Question: Hot flushes are experienced as a result of

Hot flushes are caused by noradrenaline, which disturbs the thermoregulatory system. Oestrogen deficiency reduces hypothalamic endorphins, which release more norepinephrine and serotonin. This leads to inappropriate heat loss mechanism. Other causes that can be associated with the symptom of hot flushes include: thyroid disease, epilepsy, pheochromocytoma, carcinoid syndromes, autoimmune disorders, mast cell disorders, insulinoma, pancreatic tumours and even leukemias. REF : Shaw book of gynecology

Increased noradrenaline and decreased estrogen


Question: High risk of hypoplastic left heart syndrome occurs with maternal intake of

Nitrofurantoin poses high risk of hypoplastic left heart syndrome in fetus.


Question: Nuchal translucency is measured between

Nuchal translucency represents the maximum thickness of the subcutaneous translucent area between the skin and soft tissue overlying the fetal spine at the back of the neck. It is measured in the sagittal plane between 11 and 14 weeks using precise criteria. Increased NT is seen inChromosomal abnormalitiesGenetic SyndromesCardiac anomaliesSkeletal deformities(Ref: William's Obstetrics; 25th edition)


Question: Shortest fetal skull diameter is

Ans: A (Bimastoid) Ref: Dana textbook of obstetrics 5th ed pg 85Explanation: (See the following figure and table)


Question: Fothergill's repair is also known as

(Manchester operation): Ref: 327-S (305-S14th)OPERATION FOR GENITAL PROLAPSE* FothergilPs repair (Manchester operation). It is suitable for women under 40 years who are desirous of retaining their menstrual and reproductive functions* Le Fort's repair - reserved for very elderly menopausal patient with an advanced prolapse* Abdominal sling operations: designed for young women suffering from second or third degree uterovaginal prolapse(I) Abdominocervicopexy(II) Shirodkar's abdominal sling operations(III) Khann's abdominal sling operationsIn younger women desirous of retaining child bearing functions conservating surgical repair operations are indicated, where as in the perimeopausal and menopausal women, vagional hysterectomy with repair of the pelvic floor is the operation of choice.


Question: Adequate steroidogenesis in corpus luteum depends on serum levels of

LH levels in serum, determine adequate steroidogenesis in corpus Luteum.


Question: A pregnant woman presents with red degeneration of myoma. The management is

Most fibroids do not increase in size during pregnancy. clinical symptoms and sonographic evidence of fibroid degeneration occurs in about 5% Very rarely does the presence of a fibroid during pregnancy lead to an unorable outcome Few complications of fibroids in pregnancy are: aboion preterm delivery placenta pre postpaum hemorrhage malpresentations increased operative interference Red degeneration develops most frequently in pregnancy The myoma becomes tense and tender and causes severe abdominal pain with constitutional upset and fever. The tumour itself assumes a peculiar purple red colour and develops a fishy odour. Although the patient is febrile with moderate leucocytosis and raised ESR, the condition is an aseptic one The treatment is done with conservative approach, using analgesics and bed rest


Question: Percentage of tubal causes in female infertility is

Tubal factor infertility is most commonly caused by pelvic inflammatory diseases, sexually transmitted diseases or other diseases such as endometriosis.
The American Society for Reproductive Medicine (ASRM) says that 25 to 35 percent of female infertility is due to tubal factors.


Question: Progesterone is produced by


Question: Neural tube defects is prevented by

(Folic acid) (343 - Dutta 6th)Pre pregnancy folic acid therapy (4mg daily) is given when there is any history of neural tube defects in previous birth. Therapy is started 1 month before conception and is continued in the first trimester


Question: Puerperal sepsis can occur upto

Infection of genital tract which occurs as a complication of delivery is termed puerperal sepsis Puerperium lasts until 6 weeks after delivery Ref: Dutta Obs 9e pg 406.


Question: Commonest cause of carcinoma endometrium is

(Unopposed estrogen) (392-S) (374-SI4th)Predisposing factors for carcinoma endometrium* Unsupervised administration of HRT with oestrogens alone during the menopause predisposes these women to develop endometrial hyperplasia and cancer* Women with oestrogen dominance suffering from endometrial hyperplasia and presenting as cases of DUB are prone to endometrial cancer* In some families there is a strong familial predisposition to the disease. This may be due to genetic factors or dietic habits* Tamoxifen prescribed to women with breast cancer are prone to develop endometrial hyperplasia / cancer* OCP have a protective effect. Also the practice of adding progestogens to oestrogen for HRT during the last 12 to 14 days of the cycle is protective against development of endometrial cancer* Obesity, Hypertension, DM are associated with endometrial cancer in 30% cases* Infertile women, those with fewer children and subjects of PCOD are prone to the disease


Question: Increased risk of endometrial and ovarian cancer is seen in

HNPCC or Lynch II syndrome is caused by an inherited mutation in one of the following mismatch repair genes: hMSH2, hMLH1, PMS1, PMS2, or hMSH6. The disorder is characterized by early age (average age younger than 45 years) at onset of neoplastic lesions in a variety of tissues, including the colon, uterus, stomach, ureters, ovaries, and skin. The lifetime risk of endometrial cancer in women with Lynch II syndrome is 32% to 60% and the lifetime risk of ovarian cancer is 10% to 12%. Reference: Novak's gynecology; 14th edition; Chapter 35; Uterine cancer

Hereditary nonpolyposis colorectal cancer


Question: Glands of littre are homologous to

Glands of littre are the urethral glands of males Skene glands are the paraurethral glands Glands of littre are homologous to skene glands Ref: Internet sources,Shaw Gynecology 17 e pg 2.


Question: LH surge occurs at

C. i.e. (24 - 36 hours before ovulation) (37-Shaw's 14th/64-Dutta 4th)* LH surge precedes ovulation by 24 to 36 hours (mean 30 hours) and minimum of 75 ng/ml is required for ovulation (37 - Shaw's 14th)* LH levels remains almost static throughout the cycle except at least 12 hours prior to vulation. When it attains its peak, called LH surge (64 - Dutta 4th)* The main function of LH is steroidogenic, but along with FSH. It is responsible for full maturation of the graffian follicle and oocyte and ovulation


Question: Diagnostic criteria for ovarian pregnancy is

Ectopic implantation of the feilized egg in the ovary is rare and is diagnosed if four clinical criteria are met. These were outlined by Spiegelberg (1878):The ipsilateral tube is intact and distinct from the ovary The ectopic pregnancy occupies the ovaryThe ectopic pregnancy is connected by the uteroovarian ligament to the uterusOvarian tissue can be demonstrated histologically amid the placental tissue. Risk factors are similar to those for tubal pregnancies, but A or IUD failure seems to be dispropoionately associated Classically, management for ovarian pregnancies has been surgical. Small lesions can be managed by ovarian wedge resection or cystectomy, whereas larger lesions require oophorectomy Reference: William's Obstetrics; 25th edition; Chapter 19; Ectopic pregnancy


Question: Vaginal epithelium is derived from

Vaginal epithelium is derived from the endoderm of the urogenital sinus Sinovaginal bulbs fuse to form vaginal plate which breaks down in centre to form lumen of vagina Peripheral cells of vaginal plate forms the vaginal epithelium Hymen is formed by invagination of the posterior wall of the urogenital sinus Ref: Essentials of embryology and bih defects; Ninth edition; chapter 13


Question: In Down's syndrome, the serum markers..........

Triple test (combined test): MSAFP, Unconjugated estriol (E3) and hCG. Quadruple test: MSAFP, UE3, hCG, Inhibit-A Integrated test: NT, PAPP-A + hCG reference: D C Dutta's Textbook of obstetrics 7th edition page no 494

Increased MSAFP and UE3, Decreased PAPP-A and hCG, NT < 3mm

Decreased MSAFP, PAPP-A and UE3 and Increased hCG, NT > 3mm

Decreased MSAFP, PAPP-A , UE3 and hCG, NT > 3mm

Increased MSAFP, UE3, PAPP-A and hCG, NT < 3mm


Question: Most sensitive diagnosis test for ectopic pregnancy

Transvaginal ultrasound Diagnosis of Ectopic pregnancy Pregnancy is definitely diagnosed by demonstrating intrauterine sac. - A normal intrauterine sac appears regular and well defined on ultrasound. So ectopic pregnancy can be diagnosed by demonstrating the absence of the intrauterine sac. In a woman in whom ectopic pregnancy is suspected because of pain, bleeding and positive pregnancy test, performance of vaginal sonography is the logical first step. If the sonography demonstrates live intrauterine fetus then ectopic pregnancy is extremely unlikely. Alternatively if the uterus is empty, an ectopic pregnancy can be diagnosed based on the visualization of an adnexal mass separate from the ovaries. 3-hCG hormones also play an impoant role in the diagnosis of pregnancy. fi HCG is a hormone secreted during pregnancy. It is positive in viually 100% of ectopic pregnancies. However, a positive test only confirms pregnancy and does not indicate whether it is intrauterine or extrauterine. In normal pregnancy pHCG should double up every 2 days but in ectopic pregnancy the rate of increase of fl hCG is slow. 13 hCG litres and ultrasound complement one another in detecting ectopic pregnancy and have led to earlier detection. By correlating fl hCG titres with ultrasound .findings an ectopic pregnancy can often be differentiated.from intrauterine pregnancy. An intrauterine sac should be visible by transvaginal ultrasound when the p hCG is approximately 1000 ml p/m1 and by transabdominal ultrasound approximately 1 week later when the fi hCG is 1800-3600 ?nip/int. Thus when an empty uterine cavity is seen with a 13 hCG litre above this threshold, the patient is likely to have an ectopic pregnancy. An empty cavity is less of a concern when a fihCG below this threshold is obtained. Serum progesterone measuremen A single measurement of serum progesterone may sometimes clarify the diagnosis when ectopic pregnancy is suspected, but Its accuracy is crude and the customary thresholds are < 5 ng/m and > 25 'tend. i.e.a value exceeding 25 ng/m1 excludes ectopic pregnancy with 97.5% sensitivity, value below 5 ng/ml occur in only .3 percent of normal regnancies. So normal pregnancies can be excluded if the progesterone level is below 5%. Surgical diagnosis of ectopic pregnancy :- Laparoscopy Direct visualization of the ,fallopian tubes and pelvis by diagnostic laparoscopy offers a reliable diagnosis in most cases of suspected ectopic pregnancy and a ready transition to definitive operative therapy. At times, identification of an early unruptured tubal pregnancy may be difficult even if the tube is .fully visualized. Inspite of the low morbidity and quick recovery time, laparoscopy usually is performed when, on the basis of noninvasive test or curettage results, the diagnosis of ectopic pregnancy is fairly ceain and medical therapy is not planned. In these cases laporoscopy is used both for therapeutic and diagnostic purpose. Laparotomy Open abdominal surgery is preferred when the woman is hemodynamically unstable or when laparoscopy is not feasible. Laparotomy should not be delayed while laparoscopy is performed in a woman with obvious abdominal hemorrhage that required immediate definitive treatment. Culdocentesis Culdocentesis is the transvaginal passage of a needle into the posterior cul-de-sac in order to determine whether free blood is present in the abdomen. This procedure is useful in the diagnosis of intraperitoneal bleeding. This procedure will reveal nonclotting blood if intra-abdominal bleeding has occurred. If culdocentesis is positive, laparoscopy or laparotomy should be performed immediately. Indeed, some argue that the main purpose of culdocentesis is, not in diagnosis but to better prioritize patients so that those with positive culdocentensis are taken immediately to the operating room. More on imaging procedures used in the diagnosis of ectopic pregnancy Vaginal sonography There has been much improvement in the early diagnosis of ectopic pregnancy using vaginal sonography. Its use results in earlier and more specific diagnosis of uterine pregnancy than abdominal sonography and it has become the imaging method of choice in early pregnancy. Abdominal sonography:- Id entification of pregnancy products in the fallopian tube.


Question: First line Treatment of Abnormal Uterine bleeding is

Managment of Abnormal uterine bleeding Medical management is the first line treatment, If medical therapy fails or is contraindicated, consider Mirena IUCD. If Mirena fails or side effects develop, go for ablative techniques. When the above methods fail, consider hysterectomy Versapoint- Bipolar electrosurgical system works in normal saline, is cheap, has excellent haemostasis NovaSure Impedance-controlled endometrial ablation is the latest and most safe procedure, taking just 90 sec. It uses bipolar radiofrequency and vaporizes endometrium upto myometrium.

Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception


Question: Depot medroxy progesterone acetate is

DMPA is an injectable progestin, given i.m Being a progestin it doesn't increase risk of ovarian and endometrial cancer.


Question: Criteria used for diagnosing Cervical pregnancy is

Cervical ectopic pregnancyReference: Te Linde&;s Operative Gynecology, 10th Edition


Question: 51 yr female with abdominal mass & ascites. On H/P ovarian Ca is +ve for..

Ans. is 'a' i.e., Ca 125 "Fertility preservation in early stage ovarian cancer the uterus and the contralateral ovary can be preserved in women with stage la, grade 1& 2 who desire to preserve fertility. The condition of the women should be monitored carefully with routine periodic pelvic examinations and determinations of serum CA 125 levels."


Question: Best management of Vault prolapse

SACRAL COLPOPEXY Vault suspension Principle:To suspend the vaginal vault to the anterior longitudinal ligament of the 3rd sacral veebra Non absorbable suture material is used. Most common complication is stress urinary incontinence Ref: D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY; 6th edition; Pg no:221


Question: The desired level of HBA1C in diabetic pregnant women is

Self-Monitored capillary blood glucose GoalsFasting<= 95mg/dlPremeal<= 100mg/dl1-hr postprandial<= 140mg/dl2-hr postprandial<= 120mg/dlMean100mg/dlHBA1C<= 6%(Ref: William's Obstetrics; 25th edition)


Question: Postpaum tubectomy in a hea disease patient is done at

Sterilization should be considered with the completion of the family at the end of first week in the puerperium under local anaesthesia throught abdominal route by minilap technique. If the hea is not well compensated the husband advised for vasectomy.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Most hereditary ovarian cancers result from germline mutations in the

Most hereditary ovarian cancers result from germline mutations in the BRCA1 and BRCA2 genes. The mutations are inherited in an autosomal dominant fashion, and therefore a full pedigree analysis (i.e., both maternal and paternal sides of the family history for both breast and ovarian cancer) must be carefully evaluated in all patients with epithelial ovarian cancer, and those withfallopian tube cancer and peritoneal cancer


Question: The volume of amnionic fluid peaks at

The volume of amnionic fluid at each week is variable. In general, the volume increases by 10 mL per week at 8 weeks and increases to 60 mL per week at 21 weeks, then peaks at 34 weeks(Ref: William's Obstetrics; 25th edition)


Question: Earliest symptom of carcinoma cervix is

Ans. is a i.e. Irregular vaginal bleeding "In its very early stage, invasive carcinoma of cervix causes no symptoms and is discovered accidently or as a result of routine search. Symptoms come with surface ulceration and consist only of irregular uterine bleeding or discharge or both. These being pe-or postmenopausal in half the cases. The first episode of bleeding commonly follows coitus, straining at stool or trauma." "For those with symptoms, however, early stage cervical cancer may create a watery, blod tinged vagina! discharge. Intermittent vaginal bleeding that follows coitus or douching may also be noted." Thus earliest symptom is irregular vaginal bleeding which usually follows coitus. So I am taking option 'a' i.e. irregular vaginal bleeding as the correct answer. Also Know : CIN is most commonly detected in women in their 20's. Peak incidence of carcinoma in situ : 25 - 35 yearsdeg Ca cervix has bimodal peak - first at 35-39 yearsdeg and second at 60-64 yearsdeg. Histology of Ca cervix : Squamous cell carcinoma (Epidermoid carcinoma) Accounts for 80% of carcinoma cervixdeg Arises from squamocolumnar junctiondeg Squamous cell carcinoma can be fuher classified as : Adenocarcinoma Accounts for 20% of carcinoma cervixdeg Arises from Endocervixdeg Recently increased in incidence because of use of OCP, Progesterone pills for long time. MC suply be of adenocarcinoma is mucinous endocervical adenocarcinoma. Discharge : -- It is at first creamy and later becomes diy brown in colour and is very offensive.deg -- The odour is caused by infection of necrotic tissue with saprophytes. Symptoms of Advanced Stage : Deep pelvic paindeg often unilateral and radiating to hip or thigh. Urinary incontinence, dysuria, increased urinary frequency, ureteric colic. Rectal pain Low backache Sciatica Oedama of legs Weight loss, anorexia, malaise. Adenocarcinoma Accounts for 20% of carcinoma cervixdeg Arises from Endocervixdeg Recently increased in incidence because of use of OCP, Progesterone pills for long time. MC suply be of adenocarcinoma is mucinous endocervical adenocarcinoma.


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

In pcos , ovulation is usually induced with combination of clomiphene citrate and hMG.The patient is advised to take CC 50-100mg/dl from day 2-6 of cycle for 5 days. Injecting hMG 75units IM is added on day 3,5 and 7 and more if required. Shaws Textbook of Gynaecology 16th edition page no 254.


Question: Normal pregnancy can be continued in aEUR'

Wolf Parkinson-While syndrome Marfan's syndrome Ideally, a patient with Marfan's syndrome contemplating pregnancy should have a preconceptional echocardiography to determine the diameter of the aoic root risk depends upon the diagmeter of aoic root. If it is greater than 4.0 cm, she is at significant risk for aoic dissection and she should be offered surgery. If the patient is in early pregnancy, she should be informed that termination of pregnancy is an option. Eisenmengher syndrome & Pulmonary hypeension Pulmonary vascular disease whether secondary to a reversed large left to right shunt such as VSD, Eisenmenger's syndrome or lung or connective tissue disease (e.g., scleroderma) or due to primary pulmonary hyeension is extremely dangerous in pregnancy and women known to have significant pulmonary vascular disease should be adviced from an early age to avoid pregnancy and be given appropriate contraceptive advice. Arias says "Pregnancy is deleterious to patients with primary pulmonary hypeension. The maternal moality is approximately 40% and the fetal outcome is also poor with frequent spontaneous aboions and fetal demises secondary to maternal deaths." According to Dutta, Absolute indications for termination of pregnancy are:? a) Primary pulmonary hypeension b) Eisenmengers syndrome c) Pulmonary veno-occlusive disease Relative indications are a) Parous woman with grade HI and grade IV cardiac lesions. b) Grade I or II with previous history of cardiac failure in early month or in between pregnancy. The termination should be done within 12 weeks by suction evacuation (MVA) or by conventional D & E.


Question: karyopyknotic index is

Karyopyknotic index is ratio of mature squamous cells over the intermediate and basal cells.

Ratio of mature squamous cells over the intermediate and basal cells.

Ratio of dysplastic squamous cells over the normal squamous cells.

Ratio of Koilocytes over normal squamous cells.

Ratio of immature basal cells over total number of cells.


Question: The Hymen is the membranous vestige of junction between

Hymen is the Partition between sino vaginal bulbs and urogenital sinus.


Question: Most common cause of first trimester aboion is.

Ans. is a i.e. Chromosomal abnormalities Aboion is spontaneous termination of pregnancy before the period of bility There are various definitions of aboion depending on the criteria for bility or survival of fetus. In the past, the criterion for bility was considered from 28 weeks onwards, but due to improvement in neonatal survival, this has been changed to 20th completed weeks". Another commonly used definition is the "-delivery of a fetus or any pa of product of conception with weight less than 500gms.'deg Incidence : About 15% of all conceptions end up in spontaneous aboions. Out of these 80% occur before 12 weeks i.e. in 1st trimester and among these 50-75% are due to chromosomal anomalies. Common causes of aboion : Petal factors Chromosomal abnormalities Hydropic degeneration of villi Multiple pregnancy Maternal factors Maternal infections like : TORCH infections, malaria,ureoplasma, chlamydia, brucella, spirochaetes Maternal medical disorders like : -- Hypeension -- Chronic renal disease -- Cyanotic hea disease -- Hemoglobinopathies Environmental factors like : -- Alcohol, caffeine. -- Exposure to radiation (> 5 rads) & anaesthetic gases Endocrine problems like : - Luteal phase defect (deficiency of progesterone) -- Thyroid abnormalities - hypothyroidism. - Poorly controlled diabetes mellitus -- PCOD Immunological causes : -- Antiphospholipid antibody syndrome -- Inherited thrombophilias Uterine factors like -- Cervical incompetence -- Mullerian anomalies - Large and multiple submucous leiomyoma -- Ashermann syndrome -- DES exposure in utero Others : Trauma; Subchorionic hematoma; Defective placentation Mnemonic to remember maternal causes of aboion--Mnemonic T = Trauma 12 = Infections/immunological causes M = Maternal medical diseases E' = Environmental factors/Endocrine problem D = Developmental/anatomical problems Mnemonic to remember maternal causes of aboion--Mnemonic T = Trauma 12 = Infections/immunological causes M = Maternal medical diseases E' = Environmental factors/Endocrine problem D = Developmental/anatomical problems


