Q-131. Regarding Duncan’s method of placental separation, all of the following are true except
a) It is most common method of separation
b) Maternal surface of placenta presents at the vulva
c) There is peripheral separation of placenta
d) Blood collects between the placenta and fetal membranes and escapes from the vagina
Answer: It is most common method of separation
Explanation:
Methods of expulsion of placenta:
Shultz (Most common method)- Placenta separates centrally
Duncan method (Results more bleeding)- Placenta separates marginally
Q-132. All of the following constitute the active management of third stage of labour for the prevention of post-partum hemorrhage (PPH) except
a) Direct injection of oxytocin when the baby’s shoulders are delivered
b) Early clamping and cutting of the umbilical cord
c) Constant controlled cord traction
d) Misoprostol
Answer: Early clamping and cutting of the umbilical cord
Explanation:
Active management of third stage of labor (WHO):
Administration of uterotonic soon after birth of baby
Delayed cord clamping and cutting
Controlled cord traction for delivery of placenta
Uterine massage
Q-133. Perinatal transmission of HIV can be prevented by all of the following except
a) Zidovudine administration to both the mother and the baby
b) Normal vaginal delivery
c) Avoidance of breast-feeding
d) Administration of vitamin A
Answer: Normal vaginal delivery
Explanation:
HIV infection during pregnancy:
Maternal transmission of HIV occur trans-placentlly before birth, peri-partum by exposure to blood and bodily fluid at delivery or post-partum through breast feeding.
Majority of infection occur during labour & perinatal period.
Majority of fetuses are not infected even without any intervention
Risk is related to the status of infection in mother. Both HIV infection and pregnancy are considered to be risk factor for vitamin A deficiency. Vitamin A plays an important role in the immune function.
Emergency CS decreases chance of transmission.
Nevirapine should be initiated in pregnant women with CD4+ counts greater than 250 cells /mm3.
Zidovudine/ HAART (Highly active anti-retro-viral therapy) to mother reduce overall transmission
Q-134. A young female presents with short stature, widely spaced nipples and amenorrhea. Her genetic constitution is most likely going to be
a) 47 XXX
b) 47 XXY
c) 46 XY
d) 45 XO
Answer: 45 XO
Explanation:
Turner syndrome: 45 XO
Most common chromosomal abnormality
Short stature in girl and primary amenorrhea due to early ovarian failure
Q-135. The most accurate and safe method to diagnose viable pregnancy at 6 weeks of gestation is
a) Per vaginal examination of uterine size corresponding to 6 weeks gestation
b) Urine h-CG pregnancy test positive
c) Ultrasound visualization of fetal cardiac activity
d) Doppler assessment of fetal cardiac activity
Answer: Ultrasound visualization of fetal cardiac activity
Explanation:
Ultrasound examination of fetus:
Gestational sac and yolk sac- 5 weeks
Cardiac activity- 5-6 weeks
Limb buds- 7-8 weeks
Important points:
The first definite Sonographic finding to suggest pregnancy is visualization of the gestational sac.
The first sign of intra-uterine pregnancy is presence of yolk sac within the gestational sac.
Fetal crown to rump length (CRL) can be measured at 5-13 weeks and is the most accurate means to determine gestational age.
Beyond 13 weeks, measurement of fetal bi-parietal diameter is used in conjunction with femur length and abdominal circumference to access gestational age.
Q-136. All of the following are true regarding fetal breathing in utero except
a) Increase at or near term
b) Has a higher risk of respiratory distress syndrome
c) Increases risk for amniotic fluid aspiration
d) Causes conditioning of respiratory muscles
Answer: Increase at or near term
Explanation:
Fetal breathing movements are episodic and irregular, interspersed with periods of apnea, and they become detectable by ultrasound at 10-11 weeks gestation.
Fetal breathing movements become more regular and uniform as gestational age increases.
Breathing movement frequency increases until the 10 weeks before birth, when periods of apnea increase.
Fetal breathing movements in utero are vital for postnatal lung function.
Q-137. A 30 year old female from poor socio- economic strata from a hill station presents with complaints of frequency, dysuria, and hematuria, loss of appetite, mild fever and amenorrhea. The most likely cause for her complaints is
a) Bacterial cystitis
b) Pelvic inflammatory disease
c) Genitourinary tuberculosis
d) Foreign body in the urinary bladder
Answer: Genitourinary tuberculosis
Explanation:
Presentation of genitourinary tuberculosis:
Low grade fever
Loss of appetite
Amenorrhea
Menstrual irregularity
Infertility
Vaginal discharge
Post menopausal bleeding
Q-138. Modified biophysical profile includes:
a) NST plus amniotic fluid
b) MST plus tone
c) MST plus movement
d) NST plus breathing movement
Answer: NST plus amniotic fluid
Explanation:
The Modified Biophysical Profile (MBPP):
The modified BPP consists of the non-stress test (NST) and ultrasound evaluation of amniotic fluid volume.
The modified BPP is considered normal if the NST is reactive and the deepest vertical pocket of amniotic fluid is greater than 2 centimeters.
The modified BPP is considered abnormal if either the NST is nonreactive or the deepest vertical pocket of amniotic fluid is 2 cm or less.
Biophysical profile: The five components
Non-stress test
Fetal breathing movements
Fetal movement
Fetal tone
Determination of the amniotic fluid
Q-139. Dose of misoprostol in treatment of PPH
a) 600 microgram
b) 400 micrograms
c) 800 micrograms
d) 1000 micrograms
Answer: 600 microgram
Explanation:
WHO has developed guidelines supporting the use of a uterotonic when the full package of active management of the third stage of labour is not practised, which can be either oxytocin, 10 IU administered parenterally, or misoprostol, 600 µg administered orally.
Important point:
Misoprostol has been widely recommended to prevent postpartum hemorrhage when other methods are not available.
Life-threatening hyperpyrexia has been reported following the use of misoprostol, 800 µg orally, after childbirth.
Q-140. Anti Rh Ig given at how many weeks of pregnancy:
a) 24 weeks
b) 26 weeks
c) 28 weeks
d) 32 weeks
Answer: 28 weeks
Explanation:
Anti Rh Ig given prophylactically to all Rh D-negative un-sensitized women at approximately 28 weeks and second dose is given after delivery within 72 hours if the infant is Rh D-positive.
Important points:
Indication: Rh negative mother with Rh positive father
Dose: IM dose 1500 IU