151. Topic: Metrorrhagia

Correct Answer: D. Bleeding between periods

Explanation: Metrorrhagia specifically refers to irregular bleeding or spotting that occurs between menstrual periods. This distinguishes it from conditions like increased period duration (A), increased menstrual flow (B), and shorter menstrual cycles (C). Therefore, “bleeding between periods” (D) accurately defines metrorrhagia, whereas the other options describe different types of menstrual irregularities.

152. Topic: Postmenopausal Metrorrhagia

Correct Answer: E. Taking OVESTIN* (Estriol) for vaginal dryness

Explanation: Postmenopausal metrorrhagia refers to abnormal uterine bleeding occurring after menopause. It is important to identify conditions that can cause this symptom: (E) Taking OVESTIN* (Estriol) for vaginal dryness (E) is incorrect because Estriol, a form of estrogen therapy, can potentially cause postmenopausal bleeding and is not considered appropriate in this context due to the risk of endometrial hyperplasia or cancer. (A) Atypical adenomatous hyperplasia (A), B. Ovarian thecoma (B), C. Endometrial atrophy (C), and D. Tubal adenocarcinoma (D) are conditions that can potentially cause postmenopausal metrorrhagia due to their association with hormonal changes or malignancies affecting the reproductive organs in menopausal women.

153. Topic: Contraindications to Progressive Lenses

Correct Answer: C. Uterine fibroids

Explanation: Progressive lenses are multifocal lenses used to correct presbyopia. Contraindications to their use typically include conditions that can affect vision or systemic health. Here’s why uterine fibroids (C) are not a formal contraindication:A. Malignant tumors of the breast and uterus (A) are contraindications due to their potential systemic effects and the need for regular medical monitoring. B. Thromboembolic accidents (B) pose a risk due to the potential for clotting disorders affecting blood flow, including to the eyes. D. Cholestatic hepatitis (D) can affect liver function and may alter the metabolism of medications, including those used in progressive lenses. E. Pituitary adenoma (E) can impact hormonal balance, which may indirectly affect vision and eye health. Uterine fibroids (C) are benign growths in the uterus and do not directly affect vision or eye health, making them not a formal contraindication to using progressive lenses.

154. Topic: Effects of Excess Estrogen in Birth Control Pills

Correct Answer: A. Acne

Explanation: Excess estrogen in birth control pills can lead to various side effects and pathological conditions. Here’s why acne (A) is not listed as one of them:B. Metrorrhagia (B) refers to irregular bleeding between periods, which can occur with excess estrogen due to altered hormonal balance. C. Depressed state (C) can be a side effect of hormonal fluctuations induced by excess estrogen. D. Mastosis (D), or breast tenderness and enlargement, can result from increased estrogen levels. E. Heavy legs (E) can occur due to fluid retention, a common side effect of excess estrogen. Acne (A) is typically associated with androgenic effects rather than estrogenic effects. Therefore, it is not commonly caused by excess estrogen and is not listed among the effects of high estrogen levels from birth control pills.

155. Topic: Clinical Symptoms of Premenopause

Correct Answer: D. Vulvar atrophy

Explanation: Premenopause is characterized by various clinical symptoms related to hormonal changes. Here’s why vulvar atrophy (D) is not typically associated with this phase:A. Mastodynia (A), or breast pain, can occur due to hormonal fluctuations. B. Menstrual rhythm disorders (B) are common as menstrual cycles may become irregular. C. Premenstrual syndrome (C) refers to symptoms that occur before menstruation due to hormonal changes. E. Menorrhagia (E), or excessive menstrual bleeding, can occur as hormonal balance shifts. Vulvar atrophy (D) is more commonly associated with postmenopausal changes rather than the premenopausal phase, making it the incorrect answer in this context.

156. Topic: Galactorrhea Amenorrhea Syndrome

Correct Answer: E. Postpartum Sheehan’s syndrome after several months of evolution

Explanation: Galactorrhea amenorrhea syndrome is commonly associated with conditions such as prolactin microadenoma (A), bulky somatotropic adenoma with acromegaly (B), hypothyroidism of peripheral origin (C), and treatment with sulpiride (Dogmatil) (D), all of which can elevate prolactin levels and disrupt menstrual cycles. However, Sheehan’s syndrome (E), which is due to postpartum pituitary necrosis and typically presents with pituitary insufficiency, is not commonly associated with galactorrhea amenorrhea syndrome after several months. The focus here is on hyperprolactinemia-inducing conditions, unlike Sheehan’s syndrome.