Question: Test for ovarian reserve

FSH Ovarian reserve is the capability of ovary to produce egg. The ovary is generally thought of as an egg bank from which the woman draws during the reproductive life. During the .flrst few days of each monthly cycle, under the influence of FSH and LH there is rapid growth of several follicles in the ovary. After a week or more of growth one of the follicles begin to outgrow. All the others and the remaining follicles involute (a process called atresia), and these follicles are said to become atretic. The process of atresia is impoant because it normally allows only one of the follicles to grow large enough, each month, to ovulate. This usually prevents more than one child from developing with each pregnancy. The single follicle reaches a diameter of 1-1.5 centimeters at the time of ovulation and is called the mature follicle. With advancing age the capability of the ovary to produce eggs declines. Methods of assessing ovarian reserve: With advancing age the capability of the ovary to produce egg declines i.e. ovarian reserve decrease with age. - Usually age is the best predictor of ovarian reserve but approximately 10% of women have an accelarated loss of ovarian reserve by their mid-30's. - So age alone does not tell the whole story. Consequently more refined methods .for predicting ovarian reserve have been developed. The methods for assessing ovarian reserve are classified into two groups:- a)Passive testing b)Dynamic testing The goal of both the approaches is to provide information regarding oocyte (egg) quality and quantity. Passive testing FSH level Early follicular phase FSH levels play an impoant role in pregnancy outcomes. As woman ages FSH becomes elevated in an attempt to force the aging ovary to respond. However, the exact mechanism responsible for this adaptive response remains unknown. A rise in early follicular phase FSH is also accompained by a decline in oocyte quality. High FSH has been correlated with poor ovarian reserve but it is difficult to establish absolute values that define how high an FSH level can be and still achieve pregnancy. Generally FSH level are expected to be below 10 lu/mlin women withreproductive potential - In one study it was .found out that 3 day FSH of less than 15 mlu/ml were twice as likely to conceive than women with FSH values between 15 and 24.9 mlu/ml. - Cycle day 3 is chosen because at this time the estrogen level is expected to be low, a critical feature as FSH levels are subject to a negative feedback. - Thus any determination of FSH needs to include corresponding estradiol level to indicate that the FSH level was drawn when estrogen level was low. Other methods for passive ovarian reserve testing Measurement of Inhibin B Inhibit B is an ovarian hormone that inhibits FSH release. Although present in ovulating women it is not normally .found in postmenopausal women. - Low inhibin levels suggests poor ovarian reserve. Transvaginal ultrasound Diminished ovarian reserve means that fewer follicles are available for stimulation and recruitment by _feility drugs. Transvaginal ultrasound allows the observation of ovaries and assess the number of follicles (ovarian volume). Dynamic ovarian reserve testing Clomiphene citrate challenge test ? Clomiphene is an antiestrogen which inhibits the negative feedback of estrogen on hypothalamus i.e. the hypothalamus gets false signals that the patient does nor have enough estrogen. In response, the hypothalamus induces the pituitary gland to produce more FSH and LH. This is turn initiates follicular growth to produce estrogen. Clomiphene is able to exe this effect only when the estrogen level is low or the ovarian reserve is low. In a normal woman with adequate ovarian reserve there is enough inhibin and estrogen to suppress FSH production through negative feedback and resist the effects clomiphene. - When undergoing clomiphene citrate challenge test, the .first step is to measure day 3 FSH and estrogen. Then 100 ing of clomiphene is administered on cycles day 5 through 9 and FSH and estrogen measurements are repeated on cycle day 10. In general, a high day 10 FSH suggests poor ovarian reserve.


Question: Antibody to cross placenta

Ans. (b) Ig GRef: Robbin's 9th ed. /198-199

Endocrinology in Relation to Reproduction


Question: Changes in the respiratory system in pregnancy;

Anatomical changes:The lower ribs flare out,the subcoastal angles increases from 68 to 103 degree,transverse diameter of chest increases by 2 cm and the diaphragm rises about 4cm in pregnancy. Functional changes:Increase in ventilation in pregnancy is achieved by an increase in tidal volume by 40%.Minute ventilatory volume also increases.There is no change in vital capacity.The functional residual capacity and residual volume are decreased due to elevated diaphragm. TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.80

Medical, surgical and gynaecological illness complicating pregnancy


Question: serum prolactin level are highest

proactin is more in NREM sleep in ovulation its low ref : dutta 9th ed


Question: Bih is defined as

Bih: The complete expulsion or extraction from the mother of a fetus after 20 weeks gestation. In the absence of accurate dating criteria, fetuses weighing < 500 g are usually not considered as bihs but rather are termed abouses for purposes of vital statistics(Ref: William's Obstetrics; 25th edition)

The complete expulsion or extraction from the mother of a fetus after 28 weeks gestation

The complete expulsion or extraction from the mother of a fetus after 38 weeks gestation

The complete expulsion or extraction from the mother of a fetus after 40 weeks gestation


Question: Most common complaints of ectopic pregnancy

Ans. A. Pain* An ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the normal endometrial cavity.* Classic Triad of Ectopic Pregnancy* Pain (100%)* Amenorrhea (75%)* Bleeding per vaginam (70%)* NOTE: Triad is present only in 50% case of ectopic* Most common/Consistent finding of Ectopic Pregnancy PainSymptoms* Nausea and Vomiting* Lower Abdominal pain/generalized Abdomen pain* Shoulder tip pain (25%)* Syncopal attacks (10%)


Question: "Schiller Dual" bodies are seen in

Ans. a (Endodermal sinus tumor) (Ref. Dutta Gynecology 4th/pg. 354)SCHILLER-DUVAL BODIES are characteristic structures resembling fetal glomeruli composed of a central blood vessel surrounded by embryonal cells lying within a space also lined by embryonal cells. They are seen in endodermal sinus tumors (yolk sac tumors). AFP is its tumor marker.


Question: Rate of recurrence of breech presentation in the second pregnancy is

Following one breech delivery, recurrence rate for second pregnancy to have breech is 10% and that for a subsequent third pregnancy is 27%.


Question: a and 13 subunits are not seen in

Ans. is c i.e. Prolactin HCG (Human chorionic gonadotropic hormone) has alpha and beta subunits. its alpha subunit is similar to that of LH (leutinizing hormone), FSH (Follicular stimulating hormone) and TSH (Thyroid stimulating hormone) whereas beta is specific. We have also studied that insulin hormone has alpha and beta subunits. Remember : Hormones with alpha and beta subunits HOGdeg * LHdeg FSHdeg * TSHdeg Insulindeg


Question: Currently, the threshold of bility lies between

Threshold of ViabilityBihs once considered to be "abouses" because the fetus weighed <500 g are now classified as live bihs. For those newborns delivered before 33 weeks' gestation, perinatal and neonatal care has advanced tremendously. As a result, the threshold of bility, which is the lower limit of fetal maturation compatible with extrauterine survival, has been reassessed. Currently, the threshold of bility lies between 20 and 26 weeks' gestationReference: William's Obstetrics; 25th edition; Chapter 42; Preterm bih


Question: Snowstorm appearance in sonography is characteristic of

Sonographically, a complete mole appears as an echogenic uterine mass with numerous anechoic cystic spaces but without a fetus or amniotic sac. The appearance is often described as a "snowstorm"Paial mole has features that include a thickened, multicystic placenta along with a fetus or at least fetal tissueReference: William's Obstetrics; 25th edition, chapter 20; Gestational trophoblastic diseases


Question: During active labor cervIcal dilatation per hour in a primigravida is

In primigravida dilatation of cervix at the rate of 1cm/hr and in multigravida -1.5cm/hr.D.C.DUTTA&;S TEXTBOOK OF OBSTETRICS,Pg no:130,7th edition


Question: Drug that is used for fetal lung maturity is

* Betamethasone and dexamethasone are coicosteroids, also called glucocoicoids, that are given before bih (antenatally) to speed up a preterm fetuses lung development. * Either is used when a mother is in preterm labor and bih may occur in 24 to 48 hours REF : DUTTA BOOK OF OBESTETRICS


Question: Laparoscopy is contraindicated in

Contraindications of Laparoscopy Severe cardiopulmonary disease Patient hemodynamically unstable Generalised peritonitis Significant hemoperitoneum Extensive peritoneal adhesions Large pelvic tumor Pregnancy >16 weeks Advanced malignancy On anticoagulation therapy D.C.DUTTA&;S TEXTBOOK OF GYNECOLOGY,Pg no:615,6th edition

Gynaecological diagnosis and operative surgery


Question: Paramesonephric ducts develop at

Paramesonephric ducts develop from invagination of intermediate mesoderm at 6th week of gestation.


Question: Incomplete Androgen insensitivity syndrome is

Incomplete AIS =

Less severe than complete AIS.
As testosterone gets converted to estrogen, breast development is proper.
Karyotype is 46 XY.
Clitoromegaly is the characterisitic feature.

More severe than complete androgen insensitivity.

Clitoromegaly and partial fusion of Labia.


Question: Most common site for metastasis in choriocarcinoma


Question: Ideal contraceptive for newly married couple is

Combined oral contraceptive pill [Ref. Dutta 7/e p. 5591 Best contraceptive for newly married couple is combined oral contraceptive pill (COC). -Combined oral contraceptive has lesser failure rate than progestin only pill. - IUCD's should not be used in newly married couple. Also know Best contraceptive for parous young women --) IUCD (considered the best method for spacing child bih).


Question: Type IIIB Endometrial cancer (FIGO) is

Endometrial cancer invading cervical stroma

Endometrial cancer with vaginal involvment

Endometrial cancer involving uterine adnexa

Endometrial cancer invading Pelvic lymph nodes


Question: Mrs. A, 30years with the previous history of preterm delivery at 24weeks and baby is stillborn, now presently at 30 weeks of gestation, her obstetric score 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: Varicoceles appear to cause male infertility by

The incidence of varicoceles in the general population is about 15%, but 40% of males with infertility are found to have varicoceles. Because of the anatomy and physiology, varicoceles are more likely to occur on the left side. There is no correlation between the size of the varix and prognosis for fertility. The characteristic stress pattern seen with varicoceles is decreased number of sperm, decreased motility, and increased abnormal forms. How the varicocele causes abnormal semen quality, and the relationship between varicocele, semen abnormalities, and male infertility (especially when semen quality appears normal) is unclear.

Blocking epididymal sperm motility activation

Increasing the likelihood of sperm antibody formation

Interfering with sperm movement through cervical mucus


Question: Vaginal delivery is contraindicated in

Vaginal delivery is contraindicated in Classical C.S because there is more chance of rupture of the uterus. 8-10% risk of uterine rupture is there in next pregnancy. This is because this poion of the uterus is taking pa in active contractions and will predispose to uterine rupture.


Question: Superfecundation refers to

Mechanism of monozygotic twinning:The outcome of the monozygotic twinning process depends on when division occurs. If zygotes divide within the first 72 hours after feilization, two embryos, two amnions, and two chorions develop, and a diamniotic, dichorionic twin pregnancy evolves.If division occurs between the fouh and eighth day, a diamniotic, monochorionic twin pregnancy results. By approximately 8 days after feilization, the chorion and the amnion have already differentiated, and division results in two embryos within a common amniotic sac, that is, a monoanionic, monochorionic twin pregnancy. Conjoined twins result if twinning is initiated later.(Ref: William's Obstetrics; 25th edition)

Feilization of one ovum with two spermatozoa

Feilization of two ova in the same menstrual cycle

Feilization of two ova in different menstrual cycles

Feilization of three ova in the same menstrual cycle


Question: Total amount of iron needed by the fetus during entire pregnancy

Iron needs in pregnancy Fetus and placenta 300mg Red cell expansion 500mg Net need in pregnancy 900mg Reference: Textbook of Obstetrics; Sheila Balakrishnan; 2nd edition; Page no: 285

Medical, surgical and gynaecological illness complicating pregnancy


Question: A 20yr old P1L1 with RhD negative pregnancy had a spontaneous vaginal delivery. Her baby is RhD positive. Anti D Ig should be administered within

* For successful immunoprohylaxis anti D Ig should be given as soon as possible after the sensitizing event but always within 72hours * If not given within 72hours, effo should still be made to give anti D Ig, as a dose given within 9 to 10 dose will offer some protection * Women who is already sensitized should not be given anti D Ig Reference: Greentop guidelines no 22

Medical, surgical and gynaecological illness complicating pregnancy


Question: Length of Umbilical cord is

Umbilical cord - Normal length- 40-70 cm long- Cord has three vessels : 1 vein(left) and 2 aeries - Length is influenced by amniotic fluid volume and fetal mobility.


Question: IUCD having the longest life span is

The time periods for replacement for various IUDs are: - Copper T 200:3years- Multiload Cu 250:3 years - Multiload Cu 375: 5 years- LNG-IUS/Mirena : 5 years- Cu T 380A : 10 years ( also known as Paraguard)- Nova : 3years - Progestase : 1 years


Question: Induction at term is not done in

Preeclampsia is associated with significant maternal and fetal morbidity and moality. No pregnancy complicated by preeclampsia should be allowed to cross 38 weeks and earlier terminations will often have to be considered depending on maternal and fetal status. Refer page no 559 of Textbook of obstetrics, Sheila Balakrishnan, 2 nd edition.


Question: Drug of choice for maternal toxoplasmosis

Ref: Text book of Obstetrics by D.C.Dutta. 7th ed. Pg. 297.Explanation:Treatment of choice for toxoplasmosis during pregnancy:Spiramycin 3 g/dayPyrimethamine 25mg + sulphadiazine 1 gQlD for 4-6 weeksPyrimethamine is not given in 1' trimesterMode of infection : Eating raw, Uncooked meat/ through cat feces/ Through placentaEffects on baby:HydrocephalusChorioretinitisCerebral calcificationsMicrocephalyMental retardation


Question: Bonney&;s test demonstrates

MARSHALL AND BONNEY&;S TEST To demonstrate stress incontinence Procedure: Two fingers are placed in the vagina at the urethrovesical junction, on either side of urethra and the bladder neck region is elevated, on straining or coughing absence of leakage of urine indicates a positive test Positive stress test is indicative of beneficial outcome following surgical repair Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:189


Question: Condyloma acuminata in pregnancy is treated by

Chemical cauterization is usually done with liquified phenol or concentrated trichloroacetic acid


Question: The normal range of AFI is

AFI : It is the sum of the single deepest pocket from four quadrants of the uterus. Normal range: 5 to 24cm(Ref: William's Obstetrics; 25th edition)


Question: Treatment of choice in a postmenopausal lady with atypical endometrial hyperplasia is ;


Question: Test used to differentiate between maternal and fetal blood in a given sample

Ans. c. Apt test Both Apt test and Kleihauer-Betke test can be used to detect the presence of fetal blood within a sample but test used to differentiate between maternal and fetal blood in a given sample is Apt test. Apt Test: Used to detect the presence or absence of fetal blood (qualitative) in a vaginal discharge to rule out vasa pre late in pregnancy or to detect the origin of a neonatal bloody vomiting, whether it is a genuine upper GI hemorrhage/ hemoptysis or simply swallowed maternal blood during delivery or from cracked nipple. Kleihauer-Betke Test: The sample is maternal peripheral smear and is used to see how much of fetal blood (quantitative) has been transfused into the maternal serum in order to assess the risk of isoimmunization and then the risk of hemolytic disease of newborn. Both of them relies on the fact that HbF is resistant to alkali (Apt) and acids (Kleihauer-Betke) and so the HbA containing RBCs (Maternal) will be hemolyzed but not the fetal RBCs as they contain the HbF. When fetal blood needs to be differentiated from maternal blood Apt test is usedQ (Qualitative estimation) When the amount of fetal bleeding needs to be estimated Kleihauer-Betke test is usedQ (Quantitative estimation) Apt test Kleihauer-Betke test Source of sample Maternal or neonatal MaternalQ Principle Adding 1% NaOH destroys adult HbA but not fetal HbF Adding acid destroys adult HbA but not fetal Assessment Type QualitativeQ QuantitativeQ Result Positive means blood is of fetal origindeg Repoed in estimated milliliters of fetal


Question: For "Postcoital douche method" of contraception, select the most appropriate rate of use effectiveness (failure rate or percentage of pregnancies per year of actual patient use). (SELECT 1 RATE)

There are two methods of describing the effectiveness of contraceptive agents: the theoretical or method effectiveness rate and the actual use effectiveness rate. When comparing different methods, it is important to use comparable figures. The effectiveness of the rhythm method is influenced by the woman's ability to predict the time of ovulation from the regularity of her menses, and by her motivation to successfully abstain from intercourse during the 10 days around suspected ovulation. The menstrual and ovulatory irregularities and lapses in the woman's motivation account for a pregnancy rate of 40% with the rhythm method. In contrast to the rhythm method, the IUD requires little or no action on the part of the woman. For this reason the device's actual use effectiveness approaches its maximal theoretical effectiveness, with a pregnancy rate of 3 to 10%. Unrecognized expulsion or misplaced insertion of the IUD are responsible for most failures. The vaginal diaphragm and the condom are barrier contraceptives in that for each act of sexual intercourse they pose a barrier between the sperm ejaculate and the endocervical canal. In theory, both can be very effective. However, both require recurrent motivation for application with each act of intercourse. Lapses in motivation are not uncommon, and there is a pregnancy rate of 15 to 25% for each of these two methods. The condom used with a spermicidal agent is very effective, more so than either used alone. The pregnancy rate with postcoital douching is almost the same as that for unprotected intercourse (80%). This lack of effectiveness is readily explained by the extremely rapid progression of motile sperm into the endocervical canal. Within several minutes of coitus, sperm have ascended the female reproductive tract and can be found within the endocervical mucus, uterus, and fallopian tubes. Coupled with the failure of a vaginal douche to reach the endocervix, this method is essentially useless. Combined oral contraceptive birth control pills are clearly the most effective reversible contraceptive currently available. With correct use, many studies report a contraceptive effectiveness that approaches 100% (pregnancy rate less than 0.1%). This extreme effectiveness is best explained by the pill's multiplicity of actions, i.e., suppression of ovulation, hostility of cervical mucus to sperm penetration, and hostility of atrophic endometrium to the implantation of a conceptus. Failure to take the pills regularly is responsible for most failures, and in practice pregnancy rates of at least 5% are common.


Question: Antimullerian hormone levels, during menopausal transition

Anti mullerian hormone levels decrease markedly and progressively across menopausal transition.


Question: Most commonly uterine fibroid presents as heavy menstrual bleeding. Most likely cause is

Dysregulation of local vasoactive growth factors is known to cause dilatation of endometrial venules which causes heavy menstrual bleeding.


Question: Moschcowitz repair is done for

In Moschcowitz repair, several purse string sutures staing from below are used to obliterate the cul-de-sac of the pouch of Douglas. Care should be taken not to include the ureter in the stitch. Ref: Shaw's Textbook of Gynaecology,18th edition, p342.


Question: NOT included in third stage of labour

(C) (IV - Methergin) (142 - Dutta 7th)Methergin 0.2 mg IM (Intramuscular) to the mother within one minute of delivery of the babyOyxtocin may be given with crowning of the head, with delivery of the anterior shoulder of the baby or after the delivery of the placenta.Components of Active Management of Third stage of Labour (WHO)* Administration of uterotonic (oxytocin/Ergometrine) soon after birth of baby* Delayed cord clamping and cutting* Controlled Cord traction for delivery of placenta* Uterine massageCurrent evidence show that delayed cord clamping is beneficial for baby, immediate cord clamping has been shown to increase the incidence of iron deficiency anemia for premature and LBW babies immediate cord clamping can also increase the risk of intraventricular haemorrhage and late onset sepsis


Question: Halban's disease is due to

Halban's disease: Rare, self-limiting process. Also called Irregular shedding endometrium Due to persistent corpus luteum due to incomplete withdrawal of LH even on 26 in day of cycle. The corpus luteum continues to secret progesterones Menstruation comes on time, is prolonged but not heavy. Slight bleeding continues intermittently for several days after proper flow. On D& C done on 5-6th of cycle - endometrial tissue shows presence of proliferative endometrium along with secretory endometrium

Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception


Question: In twin pregnancy, Vaginal delivery is contraindicated in

Monoamniotic twins are at a great risk of developing cord accidents like entanglement which can lead to sudden fetal death. Therefore all monoamniotic twins have to be delivered by a Cesarean sections between 32-34 weeks , after ensuring lung maturation

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


Question: In Peripaum cardiomyopathy, cardiac failure can develop anytime during

Diagnostic criteria for peripaum cardiomyopathy: Development of cardiac failure in the last month of pregnancy or within 5 months after deliveryThe absence of an identifiable cause for the cardiac failure, The absence of recognizable hea disease prior to the last month of pregnancy, and Left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria, such as depressed ejection fraction or fractional shoening along with a dilated left ventricle (Ref: William's Obstetrics; 25th edition)

Last month of pregnancy or within 5 months after delivery


Question: Vertical transmission of HIV is most likely to occur

Most of the vertical transmission of HIV is likely to occur during labor.


Question: Labetalol is an

Labetalol is a commonly used a 1 and non-selective b-adrenergic blockerDose: 200-2400mg/day, orally in two to three divided dosesIn an emergency: 20mg IV, followed by 20-80mg every 20min to a maximum of 220mg. Avoid in patients with Asthma, congestive cardiac failure, Liver failure(Ref: William's Obstetrics; 25th edition)


Question: Endometriomas on ultasound appear as

Endometrioma  classically is cystic with homogenous, low-level internal echoes, i.e ground-glass echogenicity.

Solid with diffuse internal low-level echoes.

Solid with focal internal low-level echoes.

Cystic with diffuse internal low-level echoes.

Cystic with focal hyperechoic internal echoes.


Question: In utero, the fetal human ovary has capacity to produce oestrogen by

By 8 weeks, fetal human ovary has capacity to produce oestrogen.


Question: Asthenozoospermia is

Asthenozoospermia is decreased sperm motility.


Question: Impetigo herpetiformes in pregnancy is treated with

Generalized pustular psoriasis of pregnancy (impetigo herpetiformes) is treated with systemic steroids along with antimicrobials for secondary infection.

