Q-161. In severe preeclampsia, proteinuria level
a) 20 gm
b) 200 gm
c) 300 gm
d) 3000 gm
Answer: 300 gm
Explanation:
Significant protein excretion is defined as ≥ 300 mg in a 24-h urine collection or 1+ or greater on urine dipstick testing of two random urine samples that are collected at least 4 h apart.
Preeclampsia is defined by the new onset of elevated blood pressure and proteinuria after 20 weeks of gestation.
Important point:
According to the new ACOG guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria).
Q-162. A lady underwent vaginal hysterectomy for Ca cervix. Following the surgery after her urethral catheter was removed, she complained of urinary incontinence. On examination she had normal voiding as well as continuous incontinence. Methylene blue dye was instilled in her bladder through her urethra and she was given oral Phenazopyridine. After some time her pad was checked and it showed yellow staining at the top portion, but not the middle or bottom portions. She is likely to have
a) Uretero-vaginal fistula
b) Vesico-vaginal fistula
c) Urethro-vaginal fistula
d) Vesico-uterine fistula
Answer: Uretero-vaginal fistula
Explanation:
Three swab test:
Three swabs test is used to differentiate between uretero-vaginal fistula, Vesico-vaginal fistula and urethro-vaginal fistula.
Three cotton swabs are placed in the vagina – at the vault, in the middle and just above the introitus.
Methylene blue is introduced into the bladder using a rubber catheter.
Interpretation of three swab test:
Top swab soaked in urine, unstained – Uretero-vaginal fistula
Middle swab stained with dye – Vesico-vaginal fistula
Bottom swab stained with dye – Urethro-vaginal fistula
Double dye test:
It is useful for diagnosing Vesico-vaginal or uretero-vaginal fistulae.
For this test, the patient takes oral phenazopyridine and indigo carmine or methylene blue is filled into the empty urinary bladder via a urethral catheter.
Phenazopyridine turns urine orange in the kidneys, and methylene blue turns urine blue in the bladder.
A tampon is placed into the vagina. If the tampon turns blue, Vesico-vaginal fistula is suspected. If the tampon turns orange, uretero-vaginal fistula is suspected.
Q-163. A G6 + 0 + 0 lady with h/o recurrent missed abortion at 14-16wks, comes to you with a missed abortion. Which of the following tests is not warranted?
a) Lupus anticoagulant
b) Anti-cardiolipin ab
c) VDRL for wife and husband
d) Fetal Karyotype
Answer: VDRL for wife and husband
Explanation:
Causes and diagnosis of recurrent abortion:
Genetic error: Fetal and parental karyotyping
Anatomical abnormalities: Hysteroscopy or hystero-salpingogram
Hormonal abnormalities: T3 T4 and TSH, serum progesterone or endometrial biopsy during luteal phage and glucose tolerance test
Autoimmune diseases: Lupus anticoagulant and Anti-cardiolipin ab
Infection: Cervical culture
Q-164. What should be screened along with prolactin in Galactorrhea amenorrhea syndrome?
a) LH
b) TSH
c) HCG
d) Urine keto-acids
Answer: TSH
Explanation:
Patients with primary hypothyroidism have elevated TSH levels. TSH acts to stimulate the release of prolactin and may there by lead to Galactorrhea amenorrhea syndrome.
Q-165. A young girl with a mass in lower abdomen involving umbilical and hypogastric regions. On examination it is cystic and mobile and the examiner is unable to insinuate fingers between the mass and the pelvic bone. Likely diagnosis
a) Duplication of intestine
b) Mesenteric cyst
c) Omental cyst
d) Ovarian cyst
Answer: Ovarian cyst
Explanation:
Physical examination suggests pelvic mass. Correct answer is ovarian cyst.