DR Bhatia Medical Coaching Institute - Online Test Platform Gynae

7/4/2016
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GrandTestSeries
(Q.1)
2014
SubjectTestSeries
2014
GrandTestSeries
2013
SubjectTestSeries
2013
Ulipristalacetateisusedfor
(a)
Breastcancer
(b)
Endometriosis
(c)
Emergencycontracepon
(d)
AUB
YourResponse:
CorrectAnswer:
Exp:
ThisdrugisaSPRM(selecveprogesteronereceptormodulator).Itisusedforemergency
contraceponandistheonlyhormonalcontraceponthatiseecvefor120hrs.Itis
contraindicatedinhepacdisorderandinlactaonalmothers.
Foremergencycontracepon.a30mgtabletisusedwithin120hours(5days)aeran
unprotectedintercourseorcontracepvefailure.Ithasbeenshowntopreventabout60%
ofexpectedpregnancies,andpreventsmorepregnanciesthanemergencycontracepon
withlevonorgestrel.
Ulipristalacetateisusedforpreoperavetreatmentofmoderatetoseveresymptomsof
uterinebroidsinadultwomenofreproducveageinadailydoseofa5mgtablet.
SpecialVisualBased
Test
APPGFREEMOCK
PART1
(Q.2)
Riskofendometrialcancerincreaseswith
(a)
Nulliparity
(b)
Prolongedlactaon
(c)
PCOD
(d)
Bothaandc
YourResponse:
CorrectAnswer:
Exp:
Endometrialcancerisassociatedwithhyperestrogenicstates.Thepreneoplascstates
includeshyperplasias(simpletypical,simpleatypical,complex,complexatypical).
Theriskfactorsare
a.Nulliparity
b.Earlyageatmenarche
c.Lateageatmenopause
http://test.dbmci.com/Result/ShowAllQuestionInHtml.aspx?testid=4877
1/70
7/4/2016
d.PCOD
e.Exogenousadministraonofestrogen
f.Obesity
g.Nonlactaonal
TheProtecvefactorsinclude
a.Mulparity
b.Prolongedlactaon
c.OCPs
d.Smoking
(Q.3)
Bestmingoftransabdominalchorionicvillousbiopsy
(a)
911weeks
(b)
1113weeks
(c)
1214weeks
(d)
57weeks
YourResponse:
CorrectAnswer:
Exp:
Chorionicvillussampling(CVS)isaformofprenataldiagnosisto
determinechromosomalorgenecdisordersinthefetus.
Itentailsgengasampleofthechorionicvillus(placentalssue)andtesngit.
CVScanbecarriedout911weeksaerthelastperiod,earlierthanamniocentesis(whichis
carriedoutat1620weeks).
CVScanbeperformedviatransabdominalortranscervicalroute.
Indicaons
Mother'sageof35yearsorgreater
Abnormalrsttrimesterscreenresults
Increasednuchaltranslucencyorotherabnormalultrasoundndings
Pasthistoryofachromosomalabnormalityorothergenecdisorder
Parentsareknowncarriersforagenecdisorder
Risk
Thereisariskofmiscarriage(0.81%)
Thereisariskofinfecon
Thereisariskofamniocuidleakage.
Theresulngamniocuidleakcancause.
Iftheresulngoligohydramniosisnottreatedandtheamniocuidconnuestoleakitcan
resultinthebabydevelopinghypoplasclungs(underdevelopedlungs).
Addionally,thereisariskofCVScausingdigit/limbreducondefects&oromandibular
defectsifperformedbefore11weeks.
ThereforetherecommendaontoperformCVSisaer10completedweeks.
Summarytableofalltestsusedforscreening/Diagnosingcongenitalanomalies.
Invesgaon
PeriodofGestaon
Materialofstudy
Maternalserum
Alphafetoprotein
1520weeks
Maternalserumalfafetoprotein
Tripletest
1518wks
MSAFP()
UnconjugatedEstriol()
FreebetahCG()
Integratedtest
10wks
Nuchaltranslucency()
PAPPA()
MSAFP()
Unconjugatedestriol()
BetaHCG()
Inhibin()
1420wks
USG
1014wks
1622wks
FetalAnatomytoseenuchal
translucency
Fetalanatomy
2/70
7/4/2016
Amniocentesis
Early
Amniocentesis
1416wks
1214wks
(canbedoneat10wks)
Fibroblast
Amnioc
Disorders
Chorionicvillisampling
1012weeks
Trophoblastcellsofchorionicvilli
Cordocentesis
(Percutaneousumbilical
bloodsampling)
1820weeks
Bloodandfetalwhitebloodcells
Fetoscopy
1620weeks
Visualizaonofanatomy
Note:
ThisquesonhasbeenaskedinanearlierallIndiaaswell.Thenthechoiceswere810,10
12,1214,1416.Williamsobstetricswritethebestmeas1013weeks.Nowinthis
quesonthechoiceareoddchoices,i.e911,1113.Thebestmehereis911weeksas
11weeksandlaterisinfacttoolate.Themechosenbyalmostallcentersaroundthe
worldtodoCVSisinfact911weeks.
(Q.4)
(Q.5)
(Q.6)
Themostreliablefetalparameterforesmaonofgestaonalageinrsttrimesteris
(a)
Femurlength
(b)
Gsacdiameter
(c)
CRL
(d)
BPD
YourResponse:
CorrectAnswer:
Exp:
Gestaonalage(GA)inthersttrimesterisusuallycalculatedfromthefetalcrownrump
length(CRL).Thisisthelongestdemonstrablelengthoftheembryoorfetus,excludingthe
limbsandtheyolksac.ThecorrelaonbetweenCRLandGAisexcellentunlapproximately
12weeks.Nosexorracedierencesareappreciable,butmaternalcharacteriscs,suchas
ageandsmoking,mayhaveasignicanteectbeyond10weekgestaon.TheGAesmate
hasa95%condenceintervalofplusorminus6days,anditismostaccuratebetween7
and10weeksofpregnancy.Transabdominalultrasonographymayunderesmate
gestaonalagebyanaverageof1.6dayscomparedwithtransvaginalultrasonography.
MostcommonserotypeofHPVassociatedwithinvasivecervicalcarcinomais?
(a)
HPV16
(b)
HPV18
(c)
HPV32
(d)
HPV36
YourResponse:
CorrectAnswer:
Exp:
HPVisassociatedwith80%ofCINandover90%ofinvasivecarcinoma
'HPV16ismostcommonHPVassociatedwithsquamouscellcarcinoma.HPV18ismost
commonHPVassociatedwithAdencarcinoma.'CGDT9thedpg904
Asitiswellknownthathistologically95%ofcervicalcaareSCCandonly5%adenoca.
HenceHPVisthemostcommonserotypeofHPVassociatedwithcervicalca.
Onthebasisofstrengthofassociaontocacervix,HPVhasbeenclassiedinto:
Lowrisktype6,11,42,43
CausesCINandcondylomaacuminate
Intermediaterisk33,35,55,52
CausesCINIandCINthatdon'tprogress.
Highrisk16,18,31,39,45,56,48,59
CauseshighgradeCINthatprogressestoinvasiveca.
Shapeofnulliparouscervixis:
(a)
Transverse
(b)
Longitudinal
(c)
Circular
(d)
Tshaped
3/70
7/4/2016
(Q.7)
(Q.8)
(Q.9)
YourResponse:
CorrectAnswer:
Exp:
Shapeofnulliparouscervixiscircularthecervixisspindleshapedandmeasures2.5cm.It
isboundedabovebyinternalosandbelowbyexternalos.Innulliparouswomenthe
externalosiscircularwhereasparouscervixischaracterizedbyatransverseslit.
Fibroidcausesallthefollowingexcept
(a)
Inferlity
(b)
Amenorrhea
(c)
Pelvicmass
(d)
Menorrhagia
YourResponse:
CorrectAnswer:
Exp:
Symptomsofbroidare:
Menorrhagia,polymenorrheaandmetrorrhagia
Inferlity,recurrentaborons
Pain
Abdominallump
Pressuresymptoms
Vaginaldischarge
Around50%womenareasymptomac.
Importantpoints:
Thesearebenignneoplasmsoccurringin520%ofwomeninreproducveagegroup.
Oestrogendependenceongrowthismostimpeologicalfactor,sorarebeforepubertyand
aermenopause.
Calcicaonbeginsatperipherywhereasdegeneraonbeginsincentralporon.
Distribuonofmyomainbodyofuterusisintramural(75%),submucous(15%)and
subserous(10%).
Reddegeneraonisseenin2ndhalfofpregnancyandneedsconservavemanagement.
Sarcomatouschangeisseenin0.5%ofallmyomas.Itoccursinpostmenopausalwomen
andcharacterizedbysuddengrowth,painandpostmenopausalbleeding.
Endometrialcaisassociatedwithbromyomasinwomenover40yrsofagein3%cases.
AnovarianTUMOURwasidenedinimmediatepostpartumperiod,themingofsurgerywillbe:
(a)
Immediatelyaerdelivery
(b)
6wks
(c)
1wk
(d)
3mths
YourResponse:
CorrectAnswer:
Exp:
Treatmentofovariantumourinpregnancydependingonmeofpregnancy:
Duringpregnancy
Inanuncomplicatedcase,thebestmeofelecveoperaonisb/w1418wksaschances
ofaboronarelessandaccesstothepedicleiseasy.Butifthetumourisdiagnosedbeyond
36weeks,tumourisremovedearlyinpuerperium.
Duringlabour
Ifthetumourisabovethepresenngpartwatchfulexpectancyisfollowedbutifits
impactedinpelvis,caesarianseconshouldbedonefollowedbyremovaloftumourin
sameseng.
Duringpuerperium
Thetumourshouldberemovedasearlyinpuerperiumaspossible.
Treponemapallidumcrossesplacenta:
(a)
Aer36weeks
4/70
7/4/2016
(b)
Aer28weeks
(c)
Aer2ndtrimester
(d)
Atanystageofpregnancy
YourResponse:
CorrectAnswer:
Exp:
TransmissionofTreponemapallidumfromaninfectedwomantoherfetusacrossthe
placentamayoccuratanystageofpregnancy,butthelesionsofcongenitalsyphilisusually
developaerthe4thmonthofgestaon,when"fetalimmunologic"competencebeginsto
develop.
(Q.10)
ContraindicaonofvaginaldeliveryinfemalewithpreviouscesareanseconincludeallEXCEPT.
(a)
Previousclassicalcesareansecon
(b)
Breechpresentaon
(c)
Nohistoryofvaginaldeliveryinthepast
(d)
Puerperalinfeconinpreviouspregnancy
YourResponse:
CorrectAnswer:
Exp:
Absoluteindicaonsforcesareanseconare:
(Wherevaginaldeliveryisnotpossiblecesareanseconisneededevenwithadeadfetus)
a.Centralplacentaprevia
b.Contractedpelvisorcephalopelvicdisproporonabsolute
c.Pelvicmasscausingobstrucon(cervicalorbroadligamentbroid)
d.Advancedcarcinomacervix
e.Vaginalobstrucon(atresia,stenosis)
Commonindicaonsare
Primigravida
a.Cephalopelvicdisproporon
b.Fetaldistress
c.Dystocia
Mulgravida
a.Previouscesareandelivery,parcularlypreviousclassicalcesareansecon
b.Antepartumhemorrhage(placentaprevia,placentalabrupon)
c.Malpresentaon(breech)
Relaveindicaonsforcesareansecon:
(Vaginaldeliverymaybepossiblewithorwithoutaids.Butriskstothemotherand/orto
thebabyarehigh.Moreoenmulplefactorsmayberesponsible.Indicaonsaremore
commonthantheabsoluteones)
a.Cephalopelvicdisproporon(relave)
b.Previouscesareandelivery
WhenprimaryC.S.wasduetorecurrentindicaon(contractedpelvis)
PrevioustwoC.S.
Featuresofscardehiscence
PreviousclassicalC.S.
c.NonreassuringFHR(fetaldistress)
d.DystociamaybeduetothreePsrelavelylargefetus(Passenger),smallpelvis(Passage)
orinecientuterinecontracons(Power).
e.Antepartumhemorrhage
Placentapreviaand
Abrupoplacenta
f.Malpresentaon
Breech,Shoulder(transverselie),Brow
g.Failedsurgicalinduconoflabor,Failuretoprogressinlabor
h.Badobstetrichistorywithrecurrentfetalwastage
i.Hypertensivedisorders
Severepreeclampsia
5/70
7/4/2016
Eclampsiauncontrolledtsevenwithanseizuretherapy
j.MedicalGynecologicaldisorders
Diabetes(uncontrolled),heartdisease(coarctaonofaorta),
Marfanssyndrome
Mechanicalobstrucon(duetobenignormalignantpelvictumors(carcinomacervix),or
followingrepairofvesicovaginalstula
Note
a.PreviousClassicalCesareanseconpresentswithincreasedriskofscarruptureduring
subsequentlaborandonecanpermitvaginaldeliverywithgreatercondenceaerlower
segmentseconthanaerclassicalsecon
b.NoHistoryofVaginalDeliveryinthepastpointstowardsapersisngindicaon(like
contractedpelvis)anditisbeertodoElecveCesareanratherthantryforVaginal
Delivery
c.BreechpresentaonperseinapaentwithpreviousLSCSisnotanindicaonfor
elecverepeatcesareansecon,ifthebabyisaverageinsizeandpelvisadequate.
d.Puerperalinfeconinpreviouspregnancymayresultinbadhealingandhenceaweak
scar.
(Q.11)
(Q.12)
(Q.13)
Mostcommonsiteforendometriosisis:
(a)
Ovary
(b)
Peritoneum
(c)
Appendix
(d)
Urinarybladder
YourResponse:
CorrectAnswer:
Exp:
Endometriosisischaracterizedbythepresenceandproliferaonofendometrialssue
(stromaandglands)outsidetheendometrialcavity.Itoccursmostcommonlybetweenthe
agesof3040andisfoundincidentallyatthemeofsurgery.Themostcommonly
involvedsitesaretheovary,fallopiantubes,uterineligaments,andpelvicperitoneum.The
majorsymptomispelvicpain,characteriscallydysmenorrhea.Theferlityrateis
reduced.
Carcinomacervixpresentswith
(a)
Postcoitalbleed
(b)
Abnormalvaginalbleed
(c)
Purulentdischargepervaginum
(d)
Alloftheabove
YourResponse:
CorrectAnswer:
Exp:
Carcinomacervixhasabimodalpeakoneat3035yrsandasecondpeakat5055yrs..
Presentaonistypicallyabnormalvaginalbleedinginreproducveagegroupwith
metrorrhagiaandinpostmenopausalwomenwithpostmenopausalbleeding.Therecan
beacervicalgrowthwhichcanleadtopostcoitalbleeding.Ititundergoesnecrosisthen
therecanbepurulentdischargepervaginum.Somemescancercervixcanpresentwith
VVFandwithalsowithfeaturesofuraemia.
Pregnancyiscontraindicatedinallexcept:
(a)
Eisenmengersyndrome
(b)
Primarypulmonaryhypertension
(c)
Marfansyndromewithaorcrootdilaon
(d)
WPWsyndrome
YourResponse:
CorrectAnswer:
Exp:
Eisenmengerssyndromecarriesaveryhighmortalityinpregnancy(upto50%)andhence
pregnancyandcesareanseconarebothcontraindicatedinthiscondion.
Perseinheartdiseasepaentscesareanseconisdoneonlyforobstetricindicaons.
6/70
7/4/2016
Heartdiseaseinwhichelecvecesareanseconshouldbedoneis:
Marfanssyndromewithaorcrootdilataon>4cm(duetoriskofaorcdisseconduring
labour)coarctaonofaortaandaorcaneurysmshouldalsobepreferablydeliveredby
cesareanseconduetoriskofruptureduringlabour
ClarkesClassicaonOfMortalityInHeartDiseaseInPregnancy
LowRisk(mortality<1%)
Atrialseptaldefect
Ventricularseptaldefect
Patentductusarteriosus
Pulmonary/tricuspiddisease
MS(NYHA1&2)
CorrectedTOF
IntermediateRisk(515%)
UncorrectedTOF
UNcomplicatedCoarctaonoftheaorta
Marfansyndromewithanormalaorcroot
MS(NYHA3&4)
AS
HighRisk(2550%)(CONTRAINDICATIONSTOPREGNANCY)
Eisenmenger'ssyndrome
Primarypulmonaryhypertension
Complicatedcoarctaonofaorta
Marfansyndromewithaorcrootorvalveinvolvement
(Q.14)
(Q.15)
(Q.16)
Puerperalfeverfrombreastengorgement
(a)
Appearsinlessthan5%ofpostpartumwomen
(b)
Appears3to4daysaerthedevelopmentoflactealsecreon
(c)
Isalmostpainless
(d)
Islesssevereandlesscommoniflactaonissuppressed
YourResponse:
CorrectAnswer:
Exp:
Puerperalfeverfrombreastengorgementisrelavelyuncommon,aecng13to18%of
postpartumwomen.Itappears24to48hfollowinginiaonoflactealsecreonand
rangesfrom38to39C(100.4to102.2F).Painisanearlyandcommonsymptom.
Treatmentconsistsofbreastsupport,icepacks,andpainrelievers.Theincidenceand
severityofbreastengorgementareloweriftreatmentisgivenforsuppressionoflactaon.
Maximumincreaseincardiacoutputduringpregnancyisseenin:
(a)
32weeks
(b)
36weeks
(c)
Duringlabour
(d)
Justaerdelivery
YourResponse:
CorrectAnswer:
Exp:
Thecardiacoutputstartstoincreasefrom5thwkofpregnancyandreachesitspeak(40
50%)atabout3034wks.Thereaeritremainsstaclllabour(+50%)andimmediately
followingdelivery(+70%)overtheprelabourvalues.Thisincreaseincardiacoutputisdue
tosqueezingoutofbloodfromtheuterusintothematernalcirculaon(autotransfusion)
duringlabourandintheimmediatepostpartum.
Cardiacoutputreturnstotheprelabourvaluesby1hrfollowingdeliveryandtothepre
pregnantlevelsby4weeksme.
Gartner'sductcystisseenin:
(a)
Vagina
(b)
Cervix
7/70
7/4/2016
(Q.17)
(Q.18)
(Q.19)
(c)
Hymen
(d)
Labiaminora
YourResponse:
CorrectAnswer:
Exp:
ThemostGammontypeofvaginalcystsisGartner'sductCyst.Thesecystsarisefromthe
caudalremnantsofthemesonephricorWolanductsystem.Theyareusuallylocated
alongtheanterolateralaspectofthevaginalwallsandarefrequentlybilateral.
Gartner'sductsareremnantsofthemesonephric(Wolan)ductinthefemaleandconsist
ofaseriesofnyvesgialcystsextendingalongthelateralaspectoftheuterustothe
vaginalvesbule.
Fetallungmaturityisassessedbyallthefollowingexcept
(a)
Lecithinsphingomyelinrao
(b)
Nilebluesulfatetest
(c)
Nitrazinepapertest
(d)
Creanineesmaonofamniocuid
YourResponse:
CorrectAnswer:
Exp:
Nitrazinepaperisusedtodetectsmallquanesof'amniocuid'invaginalsecreons.It
isusedinconjunconwiththeferntesttohelpdetectrupturedmembranes.False
posiveresultsmayoccurfromspecimencontaminaonduetoheavyvaginaldischarge,
blood,cervicalmucus,semen,alkalineurine,andsoap.Fa/senegaveresultsmaybe
producedbyprolongedruptureofmembranes(>24hours)orwhenasmallvolumeof
uidhasleaked.SpecimencontaminaonwillresultinerroneouspHresults.
TheonlynonhormonaltreatmentofhotushesapprovedbyFDA?
(a)
Fluoxene
(b)
Paroxen
(c)
Estriol
(d)
Noneoftheabove
YourResponse:
CorrectAnswer:
Exp:
ThereareavarietyofFDAapprovedtreatmentsforhotashes,butallcontaineither
estrogenaloneorestrogenplusaprogesn.Hotashesassociatedwithmenopauseoccur
inupto75percentofwomenandcanpersistforuptoveyears,orevenlongerinsome
women.Brisdelle,whichcontainstheselecveserotoninreuptakeinhibitorparoxene
mesylate,iscurrentlytheonlynonhormonaltreatmentforhotashesapprovedbythe
FDA.ThemechanismbywhichBrisdellereduceshotashesisunknown.Themost
commonsideeectsinpaentstreatedwithBrisdellewereheadache,fague,and
nausea/voming.
Clomiphenecitrateisusedin:
(a)
Carcinomaendometrium
(b)
Asherman'ssyndrome
(c)
SteinLeventhalsyndrome
(d)
Adrenogenitalsyndrome
YourResponse:
CorrectAnswer:
Exp:
ClomipheneisthedrugofchoiceinpaentssueringformSteinLeventhalsyndrome.Itis
alsousedinthetreatmentof:
Anovulaonoroligoovulaoninpaentsdesiringpregnancy,whosesexualpartnershave
adequatesperm,andwhohavepotenallyfunconalhypothalamichypophysealovarian
systemsandadequateendogenousestrogen;
Corpusluteumdysfuncon;
Inferlityinmaleswitholigospermia.
8/70
7/4/2016
(Q.20)
Whichofthefollowingisthemechanismofaboronscks?
(a)
Smulaonofuterinecontracon
(b)
Menstrualbleeding
(c)
IrritaonoftheGIT
(d)
Irritaonofthegenitourinarytract
YourResponse:
CorrectAnswer:
Exp:
(Q.21)
Themainmechanismoftheuseofaboronscksistoproduceanirritantacononthe
uterussoastoinduceuterinecontraconsandexpulsionofthefetus.
Aboronsckisanobjectusedtoprocureillegalaboronbyunskilledinterferenceby
eitherselforbysomeoneelse(adai/midwife).
Itusuallyconsistsofaspeciallymadewoodenorbamboosckabout1520cmlongora
twigofsimilarlengthwithsomeirritantplantsuchasMadar(Calotropis),Chitra
(Plumbagozeylanica)orKaner(Neriumodorum)appliedatoneofitsends.
Theirritantsubstanceisappliedtosomecoonwoolorapieceofragatoneendofthe
sck.
Theaboronsickisintroducedintotheosoftheuterusthuscausingaboronwithor
withoutruptureofthemembranes.
Excoriaon,bruisingorperforaonofthevaginaoruterusmayoccurasaresultofthe
irritantaconofthesubstance.
Allthefollowingdrugsareusedforpostcoitalcontraceponexcept
(a)
Danazol
(b)
Ethinylestradiol
(c)
Levonorgestrel
(d)
Mifepristone
YourResponse:
CorrectAnswer:
Exp:
Postcoitalcontracepveagentsinterferewithpostovulatoryeventsleadingtopregnancy
andareknownasintercepve.Theyarechieyusedfollowingrape,unprotected
intercourseoraccidentalruptureofacondomduringcoituswhichtakesplacearound
ovulaon.Theseagentsare:
1.2tabletsofrelavelyhighdosesofcombinedpillcontaining100gethinylestradiol
and1mgnorethisteronearetakenwithin72hoursofintercoursefollowedby2tablets
taken12hourslater.
2.Ethinylestradiol5mgdailyfor5daysstarngwithin72hoursofexposure.
Slboestrol50mgdailyfor5days.
3.IVequineconjugatedestrogentwicedaily
4.Levonorgestrel600ganddnorgestrel.54mgfor5days.
