OBSTETRICS
&
GYNAECOLOGY
(Instruments, Procedures and Self assessment)
By
Dr. Mukesh Raghav
Associate Professor,
Department of Obstetrics & Gynaecology,
S. P. Medical College,
Bikaner : 334003
FROM AUTHOR’S DESK
I always try my level best to teach students and ask Questions on any topic and at any place too., just to give stimulus to their grey matter. It’s the blessings of the almighty God by which I could manage to express my view in the book in your hands.
I feel highly indebted to my Mummy & Papa for their constant inspiring thoughts.
Words are too frail to express my indebt ness to my wife for her kind Co-Operation and timely suggestions. I am also grateful to my ever loving children Sunny and Neha, to whom I could not share my love and affection to the extent desired by them, during writing the book.
I wish book will help students to perform well in the examinations and will help them to get some expertise in the field of Obstetrics & Gynaecology. I will like to further add that knowingly the diagrams have not been included, keeping in mind that students can very well understand the thing with practical demonstration than diagrams. Wishing all my readers a very happy and prosperous years to come, full of success.
Dear Readers , your suggestions will be admired and welcomed by me and I will like to review myself & the book, I assure you that in future editions you will not find short comings observed by you in this book.
Regards,
Dr. Mukesh Raghav
M.B.,B.S;M.S.,FICG.
Associate Professor,
Deptt. Of obstetrics & Gynaecology,
S. P. Medical College ,
Bikaner : 334003.
Email : drmraghav@yahoo.co.in Lohri,2009
ABOUT THE AUTHOR
Dr. Mukesh Raghav, born 1956, did his M.B.,B.S.M.S. ( Obst. & Gynae. ) from University of Rajasthan. At present wrking as Associate professor in the Department of obstetrics & Gynaecology, S.P. Medical College, Bikaner., after serving as Assistant Professor for 21 years.
In his credit he has got number of research papers published in various National journals and in Popline sponsored by the John Hopkins University, Baltimore, United States of America., Has read number of scientific article in various conferences. Stood first in Paper competition at Rajasthan Obstetrics and Gynaecology Conference.
He is life member of Indian Medical Association ,Life member of SPMC International Club .,Life member of RMCTA and is an active member of Bikaner branch of Federation of Obstetrics & Gynaecology society of India.
He has been awarded with the fellowship of Indian College of Geriatrics. He rendered commendable job for family welfare programme and has been awarded at District level, in addition he is Family planning Counselor.
He has contributed Obstetrics and Gynaecology portion of Mediword’s medical Examination review,1994 and another book on Obstetrics & Gynaecology MCQ’S is under print.
Besides Medicine the other areas of interest are dramatics, Cartoonist, debaters and writer on health topics for Delhi press publications and number of talks & discussions on All India Radio, since 1976.
Dr. Mukesh Raghav.
I-D/107, J. N. Vyas Colony,
BIKANER :334003
DEDICATED
TO
RESPECTED
MUMMY
&
PAPAJI
INDEX
Instruments
Gynaecologists are in their blues, when during an examination Operation of a patient, they forget to have instruments in their Instrument Tray. Instruments commonly used by Gynaecologists are discussed herewith.
SPECULUM:
Speculum is necessary for the examination of Vagina and the cervix.
Various types of Speculums are available, as:
1. Sim’s Speculum
2. Cusco’s Bivalved speculum
3. Ferguson’s Speculum
4. Duck Bill’s Speculum
5. Auvard’s Speculum
Out of the above former two are used in routine clinical practice., depending upon their mode of function, they can be categorized as:
A. Self Retaining Speculum:
i) Cusco’s Bivalved
ii) Auvards
B. Non Self retaining Speculum:
i) Sim’s Single bladed
ii) Sim’s Double bladed
SIM’S SPECULUM:
Features:
i) Light weighted and made up of Stainless Steel.
ii) Single bladed has a handle and a blade at right angle, while double bladed has two blades on two poles. Central portion of both can be used to handle or to have a grip.
iii) Both the blades of double bladed Speculum has different sizes, to be used for different technical advantages.
How to use it ?
a. Patient is put in Lithotomy or Sim’s position depending on the technique or operation to be performed, preferably if possible an assistant can be of great help.
b. Under all aseptic and aseptic conditions, the Labia minora are separated by thumb and Index finger of left hand.
c. Hold the Speculum in Right hand and insert along it’s edge with the blades lying vertically in anterior posterior diameter of Vagina, the instrument is then rotated into it’s position after introduction.
Indications:
1. Inspecting Vagina & Cervix
2. Dilatation of Cervix
3. Curretting Uterine cavity
4. Biopsy from Vagina & Cervix
5. Endometrial Biopsy
6. Cauterization of Cervix
7. Removing IUCD thread
8. As a routine per Speculum examination
9. Repair of Cervical tears
10. Anterior & posterior Colpo perineorrhaphy
11. Repair of Vesico vaginal fistula
12. Fothergill’s Operation
13. Tubal Insufflation test
14. Chromopertubation
15. Hystro salpingography
16. Introducing Radium Modules.
In most of the indication cited above, it plays a secondary role except in (1) and (8)
Dis advantages:
a. Assistant is required to hold the speculum
b. For better view of Cervix, another Speculum for retracting anterior Vaginal wall is required.
c. Posterior Vaginal wall can not be seen.
Viva- Voice:
Q.1. Which Speculum you will like to prefer ?
Ans: Sims Bivalved.
Q.2. Patients position of your choice?
Ans: Lithotomy, if not possible Sim’s position.
Q.3. What do you mean by Sim’s position?
Ans: In brief, it’s exaggerated left lateral position.
Q.4. Enumerate the conditions/ diseases, where this instrument can not be used?
Ans: They include- i) Vaginal malignancy
ii) Removing Vaginal Cyst from posterior Vaginal wall
iii)Repair of Recto vaginal fistula/ perineal tears
iv) Posterior colpo perineorrhaphy.
Q.5. How do you sterilize this Instrument?
Ans: Autoclaving, if not available by just boiling for 10 minutes.
CUSCO’S BIVALVED SPECULUM:
Features:
1.Self retaining, has two hinged blades, which are adjustable.
2.Cervix can better be visualized.
3.Introduced in the vagina with closed blades, then the blades are opened and adjusted.
Aadvantages:
1. No Assistant required.
2. vaginal wall can be retracted to variable extent.
3. causes least pain to patient.
4. cervical visualization or operation can easily be performed.
Dis advantages:
1. Space of Vagina is being obliterated by instrument, hence difficulty for surgeon., for better movement in Operative technique.
2. Visualization or operation of vaginal wall is not possible.
AUVARD’S SPECULUM:
Features:
1. It’s the heaviest speculum.
2. Blade is having a central depression.
3. It’s a mechanical self retaining posterior vaginal wall speculum.
4. It has flange with two holes, to which weight can be attached as self retaining device.
Viva- Voice:
Q.1. What is the weight of instrument?
Ans: Nearly 45 – 50 Ozs.
Q.2. Can this instrument be used in routine?
Ans: No.
Q.3. Can it be used in Gynaecology OPD’S
Ans: No.
Q.4. Any anaesthesia you will like to give before inserting this instrument?
Ans: Yes, depending on duration of surgery, Local or General anaesthesia can be given.
Q.5. Is there any chance of perineal laceration or tears after it’s use ?
Ans: Usually not, but in puerperal patient the possibility can not be ruled out.
Q.6. Patient must be complaining of Pain after it’s use/
Ans: Yes, Occasionally.
Q.7. Have you/ Yourself or seen any surgeon using it?
Ans: No, Now a days most of surgeon prefer Sim’s hence, I will also like Sim’s Speculum.
FEMALE CATHETER:
Catheter are the Instruments or devices ment for emptying the urinary
bladder. They may be-
i) Simple Catheter
ii) Rubber
iii) Polyurethane
iv) Metal
v) Self retaining Foley’s Catheter
Simple Metal Catheter for females
It is hollow metallic tube, straight or may be curved, tapering at the tip with an opening at the side and a ring at the base.
Functions:
1. In addition to emptying the urinary bladder the instrument is of help in differentiating between Vesico Vaginal fistula and Urethro Vaginal fistula.
2. To even diagnose a Vesico Vaginal Fistula.
3. To ascertain lower limit of the bladder before operations for genital prolapse.
ANTERIOR VAGINAL WALL RETRACTOR:
Features:
1. Also known as Sim’s Anterior Vaginal wall retractor.
2. Has loops with slight angulation at both ends, loops are ridged or transversely serrated.
3. It is used to push back the anterior vaginal wall upwards., in multipara where the walls are lax and hanging over the operating field.
4. Other than multipara, indications for it’s use are loose and lax vaginal walls and moderate Cystocoele.
5. It can not be used alone, needs the help of a Speculum to retract posterior Vaginal wall.
SPONGE HOLDING FORCEPS:
( Also known as Rampley’s sponge holding forceps or Swab holding forceps)
Features:
1. Made up of Stainless steel, having a hinge in the middle.
2. Tip is ring shaped with transverse serration.
3. Other end of the forceps is having locking device, so as to function as holding forceps.
Uses:
1. Swabbing the operative field for dis infection.
2. Holding the sponge and swabbing the vagina.
3. In case where the cervix is soft, the instrument can be used to hold the cervix.
4. For Removing product of conception , when Ovum forceps are not available or even available ( in selected cases ).
5. Vaginal packing.
6. Applying medication to deep seated areas.
7. Swabbing and applying pressure over the small areas which are oozing.
Viva – Voice:
Q.1. Why the tip of instrument is serrated?
Ans: To have a firm grip.
Q.2. What’s the use of having lock in the Instrument?
Ans.: So the loose pieces of foreign particles ( or Gauze ) may not be lost in the abdominal cavity, while doing swabbing.
Q.3. Suppose you are using this Instrument in place of Ovum forceps and accidentally pregnant Uterus gets perforated accidentally. How you will manage?
Ans.: I will manage the patient as-
i) Monitor the general condition of the patient
ii) Amount of blood loss per vaginum will be assessed
iii) Infusing Oxytocin/ Inj.ergotamine maleate / Injection Prostaglandin to be given depending on the condition of the patient.
iv) If the general condition of the patient is deteriorating , I will not hesitate in opening the abdomen ( Laparotomy )
Q.4. If the product of conception are in Uterus and uterus have been perforated, you will like to remove remaining products by Hystrotomy or not?
Ans.: Not necessarily, I will proceed for Laparotomy and see for the rent in the uterus , through this rent I will like to remove the products and will stitch the rent.
Q.5. Suppose the rent is not clear, still peritoneum is covering the rent, what change in the management you will like to make?
Ans.: I will like to request my assistant for continuing removing the products under my supervision, as abdomen is already open and if perforation takes place, we will manage accordingly.
Q.6. If slight oozing is there from that site, you will like to interfere?
Ans.: I will like to press that area for time being, if at all bleeding does’nt stop, I will not hesitate in applying a stitch but this will be done keeping in mind the general condition of patient.
VOLSELLUM FORCRS:
Features:
1. It is made up of Stainless Steel.
2. Tip of the instrument is toothed for the firm grip and to cause minimum trauma.
3. Has got a curvature so as to help in retracting anterior vaginal wall.
4. Other end of the instrument has got a locking arrangement.
Uses:
1. Chiefly used to hold the cervical lips for different indications.
2. To hold the fundus of the uterus mostly in vaginal Hysterectomy and occasionally in cases of Abdominal Hysterectomy.
3. To remove Fibroid polyps.
4. To arrest the mobility of cervix.
5. In rare cases where the cervix is merged with vagina the biopsy from that area can be taken.
Viva – Voice:
Q.1. Because of sharp teeth, it causes bleeding, how you will manage?
Ans.: Certainly, in most cases it happens but is controlled by haemostatic mechanism., If the bleeding is profuse a stitch can be applied to achieve homeostasis.
Q.2. The Instrument is single toothed or multiple?
Ans.: Multiple.
Q.3. Who invented the Instrument?
Ans.: ‘Teal’ invented the Instrument hence sometimes named as “Teal’s Volsellum Forceps”.
Q.4. Is the curvature in Instrument is essential?
Ans.: Yes, for retraction of anterior wall and better view of operative field it’s necessary , otherwise straight variety of volsellum forceps are also available.
Q.5. Can this Instrument be used for culdocentesis in cases of ectopic gestation?
Ans.: Yes, it is routinely used in this method to hold posterior lip of cervix., concisely the volsellum forceps can be used where surgeon wants firm grip and can sacrifice the trauma of teeth and bleeding, if any.
Q.6. What are different indications for catching posterior lip of cervix?
Ans.: The Indications are-
i) Cervix is torn, friable and having a growth on anterior lip of cervix
ii) Fothergill’s Operation
iii) Vaginal Hysterectomy
iv) Posterior Colpotomy
v) Vaginal Tubectomy ( now a days not being performed because of higher sepsis rate, availability of better techniques and dyspareunia).
Q.7. How you will sterilize the Instrument?
Ans.; Only by Autoclaving.
TENACULUM FORCEPS: ( named after Jarcho)
Features:
1. It has Sharp , single teeth at one end and to have a firm grip.
2. Made up of Stainless Steel with a hinge in the middle.
3. Other end of the Instrument is having a locking device.
Uses:
i) Used in Operations where holding of anterior lip of cervix is required.
ii) Enucleation of seedling Fibroids during Myomectomy.
iii) Can be used to insert laminaria tent in the cervix, but now a days it’s obsolete.
iv) In the event of shortage of Towel clip , this Instrument can be substitute.
SOUNDS:
In routine two types sounds are in use in general practice
i) Simpson’s uterine sound.
ii) Bladder sound.
SIMPSON’S UTERINE SOUND:
Features:
1. Instrument is made of Stainless Steel
2. Apex is blunt, while opposite end is flat, for holding
3. It is graduated usually in inches, however now a days graduation in cms. is also available.
4.Length is usually one feet.
5.Two and half inches away from the end there is a knob marking for normal utero cervical length, with an angulation of 60 degrees
Precautions for it’s use:
Bimanual examination should always be done before using this instrument to detect the position of cervix., so that sound is passed in required direction and to avoid danger of uterine perforation.
Uses:
1.To find out length and direction of uterine cavity
2.To correct mobile retrovers
3.To determine the relation of any pelvic mass to uterus 4.Used routinely before Operation of Uterus and Cervix e.g. Dilatation and curettage
5.To determine abnormal uterine contents viz. polyps, placenta, product of conception, tumours and IUCD with missed threads
6.To differentiate between sub mucous fibroid and sub acute inversion of the uterus
Contra indications:
i) Missed period, suspicion of Pregnancy
ii) Pregnancy
iii) Uterine Sepsis
iv) Clinically visible Infected cervix
v) During puerperium
Complications:
A. Haemorrhage
B. Perforation of Uterus
C. Peritonitis
D. Vaginal sepsis may be carried out to Uterus and adenexa
viva – Voice:
Q.1. Why this Instrument is malleable?
Ans.: So that Instrument can adopt itself to the position and direction of the uterus.
Q.2. How you will hold this Instrument?
Ans.: Very gently, just like holding a pen
BLADDER SOUND:
Most of the times this Instrument is being confused by Uterine sound, hence for convenience, the differentiating points are:-
i). Length is smaller than uterine sound
ii). Not graduated
iii). Curve of this instrument at apical region is uniform
iv). There is no knob or angle on it.
Features:
i) Non graduated metallic rod, preferably of Steel
ii) Length of this sound is 10 cms.
iii) Length after the curve is very small nearly 1- 1.5 cms
Uses:
A. To define the limits of Bladder during operation on anterior vaginal wall & in cases of anterior Colpo perineorrhaphy
B. To determine relation and position of Urinary fistulae in the vagina
C. To diagnose Vesical calculus
D. To differentiate between Cystocoele or Urethro coele and anterior vaginal
Wall cyst.
E. To detect foreign body in urinary bladder
Complications:
i) Urethral sepsis
ii) Cystitis ( Bladder Infection)
CERVICAL DILATORS:
These are metallic Instruments, mostly used to dilate the cervix, usually for diagnostic/ therapeutic purposes. Commonly used varieties are:-
1.Hegar’s dilators :
a. 6 double ended and 25 single ended
b. Diameter varies from 3 to 26 mm.
2.Hawkins Ambler’s dilators:
a. Used commonly for Obstetrical use
3. Rare varieties are:
a. Goodal’s dilators
b.Bossi’s dilators
c.Fenton’s dilators
d.Frommer’s dilators
HEGAR’S DILATORS:
· They are metallic
· Each dilator differs 1 mm in diameter from one another adjoining one
· Single bladed , on one side are flat for holding the dilator properly and other end is tapering and round
METHEW DUNCAN’S DILATORS:
They can be identified from a distance even, besides metal base they are long and rounded.
On one end for better holding the wider area has been marked, while other is same tapering and rounded.
Viva – Voice:
Q.1. Can the Instrument be used just after boiling?
Ans.: No, preferably instrument should be autoclaved and then used.
Q.2. What are the different indications of dilatation of cervix?
Ans.: The indications are: i) Diagnostic ii) Therapeutic
Diagnostic Indications are:
· Intra Uterine manipulation
· Tubal Insufflation test
· Fothergill’s Operation
· To confirm Incompetent Os
· Insertion of Radium Implants
· Various Operations on cervix
· Before Hysteroscopy
Therapeutic Indications are:
Spasmodic Dysmenorrhoea
Cervical Stenosis
Pyometra
Q.3. How you will know that Instrument has crossed Internal Os?
Ans.: Sudden loss of resistance and when left inside, remain in site otherwise it falls or extruded out.
Q.4. Enumerate various complication of dilatation of cervix.?
Ans.: The complications are:-
1. Cervical tears
2. Perforation of Uterus
3. Haemorrhage
4. Shock
5. Sepsis
6. Cervical Incompetence
7. Cervical Stenosis following healed lacerations.
Q.5. What are the contra indications of their use?
Ans.: The contra indications are:
A. Pregnancy or suspected Pregnancy
B. Sepsis in genital tract.
Q.6. Can the instrument , be used in puerperal patients ?
Ans. It’s not an absolute contra indications , can be used with great caution as puerperal uterus is soft, otherwise also there is hardly an indication for its use.
Q.7. If you are the treating surgeon, which type of dilators you will prefer to use and why?
Ans.: I will prefer to use Hegar’s single ended dilators because of curve they have and secondly the grip on this Instrument is firm.
UTERINE CURETTES:
These are metallic Instruments used for curetting the endometrium., depending on the integrity of Uterus and indication. Various types are available.
Functions:
The Instrument has a tip with an edge., when the tip moves in contact with the endometrium, the endometrium is being scrapped out. Usually the Instruments are having a handle for grip, otherwise central part is ridged to act as a handle.
Types:
Blunt Curette
Sim’s Sharp Uterine curette
Flushing curette ( Gottstein’s )
Biopsy curette
Simple endometrial biopsy curette
Randall’s suction endometrial biopsy curette.
Combined Blunt and Sharp curette ( Blake’s )
Indications for curettage:
The Indications can be divided in two-
· Diagnostic
· Therapeutic
Diagnostic curettage indicated in-
1. Sterility
2. Functional Uterine bleeding
3. Tubercular Endometritis
4. Endometrial Carcinoma
Therapeutic curettage indicated in –
i) Incomplete abortion
ii) Missed abortion
iii) Vesicular mole
iv) Dysmenorrhoea
v) Functional Uterine bleeding
Indications of Dilatation and curettage-
A. Dysfunctional Uterine bleeding.
B. Sterility.
C. Menopausal and post menopausal bleeding.
D. Prior to insertion of radium needles for producing ‘Artificial Menopause’ or treatment of cancer.
E. Cases of vesicular mole and follow up.
F. Cases of Sub involution of Uterus, Metropathica hamorrhgica and Chronic endometritis.
G. Suspected malignancy of Uterus or Cervical canal.
H. Mennorrhagia.
I. Misuse of hormones or unsuitable intra uterine device.
Uses of Blunt or Blunt flushing curette-
1. To curette out thick deciduas of Pregnancy in cases of incomplete or inevitable abortions.
2. Some cases of Vesicular mole.
3. To flush out the Uterus to control Post abortal hemorrhage or post partum haemorrhage.
Advantages in use of endometrial biopsy curette-
1. Can be used without dilatation of curette.
2. Can be used without anesthesia.
SHARP UTERINE CURETTE:
This is a metallic Instrument having handle on one end and sharp edged loop on the other., with the advantage of it’s sharp edge and a broder area, the time period in experienced hands is less.
Disadvantages:
The Instrument is prone to cause dangerous perforation of uterine wall, requires at least dilatation up to Hegar’s No. 10 dilators for it’s free mobility.
BLUNT AND SHARP CURETTE ( BLAKE’S ) :
Both the ends are provided with loops, at one end its sharp and at other one it’s blunt., Because of ridge in the middle part, which act as a handle. The Instrument have to be autoclaved.
FLUSHING CURETTE ( GOTTSTEIN IRIGATION CURETTE)-
1. It’s Metallic one.
2. Hollow Instrument.
3. Proximal end has a spoon shaped fenestrated blunt loop.
4. Other or distal end of the curette has a facility for attaching rubber tubing for the purpose of suction.
Viva –Voice:
Q.1. At what time you will like to take curetting?
Ans.: Just before menstruation i.e. Pre menstrual phase.
Q.2. How long to curette?
Ans.: Till there is gritty sensations.
Q.3. What are the various dangers?
Ans.: Dangers includes perforation, hemorrhage and sepsis.
Q.4. What happens, if curettage is done after septic abortion?
Ans.: Curettage will break the leukocyte barrier and help in precipitation of septicemia.
Q.5. Gritty sensations during and after curettage is because of ?
Ans. This is due to the scrapping off of the stratum spondeosum layer of the endometrium.
Q.6. Enumerate difference contraindication of curettage?
Ans. i) Pregnancy or suspicious pregnancy .
ii) Cases of septic conditions of genital tract for fear of spreading infection.
iii)Gross malignancy- a relative contra indication as continuation of curetting will lead to hemorrhage, patient may go in shock.
ENDOMETRIAL BIOPSY CURETTE:
Features:
· Blunt tipped, hollow metallic instrument.
· Near the tip has got a notch with cutting edge.
· Slight angulation is there on Instrument about 6 cms. from the tip.
· A stillete has been provided to remove the biopsied tissue.
· Can be used without dilatation of cervix and without anaesthesia.
· Sterilized by autoclaving.
CERVICAL PUNCH BIOPSY FORCEPS:
Features:
1. It has got a punched end, slightly curved with locking device.
2. Punched end have basket like facility to hold the specimen firmly.
3. It is used to remove suspicious areas of cervix, can be located clinically or by Schiller’s test and biopsied material to be sent for histo pathological examination.
4. In most of the cases, after taking biopsy, achievement of haemostasis is required, usually after applying 2-3 interrupted stitches with chronic Catgut No. One, otherwise vaginal packing must be done simultaneously.
LAMINARIA TENT INTRODUCER:
Features:
i) It is used to introduce tent for cervical dilatation.
ii)The blades of Instrument when closed, make a circular grip improvised to grasp and introduce laminaria tent.
iii)Laminaria tent is made of cylindrical material made from sea woods., having a property of absorbing moisture and swells up, as such acts as a slow dilator. On an average it takes 24 hrs. for the action to complete, but may require more. The tent is to be sterilized in absolute alcohol for two days., because of more chances of infection.
iv)Now a days used very rarely as in cases of missed abortion, in vesicular mole and lastly before putting radium needles
v)After all aseptic and antiseptic technique the laminaria tent is placed in cervical canal and vaginal packing is to be done to prevent displacement.
vi)Patient is being advised Bed rest and secondly to inform duty doctor about bleeding if there is, and if tent comes out.
RUBIN’S TUBAL INSUFFLATION CANNULA:
Features:
A. Instrument was designed by Rubin for performing Rubin’s test in early 19’s.
B. Patency of fallopian tube can be checked by the instrument in cases of sterility.
C. Hydrotubation can also be performed by this metallic instrument , where there is need to open closed fallopian tube caused by mild adhesions or plugs of mucous.
D. Hystero salpingography.
E. Diagnostic laparoscopy can be performed with the Instrument.
Contra indications:
i) Sepsis of genital organs.
ii) History of recent pelvic infections.
iii) During menstruation or in presence of bleeding from the genital organs due to some cause or other pathology.
iv) Serious constitutional diseases
· Cardiovascular
· Respiratory
· Hepatic
v) During Pregnancy.
Dangers:
· Air embolism.
· Sepsis.
· Shock.
· Abdominal and Shoulder pain.
· Rupture of Uterus and tubes.
· Regurgitation Endometriosis, if not done at proper time.
Precautions:
i) Best time for the test is first 10 days after menses.
ii) Never raise pressure above 200 mm of Hg., to avoid rupture of fallopian tube.
iii) Never pump more than 160 cc. of Carbon dioxide or Air.
iv) Rate of flow of gas should not exceed 60 pc. Per minute.
v) If Shoulder pain is severe, patient should be kept in knee chest position for 15 – 20 minutes off and on.
Method:
i) Urinary bladder must be empty before the test is performed.
ii) Patient must be Lithotomy position.
iii) Under General anaesthesia toilet Vulva and vagina.
iv) Verify the size and position of Uterus by Bi- manua examination
v) Introduce the cannula in the axis of cervix, just to cross the Internal Os and in the uterine cavity.
vi) The cannula is connected to a inflator and manometer for
measuring rise and fall of pressure.
vii) Put Stethoscope over lower abdomen over tubal areas and gently pump in gas with the inflator.
viii) In normal women with tubes patent when the pressure with in uterus rises 60 – 100 mm., the manometer sho sudden fall of pressure and we hear a hissing sound due to the escape of gas in peritoneal cavity. If doubt X-Ray is to be taken to see gas under the diaphragm.
Rational of the test:
Yes, it’s true that by declaring tubes patent after a single test is not possible, after performing test for 3-4 times one can go for conclusion, but on other side of the coin, by this test apart from diagnosing the cause of infertility, this test may also cure infertility by just-
· Straightening out a kinked tube.
· By breaking down mild adhesion in the tube or in the uterine cornue.
Complications of the test:
1. Ascending Infection.
2. Air embolism.
3. Peritonitis.
4. Cervical Incompetence.
5. Tubal rupture.
OVUM HOLDING FORCEPS:
Features:
i) It’s a metallic instrument with cupped blade with linear fenestrations.
ii) Tip of the Instrument has been deviced in view to have minimum damage to the surrounding organs and the organ itself.
iii) It has no locking device, blades allow to hold a reasonable amount of tissue with a good grip.
iv) It helps in -
· Removing Ovum.
· Removing Placenta and it’s membranes.
· Removing Foreign bodies.
· Also it can be used in removing twisted pediculated polyps.
NEEDLE HOLDERS:
It is an Instrument used for grasping a needle, applying stitches with little force in a cavity or in other parts of the body which are deeply seated.
Tip of the blade of the Instrument is smaller and pointing and having serrations in crisscross fashion, over the inner surface of which already have a groove for better adjustment and firm grip over the shaft of the needle.
Various type available are-
· Straight ( Blalock’s)
· Curved ( Kilner’s )
In both the types three sizes are available from small, medium to long.
In Gynaecological practice the commonly used, one is Kilner’s curved needle holder. It is used to hold the needle during suturing at depth and at the walls of a shallow cavity, where the curve gives a better view of the tip of the instrument without obstructing the operative field.
The Instrument is sterilized by autoclaving preferably or by boiling.
HAEMOSTATIC FORCEPS:
These forceps are of utmost importance to the Gynaecologists as Operative field is better visualized, because of lack of oozing helped by haemostatic forceps. The commonly used are-
· Artery Forceps.
· Spencer-Well’s Haemostatic ( Non toothed) forceps.
· Kocher’s Artery forceps ( toothed ).
· Green Armytage forceps.
ARTERY FORCEPS:
The Instrument is basically used for haemostatic purposes, can be classified on the basis of size and shape. They are –
· Small or mosquito - Straight
-Curved
· Medium - Straight
-Curved
· Large or Pedicular
Uses of Artery Forceps:
1. As a hemostat.
2. As a pedicular clamp.
3. To crush fallopian tube.
4. To hold needle as a substitute of needle holder, to hold sutures left long during major or minor surgeries and to hold cut end of fascias.
5. To open up the Abscess cavity, breaking the loculi as in Breast abscess.
MOSQUITO ARTERY FORCEPS:
This metallic Instrument has got the features of Artery forceps except that-
· It is small in size.
· Has relatively pointed tips.
· Handle of the Instrument can be locked.
· Inner surface of the tip is serrated transversely.
Uses:
1.As Hemostat, stops bleeding by crushing the bladder.
2. As peanut ( Hold Gauze palletes ) for blunt dissection.
SPENCER- WELL’S HAEMOSTATIC FORCEPS:
These metallic Instruments are the variety of Artery forceps. In addition to straight and curved types, all the varieties ranging from long to short are available.
Features:
· Size of the blade is roughly half than handle.
· Inner surface of the blade is serrated transversely.
· The tip of the Instrument is Un toothed and Conical.
· Handle has been provided with a lock.
KOCHER’S HAEMOSTATIC FORCEPS:
Metallic Instrument, a variety of Artery forceps.
Features:
1. The blades are comparatively narrow and long, having a single sharp tooth at it’s tip.
2. Blades in addition to a tooth has transverse serration.
3. Two types are available- Straight and Curve.
4. Because of tooth it holds the bleeders effectively.
Uses:
· Holds the retracting cut ends of the vessels in tough fibrous tissue.
· Holds the pedicles in cases in major surgeries.
· Can be used for Artificial rupture of membranes.
· Holds the pedicles with minimum trauma to adjoining tissues.
GREEN ARMYTAGE FORCEPS:
Features:
Solid metallic Instrument for compressing the broader area of tissue.
The tip of Instrument has triangular blades with a serrated edge, other end of Instrument as in haemostatic forceps has a locking device.
The small space is left between the blades even when the forceps is fully closed.
In the Operations on Uterus viz. Caeserean Section, the Instrument in addition to haemostatic action, acts as a retractor also.
BABCOCK’S TISSUE FORCEPS:
Features:
1. Metallic Instrument with the tip or blades which are curved.
2. Blades are fenestrated and have a transverse bar, which is also serrated transeversly.
3. Handles are provided with catches.
4. Very light Instrument for use, cause minimum trauma to the tissue, helps in holding soft tissues and delicate structures.
Uses:
· Tubectomy.
· Tuboplasty.
· Holding the fallopian tube in different Operations .
· Holding the Intestines in Abdominal surgeries.
· Removing the adhesions surrounding the tissue to be Operated.
ALLIS TISSUE FORCEPS:
Features:
1. Very light Instrument for holding the tissues.
2. Tips are slightly curved for a better grip on tissues.
3. Tips having teeth which are interlocked.
4. Opposite end is having catches.
5. Because of less space between the blades it holds thinner structures, like fascia, Rectus Sheath and fibrous tissue of any capsule very firmly.
DISSECTING FORCEPS :
Features:
Helps in holding the tissue and help in maintaining a clear Operative field, keeps the dealing part straight as such helps in firm needle bites for suturing .
Two types of Dissecting forceps are commonly used –
· Non – toothed
· Toothed
NON TOOTHED DISSECTING FORCEPS:
Features:
· The Instrument is used to hold friable and soft tissues without causing much injury.
· The handles of the Instrument has spring like action.
· For better holding on the tissues the blades are transversely serrated.
· Central portion of outer surface has few ridges to give a better grip, inspite of all these measures sometimes tissue slip out from the spring mechanism of the two armed Instruments.
TOOTHED DISSECTING FORCEPS:
Features:
· This Instrument is nearly of the same variety as non toothed, except a tooth at the centre of the blade.
· Because of the tooth it give better grip on the tissues, tooth holds the tissue and definitely less injury is inflicted on neighboring tissues.
· Tooth does not permit the tissue to slip out, but in cases of soft and friable tissues, the Instrument has got it’s own limitations.
BARD PARKER KNIFE HANDLE:
Features:
Two types of blades are available now a days-
Handle with detachable blades.
Handle with combined blades.
Former is used quite frequently for simple reason of it’s being versatile type of Instrument, by simply changing the type of blades, a knife handle can be used for incision making and other dissections.
Second factor or advantage of use of such handle is that deterioration of it’s sharpness is easily done away with , by simply changing the blades.
SCISSORS:
Features:
The Instrument used for blunt as well as sharp dissection and also for cutting various sutures and tissues.
The Scissors are available in various sizes and shapes and can be used accordingly.
STRAIGHT SCISSORS:
Shape of the Instrument is Straight, the tip may be blunt or Sharp otherwise the action of almost all the scissors is same.
CURVED OR ANGLED SCISSORS:
The curvature of the scissor is again of two types-
Curved on flat scissors.
Curved on angle scissors.
Curved on flat Scissors:
This Scissors is curved in vertical plane along it’s longitudinal axis, such a Scissors is preferred while undergoing surgery in depth.
Curved on Angle Scissors:
The blades are curved at an angle, along it’s long axis in the horizontal plane. The Structure which are obliquely directed are better cut by such scissors. Irrespective of the type of scissors used the scissors should always be held in right hand with a firm grip to have a firm and steady control over the scissors. The other hand may be used to support the scissors from below if required.
UTERINE HOLDING FORCEPS:
Features:
The metallic Instrument used for holding the uterus, during Operation. The blade are protected with rubber tubes to minimize trauma to the uterus. This Instrument is specially used for holding the uterus. Salpingectomy operation , oophropexy, and Gilliums operations. Uterus is pushed anteriorly through the fundus to retain retroverted uterus in position, While the round ligaments are plicated and sutured together in front of rectus.
MYOMA SCREW:
The shape of the Instrument is such that Identification is quite easy. This screw is used in the operation for the removal of Fibroid Uterus. The Instrument is Screwed into the myoma to give a good grip in the tumour masses., and it adds manipulation and removal of Fibroid.
BONNEY’S MYOMECTOMY CLAMP:
Features:
1. Stainless steel instrument
2. Rubber cap over its blades
3. Two pair of finger grip’s, proximal and distal present; with a ratched lock on the handle near the proximal finger grip.
4. The blades are at an angle of about 120˚ with the handles.
5. Two overlapping transverse bars are attached to the blades one each, dividing the space between two blades into two equal parts.
6. The distal finger grips are used during the application of instrument because blades can be operated wider.
7. For tightening the lock as well as releasing it, the proximal grip is to be used as they offers greater degree of mechanical advantage than the distal one.
Sterilization:
Instrument is sterilized by autoclaving or boiling, but rubber caps over it by chemicals.
Indications:
1. Hysterectomy 2. Myomectomy
AYRE’S SPETULA
Features:
Usually the Instrument is made up of wood, but now a days spatula made of plastic and stainless steel are also available.
The length of this Instrument is 15 to 17 cms.
One end of the Instrument is larger ( 3 cms.) while the other one is comparatively shorter ( 2 cms.)
The Instrument is to be sterilized depending on the material of spatula, they are sterilized as follows-
Wooden spatula – Dry hot air oven.
Plastic spatula - Antiseptic solutions like cetrimide or Habitane.
Stainless steel spatula – Autoclaving or boiling.
Indications:
Cytological screening for-
Cervical malignancy.
Upper genital tract malignancy.
Hormones assessment.
Graham’s test.
Buccal smear for evaluation of Barr bodies.
Procedure:
The smear can be prepared as an outdoor procedure
The Bi manual examination should not be done before making the slide.
Expose the cervix.
Insert longer end of spatula into external Os, while the shorter in direct contact of Portio vaginalis., rotate the Instrument through 360 degrees.
Material collected on the slide must be fixed in a mixture of equal amount of ether and absolute alcohol.
A great caution must be taken in patient with bleeding per vaginum or Vaginal Infection . In these cases smear should not be prepared, so as to avoid false positive / negative reports.
PINARD’S FETAL STETHESCOPE:
The Instrument is funnel shaped having a broad flat disc with central perforation attached at the narrow end of the channel at right angles to the long axis of the funnel.
It is used to hear fetal heart sounds in the antenatal and the intrapartum period.
The broad end of the Instrument is placed over the maternal abdominal wall, the ear is placed over the other end , Instrument being perpendicular to the maternal abdominal wall .
This Instrument can be made of wood or metal, but because of the cost factor usually metallic is used.
The Stethoscope is lacking in diaphragm but stretched maternal skin serves the purpose of the diaphragm.
Now a days the Instrument is not being used to frequently particularly by young obstetricians, who prefer to use routine Stethoscope or other modern fetal monitoring devices, hence in the future the scope of this foetal Stethoscope seems to be in doldrums.
RETRACTORS:
Execution and planning of surgery needs good exposure of the operative field hence, retraction of the tissue to give better exposure of the surgical field is of utmost importance.
It plays a key role in surgery by-
Better view of Surgical field.
Prevent damage to adjoining tissues.
Homeostasis can be achieved under direct vision.
Provided the retractor is to be placed at correct site and angle, traction must be measured otherwise damage to the tissue can take place.
Types of Retractors:
A. Simple or plain retractor.
B. Self retaining retractor.
Czerny’s Retractor:
This Retractor is a simple variety of retractor, widely used in mini laparotomies and sometimes in cases of Vaginal Hysterectomies.
It is characterized by a biflanged hook on one corner while other is having a blade. Its one of the lightest retractor because of the fenestra at its shaft. The retractor has been devised or used only for superficial retraction at its shaft. The blades retracts the margins of the wound while biflanged end can be used for retraction of deeper level for applying stitches.
Deaver’s Retractor:
Features:
The metallic Instrument being used to retract broad area of tissue., depending upon the retraction required medium or large Deaver’s retractor can be used. Because of metallic sharpness, better to apply a pack between blade and viscera to prevent direct injury to the tissue.
It has got-
· Curved blades.
· Other end of the Instrument is provided with a smaller blade or a neck to have a firm grip.
Advantages:
1. Curve of the retractor prevents damage to adjoining viscera’s.
2. During Total abdominal hysterectomy, this is being used to retract bladder. The Instrument retracts uterus for facilitating separation of posterior peritoneum.
Self Retaining Retractor:
Features:
As the name suggests these are self retaining , no assistant is required for retraction of tissue, particularly in abdominal surgery.
Secondly a constant traction can be applied by the instrument, hence minimizing the trauma to the tissues.
The Instrument is solid, metallic with a provision for retracting the tissues to the extent which ever is desired, because of locking arrangement.
In addition it has got two blades, tip of blades are blunt, so as to minimize the Injury.
Sterilization as with other metallic instruments, should be done by autoclaving.
Embroyotomy Scissors:
Features:
It is used in Destructive Operation like –
· Cleidotomy.
· Evisceration in cases of locked twins.
· Impacted Shoulder presentation when neck is out of reach.
· Obstructive delivery due to enlargement of foetal abdomen as in cases of –
Ascitis.
Tumour.
As name suggests it is a scissor, but comparatively long and having a slight curvature.
Precaution to be taken are- Cutting and handling with the instrument must be done under direct feel or vision and in doing by former method finger must be placed between the scissor and part to be cut, so as to prevent damage to adjoining structures/ tissues.
Decapitation:
Features:
This is the procedure which means separating the foetal head from it’s body to facilitate vaginal delivery. This procedure requires the help of the following instruments.
1. Decapitation Knife.
2. Decapitation saw – used in lock twins.
3. Decapitation hook – It dislocates and cuts the neck of the foetus at the same time., can also be used in application of traction in Breech.
4. Blunt hook and Crochet-
· It is used to extract the decapitated head.
· To extract a perforated head in cases of after coming head in Breech presentation with dead foetus and in Hydrocephalus.
· Dead child in face and Brow presentation after perforation hooked into orbit or mandible and traction applied.
Indications of Decapitation:
1. Neglected Shoulder presentation with hand prolapse and dead foetus.
2. Double or conjoined monsters.
3. Locked twins.
Procedure:
Decapitation saw or hook is passed along with the back of child under guidance of hand. Tip of the Instrument should not point towards bladder. After decapitation the body is delivered by pulling the prolapsed hand and then the head is delivered by applying Supra pubic pressure and hooking it with Crochet.
SIMPSON’S PERFORATOR:
Features:
The Instrument is used for craniotomy. It has a triangular sharp pointed end with cutting sides. When the handles are pressed together the cutting edge of the tip are forced apart. There is a simple lock at the end.
Uses:
v To perforate skull of dead foetus in cases of Hydrocephalus.
v Impacted after coming head in Breech.
v Obstructed labour due to contracted pelvis where foetus is dead when caesarean section is refused.
v Failed forceps and baby is dead.
Sites of Perforation:
The sites depends mainly on the presenting part, as:
v Vertex – Anterior or presenting parietal bone.
v After coming head – Occiput.
v Face or Brow – Palate or Orbit, may be frontal bone in cases of Brow presentation..
Advantages of Bone perforation over frontanellae perforation:
Ø Frontanellae being membranous the opening becomes valvular and does not allow the contents of skull to flow out easily.
Ø It is difficult to locate the opening after removal of perforator.
Contra indications of Craniotomy:
1. Extreme degree of contracted pelvis ( Conjugate diameter less than three inches )
2. Live foetus.
3. Undilated Cervix.
After performing the operation of Craniotomy or perforation of Skull the head is delivered either by forceps, crochet, fingers or let it come out naturally.
COMBINED CRANIOCLAST AND CEPHALOTRIBE:
It is an Instrument for destructive Operations, but in modern obstetrics, it is merely of academic Interest.
Just for the sake of Identification it’s three bladed Instrument., used to crush the perforated vault and base of skull.
GIGLI SAW:
This is also one of the Instrument only of academic interest. It is a flexible saw and has two detachable handles at its ends. Instrument was formerly used for decapitation and Symphysiotomy.
VECTIS:
This is also one of the Instrument metallic one, only of academic interest. Previously it was used in cases of caesarean section but in modern era, it’s rarely being remembered, Anyhow, this is a spoon shaped Instrument resembling to the blades of Obstetrical forceps.
It was used in extraction of head in lower segment caesarean section and rarely in flexing the head from brow to vertex presentation.
( Instruments which are not being used now a days in modern Obstetrics in one sense should not be included even in new books, but for the benefit of student from examination point of view ,or for reference purposes, author feels it beneficial to cover such topics in brief for academic purposes.)
BONNEY’S UTERINE COMPRESSOR:
This Instrument was also used in cases of lower segment caesarean section .
The Instrument is to compress the lower uterine segment having placenta underneath it. The incision at that time was made in the sing.
MILNE MURRAY’S FORCEPS:
Features:
This is a long axis traction forceps. The blade of forceps are fenestrated and following characteristics-
· Have two curves- Pelvic and cephalic.
· Maximum distance between two blades in the centre is 85 cms. and at tips it is merely 2.5 cms.
· Due to cephalic curve it fits on head of child and due to pelvic curve it accommodates in the pelvis.
· There is locking system in it.
WRIGLEY’S FORCEPS:
Features:
· It is a short forceps.
· It is short because it lacks in shank.
· It has no pelvic curve, but has only cephalic curve.
· It has got no fixation screw but double slot lock is present
Uses:
1. Delivery of head delayed at perineum.
2. delivery of head in lower uterine caesarean section ( occasionally ).
3. Delivery of after coming head in breech presentation.
LONG FORCEPS:
These forceps have fenestrated blades with the pelvic and cephalic curve. Fenestration of the blades make the Instrument lighter, gives good grip over the head and impose less pressure over the head. Usually they are not being provided with fixation screw.
KJELLAND’S FORCEPS:
Features:
The blade of forceps are narrow and slight pelvic curve is there.
There is no lock but one blade carries a slot in which other blade slides so that head can be grasped, if blades are at different levels.
Head enters the pelvic cavity transversely, so first blade is passed anteriorly and other posteriorly and then Occiput is rotated forwards.
Uses:
Persistent Occipito posterior position.
Deep transverse arrest.
