Diagnosis In Pregnancy

Diagnosis In Pregnancy

Q. 1

Signs positive in early pregnancy are :

 A

Hegar’s sign

 B

Palmer’s sign

 C

Goodell’s sign and Osiander’s sign both

 D

All

Q. 1

Signs positive in early pregnancy are :

 A

Hegar’s sign

 B

Palmer’s sign

 C

Goodell’s sign and Osiander’s sign both

 D

All

Ans. D

Explanation:

All


Q. 2

Changes that are found in 2nd trimester of pregnancy

 A

Braxton-Hicks contraction

 B

Show

 C

Amenorrhea

 D

a and c both

Q. 2

Changes that are found in 2nd trimester of pregnancy

 A

Braxton-Hicks contraction

 B

Show

 C

Amenorrhea

 D

a and c both

Ans. D

Explanation:

Ans. is a and c i.e. Braxton hicks contraction; and Quickening

Second trimester of pregnancy (13-28 weeks) can be diagnosed by :

Symptoms :

  • Quickening • Perception of active fetal movements felt by 18 weeks of pregnancy in pnrnipara and 2 weeks earlier in multiparae
  • Progressive enlargement : Of the lower abdomen by the growing uterus.

Q. 3

An expectant mother feels quickening at:

 A

12-18 weeks

 B

16-20 weeks

 C

26 weeks

 D

24-28 weeks

Q. 3

An expectant mother feels quickening at:

 A

12-18 weeks

 B

16-20 weeks

 C

26 weeks

 D

24-28 weeks

Ans. B

Explanation:

Ans. b is 16-20 wks

“Quickening (feeling of life) denotes the perception of active fetal movements by the women. It is usually felt about the 18th week°, 2 weeks earlier in multiparae. Its appearance is an useful guide to calculate the expected date of delivery with reasonable accuracy”

“Quickening is felt b/w 16” to 2G weekc“-Reddy 

Phenomenon                                                                   me

  • Palpation of fetal part                         20 weeks
  • Active fetal movement felt by

placing a hand on abdomen                                20 weeks

  • External ballotment                                 20 weeks
  • Internal ballotment                                 16-28 weeks
  • Fl-IS audible by Stethoscope                18-20 weeks
  • Lightening                                                38 weeks



Q. 4

Which one of the following is not a sign of early pregnancy?

 A

Goodell’s sign

 B

Hegar’s sign

 C

Cullen’s sign

 D

Palmer sign

Q. 4

Which one of the following is not a sign of early pregnancy?

 A

Goodell’s sign

 B

Hegar’s sign

 C

Cullen’s sign

 D

Palmer sign

Ans. C

Explanation:

Cullen’s sign


Q. 5

In early pregnancy clinical signs of feeling the cer­vix and the body of bulky uterus separated be­cause of softened isthmus at 6 – 10 weeks of gestation :

 A

Goodell’s sign

 B

Chadwick’s sign

 C

Piskacek’s sign

 D

Hegar’s sign

Q. 5

In early pregnancy clinical signs of feeling the cer­vix and the body of bulky uterus separated be­cause of softened isthmus at 6 – 10 weeks of gestation :

 A

Goodell’s sign

 B

Chadwick’s sign

 C

Piskacek’s sign

 D

Hegar’s sign

Ans. D

Explanation:

Hegar’s sign


Q. 6

Osiander’s sign means :

 A

Pulsation in the lateral vaginal fornix

 B

Bluish colour change in the vagina

 C

Softening of the cervix

 D

On bimanual palpation the finger can be approxi­mated as if nothing is in between

Q. 6

Osiander’s sign means :

 A

Pulsation in the lateral vaginal fornix

 B

Bluish colour change in the vagina

 C

Softening of the cervix

 D

On bimanual palpation the finger can be approxi­mated as if nothing is in between

Ans. A

Explanation:

Pulsation in the lateral vaginal fornix


Q. 7

Chadwick’s sign is :

 A

Intermittent urine contraction

 B

Bluish discoloration of vagina

 C

Vaginal pulsations

 D

Softening of the cervix

Q. 7

Chadwick’s sign is :

 A

Intermittent urine contraction

 B

Bluish discoloration of vagina

 C

Vaginal pulsations

 D

Softening of the cervix

Ans. B

Explanation:

Bluish discoloration of vagina


Q. 8

All the definitive signs of pregnancy except :

 A

Amenorrhoea

 B

Fetal movements

 C

Fetal heart sounds

 D

Fetal skeleton seen an X-ray

Q. 8

All the definitive signs of pregnancy except :

 A

Amenorrhoea

 B

Fetal movements

 C

Fetal heart sounds

 D

Fetal skeleton seen an X-ray

Ans. A

Explanation:

