Hypertonic uterine dysfunction is managed by *sedation.

After being sedated for a few hours affected women generally wakens in active labour. Internal iliac= hypogastric A. During pregnancy o RBC Volume increase by 20-30% o Plasma volume increase by 40% o Decreased hematocrit o Hb: Apparent fall (but total Hb increase by 18-20%) In a well controlled diabetic patient who does not have any other complications induction by 40 wks is usually undertaken. In general women are offered elective CS if estimated fetal weight is >4500 g to avoid risk of shoulder dystocia. Labouring women with gestational diabetes can be managed in labour with a constant infuson of 5% dextrose and an insulin drip as needed. Women with gestational diabetes are at an increased risk of developing diabetes in late life. Therefore women with GDM should undergo 75 glucose tolerance test 2 to 4 months postpartum. Women experiencing gestational diabetes may safely use combination OCPs in the post partum period (though contraindicated in overt DM) DOC for management of premature labourNifedipine*, Atosiban, Ritodrine in that order Repeat CS in pt. with h/o CS if Previous classical CSb Previous 2 or more CS Breech presentation Placenta previa Trial of labour can be given if Previous scar is healthy(scar thickness >6 mm) Duration of previous LSCS > 5yrs Neither parathormone nor calcitonin crosses placenta Injuries at birtho Liver is the most commonly injured abdominal organ during birth o Facial N. is the most commonly injured peripheral nerve o M/C fracture: Clavicle fracture Studies and their samples o CVS-Trophoblastic cells o Amniocentesis-Fetal fibroblasts Dutta- 45 Ductus arteriosus Ligamentum arteriosum Ductus venosus Umbilical vein Ligamentum venosum Ligamentum teres

Anemia in preg- Overall Physiological anemia (normochromic, normocytic) is m.c. cause of anemia in pregnancy. But if they specifically mention the word "India" or "Tropics", then mark "Dimorphic anemia" Ectopic preg commoner on Rt. side. This is due to secondary causes like Appendicitis, endometriosis which involve fallopian tube in adhesions which limit mobility and impair it's peritalsis.....(Shaws P-239)
Malariaworsens Chloroquine is DOC Appendicitis worsens

Pregnancy

Sclerodermaworse TB worst in puerperium(indian womenpoor nutrition) Worsens--> DM

Q-1. Which of the following is the most common predisposing factor for placenta accreta1. Myomectomy 2. Recent curettage 3. Previous cesarian section 4. Placenta praevia Answer-4

Layer of fibrinoid necrosisNatabachs membraneIn Placenta accretaPlacenta stuck directly to uterus Placenta accreta 1. Placenta increata 2. Pacenta percreta Say if some placenta accrete stuck while removing it leave it behind but the remains can cause persistent trophoblastic diseaseto prevent it useMtx Placenta percreta bleeds profuselyso got to remove anywayeven Hx may be required to prevent blood loss Q-2. In first trimester, all the following can be well appreciated, except1. Nuchal translucency 2. CRL 3. Hydrocephalous 4. Anencephaly Answer-3 Diagnosis of Downs Syndrome: If >3 Cms associated with Downs syndrome If >6 Cms Strongly associated with Downs syndrome NT(Nuchal Translucency) >6cm + PAPP-A Helpful for Downs Diagnosis Q. A 47-yr old woman has achieved a pregnacy via IVF using donor eggs from a 21-yrs old donor and spern from her 46 yrs old husband. She has a sonogram performed at 7 wks gestational age that shows a quintuplet pregnancy. A 5 mm nuchal translucency is discovered in one of the embros. Implications of this innclude which of the following1. The embryo has a high risk of neural tube defect 2. The embryo has a high risk of cardiac malformations 3. The nuchal translucency will enlarge by 20 weeks 4. If the nuchal translucency resolve, the risk of a chromosome abnormality is comparable to that of

other embryos Discussion- Since it is too early to predict I think answer should be 4 (radio addict). William's--> Nuchal fold is the maximum thickness of the subcutaneous translucent area between the skin and soft tissue overlying the fetal spine at the back of the neck. It is measured in the sagittal plane between 11 and 14 weeks using precise criteria. When increased, there is a higher risk for fetal aneuploidy and a variety of structural anomalies. The nuchal transparency usually disappears by 15 weeks but this does

not reduce the risk of down's syndrome.

