Offline dictionary of medical terms

Offline dictionary of medical terms

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APPEARENCES

� Bird's Beak deformity of lower oesophagus -

Achalsia cardia (Barium Swallow)
� Rat tail tapering of lower
oesophagus - Carcinoma oesophagus (Barium
Swallow)
� Cork screw oesophagus-- Diffuse oesophageal
spasm (Barium Swallow)
� Commonest radiological
appearance of gastric carcinoma (in barium meal
follow through) is - filling defect in antrum / body of
stomach
� Trifoliate duodenum - Chronic duodenal ulcer
with scarring (Barium Meal)
� Hour Glass stomach - Peptic ulcer
� Cup & Spill / Cascade stomach - Volvulus of
stomach
� Constriction of transverse
duodenum - superior mesenteric artery syndrome
� Bull's eye lesion (in barium meal) -
Leiomyosarcoma
� Single-bubble appearance - pyloric stenosis
� Double-bubble sign--Duodenal atresia, duodenal
stenosis, annular pancreas
� Triple-bubble sign - Jejunal atresia
� Coffee bean sign--Strangulation of incompletely
obstructed loop of small intestine
� String of Beads - Small bowel obstruction
� Coiled spring appearance -
Intussusception
� Pincer-shaped ending in barium enema--
Intussusception
� Bird of Prey sign - Sigmoid
volvulus
� Moulage sign (flocculation of barium, with
mucosal thickening) -- malabsorption syndrome
� String sign of Cantor--Crohn's disease
� Pipe-stem appearance (Loss of Haustrations)-
Ulcerative Colitis (Barium Enema)
� Saw-tooth appearance and / or diverticula -
Diverticular disease /Diverticulosis (Barium Enema)
� Scalloping of edge of sigmoid colon on barium
enema - Ulcerative colitis
� Napkin ring sign - Annular
carcinoma of colon
� Porcelain gall bladder -
Carcinoma of gall bladder
� Pad sign - Carcinoma pancreas (Barium Meal)
ERCP
� Scrambled Egg appearance - Carcinoma of
pancreas
� Chain of Lakes appearance - Chronic pancreatitis
� Double duct sign - Carcinoma of Pancreas
� Meniscus sign -- Choledocholithiasis

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APPG 2013; 001-020



1. In Dysphonia Plica Ventricularis 

(Ventricular Dysphonia) voice is produced by
 
ventricular folds 

vocal cords
 

aryepiglottic fold
 

Epiglottis
 

Ans A
 

Dysphonia Plica Ventricularis (Ventricular Dysphonia)
 

Here voice is produced by ventricular folds (false cords) which have taken over the function of true cords. Voice is rough, low-pitched and unpleasant. Ventricular voice may be secondary to impaired function of the true cord?such as paralysiS, fixation, surgical excision, or tumours.?
 

Ventricular bands in these situations try to compensate?or assume phonatory function of true cords.?Functional type of ventricular dysphonia occurs in?normal larynx . Here cause is psychogenic. In this type,?voice begins normally but soon becomes rough when?false cords usurp the function of true cords. Diagnosis is?made on indirect laryngoscopy; the false cords are seen to?approximate partially or completely and obscure the?view of true cords on phonation. Ventricular dysphonia?secondary to laryngeal disorders is difficult to treat but?the function al type can be helped through voice therapy?and psychological counsellin

2.Lupus of the larynx mostly affects
 

Posterior part
 
Anterior part 

Subglottis
 

Hypopharynx
 

Ans B
 

Syphilis affects the larynx and produces ulcers. These may involve almost *any portion but usually they are anterior, involving the epiglottis. They are often associated with syphilitic manifestations in the mouth. Tuberculosis affects the posterior portion of the larynx and the bulb-like swellings of the arytenoids are almost pathognomonic. Ulcers when they occur are most marked posteriorly. This affection is associated with a blanching of the mucous membrane of the mouth and the presence of a white frothy mucus, which will lead the laryn-gologist to suspect the existence of the disease before a view of the larynx is obtained.