Amenorrhoea


Q. 9

Definitive sign of pregnancy :

 A

Uterine souffle

 B

Ballottement

 C

Fetal heart sound

 D

Amenorrhea

Q. 9

Definitive sign of pregnancy :

 A

Uterine souffle

 B

Ballottement

 C

Fetal heart sound

 D

Amenorrhea

Ans. C

Explanation:

Fetal heart sound


Q. 10

All are positive signs of pregnancy except :

 A

Vomiting

 B

Fetal movements

 C

Fetal heart sounds

 D

Excessive salivation 

Q. 10

All are positive signs of pregnancy except :

 A

Vomiting

 B

Fetal movements

 C

Fetal heart sounds

 D

Excessive salivation 

Ans. D

Explanation:

Excessive salivation 


Q. 11

Braxton — Hicks contractions :

 A

Is a positive feedback system

 B

Is another terms for labor contraction

 C

Occur during most of the months of pregnancy

 D

Result in hypoxia of the fetus

Q. 11

Braxton — Hicks contractions :

 A

Is a positive feedback system

 B

Is another terms for labor contraction

 C

Occur during most of the months of pregnancy

 D

Result in hypoxia of the fetus

Ans. C

Explanation:

Occur during most of the months of pregnancy


Q. 12

In normal pregnancy character of vagina is:

 A

↑ed pH

 B

↑ed number of lactobacilli

 C

↓ed Glycogen content

 D

↑ed number of pathogenic bacteria

Q. 12

In normal pregnancy character of vagina is:

 A

↑ed pH

 B

↑ed number of lactobacilli

 C

↓ed Glycogen content

 D

↑ed number of pathogenic bacteria

Ans. B

Explanation:

Lactobacillus acidophilus is increased in pregnancy.

Ref: Textbook of Obstetrics By Dutta, 6th Edition, Page 47 ; Williams Gynaecology, 2nd Edition, Page 172


Q. 13

The breast becomes fully differentiated during pregnancy and lactation. All the following statements are TRUE regarding the pregnant and lactating breast, EXCEPT:

 A

The terminal lobular units are most affected during pregnancy

 B

Cuboidal luminal epithelial cells show vacuolization

 C

Fat droplets occur in the cytoplasm of the epithelium

 D

There is an increase in the interlobular connective tissue

Q. 13

The breast becomes fully differentiated during pregnancy and lactation. All the following statements are TRUE regarding the pregnant and lactating breast, EXCEPT:

 A

The terminal lobular units are most affected during pregnancy

 B

Cuboidal luminal epithelial cells show vacuolization

 C

Fat droplets occur in the cytoplasm of the epithelium

 D

There is an increase in the interlobular connective tissue

Ans. D

Explanation:

The breast becomes fully differentiated during pregnancy and lactation.

The terminal lobular units are most affected during this physiologic state.

Several histologic changes occur in the terminal ducts and lobules with enlargement and formation of new lobular units early in pregnancy.

By the end of the second trimester secretory changes are well developed and the cuboidal luminal epithelial cells show evidence of vacuolization.

Accumulation of fat droplets occurs within the cytoplasm of the epithelium of the lobules during the third trimester.

The lobules undergo striking hyperplasia to occupy most of the breast parenchyma during this time, with a decrease in the interlobular connective tissue.

At term the expanded lobular units show marked distention of their lumina by colostrum.


Q. 14

Supine hypotension syndrome is characteristic finding of the following trimester:

 A

First trimester of pregnancy

 B

2nd trimester of pregnancy

 C

3rd trimester of pregnancy

 D

Twin pregnancy

Q. 14

Supine hypotension syndrome is characteristic finding of the following trimester:

 A

First trimester of pregnancy

 B

2nd trimester of pregnancy

 C

3rd trimester of pregnancy

 D

Twin pregnancy

Ans. C

Explanation:

During third trimester, in about 10 percent of women, supine compression of the great vessels by the uterus causes significant arterial hypotension, sometimes referred to as the supine hypotensive syndrome.

Also when supine, uterine arterial pressure—and thus blood flow—is significantly lower than that in the brachial artery.

This may directly affect fetal heart rate patterns. This also occurs with hemorrhage or with spinal analgesia.
 
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

 


Q. 15

Under which of the following condition uterus shows both hypertrophy and hyperplasia at the same time?

 A

Pregnancy

 B

Multiparity

 C

Nulliparity

 D

Puberty

Q. 15

Under which of the following condition uterus shows both hypertrophy and hyperplasia at the same time?