Triple markers(Screening test) 16-20 wks: MSAFP Unconjugated Estriol HCG(increased) AFB(In desending order): Fetal serum contains AFP 1000 times more than maternal serum Amnotic fluid Maternal serum Quadruple marker triple markers as above + Inhibin(increased) Confirmatory: Amniocentesis 16-18wks Amniotic fluid karyotype and genetic analysis < 0.1% chance of abortion CVS done at 9-11wks (mark this period) associated with <1% abortion Procedureat the placenta: o Maternal villi Discarded o Fetal villi(=chorionic villi) karyotyping+genetic analysis If done < 10 wks limb reduction defects Though all parameters are used to assess the gestational age of fetus, still if single best parameter is asked 1. First trimester CRL 2. Second trimester Biparietal diameter 3. Third trimester Trans-cerebellar diameter Abdominal circumference is least useful Hydrocephalus After 18 weeks Q-3. Which of the following is the most common termination event of ectopic pregnancy1. Endocrine insufficiency 2. Vascular cause 3. Nutritional inadequacy 4. Immunological response Answer-3(I prefer option 2 since it outgrows vascular supply....see Q-152, AA-I, P-12; Supported by Shaws P-240) After some-time in tubal pregnancy pregnancy outgrows vascular supplyembryo dies and degeneratestrophoblast persists for sometimebecomes edematousruptures Mx of ectopic- P-190 Dutta Q-4. Umbilical cord insertion at the placental margin is called as1. Velamentous insertion 2. Vasa previa 3. Battledore insertion 4. Succenturiate lobe Answer-3 (P-547 ROAMS)

 Circumvellete placenta-The fetal surface is divided into a central depressed zone surrounded by thickened white ring. Vessels radiate from the cord insertion as far as the ring. Placenta Succenturiata- Usually one or more small lobes of placenta may be placed at varying distances from the main placental margin. A leash of vessels connecting the main to the small lobe traverse through the membranes. In absence of communicating blood vessels, it is called placenta spuria. Some times it can be retainedPPH Secondary typei.e. bleeding after 24 hrs upto 6 wks (Primary PPH is Atonic PPH give ergometrine given i.v. after first shoulder comes outacts in 90 sec) Velamentous cord- The cord is attached to the membranes. The branching vessels traverse between the membranes for a varying distance before they reach and supply the placenta When leash of blood vessels happen to traverse through the membranes overlying the internal os, in front of the presenting part it is called Vasa previa When placenta is in lower segment Placenta previa Q-5. Which of the following is contraindicated if lactation is to be suppressed1. Expression of milk from engorged breast 2. Ice packs and analgesics 3. Tight breast support 4. Bromocriptine Answer-1 Q-6. Regarding diabetes in pregnancy following statements are true EXCEPT1. Screening done best between 20-24 wks of gestation 2. 50 gm of sugar given after meal for screening test with test done after a hour 3. Control diabetes before conception is important to prevent fetal malformation 4. Insulin resistance improves as pregnancy advances Answer-4 worsens 1st trimester Most chances of fetal malformation But it is due to Overt DM not GDM Placenta HPL(Human Placental Lactogen) insulinase action reduces insulinleads to increase sugars in all womenbutif sugar is found increased at 20 wks GDM Screening for diabetes should be done in all pregnant women(P-284): Screening testGlucose challenge test 20-24 wks fasting not required 50g glucose after 1 hr i. sugar >140do a diagnostic test ii. Sugar >200 Diagnose GDM Diagnostic testGTT done directly in high risk women100 gm(75 for non pregnant women and normal menhttp://www.nlm.nih.gov/medlineplus/ency/article/003466.htm) Plasma Blood Generally blood Fasting < 105 < 90 values are 15% 1 hr < 190 < 105 less than the 2 hr < 165 < 145 plasma 3 hr < 145 <125 Only humans have ectopic pregnancyanimals dont have Q-61. In normal pregnant women, fasting plasma glucose levels should be of what value in case of 100 mg GTT1. < 105 2. < 90 3. < 140 4. < 120 Answer-1 Q-7. A women presents with pre-term rupture of membranes with vertex presentation and gestational age of greater than 34 weeks; the appropriate management is-

1. Expectant 2. To wait for spontaneous labour for 6 hrs 3. To wait for spontaneous labour for 24 hrs 4. Immediate caeserian section Answer-3 Membrane ruptures in 2nd stage of labour Stages of labour First stage Onset of true labour pain to- full dilatation of cervix Second stage Full dilatation of cervix to- expulsion of the fetus (Expulsive phase is distinguished by maternal bearing down efforts) Third stage Expulsion of the placenta and membranes Forth stage Observation for 1 hr PPH etc Q-8. A 39 yr P3 in labour with Rupture membranes & fetus in vertex. FHS 120. Oxytocin is started, 3 hrs later on CTG, there are contractions every minute and lasting 1 minute with no rest in between contractions. The fetal heart rate changes from 120s to 80s. On P/V cervix is 6 cm. Which of the following is the most appropriate next step1. Discontinue oxytocin 2. Start magnesium sulphate 3. Perfrom forceps assisted vaginal delivery 4. Perform caesarean delivery Answer-1 3 contraction lasting for 1 min in 10 min Good ccontraction Q-9. A patient has been referred with prolonged second stage of labour. On examination there is severe moulding of the head and the station of head is +1. Foetal heart rate is 120/min and she is having good uterine contractions. Which one of the following should be done1. Manual rotation and forceps extraction 2. Forceps extraction 3. Caeserian section 4. Vacuum delivery Answer-3 Indications of Forceps/Vacuum: Membranes Vertex Dilatation Rotation of head Forceps Absent 2+ and below Fully dilated Full rotation must Vacuum Absent Same > 6 cm dilatation Can be done on non-rotated head as well

