotion is noticed. This may be due to genetic or dietic habits such as animal protein and fat. The oestrone is derived by peripherlal aromatization in the fat tissue from androstenedione and contributes to high level of oestrogen. Women with familial Lynch II syndrome suffering from anorectal and breast cancer are also likely to suffer from endometrial cancer* Tamoxifen given to women with breast cancer increases the risk of endometrial hyperplasia and cancer to 2- 3 folds* Combined oral hormonal pills have protective effect and reduce its risk by 40-50% and also adding progestogens for 12 days each cycle to oestrogen in HRT reduces its risks to 20%**** Obesity, hypertension and diabetes characterize this cancer in 30%* Infertile women and women with PCOS on account of non-ovulation have high oestrogen. They develop endometrial hyperplasia and endometrial cancer more than normal women. The uterine fibroid is associated with endometrial cancer in 3% after the age of 40 years* 15% women with endometrial cancer have feminizing ovarian tumour at the time of diagnosisOCP|| |Tumours associated Provides protection1. Cervical cancer 1. Ovarian tumours2. Hepatic adenoma 2. Uterine tumours3. Pituitary adenoma 3. Benign breast disease


Question: Mrs. X, 20years with 30weeks of pregnancy, her parity is

Nullipara: a woman who has never completed a pregnancy beyond 20 weeks' gestation. She may not have been pregnant or may have had a spontaneous or elective aboion(s) or an ectopic pregnancy.Primipara: a woman who has been delivered only once of a fetus or fetuses born alive or dead with an estimated length of gestation of 20 or more weeks.Multipara: a woman who has completed two or more pregnancies to 20 weeks' gestation or more. Parity is determined by the number of pregnancies delivered reaching 20 weeks. It is not increased to a higher number if multiples are delivered in a given pregnancy. Moreover, stillbih does not lower this number.Reference: William's obstetrics; 25th edition


Question: HIV transmission to the fetus is maximum during

Ans. d (Vaginal Delivery) (Ref. Harrison 18th/ p 38, 1082)HUMAN IMMUNODEFICIENCY VIRUS (HIV)# Exposures, which increase the risk of mother-to-child transmission, include -- Vaginal delivery, Preterm delivery; Maternal bleeding, and Trauma to the fetal skin,# Additional factors that may increase the risk of transmission include:- Recent infection with high maternal viral load,- Low maternal CD4 T cell count, prolonged labor,- Prolonged length of membrane rupture, and- The presence of other genital tract infections, such as syphilis or herpes.# Maternal transmission to the fetus occurs most commonly in the perinatal period.# In the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor, and delivery, and to the fetus following birth, the probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% in industrialized countries and from 25 to 35% in developing countries.# HIV transmission from mother to the baby can be minimized by:A. Antepartum Zidovudine therapy to mother and to the neonate after birthB. Maternal Vitamin A therapyD. Avoidance of breast feeding# The rate of MOTHER-TO-CHILD TRANSMISSION IS APPROACHING 1 % OR LESS IN PREGNANT women who are receiving combination antiretroviral therapy for their HIV infection.WHO guidelines for PMTCT drug regimens in resource-limited settings:PREGNANCYLABOURAFTER BIRTH: MOTHERAFTER BIRTH: INFANT RecommendedAZT after 28 wkssingle dose nevirapine; AZT + 3TCAZT+3TC for seven daysSingle dose nevirapine; AZT for seven daysAlternative (higher risk of drug resistance)AZT after 28 wksSingle dose nevirapine-Single dose nevirapine; AZT for seven daysMinimum (less effective)-Single dose nevirapine; AZT + 3TCAZT+3TC for seven daysSingle dose nevirapineMinimum (less effective; higher risk of drug resistance)-Single dose nevirapine-Single dose nevirapineTreatment# The majority of cases of mother-to-child (vertical) transmission of HIV-1 occur during the intrapartum period.# Mechanisms of vertical transmission include infection after rupture of the membranes and direct contact of the fetus with infected secretions or blood from the maternal genital tract.# In women with HIV infection who are not receiving antiretroviral therapy, the rate of vertical transmission is approximately 25%.# Cesarean section and treatment with zidovudine, administered both before and during delivery, decrease the rate of vertical transmission.# In a meta-analysis, zidovudine treatment of both the mother during the prenatal and intrapartum periods and the neonate at birth reduced the risk of vertical transmission to 7.3%.# The combination of elective cesarean section plus zidovudine treatment reduced the risk of vertical transmission to 2%.CYTOMEGALOVIRUS INFECTION# The most common cause of congenital viral infection in the United States is cytomegalovirus (CMV).# Severe CMV disease in the newborn is characterized most often by petechiae, hepatosplenomegaly, and jaundice.# Chorioretinitis ("tomato sause & cheese" appearance), microcephaly, intracranial calcifications, hepatitis, hemolytic anemia, and purpura may also develop.# Central nervous system involvement, resulting in the development of psychomotor, ocular, auditory, and dental abnormalities over time, has been described.RUBELLA# First trimester rubella carries a high risk of fetal anomalies, though the risk decreases significantly later.# Congenital rubella may be diagnosed by PUBS with the detection of IgM antibodies in fetal blood.HERPESVIRUS# The acquisition of genital herpes during pregnancy is associated with spontaneous abortion, prematurity, and congenital and neonatal herpes.# Infection occurs equally in all three trimesters.# In women who acquired genital herpes shortly before delivery, the risk of transmission is high.# The risk of active genital herpes lesions at term can be reduced by prescribing acyclovir for the last 4 weeks of pregnancy to women who have had their first episode of genital herpes during the pregnancy.# It is recommended that pregnant women with active genital herpes lesions at the time of presentation in labor be delivered by cesarean section.PARVOVIRUS (human parvovirus B19)# It rarely causes sequelae.# But susceptible women infected during pregnancy may be at risk for fetal hydrops secondary to erythroid aplasia and profound anemia.TOXOPLASMOSIS# The diagnosis of congenital toxoplasmosis is possible through sampling of fetal umbilical blood.# If there is no evidence of placental/fetal infection, single-drug treatment with spiramycin is recommended.# Triple-drug therapy with spiramycin, pyrimethamine, and sulfa is recommended if there is evidence of fetal infection and the woman does not wish to terminate the pregnancy or cannot terminate it because of advanced gestational age.


Question: The shoest diameter of fetal head is

1. The occipitofrontal (11.5 cm), which follows a line extending from a point just above the root of the nose to the most prominent poion of the occipital bone. 2. The biparietal (9.5 cm), the greatest transverse diameter of the head, which extends from one parietal boss to the other. 3. The bitemporal (8.0 cm), which is the greatest distance between the two temporal sutures. 4. The occipitomental (12.5 cm), which extends from the chin to the most prominent poion of the occiput. 5. The suboccipitobregmatic (9.5 cm), which follows a line drawn from the middle of the large fontanel to the undersurface of the occipital bone where it joins the neck.Reference: William&;s Obstetrics; 24th edition; Chapter 7; Embryogenesis and Fetal Morphological Development


Question: Most useful investigation for VVF

Big fistula Fistula tract is available Obvious escape of urine Tiny fistula Dye test Knee chest position: Escape of bubbles on coughing Three-swab test Gold Standard Cystoscopy Ref: D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY; 6th edition; Pg no: 420


Question: Use of valproate during pregnancy may result in

Valproate crosses the placenta and has been repoed to have caused teratogenic effects, including neural tube defects (anencephaly, meningomyelocele, and spina bifida) in the fetus when the mother received valproate during the first trimester of pregnancy.


Question: Peak value of Karyopyknotic index is reached on

Normally, peak value of KPI is reached on the day of ovulation.


Question: The progesterone of choice for emergency contraception is aEUR'

Levonorgestrel [Ref: Dutra Obstetrics 6/e, p 549-550; S.K. Chaudhuri Feility Control 6/e, p 190-199; Novak's Gynaecology I4/e, p 283-385. Repeat from Nov 09 Q no.154


Question: According to FIGO staging, Women diagnosed with choriocarcinoma with metastasis to lungs will be staged under

Anatomical stagingStage IGTN confined to the uterusStage IIGTN extends outside of the uterus but is limited to the genital structures Stage IIIGTN extends to the lungs, with or without genital tract involvementStage IVDistant metastasisReference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: Best reproductive out come among mullerian duct anomalies is

Best reproductive out come is seen is arcuate uterus > Didelphic uterus > Bicornuate uterus.

Bicornuate uterus > Arcuate uterus > Didelphic uterus

Didelphic uterus > Bicornuate uterus > Arcuate uterus

Arcuate uterus > Didelphic uterus > Bicornuate uterus

Unicornuate uterus > Arcuate uterus > Didelphic uterus


Question: Endocervical polyps causing abnormal menstrual bleeding are seen most commonly in

Endocervical polyps are seen more commonly in multiparous women.


Question: Most common cause of postmenopausal bleeding is

Causes of Postmenopausal Uterine BleedingCausesPercentageEndometrial atrophy60-80Estrogen replacement therapy15-25Endometrial polyps2-12Endometrial hyperplasia5-10Endometrial cancer10Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer


Question: A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is

Urethral syndrome Urethral syndrome is defined as a symptom complex including dysuria, frequency, urgency, suprapubic discomfo , post void fullness and dyspareunia in the absence of any abnormality of urethra or bladder. Cause is unceain and is attributed to subclinical infection, urethral obstruction, psychogenic and allergic factors. It is a diagnosis of exclusion, after ruling out UTI, malignancy, vulvovaginitis. Cystoscopy to rule out urethral diveiculum, stones and malignancy. Management: multidisciplinary approach, antibiotics for sterile pyuria. Post menopausal women may benefit from local estrogen. Physical therapy, cognitive-behavioral therapy and psycological suppo. Asymptomatic bacteriuria is ruled out with normal urine culture, Cystitis with normal urine r/m, c/s, and USG. Vulvovaginitis is ruled out by the given symptoms and normal local examination


Question: Cryptomenorrhea is seen in

Cryptomenorrhea means monthly subjective symptoms of menstruation without the outflow of blood.In women with cryptomenorrhoea presenting as primary amenorrhoea, the common cause is an intact hymen or vaginal septum. A history of cyclic abdominal colickypain, retention of urine, the presence of a palpable abdominal lump and the visualization of a tense bluish bulging membrane on separation of the labia enables the diagnosis.Ultrasound scan of the pelvis confirms it. A simple cruciate incision of the hymen permits free drainage of the collected menstrual blood and leads to normal reproductive function.Ref: Shaw&;s Textbook of Gynecology; 16th edition; Page no: 324


Question: The iron content in 100 gm of breast milk is

(100 ng) Ref: 149, 455-D, 398-PK 17thPercentage composition of colostrums and breast milk ProteinFatCarbohydrateWaterColostrum8.62.33.286Breast milk1.23.27.587 Composition of Human and Cow's milk Lactose g/ 100mlFat g/ 100mlProtein g/100mlSodium mmol/LWaterCalories kcal/mHuman73.51.278975Cows4.53.53.4228867 MineralsBreast milk grammes per litreCow's milk grammes per litreCa0.331P0.151-Fe0.4 to 1.5 mg0.3 to 0.5 mg


