Obstetrics 2

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Obstetrics 2
2014-11-17 12:25:33
Diagnosis pregnancy early examinations
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  1. Which of the following structures opens into peritoneal cavity? [IOM]
    A) Fallopian tube
    B) Vas deferens
    C) Epididymis
    D) Ureter 
    A) Fallopian tube
    (this multiple choice question has been scrambled)
  2. What is the shape of external OS of cervix in nulliparous and parous?
    • Nulliparous - rounded shape [IOM 06,AI 07] 
    • Parous - transverse slit or  "H-shaped"

  3. What is the nerve supply of uterus?
    • The uterus is richly supplied by both sympathetic and parasympathetic nerves, through the inferior hypogastric and ovarian plexuses.
    • Sympathetic nerves from T12, L1 segment of spinal cord produce uterine contraction and vasoconstriction.
    • The parasympathetic nerves (S2, S3, S4) produce uterine inhibition and vasodilatation.
    • Pain sensation from the body of the uterus pass along the sympathetic nerves, and from the cervix, along the parasympathetic nerves (S2, S3, S4).  [UP 97]

  4. When is gestational sac seen in USG? [AIIMS 93]
    Gestational sac is seen by 4-5 weeks. 

    Double decidual sign can be seen by 5.5-6 weeks, which is the GS surrounded by the thickened decidua.
  5. The earliest USG finding in pregnancy is: [JIPMER 02]
    A. Gestational sac
    B. Fetal cardiac activity
    C. Placenta
    D. Fundal thickening
    A. Gestational sac

    The earliest consistent finding on transvaginal sonography in early pregnancy is a small (2 to 5mm) rounded, anechoic structure eccentrically located within the thickened decidua, representing the developing gestational sac.

    (this multiple choice question has been scrambled)
  6. When is fetal heart movement detected in USG? [PGI 01]
    In 6 weeks.
  7. Which one of the following congenital malformations of the fetus can be diagnosed earliest in a first trimester ultrasound? [AI 06,11]
    A) Meningocele
    B) Microcephaly 
    C) Anencephaly 
    D) Prosencephaly 
    C) Anencephaly
    (this multiple choice question has been scrambled)
  8. When can the fetal parts detected by X-ray? [DEHLI  88]
    Middle of 4th month of pregnancy (at about 16 weeks)
  9. Best parameter for estimation of fetal age by ultrasound in 3rd trimester is [AIIMS 02]
    A) Femur length 
    B) Biparietal diameter 
    C) Abdominal circumference
    D) Interocular distance
    B) Biparietal diameter
    (this multiple choice question has been scrambled)
  10. What is the significance of nuchal translucency?
    • In the fetus, fluid may collect behind the neck because of the fetus's tendency to lie on its back. This fluid collection behind the neck can be detected as nuchal translucency on USG and can be measured. 
    • Nuchal translucency is defined as maximum thickness of the subcutaneous translucent area between the skin and soft tissue overlying the fetal spine at the back of neck. 
    • The measurement of Nuchal translucency is best made between 11-14 weeks of gestation using precise criteria.  After this period, lymphatic system is developed that drains away the excess fluid. 
    • The thickness above the 95th percentile is considered abnormal and cut off value of 3 mm is used as the threshold for an abnormal nuchal translucency at the end of first trimester. 
  11. What are the causes of increased nuchal translucency?
    • Chromosomal abnormalities
    • - Down's syndrome - most common [AI 07,10] 
    • - Trisomy 18,13
    • - Turner's syndrome
    • - Klinefelter's syndrome 

