Q-151. Drug of choice in a pregnant and hypertensive lady
a) Enalpril
b) Verapamil
c) Alpha Methyldopa
d) Thiazide
Answer: Alpha Methyldopa
Explanation:
Commonly used antihypertensive medications in pregnancy:
Severe hypertension:
Hydralazine
Labetalol
Short-acting Nifedipine
Mild to moderate hypertension:
Methyldopa
Labetalol
Hydralazine
Long-acting Nifedipine
Important points:
Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the use of ACE inhibitors during the second and third trimesters of pregnancy.
If the patient becomes pregnant, Enalapril should be discontinued as soon as possible. Enalapril is considered contraindicated during pregnancy.
Q-152. Drug not given in PCOD
a) Tamoxifen
b) Clomiphene
c) Oral contraceptive
d) Metformin
Answer: Tamoxifen
Explanation:
Management of PCOD (Polycystic ovarian disease):
Obesity:
Weight loss improves the endocrine profile
Metformin improves insulin resistance and modest wt loss
Menstrual irregularity:
Combined oral contraceptive pills
Progestogen (such as medroxy-progesterone acetate or dydrogesterone
Infertility:
Ovulation can be induced with the anti- estrogens; the treatment of first choice is clomiphene citrate.
Hyper-androgenism:
All combined oral contraceptive pills will reduce ovarian androgen secretion but the use of androgen receptor-blocking drugs will confer additional benefit.
Cyproterone acetate and other anti-androgens such as spironolactone can be given in addition to a combined oral contraceptive pills.
Q-153. Antihypertensive contra-indicated in pregnancy
a) Methyldopa
b) Labetalol
c) Nifedipine
d) Enalprilate
Answer: Enalprilate
Explanation:
Commonly used antihypertensive medications in pregnancy:
Severe hypertension:
Hydralazine
Labetalol
Short-acting Nifedipine
Mild to moderate hypertension:
Methyldopa
Labetalol
Hydralazine
Long-acting Nifedipine
Important points:
Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the use of ACE inhibitors during the second and third trimesters of pregnancy.
If the patient becomes pregnant, Enalapril should be discontinued as soon as possible. Enalapril is considered contraindicated during pregnancy.
Q-154. Which of these is not a support of the uterus?
a) Urogenital diaphragm
b) Pelvic diaphragm
c) Perineal body
d) Recto-vaginal septum
Answer: Recto-vaginal septum
Explanation:
Primary support of the uterus:
Muscular or active support:
Pelvic diaphragm
Perineal body
Urogenital diaphragm
Fibro-muscular or mechanical support:
Uterine axis
Pubo-cervical ligament
Transverse cervical ligament of Mackenrodt
Utero-sacral ligament
Round ligament of uterus
Q-155. A couple came for emergency contraception on 5th day of unprotected sexual intercourse. She is 32 years old and P2L2. What would you advice?
a) Levo-norgesterol 0.75mg
b) Copper IUCD
c) High dose OCP
d) Ligate tubes
Answer: Copper IUCD
Explanation:
Emergency contraception, or post-coital contraception, refers to methods of contraception that can be used to prevent pregnancy in the first 5 days after sexual intercourse.
Emergency contraception or post-coital contraception:
Copper-bearing intrauterine devices (IUDs)
Emergency contraception pills (ECPs) – Levo-norgestrel and Ulipristal acetate
Combined oral contraceptive pills or the Yuzpe method
Important points:
As couple family is complete, a copper-bearing IUD is preferred and most effective form of emergency contraception.
When inserted within 5 days of unprotected intercourse, a copper-bearing IUD is over 99% effective in preventing pregnancy. This is the most effective form of emergency contraception available.
Q-156. Carbetocin dose for PPH is
a) 100 microgram IM
b) 50 microgram IV
c) 150 microgram IV
d) 200 microgram IV
Answer: 100 microgram IM
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.
Carbetocin, a long-acting oxytocin agonist, appears to be a promising agent for the prevention of PPH. Recommended dose of Carbetocin is 100 microgram administered slowly over a minute.
Q-157. 35 Year old female with 6 weeks amenorrhea comes to emergency department with nausea, vomiting and abdominal pain. Her pulse is 100/min and BP is 90/60 mm Hg. On ultrasound a right 5X5 cm adnexal mass is seen. What is likely management?
a) Immediate laparoscopic surgery
b) Beta-HCG
c) Methotrexate
d) IV fluid
Answer: Immediate laparoscopic surgery
Explanation:
Laparoscopy has become the recommended approach in most cases of ectopic pregnancy unless a woman is hemo-dynamically unstable.
Laparotomy is usually reserved for patients who are hemo-dynamically unstable or for patients with cornual ectopic pregnancies.
Important points:
Treatment with methotrexate is an especially attractive option when the pregnancy is located on the cervix or ovary or in the interstitial or the cornual portion of the tube.
Surgical treatment in these cases is often associated with increased risk of hemorrhage.
Q-158. A 16 yr old girl was brought with primary amenorrhea. Her mother mentioned that she started developing breast at the age of 12. She was prescribed OCPs 2 yrs back by a doctor with no effect. She was having normal stature and was a football player. On examination breast was well developed (Tanner’s stage V) and pubic hair was minimal (Tanner’s stage I). What is the diagnosis?
a) Premature ovarian failure
b) Turner’s syndrome
c) Androgen Insensitivity
d) Mullerian agenesis
Answer: Androgen Insensitivity
Explanation:
Androgen Insensitivity syndrome:
X-linked recessive disorder
Karyotype XY
External genitalia look like female
Adequate breast development without axillary and pubic hair or minimal axillary and pubic hair
Primary amenorrhea and absent uterus, hence will not respond to OCPs
Testes are placed in either labia or inguinal canal, or are intra-abdominal
Important point:
Mullerian agenesis patients will also have primary amenorrhea & absent uterus (Hence will not respond to OCPs) but have normal well developed axillary and pubic hair.
Q-159. A lady with abdominal mass was investigated. She was found to have bilateral ovarian masses with smooth surface. On microscopy they revealed mucin secreting cells with signet ring shape. Diagnosis
a) Krukenberg tumor
b) Dysgerminoma
c) Primary Adenocarcinoma of the ovaries
d) Dermoid cyst
Answer: Krukenberg tumor
Explanation:
Krukenberg tumor is a metastatic signet ring cell adeno-carcinoma of the ovary.
Stomach is the primary site in most Krukenberg tumor cases (70%). Carcinomas of colon, appendix, and breast (mainly invasive lobular carcinoma) are the next most common primary sites.
The tumor cells have abundant intracellular mucin and small crescentric hyper-chromatic atypical nuclei.
Q-160. According to the 2010 WHO criteria, what are the characteristics of normal semen analysis?
a) Volume 1.5 ml, count 15 million, morphology 4% progressive motility 32%
b) Volume 2.0 ml, count 20 million, morphology 4% progressive motility 32%
c) Volume 1.5 ml, count 20 million, morphology 4% progressive motility 32%
d) Volume 2.0 ml, count 15 million, morphology 40% progressive motility 32%
Answer: Volume 1.5 ml, count 15 million, morphology 4% progressive motility 32%
Explanation:
2010 WHO criteria: Characteristics of normal semen analysis
Parameter: WHO 2010
Volume: 1.5 ml
Concentration: 15 million/ml
Progressive motility: 32%
Normal forms: 4 %