Acyclovir + antimicrobials for secondary infections

Systemic corticosteroids + antimicrobials for secondary infection

Systemic corticosteroids + acyclovir + antimicrobials for secondary infection


Question: Mrs. Y, 25years with the previous history of twin pregnancy delivered at 36weeks, now at 10weeks of gestation, her obstetric score is

Gravida: a woman who currently is pregnant or has been in the past, irrespective of the pregnancy outcome.With the establishment of the first pregnancy, she becomes a primigravida, and with successive pregnancies, a multigravida.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: Induction of labor by amniotomy can lead to the following complications;

Cord prolapse is te condition where the umbilical cord lies below the presenting pa after rupture of membranes. Aetiological factors includes,Mapresentations(20% transverse lie,12% footling,6% flexed breech),contracted pelvis,multiple pregnancy,polyydraminos when themembrane ruptures,exclusively long cord,battledore placenta as the cord is attached to the margin of placenta,multipara,iatrogenicaificial rupture of membranes with a mobile presenting pa, ,manual rotationor version Refer page no 386 of Text book of obstetrics ,sheila balakrishnan.


Question: Bih trauma is a risk factor for

A bh injury is impoant etiological factor for prolapse A perineal tear is less harmful than the excessive stretching of the pelvic floor muscles and ligaments that occur during childbih because overstretching cause atonicity whereas torned muscle could be stitched Squatting position used during delivery may cause excessive stretching of the pelvic floor muscles and ligaments and leads to genital prolapse a few years later. Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:332


Question: Whiff test is positive in

Bacterial vaginosis (BV) is an alteration of normal vaginal bacterial flora that results in the loss of hydrogen peroxide-producing lactobacilli and an overgrowth of predominantly anaerobic bacteria. Diagnosis A fishy vaginal odor, which is paicularly noticeable following coitus, and vaginal discharge are present.Vaginal secretions are gray and thinly coat the vaginal walls. The pH of these secretions is higher than 4.5 (usually 4.7 to 5.7). Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent. In advanced cases of BV, more than 20% of the epithelial cells are clue cells.The addition of KOH to the vaginal secretions (the "whiff" test) releases a fishy, amine-like odor. Treatment Metronidazole, an antibiotic with excellent activity against anaerobes but poor activity against lactobacilli, is the drug of choice for the treatment of BV. A dose of 500 mg administered orally twice a day for 7 days should be used. Ref: Berek and Novak's Gynecology; 15th edition; Chapter 18


Question: Strawberry vaginitis is caused by

Ans. d (Trichomonas vaginalis) (Ref. Shaw's Text book of Gynaecology, 12th/pg. 97, 98)TRICHOMONAS VAGINALIS# Trichomoniasis is disease of child-bearing age and its ingress into vagina is favoured by lowered general resistance and when pH is raised as during the menstrual period (pH 5 -6).# The vaginal discharge is profuse, thin creamy or slightly green in colour, irritating and frothy.# The vaginal walls are tender and discharge causes pruritus and inflammation of vulva. There are often multiple small punctate strawberry spots on vaginal vault and portio vaginalis of cervix-- the so-called strawberry cervix/vagina.# Actively motile Trichomonads can be seen on wet film preparation or parasite can be cultured on feinberg-Whittington medium.# Treatment is metronidazole 200 mg tid for 7 days for both partners.# In first trimester of pregnancy -Trichofuran suppositories, Vinegar douche and betadine gel are useful. STDCausative agentDiagnosisTreatment1.Chancroid (Soft sore)H. ducreyi"School of fish"/Rail road trackErythromycin/ Cotrimazole2.LGVChlamydia trachomatis(LI, L2, L3)Gram's stain with > 4 neutrophils per fieldTetracycline3.Syphilis (Hard chancre)T pallidumDark ground microscopyPenicillin4.Genital herpesH. simplex 2Tzanck preparation or Pap stainAcyclovir5.Donovaniasis (Granuloma inguinale)C.granulomatisDemonstration of Donovan bodies in mononuclear cells in smear.Erythromycin6.GonorrhoeaN. gonorrhoeaeRapid diagnosis in male is by Gram's staining of urethral exudatesPenicillin, Ceftriaxone7.TrichomoniasisT. vaginalis"Strawberry vagina'' ; Wet film preparationMetronidazole8.Bacterial vaginosisGadnerella vaginalis'Clue cells', Leucocytopenia, Reduced lactobacilliMetro/ClindaStrawberry cervix: diffusely visible punctate cervical erythema, seen with trichomonas vaginitis.Cobblestone vagina: Thickening of the natural vaginal folds due to chronic vaginitis.


Question: Twin peak sign seen in

Twin peak or lambda sign it is characterized of dichorionic pregnancies and is due to the chorionic tissue between the two layers of the intewin membrane at the placental origin . twin peak appears as a triangle with base at chorionic surface and apex in intewin membrane.


Question: Uterosacral ligament contains

Uterosacral ligaments are composed almost entirely of connective tissue and very little plain muscle. They contain sympathetic and parasympathetic nerves.


Question: A lady presents with headache, recurrent abortions, and cavernous sinus thrombosis. The diagnosis is

(A) APLA CLINICAL FEATURES OF ANTIPHOSPHOLIPID ANTIBODY SYNDROMEManifestation%Venous Thrombosis and Related Consequences Deep vein thrombosis39Livedo reticularis24Pulmonary embolism14Superficial thrombophlebitis12Thrombosis in various other sites11Arterial Thrombosis and Related Consequences Stroke20Cardiac valve thickening/dysfunction and/or Libman- Sacks vegetations14Transient ischemic attack11Myocardial ischemia (infarction or angina) and coronary bypass thrombosis10Leg ulcers and/or digital gangrene9Arterial thrombosis in the extremities7Retinal artery thrombosis/amaurosis fugax7Ischemia of visceral organs or avascular necrosis of bone6Multi-infarct dementia3Manifestation%Neurologic Manifestations of Uncertain Etiology Migraine20Epilepsy7Chorea1Cerebellar ataxia1Transverse myelopathy0.5Renal Manifestations Due to Various Reasons(Renal Artery/Renal Vein/Glomerular Thrombosis,Fibrous Intima Hyperplasia)3Osteoarticular Manifestations Arthralgia39Arthritis27Obstetric Manifestations (Referred to the Number of Pregnancies) Preeclampsia10Eclampsia4Fetal Manifestations (Referred to the Number of Pregnancies) Early fetal loss (<10 weeks)35Late fetal loss (10 weeks)17Premature birth among the live births11Hematologic Manifestations Thrombocytopenia30Autoimmune hemolytic anemia10


Question: Scale for sexual maturity is

(A) Tanners' scale # TANNER STAGES (TANNER SCALE) are stages of physical development in children, adolescents and adults. The stages define physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitalia, and development of pubic hair.> Due to natural variation, individuals pass through the Tanner stages at different rates, depending in particular on the timing of puberty.> In HIV treatment, Tanner staging is used to determine which treatment regimen to follow (adult, adolescent, or pediatric).> The Tanner stages were first identified by James Mourilyan Tanner and thus bear his name.> Pubic hair (both male and female) Tanner I: no pubic hair at all (prepubertal state) Tanner II: small amount of long, downy hair with slight pigmentation at the base of the penis and scrotum (males) or on the labia majora (females) Tanner III: hair becomes more coarse and curly, and begins to extend laterally Tanner IV: adult-like hair quality, extending across pubis but sparing medial thighs Tanner V: hair extends to medial surface of the thighs> Genitals (male) Tanner I: prepubertal (testicular volume less than 1.5 ml; small penis of 3 cm or less) Tanner II: testicular volume between 1.6 and 6 ml; skin on scrotum thins, reddens and enlarges; penis length unchanged Tanner III: testicular volume between 6 and 12 ml; scrotum enlarges further; penis begins to lengthen to about 6 cm Tanner IV: testicular volume between 12 and 20 ml; scrotum enlarges further and darkens; penis increases in length to 10 cm and circumference Tanner V: testicular volume greater than 20 ml; adult scrotum and penis of 15 cm in length> Breasts (female) Tanner I: no glandular tissue; areola follows the skin contours of the chest (prepubertal) Tanner II: breast bud forms, with small area of surrounding glandular tissue; areola begins to widen Tanner III: breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast Tanner IV: increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast Tanner V: breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla.


Question: Eclampsia is a complication of

Eclampsia is an extremely severe form of Preeclampsia characterized by the sudden onset of generalized tonic-clonic seizures.Reference: Practical guide to High-risk pregnancy and delivery; Chapter 16; Hypeensive disorders of Pregnancy

Medical, surgical and gynaecological illness complicating pregnancy


Question: Mrs. X, Primigravida at 36weeks complains of generalized pruritis with increased intensity in soles. Diagnosis is

Clinical presentation of Intrahepatic Cholestasis of Pregnancy:Pruritus develops in late pregnancy, although it occasionally manifests earlier. There are no constitutional symptoms, and generalized pruritus shows a predilection for the soles. Skin changes are limited to excoriations from scratching. Biochemical tests may be abnormal at presentation, but pruritusmay precede laboratory findings by several weeks. Approximately 10 percent of women have jaundice.Ref: William&;s Obstetrics; 24th edition; Chapter 55

Medical, surgical and gynaecological illness complicating pregnancy


Question: A woman with a history of repeated aboions gave bih to a low bih weight baby. The child is having rashes over palm and rhinitis. The most probable diagnosis is September 2009

Ans. B: Congenital Syphilis Symptoms in newborns with congenital syphilis may include: Failure to gain weight or failure to thrive Fever Irritability No bridge to nose (saddle nose) Early rash -- small blisters on the palms and soles Later rash -- copper-colored, flat or bumpy rash on the face, palms, and soles Rash of the mouth, genitalia, and anus Watery discharge from the nose Congenital rubella predominantly include cochlear (sensori-neural deafness), cardiac (septal defects, PDA), hematologic, ophthalmic (cataracts, retinopathy) and chromosomal abnormalities.


Question: P4 pf vagina during reproductive life is

Vaginal secretion is acidic during reproductive life which is oestrogen dependent, and inhibits growth of pathogenic organisms.


Question: In brachytherapy of carcinoma cervix, dose of radiation to Point A is

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: Colposcopy is best performed during

Cervix is moist with mucus and external os is slightly patulous in proliferative phase and exposes squamocolumnar junction adequately.


Question: Submucosal fibroid is detected by

USG: Ultrasound is the most readily available, least costly imaging technique to diagnose fibroid. It checks the number, location, and size of fibroids and helps to reduce overlooking small fibroids during surgery (which might lead to persistence or recurrence of symptoms).
Sonohysterography – is instillation of saline into endometrial cavity during TVS
Hysteroscopy or hysterosalpingography: These methods are useful to detect submucous fibroid in unexplained infertility and repeated pregnancy wastage. The presence and site of submucous fibroid can be diagnosed by direct visualization during hysteroscopy or indirectly as a filling defect on HSG. Hysteroscopy also allows its excision under direct vision.
Uterine Curettage: It can also help in diagnosis of submucous fibroid by feeling of a bump during curettage.
Laparoscopy: is helpful if uterine size is less than 12 weeks, for detection of subserous fibroid and not submucous. It can also differentiate a pedunculated fibroid from an ovarian tumor not revealed by clinical examination and ultrasound.


