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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