AIIMS/ NEET-PG 2017 Gynae and Obs MCQs 31-40

Q-31. Which of the following congenital malformations can be diagnosed in the first trimester?
A. Microcephaly
B. Anencephaly
C. Meningocele
D. Encephalocele

Answer: Anencephaly
Explanation:
The congenital anomalies that can be identified in the first trimester are:
Acrania – Condition in which the flat bones of the cranial vault are partially or completely absent. It is an early stage of anencephaly.
Exencephaly – An early stage of anencephaly in which the brain is located outside the skull
Anencephaly – Absence of a major part of the brain, skull and scalp. It is an anomaly that occurs when the rostral end of the neural tube fails to close.

Q-32. Weight gain in pregnancy depends on all except?
A. Smoking
B. Pre pregnancy weight
C. Ethnicity
D. Maternal age

Answer: Smoking
Explanation:
Factors influencing weight gain in pregnancy:
Maternal age
Physical activity
Pre-pregnancy
Race/ ethnicity
Parity
Hormonal milieu
Multiple pregnancy – Tend to gain more weight in multiple pregnancy
Hyperemesis gravidarum – Lower weight gain in women with hyperemesis gravidarum
Anorexia nervosa – Lower weight gain and lower birth weight in anorexic women
Substance abuse – Studies have found no significant difference in mean weight gain between smoking and non smoking women. But the birth weight was lower in babies born to women who were smokers.

Q-33. A 13-year old girl came to the casualty with acute lower abdominal pain. She had cyclical pain for the last 6 months. She has not yet attained her menarche. On examination, a tense bulge was seen in the region of the hymen. The most probable diagnosis is?
A. Mayer-Rokitansky-Küster-Hauser syndrome
B. Imperforate hymen
C. Asherman’s syndrome
D. Congenital adrenal hyperplasia

Answer: Imperforate hymen
Explanation:
Imperforate hymen prevents the drainage of menstrual blood.
This results in the accumulation of blood in the vagina leading to hematocolpos.
This is visualized as the tense bulge.
In long standing cases it can even lead to hematometra.

Q-34. Most specific marker for neural tube defects is?
A. Alpha-fetoprotein
B. Un-conjugated estriol
C. Acetyl-cholinesterase
D. Pseudo-cholinesterase

Answer: Acetyl-cholinesterase Explanation:
Neural tube defects:
Peri-conceptional use of antiepileptic drugs such as valproate and carbamazepine and deficiency of folate is associated with a high incidence of these defects. Procedures for prenatal diagnosis include:
a) Assessment of serum markers such as maternal serum alpha-feto-protein and acetyl-cholinesterase activity
The levels of these two serum markers are increased in neural tube defects and optimal time for serum screening is 10-18 weeks.
Acetyl-cholinesterase has got better diagnostic value than alfa fetoprotein
b) Pre-natal ultra-sonography
Early diagnosis by ultrasound demands skill and experience in the procedure.
c) Amniocentesis in selected cases
Levels of amniotic fluid alpha-fetoprotein and acetyl-cholinesterase activity are elevated in neural tube defects.
However, increased iatrogenic fetal loss is a disadvantage of this technique.

Q-35. The use of which of the following drugs for the treatment of menorrhagia is not supported by clinical evidence?
A. Tranexamic acid
B. Oral contraceptives
C. Ethamsylate
D. Progesterone only pills

Answer: Ethamsylate
Explanation:
Studies have failed to prove the effectiveness of ethamsylate in the treatment of menorrhagia.
Ethamsylate did not reduce mean menstrual blood loss whereas mefenamic acid reduced blood loss by 20% and tranexamic acid reduced blood loss by 54%. Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding.

Q-36. Gold standard test for measuring ß HCG levels in serum is?
A. ELISA
B. Bioassay
C. Radioimmunoassay
D. Latex agglutination test

Answer: Radioimmunoassay
Explanation:
Radioimmunoassay is the most sensitive test for measurement of beta-HCG levels in serum.
The value of RIAs that measure human-CG levels in human urine has been limited principally because of cross-reactivity with human LH.
An ectopic pregnancy should be suspected if trans-vaginal ultra-sonography shows no intrauterine gestational sac when the ß-hCG level is higher than 1,500 IU per L.

Q-37. False regarding hormone levels in polycystic ovarian disease?
A. Increased Androgen
B. Increased Prolactin
C. Increased LH
D. Increased LH/FSH ratio

Answer: Increased Prolactin
Explanation:
Hormone levels in polycystic ovarian disease:
Increased Androgen
Increased Estrogen
FSH levels within the reference range or low
Luteinizing hormone (LH) levels are elevated. The LH-to-FSH ratio is usually greater than 3.
Insulin resistance and increased insulin

Q-38. Causes of primary amenorrhea are all except
A. Turner syndrome
B. Sheehan’s syndrome
C. MRKH syndrome
D. Kallmann’s syndrome

Answer: Sheehan’s syndrome
Explanation:
Causes of primary amenorrhea:
Turner syndrome
Swyer syndrome
Testicular feminization syndrome
Mullerian agenesis (Mayer Rokitansky Kuster Hauser [MRKH] syndrome)
Crypto-menorrhea – Imperforate hymen / vaginal septum
Kallmann’s syndrome
Pituitary neoplasms

Q-39. 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 is the most common pregnancy-related liver disorder.
It is characterized by generalized itching, often commencing with pruritus of the palms of the hands and soles of the feet, with no other skin manifestations. It most often presents in the late second or early third trimester of pregnancy.
Ursodeoxycholic acid remains the drug of choice for the treatment of Intra-hepatic Cholestasis of Pregnancy.
Ursodeoxycholic acid decreases bile salt levels and relieves pruritus.
It can also decrease the chance for fetal complications.

Q-40. Virus responsible for non immune hydrops fetalis is:
A. Cytomegalovirus
B. Herpes simplex virus
C. Hepatitis B virus
D. Parvovirus

Answer: Parvovirus
Explanation:
Parvovirus is the commonest infectious etiology for hydrops fetalis.
The other viruses implicated include Cytomegalovirus, Hepatitis B virus, Herpes simplex virus, Rubella virus and Adenovirus.
These viruses are responsible for non immune hydrops fetalis.