Question 1 : All of the following are scenarios in which it is necessary to administer anti-D, EXCEPT :
  1. After a spontaneous first-trimester abortion
  2. After an ectopic pregnancy
  3. After cordocentesis for IUT
  4. After manual removal of placenta
Answer: c (After cordocentesis for IUT)
Explanation : To prevent maternal Rh sensitization, pregnant women who are Rh negative should receive Rh immune globulin (antibody to the D antigen) in the following situations:
1. At 28 weeks to all unsensitized Rh-negative mothers and postpartum within 72 h if the baby's blood group is Rh positive
2. After abortion, MTP, ectopic pregnancy
3. After amniocentesis, CVS, cordocentesis
4. After ECV
5. After manual removal of placenta (in any situation where fetomaternal hemorrhage is expected)

The anti-D binds to fetal RBCs and prevents them from stimulating the maternal immune system.
When the mother is already sensitized (positive indirect Coombs' test or positive Rh titer), there is no role of anti-D.
When cordocentesis/PUBS is being done for IUT, it means that the fetus is having severe anemia and hydrops due to Rh isoimmunization and maternal antibodies are already present and hence Anti-D has no role.
 
Question 2 : A newborn with 46XX has external genitalia of male. All of the following are the possible causes EXCEPT:
  1. Placental aromatase deficiency
  2. Maternal androgen adrenal tumor
  3. Anti-Mullerian hormone (AMH) deficiency
  4. Wnt4 mutation
 
Answer: c (AMH deficiency)
The baby has karyotype of 46 XX and external genitalia of male. So this is a case of female pseudohermaphroditism.
Causes of female pseudohermaphroditism are:
1. Congenital adrenal hyperplasia
2. Elevated androgens in the maternal circulation which cross the placenta and cause virilization of the external genitalia. Examples include maternal intake of androgenic drugs, maternal adrenal tumor etc.
3. Placental aromatase deficiency. Aromatase is responsible for conversion of testosterone to estradiol. If this does not happen there will be excess testosterone.
4. Wnt4 mutation. Wnt4 Mullerian aplasia and ovarian dysfunction is a disorder that occurs in females and affects the reproductive system. This condition is caused by abnormal development of the Mullerian duct. Individuals with Wnt4 Mullerian aplasia and ovarian dysfunction typically have an underdeveloped or absent uterus and may also have abnormalities of other reproductive organs. Women with this condition have normal breast and public hair development and primary amenorrhea. Women with Wnt4 Mullerian aplasia and ovarian dysfunction have higher than normal levels of androgens in their blood. These high levels of androgens cause acne, hirsutism and virilization. Kidney abnormalities may be present in some affected individuals.

AMH DEFICIENCY= PMDS=UTERINE HERNIA SYNDROME
Karyotype = 46 XY and normal male external genitalia.
Persistent Mullerian duct syndrome (PMDS) refers to the presence of a uterus and sometimes other Mullerian duct derivatives in a male.
PMDS typically is an autosomal recessive disorder.
Typical features include cryptorchidism and the presence of a small, underdeveloped uterus in a male. This condition is usually caused by deficiency of fetal anti-Mullerian hormone (AMH) effect due to mutations of the gene for AMH or the anti-Mullerian hormone receptor.
 

September 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Prachi P Risbud

7738535015
Mumbai

SECOND PRIZE

Dr. Shivani Barala

9602481460
Jaipur, Rajasthan

THIRD PRIZE

Dr. A Anandhi

9349502979
Patiala, Punjab

Winners Please Contact FOGSI Office

Question 1 : A 30 year-old primigravida with a twin gestation at 30 weeks presents for an USG. The sonogram indicates that the placenta appears to be diamniotic and monochorionic. Twin B is noted to have oligohydramnios and to be much smaller than twin A. In this clinical picture, all of the following are concerns for twin A, EXCEPT:
  1. Congestive heart failure
  2. Anemia
  3. Hypervolemia
  4. Hydramnios
Answer: b (Anemia)
Explanation : This is a case of twin-to-twin transfusion syndrome.
In twin gestations where monochorionic placentas exist, twin-to-twin transfusion syndrome can occur. In this syndrome, there are vascular communications or anastomoses between the twins. There is blood flow or transfusion from one twin to another. The donor twin becomes anemic and may suffer growth retardation and oligohydramnios. The recipient twin may develop hydramnios, hypervolemia, hypertension, polycythemia, and congestive heart failure.