Question: Time taken for spermatogenesis is

The process whereby the germ cells is converted into spermatids is called male gametogenesis or spermatogenesis.
Shortly before puberty, the testicular cords become canalized and form the seminiferous tubules.
Accompanying this change is the conversion of the germ cells into a group of spermatogonial cells. At regular intervals, spermatogonia arise from this stem cell cluster to start the process of spermatogenesis


Question: Cells in vaginal cytology increase in reproductive age under the influence of

Ans: d (Oestrogen)EXPLANATION:A majority of cells observed in a normal vaginal smear are, not surprisingly, vaginal epithelial cells. In addition, varying numbers of leukocytes, erythrocytes and bacteria are usually evident, and small numbers of other contaminating cells and microorganisms are sometimes observed.Analyzing a vaginal smear is largely an exercise in classifying the epithelial cells into one of three fundamental types: parabasal, intermediate or superficial cells. Parabasal cells are the smallest epithelial cells seen on a typical vaginal smear.They are round or nearly round and have a high nuclear to cytoplasmic ratio.Intermediate CellsIntermediate cells vary in size and shape, but typically have a diameter two to three times that of parabasal cells. Many cytologists subclassify these cells into:Small intermediates - nearly round or oval shape with large, prominent nucleiLarge intermediates - polygonal shape with a small nuclear/cytoplasmic ratio Intermediate cells are prevalent during all stages of the cycle except estrus.Superficial CellsSuperficial cells are the largest cells seen on a vaginal smear.They are polygonal in shape and distinctly flat, sometimes having the appearance of being rolled up.Their nuclei are either absent or pyknotic (very small and dark).Superficial cells without nuclei are often referred to as being "fully comified".

Endocrine Control of the Menstrual Cycle


Question: Increased gonadal production of estrogen is characteristic of

In persons with testicular feminization, estradiol secretion by the testes is markedly increased (but not to the level produced by normal ovaries); the mechanism is lack of suppression of LH by testosterone and consequently increased stimulation of gonadal testosterone and estradiol secretion. Ovaries containing follicle cysts may be a source of increased estrogen production, paicularly during the postmenopausal years, when gonadotropin levels are very high. The increase in estrogen production that is characteristic of PCOD is the consequence of the peripheral conversion of androstenedione to estrogen, not of direct gonadal production. During the third trimester of pregnancy estrogen production is increased because of the formation of estrogen by the placenta rather than by the ovary. Arrhenoblastoma is a virilizing ovarian tumor and does not secrete estrogen. Congenital adrenal hyperplasia causes virilization due to the increased adrenal output of androgens.


Question: Schwangershaft protein is the other name of

Schwangershaft Protein:

It is the other name for pregnancy specific B1 glycoprotein.
Produced by trophoblast.
Can be detected 18 days after ovulation.
Its concentration rises steadily and reaches 200 mg/ml at term.
Role-measure of placental function for fertility control.


Question: Drugs Supplied by NACO For Prevention of Mother to Child transmission

NACO is National AIDS Control Organization which was launched in India in the year 1987.The Ministry of Health and Family Welfare had setup NACO as a separate wing to implement and closely monitor the various components of the National Aids Control Programme.
NACO has established many integrated counselling and testing centres (ICTCs ),where pregnant women are provided counselling and testing facilities.
“Women who are found to be HIV positive are given single dose of prophylactic Nevirapine at the time of labour and new born infant is also given a single dose of Nevirapine within 72 hrs of birth”.
Park 20/e, p 373


Question: Contraceptive method of choice in lactating mothers is

Progesterone only pills or mini pill Pills that contain very low doses of progestin, do not contain estrogen, and so can be used throughout the period of breastfeeding.These pills work primarily by thickening cervical mucus, disrupting the menstrual cycle, and preventing the ovulation.Reference: Mudaliar and Menon&;s clicks obstetrics,12th edition, page no:452


Question: Late deceleration indicates

Deceleration pattern - Three types Early deceleration - due to head compression Late deceleration - chronic placental insufficiency Variable deceleration - cord compression Sinusoidal pattern - It is stable baseline FHR with fixed base line variability without any acceleration. If is often associated with fetal anaemia, feto-maternal haemorrhage, fetal hypoxia, and when narcotics are given to mothers


Question: Pawlik's grip is done in obstetrics for assessment of


Question: Corpus luteum supports endometrium in pregnancy till

(A) 6-10 weeks# At 6-8 weeks there is transfer of function of the corpus luteum to the placenta.


Question: Best prenatal treatment CAH is

Prenatal diagnosis of CAH is possible with chorion villus sampling at early weeks of pregnancy using DNA probes

The 17-OHP level in the amniotic fluid is elevated
Prenatal therapy with dexamethasone or termination of pregnancy is the option


Question: Young lady presents with acute abdominal pain and history of 11/2 months amenorrhoea, on USG examination there is collection of fluid in the pouch of douglas and empty gestational sac. Diagnosis is


Question: 1st meiotic division of oogenesis gets arrested at

The germ cell reach gonadal ridge by the 6th week to form oogonia which multiply by mitosis
By 12th week the oogonia are arranged in clusters and are covered by a layer of follicular cells to form the primordial follicle
The oogonia enter into the1st meiotic division but are arrested in diplotene stage of prophase and doesn't enter into metaphase but rest until puberty


Question: Chassar Moir technique is used in


Question: Second stage of labour begins with

Ans: a (Complete cervical Dilatation)Ref: William's Obstetrics, 23r ed. Chapter 17The dilatation and the effacement of the cervix occurs in the first stage of the labour. The patient is in active stage of labour once the cervix is effaced and dilated till 3 cm, following this the rate of dilatation is 1 cm/hour in cases of primigravidas and 1.5 cm/hour in cases of multigravidasThe beginning of the 2 stage of labour is characterized by the complete dilatation and the effacement of the cervixThe main aim of the 2 stage of the labor is the expulsion of the foetus through the female reproductive tract. The 2 stage consists of engagement, progressive flexion and descent, internal rotation, restitution, external rotation and lateral flexion for the delivery of the trunk.Engagement occurs when the greatest possible transverse diameter of the foetus enters the pelvic brim.Flexion and descent are the processes which occurs constantly during the 2 stage.Internal rotation is the most important step occurring in the 2 stage.Expulsion of the placenta is the 3 stage of labor which immediately follows the expulsion of the foetus.Once the baby is expelled, active management of the third stage of labour is recommended. In this immediately post the delivery of the baby, and after ensuring that the uterus is adequately contracted, controlled cord traction, uterine massage and administration of uterotonics is carried out.


Question: A female with recurrent abortion and isolated prolonged APTT is most likely associated with

Ans. is 'a' i.e. Lupus anticoagulant They have asked about antiphospholipid antibody syndrome.Antiphospholipid antibodies account for 3% to 5% of patients with repetitive pregnancy losses.The frequency of fetal death and recurrent abortion in untreated patients with antiphospholipid antibodies is greater than 90%.* There are several antiphospholipid antibodies. The most relevant to obstetricians are:The lupus anticoagulant (LAC),The anticardiolipin antibody andThe antibody that cause false positive syphilis test (BFP-ST). The name lupus anticoagulant was derived from the fact that this antibody was found first in patients with systemic lupus erythematosus and acted as an anticoagulant by prolonging the partial thromboplastin time (PTT).This name was a poor choice because soon it was found that lupus anticoagulant was present in many patients who did not have lupus and that in majority of patients the antibody was responsible for episodes of thrombosis, rather than anticoagulation.In the laboratory, LAC is not measured directly.It is assessed by its effect on PTT and the kaolin clotting time.Typically patients with lupus anticoagulant have a prolonged PTT and a normal PT.Unfortunately, a normal PTT does not exclude the possibility of LAC, and if the clinical suspicion is strong and the PTT is normal a kaolin clotting time or a dilute Russell viper venom time should be performed.It has also been found that some patients with LAC and recurrent abortions have elevated values of serum IgM.Other antiphospholipid antibodiesThe anticardiolipin antibody is the antiphospholipid antibody, most commonly found in patients with repetitive early pregnancy losses. Anticardiolipin antibody is found in 90% of patients with L.A.C. but the majority of patients with positive anticardiolipin antibody do not have L.A.C.Anticardiolipin antibody is measured in the laboratory by the ELISA test.BFP-STIt is the less common antiphospholipid antibody.Both BFP-ST and Anticardiolipin antibody, measure the antibody against cardiolipin but they are not the same.Clinical features of antiphospholipid antibodies.* The presence of any or several of the three antiphospholipid antibodies is associated withRecurrent early pregnancy losses.Episodes of venous and arterial thrombosisSevere preeclampsiaChorea gravidarumH/o ischemic strokes, transient ischemic episodes, migraine headaches.Postpartum complications such as pulmonary infiltrates, fever, and cardiac symptoms.Abortions in antiphospholipid antibody syndromeTypically these patients give a history of a live fetus documented by ultrasound or by Doppler before demise or abortion occurs.The majority of the pregnancy losses occur between 14 and 18 weeks.Fetal death is these patients is caused by extensive thrombosis of the placental vessels and the placenta is usually smaller than expected for the gestational age.


Question: Site of placement of tension free vaginal tapes in stress urinary incontinence

Tension-free vaginal tape A knitted 11 mm x 40 cm polypropylene mesh tape is inseed transvaginally at the level of the midurethra Complications: Sho term Voiding difficulties , Bladder perforation, de novo Urgency and Bleeding Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15th edition; Pg no:194


Question: Cervical cerclage is offered to pregnant women with prior history of preterm bih if cervical length is less than

Cervical length screening is now recommended for women with prior history of preterm bih. Between 16 and 24weeks gestation sonographic cervical measurement is completed every 2weeks. If initial or subsequent cervical length is 25 to 29mm, then a weekly interval is considered. If the cervical measurement is <25mm, cerclage is offered. Women without a history of preterm bih but with a sho cervix incidentally identified sonographically, progesterone therapy is to be offered instead of cerclage(Ref: William's Obstetrics; 25th edition)


Question: In child with ambiguous genitalia, first test to be done is

Karyotyping is first test to be done in child with ambiguous genitalia.


