Question: Impoance of the plane of midpelvis is

The pelvis is described as having four imaginary planes:The plane of the pelvic inlet--the superior strait. 2. The plane of the pelvic outlet--the inferior strait. 3. The plane of the midpelvis--the least pelvic dimensions. 4. The plane of greatest pelvic dimension--of no obstetrical significance.(Ref: William's Obstetrics; 25th edition)


Question: The first trimester of pregnancy completes by

TrimestersIt has become customary to divide pregnancy into three equal epochs of approximately 3 calendar months. Historically, the first trimester extends through completion of 14 weeks, the second through 28 weeks, and the third includes the 29th through 42nd weeks of pregnancy. Thus, there are three periods of 14 weeks each.Reference: William's Obstetrics; 24th edition; Chapter 9; Prenatal care


Question: M/c cause of vaginal discharge among reproductive age females

Ans. is c, i.e. Bacterial vaginosisRef: William Gynae 3rd/ed, p51"Bacterial vaginosis is the most common cause of vaginal discharge among reproductive age women." - Ref: Williams Gynae 3rd/ed, p51.

Sexually Transmitted Disease in the Female


Question: The contraceptive method with a failure rate of <5 is

The oral contraceptives are highly effective contraceptive method
The failure rate is very low ( 0.3℅), as ovulation is inhibited


Question: Instrumental delivery system is

Ventouse - is an instrumental device designed to assist delivery by creating a vaccum between it and the fetal scalp. In case of failed ventouse, forceps may be used if 1. Head is almost completely rotated 2. Cervix is fully dilated 3. There is some degree of descent

Forceps only used in full cervical dilation

Ventouse cannot be used in rotational deliveries of occipito-posterior and transverse presentations

Forceps can be used in breech deliveries


Question: Potential candidate for high risk of GDM is. .

High-risk of gestational diabetes History of stillbih History of neonatal death History of fetal macrosomia Concomitant obesity and/or hypeension Diabetes in a first-degree relative Overweight before pregnancy Strong family history of type II DM Previous history of GDM


Question: 'Double set up examination' is concerned with

- 'Double set up of examination' is done when there is suspicion of placenta pre and patient is having bleeding. - It is done under anesthesia, in operation theater, keeping everything ready for cesarean section. - A Digital examination through the cervix is done. Palpation of placenta on lower segment not only conclusively confirms the clinical diagnosis but also identifies its degree. *If the placenta is not felt within approximate 10 cms diameter of the internal os, then the patient can be taken up for a trial of normal vaginal delivery *If the placenta is felt within 10 cms of the cervical rim or if there is bleeding due to the examination, then an immediate cesarean section is performed


Question: Shortest diameter of fetal skull is

(B) (Submentobregmatic) (85-Dutta 7th)FETAL SKULL AND MATERNAL PELVISDimetersMeasurement in cm (inches)Attitude of the headPresentation1. Suboccipito- bregmatic- extends from the nape of the neck to the center of the bregma9.5 cm 3 3/4 ")Complete flexionVertex2. Suboccipito-frontal- extends from the nape of the neck to the anterior of the anterior fontancll or center of the sinciput10 cm (4")Incomplete flexionVertex3. Occipito-frontal- extends from the occipital eminence to the root of the nose (Glabella).11.5 cm (4 1/2 ")Marked deflexionVertex4. Mento-vertical- extends from the mid point of the chin to the highest point on the sagittal suture.14 cm (5 1/2 ")Partial extensionBrow5. Submcnto-vcrtical-extends from junction of floor of the mouth and neck to the highest point on the sagittal suture11.5 cm 4 1/2 ")IncompleteextensionFace6. Submento- bregmatic- extends from junction of floor of the mouth and neck to the centre of the bregma9.5 cm (3 3/4 ")Complete extensionFace* Transverse diameters- Biparietal diameter - 9.5 cm (3 3/4 ")- Super- subparietal - 8.5 cm (3 1/2 ")- Bitemporal dimeter - 8.cm (3 11/4")- Bimastoid diameter - 7.5 cm (3")A. Diameters of pelvic inlet1. Antero-posterior (True conjugate/Anatomical conjugate 11cm2. Obstetric conjugate 10 cm3. Diagonal conjugate 12 cm4. Transverse diameter 13 cm5. Oblique diameter 12 cm6. Sacroclyloid (smallest) 9.5 cmB. Diameter of pelvic outlet1. Obstetrical* Anteroposterior; from inferior border of symphysis pubis to tip of sacram 11 cm* Transverse (bispinous) interspinous distance between two ischial spines 10.5 cm2. Anatomical outlet* From lower borders of symphysis pubic to tip of coccyx 13 cm* Transverse diameter (inter tuberous diamcter/distance between inner borders of ischial tuberosities 11cm* Diagnal conjugate measured clinically **


Question: Presence of endometrial tissue within the myometrium is defined as

Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the uterus. The most frequent sites of implantation arethe pelvic viscera and the peritoneum.Adenomyosis is defined as the presence of endometrial stroma and glands within the myometrium, at least one low-power field from the basis of theendometrium, whereas endometriosis is characterized by ectopic endometrium appearing within the peritoneal cavityRef: Berek and Novak&;s Gynecology; 15th edition; Chapter 17


Question: Reinke crystals are found in

Hilus cell tumor: Rare virilizing tumor Arises from cells in the ovarian hilum Presence of Reinke crystals in the cells is the distinguishing feature of leydig or interstitial cells of testis Ref: Shaw Gynecology 17e pg 449.


Question: Not used as emergency contraception

Emergency contraception(EC) is based on the fact that protection is provided within 72 hours of unprotected intercourse. Mifepristone and LNG are proven easily administered oral therapy for EC whereas Cu T can be used effectively and cost effectively even till the fifth day after unprotected intercourse. However, LNG intrauterine device is more useful for disorders like menorrhagia, irregular bleeding, hyperplasia of the endometrium, etc .

Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)


Question: Increased acidosis and hypoxaemia is seen in

(Increased fetal diastolic flow in the middle cerebral artery with absent diastolic flow in the aorta)(648- D)Doppler - direction as well as velocity of blood flow can be measured by doppler ultrasound.* Reduced diastolic flow indicates high resistance in the downstream vessel and low tissue perfusion. Presence of'notch' in the early diastolic waveform also indicates high resistance in the downstream vessel and low tissue perfusion.* *Presence of notch in uterine artery when confirmed bilaterally at 24 weeks indicates the possible development of preclampsia and fetal growth restriction* Absent end diastolic flow in the umbilical artery was associated with 16% fetal death rate and reversed diastolic flow with 50% fetal death rates.* * Increased fetal diastolic flow in the middle cerebral artery (centralization of flow) with absent diastolic flow in the aorta implies fetal acidemia** Abnormal venous waveforms (ductus venosus, IVC) indicates fetal cardiac dysfunction (failure)Single umbilical artery - It is more common in twins and in babies bom of diabetic mothers or in polyhydramnios.* It is frequently associated with congenital malformation of the fetus (10-20%). Renal and genital anomalies, Trisomy 18 are common, (228-D)* There is increased chances of abortion, prematurity, IUGR, and increased perinatal mortality.

Presence of the 'notch' in the uterine artery


Question: The weight of placenta and fetus are equal at

In the first trimester, placental growth is more rapid than that of the fetus. But by approximately 17 weeks, placental and fetal weights are approximately equal. Ref:Williams Obs 24e pg 95.


Question: Maximum oogonia can be seen In ovaries at

Oogonia multiply in large numbers by mitosis averaging about 6-7 million around 18-20 weeks of intrauterine life


Question: Not a feature of diabetes mellitus in pregnancy

Neonatal complications Respiratory distress syndrome Hypoglycemia Polycythemia Hyperbilirubinemia Hyperviscosity Cardiomyopathy Bih trauma Reference: Textbook of Obstetrics; Sheila Balakrishnan, 2nd edition; Page no: 241

Medical, surgical and gynaecological illness complicating pregnancy


Question: A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy is

Midline episiotomies are easier to fix and have a smaller incidence of surgical breakdown, less pain, and lower blood loss. The incidence of dyspareunia is somewhat less. However, the incidence of extensions of the incision to include the rectum is considerably higher than with mediolateral episiotomies. Regardless of technique, attention to hemostasis and anatomic restoration is the key element of a technically appropriate repair.