157. Topic: Endocrine Conditions and Amenorrhea

Correct Answer: C. Hyperparathyroidism

Explanation: Amenorrhea, the absence of menstrual periods, can be caused by various endocrine disorders. Here’s why hyperparathyroidism (C) does not typically cause amenorrhea:A. Hypothyroidism (A) can disrupt menstrual cycles due to low thyroid hormone levels. B. Hyperthyroidism (B), characterized by excessive thyroid hormone, can also lead to irregular menstrual cycles or amenorrhea. D. Hypercorticism (D), or Cushing’s syndrome, can disrupt normal hormone levels and menstrual cycles. E. Hypocorticism (E), or Addison’s disease, can cause hormonal imbalances that affect menstruation. Hyperparathyroidism (C) primarily affects calcium metabolism and does not directly interfere with reproductive hormones, thus it is the incorrect answer in this context.

158. Topic: Fertilization Site

Correct Answer: C. The outer third of the fallopian tube

Explanation: Fertilization typically occurs in the fallopian tube, specifically in the outer third (C). Here’s why this is correct: The uterine fundus (A) is the site where the fertilized egg (embryo) usually implants after fertilization. B. The pavilion of the trunk (B) is not a recognized anatomical term in reproductive anatomy. D. The inner third of the tube (D) is not the typical site of fertilization; instead, it is where the fertilized egg travels towards the uterus. E. Douglas’ cul-de-sac (E) is a peritoneal pouch behind the uterus and is not directly involved in fertilization. Therefore, the outer third of the fallopian tube (C) is the correct answer as it is where sperm typically meets the egg during fertilization.

159. Topic: Diagnosis of Pregnancy

Correct Answer: E. Ultrasound

Explanation: Ultrasound (E) is essential for confirming the evolution and status of pregnancy, particularly to assess the presence of a viable fetus, its location, and other details. Here’s why this is correct:A. The dosage of urinary HCG (A) can indicate pregnancy but does not provide information on the status or evolution of the pregnancy. B. Dosage of plasma HCG (B) is similar to A and detects the hormone but doesn’t confirm the pregnancy’s development. C. Dosage of plasma progesterone (C) may indicate luteal phase support but does not confirm pregnancy or its progression. D. Immunological diagnosis of pregnancy (D) typically involves detecting HCG antibodies and is not used to assess pregnancy evolution. Therefore, ultrasound (E) is the correct answer as it directly visualizes the pregnancy, assesses its development, and detects potential complications such as ectopic pregnancy or miscarriage

160. Topic: Monitoring Fetal Heart Rate during Pregnancy

Correct Answer: C. Episodes of acceleration during fetal movements

Explanation: Episodes of acceleration during fetal movements (C) are indicative of a healthy fetal response to stimuli and are a positive prognostic factor during the monitoring of fetal heart rate. Here’s why this is correct: A. The flat rhythm (A) or sinusoidal rhythm (B) are abnormal patterns and do not indicate a good prognosis. Sinusoidal rhythm, in particular, can suggest fetal distress. D. Tachycardia (D) and bradycardia (E) can both indicate fetal distress depending on the context and duration. Therefore, the presence of episodes of acceleration during fetal movements (C) reflects a responsive and healthy fetal cardiovascular system, making it a positive indicator during fetal heart rate monitoring in pregnancy.

161. Topic: Contraindications in Pregnancy

Correct Answer: D. Rubella vaccination

Explanation: Rubella vaccination (D) is contraindicated during pregnancy due to the risk of causing congenital rubella syndrome, which can lead to severe birth defects and developmental delays in the fetus. Here’s why this is correct:A. Injections of human immunoglobulins (A) are generally safe during pregnancy for specific indications such as preventing certain infections. B. Rabies vaccination (B), influenza vaccination (C), and parenteral poliomyelitis vaccination (E) can be administered during pregnancy if there is a specific indication and benefit outweighs the risk. Therefore, rubella vaccination (D) stands out as contraindicated during pregnancy due to the potential harm it can cause to the developing fetus.

162. Topic: Monitoring Prolonged Pregnancy

Correct Answer: E. Regular practice of cardio-tocography

Explanation: Monitoring a prolonged pregnancy involves the regular practice of cardio-tocography (E). Here’s why this is the correct answer: (A) Studying the appearance of amniotic fluid after rupture of the membrane (A) is related to assessing the status of the amniotic fluid, which is important but not specific to monitoring prolonged pregnancy. B. Studying the aspect of amniotic fluid by amniocentesis (B) is used to assess fetal lung maturity and other conditions but does not specifically monitor the progress of a prolonged pregnancy. C. Urinary elimination of steroids (C) may be assessed for various reasons in pregnancy but is not specifically for monitoring prolonged pregnancy. D. Determination of fetal age by ultrasound (D) is important for assessing fetal growth and development but is not specific to monitoring prolonged pregnancy. (E) Regular practice of cardio-tocography (E) involves monitoring fetal heart rate and uterine contractions, which is essential in the management of prolonged pregnancies to assess fetal well-being and decide on appropriate management options. Therefore, the correct answer for monitoring prolonged pregnancy is regular practice of cardio-tocography (E), as it helps in continuous assessment of fetal status and uterine activity.