5.RU486(Mifepristone)
(Q.22)
TreatmentofchoiceforcarcinomacervixstageIBis:
(a)
Radiotherapy
(b)
Externalhysterectomy
(c)
Abdominalhysterectomy
(d)
Panhysterectomy
YourResponse:
CorrectAnswer:
Exp:
Carcinomacervixinsitu(stage0)cangenerallybesuccessfullymanagedbyconebiopsyor
byabdominalhysterectomy.ForstageIdisease,resultsappearequivalentforeither
9/70
7/4/2016
radicalhysterectomyorradiaontherapy.PaentswithstagesIItoIVdiseaseareprimarily
managedwithradicalradiaontherapy.
(Q.23)
(Q.24)
Karyopyknocindexishigheston
(a)
Proliferavephase
(b)
Dayofovulaon
(c)
Secretoryphase
(d)
Menstruaon
YourResponse:
CorrectAnswer:
Exp:
Anindexthatiscalculatedasthepercentageofepithelialcellswithkaryopyknocnuclei
exfoliatedfromthevaginaandisusedinthehormonalevaluaonofapaent.Underthe
inuenceofestrogenkaryopyknocindexincreases.Asestrogenpeaksatovulaonor
justpriortheindexishighestatovulaon.Thesmearforthesameistakenfromthe
lateralvaginalwallascellshererespondtocyclicalchangesinhormonethatoccursinthe
menstrualcycle.
Lowmaternalserumalphafetoproteinisnotseenin:
(a)
Trophoblascdiseases
(b)
Overesmatedgestaonalage
(c)
Trisomy21
(d)
Neuraltubedefect
YourResponse:
CorrectAnswer:
Exp:
Alphafetoproteinisanangenpresentinthehumanfetusandincertain
pathologicalcondionsintheadult.Thematernalserumlevelshouldbe
evaluatedat16to18weeksofpregnancytodetectfetalabnormalies.Itis
increasedinthefollowingcondions:
.Anencephaly
Meningomyelocele(NTD)
.Encephalocele
Omphalocele(Exomphalos)
.Meckelsyndrome
Congenitalnephrosis
.Impendingspontaneous
aboron
.Rhsensizaon
Presenceofintesnalatresia
DecreasedlevelsindicateanincreasedriskofhavingababywithDown
syndrome(Trisomy21).
IfanabnormallevelofAFPisfound,furthertestssuchasultrasoundor
amniocentesisshouldbedonetoestablishthenaldiagnosis.Elevatedserum
levelsarealsofoundinadultswithcertainhepaccarcinomasorchemical
injuries.
(Q.25)
Supportsofuterusareallexcept:
(a)
Uterosacralligaments
(b)
Mackenrodt'sligament
(c)
Broadligament
(d)
Levatorani
YourResponse:
CorrectAnswer:
Exp:
CLASSIFICATION
Primarysupports
a.Muscularoracve
Pelvicdiaphragm
Perinealbody
Urogenitaldiaphragm
10/70
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b.Fibromuscularormechanical
Uterineaxis
Pubcervicalligament
Transversecervicalligament
Uterosacralligament
Roundligamentofuterus
Secondarysupports
Broadligaments
Uterovesicalfoldofperitoneum
RectovaginalfoldofperitoneumBroadLigaments:
Thesearefoldsofperitoneumwhichaachtheuterustothelateralpelvicwall.ithas
anteriorandposteriorsurfacesandupper,lower,medialandlateralborders.Itcontains
thefollowingstructures:.Uterinetube
Roundligofuterus
Ligofovary
Uterineandovarianplexusandnerveplexus
Epoophoronandparoophoron
Lymphacs
Connecvessue.
(Q.26)
Notanabsolutecontraindicaonoforalcontracepvepill:
(a)
Uterinebleeding
(b)
Breastcarcinoma
(c)
Hydadiformmole
(d)
Genitalcancer
Your
Response:
Correct
Answer:
Exp:
(Q.27)
c
Absolutecontraindicaonsoforalcontracepve
pillsare:
Cancerofbreastandgenitals;
Liverdisease;
Previousorpresenthistoryof
thromboembolism;
Cardiacabnormalies;
Congenitalhyperlipidemia;
Undiagnosedabnormaluterinebleeding.
Drugnothelpfulininduconofovulaonis:
(a)
Progesterone
(b)
Clomiphene
(c)
Gonadotropin
(d)
Tamoxifen
YourResponse:
CorrectAnswer:
Exp:
(Q.28)
Chorionicgonadotropinwithmenotropinsorurofollitropinisthetreatmentofchoicefor
induconofovulaoninpaentswhodonotrespondtoclomiphene.
Clomipheneisindicatedinthetreatmentofanovulaonoroligoovulaoninpaents
desiringpregnancy.
Tamoxifenmayinduceovulaoninanovulatorywomen,smulangreleaseof
gonadotropinreleasinghormonefromthehypothalamus,whichinturnsmulatesrelease
ofpituitarygonadotropins.
Notafeatureofpseudocyesis:
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(Q.29)
(Q.30)
(a)
Weightgain
(b)
Morningsickness
(c)
Enlargementofuterus
(d)
Amenorrhea
YourResponse:
CorrectAnswer:
Exp:
Pseudocyesisorphantompregnancyorpseudopregnancyisacondioninwhichapaent
hasnearlyalloftheusualsignsandsymptomsofpregnancy(suchasenlargementofthe
abdomen,weightgain,cessaonofmenses,andmorningsickness)butisnotpregnant.
Thiscondionisusuallyseeninwomenwhoeitherareverydesirousofhavingchildrenor
wishestoavoidpregnancy.Treatmentusuallyisdonebypsychiatricmeans.
ThepresentaonofAshermansyndrometypicallyinvolves:
(a)
Hypomenorrhea
(b)
Oligomenorrhea
(c)
Menorrhagia
(d)
Metrorrhagia
YourResponse:
CorrectAnswer:
Exp:
OvulaonisnotaectedinAshermansyndrome.Becauseofthedecreasedamountof
funconalendometrium,progressivehypomenorrhea(lightermenstrualow)or
amenorrheaiscommon.Thebestdiagnoscstudyisthehysterogramunderuoroscopy.
Hysteroscopywithlysisofadhesionsisthetreatmentofchoice.Prophylaccanbiocs
mayimprovesuccessrates.
Endosalpingisisbestdiagnosedby
(a)
Laparoscopy
(b)
XRayabdomen
(c)
Hysterosalpingography
(d)
Sonosalpingography
YourResponse:
CorrectAnswer:
Exp:
Laparoscopyalsocalledlaparohysteroscopyisaprocedureinwhichthetubescanbe
examinedunderdirectvisionwithanendoscopeandifthepelvislooksinamedthenthe
bestplacetotakeabiopsyforcultureisthetubalend.Sameholdstrueforthediagnosis
ofendosalpingis.
XRayabdomenistoogrossaprocedureandinformsmostlyanatomicalproblemsofthe
pelvis.
HSGisaprocedurewhichwillinformregardingthetubalpatencyandoutlinestheuterine
anatomyalongwithuterinepolypsandbroids.
TheremaybesomellingdefectsinthetuberecognizedwithagoodHSGifthereis
Endosalpingisbutitdoesnotprovethediagnosisasisdonebyadirecttubalculture.
Sonosalpingographyisanassessmentofthetubalpatencybyperfusingtheuterusand
thereforethetubeswhileobservingtheuterusandthepouchofDouglasbyan
ultrasound.Thisprocedureisgoodforthediagnosisoftubalpatencybutnotfor
infecons.
(Q.31)
ThesourceofHCGis:
(a)
Syncyotrophoblasts
(b)
Cytotrophoblasts
(c)
Langhansslayer
(d)
Chorionicvilli
YourResponse:
CorrectAnswer:
Exp:
(Ref.TextbookofObstetricsD.C.Dua6thEd.58)
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TheSyncyotrophoblastoftheplacentaproducesHCG.ThehalflifeofHCGisabout
24hours.Byradioimmunoassay,itcanbedetectedinthematernalserumorurineasearly
as89daysfollowingovulaon.
REF:WILLIAMSOBSTETRICS23rdEdPg63states:
Before5weeks,hCGisexpressedinbothSyncyotrophoblastandcytotrophoblasts.
Laterwhenthematernalserumlevelspeak,itisproducedalmostsolelyinthe
Syncyotrophoblast.AtthismehCGmRNAsforbothalphaandbetasubunitsin
Syncyotrophoblastaregreaterthanatterm.Thismaybeanimportantconsideraon
whenhCGisusedasascreeningproceduretoidenfyabnormalfetuses.
ForallpraccalpurposestheanswertothisquesonwillbeA.Syncyotrophoblast.
(Q.32)
LHisrequiredfor:
(a)
Ferlizaon
(b)
Folliculargrowth
(c)
Tubularmolity
(d)
Menstruaon
YourResponse:
CorrectAnswer:
Exp:
Inbothmalesandfemales,LHisessenalforreproducon.
Infemales,atthemeofmenstruaon,FSHiniatesfolliculargrowth,specically
aecnggranulosacells.Withtheriseinoestrogens,LHreceptorsarealsoexpressedon
thematuringfolliclethatproducesanincreasingamountofestradiol.
Eventuallyatthemeofthematuraonofthefollicle,theoestrogenriseleadsviathe
hypothalamicinterfacetotheposivefeedbackeect,areleaseofLHovera24to48
hourperiod.This'LHsurge'triggersovulaon,therebynotonlyreleasingtheeggbutalso
iniangtheconversionoftheresidualfollicleintoacorpusluteumthat,inturn,produces
progesteronetopreparetheendometriumforapossibleimplantaon.
LHisnecessarytomaintainlutealfunconforthersttwoweeks.Incaseofapregnancy,
lutealfunconwillbefurthermaintainedbytheaconofhCG(ahormoneverysimilarto
LH)fromthenewlyestablishedpregnancy.LHsupportsthecacellsintheovarythat
provideandrogensandhormonalprecursorsforestradiolproducon.
Inthemale,LHactsupontheLeydigcellsofthetessandisresponsibleforthe
produconoftestosterone,anandrogenthatexertsbothendocrineacvityand
intratescularacvityonspermatogenesis.
(Q.33)
AllofthefollowingovariantumoursarisefromsurfaceepitheliumEXCEPT:
(a)
Mucinouscystadenoma
(b)
Endometrialcarcinoma
(c)
Brennertumour
(d)
Benigncyscteratoma
YourResponse:
CorrectAnswer:
Exp:
NOTE:Teratomaisagermcelltumour.Otherovariangermcell
tumoursare:
1.Dysgerminoma
2.Endodermalsinus(yolksac)tumour
3.Choriocarcinoma
4.Embryonalcellcarcinoma
Serouscystadenomaarisesfromsurfaceepithelium,
Sexcordstromaltumoursofovary
1.Granulosacelltumour
2.Thecacelltumour
3.Arrhenoblastoma
4.Gynandroblastoma
5.Hiluscelltumour
Mostcommonconnecvessuetumourofovaryisovarian
broma.
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(Q.34)
(Q.35)
Whichofthefollowingtypeofanesthesiaisfrequentlyassociatedwithfetalbradycardia:
(a)
Paracervicalblock
(b)
Pudendalblock
(c)
Spinalblock
(d)
Epiduralblock
YourResponse:
CorrectAnswer:
Exp:
Pudendalblockisperhapsthemostcommonformofanesthesiausedforvaginaldelivery.
Itprovidesadequatepainreliefforepisiotomy,spontaneousdeliveryforcepsdelivery,or
vacuumextracon.Thesuccessofapudendalblockdependsonaclearunderstandingof
theanatomyofthepudendalnerveanditssurroundings.Complicaons(vaginal
hematomas,retropsoas,orpelvicabscesses)arequiterare.Paracervicalblockwasa
popularformofanesthesiafortherststageoflaborunlitwasimplicatedinseveralfetal
deaths.Ithasbeenshownthatparacervicalblockwasassociatedwithfetalbradycardiain
25to35%ofcases,probablytheresponsetorapiduptakeofthedrugfromthehighly
vascularparacervicalspacewitharesultantreduconofuteroplacentalbloodow.Death
insomecaseswasrelatedtodirectinjeconofthelocalanesthecintothefetus.
Whichofthefollowingisthemostcommonsiteoftuballigaon:
(a)
Ampulla
(b)
Isthmus
(c)
Intersal
(d)
Fimbria
YourResponse:
CorrectAnswer:
Exp:
ThemostpopulartechniqueoftuballigaonisthePomeroyoperaoninthisaloopis
madebyholdingthetubebyanallisforcepsinsuchawaythatthemajorpartoftheloop
consistsofisthmusandpartofampullarypartoftubei.e.atthejunconofproximaland
middlethird.
Thetotallengthoftubeis10cmjunconofproximalandmiddlethirdisapprox3.25cm.
Lengthofvariouspartsoffallopiantube:
Intramural=1.25cm
Ampulla=5cm
Isthmus=2.5cm
Infundibulum=1.25cm
Othermethodsofsterilizaon:
Pomeroymethod
Madlenermethod
Irvingmethod
Aldridgemethod
Cornealresecon
Uchidamethod
Fimbriectomy
(Q.36)
Carcinomaendometriumwithsupercialinguinallymphnodeinvolvementisof:
(a)
StageIV
(b)
StageIII
(c)
StageII
(d)
StageI
YourResponse:
CorrectAnswer:
Exp:
TheInternaonalFederaonofGynecologyandObstetrics(FIGO)stagingsystemfor
carcinomaofcorpusuteriisasfollows:
StageIATumorlimitedtoendometrium<8cm)
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StageIBInvasiontolessthanonehalfthemyometrium(>8cm)
StageICInvasiontomorethanonehalfthemyometrium
StageIIAEndocervicalglandularinvolvementonly
StagelIBCervicalstromalinvasion
StageIlIATumorinvadesserosaand/oradnexaand/orposiveperitonealcytology
StageIIIBVaginalmetastasis
StageIUCMetastasestopelvicand/orparaaorclymphnodes
StageIVATumorinvasionofbladderand/orbowelmucosa
StageIVBDistantmetastasesincludingintraabdominaland/oringuinallymphnodes
Casesofcarcinomaofthecorpusshouldbeclassied(orgraded)accordingtothe
degreeofhistologicdierenaon.Thehistopathologyanddegreeofdierenaonisas
follows:
ClassG1Nonsquamousornonmorularsolidgrowthpaernof5%orless
ClassG2Nonsquamousornonmorularsolidgrowthpaernof650%
ClassG3Nonsquamousornonmorularsolidgrowthpaernofmorethan50%
(Q.37)
Whichofthefollowingstatementsconcerningappendicisinpregnancyistrue?
(a) Diagnosisissimilartothatinthenonpregnantpaent
(b) Thematernaldeathrateishighestinthersttrimester
(c) Surgicaltreatmentshouldbedelayedunlthediagnosisisrmlyestablished
(d) Theincidenceisunchangedbypregnancy
(Q.38)
YourResponse:
CorrectAnswer:
Exp:
Theincidenceofappendicisinpregnancyis1in2000,thesameasthatinthe
nonpregnantpopulaon.Thediagnosisisverydicultinpregnancybecauseleukocytosis,
nausea,andvomingarecommoninpregnancyandtheupwarddisplacementofthe
appendixbytheuterusmaycauseappendicistosimulatecholecyss,pyelonephris,
gastris,ordegenerangmyomas.Surgeryisnecessaryevenifthediagnosisisnotcertain.
Delaysinsurgeryduetodicultyindiagnosisastheappendixmovesupareprobablythe
causeofincreasingmaternalmortalitywithincreasinggestaonalage.Prematurebirth
andaboronaccountforarateoffetallosscloseto15%.
Intrauterinediagnosisofanencephalycanearliestbedoneatwhatgestaonalage?
(a)
10to12weeks
(b)
12to14weeks
(c)
20to26weeks
(d)
22to26weeks
YourResponse:
CorrectAnswer:
Exp:
(Ref.SuonRadiology7thed.1050)
Themainsonographicfeatureofanencephalyissymmetricabsenceoftheskullvault,and
thecerebralhemispheresbutrelavepreservaonofbrainstemandporonofmidbrain.
Althoughonultrasonographicallythediagnosiscanbesuspectedby1213weeksof
gestaon,itismorereliablebyaround1516weeks,whentheossicaoninnormal
calvarialbonesismoreobvious.
(Q.39)
NotcausedbyDMPA:
(a)
Thromboembolism
(b)
Amenorrhea
(c)
Irregularcycle
(d)
Weightgain
YourResponse:
CorrectAnswer:
Exp:
Depomedroxyprogesteroneacetate(DMPA)isasuspensionofmicrocrystalsofasynthec
progesnwhichisinjectedintramuscularly.Pharmacologicalacvelevelsareachieved
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within24hoursaerinjecon,andserumconcentraonsof1ng/mLaremaintainedfor3
months.Duringthehorsixthmonthaerinjecon,thelevelsdecreaseto0.2ng/mL,
andtheybecomeundetectableby79monthsaerinjecon.Itactsbytheinhibionof
ovulaonwiththesuppressionofFSHandLHlevelsandeliminatestheLHsurge.This
resultsinarelavehypoestrogenicstate.Singledosesof150mgwillsuppressovulaonin
mostwomenforaslongas14weeks.Thecontracepveregimenconsistsof1doseevery
3months.Itisanextremelyeecvecontracepveopon.Neithervaryingweightnoruse
ofconcurrentmedicaonshasbeennotedtoalterecacy.Withintherstyearofuse,the
failurerateis0.3%.Itdoesnotproducetheseriousadverseeectsofestrogen,suchas
thromboembolism.Dysmenorrheaisdecreased.Riskofendometrialandovariancanceris
decreased.Disadvantagesaredisruponofthemenstrualcycletoeventualamenorrhea
occursin50%ofwomenwithintherstyear.Persistentirregularbleedingcanbetreated
byadministeringthesubsequentdoseearlierorbyaddingalowdoseestrogen
temporarily.BecauseDMPApersistsinthebodyforseveralmonthsinwomenwhohave
useditonalongtermbasis,itcandelaythereturntoferlity.Otheradverseeects,such
asweightgain,depression,andmenstrualirregularies,mayconnueforaslongasone
yearaerthelastinjecon.
(Q.40)
ChorionicvillusbiopsyisdoneinallofthefollowingEXCEPT
(a)
Neuraltubedefects
(b)
Sicklecelldisease
(c)
Myotonicdystrophy
(d)
Downsyndrome
YourResponse:
CorrectAnswer:
Exp:
IndicaonsofChorionicvillusbiopsy:
KaryotypingisthemostcommonindicaonDownsyndrome
HemoglobinopathiesSicklecelldisease,Thalassemia,etc.
BiochemicalstudiesGauchersdisease,NiemannPickdisease,TaySachsdisease,etc.
SinglegenedefectsMyotonicdystrophy,Cyscbrosis,Hunngtonsdisease,
Phenylketonuria,etc.
Neuraltubedefectsarediagnosedbyultrasoundandesmaonofalphafetoproteinin
maternalserum/amniocuid.
Chorionicvillousbiopsycanbedoneaer10thweek(earlierthanamniocentesis)
Earlierresultsreducematernalstressbygoingforapossibletherapeucaboron(if
indicated)atanearlystage.
Iniallyatranscervicalrouteisacceptabletotakethesample.
Atransabdominalrouteistakenifthepregnancyexceeds12thweek.
(Q.41)
(Q.42)
Notasideeectoforalcontracepves:
(a)
Dysmenorrhea
(b)
Mastalgia
(c)
Chloasma
(d)
Breakthroughbleeding
YourResponse:
CorrectAnswer:
Exp:
Adverseeectsoforalcontracepvepillsincludenausea,breastpainandtenderness,
weightgain,breakthroughbleeding,amenorrhea,headaches,depression,anxiety,and
decreasedlibido.OCsdonotprovideproteconfromSTDs.Afewmonthsofdelayof
normalovulatorycyclesaerdisconnuaonofOCsmayoccur.Womentakingoral
contracepvepillsmayalsodevelopchloasma,whichisaugmentedbyexposuretothe
sun.
LARC(Longacngreversiblecontracepves)include?
(a)
Implants
(b)
Injecons
(c)
IUCD
(d)
Alloftheabove
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(Q.43)
YourResponse:
CorrectAnswer:
Exp:
Longacngreversiblecontracepon(LARC)aremethodsofbirthcontrolthatprovide
eecvecontraceponforanextendedperiodofmewithoutrequiringuseracon.They
includeinjecons,intrauterinedevices(IUDs)andsubdermalimplants.Theyarethemost
eecvereversiblemethodsofcontraceponbecausetheydonotdependonpaent
compliance.Inaddiontobeinglonglasng,convenient,theyareverycosteecve.
Idealmeforpostpartumligaonoffallopiantubeinapaentofheartdiseaseis:
(a)
Immediatelyaerdelivery
(b)
Onedayaerdelivery
(c)
Oneweekaerdelivery
(d)
Sixweeksaerdelivery
YourResponse:
CorrectAnswer:
Exp:
Theoperaonshouldbedoneunderlocalanaesthesiabyminilaptechnique
IMPORTANT:Oralcontracepvepilliscontraindicatedinheartdiseaseasitmay
precipitatethromboembolicphenomenon.lUCDsarecontraindicatedduetoriskof
infecon.Barriercontracepveisthebestifthefamilyisnotcomplete.
(Q.44)
(Q.45)
Apelvischaracterizedbyananteroposteriordiameteroftheinletgreaterthanthetransversediameteris
classiedas
(a)
Gynecoid
(b)
Android
(c)
Anthropoid
(d)
Platypelloid
YourResponse:
CorrectAnswer:
Exp:
Bytradion,pelvisareclassiedasbelongingtooneoffourmajorgroups.Thegynecoid
pelvisistheclassicfemalepelviswithaposteriorsagialdiameteroftheinletonlyslightly
shorterthantheanteriorsagialdiameter.Intheandroidpelvis,theposteriorsagial
diameterattheinletismuchshorterthantheanteriorsagialdiameter,limingtheuse
oftheposteriorspacebythefetalhead.Intheanthropoidpelvis,theanteroposterior(AP)
diameteroftheinletisgreaterthanthetransversediameter,resulnginanovalwithlarge
sacrosciacnotchesandconvergentsidewalls.Ischialspinesarelikelytobeprominent.
TheplatypelloidpelvisisaenedwithashortAPandwidetransversediameter.Wide
sacrosciacnotchesarecommon.Thepelvesofmostwomendonotfallintoapuretype
andareblendsofoneormoreoftheabovetypes.
Anhormoneusedininferlityis:
(a)
Tamoxifen
(b)
Clomifene
(c)
Danazol
(d)
Finasteride
YourResponse:
CorrectAnswer:
Exp:
Clomifeneisanonsteroidalcompoundrelatedtodiethylslbestrolindicatedin:
Anovulatoryinferlity
Polycyscovariandiseaseassociatedwithinferlity
Ininvitroferlizaon:GIFTandART
25mgorallyfor25dayseachmonthfor3to6monthtosmulatespermatogenesis.
Clomifenecitratesmulateshypothalamicgonadotropinsecreonbyblockingthe
negavefeedbackofestrogenbyovaries.GonadotropinsmulatespituitaryFSHandLH
secreonwhichinducesovulaon.