Question: Most common type of pelvis in women is

Caldwell (1939) repoed that the gynecoid pelvis was found in almost half of women.(Ref: William's Obstetrics; 25th edition)


Question: Intrauterine seizure in foetus is seen due to deficiency of


Question: One of the following is used for sex chromatin testing

Chromosomal sex can be determined by the study of the leucocytes or by simply taking a smear from the buccal mucosa
The nuclei of the female chromosome contain a stainable body called the sex chromatin, hence female cells are termed as chromatin positive.
In epithelial cell nuclei, this small peripherally situated darkly staining nodule is called Barr body

Male cell nuclei lack this body and termed chromatin negative.


Question: HIV transmission to the newborn is most commonly and effectively by

Ans. b (Vaginal delivery). (Ref. Harrison's Principles of Internal Medicine, 16th/pg.38, 1082)MATERN AL-FETAL/INFANT TRANSMISSION# The predominant cause of HIV infection in children is transmission of the virus from the mother to the newborn during the perinatal period.# The majority of cases of mother-to-child (vertical) transmission of HIV-1 occur during the intrapartum period.# Exposures, which increase the risk of mother-to-child transmission, include -- Vaginal delivery,- Preterm delivery,- Maternal bleeding, and# Trauma to the fetal skin.# Perinatal HIV transmission can be most accurately correlated with measurement of maternal plasma HIV RNA burden.# In the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor, and delivery, and to the fetus following birth (see below), the probability of transmission of HIV from mother to infant/fetus ranges from 15- 25% in industrialized countries and from 25-35% in developing countries.# In developed countries, current recommendations to reduce perinatal transmission of HIV include- universal voluntary HIV testing and counseling of pregnant women,- antiretroviral prophylaxis with one or more drugs in cases in which the mother does not require therapy for her HIV infection,- combination therapy for women who do require therapy,- obstetric management that attempts to minimize exposure of the infant to maternal blood and genital secretions, and- avoidance of breast-feeding.# Certain studies have demonstrated that truncated regimens of zidovudine alone or in combination with lamivudine given to the mother during the last few weeks of pregnancy or even only during labor and delivery, and to the infant for a week or less, significantly reduced transmission to the infant compared to placebo.# Short-course prophylactic antiretroviral (ARV) regimens, such as a single dose of nevirapine given to the mother at the onset of labor and a single dose to the infant within 72 h of birth, are of particular relevance to low- to mid-income nations because of the low cost and the fact that in these regions perinatal care is often not available and pregnant women are often seen by a health care provider for the first time at or near the time of delivery.# Indeed, short-course ARV regimens have now been used for several years in developing nations for the prevention of mother-to-child transmission.


Question: Diethylstilbesterol causes the following defects to expect

Diethylstilbesterol  defects

Neural tube defects
Vaginal and cervical adenosis
Clear cell adenocarcinoma
Uterine anomalies
Cryptorchidism
Testicular hypoplasia


Question: Pierre robin syndrome is a

Sequence describes anomalies that all develop sequentially from one insult.
Pierre robin sequence. Micrognathia → glossoptosis → cleft palate.


Question: A case of Gestational trophoblastic neoplasia belongs to high risk group if disease develops after

WHO SCORING FOR GESTATIONAL TROPHOBLASTIC DISEASE (Score > 6 is high risk) PROGNOSTIC SCORING 0 1 2 4 1. Age <=39 >39 2. Antecedent pregnancy mole aboion term pregnancy 3. Interval (pregnancy and sta of CT) <4 4-6 7-12 >12 4. Hcg <10,000 1000 - 10,000 10,000 - 1 lakh >1 lakh 5. Blood group O or A B or AB 6. Largest tumor size <3 3-5 >5 7. Site of metastasis spleen, kidney GIT Brain, liver 8. No. of metastasis 1-3 4-8 >8 9. Prior chemotherapy 1 drug >=2 drugs

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


Question: Of the Following, most orable breech presentation is

Most orable breech presentation is Extended / Frank breech as it has least risk of cord prolapse among all the breech types. Risk of Cord prolapse in Breech - Footling breech > Complete breech > Frank breech


Question: Oral contraceptive acts by

Neither estrogen nor progestin hormone dose used in combination hormonal oral contraceptives alone would be able to suppress ovulation but together the estrogen and progestin hormones work synergistically to suppress ovulation "successfully". The synergistic antiovulatory effect from the combined use of estrogen and progestin directly decreases the secretion of the gonadotropin-releasing hormone from the hypothalamus and is considered the main action. This negative feedback mechanism disrupts ovulation by interfering with the hypothalamus-pituitary-ovary axis and gonadotropin secretion from the pituitary. Specifically, the progestin component suppresses luteinizing hormone release and the LH surge, which is necessary for ovulation, and the estrogen component suppresses the follicle stimulating hormone, which prevents the selection and maturation of the dominant follicle.


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

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 patient. Also know, In healthy women, an intravenous bolus of 10 units of oxytocin caused a transient but marked fall in aerial blood pressure that was followed by an abrupt increase in cardiac output. These hernodynamic 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 fuher 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 Antepaum Bed rest The most impoant measure for attenuating the impact of pregnancy on diseased hea is bed rest. Bed rest increases the venous return to the hea, improves renal perfusion, induces diuresis and promotes elimination of water. Dietory salt restriction It helps to prevent excess retention of sodium and water. Diuretics It 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 digitalization It is commonly used in patients with severe hea disease who are not in ove congestive failure. During labour and delivery The 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 hea 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 hea).


Question: Factors that protect against endometrial cancer

Factors that increase
			endometrial cancer
			risk
Factors that protect
			against endometrial
			cancer

Obesity
Hysterectomy

Diabetes
Combined oral contraceptive pill

Nulliparity
Progestin - based
			Contraceptives, including injectables

Late menopause
			> 52 years
Intrauterine device, including Cu-IUD and LNG-IUS

Unopposed oestrogen
			therapy
Pregnancy

Tamoxifen therapy
Smoking

Family history of
			colorectal and
			endometrial cancer


Question: Pseudo gestational sac is seen in the USG of

Pseudo gestational sac : Irregular in outline Usually, uterus is centrally located No double decidual sign Sac remains empty Seen in ectopic pregnancy Ref: Dutta Obs 9e pg 601.


Question: Puerperal sepsis is last for

(2 weeks): Ref: 433-36-DPUERPERAL SEPSIS - An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsisPuerperal pyrexia: A rise of temperature reaching 100deg.4degF (38degC) or more (measured orally) on 2 separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery is called puerperal pyrexia* Commonest responsible organism are anaerobic streptococcus* Uterus is the most common site of puerperal infection (Placental site are the common sites to be infected first, and uterus usually occurs between the 3rd and 6th day after delivery)


Question: Congenital adrenal hyperplasia is most likely a result of

Defects in adrenal steroidogenic enzymes

Defects in coicosteroid-binding globulin


Question: A female presents with 8 weeks amenorrhea with pain left lower abdomen. On USG, there was thick endometrium with mass in lateral adnexa. Most probable diagnosis

Ans. a. Ectopic pregnancy A female with 8 weeks amenorrhea with pain left lower abdomen and on USG, thick endometrium with mass in lateral adnexa is suggestive of ectopic pregnancy


Question: The lymphatics of the vulva

Lymphatic Drainage of Reproductive Tract:Uterine Corpus - 1. Fundus-Para-aoic lymph nodes2. Cornu-Superficial inguinal3. Body-External Iliac L NCervix 1. Parametrial2. Internal iliac group3. Obturator group4. External iliac group5. SacralAll these drains into common iliac and superior lumbar group Fallopian tube and ovary-Superior lumbar groupVagina - Upper 2/3-Like cervix Lower 1/3-Inguinal and external iliac nodesVulva- Superficial inguinal Deep inguinal External iliac

Do not freely communicate with each other

Transverse the labia from medial to lateral margin

Drain directly into the deep femoral glands


Question: First histological sign of ovulation is

After ovulation, glycogen accumulates in basal portion of glandular epithelium creating subnuclear vacuoles and pseudostratification.

Vacuoles at apical portion of secretory nonciliated cells.

Absent glycoprotein in secretory non ciliated cells.

Subnuclear vacuoles and pseudostratification in basal portion of glandular epithelium.


Question: Primary amenorrhea is absence of menstruation by the age of

Primary amenorrhea refers to the failure of the onset of menstruation beyond the age of 16 years regardless of the development of secondary sexual characters Ref: Shaw Gynecology 17 e pg 141.