3. Lateral soft tissue X-Ray of neck may show "Thumb sign" in
 
acute epigiottitis 

retropharyngeal abscess
 

laryngeal stenosis
 

fractures of larynx
 

Ans A
 

In radiology, the thumbprint sign, or thumbprinting, is a radiologic sign found on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb
 

4. Herpangina is caused by
 
Coxsackie virus 

Herpes simplex
 

Staphylococcus
 

Fungus
 

Ans A
 

Herpangina, also called mouth blisters, is the name of a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term "herpangina virus" refers to coxsackievirus A)[ but it can also be caused by coxsackievirus B or echoviruses.[2] Most cases of herpangina occur in the summer,[3] affecting mostly children. However, it occasionally occurs in adolescents and adults
 

5. 'Recruitment phenomenon' is seen in one of the following conditions.
 
Meniere's disease 

Otosclerosis
 

Otitis media
 

Mastoiditis
 

Ans A
 

Most patients with Ménière's disease (MD) reveal abnormal vestibular-evoked myogenic potentials (VEMPs) and the recruitment phenomenon, whereas most sudden deafness patients display normal VEMPs without the recruitment phenomenon
 

6. Which of the following is called the "Gateway of tears" ?
 
Killian's dehiscence 

Rathke's pouch
 

Waldeyer ring
 

Sinus of Morgagni
 

Ans A
 

Killian’s dehiscence is a potential triangular gap between the oblique fibers of thyropharyngeus and the transverse fibers of cricopharyngeus (Thyropharyngeus and cricopharyngeus are 2 parts of the inferior constrictor of pharynx)
 

It is named after German ENT surgeon – Gustav Killian
 

It is through this gap that the herniation of pharyngeal mucosa occurs in case of pharyngeal pouch (Zenker’s diverticulum)
 

It is also called ‘gateway of tears‘ as it is a common site for perforation during oesophagoscopy

7. Cold-air caloric test is done with
 
Dundas Grant tube 

Montgomery T tube
 

Jackons tube
 

Fuller's tube
 

Ans A
 

Clinical tests for vestibular functions
 

Nystagmus
 

Test for gaze evoked nystagmus
 

Fistula test
 

Siegalization
 

Hennebert’s sign
 

Fitzgerald Hallpike bithermal caloric test
 

Canal paresis
 

Directional preponderance
 

Modified Kobrak test
 

Dundas Grant Cold air caloric test
 

Dix Hallpike manoeuvre
 

Nystagmus in BPPV
 

Epley’s manoeuvre
 

Tripod fracture is usually referred to as a fracture of
 

nasal bone
 

Mandible
 

Maxilla
 
Zygoma 

Ans D
 

Fractures of zygoma are the most common fractures of the upper cheek, the most common of which is the tripod fracture of zygomatic bone involving 3 separate breaks of bones of skull, through: 1. infraorbital foramen and canal to the infraorbital groove 2. zygomaticoparietal suture of lateral margin of orbit 3. zygomatic arch usually at its narrowest point, where the suture between the zygomatic process of temporal bone and temporal process of zygomatic bone occurs.
 

10. Gelle's test is a popular test done for
 

Presbycusis
 

Serous otitis media
 
Otosclerosis . 

Meniere's disease
 

Ans C
 

Gelles test was once a popular test to find out stapes fixation in otosclerosis, but now has been superceeded by tympanometry
 