Danazolisanisoxazolederivaveof17 ethinyltestosteroneusedfor:
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Endometriosis
Cyclicalmastalgia
Gynecomasa
Fibrocyscdiseaseofbreast
Improveslibido
Shrinksbroid
Tamoxifenisanonsteroidalanestrogendrugusedinpalliavetreatmentofadvanced
breastcancerinpostmenopausalwomen.
FinasterideisacompeveinhibitorofenzymeSareductase.
(Q.46)
Whatistherateofcervicaldilataonisrststageoflabourinmulgravidae?
(a)
0.5cm/hour
(b)
1cm/hour
(c)
1.5cm/hour
(d)
2cm/hour.
YourResponse:
CorrectAnswer:
Exp:
(Ref.DuaObst.5thEd.136)
CervicaldilataonrelatedwithdilataonofexternalOS.
Takingupofcervixisdeterminedbyobliteraonofprojeconofcervixintovagina.
Theanteriorlipofcervixisthelasttobeeected.
Cervicaldilataonisexpressedeitherintermsoffraconsoffulldilataon1/4th;1/2or
3/4thORintermsofngers2,2,3orfullydilated;ORbeerintermsofcm(10cmwhen
fullydilated).Onengerequalsto1.6cmandtakingupintermsof%fracon.
Inprimi,latentphaseislong(8hrs).Dilataonofcervixatrateof1.2cm/hourinprimiand
1.5cminmulbeyond3cmdilataonissasfactory.
Partogram(FreidmansCurve)iscompositegraphicalrecordofsodilataonanddescent
ofheadagainstduraonoflabourinhrs.
(Q.47)
(Q.48)
Duringthedelivery,itisnecessarytodoanepisiotomy.Thetearextendsthroughsphincteroftherectum,but
therectalmucosaisintact.Howwouldyouclassifythistypeofepisiotomy?
(a)
Firstdegree
(b)
Seconddegree
(c)
Thirddegree
(d)
Fourthdegree
YourResponse:
CorrectAnswer:
Exp:
Arstdegreetearinvolvesthevaginalmucosaorperinealskin,butnottheunderlying
ssue.Inaseconddegreeepisiotomy,theunderlyingsubcutaneousssueisalsoinvolved,
butnottherectalsphincterorrectalmucosa.Inathirddegreetear,therectalsphincteris
aected.Afourthdegreeepisiotomyinvolvesatearthatextendsintotherectalmucosa.
Episiotomyisbestdone:
(a)
Medially
(b)
Laterally
(c)
Mediolaterally
(d)
Jshaped
Your
Response:
Correct
Answer:
Exp:
c
(Ref.TextbookofObstetricsD.C.Dua6thEd.
606)
Typesofepisiotomy:
Mediolateral(bestandrounelydone)
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Median
Lateral
Jshaped
Onlymediolateralormedianepisiotomyisdone
commonly.
(Q.49)
Inapaentwhocomplainsofurinaryinconnence,cystometrogramisperformedto:
(a)
Determineurethrallength
(b)
Ruleoutanunstabletrigone
(c)
Diagnosestressurinaryinconnence
(d)
Determineifapaenthasnormalbladdersensaon
YourResponse:
(Q.50)
CorrectAnswer:
Exp:
Asacatheterisintroducedforperformingacystometrogram,measurementofresidual
urineisobtained.Duringthecystometrogram,anormalrstsensaonisoffullnessfeltat
100mL.Urgeisfeltatapproximately350mL,withmaximumcapacityat450mL.The
primaryreasontoperformacystometrogramistoruleoutuninhibiteddetrusor
contracons.Thecystometrogramisaurodynamictest,anditcannotdeterminewhether
ureterovesicalreuxexists.Thedegreeofreuxcanbeevaluatedwiththevoiding
cystogram,aradiologictest.
WhichofthefollowingisnotincludedinAcvemanagementofIIIStageofLabor?
(a)
Uterotonicwithin1minuteofdelivery
(b)
Immediateclamping,cungandligaonofcord
(c)
GeneralMassageoftheuterus
(d)
Controlledcordtracon
YourResponse:
CorrectAnswer:
Exp:
Clampingandligatureofcordisdoneinthesecondstageoflaborandnotthethird.
AcvemanagementIIIstageoflaborinvolvesacveassistanceindeliveryofplacenta,so
astoreducethechancesofpostpartumhemorrhage.
Itincludes:
AdministraonofuterotonicslikeOxytocinControlledcordtracon
Generalmassageoftheuterus
DuringacvemanagementIIIstagewehavetoruleoutanyincidenceofmulple
pregnanciesandthenadministerintramuscularoxytocinwithinoneminuteofthe
delivery.
Todelivertheplacenta,gentletraconontheumbilicalcordisput,whilethecontracted
uterusisbeingheldback.
Uterinemassageisdonetomaketheuterusgointocontraconandfacilitateexpulsionof
anyretainedclots.
(Q.51)
Whichofthefollowingabnormaliesoflaborisassociatedwithasignicantlyincreasedincidenceofneonatal
morbidity?
(a)
Prolongedlatentphase
(b)
Protracteddescent
(c)
Secondaryarrestofdilaon
(d)
Protractedacvephasedilaon
YourResponse:
CorrectAnswer:
Exp:
Threesignicantadvancesinthetreatmentofuterinedysfunconhavereducedtherisk
ofperinatalmorbidityandmortality:(1)theavoidanceofundueprolongaonoflabor;(2)
theuseofintravenousoxytocininthetreatmentofsomepaernsofuterinedysfuncon;
and(3)theliberaluseofcesareansecon(ratherthanmidforceps)toeectdeliverywhen
oxytocinfails.Prolongedlatentphaseisnotassociatedwithincreasedriskofperinatal
morbidity(PNM)orlowApgarscoresandshouldbetreatedbytherapeucrest.Pro
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tracondisordershaveahigherrateofPNMandlowApgarscores,butnotifspontaneous
laborfollowstheabnormalityArrestdisordersareassociatedwithsignicantlyhigher
ratesofPNMfollowingeitherspontaneousorinstrumentassisteddelivery
(Q.52)
Emergencycontraceponiscontraceponprovidedto:
(a) Contracepvefailure
(b) Couplenotwanngtouseothercontracepves
(c) Contraceponprovidedtocouplelivingincampsprovidedbygovernmentagencies
(d) Unprotectedintercourse
(Q.53)
YourResponse:
CorrectAnswer:
Exp:
Emergencypostcoitalcontraceponisdenedastheuseofadrugordevicetoprevent
pregnancyaerunprotectedsexualintercourse.Candidatesforemergencycontracepon
includereproducveagedwomenwhohavehadunprotectedsexualintercoursewithin72
hoursofpresentaonindependentofthemenstrualcycle.
Secondaryamenorrhoeaaeraboronduetointrauterineadhesionsisseenin:
(a)
Uterineinera
(b)
Imperforatehymen
(c)
Bicomuateuterus
(d)
Asherman'ssyndrome
YourResponse:
CorrectAnswer:
Exp:
CausesofAsherman'ssyndromeare
i.Vigorouscureageii.AboronandMTP
iii.Puerperalinfeconiv.Endometrialtuberculosis
DiagnoscinvesgaonsforAsherman'ssyndromehysterosalpingography
andhysteroscopy.
TreatmentofchoiceBreakingofintrauterineadhesionsbyuterinesound
underanaesthesia.
(Q.54)
(Q.55)
Falseregardingdermoidcystofovaryis:
(a)
Bilateralin35%ofcases
(b)
>10cm
(c)
Linedbyepithelialcells
(d)
Hassebaceousmaterial
YourResponse:
CorrectAnswer:
Exp:
Ofallcysctumorsofovary510%aredermoids.Dermoidcystsareusuallyunilocular
swellingwithsmoothsurfaces,seldomaainingmorethan15cmindiameter.They
containsebaceousmaterialandhairandthewallislinedinpartbysquamousepithelium
whichcontainshairfolliclesandsebaceousglands.Teeth,bone,carlage,thyroidssue
andbronchialmucousmembraneareoenfoundinthewall.Dermoidcystsfrequently
ariseinassociaonwithpseudomucinouscystadenomastoformacombinedtumor.They
arenotinfrequentlybilateral,12%.Dermoidcystsareinnocentovariantumorsbut
epidermoidcarcinomaoccursin1.7%ofalldermoidsandsarcomatouschangeshavealso
beendescribed.
Shapeofcervicalcanalpredicngpretermlabouris:
(a)
Ushaped
(b)
Vshaped
(c)
Yshaped
(d)
Oshaped
YourResponse:
CorrectAnswer:
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7/4/2016
Exp:
Diagnosisofpretermlabourincludes:
1.Regularuterinecontraconswithorwithoutpainwithafrequencyofatleastonein
every10minutes
2.Dilataon>2cmandeacement>80%ofcervix
3.Lengthofcervixontransvaginalultrasound<2.5cmandfunnelingofinternalos
(funnelshape=Yshape)
4.Pelvicpressure,backache,vaginaldischargeorbleed.
(Q.56)
(Q.57)
(Q.58)
(Q.59)
Macrosomiaisnotseenin:
(a)
Postmaturity
(b)
Hydrocephalus
(c)
Obesity
(d)
Diabetesmellitus
YourResponse:
CorrectAnswer:
Exp:
RiskFactorsforMacrosomia
. Maternaldiabetesmellitusorglucose .
intolerance
Mulparity
. Priorhistoryofmacrosomicinfant
Postdatesgestaon
. Maternalobesityorexcessiveweight
gain
Malefetus
. Parentalstature
Labordystocia
Vaginalcytologyfordetecnghormonalchangesistakenfrom:
(a)
Fornices
(b)
Lateralwall
(c)
Posteriorwall
(d)
Anteriorwall
YourResponse:
CorrectAnswer:
Exp:
Forhormonalcytology,thelateralwalloftheupperthirdofthevaginaislightlyscraped.
Thispartofthevaginaismostsensivetohormonalinuence.Smearisstainedwith
Shorr'sstain.
Allthefollowingaregiveninpostpartumhemorrhageexcept
(a)
Methylergonovine
(b)
Carboprost
(c)
Oxytocin
(d)
Misoprostol
YourResponse:
CorrectAnswer:
Exp:
Misoprostolisindicatedfortheprevenonofgastriculcerassociatedwiththeuseof
nonsteroidalaninammatorydrugs(NSAIDs),includingaspirin,inpaentsathighriskof
complicaonsfromgastriculcer,suchastheelderly,andinpaentswithconcomitant
diseaseorpaentsathighriskofdevelopinggastriculceraon,suchasthose.
Pointofdisnconbetweenparalmoletocompletemoleis:
(a)
Paralmoleshowtrophoblascproliferaonwithabsentvilli
(b)
Typicalofparalmoleiscellularatypia
(c)
Paralmoleismorepronetotumormalignancy
(d)
Paralmoleistriploid
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YourResponse:
CorrectAnswer:
Exp:
Completemole
Paralmole
Acompletemolecontainsnofetal
ssue
Fetalssueisoenpresentinaparal
mole
90%are46,XX,and10%are46,XV.
69,XXXor69,XXY
Allchromosomesareofpaternalorigin
Anenucleateeggisferlizedbya
haploidsperm
Thisresultsfromferlizaonofa
haploidovumandduplicaon
(whichthenduplicatesits
chromosomes),orthe
ofthepaternalhaploidchromosomes
orfromdispermy.
Eggisferlizedby2sperm
Chorionicvillihavegrapelike
(hydadiform)swelling
Swellingofthechorionicvilli
Thereistrophoblaschyperplasia
Thereishyperplasctrophoblasc
ssue
Aeracompletemoledevelops,
uterineinvasion
Nocasesofchoriocarcinomahavebeen
reportedaeraparalmole,although
4%ofpaentswithparalmoles
developpersistentnonmetastac
trophoblascdisease
occursin15%ofpaents,and
metastasisoccurs
in4%.
(Q.60)
MullerianductanomalymayincludetheabsenceofanyofthefollowingEXCEPT
(a)
Uterus
(b)
Vagina
(c)
Ovary
(d)
Uterinetube
YourResponse:
CorrectAnswer:
Exp:
Mullerianductisamesodermalderivaveandgivesrisetouterusanduterinetubes.It
alsoformsmesodermalpartofthevagina,whenitmeetswiththesinovaginalbulbs.
Sinovaginalbulbsareinducedbythemullerianductandtheyformthelower
(endodermal)partofvagina.
Nowifmullerianductsareabsent,therewillbenouterusanduterinetubes.Vaginawill
alsonotformbecauseitisthemullerianductwhichinducestheformaonofvagina.
Ovarieswillbepresent,sincetheyarisefromaseparatesourcethegenitalridges.
Note
1.ApaentwithMullerianagenesiswillhaveamenorrheaduetotheabsenceofuterus.
Andthisamenorrheacannotbecorrected.
2.Theladycanbecomeamotherbyusingasurrogatetowhomshecontributesoocytefor
invitroferlizaon.
(Q.61)
Amnionisseenon?
(a)
Fetalsurface
(b)
Maternalsurface
(c)
Decidua
(d)
Placenta
YourResponse:
CorrectAnswer:
Exp:
Amnionistheinnermostfetalmembrane.Itisathin,transparentsacthatholdsthefetus
suspendedintheliquoramnii.Theamniongrowsrapidlyattheexpenseofthe
extraembryoniccoelom,andbytheendofthe3rdmonthitfuseswiththechorion,
formingtheamniochorionicsac.
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(Q.62)
Allofthefollowingareknownriskfactorsfordevelopmentofendometrialcarcinomaexcept:
(a)
Obesity
(b)
Familyhistory
(c)
Useofhormonereplacementtherapy
(d)
Earlymenopause
YourResponse:
CorrectAnswer:
Exp:
Eologyofendometrialcarcinoma
Estrogen(mostcommon):Persistentsmulaonofendometriumwithunopposed
estrogen;
Age:75%ofpaentsarepostmenopausalwomen;
Nulliparity;
Latemenopause;
Corpuscancersyndrome(obesity,hypertensionanddiabetes);
Obesity;
Polycyscovariansyndromeandfunconingovariantumors(granulosacelltumor)dueto
unopposedestrogensmulaon
Longtermuseoftamoxifen;
Familyhistoryorpersonhistoryofcancersofcolon,ovaryorbreast;
Fibroid;and
Endometrialhyperplasia
(Q.63)
Commonestchromosomalanomalyleadingtospontaneousaboronsis:
(a)
Trisomy16
(b)
Trisomy21
(c)
Tetraploidy
(d)
Turner'ssyndrome
YourResponse:
CorrectAnswer:
Exp:
Cytogenecstudyoftheabortuscanrevealchromosomalabnormalitymostcommonis
trisomy
Themostcommontypeofparentalchromosomalabnormalityisbalancertranslocaon,
(Q.64)
Micronizedprogesteronecanbegivenbywhichofthefollowingroutes:
(a)
Oralandvaginalroutes
(b)
I/V
(c)
Vaginalrouteonly
(d)
Oralonly
YourResponse:
CorrectAnswer:
Exp:
(Q.65)
Naturalprogesterone
Progestogencontent
Routeofadministraon
Progesterone
25mg
Intramuscular
Micronizedprogesterone
100mg
Oral/vaginal
IUCDlasngfor10yearsis:
(a)
Progestasert
(b)
CuT380A
(c)
CuT220
(d)
NovaT
YourResponse:
CorrectAnswer:
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CuT380AisasecondgeneraonIUD.Itcarries80mmsurfaceareaofcoppewire.The
framecontainsbariumsulphateandisradioopaque.Replacementisdoneevery10years.
Exp:
ThemeperiodforreplacementforvariousIUDsare:
CopperT2003years
CopperT200B4years
CopperT380A(Paraguard)10years
MulloadCu2503years
Mulload3755years
LNGIUS5years
Progestasert1years
NovaT5years
Levonova5years
Mirena5years
(Q.66)
InacaseofgradeIIendometrialcarcinomawithmyometrialinvolvementupto10cmintheuterinecavity,
stagingis
(a)
IA
(b)
IB
(c)
IIA
(d)
lIB
YourResponse:
CorrectAnswer:
Exp:
CarcinomaendometriumstagingFIGO
Stage0carcinomainsitu
StageIcarcinomaconnedtoendometrium,myometriumintact
StageIALengthofuterinecavity8em,orless
StageIBLengthuterinecavitymorethan8cm
StageIIcarcinomahasinvolvedcorpusandcervix
(Q.67)
Apaenttreatedforinferlitypresentswith8weeks'amenorrhoea,retenonofurineandabdominalpain.
Diagnosisis
(a)
Impactedcervicalbroid
(b)
Retrovertedgravidbroid
(c)
Pelvichematocele
(d)
Uterinehematoma
YourResponse:
CorrectAnswer:
Exp:
Pelvichematocelemayfollowaninstrumentaldelivery,aparacervicalorpudendalblock
anaesthesia,vigorousironingofthelowervaginaandperineumduringdeliveryoreven
rarelyaeranormaldelivery.
Retrovertedgraviduteruscausesurinaryretenonat12weeksofgestaons.
Thepaentstreatedwithinferlitymostlikelytheincidenceofectopicpregnancyismuch
higherpresentswithamenorrhoea(75%),Abdominalpain(95%),vaginalbleeding,
retenonofurine
RetenonofurineInasubacutevarietyofectopicpregnancy,thebloodcollectsinpouch
ofDouglastoformapelvichaemotocele,thishaematoceleformsanirregularmassof
dieringconsistencyduetoamixtureofclotandblood,andbulgesforwards,displacing
thecervixagainstthebladderandleadingtoretenonofurine
Cervicalbroidinthecervixorloweruterinesegmentmayobstructlabourandmaybe
confusedwiththefetalhead.
(Q.68)
Puerperiumistheperiod:
(a)
6wksfollowingdelivery
(b)
3wksfollowingdelivery
(c)
1wkfollowingdelivery
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(d)
Noneoftheabove
YourResponse:
CorrectAnswer:
Exp:
Purperiumbeginsassoonastheplacentaisexpelledandlastsforapproximately6wks
whentheuterusbecomesregressedalmosttothenonpregnantsize.
(Q.69)
A30yearoldfemalehasahistoryoftwopreviousanencephalicpregnancies.Thechancesofthenext
pregnancybeinganencephalicare
(a)
10%
(b)
40%
(c)
20%
(d)
25%
YourResponse:
CorrectAnswer:
Exp:
Anencephalimostseveredefectinwhichtheforebrainmeninges,vaultoftheskull,and
scalpallfailtoform
Recurrencerate
7.8%withhighspinabida
0.7%withlowspinabida
2.2%withanencephalyandnoincreasedriskofrcraniorachischisis,encephaloceleor
mulpledefects
Neuraltubedefectsareclassicalexamplesofmulfactorialinheritance
Theempiricalrecurrenceriskofrstdegreerelavesisusuallyquotedas23%inmul
factorialinheritance
(Q.70)
Bestreversalaertubectomyisinwhichofthefollowingtypes?
(a)
Isthemoisthemic
(b)
Isthemoampullary
(c)
Ampulloampullary
(d)
Cornualimplantaon
YourResponse:
CorrectAnswer:
Exp:
Tuballigaonreversalulizesthetechniquesofmicrosurgerytoopenandreconnectthe
fallopiantubesegmentsthatareremainingaeratubalsterilizaonprocedure.
Microsurgeryminimizesssuedamageandbleedingduringsurgery.
Essenalelementsofmicrosurgicaltechniqueincludegentlessuehandling,magnifying
theoperangeld,keepingbodyssuesintheirnormalstatewithwarmedirrigaon
uids,andusingthesmallestsutureswiththethinnestneedlescapableofholdingthe
tubalendstogethertopromoteproperhealingoftherejoinedtubalsegments.
AnIsthemoisthemicanastomosishasthebestoutcomewithlivebirthratesof6080%,
providedthatthereconstructedtubeislongerthan4cmandtheampullaryporonis
morethan1cm.
(Q.71)
InIUCD,theorganismcausinginfeconis:
(a)
Cryptococcus
(b)
Herpes
(c)
Chlamydia
(d)
Acnomycosis
YourResponse:
CorrectAnswer:
Exp:
Acnomycocinvolvementofthepelvisoccursmostcommonlyinassociaonwithan
IUD.ThediseaserarelydevelopsunlesstheIUDhasbeeninplaceforatleast2years,but
itcanpresentmonthsaertheremovalofthedevice.
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(Q.72)
Lochiaserosapersistsupto:
(a)
13days
(b)
510days
(c)
1015days
(d)
Upto21days
YourResponse:
CorrectAnswer:
Exp:
Lochiaisthevaginaldischargefortherstfortnightduringpuerperium.Ithasgotpeculiar
oensiveshysmell.Itsreaconisalkalinetendingtobecomeacidtowardstheend.Itis
namedas:
LochiaRubra(red)1to4days
Lochiaserosal59days
Lochiaalba(Palewhite)1015days
(Q.73)
Mostcommoncomplicaonoflaparoscopichysterectomyis:
(a)
Urinarytractinjury
(b)
Bowelinjury
(c)
Vaginalcuabscess
(d)
Uncontrolledhaemorrhage
YourResponse:
CorrectAnswer:
Exp:
Mostcommoncomplicaonoflaparoscopichysterectomyisbowelinjury.
Laparoscopeassistedvaginalhysterectomy(LAVH)convertsanabdominalhysterectomy
intovaginalhysterectomyandthusavoidsanabdominalscaranddecreasesthemorbidity
(Q.74)
Causeofrepeated2ndtrimesterfoetalloss:
(a)
Chromosomalanomaly
(b)
Intrauterineinfecon
(c)
Abnormalityofcervixanduterus
(d)
Hormonalimbalance
YourResponse:
CorrectAnswer:
Exp:
Commonknowncausesofaboron:
Firsttrimester:defecvegermplasm,hormonaldeciency,trauma,acuteinfecon.
Midtrimester:Cervicalincompetence,uterinemalformaons,uterinebroid,low
implantaonofplacenta,twinsandhydramnios
(Q.75)
Techniqueusedforaspiraonofspermdirectlyfromtestesforinvitroferlizaonis:
(a)
TESA
(b)
MESA
(c)
GIFT
(d)
IVF
YourResponse:
CorrectAnswer:
Exp:
Spermaspiraontechniqueinvolvestheuseofminorsurgicalprocedurestocollect
spermsfromorganswithinthegenitaltract.Inmeninwhomtransportofspermsisnot
possible.
Thismayinvolveaspiraonofspermsfromthevasdeferens,epididymis,ortescles.
Invitroferlizaonisrequiredtoachievepregnancywiththemajorityoftheseextracon
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procedures.
ProcedureSourceIVF
VasalaspiraonVasdeferensMaybe
EpididymalaspiraonEpididymisYes
TescularaspiraonTescleYes
Epididymalaspiraon:isoftwotypes:
MESA:MicrosurgicalEpididymalSperm
Aspiraon
PESA:PercutaneousEpididymalSpermAspiraon
Thisisperformedinsituaonsinwhichvasiseithernotpresentorisscarredfromprior
surgery,trauma,orinfecon.
Tescularspermextracon(TESE,TESA)
Thenewestofthethreeaspiraontechniques,tescularspermretrievalisabreakthrough
asitdemonstratesthatspermsdonothavetomatureandpassthroughepididymisin
ordertoferlizeanegg.Becauseoftheirimmaturity,however,tescularspermsneedto
beinjecteddirectlyintotheeggwithICSI(intracytoplasmicsperminjecon)for
ferlizaontooccur.Tescularspermextraconisindicatedforpaentsinwhomthereis
blockadeintheepididymisveryclosetowhereitaachestothetessorablockadewith
inductsthatconductspermoutofthetess.