Question: Fetal heart starts contracting at

(C) 3-5 weeks[?]The Beginning:The human heart begins to beat and pump blood through the embryo around day 22 of gestation.The electric stimulus that triggers contractions in the myocardium arise spontaneously within the myocardium itself, and propagate from cell to cell. Input from the central nervous system can modify the heart rate (the frequency of heart beats), but it does not initiate beats.The ability of cardiac myocytes to beat is an intrinsic property of these cells. It has been found that myocytes removed from the early heart and grown in culture will beat sporadically, and if they become connected to each other, will then begin to beat rhythmically, in unison.As a functional organ, the heart begins to beat very early, even before it has assumed its final form.Interestingly, the heart begins to beat even before structures such as valves and septa (singular: septum; the muscular walls that divide the chambers) have formed. The initial contractions are peristaltic - that is, they proceed in a wave like fashion along the length of the heart. IMPORTANT EVENTS FOLLOWING FERTILIZATION0' hourFertilization (day-15 from LMP)30 hours2 cell stage (blastomeres)40-50 hours4 cell stage72 hours12 cell stage96 hours16 cell stage. Morula enters the uterine cavity5th dayBlastocyst4-5th dayZona pellucida disappears5-6th dayBlastocyst attachment to endometrial surface6-7th dayDifferentiation of cyto and syncytiotrophoblast layers10th daySynthesis of hCG by syncytiotrophoblast9-10th dayLacunar network forms10-11th dayTrophoblasts invade endometrial sinusoids establishing uteroplacental circulationInterstitial implantation completed with entire decidual coverage13th dayPrimary villi16th daySecondary villi21st dayTertiary villi21st-22nd dayFetal heart, Fetoplacental circulation


Question: the distention media used in diagnostic hysteroscopy with bipolar couesy is


Question: Previous ectopic pregnancy is a contraindication for

LNG-IUS is considered to be contraindicated in women with history of previous ectopic pregnancy.


Question: The condition listed below that would most likely pursue a benign course is

Adenomyosis is the presence of benign glands and stroma within the myometrium. It is a common cause of diffuse uterine enlargement and menstrual irregularities; however, it is not a precancerous lesion. Ref: Shaw&;s Textbook of Gynaecology; 16th edition; Chapter 30; Endometriosis and Adenomyosis


Question: The GnRH (Gonadotrophic Releasing hormone) reaches the anterior pituitary from the hypothalamus along

The poal hypophyseal vessels form a direct vascular link between the hypothalamus and the anterior pituitary. Hypothalamic hormones like GnRH (Gonadotrophic Releasing hormone) reach the anterior pituitary from the hypothalamus along the hypophyseal poal system


Question: Complete failure of mullerian duct fusion will result in


Question: Selective reduction of multi chorionic multifetal gestation is performed around

Selective Reduction Reduction of a selected fetus or fetuses in a multi chorionic multifetal gestation may be chosen as a therapeutic intervention to enhance survival of the remaining fetuses (ACOG, 2013a).Transabdominal fetal reductions are typically performed between 10 and 13 weeks. This gestational age is chosen because most spontaneous aboions have already occurred, the remaining fetuses are large enough to be evaluated sonographically, the amount of devitalized fetal tissue remaining after the procedure is small, and the risk of aboing the entire pregnancy as a result of the procedure is low. The smallest fetuses and any anomalous fetuses are chosen for reduction. Potassium chloride is then injected under sonographic guidance into the hea or thorax of each selected fetus(Ref: William's Obstetrics; 25th edition)


Question: PIH can be prevented by

Smoking is the only environmental factor that reduces the risk of pre-eclampsia Smoking during pregnancy has adverse effects on other organs It may have effects on angiogenic factors, endothelial function and immune system reducing the risk of pre-eclampsia. Ref: Internet sources.

Medical, surgical and gynaecological illness complicating pregnancy


Question: Drug not used in the management of PPH

Misoprostol is another prostaglandin that increases uterine tone and decreasespostpaum bleeding.36 Misoprostol is effective in the treatment of postpaum hemorrhage, but side effects may limit its use.28,37 It can be administered sublingually, orally, vaginally, and rectally Ref mudaliar textbook of obstetrics 6e


Question: A unilateral ovarian tumour with visible peritoneal implants belong to

Ovarian cancer staging:Stage III Tumor involves 1 or both ovaries or fallopian tubes or primary peritoneal cancer with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes. III b: macroscopic extrapelvic peritoneal metastasis < or = 2cm with or without positive retroperitoneal lymph nodes. Includes extension to capsule of liver/ spleen. III c: macroscopic extrapelvic peritoneal metastasis > 2cm with or without positive retroperitoneal lymph nodes. Includes extension to capsule of liver/ spleen. Reference : textbook of gynaecology Sheila balakrishnan, 2nd edition, pg no: 277


Question: Fibroid with a typical "Lantern on top of  St Paul's cathedral" appearance is

Cervical Fibroid is compared to "Lantern on dome of st Paul's catherdral".


Question: Granuloma inguinale

Granuloma inguinale is caused by Klebsiella granulomatis. It is painless. It has incubation period of weeks to months (long).


Question: Definition of Prolonged pregnancy is

The international definition of prolonged pregnancy, endorsed by the American College of Obstetricians and Gynecologists (2013a), is 42 completed weeks, 294 days or more from the first day of the last menstrual period.Reference: William's Obstetrics; 24th edition; Chapter 43; Postterm Pregnancy


Question: Hormonal therapy is indicated in menopausal women for

(A) Hot flashes[?]Hot Flashes:They are sudden, intense feelings of heat in the neck face, and torso. They can be accopanied by:Heart palpitations; Sleep disturbances; Profuse perspiration; Cold chills; Anxiety; FlushingHot flashes are: Mainly women over 40 as they transition into menopause as well as pregnant women.Other causes of Hot Flushes:Thyroid disease, epilepsy, autoimmune disorders, insulinomas, pancreatic tumors, leukemias.Hot flushes are waves of vasodilation affecting face & neck last for 2-5 min each more severe during night, disturb sleep.Mechanism:Estrogen deficiency - Reduces hypothalamine endorphine - Release more norepinephrine & serotonin - Leads to inappropriate heat loss mechanism.Hormonal Replacement Therapy:Benefit of HRT for Relief of Symptoms:Hot flashes: Highly effective; Usually required for a relatively short period of time, E.g., 1 to 3 years.Mood disturbance: Improve irritability & anxiety in many menopausal women; Relieve mild depressive symptoms.Hormone Replacement Therapy (HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency. HRT can be administered orally (in pill form), vaginally (as a cream) or trans dermally (in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. Used before, during & after menopause.Who needs HRT:Symptomatic women who suffer from estrogen deficiency (Therapeutic); High risk cases for menopausal complications such as cardiovascular disease, osteoporosis, stroke, Alzheimer's disease, colonic cancer (prophylactic)Premature & surgical menopause; Gonadal dysgenesis in adolescents.Treatment of Hot Flashes: If mild symptoms & signs advised exercise.Initiate low dose HRT if:Moderate or severe symptoms: Non-hormonal treatments have failed; No interest in non-hormonal therapyTitrate estrogen dosage upward if needed.When estrogen can't be used, offer:SSRI or SNRI; Gabapentin, clonidine, alpha-methyldopa; MPA or MegesterolAttempt discontinuation after 1-2 yearsTREATMENT OPTIONS FOR MENOPAUSAL SYMPTOMS SHOWN TO HAVE CLINICAL BENEFITSSymptomsHormone TherapyNon-hormonal TreatmentsLifestyle ChangeVasomotorOral conjugated estrogens and MPAParoxetineSmoking cessationContinuous and sequentialVenlafaxineDecrease alcohol consumptionOral estradiol and norgestimatelGabapentinRelaxation techniquesTransdermal*. 17 beta estradiol-norethindrone acetate*. 17 beta estradiol - levonogestre*. 17 beta estradiol*. EstradiolClonidine Oral conjugated estrogen (unopposed)Oral 17 beta estradiolEstradiol vaginal ringVaginal atrophyEstradiol vaginal creamVaginal moisturizersSmoking cessationConjugated estrogen vaginal creamVaginal lubricantsregular sexual activityEstradiol vaginal ring OsteoporosisHT not recommended as first-line therapy for prevention or treatmentCalcium & Vitamin D supplementsWeight bearing exercisesBisphosphonatesSmoking cessationRaloxifeneDecrease alcohol consumptionCalcitonin Teriparatide


Question: Not used in emergency contraceptions aEUR'

LNG intrauterine device Levonorgestrel alone, 0.75 mg stat F/B another 0.75 mg 12 hrs later, taken within 72 hrs of unprotected intercourse is the method of choice .for emergency contraception Emergency contraception is also k/a postcoital morning after contraception. Basically the methods used interfere with the physiological events before implantation, for e.g. inhibition or delaying of ovulation or interference with postovulatory events necessary for implantation & longevity of the blastocyst. Agents used for emergency contraception are known as 'interceptives'. Methods of emergency contraception Drugs Dosage Time frame Preg. rate * High dose estrogens (not used now) - Ethinyl estradiol (EE) 2.5 mg BD x 5 days Within 72 hrs of coitus -L. 0.15% - Conjugated equine estrogen (CEE) 15 mg BD x 5 days 0-0.6% * Estrogen & progestin combination pill - Yuzpe method EE 50 lag + d, 1-NG 0.5 mg (Ovral) 2 tabs stat & 2 tabs after 12 hrs (Total dose EE 0.2 mg & LNG 2 mg) " 0-2% - Low dose pills EE 30 lig + LNG 0 0.15mg (Ovral L, Mala-N etc.) 4 tabs stat & 4 tabs after 12 hors 0-2% * Levonorgestrel (LNG) alone (Ecee 2, i-pill, E-pill, unwanted-72, Plan-B) 0.75 mg stat FIB 0.75 mg after 12 hrs or 1.5 mg stat Preferably within 72 hrs but can be given upto 5 days 0-1% * Centchroman 30mg (Saheli) 2 tab BD x 1 day 400/800 x BD mg m 3 Within 5 days not known * Danazol days or 1200 mg BD x 2 days Within 72 hrs 0.8 - 1.7% * Mifepristone (RU 486) 600 mg/200 mg / 10 mg single dose Within 5 days to 27th day of cycle 1.3% * Copper HID (more effective than s steroids) ) To be inseed within 7 days < 1%


Question: Oral anticoagulants given to pregnant women can cause


Question: First line of Rx of osteoporosis in postmenopausal women


Question: Probability to achieve a live birth within a single cycle is

Probability to achieve a live birth within a single cycle is called Fecundity.


Question: Congenital hea block develops in fetuses of women suffering from

Congenital hea block develops almost exclusively in fetuses of women with antibodies to the SS-A or SS-B antigens. (Ref: William's Obstetrics; 25th edition)


Question: Maximum dose of radiation exposure during pregnancy is

The biological effects of x-rays are caused by an electrochemical reaction that can damage tissue. Embryo-fetal risks from low-dose diagnostic radiation appear to be minimal. Current evidence suggests that there are no increased risks for malformations, growth restriction, or aboion from a radiation dose of less than 0.05 Gy (5 rad). Reference: William&;s Obstetrics; 24th edition; Chapter 46; General Considerations and Maternal Evaluation


Question: Gland homologous to prostate in females is

Masculine counterpas: Labia majora - scrotum clitoris - penis Labia minora - penile urethra and a pa of skin of penis in males Baholin's glands - bulb of penis Skene's glands - prostrate vestibular bulb - bulb of penis and corpus spongiosum DC Dutta's Textbook of Obstetrics 7th edition page no 1


Question: Time taken for capacitation of sperms is

Capacitation is the process of reconditioning of the sperm, making it more suitable for penetration into the ovum.
It takes about 6-8 hours and occurs in FGT chiefly in the tubes.