8. Early Laryngeal cancer which neither impaired cord mobility nor invaded cartilage or cervical nodes is treated by
 

Chemotherapy
 
Radiotherapy – ans/

Hemilaryngectomy
 

Total laryngectomy

11. Aqueous flare in inclocyclifis is due to
 

A. Platelets
 

B. pigments
 

C. RBCs
 
D. Proteins 

Ans D
 

• Aqueous flare is a pathognomonic sign of uveitis and is due to breakdown of the blood-ocular barrier with subsequent leakage of proteins into the anterior chamber. Aqueous flare is best detected using a very focal, intense light source in a totally darkened room. The passage taken by the beam of light is viewed from an angle. In the normal eye, a focal reflection is seen where the light strikes the cornea. The beam is then invisible as it traverses the almost protein- and cell-free aqueous humor in the anterior chamber. The light beam is visible again as a focal reflection on the anterior lens capsule and then as a diffuse beam through the body of the normal lens due to presence of lens proteins. If uveitis has allowed leakage of serum proteins into the anterior chamber then these will cause a scattering of the light as it passes through the aqueous. Aqueous flare is therefore detected when a beam of light joining the focal reflections on the corneal surface and the anterior lens capsule is visible traversing the anterior chamber. A slit lamp provides ideal conditions for detecting flare, however the beam produced by the smallest circular aperture on the direct ophthalmoscope held as closely as possible to the cornea in a completely darkened room and viewed transversely will also provide excellent results. The slit beam on the direct ophthalmoscope is not as intense and does not provide as many "edges" of light where flare can be appreciated most easily. Assessment of flare may be easier after complete pupil dilation due to the apparent dark space created by the pupil. Combined assessment of IOP and aqueous flare should be performed whenever glaucoma or uveitis is suspected because of the frequency with which these conditions co-exist.
 

12. The following laser beam is used in LAS 1K (Laser-Assisted in Situ Keratomileusis)
 
A. Excimer 

B. Argon
 

C. Diode
 

D. Krypton
 

Ans A
 

LASIK is a surgical procedure which combines a micro-keratome (an automated knife for shaving the cornea) and an Excimer Laser (an ultraviolet light beam) to reshape the cornea.
 

13. Cobblelstone appearance of the palpebral conjunctiva is seen in
 

A. Trachoma
 
B. Spring Catarrh 

C. Ophthalmia nodosa
 

D. Long term use of miotics
 

Ans b
 

Allergic conjunctivitis is suggested by bilateral itchy eyes, a history of atopy, and a ‘cobblestone’ appearance of the upper palpebral conjunctiva.
 

• Signs of VKC can be described in three clinical forms.
 

1. Palpebral form- Usually upper tarsal conjunctiva of both the eyes is involved. Typical lesion is characterized by the presence of hard, flat-topped papillae arranged in cobblestone or pavement stone fashion. In severe cases papillae undergo hypertrophy to produce cauliflower-like excrescences of 'giant papillae'.
 

2. Bulbar form- It is characterised by dusky red triangular congestion of bulbar conjunctiva in palpebral area, gelatinous thickened accumulation of tissue around limbus and presence of discrete whitish raised dots along the limbus (Tranta's spots).
 

Mixed form- Shows the features of both palpebral and bulbar types
 

14. Subconjunctival haemorrhage freluently is seen in children with
 
A. Whooping cough 

B. Measles
 

C. Influenza
 

D. Chicken pox
 

Ans A
 

Causes of Subconjunctival haemorrhage
 

• Eye trauma
 

• Congenital or acquired (coagulation disorder)
 

• Diving accidents - Mask squeeze (volume inside in mask creates increased pressure with increased depth)
 

• Head injury
 

• Whooping cough or other extreme sneezing or coughing [1] [2]
 

• Severe hypertension
 

• LASIK
 

• Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
 

• Leptospirosis
 

• Increased venous pressure (e.g., extreme g-force, straining, vomiting, choking, or coughing)
 

Subconjunctival hemorrhages in infants may be associated with scurvy (a vitamin C deficiency),] abuse or traumatic asphyxia syndrome
 

15. Acute hydrops is seen in
 

A. Keratoglobus
 

B. Buphthalmos
 

C. Keratoconus
 

D. Bullous keratopathy
 

Ans C
 

Acute Corneal Hydrops
 

CLINICAL DESCRIPTION:
 

Corneal hydrops is an uncommon complication seen in patients with keratoconus. It is characterized by significant corneal edema resulting from a spontaneous rupture in Descemet's membrane. Clinical findings include dense stromal and epithelial edema with corneal protrusion, possible conjunctival hyperemia and irregular epithelium secondary to microcystic edema
 

The location and area of the involved cornea is variable
 

16. Ciliary staphyloma is due to
 

A. Scleritis
 

B. irido cyclitis
 

C. degenerative Myopia
 

D. choroiditis
 

Ans a
 

Ciliary staphyloma
 

As the name implies, it is the bulge of weak sclera lined by ciliary body, which occurs about 2–3 mm away from the limbus. Its common causes are thinning of sclera following perforating injury, scleritis & absolute glaucoma.
 