These days caeserian is preferred though they say good cesarean is better than bad forceps Moulding Alteration in shape (size remains almost constant) of the forthcoming head while passing through the resistant birth passage Q-59. Criteria for forceps application include all of the following except1. Fetal head at perineum 2. Cervix fully dilated 3. Situation below 0 4. Saggital suture in AP Dia of pelvis Answer-3 Q-10. Which of the following cardiac disorder is very common in pregnancy1. Type II B block 2. Restrictive cardiomyopathy 3. Ventricular ectopic

4. Dilated cardiomyopathy Answer-4 May occur during the last trimester of pregnancy or within 6 months of delivery. About half of patient will recover completely* with most of the rest improving. However the current advice is to avoid future pregnancies d/t risk of recurrence. Treatment is same as that for other dilated cardiomyopathies except that ACE inhibitors are contraindicated in pregnancy. Q-11. A 22-yr old primi at term comes to the labour ward with regular contractions. P/V- cervix 6 cm, 100% effaced; head at 0 station. FHS 150. Before an epidural for pain relief, what should be given1. Antacid 2. Antibiotic 3. Aspirin 4. Clear liquid meal Answer-1 In a women with heart disease with breech preferably give epidural associated with hypotension(though less than other anaesthtics)leads to vomiting Mandelsons Syndrome(chemical pneumonitis)antacid for prevention Q-12. HIV transmission from mother to fetus, what is not true1. Most common, 15-25% during delivery 2. Vertical transmission more in preterm-birth 3. Caesarean or vaginal delivery have equal chance of transmitting virus 4. Breast-feeding in developing countries is not absolutely contraindicated Answer-3 In all cases of HIV do C/S provided membrane not ruptured HIV, Hep B, TB all are contraindication to BF but not in developing countries

Placenta previa Indications of C/S for Placenta praevia (37-42 wks placenta not bleeding): Type IV- C/S Type III examination under anaesthesia 1. if placenta has moved with effacement to interiors N Delivery 2. but if placenta did not move C/S Type IIb C/S Type IIa N Delivery Type I N Delivery 37-42 wk painless bleeding P/V Type I-IV C/S < 34 weeks placenta previa bleeds can go for conservative Mx Rest Advocated by Macafee Johnson Reduce bleeding in upto 90% Sedation Steroids If > 34 wks bleeding C/S 38-42 wks no conservation Delivery by ARM to reduce duration of labour and hence bleeding Abruptio placenta- Consumption of clotting factors DIC Deathso no role of comsevative Mx only C/S Q-14. Absolute contraindications for induction of labour include the following, except1. Major degree placenta praevia 2. Previous metroplasty 3. Breech presentation 4. Previous hysterotomy Answer-3

But complicated breech is an indication of C/S Metroplasty Uterine repair C/S at < 28 wkswhen Lower Segment is not formed is called Hysterotomy(done on upper segment)so no normal vaginal delivery now may lead to rupture of upper segment Q-15. In an IUGR baby the Doppler finding which will most significantly predict the intra uterine death of the foetus1. Absent systolic flow 2. Absent diastolic flow 3. Reversal of diastolic flow 4. Presence of diastolic notch Answer-3 Option 1 it does not predict but diagnoses death Diastolic notching First sign of fetal compromise AC is the single most imp parameter for IUGR Q-16. Maximum increase in cardiac output during pregnancy and post partum is seen in1. 32 wks 2. 36 wks 3. During labour 4. Just after delivery Answer-4 (P=53 dutta) M/C cardiac heart disease in pregnancy RHD M/C cardiac lesion MS Pregnancy is contraindicated in following cardiac disease: 1. Eisenmenger 2. Severe Aortic Stenosis 3. Primary pulmonary Hypertension 4. Marfan with Aortic Regurgitation Q-17. You are delivering a 26-yr old G3P2 at 40 wks. She has a history of two previous uncomplicated vaginal deliveries and has no complications in this pregnancy. After 15 minutes of pushing, the babys head delivers spontaneously, but then retracts back against the perineum. As you apply gently downward traction to the head, the babys anterior shouler fails to deliver. All of the following are appropriate next steps in the management of this patient except1. Cut a generous episiotomy 2. Instruct the nurse to apply suprapubic pressure 3. Instruct the nurse to flex this patients hip joint upwards 4. Instruct the nurse to apply fundal pressure Answer-4: It is Shoulder dystocia. Fundal pressure is avoided as it causes further impaction of the shoulder. Moreover it causes neurologic and orthopaedic damage this retraction of head is called Turtle sign Option 3 McRoberts manoeuvre Flexion 90 degrees and more M/C nerve injured Lat. cutaneous nerve of the thigh Supra-pubic pressure also given for after coming head in breech presentation Zavanellis procedure In this maneuver the fetal head is replaced within the uterus. Thereafter the baby is delivered by C/S Q-18. A pregnant woman with mitral stenosis with grade II dysponea at 38 wks comes to the antenatal clinic. The appropriate management in this case would be1. Induction of labour to avoid further cardiac load 2. Outpatient management with tablets digoxin and lasix till she goes in labour 3. Admission of the patient to achieve the maximal functional capacity of the heart & wait for delivery