Question: The pH ot vagina in adults is 1

4.5 - 5.5 The pH of vagina in an adult woman is 4 - 5.5 with an average of 4 5 The pH of vagina varies with age Age Vaglnal pH - In a newborn infantdeg Between 4.5 - 7deg - 6 weeks old child deg 7deg - Pubeydeg Changes from alkaline to acidicdeg - Reproductive age groupdeg 4S 5.5deg - Pregnancydeg 3.5 - 4.5deg -- LoLL'4 - Late post menopausaldeg 6 - 8deg pH of vagina also varies along its length, being highest in the upper pa because of admixture of alkaline cervical mucus. The acidity of vagina is because of the action of doderlein's bacilli (lactobacilli) a normal inhabitant of vagina which acts on the glycogen contained in the vaginal cells to produce lactic acid. Vagina is lined by squamous epithelium in adults and by transitional epithelium in newborn.deg No glands open in vagina.deg The squamous cells of vagina and cervix stain deep brown in colour after being painted with iodine solution, owing to the presence of glycogen in healthy cells (positive schiller test).deg


Question: Diagnosis of Gestational hypeension is made if blood pressure is

Diagnostic Criteria for Pregnancy-Associated HypeensionConditionCriteriaGestational HypeensionBp > 140/90 mmHg after 20weeks in previously normotensive womenPreeclampsiaHypeension andProteinuria orThrombocytopenia Renal Insufficiency cerebral symptoms Pulmonary edemaReference: William&;s Obstetrics; 24th edition; Chapter 40; Hypeensive disorders

> 130/90 mmHg after 20weeks in previously normotensive patient

> 140/90 mmHg after 20weeks in previously normotensive patient

> 150/90 mmHg after 20weeks in previously normotensive patient

> 160/90 mmHg after 20weeks in previously normotensive patient

Medical, surgical and gynaecological illness complicating pregnancy


Question: After an initial pregnancy resulting in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring. An appropriate answer would be that the chance of recurrence

An initial spontaneous aboion, irrespective of the karyotype of sex of the child, does not change the risk of recurrence in the next pregnancy. The rate of aboion is commonly quoted as 15% of all known pregnancies. Recurrent pregnancy loss is seen in around 1 in 300 pregnancies. For patients with a history of RPL, the risk of subsequent pregnancy loss is estimated to be: 24% after two clinically recognized losses, 30% after three losses 40% to 50% after four losses

Depends on the genetic makeup of the prior abous

Is no different than it was prior to miscarriage

Is increased most likely to greater than 50%

Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)


Question: Likely size of uterus at 8 weeks post paum is

Ans. is a i.e. 100 gm Weight of uterus : Immediately after delivery -- 1000 gm. At the end of 1 week -- 500 gm. At the end of 2 weeks -- 300 gm. At the end of 6 weeks it weighs -- 60 - 100 gm (Pre-pregnant state). Also Know : Immediately following delivery, the fundus is just below the umbilicus (13.5 cms above the symphysis pubis/ 20 weeks gestational age size.)deg Involution of the uterus After 24 hours of delivery, height of uterus decreases by 1.25 cm/day.deg Uterus is a pelvic organ.deg by the end of 2 weeks. Uterus returns almost to its normal size (pre pregnant size) by the end of 6 weeks. The process by which the post paum uterus returns to its pre pregnant state is called as Involution. Involution is achieved by decrease in the size of muscle fibres.deg (and not in the number)deg


Question: Duration of second stage of labour in a multipara is

Ans. is 'b' i.e., 20 minutes o Second stage begins with full dilatation of the cervix and ends with expulsion of the fetus.o Mean duration of second stage is 50 minutes for nullipara and 20 minutes in multipara. Prolonged second stage is diagnosed if the duration exceeds 2 hours in nullipara and 1 hour in multipara when no regional anaesthesia is usedo One hour or more is permitted in both the groups when regional anaesthesia is used during labour.


Question: In a young female of reproductive age an absolute contraindication for prescribing OCP&;s is

OCP act by - causing atropic changes of endometrium preventing nidation - Thickening cervical mucus - Increasing the tubal motility. The hormones of the OCP are metabolized in the liver. Hence, chronic liver diseases and liver failure are absolute CI of OCP.


Question: Second stage of labor begins with

Second Stage of LaborThis stage begins with complete cervical dilation and ends with fetal delivery. The median duration is approximately 50 minutes for nulliparas and about 20 minutes for multiparas, but it is highly variable Reference: William's Obstetrics; 25th edition; Chapter 22; Normal Labor


Question: Clomiphene citrate used in initial treatment for most anovulatory infertile women is

Clomiphene citrate is non-steroidal derivative given on 3rd to 5th day of cycle. It has both oestrogen agoinst and antagonist properties.

Given on 7th day to 10th day after onset of spontaneous menses

Can be administered if no follicle is >20mm and endometrium is <5mm


Question: Keyhole sign is seen in

Distal obstruction of the urinary tract is more frequent in male fetuses, and the most common etiology is posterior urethral valves. Characteristically, there is dilatation of the bladder and proximal urethra, termed the"keyhole" sign, and the bladder wall is thick (Ref: William's Obstetrics; 25th edition)


Question: Paramesonephric duct develop into


Question: Proteinuria in preeclampsia is due to

Endothelial cell dysfunction and increased free radicals cause activation of microvascular coagulation that manifest by thrombocytopenia and increased capillary permebility manifest as edema and proteinuria.


Question: Menorrhagia is defined as

Ans. c (Increased loss of blood than normal during menstrual cycle). (Ref. Shaw's textbook of Gynaecology 13th ed. 291)A normal menstrual blood loss is 50-80 ml, & does not exceed 100 ml. Menorrhagia is increase in duration & quantity of menstrual loss (> 100 ml).

Increased loss of blood than normal during menses


Question: Herpes gestatioinalis is

Herpes gestationalis (pemphigoid gestationis ) is characterized by eosinophilic degranulation at dermal-epidermal junction. Becomes severe with subsequent pregnancies.

Autoimmune reaction to collagen XVII in  basement membrane of skin

Neutrophilic degranulation at dermal - epidermal junction


Question: Calories in human milk (gm per 100 mL) are

Ans. d (67 Kilocalories). (Ref. Park PSM, 19th ed., 429; OP Ghai Paediatrics, 6th/pg 97)MILKNutrientContent/100 mL of the human/breast milkCalories67 kcal.... (Ref. OP Ghai Paediatrics); 70 kcal.... (Ref. Park PSM)Proteins1.1 gWhey/casein ratio80:20Fat3.5 gLactose7.0 gSodium0.9 mEqPotassium1.4 mEqCalcium35 mgPhosphorus15 mgIron30-50 mgZinc120 mgVitamin A60 mgVitamin C5.2 mg % of contents inProteinsFatCarbohydrateWaterColostrum8.62.33.286Breast milk1.23.27.587


Question: A 55 year old lady presenting to OPD with postmenopausal bleeding for 3 months has a 1 x1cm nodule on the anterior lip of cervix, The most appropriate investigation to be done subsequently is

Post menopausal bleeding with a visible cervical growth needs a tissue diagnosis, done by a punch biopsy of the lesion. Paps smear is a screening test, done in asymptomatic patients. Colposcopy + biopsy is a diagnostic test, indicated in symptomatic patients, like those with postmenopausal or post coital bleeding, or in asymptomatic patients where paps screening was done and turned out abnormal Endocervical curettage is indicated in patients with suspected endocervical lesion, or if entire transformation zone could not be evaluated at colposcopy


Question: Surfactant appears in amniotic uid at the gestational age of

Read below what Nelson has to say about the appearance of surfactant.
"Surfactant is present in high concentrations in fetal lung homogenates by 20 wk gestation* but does not reach the surface of the lung until later. It appears in the amniotic uid between 28-32 wks. Mature level of pulmonary surfactant is usually present after 35 wks".
Now I am leaving it to you to decide between 28 and 32 wks. I personally feel the answer should be 28 wks


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

Placental alkaline phosphatase (PLAP) and lactate dehydrogenase (LDH) are produced by up to 95% of dysgerminomas, and serial measurements of LDH may be useful for monitoring the disease. A karyotype should be obtained preoperatively for all premenarcheal girls, paicularly those with dysgerminomas, because of the propensity of these tumors to arise in dysgenetic gonads


Question: The weight of term uterus is

Non pregnant state of uterus Weight - 60g Length - 7.5 cm Capacity - 5-10 ml Pregnant uterus Weight - 900-1000g Length - 35 cm Capacity - increased to 500-1000 times Ref: Dutta Obs 9e pg 42.