Question: In ovarian cycle increaed levels of LH are due to

Luteinising Hormone

LH is a water-soluble glycoprotein of high molecular weight secreted by beta cells of the anterior pituitary gland
LH surge initiated by estrogen lasts for 48 h. LH level doubles up in 2 hrs and peak plateaus for 14 hours before declining.
Minimum of 75 ng/ml is required for ovulation


Question: Earliest pregnancy is detected by

A. i.e. (b hCG) (67-69- Dutta 6th)Immunological Test for Diagnosis of Pregnancy* Immunological Tests (Urine)Positive on* Agglutination inhibition test (Latex test)2 days after missed period* Direct latex agglutination test2-3 days after missed period* Card testOn the first day of the missed periodELISA**5 days before the first missed period* Radioimmunoassay (b-subunit)** 25th day of cycle* Immuno- radiometric assay (IRMA)8 days after conceptionULTRASONOGRAPHY - Intradecidual gestational sac (GS) is identified as early as 29 to 35 days of gestation* Gestational sac and yolk sac - 5 menstrual weeks* Fetal pole and cardiac activity - 6 weeks* Embryonic movements - 7 weeks* Fetal gestational age is best determined by measuring the (RL between 7 and 12 weeks (variation + 5 days)* Doppler effect of ultrasound can pick up the fetal heart rate reliably by 10th week.*** Active fetal movements can be felt at intervals by placing the hand over the uterus as early as 20th week**.It not only gives positive evidence ofpregnancy but of a live fetus* b- hCG- is marker of Dysgerminoma*** Inhibin is marker for 'Granulosa cell tumour*** The secreening test for gestational diabetes mellitus has the highest sensitivity is - 50 gram glucose challenge test**


Question: Secondary oocyte consists of

Ans. d (23 X)Secondary oocyte consist of 23 X chromosomes.The chromosomal complement of a primary oocyte is 46 XX and that of secondary oocyte is 23 X.Sequence of maturation of ovarian primordial follicle after primary follicle stage:Primordial follicle(Single layered ovarian follicle)Spermatogonium (diploid, 2N) ||Primary Spermatocyte (diploid, 2N)Primordial follicle ||Secondary Spermatocyte (haploid, N)Secondary follicle (Antral follicle) ||Spermatid (haploid, N)(Spermatogenesis begins with Spermatogonia.Full development takes 2 months.It occurs in seminiferous tubules)Graffian follicle|Corpus luteum| Corpus albicans # While majority of oogonia divide, some enter into prophase of first meiotic division and are primary oocytes. These are surrounded by flat cells, which are called primordial follicles, and are present in cortex of the ovary.# At birth, there is no more mitotic division and all the oogonia are replaced by primary oocytes, which have finished prophase of first meiotic division and remain in resting phase between prophase and metaphase.# The first stage of maturation occurs with full maturation of ovarian follicle just prior to ovulation but the final maturation occurs only after fertilization.# The primary oocyte undergoes first meiotic division giving rise to secondary oocyte and one polar body.# Secondary oocyte has haploid number of chromosomes.# Ovulation occurs soon after formation of secondary oocyte.# The secondary oocyte completes the second meiotic division only after fertilization by the sperm in the fallopian tube.


Question: Longest diameter of fetal skull is

Mentoveical is the longest anteroposterior diameter of the fetal head measuring approximately 13.5cms It is the diameter in brow presentation


Question: The peak level of chorionic gonadotropin in normal pregnancy occurs

Peak maternal levels of chorionic gonadotropin in normal pregnancy occurs between 60th and 80th days after menses and is around 100,000 mIU/mL. Before 5 weeks of gestation, hCG is expressed in both cytotrophoblast and syncytiotrophoblast. Later during gestation, when maternal serum levels peak, hCG is produced almost solely in syncytiotrophoblasts. Plasma levels of hCG begin to decline at 10 to 12 weeks and a nadir is reached about 16 weeks. Plasma levels are maintained at this lower level for the remainder of pregnancy. Human Chorionic Gonadotropin is a glycoprotein with biological activity similar to luteinizing hormone. It has a molecular weight of 36,000 to 40,000 Da. It is structurally related to LH, FSH and TSH. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 3. Implantation, Embryogenesis, and Placental Development. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


Question: Kalavati, a 29 year old nulliparous women complains of severe menorrhagia and lower abdominal pain since 3 months. On examination there is a 14 wks size uterus with fundal fibroid. The treatment of choice is.

Ans. is 'a' is i.e.,. Myomectomy (Ref.: Robert Shaw, Patrice Soutter, 3/e, p 487, 488, Shows, 73/e, p 346 (72/e, p 283;;Guidelines for the management of MvomaAbout medical t/t of myoma with GnRH analogues * For this we have consulted many books and consultants in gynecology. Allof them except 'Shaws gynae' were of the opinion that the medical t/t is not used as a curative therapy. Though it can reduce the size of the fibroid by upto 50%, the effect persists only for the duration of t/t. Once its stopped, the fibroid rapidly regrows to its pretreatment size. So It's only used in patients who are keen to avoid surgery or those with contraindications to surgery.Main aim of medical management in myomaRelief of symptomsReduction in fibroid size and vascularity preoperatively.


Question: Drug contraindicated in patient with rheumatic heart disease in PPH is

Ans. is 'b' i.e. Methyl ergometrine Cardiac patients should not receive ergotamine because these agents cause significant vasoconstriction and elevation of blood pressure which can be deleterious to the patientAlso know,In healthy women, an intravenous bolus of 10 units of oxytocin caused a transient but marked fall in arterial blood pressure that was followed by an abrupt increase in cardiac output.These hemodynamic changes could be dangerous to women already hypovolemic from hemorrhage or who had cardiac disease that limited cardiac output.The same danger is present for women with right to left cardiac shunts because the decrease in systemic resistance would further increase the shunt.So, - Oxytocin should not be given intravenously as a large bolus, but rather as a much more dilute solution by continuous intravenous infusion or as an intramuscular infection.Management of cardiac patient during pregnancy Antepartum Bed restThe most important measure for attenuating the impact of pregnancy on diseased heart is bed rest.Bed rest increases the venous return to the heart, improves renal perfusion, induces diuresis and promotes elimination of water.Dietary salt restrictionIt helps to prevent excess retention of sodium and water.DiureticsIt should be given to cardiac pregnant patient if moderate restriction in sodium intake is insufficient to limit the normal intravascular volume expansion that occurs during gestation.Prophylactic digitalizationIt is commonly used in patients with severe heart disease who are not in overt congestive failure.During labour and deliveryThe pregnant cardiac patient should always labor and deliver in lateral supine position to avoid hemodynamic impairment caused by dorsal decubitus position.Effective pain relief during labour with morphine.Continuous monitoring with pulse oximetry.Restriction of i.v. fluids to 75 ml/hr (Almost all cardiac patients in labour should be kept on the dry side).Antibiotic prophylaxis (This is given in patients with congenital or acquired heart lesions).Thrombosis prophylaxis.Patient should be placed in sitting position after delivery. This is done to avoid pulmonary edema (sitting will increase venous pooling in the lower extremities and decrease the venous return to the heart).


Question: Highest maternal mortality is seen in following congenital heart disease

Ans. is 'a' i.e. Eisenmenger syndrome This syndrome is secondary pulmonary hypertension that can develop with any cardiac lesion in which pulmonary vascular resistance becomes greater than the systemic vascular resistance and there should also be some right to left shunting. The most common underlying defects are atrial or ventricular septal defects and persistent ductus arteriosus.Patients usually are asymptomatic but eventually pulmonary hypertension becomes severe enough to cause right to left shunting.The prognosis for pregnancy depends upon the severity of pulmonary hypertension.The mortality rate in Eisenmenger's syndrome is 50%. It is the maximum mortality for any cardiovascular disorder in pregnancy. So termination of pregnancy is done in most cases.Maternal tolerance to specific heart conditions;Well toleratedPulmonary stenosisAortic insufficiencyMitral insufficiencyCongenital heart blockWell tolerated if pulmonary hypertension is not presentAtrial septal defectsVentricular septal defectsPatent ductusVariable tolerance depending on the functional capacity of the heartUncomplicated Aortic coarctationAortic stenosisMitral regurgitationAortic regurgitationPoorly tolerated and source of significant problems during pregnancyMitral stenosisPeripartum cardiomyopathyPrimary pulmonary hypertensionEisenmenger's syndromeMarfan's syndrome with dilated aortic rootMetallic valve prosthesisCongenital cyanotic heart diseaseConditions listed in group C if pulmonary hypertension is present.Any class III or IV lesion.


Question: Twin peak sign on obstetric ultrasound indicates the presence of

(A) Dichorionic twins# TWIN PEAK SIGN indicates the presence of a dichorionic-diamniotic twin gestation. It represents the extension of placental villi into the potential space that is formed from the reflection of apposed amniotic and chorionic layers from each fetus.> By performing an obstetric ultrasound at a gestational age of 10-14 weeks, monochorionic-diamniotic twins are discerned from dichorionic twins.> Presence of a "T-sign" at the inter-twin membrane-placental junction is indicative of monochorionic-diamniotic twins (that is, the junction between the inter-twin membrane and the external rim forms a right angle), whereas dichorionic twins present with a "lambda (I) sign" (that is, the chorion forms a wedge-shaped protrusion into the inter- twin space, creating a rather curved junction).> "Lambda sign" is also called the "twin peak sign". At ultrasound at a gestational age of 16-20 weeks, the "lambda sign" is indicative of dichorionicity but its absence does not exclude it.


Question: Prevention of neural tube defect in the newborn is by

(Folic acid): (865 H186th edition)* Folic acid supplementation of the time of conception and in the first 12 weeks of pregnancy reduce by -70% the incidence of neural tube defects (NTDs) (Anencephaly , meningomyelocele,encephalocele and spina bifida) in the fetus.* Most of this protective effect can be achieved by taking folic acid 0.4mg daily at the time of conception* The incidence of cleft palate and have lip also can be reduced by prophylactic folic acid* NTDs also can be caused by antifolate and antiepileptic drugs


Question: The regimens of Mg So4 for the management of severe preclampsia and eclampsia is known as

(Pritchard regime) (236-D)* Magnesium sulphate is the drug of choice in preeclampsia and eclampsia, Pritchard and Zuspan or Sibai regime are used* Lvtic cocktail regime (Menon 1961) using chloropromazine, phenergan and pethidine (CPP)* Diazepam therapy (Lean)* Pinard's maneuver - frank breech extraction


Question: A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as

The anthropoid pelvis is marked by an oval inlet (but the anteroposterior diameter exceeds the transverse), the pelvic side walls diverge, and the sacrum is inclined posteriorly. Its associated with Persistent occipito posterior presentation and Face to pubis delivery The android (male-like) pelvis, where the inlet is wedge shaped, the pelvic sidewalls are convergent, the ischial spines are prominent, the subpubic arch is narrow, and the sacrum is inclined anteriorly in its lower one third. It is likely to be associated deep transverse arrest dystocia. Gynaecoid Android Anthropoid Platypelloid Shape of inlet Round Hea-shaped/triangular Long oval Flat Sacrosciatic notch Wide Narrow Wide Narrow Side walls Straight Convergent Straight Straight Ischial spine Not prominent Prominent Not prominent Not prominent Subpubic angle Wide Narrow Medium Wide


Question: Commonest site for fibroids in uterus is

Fibroids always sta intramural Outwards Inwards Pedunculated Fibroid Subserosal fibroid Mucosal fibroid Pedunculated Submucosal fibroid Intramural fibroids are the m/c Fibroids are the most common cause of hysterectomy in the world. Fibroids have genetic predisposition & estrogen cause | in size of fibroids Rx fibroids is Medically - Mifepristone Surgically can be removed by laparoscopy or laparotomy FIGO Classification Leiomyoma Sub classification System Submucosal 0. Pedunculated intra cavity 1. < 50 % intra moral 2. >= 50 % intra moral Others 3. Contacts endometrium 100% intra moral 4. Intramural 5. Sub serosal >= 50% Intra moral 6. Sub serosal < 50 % intra moral 7. Sub serosal pedunculated 8. Cervical, parasitic


Question: Caudal regression syndrome is seen in

Gestational diabetes is associated with caudal regression syndrome.


Question: Cardinal movements of labour in order

The cardinal movements of labour are engagement, descent, flexion, internal rotation, extension, restitution, external rotation and expulsion Reference: William&;s Obstetrics; 24th edition; Chapter 22; Normal labour


Question: Area of the mitral valve in severe mitral stenosis during pregnancy

Normal area of the mitral valve is 4-6cm2
Severe mitral stenosis is less than 1.5cm2
Critical area is less than 1cm2


Question: A female presents with leaking and meconum stained liquior at 32 weaks. She is infected with

“Discolored brownish or meconium stained amniotic fluid is common with fetal infection, even with preterm gestation”
Hence, the correct answer is Listeria, rest of the infections do not lead to preterm labour with meconium stained liquor.
Listeriosis

Causative organism- listeria monocytogenes (facultative intracellular gram positive bacillus)
Mode of infection- Food-borne infection caused by eating food like raw vegetables, Coleslaw, Apple cider, Melons, Milk, Fresh mexican style cheese, Smoked fish, Processed foods.

Clinical features

Can be asymptomatic
Can cause febrile illness.

Maternal complications which can occur due to listeria infection are:

Preterm labor,
Chorioamnionitis,
Menonium stained liquor,
Abortions,
Placental Macroabscesses

Maternal infection can lead to fetal infection characterised by:

Disseminated granulomatous lesions with microabscess in skin
Stillbirth
Overall perinatal mortality-50%.

Management

Drug of choice is combination of Ampicillin + gentamicin or in case of pencillin allergy – Trimethoprim sulfamethoxazole
Maternal treatment may be effective for fetal infection
There is no vaccine for listeriosis.


Question: Fetal position refers to

Fetal Lie: The relation of the fetal long axis to that of the mother is termed fetal lie and is either longitudinal or transverse. The presenting pa is that poion of the fetal body that is either foremost within the bih canal or in closest proximity to it.In the later months of pregnancy, the fetus assumes a characteristic posture described as attitude or habitus. As a rule, the fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity.Position refers to the relationship of an arbitrarily chosen poion of the fetal presenting pa to the right or left side of the bih canal.(Ref: William's Obstetrics; 25th edition)

The relationship of an arbitrarily chosen poion of the fetal presenting pa to the right or left side of the bih canal

That poion of the fetal body that is either foremost within the bih canal or in closest proximity to it

The form of an ovoid mass that corresponds roughly to the shape of the uterine cavity


Question: Threshold values for Diagnosis of Gestational diabetes from a 75g of OGTT is

Threshold values for diagnosis of Gestational diabetes is Fasting: 92mg/dl1-hour: 180mg/dl2-hour: 153mg/dlOne or more of these values must be equaled or exceeded for the diagnosis of gestational diabetes(Ref: William's Obstetrics; 25th edition)


Question: In a case of Dysgerminoma of ovary one of the following tumor markers is likely to be raised;

- dysgerminoma is the most common among the malignant germ cell tumors accounting for 40%. - tumors markers like placental alkaline phosphatase and lactic dehydrogenase may be elevated in dysgerminoma. Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no: 283 <\p>


Question: The commonest route of spread of puerperal sepsis is

The organisms responsible are typically those that normally colonize the cervix, vagina, and perineum and are usually of low virulence. The uterine cavity is sterile before rupture of membranes but later becomes contaminated. Other factors which help to create a suitable environment for these ascending organisms are tissue trauma, devitalization of tissues and the alkaline lochia (refer pgno:434 Sheila 2 nd edition)


Question: A lady presented with creamy white vaginal discharge with fishy odour, drug of choice is aEUR'

Metronidazole This is a case of bacterial vaginosis D.O.C. of bacterial vaginosis Metronidazole Features Vulvovaginal candidiasis Trichomonal vaginitis Bacterial Vaginosis Etiology Candida albicans Trichomonas Trich vaginalis vaginitis Symptoms Vulval itching irritation Profuse purluent discharge M alodorus slightly increased discharge Colour White White or yellow White or gray Inflammation vulvar or vaginal epithelium Erythema of vaginal epithelium Erythema of vaginal and vulvar epithelium None Amine "fishy"odour with KOH None Sometimes Present


Question: Most accurate tool for gestational age assignment is

A first-trimester crown rump length is the most accurate tool for gestational age assignment and is performed as clinically indicated. (Ref: William's Obstetrics; 25th edition)


Question: A major causal factor in some cases of hypogonadism is

Reduced secretion of GnRH will result in extremely low levels of circulating LH and FSH, causing testicular atrophy, as in Kallmann's syndrome.

Reduced secretion of gonadotropin-releasing hormone (GnRH)

Hypersecretion of pituitary LH and FSH as the result of increased GnRH

Excess secretion of testicular activin by Seoli cells

Failure of the hypothalamus to respond to testosterone


Question: Increased estrone levels is PCOD is derived from

Elevated androstenedione levels contribute to an increase in estrone levels through peripheral conversion of androgens to estrogens by aromatase.


Question: A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for

In modern clinical medicine, once the diagnosis of fetal demise has been made, the products of conception are removed. If, however, the gestational age is over 14 weeks and the fetal death occurred 5 weeks ago, coagulation abnormalities may be seen. Septic abortions were more frequently seen during the era of illegal abortions, although occasionally sepsis can occur if there is incomplete evacuation of the products of conception in either a therapeutic or spontaneous abortion.

Consumptive coagulopathy with hypofibrinogenemia


Question: Gold standard investigation for septate uterus is

Septate uterus: Defined as uterus with normal outline and an internal indentation at the fundal midline Can be of two types- paial and complete Combined hysteroscopy and laproscopy help to differentiate between bicornuate uterus and septate uterus Ref: Shaw Gynecology 17 e pg 72.


Question: Select the antibiotic most frequently associated with the Gray baby syndrome (SELECT 1 ANTIBIOTIC)

Fetal exposure to an antibiotic depends on many factors such as gestational age, protein binding, lipid solubility, pH, molecular weight, degree of ionization, and concentration gradient. Some antibiotics are even concentrated in the fetal compartment. Tetracycline is contraindicated in all three trimesters. It has been associated with skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, and fatal maternal liver decompensation. Sulfonamides are associated with kernicterus in the newborn. They compete with bilirubin for binding sites on albumin, thereby leaving more bilirubin free for diffusion into tissues. Sulfonamides should be withheld during the last 2 to 6 weeks of pregnancy. With prolonged treatment of tuberculosis (TB) in pregnancy, streptomycin has been associated with fetal hearing loss. Its use is restricted to complicated cases of TB. Nitrofurantoin can cause maternal and fetal hemolytic anemia if glucose- 6-phosphate dehydrogenase deficiency is present. Chloramphenicol is noted for causing the gray baby syndrome. Infants are unable to properly metabolize the drug, which reaches toxic levels in about 4 days and can lead to neonatal death within 1 to 2 days.


Question: Urine formation in intra uterine life stas at


Question: The Kleihauer Betke test for detecting foetal erythrocytes is based on the fact that

The most commonly used quantitative test for fetal red cells in the maternal circulation is the acid elution or Kleihauer Betke test. Fetal erythrocytes contain HbF, which is more resistant to acid elution than HbA.

Adult erythrocytes are larger than those of foetus

HbF is more resistant acid elution than HbA

HbA takes up erythrosin stain less than HbF

Intra Uterine Growth Restriction, Intrapaum and Antepaum Fetal Surviellance


Question: A 3.8 kg baby of a diabetic mother developed seizures 16 hours after bih. The most probable cause would be

The neonate has seizures developed at around 16 hrs after bih. There are two possibilities in this neonate i.e. hypoglycemia and hypocalcemia. Hypoglycemia in first 18-36 hrs is usually due to transient neonatal hypoglycemia and after 36 hrs metabolic and other causes are likely. Hypoglycemia develops in about 25-50% of infants of diabetic mothers and 15-25% of infants of mothers with gestational diabetes, but only a small percentage of these infants become symptomatic.


Question: P57KIP2 immunostaining is helpful in diagnosing

In pregnancies before 10 weeks, classic molar changes may not be apparent because villi may not be enlarged and molar stroma may not yet be edematous and avascularOne takes advantage of the differing ploidy to distinguish paial (triploid) moles from diploid entities. Another technique involves histological immunostaining to identify the p57KIP2 nuclear protein. Because the gene that expresses p57KIP2 is paternally imprinted, only maternally donated genes are expressed. Because complete moles contain only paternal genetic material, they cannot express this gene; do not produce p57KIP2; and thus, do not pick up this immunostain. In contrast, this nuclear protein is strongly expressed in paial moles and in non-molar pregnancies with hydropic change. As a result, the combined use of ploidy analysis and p57KIP2 immunostaining can be used to differentiate: (1) a complete mole (diploid/p57KIP2-negative), (2) a paial mole (triploid/p57KIP2-positive), and spontaneous aboion with hydropic placental degeneration (diploid/p57KIP2-positive).Reference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: Interpret the paogram


Question: Most common cause of vaginal discharge in prepubeal girls is

A foreign body in the vagina is a common cause of vaginal discharge in young girls, which may appear purulent or bloody.Ref: Berek and Novak&;s Gynecology; 15th edition; Chapter 14


Question: For a woman with history of prior two molar pregnancies, the risk of having a third molar pregnancy is

For those with a prior complete mole, the risk of another mole is 0.9 percent. With a previous paial mole, the rate is 0.3 percentAfter two prior molar pregnancies, approximately 20 percent of women had a third moleReference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: GnRH agonists used in treatment of leiomyoma suppress progesterone levels after

After 1-2 weeks of GnRH agonist therapy, estrogen and progesterone levels start to decline.


