Category: Image Based Question

Image Based Question – 65421

Question

A patient presented with fever, night sweats and weight loss. Clinical examination revealed painless lymphadenopathy. Microscopy shows these cells. Most likely condition is:

A. HIV

B. Chronic lymphocytic leukemia

C. Hodgkin’s lymphoma

D. Secondary TB

 

Show Answer

Practice Test

Testing Quiz

Description

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. 


Instruction

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. Keep the following in mind:

  • Multiple Attempts – You will have three attempts for this quiz with your highest score being recorded in the grade book.
  • Timing – You will need to complete each of your attempts in one sitting, as you are allotted 30 minutes to complete each attempt.
  • Answers – You may review your answer-choices and compare them to the correct answers after your final attempt.

To start, click the “Take the Quiz” button. When finished, click the “Submit Quiz” button.

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Q. 1

After how many days of ovulation embryo implan­tation occurs ?

 A

3 – 5 days

 B

7 – 9 days

 C

10 – 12 days

 D

13 – 15 days

Q. 1

After how many days of ovulation embryo implan­tation occurs ?

 A

3 – 5 days

 B

7 – 9 days

 C

10 – 12 days

 D

13 – 15 days

Ans. B

Explanation:

7 – 9 days

“From the time a fertilized ovum enters the uterine cavity from the fallopian tube (which occurs 3-4 days after ovulation) until the time ovum implants (7-9 days after ovulation) the uterine secretions called uterinemilk provide nutrition for the early dividing ovum

“At the time of implantation, on days 21-22 of menstrual cycle the predominant morphologic feature is edema of the endometrial stroma.”

Important facts :

  • Oogenesis begins in ovary at 6-8 weeks of gestation.°
  • Maximum number of oocytes (6-7 million) are attained at 20 weeks of gestation.°
  • All the primary oocytes in the ovary of a newborn are arrested In the late prophase (of meiosis) till puberty.°
  • At puberty as a result of mid cycle preovulatory surge, meiosis is resumed and compTetedjust prior to ovulation.°
  • Therefore first polar body is released just prior fo ovulation
  • The second division starts immediately after_ it and is arrested in metaphase.°
  • At the time of fertilization second division is completed which results in the release of oocyte and second polar body.
  • Therefore second polar body release occurs only at the time of fertilisation.°
  • LH surge preceedes ovulation by 34-36 hours.o
  • LH peak preceedes ovulation by 10-16 hours.o
  • Prior to ovulation :- Follicle reaches a size of 18-20mm.

                                    – Endometrium is 9-10 min trick.o

                                    – Endometrium show triple line on USG.o

  • Ovulation occurs 14 days before the next menstruation.°
  • Maximum action of corpus luteum is at 22 day of menstruation° (following which it starts regressing ~ 8 years after ovulation).°
  • In absence of fertilisation and implanation the corpus leteum persists for 12-14 days.o
  • Maximum growth of corpus lutem of pregnancy is at 8th week of gestation and degenerates at 6  months of gestation.o
  • Fertilisation occurs in the ampullary part of fallopian tube.°
  • Fertilised egg enters the uterus on day 18 – 19 of the cycle.°
Q. 2

In a young female ot reproductive age with regular menstrual cycles of 28 days, ovulation occurs around 14th day of periods. When is first polar body extruded ?

 A

24 hours prior to ovulation

 B

Accompanied by ovulation

 C

48 hours atter the ovulation

 D

At ths time of fertilization

Q. 2

In a young female ot reproductive age with regular menstrual cycles of 28 days, ovulation occurs around 14th day of periods. When is first polar body extruded ?

 A

24 hours prior to ovulation

 B

Accompanied by ovulation

 C

48 hours atter the ovulation

 D

At ths time of fertilization

Ans. B

Explanation:

Accompanied by ovulation

Q. 3

ln which of the following transmission, meiosis occurs :

 A

Primary to secondary spermatocyte

 B

Secondary spermatocyte to globular spermatid

 C

Germ cells to spermatogonium

 D

Spermatogonium to primary spermatocyte

Q. 3

ln which of the following transmission, meiosis occurs :

 A

Primary to secondary spermatocyte

 B

Secondary spermatocyte to globular spermatid

 C

Germ cells to spermatogonium

 D

Spermatogonium to primary spermatocyte

Ans. A

Explanation:

Primary to secondary spermatocyte

Q. 4

Primary oocyte :

 A

ls formed after single meiotic division

 B

Maximum in number in 5 month fetus

 C

ls in prophase arrest

 D

Option B and C both

Q. 4

Primary oocyte :

 A

ls formed after single meiotic division

 B

Maximum in number in 5 month fetus

 C

ls in prophase arrest

 D

Option B and C both

Ans. D

Explanation:

Ans. is b and c i.e. Maximum in number at 5th month of the fetus; and ls in the prophase arrest

The process involved in the development of mature ovum is called Oogenesis.
The primitive germ cells take their origin from the yolk sac at about the end of 3rd week and migrate to the developing gonadal ridge, at aboul the end ol 4th week.

