৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মডেল টেস্ট [Archived]

Explanation :
(a) Ovary is measuring avout 3cm in length,2 cm in breadth,1 cm in thickness
(b) The ovaries are intraperitoneal structures 
(d) The ovarian fossa is related superiorly to the external iliac vein, posteriorly to ureter and internal iliac vessels and laterally to the peritoneum seperating the obturator vessels and nerves

Explanation :
Drugs That Cause Premature Closure of Ductus Arteriosus: 
1. Indomethacin
2. Ibuprofen
3. Aspirin (high doses)
4. Other NSAIDs
 These drugs inhibit prostaglandin synthesis (especially PGE₂), which is essential to keep the ductus arteriosus open during fetal life.

Explanation :
In girl,Tanner staging -
1.Beginning of the growth spurt
2.Breast budding ( Thelarche)
3.Pubic and axillary hair growth ( Adrenarche)
4.Peak growth in height
5.Menstruation ( Menerche)

Explanation :
Following 10th day of postfertilization hCG formation occurs.

Explanation :
Low estrogen is the main cause of hot flush
Also related to GnRH and High LH level

Explanation :
Risk Factors for Neonatal Infection :

1. Premature rupture of membranes (PROM)

2. Prolonged labor

3. Maternal fever during labor

4. Chorioamnionitis

5. Preterm birth

6. Low birth weight(<2.5 kg)

7. Maternal urinary tract infection


8. Maternal sexually transmitted infections or Group B streptococcus carrier
9.Male infants

Explanation :
Anterior Pituitary Hormones (Adenohypophysis):

1. Growth Hormone (GH)


2. Prolactin (PRL)


3. Adrenocorticotropic Hormone (ACTH)


4. Thyroid-Stimulating Hormone (TSH)


5. Follicle-Stimulating Hormone (FSH)


6. Luteinizing Hormone (LH)

? Posterior Pituitary Hormones (Neurohypophysis):

1. Antidiuretic Hormone (ADH) (also called vasopressin)


2. Oxytocin

Explanation:
Maternal blood bathes the intervillous space, so there are no maternal capillaries directly involved in exchange.
The placental barrier at term includes:

Fetal capillary endothelium

Basement membrane

Thin cytotrophoblast layer (may be minimal)

Syncytiotrophoblast

Explanation :
Genital tuberculosis is restricted( 80%) to childbearing period (20-40 years).
Genital tuberculosis occurs in 10-20% of patients who have pulmonary tuberculosis in adolescence. 

Explanation :
Rubella virus infection :
Effects in Pregnancy:

Highest risk during first trimester

Can lead to Congenital Rubella Syndrome (CRS)

Congenital Rubella Syndrome – Classic Triad:

1. Sensorineural deafness


2. Congenital cataract or retinopathy


3. Congenital heart defects (e.g., PDA, pulmonary artery stenosis)

Explanation :
Submucous fibroid is least  common (5%) but mostly symptom producing.It causes uterine cavity irregular and distorted.

Explanation :
Pregnancy is a state of respiratory alkalosis due to hyperventilation.

Explanation :
Leiomyoma is the most common structural cause of AUB.

Explanation :
Fetal macrosomia occurs in 40-50% cases
Fetal weight >4 kg
Cause due to maternal hyperglycemia and elevation of maternal free fatty acid 

Explanation :
Dermoid cyst :
Germ cell ovarian tumor
• >90% of all germ cell tumors
• 30% of all ovarian tumors
• Bilateral: 15-20%
• Contains elements of three germ cell layers
• Many contain thyroid tissues (struma ovarii) • