Q-1. Dose of misoprostol to prevent PPH
a) 200 micro g
b) 400 micro g
c) 800 micro g
d) 600 micro g
Answer: 600 micro g
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-2. Capacity of Bakri balloon used as tamponade technique in PPH
a) 500 ml
b) 1000 ml
c) 1500 ml
d) 2000 ml
Answer: 500 ml
Explanation:
Bakri balloon is an effective, easy to use, and safe procedure for massive PPH after failed medical treatment.
Once the correct placement of Bakri Balloon is confirmed, inflate the balloon with sterile saline using the enclosed syringe.
Important point:
The recommended maximum capacity of the balloon is 500 mL.
Q-3. Primary amenorrhea, normal breast, vagina with clitoromegaly and gonads visible on USG
a) Complete androgen insensitivity syndrome
b) Partial androgen insensitivity syndrome
c) Partial gonadal dysgenesis
d) Complete gonadal dysgenesis
Answer: Partial androgen insensitivity syndrome
Explanation:
Complete androgen insensitivity syndrome:
Karyotype 46 XY
Testes develop during gestation. The fetal testes produce mullerian inhibiting hormone and testosterone. Mullerian inhibiting hormone causes the fetal mullerian ducts to regress, so the fetus lacks uterus, fallopian tubes, and cervix plus upper part of vagina. However, because cells fail to respond to testosterone, the genitals differentiate in the female, rather than the male pattern.
The newborn AIS infant has genitals of normal female appearance, un-descended or partially descended testes, and usually a short vagina with no cervix.
At puberty, the testes are stimulated by the pituitary gland, and produce testosterone. Some of the testosterone converts back to estrogen in the bloodstream. This estrogen produces breast growth, though it may be late.
Because the development of pubic and underarm hair, in women as well as in men, depends upon testosterone, most androgen insensitivity syndrome women have no pubic or underarm hair, but some have sparse hair.
Important point:
Partial androgen insensitivity typically results in ambiguous genitalia.