Posterior staphyloma
 

In the posterior segment of the eye, typically diagnosed at the region of the macula, deforming the eye in a way that the eye-length is extended associated with myopia (nearsightedness). It is diagnosed by ophthalmoscopy, which shows an area of retinal excavation in the region of the staphyloma.

17. If you have to treat a patient with active trachoma all of the following drugs will be effective against Chlamydia, EXCEPT
 

A. Azithromycin
 

B. Ivermectin
 

C. Rifampicin
 

D. Erythromycin
 

Ans C
 

• Topical therapy regimes. It is best for individual ?cases. It consists of 1 percent tetracycline or 1 percent erythromycin eye ointment 4 times a day for 6 weeks or 20 percent sulfacetamide eye drops three times a day along with 1 percent tetracycline eye ointment at bed time for 6 weeks. The continuous treatment for active trachoma should be followed by an intermittent treatment especially in endemic or hyperendemic area.
 

• Systemic therapy regimes. Tetracycline or erythromycin 250 mg orally, four times a day for 3-4 weeks or doxycycline 100 mg orally twice daily for 3-4 weeks or single dose of 1 gm azithromycin has also been reported to be equally effective in treating trachoma.
 

• Combined topical and systemic therapy regime. It is preferred when the ocular infection is severe (TI) or when there is associated genital infection. It includes: (i) 1 per cent tetracycline or erythromycin eye ointment 4 times a day for 6 weeks; and (ii) tetracycline or erythromycin 250 mg orally 4 times a day for 2 weeks.
 

• Ivermectin Inhibits Growth of Chlamydia trachomatis
 

18. Angular conjunctivitis is typically due to "Moraxella lacunata" which is a
 

A. Gram negative diplococci
 

B. Gram positive diplococci
 

C. Gram negative diplobacilli
 

D. Gram positive diplobacilli
 

Ans C
 

Morax-Axenfeld diplobacillus or Moraxella lacunata is a rod-shaped, Gram negative, non motile bacteria, generally present as diploid pairs. They cause one of the commonest forms of catarrhal conjunctiviti
 

19. Which one of the following lenses is manufactured from
 

19 Hydroxyethylmethacrylate (HEMA) ?
 

A. Hard lenses
 

B. Gas permeable lenses
 

C. Soft lenses
 

D. None of the above
 

Ans C
 

More common monomers in contact lens materials include:
 

??Methylmethacrylate (MMA), which contributes hardness and strength
 

???Silicone (SI), which increases flexibility and gas permeability through the material's silicon-oxygen
 

bonds but has the disadvantage of poor wettability???Fluorine (FL), which also adds a smaller degree of gas permeability and improves wettability and
 

deposit resistance in silicone-containing lenses?
 

??Hydroxyethyl-methacrylate (HEMA), the basic water-absorbing monomer of most soft lenses?
 

??Methacrylic acid (MAA) and n vinyl pyrolidone (NVP) mono-mers, both of which absorb high amounts
 

of water and are usually adjuncts to HEMA to increase lens water content?
 

??Ethylene glycol dimethacrylate (EGDMA), a cross-linking agent that adds dimensional stability and stiffness but reduces water content
 

Hydroxyethylmethacrylate or HEMA is the monomer that is used to make the polymer polyhydroxyethylmethacrylate. The polymer is hydrophobic; however, when the polymer is subjected to water it will swell due to the molecule's hydrophilic pendant group. Depending on the physical and chemical structure of the polymer, it is capable of absorbing from 10 to 600% water relative to the dry weight. Because of this property, it was one of the first materials to be successfully used in the manufacture of flexible contact lenses
 