IVF(invitroferlizaon)
Inthisinduconofovulaonisdonefollowedbyaspiraonofmatureoocytesunder
ultrasonicguidance.50000selectedspermsareusedforinseminaonandat2to4cell
stage,threeemryotransferintotheuterinecavity1cmbelowthefundusisperformed.
GIFT(gameteintrafallopiantransfertechnique)
Itinvolvesaspiraonofoocytesfollowingovulaoninducon.Thesearemixedwith
50,000preparedspermsandtransferredtoampullaryporonsofboththefallopiantubes
4cmfromthembrialend.ThusMESAandTESAarebothtechniquesofspermaspiraon
butsincethequesonspecicallyasksaboutaspiraondirectlyfromthetestes,TESAis
themostappropriateanshere.
Ofallthechoicesmenoned,MESAisachoicewhichcanbeansweredGene.Butb
achoicebetweenMESAandPESAisgiven,thenPESAistheanswerasPESAismuch
simpler.
(Q.76)
Thefollowingisusedonlyextraamniocally:
(a)
Ethacrydinelactate(0.1%)
(b)
20%mannitol
(c)
50%Urea
(d)
Misoprostol
YourResponse:
CorrectAnswer:
Exp:
Ethacrydinelactate(0.1%)isusedonlyextraamniocally.
Ethacridinelactate(ethacridinemonolactatemonohydrate,acrinol,tradenameRivanol)is
anaromacorganiccompoundbasedonacridine.Itsprimaryuseisasanansepcin
soluonsof0.1%.Ethacridineisalsousedasanagentforsecondtrimesteraboron.
Extraamniocethacridinelactateplusintramuscularprostaglandinhasbecomeapopular
methodforterminangsecondtrimesterpregnancies.
(Q.77)
Thetreatmentoftheluteincystinahydaformmoleis
(a)
Ovariancystectomy
(b)
Ovariectomy
(c)
Suconevacuaon
(d)
Ovariotomy
YourResponse:
CorrectAnswer:
Exp:
ThecaluteincystTheincidenceofobviouscystsinassociaonwithamoleisreportedto
be2560%thesecystsarethoughttoresultformoversmulaonofluteinelementsby
largeamountsofchorionicgonadotrophinelementssecretedbyproliferangtrophoblasts
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CystsarenotlimitedtocaseofH.moleandareassociatedwithplacentalhypertrophy
withfetalhydropsormulfetalpregnancy
Becauseofthecystsregressaerdeliveryoophorectomyshouldnotbeperformedunless
theovaryisextensivelyinfarcted.
SuconevacuaonisbestlineoftreatmentforH.mole.
(Q.78)
Retenonofurineinapregnantwomanwitharetroverteduterusisseenat
(a)
810weeks
(b)
1216weeks
(c)
2024weeks
(d)
2832weeks
YourResponse:
CorrectAnswer:
Exp:
RetrovertedgraviduterusAsaresultofretensionthebladdergetsdistendedand
becomesanabdominalorganreachingevenuptoumbilicus.
Aspressurefromthefullbladderincreases,smallamountsofurinearepassed
involuntarily,butthebladderneverempesenrelyparadoxicalinconnence
Aerincarceraon(1216weeks)theinialsymptomsisfrequencyofurinaonfollowed
bydicultyinmicturionwhichulmatelyculminatesintoretensionofurine
Inmajorityofpaentsspontaneousreccaonoccursby12weeks.
(Q.79)
PrecociouspubertyisseeninallthefollowingEXCEPT
(a)
Granulosacelltumour
(b)
Headinjury
(c)
Corcosteroidintake
(d)
Hyperthyroidism
YourResponse:
CorrectAnswer:
Exp:
CausesofprecociouspubertyTumorsinthebrain(Hamartoma),postinammatory
lesionssuchasmeningis,encephalis,hypothyroidism(nothyperthyroidism)hormone
secrengovariantumorslikegranulosaandthecacelltumorsandadrenalmasses
MccuneAlbrightsyndrome,Russel,Silversyndrome,Estrogencontainingmedicaons.
(Q.80)
Duringpregnancythereisreducedriskofwhichofthefollowingcondion?
(a)
Relapseofmulplesclerosis
(b)
Bellspalsy
(c)
Meningoma
(d)
Chorea
YourResponse:
CorrectAnswer:
Exp:
Theonsetofanewmovementdisorderduringpregnancysuggestschoreagravidarum,a
variantofSydenham'schoreaassociatedwithrheumacfeverandstreptococcalinfecon;
thechoreamayrecurwithsubsequentpregnancies.Paentswithpreexisngmulple
sclerosisexperienceagradualdecreaseintheriskofrelapsesaspregnancyprogresses
and,conversely,anincreaseinaackriskduringthepostpartumperiod.Betainterferons
shouldnotbeadministeredtopregnantMSpaents,butmoderateorsevererelapsescan
besafelytreatedwithpulseglucocorcoidtherapy.Finally,certaintumors,parcularly
pituitaryadenomaandmeningioma,maymanifestduringpregnancybecauseof
acceleratedgrowth,possiblydrivenbyhormonalfactors.
PeripheralnervedisordersassociatedwithpregnancyincludeBell'spalsy(idiopathicfacial
paralysis),whichisapproximatelythreefoldmorelikelytooccurduringthethirdtrimester
andimmediatepostpartumperiodthaninthegeneralpopulaon.
(Q.81)
Thecommonestprostaglandinusedfortheterminaonof2ndtrimesterpregnancy:
(a)
PGE1
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(b)
PGI2
(c)
PGA2
(d)
15methylPGF2
YourResponse:
CorrectAnswer:
Exp:
Methodsofterminaonofpregnancy:
SecondTrimester(1320weeks):
1.Intrauterineinsllaonofhypertonicsoluons
1.Intraamnioc
20%saline,40%ureamannitol
2.Extraamnioc
Ethacrydinelactate
2.ProstaglandinsF2aandE2
3.Oxytocininfusion
4.Hysterotomy
(Q.82)
Acaseofgestaonaltrophoblascneoplasiaisdetectedtohavelungmetastasis.Sheshouldbestagedas:
(a)
StageI
(b)
StageII
(c)
StageIII
(d)
StageIV
YourResponse:
CorrectAnswer:
Exp:
(Q.83)
(Q.84)
Anatomicstagingforgestaonaltrophoblasctumors(GTT)aFIGO
guideline
StageI
Thelesionisconnedtotheuterus
StageII
Thelesionspreadsoutsidetheuterusbutisconnedtothegenitalorgans
StageIII
Thelesionmetastasizestothelungs
StageIV
Thelesionmetastasizestositessuchasbrain,liverandGItract
CriteriaforfetalgrowthareallEXCEPT:
(a)
Heightoftheuterus
(b)
Maternalweightgain
(c)
Ultrasonographicmeasurementofbiparietaldiameter
(d)
Ultrasonographicmeasurementoffetalabdominalcircumference
YourResponse:
CorrectAnswer:
Exp:
Maternalweightgainisnotasensivecriteriaforfetalgrowthbecausecontribuonof
fetalweighttomaternalweightgainduringpregnancyislesssignicantthanthatofwater
retenonandfataccumulaonduringpregnancy.
Thetotalweightgainduringthecourseofasingletonpregnancyis11kg.,outofwhich
fetuscontributesonlyabout3kg.
Whichoneofthefollowingbiochemicalparametersismostsensivetodetectopenspinabida?
(a)
Maternalserumalphafetoprotein
(b)
Amniocuidalphafetoprotein
(c)
Amniocuidacetylcholinesterase
(d)
Amniocuidglucohexaminase
YourResponse:
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(Q.85)
CorrectAnswer:
Exp:
Ithasbeenfoundthatahighconcentraonofalphafetoproteinintheamniocuidis
stronglysuggesveofasevereneuraltubedefectinthefetus.Furthermore,ahighlevelof
alphafetoproteininmother'sserumgivesanindicaonthattheAFPintheamniocuid
islikelytoberaised.
WhichofthefollowingisthemostcommoncauseofpersistenttrophoblascdiseaseaerH.Moleevacuaon?
(a)
Choriocarcinoma
(b)
Invasivemole
(c)
Placentalsitetrophoblasctumor
(d)
ResidualMole
YourResponse:
CorrectAnswer:
Exp:
Upto20%ofwomenwithH.Moleshowpersistenceoftumorinuterusfollowingsurgical
evacuaon.
15%persistaspersistantorresidualmole.
5%developchoriocarcinoma.
Trophoblasctumorsdiagnosedforupto6monthsfollowinganaboronormoleisoen
Aninvasivemole,buttheonediagnosedaer6monthsisusuallychoriocarcinoma.
Itistobenotedthattrophoblasctumordevelopingaerafulltermpregnancyisalways
achoriocarcinoma.
(Q.86)
(Q.87)
Misoprostolhasbeenfoundtobeeecveinallofthefollowing,except
(a)
Missedaboron
(b)
Induconoflabor
(c)
Menorrhagia
(d)
Prevenonofpostpartumhemorrhage(PPH)
YourResponse:
CorrectAnswer:
Exp:
StudiesinhumanshaveshownthatMisoprostolcausesanincreaseinthefrequencyand
intensityofuterinecontracons.Misoprostoladministraonhasalsobeenassociatedwith
ahigherincidenceofuterinebleedingandexpulsionofuterinecontents.
Gonococcalinfeconspreadsby
(a)
Ascendingroute
(b)
Haematogenousroute
(c)
Lymphacs
(d)
Involvementofadjacentstructures
YourResponse:
CorrectAnswer:
Exp:
Gonococcalinfeconsspreadingalongthemucousmembranestoaectthecervix,
endometriumandthefallopiantubes
Inrarecasesspreadsbybloodstreammayoccurcausingendocardis,arthrisandiris.
(Q.88)
Stressinconnenceisbestcorrectedby
(a)
Colposuspension
(b)
Hysterectomy
(c)
Bladderneckrepair
(d)
Bladderexercise
YourResponse:
CorrectAnswer:
Exp:
StressinconnenceInvoluntarylossofurineduringstress(coughing,sneezingorphysical
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7/4/2016
train)isacommoncomplaintofpostmenopausalwomen
Digitalpressureappliedtotheparaurethralssuesisananteriordireconthroughthe
vaginawillreestablishtheurethrovesicalangleandpreventstressinconnence[Marshall's
test]
Treatmentinpaentswithnormalbladderfunconandlowresidualurineisiniated
withbehavioraltherapyandperinealexercise.
Ifunsuccessfullygiveoxybutyricandephedrine
Denivemanagementissurgical
MarshallMarcheKrantzprocedure
StameymodicaonofthePereyraprocedure
*CurrentlyThemosteecvesurgicalapproachisslingprocedurewithapieceof
autologousorsynthecfasciaaachedtotherectusmuscleorospubisandsurrounding
theurethraatthebladderneck
Newerapproachesincludestheuseofcollageninjeconintotheperiurethralssues,
resulnginincreasedurethraloulowresistance..
Themenstrualcycleisreducedfromthenormalof28daystocycleof23weeksand
remainsconstantatthatfrequency
Menorrhagia(Hypermenorrhea)excessiveorprolongedbleedingatthenormalmeof
menstruaon.
(Q.89)
ForcepsareappliedinallthefollowingEXCEPT
(a)
Aercomingheadinbreechpresentaon
(b)
Facepresentaon
(c)
Occipitoposteriorpresentaon
(d)
Browpresentaon
YourResponse:
CorrectAnswer:
Exp:
Fetal
Maternal
Fetaldistress
Maternaldistress/exhauson
PretermbabyLBW(prevenng
ProlongedIIndstageoflabour
intracranialdamage)
Medicaldisorderslikecardiac,severeanemia,
Aercomingheadinbreach
Cordprolapse
Postmaturity
TBPIH,eclampsiaordebilitangillness
.
Failureofdescentorinternalrotaonfor2
hoursinprimigravidaand1hourina
mulpara.
Situaonswhichpredisposetoarrestofprogressinclude
Pooruterinecontracons
MalposionslikerightorleOPP
Deexedhead
Prominentspinesorsubtledisproporoninlowerpelvicstrait
Rigidperineum
Divaricaonofrec
Laxpelvicoor
Heavysedaonoranalgesia
BrowpresentaonAemptstoconvertthebrowmanuallytoeitherafaceoravertexfor
deliverywithforcepsorthevacuumarenotpraccedanymore,ifthepaenthasbeen
longinlabourthesemanipulaonshouldbetriedastheriskofuterineruptureishigh
Caesareanseconisthesafestmethodofdelivery
Forcepsdeliveryisonlyreservedformentoanterior.
Contraindicaontouseofforces
Absenceofaproperindicaon.
Absenceoffulldilataonofcervix
Cephalopelvicdisproporoncannotberuledout
Highstaonoffetalhead
Uterinecontraconcease.
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(Q.90)
Placentawithumbilicalcordaachedtoitsmarginiscalled:
(a)
Baledoreplacenta
(b)
Circumvallateplacenta
(c)
Succenturiateplacenta
(d)
Velamentousplacenta
YourResponse:
CorrectAnswer:
Exp:
(Ref.TextbookofobstetricsDCDua6thed.233)
InBaledoreplacenta,theumbilicalcordisaachedtothemarginofplacenta.Itis
associatedwithlowimplantaonoftheplacenta;thereischanceofthecordcompression
invaginaldeliveryleadingtofoetalanoxiaandevendeath.
Succenturiateplacenta:Anextraplacentaseparatefromthemainplacenta
Velamentouscordinseronisanabnormalcondionduringpregnancy.Normally,the
umbilicalcordinsertsintothemiddleoftheplacentaasitdevelops.Invelamentouscord
inseron,theumbilicalcordinsertsintothefetalmembranes(choriamniocmembranes),
thentravelswithinthemembranestotheplacenta(betweentheamnionandthe
chorion).TheexposedvesselsarenotprotectedbyWharton'sjellyandhenceare
vulnerabletorupture.Ruptureisespeciallylikelyifthevesselsarenearthecervix,in
whichcasetheymayruptureinearlylabor,likelyresulnginasllbirth.Earlydetecon
canreducetheneedforemergencycesareansecons
(Q.91)
ThemostcommoncomplicaonofIUCDis
(a)
Ectopicpregnancy
(b)
Bleeding
(c)
Backache
(d)
Cervicalstenosis
YourResponse:
CorrectAnswer:
Exp:
ThecommonestcomplaintofawomanedwithanIUCD(inertormedicated)is
increasedvaginalbleeding)
ComplicaonofIUCD
(Q.92)
Immediate
Early
Late
1.
Dicultyininseron
1. Expulsion
1. PID
2.
Vasovagalaack
2. Perforaon
2. Ectopicpregnancy
3.
Uterinecramps
3. Spong,menorrhagia
3. Perforaon
4. Dysmenorrhea
4. Menorrhagia
5. Vaginalinfecon
5. Dysmenorrhea
6. Acnomycosis*
6. Pregnancy
Themostcommontypeofpelvisassociatedwithoccipitaposteriorposionis
(a)
Gynecoid
(b)
Platypelloid
(c)
Anthropoid
(d)
Android
YourResponse:
CorrectAnswer:
Exp:
Inmorethan50%,theoccipitoposteriorposionisassociatedwitheither
anthropoidorandroidpelvis
Deeptransversearrestiscommoninandroidpelvis.
Facetopubisdeliveryoccursinanthropoidpelvis
(Q.93)
Mediolateralepisiotomyispreferredovermidlineepisiotomybecause:
(a)
Bloodlossisless
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(b)
Lesschanceofthirddegreeextension
(c)
Easiertorepair
(d)
Noneoftheabove
YourResponse:
CorrectAnswer:
Exp:
(93).Ans:b.
Exp.Lesschanceofthirddegreeextension
Meritsofmidlineemsiotomvovermediclateralepisiotomv
Bloodlessisless.
Repairiseasy.
Healingissuperior.
Dyspareuniaisrare.
Wounddisruponisrare.
Postoperavecomfortismore.
Meritsofmedialateraleptswtomvovermidlineepisiotomv
Lesserriskofrectalthirddegreeextension.
Suitableformanipulavedeliveryorinabnormalpresentaon
orposion.
(Q.94)
ChorionicvilloussamplingisusefulinallthefollowingEXCEPT
(a)
TaySachsdisease
(b)
Spinabida
(c)
Thalassanemia
(d)
Downsyndrome
YourResponse:
CorrectAnswer:
Exp:
Chorionicvilloussampling(CVS)isgenerallyperformedat10to13weeks.
1.Secondtrimesteramniocentesisforgenecdiagnosisisusuallyperformedbetween
15and20weeks.
2.Earlyamniocentesisthisisperformedbetween11and14weeksCVSfor
trophoblasccells(derivedembryologicallyfromthesameferlizedeggsasthefetusis
usuallydoneduringgestaonalweeks1113
TheadvantageofCVSisthattheresultsareavailableearlyinpregnancy
IndicaonsAdvancedmaternalage(>35years),previouschildwithchromosomal
abnormality,abnormalparenteralkaryotype,inversion,balancedorreciprocal
translocaon,Robertsonian,foetalkaryotypingforXlinkeddisorder,maternalanxiety,
inbornerrorofmetabolism.
LipidstoragediseaseGaucher'sdisease,Fabrydisease.Krabbediseasemetachromac
leukodystrophy,NiemannPick'ssyndromemucolipidosisIIsialidosis
MucopolysaccharidedisorderHunter,HurlerandSanlipposyndrome
Carbohydratedisordergalactosemia,glycoestorage(typen&IV)Aminoacidopathies
Homocysnuria,cysnosis,tyrosinemia,maplesyrupurinedisease.Autosomaldominant
disordersadultpolycysckidneydisease.myotonicdystrophy,Hunngton'schorea,
osteogenesisimperfecta,renoblastoma
Autosomalrecessivedisordersaandthalassanemia,alantrypsindeciency,CAH,
phenylketonuria,cyscbrosissicklecelldisease
SexlinkeddisordersDuchenne'sA&B,chronicgranulomatousdisease,Norrie'sdisease,
renispigmentosa
Relavecontraindicaons
1.Vaginalbleedingorspong
2.Extremeanteorretroversionoftheuterus
3.Paentbodyhabitusprecludingeasyaccesstotheuterus
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4.Clearvisualizaonofitscontentwithultrasound
5.Acveinfecon.
(Q.95)
MostcommoncauseforpostmenopausalbleedinginIndianwomanis,
(a)
Cacervix
(b)
Caendometrium
(c)
DUB
(d)
Caovary
YourResponse: a
CorrectAnswer:
Exp:
Postmenopausalbleeding:
Asmanyas1/3rdofcasesareduetomalignancy
Genitalmalignancy
Cacervix,endometrium,vagina,vulva,fallopiantube
Sarcomaofuterus
Granulosacelltumoutofovary
Commoncausesofpostment)pausalbleeding
Genitalmalignancy
DUB
Senileendometris
Decubitusulcer
Urethralcaruncle
CommonestcauseinIndiaisCacervix.
(Q.96)
AllthefollowingareTRUEaboutKrukenbergstumourEXCEPT
(a)
Largecyscspaces
(b)
Maintainsovarianshape
(c)
Bilateral
(d)
Usuallyfromstomachcarcinoma
YourResponse:
CorrectAnswer:
Exp:
Krukenberg!tumorarealmostinvariablybilateral
Thereisnotendencytoformadhesionswithneighboringvisceraandthereisno
inltraonthroughthecapsule
Thetumorretainstheshapeofthenormalovaryandhasapeculiarsolidwaxy
consistence,althoughcyscspacesduetodegeneraonofthegrowtharecommon
Histologicallythetumorhasacellularormyxomatousstromaamongstwhicharecatered
largesignetringcells
Thetumorsaresecondarygrowthsintheovaryandmostoenarisefromaprimary
carcinomaofthestomach(70%),Largebowel(15%)andbreast(6%)
Thetumoralmostcertainlyarisebyretrogradelymphacspread
(Q.97)
Whichoneofthefollowingisthebestdrugofchoicefortreatmentofbacterialvaginosisduringpregnancy?
(a)
Clindamycin
(b)
Metronidazole
(c)
Erythromycin
(d)
Rovamycine
YourResponse:
CorrectAnswer:
Exp:
Treatmentofbacterialvaginosis:
Sensivetometronidazole/clindamycin
Metronidazoleuseinthersttrimesternohumanevidenceofterratogenesis
Topicaltherapyusingvaginalgeliseecvebutmaynotreducetheriskofpreterm
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delivery.
(Q.98)
IUCDisabsolutelycontraindicatedinallthefollowingEXCEPT
(a)
Undiagnosedvaginalbleeding
(b)
Suspectedpregnancy
(c)
Congenitalmalformaonofuterus
(d)
PID
YourResponse:
CorrectAnswer:
Exp:
ContraindicaonofIUCD
Absolute
Relave
1.
Suspectedpregnancy
1. Anaemia
2.
PID
2. Menorrhagia
3.
Vaginalbleedingofundiagnosed 3. H/oPIDsincelastpregnancy
Aeology
4.
4. Purelentcervicaldischarge
Cancerofthecervix,uterusor
adnexaandotherpelvic
tumours
5.
Previousectopicpregnancy
5. Distoronsoftheuterinecavitydueto
congenitalmalformaons,broids
6. Unmovatedperson
(Q.99)
AntenataldiagnosiscanbemadefromallthefollowingEXCEPT
(a)
Foetalblood
(b)
Maternalblood
(c)
Amniocuid
(d)
Decidua
YourResponse:
CorrectAnswer:
Exp:
Foetalbloodforanemia,bleedingdisorders,RhdiseaseNonImmunehydropsfetalis
Maternalbloodforalfafetoproteinesmaonforcongenitaldisease
Amniocuidassessingthefetalmaturity,diagnosisofvariousmalformaonsofthe
fetusandmonitoringwellbeingofthefetusinhighrisk,pregnancies.
Deciduaetheendometrialiningoftheuterusiscalleddeciduaduringpregnancy,anditis
shedaerdelivery,andnoroleforantenataldiagnosis.
(Q.100)
DrugnotusedinthemanagementofPPH?
(a)
Mifepristone
(b)
Misoprostol
(c)
Oxytocin
(d)
Ergotamine
YourResponse:
CorrectAnswer:
Exp:
DrugsusedinthemanagementofPostpartumHemorrhage
Oxytocincanbeadministeredasa5Uintravenousbolus,as20Uin1LofNS
intravenouslyrunasfastaspossible,oras10Uintramyometriallywithaspinalneedleif
noimmediateintravenousaccessisavailable.
Thetradionalsecondlineagentforuterineatonyhasbeenergonovine(orErgotrate)
givenasaninialdoseof100or125mcgintravenouslyorintramyometriallyor200or
250mcgintramuscularly.
Themaximumtotaldoseis1.25mg.Hypertensionisarelavecontraindicaon.Insome
regions,theavailabilityofergotpreparaonshasbecomeproblemac.Everyeort
shouldbemadetosecuresuppliesofthisinexpensiveandusefulagent.
Manyauthoriesnowrecommendtheuseofintramuscularcarboprostasthesecond
lineagentwhenitisavailable.Therecommendeddoseis250mcgintramuscularlyor
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intramyometrially,nottoexceed2mg(8doses).Asthmaisarelavecontraindicaon.