Question: Bleeding that follows paial or complete placental separation and dilation of the cervical os in first 20 weeks is termed as

Incomplete Aboion: Bleeding that follows paial or complete placental separation and dilation of the cervical os is termed incomplete aboion. The fetus and the placenta may remain entirely within the uterus or paially extrude through the dilated os. Management options of incomplete aboion include curettage, medical aboion, or expectant management in clinically stable women.(Ref: William's Obstetrics; 25th edition)


Question: Secondary amenorrhea is defined as

A woman who previously menstruated can develop secondary amenorrhea.Which is defined as absence of menstruation for three normal menstrual cycles. A woman with regular cycles and a delay of menses of even a week may warrant assessment with a pregnancy test.It is reasonable to evaluate a woman who has fewer than nine cycles per year.Reference: Berek and Novak's gynecology; 14th edition; Chapter 30; Amenorrhea

Absence of menstruation for one normal menstrual cycle

Absence of menstruation for three normal menstrual cycles

Absence of menstruation for six normal menstrual cycle


Question: Most effective treatment for Hirsutism is

Low-dose OCPs are most effective treatment for Hirsutism.


Question: Diagnosis of Down syndrome at 11 weeks in the best assessed by


Question: Goniometer is used for

Goniometer

It is used to measure baseline urethral angle and maximum strain angle of urethra with a cotton tip swab in place
The bladder forms an angle of 100 degree with posterior urethral wall which is also responsible for maintaining urinary continance


Question: Extrophy of the bladder is associated with

Bladder extrophy is associated with bifid clitoris and labial fusion.


Question: Following vasectomy,

Sterility following vasectomy is not immediate nor is its onset predictable. Thus another form of contraception is recommended until azoospermia is documented.

Semen has to be analyzed till 2 consecutive sperm counts are zero

No need to use additional contraception after 1 month


Question: Smt. Gupta presented with bleeding PV and enlarged inguinal nodes. She was diagnosed as a case of endometrial carcinoma. State the stage


Question: 37 weeks primigravida presents with irregular uterine contractions, on examination the cervix is 1cm dilated and poorly effaced, management is

The Uterine activity that causes discomfo, but that does not represent true labor, may develop at any time during pregnancy. False labor often stops spontaneously, or it may proceed rapidly into effective contractions. Sedation can be given and watch for some time. The patient may proceed into true labor or pain may subside.Ref: William&;s Obstetrics; 24th edition


Question: Hysteroscopic resection can be done in submucosal myomas of size

For submucosal myomas Grade 0-1, hysteroscopic resection (for <4 cm diameter) or abdominal myomectomy (for >4 cm diameter) is the recommended treatmentReference: NICE Guidelines


Question: Single pelvic ala is seen in

Naegele's pelvis - Ala on one side is absent Robe's pelvis - Ala on both sides are absent Osteomalacic pelvis - the shape of inlet is triradiate Rachitic pelvis - shape of inlet is reniform


Question: Cause of secondary PPH is

Causes of secondary PPH: Retained bits of cotyledon or membranes Infection and separation of slough over a deep cervicovaginal laceration Endometritis Hemorrhage from cesarean section wound Withdrawal bleeding following estrogen therapy for suppression of lactation Ref: Dutta Obs 9e pg 392.


Question: Bacterial vaginosis is named as

Bacterial vaginosis is also named as:

Haemophilus vaginitis
Corynebacterium vaginitis
Gardnerella vaginitis
Anaerobic vaginitis
Non - specific vaginitis


Question: Fibromyoma is seen in age group

Ans. is'a'i.e., ReproductiveFibroids are the most common benign solid tumours in females.It is the most common Pelvic tumourMost commonly affects the reproductive age group.Most commonly seen in nulliparous common


Question: Cervical smear fixation is done by

Ans. is 'a' i.e. Ethyl alcohol The fixative used to prevent air drying in case of Pap smear is ethyl alcohol.Ordinarily when a slide is prepared it is air dried but when a slide prepared for pap smear is air dried it gets damaged.''Thus while preparing Pap smear slide ethanol is used as a fixative to prevent air drying".Procedure:-The techniques of collection of a pap smear may vary but the following is a common procedure.The patient should not have douched for at least 24 hours before the examination and should not be menstruating.The speculum is placed in the vagina after being lubricated with water only.With the cervix exposed, either a cotton-tipped applicator slightly dampened with saline solution or a specially designed plastic or wooden spatula is applied to the cervix and rotated 360 degrees to abrade the surface slightly and to pick up cells from the squamocolumnar area of the cervical os.Care should be taken to ascertain that endocervical cells are also obtained.If this is not accomplished with the spatula, a cotton tipped applicator or small brush is now available for this purpose, it can be inserted into the cervical canal of most of the women and rotated picking up cervical cells more efficiently.These 2 specimens may be mixed or put on the slide, separately according to the preference of the examiner.A preservative is applied immediately to prevent air drying, which will compromise the interpretation.The preservative or the fixative used is 95% ethyl alcohol (Note: To prevent the air drying, slide is transported in the bottle containing the fixative).

Staging, Investigation and Prognostic Factors


Question: A 35 yr old P 3+0 is observed to have CIN grade III on colposcopic biopsy. Best treatment will be

LEEP Repeat All India 2009 "Although CIN can be treated with a variety of techniques, the preferred treatment for CIN 2 and 3 has become LEE?" - Novak's Gynecology p582 Though the patient is 35 yrs old and has completed her family, still hysterectomy won't be treatment of choice as-"Hysterectomy is currently considered too radical .for treatment of CIN"Novak's Gynecology p.585 Following are some situations in which hysterectomy remains a valid and appropriate method of treatment for CIN Microinvasion CIN 3 at limits of conizution specimen in selected patients Poor compliance with follow-up Other gynecologic problems requiring hysterectomy, such as fibroids, prolapse, endometriosis, and pelvic inflammatory disease Cervical intraepithelial neoplasia(CIN) Invasive squamous cell cervical cancers are preceded by a long phase of preinvasive disease, collectively referred to as cervical intraepithelial neoplasia (CIN). Histopathologically a pa or the full thickness of cervical squamous epithelium is replaced by cells showing varying degree of dysplasia, with intact basement membrane. CIN may be suspected through cytological examination using the Pap smear test or through colposcopic examination. Cervical cytology is the most efficacious and cost-effective method for cancer screening. Final diagnosis of CIN is established by the histopathological examination of a cervical punch biopsy or excision specimen. Additionally, human papilloma virus (HPV) testing can be performed in order to better triage women with early cytologic changes. Cervical Cytology Screening (American College of Obstetricians and Gynecologists Guideline) Initial screening Age 21 or 3 y after vaginal sex Interval Every year Every 2-3 y after age 30 with 3 consecutive normals Discontinue No upper limit of age Comparison of Cytology Classification Systems (in simplified form) Bathesda CIN llysplasia Limit of histologic changes *LSIL CIN 1 Mild Basal 1/3rd of sq. epithelium HSIL ON 2 Moderate Basal 1/2 to 2/3rd CIN3 Severe Whole thickness except one or two superficial layers CIS Whole thickness LSIL - Low grade squamous intraepithelial lesion HSIL - High grade squamous intraepithelial lesion CIS - Carcinoma in situ *LSIL incorporates HPV changes (koilocytotic atypia) along with CIN I. Role of HPV HPV infection is found in approx. 90% cases of intraepithelial neoplasia. Type H&18 are most commonly associated. HPV-18 is more specific than HPV-16 for invasive tumors. In most women, the HPV infection clears in 9 to 15 months. Only a minority of women exposed to HPV develop persistent infection that may progress to CIN. Type-16 is the most common HPV type found in women with normal cytology. Treatment CIN 1 Spontaneous regression of CIN 1 is seen in 60% to 85% of cases, typically within 2yrs. So patients who have biopsy diagnoses of C1N 1 are kept under observation with: Pap testing performed at 6 and 12 months Or HPV DNA testing at 12 months After two negative test results or a single negative HPV DNA test, annual screening may be resumed. Women with persistent CIN 1 after 24 months should be treated with a local ablative method. CIN 2 and3 CIN 2&3 carries a much higher probability of progressing to invasive cancer. All CIN 2 and 3 lesions require t reatment. LEEP ( loop electrosurgical excision procedure) is the preferred treatment for CIN 2 and 3. Because all therapeutic modalities carry an inherent recurrence rate of upto 10%. cytologic follow-up at about 3-month intervals for 1 year is necessary. Cryotherapy Considered acceptable therapy when the following criteria are met: - Cervical intraepithelial neoplasia, grade 1 to 2 - Small lesion Ectocervical location only - Negative endocervical sample - No endocervical gland involvement on biopsy Laser Ablation It has been used effectively for the treatment of CIN .But because of the expense of the equipment as well as necessity for special training, laser ablation has fallen out of or. Laser has been widely replaced by LEEP. Laser Excisional Conization Rather than using laser for vaporization leading to ablation, it can be used to excise a conization specimen. The ease of LEEP conization has significantly reduced the indications of laser conization. Loop electrosurgical excision( LEEP) LEEP, variably known as simply loop excision or LLETZ (large loop excision of the transformation zone), is a valuable tool for the diagnosis and treatment of CIN. It uses low-voltage, high-frequency, thin wire loop electrodes to perform a targeted removal of a cervical lesion, an excision of the transformation zone, or a cervical conization. This technique can be used in the outpatient setting Cold knife conization (scalpel) Conization is both a diagnostic and therapeutic procedure and has the advantage over ablative therapies of providing tissue for fuher evaluation to rule out invasive cancer. Conization is indicated for CIN 2&3 in following conditions: - Limits of the lesion cannot be visualized with colposcopy. - The squat-no-columnar junction (SCE) is not seen at colposcopy. - Endocervical curettage (ECC) histologic findings are positive for CIN 2 or CIN 3. - There is a substantial lack of correlation between cytology, biopsy, and colposcopy results. - Microinvasion is suspected based on biopsy, colposcopy, or cytology results. - The colposcopist is unable to rule out invasive cancer.


Question: Regarding PCOS and hyperinsulinaemia

In PCOS

Hyperinsulinemia is seen in 50-70% cases of PCOS
Insulin induces LH to cause thecal hyperplasia and secrete androgens
Hyperandrogenism lowers the level of hepatic sex hormone binding globulin
Metformin treats the root causes, rectifies endocrine and metabolic function, improves fertility rate, used as insulin sensitiser
It reduces insulin level, delays glucose absorption, liver production of glucose and improves peripheral resistance
Metformin do not cause hypoglycemia in a normoglycemic women

Hyperinsulinaemia is observed in about 40% to 80% of women with PCOS

Metformin has many other health benefits

Metformin causes hypoglycaemia in normoglycaemic women

Hyperinsulinaemia stimulates hepatic synthesis of SHBG