20 By using which one of the instruments corneal thickness can be best measured ?
 

A. Optometer
 

B. Ophthalmometer
 

C. Ultrasonic Pachymeter
 

D. Tensiometer
 

Ans c
 

A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to LASIK surgery, for Keratoconus screening, LRI surgery [8] and is useful in screening for patients suspected of developing glaucoma among other uses. Modern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters.[9] work by way of Corneal Waveform (CWF).[10] Using this technology the user can capture an ultra high definition echogram of cornea,[11] think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have to ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform[12] to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cu
 

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APPG 2013; 021-040

21. The engaging diameter in 'brow' presentation is 


A. sub mentobregmatic
 

B. mento vertical
 

C. sub occipito frontal
 

D. occipito frontal
 

Ans B
 

The different presenting antroposterior diameters of the fetus are presented below:
 

• attitude = flexed; presentation = vertex; mean presenting diameter = suboccipito-bregmatic (9.5 cm)
 

• attitude = deflexed +; presentation = deflexed; mean presenting diameter = occipito-frontal (11.5 cm)
 

• attitude = deflexed ++; presentation = brow; mean presenting diameter = mento-vertical (13.5 cm)
 

• attitude = deflexed +++; presentation = face; mean presenting diameter = submento-bregmatic (9.5 cm)

22. During normal involution, uterus becomes a pelvic organ by the end of
 

A. first week
 

B. second week
 

C. fourth week
 

D. sixth week
 

Ans B
 

by end of second week uterus becomes a pelvic organ
 

23. For the Rhesus positive new born of a Rhesus negative mother, all are indications for exchange transfusion EXCEPT
 

A. Cord blood bilirubin level > 4 mg/dl
 

B. Cord blood haemoglobin level < 11 gm/dl
 

C. Rising level of bilirubin is over 1 mg/dl/hour despite phototherapy
 

D. Total bilirubin level 10 mg/dl
 

Ans d
 

Early exchange transfusion has usually been performed because of anemia (cord hemoglobin < 11 g/dL), elevated cord bilirubin level (>70 µmol/L or 4.5 mg/dL), or both.
 

A rapid rate of increase in the serum bilirubin level (>15-20 µmol/L /h or 1 mg/dL/h) was an indication for exchange transfusion, as was a more moderate rate of increase (>8-10 µmol/L/h or 0.5 mg/dL/h) in the presence of moderate anemia (11-13 g/dL).
 

The serum bilirubin level that triggered an exchange transfusion in infants with hemolytic jaundice was 350 µmol/L (20 mg/dL) or a rate of increase that predicted this level or higher. Strict adherence to the level of 20 mg/dL has been jocularly referred to as vigintiphobia (fear of 20).
 

24. Which of the following is NOT a feature of severe pre-eclampsia ?
 

A. BP 160 /110 mmHg
 

B. Visual disturbances
 

C. Oliguria
 

D. Convulsions
 

Ans D
 

one of the following findings is also necessary for a diagnosis of severe preeclampsia:
 

• Signs of central nervous system problems (severe headache, blurry vision, altered mental status)
 

• Signs of liver problems (nausea and/or vomiting with abdominal pain)
 

• At least twice the normal measurements of certain liver enzymes on blood test
 

• Very high blood pressure ( greater than 160 systolic or 110 diastolic)
 

• Thrombocytopenia (low platelet count)
 

• Greater than 5g of protein in a 24-hour sample
 

• Very low urine output (less than 500mL in 24 hours)
 

• Signs of respiratory problems (pulmonary edema, bluish tint to the skin)
 

• Severe fetal growth restriction
 

• Stroke
 

25. All may be associated with oligo-hydramnios EXCEPT
 

A. Amnion nodosum
 

B. Placental insufficiency
 

C. Fetal renal agenesis
 

D. Rhesus isoimmunization
 

Ans D
 

Amnion nodosum are nodules on the fetal surface of the amnion, and is frequently present in oligohydramnios
 

It is typically caused by fetal urinary tract abnormalities such as unilateral renal agenesis ( Potter's syndrome ), fetal polycystic kidneys, or genitourinary obstruction. Uteroplacental insufficiency is another common cause. Most of these abnormalities can also be detected by obstetric ultrasound. It may also occur simply due to dehydration of the mother, maternal use of angiotensin converting enzyme inhibitors, or without a determinable cause (idiopathic).
 