Carboprosthasbeenshowntobe8090%eecveinstoppingPPHincasesrefractoryto
oxytocinandergonovine.Intramuscularadministraonoftheseagentsisnot
recommendedifthepaentdemonstratesevidenceofshockbecauseabsorponwould
becompromised.
MisoprostolmayalsobecomeavaluableagentinthetreatmentofPPH.Thelowcostof
thedruganditsheatstability(doesnotrequirerefrigeraon)makesitespecially
appealingforuseinthedevelopingworld.Moretrialsarepending.
(Q.101)
Carcinomacervixextendstothelateralpelvicwallinwhichstage
(a)
StageI
(b)
StageII
(c)
StageIII
(d)
StageIV
YourResponse:
CorrectAnswer:
Exp:
StageIIIBmoreprecisely.
FIGOstagingofcancerofcervix
Preinvasivecarcinoma
Stage0carcinomainsitu
Invasivecarcinoma
Stage1
IACarcinomastrictlyextendtothecervix
Invasivecancerdiagnosedonlybymicroscopy.
Allgrosslesions,evenwithsupercialinvasionsarestagem
IA1Measuredinvasionofstromanogreaterthen3mmindepthandnowiderthan7mm
IA2Measuredinvasionofstromagreaterthan3nunindepthandnolongerthan5mmin
depth
andnowiderthan7mm
IBClinicallesionconnedtothecervixorpreclinicallesionsgreaterthan1A
IB1Clinicallesionongreaterthan4cm
IB2Clinicallesionsgreaterthan4cm
StageIICarcinomaextendsbeyondthecervixbuthasnotextendedtothepelvicwall,
thecarcinomainvolvesofvaginabutnotasfaraslowerthird
IIANoobviousparametrialinvolvement
IIBObviousparametrialinvolvement
StageIIICarcinomahasextendedeithertothelowerthirdofthevaginaortothepelvic
sidewall,allcasesofhydronephrosis
IIIAInvolvementoflowerthirdofvagina,noextensiontopelvicsidewall
IIIBExtensiononthepelvicwalland/orhydronephrosisornonfunconingkidney
StageIVCarcinomaextendedbeyondthetruepelvisorclinicallyinvolvingthemucosa
ofthebladderorrectum
IVASpreadofgrowthotadjacentorgans
IVBSmeadofgrowthtodistantorgans
(Q.102)
Theweightoftheuterusat8weekspostpartumis
(a)
100g
(b)
500g
(c)
700g
900g
(d)
YourResponse:
CorrectAnswer:
Exp:
Theuterusweightabout1000to1200gmimmediatelyaerdelivery,Asaresultof
involuon,itdecreasesinweighttoabout500gmbyoneweek,andtoabout30gmat
theendofsecondweek
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Attheendof6weeksitsmeasurementisalmostsimilartothatofthenonpregnantstate
andweightabout60gm.
(Q.103)
Followingpredisposetothehighriskofvulvovaginalcandidiasisexcept:
(a)
HIV
(b)
Hypertension
(c)
Pregnancy
(d)
DM
YourResponse:
CorrectAnswer:
Exp:
(Ref.ShawsTextbookofGynaecology14th/pg.98;H
17th/pg.1254)
Candidiasis(monilialvaginis)
Candidiasisisduetogramposivefunguscandidaalbicans.
Predisposingfactors:
Pregnancy
Diabetes
Hormonalcontracepvespills.
Predisposingfactorsforhematogenouslydisseminated
candidiasis:
Anbacterialagents,
Indwellingintravascularcatheters,
Hyperalimentaonuids,
Indwellingurinarycatheters,
Parenteralglucocorcoids,
Respirators,
Neutropenia,
Abdominalandthoracicsurgery,
Cytotoxicchemotherapy,and
Immunosuppressiveagentsfororgantransplantaon.
Severeburns
Lowbirthweightneonates,and
IllicitIVdrugabusers
HIVinfectedpaents.
(Q.104)
(Q.105)
WhichofthefollowingisnotcausedbyOxytocin:
(a)
Milkejecon
(b)
Lactogenesis
(c)
Contraconofuterinemuscles
(d)
Myoepithelialcellcontracon
YourResponse:
CorrectAnswer:
Exp:
OXYTOCINcausescontraconofthemyoepithelialcellsthatlinetheductsofthebreast.
Thissqueezesthemilkoutofthealveoliofthelactangbreastintothelargeductsand
thenOutofnipple(milkejecon)Oxytocinalsocausescontraconofsmoothmuscleof
uterus.
Caudalregressionsyndromeisseeninbabiesofmotherhaving
(a)
Gestaonaldiabetes
(b)
PIH
(c)
Cardiacdisease
(d)
Anaemia
Your
Response:
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Correct
Answer:
Exp:
Diabetogeniceectsofpregnancy
Insulinresistance
ProduconofplacentalSomatostan
Produconofcorsol,estriolandprogesterone
Increasedinsulindestruconbykidneyand
placenta
Increasedlipolysis(byHPL)
Changesingluconeogenesis
EectofDMonfoetus
Hypoglycemia
CongoAbnormalityHyperviscosity
Macrosomia
HMO
Hypocalcemia
Apneaandbradycardia
Traumacdelivery
EectsofDMonmothers
Preeclampsia
Infecon
PPH
HighincidenceofLSCS
IUD
Eectsofpregnancyondiabetes
Moreinsulinnecessaryformetaboliccontrol
Progressionofdiabecrenopathy
Worseningofdiabecnephropathy
Worseningofdiabeccardiomyopathy
Riskfactorsrequiringdiabecscreening
Age>30yrs
FamilyhistoryofDM
Priormacrosomia
Malformedorsllborninfant
Obesity
HT
Glucosuria
(Q.106)
Endometrialhyperplasiaisseenin
(a)
Endodermalsinustumour
(b)
Dysgerminoma
(c)
Polycyscovariandisease
(d)
Carcinomaofcervix
YourResponse:
CorrectAnswer:
Exp:
Polycyscovariandiseaseendometrialhyperplasiaduetohighcontentofestrogen,
largelyestrone,byextraglandulararomazaonofcirculangandrostenedione.
Endometrialhyperplasiaiscommonincarcinomaendometrium
Treatmentsimpleendometrialhyperplasiacallsforcyclicprogesntherapy
(medroxyprogesteroneornorethindrone)
Ifendometrialhyperplasiawithatypicalcellsorcarcinomaoftheendometriumisfound,
hysterectomyisnecessary
(Q.107)
Oralancoagulantsgiventopregnantwomencancause?
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(a)
Longboneslimbdefect
(b)
Craniofacialmalformaon
(c)
CVSmalformaon
(d)
Costochondrodysplasia
YourResponse:
CorrectAnswer:
Exp:
Oralancoagulants(Warfarin)causes
Conradissyndrome(Skeletalandfacialanomaliesopcatrophy,microcephaly,
chondrodysplasiapunctata
Warfaringiveninearlypregnancyincreasesbirthdefects,speciallyskeletalabnormality
foetalwarfarinsyndromehypoplasiaofnose,eyesockethandbones,growth
retardaon
GivenlaterinpregnancyitcancauseCNSdefects,foetalhaemorrhage,foetaldeathand
accentuatesneonatalhypoprothrombinemia.
(Q.108)
Condylomaacuminatainpregnancyistreatedby
(a)
Podophyllin
(b)
Podophyllintoxin
(c)
Trichloroacecacid
(d)
5FUcream
YourResponse:
CorrectAnswer:
Exp:
Treatmentofcondylomaacuminata(verrucagenitalis)
Podophyllumiseecveonlyonthegenitalwarts
Podophyllumispotenallytoxicandmustbeavoidedinduringpregnancy
Chemicalcauterizaonisusuallydonewithliquiedphenolorconcentrated
trichloroacecacid
(Q.109)
PlacentapraeviaisseeninallthefollowingEXCEPT
(a)
Largeplacenta
(b)
PreviousCSscar
(c)
Primigravida
(d)
Previousplacentapraevia
Your
Response:
Correct
Answer:
Exp:
c
Eologyoftheplacentapraeviamainly
Advancedmaternalage
Mulparity
Priorcesareandelivery
Smoking
Placentalabnormalieseg,Bigsurface
succenturiatelobes
(Q.110)
RiskofHIVtransmissionishighestduring?
(a)
DuringCaesariansecon
(b)
Duringantepartumperiod
(c)
Duringvaginaldelivery
(d)
Breastfeeding
YourResponse:
CorrectAnswer:
Exp:
(Ref.TextbookofGynaecologybyDCDua5th/pg.538)
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MotherswhoareHIVinfectedcanpassthevirusontotheirfetusesinuteroortoinfants
viabreastmilk.Vaginaldeliveryisthemostcommonandmosteecvemodeof
transmission.
PerinataltransmissionThevercaltransmissiontoneonatesoftheinfectedmothersis
2535%.Thebabymaybeaectedinutero(30%)throughtransplacentaltransfer,during
delivery(7075%)bycontaminatedsecreonsandbloodofthebirthcanalandthrough
breastmilkinneonatalperiod(1020%).
ItisclearfromrecentEuropeanstudiesthatCesareanseconalone,orincombinaon
withanretroviraltherapycaneectanaddionalsignicantreduconinperinatalHIV
transmission.TheseresultssupporttheconclusionthatsomeHIVinfeconmustbe
acquiredduringpassagethroughthevaginalcanal.Innonbreastfeedingpopulaonsitis
esmatedthat50to70%ofHIVinfeconisacquiredduringlaboranddeliveryandthe
remainderinutero.Todate,studiesdirectedatreducingexposuretoHIVduringbirth
otherthanCesareansecon,havenotdemonstratedabenetinreducingHIV
transmission.
(Q.111)
XraypelvimetryisindicatedinallthefollowingEXCEPT
(a)
SevereCPD
(b)
Breechpresentaoninvaginaldelivery
(c)
Outletobstrucon
(d)
Osteomalacia
YourResponse:
CorrectAnswer:
Exp:
Radiographicpelvimetryisthemostaccuratemethodwehavetomeasuringthesizeand
determiningtheshapeofhepelvis
Radiographicpelvimetryinpregnancyisalwaysrestrictedtoasinglestandinglaterallm
Currentlymajorityofxraypelvimetryarelimitedtoasinglelmtakenintheerectlateral
posion.
IndicaonofcaesareanseconinCPD
Severelycontractedpelvis,trueconjugateislessthan9cm
Elderlyprimigravida
Breechpresentaon
Previouscaesariansecon
Failedtrialoflabour
NoindicaonofxraypelvimeterisdonebecausePNexaminaondetectssevere
CPDandadviseforcaesariansecon
(Q.112)
Latedeceleraonindicates
(a)
Headcompression
(b)
Cordcompression
(c)
Foetalhypoxia
(d)
Breechpresentaon
YourResponse:
CorrectAnswer:
Exp:
DeceleraonpaernThreetype
Earlydeceleraonduetoheadcompression
Latedeceleraonchronicplacentalinsuciency
Variabledeceleraoncordcompression
SinusoidalpaernItisstablebaselineFHRwithxedbaselinevariabilitywithoutany
acceleraon.Ifisoenassociatedwithfetalanaemia,fetomaternalhaemorrhage,fetal
hypoxia,andwhennarcocsaregiventomothers
Insituaonsofuteroplacentalinsuciency,theuterinecontraconsmaydecreasethe
placentalperfusionsucientlytocausefetalhypoxiawhichoutlaststheduraonofthe
contracon.
TheFHRtracingshowsdeceleraonswhichbeginwiththepeakoftheuterine
contraconsandpersistsevenaertheconclusionofthecontracon(latedeceleraon),
latedeceleraonsareindicaveoffetalcompromise
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(Q.113)
(Q.114)
Allofthefollowingautoimmunedisorderaremorecommoninfemalesexcept?
(a)
ITP
(b)
Mulplesclerosis
(c)
TypeIdiabetes
(d)
Scleroderma
YourResponse:
CorrectAnswer:
Exp:
Mostautoimmunedisordersoccurmorecommonlyinwomenthaninmen;theseinclude
autoimmunethyroidandliverdiseases,lupus,rheumatoidarthris(RA),scleroderma,
mulplesclerosis(MS),andidiopathicthrombocytopenicpurpura.However,thereisno
sexdierenceintheincidenceoftype1DM
Paramesonephricductdevelopinto:
(a)
Vasdeferens
(b)
Seminalvesicle
(c)
Ureter
(d)
Uterus
YourResponse:
CorrectAnswer:
Exp:
Male
Female
Mesonephricduct
Ductofepididymis
Ductofepoophoron
(Wolanduct)
Ductusdeferens
Partofbladderand
urethra
Ejaculatoryduct
Partofbladderand
prostacurethra
Female
Appendixoftess
Uterinetube
(Paramesonephricor
Mullerianduct)
Prostacutricle
Uterus
Vagina(?)
(Q.115)
HRTishelpfulinallofthefollowingexcept:
(a)
Vaginalatrophy
(b)
Flushing
(c)
Osteoporosis
(d)
Coronaryheartdisease
YourResponse:
CorrectAnswer:
Exp:
ConsequenceofHRT
1.Benets
Decreasedincidenceof
a.Hip#b.Vertebral#c.Wrist#d.Coloncancer
Harms:
Increasedincidenceof
a.Coronaryheartdiseaseb.Thromboemboliceventsc.Breastcancer
d.Cholecyss
2.Uncertainbenets
Prevenonofdemena
(Q.116)
AdvantagesofultrasoundnuchaltranslucencyoverbiochemicalscreeningforDownsyndromeinclude:
(a)
Usestransvaginalapproach
(b)
Moreconsistentmeasurementsthanlabtests
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(Q.117)
(c)
Beerinmulplegestaon
(d)
Widegestaonalagerange
YourResponse:
CorrectAnswer:
Exp:
Theultrasoundnuchaltranslucency(NT)isnowappreciatedasasensivemarkerfor
Downsyndromeandotheraneuploidiesbetween10and13weeks.Outsidethatrange,
theNTdisappears.Althoughsomecentershavehadsuperbresults,othershavenotdone
well.BloodfreehCGandPAPPAinthersttrimester,anddouble(AFPandhCG)ortriple
(AFP,hCG,andestriolat15to20weeks)evaluaonsarestascallycomparable.The
combinaonofNTandrsttrimesterbiochemistrywilllikelybetheopmalapproach.
Biochemistrydoesnotworkwellformulplegestaons.Ultrasoundcanalsodetect
structuralanomalies,butoenhighqualityultrasoundservicesrequirepaentstotravel
longdistances,whereasbloodcanbeshippedfromessenallyanywheretoacompetent
lab.
Instrumentaldeliverysystemis
(a) Forcepsonlyusedinfullcervicaldilaon
(b) Forcepsusedwhenventousefails
(c) Ventousecannotbeusedinrotaonaldeliveriesofoccipitoposteriorandtransversepresentaons
(d) Forcepscanbeusedinbreechdeliveries
YourResponse:
CorrectAnswer:
Exp:
Ventouseisaninstrumentaldevicedesignedtoassistdeliverybycreangavaccum
betweenitandthefetalscalp.
Incaseoffailedventouse,forcepsmaybeusedif
1.Headisalmostcompletelyrotated
2.Cervixisfullydilated
3.Thereissomedegreeofdescent
(Q.118)
ApaentwithposiveanphospholipidanbodieswouldhaveallthefollowingEXCEPT
(a)
Recurrentfoetalloss
(b)
Venousthrombosis
(c)
Thrombocytosis
(d)
Neurologicalcomplicaons
YourResponse:
CorrectAnswer:
Exp:
Commonobstetriccomplicaonsassociatedwithanphosphoidsyndrome
1.Recurrentfetalloss4.Placentalabrupon(2ndtrimester
2.IUGR5.Recurrentthrombocevents(Arterial
3.PIHvenousthrombosis)
6.Thrombocytopenia7.Autoimmuneorconnecvessuedisease
ManyofthesepaentshaveSLElikesymptoms,butdonotmeetspecicdiagnosc
criteriaforthatdisease
Livedorecularis,skinulcers,mentalstatuschangesandmitralregurgitaonarealso
noted
Treatmentmayrequireimmunosuppressiveorancoagulantmedicaons(prednisone,
aspirin,heparinIGIV)azathioprineandcyclosporine
Diagnosis
Falseposiveserologicaltestforsyphilis
Prolongedcoagulaonstudies(PT,PTT)
Posiveautoanbodytest
Currentdatasuggeststhemostecacioustherapytolowdoseheparin,alongwithlow
doseaspirin,Ifacvelupusispresentthenprednisoneisusuallyalsogiven
(Q.119)
Ramkali,a37yearold,isacaseofpolycyscovarydisease.LH/FSHesmaonhastobedoneinwhichpartof
themenstruaoncycle
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(a)
14days
(b)
810days
(c)
1315days
(d)
2426days
YourResponse:
CorrectAnswer:
Exp:
Preovulatory,LH,FSHlevelwillneedtobeesmated
Menstrual13days
Preovulatory810days
Ovulatory1315days
Postovulatoryorpremenstrual2628days
(Q.120)
(Q.121)
18yearoldgirlpresentswithamenorrhoea,milkdischarge,weightloss.Diagnosisis
(a)
PitutaryCancer
(b)
Anorexianervosa
(c)
Hypothyroidism
(d)
Hypohalamiccause
YourResponse:
CorrectAnswer:
Exp:
ItstempngheretogoforHypothyroidismbutthatisusuallyassociatedwithweight
gain.However,pituitarytumorsandcraniopharyngiomascancauseincreaseinPRLand
consequentgalactorrheaweightlossaributedthentothemalignantprocess.
Whichofthefollowingisthebiochemicalmarkerofchoicefromcholestacjaundiceofpregnancy?
(a)
SerumBilirubin
(b)
Bileacids
(c)
Bilesalts
(d)
Alkalinephosphataselevels
YourResponse:
CorrectAnswer:
Exp:
(Ref.DuaObstetrics6th/291;H17th/265)
Cholestasisofpregnancyoccursinthesecondandthirdtrimestersandresolvesaer
delivery.Itscauseisunknown,butthecondionisprobablyinheritedandcholestasiscan
betriggeredbyestrogenadministraon.Incasesofintrahepaccholestasisofpregnancy,
bileacidsareclearedincompletelyandaccumulateinthedermis,whichcausesintense
itching.Thesepaentsdeveloppruritusinlatepregnancy;therearenocharacteriscskin
changesorrashesexceptinwomenwhodevelopexcoriaonsfromscratching.
Cholestyramineisoenusedincasesofcholestasisofpregnancytolowerserumbile
saltsanddecreasepruritus.16weeks.Insomecases,therecanbeatransienthepac
dysfuncon.Intrahepaccholestasisofpregnancyischaracterizedbypruritusand/or
icterus.Somewomendevelopcholestasisinthethirdtrimestersecondarytoestrogen
inducedchanges.Thereisanaccumulaonofserumbilesalts,whichcausesthepruritus.
Liverenzymesareseldomelevatedabove250U/L.
(Q.122)
Inpostmenopausalwomen,estrogenismetabolizedmostlyinto:
(a)
Estriol
(b)
Estrone
(c)
Estradiol
(d)
Androstenedione
YourResponse:
CorrectAnswer:
Exp:
CirculangestrogensIntheovulangwomanarederivedfromtwosources:
Sixtypercentofmeanestrogenformaonduringthemenstrualcycleisintheformof
estradiolQ,formedprimarilybyovaries.
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Remainderisestroneformedmainlyinextraglandularssuesfromandrostenedione
Aermenopauseextraglandularestrogenformaonisthemajorpathwayforestrogen
synthesisQEstrogenproduconbythemenopausalovaryisminimalPlasmalevelsof
estradiolarelowerinpostmenopausalwomenthanlevelsofestroneTherateof
peripheralformaonofestroneincreasesinmenopausalwomensothatestrone
produconisonlyslightlylessthanitwaspriortothemenopausedespitethefallin
plasmaandrostenedione.ThepredominantestrogenformedisESTRONEratherthan
estradiol.Q
(Q.123)
Adenoacanthomaiswhichtypeofuterinecancer?
(a)
Poorlydierenatedadenocarcinoma
(b)
WelldierenaonAdenocarcinoma
(c)
Mucinouscarcinoma
(d)
Papillaryserouscarcinoma
YourResponse:
CorrectAnswer:
Exp:
(Q.124)
Between75and80%ofallendometrialcarcinomasareadenocarcinomas,andthe
prognosisdependsonstage,histologicgrade,andextentofmyometrialinvasion.GradeI
tumorsarehighlydierenatedadenocarcinomas,gradeIItumorscontainsomesolid
areas,andgradeIIItumorsarelargelysolidorundierenated.Adenocarcinomawith
squamousdierenaonisseenin10%ofpaents;themostdierenatedformis
knownasadenoacanthoma,andthepoorlydierenatedformiscalledadenosquamous
carcinoma.Otherlesscommonpathologiesincludemucinouscarcinoma(5%)and
papillaryserouscarcinoma(<10%).
Provisionalshortanretroviralregimegivenintheperipartumperiodreducestheriskofvercaltransmission
by
(a)
35%
(b)
50%
(c)
65%
(d)
75%
YourResponse:
CorrectAnswer:
Exp:
MosttransmissionofHNoccursduringpregnancyandbirth,breastfeedingmayaccount
for515%ofinfantsbecominginfectedaerdelivery
Studieshavedemonstratedthattruncatedregimensofzidovudinealoneorwith
Lamivudinegiventomotherduringlastfewweeksofpregnancyorevenduringlabour&
delivery&totheinfantforaweekorlessreducedtransmissiontoinfantby50%
comparedtoplacebo.
(Q.125)
Whichofthefollowingneoplasmshasbeenassociatedwiththeuseoforalcontracepves?
(a)
Breastcancer
(b)
Ovariancancer
(c)
Endometrialcancer
(d)
Hepacadenoma
YourResponse:
CorrectAnswer:
Exp:
Beginningwithhighdosecombinaoncontracepvepillsusedover20yearsago,pills
havebeenstudiedextensivelyforapossibleassociaonwithneoplasia.
Thereisonlyscantevidencefromthisexperiencethatuseoforalcontracepves
increasestheriskofanytypeofcancer.
Actually,theprogestaonalcomponentofcombinaonpills(orprogesnonlyminipills)
mayconferaprotecveeectagainstcarcinomaofthebreastandendometrium,and
avoidingovulaonmaydecreasetheriskofdevelopingovariancarcinoma.
Aslightlyhigherriskofcervicalcarcinomawasobservedinsomestudiesofusersoforal
contracepves.Thesestudieswerenotcontrolled,however,forconfoundingvariables
suchasmulplepartnersorageatonsetofsexualintercourse,anditisgenerallybelieved
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nowthatanyincreasedriskincontracepvepilluserswouldbeaributabletothese
otherfactorsandnotthesteroidsthemselves.Althoughtheriskofdevelopingbenign
liveradenomaistherewithwiththeuseoforalcontracepves.
