Q-21. A woman presents with 2 months of amenorrhea, lower abdominal pain, facial pallor and shock. Diagnosis is
a) Ruptured ovarian cyst
b) Ruptured ectopic pregnancy
c) Threatened labor
d) Septic abortion
Ans: b
Explanation:
The most common symptoms of ectopic pregnancy:
Abdominal pain
Pelvic pain
Amenorrhea or missed period
Vaginal bleeding
The most common complication of ectopic pregnancy is tubal or uterine rupture which in turn can lead to massive hemorrhage, shock, disseminated intravascular coagulopathy (DIC), and even death.
Q-22. Complete failure of Mullarian duct fusion will result in
a) Uterus didelphys
b) Arcuate uterus
c) Sub-septate uterus
d) Unicornuate uterus
Ans: a
Explanation:
Uterus didelphys represents a uterine malformation where the uterus is present as a paired organ as the embryo-genetic fusion of the Mullerian ducts completely failed to occur.
As a result there is a double uterus with two separate cervices, and often a double vagina as well.
Many patients are asymptomatic although some may occasionally experience dyspareunia as a result of the vaginal septum.
Q-23. B lynch suture is applied on
a) Cervix
b) Uterus
c) Fallopian tubes
d) Ovaries
Ans: b
Explanation:
The B-Lynch suture or B-Lynch procedure is a form of compression suture used in gynecology.
It is used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage.
It is regarded as “the best form of surgical approach for controlling atonic PPH as it helps in preserving the anatomical integrity of the uterus.
Q-24. All of the following are ultrasonographic fetal growth parameters except
a) Bi-parietal diameters
b) Femur length
c) Trans-cerebellar diameter
d) Head circumference
Ans: c
Explanation:
Fetal biometric parameters are antenatal ultrasound measurements that are used to indirectly assess the growth and well being of the fetus.
Standard parameters:
Assessed and reported on a routine 2nd trimester scan or when growth reassessment is required in the second or third trimester.
Bi-parietal diameter (BPD)
Head circumference (HC)
Abdominal circumference (AC)
Femur length (FL)
Additional parameters
Humeral length (HL)
Trans-cerebellar diameter (TCD)
Occipito-frontal diameter (OFD)
Inter ocular distance (IOD)
Binocular distance (BOD) ratios
Fetal cardio-thoracic circumference ratio
Fetal thoracic to abdominal circumference ratio
Fetal thoracic to head circumference ratio
Q-25. All are causes of intra-uterine growth retardation except
a) Anemia
b) Gestational diabetes
c) Maternal heart disease
d) Pregnancy induced hypertension
Ans: b
Explanation:
Causes of Intrauterine Growth Restriction (IUGR):
A common cause is a problem with the placenta. The placenta is the tissue that joins the mother and fetus, carrying oxygen and nutrients to the baby and permitting the release of waste products from the baby.
Advanced diabetes
High blood pressure or heart disease
Infections such as rubella, cytomegalovirus, toxoplasmosis, and syphilis
Kidney disease or lung disease
Malnutrition or anemia
Sickle cell anemia
Smoking, drinking alcohol, or abusing drugs
Other possible causes include chromosomal defects in the baby or multiple gestations
Q-26. The following hormone is raised in polycystic ovarian syndrome
a) 17- OH progesterone
b) FSH
c) LH
d) TSH
Ans: LH
Explanation:
Polycystic ovarian syndrome:
Serum (blood) levels of androgens (male hormones), including androstenedione and testosterone may be elevated.
The ratio of LH (Luteinizing hormone) to FSH (Follicle-stimulating hormone), when measured in international units, is elevated in women with PCOS.
2-Hour oral glucose tolerance test (GTT) in patients with risk factors may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with PCOS.
Fasting insulin level or GTT with insulin levels (also called IGTT): Elevated insulin levels have been helpful to predict response to medication and may indicate women needing higher dosages of metformin or the use of a second medication to significantly lower insulin levels
Q-27. The shape of a nulliparous cervix is:
a) Fimbriated
b) Longitudinal
c) Transverse
d) Circular
Answer:Circular
Explanation:
The cervix is the narrow inferior segment of the uterus which projects into the vaginal vault.
In the nulliparous female it is barrel shaped but it changes shape in pregnancy and the menopause.
The cervix is traversed by the endo-cervical canal which is continuous with the body of the uterus at the isthmus above and opens into the vaginal cavity at the cervical os.
The shape of the external os varies. In the nulliparous woman it is small and circular. After pregnancy it is slit like. After the menopause it may narrow almost to a pin point.
Q-28. Which of the following dietary supplements is recommended for the pregnant lady on heparin?
a) Calcium
b) Zinc
c) Copper
d) Folic acid
Ans: Calcium
Explanation:
Heparin does not cross the placenta and is the anticoagulant of choice for use during pregnancy because it does not affect blood clotting mechanisms in the fetus.
Use of heparin may be associated with transient hypo-calcemia.
Q-29. Which of the following is not a cause of primary amenorrhea?
a) Rokitansky syndrome
b) Turner’s syndrome
c) Kallman’s syndrome
d) Sheehan’s syndrome
Answer: Sheehan’s syndrome
Explanation:
Primary amenorrhea is typically the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant.
Causes of primary amenorrhea:
Hypothalamus
Anovulation
Constitutional: Family History
Gonadotropin deficiency such as Kallmann’s Syndrome (Rare): Associated with Anosmia
Pituitary
Hyper-prolactinemia
Pituitary Tumor
Ovarian insufficiency
Polycystic Ovary Syndrome
Turners Syndrome and Mosaics (30% of primary causes)
Genetic Male (10% of primary causes)
Gonadal dysgenesis
Uterus (outflow tract)
Mullerian Agenesis (20% of primary causes)
Mayer-Rokitansky-Kuster-Hauser Syndrome
Imperforate Hymen
Transverse vaginal septum
Complete androgen resistance
Causes of secondary amenorrhea:
Hypothalamus
Anovulation (50% of secondary causes)
Post-Hormonal Contraception (Post-Pill)
CNS injury
Miscellaneous-Eating disorder (e.g. Anorexia Nervosa) and Mal-absorption, malnutrition or rapid weight loss
Pituitary:
Hyper-prolactinemia (25% of secondary causes)
Sheehan Syndrome (rare)
Hypothyroidism: Prolactin-like effect
Pituitary infiltration (e.g. Sarcoidosis)
Cushing Syndrome
Ovarian insufficiency
Polycystic Ovary Syndrome
Premature Ovarian Failure
Oophoritis (rare)
Uterus (outflow tract)
Asherman Syndrome
Endometritis
Cervical stenosis
Q-30. Drug of choice for treatment of intra-hepatic cholestasis in pregnancy is?
a) Ursodeoxycholic acid
b) Dexamethasone
c) Antihistamines
d) Cholestyramine
Answer: Ursodeoxycholic acid
Explanation:
Intra-hepatic cholestasis of pregnancy (ICP) is a reversible type of hormonally influenced cholestasis.
It frequently develops in late pregnancy in individuals who are genetically predisposed.
It is the most common pregnancy-related liver disorder.
Ursodeoxycholic acid remains the drug of choice for the treatment of ICP.