Question 2 : A lady underwent hysterectomy for Ca cervix. Following the surgery she complained of urinary incontinence. On examination she had normal voiding as well as continuous incontinence. Methylene blue dye was instilled in her bladder through her urethra and she was given oral Phenazopyridine. After some time her pad was checked and it showed orange staining at the top portion. She is likely to have:
  1. Ureterovaginal fistula
  2. Vesicovaginal fistula
  3. Urethrovaginal fistula
  4. Vesicouterine fistula
Answer: Options a) and b) both are complications of hysterectomy.
In this case, even without the dye test, the history is classically suggestive of ureterovaginal fistula.
Patients with VVF present with continuous incontinence with no urge to pass urine (as the bladder is always empty).
Patients with ureterovaginal fistula also present with continuous incontinence, but there is an urge to pass urine( as the bladder will eventually fill up)

MOIR's Three Tampon (Swab) Test

  • Patient is placed in dorsal lithotomy or knee chest position
  • Three cotton tampons are placed in the vagina
  • Methylene blue is instilled into the bladder through urethra. (It will remain only in bladder & not enter into ureter)
  • Patient made to walk for 10–15 min
  • Tampons removed and examined

Interpretation :

Ureterovaginal fistula : Upper most swab is soaked with urine (not with dye), lower two are dry
Vesicovaginal fistula : Middle swab is wet with dye (blue in color); other two are dry
Urethrovaginal fistula :Lowest swab is wet with dye (blue); other two are dry
Phenazopyridine given orally produces a vivid color change in urine, typically to a dark orange to reddish color (which will leak from ureter and will soak the uppermost swab orange).

August 2017 QUIZ WINNERS

FIRST PRIZE

Chetan Khate

9818427823
Bhopal

SECOND PRIZE

Dr. Avantika Gupta

8903650441
Jipmer Campus

THIRD PRIZE

Dr. Ashutosh Gupta

9968627696
Delhi

Winners Please Contact FOGSI Office

Question 1 : True about Swyer syndrome
  1. 46XX
  2. Ambiguous Genitalia
  3. Pregnancy possible with donor oocyte
  4. All of the above
Answer: c. pregnancy possible with donor oocyte
Explanation : Swyer syndrome is XY pure gonadal dysgenesis. The syndrome was named by Gerald Swyer, an endocrinologist, based in London. Swyer syndrome occurs in approximately 1 in 80,000 people. Patient with Swyer syndrome have typical female external genitalia & are typically raised as girls and have a female gender identity but the karyotype is 46XY. The uterus and fallopian tubes are formed, but the gonads are not functional; affected individuals have undeveloped clumps of tissue called streak gonads. Without testes ,testosterone & AMH both are NOT produced. Without testosterone, the wolffian ducts fail to develop, so no internal male organs are formed. Also, the lack of testosterone means that no dihydrotestosterone is formed and so the external genitalia fail to virilize, resulting in normal female genitalia. Since AMH is absent the Müllerian ducts develop into normal internal female organs (uterus, fallopian tubes, cervix, vagina). Because they lack ovaries, girls with Swyer syndrome do not produce sex hormones and will not undergo puberty (unless treated with hormone replacement therapy). As they do not have functional ovaries, affected individuals usually require hormone replacement therapy during adolescence to induce menstruation and development of female secondary sex characteristics such as breast enlargement and uterine growth. Hormone replacement therapy also helps reduce the risk of osteopenia and osteoporosis. Women with this disorder cannot have their own biological child as they do not produce ova but they can become pregnant with IVF & DONOR OOCYTE. As uterus is present surrogacy is not required. The residual gonadal tissue often becomes cancerous, so it is usually removed surgically early in life. Streak gonads are usually removed within a year or so of diagnosis since the cancer(gonadoblstoma) can begin during infancy.
 