The diagnostic approach to polyhydramnios consists of (1) physical examination of the mother with an investigation for diabetes mellitus, diabetes insipidus, and Rh isoimmunization; (2) sonographic confirmation of polyhydramnios and assessment of the fetus; (3) fetal karyotyping; and (4) maternal serologic testing for syphilis.
 

26. For ultrasound diagnosis of chronic polyhydramnios, the amniotic fluid index should be more than
 

A. 6 cm
 

B. 12 cm
 

C. 18 cm
 

D. 25 cm
 

Ans D
 

Polyhydramnios (polyhydramnion, hydramnios, polyhydramnios) is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies] It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm

24. Which of the following is NOT a feature of severe pre-eclampsia ?
 

A. BP 160 /110 mmHg
 

B. Visual disturbances
 

C. Oliguria
 

D. Convulsions
 

Ans D
 

one of the following findings is also necessary for a diagnosis of severe preeclampsia:
 

• Signs of central nervous system problems (severe headache, blurry vision, altered mental status)
 

• Signs of liver problems (nausea and/or vomiting with abdominal pain)
 

• At least twice the normal measurements of certain liver enzymes on blood test
 

• Very high blood pressure ( greater than 160 systolic or 110 diastolic)
 

• Thrombocytopenia (low platelet count)
 

• Greater than 5g of protein in a 24-hour sample
 

• Very low urine output (less than 500mL in 24 hours)
 

• Signs of respiratory problems (pulmonary edema, bluish tint to the skin)
 

• Severe fetal growth restriction
 

• Stroke
 

@28. A multigravida with 26 weeks pregnancy presenting with Hb°/o of 6 grams. The ideal management is
 

A. oral iron therapy
 

B. parental iron therapy a
 

C. packed cell transfusion
 

D. exchange transfusion
 

Indications for oral iron supplementation
 

Women with a Hb < 110g/l up until 12 weeks or <105g 12="" a="" and="" be="" beyond="" checked="" ferritin="" g="" haemoglobinopathy="" if="" in="" iron="" is="" known="" l.="" l="" of="" offered="" presence="" replacement.="" replacement="" serum="" should="" span="" the="" therapeutic="" trial="" weeks="" women=""> 

Treatment must begin promptly in the community. Referral to secondary care should be considered if there are significant symptoms and/or severe anaemia (Hb<70g advanced="" gestation="" l="" or="">34 weeks) or if there is no rise in Hb at 2 weeks
 

Parenteral iron should be considered from the 2nd trimester onwards and postpartum period in women with iron deficiency anaemia who fail to respond to or are intolerant of oral iron
 

29. Couvelaire uterus is a complication of
 

A. Rupture uterus
 

B. Torsion of gravid uterus
 

C. Red degeneration of fibroid
 

D. Severe form of concealed accidental haemorrhage
 

Ans D
 

Couvelaire uterus (also known as uteroplacental apoplexy)[1] is a life threatening condition in which loosening of the placenta (abruptio placentae) causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity.
 

"Couvelaire uterus" is a phenomenon wherein the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate into the myometrium (the muscular wall of the uterus). The myometrium becomes weakened and may rupture due to the increase in intrauterine pressure associated with uterine contractions. This may lead to a life-threatening obstetrical emergency
 

30. Obstetric conjugate is the distance between
 

A. lower border of symphysis pubis to sacral promontory
 

B. upper border of symphysis pubis to sacral promontory
 

C. lower border of symphysis pubis to tip of the coccyx
 

D. prominent bony projection on the inner surface of pubis to sacral promontory
 

Ans D
 

Antero -posterior diameters:
 

• Anatomical antero-posterior diameter (true conjugate) = 11cm
 

from the tip of the sacral promontory to the upper border of the symphysis pubis.
 

• Obstetric conjugate = 10.5 cm
 

from the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero-posterior diameter.
 