Viva-voice:
Q.1. Enumerate the various pre – requisite for forceps application ?
Ans. The pre – requisite are :
· Cervix must be fully dilated.
· Membranes must be fully absent.
· Pelvis must be adequate.
· Preferably presentation should be vertex.
Q.2. What are the different signs of foetal distress ?
Ans. They are –
· Irregular foetal heart sounds , Foetal heart sound less than 110 per minute or more than 160 per minute.
· Meconium stained liquour in various presentations other than Breech.
· Tumultuous foetal movements.
· Foetal scalp blood pH less than 7 ( Acidic ).
Q.3. What are the different signs of maternal exhaustion ?
Ans. The signs are-
· Rise of pulse rate and temperature.
· Restlessness and sweating.
· Anxious look.
· Pain becomes irregular and colicky.
· Vagina becomes hot and dry.
· Appearance or palpable Bandle’s ring.
VACCUM EXTRACTOR:
Features:
The apparatus is called as the ventous. This consists of a metal cup, a chain inside the cup, rubber tube connected to bottle and one manometer. Metal cup can be attached to child’s head, chain acts as traction rod. Bottle can be evacuated by a pump.
Uses:
In all cases where Forceps are indicated specially in cases of cervix incompletely dilated with inadequate uterine contraction.
Mode of action;
Negative pressure inside the bottle causes suction which will produce a caput and this helps in fixation of cup to the head. The chain acts as a traction rod, after removing the cup caput is formed over scalp known as ‘chignon’. Vacuum is produced slowly.
Advantages over forceps:
· Can be used with cervix half dilated.
· Requires minimum manipulation.
· In cases of Uterine inertia helps to initiate uterine contraction.
· Causes minimum compression of head.
· Can be applied at any level of Head.
Disadvantages over Forceps:
Takes longer time for delivery so can not be used in foetal distress.
Can not be used in face or in after coming head in Breech.
Large Cephalhaematoma may form.
May Injure cervix, vagina and vulva.
May cause-
1. Intra cranial haemorrhage.
2. Necrosis of scalp.
3. Alopecia.
PROCEDURES
DILATATION OF CERVIX:
Method-
Patient is placed in lithotomy position under all aseptic and antiseptic precautions. Painting and draping done. Intravenous injection of Diazepam 10 mg given along with IV Pentazocin 30 mg given. Catheterization done.
Bi – manual examination done, after observing the position and size of uterus, posterior vaginal wall is retracted with the help of Sim’s Speculum. Cervix is exposed and held with a Volsellum forceps. The Uterine cavity is measured with exposed and held with a Volsellum forceps.
The Uterine cavity is measured with Uterine sound. The cervix is gradually dilated with Hegar dilators up to No. 8 – 10.
INDICATIONS:
(A) Therapeutic:
(a) As a preliminary stage to curettage of Uterine cavity.
(b) Acquired or congenital cervical Stenosis
(c) Dysmenorrhoea
(d) Sterility
(e) Introduction of Intra cervical and Intra Uterine radium .
(f) Allow drainage of Uterine cavity in presence of Pyometra, Haematometra and
Hydrometra.
(g) As a part of other operation on cervix as in Fothergill’s Operation.
(B) Diagnostic:
Diagnosis of Incompetent Os.
COMPLICATIONS:
1. Ascending Infection
2. Cervical tears and haemorrhage.
3. Disturbance of undiagnosed pregnancy
4. Over dilatation leads to Incompetent Os and habitual abortion in future.
5. Perforation of Uterus
DILATATION AND CURRETTAGE:
Method:
1. Patient to be placed in supine position on Operation table.
2. Intravenous anaesthesia given in the form of Diazepam 10 mg. I.V. and Injection Pentazocin 30 mg.
3. Place the patient in lithotomy position , under all aseptic & antiseptic condition the painting & draping done.
4. If the bladder is not empty catheterization done, Bimanual examination to be carried out.
5. Expose cervix with Sim’s Speculum.
6. Cervix is held and steadied with the help of Volsellum and Uterine cavity is measured with the help of Uterine sound.
7. Cervix is gradually dilated with Hegar’s dilators up to 8 – 9.
8. Curette is introduced into the Uterine cavity up to fundus and is withdrawn, it’s sharp Curretting edge scraping against the endometrium. All the walls of uterine cavity are explored.
Indication:
A. Diagnostic:
1. Chief purpose of curettage of uterus is removal of endometrium and cervical tissue to be sent for histopathogy exam.
2. Diagnosis of endometrial malignancy and tuberculosis.
3. Hormonal status in a women with menstrual disorders and Infertility.
4. Along with Fothergill’s operation to rule out neoplastic disease of the
endometrium as the uterus is being conserved.
B. Therapeutic:
i) Abortion.
ii) Hydatidiform mole.
iii) Endometrial polyp.
iv)Functional Uterine bleeding.
Contraindication:
i) Sepsis.
ii) Pyometra.
iii) Suspected Pregnancy.
Complication:
i) Ascending Infection..
ii) Disturbance of undiagnosed pregnancy.
iii) Cervical tear and haemorrhage.
iv) Over dilatation of cervix lead to Incompetent Os and habitual abortion in future.
v) Perforation of Uterus
vi) Vigorous curettage ending to Asherman syndrome and secondary amenorrhea due to formation of Synaechia.
HYSTERO SALPINGOGRAPHY:
It is defined as radiography of interior of uterus and tubes.
Indications:
i) Diagnosis of tubal blockage.
ii) Hydrosalpinx.
iii) Peri tubal intra pelvic adhesions.
iv) Malformation of Uterus .
v) Small intra cavity tumor.
vi) Defective internal cervical Os causing abortion .
vii) Diagnosis of Tubal tuberculosis and endometrial carcinoma .
viii)To evaluate the result of Tuboplasty post operatively .
ix) To detect uterine abnormality such as Fibroid polyp, in cases of Mennorrhagia , Septate Uterus in cases of habitual abortion and in Ashermann’s syndrome in cases of secondary amenorrhea when uterine synaechia is suspected .
Contra – Indications:
i) Presence of active Infection..
ii) Suspected tuberculosis of genital tract.
iii)Suspected Pregnancy.
Method
Procedure is conducted on Radiological table in radiology department, which is fitted for that particular purpose. Patient is placed as usual in lithotomy position or on her back. After painting & draping vaginal wall is retracted with the help of Sim’s Speculum. Anterior lip of cervix is caught with the help of Volsellum forceps., Cannula fitted with cervical nozzle for injecting medium. The Radio opaque material is injected slowly by the syringe. Amount required varies from 2 – 20 mls. , for sufficient study watch the flow through uterus and tubes by screening films being exposed at suitable intervals.
Medium used are:-
Conray 280 ( 2-20 mls. )
Urograffin 60%
TUBAL INSUFFLATION:
Indications:
For diagnosis of Patency of tubes.
Method
Patient placed in lithotomy position.
Bimannual examination done.
Speculum is then inserted, vaginal portion of cervix is cleaned.
Anterior lip of cervix is caught by volsellum.
Cannula attached to Kymograph is introduced through cervical canal into the uterine cavity.
This cannula and the connecting rubber pressure tubing should first have been purged with CO2.
The Cannula is equipped with a conical rubber collar & when this is held firmly against the external cervical Os with simultaneous traction on the Volsellum.
A gas tight closure is obtained.
The Kymograph is now started and is set to deliver gas at a rate of 60 ml/ minute.
M.C.Q.
Q.1 : When a second menstrual period is missed, the probability
Of pregnancy is much greater:-
Yes/No
Q.2 : Production of HCG in trophoblast begins at:-
A. Fertilisation of Ova.
B. Implantation of fertilized Ova.
C. After 3 days of implantation.
D. After 24 hrs. of implantation.
Q.3 : The sensitivity of ELISA for HCG in serum is:-
A. 10 mIU/ml.
B. 50 mIU/ml.
C. 75 mIU/ml.
D. 100mIU/ml.
Q.4 : Echocardiography can be used to detect foetal heart action as early as :-
A. 5 weeks after I day of last normal menses
B. 48 days after I day of last normal menses
C. 8 weeks after I day of last normal menses
D. None of the above
Q.5 : Characteristic feature of Blighted ovum are following :-
A. Loss of definition of gestational sac
B. An unusually small gestational sac
C. Separation of trophoblastic layer
D. Absence of echoes emanating from foetus after
8 weeks
Q.6 : Pathogenesis of Lymphocytic hypophysitis is :-
A. Collagen disorder
B. Metabolic disorder
C. Autoimmune disorder
D. Genetic disorder
Q.7 : Average weight & average volume of uterus at term is
Respectively is :-
A. 1.0Kg.,6 ltrs.
B. 1.7Kg.,6 ltrs.
C. 1.5Kg.,5 ltrs.
D. 1.1Kg.,5 ltrs.
Q.8 : Diameter of round ligament in non-pregnant women is:-
A. 6-8 mm
B. 10-12 mm
C. 1-2 mm
D. 3-5 mm
Q.9 : Embryologically Round ligament corresponds to :-
A. Wolffian system
B. Mullerian
C. Gubernaculum testis
D. Urogenital sinus
Q.10 : True lymphatic vessels are confined largely in which
layer of endometrium? A. Superficial epithelium
B.Basal layer
C.Glands
D.Interglandular mesenchymal tissue
Q.11 : Musculature of fallopian tube is arranged :-
A. In circular layer
B. In longitudinal layer
C. An inner circular & outer longitudinal layer
D. An inner longitudinal & outer circular layer.
Q.12 : First indication of development of Mullerian duct is :-
A. Ridge of Mesonephros.
B. Thickening of Coelomic epithelium
C. Development of Morula
D. Development of Wolffian system
Q.13 : Diameter of smallest oocyte in the ovary of adult women
Averages :-
A. 50 µm
B. 05 µm
C. 33 µm
D. 100 µm
Q.14 : Caldwell-Moloy classification pertains to :-
A. Causes of amenorrhoea
B. Development of Graffian follicle
C. Pelvic organs
D. Pelvis
Q.15 : Progesterone acts in endometrium by the mechanism to decrease oestrogen action by the following except:-
A. Blocking 17-B receptors complex
B. Decrease number of oestrogen receptors
C. Sulfurylation of oestrone
D. Increases oestradiol 17-B metabolis
Q.16 : Stromal oedema of endometrium is pronounced in :-
A. Menstrual phase
B. Proliferative phase
C. Secretory phase
D. Pathological condition of endometrium
Q.17 : Origin of menstrual blood is of :-
A. Arterial
B. Venous
C. Both A & B
D. None of the above
Q.18 : Caldeyro Barcia Type II dips on foetal heart rate Monitoring are :-
A. Temporary dips
B. Sinusoidal pattern
C. Late deceleration
D. Loss of baseline variability
Q.19 : The Statement:Passage of meconium is common in the asphyxiated premature infant and relatively rare in prolonged pregnancy’ is right:-
Yes/No
Q.20: Absence of amniotic fluid in dysmaturity and with Prolonged pregnancy is an important danger sign :-
Yes/No
Q.21: Rapid development of moulding shows:-
A. Physiological phenomenon
B. Foetal distress
C. Marked disproportion
D. All of the above
Q.22: Moulding should be assessed at:-
A. One location of head
B. Two location of head
C. Three locations of head
D. Four locations of the head
Q.23: Moulding grade II indicates:-
A. Closing of suture line
B. Reducible overlape
C. Irreducible overlape
D. None of the above
Q.24: Augmentation of labour with oxytocin should be avoided Whenever possible,to reduce foetal distress.The Statement is correct:-
Yes/No
Q.25: The observation that “Delivery should be conducted in a gentle atraumatic manner,with an adequate episiotomy. Both the forceps & the ventouse are better avoided. The clamping of cord should be delayed” is correct:-
Yes/No
Q.26: Propagation of uterine contraction occur directly from one muscle to another in a downward direction, spreading at a rate of :-
A. 0.1-0.2 cm/second
B. 5-6 cms/second
C. 1-3 cm/second
D. None of the above
Q.27: The statement “ Most of the plain muscles in the cervix are in its uppermost part,there are circular muscle fibres around the circumference of cervix” is correct:-
Yes/No
Q.28: The prostaglandins are present in the following, except:
A. Menstrual blood
B. Saliva
C. Seminal fluid
D. Amniotic fluid
Q.29: The Serotonin, released from platelets is responsible for tonic condition of the uterus after Abruptio placentae:-
Correct/Incorrect
Q.30: For induction, the dose of oxytocin necessary to initiate adequate contraction is :-
A. 10 milliunits/mt.
B. 05 milliunits/mt.
C. 04 milliunits/mt.
D. 20 milliunits/mt.
Q.31: Internal rotation of presenting part results from the following except:-
A. Unusually large pelvis
B. Back of foetus posterior
C. Cord around the neck
D. Dolichopelvic pelvis
Q.32: Following are the part of high risk evolution form excluding:-
A. Previous cesaream section
B. Myoma uterus
C. Polyhydroamnios
D. Anemia
Q.33: ‘Clinical dating is not 100% accurate, patient should have real time ultrasound examination for confirmation’ the statement is:-
Right/Wrong
Q.34: For determining expected date of delivery USG should preferable be done between:-
A. 8 wks. & 30 wks.
B. 12 wks. & 32 wks.
C. 16 wks. & 24 wks.
D. None of the above
E. Presence or absence of deceleration
Q.35: False negative rate of non stress test is:-
A. 4.7 per 1000
B. 10.6 per 1000
C. 3.2 per 1000
D. 1.75 per 1000
Q.36: The variable of NST are following except:-
A. Base line foetal heart rate.
B. Variation of foetal heart rate.
C. Foetal movement.
D. Presence or absence of acceleration.
E. Presence or absence of deceleration.
Q.37: Advantage of NST are following except:-
A. Non invasive
B. Cost effective
C. Short duration
D. Patient acceptance
E. None of the above
Q.38: Foetal biophysical profile include following except:-
A. Amniotic fluid volume
B. Foetal reactivity
C. Foetal breathing movement
D. L/S ratio
E. Scalp blood pH
Q.39: The most important indication for percutaneous umbilical blood sampling are the following except:-
A. Rapid foetal karyotyping
B. Foetal evalution in suspected foetal infection
C. To determine Rh. Incompatibility
D. Foetal evalution in patients with haemolytic disease
Q.40: “Pregnancies in couples at risk of inborn error of metabolism are the candidates for further genetic testing”
Yes/No
Q.41: Ethiological categories of patient with mental retardation are:-
A. Intrauterine infection
B. Neonatal infection
C. Birth trauma
D. Downs syndrome
E. All of the above except ‘D’
F. None of the above
Q.42: Claft lip & cleft palate can be detected by USG at 16 weeks of gestation:-
Right/Wrong
Q.43: Which statement is wrong:-
A. Maternal serum alpha fetoprotein (MSAFP) screening is usually Carried out between 12 & 15 weeks of gestation
B. Prenatal detection of Neural tube defect can be done by MSAFP Screening
C. Diabetic mother have lower MSAFP levels than non diabetic
D. Black women have lower MSAFP than do white women
E. None of the above
Q.44: Chorionic villi Sampling is a procedure to determine:-
A. Down syndrome
B. Inherited metabolic disorders
C. Prenatal genetic diagnosis
D. Foetal well being
Q.45: Best time for performing Chorionic villi Sampling is between:-
A. 5-6 weeks
B. 14-16 weeks
C. 9-12 weeks
D. 16 weeks onwards
Q.46: Contraindications to trans cervical Chorionic villi sampling are following except:-
A. Toxoplasmosis
B. Active genital Herpes
C. Cervical stenosis
D. Severe cervicitis
Q.47: Transcervical Chorionic villi sampling has a slight higher risk of foetal loss than traditional amniocentesis:-
Yes/No
Q.48: Maternal Coagulopathy is not a contraindication for Tramcervical Chorionic villi sampling:-
Yes/No
Q.49: Transabdominal Chorionic villi sampling causes more discomfort to patient than amniocentesis:-
Yes/No
Q.50: The risk of foetal loss after Transabdominal Chorionic villi sampling is similar to the risk of amniocentesis:- Yes/No
Q.51: Maple syrup Urine disease is diagnosed by:-
A. Maternal Urine
B. Immunoslot analysis
C. Amniotic fluid analysis
D. Foetal liver biopsy
Q.52: Bone stippling in foetus is caused by administration of following drug to mother:-
A. Retinoic acid
B. Anticonvulsant
C. Warfarin
D. Folic acid antagonist
E. Alcohol
Q53: Following are nonteratogenic agents, except:-
A. Spermicides
B. DES
C. Codeine
D. Video terminal
Q.54: “ The risk of causing foetal malformation with the radiation involved in making a chest X-Ray film or a flat plate of abdomen is negligible.”:-
Right/Wrong
Q.55: Citrovorum factor is related to:-
A. Benzodiazepins
B. Thiazides
C. Cisplatin
D. Methotrexate
Q.56: “The function of antenatal cave is to reduce the need for desperate measures at the time of delivery”:-
Yes/No
Q.57: The parous woman who is most harassed & worried about getting home to resume her domestic responsibility is the one who is in need of:-
A. Diazepam
B. Phenobarbitone
C. Tender loving care
D. None of the above
Q.58: Out of the following which Game/Exercise is contraindicated in pregnancy:-
A. Golf
B. Tennis
C. Diving
D. Cycling
Q.59: Blood loss through Vagina has dark ‘Prune juice’ appearance in:-
A. Choriocarcinome
B. Blighted ova
C. Ectopic gestation
D. Chalamydial vaginitis with CIN
Q.60: The use of radioimmunoassay of human placental lactogen levels has been found,”not helpful in predicting the outcome in cases of threatened abortion”:-
True/False
Q.61: Causes of acute pain abdomen during first half of Pregnancy related conditions are, except:-
A. Abortion
B. Disturbed ectopic Pregnancy
C. Hydatidiform mole
D. Acute hydroamnios
E. Retroplacental Hemorrhage
F. None of the above.
Q.62: Causes of foetal oedema at birth are, except:-
A. Erythroblastosis foetalis
B. Babies of diabetic mothers
C. Congenital syphilis
D. Severe congenital heart disease of the body
Q.63: Complications of manual removal of placenta are, Except:-
A. Hemorrhage
B. Shock
C. Air embolism
D. None of the above
E. Injury to the uterus
Q.64: The uterine blood flow per minute at term Approximates:-
A. 500 ml.
B. 750 ml.
C. 1000 ml.
D. 1250 ml.
Q.65: The official time of birth in normal delivery is the instant at which time,pick right one:-
A. head is out
B. Whole foetus is outside
C. As soon as umbilical cord is cut
D. As soon as baby cries
Q.66: The common maternal side effects following isoxsuprine therapy are following,except :-
A. Tachycardia
B. Palpitation
C. Hypertension
D. Diuresis
Q.67: The following are the physiological changes during late pregnancy,except:-
A. Blood volume is increased
B. Cardiac output is increased
C. Arterial PO2 is decreased
D. Tidal volume is increased
Q.68: Supine hypotension syndrome can be relieved promptly by placing the patient in,except:-
A. Propped up position
B. Left lateral position
C. Right lateral position
D. Any one of her side
Q.69: Causes of Hydprops foetalis are following, except:-
A. Rh - isoimmunization
B. Chronic foeto maternal transfusion
C. Infection with cytomegalo virus
D. Alphathalassaemia
E. None of the above.
Q.70: Copper IUCD in the peritoneal cavity is best removed by:-
A. Laparotomy
B. Laparoscopy
C. Colpotomy
D. Culdoscopy
Q.71: TORCH infective diseases includes following,except:-
A. Toxoplasmosis
B. Rubella
C. Cytomegalovirus
D. Hepatitis virus B
Q.72: Cervical incompetence is related to the following,except:-
A. Mid trimester abortion
B. Associated with Bicornuate uterus
C. Causes Hydroamnios
D. PROM
Q.73: Ectopic pregnancy rate per 1000 women years is highest in following,except:-
A. Copper-T IUD’S
B. Progesterone –IUD
C. Levonorgesterol –IUD
D. Norplants
Q.74: HELLP Syndrome includes the following,except:-
A. Haemolytic anaemia
B. Elevated liver enzymes
C. Leucopenia
D. Decreased Platlet count
Q.75: Perforation of uterus by a sound during D&C in case of suspected carcinoma body uterus should ideally be managed by:-
A.Carefully watch general condition of patient
B. Antibiotics
C. Do D&C at a later date
D. Urgent laparotomy
Q.76: Commonest indication for abdominal hysterectomy for benign lesion is :-
A. Dysfunctional uterine bleeding
B. Fibroid uterus
C. Endometriosis
D. Tubo-ovarian mas
Q.77: Ratio between cervix & corpus uterus in 70 years of women is:-
A. 1:2 B. 2:1
C. 3:2 D. 2:3
Q.78: The ovary is attached with following,except:-
A. Ovarian ligament
B. Posterior leaf of Broad ligament
C. Infundibulopelvic ligament
D. None of the above
Q.79: The most common site of vulval cancer is :-
A. Labia majora
B. Labia minora
C. Prepuce of the clitoris
D. Bartholian gland
Q.80: The most common organism causing Salpingitis:-
A.Gonoccocal
B. Pyogenic
C. Tubercular
D. None of the above
Q.81: Gonoccocal infection of genital tract is diagnosed by :-
A. Cervical & urethral smear
B. D & C
C. Hystersalpingography
D. Laparoscopy
Q.82: Vaginal pH during child bearing period is :-
A. 3.5-3.8
B. 4-5.6
C. 5-6.4
D. 6.1-7.8
Q.83: Yellow color of Corpus luteum is due to :-
A. Accumulation of fatty granules
B. Vitamin A lipofuscin
C. Cholesterol
D. Carotene
Q.84: The commonest method adopted for family planning in India is:-
A. Tubectomy
B. Vasectomy
C. Conventional contraceptives
D. Oral pills
Q.85: The surgical treatment of uterine polyp is following,except:-
A. D & C
B. Removal by twisting
C. Hysterectomy
D. None of the above
Q.86: The commonest use of combined OC’S is:-
A. Dysmenorrhora
B. Endometriosis
C. Diagnosis of Pregnancy
D. Contraception
Q:87: Erosion cervix is related to following, except :-
A. Not associated in Nullipara
B. True sense an ulcer
C. Only cured by cauterization
D. Only cured by Hysterectomy
Q.88: Midfollicular fluid normally contains the following,except:-
A. Prosenin
B. Follistalin
C. Pregnancy associated plasma protein A
D. Luteinizing hormone
Q.89: Incidence of ectopic pregnancy following Gonococcal salpingitis increases by:-
A. 15-20%
B. 0-5%
C. 7-10%
D. 25%
Q.90: Diagnosis of Lymphogranuloma venereum is being confirmed by:-
A. Presence of Donovan bodies
B. Florescent antibody absorption test
C. Frei’s test
D. None of the above
Q.91: Perforation of Uterus during D & C is common in:-
A. Pregnancy termination
B. Uterine malignancy
C. Removal of Intra Uterine Contraceptive devices
D. All of the above
Q.92: Urethral Syndrome usually occurs in:-
A. Puberty
B. Child bearing period
C. Menopausal women
D. None of the above
Q.93: Urethral Caruncle is frequently encountered in:-
A. Women of child bearing age
B. Women suffering from urethral prolapse
C. Post menopausal women
D. None of the above
Q.94: Artificial insemination with husband semen is indicated in:-
A. Retrograde ejaculation
B. Hypospadias
C. Antispermal antibodies in cervical mucus
D. All of the above
E. None of the above
Q.95: Ovulation is ideally inducted in Polycystic Ovarian diseases with:-
A. Clomiphene citrate
B. Gn RH analoge
C. Clomiphene & human menopausal
D. Gonadotrophin
E. Danazole
Q.96 Bromocryptine is drug of choice in cases of:-
A. Endometrial Carcinoma
B. Menorrhagia
C. Hyper prolactinaemia
D. Hypo gonadism
Q.97: Insertion of Intra uterine contraceptives are contra indicated in:-
A. Multiparous women
B. Patients with low risk of STD
C. Previous Ectopic gestatio
D. None of the above
Q.98: Sion test is safe & practical method of evaluating:-
A. Chalamydial infection
B. Tubal patency
C. Genital tuberculosis
D. Stress incontinence
Q.99: Late complication of intrauterine contrceptive devices is:-
A. Vaginal infection
B. Dysmenorrhoea
C. Ectopic pregnancy
D. Actinomycosis
Q.100: Oral contraceptive pills are contraindicated in patients who are taking:-
A. Streptomucin
B. Isoniazide
C. Ethambutol
D. Rifampicin
Q.101: Failure rate of laparoscopic sterilization is:-
A. 1.0 per 100 women years
B. 1.5 per 100 women years
C. 0.6 per 100 women years
D. 0.2 per 100 women years
Q.102: Diameter of Dumas cap varies from:-
A. 9-10 cms.
B. 5.5-7.5 cms.
C. 2-4 cms.
D. 1-2 cms.
Q.103: The best procedure to diagnose carcinoma cervix following positive cytology is:-
A. Four quadrant cervical biopsy
B. Cone biopsy
C. Ring biopsy
D. Colposcopic directed biopsy
Q.104: Condition being aggravated by the oral contraceptive pills,is :-
A. Hirsuitism
B. Endometriosis
C. Premenstrual tension
D. Cervical erosion
Q.105: Micro invasive carcinoma cervix can be treated by following,except:-
A. Simple Hysterectomy
B. Amputation of cervix
C. Radical Hysterectomy
D. Cryocauterization
Q.106: Presumptive diagnosis of adenomyosis is made from the following,except:-
A. Age of patient 35-40 years
B. Parous women
C. Menorrhagia
D. Spasmodic Dysmenorrhoea
Q.107: Which of the following is related to Genital tuberculosis:-
A. Ovarian involvement without tubal affection
B. Absence of tubercle in endometrium
C. Tubercular endometritis
D. All of the above
Q.108: Follicular cyst of ovary can undergo following,except:-
A. Spontaneous resorption
B. Malignant change
C. Intracystic haemorrage
D. Rupture of cyst
Q.109: Germ cell tumour are not related to:-
A. Choriocarcinoma
B. Dysgerminoma
C. Granulosa cell tumour
D. Endometrial sinus tumour
Q.110: Complete perineal tear does not occur in :-
A. Forcep delivery in occipito posterior
B. Extension of mediolateral episiotomy
C. Vulval oedema in diabetes
D. Precipitate labour
Q.111: Out of the following,which is not the definitive surgery for carcinoma cervix:-
A. Hysterectomy with oophrectomy
B. Hysterectomy without removal of vaginal cuff
C. Radical Hysterectomy
D. None of the above
Q.112: Complete failure of fusion of Mullerian duct results in :-
A. Uterine didelphus
B. Subseptate uterus
C. Bicornuate uterus
D. Absence of uterus
Q.113: Uterne synaechia may be due to following,except:-
A. Puerperal curettage
B. Post abortal curettage
C. Tubercular Endometritis
D. None of the above
Q.114: Postmenopausal vaginal bleeding may be due to the following,except:-
A. Urethral caruncle
B. CIN III
C. Carcinoma of the fallopian tube
D. Atrophic vaginitis
Q.115: Commonest cause of RVF is:-
A. Repair of complete perineal tear
B. Congenital
C. Following obstructed labour
D. Carcinoma Vagina
Q.116: Painless vaginal bleeding at 34 weeks is treated by:-
A. Vaginal Examination
B. Rest & Sedation
C. Oxytocin drip
D. Caeserean Section
Q.117: Central Placenta praevia with Anencephaly, the treatment of choice is:-
A. Induction of labour
B. LSCS
C. Wait & Watch
D. None of the above
Q.118: Blood loss of foetal origin is found in:-
A. Placenta praevia
B. Vasa praevia
C. Abruptio placentae
D. Placenta Accreta
Q.119: The effect of epidural anaesthesia on the labour is:-
A. No effect
B. Prolongation of II stage of labour
C. Precipitate labour
D. None of the above
Q.120: X-ray is useful in twin pregnancy to know:-
A. Maturity of skeleton
B. Congenital malformation
C. Presenting part
D. Hydramnios
Q.121: Cause of Acute Inversion Uterus is:-
A. Rupture Uterus
B. Mismanaged III stage of labour
C. Cervical rigidity
D. Cervical tear
Q.122: Most common cause of Postpartum Endometritis is:-
A. E.Coli
B. Streptococcus
C. Gonococcus
D. Proteus
Q.123: Commonest cause of puerpereal pyrexia is:-
A. Puerpereal Sepsis
B. UTI
C. Breast Abscess
D. Respiratory tract infection
Q.124: Commonest cause of maternal mortality in India is:-
A. Haemorrhage
B. Sepsis
C. Embolism
D. Toxaemia
Q.125: Best method of suppression of lactation in Heart patient is:-
A. Oestrogen + Testosterone
B. Bromocriptine
C. High dose Oestrogen
D. Oral pills
Q.126: Operation not used in Incompetent Os is:-
A. Mc Donalds
B. Shirodkars
C. Strumdorfs
D. Lash & lash
Q.127: Management after failed forceps is:-
A. Craniotomy
B. Normal Delivery
C. Caeserean Section
D. None of the above
Q.128: Vaccum extraction is done in all, except:-
A. Prolonged II stage
B. Prolonged III stage
C. Persistent Occipito posterior position
D. Uterine Inertia
Q.129: The most unfavorable presentation is:-
A. Occipito posterior
B. Mento posterior
C. Occipitotransverse
D. Mento anterior
Q.130: Tomkins operation pertains to:-
A. Incision of fundus in midline
B. Wedge resection of a part of fundus
C. Reunification of uterine cavity
D. None of the above
Q.131: Indication of HRT are following,except:-
A. Feminine forever cult
B. Turners syndrome
C. Prolonged use of cortisones
D. Polycystic ovarian diseases
Q.132: Causative agent for condylomata acuminata is:-
A. Human papilloma virus
B. cytomegalovirus
C. E.coli
D. Listeria
Q.133: Macrosomia is seen in babies:-
A. Obese parents
B. Multiparous women
C. Diabetes mellitus
D. All of the above
Q.134: Short stature is seen in all,except:-
A. Klinfelter’s syndrome
B. Turners syndrome
C. Frohlich’s syndrome
D. Precocious puberty
Q.135: Single Barr body indicates:-
A. Normal male
B. Normal female
C. Super female
D. Turner’s syndrome
Q.136: The ovarian oestrogen produced in high amounts as:-
A. Oestradiol
B. Oestriol
C. Oestrone
D. None of the above
Q.137: Hydrolysis of Pragnenediol occurs in the:-
A. Intestine
B. Liver
C. Spleen
D. Kidney
Q.138: Pareyra Operation is done for:-
A. Urgency incontinence
B. Female Sterilization
C. Stress incontinence
D. Artificial Vagina
Q.139: Sonosalpingography is also known as:-
A. Amine test
B. Sions test
C. Elisa test
D. Fluorescent test
Q.140: Clue cells are seen on a vaginal smear in infection with:-
A. Haemophilus Vaginalis
B. Trichomonas Vaginalis
C. Herpes Simplex type II
D. Haemophilus Influenza
Q.141: Commonest site for Gartners cyst is:-
A. Vagina
B. Labia
C. Ovary
D. Fallopian tube
Q.142: Causative organism for Non gonococcal Urethritis is:-
A. T.pallidum
B. Ureaplasma Urealyticum
C. L.Venerum
D. Neisseria
Q.143: Which disease is not a cause of Hirsutism in females:-
A. Granulosa cell tumour
B. Familial trait
C. Polycystic Ovary
D. Congenital Adrenal Hyperplasia
Q.144: Hydramnios is associated with:-
A. Diabetes Mellitus
B. Anencephaly
C. Tracheo-oesophageal fistula
D. All of the above
Q.145: What is the proper time to do pelvic assessment in primigravida:-
A. 32 weeks
B. 34 weeks
C. 38 weeks
D. 40 weeks
Q.146: First stage of labour is upto:-
A. 3/5th dilation of cervix
B. Full dilation of cervix
C. Rupture of membranes
D. Crowning of head
Q.147: Shortest diameter of foetal skull is:-
A. Biparietial
B. Bitemporal
C. Verticomental
D. Suboccipito bregmatic
Q148: All of the following are features of pseudocyesis except:-
A. Enlargement of abdomen
B. Enlargement of uterus
C. Amenorrhea
D. Morning sickness
Q.149: Weight of normal placenta is:-
A. 125 gms.
B. 200 gms.
C. 500 gms.
D. 350 gms.
Q.150: Normal foetal heart rate at 37-40 weeks of pregnancy is:-
A. 80-120/min.
B. 120-160/min.
C. 140-180/min.
D. 160-200/min.
Q.151: Internal rotation occurs at the:-
A. Brim
B. Ischial spine
C. Cavity
D. Outlet
Q.152: Post term pregnancy is that which continuous beyond:-
A. 280 days
B. 300 days
C. 270 days
D. 294 days
Q.153: Only foetal blood loss occurs in:-
A. Placenta previa
B. Vasaprevia
C. Circumvallate placenta
D. Uterine rupture
Q.154: Which vaccine is not indicated during pregnancy:-
A. Polio-myelitis
B. Typhoid
C. Tetanus toxoid
D. Rubella
Q.155: The shortest diameter of palvic inlet is:-
A. True conjugate
B. Diagonal conjugate
C. Obstetric conjugate
D. Transverse diameter
Q.156: Methyl-ergometrine is contraindicated in:-
A. Multiparity
B. Bicornuate uterus
C. Post-partum haemorrhage
D. Eclampsia
Q.157: Decidua is cast off in puerperium as:-
A. Lochia
B. Amniotic fluid
C. Meconium
D. Placental bits
Q.158: Women belonging to this group of blood are more
Susceptible to Hydatidiform mole:-
A. A
B. B
C. AB
D. O
Q.159: Failure rate of female Sterilization by Medlener
method is:-
A. 7%
B. 5-6%
C. 0.4%
D. 0.2%
Q.160: Mifeprostone acts by the following ways,except:-
A. Prevent Ovulation
B. Prevent Fertilisation
C. Blocks the action of Progesterone
D. None of the above
Q.161: Oral contraceptive pills are contraindicated in,except:-
A. Women who wear contact lenses
B. Lactating mother
C. Patients on Rifampicin
D. None of the above
Q.162: Billing method pertains to:-
A. Birth control
B. Female Sterilisation
C. AIDS
D. Stress incontinence
Q.163: Stamey’s operation pertains to:-
A. Repair of RVF
B. Stress Incontinence
C. Polycystic ovarian diseases
D. Female Sterilisation
Q.164: Third generation Sexually transmtted disease is:-
A. Trichomoniasis
B. AIDS
C. Chancroid
D. Granuloma inguinale
Q.165: Balls operation is rarely performed for:-
A. Dyspareunia
B. Pruritis Vulvae
C. Urethral Caruncle
D. Urethral prolapse
Q.166: Portio vaginalis eventually disappear at:-
A. Puberty
B. Menarche
C. Menopause
D. 8-10 years of age
Q.167: The diameter of Isthemic portion of fallopian tube is:-
A. 2 mm
B. 8 mm
C. 6 mm
D. 10 mm
Q.168: Cranial end of Wolffian body is known as:-
A. Epoophoron
B. Paroophoron
C. Mesovarium
D. None of the above
Q.169: Size of Graffian follicle before puberty is:-
A. Less than 5mm
B. 12-14mm
C. 18-20 mm
D. 30 mm
Q.170: Adrenalarche is the term used for:-
A. Development of Breast
B. Development of public & axillary hairs
C. Cessation of menstruation
D. Cessation of Ovulation
Q.171: The term Premature is used when menopause
Occurs:-
A. At the age of 55 years
B. Before the age of 40 years
C. Beyond the age of 50 years
D. None of the above
Q.172: Commonest cause of abortions are:-
A. Blighted ovum
B. Cervical incompetency
C. Syphylis
D. Tuberculosis
Q.173: Most common cause of second trimester abortion
is:-
A. Cervical Incompetency
B. Chromosomal disorders
C. Defect in germplasm
D. Syphilis
Q.174: 43 years old women, diagnosed to have Vesicular Mole, Uterus is 26-28 wks. size, appropriate Treatment is:-
A. Suction Evacuation
B. Syntocinon drip
C. Hystrotomy
D. Hysterectomy
Q.175: Hydroamnios is associated with all, except:-
A. Renal agenesis
B. Anencephaly
C. Toxaemia
D. Tracheo oesophageal fistula
Q.176: In tuberculosis of placenta, the tubercle may be found at:-
A. Decidua
B. Chorion epithelium
C. Stroma of villi
D. All of the above
Q.177: In contrast to nonpregnant state, the oxytocin receptors concentration in myometrium at term increases to:-
A. 270 folds
B. 15-45 folds
C. 80 folds
D. 120 folds
Q.178: The usual range of intrauterine pressure during second stage of labour during contraction,with the patient not bearing down is:-
A. 200 mm. Hg.
B. 100-130 mm.Hg
C. 300-350 mm.Hg
D. 50-85 mm.Hg
Q.179: Best way of diagnosis foetal hypoxia is:-
A. Apgar score
B. Foetal scalp pH
C. Manning score
D. Foetal subcutaneous pyruvate levels
Q.180: Antihypertensive drug which inhibits labour:-
A. Reserpine
B. Diazoxide
C. Minoxidil
D. Captopril
Q.181: Epidural anaesthesia for a pregnant women is:-
A. Equal to normal
B. 10% of normal
C. 80% of normal
D. 45% of normal
Q.182: Commonest cause of Breech presentation is :-
A. Cephalopelvic disproportion
B. Hydrocephalus
C. Placenta praevia
D. Prematurity
Q.183: Commonest cause of perinatal mortality in Breech is:-
A. Asphyxia
B. Birth trauma
C. Congenital anomaly
D. Cord prolapse
Q.184: Late deceleration is because of:-
A. Placental compression
B. Foetal compression
C. Foetal death
D. Toxaemia of pregnancy
Q.185: Placenta succenturiata causes:-
A. Foetal anomales
B. Post partum haemorrhage
C. Foetal death
D. Hydramnios
Q.186: All of the following signs or symptoms characterizes placenta praevia,except:-
A. Painless vaginal bleeding
B. Increased Uterine tone
C. Erythroblastosis
D. Thinning of lower uterine segments
Q.187: All of the following sign or symptoms characterizes severe placental abruption except:-
A. Extensive external bleeding
B. Fetal demise
C. Tetanic uterine contraction
D. Severe abdominal pain
Q.188: Severe placental abruption has been associated with all of the following conditions, except:-
A. Fetal demise
B. Renal failure
C. Rh sensitization
D. Hypertension
Q.189: Post partum haemorrhage following Placenta praevia may be complicated by:-
A. Implantation in the lower uterine segment
B. Ineffective uterine muscular control
C. Retained placental fragments
D. All of the above
Q.190: Mechanism of heat loss in the newborn include all of the following except:-
A. Evaporation
B. Condensation
C. Radiation
D. Conduction
Q.191: A Neonate’s susceptibility to Necrotizing enterocolitis increases by the following factors, except:-
A. Excessive Bleeding
B. Perinatal Asphyxia
C. Phototherapy
D. Crowded nurseries
Q.192: All of the following problem are associated with IUGR infants except:-
A. Congenital anomaly
B. Shoulder dystocia
C. Hypoglycaemia
D. Metaboic acidosis
Q.193: The most important result of increased number of caesarean section being performed today is:-
A. Decreased maternal morbidity
B. Decreased perinatal mortality
C. Increased use of foetal monitor
D. All of the above
Q.194: Indication for caesarean section includes all, except:-
A. Previous caesarean section
B. Cervical circlage
C. Foetal distress
D. Cord prolapse
Q.195: Absolute pre requisite for the use of Forceps or the vacuum extractor include:-
A. Breech presentation
B. Ruptured membranes
C. Uterine inertia
D. Foetal distress
Q.196: Anaesthetic drug associated with increased post partum blood loss includes:-