Question 2 : 34 weeks G2P1L1 pregnant lady complains of bleeding PV since 4 hours. Hb 6gm%, BP-90/60, P/A- FHS absent & uterus tonically contracted & deranged DIC profile. As per Page's classification this is what grade of abruption ?
  1. Grade IV
  2. Grade III
  3. Grade II
  4. Grade I
Answer: b. Grade III
Page's Classification for Abruptio Placentae
Grade 0 :Retrospective diagnosis (after delivery)
Grade 1 :External bleeding, uterine tenderness, and no fetal distress
Grade 2: Fetal distress or IUFD
Grade 3: Maternal shock, with or without DIC
 

JULY 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Avantika Gupta

8903650441
Pondicherry

SECOND PRIZE

Dr. Ashutosh Gupta

9818427823
New Delhi

THIRD PRIZE

Dr. Prachi P Risbud

7738535015
Mumbai

Winners Please Contact FOGSI Office

Question 1: 35 years old obese female complaints of amenorrhea of 7 months following her abortion at 18 weeks of gestation due to cervical incompetence. Now her UPT is negative. Progesterone challenge test is negative & Estrogen + progesterone test is also negative. Likely diagnosis is :
  1. PCOS
  2. Premature ovarian failure
  3. Hypothalamo – Pituitary failure
  4. Asherman's syndrome
Answers : (d) Asherman's syndrome
Explanation :
In patients with secondary amenorrhea, after ruling out pregnancy, progesterone challenge test is to be done.
Patients with anovulation will get menses with progesterone.
If the patient does not get menses with progesterone then E + P challenge test is done.
Patients with pituitary failure and ovarian failure will get menses with E + P.
Absence of withdrawal by E + P indicates end organ failure. (Asherman syndrome).
The patient had a second-trimester abortion, following which a curettage may have been done to remove the retained products leading to Asherman syndrome.
 
Question 2: Identify the stalwart (Hint : Life saving technique)
stalwart
 
Answers : Dr. Christopher B-Lynch
The B-Lynch suture is a form of compression suture used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. It was developed by Christopher B-Lynch, a consultant obstetrician and gynaecological surgeon based at Milton Keynes General Hospital, Milton Keynes, Buckinghamshire, England. B-Lynch was born in 1947 in Sierra Leone with the birth name of Christopher Balogun-Lynch.The technique was first described in 1997.
 

JUNE 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Juhi Deshpande

9451895044
Jhansi

SECOND PRIZE

Dr. Chanchal Kumar Singh

9092546852
Pondicherry

THIRD PRIZE

Dr. Rohani Nayak

8763534814
Odisha

Winners Please Contact FOGSI Office

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

 

MAY 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Shilpa Kaushal

7506012801
Navi Mumbai

SECOND PRIZE

Dr. Juhi Deshpande

9451895044
Jhansi

THIRD PRIZE

Dr. Prachi P Risbud

7738535015
Mumbai

Winners Please Contact FOGSI Office

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
 

APRIL 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Avantika Gupta

8903650441
New Delhi

SECOND PRIZE

Dr. Kiran Dabholkar

9167008017
Mumbai

THIRD PRIZE

Dr. Tara D.

9482387831
Bangalore

Winners Please Contact FOGSI Office

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.
 

MARCH 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Sindhura Vaddamani

9943642594
Hyderabad

SECOND PRIZE

Dr. Sushruta Shrivastava

7697908003
Madhya Pradesh

THIRD PRIZE

Dr. Ramiti Gupta

9876635837
Sri Muktsar Sahib

Winners Please Contact FOGSI Office

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.
 

FEBRUARY 2017 QUIZ WINNERS

FIRST PRIZE

Dr. Avanthi Gadipudi

9703868248
Pondicherry

SECOND PRIZE

Dr. Sunayna Rao

9448105581
Karnataka

THIRD PRIZE

Dr. Freni Shah

9869562008
Mumbai

Winners Please Contact FOGSI Office