    • No chromosomal abnormalities 
    • - Cardiac defects (most common) 
    • - Pulmonary defects (diaphragmatic hernia) 
    • - Skeletal dysplasia 
    • - Renal and abdominal wall defects
  12. What are various prenatal diagnostic testings?
    • Test // Sample // Timing 
    • Chorionic villus sampling // Chorionic villi // 10-12 weeks 
    • Amniocententesis // Amniotic fluid // 14-16 weeks 
    • MS AFP // Maternal blood // 15-18 weeks 
    • Cordocentesis // Fetal blood // 18-20 weeks
  13. What is Chorionic Villus sampling?
    • In chorionic villus sampling, a sample of placental tissue is obtained via a catheter placed under ultrasound guidance either transcervically or transabdominally. 
    • Fetal karyotyping can be done with the sample.  
    • It is done between 10-12 weeks [AI 98, 05] without anesthesia.  
    • CVS provides the earliest possible detection of a genetically abnormal fetus through analysis of trophoblast cells. 
    • There is risk of miscarriage [UP 99] in at least 1-3%.
  14. The best time to do chorionic villus sampling is [AIIMS 05]
    A) 9-11 weeks
    B) 6-8 weeks
    C) 7-9 weeks
    D) 11-13 weeks
    A) 9-11 weeks
    (this multiple choice question has been scrambled)
  15. Which of the following conditions is not diagnosed by Chorionic Villous Biopsy? [AI 08]
    A) Down's syndrome 
    B) Sickle cell anemia
    C) Neural tube defects 
    D) Phenylketonuria 
    C) Neural tube defects

    The indications of CVS and amniocentesis are usually the same. However disorders that specifically require analysis of amniotic fluid such as neural tube defects are not amenable to prenatal diagnosis by CVS.
    (this multiple choice question has been scrambled)
  16. What are the  indications for amniocentesis?
    • Genetic diagnosis - Down syndrome - amniocentesis is investigation of choice, [AIIMS 00] 
    • Neural tube defects, 
    • Lung maturity 
    • Rh incompatibility 
    • Decompression of polyhydraminos.
  17. What is the benefit of Amniocentesis over Chrionic Villous Sampling?
    Both are used for karyotyping to detect fetal abnormalities. But, amniocentesis has the benefit that Alpha-feto protein can be detected from amniotic fluid.

    • Maternal fluid serum α-FP has significant false positive rates, but amniotic fluid α-FP has very less false positive results and is most sensitive to detect open spina bifida. [AI 05]. 
    • It is performed between 15-20 weeks.
  18. The best way of diagnosis of Trisomy 21 during second trimester of pregnancyis [AI 06]
    A) Chorionic villus sampling 
    B) Triple marker estimation 
    C) Nuchal skin fold thickness measurement 
    D) Amniocentesis
    D) Amniocentesis

    Diagnosis of Down's syndrome 
    1. Diagnostic tests (invasive methods are diagnostic) 
    - Chorionic villus sampling in first trimester 
    - Amniocentesis in second trimester 

