Question 1: A baby is born with the following birth defects: Craniofacial defects, cleft palate, cardiac defects, hydrocephalus & thymic defects. Identify the teratogen.
  1. DES (Diethylstilbestrol)
  2. Misoprostol
  3. Isotretinoin
  4. Cocaine abuse
Answers : (c) Isotretinoin.
Following are the teratogenic effects :
  1. Isotretinoin : Craniofacial defects, Cleft Palate, Cardiac Defects, Hydrocephalus, Thymic Defects
  2. DES : Clear cell adenocarcinoma of cervix/vagina, ectropion and adenosis, hypoplastic T-shaped uterus, cervical collars, hoods, septa, withered fallopian tubes; in male fetuses epididymal cysts, microphallus, cryptorchidism, testicular hypoplasia, hypospadias
  3. Misoprostol : Moebius Syndrome
  4. Cocaine : Placental abruption, abortions, stillbirth, skull defects, cutis aplasia, porencephaly, ileal atresia, cardiac anomalies and visceral infarcts, urinary defects, periventricular leukomalacia, prune-belly syndrome
 
Question 2: IDENTIFY
may-quiz-pic
 
Answers :

ESSURE: Essure is a permanent, transcervical sterilization procedure. Small, flexible inserts are placed into the fallopian tubes by a catheter passed from the vagina through the cervix and uterus.

The insert contains inner polyethylene terephthalate fibers to induce inflammation causing fibrotic reaction and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil. Once in place, the device is designed to elicit tissue growth in and around the insert over a period of three months to form an occlusion or blockage in the fallopian tubes.

Initially additional forms of birth control must be continued for 3 months to prevent pregnancy

 

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Question 1: Identify the deformity & in which condition is it seen?

quiz-02

Answers : USG showing Sandal Gap. There is an apparent increase in the interspace between the great toe of the foot from the rest of the toes (likened to the gap caused by a sandal). It is a soft tissue marker of Down's Syndrome
 
Question 2: 17 year old girl was brought with primary amenorrhoea. Her mother mentioned that she started developing breast at the age of 12. She was prescribed OCPs few years back by a doctor with no effect. On examination breast was well developed (Tanner's stage 5) and pubic hair was minimal (Tanner's stage 1). What is the diagnosis ?
  1. Androgen insensitivity syndrome
  2. Turner syndrome
  3. Mullerian agenesis
  4. Kallman Syndrome
Answers : A) Androgen Insensitivity syndrome
  • X-linked recessive disorder.
  • External genitalia looks normal (like female)
  • Adequate breast development without axillary and pubic hair (or minimal axillary and pubic hair)
  • Primary amenorrhea and absent uterus ( and hence will not respond to OCPs)
  • Gonads (testes) are placed in either labia or inguinal canal, or are intra-abdominal
  • Karyotype XY
  • Mullerian agenesis patients will also have primary amenorrhea & absent uterus ( & hence will not respond to OCPs) but have normal well developed axillary and pubic hair
 

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Question 1: Identify the procedure & Name the instrument

quiz-02

Answers : Piper's forceps for delivery of after coming head of breech
Piper's forceps is the best method to deliver the after-coming head of breech because: It is a controlled delivery, sudden decompression of the head is avoided Undue traction on the neck is avoided, so the risk of brachial plexus injury is least
 
Question 2: FIGO recommended dose of misoprostol for PPH prevention is:
  1. 600µg orally
  2. 600µg sublingual
  3. 800 µg orally
  4. 800µg rectally
Answers : A) 600µg orally
  • In 2012, FIGO finalised guidelines that reflect the latest best available research on the prevention and treatment of PPH with misoprostol. The guidelines include evidence-based recommendations for dosages and routes of administration as well as the side effects and precautions associated with its use.
  • For PPH prophylaxis recommended dose is 600µg orally, single dose.
  • For PPH treatment recommended dose is 800µg sublingual, single dose.
 

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Question 1:

image

This CTG is most likely to be seen in which condition ?
  1. Fetus is sleeping
  2. Ruptured vasa previa
  3. Cord compression
  4. Excess of Epidural analgesia
  5. All of the above
Answers : Ruptured vasa previa
The CTG shows "Sinusoidal Pattern" seen in following cases :
  • Fetal anemia (ruptured vasa previa, abruption,fetal hemolysis etc)
  • Chorioamnionitis
  • Severe fetal asphyxia
  • Morphine administration to mother
 
Question 2: Test used to differentiate maternal and fetal blood is:
  1. APT test
  2. Osmotic fragility test
  3. Bubblin test
  4. Kleihauer–Betke test
Answers : APT test
  • The Apt test is a medical test used to differentiate maternal and fetal blood.
  • Leonard Apt, an American pediatric ophthalmologist, first developed this. It was used by him to identify the source of blood in stools in newborn infants. It was then modified to distinguish fetal hemoglobin from maternal hemoglobin in blood samples from any source.
  • The Apt test may be used in cases of vaginal bleeding late during pregnancy (in cases of APH) to determine if the bleeding is from the mother or the fetus.
  • A positive test would indicate that blood is of fetal origin, and could be due to vasa previa. A negative test indicates that the blood is of maternal origin. In practice, the Apt test is almost never done when there is bleeding PV and a suspicion of vasa previa, because the time to fetal collapse with bleeding from vasa previa is often very short.
  • Adult hemoglobin is susceptible to alkaline denaturation whereas the fetal hemoglobin is resistant to it. The blood specimen is exposed to sodium hydroxide (NaOH) which will denature the adult hemoglobin but not the fetal hemoglobin. Under the microscope, the fetal hemoglobin will appear as a pinkish color while the adult hemoglobin will appear as a yellow-brownish color.
  • The Kleihauer–Betke (KB) test, is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream (to quantify the fetomaternal hemorrhage). It is performed on Rh negative mothers to help calculate the dose of ANTI-D injection.
 

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