163. Topic: Diagnosis of Ectopic Pregnancy

Correct Answer: C. Ask for the beta HCG dosage and an ultrasound

Explanation: When clinical examination suggests a suspicion of ectopic pregnancy but appears normal, the appropriate next step is to perform a beta hCG (human chorionic gonadotropin) assay and an ultrasound (C). Here’s why this is correct:A. Calling the patient again two weeks later for a new examination (A) may delay diagnosis and management if an ectopic pregnancy is suspected. B. Doing a laparoscopy (B) or operating immediately (D) without confirming the diagnosis through beta hCG and ultrasound can be invasive and unnecessary if the pregnancy is intrauterine. E. None of the above (E) is incorrect because performing beta hCG and ultrasound is crucial in confirming or ruling out ectopic pregnancy. Therefore, beta hCG and ultrasound (C) are essential to evaluate the location of the pregnancy and determine the appropriate management plan.

164. Topic: Pregnancy in Women with Insulin-Dependent Diabetes

Correct Answer: C. Hyperglycemia at the time of conception has no pejorative significance

Explanation: In women with insulin-dependent diabetes who wish to get pregnant, it’s crucial to manage their condition carefully. Here’s why option C is incorrect:A. Pregnancy should be avoided in case of progressive proliferative retinopathy (A) because pregnancy can exacerbate retinopathy due to hormonal changes and increased vascular permeability. B. Education in glycemic self-monitoring is necessary before pregnancy (B) to ensure the woman can manage her blood glucose levels effectively, which is crucial for the health of both mother and baby. C. Hyperglycemia at the time of conception has pejorative significance (C) because elevated blood glucose levels at conception and during early pregnancy increase the risk of congenital malformations and adverse pregnancy outcomes. D. Advising wearing an insulin pump or multiple insulin injections (D) helps achieve better glycemic control, which is beneficial for pregnancy outcomes. E. Strict glycemic balance during pregnancy (E) is essential to reduce the risks of fetal macrosomia, birth complications, and neonatal hypoglycemia. Therefore, the false statement among the options provided is C. Hyperglycemia at the time of conception does have pejorative significance, as it increases the risk of complications for both the mother and the fetus during pregnancy.

165. Topic: Spontaneous Abortions in the 1st Trimester

Correct Answer: E. Chromosome abnormalities of the egg

Explanation: Spontaneous abortions, or miscarriages, are common in the first trimester of pregnancy. Chromosome abnormalities of the egg (E) are the most frequent cause of spontaneous abortions in this period. Here’s why the other options are not correct:A. Hormonal causes (A) can contribute to miscarriages but are less common compared to chromosomal abnormalities. B. Uterine malformations (B) may lead to miscarriages but are generally less common than chromosomal abnormalities. C. Fibromas (C), referring to fibroids, typically do not cause spontaneous abortions in the first trimester unless they are large and impinge upon the pregnancy, which is less frequent. D. Isthmus gape (D) is not a recognized cause of spontaneous abortions. Therefore, among the provided options, chromosome abnormalities of the egg (E) are the most common and significant cause of spontaneous abortions in the first trimester of pregnancy.

166. Topic: Consequences of Pyelonephritis in Pregnancy

Correct Answer: A. Macrocytic anemia

Explanation: Pyelonephritis during pregnancy can lead to various complications, but macrocytic anemia (A) is not typically associated with this condition. Here’s why the other options are related to pyelonephritis in pregnancy:B. Maternal bacteremia (B): Pyelonephritis can lead to systemic bacterial infection with bacteria spreading through the bloodstream (bacteremia). C. A threat of premature birth (C): Pyelonephritis increases the risk of preterm labor and premature birth due to uterine contractions and inflammation. D. Fetal death in utero (D): Severe cases of pyelonephritis can lead to fetal death if the infection is not adequately treated, impacting fetal health and viability. E. Interstitial nephritis (E): Pyelonephritis can cause inflammation of the interstitial tissue of the kidneys (interstitial nephritis), which can impair kidney function. Therefore, among the consequences listed, macrocytic anemia (A) is not a recognized consequence of pyelonephritis in pregnancy.

167. Topic: Complications of Eclamptic Seizures

Correct Answer: C. Renal failure

Explanation: Eclamptic seizures, a severe complication of preeclampsia, can lead to various serious complications. Renal failure (C) is particularly common due to the severe hypertension and vascular changes affecting renal function. Here’s a brief explanation of why the other options are not as commonly associated with eclamptic seizures: Acute lung edema (A): While pulmonary edema can occur due to fluid shifts and increased vascular permeability, renal failure is more frequent. B. Stroke (B): Although hypertension associated with eclampsia increases the risk of stroke, renal failure is a more prevalent complication. D. Liver failure (D): Liver complications like HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) are possible but less common than renal failure. E. Uterine rupture (E): This is a rare complication and not typically associated with eclamptic seizures. Therefore, renal failure (C) is the most common and significant complication of eclamptic seizures due to its impact on renal perfusion and function during severe hypertensive crises in pregnancy.

168. Topic: Diagnosis Postpartum Metrorrhagia

Correct Answer: E. A retained placenta

Explanation: Moderate metrorrhagia (bleeding) and fever (temperature of 38°C) occurring on the 6th day postpartum typically raise suspicion of a retained placenta (E). Retained placenta can lead to postpartum hemorrhage and is often associated with signs of infection such as fever due to retained placental tissue becoming infected. Here’s why the other options are incorrect: Endometriosis (A): Unlikely to present with acute postpartum bleeding and fever. B. A small return of diapers (B): This is a non-specific term and not a recognized medical condition. C. Hyperprolactinemia (C): Does not typically cause acute postpartum bleeding and fever. D. Sural thrombophlebitis (D): Presents with pain and swelling in the calf, not typically with metrorrhagia and fever. Therefore, in the scenario described, the most likely diagnosis is a retained placenta (E), which requires prompt evaluation and management to prevent complications such as infection and hemorrhage.

169. Topic: Breast Lymphangitis During Breastfeeding

Correct Answer: D. The existence of pus in milk

Explanation: Breast lymphangitis during breastfeeding typically presents with the following signs: The temperature at 40°C (A): Fever is common due to infection. Localized redness or red streak (B): Indicates inflammation along lymphatic vessels. Sensitive axillary lymph nodes (C): Often swollen and tender due to lymphatic involvement. Very painful tense breasts (E): Breast engorgement and pain are characteristic. The incorrect statement is: D. The existence of pus in milk: Breast lymphangitis does not typically lead to the presence of pus in breast milk. Instead, it manifests with systemic signs of infection and local inflammation along lymphatic vessels. Therefore, among the listed signs, the presence of pus in milk (D) is not associated with breast lymphangitis during breastfeeding.

170. Topic: Complications of Gonococcal Urethritis

Correct Answer: B. Glomerulonephritis

Explanation: Gonococcal urethritis can lead to several complications: Acute arthritis (A): Commonly affects joints due to disseminated gonococcal infection. Epididymitis (C): Inflammation of the epididymis, a common complication in males. Salpingitis (D): Inflammation of the fallopian tubes, a significant complication in females. Sterility (E): Can result from untreated infections affecting the reproductive organs. The incorrect statement is: B. Glomerulonephritis: This is not a common complication of gonococcal urethritis. While untreated gonococcal infections can lead to systemic complications like septic arthritis and pelvic inflammatory disease, glomerulonephritis (inflammation of the kidney’s glomeruli) is not typically associated with gonococcal infections. Therefore, among the listed complications, glomerulonephritis (B) is not typically associated with gonococcal urethritis.

171. Topic: Vaginal Discharge (Leucorrhoea)

Correct Answer: E. By Trichomonas vaginalis

Explanation: Abundant greenish foamy smelly leucorrhoea typically suggests an infection by Trichomonas vaginalis. This protozoan infection commonly presents with such characteristic discharge. Candida albicans (A) usually causes thick, cottage-cheese-like discharge. Mycoplasma (B) and Klebsiella (D) are less commonly associated with vaginal infections. The bacillus of Doderlein (C) refers to lactobacilli, which are part of the normal vaginal flora and do not typically cause pathological discharge.

172. Topic: Metrorrhagia in a Woman on Oral Contraceptive Pill

Correct Answer: E. Tranexamic acid

Explanation: Metrorrhagia in a woman on oral contraceptive pills (OCPs) can often be managed conservatively with tranexamic acid (E), which helps reduce excessive bleeding. Endometrial biopsy (A) is usually reserved for cases where other causes need to be ruled out, such as abnormal bleeding persisting despite management. Oral iron therapy (B) may be indicated if there is significant blood loss leading to iron deficiency anemia. Laparoscopy (C) and dilation and curettage (D) are typically not initial management options for metrorrhagia related to OCP use unless there are specific indications such as suspicion of other pathologies or failed conservative management.