4. Perform immediate C/S to avoid further cardiac load and deterioration Answer-3 Obseve 24 hrs in cases of Heart Disease for cardiac failure Q-19. A patient with severe pregnancy induced hypertension presents with cardiac failure after 1 week of an uneventful normal vaginal delivery. The chest roentgenogram demonstrates enlargement of the cardiac silhouette, suggestive of Dilated cardiomyopathy. The mortality in this condition is1. 10% 2. 30% 3. 50% 4. 70% Answer-1(Corrected answer from Harrison) Q-20. Most common cause of maternal mortality in INDIA is1. Hemorrhage 2. Anemia 3. Sepsis 4. Heart disease Answer-1 MM1. Obstetric hemorrhage 2. Sepsis 3. Anemia Q-21. External cephalic version is contraindicated in1. Flexed breech 2. Primigravida 3. PIH 4. Prematurity Answer-4 it will reverse again 3,4 both are correct but 4 is more correct Mild PIH can be done Liquor is maximum at 36 wks IPV is indicated in--> 2nd twin in transverse lie--> When two babies are inside a contracting uterus (IPV not possible) 1 baby delivers interval uterine relaxation IPV can be done Q-22. A pregnant 35-yrs old patient is at highest risk for the concurrent development of which of the following malignancies1. Vagina 2. Ovary 3. Breast 4. Cervix Answer-4 2b and beyond Hx in first trimester After 1st trimester Classical C/S Dont let her go in labour cervix is very hard in CaCx no effacement/dilatation Preventive measures Do PAP Smear Screening in ANC Q-23. Which one of the following statements is not correct1. Blood volume increases during pregnancy 2. Hemoglobin level becomes lower than the pre-pregnant levels 3. Serum level of bilirubin increases in pregnancy 4. Increased frequency of micturition is common during pregnancy Answer-3 though cholestasis (i.e increased bile acids) is found often but not a physiological necessity

Q-25. In a pregnant woman with red degeneration. Management is1. Myomectomy 2. Analgesics, antipyretics 3. Hysterectomy 4. Termination of pregnancy Answer-2--> Dont touch fibroid in pregnancy you will kill the patient Q-26. 8 cm ovarian cyst, chance detection in an 8 week pregnant woman; management1. Immediate 2. CT to rule out malignancies and secondaries 3. Second trimester surgery 4. Remove at the time of C/S Answer-3 Q-27. HIV transmission to the fetus from mother occurs commonly at what gestational age1. Perinatal period 2. Ist trimester 3. IInd trimester 4. IIIrd trimester Answer-1 Q-28. Internal podalic version for transverse lie, complication is1. Uterine rupture 2. Cervical dilatation 3. Uterine inertia 4. Vaginal laceration Answer-1 Q-29. Best investigation for diagnosis of ectopic pregnancy1. Transvaginal sonography 2. Serial estimation of HCG levels 3. Culdocentesis 4. Colposcopy Answer-1 Q-30. All of the following drugs are used for management of post-partum hemorrhage except1. Misoprostol 2. Oxytocin 3. Prostaglandin 4. Mifepristone (RU-486) Answer-4 Q-31. All of the following are indications for termination of pregnancy in APH patient except1. 37 wks 2. IUD (Intrauterine death) 3. Transverse lie 4. Continuous profuse bleeding Answer-3

Internal iliac put sling ligature blood flow through internal iliac continues at lower pulse pressure (comparable to vein) promotes thrombosis at uterine bed Q-32. Chorionic villus biopsy is done in all of the following except1. Neural tube defects 2. Sickle cell disease 3. Myotonic dystrophy 4. Downs syndrome Answer-1 Q-33. All are true about cephalhematoma except1. Occurs due to subcutaneous edema 2. Seen mostly over parietal lobe 3. Treatment is conservative 4. May require blood transfusion Answer-1 Caput succedaneum In cephalohematoma bleeding in parietal bone limited by sutures Option 4 Baby may become anemic d/t cephalohematoma Paediatric transfusions10ml/kg wt (so 2 kg baby 20 ml syringe will do) Q-35. All are indications for cesaean section except1. Placenta previa grade 4 2. Primary breech 3. Genital carcinoma Stage IB 4. Vulval warts Answer-2 Q-36. Which surgical procedure has the highest incidence of ureteric injury1. Vaginal hysterectomy 2. Forceps operation 3. Wertheims hysterectomy 4. Vacuum application Answer-3 But forceps can also cause ureteric injury(see below diagram)