    2. Suggestive but not diagnostic 
    - Ultrasonography (6-40 weeks) 
    - Triple test (15-18 weeks) 
    - MSAFP (15-18 weeks)
    (this multiple choice question has been scrambled)
  19. What is Cordocentensis?
    • Cordocentensis or Percutaneous Umbilical Blood Sampling(PUBS) is the procedure of transabdominal needle aspiration of fetal umbilical cord blood  from umbilical vein.
    • It can only be done later in the pregnancy, from about 18-24 weeks, [AI 06] when the umbilical cord has adequately developed.
  20. How do you do Intrauterine transfusion of  blood?
    • By cordocentesis (PUBS).
    • In case of fetal anemia as in Rh incompatibility or Parvovirus-19 infection.
  21. What are amniocytes?
    These are floating live skin cells in amniotic fluid obtained in amniocentesis.
  22. What is fetoscopy? What are its indications?
    • Transabdominal procedure performed after 20 weeks under regional or general anesthesia.
    • Indications are  Intrauterine surgery  or fetal skin biopsy in suspected fetal icthyosis.
  23. What is the definitive diagnosis  of  pregnancy?
    Sonography of fetus and Fetal heart sound.[IOM 11]
  24. How do you determine the age of pregnany?
    • Conceptional method - 266 days or 38 weeks from conception. 
    • Menstrual method - 280 days or 40 weeks from LMP. 
    • Naegle's rule:
    • LMP -3 months + 7 days
    • or LMP + 9 months + 7 days
  25. When does Quickening occurs in Primigravida and Multigravida?
    • Primigravida – 18-20 weeks 
    • Multigravida – 16-18 weeks
  26. After which weeks should  be the gestational weeks equal cm from pubis to top of fundus?
    • After 20 weeks the fundal height should measure (in cm) the number of gestational weeks.  
  27. What are Braxton Hicks Contraction?
    These are low intensity, long duration contraction that has no effect on dilatation and effacement of cervix, develops after 14 weeks, benign.
  28. What is the  normal level of maternal  serum  AFP?
    • The level varies according to gestational age. 
  29. When should you do the maternal serum –AFP test?
    Between 15-20 weeks.
  30. What are the conditions in which maternal serum-AFP is increased? [IOM 2067,63]
    • Dating error 
    • Twins 
    • Neural tube defect [UP 00] 
    • Ventral wall defects  - Gastroschisis and Omphalocele (Exomphalos
    • Renal disease (Congenital nephrosis
    • Sacrococcygeal teratoma
    • Fetal death
    • Maternal hepatoma
  31. What do you do next if you find elevated Maternal serum-AFP?
    • Sonogram for dating error and anomalies.  If there is dating error, recalculate MS-AFP and no further workup is required. 
    • If the dating is correct, and if sonogram shows NTD, VWD, twins or renal causes, no further work up. 
    • If sonogram is correct, and there is unexplained increase in MP-AFP, go for amniocentesis for Amniotic  fluid AFP and acetylcholinesterase.
  32. What are the causes of decreased serum-AFP?
    • Dating error 
    • Trisomy 21 [AI 94, AIIMS 92] 
    • [@ in down syndrome, AFP is down]
  33. What  is the triple marker screen for Down’s syndrome? [AIIMS 03,04,05]
    MS-AFP, β-hCG, estriol, Now  Inhibin A is added to make it a quadruple screen or Extended AFP screen.(X-AFP screen).
  34. What is the profile that  you would expect  in triple screen for trisomy 21?  [IOM 10, MANIPAL 01, AI 99]
    • MS-AFP- decreased 
    • Estriol – decreased [UP 99] 
    • β-hCG – increased 
    • Inhibin A – increased
    • [@ HI (HCG and Inhibin) are high in trisomy]
  35. Which of the following ultrasound marker is associated with greatest increased risk for trisomy 21 in fetus? [AI 05]
    A. Nuchal edema
    B. Choroid plexus cysts
    C. Echogenic foci in heat
    D. Hyperechogenic bowel
    A. Nuchal edema

    Among numerous ultrasound markers of Down's syndrome at 15-22 weeks, nuchal fold thickness is the most discriminatory of its own, but not discriminatory enough for screening.
    (this multiple choice question has been scrambled)
  36. A 21 yrs old is at 16 weeks gestation. Blood type is Rh negative, Her atypical antibody test is negative. What do you recommend?
    A) Chorionic Villous Sampling 
    B) RhoGAM
    C) Amniocentesis
    D) X-AFP or
    D) X-AFP

    X-AFP = Extended Alpha feto protein

    RhoGAM is given only in 28 weeks.  
    CVS is done between 10-12 weeks. 
    For Amniocentesis, there is no risk factors.
    (this multiple choice question has been scrambled)
  37. What is pseudocyesis? [AI 96]
    Pseudocyesis or phantom pregnancy is a condition in which a patient has nearly all of the usual signs and symptoms of pregnancy (such as enlargement of the abdomen, weight gain, cessation of menses, and morning sickness) but is not pregnant. And there is no enlargement of uterus. 
  38. What is uterine soufflé? [UP 00]
    A blowing sound, synchronous with the cardiac systole of the mother, heard on auscultation over the pregnant uterus. Also called placental soufflé.