 A

Pregnancy

 B

Multiparity

 C

Nulliparity

 D

Puberty

Ans. A

Explanation:

During pregnancy, the myometrium goes through a period of extensive growth involving both hyperplasia (increasing the number of smooth muscle cells), cell hypertrophy, and increased collagen production by the muscle cells, which strengthens the uterine wall.

This well-developed uterine myometrium contracts very forcefully during parturition to expel the infant from the uterus.

After pregnancy, uterine smooth muscle cells shrink and many undergo apoptosis, with removal of unneeded collagen, and the uterus returns almost to its prepregnancy size.

Ref: Mescher A.L. (2013). Chapter 22. The Female Reproductive System. In A.L. Mescher (Ed), Junqueira’s Basic Histology, 13e.


Q. 16

A 23 year old female presents to the clinic with 5 weeks history of amenorrhea. Pregnancy test done in her was found to be positive and on examination Palmer sign is present. What does Palmer’s sign indicate?

 A

Pulsation in lateral fornix

 B

Softening of uterus

 C

Rhythmic contraction of uterus

 D

Bluish colouration of vagina

Q. 16

A 23 year old female presents to the clinic with 5 weeks history of amenorrhea. Pregnancy test done in her was found to be positive and on examination Palmer sign is present. What does Palmer’s sign indicate?

 A

Pulsation in lateral fornix

 B

Softening of uterus

 C

Rhythmic contraction of uterus

 D

Bluish colouration of vagina

Ans. C

Explanation:

Palmer’s sign refers to the regular and rythmic uterine contractions which is elicited during bimanual examination.

It is present as early as 4-8 weeks.

  • Osiander’s sign refers to the feeling of increased vaginal pulsation felt through the lateral fornices at 8th week of gestation.
  • Jacquemier’s sign or Chadwick’s sign refers to the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy.
  • Goodell’s sign refers to softening of the cervix as early as 6th week of gestation.
Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 65

 


Q. 17

Jacquemier’s sign is?

 A

Asymmetric enlargement of uterus

 B

Bluish hue of vagina

 C

Cervical softening

 D

Lateral fornix pulsation

Q. 17

Jacquemier’s sign is?

 A

Asymmetric enlargement of uterus

 B

Bluish hue of vagina

 C

Cervical softening

 D

Lateral fornix pulsation

Ans. B

Explanation:

Jacquemier’s or chadwick’s sign: It is the husky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy due to local vascular congestion and as such it may be brought about by pelvic tumour such as uterine fibroid.

Also Know:
Osiander’s sign: There is increased pulsation, felt through the lateral fornices at 8th week of gestation.
Ref: Textbook of Obstetrics D.C.Dutta, 6th Ed, page 65.

Q. 18

Which of the following statements about human chorionic gonadotropin (hCG) is correct?

 A

hCG is often negative in patients with ectopic pregnancy

 B

hCG is usually negative in patient with choriocarcinoma

 C

hCG can be detected in the urine prior to the first missed period

 D

hCG levels are highest at the end of pregnancy

Q. 18

Which of the following statements about human chorionic gonadotropin (hCG) is correct?

 A

hCG is often negative in patients with ectopic pregnancy

 B

hCG is usually negative in patient with choriocarcinoma

 C

hCG can be detected in the urine prior to the first missed period

 D

hCG levels are highest at the end of pregnancy

Ans. C

Explanation:

New generation pregnancy tests using an immuno concentration method (ICON) can detect urine hCG as early as 4 to 5 days before the first missed period. HCG is a glycoprotein produced by the syncytial trophoblast. It is composed of an alpha and a beta subunit and the alpha subunit is identical to the alpha subunits of LH, FSH, and TSH. HCG is usually positive in patients with ectopic pregnancy or a choriocarcinoma. HCG has its highest levels at the end of the first trimester, not the end of pregnancy. Levels of estradiol, and progesterone however, continue to rise until term. The role of hCG is to maintain the corpus luteum in the ovary, and it has no direct effect on fetal production of steroids.
 
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 22. Reproductive Development & Function of the Female Reproductive System. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong’s Review of Medical Physiology, 24e.

Q. 19

At how many weeks of gestation can Hegar’s sign be elicited?

 A

8 weeks

 B

10 weeks

 C

12 weeks

 D

15 weeks

Q. 19

At how many weeks of gestation can Hegar’s sign be elicited?

 A

8 weeks

 B

10 weeks

 C

12 weeks

 D

15 weeks

Ans. A

Explanation:

Hegar’s sign refers to widening and softening of of the body or isthmus of the uterus.

It usually occurs at 6-8 weeks of gestation.