Q-37. A 25-yr old kamla, with mitral stenosis having Class II symptoms in pregnancy. All the following are done for managing this patient except1. Application of outlet forceps to cut short 2nd stage 2. After delivery of the placenta, intravenous furosemide can be used to reduce the preload 3. 1 hr post delivery (stage 4) observation in high risk allotment/ICU 4. Antibiotic is to be given Answer-3P=279 table dutta Antibiotic used in IE prophylaxis Ampicillin+Gentamicin Vagina during pregnancy becomes acidic pH decreases (d/t conversion of glycogen into lactic acid by the lactobacillus consequent to high estrogen level) Acidic pH prevents multiplication of pathogenic organisms. Q-39. In pregnancy, drug nitrofurantoin comes in which category1. A 2. B 3. C 4. D Answer-2 Category (A) Safe drugs (B) Safe in animals (C) Teratogenic (D) Teratogenic in humans (X) Teratogenic in humans Trials Safe Less human trial data, safe in few studies Less evidence Benefits > risk Benefits < risk Example Multivitamins Penicillins, Cephalosporins, Nitrofurantoin, Metronidazole, Didanocin, Nystatin Chloroquine, Albendazole, Acyclovir, Gentamycin Antiepileptics Vit. A, ACE inhibitors, Warfarin, Lithium, DES, Thalidomide

Q-40. B Lynch hemostatic suture is applied on1. Vagina after biopsy 2. Uterus in PPH 3. Fallopian tubes after re-anstomosis 4. Ovaries after cystectomy Answer-2 Q-42. The engaging diameter in brow presentation is1. Mento-vertical 2. Submento-vertical 3. Suboccipitofrontal 4. Suboccipito-bregmatic Answer-1 Presentation- part of body in lower segment

Presenting part- Part of presentation Face presentation(9.5 cm) M/C face presentation LMA (Lt. Mento Anterior) Brow presentation (mento-vertex)engagement diameter 14 cmdoes not deliverlowest point supra-orbital ridge or glabella MP can deliver only if it rotates anteriorly

Q-43. The causes of breech presentation are all except1. Placenta previa 2. Previous ceserean section 3. Contracted pelvis 4. Hydrocephalus Answer-2 Flexed/complete breech Extended/Frank/Buttock presentation M/C breech best breech for vaginal delivery Footling breech does not deliver After coming head o Burn Marshal method o Modified Mauriceau-Smellie-Veit technique (Malar flexion and shoulder traction) o Forceps Extended arm Lowsets maneuver Extended legs Perinards Q-44. A 26-yr old woman with fetus in transverse lie, shoulder presentation, membranes absent, comes to casuality in second stage of labour, management includes1. McRoberts maneuver 2. Internal podalic version 3. Cleidotomy 4. Caeserean section Answer-4Better than McRoberts Shoulder dystocia(Baby macrosomic usually) McRoberts maneuver P=407 Shoulder presentation Tranverse lie Face to pubic(Anthropoid pelvis) Occitpito-posterior presentation(not face presentation) Q-45. In triple screening test for Downs syndrome during pregnancy all of the following are included except1. Serum beta-HCG 2. Serum estriol 3. MSAFP 4. Acetyl cholinesterase Answer-4 Q-46. Contraindication to ventouse extraction, all except1. Prematurity 2. Failed forceps 3. Recent scalp blood sampling 4. High station Answer-2 Q-47. Uterus becomes the pelvic organ after how many weeks following delivery1. 6 weeks 2. 4 weeks 3. 3 weeks 4. 2 weeks

Answer-4 Uterus back in original shape and size at 6wk Post partum sterlisationdone upto 2 wks(best done within 2 days) so that it is still abdominal organ easy to sterlise Sterlisation at 6 wks called Post puerperal/Interval sterilisation Concurrent sterilisation Sterlisation done with MTP/LSCS Q-48. Investigation of choice in a pregnant woman during first trimester to screen for diabetes1. Fasting blood glucose 2. Hb1AC 3. Amniocentesis 4. Chorionic Villous Sampling Answer-2 1st trimester screening: 1. HbA1C 2. HbA2 Thalassemia 3. Thyroid 4. PAP Smear Pregnancy is associated with Hypothyroidism Q-49. A 39-yr old woman, gravida-2, para-1 at 30-weeks gestation. The patients due date was determined by a 7-week ultrasound. She has no complaints and her baby is moving well. Examintion demonstrates a fetal heart rate of 150 and a fundal height of 27 centimeters, which is the same measurement as that determined 4 weeks ago. This patients fundal height measurement is most suggestive of which of the following1. Inaccurate estimated date of delivery (due date) 2. IUGR 3. Premature labour 4. Twin gestation Answer-2 When gestational defect 2-3 wks and more IUGR M/C cause of IUGR Idiopathic

T/t of IUGR Vigilance(BPP,NST etc.) Nutrition of mother has a little role here Fetus is a parasite on mother so irrespective of maternal nutritional status it will continue to extract its nutrition from mother

Q-50. What is a reactive NST(non-stress test): 1. Two or more FHR acceleration, in response to fetal movement of 15 beats/more and persisting for atleast 15 seconds in 20 min examination period

Two FHR accelarations in 30 minutes period both persisting for 20 second and 20 beats/minutes 3. One acceleration of FHR in 20 minutes for 15 minutes and 15 seconds 4. Two FHR acceleration in 30 minutes Answer-1

2.