Question: Risk factor for Ca Cervix

Ans. is a i.e. HPV; Smoking; and Early sexual intercourse


Question: Ovulation occurs

(Before 14 days of the menstruation) (27- Shaw's 14th)Ovulation is estimated to occur 14 days before the first days of the succeeding cycle* Ovulation occurs when the ovum surrounded by the corona radiata escapes out of the graffian follicle. It is quickly picked up by the tubal fimbria which hugs the ovary at ovulation* The peak level of 75 ng /ml of LH is required for ovulation.* Normally, one single ovum is discharged from the graffian follicle. However multiple ovulation can occur and results in a multiple dizygotic pregnancy.


Question: Most common twin presentation is

(C) Vertex + vertex # Twin pregnancy:> Most common lie of the fetus is longitudinal (90%) but malpresentations are quite common.# Combinations of presentation of the fetuses are Both vertex (commonest) First vertex and second breech First breech and second vertex Both breech, first vertex and second transverse and so on but rarest one, being both transverse when the possibility of conjoined twins should be ruled out.# Combinations of presentations of twin fetuses are Both vertex 60% First vertex, secon breech - 20% First breech, second vertex 10% Both breech 10%


Question: Most common CNS tumor to cause precocious puberty is

Hamartoma is most common CNS tumor to cause precocious puberty.


Question: Most frequent site of tubal ectopic pregnancy is

Nearly 95 percent of ectopic pregnancies are implanted in the various segments of the fallopian tube. The ampulla (70 percent) is the most frequent site, followed by isthmic (12 percent), fimbrial (11 percent), and interstitial tubal pregnancies (2 percent).The remaining 5 percent of non-tubal ectopic pregnancies implant in the ovary, peritoneal cavity, cervix, or prior cesarean scarReference: William's Obstetrics; 25th edition; Chapter 19; Ectopic pregnancy


Question: Umbilical cord separation takes

Umbilical cord separation usually takes place within first 2 weeks.


Question: Cesarean delivery has following advantage over vaginal delivery

Elective cesarean delivery offers decreased risks for hemorrhage and chorio amnionitis compared to vaginal delivery.


Question: Acanthosis Nigricans associated with malignancy has

Acanthosis Nigricans associated with malignancy has extensive skin involvement and sudden onset.


Question: Bandle ring on uterus suggests

In Tonic Uterine Contraction and Retraction, a circular groove encircling the uterus is formed between the active upper segment and the distended lower segment, called pathological retraction ring (Bandl's ring). Reference: D C Dutta Textbook of Obstetrics 7th edition page 362


Question: A 55 year old female presents with abdominal pain, distension, ascites and dyspnea. Her CA 125 levels are elevated The most likely diagnosis is a.

– M/c age incidence for primary ovarian neoplasms is 40-60 years, peak age incidence being 55–60 years. Ovarian malignancies generally present with vague symptoms like abdominal pain, dyspepsia, and patient may also experience irregular menses and if pelvic mass compresses the bladder or rectum she may have urinary frequency or constipation.
In advanced stages patients have symptoms related to presence of ascites, omental metastasis or bowel metastasis like abdominal distension, dyspnea, bloating, nausea, anorexia or early satiety.
In the patient given in the question all these symptoms are present (which could be seen in other cancers as well) plus her Ca 125 levels are raised, which favors the diagnosis of ovarian cancer in her.Remember
The most important sign of epithelial ovarian cancer is the presence of a pelvic mass on physical examination.
For postmenopausal patients with an adnexal mass and a very high serum CA125 level (>200U/ml), there is 96% positive predictive value for ovarian malignancy.


Question: DOC for candidiasis in pregnancy

Ans. (c) FluconazoleRef. Shaws 15thed, /: 352CANDIDAL (MONILIAL) VAGINITIS* It is a fungal infection caused by yeast-like microorganisms called Candida or Monilia.* The commonest species causing human disease isCandida albicansClinical Features* Vulval itching is the most common symptom, accompanied by vaginal irritation, dysuria, or both* Thick curdy or flaky vaginal discharge.Diagnosis* Essentially based on clinical findings. But the diagnosis can be confirmed on microscopic examination of a smear of the vaginal discharge treated with 10% KOH solution.* Pap smear shows thick red-stained hyphae and dark red spores.Treatment* A single dose of fluconazole 150 mg has been found to be very effective.* Ideally, both partners should be treated and the underlying predisposing factor corrected to give long- term relief.* Recurrent infection requires fluconazole orally 150 mg every 72 hours for 3 doses.


Question: Extreme preterm is defined as

Preterm labor is defined as one where the labor stas before 37th completed week, counting from the first day of the last menstrual period Lower limit of gestation is - 20 weeks in developed countries 28 weeks in developing countries Ref: Dutta Obs 9e pg 294.


Question: Value of Serum FSH in a normal adult female is

Clinical StateSerum FSHSerum LHNormal adult female5-20 IU/L (midcycle peak 2 timesthe basal level in ovulatory women5-20 IU/L (midcycle peak 3 timesthe basal level in ovulatory womenHypogonadotropic state: Prepubeal,Hypothalamic or pituitary dysfunction<5 IU/L<5 IU/LHypergonadotropic state: Postmenopausal,Castrate, or Ovarian failure>20 IU/L>40 IU/LReference: Clinical gynecologic endocrinology; 10th edition; Chapter 9; Normal and Abnormal Sexual Development; Page no: 443


Question: A 25 yr. old girl admitted as a case of septic abortion with tricuspid valve endocarditis. Vegetation from the valve likely to affect will be

Ans. D. LungBacteria present within the uterus colonizes dead conception products are responsible for the initiation of maternal infection and this infection may extend to cause endocarditis, peritonitis, parametritis and septicemia.Septic pelvic thrombophlebitis with or without septic pulmonary embolization is an uncommon but devastating complication of septic abortion. Right sided endocarditis often results in septic pulmonary emboli responsible for the cause of infarction and lung abscess.


Question: In Dysgerminoma stage 1A, treatment of choice is

Surgical management of dysgerminoma Veical midline abdominal incision Peritoneal washings Exploration of abdominal and pelvic organs Unilateral salpingoopherectomy with preservation of uterus Pelvic and paraaoic lymph node sampling Infraacolic omentectomy Removal of the other tumor masses Ref: Shaw Gynecology 17 e pg 469.

Unilateral ovariotomy with preservation of uterus

Bilateral ovariotomy with preservation of uterus


Question: Mechanism responsible for high rates of spontaneous abortion in septate uterus is

The primary mechanism responsible for spontaneous abortion in septate uterus is partial or complete implantation on avascular septum.


Question: Maximum number of oogonia is seen at

Maximal number of oogonia is achieved at 20th week of gestation.


Question: A case of Gestational trophoblastic neoplasia is detected to have lung metastasis. She should be staged as

FIGO staging system of GTN: Stage I: Disease confined to the uterus Stage II: Gestational trophoblastic tumor (GTT) extends outside of the uterus but is limited to the genital structures (ovary, tube, vagina, and broad ligament) Stage III: GTT extends to the lungs, with or without known genital tract involvement Stage IV: All other metastatic sites

Twin Pregnancy, Molar Pregnancy, Gestational Trophoblastic disease and contraception in special situations (Sour Grapes!)


Question: With oral iron therapy, rise in hb% can be seen after

The improvement should be evident within 3 weeks of the therapy. After a lapse of few days, the hemoglobin concentration is expected to rise at the rate of about 0.7 gm/100 mL per week. Reference: Textbook of Obstetrics; Sheila Balakrishnan; 2nd Edition; Page no: 287

Medical, surgical and gynaecological illness complicating pregnancy


Question: The widest transverse diameter of the fetal skull is

Transverse diameters of fetal skull are

Biparietal diameter: 9.5cm
Super-subparietal: 8.5cm
Bitemporal: 8cm
Bimastoid: 7.5cm


Question: A patient is diagnosed with carcinoma of the breast. The most important prognostic factor in the treatment of this disease is

Recognition of the high risk associated with axillary metastases for early death and poor 5-year survival has led to the use of postsurgical adjuvant chemotherapy in these patients. Patients who have estrogen- or progesterone-receptive tumors (i.e., receptor present or receptor-positive) are particular candidates for this adjuvant therapy, as 60% of estrogen-positive tumors will respond to hormonal therapy. Age and size of the tumor are certainly factors of importance, but they are secondary to the presence or absence of axillary metastases.


Question: Most common congenital abnormality of uterus

Types of fusion anomalies Arcuate - 18% Uterus didelphys- 8% Uterus bicornis - 26% Septate uterus- 35% Uterus unicornis- 10% D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY Pg no:45,6th edition


Question: Paial mole is

Paial mole : Karyotype is triploid either 69XXY or 69XYY One maternal and usually two paternal haploid chromosomes Ref: Dutta Obs 9e pg 186.


Question: Side effect of MgSo4 used in the treatment of eclampsia is

Complications : Pulmonary edema Anuria Hea failure Hyperpyrexia Psychosis Ref: Dutta Obs 9e pg 222.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Suspected ectopic pregnancy is best diagnosed by

Ans. B. TVS* Investigation of choice in a case of ectopic pregnancy/suspected case of ectopic pregnancy is Transvaginal scan.* Findings raising suspicion of ectopic on TVS:* Empty uterine cavity: most important* Finding of complex adnexal mass* Fluid (echogenic) in the pouch of Douglas.* Adnexal mass clearly separated from the ovary.* Rarely cardiac motion may be seen in an unruptured tubal ectopic pregnancy.


Question: Most common uterine malformation associated with renal anomalies

Unicornuate uterus is seen in 1% cases; Due to failure of development of one mullerian duct or failure of migration to proper location Most commonly associated with abnormality of urinary tract anomaly usually of kidney It is diagnosed by absence of round ligament and fallopian tube on the opposite side Associated with Endometriosis, Early spontaneous aboions, Ectopic pregnancy, Preterm labour and Fetal growth resriction SHAW&;S TEXTBOOK OF GYNAECOLOGY,PG NO:99,15th edition


Question: Best tocolytic in a cardiac patient is

Atosiban is oxytocin antagonist and best tocolytic in cardiac patients. B agonists and Calcium channel blockers are contraindicated in hea disease complicated pregnancies.


Question: A P2L2 poorly compensated cardiac patient delivered 2 days back. Contraceptive advise is

If Patient is hemodynamically unstable better to advise vasectomy for the husband. Contraception in Hea disease Patients Steroidal contraception is contraindicated as it may precipitate thromboembolic phenomenon IUCD's are avoided in fear of infection Progestin only pills are SAFE and EFFECTIVE. They may cause Irregular bleeding if the patient is anticoagulated. Barrier methods is the BEST but failure rate is high Sterilisation should be considered with the completion of family at the end of first week in the puerperium under local anaesthesia through abdominal route by minilap technique. The procedure can be delayed up to several days to ensure that the mother has become hemodynamically near normal and that she is afebrile, not anemic, and ambulating normally. Reference: DC. Duttas textbook of OBG & GYN , 9th edition .Page 260

Undergo sterilization (tubectomy) after 1 week

Suggest her husband to undergo vasectomy

Medical, surgical and gynaecological illness complicating pregnancy


Question: Most common cause of early miscarriages is

Ans. c (Chromosomal abnormality). (Ref. Dutta, Obstetrics, 5th ed., 211)ETIOLOGY OF SPONTANEOUS ABORTION/MISCARRIAGE1. Ova- fetal factors (60%)- operate in early abortion.# Chromosomal abnormality (commonest being autosomal trisomy, monosomy)# Gross congenital malformations.# Blighted ovum, hydropic degeneration of villi# Interference with circulation (cord twist)


Question: Pure gonadal dysgenesis will be diagnosed in the presence of

Pure gonadal dysgenesis is characterised by B/L streak gonads. The external phenotype is female and mullerian structures are present. Usually present with primary amenorrhea (hypergonadotropic hypogonadism)

One side streak and other side normal gonad

One side dysgenetic testis and other side dysgenetic ovary


Question: HT indicated in menopausal women

* Hormone Therapy (HT) is one of the government-approved treatments for relief of menopausal symptoms. * These symptoms, caused by lower levels of estrogen at menopause, include : * Hot flashes, * Sleep disturbances, and * Vaginal dryness. * HT is also approved for the prevention of osteoporosis REF : SHAW BOOK OF GYNECOLOGY


Question: Premature adrenarche is growth of axillary and pubic hair prior to the age

Premature adrenarche is defined as growth of axillary and pubic hair prior to age of 8 years.


Question: Grade 2 abruptio placenta is characterized by

Grade 2 abruptio placenta is characterized by fetal distress. Page clinical classification of placental abruption: Grade 1 Grade 2 Grade 3 Vaginal bleeding is slight Vaginal bleeding mild to moderate Bleeding is moderate to severe or concealed Uterus irritable, minimal tenderness Uterine tenderness is always present Uterine tenderness is marked Maternal BP and fibrinogen unaffected Maternal pulse increased, BP maintained Shock is pronounced FHS good Fetal distress present Fetal death is the rule Maternal shock absent Maternal shock absent Associated coagulation defect or anuria may complicate Ref: DC Dutta&;s Textbook of Obsterics 8th edition Pgno: 297


Question: First sign of magnesium sulphate toxicity is

Magnesium sulfate toxicity : Loss of deep tendon reflexes. - >7 mEq/L Respiratory depression more than 10 meq/L Cardiac arrest more than 25mEq/L Ref: Dutta Obs 9e pg 222.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Amount of iron required for fetus in pregnancy tenure is

Ans. c (0.3 gm). (Ref. Textbook of Obstetrics, D.C. Dutta, 6th /- Tab no. 19)The total iron requirement of pregnancy is 1,000 mg:# 500 mg increases the maternal red blood cell mass,# 300 mg is transported to the fetus and placenta, and# 200 mg compensates for blood loss at delivery.- The iron requirements of pregnancy increase steadily towards term but average 3.5 mg per day.Recommended supplementation for nonanemic gravidas is 300 mg of ferrous sulfate per day, which contains 60 mg of elemental iron.- Anemic gravidas (Hb of 8 or 9 g/dL) should take 300 mg ferrous sulfate 2 or 3 times a day.- Vitamin C facilitates iron absorption.- Therapeutic results can be expected after 3 weeks of therapy.- The severely anemic patient (Hb less than 8 g/dL) may require parenteral therapy in the form of intramuscular or intravenous iron dextran.- The total dose of iron required can be calculated using this formula:# Total dose of iron dextran (mL) = (0.0476 x body weight in kg x ) + 1 mL/5 kg of body weight up to a maximum of 14 mL.- Adequate parenteral therapy should result in a marked increase in the reticulocyte count within 7 to 14 days.


Question: Advantages of ultrasound nuchal translucency over biochemical screening for Down syndrome include

Biochemistry does not work well for multiple gestations.

More consistent measurements than lab tests


Question: Pseudogestational sac is seen in

The gestational sac --an anechoic fluid collection that represents the exocoelomic cavity--may be seen by 4.5 weeks.A caveat is that a gestational sac may appear similar to other intrauterine fluid accumulations--the so-called pseudogestational sac. This pseudosac may be seen with ectopic pregnancy and is easier to exclude once a yolk sac is seen. Typically, the yolk sac is visible by 5.5 weeks and with a mean gestational-sac diameter of 10 mm. Thus, the diagnosis of a uterine pregnancy should be made cautiously if the yolk sac is not yet seen.Ref: William&;s Obstetrics; 24th edition; chapter 19


Question: Absolute proof of monozygosity is determined by

Zygosity refers to the type of conception and can only be determined by DNA testing. Refer page no 179 of Text book of obstetrics,sheila balakrishnan,2 nd edition.


Question: Unicollis bicornis

In uterus bicornis unicollis:Two cornua of uterus are seperate in the region of the body but there is a single cervix and single vagina In uterus bicornis bicollis: Vagina is single but the two cornua of the uterus remains seperate and two complete cervices project into the vagina Uterus subseptus:This septum is restricted to the body of the uterus SHAW'S TEXTBOOK OF GYNAECOLOGY,Pg no:99,15th edition


Question: Hyperprolactinemia results in


Question: Placental site involution takes

Complete placental site involution takes upto 6 weeks.


Question: Maximum dose of PGF2 alpha in postpaum hemorrhage is

Max dose of PGF2 alpha in postpaum haemorrhage is 2 mg. Carboprost tromethamine (Hemabate) is the 15-methyl derivative of Prostaglandin F2 alpha. It is approved for uternine atony treatment in a dose of 250mcg (0.25 mg) given intramuscularly. This dose can be repeated if necessary at 15- to 90- minutes intervals up to maximum of eight doses (2 mg) C/I- Asthmatic women and those with suspected amniotic fluid embolism (as they cause pulmonary airway and vascular condstriction) It is the best drug to control PPH. Is also used an aboifacient in second trimester. Ref: Williams Obsterics 24th edition PGno: 760


Question: Mean incubation period for primary syphilitic chancre is


Question: Ovarian hyper thecosis is characterized by

Ovarian Hyperthecosis is severe variant of PCOD which exhibit severe hyperandrogenism.

Nests of lutenized theca cells in ovarian stroma.


Question: Infertility due to PCOD is

Infertility due to PCOD is reversible and treatable using ovulation inducing drugs.


Question: Cut off value of length of cervix at 24 weeks of gestation for prediction of preterm delivery is

Diagnosis of preterm labor : Regular uterine contractions with or without pain Dilatation more than 2cm and 80% effacement of cervix Length of the cervix <2.5 cm and funnelling of internal os Pelvic pressure, backache ,vaginal discharge Ref: Dutta Obs 9e pg 294.


Question: Mirena is a

LNG-IUS or Mirena
It is a levanorgestrel releasing device
It contains about 52 mg of levanorgestrel released at a rate approximately 20 microgram per day


Question: Ha&;s rule is related to

Elastic recoil of Levator Ani occurs bringing the occiput forwards in the midline. The process is repeated until the occiput is placed anteriorly. This is called as rotation by law of pelvic floor- Ha&;s rule.


Question: In cervical cancer surgery is limited to patients with

Radiation therapy can be used in all stages of disease, but surgery is limited to patients with stage I to IIa disease. The 5-year survival rate for stage I cancer of the cervix is approximately 85% with either radiation therapy or radical hysterectomy. Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer


Question: Yuzpe method is a type of

Ans. a (Emergency post-coital hormonal contraception) (Ref. Shaw's Textbook of Gynaecology 13th ed:233)In Yuzpe method, a post-coital hormonal contraception, two doses of 100 meg ethinyl-oestradiol + 500 meg levonorgestrel 12 h apart are given in 72 hours of intercourse.EMERGENCY CONTRACEPTION (POSTCOITAL CONTRACEPTION)Mechanism of action1. Delaying/inhibiting ovulation2. Inhibiting fertilization3. Preventing implantation of fertilized egg.4. Degenartion of Corpus leuteumIndications1. Unprotected intercourse2. Condom rupture3. Missed pills4. Sexual assault or rape5. First time intercourse.Risk of pregnancy after single act of unprotected coitus around time of ovulation--8%.Methods1. Morning after pills (Conjugated estrogen and ethnyl estradiol)--use in 72 hr.2. Combined hormonal regimen (YUZPE method)23. POP (very successful)4. IUCD (should be inserted within 5 days)5. RU486 (Mifepristone)-single dose 600 mg irrespective of day and number of intercourse.ALSO KNOWVery low dose OC pills called Mircette - (desogestrel/ethinyl estradiol and ethinyl estradiol) Tablets provide an oral contraceptive regimen of 21 white round tablets each containing 0.15 mg desogestrel and 0.02 mg ethinyl estradiol.

Emergency post-coital IUCD contraception

Emergency Contraception - Ulipristal acetate (UPA)


Question: A 18yr old girl comes to gynaec OPD presenting with 6months A amenorrhea with his low grade fever weight loss pain abdomen generalised weakness On clinical examination pelvic mass felt on left side with features of ascites Diagnosis


Question: Dystocia dystrophia syndrome is seen in

Dystocia dystrophia syndrome
Charecteristic appearence

Short
Stalky
Subfertile
Masculine hair distribution
History of delayed menarche
Has android pelvis


Question: Earliest sign of intrauterine death is

Intrauterine death : Presence of gas in the fetal large vessels - Robes sign is the earliest sign seen 12 hrs after fetal death Ball sign - Crumpled up spine of the fetus or hyperflexion of the spine Spalding's sign -Overlapping of the fetal skull bones due to shrinkage of cerebrum after death of fetus. Ref:Dutta Obs 9e pg 303.


Question: Endodermal sinus tumour is assocaited with

Schiller duval body [Ref. Robbins 7th/e p 11011 Endodermal sinus tumour (yolk sac tumour) This tumour is rare but it is the second most common malignant tumour of germ cell origin. It is thought to be derived from differentiation of malignant germ cells towards extraembryonic yolk sac structure. Similar to the yolk sac the tumour is rich is a feto protein and a1 antitrypsin. The characteristic histological feature of yolk sal tumour is schiller duval body. Schiller Duval body is a glomerulus like structure composed of central blood vessel enveloped by germ cells within a space lined by germ cells. Also know Call Exner body --> Granulosa cell tumour Reinke's crystal ---> Hilus cell tumour Signet ring cells Krukenberg tumour Hobnail cells Clear cell carcinoma Psammoma bodies -4 Papillary serous cystadenoma of ovary.


Question: Most common complication of vaginoplasty is

Restenosis and dyspareunia are most common complication of vaginoplasty.