Question: Least pregnancy failure rate in

(Oestrogen + Progesterone) (547-Dutta 6th)Pregnancy Failure Rate (H,W,Y) (PEARL - INDEX)**Number of accidental pregnancies x 1200Number of patients in 100 year1200 = Number of months in 100 years* Condome = 14 * IUCD = 2* Diaphragm = 20 LNG- IUS (0.2 H.W.Y)]* Rhythm method = 20-30 = 1-2 H.W.Y* Coitus interruptus = 20 * OCP = * Progesterone alone [0.5-2 H.W.Y


Question: The best gas used for pneumoperitoneum laparoscopy is

Carbon dioxide is the most widely used peritoneal distention medium, because it is non-flammable, colourless and has a higher blood solubility than air & the rapid absorption of CO2 in blood reduces the incidence of gas emboli.


Question: MIRENA is

Ans. is 'a' i.e. Progesterone IUCD MIRENA is an intrauterine device.There are two types of IUD'sChemically inert IUD's - They are composed of a nonabsorbable material, most often polyethylene and impregnated with barium sulfate for radiopacity.Chemically active IUD's * They either haveContinuous elution of copper orProgestational agent.At present time only chemically active IUD's are available.MIRENA is a progesterone containing IUDThe progesterone agent present in it is levonorgestrel.MIRENA releases levonorgestrel into the uterus at a relatively constant rate of 20 mg/day.It works by causing endometrial atrophy.Other beneficial effect:The MIRENA device reduces menstrual blood loss and can even be used to treat menorrhagia.

Methods - Progestogen-Only Contraception


Question: The best method of cuailing the second stage of labour in hea disease is by

Seccond stage management in a Hea disease complicating Pregnancy Maternal pushing and the tendency to delay in the second stage of labour is to be cuailed by forceps or ventouse under pudendal /perineal block Ventouse is preferable to forceps as it can be applied without putting patient in lithotomy position IV ergometrine after the delivery should be withheld to prevent sudden overloading of the hea by additional blood squeezed out from the uterus Reference: D.C.Dutta&;s Textbook of Obstetrics; 7h edition; Page no: 278

Medical, surgical and gynaecological illness complicating pregnancy


Question: A 40 year old multiparous women complains of involuntary loss of urine associated with coughing, laughing, lifting weight or standing. The history is most likely suggestive of

Stress incontinence When the woman voids a small quantity of urine involuntarily while sneezing, coughing or laughing. The condition also develops during pregnancy and soon after delivery There is no desire to pass urine, but dribbles a small quantity on stress Grading: Grade 0:Incontinence without leakage Grade I: Incontinence caused only with severe stress such as coughing , sneezing and jogging Grade II: Incontinence caused by moderate stress such as fast walk,going up and down the stairs Grade III: Incontinence caused by mild stress such as standing Other options Fistula: a fistula is a communication between two cavities, such as vesico-vaginal fistula, urethrovaginal, uretero-vaginal fistulas. These fistulas have will present with incontinence, unrelated to activity or raised intra-abdominal pressure Urge incontinence :associated with sudden and abrupt desire to void. It is associated with detrusor instability (overactive bladder) or detrusor hyperreflexia secondary to neurological disease Overflow incontinence: leakage of small amount of urine resulting from mechanical forces on overdistended bladder

Genital Prolapse - various presentation of prolapse and management of urinary stress incontinence (I am hanging by my nails !)


Question: Failure rate of vasectomy is


Question: A 8th week pregnant women presents with mild vaginal bleeding and pain in the lower abdomen. The size of the uterus is 8 weeks. The cause is

A i.e. (Threatened abortion) (161 - 165 - Dutta 6th)THREATENED ABORTIONINEVITABLE ABORTIONINCOMPLETE ABORTION* Clinical entity where the process of abortion has started but has not progressed to a state from which recovery is impossible* Bleeding per vaginam is usally slight and bright red in colour. Bleeding stops spontaneously* Bleeding is painless mild backache or dull pain in lower abdomen**. Pain appears usually following haemorrhage(i) Closed external os(ii) Uterine size corresponds to the period of amenorrhoea**(iii) Uterus and cervix feel soft* A state from where continuation of pregnancy is impossible* Increased vaginal bleeding* Aggravation of pain in the lower abdomen (colicky in nature)* Dilated internal os of the cervix through which the products of conception are felt* The general condition of the patient is proportionate to the visible blood loss.* When the entire products of conception are not expelled, instead a part of it is left inside the uterine cavity* This is the commonest type met amongst women, hospitalized for abortion complications* History of expulsion of a fleshy mass per vaginum*** Continuation of pain lower abdomen coliky in nature* Persistence of vaginal bleeding of varying magnitude* Uterus smaller than the period of amonorrhea*** Patulous cervical is often admitting tip of the finger* Varying amounts of bleeding* Expelled mass is found incomplete* Mifepristone is used in Threatened abortion*** HIV is associated with minimal teratogenic risk to the fetus**


Question: In post menopausal women, there is an increased level of


Question: A 9 year girl presents with menarche. History reveals thelarche at the age of 8 years the most common cause of this condition in girls is

Precocious pubey:The term is reserved for girls who exhibit any secondary sexual charecters before the age of 8 or menstruate before the age of 10 Causes GnRH Dependent: 80% Constitutional : Activation of HPO axis Juvenile Primary Hypothyroidism Intracranial Lesions GnRH Independent Ovary Adrenal Liver Iatrogenic Granulosa cell tumour Theca cell tumor Leydig cell tumor Androblastoma McCune Albright syndrome Hyperplasia Tumor Hepatoblastoma Exogenous Estrogen or Androgen intake Ref: D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY; 6th edition; Pg no:51


Question: Peripartum cardiomyopathy occurs at

(D) Within 5 months[?]PPCM is a structural heart muscle disease that occurs in women either at the end of pregnancy or up to five months after giving birth.Peripartum Cardiomyopathy:Peripartum cardiomyopathy is a cardiomyopathy that occurs in the third trimester or in the months following delivery and presents with congestive heart failure.The etiology is poorly understood.Treatment must include anticoagulation because of the high risk of thromboembolism.Over one third of patients have complete recovery.A risk of recurrence exists in subsequent pregnancies.Peripartum Cardiomyopathy - Pathophysiology:Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy documented with echocardiographic left ventricular dysfunction occurring in the last month of pregnancy or within 5 months of delivery.Patients with a prior history of myocardial disease are excluded from this definition.Risk factors include multi-parity, being black, older maternal age and preeclampsia. In a retrospective study of 123 women with PPCM, a history of hypertension was obtained in 43% of patients and twin pregnancies were reported in 13%.Idiopathic cardiomyopathy presenting with heart failure secondary to LV systolic dysfunction from 1 month antepartum, up to 5 months after delivery, when no other causes of heart failure is evident.Incidence of 1:300 to 1:4000 pregnancies.Predisposing factors:Multi-parity, Multiple Births, Smoking, diabetes, Pregnancy complicated by pre-eclampsia, eclampsia or hypertension, Advanced age or teenage pregnancy.Criteria for Peripartum Cardiomyopathy:Classic:Development of Cardiac failure in the last month of pregnancy or within 5 months after delivery.Absence of an identifiable cause for the cardiac failure.Absence of recognizable heart disease prior to the last month of pregnancy.Additional:Left ventricular systolic dysfunction demonstrated by classic Echo Cardio Graphic criteria such as depressed shortening fraction or ejection fraction.Peripartum Cardiomyopathy:Important diagnostic criteria are:Cardiac failure within last month of pregnancy or within 5 months postpartum.No determinable cause for failure.Absence of previous heart disease.Left ventricular dysfunction as evidenced on echocardiography-Ejection fraction <45%-Left ventricular end diastolic dimension >2.7cm/m2. Peripartum cardiomyopathy is a diagnosis of exclusion. The patients are usually multiparous & young (20-35 years). They complain of weakness, shortness of breath, cough, nocturnal dyspnoea & palpitation. Examination reveals - tachycardia, arrhythmia, peripheral oedema & pulmonary rales. Pregnancy is poorly tolerated in women with dilated cardiomyopathy.The treatment is bed rest, digitalis, diuretics (preload reduction), hydralazine or ACE inhibitors (postpartum) (after load reduction), beta blocker & anticoagulant therapy. Vaginal delivery is preferred. Epidural anaesthesia is ideal. There is no contraindication of breast feeding. Mortality is high (20-50%) due to pulmonary embolism & cerebral thrombosis. It may recur in subsequent pregnancies.Myocardial infarction is rare in pregnancy. Management is mostly as in on pregnant state. Coronary angioplasty, stenting and thrombolytic therapy has been done in pregnancy when indicated. Supine position and hypotension should be avoided. Labor: managed as with standard cardiac care. Elective delivery within two weeks of infarction should be avoided. Regional analgesia for pain in labor and p blockers for tachycardia may be used. Maternal pushing is avoided and second stage is shortened by forceps or vacuum. Syntocinon should be used in the third stage management as ergometrine may cause coronary artery spasm. Percutaneous transluminant coronary angioplasty can be done successfully around 36 weeks of pregnancy if needed.


Question: Most common infection associated with IUCD use is

Ans. a.Chlamydia Infections with chlamydia and actinomyces are most common with use of IUCD


Question: Kelly&;s plication operation is done in

Stress Incontinence Management Surgical: Kelly&;s repair : Plication of bladder neck Pacey&;s repair : apposing medial fibres of the puborectalis muscles in the midline under the bladder neck region to elevate the same Both may be combined with anterior colporrhaphy Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY;15th edition; Pg no:193


Question: Initial site of RBC production in fetus

Hematopoiesis - 1st demonstrable in yolk sac followed by liver and then finally spleen and bone marrow life span of fetal RBCs at term - 90 days


Question: Infertility issues with leiomyoma can be addressed by

GnRH agonist treatment is approved for treating infertility associated with fibroid uterus.


Question: A 21 yrs old girl with 8 weeks amenorrhoea, now comes in shock. The likely diagnosis is

Ans. is a i.e. Ruptured ectopic pregnancy Always remember : History of acute abdominal catastrophe with fainting attack and collapse i.e. shock following sho period of amenorrhea, in a woman of child bearing age always points towards ectopic pregnancy (ruptured) and no other diagnosis.


Question: Most sensitive diagnostic technique for Trichomonas infection

Ans. is a, i.e. Culture in Diamond mediaRef. Williams Gynae 3rd/ed, p63"The most sensitive diagnostic techniques is culture which is impractical because special media (Diamond media) is required."

Sexually Transmitted Disease in the Female


Question: Best time to do quadruple test

* The quad screen is done in the second trimester, usually between 15 and 20 weeks of pregnancy. * Ideally, the test should be performed in conjunction with first-trimester screening tests. REF : DUTTA BOOK OF OBSTETRICS


Question: Prostaglandin that can be used to induce labour at term is

Ans. a. PGE2. (Katzung Clinical Pharmacology 11th edition./, Ch.l8/page 410)Dinoprostone, a synthetic prep of PGE2, is administered vaginally for oxytocic use. It is used for inducing abortion in the second trimester of pregnancy, for missed abortion, for benign hydatidiform mole, and for ripening of the cervix for induction of labor in patients at or near term. An analog of PGF2a (carboprost tromethamine) is also used in obstetrics - used to induce second-trimester abortions and to control PPH not responding to conventional methods of Rx.PROSTAGLANDINS# Have very short half-life.# Arachidonic acid is common precursor (acylic fatty acid derivatives).# The subscript numeral after the letter (e.g., PGE2) indicates degree of unsaturation.# PGF2 alpha acts predominantly on myometrium, while PGE2 on cervix due to its collagenolytic property. (Hint: F for fundus and E for effacement of cervix.).# Carboprost is effective in refractory cases of PPH.# Misoprostol is methyl ester of PGE1, rapidly absorbed and more effective than oxytocin and prostaglandins in induction of labour, also effective in treatment in NSAID induced peptic ulcer.# Inflammatory mediators from arachidonic are:- TxA2, PGD2, PGE2, PGF2 alpha, PGI2 (Cycloxygenase pathway) leukotrienes (Lipoxygenase)--LTB4 is a neutrophil chemotactic agent. LTC4, D4 and E4 (SRS-A) function in broncho-constriction, vasoconstriction, contractions of smooth muscle and increased vascular permeability.PgActionsPGE2Bronchoconstriction, platelet aggregation.PGE2Potent inducer of bone resorption and releases Ca++ from bones and cervical effacement.PGE2Bronchoconstriction, role in uterine and ovarian function (fundal contraction).PGI2Bronchodilation, vasoconstriction, and platelet aggregation.TXA2Bronchodilation, vasoconstriction, and platelet aggregation stimulation (Bradykinin and histamine are potent vasodilators)USES OF PROSTAGLANDINS IN OBSTETRICS# Induction of abortion (MTP and missed abortion); Antiprogestins (eg, mifepristone) have been combined with an oral oxytocic synthetic analog of PGE1 (misoprostol) to produce early abortion.# Induction of labour# Termination of molar pregnancy# Cervical ripening before induction of labour/abortion# Acceleration of labour# Management of atonic PPH# Management of tubal ectopic pregnancyActionArachidonic Acid Metabolites (Eicosanoids)VasodilationPGI2 (prostacyclin), PGE1, PGE2, PGD2VasoconstrictionThromboxane A2, leukotrienes C4, D4, E4Increased vascular permeabilityLeukotrienes C4, D4, E4Chemotaxis, leukocyte adhesionLeukotriene B4


Question: Betamethasone in pregnancy is given to prevent

Respiratory distress syndrome can be prevented by administration of Betamethasone to the mother two doses IM 24hrs apa given before 34 weeks Ref: Dutta Obs 9e pg 444.


Question: The use of combined oral contraceptive pill is associated with an increased incidence of

Ans. is b i.e. Chlamydial endocervicitis This is a tricky question as some believe Option "b should be the answer while others believe Option "c" should be concerned. As far as candidial (monilial) vaginitis is concerned, OCP's use increase their incidence. But for Chlamydial infections : "Persons who use barrier contraception are less frequently infected by C. Trachomatis than those who use no contraception, and women who use oral contraceptives may have a higher incidence of cervical infection than women not using oral contraceptives". As if replying to CGDT "Chlamydial colonization of the cervix appears more likely in OC users than in non users, but despite this. there is a 40-50% reduction in risk for Chlamydial PID" I then had to confirm the answer from Clinical Gynaecologic Endocrinology and Infeility 7,/e by Leon Speroff (It is the most authentic and reliable book for all problems related to Endocrinology, Contraception and Infeility) "Fifteen of the 17 published studies repoed a positive association of oral contraception with lower Genital tract infections caused by Chlamydial cervicitis. Because lower genital tract infection are on the rise (now the most prevalent STI in the US) and the rate of hospitalization for PID is also increased, it is wohwhile for both patients and clinicians to be ale for symptoms of cervicitis or salpingitis in women on oral contraceptives who are at high risk of sexually transmitted infections." As far as HPV infection i.e. Vaginal was is concerned 'The viral sexually transmitted infections (STI's) include HIV, Human papilloma virus (HPV), Herpes simplex virus (HSV) and hepatitis B (HBV). At the present time, no known associations exist between oral contraception and the viral STI'S' ... Leon Speroff 7/e, p 904 So, now we can be sure that the answer is Chlamydial endocervicitis. Also know : Infections and Oral contraception : Use of OCP is associated with Increased risk of infection - Candida (Moniliasis) - Gonorrheadeg - Viral STI's i.e. HIVdeg . HPVdeg - Chlamydia - Trichomonasdeg - Hepatitis B virus - Urinary tract infections - Bacterial vaginosis - Herpes simplex virus Note : If question says PID and does not specify any organism. Then OCP'S overall not only decrease the incidence of PID but also risk of hospitalisation and severity of the disease is decreased. For protection against PID, at least 12 months of continuous use is necessary and this protection is limited only to current users.


Question: A pregnant woman with fibroid uterus develops acute pain in abdomen with low grade fever and mild leucocytosis at 28 weeks ,the most likely diagnosis is

Red degeneration of fibroid: It results from softening of surrounding connective tissue The capillaries tend to rupture and blood effused out into the myoma causing a diffuse reddish discoloration The tumor it self assumes a peculiar purple red colour and develops a fishy odour,if the tumor is carefully examined We may find some vessels and large veins in the capsule thrombosed This is the most common complication with fibroid during pregnancy . And the patient is usually febrile and with moderate leucocytosis and raised ESR, the condition is aseptic one. And ultrasound is useful for diagnosis Ref Shaw 16/e pg 395


Question: Tumor marker of ca ovary for follow up

Ans. (c) CA 125Ref : Shaws 15th ed. 1422,, Shaws 15th ed./ 928* Tissue markers such as CA-125 and NB/70k are useful mainly in the follow-up of certain tumors.* CA-125 is a glycoprotein and surface cell antigen which is secreted by the malignant epithelial tumors.* Level of CA-125 more than 35 U/ml suggests malignant and residual tumor, and indicates the need of chemotherapy.* CA-125 is also raised in abdominal tuberculosis and endometriosis.* CEA (carcinoembryonic antigen) more than 5 mg/1 is seen in mucinous ovarian tumour.* NOTE: CA-125 is raised in only 50% cases in Stage I and 90% in Stage II ovarian cancer.