Q-51. Prophylactic anti D injection in non-immunized Rh negative woman should be given at1. 28 weeks, 32 weeks, within 72 hours after delivery 2. 28 weeks, 36 weeks, within 72 hours after delivery 3. 28 weeks, 34 weeks, within 72 hours after delivery 4. 28 weeks, term pregnancy, within 72 hrs after delivery Answer-3 Mixing of blood can occur in Delivery, Abortion, Abruption, Injury, CVS, ECV, Ectopic Injection of Anti-D is to be given within 3 days of exposure otherwise mother will make anti-D Anti-D works for 6 wks so for prevention given at 28 wks works upto 34 wksthen one more shot given Q-52. Best reversal after tubectomy is in which of the following types1. Isthmo-isthmic 2. Isthmo-ampullary 3. Ampullo-ampullary 4. Cornual implantation Answer-1 Q-53. Anti-epileptic agent given most preferably for effect in pregnancy is1. Phenytoin 2. Phenobarbitone 3. Carbamazepine 4. Lamotrigine Answer-3 DOC in pregnancy with Eclampsia- Mag. Sulphate (Magnesium sulphate is used primarily for seizure prophyllaxis it has no anticonvulsant property. Phenobarbiatal, diazepam are standard antoconvulsant mediactions) Epilepsy- Dutta P-298 Phenobarbitone: safe in pregnancy but not effective in epilepsy control Phenytoin Carbamazepine: DOC also causes fetal hydantoin syndrome like phenytoin; (neurosurgeon in aiims it is for past 5 yrs n doesnt seem to b changin in near future..lamotrigene stil trials r goin on...phenytoin totally abondoned in preg.) Fits are controlled by Diazepam No contraindication for Breast feeding

Lamotrigine produces nasal defects

Q-54. Gestational sac can be seen earliest on trans-vaginal scan at1. 4-5 wks 2. 5-6 wks 3. 7-8 wks 4. 10 wks Answer-1 Advantages of sonography in early months of pregnancy o Gestational ring-5th wk o Fetal pole, yolk sac- 6th wk o Cardiac pulsation- 7th wk o Acute determination of gestational agecrown rump length at 9-11 wks gives the best predictive value o Diagnosis of undiagnosed placenta previa Q-55. Commonest diameter of fetal head engagement is1. Submentovertical 2. Occipitofrontal 3. Suboccipitobregmatic 4. Mentovertical Answer-3 Q-56. Shoulder dystocia occurs in delivery of fetus with1. Anencephaly 2. Transverse lie 3. Fetal ascites 4. Macrosomia Answer-4 (Macrosomia is also found in anencephalic baby) Q-57. A lady with 16 weeks pregnancy presents with acute appendicitis, TLC of 24000. Management includes1. Conservative treatment and surgery at 20+ weeks 2. Do early surgery 3. Appendecectomy with termination of pregnancy 4. Appendecectomy following childbirth after 3rd trimester Answer-2 high chance of rupture Q-58. A pregnant woman with Mitral Stenosis is most likely to undergo failure in which period1. 16 wks 2. 24 wks 3. 20 wks 4. 32 wks Answer-4 Q-60. The Fetal Biophysical Profile(Manning) scoring include all of the following parameters, except1. Breathing episodes in 30 minutes 2. Doppler USG 3. Fetal tone 4. NST Answer-2 Fetal tone Movement Breathing NST

AFI

Q-62. What is the most common type of conjoined twin1. Craniopagus 2. Thoracopagus 3. Ischiopagus 4. Pygopagus Answer-2 dies Q-63. Which of the following biochemical parameters is the most sensitive to detect open spina bifida1. MSAFP 2. Amniotic fluid alpha feto protein 3. Amniotic fluid acetyl-cholinesterase 4. Amniotic fluid glucohexaminase Answer-3 Q-64. The Kleihauer test for detecting foetal erythrocytes is based on the fact that1. Adult erythrocytes are larger than those of the fetus 2. HbA has higher oxygen affinity than HbF 3. HbF is more resistant to acid elution than HbA 4. HbA takes up erythrosin stain less than HbF Answer-3 Mothers blood Put acid on slide eludes Hb except fetal RBC(nucleated RBC holds Hb)

The KB test is the standard method of detecting fetal-maternal hemorrhage (FMH). It takes advantage of the differential resistance of fetal hemoglobin to acid. A standard blood smear is prepared from the mother's blood, and exposed to an acid bath. This removes adult hemoglobin, but not fetal hemoglobin, from the red blood cells. Subsequent staining makes fetal cells (containing fetal hemoglobin) appear rose-pink in color, while adult red blood cells are only seen as 'ghosts'. A large number of cells (over 5000) are counted under the microscope and a ratio of fetal to maternal cells generated.