Question: Commonest cause of post partum haemorrhage is

(Atonic Uterus) (411-Dutta 6th)* Atonic uterus (80%) is the commonest cause of PPH* Other causes of PPH are - Traumatic (20%), combination of atonic and traumatic causes, Blood coagulation disordes* The conditions where such disorders may occur are abruptioplacentae. Jaundice in pregnancy thrombocytopenia purpura, HELLP syndrome or in IVD.* Minimum duration between onset of symptoms and death is seen in PPH* Secondary PPH usually occur between 8th to 14th day of deliverySurgical method to control PPH(a) Ligation of ascending branch of uterine artery**(b) Ligation of ovarian & uterine artery anastomosis(c) Ligation of anterior division of internal iliac artery**(d) B- Lynch brace suture** & haemostatic suturing(e) Angiographic arterial embolisation (bleeding vessels)


Question: Cervical cerclage is advised in an antenatal woman with a prior preterm bih if the cervical length measures

Cervical length screening is now recommended by both the American College of Obstetricians and Gynecologists (2016b) and the Society for Maternal-Fetal Medicine (2015) for women with prior preterm bih.Between 16 and 24 weeks' gestation, sonographic cervical measurement is completed every 2 weeks.If an initial or subsequent cervical length is 25 to 29 mm, then a weekly interval is considered.If the cervical length measures <25 mm, cerclage is offered to this group of women. Notably, for women without history of preterm bih but with a sho cervix incidentally identified sonographically, progesterone therapy is offered instead of cerclage.Reference: William's Obstetrics; 25th edition; Chapter 18; Aboion


Question: Concerning fibroids

EGF, IGF-1, TGF stimulates the growth of leiomyoma either directly or estrogen GnRH analogues reduces 50%-80% of myoma size when used for 6months Pregnancy rate following myomectomy is 40-60% Recurrence and persistance following myomectomy is 30-50% D.C.DUTTA'S TEXTBOOK OF GYNECOLOGY,Pg no:272,281,282,6th edition *Intramural fibroid : endometrial sampling next step of management

Use of GnRH analogues cause permanent reduction in size

Pregnancy following myomectomy is about 80%

Recurrence rate following myomectomy is about 20%

Growth factors (IGF-L EGF) stimulates myoma to grow


Question: One of the following features can be used to define contracted pelvis

Minimal/Critical diameters of the Pelvis: If any of the following diameter is less than critical diameter, Pelvis is said to be contracted


Question: Maximum chances of ureteric injury are with

Weheim's hysterectomy:includes Radical abdominal hysterectomy Bilateral extra peritoneal dissection Excision of iliac and pelvic lymph nodes for cancer of the cervix Ureter injury is the major complication Ref : Shaw Gynecology 17e pg 526.

Gynaecological diagnosis and operative surgery


Question: The production of cervical mucus is stimulated by

Cervical mucus is a glycoprotein gel that expand and contract in response to cyclic changes in the steroid hormone environment across the menstrual cycle to facilitate or inhibit the passage of sperm

Estrogen stimulates cervical mucus production, and as levels rise during the follicular phase, mucus becomes more abundant and watery, less cellular, and more easily penetrated by sperm
Progesterone inhibits cervical mucus production and renders it opaque, viscid, and impenetrable


Question: The dose of betamethasone for fetal lung maturation is

A single course of coicosteroids is currently recommended for women between 24 to 34 weeks who are at risk for delivery within 7days. Betamethasone and dexamethasone appear to be equivalent for fetal lung maturation. Dose: 12mg doses of betamethasone, each dose is given intramuscularly 24hours apa. With dexamethasone, 6mg doses are given intramuscularly every 12hours for four doses. (Ref: William's Obstetrics; 25th edition)


Question: Misoprostol is an analogue of

Misoprostal: PGE-1 Given transvaginally and orally Dose of 25 micrograms every 4 hrs is found to be more effective than PGE -2 for cervical ripening and labor induction. Oral use of misoprostal is less effective than vaginal administration . Ref: Dutta Obs 9e pg 485.


Question: The technique used for aspiration of sperm directly from testes for in vitro feilization is

MESA and TESA are both techniques of sperm aspiration but since the question specifically asks about aspiration directly from the testes, TESA is the most appropriate answer here.Ref: Clinical Gynecologic Endocrinology and Infeility; 8th edition; Section IV; Infeility


Question: Cochlear function in fetus develops between

Cochlear function develops between 22 and 25 weeks, and its maturation continues for six months after delivery.Reference: William&;s Obstetrics; 24th edition; Chapter 7; Embryogenesis and Fetal Morphological Development


Question: Extremely low bih weight refers to neonates weighing

Low bihweight refers to neonates weighing 1500 to 2500 g; Very low bihweight are those between 1000 and 1500 g; and Extremely low bihweight refers to those between 500 and 1000 g.Reference: William's Obstetrics; 25th edition; Chapter 42; Preterm bih


Question: Dose of folic acid per day for treating megaloblastic anemia in pregnancy

Folic acid deficiency in Pregnancy In nonpregnant women, the folic acid requirement is 50 to 100 mg/day During pregnancy, requirements are increased and 400 mg/day is recommended The earliest biochemical evidence is low plasma folic acid concentrations Normal serum folate levels Non Pregnant women: 5.4-18ng/ml 1st trimester: 2.6-15ng/ml 2nd trimester: 0.8-24ng/ml 3rd trimester: 1.4-20.7ng/ml Early morphological changes usually include neutrophils that are hypersegmented and newly formed erythrocytes that are macrocytic As the anemia becomes more intense, peripheral nucleated erythrocytes appear, and bone marrow examination discloses megaloblastic erythropoiesis The fetus and placenta extract folate from maternal circulation so effectively that the fetus is not anemic despite severe maternal anemia Treatment As little as 1mg of folic acid administered orally once daily produces a striking hematological response By 4 to 7 days after beginning folic acid treatment, the reticulocyte count is increased, and leukopenia and thrombocytopenia are corrected American College of Obstetricians and Gynecologists (2013c) have recommended that all women of childbearing age consume at least 400 mg of folic acid daily Increased need of Folic acid Multifetal pregnancy Hemolytic anemia Crohn disease Alcoholism Inflammatory skin disorders Reference: William&;s Obstetrics; 24th Edition; Chapter 56

Medical, surgical and gynaecological illness complicating pregnancy


Question: In embryo, Hemopoiesis is first demonstrable in

In the early embryo, hemopoiesis is demonstrable first in the yolk sac, followed by the liver and finally bone marrow.Reference: William&;s Obstetrics; 24th edition; Chapter 7; Embryogenesis and Fetal Morphological Development


Question: Early hormonal sign of puberty

Early sign of puberty is Sleep-associated increase in LH secretion.


Question: Low dose progestational contraceptives primarily act on

Progesterone in bih control pills thickens cervical mucus (primary action): hinders the travel of sperm to the uterus and making it hard for sperm to enter the tubes and feilise the egg. thins the lining of the uterus: makes implantation unlikely. Progestogen only pills are generally less effective than other forms of oral contraceptive pill with a failure rate of 2 - 6 per 100 women years. The main side effects are Irregular, low-grade, breakthrough uterine bleeding but this may settle into a regular cycle after 6 - 9 months. Skin reactions, Breast fullness Depression Increased risk of ectopic pregnancy. Benefits include: Do not carry risk of thromboembolism Do not inhibit lactation - so can use when breast feeding Suitable for diabetics - as pills containing oestrogen exacerbate risk of aerial disease in such patients Suits smokers for whom oestrogen containing formulations are contra-indicated


Question: Leash sign is found in

Ans. A. Ectopic PregnancyAll cases of ectopic pregnancies had a typical eccentric leash of vessels on color Doppler that showed a low resistance placental type of flow on spectral Doppler. This is called leash sign. This sign has a sensitivity of 100% and specifity of 99% a positive predictive value of 95% and negative predictive value of 100% thus helping in the diagnosis of early ectopic pregnancy, and resulting in earlier treatment with reduced morbidity and mortality.


Question: For the first 2hrs after delivery, the temperature should be recorded

Care after delivery: For 2hrs after delivery, BP and pulse should be taken every 15 min. Temperature assessed every 4 hrs for the first 8hrs and then 8 hourly subsequently Amount of vaginal bleeding should be monitored Fundus of uterus palpated to ensure that it is well contracted. Ref: Williams 24e pg 675.


Question: Cfitoris develops from


Question: Normal Biophysical Profile (Manning Score) is

Ans. a (8-10) (Ref. Dutta, Obstetrics, 6th ed., p 109, 464)BIOPHYSICAL PROFILE (MANNING SCORE)# The BPP measures- fetal heart rate,- muscle tone,- movement,- breathing, and the- amount of amniotic fluid around fetus.# A BPP is commonly done in the last trimester of pregnancy.# If patient has a high-risk pregnancy, a BPP may be done by 32 to 34 weeks or earlier.# Its 5 components are:Q- Non-stress test (NST)- Fetal breathing movements (at least 1 episode within 30 min lasting for > 30 seconds).- Fetal tone (> 1 episode of limb extension with return to flexion within 30 seconds).- Gross fetal movements (at least 3 discrete GFM within 30 minutes).- Amniotic fluid volume (> 1 large pocket more than 1 cm vertical diameter).# Score - In absence of oligohydramnios:- Normal score = 8-10,e- Equivocal = 6 and- Abnormal = < 4.Fetal heart rate in "sinusoidal pattern"Fetal heart rate in "saltatory pattern" is seen ina) Rh isoimmunizationb) Normal fetusc) Drugs-alphaprodinea) Acid-base imbalanceb) Labourc) Acute brief hypoxia in fetusd) Depressed fetus with low APGAR


Question: Page system of grading is used in

Page system of grading: depends upon the degree of placental abruption 0- Clinical features are absent 1 - Vaginal bleeding is slight,FHS is good, uterine tenderness is minimal or absent 2 - Vaginal bleeding is mild or moderate, uterine tenderness is present,Fetal distress occurs, shock is absent 3 - Bleeding is moderate to severe, uterine tenderness is marked, fetal death Ref: Dutta Obs 9e pg 239.


Question: Glomerular filtration rate increases in pregnancy by

Both the glomerular filtration rate (GFR) and renal plasma flow increase early in pregnancy. The GFR increases as much as 25 percent by the second week after conception and 50 percent by the beginning of the second trimester(Ref: William's Obstetrics; 25th edition)


Question: Precocious puberty in females is defined as

Ans. C. Appearance of Secondary sexual characteristics before 8 years* Precocious puberty: This is defined as the appearance of any of the secondary sexual characteristics before the age of 8 years or the occurrence of menarche before the age of 10 years* Precocious puberty in females is pubertal changes before the age of 8 years.* In males it is onset of puberty before the age of 9 years

Occurrence of menarche before age of 8 years

Occurrence of menarche before age of 12 years

Appearance of secondary sexual characteristics before 8 years

Appearance of secondary sexual characteristics before 10 years


Question: Endocervical sampling is recommended during colposcopy in the following situation

Recommendations for Endocervical sampling:

Colposcopy in inadequate, or colposcopy is adequate but no lesion is identified. Endocervical sampling is acceptable in other cases at provider discretion.
Initial evaluation of ASC - H, HSIL, AGC, or AIS cytology test results.
Surveillance 4 to 6 months after excisional therapy if specimen margins are positive of HSIL.
Surveillance after conization for AIS has been performed in women wishing fertility preservation. Negative endocervical curettage results add reassurance to this management.

Initial evaluation of LSIL in pregnant female

Surveillance 4 to 6 months after excisional therapy if specimen margins are positive for HSIL

Along with co-testing in post-menopausal LSIL

Reassure LSIL patients in age group of 25 to 30 years.