(Q.126)
AcaseofGestaonaltrophoblascneoplasiabelongstohighriskgroupifdiseasedevelopaer
(a)
Hydadiformmole
(b)
Fulltermpregnancy
(c)
Spontaneous
(d)
Ectopicpregnancyaboron
YourResponse:
CorrectAnswer:
Exp:
Classicaonofgestaonaltrophoblascdisease
H.mole1.Complete2.Paral
Gestaonaltrophoblasctumors
Nonmetastac
MetastacLowrisknoriskfactors
Highriskanyriskfactors
PyretherapyhCGlevel>40,000miu/mL
Duraon>4months
Brainorlivermetastasis
Priorchemotherapyfailure
Antecedenttermpregnancy
Hydadiformmole(181H&B)Itisregardedasabenignneoplasmofthechorionwitha
highmalignantpotenal,Itmayresultinoneofthemostfatalmalignanciesinwomen
andisalsopotenallythemostcurableduetorecentadvancesindiagnosisand
management.
(Q.127)
(Q.128)
MrsShikha,50yrsoldwomanisdiagnosedwithcervicalcancer.Whichlymphnodegroupwouldbetherst
involvedinmetastacspreadofthisdiseasebeyondthecervixanduterus?
(a)
Commoniliacnodes
(b)
Parametrialnodes
(c)
Externaliliacnodes
(d)
Paracervicalorureteralnodes
YourResponse:
CorrectAnswer:
Exp:
Themainroutesofspreadofcervicalcancerincludevaginalmucosa,myometrium,
paracervicallymphacs,anddirectextensionintotheparametrium.Theprevalenceof
lymphnodediseasecorrelateswiththestageofmalignancyPrimarynodegroups
involvedinthespreadofcervicalcancerincludetheparacervical,parametrial,obturator,
hypogastric,externaliliac,andsacralnodes,essenallyinthatorder.Lesscommonly,
thereisinvolvementinthecommoniliac,inguinal,andparaaorcnodes.InstageI,the
pelvicnodesareposiveinapproximately15%ofcasesandtheparaaorcnodesin6%.
InstageII,pelvicnodesareposivein28%ofcasesandparaaorcnodesin16%.Instage
III,pelvicnodesareposivein47%ofcasesandparaaorcnodesin28%.
Normalstaturewithminimalorabsentpubertaldevelopmentmaybeseenin
(a)
Tescularfeminizaon
(b)
Kallmannsyndrome
(c)
Puregonadaldysgenesis
(d)
Turnersyndrome
YourResponse:
CorrectAnswer:
Exp:
Tescularfeminizaonisasyndromeofandrogeninsensivityingenecmales,
characterizedbyanormal46,Xgenotype,normalfemalephenotypeduringchildhood,
tallstature,andnormalbreastdevelopmentwithabsenceofaxillaryandpubichair.
Breastdevelopment(gynecomasa)occursinthesemalesbecausehighlevelsof
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circulangtestosterone(whichcannotactatitsreceptor)arearomazedtoestrogen,
whichthenactsonthebreast.Theexternalgenitaliadevelopasthoseofafemale
becausetestosteronecannotmasculinizethem,whiletheMullerianstructuresareabsent
becauseoftescularsecreonofMullerianinhibingfactorinutero.Gonadaldysgenesis
(e.g.,45,XTurnersyndrome)ischaracterizedbyshortstatureandabsenceofpubertal
development;inthesegirlstheovariesareeitherabsentorstreakgonadsthatare
nonfunconal.Ineithercase,estrogenproduconispossible,andthereforeisosexual
pubertaldevelopmentdoesnotoccur.Mailmansyndrome(hypogonadotropic
hypogonadism)shouldbesuspectedinpaentsofnormalstaturewithdelayedorabsent
pubertaldevelopment,especiallywhenassociatedwiththeclassicndingofanosmia.
TheseindividualshaveastructuraldefectoftheCNSinvolvingthehypothalamusandthe
olfactorybulbs(locatedincloseproximitytothehypothalamus),suchthatthe
hypothalamusdoesnotsecreteGnRHinnormalpulsalefashion,ifatall.Othercausesof
minimalorabsentpubertaldevelopmentwithnormalstatureincludemalnutrion;
anorexianervosa;severesystemicdisease;andintensiveathlectraining,parcularly
balletandrunning.
(Q.129)
(Q.130)
(Q.131)
Asherman'ssyndromeisdueto:
(a)
Trauma
(b)
CuTinseron
(c)
Cureage
(d)
Forcepsapplicaon
YourResponse:
CorrectAnswer:
Exp:
"Intrauterinesynechiae"representanimportantacquireduterinecondionthatmay
seriouslyimpairferlity.Adhesionsusuallyresultfromvigorouscureageoftheuterus.If
thecureagehasactuallyremovedtheendometrium,synechiaewithassociated
amenorrheamayresult(Asherman'ssyndrome).Asherman'ssyndromeusuallyfollows
vigorouscureageforpostpartumhemorrhageoraertherapeucaboroncomplicated
byinfecon.
Whichofthefollowingcausesincreaseinbasalbodytemperatureduringovulaon:
(a)
Progesterone
(b)
Estrogen
(c)
Luteinizinghormone
(d)
Folliclesmulanghormone
YourResponse:
CorrectAnswer:
Exp:
BiphasicchangesinBASALBODYTEMPERATUREaretypicaloftheovulatorycycleandare
mediatedbyalteraonsinPROGESTERONElevels.Anincreaseinbasalbodytemperature
by0.3to0.5Cbeginsaerovulaon,persistsduringthelutealphase,andreturnstothe
normalbaseline(36.2to36.4C)aertheonsetofthesubsequentmenses.
Notafeminizingtypeatovariantumor:
(a)
Arrhenoblastoma
(b)
Luteoma
(c)
Thecoma
(d)
Granulosacelltumor
YourResponse:
CorrectAnswer:
Exp:
Themostcommonvirilizingovariantumoristhearrhenoblastoma,butotherovarian
tumors,suchasadrenalresttumor,granulosacelltumor,hilarcelltumor,andBrenner
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tumor,mayalsocausevirilizaon.
(Q.132)
Imiquimodisusedfortreatmentof
(a)
Molluscumcontagiosum
(b)
Warts
(c)
Skincancer
(d)
Alloftheabove
YourResponse:
(Q.133)
CorrectAnswer:
Exp:
Imiquimodbelongstoagroupofdrugscalledimmuneresponsemodiers.Itworksby
helpingimmunesystemtoghttheseabnormalskingrowthsprecancerousgrowths
(acnickeratoses),acertaintypeofskincancer(supercialbasalcellcarcinoma),and
wartsontheoutsideofthegenitals/anus,keloid.
WhichofthefollowingcanceriscommonlypredisposedintheLynchsyndrome?
(a)
Nonpolyposiscoloncancer
(b)
Ovariancancer
(c)
Endometrialcancer
(d)
Alloftheabove
YourResponse:
(Q.134)
CorrectAnswer:
Exp:
TheLynchsyndromeoccursinfamilieswithanautosomaldominantmutaonof
mismatchrepairgenesMLH1,MSH2,MSH6,andPMS2,whichpredisposeto
nonpolyposiscoloncanceraswellasendometrialandovariancancer.
Themostcommonpuregermcelltumoroftheovaryis:
(a)
Choriocarcinoma
(b)
Dysgerminoma
(c)
Embryonalcelltumor
(d)
Malignantteratoma
YourResponse: d
CorrectAnswer:
Exp:
(Ref.ShawstextbookofGynacology13thEdn361)
Dysgerminoma:
Itisthemostcommonpuregermcelltumorofovary.
ItcorrespondstoSeminoma.
Itiscommonundertheageof20.
Itisusuallyunilateral.
Itisneutral.
Itsecretsplacentalalkalinephosphatase.
Itmaybeassociatedishypoplasiaoraplasiaofpartof
genitaltract.
Itisveryradiosensive.
Itispotenallymalignantwithmalignancyrateof3050%.
Endodermalsinus/yolksactumoris2ndmostcommon
germcelltumor.
Embryonalcelltumorisrare.
(Q.135)
Uterinebloodowatterm:
(a)
5075ml/min
(b)
150200ml/min
(c)
350400ml/min
(d)
500700ml/min
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YourResponse:
(Q.136)
CorrectAnswer:
Exp:
(Ref.DuaObstetrics4thed.53)
Uterinebloodowisincreasedfrom50mlperminuteinnonpregnantstatetoabout
750mlnearterm.
Whichofthefollowingcongenalanomaliesisseenwithmaternaluseofcocaine
(a)
Sacralagenesis
(b)
Hydrops
(c)
Cerebralinfarcon
(d)
Hypertrichosis
YourResponse:
CorrectAnswer:
Exp:
CocaineusehasbeenassociatedwithMI,arrhythmiasaorcrupture,strokesseizures,
bowelischemia,hyperthermia,andsuddendeath
Riskofvasculardisruponwithintheembryofetusorplacentaishighestaertherst
trimesterandlikelyaccountsfortheincreasedincidenceofsllbirths
Anumberofcocainerelatedcongenitalanomaliesduetovascularbaseddisrupon,they
includeskulldefect,cusaplasia,porencephaly,ilealatresia,cardiacanomaliesand
visceralinfarcts
Drugofabuseduringpregnancy
CocaineLBW,pretermdelivery,increasedplacentalabruptus,increasedfetaldeath,
fetaltachycardiaandhypertension,CNSirritability,cerebralinfarct
CaeineIncreasedmiscarriageandsllbirths
MarijuanaThymichypoplasia
(Q.137)
WhichofthefollowingisTRUEaboutMifepristone
(a)
Usedforinducingaboroninearlypregnancy
(b)
Usedalongwithcontracepvepills
(c)
Actsonthecytoplasmicreceptors
(d)
Usedforprevenngectopicimplantaon
YourResponse:
CorrectAnswer:
Exp:
Mifepristone
Thisisprogesteroneantagonist
Terminaoniseecveupto9weeksofpregnancy
Asingledoseof600mgisgivenorally.Ifaboronfailstooccurby36hours,
prostaglandinsElmethylesterpessary(germPROST)1mgisintroducedvaginallyto
completetheaboronprocess
Misoprostol(anotherPGE1analogue)isequallyeecve
SideeectsNausea,vomingandrarelyhaemorrhage
ContraindicaonItshouldnotusedinwomenageover35years,heavysmokers,and
thoseonthelongtermcorcosteroid.
(Q.138)
Besttreatmentofendometriosisinayounggirlis
(a)
Oestrogen
(b)
Gonadotrophins
(c)
Surgery
(d)
Danazol
YourResponse:
CorrectAnswer:
Exp:
EndometriosisTreatmentDanazolcausesmarkedimprovementsin75%90%casesis
thepreferreddrugbymost,Androgenicsideeectsarethelimingfactors
GnRHanalogsuchasnafarelinnasalspraysuppressovulaon,sideeectsconsisngof
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vasomotorsymptomsandbonedemineralizaonmayberelievedby"addback"therapy
withnorethindrone
Surgicalmeasureformoderatelyextensiveendometriosisforundertheageof35years,
resectthelesion,freeadhesions,andsuspendtheuterus.
Ifpaentisover35yearsoldsalpingooophorectomyandhysterectomywillprobablybe
necessary
Fociofendometriosiscanb~treatedatlaparoscopybybipolarcoagulaonorlaser
vaporizaon.
(Q.139)
Theengagingdiameterinthefollowingpresentaonis?
(a)
Submentobregmac
(b)
Submentovercal
(c)
Mentovercal
(d)
Occipitofrontal
YourResponse:
CorrectAnswer:
Exp:
Variousdiameter:
Suboccipitobregmacdiameter:Measuredfrombelowtheoccipitalprotuberanceand
thecentreofthebregmaoranteriorfontanelle
Suboccipitofrontaldiameter:Measuredfrombelowtheoccipitalprotuberanceandthe
centreofthefrontalsuture
Occipitofrontaldiameter:Measurefromtheoccipitalprotuberancetotheglabellaorroot
ofthenose
Mentovercaldiameter:Measuredfromthepointofthechintothehighestpointofthe
vertex
Submentovercaldiameter:measuredfromthepointwherethechinjointstheneckto
thehighestpointofthevertex
Submentobregmacdiameter:measuredfromthepointwherethechinjointstheneck
tothecentreofthebregma
Biparietaldiameter:Thediameterbetweenthetwoparietaleminences
Bitemporaldiameter:Thediameterbetweenthefurthestpointsofthecoronalsuturesat
thetemples
(Q.140)
Inwhichofthefollowingheartdiseasesismaternalmortalityduringpregnancyisfoundtobethehighest?
(a)
Coarctaonofaorta
(b)
Eisenmengerscomplex
(c)
Aorcstenosis
(d)
MitralStenosis
YourResponse:
CorrectAnswer:
Exp:
PULMONARYHYPERTENSIONMaternalmortalityinthesengofseverepulmonary
hypertensionishigh,andprimarypulmonaryhypertensionisacontraindicaonto
pregnancy.Terminaonofpregnancymaybeadvisableinthesecircumstancesto
preservethelifeofthemother.IntheEisenmengersyndrome,i.e.,thecombinaonof
pulmonaryhypertensionwithrighttoleshunngduetocongen,italabnormalies
maternalandfetaldeathoccurfrequently.Systemichypotensionmayoccuraerblood
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loss,prolongedValsalvamaneuver,orregionalanesthesia;suddendeathsecondarytol
hypotensionisadreadedcomplicaon.Managementofthesepaents,ischallenging,
andinvasivehemodynamicmonitoringduringlaboranddeliveryisgenerally
recommended.Inpaentswithpulmonaryhypertension,vaginaldeliveryisteststressful
hemodynamicallythanCesareansecon,whichshouldbereservedforacceptedobstetric
indicaons.
(Q.141)
TreatmentofmenorrhagiaareallthefollowingEXCEPT
(a)
NSAIDS
(b)
Tranexamicacid
(c)
Norethisterone
(d)
Clomiphene
YourResponse:
CorrectAnswer:
Exp:
Treatmentofmenorrhagia
ConservaveRest,sedaves,reassurance,oraliron,bloodtransfusions
Hormonestherapyoestrogen,progestaonalsteroids(Norethynodrel,norethisterone)
Danazol,OCP,Testosterone
NSAIDS,Mefenamicacid
AnbrinolycagentsTranexamicacid
GnRHagonist,ethamsylate,radiotherapy
Clomiphenemaybeadvocatedifpregnancyisdesireandifcyclesareanovulatory
(Q.142)
Paininearlylaboristransmiedthrough:
(a)
T11T12
(b)
L2L3
(c)
L4L5
(d)
S2S3
YourResponse:
CorrectAnswer:
Exp:
(Ref.WilliamsObstetrics22nded.Chapter19.ObstetricalAnesthesia)
UterineInnervaon
Painduringtherststageoflaborisgeneratedlargelyfromtheuterus.
Visceralsensorybersfromtheuterus,cervix,anduppervaginatraversethroughthe
Frankenhuserganglion,Q
TheFrankenhuserganglionliesjustlateraltothecervix,intothepelvicplexus,andthen
tothemiddleandsuperiorinternaliliacplexuses.
Fromthere,theberstravelinthelumbarandlowerthoracicsympathecchainstoenter
thespinalcordthroughthewhiteramicommunicantesassociatedwiththeT10through
T12andL1nerves.
Earlyinlabor,thepainofuterinecontraconsistransmiedpredominantlythroughthe
T11andT12nerves.
ThemotorpathwaystotheuterusleavethespinalcordattheleveloftheT7andT8
vertebrae.
Theorecally,anymethodofsensoryblockthatdoesnotalsoblockthemotorpathways
totheuteruscanbeusedforanalgesiaduringlabor.
(Q.143)
Allofthefollowingdrugsarecommonlyuseintreatmentofmalignantgermcelltumorexcept:
(a)
Bleomycin
(b)
Etoposide
(c)
Cisplan
(d)
Doxorubicin
YourResponse:
CorrectAnswer:
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Mostofthemalignantgermcelltumorsaremanagedwithchemotherapyaersurgery.
Regimenssimilartothoseusedintescularcancer,suchasBEP(bleomycin,etoposide,
andcisplan),withthreeorfourcoursesgivenat21dayintervals,haveproduced95%
longtermsurvivalinpaentswithdiseasestagesIIII.Thisregimenisthetreatmentof
choiceforallmalignantgermcelltumorsexceptgradeI,stageIimmatureteratoma,
wheresurgeryaloneisadequate,andperhapsearlystagedysgerminoma,wheresurgery
andradiaontherapyareused.
Exp:
(Q.144)
(Q.145)
MostpreferablecontracepvedeviceforafemalesueringfromRheumacHeartDiseasewhohascompleted
herfamilyis:
(a)
IUCD
(b)
Tuballigaon
(c)
Norplant
(d)
Barriermethod
YourResponse:
CorrectAnswer:
Exp:
Tuballigaonunderlocalanaesthesiabyminilaptechniqueistheprocedureofchoicefor
permanentsterilizaoninafemalewithRHDwhohascompletedherfamily.
Thebestmefortheprocedureisattheendoftherstweekinthepuerperiumwhen
theheartiswellcompensated.
TrueaboutVasaprevia.
(a)
RiskfactorislowLyingplacentainsecondtrimester
(b)
ManagementisCaesarianseconat38weeks
(c)
Incidenceis1in1500
(d)
Undiagnosedvasapreviacarriesaperinatalmortalityof20%
YourResponse:
CorrectAnswer:
Exp:
VasaPrevia
Vasapreviaisararely(1:2500)(oponc)reportedcondioninwhichfetalbloodvessel(s)
fromtheplacentaorumbilicalcordcrossestheentrancetothebirthcanal,beneaththe
baby.
Thecondionhasahighfetalmortalityrate(5095%)(opiond).Thiscanbeaributedto
rapidfetalexsanguinaonresulngfromthevesselstearing.
Vasapreviamightbepresentifanyofthefollowingcondionsexist:
Velamentouscordinseron
Bilobedplacenta
Succenturiatelobedplacenta
Lowlyingplacentaorplacentaprevia
Pregnanciesresulngfrominvitroferlizaon
Mulplepregnancies
MaternalhistoryofD&Coruterinesurgery
Management
Whenvasapreviaisdetectedpriortolabor,thebabyhasamuchgreaterchanceof
surviving.Survivalratescanrangefrom5095%,
Vasapreviacanbedetectedduringpregnancywithuseoftransvaginalsonography,
preferablyincombinaonwithcolorDoppler.Womenwiththeaboveriskfactorsshould
havethistesttoruleoutvasaprevia.
Whenvasapreviaisdiagnosed,elecvedeliverybycaesarean(3738weeks)beforelabor
beginscansavethebaby'slife.Ideally,itshouldbeperformedearlyenoughtoavoidan
emergency,butlateenoughtoavoidproblemsassociatedwithprematurity.
(Q.146)
Hyperemesisgravidarumin1sttrimesterisseenwithincreasedfrequencyinallofthefollowingexcept
(a)
Hydadiformmole
(b)
Twins
(c)
Preeclampsia
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(d)
Primigravida
YourResponse:
(Q.147)
CorrectAnswer:
Exp:
Hyperemesisgravidarumisaseveretypeofvomingofpregnancy,whichhasgot
deleteriouseectonthehealthofthemotherand/orincapacitatesher"indaily
acvies.Itismostlylimitedtothersttrimesterofpregnancyandmorecommoninrst
pregnancybuthasatendencytorecuragaininsubsequentpregnancy.Ithasgotafamily
historyandismorecommoninUnplannedpregnancies.Itismoreprevalentin
hydadiformmoleandmulplepregnancy.
ThemostsensivemethodfordetecngcervicalChlamydiatrachomasinfeconis:
(a)
Directuorescentanbodytest
(b)
Enzymeimmunoassay
(c)
CultureonirradiatedMacConkeycells
(d)
Polymerasechainreacon
YourResponse:
(Q.148)
CorrectAnswer:
Exp:
Nucleicacidprobeshavebeendevelopedforuseinamplicaonassayssuchasligase
chainreaconandpolymerasechainreacon(PCR).Thesetestsarenowthemost
sensivechlamydialdiagnoscmethodsavailable,beingtherstnoncultureassays
actuallytosurpasscultureitselfinsensivity.
Pressureofnormaluterinecontraconsisbetween190300.Itismeasuredintermsof?
(a)
Montevideounits
(b)
MmofHg
(c)
Cmofwater
(d)
Joules/kg
YourResponse:
CorrectAnswer:
Exp:
(Ref.Williamsobstetrics22nded.,p466;DanforthsObstetricsandGynecology,9thed.,
ch9)
TheMontevideounit=
TheAverageintensityoftheuterinecontraconsXNumberofcontraconsovera10
minuteperiod(expressedasmmHg/10min).
UTERINEACTIVITYSTRENGTH
ThestrengthofthecontraconscanonlybeassessedwiththedirectIntrauterine
PressureCatheters(IUPC).
Thenormalbaselineuterinepressurebetweencontraconsisapproximately10mmHg.
Abnormallyhighbaselinepressuresinexcessof20mmHgmayresultfrom
hypersmulaonoroccasionallyfromoverdistenonoftheuterusbyexcessive
amnioinfusion,polyhydramnios,orfetalmacrosomia.
Duringcontracons,normaluterinepressurerangesfrom30to80mmHg,although
pressuresinexcessof80mmHgmaybeobservedduringthesecondstageoflabor.
Manydierentquantaveapproachestouterinecontraclityhavebeenproposed
usingIUPCtechnology.
(Q.149)
WhichofthefollowingisNOTanassistedreproducontechnique
(a)
ZIFT
(b)
GIFT
(c)
IVFandembryonaltransfer
(d)
Arcialinseminaonintotheuterus
YourResponse:
CorrectAnswer:
Exp:
Assistedreproducvetechnologies
Coupleswhohavefailedtorespondtotradionalinferlitytreatments,includingthose
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withtubaldisease,severeendometriosis,oligospermia,immunologicorunexplained
inferlity,maybenetfrominvitroferlizaon(IVF),gameteintrafallopiantransfer(GIFT)
andzygoteintrafallopiantransfer(ZIFT)
Alloftheproceduresinvolveovariansmulaontoproducemulpleoocytes
GIFTinvolvestheplacementofspermandeggsintheuterinetubebylaparoscopyor
minilaparotomyandismoreinvasivethanIVF
GIFTisnotappropriateforwomenwithseveretubaldiseaseandislesssuccessfulthan
IVFZIFTferlizaonoccursinvitro,andtheearlydevelopmentoftheembryooccursin
theuterinetubeaertransferbylaparoscopyorminilaparotomy
Arecentdevelopmentisintracytoplasmicsperminjecon(ICSI)whichallowferlizaon
withasinglesperm,thisprovidestheopportunityformenwithsevereoligospermiaor
obstrucveazoospermiatofatherchildren.
ArcialinseminaoninAzoospermiaifazoospermiaispresent,arcialinseminaon
byadonorusuallyresultinpregnancy,assumingfemalefunconisnormal
(Q.150)
Amniocuidcontainsacetylcholinesteraseenzyme.Whatisthediagnosis.
(a)
Openspinabida
(b)
Gastroschisis
(c)
Omphalocele
(d)
Osteogenesisimperfecta
YourResponse:
CorrectAnswer:
Exp:
Amniocuidafetoproteinlevelsaremeasuredifaneuraltubedefectissuspectedorif
USGisnondiagnoscinthepresenceofelevatedmaternalserumAFP.
Ifelevated,presenceorabsenceofacetylcholinesteraseisdeterminedinamniocuid.
Presenceofthisenzymeconrmsthatthereisexposedneuralssue.Elevaonof
amniocuidAFPlevelwithoutacetylcholinesterasesuggestanothereology.
MaternalAFPraisedin
Neuraltubedefect
Umbilicalhernia
Sacralteratoma
IUD
Congonephrosis
Mulplepregnancy
(Q.151)
Whichofthefollowingndingscharacterizesanormalsemensample?