Oogenesis :

Primordial

       

Enters the gonad of a genetic female & differentiate into

       

Oogonlum tl4 XX

       Mitosis (not meiosis, as given in option)

Primary Oocyte 44 xx

                                                    (At birth no more mitosis occur & all oogonium are replaced by primary oocyte)

Enters Ist meiotic division

   ↓

Anested in prophase

   ↓

Ist meiotic division is completed after puberty, just prior to ovulationo

                                            releasing

             ___________________________________________

    ↓                                   

Secondary Oocyte 22 X
First Polar Body 22 X

                 2nd meiotic oivision

Arrested in metaphase

      ↓ At the time of  Fertilisation

       _________________________________

  ↓                          

Ovum 22 X
2nd Polar Body 22 X

lmportant facts

  • Oogenesis begins in the ovary at 6-8 A weeks of gestationo
  • Maximum number of oocytes/oogonia are in the ovary at 5th month of ddvelopmento (20 weeks of gestation)o.
  • Al birth total content ol both ovaries is 2 million primary oocytes.o
  • At puberty is further decreased and is  ~ 300000 – 500000, of which only 500 are distined to mature during an individual’s life time.o
Q. 5

Normal pH ot cervix ls :

 A

2

 B

3

 C

8

 D

11

Q. 5

Normal pH ot cervix ls :

 A

2

 B

3

 C

8

 D

11

Ans. C

Explanation:

8

The secretion of cervix are akaline and has a pH of 7.8.

  • The glands of cervix are racemose in type and secrete mucus with a high content of fructose which renders it attractive to sperm.
Q. 6

From which of the following layers the regeneration of endometrium take place :

 A

Zona basalis

 B

Zona pellucidum

 C

Zona compacta

 D

Zona spongiosum

Q. 6

From which of the following layers the regeneration of endometrium take place :

 A

Zona basalis

 B

Zona pellucidum

 C

Zona compacta

 D

Zona spongiosum

Ans. A

Explanation:

Zona basalis

 

                                                                                                                                Endometrium
Superficial layer (2/3) Deep layer (1/3)

It consists of stratum compactum stratum spongiosum These Layers are supplied by sprial which undergo vasocostriction during secretory phase

                          

This causes necrosis or sloughing of these layers at the time of menstruation

Stratum basale (Zona basalis) it is supplied by basllar arteries

                                   

During secretory phase these basilar arteries remain straight, so the blood supply stratum basale remains intact. Therefore this layer is not shed and during secretory phase it causes the regeneration.

 

Q. 7

True about galactorrhoea :

 A

Found in pregnancy and lactation

 B

Always B/L

 C

Surgery done

 D

A/w adrenal gland tumor

Q. 7

True about galactorrhoea :

 A

Found in pregnancy and lactation

 B

Always B/L

 C

Surgery done

 D

A/w adrenal gland tumor

Ans. C

Explanation:

Surgery done

Galactorrhea refers to mammary secretion of milky fluid which is not physiological (not related to pregnancy or needs of child) and is persistent and sometimes excessive.

  • Colour of fluid : Usually white, but can be yellow/green (local breast disease).
  • Hormonally induced secretions come from multiple duct openings in contrast to pathological discharge that usually comes from a single duct.
  • lt can be bilateral or unilateral
  • Any galactorrhea demands evaluation in a multiparous woman and if atleast 12 months have elapsed since the last pregnancy or weaning in a parous woman.

Differential diagnosis of Galactorrhea :

The bastc mechanism ts tncteased release ol prolactin or depletion of dopamlne.