Question: Pathology of endometriosis is best explained by

Retrograde menstruation is the most acceptable theory


Question: The best time to do chorionic villous sampling is

Ans. is d i.e. Between 11 - 13 weeks Chorionic villi sampling "CVS is the second most common procedure for genetic prenatal diagnosis. Because this procedure is routinely performed at about 10 to 12 weeks of gestation, it allows for an earlier detection of abnormalities and a safer pregnancy termination, if desired."


Question: Cystitis is most commonly caused by

(E. coli): Ref: 173-S* The organisms found in urine in cystitis are the E. coli, streptococci, staphylococci and B. proteus, the tubercle bacillus, and occasionally pseudomonas pyocyanea, Gonococcal cystitis is relatively rare, and almost invariably follows instrumentation.* The organism which is found most frequently is the E. coli* As the result of antibiotic treatments Pseudomonas, pyocyanea sometimes become the dominant infecting organism because of its resistance to antibiotics relative to the other infecting organisms.


Question: The critical mitogen for uterine fibroid growth is

Cell proliferation, extracellular matrix accumulation and cell hypertrophy which all lead to leiomyoma growth are controlled by progesterone directly.


Question: Knots in umbilical cord

Knots in umbilical cord are caused by fetal movements.
Common in monoamniotic twins (dangerous). C-section is not indicated always.


Question: Premature ovarian insufficiency is defined as hypogonadotropic hypogonadism and amenorrhea arising before the age of

Premature ovarian failure (POF), traditionally defined as hypogonadotropic hypogonadism and amenorrhea arising before the age of 40.Reference: Clinical gynecologic endocrinology; 10th edition; Chapter 9; Normal and Abnormal Sexual Development; Page no: 463


Question: Most common cause of Breech presentation


Question: Most common degenerative change in fibroid seen in post menopausal women is

Cystic degeneration is most common in post menopausal females.


Question: The major contribution of the ammiotic fluid after 20 weeks of gestations

(Foetal urine): Ref: 37, 214, 218, 464-D Obstetrics - G. Chamberlain 7thAMNIOTIC FLUIDProduced: In early pregnancy, from amnion over placenta and sacLate pregnancy: from fetal urine as wellVolume: Increase to 38 weeks (500 - 1500 ml)50 ml: 12 weeks500 ml: 24 weeks1000 ml: 36 weeksOsmolality: Decreases in late pregnancyCreatinine: Increases in late pregnancyAcid - base: Normally accumulation of CO2 and fixed acid causes a slight reduction in pH (About 7.15 - 7.20)* The foetus drinks about 400 ml of liquer every day at term and equal amount is excreted in the urine* The water in the amniotic fluid is completely changed and replaced in every 3 hours.* Abnormal colour- Meconium stained (green) - Foetal distress Breech or transverse- Golden colour - Rh. Incompatibility- Greenish yellow (Saffron) - Post maturity- Dark coloured - concealed accidental hemorrhage- Dark brown (tobacco juice) - IUD* Amniotic Fluid Index (AFI) - An AFI between 5 and 25 cm is normal and an AFI less than 5 cm (< 10 centile) indicates oligohydramnios and AFI more than 25 cm (> 95 centile for gestational age) indicates Polyhydramnios (464-D)


Question: Zona hatching occurs

Five days after feilisation, blastocyst performs zona hatching and it undergoes degeneration to be replaced by trophoblastic cells


Question: Subfertility is seen most likely in

Of myoma, subfertility is more closely associated with submucous leiomyoma.


Question: After a full term normal delivery patient went into shock Most probable cause is


Question: Recruitment of follicles is caused by

FSH is responsible for recruitment of follicles.


Question: Risk factors for uterine fibroid is

Age and race are risk factors for fibroid.

Reproductive age group
African-american women.


Question: Dysgerminoma is

Dysgerminoma is germ cell tumor of ovary.


Question: The double decidual sac sign (DDSS) is the best method for ultrasound diagnosis of

Double decidual sac sign on USG - Intra-uterine sac (Eccentrically placed) Outer layer - Decidua Parietalis Inner layer - Decidua Capsularis Indicates - Intrauterine pregnancy Intradecidual ring sign is the first sign of pregnancy on USG.


Question: A young female presented with vaginal discharge. Endocervical biopsy revealed chlamydial antigen. Treatment given should be

Treatment of Chlamydial infection: Azithromycin 1 g orally as a single doseor Doxycycline (100 mg bid for 7 days) Contact tracing, avoidance of sex or barrier contraceptive is necessary to avoid recurrence. Note: out of the given options, both azithromycin and doxycycline (not metronidazole) can be used for treatment of chlamydia, however since contact tracing is equally impoant, option 2 is preferred. Chlamydia infection :most common cause of tubal block in India

Genital Tract Infections (Too hot to handle!)


Question: Intrahepatic cholestatis liver disease of pregnancy, plan delivery at

Management of Intrahepatic cholestatis of Pregnancy: 1. Ursodeoxycholic acid - increases excretion of bile acis. Also reduces neontal complications 2. Strict maternal and fetal surveillance 3. Termination of pregnancy - Definitive management. Done at 37 weeks after which fetal risk of morbidity and moality keeps on increasing

Labour - normal, abnormal, malposition, malpresentation and their management


Question: The following curve is used in evaluation to

Ans. C. Rh incompatibilityThe image shows Lily's curve, which is used to predict the severity of fetal hemolysis.The optical density of liquor containing bilirubin pigment is observed at wavelength 250-700nm. In presence of bilirubin, there is a deviation bulge/peak at 450nm. Bigger the bulge, more is the effect on the fetus.


Question: Normal junctional Zone thickness of uterus is

Junctional zone thickness is normally 5mm.


Question: GnRH agonists given along with progestins cause

If progestins, are given simultaneously with GnRH agonists, there is typically increased leiomyoma growth.


Question: Chassar Moir surgery is done is a case of

Chassar moir technique is widely used in the repair of vesicovaginal fistula.
Vagina and bladder are separated all around by flap splitting method and sutured separately in two layers.


Question: Pus discharge (crviitis/urethritis) in a female caused by

(Chlamydia): (144-45- Dutta Gynae 6th edition; 123. 160 161 -Dutta Gynae 6th)CHLAMYDIAL INFECTIONS - The infection is mostly localized in the urethra, Bartholins gland and cervix* Mucopurulent cervical discharge, cervical oedema, cervical ectopy cervical friabilityComplication - Urethritis and bartholinitis are manifested by dysuria and purulent discharge, chlamydial cervicitis spreads upwards to produce endometritis and salpingitis.Gardnella (Bacterial) Vaginosis - Polymicrobial infectionCaused by Gard nerella vaginalis (Haermophilus vaginalis). The present concept is that long with G. vaginalis anaerobic organism such as Bacterioids species. Peptococcus species, mobiluncus and Mycoplasma hominis act synergistically to cause vaginal infection* Characterized by white milky (creamy) non viscous discharge adherent to vaginal wall* Fishy odour when mixed with 10% KOH* Presence of Clue cells - the epithelial cells have Puzzy border due to adherence of bacteriaAcute cervicitis - responsible organism are ryogenicAerobic(i) Gram positive organisms are. Staphylococcus(ii) Gram negative are - E.coli, pseudomonas, Klebsiella, N.gonnorhoeaeAnaerobes(i) Gram positive are - Streptococucus. Cl.welchii Cl.tetani(ii) Gram negative are mainly bacteroides group of which Bacteroides fragilisOther common pathogens are: Gonococcus, Chlamydia trachomatis, trichomona, bacterial vaginosis, mycoplasma and HP V. The first one being less common nowdaysClinical Features - Cervix is tender on touch or movements oedematous and congested. Mucopurulent discharge is seen escaping out through the external osChronic cervicitis - potential reservoir for N-gonorrhoea, Chlamydia. HPV, mycoplasma and bacterial vaginosisMucopurulent is the predominant symptomsCandida Vaginitis (Moniliasis) caused by Candida albicans* Pruritis is out of proportion to the discharge* Discharge is thick, curdy white and in flakes (cottage cheese type) often adherent to the vaginal wall


Question: Not an indication for blood transfusion

Indications for Blood Transfusion To correct anemia due to blood loss and to combat postpaum hemorrhage Patient with severe anemia seen in later months of pregnancy (beyond 36 weeks) Refractory anemia: Anemia not responding to either oral or parenteral therapy in spite of correct treatment Associated infection Reference: Textbook of Obsteics; Sheila balakrishnan; 2nd edition; Page no: 288

Medical, surgical and gynaecological illness complicating pregnancy


Question: Select the antibiotic most frequently associated with the Hypoplasia and staining of fetal teeth (SELECT 1 ANTIBIOTIC)

Fetal exposure to an antibiotic depends on many factors such as gestational age, protein binding, lipid solubility, pH, molecular weight, degree of ionization, and concentration gradient. Some antibiotics are even concentrated in the fetal compartment. Tetracycline is contraindicated in all three trimesters. It has been associated with skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, and fatal maternal liver decompensation. Sulfonamides are associated with kernicterus in the newborn. They compete with bilirubin for binding sites on albumin, thereby leaving more bilirubin free for diffusion into tissues. Sulfonamides should be withheld during the last 2 to 6 weeks of pregnancy. With prolonged treatment of tuberculosis (TB) in pregnancy, streptomycin has been associated with fetal hearing loss. Its use is restricted to complicated cases of TB. Nitrofurantoin can cause maternal and fetal hemolytic anemia if glucose- 6-phosphate dehydrogenase deficiency is present. Chloramphenicol is noted for causing the gray baby syndrome. Infants are unable to properly metabolize the drug, which reaches toxic levels in about 4 days and can lead to neonatal death within 1 to 2 days.


Question: Most common symptom present in undisturbed ectopic


Question: Latzko procedure is done in case of

Latzko procedure is surgical technique for vesicovaginal fistula repair.


Question: Investigation of choice to diagnose congenital malformations

MRI is the investigation of choice to diagnose congenital malformaiton.