• Diagonal conjugate = 12.5 cm
 

i.e. 1.5 cm longer than the true conjugate. From the tip of sacral promontory to the lower border of symphysis pubis.
 

• External conjugate = 20 cm
 

from the depression below the last lumbar spine to the upper anterior margin of the symphysis pubis measured from outside by the pelvimeter . It has not a true obstetric importance.
 

31. In pregnancy which one of the following heart diseases is associated with the least maternal mortality ?
 

A. Aortic stenosis
 

B. Marian syndrome
 

C. Pulmonary hypertension
 

D. Patent ductus arteriosus
 

Ans D
 

Patent ductus arteriosus — Although predominantly found in females, patent ductus arteriosus (PDA) is of less practical importance as a complication of pregnancy since the clinical diagnosis is simple and because operative or catheter closure is routine and curative in childhood . An asymptomatic young woman with a small or moderate-sized ductus and normal pulmonary arterial pressure can anticipate an uncomplicated pregnancy, apart from the risk of infective endarteritis during delivery
 

Eisenmenger syndrome : Reported risk of maternal mortality in this disorder has ranged from 30 to 50 percen
 

32. The risk of rupture of lower segment caesarean section scar during labour is
 

A. more than 10%
 

B. 5 to 8%
 

C. about 0.2 to 1.5°/0
 

D. 4%
 

Ans C
 

There is a very small risk that the scar may separate or rupture during a VBAC. About 1 in 300 (0.3%) women attempting a VBAC may experience rupture of the scar on the uterus. Because of this, you will be offered continuous monitoring of your baby's heart beat during your labour if you decide on a VBAC. Studies have shown that the most common sign that a caesarean scar may be separating is a sustained drop in the baby's heart rate. Having continuous monitoring will reduce the risk of an adverse outcome to about 1 in 3,000 (0.03%). (This compares favourably to the over all risk of stillbirth for any pregnancy of 1 in 2,000)
 

33. Which drug is contraindicated in Malaria with pregnancy ?
 

A. Quinine
 

B. Mefloquine
 

C. Chloroquine
 

D. Primaquine
 

Ans D
 

34. Which one of the following is decreased during normal pregnancy ?
 

A. Glomerular filtration rate
 

B. Serum creatinine
 

C. Tidal volume
 

D. Plasma fibrinogen
 

Ans B
 

the physiologic increase in GFR during pregnancy normally results in a decrease in concentration of serum creatinine, which falls by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl.1 Hence, a serum creatinine of 1.0 mg/dl, although normal in a nonpregnant individual, reflects renal impairment in a pregnant woman
 

35. Which placenta praevia is called dangerous placenta praevia ?
 

A. Type 4
 

B. Type 3
 

C. Type 2 posterior
 

D. Type 1 posterior
 

Ans C
 

Type II posterior placenta previa is also known as 'Dangerous Placenta Previa
 

36. Brenner tumour of ovary is
 

A. an epithelial tumour
 

B. a sex cord stromal tumour
 

C. an unclassified tumour
 

D. a germ cell tumour
 

Ans A
 

Brenner tumors are uncommon tumours that are part of the surface epithelial- stromal tumor group of ovarian neoplasm
 

Epithelial-stromal tumors are classified on the basis of the epithelial cell type, the relative amounts of epithelium and stroma, the presence of papillary processes, and the location of the epithelial elements. Microscopic pathological features determine whether a surface epithelial-stromal tumor is benign, borderline, or malignant (evidence of malignancy and stromal invasion). Borderline tumors are of uncertain malignant potential.
 

This group consists of serous, mucinous, endometrioid, clear cell, and brenner (transitional cell) tumors, though there are a few mixed, undifferentiated and unclassified types.
 

37. The acidity of vagina is due to
 

A. E. coil
 

B. Anaerobic streptococci
 

C. Diphtheroids
 

D. Doderlein's bacilli
 

Ans D
 

Oral contraceptives, steroids, and antibiotics disrupt either the normal flora or the pH which is naturally acidic. This acidic environment is produced by the Doderlein's bacilli which is a normal flora found in the vagina it can be destroyed by broad-spectrum antibiotics (kills pretty much all bacteria). The acidic environment is produced by the Doderlein's bacilli and helps protect the vagina from the invading vaginal infections.
 