(a)
Agglunaon
(b)
Spermconcentraonof35millionperml
(c)
5%normalspermmorphology
(d)
10%progressivespermmolity
YourResponse:
(Q.152)
CorrectAnswer:
Exp:
Becauseofthevariabilityinsemenspecimensfromthesameperson,preferablythree
specimensshouldbeevaluatedoverthecourseofaninvesgaonforinferlity.Anormal
semenanalysiswilldemonstrateatleast20millionspermpermilliliter,over60%ofthe
spermwithanormalshape,avolumeofbetween2and6mL,andatleast50%ofthe
spermwithprogressiveforwardmolity.
Apregnant35yrsoldpaentisathighestriskfortheconcurrentdevelopmentofwhichofthefollowing
malignancies?
(a)
Cervix
(b)
Ovary
(c)
Breast
(d)
Vagina
YourResponse:
CorrectAnswer:
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Exp:
(Q.153)
Cervicalcancerisamorecommongynecologicmalignancyinpregnancythanovarianor
breastcancerduetothefactthatitisadiseaseofyoungerwomen.Managementof
cervicalintraepitheliallesionsiscomplicatedinpregnancybecauseofincreased
vascularityofthecervixandbecauseoftheconcernthatmanipulaonofandtraumato
thecervixcancompromiseconnuaonofthepregnancyAtradionalconebiopsyis
onlyindicatedinthepresenceofapparentmicroinvasivediseaseonacolposcopically
directedcervicalbiopsyOtherwise,morelimitedproceduressuchasshallowcoin
biopsiesaremoreappropriate.Ifinvasivecancerisdiagnosed,thedecisiontotreat
immediatelyorwaitunlfetalviabilitydependsinpartonthegestaonalageatwhich
thediagnosisismadeandtheseverityodisorder.Survivalisdecreasedformalignancies
discoveredlaterinpregnancyRadiaontherapyalmostalwaysresultsinspontaneous
aboron,inpartbecausethefetusisparcularlyradiosensive.Chemotherapyis
associatedwithhigherthanexpectedratesoffetalmalformaonsconsistentwiththe
anmetaboliteeectsofagentsused.Specicmalformaonsdependontheagentused
andthemeinpregnancyatwhichtheexposureoccurs.
Bevicizumabisusedinthetreatmentof?
(a)
Ovariancancer
(b)
Uterinecancer
(c)
Cervixcancer
(d)
Carcinomaofthefallopiantube
YourResponse:
(Q.154)
CorrectAnswer:
Exp:
Bevicizumabisamonoclonalanbodythattargetsthevascularendothelialgrowthfactor.
Inialtrialsproduceda17%overallresponserateinheavilypretreatedpaents.
However,hypertension,thrombosis,andbowelperforaonshavebeenreportedinsome
trials.
Inleiomyomaofuteruswhichofthefollowingchangesdoesnotoccur:
(a)
Faydegeneraon
(b)
Squamousmetaplasia
(c)
Hyalinedegeneraon
(d)
Atrophy
YourResponse:
CorrectAnswer:
Exp:
SecondaryChanges(Degeneraons)AssociatedwithLeiomyomas
Atrophy.
Itoccursduetoreducedvascularity
Hyaline
degeneraon
Ahyalinemyomaishardandrmanditcausesnospecic
clinicalsymptoms.
Cysc
degeneraon
Itisseenmostfrequentlyinlargeintramuraltumorsandis
bestmarkedinthemiddlebecausethebloodsupplyisless
plenfulhere.
Faychanges
Mostcasesresultfrompreviousreddegeneraon
Reddegeneraon Developsmostfrequentlyduringpregnancyalthoughitis
notrare.incasesofpainfulmyomasinwomenovertheage
of40.Myomabecomestenseandtenderandcausessevere
abdominalpainwithconstuonalupsetandfever.Tumor
itselfassumesapeculiarpurpleredcoloranddevelopsa
shyodor.Carefulexaminaonshowsthatsomeofthe
largeveinsofthecapsuleandthesmallvesselsinthe
substanceofthetumorarethrombosed.Discoloraonis
possiblycausedbydiusionofbloodpigmentsfromthe
thrombosedvessels.
Sarcomatous
changes
Itisextremelyrareinleiomyomaandtheincidenceisless
than0.5%ofallmyomas.
Intramuralandsubmucoustumorshaveahigherpotenal
forsarcomatouschangethanasubseroustumor.
Torsion
Subserousmyomamayundergorotaonatthesiteofits
aachmenttotheuterus.Veinsareoccludedandtumor
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becomesengorgedwithblood.Verysevereabdominalpain
isexperiencedandmostpaentsareoperatedupon
immediately.Veryrarelytherotatedtumormayadhereto
adjacentviscera,obtainafreshbloodSupplyfromtheses
adhesionsandnallybedetachedcompletelyfromuterus,
thesocalledwanderingbroidorparasicbroid.
(Q.155)
Inversion
Causedbysubmucousfundalmyoma.
Capsulerupture
Veryrare.
Inammatory
changes
Mostfrequentlyariseinsubmucousmyomasand
myomatouspolypi.
AladydiagnosedwithsputumposiveTB.Bestmanagementis
(a)
Waitfor2ndtrimestertostartATT
(b)
StartCategoryIATTinItrimester
(c)
StartCategoryIIATTinItrimester
(d)
StartCategoryIIIATTItrimester
YourResponse:
CorrectAnswer:
Exp:
Tuberculosisduringpregnancyshouldbediagnosedpromptlyandasearlyaspossible.
Latediagnosisandcareisassociatedwith4foldincreaseinobstetricmorbidityand9fold
increaseinpretermlabour.
Poornutrionalstates,hypoproteinemia,anaemiaandassociatedmedicalcondions
addtomaternalmorbidityandmortality.
AfoetuscangetTBinfeconeitherbyhematogenousspreadthroughumbilicalveinto
foetalliverorbyingesonoraspiraonofinfectedamniocuidTruecongenitalTBis
believedtoberare.
TherisktoneonateofgengTBinfeconshortlyaerthebirthisgreater
ATTshouldbestartedpromptlyasuntreateddiseasepresentsahazardtothemotherand
foetus.
Thesameregimensarerecommendedforuseinpregnancyasforthenonpregnantstate
exceptforwithholdingofStreptomycin.DoubtsabouttheuseofPyrazinamide
inpregnancyhavesincebeensetasrest.Currently,anintermientregimen(thrice
weeklyonalternatedays)undertheDOTSstrategyofRNTCPisbeingincreasinglyused
worldwideforthepregnantwomenhavingTB
NoneoftheATTdrugsareteratogenicandATTshouldbestartedassoonasthediagnosis
ismadesputumposivetuberculosisiscategory1
(Q.156)
Theriskofthromboembolismincreasesinpregnancybecause
(a)
Viscosityofbloodincreases
(b)
Increasedhepacproduconofclongfactor
(c)
IncreasedanthrombinIIIlevels
(d)
Increasedprogesteronelevels
YourResponse:
CorrectAnswer:
Exp:
ThromboembolismThepostpartumperiodisthecommonestmeinpregnancyfora
thromboembolismasthepuerperiumfulllsallthecriteriaofVirchow'striad.
1.IncreasedcoagulaonTheincreasesinclongfactorfrompregnancyremains
although
plasmavolumereturnstonormalwithafewhoursofdelivery2.StasisManywomen
areimmobilizedduringlabourortheimmediatepuerperium3.Damagetovenous
endothelium
Uterineveinwhenplacentaseparates
Deeplegveinswhenweightoflegsconnuestocompressveinsifwomenis
immobilizedinbed.
(Q.157)
Singlepelvicalaisabsentin
(a)
Robert'spelvis
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(b)
Naegele'spelvis
(c)
Osteomalaciapelvis
(d)
Ricketspelvis
YourResponse
:
CorrectAnswer
:
Exp:
b
Naegele'spelvisAlaononesideisabsent
Robert'spelvisAlaonbothsidesareabsent
Osteomalacicpelvistheshapeofinletistriradiate
Rachicpelvisshapeofinletisreniform
Theexpecteddateofdeliverycanbecalculatedby
Naegele'srule
(Q.158)
InSheehan'ssyndrome,themosteecvedrugis:
(a)
Corcosteroid
(b)
Prolacn
(c)
Estrogen
(d)
Gonadotropins
YourResponse:
(Q.159)
CorrectAnswer:
Exp:
Ifsystemichypotensiondevelops,aswithpostpartumhemorrhage,thepituitarymay
undergoinfarcon(Sheehan'ssyndromeorpostpartumpituitarynecrosis).The
managementofthepaentswhohavealreadydevelopedSheehan'ssyndromeshouldbe
donebyendocrinologydepartmentandconsistsof"maintenanceregime"ofthyroxin,
adrenalcorcalhormoneandpossiblygonadotropin.
Whichofthefollowingisresponsibleformenopausalhotashes:
(a)
Decreasedprogesterone
(b)
Decreasedestrogen
(c)
LHsurge
(d)
FSHsurge
YourResponse:
(Q.160)
CorrectAnswer:
Exp:
Themostcommonmenopausalsymptomsarevasomotorinstability(hotashes),atrophy
oftheurogenitalepitheliumandskin,decreasedsizeofthebreasts,andosteoporosis.
HOTFLASHES(FLUSHES)maystartwithanauraprecedingabdominaldiscomfortquickly
followedbyafeelingofheatmovingtowardthehead.Nextthefacebecomesred,and
thenthereissweangfollowedbyexhauson.Thepathogenesisofthehotashis
uncertain.Thereisaclose.Relaonshipbetweentheonsetofthehotashandpulsesof
LHsecreon.LHissecretedinepisodicburstsatintervalsof3060minutes,andinthe
absenceofgonadalhormones,theseburstarelarge.EACHHOTFLASHBEGINSWITHTHE
STARTOFABURST.
WhichofthefollowingistrueaboutMayerRokitanskyKsterHauser?
(a)
Ovaryuterustubesabsent
(b)
Uterusabsent,tubesandovarypresent
(c)
Uteruspresent,tubesandovaryabsent
(d)
Uterus,tubesandovarypresent
YourResponse:
CorrectAnswer:
Exp:
Mllerianagenesisisacongenitalmalformaoninwomencharacterisedbyafailureof
theMllerianductstodevelop,resulnginabsentuterusandvariablemalformaonsof
thevagina.
Itisthesecondmostcommoncauseofprimaryamenorrhea.
ThecondionisalsocalledMRKHorMayerRokitanskyKsterHauserSyndrome,named
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aerAugustFranzJosephKarlMayer,CarlFreiherrvonRokitansky,HermannKster,
andG.A.Hauser.
Signsandsymptoms
Awomanwiththiscondionishormonallynormal,thatisshewillenterpubertywith
developmentofsecondarysexualcharacteriscsincludingthelarcheandadrenarche.Her
chromosomeconstellaonwillbe46,XX.
Typically,thevaginaisshortenedandintercourseisdicultandpainful.
GynecologicUltrasonographydemonstratesacompleteorparalabsenceof
thecervix,uterus,andvagina.
Thissyndromeischaracterizedbycongenitalabsenceofvagina,primaryamenorrhea,
rudimentarycornuauteriorabsentuterusandmorphologicallynormalovariesand
rudimentaryFallopiantubes(orfallopiantubesmayalsobeabsent)situatedonthepelvic
sidewall.
Normalovulaon;normalbreastdevelopment;normalbodyandhair.Thewomanis
amenorrheicandinferle.
Frequentlyassociatedwithurinarytractanomalies,skeletalabnormalies,congenital
heartcondions,andinguinalhernia.
DueSincethereisnouterus,womenwithMRKHcannotcarryapregnancy.
WomenwithMRKHtypicallydiscoverthecondionwhen,duringpubertyyears,the
menstrualcycledoesnotstart.
Treatment
Althoughtherearetreatmentstoincreasethecomfortinsexualintercourse,thereare
nonetoletthewomanbecomepregnant.Sincethewomendohaveovaries,womenwith
thiscondioncanhavegenecchildrenthroughIVFwithembryotransfertoagestaonal
carrier.Somewomenalsochoosetoadopt.
(Q.161)
Falseregardingcompletetescularfeminizaonis:
(a)
Prelobularbulb
(b)
Presenceoffemininebreast
(c)
Primaryamenorrhea
(d)
Blindvagina
YourResponse:
(Q.162)
CorrectAnswer:
Exp:
Completetescularfeminizaonisacommonformofmalepseudohermaphrodism.Itis
the3rdmostcommoncauseofprimaryamenorrheaaergonadaldysgenesisand
congenitalabsenceofthevagina.Thefeaturesarecharacterisc.Namely,a''woman"is
ascertainedeitherbecauseofinguinalhernia(prepubertal)orprimaryamenorrhea
(postpubertal).Thedevelopmentofthebreasts,thehabitus,andthedistribuonofbody
fatarefemaleincharactersothatmosthavea''truly"feminineappearance.Axillaryand
pubichairsareabsentorscanty,butsomevulvalhairsareusuallypresent.Scalphairsare
thatofanormalwoman,andfacialhairsareabsent.Theexternalgenitaliaare
unambiguouslyfemale,andtheclitorisisnormal.Thevaginaisshortandblindending
andmaybeabsentorrudimentary.Allinternalgenitaliaareabsentexceptfortestesthat
containnormalLeydigcellsandseminiferoustubuleswithoutspermatogenesis.The
testesmaybelocatedintheabdomen,alongthecourseoftheinguinalcanal,orinthe
labiamajora.
Themostcommonseriousliverdiseaseencounteredduringpregnancyis:
(a)
Acutefayliverofpregnancy
(b)
Liverdamageduetopreeclampsia
(c)
Viralhepas
(d)
Intrahepaccholestasisofpregnancy
YourResponse:
CorrectAnswer:
Exp:
Viralhepasisthemostcommonseriousliverdeseaseencounteredinpregnant
women.The5disncttypesofviralhepasareA,B,D(causedbyhepasB
associatedwithagent),C&E.Accutefayliverofpregnancyoracutemeramorphosisor
acuteyellowatrophyisaseriousbutuncommoncomplicaon.Thelivermaybe
involvedinseverepreeclampsia,thislesionisuniqueandconsistofperiportal
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haemorrahage,brindeposionandhepatocytedisruponwithnecrosis.
(Q.163)
EMACOregimeofchemotherapyisusedinthetreatmentof?
(a)
Gestaonaltrophoblascneoplasia
(b)
MalignantOvariangermcelltumor
(c)
(d)
CAcervix
YourResponse:
(Q.164)
CorrectAnswer:
Exp:
Paentswithhighrisktumors(highbetahCGlevels,diseasepresenng4monthsaer
antecedentpregnancy,brainorlivermetastasis,orfailureofsingleagentmethotrexate)
areiniallytreatedwithcombinaonchemotherapy.EMACO(acyclicnoncrossresistant
combinaonofetoposide,methotrexate,anddacnomycinalternangwith
cyclophosphamideandvincrisne);cisplan,bleomycin,andvinblasne;andcisplan,
etoposide,andbleomycinareeecveregimens.EMACOisnowtheregimenofchoice
forpaentswithhighriskdiseasebecauseofexcellentsurvivalrates(>80%)andless
toxicity.
Velamentousinseronofthecordisassociatedwithanincreasedriskfor:
(a)
Prematureruptureofthemembranes
(b)
Fetalexsanguinaonsbeforelabor
(c)
Torsionoftheumbilicalcord
(d)
Fetalmalformaons
YourResponse:
(Q.165)
CorrectAnswer:
Exp:
Withvelamentousinseronofthecord,theumbilicalvesselsseparateinthemembranes
atadistancefromtheplacentalmargin,whichtheyreachsurroundedonlybyamnion.It
occursinabout1%ofsingletongestaonsbutisquitecommoninmulplepregnancies.
Fetamalformaonsaremorecommonwithvelamentousinserontheumbilicalcord.
Whenfetalvesselscrosstheinternalus(vasaprevia),ruptureofmembranesmaybe
accompaniedbyruptureofafetalvessel,leadingtofetalexsanguinaon.Anincreased
riskofprematureruptureofmembranesandoftorsionoftheumbilicalcordhasnot
beendescribedinassociaonwithvelamentousinseronofthecord.
Thisinstrumentcanbeappliedtoallpresentaonsexcept?
(a)
Face
(b)
Vertex
(c)
Aercomingheadinbreech
(d)
Brow
YourResponse:
(Q.166)
CorrectAnswer:
Exp:
Simpsonforcepsarethemostcommonlyusedamongthetypesofforcepsandhasan
elongatedcephaliccurve.Theseareusedwhenthereissubstanalmolding,thatis,
temporaryelongaonofthefetalheadasitmovesthroughthebirthcanal
Thereistheamplepelviccurveinthesinglebladeaboveandthecephaliccurveevident
inthearculatedbladesbelow.Thefenestratedbladeandthewideshankinfrontofthe
EnglishstylelockcharacterizetheSimpsonforceps.
Highestrateoftransmissionoftoxoplasmosisinpregnancyis:
(a)
Puerperium
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(b)
3rdtrimester
(c)
2ndtrimester
(d)
1sttrimester.
YourResponse:
(Q.167)
CorrectAnswer:
Exp:
About1/3rdofallwomeninfectedwithToxoplasmagondiiduringpregnancytransmitthe
parasitetothefetus;theremainderwillgivebirthtonormal,uninfectedbabies.Ofthe
variousfactorsthatinuencefetaloutcome,gestaonalageatthemeofinfeconisthe
mostcrical.Inpregnancy,ifthemotherbecomesinfectedduringthersttrimester,the
incidenceoftransplacentalinfeconislowest(about15%),butthediseaseinthe
neonateismostsevere.Ifmaternalinfeconoccursduringthethirdtrimester,the
incidenceoftransplacentalinfeconisgreatest(65%),buttheinfantisusually
asymptomacatbirth.
Ru486canbeusedinallofthefollowingcondionsexcept
(a)
Endometriosis
(b)
Emergencycontracepon
(c)
Tocauseaboron
(d)
YourResponse:
CorrectAnswer:
Exp:
Mifepristone(RU486)isarecentlydeveloped19nonsteroidwithpotentcompevean
progestaonalandsignicantanglucocorcoidacvity.Itsusesareasunder:
Terminaonofpregnancyofupto9weeks:600mgassingleoraldosecausescomplete
aboronin6085%'1cases.Mifepristoneadministeredwithin10daysofamissedperiod
resultsinanapparentlateheavyperiod(withdislodgedblastocyst)inupto90%ofcases.
Ontragestaonal:Givenonceamonthontheexpecteddateofmenstruaonitcan
dislodgetheembryo(ifpresent)andthusensuremenstruaonirrespecveof
contraceponorotherwise.Administeredasasingledosewithin72hoursofintercourse,
itcanserveasapostcoitalcontracepvewithfewersideeectsthanhighdoseestrogen.
Induconoflabor:Byblockingtherelaxantaconofprogesteroneonuterusoflate
pregnancy,mifepristonecaninducelabor.
Cushing'ssyndrome:Forinoperavecases.
Otherusesunderevaluaon:Endometriosis,uterinebroid,certainbreastcancersand
meningioma
(Q.168)
Excessiveintake(hypervitaminosis)ofwhichofthefollowingvitaminisassociatedwithincreasedriskof
congenitalmalformaons:
(a)
VitaminA
(b)
Bion
(c)
Folicacid
(d)
VitaminK
YourResponse:
(Q.169)
CorrectAnswer:
Exp:
Fetalabnormalies(includingurinarytractmalformaons),growthretardaon,andearly
epiphysealclosurehave;beenreportedinchildrenwhosemotherstookexcessive
amountsofVitaminAduringpregnancy.
Allofthefollowingarecausesofintrauterinegrowthretardaon,except
(a)
Anemia
(b)
Pregnancyinducedhypertension
(c)
Maternalheartdisease
(d)
Gestaonaldiabetes
YourResponse:
CorrectAnswer:
Exp:
MaternalcausesofIUGR
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Smallwomen
Maternalgenecandracialfactors
Malnutrionduring
pregnancy
Anemia
Hypertension
Anphospholipidsyndrome
Poorweightgainduring
pregnancy
Cyanocheartdisease
Malabsorponsyndrome
Alcoholdrinking
Cigareesmoking
Chronicrenalfailure
ChronicUTI
(Q.170)
Whichofthefollowingcardiacdisorderisverycommoninpregnancy?
(a)
Supraventriculartachycardia
(b)
Restricvecardiomyopathy
(c)
Ventricularectopic
(d)
TypeIIBblock
YourResponse:
(Q.171)
CorrectAnswer:
Exp:
Supraventriculartachycardiaisacommoncardiaccomplicaonofpregnancy.Treatment
isthesameasinthenonpregnantpaent,andfetaltoleranceofmedicaonssuchas
adenosineandcalciumchannelblockersisacceptable.Whennecessary,
electrocardioversionmaybeperformedandisgenerallywelltoleratedbymotherand
fetus.
Integraseinhibitorsareusedforthetreatmentof?
(a)
HPV
(b)
HIV
(c)
Tuberculosis
(d)
Cancers
YourResponse:
(Q.172)
CorrectAnswer:
Exp:
IntegraseisanenzymethatintegratesHIVgenecmaterialintotheDNAofhumanCD4
cellsmakingitpossiblefortheinfectedcelltomakenewcopiesofHIV.Byinterferingwith
integrase,theintegraseinhibitorspreventHIVgenecmaterialfromingrangintothe
CD4cell,thusstoppingviralreplicaon
Themostunfavorablepresentaonforvaginaldeliveryis
(a)
Mentoposterior
(b)
Mentoanterior
(c)
Occipitoposterior
(d)
Deeptransversearrest
YourResponse:
CorrectAnswer:
Exp:
Thereisnopossibilityofspontaneousdeliveryinpersistentmentoposterior,thisis
because,therelavelyshortneckcannotclearothetotallengthofthesacrum(12cm)
Assuchthethoraxisthrustin,resulngbregmacsternaldiameter(18cmor7")to
occupythepelvisAsaresultthelabourbecomesinevitablyobstructed.
Mentoanteriorvaginaldelivery
FirststageInuncomplicatedcases,awaitandwatchpolicyisadopted,labouris
conductedintheusualprocedureandthespecialinstrucons,aslaiddowninoccipito
posteriorposion,aretobefollowed.
Secondstageoneshouldwaitforspontaneousdeliverytooccur,perineum,shouldbe
protectedwithliberalmediolateralepisiotomy,Incaseofdelay,forcepsdeliveryisdone
Deeptransversearrest
A.VaginaldeliveryisfoundsafeAnyofthemethodsmaybeemployed(1)ventouse
idealinthesecases(2)Manualrotaonandapplicaonofforceps(3)forcepsrotaon
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withKiellandinthehandsofanexpert(4)craniotomyindeadbaby.
B.Vaginaldeliveryisnotsafe(withbigbabyandorinadequatepelvis)Cesareansecon
istobedone.
(Q.173)
Whichofthefollowingisthemostcommoncauseofpostpartumhemorrhagemandanghysterectomy?
(a)
Uterineatony
(b)
Placentaprevia
(c)
Placentaaccreta
(d)
Genitaltractlaceraon
YourResponse:
(Q.174)
CorrectAnswer:
Exp:
Anabnormallyadherentplacenta,althoughanuncommoncondion,assumes
considerablesignicanceclinicallybecauseofmorbidityand,atmes,mortalityfrom
severehemorrhage,uterineperforaon,andinfecon.Abnormallyadherentplacentaon
caused65percentofcasesofintractablepostpartumhemorrhagerequiringemergency
peripartumhysterectomy.