Due to Disordsrs Drug Induced
  • Pituitary tumorso : Micro / Macro adenoma
  • Hypothyroidism
  • Prolonged intensive suckling. Similar
  • effect is seen in : ThoracotomY scarso,
    Cervical spine lesiono, Herpes zoster, stresso
  • Hypothalamic lesions / stalko
  • lesions or compressions
  • Non pituitary sources like : Lung tumor’
  • Renal tumor, Uterine leiomyoma, Severe
    renal disease requiring hemodialysis
  • Drugs which inhibit hypothalamic dopamine viz
  • Phenothiazines
  • Reserpineo
  • Amphetamineo
  • Opiates
  • Diazepamo
  • Butyrophenoneo
  • α methyl dopa
  • Tricyclic antidepressanto
  • Excessive estrogen like OCP’s

Clinical problem of Galactorrhea :

The clinical problems related to galactorrhea are related to hyperprolactinemia like :

  • Menstrual cycle disturbanceso leading to oligo-ovulation, corpus luteum insufficiency and amenorrhea.
  • Mild hirsutism.o
  • HYPerinsulinemia.o

Treatment of Galactorrhea :

Ireatment of Choice / Drug of Chorbe : Dopamine agonists viz Bromocriptine / Pergolide / Cabergoline.

ln case of pituitary tumors : Treatment of Choice is medical management with dopamine agonist but in
case medical management tails, Transsphenoidat resection of tumor can be done which is more successful
in case of Microprolactinomas than larger tumors (Macro Protactinomas

Surgery is one of the treatment modalities but not the IoC and since no other option is conect so, for this
question it is our option of choice.

Q. 8

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Q. 8

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Ans. A

Explanation:

FSH

Initiated by the release of FSH (From Anterior pituitary)
FSH stimulates the Growth of Multiple Follicles (Folliculogenesis)

Selection of a dominant Follicle (Graffian Follicle), by day 5-7.
Graffian Follicle acquires FSH receptors on Granulosa cells and LH receptors on Theca cell.
Under the influence of FSH, Graffian follicle secretes 178 estradiol (Day 7)
178 estradiol causes

4,                                                                   i                                                                    4,

Proliferative changes              Negative feedback on FSH                    Positive feedback on LH therefore

in the endometrium                                                                                      LH increases in amount.

Decreased Amount of FSH                      Increased LH leads to :

 

 

Production of androgen from Theca cells

which is converted peripherally to estrogen therefore Estrogen peak occurs (48 hours before ovulation)

LH surge (32-36 hours before ovulation) & LH peak (10-16 hours before ovulation) 1

Ovulation Occurs (14 days prior to next cycle)

Formation of corpus luteum & 2nd phase of ovulatory cycle i.e. Luteal Phase begins.

Secretes Progesterone

 

Stimulates Endometrium to undergo secretory changes 1.

In absence of Fertilisation corpus luteum degenerates

 

Oestradiol                          Progesterone                         Inhibin

(inhibin      FSH production)

(Leads to menstruation in menstrual

cycle) & will release the negative                         Increased FSH as

feedback on GnRH, therefore                               compared to LH increases GnRH pulses

L

Another follicular phase begins

Q. 9

Narrowest part of Fallopian Tube is:

 A

Interstitial portion

 B

lsthmus

 C

lnfundibulum

 D

Ampulla

Q. 9

Narrowest part of Fallopian Tube is:

 A

Interstitial portion

 B

lsthmus

 C

lnfundibulum

 D

Ampulla

Ans. A

Explanation:

Interstitial portion

Important Facts about Fallopian Tube :

1. Length = 4 inches or 10 – 12 cms.

2. Parts are : a. Interstitium (Intramural) : 1.8 cm long and 1 mm diameter (narrowest part°). It has no longitudinal muscles, only circular muscles are present.°

  1. Isthmus 3.5cm long and 2mm in diameter.°
  2. Ampulla : widest° and longest part° 6-7.5cm and fertilization occurs here°
  3. Fimbria/infundibulum°

3. Blood supply – Tubal branch of ovarian and uterine artery.°

4. Lymphatics – Via ovarian vessels to para-aortic nodes and uterine vessels to internal iliac nodes.°

5. Histologically – Fallopian tubes have unique type of cells called as Peg cells° whose function is not known.°

Also know : Friends, some other measurements are commonly asked in PGME exams from female genital Tract. I am listing a few of them :

Structure                                                                            Measurement

  • Isthumus which forms Inwpr laprinp gpampnt       5-6mmt)
  • Female urethra                                                       35-40 mm°
  • Posterior vaginal wall                                            11.5 cms
  • Anterior vaginal wall                                              9 cms
  • Uterus(Nulliparous)                                               8 cm X 6 cm X 4 cm
  • Cervix                                                                     2.5- 3.5 cms
  • Ovary                                                                      3.5 cms length


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