Question: Pseudogestational sac is seen in ultrasonography is suspicious of

Anechoic fluid collections, which might normally suggest an early intrauterine gestational sac, may also be seen with ectopic pregnancy. These include pseudogestational sac and decidual cyst.A pseudosac is a fluid collection between the endometrial layers and conforms to the cavity shape. If a pseudosac is noted, the risk of ectopic pregnancy is increased Reference: William's Obstetrics; 25th edition; Chapter 19; Ectopic pregnancy


Question: Estrogen administration in a menopausal woman increases the

Ans. is c i.e Bone mass Before seeing any Reference for the Question let's rule out some options. Estrogen administration will exe a negative feedback on gonadotropin secretion and decreases Gonadotropin secretion rather than increasing it (Option 'a' ruled out). As I have already discussed in previous Question -Estrogen decreases LDL and not increases it (ruling out Option `b). Now we are left with 2 options, Option 'c' i.e. Bone mass and Option 'rile. Muscle mass. Estrogen given as hormone replacement therapy is most beneficial in preventing osteoporosis i.e it must be increasing bone mass. So, Option 'c'seems to be correct. Now have a look what texts have to say : Estrogen helps to maintain bone mass and skeletal integrity thereby protecting against osteoporosis. Effect of estrogen on bones : Estrogen causes increased osteoblastic activity in the bones. It is impoant in maintaining bone mass primarily by retarding bone resorption. The major action of estrogen is directed at reducing the maturation and activity of osteoclasts, by modifying regulatory cytokine signals from osteoblasts. The action of estrogen and progesterone result in increased expression of bone matrix proteins such as osteonectin, osteocalcin, collagen and alkaline phosphatase. Extra Edge : An overveiw of osteoporosis Risk factors for osteoporosis Non modifiable Modifiable Associated Medical Conditions * Age * Race (caucasian, asian) * Small body frame * Early menopause * Prior fracture * Family history of osteoporosis Inadequate intake of calcium and vitamin D Smoking Low body weight Excess alcohol use Sedentary lifestyle Hypehyroidism Hyperparathyroidism Chronic renal disease Conditions requiring systemic coicosteroid use Diagnosis : Bone Mineral Density Measurement (BMD) Dual X-ray Absorptiometry (DXA) of hip and spine is the primary technique for BMD assessment. BMD is expressed as a T score, which is the number of standard detions from the mean for a young healthy woman. A T score above --1 is considered normal, a value between --1 and --2.5 denotes osteopenia and a score below --2.5 indicates osteoporosis. Evaluation of BMD by DXA is recommended for all women aged 65 and older, regardless of risk factors and for younger postmenopausal women with 1 or more risk factors. Prevention : Women should receive 1000 to 1500 mg of calcium and 400 to 800 IU of vitamin D daily Options for osteoporosis prevention and treatment BisphosphonatesO Alendronate : 35 - 70 mg/week Risedronate : 35 mg/week lbandronate : 150 mg/month Additional potential benefits : none Potential risks : esophageal ulcers Side effects : gastrointestinal distress, ahralgia / myalgia Hormone therapy Estrogendeg or estrogen / progestin therapydeg Additional potential benefits : treatment of vasomotor symptoms and urogenital atrophy Potential risk : breast cancer, gallbladder disease, venous thromboembolic events, cardiovascular disease, stroke. Side effects : vaginal bleeding, breast tenderness Selective estrogendeg receptor modulators (SERMSP Raloxifenedeg : 60 mg/day Additional potential benefits : reduced risk of breast cancer Potential risks : venous thromboembolic events Side effects : Vasomotor symptoms, leg cramp Calcitonindeg : 200 IU/day intranasally or 100 IU/day subcutaneously or intramuscularly Additional potential benefits : non Potential risks : none Side effects : rhinitis, back pain Tariparatidedeg : 20 mg/day subcutaneously Additional potential benefits : none Potential risks : osteosarcoma after long - term use in rodents, hypercalcemia Side effects : leg cramps


Question: Grade 3 endometrial tumors according to FIGO staging is

The differentiation of a carcinoma, expressed as its grade, is determined by architectural growth pattern and nuclear features. In the International Federation of Gynecology and Obstetrics (FIGO) grading system proposed in 1989, tumors are grouped into three grades: grade 1, 5% or less of the tumor shows a solid growth pattern; grade 2, 6% to 50% of the tumor shows a solid growth pattern; and grade 3, more than 50% of the tumor shows a solid growth pattern. The presence of notable nuclear atypia that is inappropriate for the architectural grade increases the tumor grade by one.Histopathologic degree of differentiation:G1 <5% non squamous or non morular growth patternG2 6%-50% non squamous or non morular growth patternG3 >50% non squamous or non morular growth patternReference: Novak's gynecology; 14th edition; Chapter 35; Uterine cancer

>75% non squamous or non morular growth pattern


Question: Follow uo in a patient of H mole is done

Ans. is a i.e. Serum Beta HCG monitoring The chances of persistent trophoblastic disease and choriocarcinoma are high after evacuation of H.mole therefore regular follow up is mandatory. "After molar evacuation, patients should be monitored with weekly determinations of 0-subunit HCG levels until these levels are normal for 3 consecutive weeks, followed by monthly determinations until the levels are normal for 6 consecutive months. The average time to achieve the first normal HCG level after evacuation is about 9 weeks. At the completion of follow-up, pregnancy may be undeaken. After a patient achieves a nondetectable HCG level, the risk of developing tumour relapse is very low and may approach zero." Besides Serum Beta HCG at follow up following investigations are done : Pelvic examination -- To rule out any vulval and vaginal metastasis. -- To see the size of the uterus. -- To note the presence of any ovarian cysts and their sizes. It should be repeated every four weeks in the observation period. unest X-ray To detect lung metastasis Repeated at four weeks till spontaneous remission occurs and then at 3 months interval in the observation period. Pelvic Ultrasound : To detect any residual or locally invasive tumour and presence of ovarian cysts. Also Know : Patients are encouraged to use effective contraception during the entire interval of HCG follow up (i.e. atleast for 1 year). Choice of contraception : IUCD : should not be used because of the potential risk of uterine perforation and IUCDs cause irregular uterine bleeding which can be confused with persistent trophoblastic disease. Progestin pills : cause irregular bleeding therefore should not be used. OCP's : Earlier it was believed that OCP's should not be used till HCG values return to normal. But now it is said - "OCP's may be used safely after molar evacuation during the entire interval of hormonal follow up". "Oral contraceptives are found to be superior to Barrier method or use of IUCD in decreasing the risk of developing gestational trophoblastic neoplasia". Barrier method : Earlier they were the contraception of choice in case of GTDs. (Now it is combined pills).


Question: Most commonly gas used in Laparoscopy is

B. i.e. (Carbon - dioxide) (560 - Dutta 4th) (217- Shaw's 14th)* Pneumoperitoneum - Most commonly used gas is carbon dioxide (1L - 4L)* For diagnostic purposes nitous oxide or room air or oxygen can be used* CO2 is safer than air and nitrous oxide which can cause air embolism and accidental explosion respectively* The flow rate of the gas is about 1 L/minutc with a pressure not exceeding 20 mm HgCONTRAINDICATIONS OF LAPAROSCOPY* Severe cardiopulmonary disease* Extensive peritoneal adhesion* Patient haemodynamically unstable* Large pelvic tumour* Generalized peritonitis* Pregnancy > 16 weeks* Significant haemoperitoneum* Previous periumbilical surgery (relative)* Intestinal obstruction* Extreme obesity


Question: Stage of Ovarian tumor with surgical spill

Stage 1: tumor confined to ovaries or fallopian tubes. 1c: tumor limited to one or both ovaries. : Surgical spill : Capsule rupture before surgery or tumor on ovarian surface : Malignant cells present in ascites or peritoneal washings Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no:277 <\p>


Question: Point B in cervical radiotherapy represents

Point A: 2cm cephalic and lateral to the external os It is the point of crossing of uterine aery and ureter It receives 7000-8000cGy Point B: 2cm cephalic and 5cm lateral at the same plane and is approximately the site of obturator gland It receives 2000cGy initially and rest of dose supplemented by external beam irradiation of 4000cGy spreading over another 3 weeks total of 6000cGy Ref: D.C.DUTTA'S TEXTBOOK OF GYNECOLOGY; 6th edition; Pg no:350


Question: Surest sign of salpingitis is

[Cl (Seropuralent discharge from the part of tubes) (419-S) (166-Gynae -Dutta 5th)Acute salpingitis, the fallopian tube is swollen, oedematous, and hyperaemic with visible dilated vessels on the peritoneal surface. Some degree of serous exudation is seen around the fallopian tubes.* The sure sign of salpingitis is the discharge of seropurulent fluid from the fimbrial end of the tubes, without which the diagnosis cannot be justified at laparotomy, as the peritoneal surface may be inflamed in pelvic peritonitis due to any other cause.