Question: Investigation of choice in cholestasis of pregnancy

Serum bile acid levels Obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy or cholestasis of pregancy) is a liver disease unique to pregnancy which presents with pruritus. Clinical features Obstetric cholestasis most commonly presents in the third trimester (80% develop symptoms after 1st week). The pruritus is often severe and typically the palms of the hands and the soles of the feet are involved but the legs, thighs arms, backs, breasts and abdomen are also repoed. The diseaes tends to recur in every pregnancy and so a pa history of the condition is impoant. The disease is more common among multiple gestations. Other signs and symptoms of liver disease are not observed. Additional symptoms which may be repoed in common with other forms of cholestasis are right upper quadrant pain, pale stools and dark urine. Changes in liver function in obstetric cholestasis The most common abnormalities in liver function are - Increase in ALT (seen in 100% cases) - Increase in AST (seen in 99% cases) - Increase in bile acids (seen in 92% cases) - Elevated bilirubin (22% of cases) - Increased GGT (39% cases) Elevations in alkaline phosphatase are seen in cholestatic disease such as obstetric cholestasis as it is released from the damaged liver but because the enzyme is also released from the placenta in normal pregnancies, measurements are less helpful than outside the pregnancy. Serum bile acid test is the most accurate determinant of cholestasis of pregnancy. The problem with the bile acid test is that only a small number of labs around the world have the equipment necessary to perform it which can result in a considerable delay for women experiencing symptoms of the conditions. Liver biopsy in a case of obstetric cholestasis: ? Liver biopsy demonstrates: ? - Acinar cholestasis with centrilobular bile staining and bile plugs in the canaliculi. Liver biopsy is the definitive diagnostic test of the disease. Postnatal course in obstetric cholestasis - Biochemical abnormalities and pruritius in obsetric cholestasis persists until delivery following which resolution occurs. - Pruritus is typically absent within 48 hour after delivery usually improved within 1 week. - Liver function tests becomes normal within 6 weeks. Complications of obstetric cholestasis - Meconium stained liquor - Premature delivery - Fetal distress - Post paum hemorrhage Treatment of obstetric cholestasis : - i) Antihistamines - Chlorpheniramine can provide symptomatic relief in pruritus. ii) Topical treatments - If the skin is well moistured pruritus may be relieved. iii) Ursodeoxycholic acid iv) S-Adenosyl methiomine v) Dexamethasone - Dexamethasone in high dose results in resolution of all pruritus cases and significant reduction in total bile acids and ALT. vi) Vitamin K - In obstetric cholestasis there is malabsorption and subsequent deficiency of vitamin K. This will increase the risk of postpaum hemorrhage. - Vitamin K injection is given to reduce the risk of PPH.


Question: The gene coding for androgen receptors is located on

C i.e. Long arm of X-Chromosome The androgen receptor is a typical member of the steroid/ thyroid family and is encoded by a gene on the long arm of X-chromosomeQ.


Question: Maximum chances of ureteric injury are with;

Weheim's hysterectomy:includes Radical abdominal hysterectomy Bilateral extra peritoneal dissection Excision of iliac and pelvic lymph nodes for cancer of the cervix Ureter injury is the major complication Ref : Shaw Gynecology 17e pg 526.

Gynaecological diagnosis and operative surgery


Question: Most common uterine anomaly is

Incidence of uterine anomalies: Bicornuate uterus - 35-40% Arcuate uterus - 15% Uterus didelphys - 10% Uterine septum - 5-10% Ref: Shaw Gynecology 17 e pg 72.


Question: Risk factor for breech presentation is

Risk factors for breech presentation

Oligohydramnios
Fundal placental implantation
Placenta previa
Hydrocephaly
Twin gestation
Anencephaly
Prior breech delivery


Question: Most common cause aof ambigious genitalia in a female child is

CONGENITAL ADRENAL HYPERPLASIA

Clinical presentation: Ambiguity of sex detected at birth are due to androgenital syndrome unless proved otherwise. Hirsutism and amenorrhea may be presenting features around puberty in milder form

Diagnosis at birth

An enlarged clitoris
Presence of penile urethra or hypospadius
Hyponatremia,hypakalemia and hypotension
Fusion of labia minora


Question: Total lung capacity during pregnancy is

Total lung capacity: the combination of FRC and inspiratory capacity is unchanged or decreases by less than 5 percent at term(Ref: William's Obstetrics; 25th edition)

Increases in the early pregnancy followed by decreasing as the pregnancy progresses


Question: Polyhydramnios is NOT seen with

(A) Renal agenesis # POLYHYDRAMNIOS: The underlying cause of the excessive amniotic fluid volume is obvious in some clinical conditions and is not completely understood in others.> Causes include the following: Multiple pregnancy: Twin gestation with twin-to-twin transfusion syndrome (increased amniotic fluid in the recipient twin and decreased amniotic fluid in the donor) or multiple gestations> Fetal anomalies, including esophageal atresia (usually associated with a tracheoesophageal fistula), tracheal agenesis, duodenal atresia, and other intestinal atresias CNS abnormalities Anencephaly; Open spina bifida; and neuromuscular diseases that cause swallowing dysfunction; Congenital cardiac-rhythm anomalies associated with hydrops, fetal-to-maternal hemorrhage, and parvovirus infection; Facial clefts & neck masses; Hydrops fetalis> Chromosomal abnormalities, most commonly trisomy 21, followed by trisomy 18 and trisomy 13.> Fetal akinesia syndrome with absence of swallowing> Placental: Chorioangioma of the placenta> Maternal: Poorly controlled maternal diabetes mellitus (Oligohydramnios may also be seen if severe vascular disease is present.) & cardiac or renal disease> Oligohydramnios:> Fetal urinary tract anomalies, such as renal agenesis, polycystic kidneys, or any urinary obstructive lesion (E.g., posterior urethral valves)> PROM and chronic leakage of the amniotic fluid> Chorioamnionitis is an additional important maternal complication from oligohydramnios due to rupture of the membranes, which has an incidence of 21-74%.> The earlier chorioamnionitis occurs in pregnancy, the greater the fetal risk of bronchopulmonary dysplasia (BPD), neurologic complications, pulmonary hypoplasia, and, in severe cases, respiratory failure in the neonate.> Placental insufficiency, as seen in pregnancy-induced hypertension (PIH), maternal diabetes, or postmaturity syndro ne when the pregnancy extends beyond 42 weeks' gestation> Maternal use of prostaglandin synthase inhibitors or ACE inhibitorsHYDRAMNIOSOligo hydramnios (< 100 ml AF)Polyhydramnios (> 2000 ml AF)Potter syndrome (renal agenesis)Obstruction to GIT (E.e. Esophageal atresia) 100%Urinary tract obstructionAnencephaly (in 50%)Placental insufficiency with IUGROpen spina bifidaBreechMaternal DM


Question: Difference between ectopic pregnancy and threatened aboion is

In Threatened aboion , uterus corresponds to the period of amenorrhea In ectopic pregnancy, uterus is normal or slightly bulky. Ref: Dutta Obs 9e pg171.

Uterine size corresponds to gestational age


Question: During the active phase of labour, the minimum effective dilatation of the cervix in primigravida should be at the rate of

Dilatation of cervix1cm/hr in primigravidae1.5cm/hr in multigravidaeD.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY, Pg no;130,7th edition


Question: A 26 weeks pregnant female presented with HTN for the first time. There is no proteinuria. Diagnosis of such condition

Gestational hypeension - bp > 140/90 , > 20weeks of gestation Pre eclamptic toxemia - gestational hypeension + proteinuria > 300mg Eclampsia - above 2 + convulsions Chronic hypeension - hypeension before she is pregnant


Question: Women with infeility with B/L cornual block on HSG, Next investigation for management is

HSG is the initial test for tubal patency The cornua of the uterus may go into spasm, as a result of which the dye may not enter the tubes at all. This may be interpreted as a tubal block, when the tubes are actually open. If the spill is "loculated", the presence of adhesions can be suspected, but not confirmed. If the HSG shows that the tubes are closed, then one must do a laparoscopy to confirm this diagnosis. Laparoscopy with Chromopeubation is confirmative for making a diagnosis of tubal disease.


Question: The usual dose of radiation delivered to point A in cervical cancer management is

The usual doses delivered are 7,000 to 8,000 cGy to point A (defined as 2 cm superior to the external cervical os and 2 cm lateral to the internal uterine canal) and 6,000 cGy to point B (defined as 3 cm lateral to point A), limiting the bladder and rectal dosage to less than 6,000 cGy.To achieve this level, it is necessary to adequately pack the bladder and bowel away from the intracavitary sourceReference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer


Question: Fetal blood loss occurs in

Vasa pre occurs when there is velamentous inseion of placenta i.e. the umbilical cord vessels are splitting before getting attached to the placenta. The inseion of the cord may be close to the internal os. The fetal head can compress the cord leading to rupture of vessels. In this case the blood loss occurs from fetal vessels.


Question: Indications of medical management In ectopic

Criteria for selection Hemodynamically stable No intrauterine pregnancy on ultrasound No tubal rupture Size of ectopic less than 4 cm If there is foetal cardiac activity use with caution Beta hcg level preferably less than 3000 IU/L (refer pgno:162 sheila 2 nd edition)


Question: Veical transmission of HIV is most common in

Veical transmission to the neonates is about 14-25% Transmission of HIV2 is less frequent than HIV1 Transplacental transmission 20% before 36 weeks, over 80% occur around the time of labor and delivery Risk of veical transmission is directly related to maternal viral load and inversely to the maternal immune status Maternal antiretroviral therapy reduces the risk of veical transmission by 70%. Ref: Dutta Obs 9e pg 282.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Uterine contraction pressure is measured in terms of

Montevideo units are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10minute window and adding the pressures generated by each contraction.For example, three contractions in 10 minutes, each of 50 mm Hg intensity, would equal 150 Montevideo units.Clinical labor usually commences when uterine activity reaches values between 80 and 120 Montevideo units. This translates into approximately three contractions of 40 mm Hg every 10 minutes.Reference: William&;s Obstetrics; 24th edition; Chapter 23; Abnormal Labor


Question: The definite sign of placental separation in stage 3 of paurition is

Placental separationMarked retraction reduces effectively the surface area at the placental site to about its half. But as the placenta is inelastic it cant keep pace with such an extent of diminution resulting in its buckling.The detachment of the placenta from the uterine attachment stas in the center resulting in opening up of few uterine sinuses and accumulation of blood behind the placenta.Marginal separation occursD.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY, Pg no:122,7th edition


Question: Meconium ileus occurs in

(A) Cystic fibrosis # CYSTIC FIBROSIS: CF is an autosomal resessive disorder with mutation in gene for the protein cystic fibrosis transmembrane conductance regulator (CFTR). This protein is required to regulate the components of sweat, digestive fluids, and mucus.> Symptoms include: Intestinal obstruction may be an initial manifestation in the neonatal period (meconium ileus). This may be due to the presence of abnormal protein and mucoprotein secreted by the pancreatic enzymes. Later these children tend to retain the food residue in the ileum, caecum and colon and these may form firm masses. Impaction of the faeces causes intestinal obstruction. lleocaecal intussusception may occur in less than 1 percent of the patients. Two cardinal symptoms of the disease are chronic diarrhea with massive steatorrhea and recurrent respiratory tract infections Failure to thrive is also a prominent feature. Rectal prolapse occurs frequently. Biliary cirrhosis of liver is also often observed.> Crohn's disease: The disease is most often seen in teenagers but it has been also reported during infancy. Crampy abdominal pain and dysphagia are the usual early symptoms. Pain may be paraumbilical or may be localized to the right lower quadrant of the abdomen. Chronic diarrhea is the presenting symptom in nearly one-third of cases. Anemia, weight loss, fever are complained of in most cases. Extra-intestinal symptoms of arthritis, uveitis, stomatitis and erythema nodosum may be seen in some cases.> Ulcerative colitis: There is history of diarrhea with passage of bloody stools, abdominal cramps, tenesmus, fever and anorexia. The onset may either be insidious or explosive with high fever, prostration and continuous bloody diarrhea. There may be extra-intestinal manifestation of arthralgia, liver disease or pyoderma.