A. Methoxyfluranes
B. Halothane
C. Enflurane
D. All of the above
Q.197: A spinal headache after spinal anaesthesia for labour is caused by:-
A. Leakage at the puncture site
B. Traction on Pia arachnoid
C. Decreased CSF volume
D. All of the above
Q.198: A newborn female could naturally have which of the following conditions:-
A. Mucoid vaginal discharge
B. Enlarged clitoris
C. Labial fusion
D. All of the above
Q.199: The most accurate & definitive documentation of foetal life is made by:-
A. Doppler Utrasound
B. Real time scanner
C. Leopold maneuver
D. B- Scanner
Q.200: Early diagnosis of pregnancy can be done by all,except:-
A. Clinical examination
B. Symptoms of pregnancy
C. Immunological test
D. X-Ray abdomen
Q.201: Common presentation in android pelvis is:-
A. Occipito posterior
B. Breech
C. Face
D. All of the above
Q.202: Anencephaly is often associated with:-
A. Postmaturity
B. Hydramnios
C. Spina Bifida
D. All of the above
Q.203: Foetus with brow presentation is delivered by:-
A. Mannual rotation & forceps
B. Internal pudelic version
C. Caeserean section
D. None of the above
Q.204: Major symptom of Vesicular mole is:-
A. Height of uterus does not corresponds to period of amenorrhoea
B. Absent foetal movements
C. Passing vesicles with bleeding
D. All of the above
E. A & B
Q.205: Characteristic symptom of Placenta praevia is:-
A. Bleeding is painless
B. Profuse blood loss
C. Recurrent bleeding
D. All of the above
Q.206: Indication of induction in pre-eclampsia is following, except:-
A. Acute fulminating toxaemia
B. Persistence of Hypertension
C. Contracted pelvis
D. Recurrent pre-eclampsia
Q.207: A sign of foetal distress is all except:-
A. Early deceleration
B. Late deceleration
C. Increase in foetal respiration
D. Heart rate between 100-110 per minute
Q.208: Treatment of Neglected shoulder presentation is:-
A. Decapitation
B. Caeserean Section
C. Evisceration
D. All of the above
Q.209: External version is contraindicated in patients with all except:-
A. 34 weeks of pregnancy
B. Bed Obstetrics Hystory
C. Apprehensive patient
D. Suspected C.P.D.
Q.210: Ectopic pregnancy is most commonly associated with:-
A. Copper`T`
B. Condoms
C. O.C.Pills
D. None of the above
Q.211: Coagulation failure can result from:-
A. Amniotic fluid Embolus
B. Intrauterine death of foetus
C. Abruptio placentae
D. All of the above
Q.212: Habitual absorption in incomplete Os commonly occurs at about:-
A. 4-6 weeks
B. 8-10 weeks
C. 10-12 weeks
D. 12-16 weeks
Q.213: The mediolateral epiciotomy has the following advantages over median episiotomy:-
A. Less incidence of injury to rectal sphincter
B. Less painful in puerperum
C. Easier to repair
D. All of the above
Q.214: During reproductive life pH of vagina averages:-
A. 10
B. 7
C. 4.5
D. 6.4
Q.215: Which layer of uterine musculature is called ‘living ligature’:-
A. Longitudinal
B. Circular
C. Oblique
D. All of the above
Q.216: Thickened Uterosacral ligament can be felt through posterior fornix in following diseases except:-
A. Carcinoma Cervix
B. Endometriosis
C. Fibroid Uterus
D. None of the above
Q.217: Before puberty the cervix to corpus ratio is:-
A. 1:2
B. 1:3
C. 2:1
D. 3:1
Q.218: Round ligament is inserted at:-
A. Public symphysis
B. Levator ani muscle
C. Skin of Labia minora
D. Skin of Labia majora
Q.219: Fallopian tube represents the:-
A. Caudal end of Mullerian duct
B. Cranial end of Wolffian duct
C. Cranial end of Mullerian duct
D. Urogenital Sinus
Q.220: Organ of Rosenmuller is also called:-
A. Paroophron
B. Mesovarium
C. Epoophoron
D. Wolffian duct
Q.221: ‘Thelarche’is the term used for:-
A. Cessation of menstruation
B. Development of Breast
C. Development of public & Axillary hairs
D. Commensement of menstruation
Q.222: Climacteric is the phase of:-
A. Hyperstimulation of ovaries
B. Waning of Ovarian activity
C. Defective Hypothalamo – pituitary axis
D. None of the above
Q.223: Colposcope is a binocular microscope giving a magnification of:-
A. 15.6
B. 20.5
C. 100.0
D. 13.5
Q.224: Jones Classification pertains to;-
A. Detection of Hormonal disturbance
B. Defective development of Wolffian System
C. Mullerian duct
D. None of the above
Q.225: Commonest Viral infection encountered in vulval disease is:-
A. Rubella
B. Varicella
C. Herpes simplex type-2
D. Cytomegalovirus
Q.226: Treatment of choice in Bartholian Cyst is:-
A. Incision & Drainage
B. Antibiotic & Anti inflammatory agents
C. Hot sietz bath
D. Marsupialization
Q.227: Sabouraud’s medium is used to culture:-
A. Trichomonia
B. Gardenella
C. Candida albicans
D. Calmydia
Q.228: Secretory hypertrophy of endometrium is due to the effect of:-
A. Oestrogen
B. Progesterone
C. Prolactin
D. None of the above
Q. 229: In a normal menstrual cycle, Ovulation occurs at:-
A. 14th day
B. 21st day
C. 20th day
D. 10th day
Q.230: Infertility is defined as:-
A. Failure to conceive
B. Inability to conceive
C. Either of these
D. None of the above
Q.231: Among the causes of sterility due to congenital defects of female genitalia, the following rank prominently, except:
A. Maldevelopment of vagina
B. Noncanalization of vagina
C. Rigid Hymen
D. Elongated conical cervix
E. Acute salpingitis
Q.232: Which one of the following gas is used for tubal insufflation test, except:-
A. Nitrous oxide
B. Carbon dioxide
C. Oxygen
D. Carbon mono oxide
Q.233: Contraindications of IUCD. Are following except:-
A. Pregnancy
B. Pelvic infection
C. Grand multipara
D. Post partum Endometritis
E. Functional uterine bleeding
Q.234: Treatment of threatened abortion is as follows, except:-
A. Bed rest
B. Progesterone therapy
C. Haemetinics
D. Sedation
Q.235: The best method of diagnosing Hydatidiform mole is:-
A. Laparoscopy
B. Hystero-salpingography
C. Ultrasonography
D. Urine pregnancy test
Q.236: Commonest site of Ectopic pregnancy is :-
A. Ovarian
B. Primary abdominal
C. Rudimentary horn
D. Tubal end of fallopian tube
Q.237: Turners syndrome is characterized by the following,except:-
A. Short stature
B. Webbing of the neck
C. 45XO chromosome pattern
D. Retinitis pigmentosa
Q.238: Local cause of menorrhagia are th following, except:-
A. Fibroid uterus
B. Endometrial polyp
C. Pelvic inflammation
D. Pseudomucinous cystadenoma ovary
Q.239: Manifestation of Fibroid are following, except:-
A. Menstrual disturbances
B. Pressure symptoms
C. Pain abdomen
D. Infertility
E. Amenorrhea
Q.240: Carcinoma body uterus is associated with following, except:-
A. Obesity
B. Hypertension
C. Myxoedema
D. Fibroids
E. Diabetes
Q.241: False pelvis refers to:-
A. Upper part of pelvis
B. Lower part of pelvis
C. Pelvic cavity
D. Pelvic outlet
Q.242: All these are the causes of Hydramnios except
A. Maternal diabetes
B. Anencephaly
C. Multiple pregnancy
D. Congenital obstruction of esophagus
E. Fetal renal agenesis
Q.243: Hormones chiefly produced by placenta are the following, except:-
A. Estrogen
B. Progesterone
C. H.C.G.
D. F.S.H.
Q.244: Predisposing factors in etiopathogenesis of pre-eclamptic toxaemia are the following, except:-
A. Primigravida
B. Hydramnious
C. Multiple pregnancy
D. Diabetes
E. Vesicular mole
F. Heart disease
Q.245: Causes of vaginal bleeding in first trimester of pregnancy are as follows except:-
A. Abortion
B. Ectopic pregnancy
C. Vesicular Mole
D. Antepartum Haemorrhage
E. Decidual bleeding
Q.246: Embryo is called during:-
A. First eight weeks
B. 8-10 weeks
C. 11-13 weeks
D. 14-16 weeks
Q.247: Characteristics of true labour pains are following, except:-
A. Occurrence of labour pains simultaneously
with uterine contractions
B. Show
C. Presenting part is engaged
D. P/V Exam. Reveals dilatation of cervical canal
Q.248: Velamentous insertion of cord is:-
A. Cord is attached to centre of placenta
B. Cord is attached between centre & edge of placenta
C. Cord is attached to edge of placenta
D. Cord is attached to chorion laeve away from edge of Placenta
Q.249: Average length of lower uterine segment is:-
A. 10 cms.
B. 12 cms.
C. 8 cms.
D. 14 cms.
Q.250: Braxton hick’s uterine contractions are:-
A. Regular, rhythmic & painless
B. Irregular, arrhythmic & painless
C. Regular, Rhythmic & painful
D. Irregular, arrhythmic & painful
Q.251: Quickening is usually found between:-
A. 14-16 weeks
B. 18-20 weeks
C. 22-24 weeks
D. More than 24 weeks
Q.252: Following drugs are contraindicated in pregnancy except:-
A. Tetracyclines
B. Thalidomide
C. 17 Alpha Hydroxy progesterone caproate
D. Diethyl stilboesterol
Q.253: Length of Suboccipito – bregmatic diameter is:-
A. 10 cms
B. 11.3 cms
C. 9.4 cms
D. 13.8 cms
Q.254: Following are the parent types of pelvis, except:-
A. Gynecoid
B. Android
C. Anthropoid
D. Kyphotic
E. Platypelloid
Q.255: Klumpke’s paralysis is the result of:-
A. Injury to upper roots of brachial plexus
B. Injury to lower roots of brachial
C. Injury to hand
D. Injury to spinal cord
Q.256: Hirschsprung’s disease is the commonest cause of:-
A. Atresia of Jejunum
B. Obtruction of large bowel
C. Duodenal obstruction
D. Oesophasial atrsia
Q.257: Backward displacement of toung giving rise to respiratory obstruction is common in :-
A. Down’s Syndrome
B. Pierre Robin Syndrome
C. Microcephaly
D. Hydrocephalus
Q.258: Cleidotomy is the operation which pertains to:-
A. Opening the abdomen
B. Dividing Clavicles
C. Perforating the head of foetus
D. Division of body of the pubis
Q.259: Abnormal prolongation of second stage can occur in following conditions,except:-
A. Contraction ring
B. Long cord
C. Pelvic contraction
D. Uterine inertia
Q.260: Patients with Mendelson’s syndrome present as, except:-
A. Tachypnoea
B. Hypertension
C. Cyanosis
D. Cardio vascular arrest
Q.261: Incidence of septic pelvic thrombophlebitis in pregnancy is :-
A. 1 : 1500
B. 1 : 2000
C. 1 : 10000
D. 1 : 100
Q.262: Schroeder’s ring appears in :-
A. Abruptio placentae
B. Localised tonic contraction of uterus
C. Chorio carcinoma
D. Lower segment dominance
Q.263: Following conditions can cause obstruction in labour, except :-
A. Pelvic contraction
B. Tumors of pelvic bones
C. Undilated stenosed cervix
D. None of the above
Q.264: Hydrocephalus internus is the condition where accumulation of fluid occur in :-
A. Sub arachnoid space
B. Pontine region
C. Cerebral ventricles
D. None of the above
Q.265: Cervical tears are most often:-
A. Longitudinal & lateral
B. Longitudinal & central
C. Circular & lateral
D. None of the above
Q.266: Common presentation in android pelvis is:-
A. Occipito posterior
B. Face
C. Breech
D. None of the above
Q.267: Fortuitous hemorrhage is the term given to the hemorrhage de to :-
A. Ectopic gestation
B. Abruptio placentae
C. Placenta praevia
D. Idiopathic
Q.268: Marginal Placenta praevia is the type of Placenta praevia:-
A. I
B. II
C. III
D. IV
Q.269: The contraceptive TODAY which has been recently introduced contains:-
A. Prostaglandin F2 alpha
B. Norehithisterol
C. 9- nonoxynol
D. Copper releasing mesh
Q.270: Red degeneration of Fibroid uterus is due to:-
A. Thrombosis of the veins
B. Infections
C. Rupture of capsule
D. Gangrene
Q.271: The best contraceptive method to be suggested for a 20 years multiparrous women is:-
A. Oral pills
B. IUCD
c. Condom
D. Diaphragm
Q.272: Chorio carcinoma normally follows :-
A. Abortions
B. Normal labour
C. Hydatidiform mole
D. Ectopic pregnancy
Q.273: Ovulation occurs at:-
A. 14 days before menstruation
B. 14 days after menstruation
C. 16 days before menstruation
D. With in 16 hrs. of LH Surge
Q.274: The branches of internal iliac artery include all of the following, except:-
A. Uterine artery
B. Obturator artery
C. Middle rectal artery
D. Inferior epigastric artery
Q.275: The most common site involved in tuberculosis of genital organs is:-
A. Endometrium
B. Cervix
C. Tubes
D. Ovaries
Q.276: The most common cause of death in carcinoma cervix is:-
A. Haemmorahage
B. Uraemia
C. Infection
D. Metastasis
Q.277: Ectopic pregnancy is seen maximum with:-
A. IUCD
B. OCPills
C. Barrier method
D. Tubal sterilization
Q.278: Narrowest part of fallopian tube is the:-
A. Interstitial portion
B. Isthmus
C. Infundibulum
D. Ampulla
Q.279: Bartholian duct opens into:-
A. Labia majora
B. Labia minora
C. Lower part of vagina
D. Grove between labia minora & Hymen
Q.280: Best evidence of Ovulation is ;-
A. Secretory endometrium
B. B.B.T.
C. Cervical mucus study
D. Pap’s Smear study
Q.281: Commonest malignancy of the cervix is :-
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Adeno acanthoma
D. Sarcoma
Q.282: Teratoma arises from:-
A. Ectodermal cells
B. Endodermal cells
C. Totipotent cells
D. Mesodermal cells
Q.283: The dependence of Myoma on oestrogen is demonstrable by the fact that they:-
A. Stop growing after menopause
B. Are unusually prior to menarche
C. Grow rapidly during pregnancy
D. All of the above
Q.284: Condition relatively considered relative emergency in a teenager with amennorrhoea includes:-
A. Vaginal agenesis
B. Uterine anomaly
C. Imperforate hymen
D. None of the above
Q.285: Which of the following symptoms are associated with an ectopic pregnancy in the fallopian tube:-
A. Unilateral lower abdominal pain
B. Vaginal bleeding
C. Missed menstrual period
D. All of the above
Q.286: Dyspareunia in endometriosis can be caused by:-
A. Endometrioma
B. Fixed retroversion of uterus
C. Uterosacral implants
D. Danazole therapy
Q.287: Which of the following findings suggest the diagnosis of Endometriosis:-
A. Nodularity of Uterosacral ligaments
B. Ovarian enlagement
C. Fixed retroversion of uterus
D. Laparoscopic visualization of implant
Q.288: For women in their 30’s & 40’s with abnormal uterine bleeding the most accurate diagnostic procedure is:-
A. Basal body temperature
B. D & C
C. Hysteroscopy
D. Hormone therapy
Q.289: All of the following are likely reasons for the establishment of a tubal ectopic pregnancy are , except:-
A. Pelvic infection
B. Tubal anastomosis
C. Transmigration of fertilized ovum
D. Uterine myoma
Q.290: Large sub serous myomas are associated with which of the following conditions :-
A. Anaemia
B. Hydronephrosis
C. Reproductive loss
D. None of the above
Q.291: Reproductive problems associated with Myoma includes:-
A. Recurrent abortion
B. Poor implantation
C. Blocked tubes
D. All of the above
Q.292: The occurrence of menstruation is dependent on all the following factors except:-
A. Endometrium responsive to sex steroids
B. Gonadotropins
C. Patent fallopian tube
D. Ovarian steroidal hormones
Q.293: Androgen activity is blocked at the receptor level by:-
A. Cyproterone acetate
B. Cimetidine
C. Predinisone
D. Ampicillin
Q.294: Which of the following menopausal symptom is not responsive to oestrogen replacement therapy:-
A. Depression
B. Insomnia
C. Atrophic vaginitis
D. Vaginal relaxation
Q.295: Contraindication to post menopausal oestrogen replacement therapy includes, which of the following:-
A. Hyperytension
B. Acute liver disease
C. Familial hyperlipidaemia
D. All of the above
Q.296: Ovulation is associated with all of the following processes except:-
A. Reduction division of oocyte
B. Depression of FSH
C. LH surge
D. Progesterone secretion
Q.297: The following are related to thalassaemia, except:-
A. Fresh blood transfusion
B. Folic acid
C. Massive Iron therapy
D. Partial exchange transfusion
Q.298: Incarceation of the retroverted gravid uterus usually occurs at:-
A. 8-10 weeks
B. 12-15 weeks
C. 18-20 weeks
D. 24 weeks
Q.299: In a case of pregnancy with prolapse, pessary should be kept upto:-
A. 12 weeks
B. 18 weeks
C. 24 weeks
D. Till onset of labour
Q.300: Outlet contraction diagnosed late in labour must be managed by:-
A. Forceps with deep episiotomy
B. Caeserean section
C. Symphysiotomy
D. All of the above
Q.301: Deep transverse arrest should be managed by the following, except:-
A. Oxytocin infusion till full dilatation
B. Caeserean section
C. Manual rotation and forceps exraction
D. Ventouse
Q.302: Known causes of Breech presentation are, except:-
A. Prematurity
B. Hydrocephalus
C. Placenta praevia
D. Arcuate Uterus
Q.303: Early clamping of the cord is indicated in the following,except:-
A. Rh-Incompetability
B. Diabetic mothers
C. During caesarean section
D. Post mature babies
Q.304: Sloughing VVF. Following obstructed labour can be managed by :-
A. Repair immediately
B. Self retaining catheter for 14 days
C. Repair after three months
D. None of the above
Q.305: Immediate management of a premature baby following birth is, except:-
A. Delayed of the cord
B. Keep cord length long
C. Adequate concentration of oxygen
D. Administration of vitamin ‘K’
Q.306: Intravenous ergometrine at the time of delivery of anterior shoulder is contraindicated in,except:-
A. Organic heart lesion
B. Diabetes mellitis
C. Severe Hypertension
D. Rh negative immunized mother
Q.307: Selective indications of active management of III stage of labour are following, except:-
A. Hydramnios
B. Grand multiparra
C. Anaemia
D. Severe toxaemia
Q.308: Indication of urgent delivery of second baby in twins are, except:-
A. Abruptio placentae
B. Administration of Ergometrine after delivery of first foetus
C. Cord prolapse of second baby
D. None of the above
Q.309: Foetal hazards in PET includes the following,except:-
A. Asphyxia
B. Intrauterine death
C. IUGR
D. Intracranial haemorrhage
Q.310: Indications of exchange transfusion in anaemia with pregnancy are following, except:-
A. Cardiac failure with Severe anaemia
B. Severely anaemic patient requiring surgery
C. Severe anaemia with PCV less than 13 %
D. None of the above
Q.311: Physiological causes of increased vaginal discharges are as follows,except:-
A. At the time of ovulation
B. Premenstrual phase
C. Sexual stimulation
D. Trichomoniasis
Q.312: Frequency of micturation is a symptom of the following, except:-
A. Early weeks of pregnancy
B. Urinary tract infection
C. Vesicovaginal fistula
D. Later weeks of pregnancy
E. Pelvic tumours
Q.313: Collection of blood in vagina due to imperforated hymen is termed:-
A. Haematosalpinx
B. Haematocolpos
C. Haematometra
D. None of the above
Q.314: ‘XO’ Chromosomal pattern is present in :-
A. Turner’s Syndrome
B. Klinfelter’s Syndrome
C. Superfemale
D. Stein leventhal syndrome
Q.315: Profuse,creamish,frothy vaginal discharge is characteristic of :-
A. Moniliasis
B. Trichomoniasis
C. Gonorrhoea
D. Tuberculosis
E. Syphilis
Q.316: Most common mode of spread of Tuberculosis of genital tract is:-
A. Haematogenous
B. Lymphatic
C. Direct
D. none of the above
Q.317: In 35 days menstrual cycle, ovulation occurs at:-
A. 14th day
B. 16th day
C. 21st day
D. 23rd day
E. 20th day
Q.318: Infertility is defined as :-
A. Failure to conceive
B. Inability to conceive
C. Either of these
D. None of the above
Q.319: Side effect of IUCD are as follows, except:-
A. Excessive bleeding
B. Pelvic infection
C. Vaginal discharge
D. Malignancy
Q.320: Differential diagnosis of vesicular mole is as follows, except:-
A. Threatened abortion
B. Hydramnios
C. Mistaken dates
D. Twins
E. Perforation of uterus
Q.321: First trimester pregnancy is usually terminated by:-
A. Dilatation & curettage
B. Hysterotomy
C. Ethacridine lactate instillation
D. Parenteral prostaglandins
Q.322: The best time of endometrial biopsy in cases of infertility is :-
A. Premenstrual phase
B. Postmenstrual phase
C. Ovulatory phase
D. Menstrual phase
Q.323: 50 % of Choriocarcinoma follows:-
A. Normal labour
B. Abortion
C. Vesicular mole
D. Ectopic pregnancy
Q.324: Benefits of combined pills are all, except:-
A. It effectively controls fertility
B. It can cure Dysmenorrhoea
C. It prevent anaemia
D. It cures amenorrhoea
Q.325: All of the following diseases can cause Pelvic inflammatory disease, except:-
A. Crohn’s disease
B. Syphilis
C. Appendicitis
D. Sarcoidosis
Q.326: The pathogenesis of a tubo ovarian abscess involves which of the following:-
A. Vaginitis
B. Cervicitis
C. Endometritis
D. Oophoritis
Q.327: Danazol treatment for Endometriosis is associated with all of the following sign or symptoms except:-
A. Acne
B. Weight gain
C. Hot flashes
D. Mucoid vaginal discharge
Q.328: Infertility in Endometriosis is related to:-
A. The extent of disease
B. Associated hydrosalpinx
C. Local prostaglandin secretions
D. None of above
Q.329: All of the following factors are evidence that ovulation has occurred, except:-
A. Rise in Basal bodytemperature
B. Pregnancy
C. Secretory endometrium
D. The occurrence of menses
Q.330: Clomiphene citrate is used to correct which of the following problems:-
A. Infrequent ovulation
B. High prolactin levels
C. Cervical mucus of poor quality
D. All of the above
Q.331: Clinical conditions that are suitable for clomiphene stimulation of ovulation includes:-
A. Resistant ovary syndrome
B. Gonadal dysgenesis
C. Ashermann’s syndrome
D. Psychogenic amenorrhoea
Q.332: The development of adhesions seen in Ashermann’s Syndrome is commonly preceded by which of the following event:-
A. Delivery
B. Endometritis
C. D & C
D. Post abortal haemorrhage
E. All of the above
Q.333: All of the following conditions can be found in a patient with a pituitary Chromophobe adenoma, except:-
A. Amenorrhoea
B. Galactorrhoea
C. Cushing syndrome
D. Blindness
Q.334: Which of the following tumor is most sensitive to radiation therapy:-
A. Endometriod cancer
B. Arrhenoblastoma
C. Dysgerminoma
D. Gonadoblastoma
Q.335: Which is most accurate method of diagnosing ectopic pregnancy:-
A. Endometrial biopsy
B. Laparoscopy
C. Ultrasound
D. Culdocentesis
Q.336: Myomas are associated with which of the following clinical condition:-
A. Anaemia
B. Dysmenorrhoea
C. Urinary frequency
D. All of the above
Q.337: Appropriate therapy for a luteal phase defect includes:-
A. Clomiphene citrate
B. HCG
C. Post ovulatory Progesterone supplementation
D. All of the above
Q.338: Following maternal diseases predispose to occurrence of abortion, except:-
A. Severe toxic state
B. Chronic nephritis
C. Cardiac disease
D. Diabetes Mellitus
Q.339: Septic Abortion may result in:-
A. Sterility
B. Pelvic abscess
C. Pyosalpinx
D. Pelvic inflammatory diseases
E. All of the above
Q.340: Doughy consistency of uterus occurs in cases of:-
A. Pregnancy with Fibroid uterus
B. Chronic Hydroamnios
C. Vesicular mole
D. Missed abortion
Q.341: In pregnancy,when renal functions are impaired, following drug can safely be given:-
A. Nalidixic acid
B. Nitrofurantoin
C. Ampicillin
D. Cotrimaxazole
Q.342: Total Iron stored in the body amounts to:-
A. 300 – 500 mgs.
B. 1200-1500 mgs
C. 750 -1000 mgs
D. 100 – 150 mgs
Q.343: Partogram should be maintained to monitor:-
A. Foetal well being
B. Clinical progress of labour
C. Growth if IUGR foetus
D. All of the above
Q.344: Predisposing factors of pre-eclampsia are following, except :-
A. Age & parity
B. Obesity
C. Climate & seasons
D. Genetic predisposition
E. None of the above
Q.345: Chorionic villi depends for their nutrition on:-
A. Foetal membranes
B. Maternal blood in choriodecidual space
C. Direct blood supply to chorionicc villi
D. Amniotic fluid
Q.346: Causes of Jaundice occurring during pregnancy are following, except:-
A. Severe pre-eclampsia & eclampsia
B. Acute fatty liver
C. Intra hepatic cholestasis
D. Long neglected Hyperemesis gravidarum
E. None of the above
Q.347: Potters Syndrome in foetus is seen incases of:-
A. Chronic Hydramnios
B. Oligo hydroamnios
C. Triplets
D. Clomiphene induced pregnancies
Q.348: Signs of onset of labour are following, except:-
A. Slight uterine hemorrhage
B. Commensement of dilatation of the Os
C. Formation of Bag of fore waters
D. Tense & Tender Uterus
Q.349: Caput is always absorbed with in :-
A. 6 hrs. after birth
B. 12-24 hrs. after birth
C. 24-48 hrs. after birth
D. None of the above
Q.350: On first Bi-mannual examination of a patient in labour following points are to be observed, except:-
A.Size of dilating cervix & condition of it’s walls
B. Integrity of it’s walls
C. Level of presenting part
D. Adequacy of pelvis
E. All of the above
F. None of the above
Q.351: Principle hazards of epidural block during labour is:-
A. Hypertension
B. Hypotension
C. Permanent neurological problems
D. All of the above
Q.352: Normally fertilization of ovum takes place at:-
A. Uterine cavity
B. Outer part of fallopian tube
C. Peritoneal cavity
D. Cervical canal
Q.353: Predisposing factors of pre-eclampsia are following, except:-
A. Climate & Season
B. High attitude
C. Genetic predisposition
D. Hydatiform mole
Q.354: Lytic-cocktail regimen include following drugs, except:-
A. Promethazine
B. Paraldehyde
C. Chlropromazine
D. Pethidine
Q.355: Potter’s Syndrome is associated with:-
A. Diabetes mellitus
B. Severe oligohydramnios
C. Carpel tunnel syndrome
D. Congenital heart disease
Q.356: Sub pubic angle measures:-
A. 90degrees
B. 80 degrees
C. 70 degrees
D. 110 degrees
Q.357: Number of Frontannelles, which exist in skull at term is:-
A. 4
B. 8
C. 6
D. 10
Q.358: Uterine activity can be increased by following drugs, except:-
A. Oxytocin
B. Isosuprine
C. Ergometrine
D. Prostaglandins
Q.359: One of the following positions increases obstetrical conjugate:-
A. Extreme Hyperextension
B. Lithotomy
C. Dorsal
D. Trendelenberg
Q.360: Human placental lactogen is secreted by :-
A. Foetal liver
B. Foetal Adrenals
C. Sybcytiotrophoblast
D. Cytotrophoblast
Q.361: Late deceleration is because of :-
A. Placental compression
B. Foetal Compression
C. Toxaemia of pregnancy
D. All of the above
Q.362: Multiple births are common in:-
A. Negroes
B. Indians
C. Mongoles
D. Caucasians
Q.363: Anti tubercular drug safest for mother & foetus is:-
A. INH
B. Ethambutol
C. Rifampcin
D. Pyrizinamide
Q.364: Vomiting is common feature of all, except:-
A. Hydatidiform mole
B. Missed abortion
C. Ectopic pregnancy
D. None of the above
Q.365: Activity of carpus luteum decline sharply by :-
A. 28 weeks of gestation onwards
B. 12 weeks of gestation onwards
C. 6-12 th week of gestation
D. 20 weeks of gestation onwards
Q.366: ‘Pfluger’s Description’ pertains to:_
A. Formation of Placenta
B. Formation of corpus luteum
C. Formation of oocyte
D. Formation of foetal gonads
Q.367: ‘Hack-saw’ appearance is related to :-
A. Chorion
B. Amnion
C. Endometrium
D. Trophoblast
Q.368: Serotina is a distinct portion of:-
A. Syncytiotrophoblast
B. Umbilical cord
C. Decidua
D. None of the above
Q.369: The diameter of placenta at 4th month of gestation is nearly:-
A. 200 mm
B. 170 mm
C. 80-85 mm
D. 300 mm
Q.370: Which layer has neither blood nor nerve supply nor a demonstrable lymphatic system:-
A. Endometrium
B. Placental membranes
C. Amnion
D. None of the above
Q.371: Normally sugar content of liquour amnii at term varies from:-
A. 100 - 500 mg%
B. 70 – 100 mg%
C. 10 - 60 mg%
D. 280 – 310 mg%
Q.372: At term lower uterine segment comprises:-
A. 1/8th of uterus
B. 1/4th of uterus
C. 1/10th of uterus
D. 1/6th of uterus
Q.373: Montogomery’s tubercles represents:-
A. Hypertrophy of glandular acinii
B. Increased connective tissue stroma
C. Enlarged Sebaceous gland
D. Increased vascularity under skin
Q.374: Blood volume in pregnancy is maximum at:-
A. 32 weeks
B. 36 weeks
C. Term
D. 34-36 weeks
Q.375: The usual proportion of Bonovular to uniovular twins is:-
A. 1:3
B. 3:1
C. 1:2
D. 4:1
Q.376: Foetal breathing movements are detected at the earliest by:-
A. 13 weeks
B. 10 weeks
C. 06 weeks
D. 20 weeks
Q.377: ‘Meralgia Paraesthetica’ is chacterized by the following, except :-
A. Paraesthesia
B. Oedema
C. Pain
D. Numbness
Q.378: Infective agents which predisposes to occurrence of abortion are following, except:-
A. Listeria
B. Giardia
C. Ureaplasma
D. Chalamydia
Q.379: Commonly prolonged labour in primigravida is due to:-
A. Cervical dystocia
B. Incoordinate uterine action
C. Cervical incompetence
D. Anaemia
Q.380: Commonest cause for repeated transverse lie is:-
A. Bicornuate uterus
B. Subseptate uterus
C. Septate uterus
D. Uterus Didelphus
Q.381: Fertilisation of two ova from different ovulation period is called as :-
A. Superfoecundation
B. Superfoetation
C. Binovular twins
D. Uniovular twins
Q.382: Time limit for trial of labour is :-
A. 06 hrs.
B. 24 hrs.
C. 12 hrs.
D. None of the above
Q.383: Commonest cause of secondary PPH is:-
A. Uterine inertia
B. Retained Placenta
C. Cervical tear
D. Episiotomy
Q.384: Drug contraindicated in nursing mother is:-
A. Tetracyclin
B. Chloromphenicol
C. Phenindione
D. Chlorothalidone
E. All of the above
Q.385: Immediately after delivery uterus weighs about:-
A. 500 gms.
B. 1000 gms.
C. 1500 gms.
D. 2000 gms.
Q.386: Treatment of choice in full term foetus with mother having carcinoma cervix is :-
A. Normal delivery
B. Classical caesarean section
C. Lower segment caesarean section
D. None of the above
Q.387: Total uterine paralysis is caused by:-
A. Spinal anesthesia
B. Caudal anaesthesia
C. Ether
D. Chloroform
Q.388: Contraindications of forceps delivery includes:-
A. Scar in uterus
B. Cephalo pelvic disproportion
C. Prematurity
D. Breech presentation
Q.389: Delivery with Kjelland’s forceps is the method of choice in:-
A. Occipito posterior arrest
B. Deep transverse arrest
C. Mento posterior arrest
D. All of the above
Q.390: Following are the causes of Hypofibrinogenaemia, except:-
A. Intra uterine death
B. Rh-Incompatibility
C. Septic abortion
D. Amniotic fluid embolism
Q.391: IUGR is caused by the following, excepr:-
A. Alcohol
B. Diabetes
C. Smoking
D. Chronic renal failure
Q.392: Overlapping of cranial bones of foetus in utero is due to:-
A. Moulding
B. Intra uterine death
C. Caput formation
D. Anencephaly
Q.393: Corpus lutum reaches its maximum activity after ovulation on:-
A. 14th day
B. 09th day
C. 04th day
D. None of the above
Q.394: Maximum number of follicles that can ovulate is unlikely to exceeds:-
A. 200
B. 500
C. 1000
D. 10000
Q.395: Immediately following menstruation the thickness of endometrium measures:-
A. 0.05 mm
B. 0.5 mm
C. 1.0 mm
D. 1-2 mm
Q.396: Chorionic gonadotrophins are present in very high concentration during:-
A. First three months of pregnancy
B. 4th month of pregnancy
C. At term
D. None of the above
Q.397: Dysplasia of germinal cells in the testis is found in:-
A. Turner’s syndrome
B. Klinfelter’s syndrome
C. Tay sachs disease
D. Niemann picks disease
Q.398: Area upon which the placenta is subsequently formed in great majprity of instances is:-
A. Sertina
B. Decidua Capsularis
C. Decidua vera
D. All of the above
Q.399: The diameter of placenta at term is nearly:-
A. 10 cms.
B. 20 cms.
C. 30 cms.
D. 05 cms.
Q.400: The trophoblast possesses following activities, except:-
A. Proteolytic
B. Lipolytic
C. Glycogenesis
D. Enzymatic
Q.401: Transplacental infection to the foetus are following, except:-
A. Typhoid fever
B. Anthrax
C. Pyococcal
D. E.coli
Q.402: Incidence of velamentous insertion of cord is:-
A. 7 %
B. 1-2 %
C. 17 %
D. None of the above
Q.403: Blood taken from umbilical cord of a normal infant at term cotains Billirubin, on an average:-
A. 0.4-0.8 mg/dl
B. 1 – 2 mg/dl
C. 2- 2.4 mg/dl
D. 4.4 mg/dl
Q.404: In a term foetus the incidence of adult type of haemoglobin is:-
A. 40 %
B. 20 %
C. 10 %
D. 0-5 %
Q.405: “10 day rule’ pertains to :-
A. X- Ray in pregnancy
B. Vaccination in pregnancy
C. Dog bite in pregnancy
D. Tetanus in pregnancy
Q.406: Viable foetus is at :-
A. 20 weeks of gestation
B. 12 weeks of gestation C. 24 weeks of gestation
D. 28 weeks of gestation
Q.407: Fully grown human oocyte is easily the largest cell in the body, it’s diameter being:-
A. 200 microns
B. 250 microns
C. 130 microns
D. 400 microns
Q.408: luteum reaches it’s maximum activity, after ovulation in :-
A. 10 days
B. 6 days
C. 9 days
D. 14 days
Q.409: Progesterone is necessary for the maintenance of pregnancy & is secreted in very large amounts by the:-
A. Corpus luteum
B. Decidua
C. Placenta
D. None of the above
Q.410: Placenta approaches it’s pt’s maximum thickness by:-
A. Eight minth
B. Third month
C. Fourth month
D. Seventh month
Q.411: Layers of Langhen’s disappears at:-
A. 3rd month of pregnancy
B. 4th month of pregnancy
C. 5th month of pregnancy
D. Continue to persist till late pregnancy
Q.412: The memberane ‘Amnion’ consists of:-
A. Single layer
B. Double layer
C. Triple layer
D. Five layers
Q.413: Wharton’s jelly is :-
A. Substance of Amnion
B. Substance of Chorion
C. Substance of Placenta
D. Substance of Umbilical cord
Q.414: The valve of Foramen Ovale will be patent as long as :-
A. Rt. Arterial pressure exceeds the Lt. Arterial pressure
B. Rt. Arterial pressure exceeds the Lt. Ventricular pressure
C. Lt. Arterial pressure exceeds the Rt. Arterial pressure
D. None of the above
Q.415: Cervix becomes typically ‘Mauve’ Colored in:-
A. Ectopic gestation
B. Pregnancy with heart disease
C. Normal Pregnancy
D. Threatened Abortion
E. All of the above
Q.416: The Radiogram will usually reveal the foetal skeleton earliest by :-
A. 28 weeks
B. 12 Weeks
C. 16 Weeks
D. 20 Weeks
Q.417: The Radio immuneassay test of patient serum can detect the presence of HCG as early as :-
A. First missed period
B. 27 days after last menses
C. 07 days period after missing the period
D. 48 hrs. after missing the period
Q.418: The presence of surfactants in the Amniotic fluids provides a reliable means of measuring:-
A. Functioning of Liver
B. HDL level in the blood
C. Degree of pulmonary maturity
D. All of the above
Q.419: Therupeutic amniocentesis is indicated in :-
A. Rh- Incompatibility
B. Twin pregnancy
C. Hydramnios
D. None of the above
Q.420: Cramps in calf muscles in later part of pregnancy is because of:-
A. Defective posture
B. Increased HCG levels
C. Increased Intra amniotic pressure
D. None of the above
Q.421: Average diameter of Bartholian gland is:-
A. 07 mm
B. 10 mm
C. 15-20 mm
D. 02-05 mm
Q.422: Secretions of cervical glands have high content of :-
A. Glucose
B. Sucrose
C. Fructose
D. Maltose
Q.423: Wall of fallopian tube have:-
A. One layer
B. Two layers
C. Three layers
D. Four layers
Q.424: Organ of Rosenmuller is known as:-
A. Paroophron
B. Epoophron
C. Mesovarian
D. None of the above
Q.425: Frankenhauser’s plexus is present in:-
A. Parametrium
B. Endometrium
C. Myometrium
D. Ovaries
Q.426: Folliculostatin suppresses :-
A. LH
B. GnRH
C. FSH
D. Prolactin
Q.427: At the age of 40, the bone calcium amounts to:-
A. 1200 gms.
B. 500 gms.
C. 2000 gms.
D. 3000-5000 gms
Q.428: Hot flushes can be prevented by:-
A. Thiaziade
B. Metformin
C. Glibenclamide
D. Clonidine
Q.429: Synthetic analogue of GnRh are used in following, except:-
A. Invitro fertilization
B. Precocius puberty
C. Hirsuitism
D. Ovarian malignancy
Q.430: In addition to urinary & genital abnormalities syndrome shows:-
A. Anaemia
B. Skeletal deformity
C. Cirrhosis if liver
D. Cerebral palsy
Q.431: Vaginal discharge has musty odour in :-
A. Senile vaginitis
B. Chalamydialinfection
C. Gardinella vaginitis
D. Emphysematous vaginitis
Q.432: Azidothimidine is the drug related to :-
A. Birth control
B. Choriocarcinoma
C. AIDS
D. Elephantiasis vulva
Q.433: Incidence of secondary amenoorhoea in patients of genital tuberculosis is:-
A. 1 %
B. 2-5 %
C. 10 %
D. 20-25 %
Q.434: Gland of Rosenmuller lies beneath:-
A. Mons veneris
B. Vestibule
C. Pouparts ligament
D. Uterosacral ligament
Q.435: Malignancy of genital tract accounts for postmenopausal bleeding in:-
A. 5-10 % of cases
B. 90 % of cases
C. 30-50 % of cases
D. None of the above
Q.436: Operation for reunification of Uterine Cavity is known as:-
A. Janes operation
B. Tompkins operation
C. Strassman operation
D. None of the above
Q.437: Finasteride is drug related to:-
A. Intertrigo
B. Virilism
C. Hirsuitism
D. Folliculitis
Q.438: Histopathologically Koilocytes are seen in:-
A. Molluscum Contagiosum
B. Herpes genitalis
C. Condyllma acuminatum
D. All of the above
Q.439: Miller-Kurzrok test pertains to:-
A. Vulval dystrophy
B. Stress Incontinence
C. Urge Incontinence
D. Sterility
Q.440: Success rate of gamete intrafallopian transfer is approximately:-
A. 90-100 %
B. 20-30 %
C. 50-60 %
D. 5-10 %
Q. 441: Contraindications of Centchroman use is:-
A. Cervical dysplasia
B. PCOD
C. Liver disfunction
D. All of the above
Q.442: Fox-fordyce diseases pertains to:-
A. Kraurosis Vulva
B. Lichen Sclerosis
C. Hidroadenitis of vulva
D. None of the above
Q.443: Most likely diagnosis in a 32 years old women with recurrent painful swelling in left labia minora is :-
A. Hideradenitis
B. Herpes simplex infection
C. Bartholian cyst
D. Condylomata accuminata
Q.444: Diabetic vulvitis is characterized by:-
A. Marked Pruritis
B. Red & beefy vulva
C. Complicated by Moniliasis
D. All of the above
Q.445: Sarcoma Botryoides is thought to arise primarily from:-
A. Vulva
B. Vagina
C. Cervix
D. Uterus
Q.446: Treatment of Candidiasis is:-
A. Clotrimazole
B. Nystatin
C. Gentian violet
D. All of the above
Q.447: Next line of management in 30 year old patient with severe dysplasia on vaginal cytology is:-
A. Schilleria test
B. Conization
C. Colposcopy
D. Hysterectomy
Q.448: Rete hyperplasia is important in the tissue diagnosis of:-
A. Lymphogranuloma
B. Condylomata
C. Lichen scleris
D. None of the above
Q.449: Hegar sign can be elicited by:-
A. 10 weeks
B. 05 weeks
C. 08 weeks
D. 06 weeks
Q.450: Biological half life of Oxytocin is :-
A. 3-4 minutes
B. 5-6 minutes
C. 7-8 minutes
D. None of the above
Q.451: Ripening of cervix takes place by:-
A. Oxytocin infusion
B. Intravaginal Prostaglandin application
C. Separation of membranes
D. All of the above
Q.452: Indication for removal of IUCD is :-
A. Missing thread
B. Pregnancy
C. Infection to genital tract
D. None of the above
Q.453: Pregnancy with Lippe’s loop has got increased incidence of:-
A. Ectopic pregnancy
B. Sepsis
C. Abortion
D. Prematurity
Q.454: Diagnosis of IUGR is achieved by :-
A. Serial estimation of urinary oestriol
B. Sonography
C. Cytological study
D. Clinical Examination
Q.455: Types of IUGR are:-
A. Symmetrical
B. Assymetrical
C. Indiscreminate
D. All of the above
Q.456: Which drug from the following, is uterine relaxant:-
A. Danazol
B. Clomiphene citrate
C. Isoxsuprine
D. Oestrogen progesterone pills
Q.457: Meconium aspiration syndrome occurs in:-
A. Diabetes mellitus
B. Asphyxia neonatorm
C. Dysmature foetus
D. None of the above
Q.458: Supression of lactation may occurs following the use of:-
A. Oral Contraceptive
B. Ethinyl estriol
C. Ergotamine maleate
D. Ethinyl estradiol
Q.459: Bishop’s score pertains to:-
A. Infertility
B. Maturity of Foetus
C. Induction of Labour
D. None of the above
Q.460: Foetal indication for Induction of labour are except:-
A. Spina Bifida
B. Postmaturity
C. Rh-isiimmunization
D. Intrauterine growth retardation
Q.461: Maternal indication of Induction is except:-
A. Intra uterine death
B. Hydroamnious
C. Maternal Exhaution
D. None of the above
Q.462: Pearl index is related with:-
A. Synonym with cornification index
B. Contracted Pelvis
C. Assesment of high risk pregnancy
D. Contraceptive effectiveness
Q.463: Oestrogen in oral contraceptive pills causes the following, except:-
A. Nausea,vomiting
B. Headache
C. Hypertension
D. Respiratory distress
Q.464: Neglected shoulder in live foetus should be managed by :-
A. Caeserean section
B. Internal podalic version
C. Destructive operation
D. None of the above
Q.465: Following drug cross the placental barrier to the foetus:-
A. Ampicillin
B. Tetracyclin
C. Diazepam
D. Aspirin
Q.466: Third stage complication includes:-
A. Post partum haemorrhage
B. Haemorrhagic shock
C. Inversion uterus
D. Retained placenta
E. All of the above
Q.467: Maternal complication during labour in Hydramnios is:-
A. Post partum haemorrhage
B. Uterine atonia
C. Haemorrhagic shock
D. All of the above
Q.468: Rupture uterus can be managed by:-
A. Depends on site of rupture & general condition of patient
B. Suturing the ruptured site
C. Obstetrical hysterectomy
D. Suturing the site & sterilization
Q.469: Symphysiotomy is done in cases of :-
A. No role in modern obstetrics
B. Outlet contraction
C. Flat pelvis
D. None of the above
Q.470: Least dangerous placenta praevia is:-
A. Posterior placenta praevia
B. Central placenta praevia
C. Anterior placenta praevia
D. All of the above
Q.471: Diameter of engagement in face to pubes delivery is :-
A. Mento vertical
B. Sub occipito bregmatic
C. Occipito frontal
D. Bi parietal
Q.472: Oligohydroamnios is caused by the following, except:-
A. Oesophageal atresia
B. Anencephaly
C. Meningocoele
D. Foetal renal agenesis
Q.473: Respiratory distress syndrome is clinically evident:-
A. Atbirth
B. Depends on other investigations
C. 6-12 hrs. of delivery
D. After 24 hrs. of birth
Q.474: Magnesium toxicity is reversed in pregnancy by:-
A. Sodium Bicarbonate
B. Meprobamate
C. Succinyl choline
D. Calcium gluconate
Q.475: What’s the Biparietal diameter:-
A. 95 mm.
B. 98 mm.
C. 68 mm.
D. 94 mm.
Q.476: Which of the following drugs is teratogenic:-
A. Frusemide
B. Reserpine
C. Propranolol
D. Thiazides
Q.477: Incidence of Breech presentation is:-
A. 6 %
B. 20 %
C. 20 %
D. 3-5%
Q.478: Placental cause of Hydroamnious are:-
A. Placental haemangioma
B. Placenta Circumvellata
C. Placenta succenturate
D. None of the above
Q.479: Green-Armytage forceps are used:-
A. To extract the foetus
B. Abdominal tubectomy
C. Achieve Haemostasis
D. None of the above
Q.480: Postpartum haemorrhage can lead to:-
A. Sheehan’s Syndrome
B. Haemorrhagic Shock
C. Septicaemia
D. Renal failure
E. A & B
Q.481: Ventous can cause:-
A. Scalp abrasion
B. Frecture of Skull Bone
C. Cephalhaematoma
D. Intracranial haemorrhage
Q.482: Traumatic Postpartum haemorrhage is diagnosed by:-
A. Relaxed Uterus
B. Pain with Bleeding
C. Contracted Uterus
D. All of the above
Q. 483: Gestational sac can be identified by Ultrasonography as early as:-
A. 5th week of gestation
B. 8th week of gestation
C. 10-12 week of gestation
D. None of the above
Q.484: Best method of delivering placenta is:-
A. Cord traction
B. Manual removal of placenta
C. Spontaneous explusion
D. Crede’s method
Q.485: Twiching in the newborn is due to:-
A. Hypoglycaemia
B. Hypocalcaemia
C. Cerebral damage
D. All of the above
Q.486: Intrautrine pressure in first stage of labour:-
A. 10 – 15 mm. Hg
B. 30 mm. Hg
C. 60 mm. Hg
D. 100 – 150 mm. Hg
Q.487: Rubella in early pregnancy can cause:-
A. Cataract
B. Mental deficiency
C. Cardiac anomaly
D. All of the above
Q.488: Vaginal pH in the newborn is :-
A. 6
B. 4
C. 8
D. 7
Q.489: Common presentation in Android pelvis is:-
A. Breech
B. Face
C. Occipito posterior
D. All of the above
Q.490: Chances of multiple pregnancy is common with:-
A. Bromocryptin
B. Comiphene citrate
C. Danazol
D. Oral contraceptive pills
Q.491: Danger of internal podalic version is:-
A. Rupture uterus
B. Cervical tear
C. Vaginal wall laceration
D. All of the above
Q.492: Anencephaly is often associated with:-
A. Postmaturity
B. Hydramnios
C. Spina Bifida
D. All of the above
Q.493: Spontaneous delivery of foetus with shoulder presentation is possible with:-
A. Preterm labour
B. Dead foetus
C. Congenital anomaly in foetus
D. A & B
Q.494: Acute Hydramnios can cause:-
A. Cord prolapse
B. Abnormal presentation
C. Post partum haemorrhage
D. Septic shock
Q.495: Extraction of foetal head by ventous can cause:-
A.Cephalhaematoma
B. Intracranial haemorrhage
C. Jaundice
D. All of the above
Q.496: Foetus with Brow presentation is delivered by:-
A. Mannual rotation & forceps
B. Internal podalic version
C. Caeserean section
D. None of the above
Q.497: Palpation of ischial spines of pelvis helps in:-
A. Place where pudendal block is given
B. Transversed diameter of pelvis is being assessed
C. Ruling out mid pelvic contraction
D. All of the above
Q.498: Breech presentation is caused by:-
A. Contracted pelvis
B. Hydramios
C. Placenta praevia
D. All of the above
Q.499: Anuria in Abruptio placentae sets in if patient fails to deliver:-
A. With in 6-8 hrs. of haemorrhage
B. With in 30 minutes of haemorrhage
C. With in 12 hrs.of haemorrhage
D. None of the above
Q.500: Android pelvis has:-
A. Wedge shaped inlet
B. Funnel shaped pelvis
C. Narrow anterior segment of pelvis
D. None of the above
Q.501: Proper time for pelvic assessment in primigravida is:-
A. 32-34 weeks
B. 12 weeks
C. Near term
D. During labour
Q.502: Cord prolapse is commonly encountered in:-
A. Premature rupture of membranes
B. Shoulder presentation
C. Hydramnios
D. Occipito posterior position
Q.503: Septic abortion has the complication of:-
A. Haemorrhage
B. Renal failure
C. Septicaemia
D. None of the above
Q.504: Oesophageal atresia in newborn is common in mothers with :-
A. Toxoplasmosis
B. Oligohydramios
C. Diabetes
D. Rubella
Q.505: Contra indication of oxytocin infusion is:-
A. Grand multipara
B. Obstructed labour
C. Heart disease
D. All of the above
Q.506: Methyl ergotamine maleate acts with in :-
A. 45 seconds
B. 100 seconds
C. 150 seconds
D. None of the above
Q.507: The closed IUCD device is:-
A. Ota ring
B. Cu ‘T’
C. Grafenberg ring
D. Lippe’s loop
Q.508: Mostly female sterilization is done by:-
A. Vaginal route
B. Laparoscopic sterilization
C. Conventional method
D. Minilap
Q.509: Episiotomy is to be applied at:-
A. Just prior to crowning
B. After crowning
C. After delivery of the presenting part
D. In 2nd stage of labour
Q.510: The placental separation and expulsion may be completed:-
A. Spontaneous
B. Mannual removal
C. Controlled cord traction
D. None of the above
Q.511: Muller-Munroker method is related to:-
A. Cephalopelic disproportion
B. Placental grading
C. Sex determining method
D. Foetal monitoring
Q.512: Inversion of uterus may occur due to :-
A. Mismanaged 3rd stage of labour
B. Cord traction
C. Precipitated labour
D. All of the above
Q.513: Caeserean Section is indicated in all except:-
A. Two previous Caeserean sections
B. Hydrocephalus
C. Primigravida with Breech presentation
D. Foetal distress
Q.514: Caeserean Section indicated in Breech presentation except:-
A. Placenta praevia
B. Elderly primi
C. Contracted Pelvis
D. None of the above
Q.515: Choriocarcinoma is precided by a normal pregnancy:-
A. 1 in 1000
B. 1 in 100,000
C. 1 in 160,000
D. 1 in 1,000,000
Q.516: Which of the following is not a cause of placental insufficiency:-
A. Diabetes
B. Chronic renal disease
C. Hypertention
D. Battledore placenta
Q.517: Which of the following agent leads to paralytic ileus in newborn,when given to mother:-
A. Magnesium sulfate
B. Apresoline
C. Reserpine
D. Hexamethonium
Q.518: Critical factor of diabetes in pregnancy are except:-
A. Glcosurea
B. Gross obesity
C. Blood in normal range
D. Previous still birth
Q.519: Twin pregnancy is usually associated with:-
A. Folic acid deficiency
B. Iron deficiency anaemia
C. Sickel cell anemia
D. None of the above
Q.520: Seizure in the neonatal period may be due to, except:-
A. Pyrodoxin deficiency
B. Hypoglycemia
C. Intracranial haemorrhage
D. A & B
Q.521: Puerpereal fever is caused by:-
A. Poor hygiene
B. Breast abcess
C. Urinary tract infection
D. All of the above
Q.522: Shoulder presentation in labour can causethe following, except:-
A. Uterine rupture
B. Obstructed labour
C. Cord prolapse
D. A & B
Q.523: Cause for anencephaly in post mature pregnancy is:-
A. High Oestrogen & progesterone levels
B. Aging changes in Placenta
C. Foetal adrenal hypoplasia
D. None of the above
Q.524: Rapid intravenous administration of 5% of glucose to a patient in labour may result in:-
A. Maternal Hypernatraemia
B. Neonatal hypocalcaemia
C. Maternal hypokalemia
D. None of the above
Q.525: Cause of IUGR includes:-
A. Alcohol consumption
B. Smoking
C. Chronic maternal hypertension
D. All of the above
Q.526: Mendelson syndrome pertains to:-
A. Allergic reaction to drugs
B. Pregnancy with reflux gastritis
C. Cardiac arrest during Caeserean section
D. Aspiration of gastric contents by the mother under anesthesia
Q.527: Localization of Placenta is absolutely an indication in :-
A. Prior to anaesthesia
B. Internal podalic version
C. Chronic villous biopsy
D. None of the above
Q.528: Forceps which causes maximum damage are:-
A. Kiellands forceps
B. Simsons forceps
C. Millnemurre forceps
D. Wrigley’s forceps
Q.529: Failed forceps is due to :-
A. Undilated cervix
B. High station of head
C. Unrotated head
D. B & C
Q.530: Intracranial haemorrhage in the newborn is due to:-
A. Ventous
B. Forceps
C. Prolonged 2nd stage of labour
D. All of the above
Q.531: Approximately maternal mortality rate in Rupture uterus in developing countries in rural areas is:-
A. 30-40%
B. 05-10%
C. 15-20%
D. None of the above
Q.532: Placenta praevia is associated with all of the following , except:-
A. Abnormal foetal presentation
B. Painless bleeding after 20 weeks of gestation
C. Pregnancy superimposed with hypertension
D. None of the above
Q.533: Common cause of cerebral palsy in newborn is:-
A. Asphyxia neonatorum
B. Prematurity
C. Severe hyperbilirubinaemia
D. None of the above
Q.534: Deep vein thrombosis is diagnosed by the following, except:-
A. Homan sign
B. Cuff pain test
C. Phlebography
D. Angiography
Q.535: ‘Hallo’ sign on skiagram of the living foetus indicates:-
A. Toxoplasmosis
B. Cytomegalovirus infection
C. Hydropes foetalis
D. Herpetic infection
Q.536: Premature rupture of membrane can be confirmrd by following test, except:-
A. Benzidine test
B. Ultrasonography
C. Nitrazene test
D. Fern test
Q.537: Most common presentation in anencephaly is:-
A. Face
B. Brow
C. Breech
D. Parietal
Q.538: Absolute sign of intrauterine death is:-
A. Failure of growth of foetus
B. Absent foetal movement
C. Splding sign
D. Absence of foetal heart sound
Q.539: Average duration of pregnancy is:-
A. 280 days
B. 278 days
C. 300 days
D. 180 days
Q.540: Single umbilical artery may be associated with:-
A. Rh- Incompatibility
B. Blood sugar of patient
C. Blood volume of patient
D. Foetomaternal transfusion
Q.541: Toxic shock syndrome is caused by :-
A. Use of chemicals in vagina
B. Septicaemia
C. Tampoons during menses
D. None of the above
Q.542: Zatuchni scoring pertains to:-
A. Favourable induction of labour
B. Healthy foetus
C. Breech delivery
D. Infertility
Q.543: Bluish coloration of vagina is known as :-
A. Hegar sign
B. Asheinzondak sign
C. Chadvik sign
D. None of the above
Q.544: Isoxsuprine hydrochloride to be given by:-
A. Intramuscular route
B. Subcutaneous
C. Intravenous infusion
D. None of the above
Q.545: Hydroaminos is associated with:-
A. Cogenital anomaly of foetus
B. Diabetic mother
C. Twin pregnancy
D. All of the above
Q.546: In multiparous women the internal cervical Os is:-
A. Longitudinal
B. Circular
C. Transverse
D. Septate
Q.547: Partogram help in detect of:-
A. Incordinate uterine action
B. Obstructed labour
C. Postpartum haemorrhage
D. Abruptio placenta
Q.548: Calcium requirenment during 3rd trimester of pregnancy is:-
A. 1000 mg./day
B. 750mg./day
C. 100-300mg./day
D. None of the above
Q.549: Classical caesarean section is indicated in all of the following condition, except:-
A. Carcinoma cervix
B. Vascular lower uterine segment
C. Foetal distress
D. Postmature delivery
Q.550: Post term pregnancy is one which continues beyond:-
A. 280 days
B. 294 days
C. 286 days
D. 316 days
Q.551: Low birth weight means birth weight less than:-
A. 2.0 kg
B. 1.5 kg
C. 1.8 kg
D. 1.0 kg
Q.552: Microcephaly is common in mothers with:-
A. Alcohol
B. Diabetes
C. Hypertension
D. Smokers
Q.553: Rupture of Graffian follicle occurs :-
A. 16-24 hrs. after LH surge
B. Before LH surge
C. 06 hrs. after LH surge
D. None of the above
Q.554: Which part of the head is born last in vertex presentation:-
A. Face
B. Chin
C. Forehead
D. Vertex
Q.555: Cholestrin crystals are found in :-
A. Lochia alba
B. Lochia rubra
C. lochia serosa
D. None of the above
Q.556: Milk secretion on 4th day of delivery in 24hrs. approximately:-
A. 250 mls.
B. 300 ml.
C. 150-200 mls.
D. None of the above
Q.557: Mc Donald stitch is applied in cases of :-
A. Cystocoele
B. Rectocoele
C. Incompetent cervical Os
D. Lax hiatus
Q.558: Contraindication of Mc Donald operation are:-
A. Leaking membranes
B. Amnionitis
C. Patient in active labour
D. History of vaginal bleeding
Q.559: Incarciration of the retroverted gravid uterus occurs at:-
A. 12-16 weeks
B. 08-10 weeeks
C. 18-20 weeks
D. None of the above
Q.560: Gallimanni is test for:-
A. Confirming pregnancy
B. Biological test done in frogs
C. Immunological test
D. Cytological method
Q.561: Life span of foetal red blood corpuscles is:-
A. 90 days
B. 80 days
C. 120 days
D. 140 days
Q.562: Blood cholesterol during pregnancy at term is:-
A. 200 mg. %
B. 250 mg. %
C. 400 mg. %
D. 100 mg. %
Q.563: Uterine blood flows per minute at term is:-
A. 750 ml.
B. 1000 ml.
C. 350 – 460 ml.
D. None of the above
Q.564: Plasma progesterone at term is ( in/µgms/100ml ):-
A. 15
B. 35 – 40
C. 5
D. None of the above
Q.565: Detectable amount of HCG appears in serum as early as:-
A. 7th day of implantation
B. 24 – 36 hrs. of implantation
C. 3rd day of implantation
D. 5th day of implantation
Q.566: Prostaglandins synthesis inhibitors are:-
A. Atenalol
B. Acitic acid
C. Asprin
D. Alcohol
Q.567: Recovery from eclampsia can best be predicted by:-
A. Fall in blood pressure
B. Oedema subsides
C. Urinary output increases
D. Number of eclamptic fits
Q.568: Blood pressure in uterine artery at placental sute is:-
A. 80 mm. Hg
B. 60 mm.Hg
C. 100 mm. Hg
D. 120 mm. Hg
Q.569: Contraindication of the use of ventouse are:-
A. Prematurity
B. Brow presentation
C. Foetal distress with dilation of cervix 6 – 8 cms.
D. All of the above
Q.570: Cause of high floating head at term in primigravida:-
A. Occipito posterior position
B. Cephalopelvic disproportion
C. Deflexed hand
D. All of the above
Q.571: Placenta produces mainly:-
A. Progesterone
B. Oestriol
C. Oestradiol
D. None of the above
Q.572: Abruptio placentae to be differentiated from:-
A. Placenta praevia
B. Pregnancy with carcinoma cervix
C. Rupture uterus
D. All of the above
Q.573: Gray baby syndrome has been found in association with:-
A. Chloromphenicol
B. Tetracycline
C. Streptomycin
D. Cephalosporins
Q.574: If not properly applied kielland forceps can cause:-
A. Cervical tear
B. 3rd degree perineal tear
C. Rupture of lower uterine segment
D. All of the above
Q.575: Differential diagnosis of twin pregnancy can be:-
A. Hydroamnios
B. Soft tissue mass
C. Big baby
D. All of the above
Q.576: Multiple pregnancy is least common with:-
A. Clomiphene citrate
B. Invitro fertilization
C. GnRH
D. Increased level of oestrogen
Q.577: Diameter of engagement in occipito posterior position is:-
A. 10 cms.
B. 09.4 cms.
C. 11.8 cms.
D. 13.1 cms.
Q.578: Transverse lie is often associated with following, except:-
A. Placenta praevia
B. Contracted pelvis
C. Uterine anomaly
D. Soft tissue mass in pelvis
Q.579: The dignosis of triplets can best be made by:-
A. HCG levels in urine
B. Ultrasound
C. X-Ray abdomen A.P. view
D. Human Placental lactogen
Q.580: Maternal death in abruption placentae is due to:-
A. Septic shock
B. Haemorrhage
C. Coagulation & Renal failure
D. All of the above
Q.581: Trial of labour is indicated in:-
A. Breech delivery
B. Shoulder presentation
C. Cord prolapse
D. Borderline cephalopelvic disproportion
Q.582: Commonest cause of Hydramnios is:-
A. Spina Bifida
B. Meningocoele
C. Anencephalic foetus
D. Oesophasial atresia
Q.583: Most important investigation of vesicular mole is:-
A. Estimation of HCG titre
B. Erythrocyte sedimentation rate
C. Ultrasound
D. A & C
Q.584: Absolute indication for classical caesarean section is:-
A. Placenta praevia
B. Previous lower segment caesarean section
C. Carcinoma Cervix
D. None of the above
Q.585: Causes of ectopic gestation includes, except:-
A. Tubal cilliary damage
B. Long fallopian tube
C. IUCD.
D. Blighted ovum
Q.586: Abruptio placentae was first invented by:-
A. Mc Donald
B. Rigby
C. Benson
D. Peter Johans
Q.587: Immediate complication of evacuation of Vesicular mole is :-
A. Sepsis
B. Bleeding
C. Incomplete evacuation
D. Infection
Q.588: Abnormal foetal scalp blood pH is:-
A. 7.2
B. 7.4
C. 7.3
D. 7.45
Q.589: Delivery is not possible per vaginum in:-
A. Persistant mentoposterior
B. Mento anterior
C. Extended Breech
D. Occipito posterior
Q.590: Pressure in the umbilical vein approximates:-
A. 20 mm of Hg
B. 10 mm of Hg
C. 40 mm of Hg
D. More than 40 mm of Hg
Q.591: Oxygen supply to the foetus is at the rate of:-
A. 5 ml./ Kg./mt.
B. 2 ml./ Kg./mt.
C. 25 ml./ Kg./mt.
D. 10-15 ml./ Kg./mt.
Q.592: Amniotic fluid volume at 40 weeks measures:-
A. 600-800 ml.
B. 300-500
C. 900 – 1200 ml.
D. 100 – 200 ml.
Q.593: Urinary production of term foetus per day is:-
A. 450 ml.
B. 800 ml.
C. 650 ml.
D. 1000 ml.
Q.594: Mecomium appears in intrauterine life from:-
A. 18th week
B. 26th week
C. 16 – 18th week
D. 20th week
Q.595: Uterine weight at term is:-
A. More than 1 Kg.
B. 0.8 Kg.
C. 1.2 Kg.
D. 1.5 Kg
.
Q.596: Commonest variety of eclampsia is:-
A. Intrapartum
B. Antepartum
C. Postpartum
D. None of the above
Q.597: Best way to diagnose the degree of Placenta praevia is:-
A. Abdominal palpation
B. Bi manual examination in operation theatre
C. During caesrerean section
D. Examining placenta after delivery
E. Ultrasonography
Q.598: In placenta praevia Bi manual examination should be done to confirm the diagnosis:-
A. Bleeding per vaginum
B. Bogginess in both fornices
C. Feeling of Placenta through Bi manual examination
D. All of the above
Q.599: Blood coagulopathy in abruptio placentae is due to :-
A. Decreased level of Fibrinogen
B. Consumption coagulopathy
C. Enhanced fibrinolytic activity
D. All of the above
Q.600: Normal Firinogen level in blood is:-
A. 100 mg.%
B. 300-350 mg.%
C. 600 mg.%
D. 400 mg.%
Q.601: Iron deficiency anaemia in pregnancy is characterized by:-
A. Low haemoglobin levels
B. PBF. Shows Hypochromic microcytic picture
C. Decreased Packed cell volume
D. None of the above.
Q.602: Mostly time of death in patient of Pregnancy with heart disease irrespective of cause is :-
A. Soon after delivery
B. 20 weeks of pregnancy
C. Two weeks postpartum
D. First stage of labour
Q.603: After premature rupture of membranes vaginal pH changes to :-
A. 5
B. 6-6.5
C. 7
D. 8.2
Q.604: Management of Acute inversion uterus is:-
A. Reposite uterus immediately
B. Wait for spontaneous correction
C. First improve general condition of patient
D. None of the above
Q.605: Organism commonly responsible for puerperal sepsis are:-
A. Streptococcus
B. Staphylococcus
C. Pseudomonas
D. Can not be predicted
Q.606: Emergency in a puerperal patient may be:-
A. Secondary PPH.
B. puerperal sepsis
C. Breast abscess
D. All of the above
Q.607: Immediate management required by a premature baby is:-
A. Delayed clamping of the cord
B. Vitamin K deficiency
C. To keep length of cord long
D. None of the above
Q.608: Important function of Prostaglandins are:-
A. Help in Ovulation
B. Prevent Ovulation
C. Rips the cervix
D. Oxytocic effect
Q.609: Out of the following, which drug is commonly prescribed in pregnancy:-
A. Antacid
B. Acetoaminophene
C. Antiemetic
D. Antihelmenthic
Q.610: Couvelair uterus occurs in following condition:-
A. Placenta praevia
B. Coagulation failure
C. Concealed accidental hemorrhage
D. Intra uterine death
Q.611: Page classification pertains to:-
A. Pre eclamptic toxaemia
B. Chorio carcinoma
C. Abruptio placentae
D. Diabetes mellitus
Q.612: Acute Intermittent porphyria in pregnancy cause maternal mortality at the rate of:-
A. Less than 7%
B. 18 %
C. 23 %
D. 47 %
Q.613: The most common benign tumour of the placenta is:-
A. Haemangioma
B. Fibroma
C. Placental polyp
D. Choriocarcinoma
Q.614: Uniovular twin pregnancy is not associated with:-
A. Congenital anomaly of foetus
B. Hydroamnios
C. Disseminated intravascular clotting
D. Fetal death
Q.615: Indication of lower segment caesarean section in multiple pregnancy:-
A. Cord prolapse
B. Placenta praevia
C. Conjoined twins
D. All of the above
Q616: Displaced IUCD can best be diagnosed by:-
A. Missing thread of IUCD
B. X- ray pelvis
C. Hysterosalpingography
D. None of the above
E. All of the above
Q.617: Commonest cause of maternal death in placenta raevia is:-
A. Infection
B.Haemorrhage
C. Renal failure
D. none of the above
Q.618: Rotation of vertex occurs during labour at:-
A. Pelvic brim
B. Pelvic floor
C. At the level of ischial spine
D. At the outlet
Q.619: Obstetrical Hysterectomy is contraindicated in:-
A. Rupture uterus
B. Placenta accerita
C. Uncontrolled post partum haemorrhage
D. Multiple Fibroids
Q.620: Common implicated cause of rupture uterus is:-
A. Multipara
B. Version & extraction
C. Oxytocin in high doses
D. All of the above
Q.621: Kielland forceps differs from other long forceps in:-
A. Lock is sliding
B. No axis traction required
C. Has anterior & posterior blades
D. All of the above
Q.622: Breech presentation occurs in approximately:-
A. 6% of patients at 30 weeks of gestation
B. 8% of patients in labour
C. 30% of patients at 28 weeks
D. None of the above
Q.623: Which sign is not a sign of foetal distress in Breech:-
A. Bradycardia
B. Uteroplacental apoplexy
C. Meconium stained liquor
D. Excessive foetal movements
Q.624: Sheehan Syndrome is associated with:-
A. Hypothalamus
B. Adrenals
C. Pitutary
D. Thyroid
Q.625: Bab-cock forceps are being used in:-
A. Laparoscopic sterilization
B. Holding Intestines
C. In abdominal tubectomy
D. B & C
E. All of the above
Q.626: Secondary post partum haemorrhage can be:-
A. Retention of placental tissue
B. Uterine anomaly
C. Choriocarcinoma
D. All of the above
Q.627: Normal duration of pueperium is:-
A. 02 weeks
B. 10 weeks
C. 06 weeks
D. 08 weeks
Q.628: Post maturity can cause all of the following, except:-
A. Meconium aspiration
B. Intracranial haemorrhage
C. Foetal distress & death
D. Post partum haemorrhage
Q.629: Macrosomia is seen in babies of :-
A. Obese parents
B. Multiparrous women
C. Diabetic patients
D. All of the above
Q.630: Viability of foetus is attained at :-
A. 18 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks
Q.631: Pregnancy with heart disease patient may go in Congestive heart failure at :-
A. Pregnancy of 32-34 weeks
B. During labour
C. Pregnancy with liver disorders
D. All of the above
Q.632: Complication of multiple pregnancy is:-
A. Posr partum haemorrhage
B. Cord prolapse
C. Rupture uterus
D. Lock twins
E. All of the above
Q.633: Which of the following are signs of placental separation:-
A. Infarcted area on Placenta
B. Retroplacental clot
C. Lengthening of umbilical cord
D. Sudden gush of blood
E. C & D
Q.634: Deep transverse arrest of foetal head occurs in:-
A. Anthropoid pelvis
B. Android pelvis
C. Flat pelvis
D. None of the above
Q.635: Diseases that can cause neonatal acidosis includes disorders of:-
A. Tyrosinemia
B. Urea cycle enzyme
C. Late metabolic acidosis
D. All of the above
Q.636: Which of the following can be measured during clinical assessment of pelvis:-
A. Anatomical conjugate
B. Bi ischial diameter
C. Diagonal conjugate
D. None of the above
Q.637: Toxic shock syndrome presents clinically as:-
A. Renal failure
B. Pyrexia
C.Jaundice
D. Rashes all over body
E. All of the above except ‘C’
Q.638: Presentation in anencephalic foetus is by :-
A. Brow
B. Face
C. Vertex
D. None of the above
Q.639: Low birth weight & placental anomaly are synonym,except:-
A. Placenta praevia
B. Placental infarcts
C. Haemangiomas
D. None of the above
Q.640: Preferably episiotomy is to be given:-
A. Central
B. Right mediolateral
C. Left mediolateral
D. Lateral
Q.641: Best device for locating placenta:-
A. Hysteroscopy
B. Colposcopy
C. Ultrasonography
D. Amniography
Q.642: Parenteral Oxytocin to be given in :-
A. Normal saline
B. Glucose 5%
C. Ringer lactate
D. Glucose normal saline
Q.643: Bleeding is of foetal origin in :-
A. Vaspraevia
B. Abruptio placentae
C. Placenta praevia
D. Placenta accereta
Q.644: Vaccine contraindicated in pregnancy:-
A. Tetanus toxoid
B. Typhoid
C. Polio
D. Rubella
Q.645: Aria’s stella reaction is not seen in :-
A. Ovarian pregnancy
B. Interstitial pregnancy
C. Molar pregnancy
D. Salpingitis isthimica nodosa
Q.646: Red degeneration of fibroid occurs commonly in :-
A. 3rd trimester
B. 2nd trimester
C. 1st trimester
D. Post partum
Q.647: Best timming for applying Mc Donald stitch is :-
A. 6 weks
B. 10 weks
C. 14-16 weks
D. After 20 weks
Q.648: Hydatiform mole is principally a disease of :-
A. Amnion
B. Decidua
C. Ovum
D. Chorion
Q.649: Mean ultrasonography measunment at 40 weks are :-
A. Biparietal diameter 9.6 cms.
B. Femur length 7.8 cms.
C. Bithoracic circumference 40 cms.
D. None of the above
E. All of the above
Q.650: Tongue bite occurs in the state of Eclampsia:-
A. Comma
B. Tonic
C. Clonic
D. None of the above
Q.651: Foetal blood flow through the placenta per minute approximates:-
A. 300 ml
B. 400 ml
C. 100 ml
D. 600 ml
Q.652: Iatrogenic causes of tubal pregnancy are :-
A. Tubectomy operation
B. IUCD operation
C. Tuboplastic surgery
D. Hormone therapy
Q.653: Placental sign denotes:-
A. Placental separation
B. Spotting in early months of pregnancy
C. Placental aging
D. Anomaly of foetus due to calcified placentation
Q.654: Vertico podalic diameter measures:-
A. 20 cms
B. 28 cms
C. 25 cms
D. 32 cms
Q.655: Spiegelleig’s criteria is term used in connection with:-
A. Ectopic gestation
B. Hydrocephalus
C. Ovarian pregnancy
D.Trapped ovum syndrome
Q.656: Causes of foetal oedema at birth
A. Congenital syphilis
B. Rh- Incompatibility
C. Congenital heart disease
D. All of the above
Q.657: Complication of manual removal of placenta includes, except:-
A. Haemorrhagic shock
B. Air embolism
C. Inversion uterus
D. Injury to the uterus
Q.658: Maternal hazards of Oxytocin infusion are :-
A. Hypotension
B. Uterine rupture
C. Anti diuresis
D. All of the above
Q.659: Complication of Intra uterine death is:-
A. Septicaemia
B. Disseminated intravascular coagulation
C. Infection
D. None of the above
Q.660: Treatment of neonatal Hyperbilirubinaemia includes:-
A. Plasmophoresis
B. Phototherapy
C. Immunosuppressive therapy
D. None of the above
Q.661: Energy requirement of the foetus in utero is supplied by:-
A. Fat
B. Vitamins
C. Carbohydrates
D. Minerals
Q.662: Hydramnios leads to poor fetal outcome because:-
A. Abruptio placentae
B. Fetal Malformation
C. Prematurity
D. Cord Prolapse
E. A & C
Q.663: Breech presentation with Hydrocephalus is delivered by:-
A. Assisted breech delivery with craniotomy
B. Caeserean section
C. Forceps application for after coming head
D. None of the above
Q.664: Least common type of pelvis is known as:-
A. Android
B. Anthropoid
C. Platipelloid
D. Mixed
Q.665: Painless delivery can be carried out with:-
A. Paracervical block
B. Epidural anaesthesia
C. Spinal anaesthesia
D. Pudendal block
Q.666: Abruptio placentae is usually associated with, except:-
A. pre-eclamptic toxaemia
B. Folic acid deficiency
C. Polyhydramnios
D. Alcoholic patients
Q.667: Absolute indication of caesarean section is in cases of:-
A. Central placenta praevia
B. Type 3rd placenta praevia
C. Placenta praevia type II,grading III
D. Placenta praevia type I,but with PET.
Q.668: Height of uterus at term is :-
A. 30 cms
B. 38 cms
C. 35 cms
D. 48 cms
Q.669: In high socio economic status patients, approximate antenatal visits must be:-
A. 10
B. 10-12
C. More than 12
D. Can not be a binding
Q.670: Exact gestational age can be evaluated by:-
A. Neglie’s rule
B. X-Ray
C. Ultrasonography
D. All of the above
Q.671: Features of Braxton Hicks contraction are , except:-
A. Spasmodic
B. Regular
C. Painless
D. No effect on foetus
Q.672: Brim Index in normal pelvis measures:-
A. 85-100
B. 110
C. 125-160
D. 76
Q.673: Most important feature of true labour pain is:-
A. Buldging of membranes during uterine contraction
B. Show
C. Show
D. Taking up of cervix
Q.674: Physiological basis in expulsion of placenta is:-
A. Uterine contraction
B. Bearing down effort along with bleeding
C. Pregnancy induced hypertension
D. None of the above
Q.675: When the first stage of labour is completed :-
A. The cervix is completely retracted over the presenting part
B. Rupture of membranes
C. Cervix is fully dilated
D. All of the above
Q.676: Which one is last to be retracted:-
A. Anterior lip of cervix
B. Posterior lip of cervix
C. Anterior & Posterior lip of cervix retracts simultaneously
D. None of the above
Q.677: Delivery in patient with heart disease is quick,because of:-
A. Improper saturation of oxygen
B. Congestion of cervix
C. Rheumatic factor
D. None of the above
Q.678: X-Ray finding of a case of Intrauterine death are:-
A. Spalding sign
B. Hyperflexion of the spine
C. Gas shadow in great vessels
D. All of the above
Q.679: The best way to terminate pregnancy in IUD is :-
A. Prostaglandins
B. Oxytocin
C. Intra amniotic instillation of hypertonic saline
D. Transcervical extra amniotic ethacridine lactate
Q.680: Maternal risk in precipitated labour are following, except:-
A. Genital tract injury
B. Hypertension
C. Post partum haemorrhage
D. Inversion uterus
Q.681: Cause of Breech presentation is :-
A. Hydrocephalus
B. Prematurity
C. Placenta praevia
D. All of the above
Q.682: Absolute contraindication of internal podalic version are:-
A. Contracted Pelvis
B. Hydrocephalus
C. Previos caesarean section
D. All of the above
Q.683: Risk of retained placenta is:-
A. Septicaemia
B. Haemorrhagic shock
C. Re occurrence in next pregnancy
D. A & B
Q.684: Risk related to acute Obstetrics inversion are:-
A. Neurogenic shock
B. Death of patient
C. Post partum haemorrhage
D. All of the above
Q.685: In the cardiac patient which of the following is true:-
A. Induction of labour
B. Spontaneous delivery
C. Caeserean section
D. Cut short 2nd stage of labour
Q.686: Cord prolapse in 2nd stage is best managed by:-
A. Replace the cord
B. Caeserean section
C. Delivery by ventous
D. Forceps delivery
Q.687: Coagulopathy occurs in all, except:-
A. Accidental haemorrhage
B. Intrauterine foetal death
C. Missed abortion
D. Placenta praevia
Q.688: Maternal mortality is highest in:-
A. Revealed Accidental haemorrhage
B. Concealed Accidental haemorrhage
C. Placenta praevia
D. All of the above
Q.689: Placenta praevia presents itself as:-
A. Tender & tense uterus
B. Absent foetal heart sounds
C. Atonic uterus
D. None of the above
Q.690: Quickening can be felt at:-
A. 20-22 weeks
B. 18 weeks
C. 15-16 weeks
D. 10-12 weeks
Q.691: Duodenal atresia in newborn is common in mother with:-
A. Hydramnios
B. Mongols
C. IUGR.
D. All of the above
Q.691: Outcome of induction of labour will be favourable when Bishop’s score is:-
A. Less than Two
B. Less than Four
C. Less than Ten
D. None of the above
Q.692: Preferred time for IUCD insertion is:-
A. During periods
B. After menstrual period
C. 4-6 weeks after delivery
D. B & C
Q.693: Failure rate of Modified Pomeriy’s method is:-
A. 0.01 %
B. 0.1 %
C. 1 %
D. 2-3 %
Q.694: Suction pressure for terminating pregnancy should be:-
A. 400-600 mm of Hg.
B. 700-900 mm of Hg.
C. 100-200 mm of Hg.
D. None of the above
Q.695: Haemostasis following placental separation took place by:-
A. Uterine retraction
B. Uterine contraction
C. Thrombosis
D. Disseminated intravascular coagulation
Q.696: In Disseminated intravascular coagulation main factor responsible are:-
A. Hypofibrinogenimia
B. Decrased Platelet adhesion
C. Vitamin ‘K’ deficiency
D. None of the above
Q.697: Couvelier Uterus is term related to:-
A. Abruptio placentae
B. Intra uterine death of foetus
C. Missed abortion
D. Road side accident
Q.698: Differential diagnosis of antepartum haemorrhage is, except:-
A. Abruptio placentae
B. Intra uterine death of foetus
C. Vasa praevia
D. Haemorrhoids
Q.699: Characteristic feature of Couvelier Uterus is:-
A. Uterine tenderness
B. Absent foetal heart sound
C. Undue enlargement of Uterus
D. None of the above
Q.700: Ultrasonography prior to elective caesarean section is done for:-
A. Rulling out congenital anomaly of foetus
B. To know placental grading
C. Localization of Placenta
D. Foetal maturity
E. All of the above
Q.701: Largest diameter of foetal skull is:-
A. Occipito bregmatic
B. Sub Occipito bregmatic
C. Submento vertical
D. Biparietal diameter
Q.702: Which anaesthetic agent is most often given for Caeserean section:-
A. General anaesthesia
B. Spinal
C. Epidural
D. Local anaesthesia
Q.703: Twin pregnancy in early period can be diagnosed by:-
A. Clinical examination
B. High level of HCG
C. Ultrasonography
D. Cytological examination
Q.704: Occipito posterior presentation is common in :-
A. Anthropoid pelvis
B. Android pelvis
C. Gynaecoid pelvis
D. Platepelloid pelvis
Q.705: Best method for conducting Breech delivery by Vaginal route is:-
A. Breech extraction
B. Spontaneous
C. Assisted Brech delivery
D. None of the above
Q.706: Oxygen supply to foetus depends on:-
A. Placental surface area
B. Maternal intervillous space blood flow
C. Maternal & Foetal Oxygen difference
D. All of the above
Q.707: Favourable outcome in pregnancy with heart disease depends on:-
A. previous cardio vascular complications
B. Functional capacity of heart
C. Blood volume of patient
D. Grading of Congestive heart failure
Q.708: Precipitate labour may result in, except:-
A. Uterine rupture
B. Foetal intracranial trauma
C. Laceration of genital organs
D. Death of foetus
Q.709: Drugs to control post partum haemorrhage are, except:-
A. Ergotamine maleate
B. Synthetic Oxytocin
C. Diazepam
D. Haemostatic agents
Q.710: Absolute indication for Classical Caeserean section is:-
A. Impacted Shoulder presentation
B. Fibroid in lower Uterine segment
C. Carcinoma cervix
D. Pregnancy with Ovarian Cyst
Q.711: Craniotomy is indicated, if:-
A. Foetus is alive
B. Rupture of Uterus
C. Head well above the brim
D. All of the above
Q.712: Hyaline membrane disease is chacterized by:-
A. Increased respiratory rate
B. Retraction of ribs
C. gasping foetus
D. A & B
Q.713: Willet’s forcps are being used to:-
A. Hold the cervix
B. Hold the uterus in Hysterectomy
C. Scalp traction
D. To remove the retained placental tissue
Q.714: Symptoms of Uterine rupture are, except:-
A. Vaginal bleeding
B. Loss of Uterine action
C. Increased maternal pulse rate
D. Haematuria
E. All of the above
Q.715: Uterine rupture is least common in :-
A. Hysterotomy scar
B. Myomectomy scar
C. Classical Caeserean section scar
D. Lower segment caesarean section
Q.716: Incompetent cervical Os can be diagnosed by:-
A. Hysteroscopy
B. Ultrasound
C. Bimannual examination
D. All of the above
Q.717: Rh- Antibody produced by mother is:-
A. IgM
B. IgA
C. IgG
D. A & C
Q.718: Which of the following diameter is smallest:-
A. Sub mentobregmatic
B. Mentovertical
C. Occipito frontal
D. Sub Occipito frontal
Q.719: Shortest diameter at inlet is:-
A. Transverse
B. Anterio posterior
C. Oblique
D. None of the above
Q.720: Treatment of Nullipara with Dysmenorrhea is :-
A. Hysterectomy
B. Dilatation of cervix
C. Anti allergic drugs
D. Anti prostaglandins
Q.721: Vesicular mole in most cases is associated with:-
A. Ovarian luteal cyst
B. Upper levels of HCG
C. Radiological findings
D. All of the above
Q.722: Predisposing factors in puerpereal infection is:-
A. Haemorrhage
B. Mannual removal of placenta
C. Anaemia
D. All of the above
Q.723: Survival of triplets is mostly determined by:-
A. Duration of gestation
B. Weight of foetus
C. Mode of delivery
D. Maturity of fetuses
Q.724: Post partum Haemorrhage is diagnosed when the bleeding exceeds:-
A. 500-600 mls
B. 300 mls
C. 800 mls
D. None of the above
Q.725: Uterine rupture is common in :-
A. Grand multipara
B. Obstructed labour
C. Oxytocin infusion
D. All of the above
Q.726: Specific treatment of severe pre-eclampsia is:-
A. Diuretics
B. Antiepileptics
C. Antihypertensive
D. Anticholenergic
Q.727: Examination contraindicated in Antepartum haemorrhage:-
A. Per speculum
B. Ultrasonography
C. Bi manual examination
D. Bi manual examination in operation theater
Q.728: Successful treatment of foetal growth retardation includes:-
A. Aspirin in high doses
B. I.V. glucose in high concentration
C. Hyper Oxygen
D. None of the above
E. All of the above
Q.729: Accurate method of diagnosing IUGR:-
A. Weight estimation
B. Sonographic Weight estimation
C. Vaginal cytology
D. 10th percentile of weight pattern
Q.730: Best predictor of Macrosomia is:-
A. Femur length
B. Abdominal circumference
C. Bi parietal diameter
D. Placental changes in Sonography
Q.731: Complications of cordocentesis includes :-
A. Foetal tachycardia
B. Cord bleeding
C. Complications of Amniocentesis
D. Foetal bradycardia
E. All except ‘A’
Q.732: Determinant of placental glucose transport:-
A. Placental surface area
B. Maternal arterial glucose estimation
C. Uterine blood flow
D. Placental thickness
Q.733: Nonstress test in Diabetic mother’s must be done:-
A. Twice weekly
B. Daily
C. Weekly
D. Thrice weekly
Q.734: Lipolysis in late pregnancy results because of :-
A. Insulin
B. Prolactin
C. Glucose
D. HCG
Q.735: Criteria for shunt placement for Hydrocephalus includes:-
A. Normal Karyotype
B. Progressive ventricular dilatation
C. No other malformation
D. All of the above
Q.736: Most common cause of Non immune hydrops is :-
A. Cardiac disease
B. Chromosomal abnormality
C. Alpha thalassemia
D. Meningomyelocoele
Q.737: Neural tube defect is associated with the deficiency of which Vitamin:-
A. Ascorbic acid
B. Folic acid
C. Pyridoxin
D. Riboflavin
Q.738: Foetal tachycardia may be seen in all of the following, except:-
A. Narcotic drugs
B. Maternal anxiety
C. Foetal movement
D. Beta adrenergic drugs
Q.739: Best tissue to Biopsyin early pregnancy is:-
A. Chorion leave
B. Chorion frundosum
C. Decidua Basalis
D. Amniotic membrane
Q.740: Most promising approach to gene therapy involve cells:-
A. Bone marrow
B. Nervous
C. Hepatic
D. Muscle
Q.741: Useful test for diagnosis of Vesicular mole:-
A. Amniography
B. CT Scan
C. Ultrasound
D. Thermography
Q.742: Vesicular mole is present in how many % of abortion cases:-
A. 50 %
B. 100 %
C. 30 %
D. 15 %
Q.743: The prevelance of asymptomatic Bacteriouria is:-
A. 75 %
B. 25 %
C. 05 %
D. 10 %
Q.744: Common indication of inutero transverse is:-
A. Pre mature labour
B. Pre-eclampsia
C. Ante bleeding
D. Uncontrolled Diabetes
Q.745: Concentration of Halothane anaesthesia which can cause PPH. :-
A. 1.0 %
B. 0.5 %
C. 10.0 %
D. 05 %
Q.746: Foetal weight of 4kgs. Or more can be detected by Ultrasonography:-
A. Biparietal diameter 9.3 cms.
B. Head Circumference 34 cms
C.Abdominal Circumference 38 cms
D. Chest Circumference 34 cms.
Q.747: Severe form of placental attachment to the Myometrium is:-
A. Placenta Percreta
B. Placenta increta
C. Placenta accrete
D. None of the above.
Q.748: Usual length of Simpson’s uterine sound is :-
A. 28.6 cms
B. 30.0 cms
C. 30.2 cms
D. 31.6 cms
Q.749: Length of endometrial biopsy curette is:-
A. 30 cms
B. 25 cms
C. 23 cms
D. 35 cms
Q.750: Bonney’s Myomectomy clamps have:-
A. Two grip
B. Single grip
C. Three grip
D. None of the above
&
GYNAECOLOGY
(Instruments, Procedures and Self assessment)
By
Dr. Mukesh Raghav
Associate Professor,
Department of Obstetrics & Gynaecology,
S. P. Medical College,
Bikaner : 334003
FROM AUTHOR’S DESK
I always try my level best to teach students and ask Questions on any topic and at any place too., just to give stimulus to their grey matter. It’s the blessings of the almighty God by which I could manage to express my view in the book in your hands.
I feel highly indebted to my Mummy & Papa for their constant inspiring thoughts.
Words are too frail to express my indebt ness to my wife for her kind Co-Operation and timely suggestions. I am also grateful to my ever loving children Sunny and Neha, to whom I could not share my love and affection to the extent desired by them, during writing the book.
I wish book will help students to perform well in the examinations and will help them to get some expertise in the field of Obstetrics & Gynaecology. I will like to further add that knowingly the diagrams have not been included, keeping in mind that students can very well understand the thing with practical demonstration than diagrams. Wishing all my readers a very happy and prosperous years to come, full of success.
Dear Readers , your suggestions will be admired and welcomed by me and I will like to review myself & the book, I assure you that in future editions you will not find short comings observed by you in this book.
Regards,
Dr. Mukesh Raghav
M.B.,B.S;M.S.,FICG.
Associate Professor,
Deptt. Of obstetrics & Gynaecology,
S. P. Medical College ,
Bikaner : 334003.
Email : drmraghav@yahoo.co.in Lohri,2009
ABOUT THE AUTHOR
Dr. Mukesh Raghav, born 1956, did his M.B.,B.S.M.S. ( Obst. & Gynae. ) from University of Rajasthan. At present wrking as Associate professor in the Department of obstetrics & Gynaecology, S.P. Medical College, Bikaner., after serving as Assistant Professor for 21 years.
In his credit he has got number of research papers published in various National journals and in Popline sponsored by the John Hopkins University, Baltimore, United States of America., Has read number of scientific article in various conferences. Stood first in Paper competition at Rajasthan Obstetrics and Gynaecology Conference.
He is life member of Indian Medical Association ,Life member of SPMC International Club .,Life member of RMCTA and is an active member of Bikaner branch of Federation of Obstetrics & Gynaecology society of India.
He has been awarded with the fellowship of Indian College of Geriatrics. He rendered commendable job for family welfare programme and has been awarded at District level, in addition he is Family planning Counselor.
He has contributed Obstetrics and Gynaecology portion of Mediword’s medical Examination review,1994 and another book on Obstetrics & Gynaecology MCQ’S is under print.
Besides Medicine the other areas of interest are dramatics, Cartoonist, debaters and writer on health topics for Delhi press publications and number of talks & discussions on All India Radio, since 1976.
Dr. Mukesh Raghav.
I-D/107, J. N. Vyas Colony,
BIKANER :334003
DEDICATED
TO
RESPECTED
MUMMY
&
PAPAJI
INDEX
Instruments
Gynaecologists are in their blues, when during an examination Operation of a patient, they forget to have instruments in their Instrument Tray. Instruments commonly used by Gynaecologists are discussed herewith.
SPECULUM:
Speculum is necessary for the examination of Vagina and the cervix.
Various types of Speculums are available, as:
1. Sim’s Speculum
2. Cusco’s Bivalved speculum
3. Ferguson’s Speculum
4. Duck Bill’s Speculum
5. Auvard’s Speculum
Out of the above former two are used in routine clinical practice., depending upon their mode of function, they can be categorized as:
A. Self Retaining Speculum:
i) Cusco’s Bivalved
ii) Auvards
B. Non Self retaining Speculum:
i) Sim’s Single bladed
ii) Sim’s Double bladed
SIM’S SPECULUM:
Features:
i) Light weighted and made up of Stainless Steel.
ii) Single bladed has a handle and a blade at right angle, while double bladed has two blades on two poles. Central portion of both can be used to handle or to have a grip.
iii) Both the blades of double bladed Speculum has different sizes, to be used for different technical advantages.
How to use it ?
a. Patient is put in Lithotomy or Sim’s position depending on the technique or operation to be performed, preferably if possible an assistant can be of great help.
b. Under all aseptic and aseptic conditions, the Labia minora are separated by thumb and Index finger of left hand.
c. Hold the Speculum in Right hand and insert along it’s edge with the blades lying vertically in anterior posterior diameter of Vagina, the instrument is then rotated into it’s position after introduction.
Indications:
1. Inspecting Vagina & Cervix
2. Dilatation of Cervix
3. Curretting Uterine cavity
4. Biopsy from Vagina & Cervix
5. Endometrial Biopsy
6. Cauterization of Cervix
7. Removing IUCD thread
8. As a routine per Speculum examination
9. Repair of Cervical tears
10. Anterior & posterior Colpo perineorrhaphy
11. Repair of Vesico vaginal fistula
12. Fothergill’s Operation
13. Tubal Insufflation test
14. Chromopertubation
15. Hystro salpingography
16. Introducing Radium Modules.
In most of the indication cited above, it plays a secondary role except in (1) and (8)
Dis advantages:
a. Assistant is required to hold the speculum
b. For better view of Cervix, another Speculum for retracting anterior Vaginal wall is required.
c. Posterior Vaginal wall can not be seen.
Viva- Voice:
Q.1. Which Speculum you will like to prefer ?
Ans: Sims Bivalved.
Q.2. Patients position of your choice?
Ans: Lithotomy, if not possible Sim’s position.
Q.3. What do you mean by Sim’s position?
Ans: In brief, it’s exaggerated left lateral position.
Q.4. Enumerate the conditions/ diseases, where this instrument can not be used?
Ans: They include- i) Vaginal malignancy
ii) Removing Vaginal Cyst from posterior Vaginal wall
iii)Repair of Recto vaginal fistula/ perineal tears
iv) Posterior colpo perineorrhaphy.
Q.5. How do you sterilize this Instrument?
Ans: Autoclaving, if not available by just boiling for 10 minutes.
CUSCO’S BIVALVED SPECULUM:
Features:
1.Self retaining, has two hinged blades, which are adjustable.
2.Cervix can better be visualized.
3.Introduced in the vagina with closed blades, then the blades are opened and adjusted.
Aadvantages:
1. No Assistant required.
2. vaginal wall can be retracted to variable extent.
3. causes least pain to patient.
4. cervical visualization or operation can easily be performed.
Dis advantages:
1. Space of Vagina is being obliterated by instrument, hence difficulty for surgeon., for better movement in Operative technique.
2. Visualization or operation of vaginal wall is not possible.
AUVARD’S SPECULUM:
Features:
1. It’s the heaviest speculum.
2. Blade is having a central depression.
3. It’s a mechanical self retaining posterior vaginal wall speculum.
4. It has flange with two holes, to which weight can be attached as self retaining device.
Viva- Voice:
Q.1. What is the weight of instrument?
Ans: Nearly 45 – 50 Ozs.
Q.2. Can this instrument be used in routine?
Ans: No.
Q.3. Can it be used in Gynaecology OPD’S
Ans: No.
Q.4. Any anaesthesia you will like to give before inserting this instrument?
Ans: Yes, depending on duration of surgery, Local or General anaesthesia can be given.
Q.5. Is there any chance of perineal laceration or tears after it’s use ?
Ans: Usually not, but in puerperal patient the possibility can not be ruled out.
Q.6. Patient must be complaining of Pain after it’s use/
Ans: Yes, Occasionally.
Q.7. Have you/ Yourself or seen any surgeon using it?
Ans: No, Now a days most of surgeon prefer Sim’s hence, I will also like Sim’s Speculum.
FEMALE CATHETER:
Catheter are the Instruments or devices ment for emptying the urinary
bladder. They may be-
i) Simple Catheter
ii) Rubber
iii) Polyurethane
iv) Metal
v) Self retaining Foley’s Catheter
Simple Metal Catheter for females
It is hollow metallic tube, straight or may be curved, tapering at the tip with an opening at the side and a ring at the base.
Functions:
1. In addition to emptying the urinary bladder the instrument is of help in differentiating between Vesico Vaginal fistula and Urethro Vaginal fistula.
2. To even diagnose a Vesico Vaginal Fistula.
3. To ascertain lower limit of the bladder before operations for genital prolapse.
ANTERIOR VAGINAL WALL RETRACTOR:
Features:
1. Also known as Sim’s Anterior Vaginal wall retractor.
2. Has loops with slight angulation at both ends, loops are ridged or transversely serrated.
3. It is used to push back the anterior vaginal wall upwards., in multipara where the walls are lax and hanging over the operating field.
4. Other than multipara, indications for it’s use are loose and lax vaginal walls and moderate Cystocoele.
5. It can not be used alone, needs the help of a Speculum to retract posterior Vaginal wall.
SPONGE HOLDING FORCEPS:
( Also known as Rampley’s sponge holding forceps or Swab holding forceps)
Features:
1. Made up of Stainless steel, having a hinge in the middle.
2. Tip is ring shaped with transverse serration.
3. Other end of the forceps is having locking device, so as to function as holding forceps.
Uses:
1. Swabbing the operative field for dis infection.
2. Holding the sponge and swabbing the vagina.
3. In case where the cervix is soft, the instrument can be used to hold the cervix.
4. For Removing product of conception , when Ovum forceps are not available or even available ( in selected cases ).
5. Vaginal packing.
6. Applying medication to deep seated areas.
7. Swabbing and applying pressure over the small areas which are oozing.
Viva – Voice:
Q.1. Why the tip of instrument is serrated?
Ans: To have a firm grip.
Q.2. What’s the use of having lock in the Instrument?
Ans.: So the loose pieces of foreign particles ( or Gauze ) may not be lost in the abdominal cavity, while doing swabbing.
Q.3. Suppose you are using this Instrument in place of Ovum forceps and accidentally pregnant Uterus gets perforated accidentally. How you will manage?
Ans.: I will manage the patient as-
i) Monitor the general condition of the patient
ii) Amount of blood loss per vaginum will be assessed
iii) Infusing Oxytocin/ Inj.ergotamine maleate / Injection Prostaglandin to be given depending on the condition of the patient.
iv) If the general condition of the patient is deteriorating , I will not hesitate in opening the abdomen ( Laparotomy )
Q.4. If the product of conception are in Uterus and uterus have been perforated, you will like to remove remaining products by Hystrotomy or not?
Ans.: Not necessarily, I will proceed for Laparotomy and see for the rent in the uterus , through this rent I will like to remove the products and will stitch the rent.
Q.5. Suppose the rent is not clear, still peritoneum is covering the rent, what change in the management you will like to make?
Ans.: I will like to request my assistant for continuing removing the products under my supervision, as abdomen is already open and if perforation takes place, we will manage accordingly.
Q.6. If slight oozing is there from that site, you will like to interfere?
Ans.: I will like to press that area for time being, if at all bleeding does’nt stop, I will not hesitate in applying a stitch but this will be done keeping in mind the general condition of patient.
VOLSELLUM FORCRS:
Features:
1. It is made up of Stainless Steel.
2. Tip of the instrument is toothed for the firm grip and to cause minimum trauma.
3. Has got a curvature so as to help in retracting anterior vaginal wall.
4. Other end of the instrument has got a locking arrangement.
Uses:
1. Chiefly used to hold the cervical lips for different indications.
2. To hold the fundus of the uterus mostly in vaginal Hysterectomy and occasionally in cases of Abdominal Hysterectomy.
3. To remove Fibroid polyps.
4. To arrest the mobility of cervix.
5. In rare cases where the cervix is merged with vagina the biopsy from that area can be taken.
Viva – Voice:
Q.1. Because of sharp teeth, it causes bleeding, how you will manage?
Ans.: Certainly, in most cases it happens but is controlled by haemostatic mechanism., If the bleeding is profuse a stitch can be applied to achieve homeostasis.
Q.2. The Instrument is single toothed or multiple?
Ans.: Multiple.
Q.3. Who invented the Instrument?
Ans.: ‘Teal’ invented the Instrument hence sometimes named as “Teal’s Volsellum Forceps”.
Q.4. Is the curvature in Instrument is essential?
Ans.: Yes, for retraction of anterior wall and better view of operative field it’s necessary , otherwise straight variety of volsellum forceps are also available.
Q.5. Can this Instrument be used for culdocentesis in cases of ectopic gestation?
Ans.: Yes, it is routinely used in this method to hold posterior lip of cervix., concisely the volsellum forceps can be used where surgeon wants firm grip and can sacrifice the trauma of teeth and bleeding, if any.
Q.6. What are different indications for catching posterior lip of cervix?
Ans.: The Indications are-
i) Cervix is torn, friable and having a growth on anterior lip of cervix
ii) Fothergill’s Operation
iii) Vaginal Hysterectomy
iv) Posterior Colpotomy
v) Vaginal Tubectomy ( now a days not being performed because of higher sepsis rate, availability of better techniques and dyspareunia).
Q.7. How you will sterilize the Instrument?
Ans.; Only by Autoclaving.
TENACULUM FORCEPS: ( named after Jarcho)
Features:
1. It has Sharp , single teeth at one end and to have a firm grip.
2. Made up of Stainless Steel with a hinge in the middle.
3. Other end of the Instrument is having a locking device.
Uses:
i) Used in Operations where holding of anterior lip of cervix is required.
ii) Enucleation of seedling Fibroids during Myomectomy.
iii) Can be used to insert laminaria tent in the cervix, but now a days it’s obsolete.
iv) In the event of shortage of Towel clip , this Instrument can be substitute.
SOUNDS:
In routine two types sounds are in use in general practice
i) Simpson’s uterine sound.
ii) Bladder sound.
SIMPSON’S UTERINE SOUND:
Features:
1. Instrument is made of Stainless Steel
2. Apex is blunt, while opposite end is flat, for holding
3. It is graduated usually in inches, however now a days graduation in cms. is also available.
4.Length is usually one feet.
5.Two and half inches away from the end there is a knob marking for normal utero cervical length, with an angulation of 60 degrees
Precautions for it’s use:
Bimanual examination should always be done before using this instrument to detect the position of cervix., so that sound is passed in required direction and to avoid danger of uterine perforation.
Uses:
1.To find out length and direction of uterine cavity
2.To correct mobile retrovers
3.To determine the relation of any pelvic mass to uterus 4.Used routinely before Operation of Uterus and Cervix e.g. Dilatation and curettage
5.To determine abnormal uterine contents viz. polyps, placenta, product of conception, tumours and IUCD with missed threads
6.To differentiate between sub mucous fibroid and sub acute inversion of the uterus
Contra indications:
i) Missed period, suspicion of Pregnancy
ii) Pregnancy
iii) Uterine Sepsis
iv) Clinically visible Infected cervix
v) During puerperium
Complications:
A. Haemorrhage
B. Perforation of Uterus
C. Peritonitis
D. Vaginal sepsis may be carried out to Uterus and adenexa
viva – Voice:
Q.1. Why this Instrument is malleable?
Ans.: So that Instrument can adopt itself to the position and direction of the uterus.
Q.2. How you will hold this Instrument?
Ans.: Very gently, just like holding a pen
BLADDER SOUND:
Most of the times this Instrument is being confused by Uterine sound, hence for convenience, the differentiating points are:-
i). Length is smaller than uterine sound
ii). Not graduated
iii). Curve of this instrument at apical region is uniform
iv). There is no knob or angle on it.
Features:
i) Non graduated metallic rod, preferably of Steel
ii) Length of this sound is 10 cms.
iii) Length after the curve is very small nearly 1- 1.5 cms
Uses:
A. To define the limits of Bladder during operation on anterior vaginal wall & in cases of anterior Colpo perineorrhaphy
B. To determine relation and position of Urinary fistulae in the vagina
C. To diagnose Vesical calculus
D. To differentiate between Cystocoele or Urethro coele and anterior vaginal
Wall cyst.
E. To detect foreign body in urinary bladder
Complications:
i) Urethral sepsis
ii) Cystitis ( Bladder Infection)
CERVICAL DILATORS:
These are metallic Instruments, mostly used to dilate the cervix, usually for diagnostic/ therapeutic purposes. Commonly used varieties are:-
1.Hegar’s dilators :
a. 6 double ended and 25 single ended
b. Diameter varies from 3 to 26 mm.
2.Hawkins Ambler’s dilators:
a. Used commonly for Obstetrical use
3. Rare varieties are:
a. Goodal’s dilators
b.Bossi’s dilators
c.Fenton’s dilators
d.Frommer’s dilators
HEGAR’S DILATORS:
· They are metallic
· Each dilator differs 1 mm in diameter from one another adjoining one
· Single bladed , on one side are flat for holding the dilator properly and other end is tapering and round
METHEW DUNCAN’S DILATORS:
They can be identified from a distance even, besides metal base they are long and rounded.
On one end for better holding the wider area has been marked, while other is same tapering and rounded.
Viva – Voice:
Q.1. Can the Instrument be used just after boiling?
Ans.: No, preferably instrument should be autoclaved and then used.
Q.2. What are the different indications of dilatation of cervix?
Ans.: The indications are: i) Diagnostic ii) Therapeutic
Diagnostic Indications are:
· Intra Uterine manipulation
· Tubal Insufflation test
· Fothergill’s Operation
· To confirm Incompetent Os
· Insertion of Radium Implants
· Various Operations on cervix
· Before Hysteroscopy
Therapeutic Indications are:
Spasmodic Dysmenorrhoea
Cervical Stenosis
Pyometra
Q.3. How you will know that Instrument has crossed Internal Os?
Ans.: Sudden loss of resistance and when left inside, remain in site otherwise it falls or extruded out.
Q.4. Enumerate various complication of dilatation of cervix.?
Ans.: The complications are:-
1. Cervical tears
2. Perforation of Uterus
3. Haemorrhage
4. Shock
5. Sepsis
6. Cervical Incompetence
7. Cervical Stenosis following healed lacerations.
Q.5. What are the contra indications of their use?
Ans.: The contra indications are:
A. Pregnancy or suspected Pregnancy
B. Sepsis in genital tract.
Q.6. Can the instrument , be used in puerperal patients ?
Ans. It’s not an absolute contra indications , can be used with great caution as puerperal uterus is soft, otherwise also there is hardly an indication for its use.
Q.7. If you are the treating surgeon, which type of dilators you will prefer to use and why?
Ans.: I will prefer to use Hegar’s single ended dilators because of curve they have and secondly the grip on this Instrument is firm.
UTERINE CURETTES:
These are metallic Instruments used for curetting the endometrium., depending on the integrity of Uterus and indication. Various types are available.
Functions:
The Instrument has a tip with an edge., when the tip moves in contact with the endometrium, the endometrium is being scrapped out. Usually the Instruments are having a handle for grip, otherwise central part is ridged to act as a handle.
Types:
Blunt Curette
Sim’s Sharp Uterine curette
Flushing curette ( Gottstein’s )
Biopsy curette
Simple endometrial biopsy curette
Randall’s suction endometrial biopsy curette.
Combined Blunt and Sharp curette ( Blake’s )
Indications for curettage:
The Indications can be divided in two-
· Diagnostic
· Therapeutic
Diagnostic curettage indicated in-
1. Sterility
2. Functional Uterine bleeding
3. Tubercular Endometritis
4. Endometrial Carcinoma
Therapeutic curettage indicated in –
i) Incomplete abortion
ii) Missed abortion
iii) Vesicular mole
iv) Dysmenorrhoea
v) Functional Uterine bleeding
Indications of Dilatation and curettage-
A. Dysfunctional Uterine bleeding.
B. Sterility.
C. Menopausal and post menopausal bleeding.
D. Prior to insertion of radium needles for producing ‘Artificial Menopause’ or treatment of cancer.
E. Cases of vesicular mole and follow up.
F. Cases of Sub involution of Uterus, Metropathica hamorrhgica and Chronic endometritis.
G. Suspected malignancy of Uterus or Cervical canal.
H. Mennorrhagia.
I. Misuse of hormones or unsuitable intra uterine device.
Uses of Blunt or Blunt flushing curette-
1. To curette out thick deciduas of Pregnancy in cases of incomplete or inevitable abortions.
2. Some cases of Vesicular mole.
3. To flush out the Uterus to control Post abortal hemorrhage or post partum haemorrhage.
Advantages in use of endometrial biopsy curette-
1. Can be used without dilatation of curette.
2. Can be used without anesthesia.
SHARP UTERINE CURETTE:
This is a metallic Instrument having handle on one end and sharp edged loop on the other., with the advantage of it’s sharp edge and a broder area, the time period in experienced hands is less.
Disadvantages:
The Instrument is prone to cause dangerous perforation of uterine wall, requires at least dilatation up to Hegar’s No. 10 dilators for it’s free mobility.
BLUNT AND SHARP CURETTE ( BLAKE’S ) :
Both the ends are provided with loops, at one end its sharp and at other one it’s blunt., Because of ridge in the middle part, which act as a handle. The Instrument have to be autoclaved.
FLUSHING CURETTE ( GOTTSTEIN IRIGATION CURETTE)-
1. It’s Metallic one.
2. Hollow Instrument.
3. Proximal end has a spoon shaped fenestrated blunt loop.
4. Other or distal end of the curette has a facility for attaching rubber tubing for the purpose of suction.
Viva –Voice:
Q.1. At what time you will like to take curetting?
Ans.: Just before menstruation i.e. Pre menstrual phase.
Q.2. How long to curette?
Ans.: Till there is gritty sensations.
Q.3. What are the various dangers?
Ans.: Dangers includes perforation, hemorrhage and sepsis.
Q.4. What happens, if curettage is done after septic abortion?
Ans.: Curettage will break the leukocyte barrier and help in precipitation of septicemia.
Q.5. Gritty sensations during and after curettage is because of ?
Ans. This is due to the scrapping off of the stratum spondeosum layer of the endometrium.
Q.6. Enumerate difference contraindication of curettage?
Ans. i) Pregnancy or suspicious pregnancy .
ii) Cases of septic conditions of genital tract for fear of spreading infection.
iii)Gross malignancy- a relative contra indication as continuation of curetting will lead to hemorrhage, patient may go in shock.
ENDOMETRIAL BIOPSY CURETTE:
Features:
· Blunt tipped, hollow metallic instrument.
· Near the tip has got a notch with cutting edge.
· Slight angulation is there on Instrument about 6 cms. from the tip.
· A stillete has been provided to remove the biopsied tissue.
· Can be used without dilatation of cervix and without anaesthesia.
· Sterilized by autoclaving.
CERVICAL PUNCH BIOPSY FORCEPS:
Features:
1. It has got a punched end, slightly curved with locking device.
2. Punched end have basket like facility to hold the specimen firmly.
3. It is used to remove suspicious areas of cervix, can be located clinically or by Schiller’s test and biopsied material to be sent for histo pathological examination.
4. In most of the cases, after taking biopsy, achievement of haemostasis is required, usually after applying 2-3 interrupted stitches with chronic Catgut No. One, otherwise vaginal packing must be done simultaneously.
LAMINARIA TENT INTRODUCER:
Features:
i) It is used to introduce tent for cervical dilatation.
ii)The blades of Instrument when closed, make a circular grip improvised to grasp and introduce laminaria tent.
iii)Laminaria tent is made of cylindrical material made from sea woods., having a property of absorbing moisture and swells up, as such acts as a slow dilator. On an average it takes 24 hrs. for the action to complete, but may require more. The tent is to be sterilized in absolute alcohol for two days., because of more chances of infection.
iv)Now a days used very rarely as in cases of missed abortion, in vesicular mole and lastly before putting radium needles
v)After all aseptic and antiseptic technique the laminaria tent is placed in cervical canal and vaginal packing is to be done to prevent displacement.
vi)Patient is being advised Bed rest and secondly to inform duty doctor about bleeding if there is, and if tent comes out.
RUBIN’S TUBAL INSUFFLATION CANNULA:
Features:
A. Instrument was designed by Rubin for performing Rubin’s test in early 19’s.
B. Patency of fallopian tube can be checked by the instrument in cases of sterility.
C. Hydrotubation can also be performed by this metallic instrument , where there is need to open closed fallopian tube caused by mild adhesions or plugs of mucous.
D. Hystero salpingography.
E. Diagnostic laparoscopy can be performed with the Instrument.
Contra indications:
i) Sepsis of genital organs.
ii) History of recent pelvic infections.
iii) During menstruation or in presence of bleeding from the genital organs due to some cause or other pathology.
iv) Serious constitutional diseases
· Cardiovascular
· Respiratory
· Hepatic
v) During Pregnancy.
Dangers:
· Air embolism.
· Sepsis.
· Shock.
· Abdominal and Shoulder pain.
· Rupture of Uterus and tubes.
· Regurgitation Endometriosis, if not done at proper time.
Precautions:
i) Best time for the test is first 10 days after menses.
ii) Never raise pressure above 200 mm of Hg., to avoid rupture of fallopian tube.
iii) Never pump more than 160 cc. of Carbon dioxide or Air.
iv) Rate of flow of gas should not exceed 60 pc. Per minute.
v) If Shoulder pain is severe, patient should be kept in knee chest position for 15 – 20 minutes off and on.
Method:
i) Urinary bladder must be empty before the test is performed.
ii) Patient must be Lithotomy position.
iii) Under General anaesthesia toilet Vulva and vagina.
iv) Verify the size and position of Uterus by Bi- manua examination
v) Introduce the cannula in the axis of cervix, just to cross the Internal Os and in the uterine cavity.
vi) The cannula is connected to a inflator and manometer for
measuring rise and fall of pressure.
vii) Put Stethoscope over lower abdomen over tubal areas and gently pump in gas with the inflator.
viii) In normal women with tubes patent when the pressure with in uterus rises 60 – 100 mm., the manometer sho sudden fall of pressure and we hear a hissing sound due to the escape of gas in peritoneal cavity. If doubt X-Ray is to be taken to see gas under the diaphragm.
Rational of the test:
Yes, it’s true that by declaring tubes patent after a single test is not possible, after performing test for 3-4 times one can go for conclusion, but on other side of the coin, by this test apart from diagnosing the cause of infertility, this test may also cure infertility by just-
· Straightening out a kinked tube.
· By breaking down mild adhesion in the tube or in the uterine cornue.
Complications of the test:
1. Ascending Infection.
2. Air embolism.
3. Peritonitis.
4. Cervical Incompetence.
5. Tubal rupture.
OVUM HOLDING FORCEPS:
Features:
i) It’s a metallic instrument with cupped blade with linear fenestrations.
ii) Tip of the Instrument has been deviced in view to have minimum damage to the surrounding organs and the organ itself.
iii) It has no locking device, blades allow to hold a reasonable amount of tissue with a good grip.
iv) It helps in -
· Removing Ovum.
· Removing Placenta and it’s membranes.
· Removing Foreign bodies.
· Also it can be used in removing twisted pediculated polyps.
NEEDLE HOLDERS:
It is an Instrument used for grasping a needle, applying stitches with little force in a cavity or in other parts of the body which are deeply seated.
Tip of the blade of the Instrument is smaller and pointing and having serrations in crisscross fashion, over the inner surface of which already have a groove for better adjustment and firm grip over the shaft of the needle.
Various type available are-
· Straight ( Blalock’s)
· Curved ( Kilner’s )
In both the types three sizes are available from small, medium to long.
In Gynaecological practice the commonly used, one is Kilner’s curved needle holder. It is used to hold the needle during suturing at depth and at the walls of a shallow cavity, where the curve gives a better view of the tip of the instrument without obstructing the operative field.
The Instrument is sterilized by autoclaving preferably or by boiling.
HAEMOSTATIC FORCEPS:
These forceps are of utmost importance to the Gynaecologists as Operative field is better visualized, because of lack of oozing helped by haemostatic forceps. The commonly used are-
· Artery Forceps.
· Spencer-Well’s Haemostatic ( Non toothed) forceps.
· Kocher’s Artery forceps ( toothed ).
· Green Armytage forceps.
ARTERY FORCEPS:
The Instrument is basically used for haemostatic purposes, can be classified on the basis of size and shape. They are –
· Small or mosquito - Straight
-Curved
· Medium - Straight
-Curved
· Large or Pedicular
Uses of Artery Forceps:
1. As a hemostat.
2. As a pedicular clamp.
3. To crush fallopian tube.
4. To hold needle as a substitute of needle holder, to hold sutures left long during major or minor surgeries and to hold cut end of fascias.
5. To open up the Abscess cavity, breaking the loculi as in Breast abscess.
MOSQUITO ARTERY FORCEPS:
This metallic Instrument has got the features of Artery forceps except that-
· It is small in size.
· Has relatively pointed tips.
· Handle of the Instrument can be locked.
· Inner surface of the tip is serrated transversely.
Uses:
1.As Hemostat, stops bleeding by crushing the bladder.
2. As peanut ( Hold Gauze palletes ) for blunt dissection.
SPENCER- WELL’S HAEMOSTATIC FORCEPS:
These metallic Instruments are the variety of Artery forceps. In addition to straight and curved types, all the varieties ranging from long to short are available.
Features:
· Size of the blade is roughly half than handle.
· Inner surface of the blade is serrated transversely.
· The tip of the Instrument is Un toothed and Conical.
· Handle has been provided with a lock.
KOCHER’S HAEMOSTATIC FORCEPS:
Metallic Instrument, a variety of Artery forceps.
Features:
1. The blades are comparatively narrow and long, having a single sharp tooth at it’s tip.
2. Blades in addition to a tooth has transverse serration.
3. Two types are available- Straight and Curve.
4. Because of tooth it holds the bleeders effectively.
Uses:
· Holds the retracting cut ends of the vessels in tough fibrous tissue.
· Holds the pedicles in cases in major surgeries.
· Can be used for Artificial rupture of membranes.
· Holds the pedicles with minimum trauma to adjoining tissues.
GREEN ARMYTAGE FORCEPS:
Features:
Solid metallic Instrument for compressing the broader area of tissue.
The tip of Instrument has triangular blades with a serrated edge, other end of Instrument as in haemostatic forceps has a locking device.
The small space is left between the blades even when the forceps is fully closed.
In the Operations on Uterus viz. Caeserean Section, the Instrument in addition to haemostatic action, acts as a retractor also.
BABCOCK’S TISSUE FORCEPS:
Features:
1. Metallic Instrument with the tip or blades which are curved.
2. Blades are fenestrated and have a transverse bar, which is also serrated transeversly.
3. Handles are provided with catches.
4. Very light Instrument for use, cause minimum trauma to the tissue, helps in holding soft tissues and delicate structures.
Uses:
· Tubectomy.
· Tuboplasty.
· Holding the fallopian tube in different Operations .
· Holding the Intestines in Abdominal surgeries.
· Removing the adhesions surrounding the tissue to be Operated.
ALLIS TISSUE FORCEPS:
Features:
1. Very light Instrument for holding the tissues.
2. Tips are slightly curved for a better grip on tissues.
3. Tips having teeth which are interlocked.
4. Opposite end is having catches.
5. Because of less space between the blades it holds thinner structures, like fascia, Rectus Sheath and fibrous tissue of any capsule very firmly.
DISSECTING FORCEPS :
Features:
Helps in holding the tissue and help in maintaining a clear Operative field, keeps the dealing part straight as such helps in firm needle bites for suturing .
Two types of Dissecting forceps are commonly used –
· Non – toothed
· Toothed
NON TOOTHED DISSECTING FORCEPS:
Features:
· The Instrument is used to hold friable and soft tissues without causing much injury.
· The handles of the Instrument has spring like action.
· For better holding on the tissues the blades are transversely serrated.
· Central portion of outer surface has few ridges to give a better grip, inspite of all these measures sometimes tissue slip out from the spring mechanism of the two armed Instruments.
TOOTHED DISSECTING FORCEPS:
Features:
· This Instrument is nearly of the same variety as non toothed, except a tooth at the centre of the blade.
· Because of the tooth it give better grip on the tissues, tooth holds the tissue and definitely less injury is inflicted on neighboring tissues.
· Tooth does not permit the tissue to slip out, but in cases of soft and friable tissues, the Instrument has got it’s own limitations.
BARD PARKER KNIFE HANDLE:
Features:
Two types of blades are available now a days-
Handle with detachable blades.
Handle with combined blades.
Former is used quite frequently for simple reason of it’s being versatile type of Instrument, by simply changing the type of blades, a knife handle can be used for incision making and other dissections.
Second factor or advantage of use of such handle is that deterioration of it’s sharpness is easily done away with , by simply changing the blades.
SCISSORS:
Features:
The Instrument used for blunt as well as sharp dissection and also for cutting various sutures and tissues.
The Scissors are available in various sizes and shapes and can be used accordingly.
STRAIGHT SCISSORS:
Shape of the Instrument is Straight, the tip may be blunt or Sharp otherwise the action of almost all the scissors is same.
CURVED OR ANGLED SCISSORS:
The curvature of the scissor is again of two types-
Curved on flat scissors.
Curved on angle scissors.
Curved on flat Scissors:
This Scissors is curved in vertical plane along it’s longitudinal axis, such a Scissors is preferred while undergoing surgery in depth.
Curved on Angle Scissors:
The blades are curved at an angle, along it’s long axis in the horizontal plane. The Structure which are obliquely directed are better cut by such scissors. Irrespective of the type of scissors used the scissors should always be held in right hand with a firm grip to have a firm and steady control over the scissors. The other hand may be used to support the scissors from below if required.
UTERINE HOLDING FORCEPS:
Features:
The metallic Instrument used for holding the uterus, during Operation. The blade are protected with rubber tubes to minimize trauma to the uterus. This Instrument is specially used for holding the uterus. Salpingectomy operation , oophropexy, and Gilliums operations. Uterus is pushed anteriorly through the fundus to retain retroverted uterus in position, While the round ligaments are plicated and sutured together in front of rectus.
MYOMA SCREW:
The shape of the Instrument is such that Identification is quite easy. This screw is used in the operation for the removal of Fibroid Uterus. The Instrument is Screwed into the myoma to give a good grip in the tumour masses., and it adds manipulation and removal of Fibroid.
BONNEY’S MYOMECTOMY CLAMP:
Features:
1. Stainless steel instrument
2. Rubber cap over its blades
3. Two pair of finger grip’s, proximal and distal present; with a ratched lock on the handle near the proximal finger grip.
4. The blades are at an angle of about 120˚ with the handles.
5. Two overlapping transverse bars are attached to the blades one each, dividing the space between two blades into two equal parts.
6. The distal finger grips are used during the application of instrument because blades can be operated wider.
7. For tightening the lock as well as releasing it, the proximal grip is to be used as they offers greater degree of mechanical advantage than the distal one.
Sterilization:
Instrument is sterilized by autoclaving or boiling, but rubber caps over it by chemicals.
Indications:
1. Hysterectomy 2. Myomectomy
AYRE’S SPETULA
Features:
Usually the Instrument is made up of wood, but now a days spatula made of plastic and stainless steel are also available.
The length of this Instrument is 15 to 17 cms.
One end of the Instrument is larger ( 3 cms.) while the other one is comparatively shorter ( 2 cms.)
The Instrument is to be sterilized depending on the material of spatula, they are sterilized as follows-
Wooden spatula – Dry hot air oven.
Plastic spatula - Antiseptic solutions like cetrimide or Habitane.
Stainless steel spatula – Autoclaving or boiling.
Indications:
Cytological screening for-
Cervical malignancy.
Upper genital tract malignancy.
Hormones assessment.
Graham’s test.
Buccal smear for evaluation of Barr bodies.
Procedure:
The smear can be prepared as an outdoor procedure
The Bi manual examination should not be done before making the slide.
Expose the cervix.
Insert longer end of spatula into external Os, while the shorter in direct contact of Portio vaginalis., rotate the Instrument through 360 degrees.
Material collected on the slide must be fixed in a mixture of equal amount of ether and absolute alcohol.
A great caution must be taken in patient with bleeding per vaginum or Vaginal Infection . In these cases smear should not be prepared, so as to avoid false positive / negative reports.
PINARD’S FETAL STETHESCOPE:
The Instrument is funnel shaped having a broad flat disc with central perforation attached at the narrow end of the channel at right angles to the long axis of the funnel.
It is used to hear fetal heart sounds in the antenatal and the intrapartum period.
The broad end of the Instrument is placed over the maternal abdominal wall, the ear is placed over the other end , Instrument being perpendicular to the maternal abdominal wall .
This Instrument can be made of wood or metal, but because of the cost factor usually metallic is used.
The Stethoscope is lacking in diaphragm but stretched maternal skin serves the purpose of the diaphragm.
Now a days the Instrument is not being used to frequently particularly by young obstetricians, who prefer to use routine Stethoscope or other modern fetal monitoring devices, hence in the future the scope of this foetal Stethoscope seems to be in doldrums.
RETRACTORS:
Execution and planning of surgery needs good exposure of the operative field hence, retraction of the tissue to give better exposure of the surgical field is of utmost importance.
It plays a key role in surgery by-
Better view of Surgical field.
Prevent damage to adjoining tissues.
Homeostasis can be achieved under direct vision.
Provided the retractor is to be placed at correct site and angle, traction must be measured otherwise damage to the tissue can take place.
Types of Retractors:
A. Simple or plain retractor.
B. Self retaining retractor.
Czerny’s Retractor:
This Retractor is a simple variety of retractor, widely used in mini laparotomies and sometimes in cases of Vaginal Hysterectomies.
It is characterized by a biflanged hook on one corner while other is having a blade. Its one of the lightest retractor because of the fenestra at its shaft. The retractor has been devised or used only for superficial retraction at its shaft. The blades retracts the margins of the wound while biflanged end can be used for retraction of deeper level for applying stitches.
Deaver’s Retractor:
Features:
The metallic Instrument being used to retract broad area of tissue., depending upon the retraction required medium or large Deaver’s retractor can be used. Because of metallic sharpness, better to apply a pack between blade and viscera to prevent direct injury to the tissue.
It has got-
· Curved blades.
· Other end of the Instrument is provided with a smaller blade or a neck to have a firm grip.
Advantages:
1. Curve of the retractor prevents damage to adjoining viscera’s.
2. During Total abdominal hysterectomy, this is being used to retract bladder. The Instrument retracts uterus for facilitating separation of posterior peritoneum.
Self Retaining Retractor:
Features:
As the name suggests these are self retaining , no assistant is required for retraction of tissue, particularly in abdominal surgery.
Secondly a constant traction can be applied by the instrument, hence minimizing the trauma to the tissues.
The Instrument is solid, metallic with a provision for retracting the tissues to the extent which ever is desired, because of locking arrangement.
In addition it has got two blades, tip of blades are blunt, so as to minimize the Injury.
Sterilization as with other metallic instruments, should be done by autoclaving.
Embroyotomy Scissors:
Features:
It is used in Destructive Operation like –
· Cleidotomy.
· Evisceration in cases of locked twins.
· Impacted Shoulder presentation when neck is out of reach.
· Obstructive delivery due to enlargement of foetal abdomen as in cases of –
Ascitis.
Tumour.
As name suggests it is a scissor, but comparatively long and having a slight curvature.
Precaution to be taken are- Cutting and handling with the instrument must be done under direct feel or vision and in doing by former method finger must be placed between the scissor and part to be cut, so as to prevent damage to adjoining structures/ tissues.
Decapitation:
Features:
This is the procedure which means separating the foetal head from it’s body to facilitate vaginal delivery. This procedure requires the help of the following instruments.
1. Decapitation Knife.
2. Decapitation saw – used in lock twins.
3. Decapitation hook – It dislocates and cuts the neck of the foetus at the same time., can also be used in application of traction in Breech.
4. Blunt hook and Crochet-
· It is used to extract the decapitated head.
· To extract a perforated head in cases of after coming head in Breech presentation with dead foetus and in Hydrocephalus.
· Dead child in face and Brow presentation after perforation hooked into orbit or mandible and traction applied.
Indications of Decapitation:
1. Neglected Shoulder presentation with hand prolapse and dead foetus.
2. Double or conjoined monsters.
3. Locked twins.
Procedure:
Decapitation saw or hook is passed along with the back of child under guidance of hand. Tip of the Instrument should not point towards bladder. After decapitation the body is delivered by pulling the prolapsed hand and then the head is delivered by applying Supra pubic pressure and hooking it with Crochet.
SIMPSON’S PERFORATOR:
Features:
The Instrument is used for craniotomy. It has a triangular sharp pointed end with cutting sides. When the handles are pressed together the cutting edge of the tip are forced apart. There is a simple lock at the end.
Uses:
v To perforate skull of dead foetus in cases of Hydrocephalus.
v Impacted after coming head in Breech.
v Obstructed labour due to contracted pelvis where foetus is dead when caesarean section is refused.
v Failed forceps and baby is dead.
Sites of Perforation:
The sites depends mainly on the presenting part, as:
v Vertex – Anterior or presenting parietal bone.
v After coming head – Occiput.
v Face or Brow – Palate or Orbit, may be frontal bone in cases of Brow presentation..
Advantages of Bone perforation over frontanellae perforation:
Ø Frontanellae being membranous the opening becomes valvular and does not allow the contents of skull to flow out easily.
Ø It is difficult to locate the opening after removal of perforator.
Contra indications of Craniotomy:
1. Extreme degree of contracted pelvis ( Conjugate diameter less than three inches )
2. Live foetus.
3. Undilated Cervix.
After performing the operation of Craniotomy or perforation of Skull the head is delivered either by forceps, crochet, fingers or let it come out naturally.
COMBINED CRANIOCLAST AND CEPHALOTRIBE:
It is an Instrument for destructive Operations, but in modern obstetrics, it is merely of academic Interest.
Just for the sake of Identification it’s three bladed Instrument., used to crush the perforated vault and base of skull.
GIGLI SAW:
This is also one of the Instrument only of academic interest. It is a flexible saw and has two detachable handles at its ends. Instrument was formerly used for decapitation and Symphysiotomy.
VECTIS:
This is also one of the Instrument metallic one, only of academic interest. Previously it was used in cases of caesarean section but in modern era, it’s rarely being remembered, Anyhow, this is a spoon shaped Instrument resembling to the blades of Obstetrical forceps.
It was used in extraction of head in lower segment caesarean section and rarely in flexing the head from brow to vertex presentation.
( Instruments which are not being used now a days in modern Obstetrics in one sense should not be included even in new books, but for the benefit of student from examination point of view ,or for reference purposes, author feels it beneficial to cover such topics in brief for academic purposes.)
BONNEY’S UTERINE COMPRESSOR:
This Instrument was also used in cases of lower segment caesarean section .
The Instrument is to compress the lower uterine segment having placenta underneath it. The incision at that time was made in the sing.
MILNE MURRAY’S FORCEPS:
Features:
This is a long axis traction forceps. The blade of forceps are fenestrated and following characteristics-
· Have two curves- Pelvic and cephalic.
· Maximum distance between two blades in the centre is 85 cms. and at tips it is merely 2.5 cms.
· Due to cephalic curve it fits on head of child and due to pelvic curve it accommodates in the pelvis.
· There is locking system in it.
WRIGLEY’S FORCEPS:
Features:
· It is a short forceps.
· It is short because it lacks in shank.
· It has no pelvic curve, but has only cephalic curve.
· It has got no fixation screw but double slot lock is present
Uses:
1. Delivery of head delayed at perineum.
2. delivery of head in lower uterine caesarean section ( occasionally ).
3. Delivery of after coming head in breech presentation.
LONG FORCEPS:
These forceps have fenestrated blades with the pelvic and cephalic curve. Fenestration of the blades make the Instrument lighter, gives good grip over the head and impose less pressure over the head. Usually they are not being provided with fixation screw.
KJELLAND’S FORCEPS:
Features:
The blade of forceps are narrow and slight pelvic curve is there.
There is no lock but one blade carries a slot in which other blade slides so that head can be grasped, if blades are at different levels.
Head enters the pelvic cavity transversely, so first blade is passed anteriorly and other posteriorly and then Occiput is rotated forwards.
Uses:
Persistent Occipito posterior position.
Deep transverse arrest.
Viva-voice:
Q.1. Enumerate the various pre – requisite for forceps application ?
Ans. The pre – requisite are :
· Cervix must be fully dilated.
· Membranes must be fully absent.
· Pelvis must be adequate.
· Preferably presentation should be vertex.
Q.2. What are the different signs of foetal distress ?
Ans. They are –
· Irregular foetal heart sounds , Foetal heart sound less than 110 per minute or more than 160 per minute.
· Meconium stained liquour in various presentations other than Breech.
· Tumultuous foetal movements.
· Foetal scalp blood pH less than 7 ( Acidic ).
Q.3. What are the different signs of maternal exhaustion ?
Ans. The signs are-
· Rise of pulse rate and temperature.
· Restlessness and sweating.
· Anxious look.
· Pain becomes irregular and colicky.
· Vagina becomes hot and dry.
· Appearance or palpable Bandle’s ring.
VACCUM EXTRACTOR:
Features:
The apparatus is called as the ventous. This consists of a metal cup, a chain inside the cup, rubber tube connected to bottle and one manometer. Metal cup can be attached to child’s head, chain acts as traction rod. Bottle can be evacuated by a pump.
Uses:
In all cases where Forceps are indicated specially in cases of cervix incompletely dilated with inadequate uterine contraction.
Mode of action;
Negative pressure inside the bottle causes suction which will produce a caput and this helps in fixation of cup to the head. The chain acts as a traction rod, after removing the cup caput is formed over scalp known as ‘chignon’. Vacuum is produced slowly.