Seropurelent discharge from the part of the tube


Question: The hormone responsible for lactation is

(Prolactin): Ref: 63-D, 4/4-K. Sembulingeum 3rdEndocrine control of lactation can be divided in to following stage(a) Preparation of breast (mammogenesis)(b) Synthesis and secretion of milk by breast alveoli (lactogenesis)(c) Ejection of milk (galactokinesis)(d) aintenance of lactation (galactopoiesis)* Immediately after the delivery of the baby and expulsion of placenta, there is sudden loss of estrogen and progesterone. Now the prolactin is free to exert its action on breast and to promote lactogenesis.* Prolactin is important for initiation of milk secretion rather than maintenance of milk secretion. Galactopoiesis depends upon other hormonal factors like growth hormone, thyroxine and cortisol* Milk ejection is a reflex phenomenon. It is called milk ejection reflex or milk let down reflex. It is a neuroendocrine reflex* Milk ejection in most species requires oxytocin (247-Ganong 22th)


Question: The given procedure is used to diagnose

Trattner - double balloon catheter is used to diagnose urethral diverticula.


Question: Not an absolute contraindication of laparoscopy is

Contraindications Severe cardiopulmonary disease Hemodynamically unstable Generalised peritonitis Diaphramatic hernia Hemoperitoneum Intestinal obstruction Excessive peritoneal adhesions Large pelvic tumour Pregnancy>16weeks Advanced malignancy Anticoagulation therapy D.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY,Pg no:615,6th edition

Gynaecological diagnosis and operative surgery


Question: Prophylactic chemotherapy in GTD is done for

Prophylactic chemotherapy : If the hcG levels fails to become normal by the stipulated time or re-elevation at 4-8 weeks Rising beta hcG levels after reaching normal levels Post evacuation hemorrhage Follow up facilities are not adequate Evidences of metastasis Ref: Dutta Obs 9e pg 186.


Question: Clue cells are seen in..

Ans. is "a' i.e., BV Bacterial (Gardnerellal vaginosiso It is not a sexually transmitted condition. It is termed as vaginosis rather than vaginitis because it is associated with alteration of vaginal flora rather than any specific infection. There is considerable decrease in the number of lactobacilli and lOOtimes increase in the growth of other anaerobic bacteria. These are Haemophilus vaginalis, Gardnerella, Mobiluncus, Mycoplasma hominis. Half of the females are asymptomatic carriers but majority complain of vaginal discharge without itching.o Characteristic of vaginal discharge are as follows:White, milky, non-viscous discharge adherent to vaginal wall.pH of discharge is more than 4.5.Fishy odour when mixed with 10% KOH is due to amino-metabolites (amine or whiff test positive).Presence of clue cells - the epithelial cell have fuzzy border due to adherence of bacteria,o Diagnosis is based on wet smear examination & culture.TreatmentMetronidazole 500mg bd for 7 daysAmpicillin 500 mg bd or cephalosporine 500 mg bd for 7 daysTetracycline, doxycycline, clindamycin and sulphafurazole are other options.Clindamycin (2%) cream, lacteal gel (5% lactic acidjand omidazole vaginal tabs are for local use.


Question: The least common type of female pelvis is


Question: Multipara with LSCS, Presents With Cyclical Hematuria, Diagnosis can be

VESICO-UTERINE FISTULA Usually caused during caesarean section or uterine rupture Symptoms: Cyclical hematuria Gold standard for diagnosis: Cystoscopy Treatment is abdominal repair Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:188


Question: Select the most appropriate response of Pill forgotten for 10 continuous days (SELECT 1 RESPONSE)

Common side effects of birth control pills include nausea, breakthrough bleeding, bloating, and leg cramps. If these side effects are experienced in the first two or three cycles of pills-when they are most common-the pills may be safely continued, as these effects usually remit spontaneously. On occasion, following correct use of a full cycle of pills, withdrawal bleeding may fail to occur (silent menses). Pregnancy is a very unlikely explanation for this event; therefore, pills should be resumed as usual (after 7 days) just as if bleeding had occurred. However, if a second consecutive period has been missed, pregnancy should be more seriously considered and ruled out by a pregnancy test, medical examination, or both. Women occasionally forget to take pills; however, when only a single pill has been omitted, it can be taken immediately in addition to the usual pill at the usual time. This single-pill omission is associated with little if any loss in effectiveness. If three or more pills are omitted, the pill should be resumed as usual, but an additional contraceptive method (e.g., condoms) should be used through one full cycle. Although most side effects caused by birth control pills can be considered minor, serious side effects do sometimes occur. A painful, swollen calf may signal thrombophlebitis.

Continue pills and use an additional form of contraception


Question: Method of conservative management of placenta pre

Mcafee and Johnson Regimen- It is a regimen used for placenta pre when pregnancy is <34 weeks(lungs are not maturated) and there is not active bleeding. In it, following is done: 1. Resuscitation 2. Steroids for fetal lung maturity 3. Sedation Other options Crede's method is the act of vigourous massaging and squeezing of the fundus to force the separation of the placenta. Lilly's Cha is the plotting of optical density of the amniotic fluid in Rh isoimmunisation. Brandt Andrew method is the technique of delivering the placenta with the "Controlled cord traction" method.


Question: Paogram helps in detecting


Question: In comparison to breast milk, colostrum has a higher content of

Colostrum is the milk secreted during the first three days. It is yellow, thick and contains more of antibodies and fat-soluble vitamins.Transitional milk is that secreted during the following 2 weeks and contains plenty of immunoglobulins.This is followed by mature milk which is thin and watery.(refer to pgno: 430 Sheila 2nd edition)


Question: Hysteroscopy should be done in

Hysteroscopy should be done in Pre-ovulatory phase when the endometrium is thin and bleeding is less likely to occur.


Question: A patient with spontaneous aboion came with history of amenorrhea and her FSH is 6 IU/mL, Diagnosis is

Asherman&;s Syndrome Results from intrauterine adhesions that obstruct or obliterate the uterine cavity, as a consequence of trauma There is a formation of adhesion following post aboal and puerperal curettage and diagnostic curettage in AUB Menstrual abnormalities include dysmenorrhea, hypomenorrhea, oligomenorrhea and amenorrhea May present with Infeilty and Recurrent Pregnnacy Loss Combined Estrogen and Progesterone challenge test will be negative Hysterosalpingography shows honeycomb appearance Operative hysteroscopy is the primary method for treatment of intrauterine adhesions that may be lysed by scissors, electrodissection, or with a laser Reference: Clinical Endocrinologic Gynecology and Infeility; Eigth Edition; Chapter 11


Question: Karyotype of complete molar pregnancy is

Complete moles most often have a diploid chromosomal composition. These usually are 46, XX and result from androgenesis, meaning both sets of chromosomes are paternal in origin. The chromosomes of the ovum are either absent or inactivatePaial moles usually have a triploid karyotype .Reference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: Earliest detection of pregnancy by ultrasound is by

The first definitive sonographic finding to suggest pregnancy is visualization of the gestational sac. The first sign of intrauterine pregnancy is presence of yolk sac within the gestational sac.


Question: After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned about the possibility of this recurring. An appropriate answer would be that the chance of recurrence

An initial spontaneous abortion, irrespective of the karyotype or sex of the child, does not change the risk of recurrence in a future pregnancy. The rate is commonly quoted as 15% of all known pregnancies.

Depends on the genetic makeup of the prior abortus

Is no different than it was prior to the miscarriage

Is increased most likely to greater than 50%


Question: After delivery, gonadotropin levels in the neonate

After delivery, gonadotropin levels in the neonate rise abruptly due to separation from the placenta.


Question: Moschcowitz repair is done in case of

Enterocele is repaired by Moschcowitz repair.


Question: Amount of liquor is maximum at

The volume of amniotic fluid in a normal pregnancy is about 1000 ml at 34-36 weeks and thereafter it slowly decreases. The amniotic epithelium is the major source of amniotic fluid


Question: Liley curve for evaluation of amnionic fluid bilirubin in Rh sensitized patient stas at

The main limitation of the liley curve is that it stas at 26weeks gestation and extrapolation of the lines to earlier gestational ages is inaccurate. Queenan has developed a curve for fetal assessment from 14-40weeks, divided into 4zones

Medical, surgical and gynaecological illness complicating pregnancy


Question: Women undergoing infertility treatment are advised to avoid NSAIDs in preovulatory period because

Prostaglandin stimulates smooth muscle contraction in ovary, contributing to ovulation.  prostaglandin synthetase inhibitors if taken in pre ovulatory period can cause luteinized unruptured follicle syndrome (LUFS).