AllthefollowingareTRUEaboutManningscoreEXCEPT
(a)
Nonstresstest
(b)
Oxytocinchallengetest
(c)
Bodymovement
(d)
Respiratoryacvityofachild
YourResponse:
CorrectAnswer:
Exp:
ManningscoreAmethodofbiophysicalscoringsystembasedonmulpleparameter
determinedatrealmeultrasoundscanningformsthebasisofthetest.
IthasbeenofgreathelpinthemanagementofhighriskpregnanciesincludingIUGR
casesindeterminingthemingandmodeofpregnancyterminaon,wheneverthefetus
seemstobeinimminentjeopardy,
Theparameterthatconstutethebiophysicalproleinclude
(A)Nonstresstest(B)Fetalbreathing(C)Fetaltone(D)Grossbodymovements(E)
Volumeofamniocuidpresent.
Eachparameterisgivenascoreof2points,Ascoreof8to10correlateswellwithagood
pregnancyoutcomeAscoreoflessthan6shouldbeviewedwithcauon,thetestshould
berepeatedwithin24to48hours
Ascoreoflessthan2isassociatedwithpoorfetaloutcome.
(Q.175)
HIVtransmissiontothefetusfrommotheroccursmostcommonlyatwhatgestaonalage?
(a)
Isttrimester
(b)
IIndtrimester
(c)
IIItrimester
(d)
Duringbirth
YourResponse:
(Q.176)
CorrectAnswer:
Exp:
VirologicanalysisofabortedfetusesindicatethatHIVcanbetransmiedtothefetusas
earlyastherstandsecondtrimesterofpregnancy.However,maternaltransmissionto
thefetusoccursmostcommonlyintheperinatalperiod.Studiesindicatethattherelave
proporonsofmothertochildtransmissionswere2330%beforebirth,5065%during
birth,and1220%viabreastfeeding.
Ayounggirlpresentswithprimaryamenorrhoea,gradeVthelarche,gradeIIpubarcheandnoaxillaryhair.
Themostprobablediagnosisis
(a)
Tescularfeminizaon
(b)
Mullerianagenesis
(c)
Turnersyndrome
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(d)
Gonadaldysgenesis
YourResponse:
CorrectAnswer:
Exp:
Tescularfeminizaonsyndromecompleteandrogenresistance,presentsas
phenotypicyoungwomanwithoutsexualhairbutwithnormalbreastdevelopmentand
primaryamenorrhoea
Gonadaldysgenesis(Turnersyndrome)45X,46XXcharacterizedbyprimaryamenorrhea,
sexualinfanlismshortstature,bilateralgonadsstreaks,inphenotypicalwoman
MullerianagenesisCongenitalabsenceofthevagina,isthesecondtogonadal
dysgenesisasacauseofprimaryamenorrhoea,theheightisnormalandthebreast
axillaryandpubichair,andhabitusarefeminineincharacter
(Q.177)
A15yearoldgirlpresentswithalargeunilateraladnexalmassandascites.WhichlesionisMOSTlikelyinthis
paent?
(a)
Immatureteratoma
(b)
Brennertumor
(c)
Granulosacelltumor
(d)
Serousadenocarcinoma
YourResponse:
(Q.178)
CorrectAnswer:
Exp:
Immatureteratomasconsistoffetalorembryonicssue.Theseovariantumorsoccur
mostcommonlyinprepubertaladolescents.Theygrowrapidlyandfrequentlyspreadto
theperitoneum,resulnginascites.Manymaymetastasizetodistantsites.
AllofthefollowingmaybeobservedinanormalpregnancyEXCEPT
(a)
Fallinserumironconcentraonfalls
(b)
Increaseinserumironbindingcapacity
(c)
Increaseinbloodviscosityincreases
(d)
Increaseinbloodoxygencarryingcapacity
YourResponse:
CorrectAnswer:
Exp:
Physiologicalchangesintermedphysiologicalanemiaofpregnancy,Ironsupplementaon
augmentstheRBCmassduringpregnancy,Therearedisnctadvantages,inthe
hemodiluon,Itlowerstheviscosityofthematernalbloodtoensureadequategaseous
exchangebetweenthematernalandfetalblood,italsoprotectsthemotheragainstthe
adverseeectsofbloodlossduringthedeliveryHematologicalchangesIncreased
Plasmavolume,RBCvolume
Totalhaemoglobin
Plasmaironbindingcapacity
Ironabsorpondoubles
WBCcounts
FactorI,VII,VIII,IX,X
PlateletsurvivalmeXI,XIII
Plasminogenlevelsbrinogen
Albuminlevels,ESR
Albumin:globulinrao
Plateletcountisgenerallynormal,bleedingandclongmesremainsnormal,whereas
factorII,VandXIIremainunchanged
(Q.179)
Whichofthefollowingorganismcancauseepidemicsofpuerperalsepsis?
(a)
Cytomegalovirus
(b)
GroupAhemolycstreptococci
(c)
GroupBhemolycstreptococci
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(d)
Toxoplasmagondii
YourResponse:
CorrectAnswer:
Exp:
GroupAhemolycstreptococcicancausepuerperalorpostoperavepelvicinfecon.
Outbreaksofpuerperalfeveraresllreportedonobstetricservices,thoughnotat
anywherenearthefrequencyof50yearsago.Whenthediseasedoesoccur,apoint
sourceamongthehospitalpersonnelshouldbesuspected.GroupBhemolyc
streptococci,whichcanalsocausepuerperalfever,haverecentlybeenrecognizedasa
majorcauseofsevereneonatalinfecon.Theorganismcanbeisolatedfromthecervixes
ofabout5%ofallpregnantwomen;infeconoftheinfant,whichcanresultinsepsis,
occursastheinfantpassesthroughthevaginaTgondii,aprotozoanparasite,is
transmiedbyiesfromcatfecestohumanfood.Thus,humanscanbecomeinfectedby
consuminginfectedmeatthatisinadequatelycookedorbycomingindirectcontactwith
fecesofaninfectedcat.Acutetoxoplasmosisinapregnantwomanmaycauseafulminant
fetalinfecon;infectedneonatesmaybebornwithmicrocephaly,intracranial
calcicaon,orothersymptoms.Aneecveaenuatedvirusvaccineisavailablefor
immunizaonagainstrubella.However,itsuseisgenerallycontraindicatedforpregnant
womenandcommonlyisassociatedwithdevelopmentofarthralgiainadults.Rubella
syndromehasnotbeenseeninfetuseswhenmothersarevaccinated,andvaccinaon
canbeconsideredifapregnantwomanisexposedtothevirus.
(Q.180)
Formaonofoneofthefollowingisessenalforsuccessofthisinstrument?
(a)
Caput
(b)
Chignon
(c)
Phlegmon
(d)
Noneoftheabove.
YourResponse:
CorrectAnswer:
Exp:
CMITenderTouchextractorcup.
Comparisonstootherformsofassisteddelivery
A.Posiveaspects
Anepisiotomymaynotberequired.
Themotherslltakesanacveroleinthebirth.
Nospecialanesthesiaisrequired.
Theforceappliedtothebabycanbelessthanthatofaforcepsdelivery,andleavesno
marksontheface.
Thereislesspotenalformaternaltraumacomparedtoforcepsandcaesarean
secon.
B.Negaveaspects
Thebabywillbelewithatemporarylumponitshead,knownasachignon.
Thereisapossibilityofcephalohematomaformaon,orsubgalealhemorrhage.
(Q.181)
Bonney'stestisusedtodemonstrate:
(a)
Neurogenicinconnence
(b)
Trueinconnence
(c)
Urgeinconnence
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(d)
Stressinconnence
YourResponse:
(Q.182)
CorrectAnswer:
Exp:
Mostcommoncauseofleakageofurineinwomenisstressinconnence.Thisoccur
secondarytolaxityofthepelvicoorwithincompetenceofbladderneckandsphincter
mechanism.Itmostcommonlyoccursinlatemulparous"womenalthoughaminor
degreeofstressinconnenceisexperiencedbymanyyoungwomen.Paentcomplainsof
lossofurineassociatedwithcoughing,laughing,orsneezingandthismayalsooccurs
withchangesinposture.Thedemonstraonofinconnenceassociatedwithcoughing
anditssubsequentcontrolapplyingBonney'stest(angereithersideoftheurethra
pushedupwardstosupportthepelvicoor)isimportant.
TreatmentofstageIIofcarcinomaendometriumis:
(a)
Radiotherapy+surgery
(b)
Radiotherapy
(c)
Surgery
(d)
Chemotherapy
YourResponse:
(Q.183)
CorrectAnswer:
Exp:
TreatmentofstageIIcarcinomaofendometriumconsistsofpreoperaveintracavity
radiotherapy,followedwithinaweek,byabdominalhysterectomy,bilateralsalpingo
oophorectomyandpelviclymphnodedissecon.Thisisfollowedbyexternal
radiotherapyifglandsarefoundaected.
Thefollowingsurgicalprocedureisdoneinwhichphaseofthemenstrualcycle?
(a)
Follicularphase
(b)
Lutealphase
(c)
Ovulatoryphase
(d)
Irrespecveofphase
YourResponse:
(Q.184)
CorrectAnswer:
Exp:
ThepictureisthatoflaparascopictubalsterilizaonwhichcanbedonewithMTP,If
doneintheintervalphaseitisdonewithinrst7daysofthecycletoavoidtheriskof
lutealphasepregnancy.POstpsartumsterilizaonisdonebyminilaparotomyandnot
laparoscopically.
Atbirth,oocytesareinwhichstageofdevelopment:
(a)
Prophaseof1stmeiocdivision
(b)
Oogonia
(c)
Telophaseof2ndmeiocdivision
(d)
Resngphasebetweenprophaseandmetaphaseof1stmeiocdivision
YourResponse:
CorrectAnswer:
Exp:
d
(184).Ans:d.
Exp.Resngphasebetweenprophaseandmetaphaseof1stmeiocdivision
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Inthefetustheoogoniaareproliferangmitocally.Nearbirth,themitocdivisionstop
andtheoogoniaenterintoprophaseofrstmeiocdivisiontobecomeprimaryoocytes.
Atbirth,theprimaryoocyteshavenishedtheprophaseofrstmeiocdivisionand
remaininresngphasebetweenprophaseandmetaphase.
Therstmeiocdivisionoftheprimaryoocytescompletesatpuberty.
(Q.185)
Apaentunderwentsurgeryforovarianmassdiagnosedonultrasound.Thetumormarkerswerenegave.At
laparotomyperitonealwashingsweretakenandaerthoroughinspeconofabdomenIpsilateralsalpingo
oophorectomywasperformed.Thelateralendofthepedicleisformedof?
(a)
Roundligament
(b)
Ovarianligament
(c)
Mesosalpinx
(d)
Infundibulopelvicligament
YourResponse:
(Q.186)
CorrectAnswer:
Exp:
Themedialendofthepedicleisformedofroundligamentandmedialendoffallopian
tubethatistheintersalend.Themiddleporonofthepedicleisformedof
mesosalpinx.
VentouseextraconisdoneinallEXCEPT:
(a) Deeptransversearrest
(b) Aercomingheadofbreech
(c) Delayinrststageduetouterineinera.
(d) Delayindescentofhighheadincaseofsecondbabyoftwins.
YourResponse:
CorrectAnswer:
Exp:
b
(186).Ans:b.
Exp.Aercomingheadofbreech
Absoluteindicaonsforuseofforceps(orcontraindicaonsforuse
ofventouse)
Aercomingheadofbreech.
Prematurebaby(fetalheadremainsinaprotecvecage).
Fetaldistress(ventouseisunsuitablebecauseittakeslongerme
todeliver).
Anteriorfacepresentaon.
Pelviccontracon(ventousecannotgenerateadequatetracon),
(Q.187)
Whichofthefollowingdoesntpreventprolapseofuterus
(a)
Pubococcygeus
(b)
Broadligament
(c)
Uterosacralligament
(d)
Mackenrodtsligament
YourResponse:
CorrectAnswer:
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Exp:
Supportsofuterus(pelvicviscera)aremainly:1.Muscular,2.Pelvicfasciacondensaon,
3.others
MuscularPelvicdiaphragm,Urogenitaldiaphragm&Perinealbody.Pubococcygeusisa
muscleofpelvicdiaphragm.
Pelvicfasciacondensaonpubocervical,uterosacral,lateralcervicalligamentof
Mackenrodtetc.
Othersperitonealfoldslikebroadligament,roundligamentofuterusetc.
Note:Broadligament&roundligamentarethemselveslaxstructuresanddonotprovide
astrongpelvicsupport.
(Q.188)
Nonhormonaldrugtopreventpostmenopausalosteoporosisis:
(a)
Alendronate
(b)
Calciumgluconate
(c)
VitaminD
(d)
Calcitonin
YourResponse:
CorrectAnswer:
Exp:
(188).Ans:a.
Exp.Alendronate
Alendronate,Edronate,Pamidronatearebiposphonateswhichinhibit
boneresorpon.
Uses:1.Postmenopausalosteoporosis
2.Paget'sdisease
3.Osteolycbonemetastasis
Route:Oralori.v.infusion.
SideEects:Abdominalpain,bowelupset,nausea,headache,bodyache.
(Q.189)
MTPcannotbedoneaer:
(a)
12weeks
(b)
20weeks
(c)
24weeks
(d)
28weeks
YourResponse:
CorrectAnswer:
Exp:
MTPispermiedupto20weeksofpregnancy.Whenthepregnancyexceeds12weeks,
opinionoftwomedicalpraconersisrequired.
Husband'sconsentisnotnecessaryforMTP.
(Q.190)
A16yearoldgirlpresentswithblindvaginalpouchwithabsenceofuterus.Invesgaontobedoneis
(a)
Prolacnlevels
(b)
Karyotyping
(c)
IVP
(d)
FSHlevels
YourResponse:
CorrectAnswer:
Exp:
Indicaons
Paentswithmalformaonssuggesveofoneoftherecognizedsyndromesassociated
withaspecicchromosomeaberraon
Paentsofanyagewhoaregrosslyretardedphysicallyormentallyespeciallyifthereare
associatedanomalies
Anypaentswithambiguousinternalorexternalgenitaliaorsuspected
hermaphrodisms
Girlwithprimaryamenorrhoeaandboyswithdelayedpubertaldevelopment.
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Maleswithlearningorbehavioraldisorderswhoaretallerthanexpected(Basedon
parentalheight)
Certainmalignant&premalignantdisease
Parentsofapaentswithchromosomaltranslocaons
Coupleswithhistoryofmulplespontaneousaboronofunknowncause
Coupleswhoareinferleaermorecommonobstetricandurologiccauseshavebeen
excluded
Prenataldiagnosisadvancedmaternalage,previouschildwithchromosomeaberraon,
intrauterinegrowthdelay
(Q.191)
Signofinoperabilityofovariantumouris:
(a)
Excrescencesoversurface
(b)
Stromalinvasion
(c)
Peritonealinvolvement
(d)
Pelvicmetastasis
YourResponse:
CorrectAnswer:
Exp:
StaeineofCarcinomaOvary
StageIGrowthlimitedtoovaries.
StageIIGrowthinvolvingovarieswithpelvicextensionorpelvicmetastasis.
StageIIICarcinomainvolvingovarieswithperitonealimplantoutsidethepelvis,or
posiveretroperitonealor
inguinalnodes.
StageIVGrowthinvolvingovarieswithdistantmetastasesorpleuraleusionwith
parenchymalivermetastasis.
StageandIIareoperableandtotalabdominalhysterectomywithbilateralsalpingo
ophorectomywithomentectomyshouldbedone.
StageIIIandIVareinoperable;iffoundatlaparotomy,debulkingsurgeryisdone.
(Q.192)
WhichofthefollowingdoesnotcontainFatonmammography?
(a)
Posttraumaccyst
(b)
Hamartoma
(c)
Seborrhickeratosis
(d)
Galactoele
YourResponse:
CorrectAnswer:
Exp:
(Ref:RRM5thed.545;SuonRadiology7thed1462)
Seborrheickeratosisisacutaneousdiseasethatcanoccuranywhereovethebodywith
inframammaryclesbeingoneoftheknownsiteaectedandonmammographyone
mayseeairlucenciestrappedinthelesions.Galactocelesaremorefrequentlyseenas
mixeddensitylesionsthanradiolucentlesions.Theymaybemanagedbysimpleneedle
aspiraonbutinsomecasesthisisdicultduetothethickconsistencyofthecontents.
Radiographically,agalactoceleisseenassingleormulplenodularlesionswithadensity
equaltoorlessthanthatofthebroepithelialssueofthebreast.
Note:Fatcontainedwithinalesionprovesbenignity!
MAMMOGRAPHY
DierenaldiagnosisoffatcontainingBreastlesions
Lipoma
Oilcyst
Galactocele=uidwithhighlipidcontent(lastphase)Hamartoma
Traumacfatnecrosis(cyst)
Focalcolleconofnormalbreastfat
(Q.193)
Apaentwithseverepregnancyinducedhypertensionpresentswithcardiacfailureaer1weekofan
unevenulnormalvaginaldelivery.Thechestroentgenogramdemonstratesenlargementofthecardiac
silhouee,suggesveofDilatedcardiomyopathy.Themortalityinthiscondionis?
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(a)
10%
(b)
30%
(c)
50%
(d)
70%
YourResponse:
CorrectAnswer:
Exp:
CardiacdilataonandCHFmaydevelopduringthelasttrimesterofpregnancyorwithin6
monthsofdelivery.Thecauseisunknown,althoughinammatorymyocardis,immune
acvaon,andgestaonalhypertensionhaveallbeenincriminated.Thepaentwho
developsperipartumcardiomyopathytypicallyismulparousand>30years,althoughthe
diseasemaybefoundinawidespectrumofpaents.
Themortalityrateofthisdisorderisaround10%.
Theprognosisisrelatedtowhethertheheartsizereturnstonormalaertherst
episodeofCHF.Ifitdoes,subsequentpregnanciesmaysomemesbetolerated,albeit
withanincreasedriskofrecurrentCHF;iftheheartremainsenlarged,and/ortheLV
ejeconfracon(EF)remainsdepressedaer6months,theprognosisispoor,and
furtherpregnanciesfrequentlyproduceaddionalmyocardialdamage,ulmatelyleading
torefractoryCHF.Paentswhorecoverfromperipartumcardiomyopathyshouldbe
encouragedtoavoidfurtherpregnancies,parcularlyifLVdysfunconpersists.
(Q.194)
Causeofpostmenopausalbleedingis:
(a)
Arrhenoblastoma
(b)
Cystadenoma
(c)
Granulosacelltumour
(d)
Hiluscelltumour
YourResponse:
(Q.195)
CorrectAnswer:
Exp:
Anotherfrequentlyaskedovariantumourtocausepostmenopausalbleedingis
thecacelltumour.
Bothgranulosacelltumourandthecacelltumourarefeminisingsexcord
tumoursoftheovary.
DiagnosisofAshermansyndromeisdonebyallofthefollowingEXCEPT?
(a)
Endometrialculture
(b)
Hysteroscopy
(c)
Hysterosalpingography
(d)
Sonosalpingography
YourResponse:
CorrectAnswer:
Exp:
Destruconoftheendometriumusuallyfollowsvigorouscureageforpostpartum
hemorrhage
Aertherapeucaborongengcomplicatedbyinfecon
Overzealousfraconalcureageforgynecologicaldiagnosis
TuberculosisisacommoncauseofashermansyndromeinIndiawhichprimariliydoesthis
byendometrialscarring
Thisdiagnosisisconrmedbyhysterosalpingographyorbydirectvisualexaminaonof
theendometrialscarringorsynechiaeusingahysteroscope.
(Q.196)
NotafeatureofSteinLeventhalsyndromeis;
(a)
Increasedandrogens
(b)
Increasedornormaloestrogens
(c)
Galactorrhoea
(d)
IncreasedLH
YourResponse:
CorrectAnswer:
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Exp:
SteinLeventHalsyndromeisanothertermforpolycyscovariandisease(PCOD).
Inthiscondion,androgensareraisedduetohyperthecosisleadingtohirsusm.
OestrogenlevelisnormalbutLHlevelandLH/FSHraoisraised.
Itisanimportantcauseofsecondaryamenorrhoeaandinferlityinyoungwomen.
ClomipheneisthedrugofchoiceforinferlityinPCODandcyperteroneacetateisthe
drugofchoiceforhirsusm.
(Q.197)
Whichsurgicalprocedurehasthehighestincidenceofuretericinjury?
(a)
Vaginalhysterectomy
(b)
Abdominalhysterectomy
(c)
Wertheimshysterectomy
(d)
Anteriorcolporrhaphy
YourResponse:
CorrectAnswer:
Exp:
Wertheimsrequiresdisseconoftheperiureteralssuesandremovingthelymphacs
surroundingthecourseoftheureter.Thiscandevascularizetheuretercausingureteric
stulas.Thenextmostcommoncauseofuretericinjuryisabdominalhysterectomy.
Anothercommoncause(andgenerallymissed)istheentrapmentoftheureterin
repairinghightearsinthevaginalvaultduringcervicalorvaginallaceraons
(Q.198)
Mostcommoncauseofacutecervicisis:
(a)
E.Coli
(b)
Chlamydia
(c)
Pseudomonas
(d)
Gonococcus
YourResponse:
(Q.199)
CorrectAnswer:
Exp:
Causesofacutecervicisare:1.Gonorrhoea2.Sepcaboron3.
PuerperalSepsis.
Dysfunconaluterinebleeding(DUB)isseenin:
(a)
Polycyscovariandisease
(b)
Endometrialtuberculosis
(c)
Metropathiahaemorrhagica
(d)
Mulplebroids
YourResponse:
CorrectAnswer:
Exp:
c
(199).Ans:c.
Exp.Metropathiahaemorrhagica
ThetermDUBisusedformenorrhagiaintheabsenceofanystructuralabnormality,
pelvicpathologyorevidenceofextragenitalcauseforbleedingorendocrinedisorder.
MetropathiahaemorrhagicaisaspecializedformofDUB.Connuousuterinebleedisthe
mostconstantsymptomandmaybeprecededbyamenorrhoeaofabout8l0weeks
duraon.
Bleedingisalwayspainlessandanovulatory.
Thickpolypoidalendometriumandacyscfolliclearepresentinoneovary.
(Q.200)
AllofthefollowingareindicaonsforpostoperaveradiotherapyinacaseofCarcinomaEndometrium
EXCEPT?
(a)
Myometrialinvasion>1/2thickness
(b)
Posivelymphnodes
(c)
Endocervicalinvolvement
(d)
Tumorposiveforestrogenreceptors
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YourResponse:
CorrectAnswer:
Exp:
Asfarasreceptorstatusisconcerned,thebestcorrelaonisthatofagoodprognosis
withhighprogesteronereceptorsratherthanapoorprognosiswithhighestrogen
receptors
Thebestprognoscfactorofcancerendometrium,amongstothers,istheHistological
gradingofthedisease
Otherimportantpredictorsare:
DepthofmyometrialinvasionStatusofpelvicandparaaorclymphnodes
MalignantcellsinperitonealwashingsLymphvascularinvasion
Cervicalinvasion
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