173. Topic: Complications of Submucosal Uterine Fibroid

Correct Answer: C. Metrorrhagia

Explanation: Submucosal uterine fibroids can lead to abnormal uterine bleeding, particularly metrorrhagia (C), due to their location within the uterine cavity. This bleeding occurs as the fibroid distorts the endometrial lining or disrupts the normal menstrual flow. While other complications like infection (B), torsion (A), and very rarely, transformation into cancer (D) or aseptic necrobiosis (E) can occur, metrorrhagia is the most common and clinically significant complication associated with submucosal uterine fibroids.

174. Topic: Ovarian Cancer Marker

Correct Answer: E. The CA 125

Explanation: CA 125 (E) is the most appropriate marker for the assessment of ovarian cancers. It is a protein that is often elevated in the blood of women with ovarian cancer, though it is not specific to ovarian cancer alone and can also be elevated in other conditions such as endometriosis and pelvic inflammatory disease. Alpha-fetoprotein (A) and beta HCG (B) are markers used for differentiating other types of cancers, such as testicular and trophoblastic cancers, respectively. Carcino-embryonic antigen (C) and CA 15.3 (D) are markers used in the evaluation of other types of cancers, but they are not specific to ovarian cancer.

175. Topic: Prevention of Anti-D Alloimmunization in Rhesus Negative Pregnant Women

Correct Answer: E. In the hours following childbirth

Explanation: Anti-D immunoglobulin is administered to Rhesus negative pregnant women to prevent alloimmunization against Rh-positive blood cells, which can occur if there is fetal-maternal hemorrhage during pregnancy or childbirth. The correct timing for administering anti-D immunoglobulin is shortly after childbirth (E) to prevent sensitization in future pregnancies. Administering it earlier in pregnancy (A, B, C, D) is not recommended unless there are specific indications such as trauma or invasive procedures that might lead to fetal-maternal hemorrhage.

176. Topic: Diagnosis of Genital Prolapse

Correct Answer: A. On clinical examinations

Explanation: The diagnosis of genital prolapse, such as uterine prolapse or vaginal prolapse, is primarily made through clinical examination (A). This involves a thorough assessment of the patient’s symptoms, physical examination, and pelvic organ prolapse quantification (POP-Q) system. Ultrasound (B) and hysterography (C) may sometimes be used to evaluate pelvic organ prolapse but are not the primary methods for diagnosis. Surgery (D) is not a diagnostic method but rather a treatment option for severe cases. Therefore, clinical examination is crucial for the initial diagnosis of genital prolapse.

177. Topic: Urethritis and Gonococcal Etiology

Correct Answer: A. Inguinal lymphadenopathy

Explanation: Gonococcal urethritis typically presents with symptoms such as dysuria and very sharp pain (B), sudden onset (C), short incubation period less than 5 days (D), and purulent discharge (E). Inguinal lymphadenopathy (A) is more commonly associated with non-gonococcal urethritis or other infections rather than gonococcal urethritis. Therefore, the presence of inguinal lymphadenopathy would direct less towards gonococcal etiology compared to the other listed symptoms.

178. Topic: Acute Salpingitis

Correct Answer: C. Metrorrhagia

Explanation: Acute salpingitis is characterized by inflammation of the fallopian tubes, typically presenting with symptoms such as pelvic pain, fever, abnormal vaginal discharge, and sometimes metrorrhagia (C), which is abnormal uterine bleeding between menstrual periods. Premenstrual pain (A) and absence of pain during uterine mobilization (D) are not specific signs of acute salpingitis. General condition very altered (B) could occur in severe cases but is not specific to acute salpingitis. Therefore, metrorrhagia is a key clinical sign that can suggest the diagnosis of acute salpingitis.

179. Topic: Trichomonas Vaginitis

Correct Answer: A. Direct microscopic examination of vaginal secretion

Explanation: The first-line examination for the biological diagnosis of Trichomonas vaginitis is direct microscopic examination of vaginal secretion (A). This method allows for the visualization of Trichomonas vaginalis organisms directly in the vaginal discharge. Specific serodiagnosis (B) and in vitro culture (C) are not typically used as first-line methods for diagnosing Trichomonas vaginitis. Blood count (D) and cytobacteriological examination of urine (E) are unrelated to the diagnosis of Trichomonas vaginitis. Therefore, direct microscopic examination of vaginal secretion is the most appropriate initial test for diagnosing this infection.

180. Topic: Breast Cancer Screening

Correct Answer: B. Mammography

Explanation: Mammography (B) is considered the most sensitive method for breast cancer screening. It involves X-ray imaging of the breast tissue to detect early signs of cancer, such as microcalcifications and masses, before they can be felt. Thermography (A) uses infrared imaging but is not as reliable as mammography for detecting breast cancer. Self-palpation (C), while important for breast awareness, is less sensitive than mammography for early detection. Ultrasound (D) is useful for evaluating breast lumps found during physical examination but is not typically used as a primary screening tool. Serum ACE (E) levels are not used in breast cancer screening. Therefore, mammography remains the gold standard for breast cancer screening due to its sensitivity in detecting early abnormalities.

181. Topic: Breast Nodule Diagnosis

Correct Answer: C. Fibro-adenoma

Explanation: A clinically benign breast nodule in a young woman, especially if it is well-defined and mobile, is most likely a fibro-adenoma (C). Fibro-adenomas are common benign breast tumors composed of glandular and fibrous tissue. They typically present as smooth, rubbery masses that are movable within the breast tissue. While breast cancer (A) is always a consideration and should be ruled out with further evaluation, it is less likely in a young woman with a benign clinical presentation. Cysts (B) are fluid-filled sacs and often present with fluctuant masses. Lipomas (D) are rare in breast tissue but are benign fatty tumors. Tuberculosis (E) does not typically present as a breast nodule. Therefore, based on the clinical description of a benign, well-defined breast nodule in a young woman, the most likely diagnosis is fibro-adenoma (C).

182. Topic: Symptoms of Endometrial Cancer Post-Menopause

Correct Answer: D. Polyp given birth through the cervix

Explanation: After menopause, symptoms such as vaginal bleeding (A), including vaginal burns, and hydrorrhea (C) (watery discharge) are concerning for endometrial cancer and should be investigated. These symptoms may indicate abnormal changes in the endometrium, such as hyperplasia or malignancy. Inguinal lymphadenopathy (B) typically suggests infection or neoplasm in the inguinal region and is not specific to endometrial cancer. Leucorrhea with vaginal burning (E) may suggest infection or inflammation rather than endometrial cancer. However, the presence of a polyp given birth through the cervix (D), especially in the context of post-menopausal bleeding, is highly suggestive of endometrial pathology, including cancer. Polyps can be benign but can also harbor malignancy, making this symptom a significant concern that warrants investigation. Therefore, among the symptoms listed, the one most directly associated with the need for investigation for endometrial cancer in post-menopausal women is D. Polyp given birth through the cervix.

183. Topic: Small Polypous Lesion of the Exocervix

Correct Answer: D. Excisional biopsy

Explanation: A small polypous lesion of the exocervix requires an excisional biopsy to specify its exact nature. This method involves removing the entire lesion along with a small margin of healthy tissue for histopathological examination, providing a definitive diagnosis. Options such as biopsy (A), extemporaneous examination (B), cytological examination (C), and biopsy puncture (E) may provide limited tissue samples or less comprehensive diagnostic information compared to excisional biopsy.

184. Topic: Subserous Fibroids in Pregnancy

Correct Answer: C. Aseptic necrobiosis

Explanation: Subserous fibroids, located on the outer surface of the uterus, can occasionally undergo aseptic necrobiosis, which involves tissue degeneration or necrosis without bacterial infection. This complication, although relatively rare, can cause pain and discomfort during pregnancy. Other potential complications such as twist (A), septic necrobiosis (B), ureteral compression (D), and metrorrhagia (E) are less commonly associated with subserous fibroids during pregnancy.

185. Topic: Diagnosis of Ovarian Tumor

Correct Answer: E. Pelvic ultrasound

Explanation: Pelvic ultrasound is a para-clinical exploration that can help diagnose an ovarian tumor without prejudging its histological type. It allows for visualization of the tumor’s size, location, and characteristics (such as solid, cystic, or mixed), aiding in initial assessment and guiding further management. Options like abdomen without preparation (A), hysterometry (B), hysterosalpingography (C), and barium enema (D) are not typically used for diagnosing ovarian tumors.

186. Topic: In-Utero Diagnosis by Ultrasound

Correct Answer: E. Trisomy 21

Explanation: Ultrasound is an essential tool for diagnosing various abnormalities in utero. Spina bifida (A), placenta previa (B), heart rhythm disorders (C), and fetal hydronephrosis (D) are all conditions that can be detected prenatally using ultrasound. However, Trisomy 21 (Down syndrome) is primarily diagnosed through genetic testing (e.g., amniocentesis or chorionic villus sampling), rather than by ultrasound imaging alone.