Done because 300 mg of Anti-D neutralises 30 ml of blood Q-65. Which of the following statements is incorrect in relation to pregnant women with epilepsy1. The rate of congenital malformation is increased in the offspring of woman with epilepsy 2. Seizure frequency increases in approximately 70% of woman 3. Breast feeding is safe with most anticonvulsants 4. Folic acid supplementation ay reduce the risk of neural tube defect Answer-2 Q-66. Of the following, most favourable breech presentation is1. Extended breech 2. Complete breech 3. Footling 4. Extended head Answer-1

Q-67. Anterior abdominal wall defects of fetus, which is not true1. Gastrochisisis ant abd. wall defects towards the right of umbilicus, usually 2. Gastroschisis is better long term prognosis than omphalocoele 3. Omphalocoele is covered with a sac 4. Omphalocoele is umbilical ring defect Answer-All correct Gastroschisis Uncovered comes from the side of umbilicus Omphalocoele Covered umbilical defect Q-68. Pt. at 34 wks of pregnancy has pain abdomen, uterine tenderness and bleeding per-vaginum. Her vitals are stable and has a regular fetal heart tracing. Which step of the following is not required1. Amniotomy/ Prostaglandins to induce labour 2. Arrange for blood products 3. Intravenous crystalloids and colloids 4. Tocolysis to arrest labour Answer-4 APH Dont do tocolysis Q-69. During labour on a cardiotocographic monitor, which of the following suggests head compression1. Sine wave pattern NST 2. Type-I decelerations 3. Late decelarations 4. Variable decelarations Answer-2 Q-70. Best method on ultrasonography for dating the pregnancy is1. Biparietal diameter at 10 weeks 2. Crown-rump length at 18 wks 3. Femur length at 30 wks 4. In third trimester, avg. estimation of BPD, HC, FL & AC Answer-4 Q-71. A pregnant woman developed idiopathic cholestatic jaundice. The following condition is not associated1. Intense itching 2. SGOT, SGPT less than 60 IU 3. Serum bilirubin around 8-10 mg/dl 4. Markedly increased levels of alkaline phosphatise Answer-35 and less Marker of intrahepatic cholestasia in pregnancy-Bile acids Q-72. Smallest transverse diameter of fetal skull is1. Biparietal 2. Occipitofrontal 3. Bitemporal 4. Suboccipitobregmatic Answer-3 Bimastoid is smallest though 9.5 cm Bi-parietal diameter Sub-occipitobregmatic Submento-bregmatic Q-73. Maximum amount of amniotic fluid is present at1. 30 wks

2. 3. 4.

36 wks 40 wks 43 wks

Q-74. Nitrazine test is used for detecting1. Rupture of membranes 2. APH 3. Maturity of fetus 4. Rh isoimmunisation Answer-1 Baby in GDM o M/C anomaly Cardiac o M/C cardiac anomaly TGV*/VSD/PDA o Most Specific cardiac anomalyAsymetrical septal hypertrophy(d/t insulin like growth factor)usually revert to N at 1 yr of age Q-75. Diagnosis of Downs syndrome at 11 wks is best assessed by1. USG 2. Amniocentesis 3. Chorionic Villous Biopsy 4. Doppler ultrasound Answer-3 Q-76. Amniotic fluid is mainly produced by1. Amnion 2. Placenta 3. Fetal kidney 4. Umbilical cord Answer-3 Q-77. AFP levels are highest in1. Fetal serum 2. Placenta 3. Amniotic fluid 4. Maternal serum Answer-1 Order: Fetal serum > Amniotic fluid > Maternal serum In fetal serum 1000 times more than maternal serum Q-78. Chorionic Villius biopsy is not done before 9 weeks because of1. Risk of abortion 2. Feto maternal hemorrhage 3. Limb malformation 4. Too little material Answer-3 Q-79. Which of the following disease in mother can most likely cause recurrent abortion1. Rheumatoid Arthritis 2. RHD 3. Diabetes 4. SLE Answer-4 diabetes also Q-80. Hydramnios is seen in all except1. Amnion Nodosum

2. Anancephaly 3. Open spina bifida 4. DM Answer-1seen in oligohydramnios Q-81. Most common type of malpresentation1. Breech 2. Shoulder 3. Transverse 4. Face Answer-1 Q-82. Malaria in pregnancy1. Behaves as in Non-Pregnant women 2. Worsens 3. Is better 4. Drug of choice- Quinine Answer-2 Q-83. IUGR is most commonly caused by1. Idiopathic 2. Intrauterine infection 3. PIH 4. Chromosomal abnormality Answer-1 Q-84. Investigation of choice in a pregnant patient with history of H. mole is1. Ultrasound 2. Culdoscopy 3. Per-abdominal examination 4. Chorionic villi biopsy Answer-1 Q-85. Most common cause of haemorrhage after 30 hrs of delivery is1. Uterine inertia (atony) 2. Retained placental bits 3. Prolonged labour 4. Deficient coaguability of blood Answer-2 Q-86. Which of the following can be done for the second twin in a primigravida at term in labour with transverse lie and full cervical dilatation1. LSCS 2. Bipolar version 3. Watch and wait till full dilatation of cervix 4. Internal podalic version and breech extraction Answer-4 Breech extraction in general not done now instead assisted breech is in vogue Q-88. Length of cervix in late second trimester below which the chance of preterm labour increases1. 2.5 2. 3.5 3. 4.0 4. 4.5