Advantages over forceps:
· Can be used with cervix half dilated.
· Requires minimum manipulation.
· In cases of Uterine inertia helps to initiate uterine contraction.
· Causes minimum compression of head.
· Can be applied at any level of Head.
Disadvantages over Forceps:
Takes longer time for delivery so can not be used in foetal distress.
Can not be used in face or in after coming head in Breech.
Large Cephalhaematoma may form.
May Injure cervix, vagina and vulva.
May cause-
1. Intra cranial haemorrhage.
2. Necrosis of scalp.
3. Alopecia.
PROCEDURES
DILATATION OF CERVIX:
Method-
Patient is placed in lithotomy position under all aseptic and antiseptic precautions. Painting and draping done. Intravenous injection of Diazepam 10 mg given along with IV Pentazocin 30 mg given. Catheterization done.
Bi – manual examination done, after observing the position and size of uterus, posterior vaginal wall is retracted with the help of Sim’s Speculum. Cervix is exposed and held with a Volsellum forceps. The Uterine cavity is measured with exposed and held with a Volsellum forceps.
The Uterine cavity is measured with Uterine sound. The cervix is gradually dilated with Hegar dilators up to No. 8 – 10.
INDICATIONS:
(A) Therapeutic:
(a) As a preliminary stage to curettage of Uterine cavity.
(b) Acquired or congenital cervical Stenosis
(c) Dysmenorrhoea
(d) Sterility
(e) Introduction of Intra cervical and Intra Uterine radium .
(f) Allow drainage of Uterine cavity in presence of Pyometra, Haematometra and
Hydrometra.
(g) As a part of other operation on cervix as in Fothergill’s Operation.
(B) Diagnostic:
Diagnosis of Incompetent Os.
COMPLICATIONS:
1. Ascending Infection
2. Cervical tears and haemorrhage.
3. Disturbance of undiagnosed pregnancy
4. Over dilatation leads to Incompetent Os and habitual abortion in future.
5. Perforation of Uterus
DILATATION AND CURRETTAGE:
Method:
1. Patient to be placed in supine position on Operation table.
2. Intravenous anaesthesia given in the form of Diazepam 10 mg. I.V. and Injection Pentazocin 30 mg.
3. Place the patient in lithotomy position , under all aseptic & antiseptic condition the painting & draping done.
4. If the bladder is not empty catheterization done, Bimanual examination to be carried out.
5. Expose cervix with Sim’s Speculum.
6. Cervix is held and steadied with the help of Volsellum and Uterine cavity is measured with the help of Uterine sound.
7. Cervix is gradually dilated with Hegar’s dilators up to 8 – 9.
8. Curette is introduced into the Uterine cavity up to fundus and is withdrawn, it’s sharp Curretting edge scraping against the endometrium. All the walls of uterine cavity are explored.
Indication:
A. Diagnostic:
1. Chief purpose of curettage of uterus is removal of endometrium and cervical tissue to be sent for histopathogy exam.
2. Diagnosis of endometrial malignancy and tuberculosis.
3. Hormonal status in a women with menstrual disorders and Infertility.
4. Along with Fothergill’s operation to rule out neoplastic disease of the
endometrium as the uterus is being conserved.
B. Therapeutic:
i) Abortion.
ii) Hydatidiform mole.
iii) Endometrial polyp.
iv)Functional Uterine bleeding.
Contraindication:
i) Sepsis.
ii) Pyometra.
iii) Suspected Pregnancy.
Complication:
i) Ascending Infection..
ii) Disturbance of undiagnosed pregnancy.
iii) Cervical tear and haemorrhage.
iv) Over dilatation of cervix lead to Incompetent Os and habitual abortion in future.
v) Perforation of Uterus
vi) Vigorous curettage ending to Asherman syndrome and secondary amenorrhea due to formation of Synaechia.
HYSTERO SALPINGOGRAPHY:
It is defined as radiography of interior of uterus and tubes.
Indications:
i) Diagnosis of tubal blockage.
ii) Hydrosalpinx.
iii) Peri tubal intra pelvic adhesions.
iv) Malformation of Uterus .
v) Small intra cavity tumor.
vi) Defective internal cervical Os causing abortion .
vii) Diagnosis of Tubal tuberculosis and endometrial carcinoma .
viii)To evaluate the result of Tuboplasty post operatively .
ix) To detect uterine abnormality such as Fibroid polyp, in cases of Mennorrhagia , Septate Uterus in cases of habitual abortion and in Ashermann’s syndrome in cases of secondary amenorrhea when uterine synaechia is suspected .
Contra – Indications:
i) Presence of active Infection..
ii) Suspected tuberculosis of genital tract.
iii)Suspected Pregnancy.
Method
Procedure is conducted on Radiological table in radiology department, which is fitted for that particular purpose. Patient is placed as usual in lithotomy position or on her back. After painting & draping vaginal wall is retracted with the help of Sim’s Speculum. Anterior lip of cervix is caught with the help of Volsellum forceps., Cannula fitted with cervical nozzle for injecting medium. The Radio opaque material is injected slowly by the syringe. Amount required varies from 2 – 20 mls. , for sufficient study watch the flow through uterus and tubes by screening films being exposed at suitable intervals.
Medium used are:-
Conray 280 ( 2-20 mls. )
Urograffin 60%
TUBAL INSUFFLATION:
Indications:
For diagnosis of Patency of tubes.
Method
Patient placed in lithotomy position.
Bimannual examination done.
Speculum is then inserted, vaginal portion of cervix is cleaned.
Anterior lip of cervix is caught by volsellum.
Cannula attached to Kymograph is introduced through cervical canal into the uterine cavity.
This cannula and the connecting rubber pressure tubing should first have been purged with CO2.
The Cannula is equipped with a conical rubber collar & when this is held firmly against the external cervical Os with simultaneous traction on the Volsellum.
A gas tight closure is obtained.
The Kymograph is now started and is set to deliver gas at a rate of 60 ml/ minute.
M.C.Q.
Q.1 : When a second menstrual period is missed, the probability
Of pregnancy is much greater:-
Yes/No
Q.2 : Production of HCG in trophoblast begins at:-
A. Fertilisation of Ova.
B. Implantation of fertilized Ova.
C. After 3 days of implantation.
D. After 24 hrs. of implantation.
Q.3 : The sensitivity of ELISA for HCG in serum is:-
A. 10 mIU/ml.
B. 50 mIU/ml.
C. 75 mIU/ml.
D. 100mIU/ml.
Q.4 : Echocardiography can be used to detect foetal heart action as early as :-
A. 5 weeks after I day of last normal menses
B. 48 days after I day of last normal menses
C. 8 weeks after I day of last normal menses
D. None of the above
Q.5 : Characteristic feature of Blighted ovum are following :-
A. Loss of definition of gestational sac
B. An unusually small gestational sac
C. Separation of trophoblastic layer
D. Absence of echoes emanating from foetus after
8 weeks
Q.6 : Pathogenesis of Lymphocytic hypophysitis is :-
A. Collagen disorder
B. Metabolic disorder
C. Autoimmune disorder
D. Genetic disorder
Q.7 : Average weight & average volume of uterus at term is
Respectively is :-
A. 1.0Kg.,6 ltrs.
B. 1.7Kg.,6 ltrs.
C. 1.5Kg.,5 ltrs.
D. 1.1Kg.,5 ltrs.
Q.8 : Diameter of round ligament in non-pregnant women is:-
A. 6-8 mm
B. 10-12 mm
C. 1-2 mm
D. 3-5 mm
Q.9 : Embryologically Round ligament corresponds to :-
A. Wolffian system
B. Mullerian
C. Gubernaculum testis
D. Urogenital sinus
Q.10 : True lymphatic vessels are confined largely in which
layer of endometrium? A. Superficial epithelium
B.Basal layer
C.Glands
D.Interglandular mesenchymal tissue
Q.11 : Musculature of fallopian tube is arranged :-
A. In circular layer
B. In longitudinal layer
C. An inner circular & outer longitudinal layer
D. An inner longitudinal & outer circular layer.
Q.12 : First indication of development of Mullerian duct is :-
A. Ridge of Mesonephros.
B. Thickening of Coelomic epithelium
C. Development of Morula
D. Development of Wolffian system
Q.13 : Diameter of smallest oocyte in the ovary of adult women
Averages :-
A. 50 µm
B. 05 µm
C. 33 µm
D. 100 µm
Q.14 : Caldwell-Moloy classification pertains to :-
A. Causes of amenorrhoea
B. Development of Graffian follicle
C. Pelvic organs
D. Pelvis
Q.15 : Progesterone acts in endometrium by the mechanism to decrease oestrogen action by the following except:-
A. Blocking 17-B receptors complex
B. Decrease number of oestrogen receptors
C. Sulfurylation of oestrone
D. Increases oestradiol 17-B metabolis
Q.16 : Stromal oedema of endometrium is pronounced in :-
A. Menstrual phase
B. Proliferative phase
C. Secretory phase
D. Pathological condition of endometrium
Q.17 : Origin of menstrual blood is of :-
A. Arterial
B. Venous
C. Both A & B
D. None of the above
Q.18 : Caldeyro Barcia Type II dips on foetal heart rate Monitoring are :-
A. Temporary dips
B. Sinusoidal pattern
C. Late deceleration
D. Loss of baseline variability
Q.19 : The Statement:Passage of meconium is common in the asphyxiated premature infant and relatively rare in prolonged pregnancy’ is right:-
Yes/No
Q.20: Absence of amniotic fluid in dysmaturity and with Prolonged pregnancy is an important danger sign :-
Yes/No
Q.21: Rapid development of moulding shows:-
A. Physiological phenomenon
B. Foetal distress
C. Marked disproportion
D. All of the above
Q.22: Moulding should be assessed at:-
A. One location of head
B. Two location of head
C. Three locations of head
D. Four locations of the head
Q.23: Moulding grade II indicates:-
A. Closing of suture line
B. Reducible overlape
C. Irreducible overlape
D. None of the above
Q.24: Augmentation of labour with oxytocin should be avoided Whenever possible,to reduce foetal distress.The Statement is correct:-
Yes/No
Q.25: The observation that “Delivery should be conducted in a gentle atraumatic manner,with an adequate episiotomy. Both the forceps & the ventouse are better avoided. The clamping of cord should be delayed” is correct:-
Yes/No
Q.26: Propagation of uterine contraction occur directly from one muscle to another in a downward direction, spreading at a rate of :-
A. 0.1-0.2 cm/second
B. 5-6 cms/second
C. 1-3 cm/second
D. None of the above
Q.27: The statement “ Most of the plain muscles in the cervix are in its uppermost part,there are circular muscle fibres around the circumference of cervix” is correct:-
Yes/No
Q.28: The prostaglandins are present in the following, except:
A. Menstrual blood
B. Saliva
C. Seminal fluid
D. Amniotic fluid
Q.29: The Serotonin, released from platelets is responsible for tonic condition of the uterus after Abruptio placentae:-
Correct/Incorrect
Q.30: For induction, the dose of oxytocin necessary to initiate adequate contraction is :-
A. 10 milliunits/mt.
B. 05 milliunits/mt.
C. 04 milliunits/mt.
D. 20 milliunits/mt.
Q.31: Internal rotation of presenting part results from the following except:-
A. Unusually large pelvis
B. Back of foetus posterior
C. Cord around the neck
D. Dolichopelvic pelvis
Q.32: Following are the part of high risk evolution form excluding:-
A. Previous cesaream section
B. Myoma uterus
C. Polyhydroamnios
D. Anemia
Q.33: ‘Clinical dating is not 100% accurate, patient should have real time ultrasound examination for confirmation’ the statement is:-
Right/Wrong
Q.34: For determining expected date of delivery USG should preferable be done between:-
A. 8 wks. & 30 wks.
B. 12 wks. & 32 wks.
C. 16 wks. & 24 wks.
D. None of the above
E. Presence or absence of deceleration
Q.35: False negative rate of non stress test is:-
A. 4.7 per 1000
B. 10.6 per 1000
C. 3.2 per 1000
D. 1.75 per 1000
Q.36: The variable of NST are following except:-
A. Base line foetal heart rate.
B. Variation of foetal heart rate.
C. Foetal movement.
D. Presence or absence of acceleration.
E. Presence or absence of deceleration.
Q.37: Advantage of NST are following except:-
A. Non invasive
B. Cost effective
C. Short duration
D. Patient acceptance
E. None of the above
Q.38: Foetal biophysical profile include following except:-
A. Amniotic fluid volume
B. Foetal reactivity
C. Foetal breathing movement
D. L/S ratio
E. Scalp blood pH
Q.39: The most important indication for percutaneous umbilical blood sampling are the following except:-
A. Rapid foetal karyotyping
B. Foetal evalution in suspected foetal infection
C. To determine Rh. Incompatibility
D. Foetal evalution in patients with haemolytic disease
Q.40: “Pregnancies in couples at risk of inborn error of metabolism are the candidates for further genetic testing”
Yes/No
Q.41: Ethiological categories of patient with mental retardation are:-
A. Intrauterine infection
B. Neonatal infection
C. Birth trauma
D. Downs syndrome
E. All of the above except ‘D’
F. None of the above
Q.42: Claft lip & cleft palate can be detected by USG at 16 weeks of gestation:-
Right/Wrong
Q.43: Which statement is wrong:-
A. Maternal serum alpha fetoprotein (MSAFP) screening is usually Carried out between 12 & 15 weeks of gestation
B. Prenatal detection of Neural tube defect can be done by MSAFP Screening
C. Diabetic mother have lower MSAFP levels than non diabetic
D. Black women have lower MSAFP than do white women
E. None of the above
Q.44: Chorionic villi Sampling is a procedure to determine:-
A. Down syndrome
B. Inherited metabolic disorders
C. Prenatal genetic diagnosis
D. Foetal well being
Q.45: Best time for performing Chorionic villi Sampling is between:-
A. 5-6 weeks
B. 14-16 weeks
C. 9-12 weeks
D. 16 weeks onwards
Q.46: Contraindications to trans cervical Chorionic villi sampling are following except:-
A. Toxoplasmosis
B. Active genital Herpes
C. Cervical stenosis
D. Severe cervicitis
Q.47: Transcervical Chorionic villi sampling has a slight higher risk of foetal loss than traditional amniocentesis:-
Yes/No
Q.48: Maternal Coagulopathy is not a contraindication for Tramcervical Chorionic villi sampling:-
Yes/No
Q.49: Transabdominal Chorionic villi sampling causes more discomfort to patient than amniocentesis:-
Yes/No
Q.50: The risk of foetal loss after Transabdominal Chorionic villi sampling is similar to the risk of amniocentesis:- Yes/No
Q.51: Maple syrup Urine disease is diagnosed by:-
A. Maternal Urine
B. Immunoslot analysis
C. Amniotic fluid analysis
D. Foetal liver biopsy
Q.52: Bone stippling in foetus is caused by administration of following drug to mother:-
A. Retinoic acid
B. Anticonvulsant
C. Warfarin
D. Folic acid antagonist
E. Alcohol
Q53: Following are nonteratogenic agents, except:-
A. Spermicides
B. DES
C. Codeine
D. Video terminal
Q.54: “ The risk of causing foetal malformation with the radiation involved in making a chest X-Ray film or a flat plate of abdomen is negligible.”:-
Right/Wrong
Q.55: Citrovorum factor is related to:-
A. Benzodiazepins
B. Thiazides
C. Cisplatin
D. Methotrexate
Q.56: “The function of antenatal cave is to reduce the need for desperate measures at the time of delivery”:-
Yes/No
Q.57: The parous woman who is most harassed & worried about getting home to resume her domestic responsibility is the one who is in need of:-
A. Diazepam
B. Phenobarbitone
C. Tender loving care
D. None of the above
Q.58: Out of the following which Game/Exercise is contraindicated in pregnancy:-
A. Golf
B. Tennis
C. Diving
D. Cycling
Q.59: Blood loss through Vagina has dark ‘Prune juice’ appearance in:-
A. Choriocarcinome
B. Blighted ova
C. Ectopic gestation
D. Chalamydial vaginitis with CIN
Q.60: The use of radioimmunoassay of human placental lactogen levels has been found,”not helpful in predicting the outcome in cases of threatened abortion”:-
True/False
Q.61: Causes of acute pain abdomen during first half of Pregnancy related conditions are, except:-
A. Abortion
B. Disturbed ectopic Pregnancy
C. Hydatidiform mole
D. Acute hydroamnios
E. Retroplacental Hemorrhage
F. None of the above.
Q.62: Causes of foetal oedema at birth are, except:-
A. Erythroblastosis foetalis
B. Babies of diabetic mothers
C. Congenital syphilis
D. Severe congenital heart disease of the body
Q.63: Complications of manual removal of placenta are, Except:-
A. Hemorrhage
B. Shock
C. Air embolism
D. None of the above
E. Injury to the uterus
Q.64: The uterine blood flow per minute at term Approximates:-
A. 500 ml.
B. 750 ml.
C. 1000 ml.
D. 1250 ml.
Q.65: The official time of birth in normal delivery is the instant at which time,pick right one:-
A. head is out
B. Whole foetus is outside
C. As soon as umbilical cord is cut
D. As soon as baby cries
Q.66: The common maternal side effects following isoxsuprine therapy are following,except :-
A. Tachycardia
B. Palpitation
C. Hypertension
D. Diuresis
Q.67: The following are the physiological changes during late pregnancy,except:-
A. Blood volume is increased
B. Cardiac output is increased
C. Arterial PO2 is decreased
D. Tidal volume is increased
Q.68: Supine hypotension syndrome can be relieved promptly by placing the patient in,except:-
A. Propped up position
B. Left lateral position
C. Right lateral position
D. Any one of her side
Q.69: Causes of Hydprops foetalis are following, except:-
A. Rh - isoimmunization
B. Chronic foeto maternal transfusion
C. Infection with cytomegalo virus
D. Alphathalassaemia
E. None of the above.
Q.70: Copper IUCD in the peritoneal cavity is best removed by:-
A. Laparotomy
B. Laparoscopy
C. Colpotomy
D. Culdoscopy
Q.71: TORCH infective diseases includes following,except:-
A. Toxoplasmosis
B. Rubella
C. Cytomegalovirus
D. Hepatitis virus B
Q.72: Cervical incompetence is related to the following,except:-
A. Mid trimester abortion
B. Associated with Bicornuate uterus
C. Causes Hydroamnios
D. PROM
Q.73: Ectopic pregnancy rate per 1000 women years is highest in following,except:-
A. Copper-T IUD’S
B. Progesterone –IUD
C. Levonorgesterol –IUD
D. Norplants
Q.74: HELLP Syndrome includes the following,except:-
A. Haemolytic anaemia
B. Elevated liver enzymes
C. Leucopenia
D. Decreased Platlet count
Q.75: Perforation of uterus by a sound during D&C in case of suspected carcinoma body uterus should ideally be managed by:-
A.Carefully watch general condition of patient
B. Antibiotics
C. Do D&C at a later date
D. Urgent laparotomy
Q.76: Commonest indication for abdominal hysterectomy for benign lesion is :-
A. Dysfunctional uterine bleeding
B. Fibroid uterus
C. Endometriosis
D. Tubo-ovarian mas
Q.77: Ratio between cervix & corpus uterus in 70 years of women is:-
A. 1:2 B. 2:1
C. 3:2 D. 2:3
Q.78: The ovary is attached with following,except:-
A. Ovarian ligament
B. Posterior leaf of Broad ligament
C. Infundibulopelvic ligament
D. None of the above
Q.79: The most common site of vulval cancer is :-
A. Labia majora
B. Labia minora
C. Prepuce of the clitoris
D. Bartholian gland
Q.80: The most common organism causing Salpingitis:-
A.Gonoccocal
B. Pyogenic
C. Tubercular
D. None of the above
Q.81: Gonoccocal infection of genital tract is diagnosed by :-
A. Cervical & urethral smear
B. D & C
C. Hystersalpingography
D. Laparoscopy
Q.82: Vaginal pH during child bearing period is :-
A. 3.5-3.8
B. 4-5.6
C. 5-6.4
D. 6.1-7.8
Q.83: Yellow color of Corpus luteum is due to :-
A. Accumulation of fatty granules
B. Vitamin A lipofuscin
C. Cholesterol
D. Carotene
Q.84: The commonest method adopted for family planning in India is:-
A. Tubectomy
B. Vasectomy
C. Conventional contraceptives
D. Oral pills
Q.85: The surgical treatment of uterine polyp is following,except:-
A. D & C
B. Removal by twisting
C. Hysterectomy
D. None of the above
Q.86: The commonest use of combined OC’S is:-
A. Dysmenorrhora
B. Endometriosis
C. Diagnosis of Pregnancy
D. Contraception
Q:87: Erosion cervix is related to following, except :-
A. Not associated in Nullipara
B. True sense an ulcer
C. Only cured by cauterization
D. Only cured by Hysterectomy
Q.88: Midfollicular fluid normally contains the following,except:-
A. Prosenin
B. Follistalin
C. Pregnancy associated plasma protein A
D. Luteinizing hormone
Q.89: Incidence of ectopic pregnancy following Gonococcal salpingitis increases by:-
A. 15-20%
B. 0-5%
C. 7-10%
D. 25%
Q.90: Diagnosis of Lymphogranuloma venereum is being confirmed by:-
A. Presence of Donovan bodies
B. Florescent antibody absorption test
C. Frei’s test
D. None of the above
Q.91: Perforation of Uterus during D & C is common in:-
A. Pregnancy termination
B. Uterine malignancy
C. Removal of Intra Uterine Contraceptive devices
D. All of the above
Q.92: Urethral Syndrome usually occurs in:-
A. Puberty
B. Child bearing period
C. Menopausal women
D. None of the above
Q.93: Urethral Caruncle is frequently encountered in:-
A. Women of child bearing age
B. Women suffering from urethral prolapse
C. Post menopausal women
D. None of the above
Q.94: Artificial insemination with husband semen is indicated in:-
A. Retrograde ejaculation
B. Hypospadias
C. Antispermal antibodies in cervical mucus
D. All of the above
E. None of the above
Q.95: Ovulation is ideally inducted in Polycystic Ovarian diseases with:-
A. Clomiphene citrate
B. Gn RH analoge
C. Clomiphene & human menopausal
D. Gonadotrophin
E. Danazole
Q.96 Bromocryptine is drug of choice in cases of:-
A. Endometrial Carcinoma
B. Menorrhagia
C. Hyper prolactinaemia
D. Hypo gonadism
Q.97: Insertion of Intra uterine contraceptives are contra indicated in:-
A. Multiparous women
B. Patients with low risk of STD
C. Previous Ectopic gestatio
D. None of the above
Q.98: Sion test is safe & practical method of evaluating:-
A. Chalamydial infection
B. Tubal patency
C. Genital tuberculosis
D. Stress incontinence
Q.99: Late complication of intrauterine contrceptive devices is:-
A. Vaginal infection
B. Dysmenorrhoea
C. Ectopic pregnancy
D. Actinomycosis
Q.100: Oral contraceptive pills are contraindicated in patients who are taking:-
A. Streptomucin
B. Isoniazide
C. Ethambutol
D. Rifampicin
Q.101: Failure rate of laparoscopic sterilization is:-
A. 1.0 per 100 women years
B. 1.5 per 100 women years
C. 0.6 per 100 women years
D. 0.2 per 100 women years
Q.102: Diameter of Dumas cap varies from:-
A. 9-10 cms.
B. 5.5-7.5 cms.
C. 2-4 cms.
D. 1-2 cms.
Q.103: The best procedure to diagnose carcinoma cervix following positive cytology is:-
A. Four quadrant cervical biopsy
B. Cone biopsy
C. Ring biopsy
D. Colposcopic directed biopsy
Q.104: Condition being aggravated by the oral contraceptive pills,is :-
A. Hirsuitism
B. Endometriosis
C. Premenstrual tension
D. Cervical erosion
Q.105: Micro invasive carcinoma cervix can be treated by following,except:-
A. Simple Hysterectomy
B. Amputation of cervix
C. Radical Hysterectomy
D. Cryocauterization
Q.106: Presumptive diagnosis of adenomyosis is made from the following,except:-
A. Age of patient 35-40 years
B. Parous women
C. Menorrhagia
D. Spasmodic Dysmenorrhoea
Q.107: Which of the following is related to Genital tuberculosis:-
A. Ovarian involvement without tubal affection
B. Absence of tubercle in endometrium
C. Tubercular endometritis
D. All of the above
Q.108: Follicular cyst of ovary can undergo following,except:-
A. Spontaneous resorption
B. Malignant change
C. Intracystic haemorrage
D. Rupture of cyst
Q.109: Germ cell tumour are not related to:-
A. Choriocarcinoma
B. Dysgerminoma
C. Granulosa cell tumour
D. Endometrial sinus tumour
Q.110: Complete perineal tear does not occur in :-
A. Forcep delivery in occipito posterior
B. Extension of mediolateral episiotomy
C. Vulval oedema in diabetes
D. Precipitate labour
Q.111: Out of the following,which is not the definitive surgery for carcinoma cervix:-
A. Hysterectomy with oophrectomy
B. Hysterectomy without removal of vaginal cuff
C. Radical Hysterectomy
D. None of the above
Q.112: Complete failure of fusion of Mullerian duct results in :-
A. Uterine didelphus
B. Subseptate uterus
C. Bicornuate uterus
D. Absence of uterus
Q.113: Uterne synaechia may be due to following,except:-
A. Puerperal curettage
B. Post abortal curettage
C. Tubercular Endometritis
D. None of the above
Q.114: Postmenopausal vaginal bleeding may be due to the following,except:-
A. Urethral caruncle
B. CIN III
C. Carcinoma of the fallopian tube
D. Atrophic vaginitis
Q.115: Commonest cause of RVF is:-
A. Repair of complete perineal tear
B. Congenital
C. Following obstructed labour
D. Carcinoma Vagina
Q.116: Painless vaginal bleeding at 34 weeks is treated by:-
A. Vaginal Examination
B. Rest & Sedation
C. Oxytocin drip
D. Caeserean Section
Q.117: Central Placenta praevia with Anencephaly, the treatment of choice is:-
A. Induction of labour
B. LSCS
C. Wait & Watch
D. None of the above
Q.118: Blood loss of foetal origin is found in:-
A. Placenta praevia
B. Vasa praevia
C. Abruptio placentae
D. Placenta Accreta
Q.119: The effect of epidural anaesthesia on the labour is:-
A. No effect
B. Prolongation of II stage of labour
C. Precipitate labour
D. None of the above
Q.120: X-ray is useful in twin pregnancy to know:-
A. Maturity of skeleton
B. Congenital malformation
C. Presenting part
D. Hydramnios
Q.121: Cause of Acute Inversion Uterus is:-
A. Rupture Uterus
B. Mismanaged III stage of labour
C. Cervical rigidity
D. Cervical tear
Q.122: Most common cause of Postpartum Endometritis is:-
A. E.Coli
B. Streptococcus
C. Gonococcus
D. Proteus
Q.123: Commonest cause of puerpereal pyrexia is:-
A. Puerpereal Sepsis
B. UTI
C. Breast Abscess
D. Respiratory tract infection
Q.124: Commonest cause of maternal mortality in India is:-
A. Haemorrhage
B. Sepsis
C. Embolism
D. Toxaemia
Q.125: Best method of suppression of lactation in Heart patient is:-
A. Oestrogen + Testosterone
B. Bromocriptine
C. High dose Oestrogen
D. Oral pills
Q.126: Operation not used in Incompetent Os is:-
A. Mc Donalds
B. Shirodkars
C. Strumdorfs
D. Lash & lash
Q.127: Management after failed forceps is:-
A. Craniotomy
B. Normal Delivery
C. Caeserean Section
D. None of the above
Q.128: Vaccum extraction is done in all, except:-
A. Prolonged II stage
B. Prolonged III stage
C. Persistent Occipito posterior position
D. Uterine Inertia
Q.129: The most unfavorable presentation is:-
A. Occipito posterior
B. Mento posterior
C. Occipitotransverse
D. Mento anterior
Q.130: Tomkins operation pertains to:-
A. Incision of fundus in midline
B. Wedge resection of a part of fundus
C. Reunification of uterine cavity
D. None of the above
Q.131: Indication of HRT are following,except:-
A. Feminine forever cult
B. Turners syndrome
C. Prolonged use of cortisones
D. Polycystic ovarian diseases
Q.132: Causative agent for condylomata acuminata is:-
A. Human papilloma virus
B. cytomegalovirus
C. E.coli
D. Listeria
Q.133: Macrosomia is seen in babies:-
A. Obese parents
B. Multiparous women
C. Diabetes mellitus
D. All of the above
Q.134: Short stature is seen in all,except:-
A. Klinfelter’s syndrome
B. Turners syndrome
C. Frohlich’s syndrome
D. Precocious puberty
Q.135: Single Barr body indicates:-
A. Normal male
B. Normal female
C. Super female
D. Turner’s syndrome
Q.136: The ovarian oestrogen produced in high amounts as:-
A. Oestradiol
B. Oestriol
C. Oestrone
D. None of the above
Q.137: Hydrolysis of Pragnenediol occurs in the:-
A. Intestine
B. Liver
C. Spleen
D. Kidney
Q.138: Pareyra Operation is done for:-
A. Urgency incontinence
B. Female Sterilization
C. Stress incontinence
D. Artificial Vagina
Q.139: Sonosalpingography is also known as:-
A. Amine test
B. Sions test
C. Elisa test
D. Fluorescent test
Q.140: Clue cells are seen on a vaginal smear in infection with:-
A. Haemophilus Vaginalis
B. Trichomonas Vaginalis
C. Herpes Simplex type II
D. Haemophilus Influenza
Q.141: Commonest site for Gartners cyst is:-
A. Vagina
B. Labia
C. Ovary
D. Fallopian tube
Q.142: Causative organism for Non gonococcal Urethritis is:-
A. T.pallidum
B. Ureaplasma Urealyticum
C. L.Venerum
D. Neisseria
Q.143: Which disease is not a cause of Hirsutism in females:-
A. Granulosa cell tumour
B. Familial trait
C. Polycystic Ovary
D. Congenital Adrenal Hyperplasia
Q.144: Hydramnios is associated with:-
A. Diabetes Mellitus
B. Anencephaly
C. Tracheo-oesophageal fistula
D. All of the above
Q.145: What is the proper time to do pelvic assessment in primigravida:-
A. 32 weeks
B. 34 weeks
C. 38 weeks
D. 40 weeks
Q.146: First stage of labour is upto:-
A. 3/5th dilation of cervix
B. Full dilation of cervix
C. Rupture of membranes
D. Crowning of head
Q.147: Shortest diameter of foetal skull is:-
A. Biparietial
B. Bitemporal
C. Verticomental
D. Suboccipito bregmatic
Q148: All of the following are features of pseudocyesis except:-
A. Enlargement of abdomen
B. Enlargement of uterus
C. Amenorrhea
D. Morning sickness
Q.149: Weight of normal placenta is:-
A. 125 gms.
B. 200 gms.
C. 500 gms.
D. 350 gms.
Q.150: Normal foetal heart rate at 37-40 weeks of pregnancy is:-
A. 80-120/min.
B. 120-160/min.
C. 140-180/min.
D. 160-200/min.
Q.151: Internal rotation occurs at the:-
A. Brim
B. Ischial spine
C. Cavity
D. Outlet
Q.152: Post term pregnancy is that which continuous beyond:-
A. 280 days
B. 300 days
C. 270 days
D. 294 days
Q.153: Only foetal blood loss occurs in:-
A. Placenta previa
B. Vasaprevia
C. Circumvallate placenta
D. Uterine rupture
Q.154: Which vaccine is not indicated during pregnancy:-
A. Polio-myelitis
B. Typhoid
C. Tetanus toxoid
D. Rubella
Q.155: The shortest diameter of palvic inlet is:-
A. True conjugate
B. Diagonal conjugate
C. Obstetric conjugate
D. Transverse diameter
Q.156: Methyl-ergometrine is contraindicated in:-
A. Multiparity
B. Bicornuate uterus
C. Post-partum haemorrhage
D. Eclampsia
Q.157: Decidua is cast off in puerperium as:-
A. Lochia
B. Amniotic fluid
C. Meconium
D. Placental bits
Q.158: Women belonging to this group of blood are more
Susceptible to Hydatidiform mole:-
A. A
B. B
C. AB
D. O
Q.159: Failure rate of female Sterilization by Medlener
method is:-
A. 7%
B. 5-6%
C. 0.4%
D. 0.2%
Q.160: Mifeprostone acts by the following ways,except:-
A. Prevent Ovulation
B. Prevent Fertilisation
C. Blocks the action of Progesterone
D. None of the above
Q.161: Oral contraceptive pills are contraindicated in,except:-
A. Women who wear contact lenses
B. Lactating mother
C. Patients on Rifampicin
D. None of the above
Q.162: Billing method pertains to:-
A. Birth control
B. Female Sterilisation
C. AIDS
D. Stress incontinence
Q.163: Stamey’s operation pertains to:-
A. Repair of RVF
B. Stress Incontinence
C. Polycystic ovarian diseases
D. Female Sterilisation
Q.164: Third generation Sexually transmtted disease is:-
A. Trichomoniasis
B. AIDS
C. Chancroid
D. Granuloma inguinale
Q.165: Balls operation is rarely performed for:-
A. Dyspareunia
B. Pruritis Vulvae
C. Urethral Caruncle
D. Urethral prolapse
Q.166: Portio vaginalis eventually disappear at:-
A. Puberty
B. Menarche
C. Menopause
D. 8-10 years of age
Q.167: The diameter of Isthemic portion of fallopian tube is:-
A. 2 mm
B. 8 mm
C. 6 mm
D. 10 mm
Q.168: Cranial end of Wolffian body is known as:-
A. Epoophoron
B. Paroophoron
C. Mesovarium
D. None of the above
Q.169: Size of Graffian follicle before puberty is:-
A. Less than 5mm
B. 12-14mm
C. 18-20 mm
D. 30 mm
Q.170: Adrenalarche is the term used for:-
A. Development of Breast
B. Development of public & axillary hairs
C. Cessation of menstruation
D. Cessation of Ovulation
Q.171: The term Premature is used when menopause
Occurs:-
A. At the age of 55 years
B. Before the age of 40 years
C. Beyond the age of 50 years
D. None of the above
Q.172: Commonest cause of abortions are:-
A. Blighted ovum
B. Cervical incompetency
C. Syphylis
D. Tuberculosis
Q.173: Most common cause of second trimester abortion
is:-
A. Cervical Incompetency
B. Chromosomal disorders
C. Defect in germplasm
D. Syphilis
Q.174: 43 years old women, diagnosed to have Vesicular Mole, Uterus is 26-28 wks. size, appropriate Treatment is:-
A. Suction Evacuation
B. Syntocinon drip
C. Hystrotomy
D. Hysterectomy
Q.175: Hydroamnios is associated with all, except:-
A. Renal agenesis
B. Anencephaly
C. Toxaemia
D. Tracheo oesophageal fistula
Q.176: In tuberculosis of placenta, the tubercle may be found at:-
A. Decidua
B. Chorion epithelium
C. Stroma of villi
D. All of the above
Q.177: In contrast to nonpregnant state, the oxytocin receptors concentration in myometrium at term increases to:-
A. 270 folds
B. 15-45 folds
C. 80 folds
D. 120 folds
Q.178: The usual range of intrauterine pressure during second stage of labour during contraction,with the patient not bearing down is:-
A. 200 mm. Hg.
B. 100-130 mm.Hg
C. 300-350 mm.Hg
D. 50-85 mm.Hg
Q.179: Best way of diagnosis foetal hypoxia is:-
A. Apgar score
B. Foetal scalp pH
C. Manning score
D. Foetal subcutaneous pyruvate levels
Q.180: Antihypertensive drug which inhibits labour:-
A. Reserpine
B. Diazoxide
C. Minoxidil
D. Captopril
Q.181: Epidural anaesthesia for a pregnant women is:-
A. Equal to normal
B. 10% of normal
C. 80% of normal
D. 45% of normal
Q.182: Commonest cause of Breech presentation is :-
A. Cephalopelvic disproportion
B. Hydrocephalus
C. Placenta praevia
D. Prematurity
Q.183: Commonest cause of perinatal mortality in Breech is:-
A. Asphyxia
B. Birth trauma
C. Congenital anomaly
D. Cord prolapse
Q.184: Late deceleration is because of:-
A. Placental compression
B. Foetal compression
C. Foetal death
D. Toxaemia of pregnancy
Q.185: Placenta succenturiata causes:-
A. Foetal anomales
B. Post partum haemorrhage
C. Foetal death
D. Hydramnios
Q.186: All of the following signs or symptoms characterizes placenta praevia,except:-
A. Painless vaginal bleeding
B. Increased Uterine tone
C. Erythroblastosis
D. Thinning of lower uterine segments
Q.187: All of the following sign or symptoms characterizes severe placental abruption except:-
A. Extensive external bleeding
B. Fetal demise
C. Tetanic uterine contraction
D. Severe abdominal pain
Q.188: Severe placental abruption has been associated with all of the following conditions, except:-
A. Fetal demise
B. Renal failure
C. Rh sensitization
D. Hypertension
Q.189: Post partum haemorrhage following Placenta praevia may be complicated by:-
A. Implantation in the lower uterine segment
B. Ineffective uterine muscular control
C. Retained placental fragments
D. All of the above
Q.190: Mechanism of heat loss in the newborn include all of the following except:-
A. Evaporation
B. Condensation
C. Radiation
D. Conduction
Q.191: A Neonate’s susceptibility to Necrotizing enterocolitis increases by the following factors, except:-
A. Excessive Bleeding
B. Perinatal Asphyxia
C. Phototherapy
D. Crowded nurseries
Q.192: All of the following problem are associated with IUGR infants except:-
A. Congenital anomaly
B. Shoulder dystocia
C. Hypoglycaemia
D. Metaboic acidosis
Q.193: The most important result of increased number of caesarean section being performed today is:-
A. Decreased maternal morbidity
B. Decreased perinatal mortality
C. Increased use of foetal monitor
D. All of the above
Q.194: Indication for caesarean section includes all, except:-
A. Previous caesarean section
B. Cervical circlage
C. Foetal distress
D. Cord prolapse
Q.195: Absolute pre requisite for the use of Forceps or the vacuum extractor include:-
A. Breech presentation
B. Ruptured membranes
C. Uterine inertia
D. Foetal distress
Q.196: Anaesthetic drug associated with increased post partum blood loss includes:-
A. Methoxyfluranes
B. Halothane
C. Enflurane
D. All of the above
Q.197: A spinal headache after spinal anaesthesia for labour is caused by:-
A. Leakage at the puncture site
B. Traction on Pia arachnoid
C. Decreased CSF volume
D. All of the above
Q.198: A newborn female could naturally have which of the following conditions:-
A. Mucoid vaginal discharge
B. Enlarged clitoris
C. Labial fusion
D. All of the above
Q.199: The most accurate & definitive documentation of foetal life is made by:-
A. Doppler Utrasound
B. Real time scanner
C. Leopold maneuver
D. B- Scanner
Q.200: Early diagnosis of pregnancy can be done by all,except:-
A. Clinical examination
B. Symptoms of pregnancy
C. Immunological test
D. X-Ray abdomen
Q.201: Common presentation in android pelvis is:-
A. Occipito posterior
B. Breech
C. Face
D. All of the above
Q.202: Anencephaly is often associated with:-
A. Postmaturity
B. Hydramnios
C. Spina Bifida
D. All of the above
Q.203: Foetus with brow presentation is delivered by:-
A. Mannual rotation & forceps
B. Internal pudelic version
C. Caeserean section
D. None of the above
Q.204: Major symptom of Vesicular mole is:-
A. Height of uterus does not corresponds to period of amenorrhoea
B. Absent foetal movements
C. Passing vesicles with bleeding
D. All of the above
E. A & B
Q.205: Characteristic symptom of Placenta praevia is:-
A. Bleeding is painless
B. Profuse blood loss
C. Recurrent bleeding
D. All of the above
Q.206: Indication of induction in pre-eclampsia is following, except:-
A. Acute fulminating toxaemia
B. Persistence of Hypertension
C. Contracted pelvis
D. Recurrent pre-eclampsia
Q.207: A sign of foetal distress is all except:-
A. Early deceleration
B. Late deceleration
C. Increase in foetal respiration
D. Heart rate between 100-110 per minute
Q.208: Treatment of Neglected shoulder presentation is:-
A. Decapitation
B. Caeserean Section
C. Evisceration
D. All of the above
Q.209: External version is contraindicated in patients with all except:-
A. 34 weeks of pregnancy
B. Bed Obstetrics Hystory
C. Apprehensive patient
D. Suspected C.P.D.
Q.210: Ectopic pregnancy is most commonly associated with:-
A. Copper`T`
B. Condoms
C. O.C.Pills
D. None of the above
Q.211: Coagulation failure can result from:-
A. Amniotic fluid Embolus
B. Intrauterine death of foetus
C. Abruptio placentae
D. All of the above
Q.212: Habitual absorption in incomplete Os commonly occurs at about:-
A. 4-6 weeks
B. 8-10 weeks
C. 10-12 weeks
D. 12-16 weeks
Q.213: The mediolateral epiciotomy has the following advantages over median episiotomy:-
A. Less incidence of injury to rectal sphincter
B. Less painful in puerperum
C. Easier to repair
D. All of the above
Q.214: During reproductive life pH of vagina averages:-
A. 10
B. 7
C. 4.5
D. 6.4
Q.215: Which layer of uterine musculature is called ‘living ligature’:-
A. Longitudinal
B. Circular
C. Oblique
D. All of the above
Q.216: Thickened Uterosacral ligament can be felt through posterior fornix in following diseases except:-
A. Carcinoma Cervix
B. Endometriosis
C. Fibroid Uterus
D. None of the above
Q.217: Before puberty the cervix to corpus ratio is:-
A. 1:2
B. 1:3
C. 2:1
D. 3:1
Q.218: Round ligament is inserted at:-
A. Public symphysis
B. Levator ani muscle
C. Skin of Labia minora
D. Skin of Labia majora
Q.219: Fallopian tube represents the:-
A. Caudal end of Mullerian duct
B. Cranial end of Wolffian duct
C. Cranial end of Mullerian duct
D. Urogenital Sinus
Q.220: Organ of Rosenmuller is also called:-
A. Paroophron
B. Mesovarium
C. Epoophoron
D. Wolffian duct
Q.221: ‘Thelarche’is the term used for:-
A. Cessation of menstruation
B. Development of Breast
C. Development of public & Axillary hairs
D. Commensement of menstruation
Q.222: Climacteric is the phase of:-
A. Hyperstimulation of ovaries
B. Waning of Ovarian activity
C. Defective Hypothalamo – pituitary axis
D. None of the above
Q.223: Colposcope is a binocular microscope giving a magnification of:-
A. 15.6
B. 20.5
C. 100.0
D. 13.5
Q.224: Jones Classification pertains to;-
A. Detection of Hormonal disturbance
B. Defective development of Wolffian System
C. Mullerian duct
D. None of the above
Q.225: Commonest Viral infection encountered in vulval disease is:-
A. Rubella
B. Varicella
C. Herpes simplex type-2
D. Cytomegalovirus
Q.226: Treatment of choice in Bartholian Cyst is:-
A. Incision & Drainage
B. Antibiotic & Anti inflammatory agents
C. Hot sietz bath
D. Marsupialization
Q.227: Sabouraud’s medium is used to culture:-
A. Trichomonia
B. Gardenella
C. Candida albicans
D. Calmydia
Q.228: Secretory hypertrophy of endometrium is due to the effect of:-
A. Oestrogen
B. Progesterone
C. Prolactin
D. None of the above
Q. 229: In a normal menstrual cycle, Ovulation occurs at:-
A. 14th day
B. 21st day
C. 20th day
D. 10th day
Q.230: Infertility is defined as:-
A. Failure to conceive
B. Inability to conceive
C. Either of these
D. None of the above
Q.231: Among the causes of sterility due to congenital defects of female genitalia, the following rank prominently, except:
A. Maldevelopment of vagina
B. Noncanalization of vagina
C. Rigid Hymen
D. Elongated conical cervix
E. Acute salpingitis
Q.232: Which one of the following gas is used for tubal insufflation test, except:-