187. Topic: Amenorrhea Postpartum

Correct Answer: D. Taking parlodel* for too long

Explanation: Amenorrhea in the postpartum period can have various causes. Continued breastfeeding (A) can delay the return of menstruation due to the suppression of ovulation. A new pregnancy (B) can also cause amenorrhea. Synechiae after uterine curettage (C) and Sheehan’s syndrome (E) are other possible causes of postpartum amenorrhea. Taking parlodel (bromocriptine) for too long (D) is not typically associated with postpartum amenorrhea. Bromocriptine is used to suppress prolactin levels and is often used to stop lactation but is not typically a cause of prolonged postpartum amenorrhea.

188. Topic: Fetomaternal Immunization in Rhesus System

Correct Answer: C. When fetal red blood cells pass through the maternal circulation

Explanation: Fetomaternal immunization in the context of the Rhesus (Rh) system occurs when fetal red blood cells, which may possess Rh antigens (positive), pass into the maternal circulation. This exposure to Rh-positive fetal blood cells can sensitize an Rh-negative mother, leading to the production of anti-Rh antibodies. These antibodies can cross the placenta in subsequent pregnancies and cause hemolytic disease of the newborn (HDN) in Rh-positive fetuses.

189. Topic: Premature Delivery

Correct Answer: D. 37 weeks of amenorrhea

Explanation: Premature delivery refers to the delivery of a baby before completing 37 weeks of gestation (amenorrhea). This definition is crucial as babies born before 37 weeks may face health challenges due to incomplete development of organs and systems. It’s a critical milestone in obstetrics for assessing the risk and management of preterm birth.

190. Topic: Premature Rupture of Membranes

Correct Answer: A. Prematurity

Explanation: Premature rupture of membranes (PROM) refers to the rupture of the amniotic sac and leakage of amniotic fluid before the onset of labor in pregnancies less than 37 weeks of gestation. The consequences primarily include prematurity (option A), which poses risks such as respiratory distress syndrome and other complications associated with premature birth. Understanding the consequences of PROM is crucial in managing preterm labor and its associated risks.

191. Topic: Metrorrhagia in Early Pregnancy

Correct Answer: A. Molar pregnancy

Explanation: Metrorrhagia, which is abnormal uterine bleeding, during the first ten weeks of pregnancy can be caused by several conditions. The correct answer, molar pregnancy (option A), refers to a gestational trophoblastic disease where abnormal tissue grows inside the uterus instead of a normal fetus. This abnormal tissue can lead to bleeding due to its invasive nature and disruption of normal pregnancy development. Understanding the potential causes of metrorrhagia in early pregnancy is important for timely diagnosis and appropriate management.

192. Topic: Obstetric Emergency – Premature Abruption of Normally Inserted Placenta

Correct Answer: C. Premature abruption of the normally inserted placenta

Explanation: Premature abruption of the normally inserted placenta (option C) is characterized by the premature separation of a normally situated placenta from the uterine wall before delivery. This condition typically presents with sudden onset of severe abdominal pain, uterine contracture, and often signs of fetal distress such as decreased fetal movement or heart rate abnormalities. The bleeding associated with placental abruption can vary in severity, ranging from mild to severe hemorrhage. Understanding the clinical features and management of placental abruption is crucial in obstetric emergencies to prevent maternal and fetal complications.

193. Topic: Congenital Abnormalities and Toxoplasma Infection

Correct Answer: B. Hydrocephalus

Explanation: Toxoplasma gondii infection during pregnancy can lead to congenital toxoplasmosis, which may manifest with various fetal abnormalities. Hydrocephalus (option B), which is an abnormal accumulation of cerebrospinal fluid within the brain’s cavities, is a known complication of congenital toxoplasmosis. The parasite can cause inflammation and damage to the fetal brain, leading to structural abnormalities such as hydrocephalus. Understanding the specific congenital abnormalities associated with toxoplasma infection is important for prenatal diagnosis and management.

194. Topic: Maternal-Fetal Transmission of HIV

Correct Answer: B. It occurs in more than 90% of cases during the first half of pregnancy

Explanation: Maternal-fetal transmission of HIV primarily occurs during pregnancy, labor, and delivery, as well as through breastfeeding. Option B is correct because transmission can occur in more than 90% of cases during the first half of pregnancy, primarily due to direct exposure of the fetus to infected maternal blood.