Answer-1 Q-89. Face to pubis delivery is seen in pelvis1. Platypelloid 2. Android 3. Gynaecoid 4. Anthropoid Answer-4: OP Anthropoid Face to pubis delivery Q-90. In case of uniovular twins if separation occurs within 72 hours then it results in twins1. Diamniotic monochorionic 2. Diamniotic dichorionic 3. Monoamniotic monochorionic 4. Conjoint Answer-2 P=203 B/N 4-8 days Diamniotic Monochorionic >8 day Monoamniotic Monochorionic Q-91. Twin to twin transfusion syndrome, the most common communication is1. Artery to Artery 2. Vein to Vein 3. Superficial vascular anstomosis 4. Deep arteriovenous villous anastomosis---------------ans Q-92. On performing per vaginal examination the fingers could feel the anterior fontanelle and the superior orbital ridges. The presentation is1. Vertex 2. Brow 3. Deflexed 4. Extended Answer-2 Q-93. Which of the following is not a criteria for diagnosis of twin-twin transfusion syndrome1. Only one placenta seen on USG 2. > 25% discrepancy in weight 3. Twins are always of same sex 4. Hb difference of atleast 10gm/dl Answer-45gm/dl(P=209) Twin-Twin trasfusion syndrome Exclusively seen in monozygotic twins Unidirectional deep artriovenous anastomosis Q-94. Which of the following is the most common type of face presentation1. Left mento anterior(LMA) 2. Right mento posterior(RMP) 3. Left mento posterior(LMP) 4. Right mento anterior(RMA) Answer-1 Q-95. One full dose of anti-D immunoglobulin given after delivery of Rh+positive baby born to Rhnegative mother will be able to neutralise how much amount of fetal blood1. 15 ml of fetal blood 2. 30 ml of fetal blood 3. 50 ml of fetal blood 4. 80 ml of fetal blood

Answer-2 Q-34. Congenital infection affecting the fetus with minimal teratogenic risk is1. HIV 2. Rubella 3. Varicella 4. CMV Answer-1 (See ROAMS P-698) Maximum teratogenic affect is seen with Rubella/Toxoplasma Earlier infection with both Toxoplasma and Rubella is bad Toxo* 1st trimester transmission rare but if occurs deformities more but in 3rd trimester transmission more deformities less 1st trimester 3rd trimester Congenital toxoplasmosis : more severe deformities Congenital toxoplasmosis: more transmission

Q-96. Regarding congenital toxoplasmosis,which is false1. 10% incidence in 1st trimester 2. 60% incidence in 3rd trimester 3. Chorioretinitis is seen in 5% affected infants 4. Spiramycin is effective Answer-3(Dutta-296) Q-97. Engaging diameter in fully extended head1. Submentovertical 2. Mentovertical 3. Biparietal 4. Bis acromial Answer-1 also submentobregmatic (P-551 ROAMS) Q-98. One of the following is the best regime for ecclampsia1. Phenytoin infusion 2. Menon Regime 3. Pritchard 4. Lytic cocktail Answer-3P=236 Magnesium Sulphate 1st drug to be given Q-99. A twenty years old woman is admitted with vaginal bleeding at 34 wks of gestation. On examination BP is 150/96, uterus is 34 weeks size and tense. Foetal heart sounds are not heard. The correct line of treatment will be1. Immediate caesarean section 2. Conservative management 3. Artificial rupture of membranes 4. Syntocinon drop Answer-3 (page 261 dutta) Here fetus has died otherwise if fetus is only detressed go for caeserian....... Q-100. Non immune hydrops is not a feature of which of the following1. Chromosomal abnormalities 2. Beta-thalassemia 3. Ureteral stenosis 4. Congenital heart block Answer-2 alpha M/C in cardiac anomaly

Immune hydrops Rh isoimmunisation Ref. drprasson@yahoo.com ck if it is drprassan Q-46. All of the following are true regarding medical management of unruptured ectopic pregnancy, except1. HCG < 5000 IU/mL 2. Absent cardiac activity 3. Size of gestation sac is not more than 5cm 4. Actinomycin D can be used Answer.3 Conservative management: HCG < 500 Ca absent Sac size < 3.5 cm Q-50. Diagnostic criteria for primary abdominal pregnancy1. Spielburg 2. Rubins 3. Studdiford 4. Wrigly Answer3 Q-52. Nulliparous female presents with unruptured ectopic pregnancy. Best surgical Mx includes1. Salpingostomy 2. Salpingectomy 3. Milking of tube 4. Injecting Methotrexate Answer1 Linear salpingostomy