Softening and dilatation at the external os is caused by estrogen and progesterone.
  • Chadwick’s sign: It refers to bluish discoloration of cervix caused by congestion of pelvic vasculature. It is a presumptive sign of pregnancy.
  • Jacquemier’s sign: It refers to congested appearance of vaginal mucosa.
  • Osiander’s sign: It refers to increased pulsations felt in the lateral fornices at 8 weeks of gestation.
  • Goodell’s sign: It refers to softening of the cervix.
  • Palmer’s sign: refers to intermittent contractions of the uterus.
Ref: Bernstein H.B., VanBuren G. (2013). Chapter 6. Normal Pregnancy and Prenatal Care. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. Manual Of Obstretics, 3/e  By Daftary page 54

Q. 20

Which among the following is the MOST diagnostic sign of pregnancy?

 A

Amenorrhoea

 B

Quickening

 C

Foetal heart sounds

 D

Distention of abdomen

Q. 20

Which among the following is the MOST diagnostic sign of pregnancy?

 A

Amenorrhoea

 B

Quickening

 C

Foetal heart sounds

 D

Distention of abdomen

Ans. C

Explanation:

Presence of fetal heart sounds is an absolute diagnostic sign of pregnancy.
 
Other absolute signs of pregnancy are:
  • Palpation of fetal parts and perception of active fetal movements
  • Ultrasonographic evidence of gestational sac and embryo in early pregnancy and later.
Probable signs:
  • Change in size, shape and consistency of uterus
  • Softening of cervix
  • Osiander’s sign, Chadwick’s sign, Goodell sign
  • Abdominal enlargement
  • Braxton Hicks contraction
  • External and internal ballottement
Ref: Essential of Obstetrics By Arulkumaran page 39

Q. 21

Quickening is:   

March 2004

 A

Heart beat

 B

Uterine contractions

 C

Feeling of first foetal movement by mother

 D

None of the above

Q. 21

Quickening is:   

March 2004

 A

Heart beat

 B

Uterine contractions

 C

Feeling of first foetal movement by mother

 D

None of the above

Ans. C

Explanation:

Ans. C i.e. Feeling of first foetal movement by mother


Q. 22

Largest diameter of pelvic cavity:  

March 2013

 A

Anteroposterior

 B

Oblique

 C

Transverse

 D

All are same

Q. 22

Largest diameter of pelvic cavity:  

March 2013

 A

Anteroposterior

 B

Oblique

 C

Transverse

 D

All are same

Ans. D

Explanation:

Ans. D i.e. All are same

Maternal pelvis

  • MC type: Gynaecoid
  • Platypelloid/ flat pelvis: Transverse diameter is more than AP diameter
  • Least common type of pelvis: Platypelloid
  • Deep transverse arrest/ persistent occipito posterior position is common in: Android pelvis
  • AP diameter more than transverse diameter: Anthropoid pelvis
  • Face to pubis delivery is common in: Anthropoid pelvis
  • Shortest diameter of pelvic inlet: Obstetric conjugate

Q. 23

pH of vagina in pregnancy is:       

September 2009

 A

2-4

 B

4- 6

 C

6-8

 D

8-10

Q. 23

pH of vagina in pregnancy is:       

September 2009

 A

2-4

 B

4- 6

 C

6-8

 D

8-10

Ans. B

Explanation:

Ans. B: 4- 6

Vaginal walls becomes hypertrophied and more vascular.Increased blood supply of the venous plexus surrounding the walls gives the bluish colouration of the mucosa (Jacquemier’s sign)

Vaginal secretion becomes copious, thin and curdy white, due to marked exfoliated cells and bacteria. The pH becomes acidic (3.5-6) due to more conversion of glycogen into lactic acid by the lactobacillus.


Q. 24

Uterus reaches up to umbilical level at:

September 2009

 A

16 weeks

 B

20 weeks

 C

24 weeks

 D

28 weeks

Q. 24

Uterus reaches up to umbilical level at:

September 2009

 A

16 weeks

 B

20 weeks

 C

24 weeks

 D

28 weeks

Ans. C

Explanation:

Ans. C: 24 weeks

The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cartilage at 28th week.


Q. 25

Plasma levels of hCG during pregnancy doubles every:         

September 2010

 A

Daily

 B

2 days

 C

4 days

 D

6 days

Q. 25

Plasma levels of hCG during pregnancy doubles every:         

September 2010

 A

Daily

 B

2 days

 C

4 days

 D

6 days

Ans. B

Explanation:

Ans. B: 2 days

Pregnancy tests may be used to determine the viability of a pregnancy.

Serial quantitative blood tests may be done, usually 2-3 days apart.

Below an hCG level of 1,200 mIU/ ml the hCG usually doubles every 48-72 hours, though a rise of 50-60% is still considered normal.

Failure to increase normally may indicate an increased risk of miscarriage or a possible ectopic pregnancy.



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