195. Topic: Treatment of Acute Pyelonephritis in Pregnancy

Correct Answer: A. Amoxicillin

Explanation: During pregnancy, the treatment of acute pyelonephritis caused by gram-negative bacteria typically involves using antibiotics that are safe for both the mother and the fetus. Amoxicillin is considered safe in pregnancy and is often used empirically before the results of antibiogram (bacterial sensitivity testing) are available. It covers a broad spectrum of gram-negative bacteria and is effective against many common urinary pathogens.

196. Topic: Management of Gestational Diabetes

Correct Answer: D. Glycemic control of the newborn

Explanation: In the management of gestational diabetes mellitus (GDM), ensuring appropriate glycemic control is essential not only for the mother but also for the newborn. After birth, it is crucial to monitor the newborn’s blood glucose levels closely to prevent complications associated with maternal hyperglycemia during pregnancy. This involves regular glucose monitoring and, if necessary, providing appropriate feeding strategies to maintain stable blood glucose levels in the newborn.

197. Topic: Normal Laboratory Results in Pregnancy

Correct Answer: A. Red blood cell sedimentation rate = 30 mm in the first hour

Explanation: During pregnancy, various hematological parameters can change, reflecting the physiological adaptations to support both maternal and fetal needs. The red blood cell sedimentation rate (ESR) of 30 mm in the first hour is considered within the normal range for pregnancy. ESR tends to increase during pregnancy due to increased fibrinogen and globulin levels.

198. Topic: Physiological Changes in the Mother During Pregnancy

Correct Answer: D. A diastolic murmur is common

Explanation: During pregnancy, several physiological changes occur in the maternal cardiovascular system to accommodate the needs of the developing fetus. These include: Increased Cardiac Output: Cardiac output increases by approximately 30-50% during pregnancy, not 65% as stated in option A. This increase is due to an increase in stroke volume and heart rate. Heart Rate: The heart rate increases during pregnancy to meet the increased demand, typically by about 10-15 beats per minute. It does not decrease by 65% as stated in option B. Stroke Volume: The stroke volume increases significantly during pregnancy, contributing to the increased cardiac output. It is not stable, as mentioned in option C. Heart Murmurs: Heart murmurs, particularly diastolic murmurs, can occur in pregnant women due to increased blood flow and changes in heart valve dynamics. This is considered a normal finding during pregnancy, making option D the correct statement. Postpartum Changes: Cardiac output decreases after delivery, returning to pre-pregnancy levels within hours. It does not remain high in the hour following the expulsion of the fetus, making option E incorrect. Therefore, the correct answer is D because diastolic murmurs are indeed common during pregnancy due to the physiological changes in the heart’s function and structure.

199. Topic: Normal Laboratory Results in Pregnancy

Correct Answer: E. Proteinuria at 0. 80g/24h

Explanation: During pregnancy, various hematological parameters can change, reflecting the physiological adaptations to support both maternal and fetal needs. The red blood cell sedimentation rate (ESR) of 30 mm in the first hour is considered within the normal range for pregnancy. ESR tends to increase during pregnancy due to increased fibrinogen and globulin levels. The other options are not correct because: Option B (Hemoglobin level = 8 g/dl) indicates anemia, which is not normal in pregnancy. Normal hemoglobin levels in pregnancy are typically higher, reflecting the increased blood volume. Option C (Reticulocytes = 200,000/mm3) suggests a high reticulocyte count, which is not typical in normal pregnancy. Option D (Platelets = 600,000/mm3) indicates thrombocytosis, which is not normal in pregnancy; normal platelet counts are slightly lower than this value. Therefore, the correct answer is A because an ESR of 30 mm in the first hour is within the expected range during pregnancy, reflecting the physiological changes in blood composition.

200. Topic: Menstrual Cycle and Ovulation Calculation

Correct Answer: C. 18 days

Explanation: For a woman with a usual menstrual cycle of 32 days, the pre-ovulatory phase, which includes the follicular phase (before ovulation), typically lasts around 18 days. This phase is relatively constant for most women and accounts for the time from the beginning of the menstrual cycle until ovulation occurs. Option A (14 days) is too short for most women’s menstrual cycles. Option B (16 days) is shorter than the average pre-ovulatory phase for a 32-day cycle. Option D (Variable between 14 and 18 days) suggests variability but does not accurately reflect the average. Option E (Greater than 18 days) exceeds the typical length of the pre-ovulatory phase in a 32-day cycle. Therefore, option C (18 days) is correct as it aligns with the average duration of the pre-ovulatory phase in a woman with a 32-day menstrual cycle.