A. Nitrous oxide
B. Carbon dioxide
C. Oxygen
D. Carbon mono oxide
Q.233: Contraindications of IUCD. Are following except:-
A. Pregnancy
B. Pelvic infection
C. Grand multipara
D. Post partum Endometritis
E. Functional uterine bleeding
Q.234: Treatment of threatened abortion is as follows, except:-
A. Bed rest
B. Progesterone therapy
C. Haemetinics
D. Sedation
Q.235: The best method of diagnosing Hydatidiform mole is:-
A. Laparoscopy
B. Hystero-salpingography
C. Ultrasonography
D. Urine pregnancy test
Q.236: Commonest site of Ectopic pregnancy is :-
A. Ovarian
B. Primary abdominal
C. Rudimentary horn
D. Tubal end of fallopian tube
Q.237: Turners syndrome is characterized by the following,except:-
A. Short stature
B. Webbing of the neck
C. 45XO chromosome pattern
D. Retinitis pigmentosa
Q.238: Local cause of menorrhagia are th following, except:-
A. Fibroid uterus
B. Endometrial polyp
C. Pelvic inflammation
D. Pseudomucinous cystadenoma ovary
Q.239: Manifestation of Fibroid are following, except:-
A. Menstrual disturbances
B. Pressure symptoms
C. Pain abdomen
D. Infertility
E. Amenorrhea
Q.240: Carcinoma body uterus is associated with following, except:-
A. Obesity
B. Hypertension
C. Myxoedema
D. Fibroids
E. Diabetes
Q.241: False pelvis refers to:-
A. Upper part of pelvis
B. Lower part of pelvis
C. Pelvic cavity
D. Pelvic outlet
Q.242: All these are the causes of Hydramnios except
A. Maternal diabetes
B. Anencephaly
C. Multiple pregnancy
D. Congenital obstruction of esophagus
E. Fetal renal agenesis
Q.243: Hormones chiefly produced by placenta are the following, except:-
A. Estrogen
B. Progesterone
C. H.C.G.
D. F.S.H.
Q.244: Predisposing factors in etiopathogenesis of pre-eclamptic toxaemia are the following, except:-
A. Primigravida
B. Hydramnious
C. Multiple pregnancy
D. Diabetes
E. Vesicular mole
F. Heart disease
Q.245: Causes of vaginal bleeding in first trimester of pregnancy are as follows except:-
A. Abortion
B. Ectopic pregnancy
C. Vesicular Mole
D. Antepartum Haemorrhage
E. Decidual bleeding
Q.246: Embryo is called during:-
A. First eight weeks
B. 8-10 weeks
C. 11-13 weeks
D. 14-16 weeks
Q.247: Characteristics of true labour pains are following, except:-
A. Occurrence of labour pains simultaneously
with uterine contractions
B. Show
C. Presenting part is engaged
D. P/V Exam. Reveals dilatation of cervical canal
Q.248: Velamentous insertion of cord is:-
A. Cord is attached to centre of placenta
B. Cord is attached between centre & edge of placenta
C. Cord is attached to edge of placenta
D. Cord is attached to chorion laeve away from edge of Placenta
Q.249: Average length of lower uterine segment is:-
A. 10 cms.
B. 12 cms.
C. 8 cms.
D. 14 cms.
Q.250: Braxton hick’s uterine contractions are:-
A. Regular, rhythmic & painless
B. Irregular, arrhythmic & painless
C. Regular, Rhythmic & painful
D. Irregular, arrhythmic & painful
Q.251: Quickening is usually found between:-
A. 14-16 weeks
B. 18-20 weeks
C. 22-24 weeks
D. More than 24 weeks
Q.252: Following drugs are contraindicated in pregnancy except:-
A. Tetracyclines
B. Thalidomide
C. 17 Alpha Hydroxy progesterone caproate
D. Diethyl stilboesterol
Q.253: Length of Suboccipito – bregmatic diameter is:-
A. 10 cms
B. 11.3 cms
C. 9.4 cms
D. 13.8 cms
Q.254: Following are the parent types of pelvis, except:-
A. Gynecoid
B. Android
C. Anthropoid
D. Kyphotic
E. Platypelloid
Q.255: Klumpke’s paralysis is the result of:-
A. Injury to upper roots of brachial plexus
B. Injury to lower roots of brachial
C. Injury to hand
D. Injury to spinal cord
Q.256: Hirschsprung’s disease is the commonest cause of:-
A. Atresia of Jejunum
B. Obtruction of large bowel
C. Duodenal obstruction
D. Oesophasial atrsia
Q.257: Backward displacement of toung giving rise to respiratory obstruction is common in :-
A. Down’s Syndrome
B. Pierre Robin Syndrome
C. Microcephaly
D. Hydrocephalus
Q.258: Cleidotomy is the operation which pertains to:-
A. Opening the abdomen
B. Dividing Clavicles
C. Perforating the head of foetus
D. Division of body of the pubis
Q.259: Abnormal prolongation of second stage can occur in following conditions,except:-
A. Contraction ring
B. Long cord
C. Pelvic contraction
D. Uterine inertia
Q.260: Patients with Mendelson’s syndrome present as, except:-
A. Tachypnoea
B. Hypertension
C. Cyanosis
D. Cardio vascular arrest
Q.261: Incidence of septic pelvic thrombophlebitis in pregnancy is :-
A. 1 : 1500
B. 1 : 2000
C. 1 : 10000
D. 1 : 100
Q.262: Schroeder’s ring appears in :-
A. Abruptio placentae
B. Localised tonic contraction of uterus
C. Chorio carcinoma
D. Lower segment dominance
Q.263: Following conditions can cause obstruction in labour, except :-
A. Pelvic contraction
B. Tumors of pelvic bones
C. Undilated stenosed cervix
D. None of the above
Q.264: Hydrocephalus internus is the condition where accumulation of fluid occur in :-
A. Sub arachnoid space
B. Pontine region
C. Cerebral ventricles
D. None of the above
Q.265: Cervical tears are most often:-
A. Longitudinal & lateral
B. Longitudinal & central
C. Circular & lateral
D. None of the above
Q.266: Common presentation in android pelvis is:-
A. Occipito posterior
B. Face
C. Breech
D. None of the above
Q.267: Fortuitous hemorrhage is the term given to the hemorrhage de to :-
A. Ectopic gestation
B. Abruptio placentae
C. Placenta praevia
D. Idiopathic
Q.268: Marginal Placenta praevia is the type of Placenta praevia:-
A. I
B. II
C. III
D. IV
Q.269: The contraceptive TODAY which has been recently introduced contains:-
A. Prostaglandin F2 alpha
B. Norehithisterol
C. 9- nonoxynol
D. Copper releasing mesh
Q.270: Red degeneration of Fibroid uterus is due to:-
A. Thrombosis of the veins
B. Infections
C. Rupture of capsule
D. Gangrene
Q.271: The best contraceptive method to be suggested for a 20 years multiparrous women is:-
A. Oral pills
B. IUCD
c. Condom
D. Diaphragm
Q.272: Chorio carcinoma normally follows :-
A. Abortions
B. Normal labour
C. Hydatidiform mole
D. Ectopic pregnancy
Q.273: Ovulation occurs at:-
A. 14 days before menstruation
B. 14 days after menstruation
C. 16 days before menstruation
D. With in 16 hrs. of LH Surge
Q.274: The branches of internal iliac artery include all of the following, except:-
A. Uterine artery
B. Obturator artery
C. Middle rectal artery
D. Inferior epigastric artery
Q.275: The most common site involved in tuberculosis of genital organs is:-
A. Endometrium
B. Cervix
C. Tubes
D. Ovaries
Q.276: The most common cause of death in carcinoma cervix is:-
A. Haemmorahage
B. Uraemia
C. Infection
D. Metastasis
Q.277: Ectopic pregnancy is seen maximum with:-
A. IUCD
B. OCPills
C. Barrier method
D. Tubal sterilization
Q.278: Narrowest part of fallopian tube is the:-
A. Interstitial portion
B. Isthmus
C. Infundibulum
D. Ampulla
Q.279: Bartholian duct opens into:-
A. Labia majora
B. Labia minora
C. Lower part of vagina
D. Grove between labia minora & Hymen
Q.280: Best evidence of Ovulation is ;-
A. Secretory endometrium
B. B.B.T.
C. Cervical mucus study
D. Pap’s Smear study
Q.281: Commonest malignancy of the cervix is :-
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Adeno acanthoma
D. Sarcoma
Q.282: Teratoma arises from:-
A. Ectodermal cells
B. Endodermal cells
C. Totipotent cells
D. Mesodermal cells
Q.283: The dependence of Myoma on oestrogen is demonstrable by the fact that they:-
A. Stop growing after menopause
B. Are unusually prior to menarche
C. Grow rapidly during pregnancy
D. All of the above
Q.284: Condition relatively considered relative emergency in a teenager with amennorrhoea includes:-
A. Vaginal agenesis
B. Uterine anomaly
C. Imperforate hymen
D. None of the above
Q.285: Which of the following symptoms are associated with an ectopic pregnancy in the fallopian tube:-
A. Unilateral lower abdominal pain
B. Vaginal bleeding
C. Missed menstrual period
D. All of the above
Q.286: Dyspareunia in endometriosis can be caused by:-
A. Endometrioma
B. Fixed retroversion of uterus
C. Uterosacral implants
D. Danazole therapy
Q.287: Which of the following findings suggest the diagnosis of Endometriosis:-
A. Nodularity of Uterosacral ligaments
B. Ovarian enlagement
C. Fixed retroversion of uterus
D. Laparoscopic visualization of implant
Q.288: For women in their 30’s & 40’s with abnormal uterine bleeding the most accurate diagnostic procedure is:-
A. Basal body temperature
B. D & C
C. Hysteroscopy
D. Hormone therapy
Q.289: All of the following are likely reasons for the establishment of a tubal ectopic pregnancy are , except:-
A. Pelvic infection
B. Tubal anastomosis
C. Transmigration of fertilized ovum
D. Uterine myoma
Q.290: Large sub serous myomas are associated with which of the following conditions :-
A. Anaemia
B. Hydronephrosis
C. Reproductive loss
D. None of the above
Q.291: Reproductive problems associated with Myoma includes:-
A. Recurrent abortion
B. Poor implantation
C. Blocked tubes
D. All of the above
Q.292: The occurrence of menstruation is dependent on all the following factors except:-
A. Endometrium responsive to sex steroids
B. Gonadotropins
C. Patent fallopian tube
D. Ovarian steroidal hormones
Q.293: Androgen activity is blocked at the receptor level by:-
A. Cyproterone acetate
B. Cimetidine
C. Predinisone
D. Ampicillin
Q.294: Which of the following menopausal symptom is not responsive to oestrogen replacement therapy:-
A. Depression
B. Insomnia
C. Atrophic vaginitis
D. Vaginal relaxation
Q.295: Contraindication to post menopausal oestrogen replacement therapy includes, which of the following:-
A. Hyperytension
B. Acute liver disease
C. Familial hyperlipidaemia
D. All of the above
Q.296: Ovulation is associated with all of the following processes except:-
A. Reduction division of oocyte
B. Depression of FSH
C. LH surge
D. Progesterone secretion
Q.297: The following are related to thalassaemia, except:-
A. Fresh blood transfusion
B. Folic acid
C. Massive Iron therapy
D. Partial exchange transfusion
Q.298: Incarceation of the retroverted gravid uterus usually occurs at:-
A. 8-10 weeks
B. 12-15 weeks
C. 18-20 weeks
D. 24 weeks
Q.299: In a case of pregnancy with prolapse, pessary should be kept upto:-
A. 12 weeks
B. 18 weeks
C. 24 weeks
D. Till onset of labour
Q.300: Outlet contraction diagnosed late in labour must be managed by:-
A. Forceps with deep episiotomy
B. Caeserean section
C. Symphysiotomy
D. All of the above
Q.301: Deep transverse arrest should be managed by the following, except:-
A. Oxytocin infusion till full dilatation
B. Caeserean section
C. Manual rotation and forceps exraction
D. Ventouse
Q.302: Known causes of Breech presentation are, except:-
A. Prematurity
B. Hydrocephalus
C. Placenta praevia
D. Arcuate Uterus
Q.303: Early clamping of the cord is indicated in the following,except:-
A. Rh-Incompetability
B. Diabetic mothers
C. During caesarean section
D. Post mature babies
Q.304: Sloughing VVF. Following obstructed labour can be managed by :-
A. Repair immediately
B. Self retaining catheter for 14 days
C. Repair after three months
D. None of the above
Q.305: Immediate management of a premature baby following birth is, except:-
A. Delayed of the cord
B. Keep cord length long
C. Adequate concentration of oxygen
D. Administration of vitamin ‘K’
Q.306: Intravenous ergometrine at the time of delivery of anterior shoulder is contraindicated in,except:-
A. Organic heart lesion
B. Diabetes mellitis
C. Severe Hypertension
D. Rh negative immunized mother
Q.307: Selective indications of active management of III stage of labour are following, except:-
A. Hydramnios
B. Grand multiparra
C. Anaemia
D. Severe toxaemia
Q.308: Indication of urgent delivery of second baby in twins are, except:-
A. Abruptio placentae
B. Administration of Ergometrine after delivery of first foetus
C. Cord prolapse of second baby
D. None of the above
Q.309: Foetal hazards in PET includes the following,except:-
A. Asphyxia
B. Intrauterine death
C. IUGR
D. Intracranial haemorrhage
Q.310: Indications of exchange transfusion in anaemia with pregnancy are following, except:-
A. Cardiac failure with Severe anaemia
B. Severely anaemic patient requiring surgery
C. Severe anaemia with PCV less than 13 %
D. None of the above
Q.311: Physiological causes of increased vaginal discharges are as follows,except:-
A. At the time of ovulation
B. Premenstrual phase
C. Sexual stimulation
D. Trichomoniasis
Q.312: Frequency of micturation is a symptom of the following, except:-
A. Early weeks of pregnancy
B. Urinary tract infection
C. Vesicovaginal fistula
D. Later weeks of pregnancy
E. Pelvic tumours
Q.313: Collection of blood in vagina due to imperforated hymen is termed:-
A. Haematosalpinx
B. Haematocolpos
C. Haematometra
D. None of the above
Q.314: ‘XO’ Chromosomal pattern is present in :-
A. Turner’s Syndrome
B. Klinfelter’s Syndrome
C. Superfemale
D. Stein leventhal syndrome
Q.315: Profuse,creamish,frothy vaginal discharge is characteristic of :-
A. Moniliasis
B. Trichomoniasis
C. Gonorrhoea
D. Tuberculosis
E. Syphilis
Q.316: Most common mode of spread of Tuberculosis of genital tract is:-
A. Haematogenous
B. Lymphatic
C. Direct
D. none of the above
Q.317: In 35 days menstrual cycle, ovulation occurs at:-
A. 14th day
B. 16th day
C. 21st day
D. 23rd day
E. 20th day
Q.318: Infertility is defined as :-
A. Failure to conceive
B. Inability to conceive
C. Either of these
D. None of the above
Q.319: Side effect of IUCD are as follows, except:-
A. Excessive bleeding
B. Pelvic infection
C. Vaginal discharge
D. Malignancy
Q.320: Differential diagnosis of vesicular mole is as follows, except:-
A. Threatened abortion
B. Hydramnios
C. Mistaken dates
D. Twins
E. Perforation of uterus
Q.321: First trimester pregnancy is usually terminated by:-
A. Dilatation & curettage
B. Hysterotomy
C. Ethacridine lactate instillation
D. Parenteral prostaglandins
Q.322: The best time of endometrial biopsy in cases of infertility is :-
A. Premenstrual phase
B. Postmenstrual phase
C. Ovulatory phase
D. Menstrual phase
Q.323: 50 % of Choriocarcinoma follows:-
A. Normal labour
B. Abortion
C. Vesicular mole
D. Ectopic pregnancy
Q.324: Benefits of combined pills are all, except:-
A. It effectively controls fertility
B. It can cure Dysmenorrhoea
C. It prevent anaemia
D. It cures amenorrhoea
Q.325: All of the following diseases can cause Pelvic inflammatory disease, except:-
A. Crohn’s disease
B. Syphilis
C. Appendicitis
D. Sarcoidosis
Q.326: The pathogenesis of a tubo ovarian abscess involves which of the following:-
A. Vaginitis
B. Cervicitis
C. Endometritis
D. Oophoritis
Q.327: Danazol treatment for Endometriosis is associated with all of the following sign or symptoms except:-
A. Acne
B. Weight gain
C. Hot flashes
D. Mucoid vaginal discharge
Q.328: Infertility in Endometriosis is related to:-
A. The extent of disease
B. Associated hydrosalpinx
C. Local prostaglandin secretions
D. None of above
Q.329: All of the following factors are evidence that ovulation has occurred, except:-
A. Rise in Basal bodytemperature
B. Pregnancy
C. Secretory endometrium
D. The occurrence of menses
Q.330: Clomiphene citrate is used to correct which of the following problems:-
A. Infrequent ovulation
B. High prolactin levels
C. Cervical mucus of poor quality
D. All of the above
Q.331: Clinical conditions that are suitable for clomiphene stimulation of ovulation includes:-
A. Resistant ovary syndrome
B. Gonadal dysgenesis
C. Ashermann’s syndrome
D. Psychogenic amenorrhoea
Q.332: The development of adhesions seen in Ashermann’s Syndrome is commonly preceded by which of the following event:-
A. Delivery
B. Endometritis
C. D & C
D. Post abortal haemorrhage
E. All of the above
Q.333: All of the following conditions can be found in a patient with a pituitary Chromophobe adenoma, except:-
A. Amenorrhoea
B. Galactorrhoea
C. Cushing syndrome
D. Blindness
Q.334: Which of the following tumor is most sensitive to radiation therapy:-
A. Endometriod cancer
B. Arrhenoblastoma
C. Dysgerminoma
D. Gonadoblastoma
Q.335: Which is most accurate method of diagnosing ectopic pregnancy:-
A. Endometrial biopsy
B. Laparoscopy
C. Ultrasound
D. Culdocentesis
Q.336: Myomas are associated with which of the following clinical condition:-
A. Anaemia
B. Dysmenorrhoea
C. Urinary frequency
D. All of the above
Q.337: Appropriate therapy for a luteal phase defect includes:-
A. Clomiphene citrate
B. HCG
C. Post ovulatory Progesterone supplementation
D. All of the above
Q.338: Following maternal diseases predispose to occurrence of abortion, except:-
A. Severe toxic state
B. Chronic nephritis
C. Cardiac disease
D. Diabetes Mellitus
Q.339: Septic Abortion may result in:-
A. Sterility
B. Pelvic abscess
C. Pyosalpinx
D. Pelvic inflammatory diseases
E. All of the above
Q.340: Doughy consistency of uterus occurs in cases of:-
A. Pregnancy with Fibroid uterus
B. Chronic Hydroamnios
C. Vesicular mole
D. Missed abortion
Q.341: In pregnancy,when renal functions are impaired, following drug can safely be given:-
A. Nalidixic acid
B. Nitrofurantoin
C. Ampicillin
D. Cotrimaxazole
Q.342: Total Iron stored in the body amounts to:-
A. 300 – 500 mgs.
B. 1200-1500 mgs
C. 750 -1000 mgs
D. 100 – 150 mgs
Q.343: Partogram should be maintained to monitor:-
A. Foetal well being
B. Clinical progress of labour
C. Growth if IUGR foetus
D. All of the above
Q.344: Predisposing factors of pre-eclampsia are following, except :-
A. Age & parity
B. Obesity
C. Climate & seasons
D. Genetic predisposition
E. None of the above
Q.345: Chorionic villi depends for their nutrition on:-
A. Foetal membranes
B. Maternal blood in choriodecidual space
C. Direct blood supply to chorionicc villi
D. Amniotic fluid
Q.346: Causes of Jaundice occurring during pregnancy are following, except:-
A. Severe pre-eclampsia & eclampsia
B. Acute fatty liver
C. Intra hepatic cholestasis
D. Long neglected Hyperemesis gravidarum
E. None of the above
Q.347: Potters Syndrome in foetus is seen incases of:-
A. Chronic Hydramnios
B. Oligo hydroamnios
C. Triplets
D. Clomiphene induced pregnancies
Q.348: Signs of onset of labour are following, except:-
A. Slight uterine hemorrhage
B. Commensement of dilatation of the Os
C. Formation of Bag of fore waters
D. Tense & Tender Uterus
Q.349: Caput is always absorbed with in :-
A. 6 hrs. after birth
B. 12-24 hrs. after birth
C. 24-48 hrs. after birth
D. None of the above
Q.350: On first Bi-mannual examination of a patient in labour following points are to be observed, except:-
A.Size of dilating cervix & condition of it’s walls
B. Integrity of it’s walls
C. Level of presenting part
D. Adequacy of pelvis
E. All of the above
F. None of the above
Q.351: Principle hazards of epidural block during labour is:-
A. Hypertension
B. Hypotension
C. Permanent neurological problems
D. All of the above
Q.352: Normally fertilization of ovum takes place at:-
A. Uterine cavity
B. Outer part of fallopian tube
C. Peritoneal cavity
D. Cervical canal
Q.353: Predisposing factors of pre-eclampsia are following, except:-
A. Climate & Season
B. High attitude
C. Genetic predisposition
D. Hydatiform mole
Q.354: Lytic-cocktail regimen include following drugs, except:-
A. Promethazine
B. Paraldehyde
C. Chlropromazine
D. Pethidine
Q.355: Potter’s Syndrome is associated with:-
A. Diabetes mellitus
B. Severe oligohydramnios
C. Carpel tunnel syndrome
D. Congenital heart disease
Q.356: Sub pubic angle measures:-
A. 90degrees
B. 80 degrees
C. 70 degrees
D. 110 degrees
Q.357: Number of Frontannelles, which exist in skull at term is:-
A. 4
B. 8
C. 6
D. 10
Q.358: Uterine activity can be increased by following drugs, except:-
A. Oxytocin
B. Isosuprine
C. Ergometrine
D. Prostaglandins
Q.359: One of the following positions increases obstetrical conjugate:-
A. Extreme Hyperextension
B. Lithotomy
C. Dorsal
D. Trendelenberg
Q.360: Human placental lactogen is secreted by :-
A. Foetal liver
B. Foetal Adrenals
C. Sybcytiotrophoblast
D. Cytotrophoblast
Q.361: Late deceleration is because of :-
A. Placental compression
B. Foetal Compression
C. Toxaemia of pregnancy
D. All of the above
Q.362: Multiple births are common in:-
A. Negroes
B. Indians
C. Mongoles
D. Caucasians
Q.363: Anti tubercular drug safest for mother & foetus is:-
A. INH
B. Ethambutol
C. Rifampcin
D. Pyrizinamide
Q.364: Vomiting is common feature of all, except:-
A. Hydatidiform mole
B. Missed abortion
C. Ectopic pregnancy
D. None of the above
Q.365: Activity of carpus luteum decline sharply by :-
A. 28 weeks of gestation onwards
B. 12 weeks of gestation onwards
C. 6-12 th week of gestation
D. 20 weeks of gestation onwards
Q.366: ‘Pfluger’s Description’ pertains to:_
A. Formation of Placenta
B. Formation of corpus luteum
C. Formation of oocyte
D. Formation of foetal gonads
Q.367: ‘Hack-saw’ appearance is related to :-
A. Chorion
B. Amnion
C. Endometrium
D. Trophoblast
Q.368: Serotina is a distinct portion of:-
A. Syncytiotrophoblast
B. Umbilical cord
C. Decidua
D. None of the above
Q.369: The diameter of placenta at 4th month of gestation is nearly:-
A. 200 mm
B. 170 mm
C. 80-85 mm
D. 300 mm
Q.370: Which layer has neither blood nor nerve supply nor a demonstrable lymphatic system:-
A. Endometrium
B. Placental membranes
C. Amnion
D. None of the above
Q.371: Normally sugar content of liquour amnii at term varies from:-
A. 100 - 500 mg%
B. 70 – 100 mg%
C. 10 - 60 mg%
D. 280 – 310 mg%
Q.372: At term lower uterine segment comprises:-
A. 1/8th of uterus
B. 1/4th of uterus
C. 1/10th of uterus
D. 1/6th of uterus
Q.373: Montogomery’s tubercles represents:-
A. Hypertrophy of glandular acinii
B. Increased connective tissue stroma
C. Enlarged Sebaceous gland
D. Increased vascularity under skin
Q.374: Blood volume in pregnancy is maximum at:-
A. 32 weeks
B. 36 weeks
C. Term
D. 34-36 weeks
Q.375: The usual proportion of Bonovular to uniovular twins is:-
A. 1:3
B. 3:1
C. 1:2
D. 4:1
Q.376: Foetal breathing movements are detected at the earliest by:-
A. 13 weeks
B. 10 weeks
C. 06 weeks
D. 20 weeks
Q.377: ‘Meralgia Paraesthetica’ is chacterized by the following, except :-
A. Paraesthesia
B. Oedema
C. Pain
D. Numbness
Q.378: Infective agents which predisposes to occurrence of abortion are following, except:-
A. Listeria
B. Giardia
C. Ureaplasma
D. Chalamydia
Q.379: Commonly prolonged labour in primigravida is due to:-
A. Cervical dystocia
B. Incoordinate uterine action
C. Cervical incompetence
D. Anaemia
Q.380: Commonest cause for repeated transverse lie is:-
A. Bicornuate uterus
B. Subseptate uterus
C. Septate uterus
D. Uterus Didelphus
Q.381: Fertilisation of two ova from different ovulation period is called as :-
A. Superfoecundation
B. Superfoetation
C. Binovular twins
D. Uniovular twins
Q.382: Time limit for trial of labour is :-
A. 06 hrs.
B. 24 hrs.
C. 12 hrs.
D. None of the above
Q.383: Commonest cause of secondary PPH is:-
A. Uterine inertia
B. Retained Placenta
C. Cervical tear
D. Episiotomy
Q.384: Drug contraindicated in nursing mother is:-
A. Tetracyclin
B. Chloromphenicol
C. Phenindione
D. Chlorothalidone
E. All of the above
Q.385: Immediately after delivery uterus weighs about:-
A. 500 gms.
B. 1000 gms.
C. 1500 gms.
D. 2000 gms.
Q.386: Treatment of choice in full term foetus with mother having carcinoma cervix is :-
A. Normal delivery
B. Classical caesarean section
C. Lower segment caesarean section
D. None of the above
Q.387: Total uterine paralysis is caused by:-
A. Spinal anesthesia
B. Caudal anaesthesia
C. Ether
D. Chloroform
Q.388: Contraindications of forceps delivery includes:-
A. Scar in uterus
B. Cephalo pelvic disproportion
C. Prematurity
D. Breech presentation
Q.389: Delivery with Kjelland’s forceps is the method of choice in:-
A. Occipito posterior arrest
B. Deep transverse arrest
C. Mento posterior arrest
D. All of the above
Q.390: Following are the causes of Hypofibrinogenaemia, except:-
A. Intra uterine death
B. Rh-Incompatibility
C. Septic abortion
D. Amniotic fluid embolism
Q.391: IUGR is caused by the following, excepr:-
A. Alcohol
B. Diabetes
C. Smoking
D. Chronic renal failure
Q.392: Overlapping of cranial bones of foetus in utero is due to:-
A. Moulding
B. Intra uterine death
C. Caput formation
D. Anencephaly
Q.393: Corpus lutum reaches its maximum activity after ovulation on:-
A. 14th day
B. 09th day
C. 04th day
D. None of the above
Q.394: Maximum number of follicles that can ovulate is unlikely to exceeds:-
A. 200
B. 500
C. 1000
D. 10000
Q.395: Immediately following menstruation the thickness of endometrium measures:-
A. 0.05 mm
B. 0.5 mm
C. 1.0 mm
D. 1-2 mm
Q.396: Chorionic gonadotrophins are present in very high concentration during:-
A. First three months of pregnancy
B. 4th month of pregnancy
C. At term
D. None of the above
Q.397: Dysplasia of germinal cells in the testis is found in:-
A. Turner’s syndrome
B. Klinfelter’s syndrome
C. Tay sachs disease
D. Niemann picks disease
Q.398: Area upon which the placenta is subsequently formed in great majprity of instances is:-
A. Sertina
B. Decidua Capsularis
C. Decidua vera
D. All of the above
Q.399: The diameter of placenta at term is nearly:-
A. 10 cms.
B. 20 cms.
C. 30 cms.
D. 05 cms.
Q.400: The trophoblast possesses following activities, except:-
A. Proteolytic
B. Lipolytic
C. Glycogenesis
D. Enzymatic
Q.401: Transplacental infection to the foetus are following, except:-
A. Typhoid fever
B. Anthrax
C. Pyococcal
D. E.coli
Q.402: Incidence of velamentous insertion of cord is:-
A. 7 %
B. 1-2 %
C. 17 %
D. None of the above
Q.403: Blood taken from umbilical cord of a normal infant at term cotains Billirubin, on an average:-
A. 0.4-0.8 mg/dl
B. 1 – 2 mg/dl
C. 2- 2.4 mg/dl
D. 4.4 mg/dl
Q.404: In a term foetus the incidence of adult type of haemoglobin is:-
A. 40 %
B. 20 %
C. 10 %
D. 0-5 %
Q.405: “10 day rule’ pertains to :-
A. X- Ray in pregnancy
B. Vaccination in pregnancy
C. Dog bite in pregnancy
D. Tetanus in pregnancy
Q.406: Viable foetus is at :-
A. 20 weeks of gestation
B. 12 weeks of gestation C. 24 weeks of gestation
D. 28 weeks of gestation
Q.407: Fully grown human oocyte is easily the largest cell in the body, it’s diameter being:-
A. 200 microns
B. 250 microns
C. 130 microns
D. 400 microns
Q.408: luteum reaches it’s maximum activity, after ovulation in :-
A. 10 days
B. 6 days
C. 9 days
D. 14 days
Q.409: Progesterone is necessary for the maintenance of pregnancy & is secreted in very large amounts by the:-
A. Corpus luteum
B. Decidua
C. Placenta
D. None of the above
Q.410: Placenta approaches it’s pt’s maximum thickness by:-
A. Eight minth
B. Third month
C. Fourth month
D. Seventh month
Q.411: Layers of Langhen’s disappears at:-
A. 3rd month of pregnancy
B. 4th month of pregnancy
C. 5th month of pregnancy
D. Continue to persist till late pregnancy
Q.412: The memberane ‘Amnion’ consists of:-
A. Single layer
B. Double layer
C. Triple layer
D. Five layers
Q.413: Wharton’s jelly is :-
A. Substance of Amnion
B. Substance of Chorion
C. Substance of Placenta
D. Substance of Umbilical cord
Q.414: The valve of Foramen Ovale will be patent as long as :-
A. Rt. Arterial pressure exceeds the Lt. Arterial pressure
B. Rt. Arterial pressure exceeds the Lt. Ventricular pressure
C. Lt. Arterial pressure exceeds the Rt. Arterial pressure
D. None of the above
Q.415: Cervix becomes typically ‘Mauve’ Colored in:-
A. Ectopic gestation
B. Pregnancy with heart disease
C. Normal Pregnancy
D. Threatened Abortion
E. All of the above
Q.416: The Radiogram will usually reveal the foetal skeleton earliest by :-
A. 28 weeks
B. 12 Weeks
C. 16 Weeks
D. 20 Weeks
Q.417: The Radio immuneassay test of patient serum can detect the presence of HCG as early as :-
A. First missed period
B. 27 days after last menses
C. 07 days period after missing the period
D. 48 hrs. after missing the period
Q.418: The presence of surfactants in the Amniotic fluids provides a reliable means of measuring:-
A. Functioning of Liver
B. HDL level in the blood
C. Degree of pulmonary maturity
D. All of the above
Q.419: Therupeutic amniocentesis is indicated in :-
A. Rh- Incompatibility
B. Twin pregnancy
C. Hydramnios
D. None of the above
Q.420: Cramps in calf muscles in later part of pregnancy is because of:-
A. Defective posture
B. Increased HCG levels
C. Increased Intra amniotic pressure
D. None of the above
Q.421: Average diameter of Bartholian gland is:-
A. 07 mm
B. 10 mm
C. 15-20 mm
D. 02-05 mm
Q.422: Secretions of cervical glands have high content of :-
A. Glucose
B. Sucrose
C. Fructose
D. Maltose
Q.423: Wall of fallopian tube have:-
A. One layer
B. Two layers
C. Three layers
D. Four layers
Q.424: Organ of Rosenmuller is known as:-
A. Paroophron
B. Epoophron
C. Mesovarian
D. None of the above
Q.425: Frankenhauser’s plexus is present in:-
A. Parametrium
B. Endometrium
C. Myometrium
D. Ovaries
Q.426: Folliculostatin suppresses :-
A. LH
B. GnRH
C. FSH
D. Prolactin
Q.427: At the age of 40, the bone calcium amounts to:-
A. 1200 gms.
B. 500 gms.
C. 2000 gms.
D. 3000-5000 gms
Q.428: Hot flushes can be prevented by:-
A. Thiaziade
B. Metformin
C. Glibenclamide
D. Clonidine
Q.429: Synthetic analogue of GnRh are used in following, except:-
A. Invitro fertilization
B. Precocius puberty
C. Hirsuitism
D. Ovarian malignancy
Q.430: In addition to urinary & genital abnormalities syndrome shows:-
A. Anaemia
B. Skeletal deformity
C. Cirrhosis if liver
D. Cerebral palsy
Q.431: Vaginal discharge has musty odour in :-
A. Senile vaginitis
B. Chalamydialinfection
C. Gardinella vaginitis
D. Emphysematous vaginitis
Q.432: Azidothimidine is the drug related to :-
A. Birth control
B. Choriocarcinoma
C. AIDS
D. Elephantiasis vulva
Q.433: Incidence of secondary amenoorhoea in patients of genital tuberculosis is:-
A. 1 %
B. 2-5 %
C. 10 %
D. 20-25 %
Q.434: Gland of Rosenmuller lies beneath:-
A. Mons veneris
B. Vestibule
C. Pouparts ligament
D. Uterosacral ligament
Q.435: Malignancy of genital tract accounts for postmenopausal bleeding in:-
A. 5-10 % of cases
B. 90 % of cases
C. 30-50 % of cases
D. None of the above
Q.436: Operation for reunification of Uterine Cavity is known as:-
A. Janes operation
B. Tompkins operation
C. Strassman operation
D. None of the above
Q.437: Finasteride is drug related to:-
A. Intertrigo
B. Virilism
C. Hirsuitism
D. Folliculitis
Q.438: Histopathologically Koilocytes are seen in:-
A. Molluscum Contagiosum
B. Herpes genitalis
C. Condyllma acuminatum
D. All of the above
Q.439: Miller-Kurzrok test pertains to:-
A. Vulval dystrophy
B. Stress Incontinence
C. Urge Incontinence
D. Sterility
Q.440: Success rate of gamete intrafallopian transfer is approximately:-
A. 90-100 %
B. 20-30 %
C. 50-60 %
D. 5-10 %
Q. 441: Contraindications of Centchroman use is:-
A. Cervical dysplasia
B. PCOD
C. Liver disfunction
D. All of the above
Q.442: Fox-fordyce diseases pertains to:-
A. Kraurosis Vulva
B. Lichen Sclerosis
C. Hidroadenitis of vulva
D. None of the above
Q.443: Most likely diagnosis in a 32 years old women with recurrent painful swelling in left labia minora is :-
A. Hideradenitis
B. Herpes simplex infection
C. Bartholian cyst
D. Condylomata accuminata
Q.444: Diabetic vulvitis is characterized by:-
A. Marked Pruritis
B. Red & beefy vulva
C. Complicated by Moniliasis
D. All of the above
Q.445: Sarcoma Botryoides is thought to arise primarily from:-
A. Vulva
B. Vagina
C. Cervix
D. Uterus
Q.446: Treatment of Candidiasis is:-
A. Clotrimazole
B. Nystatin
C. Gentian violet
D. All of the above
Q.447: Next line of management in 30 year old patient with severe dysplasia on vaginal cytology is:-