NSAIDs cause premature rupture of follicle

NSAIDs like aspirin cause endometrial shedding.


Question: A women at 8 months of pregnancy complains of abdominal pain and slight vaginal bleed. On examination the uterus is tender with size more than expected for dates with absent fetal hea sounds. The diagnosis

This is a case of abruption with concealed retroplacental bleed which makes the uterus tender and also increase the uterine height. Please note that there may be some amount of vaginal bleeding in concealed hemorrhage as well. The uterine tenderness is also because of bruising of the uterine surface. With abruption the fetal hea sounds are often not heard due to the taut abdominal wall and hypeonic uterus, even when the fetus is alive. If the fetal hea rate is normal, the best management here is to induce labour,


Question: Absolute contraindication of IUCD is


Question: Mature graffian follicle preovulatory is less than


Question: The first trimester completes by

Historically, the first trimester extends through completion of 14 weeks, the second through 28 weeks, and the third includes the 29th through 42nd weeks of pregnancy. Thus, there are three periods of 14 weeks each. (Ref: William's Obstetrics; 25th edition)


Question: Lamellar bodies in amniotic fluid, used to assess fetal lung maturity are derived from

Lamellar body count is rapid, simple and accurate method to assess fetal lung maturity that is comparable to L/S ratio.


Question: The first line of treatment of infertility in PCOD is

Clomifene, also known as clomiphene, is a medication used to treat infertility in women who do not ovulate.
This includes those who have polycystic ovary syndrome. Use results in a greater chance of twins. It is taken by mouth once a day.


Question: Eclampsia occurs in Antepaum in

Eclampsia occurs antepaum in 35-45%, intrapaum 15-20%, and postpaum in 35-45% of the cases.Reference: Practical guide to High-risk pregnancy and delivery; Chapter 16; Hypeensive disorders in pregnancy

Medical, surgical and gynaecological illness complicating pregnancy


Question: Best gas used for creating pneumoperitonium at laparoscopy is

Ans. (c) CO2Ref: Shaws 15th ed. 1492Pnenumoperitoneum in created with CO2 or nitrous oxide. CO2 is preferred because nitrous oxide can cause explosion in the presence of volatile anaesthetic drug.


Question: Hormones decreased in PCOD

In PCOD, Progesterone is decreased due to anovulation.


Question: An ectopic pregnancy is shed as

The endometrial lining of the uterus is called decidua during pregnancy, If there is feilization and pregnancy occurs, the decidua differentiated intoDecidua basalis - becomes the maternal poion of the placentaDecidua - capsularis - the thin layer covering the ovumDecidua vera or parietalis - which is the rest of the decidua lining the uterine cavity outside the site of implantation.


Question: The indication for amnioinfusion is

Amnioinfusion with warm saline can be performed in the presence of variable decelerations due to cord compression in oligohydramnios.
The role of amnioinfusion in cases of meconium-stained amniotic fluid is not clear. It is routinely used to dilute the meconium and reduce the chance of meconium aspiration syndrome.


Question: In long protocol IVF, GnRH agonist is staed on

Gonadotropin-Releasing Hormone Agonist ProtocolsIn the long protocol, a GnRH agonist is staed in the luteal phase (day 21) of the previous cycle. This diminishes the GnRH agonists flare effect and suppresses endogenous FSH and dominant follicle selection to promote synchronous follicular growth. After 10 to 14 days of GnRH agonist administration, a pelvic ultrasound and estradiol level are used to confirm suppression and gonadotropin stimulation begins. The GnRH agonist is continued (the dose may be halved or unchanged) throughout the cycle until the hCG trigger.The long protocol provides for better oocyte yields and pregnancy rates in normal responders when compared with shoer protocols that use later administration or early cessation of agonists. GnRH microdose flare protocols have been developed that may improve oocyte yield in poor responders. Microdose flare regimens involve pretreatment with 14 to 21 days of combination oral contraceptives.Four days following the cessation of the oral contraceptive pills, a microdose (leuprolide 25 mg) of agonist is added in the early follicular phase to take advantage of the agonist flare effect. Gonadotropin stimulation is initiated 1 to 2 days later while continuing the agonist.Reference: Novak's Gynecology; 14th edition; Chapter 32; Infeility and Assisted Reproductive Technology


Question: Simple vesicovaginal fistula is  having following feature

Simple vesicovaginal fistula is located near the cuff (supratrigonal)


Question: Le Fort's operation is done is

(Elderly menopausal patients with advanced prolapse) (329-S) (307-S14th)Operative treatment of ProlapseAnterior colporrhaphyOperation is performed to repair a cystocele and cystourethrocelePosterior-colporrhaphy and colpoperineorrhaphyOperation is done to correct a rectocele and repair a deficient perineumFothergill's repair (Manchester operation)In this operation, the surgeon combines an anterior colporrhaphy with amputation of cervix* It is suitable for women under 40 years who are desirous of retaining their menstrual and preporductive functionsVaginal hysterectomy with pelvic floor repairThis operation is suitable for women over the age of 40 years, those who have completed their families and are no longer keen on retaining their childbearing and menstrual functionsLe Fort's repairOperation is reserved for the very elderly menopausal patient with an advanced prolapse or for those women who are poor medical risks and are considered unfit for any major surgical procedureAbdominal sling operationsI) AbdominocervicopexyII) Shirodkar's abdominal sling- operationIII) Khanna's abdominal sling operation* This operation is designed for young women suffering from second or third degree uterovaginal prolapse

Elderly menopausal patients with advanced prolase

Young woman suffering from second or third degree prolapse

Women under 40 years who are desirous of retaining their menstrual and reproduction function

Women over 40 years, those who have completed their families


Question: Turner syndrome is

Ans. (a) 45 XORef: Shaws 15th ed. H10-111; Harrison 19/e 635; William's Gynecology Ch 16


Question: Most common twin after assisted reproduction is

(C) Dizygotic twin[?]Prevalence of Dizygotic twins is related to:Race: The frequency is highest amongst Negroes, lowest amongst Mongols & intermediate amongst Caucasians.Hereditary: There is hereditary predisposition likely to be more transmitted through the female (maternal side).Advancing age of the mother: Increased incidence of twinning is observed with the advancing age of the mother, the maximum being between the age of 30-35 years. The incidence of twins is markedly reduced thereafter.Influence of parity: The incidence is increased with increasing parity specially from 5th gravida onwards.Iatrogenic: Drugs used for induction of ovulation may produce multiple fetuses to the extent of 20-40% following gonadotrophin therapy, although to a lesser extent (5-6%) following clomiphene citrate.Dizygotic twins:There are two placentae, either completely separated or more commonly fused at the margin appearing to be one (9 out of 10). There is no anastomosis between the two fetal vessels.Each fetus is surrounded by a separate amnion & chorion.As such, intervening membranes consist of 4 layers - amnion, chorion, chorion & amnion. In fact in early pregnancy the decidua capsularis of each sac may be identified under the microscope in between the chorionic layers. Other Options[?]Monozygotic twins:The placenta is single. There is varying degree of free anastomosis between the two fetal vessels.Each fetus is surrounded by a separate amniotic sac with the chorionic layer common to both (Diamniotic-monochorionic).As such the intervening membranes consist of two layers of amnion only. However, on rare occasions, the uniovular twins may be diamniotic-dichorionic or mono-amniotic-monochorionic.[?]Fetus acardiacus:It occurs only in monozygotic twins. Part of one fetus remains amorphous & becomes parasitic without a heart.


Question: Chromosomal number of primary cnermatecvte is


Question: Child with history of Rh incompatibility is brought to OPD with jaundice, irritability and convulsions most common cause

(A) Kernicterus # Kernicterus is the pathological findings of bilirubin (un-conjugated) toxicity within the brain.> The main transporter of bilirubin is albumin therefore increase in albumin causes less bilirubin to be transported to the brain> This includes staining & necrosis of neurons in the basal ganglia, hippocampal cortex, subthalamic nuclei and cerebellum followed by gliosis of these areas.> The cerebral cortex is generally spared, but 50% of babies have extra neuronal lesions with necrosis of renal tubular cells, intestinal mucosa and pancreatic cells.> These may manifest as gastrointestinal hemorrhage or hematuria.> Clinically, kernicterus is described in phases, which may progress over 24 hours to 7 days