38. Human Chorionic Gonadotrophic (HOG) levels are increased in all of the following, EXCEPT
 

A. Complete mole
 

B. Partial mole
 

C. Endodermal sinus tumour
 

D. Choriocarcinoma
 

Ans C
 

The histology of EST is variable, but usually includes malignant endodermal cells. These cells secrete alpha-fetoprotein (AFP), which can be detected in tumor tissue, serum, cerebrospinal fluid, urine and, in the rare case of fetal EST, in amniotic fluid. When there is incongruence between biopsy and AFP test results for EST, the result indicating presence of EST dictates treatment.[1] This is because EST often occurs as small "malignant foci" within a larger tumor, usually teratoma, and biopsy is a sampling method; biopsy of the tumor may reveal only teratoma, whereas elevated AFP reveals that EST is also present. GATA-4, a transcription factor, also may be useful in the diagnosis of EST.
 

. Human chorionic gonadotropin can be used as a tumor marker, as its ß subunit is secreted by some cancers including seminoma, choriocarcinoma, germ cell tumors, hydatidiform mole formation, teratoma with elements of choriocarcinoma, and islet cell tumor. For this reason a positive result in males can be a test for testicular cancer. The normal range for men is between 0-5 mIU/mL. Combined with alpha-fetoprotein, ß-HCG is an excellent tumor marker for the monitoring of germ cell tumors
 

39. All are causes of deep dyspareunia EXCEPT
 

A. Fixed retroverted uterus
 

B. Prolapsed ovaries in pouch of Douglas
 

C. Senile atrophy of vagina due to menopause
 

D. Endometriosis of rectovaginal septum
 

Ans C
 

40. The following artery does not contribute to form the azygous arteries of vagina.
 

A. Vaginal branch of uterine artery
 

B. Inferior vesical
 

C. Internal pudendal
 

D. Middle rectal
 

Ans B
 

The Arterial Supply of the Vagina
 

• The vaginal artery is usually a branch of the uterine artery.
 

• It may, however, arise from the internal iliac artery.
 

• The 2 vaginal arteries anastomose with each other and with the cervical branch of the uterine artery.
 

• The internal pudendal artery and vaginal branches of the middle rectal artery also supply the vagina (branches of the internal iliac arteries).
 

These arteries form anterior and posterior azygos arteries to supply the vaginal wall
 

The uterine artery supplies branches to the cervix uteri and others which descend on the vagina; the latter anastomose with branches of the vaginal arteries and form with them two median longitudinal vessels—the vaginal branches of uterine artery (or azygos arteries of the vagina)—one of which runs down in front of and the other behind the vagina.
 

The vaginal artery (a. vaginalis) usually corresponds to the inferior vesical in the male; it descends upon the vagina, supplying its mucous membrane, and sends branches to the bulb of the vestibule, the fundus of the bladder, and the contiguous part of the rectum. It assists in forming the azygos arteries of the vagina, and is frequently represented by two or three branches.
 

The middle rectal artery usually arises with the inferior vesical artery, a branch of the internal iliac artery. It is distributed to the rectum, anastomosing with the inferior vesical artery, superior rectal artery, and inferior rectal artery.
 

In males, the middle rectal artery may give off branches to the prostate and the seminal vesicles, while in females it gives off branches to the vagina.
 

AZYGOS ARTERY OF VAGINA
 

This artery arises from the vaginal artery and anastomoses with vaginal branches of the uterine artery to complete the anastomotic longitudinal channel running from the ovary to the vagina in the broad ligament and mesosalpinx. This anastomosis is mainly responsible for the vaginal cycle that is normally in synchrony with ovarian cycle. But a blockage of the anastomotic channel could lead to abnormal vaginal cyclicity. The branches of the azygos vessels also anastomose with the perineal branches from the internal pudendal artery in the perineum

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