Q-101. Not a method of emergency contraception
a) Mifepristone
b) Danazole
c) IUCD
d) Levo-norgestrel
e) DMPA
Answer: DMPA
Explanation:
Drugs used in emergency contraceptive:
Estrogen alone (Within 72 hours):
Ethinyl estradiol for 5 days
Conjugated estrogen for 5 days
Progesterone alone (Within 72 hours):
Levo-norgestrel
Estrogen and Progesterone (Within 72 hours):
Ethinyl estradiol and Levo-norgestrel
Low dose OCP
Cu-T 380 A- Inserted within 7 days from the time of unprotected intercourse.
Mifepristone
Danazole
Q-102. Not true about ectopic pregnancy
a) Previous ectopic is greatest risk
b) POP doesn’t increase risk
c) Increased risk with pelvic infections
d) Increased risk with IVF
e) IUCD use increase risk
Answer: POP doesn’t increase risk
Explanation:
Ectopic pregnancy:
More than 95 % of extra-uterine pregnancies occur in fallopian tube.
Risk factors for ectopic pregnancy:
Tubal factors:
Salpingitis
Endometriosis
Leiomyomas
Developmental abnormalities of uterus
Previous tubal surgery
Zygote abnormalities:
Ovarian factors:
Fertilization of un-extruded ovum
Trans-migration of ovum into the contra-lateral tube
Exogenous hormones:
Progestin only pills (POP)- Due to smooth muscle relaxant effects and subsequent ovum trapping
Diethylstilbestrol
Other factors:
IUD
Previous ectopic pregnancy
Smoking
Increasing maternal age
Q-103. Management of un-ruptured tubal pregnancy includes
a) Methotrexate
b) Prostaglandins
c) Hysterectomy
d) Laparoscopic salpingostomy
e) Salpingectomy
Answer: a, b, d and e
Explanation:
Medical management of un-ruptured tubal pregnancy:
Methotrexate
KCl
Prostaglandins
Hyper-osmolar glucose
Actinomycin
Surgical management of un-ruptured tubal pregnancy:
Salpingectomy
Segmental resection
Salpingostomy
Salpingotomy
Q-104. True about complete mole
a) Presence of fetal parts and cardiac activity
b) Normal uterine size
c) Beta-hCG doubling time is 7-10 days
d) Pre-eclampsia at < 24 weeks e) PV bleeding is commonest presentation Answer: d and e Explanation: Complete mole: A complete mole contains no fetal tissue. The most common classic symptom of a complete mole is vaginal bleeding. A uterine enlargement greater than expected for gestational age Hyperemesis Hyperthyroidism due to stimulation of the thyroid gland by the high levels of circulating h-CG or by a thyroid stimulating substance (ie, thyrotropin) produced by the trophoblasts. h-CG levels greater than 100,000 mIU/mL indicate exuberant trophoblastic growth and raise suspicion for a molar pregnancy. Ultra-sonography is the criterion standard for identifying both complete and partial molar pregnancies. The classic image is of a snowstorm pattern. Q-105. Snow storm appearance on USG seen in a) Hydatiform mole b) Invasive mole c) Twin pregnancy d) Ectopic pregnancy e) Chorio-carcinoma Answer: Hydatiform mole Explanation: Classic sono-graphic appearance of Hydatiform mole: “Snowstorm” or “granular” appearance (Central heterogenous mass with numerous anechoic spaces) Low resistance arterial and venous flow Absence of embryo or fetus Q-106. Tubal patency is checked by all except a) Hystero-salpingography b) Laparoscopy c) Falloscopy d) Colposcopy e) Sono-salpingo-graphy Answer: Colposcopy Explanation: Tubal patency tests: Falloscopy- To visualize interstitial end of fallopian tube Sono-salpingo-graphy or Sion Test Hystero-salpingography Laparoscopy- For tubal and peritoneal diseases Important point: Colposcopy is a procedure to closely examine your cervix, vagina and vulva for signs of disease. Q-107. Intra-uterine insemination is indicated in all except a) Unexplained infertility b) Endometriosis c) Male infertility d) PCOD e) Tubal factor infertility Answer: Endometriosis, PCOD and Tubal factor infertility Explanation: Indications of intra-uterine insemination: Un-explained infertility Male factor infertility Indications of In Vitro fertilization: Mild endometriosis Blocked fallopian tube Failed intra-uterine or fallopian insemination Immunological factor in male and female Abnormal semen findings Un-explained male or female infertility Q-108. D/D of acute abdomen in pregnancy are all except a) Cystitis b) Threatened abortion c) Cervical incompetence d) Appendicitis e) Ruptured ectopic Answer: Cervical incompetence Explanation: Presentations of cervical incompetence: Painless cervical dilatation and bulging fetal membranes upon presentation in the second trimester of pregnancy Preterm premature rupture of membranes Rapid delivery of a pre-viable infant Rare or absent uterine contractions Important point: Cervical incompetence refers to a painless spontaneous dilatation of the cervix, and is a common cause of 2nd trimester pregnancy failure. Q-109. OCPs should be not given in a) Liver disease b) Thrombo-embolic disease c) Dys-menorrhea d) Cyclic menorrhagia e) Breast carcinoma Answer: a, b and e Explanation: Contra-indications of OCPs: Absolute contra-indications of OCPs: Previous thrombo-embolic event or stroke History of estrogen dependent tumors Active liver disease Pregnancy Undiagnosed abnormal uterine bleeding Hyper-triglyceridemia Women over age 35 who smokes heavily Relative contra-indications of OCPs: Hypertension Women receiving anticonvulsant therapy Q-110. Biophysical profile scoring includes a) Fetal muscle tone b) Fetal breathing movements c) Contraction stress test d) Placental structure e) Amniotic fluid Answer: a, b and e Explanation: Biophysical profile: Non stress test Fetal breathing movement Fetal movement Fetal tone Amniotic fluid volume Important point: Each component is worth 2 points, a score of 8 or more is normal, 6 is equi-vocal and 4 or less is abnormal