A. Schilleria test
B. Conization
C. Colposcopy
D. Hysterectomy
Q.448: Rete hyperplasia is important in the tissue diagnosis of:-
A. Lymphogranuloma
B. Condylomata
C. Lichen scleris
D. None of the above
Q.449: Hegar sign can be elicited by:-
A. 10 weeks
B. 05 weeks
C. 08 weeks
D. 06 weeks
Q.450: Biological half life of Oxytocin is :-
A. 3-4 minutes
B. 5-6 minutes
C. 7-8 minutes
D. None of the above
Q.451: Ripening of cervix takes place by:-
A. Oxytocin infusion
B. Intravaginal Prostaglandin application
C. Separation of membranes
D. All of the above
Q.452: Indication for removal of IUCD is :-
A. Missing thread
B. Pregnancy
C. Infection to genital tract
D. None of the above
Q.453: Pregnancy with Lippe’s loop has got increased incidence of:-
A. Ectopic pregnancy
B. Sepsis
C. Abortion
D. Prematurity
Q.454: Diagnosis of IUGR is achieved by :-
A. Serial estimation of urinary oestriol
B. Sonography
C. Cytological study
D. Clinical Examination
Q.455: Types of IUGR are:-
A. Symmetrical
B. Assymetrical
C. Indiscreminate
D. All of the above
Q.456: Which drug from the following, is uterine relaxant:-
A. Danazol
B. Clomiphene citrate
C. Isoxsuprine
D. Oestrogen progesterone pills
Q.457: Meconium aspiration syndrome occurs in:-
A. Diabetes mellitus
B. Asphyxia neonatorm
C. Dysmature foetus
D. None of the above
Q.458: Supression of lactation may occurs following the use of:-
A. Oral Contraceptive
B. Ethinyl estriol
C. Ergotamine maleate
D. Ethinyl estradiol
Q.459: Bishop’s score pertains to:-
A. Infertility
B. Maturity of Foetus
C. Induction of Labour
D. None of the above
Q.460: Foetal indication for Induction of labour are except:-
A. Spina Bifida
B. Postmaturity
C. Rh-isiimmunization
D. Intrauterine growth retardation
Q.461: Maternal indication of Induction is except:-
A. Intra uterine death
B. Hydroamnious
C. Maternal Exhaution
D. None of the above
Q.462: Pearl index is related with:-
A. Synonym with cornification index
B. Contracted Pelvis
C. Assesment of high risk pregnancy
D. Contraceptive effectiveness
Q.463: Oestrogen in oral contraceptive pills causes the following, except:-
A. Nausea,vomiting
B. Headache
C. Hypertension
D. Respiratory distress
Q.464: Neglected shoulder in live foetus should be managed by :-
A. Caeserean section
B. Internal podalic version
C. Destructive operation
D. None of the above
Q.465: Following drug cross the placental barrier to the foetus:-
A. Ampicillin
B. Tetracyclin
C. Diazepam
D. Aspirin
Q.466: Third stage complication includes:-
A. Post partum haemorrhage
B. Haemorrhagic shock
C. Inversion uterus
D. Retained placenta
E. All of the above
Q.467: Maternal complication during labour in Hydramnios is:-
A. Post partum haemorrhage
B. Uterine atonia
C. Haemorrhagic shock
D. All of the above
Q.468: Rupture uterus can be managed by:-
A. Depends on site of rupture & general condition of patient
B. Suturing the ruptured site
C. Obstetrical hysterectomy
D. Suturing the site & sterilization
Q.469: Symphysiotomy is done in cases of :-
A. No role in modern obstetrics
B. Outlet contraction
C. Flat pelvis
D. None of the above
Q.470: Least dangerous placenta praevia is:-
A. Posterior placenta praevia
B. Central placenta praevia
C. Anterior placenta praevia
D. All of the above
Q.471: Diameter of engagement in face to pubes delivery is :-
A. Mento vertical
B. Sub occipito bregmatic
C. Occipito frontal
D. Bi parietal
Q.472: Oligohydroamnios is caused by the following, except:-
A. Oesophageal atresia
B. Anencephaly
C. Meningocoele
D. Foetal renal agenesis
Q.473: Respiratory distress syndrome is clinically evident:-
A. Atbirth
B. Depends on other investigations
C. 6-12 hrs. of delivery
D. After 24 hrs. of birth
Q.474: Magnesium toxicity is reversed in pregnancy by:-
A. Sodium Bicarbonate
B. Meprobamate
C. Succinyl choline
D. Calcium gluconate
Q.475: What’s the Biparietal diameter:-
A. 95 mm.
B. 98 mm.
C. 68 mm.
D. 94 mm.
Q.476: Which of the following drugs is teratogenic:-
A. Frusemide
B. Reserpine
C. Propranolol
D. Thiazides
Q.477: Incidence of Breech presentation is:-
A. 6 %
B. 20 %
C. 20 %
D. 3-5%
Q.478: Placental cause of Hydroamnious are:-
A. Placental haemangioma
B. Placenta Circumvellata
C. Placenta succenturate
D. None of the above
Q.479: Green-Armytage forceps are used:-
A. To extract the foetus
B. Abdominal tubectomy
C. Achieve Haemostasis
D. None of the above
Q.480: Postpartum haemorrhage can lead to:-
A. Sheehan’s Syndrome
B. Haemorrhagic Shock
C. Septicaemia
D. Renal failure
E. A & B
Q.481: Ventous can cause:-
A. Scalp abrasion
B. Frecture of Skull Bone
C. Cephalhaematoma
D. Intracranial haemorrhage
Q.482: Traumatic Postpartum haemorrhage is diagnosed by:-
A. Relaxed Uterus
B. Pain with Bleeding
C. Contracted Uterus
D. All of the above
Q. 483: Gestational sac can be identified by Ultrasonography as early as:-
A. 5th week of gestation
B. 8th week of gestation
C. 10-12 week of gestation
D. None of the above
Q.484: Best method of delivering placenta is:-
A. Cord traction
B. Manual removal of placenta
C. Spontaneous explusion
D. Crede’s method
Q.485: Twiching in the newborn is due to:-
A. Hypoglycaemia
B. Hypocalcaemia
C. Cerebral damage
D. All of the above
Q.486: Intrautrine pressure in first stage of labour:-
A. 10 – 15 mm. Hg
B. 30 mm. Hg
C. 60 mm. Hg
D. 100 – 150 mm. Hg
Q.487: Rubella in early pregnancy can cause:-
A. Cataract
B. Mental deficiency
C. Cardiac anomaly
D. All of the above
Q.488: Vaginal pH in the newborn is :-
A. 6
B. 4
C. 8
D. 7
Q.489: Common presentation in Android pelvis is:-
A. Breech
B. Face
C. Occipito posterior
D. All of the above
Q.490: Chances of multiple pregnancy is common with:-
A. Bromocryptin
B. Comiphene citrate
C. Danazol
D. Oral contraceptive pills
Q.491: Danger of internal podalic version is:-
A. Rupture uterus
B. Cervical tear
C. Vaginal wall laceration
D. All of the above
Q.492: Anencephaly is often associated with:-
A. Postmaturity
B. Hydramnios
C. Spina Bifida
D. All of the above
Q.493: Spontaneous delivery of foetus with shoulder presentation is possible with:-
A. Preterm labour
B. Dead foetus
C. Congenital anomaly in foetus
D. A & B
Q.494: Acute Hydramnios can cause:-
A. Cord prolapse
B. Abnormal presentation
C. Post partum haemorrhage
D. Septic shock
Q.495: Extraction of foetal head by ventous can cause:-
A.Cephalhaematoma
B. Intracranial haemorrhage
C. Jaundice
D. All of the above
Q.496: Foetus with Brow presentation is delivered by:-
A. Mannual rotation & forceps
B. Internal podalic version
C. Caeserean section
D. None of the above
Q.497: Palpation of ischial spines of pelvis helps in:-
A. Place where pudendal block is given
B. Transversed diameter of pelvis is being assessed
C. Ruling out mid pelvic contraction
D. All of the above
Q.498: Breech presentation is caused by:-
A. Contracted pelvis
B. Hydramios
C. Placenta praevia
D. All of the above
Q.499: Anuria in Abruptio placentae sets in if patient fails to deliver:-
A. With in 6-8 hrs. of haemorrhage
B. With in 30 minutes of haemorrhage
C. With in 12 hrs.of haemorrhage
D. None of the above
Q.500: Android pelvis has:-
A. Wedge shaped inlet
B. Funnel shaped pelvis
C. Narrow anterior segment of pelvis
D. None of the above
Q.501: Proper time for pelvic assessment in primigravida is:-
A. 32-34 weeks
B. 12 weeks
C. Near term
D. During labour
Q.502: Cord prolapse is commonly encountered in:-
A. Premature rupture of membranes
B. Shoulder presentation
C. Hydramnios
D. Occipito posterior position
Q.503: Septic abortion has the complication of:-
A. Haemorrhage
B. Renal failure
C. Septicaemia
D. None of the above
Q.504: Oesophageal atresia in newborn is common in mothers with :-
A. Toxoplasmosis
B. Oligohydramios
C. Diabetes
D. Rubella
Q.505: Contra indication of oxytocin infusion is:-
A. Grand multipara
B. Obstructed labour
C. Heart disease
D. All of the above
Q.506: Methyl ergotamine maleate acts with in :-
A. 45 seconds
B. 100 seconds
C. 150 seconds
D. None of the above
Q.507: The closed IUCD device is:-
A. Ota ring
B. Cu ‘T’
C. Grafenberg ring
D. Lippe’s loop
Q.508: Mostly female sterilization is done by:-
A. Vaginal route
B. Laparoscopic sterilization
C. Conventional method
D. Minilap
Q.509: Episiotomy is to be applied at:-
A. Just prior to crowning
B. After crowning
C. After delivery of the presenting part
D. In 2nd stage of labour
Q.510: The placental separation and expulsion may be completed:-
A. Spontaneous
B. Mannual removal
C. Controlled cord traction
D. None of the above
Q.511: Muller-Munroker method is related to:-
A. Cephalopelic disproportion
B. Placental grading
C. Sex determining method
D. Foetal monitoring
Q.512: Inversion of uterus may occur due to :-
A. Mismanaged 3rd stage of labour
B. Cord traction
C. Precipitated labour
D. All of the above
Q.513: Caeserean Section is indicated in all except:-
A. Two previous Caeserean sections
B. Hydrocephalus
C. Primigravida with Breech presentation
D. Foetal distress
Q.514: Caeserean Section indicated in Breech presentation except:-
A. Placenta praevia
B. Elderly primi
C. Contracted Pelvis
D. None of the above
Q.515: Choriocarcinoma is precided by a normal pregnancy:-
A. 1 in 1000
B. 1 in 100,000
C. 1 in 160,000
D. 1 in 1,000,000
Q.516: Which of the following is not a cause of placental insufficiency:-
A. Diabetes
B. Chronic renal disease
C. Hypertention
D. Battledore placenta
Q.517: Which of the following agent leads to paralytic ileus in newborn,when given to mother:-
A. Magnesium sulfate
B. Apresoline
C. Reserpine
D. Hexamethonium
Q.518: Critical factor of diabetes in pregnancy are except:-
A. Glcosurea
B. Gross obesity
C. Blood in normal range
D. Previous still birth
Q.519: Twin pregnancy is usually associated with:-
A. Folic acid deficiency
B. Iron deficiency anaemia
C. Sickel cell anemia
D. None of the above
Q.520: Seizure in the neonatal period may be due to, except:-
A. Pyrodoxin deficiency
B. Hypoglycemia
C. Intracranial haemorrhage
D. A & B
Q.521: Puerpereal fever is caused by:-
A. Poor hygiene
B. Breast abcess
C. Urinary tract infection
D. All of the above
Q.522: Shoulder presentation in labour can causethe following, except:-
A. Uterine rupture
B. Obstructed labour
C. Cord prolapse
D. A & B
Q.523: Cause for anencephaly in post mature pregnancy is:-
A. High Oestrogen & progesterone levels
B. Aging changes in Placenta
C. Foetal adrenal hypoplasia
D. None of the above
Q.524: Rapid intravenous administration of 5% of glucose to a patient in labour may result in:-
A. Maternal Hypernatraemia
B. Neonatal hypocalcaemia
C. Maternal hypokalemia
D. None of the above
Q.525: Cause of IUGR includes:-
A. Alcohol consumption
B. Smoking
C. Chronic maternal hypertension
D. All of the above
Q.526: Mendelson syndrome pertains to:-
A. Allergic reaction to drugs
B. Pregnancy with reflux gastritis
C. Cardiac arrest during Caeserean section
D. Aspiration of gastric contents by the mother under anesthesia
Q.527: Localization of Placenta is absolutely an indication in :-
A. Prior to anaesthesia
B. Internal podalic version
C. Chronic villous biopsy
D. None of the above
Q.528: Forceps which causes maximum damage are:-
A. Kiellands forceps
B. Simsons forceps
C. Millnemurre forceps
D. Wrigley’s forceps
Q.529: Failed forceps is due to :-
A. Undilated cervix
B. High station of head
C. Unrotated head
D. B & C
Q.530: Intracranial haemorrhage in the newborn is due to:-
A. Ventous
B. Forceps
C. Prolonged 2nd stage of labour
D. All of the above
Q.531: Approximately maternal mortality rate in Rupture uterus in developing countries in rural areas is:-
A. 30-40%
B. 05-10%
C. 15-20%
D. None of the above
Q.532: Placenta praevia is associated with all of the following , except:-
A. Abnormal foetal presentation
B. Painless bleeding after 20 weeks of gestation
C. Pregnancy superimposed with hypertension
D. None of the above
Q.533: Common cause of cerebral palsy in newborn is:-
A. Asphyxia neonatorum
B. Prematurity
C. Severe hyperbilirubinaemia
D. None of the above
Q.534: Deep vein thrombosis is diagnosed by the following, except:-
A. Homan sign
B. Cuff pain test
C. Phlebography
D. Angiography
Q.535: ‘Hallo’ sign on skiagram of the living foetus indicates:-
A. Toxoplasmosis
B. Cytomegalovirus infection
C. Hydropes foetalis
D. Herpetic infection
Q.536: Premature rupture of membrane can be confirmrd by following test, except:-
A. Benzidine test
B. Ultrasonography
C. Nitrazene test
D. Fern test
Q.537: Most common presentation in anencephaly is:-
A. Face
B. Brow
C. Breech
D. Parietal
Q.538: Absolute sign of intrauterine death is:-
A. Failure of growth of foetus
B. Absent foetal movement
C. Splding sign
D. Absence of foetal heart sound
Q.539: Average duration of pregnancy is:-
A. 280 days
B. 278 days
C. 300 days
D. 180 days
Q.540: Single umbilical artery may be associated with:-
A. Rh- Incompatibility
B. Blood sugar of patient
C. Blood volume of patient
D. Foetomaternal transfusion
Q.541: Toxic shock syndrome is caused by :-
A. Use of chemicals in vagina
B. Septicaemia
C. Tampoons during menses
D. None of the above
Q.542: Zatuchni scoring pertains to:-
A. Favourable induction of labour
B. Healthy foetus
C. Breech delivery
D. Infertility
Q.543: Bluish coloration of vagina is known as :-
A. Hegar sign
B. Asheinzondak sign
C. Chadvik sign
D. None of the above
Q.544: Isoxsuprine hydrochloride to be given by:-
A. Intramuscular route
B. Subcutaneous
C. Intravenous infusion
D. None of the above
Q.545: Hydroaminos is associated with:-
A. Cogenital anomaly of foetus
B. Diabetic mother
C. Twin pregnancy
D. All of the above
Q.546: In multiparous women the internal cervical Os is:-
A. Longitudinal
B. Circular
C. Transverse
D. Septate
Q.547: Partogram help in detect of:-
A. Incordinate uterine action
B. Obstructed labour
C. Postpartum haemorrhage
D. Abruptio placenta
Q.548: Calcium requirenment during 3rd trimester of pregnancy is:-
A. 1000 mg./day
B. 750mg./day
C. 100-300mg./day
D. None of the above
Q.549: Classical caesarean section is indicated in all of the following condition, except:-
A. Carcinoma cervix
B. Vascular lower uterine segment
C. Foetal distress
D. Postmature delivery
Q.550: Post term pregnancy is one which continues beyond:-
A. 280 days
B. 294 days
C. 286 days
D. 316 days
Q.551: Low birth weight means birth weight less than:-
A. 2.0 kg
B. 1.5 kg
C. 1.8 kg
D. 1.0 kg
Q.552: Microcephaly is common in mothers with:-
A. Alcohol
B. Diabetes
C. Hypertension
D. Smokers
Q.553: Rupture of Graffian follicle occurs :-
A. 16-24 hrs. after LH surge
B. Before LH surge
C. 06 hrs. after LH surge
D. None of the above
Q.554: Which part of the head is born last in vertex presentation:-
A. Face
B. Chin
C. Forehead
D. Vertex
Q.555: Cholestrin crystals are found in :-
A. Lochia alba
B. Lochia rubra
C. lochia serosa
D. None of the above
Q.556: Milk secretion on 4th day of delivery in 24hrs. approximately:-
A. 250 mls.
B. 300 ml.
C. 150-200 mls.
D. None of the above
Q.557: Mc Donald stitch is applied in cases of :-
A. Cystocoele
B. Rectocoele
C. Incompetent cervical Os
D. Lax hiatus
Q.558: Contraindication of Mc Donald operation are:-
A. Leaking membranes
B. Amnionitis
C. Patient in active labour
D. History of vaginal bleeding
Q.559: Incarciration of the retroverted gravid uterus occurs at:-
A. 12-16 weeks
B. 08-10 weeeks
C. 18-20 weeks
D. None of the above
Q.560: Gallimanni is test for:-
A. Confirming pregnancy
B. Biological test done in frogs
C. Immunological test
D. Cytological method
Q.561: Life span of foetal red blood corpuscles is:-
A. 90 days
B. 80 days
C. 120 days
D. 140 days
Q.562: Blood cholesterol during pregnancy at term is:-
A. 200 mg. %
B. 250 mg. %
C. 400 mg. %
D. 100 mg. %
Q.563: Uterine blood flows per minute at term is:-
A. 750 ml.
B. 1000 ml.
C. 350 – 460 ml.
D. None of the above
Q.564: Plasma progesterone at term is ( in/µgms/100ml ):-
A. 15
B. 35 – 40
C. 5
D. None of the above
Q.565: Detectable amount of HCG appears in serum as early as:-
A. 7th day of implantation
B. 24 – 36 hrs. of implantation
C. 3rd day of implantation
D. 5th day of implantation
Q.566: Prostaglandins synthesis inhibitors are:-
A. Atenalol
B. Acitic acid
C. Asprin
D. Alcohol
Q.567: Recovery from eclampsia can best be predicted by:-
A. Fall in blood pressure
B. Oedema subsides
C. Urinary output increases
D. Number of eclamptic fits
Q.568: Blood pressure in uterine artery at placental sute is:-
A. 80 mm. Hg
B. 60 mm.Hg
C. 100 mm. Hg
D. 120 mm. Hg
Q.569: Contraindication of the use of ventouse are:-
A. Prematurity
B. Brow presentation
C. Foetal distress with dilation of cervix 6 – 8 cms.
D. All of the above
Q.570: Cause of high floating head at term in primigravida:-
A. Occipito posterior position
B. Cephalopelvic disproportion
C. Deflexed hand
D. All of the above
Q.571: Placenta produces mainly:-
A. Progesterone
B. Oestriol
C. Oestradiol
D. None of the above
Q.572: Abruptio placentae to be differentiated from:-
A. Placenta praevia
B. Pregnancy with carcinoma cervix
C. Rupture uterus
D. All of the above
Q.573: Gray baby syndrome has been found in association with:-
A. Chloromphenicol
B. Tetracycline
C. Streptomycin
D. Cephalosporins
Q.574: If not properly applied kielland forceps can cause:-
A. Cervical tear
B. 3rd degree perineal tear
C. Rupture of lower uterine segment
D. All of the above
Q.575: Differential diagnosis of twin pregnancy can be:-
A. Hydroamnios
B. Soft tissue mass
C. Big baby
D. All of the above
Q.576: Multiple pregnancy is least common with:-
A. Clomiphene citrate
B. Invitro fertilization
C. GnRH
D. Increased level of oestrogen
Q.577: Diameter of engagement in occipito posterior position is:-
A. 10 cms.
B. 09.4 cms.
C. 11.8 cms.
D. 13.1 cms.
Q.578: Transverse lie is often associated with following, except:-
A. Placenta praevia
B. Contracted pelvis
C. Uterine anomaly
D. Soft tissue mass in pelvis
Q.579: The dignosis of triplets can best be made by:-
A. HCG levels in urine
B. Ultrasound
C. X-Ray abdomen A.P. view
D. Human Placental lactogen
Q.580: Maternal death in abruption placentae is due to:-
A. Septic shock
B. Haemorrhage
C. Coagulation & Renal failure
D. All of the above
Q.581: Trial of labour is indicated in:-
A. Breech delivery
B. Shoulder presentation
C. Cord prolapse
D. Borderline cephalopelvic disproportion
Q.582: Commonest cause of Hydramnios is:-
A. Spina Bifida
B. Meningocoele
C. Anencephalic foetus
D. Oesophasial atresia
Q.583: Most important investigation of vesicular mole is:-
A. Estimation of HCG titre
B. Erythrocyte sedimentation rate
C. Ultrasound
D. A & C
Q.584: Absolute indication for classical caesarean section is:-
A. Placenta praevia
B. Previous lower segment caesarean section
C. Carcinoma Cervix
D. None of the above
Q.585: Causes of ectopic gestation includes, except:-
A. Tubal cilliary damage
B. Long fallopian tube
C. IUCD.
D. Blighted ovum
Q.586: Abruptio placentae was first invented by:-
A. Mc Donald
B. Rigby
C. Benson
D. Peter Johans
Q.587: Immediate complication of evacuation of Vesicular mole is :-
A. Sepsis
B. Bleeding
C. Incomplete evacuation
D. Infection
Q.588: Abnormal foetal scalp blood pH is:-
A. 7.2
B. 7.4
C. 7.3
D. 7.45
Q.589: Delivery is not possible per vaginum in:-
A. Persistant mentoposterior
B. Mento anterior
C. Extended Breech
D. Occipito posterior
Q.590: Pressure in the umbilical vein approximates:-
A. 20 mm of Hg
B. 10 mm of Hg
C. 40 mm of Hg
D. More than 40 mm of Hg
Q.591: Oxygen supply to the foetus is at the rate of:-
A. 5 ml./ Kg./mt.
B. 2 ml./ Kg./mt.
C. 25 ml./ Kg./mt.
D. 10-15 ml./ Kg./mt.
Q.592: Amniotic fluid volume at 40 weeks measures:-
A. 600-800 ml.
B. 300-500
C. 900 – 1200 ml.
D. 100 – 200 ml.
Q.593: Urinary production of term foetus per day is:-
A. 450 ml.
B. 800 ml.
C. 650 ml.
D. 1000 ml.
Q.594: Mecomium appears in intrauterine life from:-
A. 18th week
B. 26th week
C. 16 – 18th week
D. 20th week
Q.595: Uterine weight at term is:-
A. More than 1 Kg.
B. 0.8 Kg.
C. 1.2 Kg.
D. 1.5 Kg
.
Q.596: Commonest variety of eclampsia is:-
A. Intrapartum
B. Antepartum
C. Postpartum
D. None of the above
Q.597: Best way to diagnose the degree of Placenta praevia is:-
A. Abdominal palpation
B. Bi manual examination in operation theatre
C. During caesrerean section
D. Examining placenta after delivery
E. Ultrasonography
Q.598: In placenta praevia Bi manual examination should be done to confirm the diagnosis:-
A. Bleeding per vaginum
B. Bogginess in both fornices
C. Feeling of Placenta through Bi manual examination
D. All of the above
Q.599: Blood coagulopathy in abruptio placentae is due to :-
A. Decreased level of Fibrinogen
B. Consumption coagulopathy
C. Enhanced fibrinolytic activity
D. All of the above
Q.600: Normal Firinogen level in blood is:-
A. 100 mg.%
B. 300-350 mg.%
C. 600 mg.%
D. 400 mg.%
Q.601: Iron deficiency anaemia in pregnancy is characterized by:-
A. Low haemoglobin levels
B. PBF. Shows Hypochromic microcytic picture
C. Decreased Packed cell volume
D. None of the above.
Q.602: Mostly time of death in patient of Pregnancy with heart disease irrespective of cause is :-
A. Soon after delivery
B. 20 weeks of pregnancy
C. Two weeks postpartum
D. First stage of labour
Q.603: After premature rupture of membranes vaginal pH changes to :-
A. 5
B. 6-6.5
C. 7
D. 8.2
Q.604: Management of Acute inversion uterus is:-
A. Reposite uterus immediately
B. Wait for spontaneous correction
C. First improve general condition of patient
D. None of the above
Q.605: Organism commonly responsible for puerperal sepsis are:-
A. Streptococcus
B. Staphylococcus
C. Pseudomonas
D. Can not be predicted
Q.606: Emergency in a puerperal patient may be:-
A. Secondary PPH.
B. puerperal sepsis
C. Breast abscess
D. All of the above
Q.607: Immediate management required by a premature baby is:-
A. Delayed clamping of the cord
B. Vitamin K deficiency
C. To keep length of cord long
D. None of the above
Q.608: Important function of Prostaglandins are:-
A. Help in Ovulation
B. Prevent Ovulation
C. Rips the cervix
D. Oxytocic effect
Q.609: Out of the following, which drug is commonly prescribed in pregnancy:-
A. Antacid
B. Acetoaminophene
C. Antiemetic
D. Antihelmenthic
Q.610: Couvelair uterus occurs in following condition:-
A. Placenta praevia
B. Coagulation failure
C. Concealed accidental hemorrhage
D. Intra uterine death
Q.611: Page classification pertains to:-
A. Pre eclamptic toxaemia
B. Chorio carcinoma
C. Abruptio placentae
D. Diabetes mellitus
Q.612: Acute Intermittent porphyria in pregnancy cause maternal mortality at the rate of:-
A. Less than 7%
B. 18 %
C. 23 %
D. 47 %
Q.613: The most common benign tumour of the placenta is:-
A. Haemangioma
B. Fibroma
C. Placental polyp
D. Choriocarcinoma
Q.614: Uniovular twin pregnancy is not associated with:-
A. Congenital anomaly of foetus
B. Hydroamnios
C. Disseminated intravascular clotting
D. Fetal death
Q.615: Indication of lower segment caesarean section in multiple pregnancy:-
A. Cord prolapse
B. Placenta praevia
C. Conjoined twins
D. All of the above
Q616: Displaced IUCD can best be diagnosed by:-
A. Missing thread of IUCD
B. X- ray pelvis
C. Hysterosalpingography
D. None of the above
E. All of the above
Q.617: Commonest cause of maternal death in placenta raevia is:-
A. Infection
B.Haemorrhage
C. Renal failure
D. none of the above
Q.618: Rotation of vertex occurs during labour at:-
A. Pelvic brim
B. Pelvic floor
C. At the level of ischial spine
D. At the outlet
Q.619: Obstetrical Hysterectomy is contraindicated in:-
A. Rupture uterus
B. Placenta accerita
C. Uncontrolled post partum haemorrhage
D. Multiple Fibroids
Q.620: Common implicated cause of rupture uterus is:-
A. Multipara
B. Version & extraction
C. Oxytocin in high doses
D. All of the above
Q.621: Kielland forceps differs from other long forceps in:-
A. Lock is sliding
B. No axis traction required
C. Has anterior & posterior blades
D. All of the above
Q.622: Breech presentation occurs in approximately:-
A. 6% of patients at 30 weeks of gestation
B. 8% of patients in labour
C. 30% of patients at 28 weeks
D. None of the above
Q.623: Which sign is not a sign of foetal distress in Breech:-
A. Bradycardia
B. Uteroplacental apoplexy
C. Meconium stained liquor
D. Excessive foetal movements
Q.624: Sheehan Syndrome is associated with:-
A. Hypothalamus
B. Adrenals
C. Pitutary
D. Thyroid
Q.625: Bab-cock forceps are being used in:-
A. Laparoscopic sterilization
B. Holding Intestines
C. In abdominal tubectomy
D. B & C
E. All of the above
Q.626: Secondary post partum haemorrhage can be:-
A. Retention of placental tissue
B. Uterine anomaly
C. Choriocarcinoma
D. All of the above
Q.627: Normal duration of pueperium is:-
A. 02 weeks
B. 10 weeks
C. 06 weeks
D. 08 weeks
Q.628: Post maturity can cause all of the following, except:-
A. Meconium aspiration
B. Intracranial haemorrhage
C. Foetal distress & death
D. Post partum haemorrhage
Q.629: Macrosomia is seen in babies of :-
A. Obese parents
B. Multiparrous women
C. Diabetic patients
D. All of the above
Q.630: Viability of foetus is attained at :-
A. 18 weeks
B. 20 weeks
C. 24 weeks
D. 28 weeks
Q.631: Pregnancy with heart disease patient may go in Congestive heart failure at :-
A. Pregnancy of 32-34 weeks
B. During labour
C. Pregnancy with liver disorders
D. All of the above
Q.632: Complication of multiple pregnancy is:-
A. Posr partum haemorrhage
B. Cord prolapse
C. Rupture uterus
D. Lock twins
E. All of the above
Q.633: Which of the following are signs of placental separation:-
A. Infarcted area on Placenta
B. Retroplacental clot
C. Lengthening of umbilical cord
D. Sudden gush of blood
E. C & D
Q.634: Deep transverse arrest of foetal head occurs in:-
A. Anthropoid pelvis
B. Android pelvis
C. Flat pelvis
D. None of the above
Q.635: Diseases that can cause neonatal acidosis includes disorders of:-
A. Tyrosinemia
B. Urea cycle enzyme
C. Late metabolic acidosis
D. All of the above
Q.636: Which of the following can be measured during clinical assessment of pelvis:-
A. Anatomical conjugate
B. Bi ischial diameter
C. Diagonal conjugate
D. None of the above
Q.637: Toxic shock syndrome presents clinically as:-
A. Renal failure
B. Pyrexia
C.Jaundice
D. Rashes all over body
E. All of the above except ‘C’
Q.638: Presentation in anencephalic foetus is by :-
A. Brow
B. Face
C. Vertex
D. None of the above
Q.639: Low birth weight & placental anomaly are synonym,except:-
A. Placenta praevia
B. Placental infarcts
C. Haemangiomas
D. None of the above
Q.640: Preferably episiotomy is to be given:-
A. Central
B. Right mediolateral
C. Left mediolateral
D. Lateral
Q.641: Best device for locating placenta:-
A. Hysteroscopy
B. Colposcopy
C. Ultrasonography
D. Amniography
Q.642: Parenteral Oxytocin to be given in :-
A. Normal saline
B. Glucose 5%
C. Ringer lactate
D. Glucose normal saline
Q.643: Bleeding is of foetal origin in :-
A. Vaspraevia
B. Abruptio placentae
C. Placenta praevia
D. Placenta accereta
Q.644: Vaccine contraindicated in pregnancy:-
A. Tetanus toxoid
B. Typhoid
C. Polio
D. Rubella
Q.645: Aria’s stella reaction is not seen in :-
A. Ovarian pregnancy
B. Interstitial pregnancy
C. Molar pregnancy
D. Salpingitis isthimica nodosa
Q.646: Red degeneration of fibroid occurs commonly in :-
A. 3rd trimester
B. 2nd trimester
C. 1st trimester
D. Post partum
Q.647: Best timming for applying Mc Donald stitch is :-
A. 6 weks
B. 10 weks
C. 14-16 weks
D. After 20 weks
Q.648: Hydatiform mole is principally a disease of :-
A. Amnion
B. Decidua
C. Ovum
D. Chorion
Q.649: Mean ultrasonography measunment at 40 weks are :-
A. Biparietal diameter 9.6 cms.
B. Femur length 7.8 cms.
C. Bithoracic circumference 40 cms.
D. None of the above
E. All of the above
Q.650: Tongue bite occurs in the state of Eclampsia:-
A. Comma
B. Tonic
C. Clonic
D. None of the above
Q.651: Foetal blood flow through the placenta per minute approximates:-
A. 300 ml
B. 400 ml
C. 100 ml
D. 600 ml
Q.652: Iatrogenic causes of tubal pregnancy are :-
A. Tubectomy operation
B. IUCD operation
C. Tuboplastic surgery
D. Hormone therapy
Q.653: Placental sign denotes:-
A. Placental separation
B. Spotting in early months of pregnancy
C. Placental aging
D. Anomaly of foetus due to calcified placentation
Q.654: Vertico podalic diameter measures:-
A. 20 cms
B. 28 cms
C. 25 cms
D. 32 cms
Q.655: Spiegelleig’s criteria is term used in connection with:-
A. Ectopic gestation
B. Hydrocephalus
C. Ovarian pregnancy
D.Trapped ovum syndrome
Q.656: Causes of foetal oedema at birth
A. Congenital syphilis
B. Rh- Incompatibility
C. Congenital heart disease
D. All of the above
Q.657: Complication of manual removal of placenta includes, except:-
A. Haemorrhagic shock
B. Air embolism
C. Inversion uterus
D. Injury to the uterus
Q.658: Maternal hazards of Oxytocin infusion are :-
A. Hypotension
B. Uterine rupture
C. Anti diuresis
D. All of the above
Q.659: Complication of Intra uterine death is:-
A. Septicaemia
B. Disseminated intravascular coagulation
C. Infection
D. None of the above
Q.660: Treatment of neonatal Hyperbilirubinaemia includes:-
A. Plasmophoresis
B. Phototherapy
C. Immunosuppressive therapy
D. None of the above
Q.661: Energy requirement of the foetus in utero is supplied by:-
A. Fat
B. Vitamins
C. Carbohydrates
D. Minerals
Q.662: Hydramnios leads to poor fetal outcome because:-
A. Abruptio placentae
B. Fetal Malformation
C. Prematurity
D. Cord Prolapse
E. A & C
Q.663: Breech presentation with Hydrocephalus is delivered by:-
A. Assisted breech delivery with craniotomy
B. Caeserean section
C. Forceps application for after coming head
D. None of the above
Q.664: Least common type of pelvis is known as:-
A. Android
B. Anthropoid
C. Platipelloid
D. Mixed
Q.665: Painless delivery can be carried out with:-
A. Paracervical block
B. Epidural anaesthesia
C. Spinal anaesthesia
D. Pudendal block
Q.666: Abruptio placentae is usually associated with, except:-
A. pre-eclamptic toxaemia
B. Folic acid deficiency
C. Polyhydramnios
D. Alcoholic patients
Q.667: Absolute indication of caesarean section is in cases of:-
A. Central placenta praevia
B. Type 3rd placenta praevia
C. Placenta praevia type II,grading III
D. Placenta praevia type I,but with PET.
Q.668: Height of uterus at term is :-
A. 30 cms
B. 38 cms
C. 35 cms
D. 48 cms
Q.669: In high socio economic status patients, approximate antenatal visits must be:-
A. 10
B. 10-12
C. More than 12
D. Can not be a binding
Q.670: Exact gestational age can be evaluated by:-
A. Neglie’s rule
B. X-Ray
C. Ultrasonography
D. All of the above
Q.671: Features of Braxton Hicks contraction are , except:-
A. Spasmodic
B. Regular
C. Painless
D. No effect on foetus
Q.672: Brim Index in normal pelvis measures:-
A. 85-100
B. 110
C. 125-160
D. 76
Q.673: Most important feature of true labour pain is:-
A. Buldging of membranes during uterine contraction
B. Show
C. Show
D. Taking up of cervix
Q.674: Physiological basis in expulsion of placenta is:-
A. Uterine contraction
B. Bearing down effort along with bleeding
C. Pregnancy induced hypertension
D. None of the above
Q.675: When the first stage of labour is completed :-
A. The cervix is completely retracted over the presenting part
B. Rupture of membranes
C. Cervix is fully dilated
D. All of the above
Q.676: Which one is last to be retracted:-
A. Anterior lip of cervix
B. Posterior lip of cervix
C. Anterior & Posterior lip of cervix retracts simultaneously
D. None of the above
Q.677: Delivery in patient with heart disease is quick,because of:-
A. Improper saturation of oxygen
B. Congestion of cervix
C. Rheumatic factor
D. None of the above
Q.678: X-Ray finding of a case of Intrauterine death are:-
A. Spalding sign
B. Hyperflexion of the spine
C. Gas shadow in great vessels
D. All of the above
Q.679: The best way to terminate pregnancy in IUD is :-
A. Prostaglandins
B. Oxytocin
C. Intra amniotic instillation of hypertonic saline
D. Transcervical extra amniotic ethacridine lactate
Q.680: Maternal risk in precipitated labour are following, except:-
A. Genital tract injury
B. Hypertension
C. Post partum haemorrhage
D. Inversion uterus
Q.681: Cause of Breech presentation is :-
A. Hydrocephalus
B. Prematurity
C. Placenta praevia
D. All of the above
Q.682: Absolute contraindication of internal podalic version are:-
A. Contracted Pelvis
B. Hydrocephalus
C. Previos caesarean section
D. All of the above
Q.683: Risk of retained placenta is:-
A. Septicaemia
B. Haemorrhagic shock
C. Re occurrence in next pregnancy
D. A & B
Q.684: Risk related to acute Obstetrics inversion are:-
A. Neurogenic shock
B. Death of patient
C. Post partum haemorrhage
D. All of the above
Q.685: In the cardiac patient which of the following is true:-
A. Induction of labour
B. Spontaneous delivery
C. Caeserean section
D. Cut short 2nd stage of labour
Q.686: Cord prolapse in 2nd stage is best managed by:-
A. Replace the cord
B. Caeserean section
C. Delivery by ventous
D. Forceps delivery
Q.687: Coagulopathy occurs in all, except:-
A. Accidental haemorrhage
B. Intrauterine foetal death
C. Missed abortion
D. Placenta praevia
Q.688: Maternal mortality is highest in:-
A. Revealed Accidental haemorrhage
B. Concealed Accidental haemorrhage
C. Placenta praevia
D. All of the above
Q.689: Placenta praevia presents itself as:-
A. Tender & tense uterus
B. Absent foetal heart sounds
C. Atonic uterus
D. None of the above
Q.690: Quickening can be felt at:-
A. 20-22 weeks
B. 18 weeks
C. 15-16 weeks
D. 10-12 weeks
Q.691: Duodenal atresia in newborn is common in mother with:-
A. Hydramnios
B. Mongols
C. IUGR.
D. All of the above
Q.691: Outcome of induction of labour will be favourable when Bishop’s score is:-
A. Less than Two
B. Less than Four
C. Less than Ten
D. None of the above
Q.692: Preferred time for IUCD insertion is:-
A. During periods
B. After menstrual period
C. 4-6 weeks after delivery
D. B & C
Q.693: Failure rate of Modified Pomeriy’s method is:-
A. 0.01 %
B. 0.1 %
C. 1 %
D. 2-3 %
Q.694: Suction pressure for terminating pregnancy should be:-
A. 400-600 mm of Hg.
B. 700-900 mm of Hg.
C. 100-200 mm of Hg.
D. None of the above
Q.695: Haemostasis following placental separation took place by:-
A. Uterine retraction
B. Uterine contraction
C. Thrombosis
D. Disseminated intravascular coagulation
Q.696: In Disseminated intravascular coagulation main factor responsible are:-
A. Hypofibrinogenimia
B. Decrased Platelet adhesion
C. Vitamin ‘K’ deficiency
D. None of the above
Q.697: Couvelier Uterus is term related to:-
A. Abruptio placentae
B. Intra uterine death of foetus
C. Missed abortion
D. Road side accident
Q.698: Differential diagnosis of antepartum haemorrhage is, except:-
A. Abruptio placentae
B. Intra uterine death of foetus
C. Vasa praevia
D. Haemorrhoids
Q.699: Characteristic feature of Couvelier Uterus is:-
A. Uterine tenderness
B. Absent foetal heart sound
C. Undue enlargement of Uterus
D. None of the above
Q.700: Ultrasonography prior to elective caesarean section is done for:-
A. Rulling out congenital anomaly of foetus
B. To know placental grading
C. Localization of Placenta
D. Foetal maturity
E. All of the above
Q.701: Largest diameter of foetal skull is:-
A. Occipito bregmatic
B. Sub Occipito bregmatic
C. Submento vertical
D. Biparietal diameter
Q.702: Which anaesthetic agent is most often given for Caeserean section:-
A. General anaesthesia
B. Spinal
C. Epidural
D. Local anaesthesia
Q.703: Twin pregnancy in early period can be diagnosed by:-
A. Clinical examination
B. High level of HCG
C. Ultrasonography
D. Cytological examination
Q.704: Occipito posterior presentation is common in :-
A. Anthropoid pelvis
B. Android pelvis
C. Gynaecoid pelvis
D. Platepelloid pelvis
Q.705: Best method for conducting Breech delivery by Vaginal route is:-
A. Breech extraction
B. Spontaneous
C. Assisted Brech delivery
D. None of the above
Q.706: Oxygen supply to foetus depends on:-
A. Placental surface area
B. Maternal intervillous space blood flow
C. Maternal & Foetal Oxygen difference
D. All of the above
Q.707: Favourable outcome in pregnancy with heart disease depends on:-
A. previous cardio vascular complications
B. Functional capacity of heart
C. Blood volume of patient
D. Grading of Congestive heart failure
Q.708: Precipitate labour may result in, except:-
A. Uterine rupture
B. Foetal intracranial trauma
C. Laceration of genital organs
D. Death of foetus
Q.709: Drugs to control post partum haemorrhage are, except:-
A. Ergotamine maleate
B. Synthetic Oxytocin
C. Diazepam
D. Haemostatic agents
Q.710: Absolute indication for Classical Caeserean section is:-
A. Impacted Shoulder presentation
B. Fibroid in lower Uterine segment
C. Carcinoma cervix
D. Pregnancy with Ovarian Cyst
Q.711: Craniotomy is indicated, if:-
A. Foetus is alive
B. Rupture of Uterus
C. Head well above the brim
D. All of the above
Q.712: Hyaline membrane disease is chacterized by:-
A. Increased respiratory rate
B. Retraction of ribs
C. gasping foetus
D. A & B
Q.713: Willet’s forcps are being used to:-
A. Hold the cervix
B. Hold the uterus in Hysterectomy
C. Scalp traction
D. To remove the retained placental tissue
Q.714: Symptoms of Uterine rupture are, except:-
A. Vaginal bleeding
B. Loss of Uterine action
C. Increased maternal pulse rate
D. Haematuria
E. All of the above
Q.715: Uterine rupture is least common in :-
A. Hysterotomy scar
B. Myomectomy scar
C. Classical Caeserean section scar
D. Lower segment caesarean section
Q.716: Incompetent cervical Os can be diagnosed by:-
A. Hysteroscopy
B. Ultrasound
C. Bimannual examination
D. All of the above
Q.717: Rh- Antibody produced by mother is:-
A. IgM
B. IgA
C. IgG
D. A & C
Q.718: Which of the following diameter is smallest:-
A. Sub mentobregmatic
B. Mentovertical
C. Occipito frontal
D. Sub Occipito frontal
Q.719: Shortest diameter at inlet is:-
A. Transverse
B. Anterio posterior
C. Oblique
D. None of the above
Q.720: Treatment of Nullipara with Dysmenorrhea is :-
A. Hysterectomy
B. Dilatation of cervix
C. Anti allergic drugs
D. Anti prostaglandins
Q.721: Vesicular mole in most cases is associated with:-
A. Ovarian luteal cyst
B. Upper levels of HCG
C. Radiological findings
D. All of the above
Q.722: Predisposing factors in puerpereal infection is:-
A. Haemorrhage
B. Mannual removal of placenta
C. Anaemia
D. All of the above
Q.723: Survival of triplets is mostly determined by:-
A. Duration of gestation
B. Weight of foetus
C. Mode of delivery
D. Maturity of fetuses
Q.724: Post partum Haemorrhage is diagnosed when the bleeding exceeds:-
A. 500-600 mls
B. 300 mls
C. 800 mls
D. None of the above
Q.725: Uterine rupture is common in :-
A. Grand multipara
B. Obstructed labour
C. Oxytocin infusion
D. All of the above
Q.726: Specific treatment of severe pre-eclampsia is:-
A. Diuretics
B. Antiepileptics
C. Antihypertensive
D. Anticholenergic
Q.727: Examination contraindicated in Antepartum haemorrhage:-
A. Per speculum
B. Ultrasonography
C. Bi manual examination
D. Bi manual examination in operation theater
Q.728: Successful treatment of foetal growth retardation includes:-
A. Aspirin in high doses
B. I.V. glucose in high concentration
C. Hyper Oxygen
D. None of the above
E. All of the above
Q.729: Accurate method of diagnosing IUGR:-
A. Weight estimation
B. Sonographic Weight estimation
C. Vaginal cytology
D. 10th percentile of weight pattern
Q.730: Best predictor of Macrosomia is:-
A. Femur length
B. Abdominal circumference
C. Bi parietal diameter
D. Placental changes in Sonography
Q.731: Complications of cordocentesis includes :-
A. Foetal tachycardia
B. Cord bleeding
C. Complications of Amniocentesis
D. Foetal bradycardia
E. All except ‘A’
Q.732: Determinant of placental glucose transport:-
A. Placental surface area
B. Maternal arterial glucose estimation
C. Uterine blood flow
D. Placental thickness
Q.733: Nonstress test in Diabetic mother’s must be done:-
A. Twice weekly
B. Daily
C. Weekly
D. Thrice weekly
Q.734: Lipolysis in late pregnancy results because of :-
A. Insulin
B. Prolactin
C. Glucose
D. HCG
Q.735: Criteria for shunt placement for Hydrocephalus includes:-
A. Normal Karyotype
B. Progressive ventricular dilatation
C. No other malformation
D. All of the above
Q.736: Most common cause of Non immune hydrops is :-
A. Cardiac disease
B. Chromosomal abnormality
C. Alpha thalassemia
D. Meningomyelocoele
Q.737: Neural tube defect is associated with the deficiency of which Vitamin:-
A. Ascorbic acid
B. Folic acid
C. Pyridoxin
D. Riboflavin
Q.738: Foetal tachycardia may be seen in all of the following, except:-
A. Narcotic drugs
B. Maternal anxiety
C. Foetal movement
D. Beta adrenergic drugs
Q.739: Best tissue to Biopsyin early pregnancy is:-
A. Chorion leave
B. Chorion frundosum
C. Decidua Basalis
D. Amniotic membrane
Q.740: Most promising approach to gene therapy involve cells:-
A. Bone marrow
B. Nervous
C. Hepatic
D. Muscle
Q.741: Useful test for diagnosis of Vesicular mole:-
A. Amniography
B. CT Scan
C. Ultrasound
D. Thermography
Q.742: Vesicular mole is present in how many % of abortion cases:-
A. 50 %
B. 100 %
C. 30 %
D. 15 %
Q.743: The prevelance of asymptomatic Bacteriouria is:-
A. 75 %
B. 25 %
C. 05 %
D. 10 %
Q.744: Common indication of inutero transverse is:-
A. Pre mature labour
B. Pre-eclampsia
C. Ante bleeding
D. Uncontrolled Diabetes
Q.745: Concentration of Halothane anaesthesia which can cause PPH. :-
A. 1.0 %
B. 0.5 %
C. 10.0 %
D. 05 %
Q.746: Foetal weight of 4kgs. Or more can be detected by Ultrasonography:-
A. Biparietal diameter 9.3 cms.
B. Head Circumference 34 cms
C.Abdominal Circumference 38 cms
D. Chest Circumference 34 cms.
Q.747: Severe form of placental attachment to the Myometrium is:-
A. Placenta Percreta
B. Placenta increta
C. Placenta accrete
D. None of the above.
Q.748: Usual length of Simpson’s uterine sound is :-
A. 28.6 cms
B. 30.0 cms
C. 30.2 cms
D. 31.6 cms
Q.749: Length of endometrial biopsy curette is:-
A. 30 cms
B. 25 cms
C. 23 cms
D. 35 cms
Q.750: Bonney’s Myomectomy clamps have:-
A. Two grip
B. Single grip
C. Three grip
D. None of the above
Hospital Tray- manufacturer and supplier of hospital trays in delhi/india and deal in bed hospital tray, instrument tray, kidney tray, cateter tray, Bowls(s/s), Hospital Basin(s/s).
ReplyDeleteआप को शायद याद होगा , बीकानेर में , मैं आपका शिष्य था , दोस्तों से चर्चा के दौरान यह जानकर बहुत ख़ुशी हुई कि आपने स्त्री एवं प्रसूति विषय पर , अनेकों ब्लॉग अंतर्जाल पर , पर उपलब्ध हँ , जिज्ञासा वश मैंने यह ब्लॉग देखा , तो गुरुदेव मैं अचंभित रह गया , ब्लॉग पर उपलब्ध सामग्री देख कर , काफी ख़ुशी हुई , गुरुदेव आप महोदय के बारे मैं इतना ही कहूँगा कि ईश्वर की कृपा से आप हमारा ज्ञान और बढ़ाएं , सादर . - डॉ. कपिल गुप्ता
ReplyDeleteDear Dr. Mukesh Raghav, While surfing on internet , I got your nice blog. Being your teacher and guide , you can understand my feelings, just as that of Mother and son. I have seen such a blog for the first time in my life of 79 years. Material is very useful for both UG and PG students. I am remembering since student life you were very intelligent and laborious too .I feel proud of you. God bless you. Keep it up.
ReplyDeleteDr. Raghav , What a beatiful blog , which I have ever seen , Quite informative from subject point of view., The Faculty must take advantage of the material in the blog. You are the asset for the obstetrics and Gynaecology , faculty as a whole in the world.
ReplyDeleteThanks a lot.
I belong to the group of obstetricians and Gynaecologist . In my life career , I have not seen a blog of this kind.....It is remarkable , educational and beautiful too. Full marks Dr. Raghav. Keep it up , I expect a lot from male Gynaecologist in general , but you are on top.
ReplyDeleteThanks .
Dr. Mukesh Raghav , I am proud of your beautiful blog, and it is quite informative too.
ReplyDeleteThanks.
I feel comfortable after seing your natural blog, having contents , which are useful., but for hipnotizing us ,you have number of things on the blog.
ReplyDeleteDr. Mukesh Raghav, Being a under graduate student , one of my friend told me to see this blog. Sir, I was thrilled to read it and I am sure this material, if I will go through twice , will help in my practical exams.
ReplyDeleteRegards.
Dr. Raghav Sir, With due regards , I submit that blog and contents are too much impressive and informative. Why you have not published this blog , when I was your student.Do not mind Sir,
ReplyDeleteRegards Sir.
Dr. Raghav Sahib, We are eagarly waiting for more material to come suitable for our PG exams.
ReplyDeleteRegards.
Respected Sir , We the students wanted to come to you to see what you eat, when you sleep , when you enjoy your life. What is the size of your brain., and capacity to remember.
ReplyDeletethat is the only reason that , I am writting , but with fake identity.
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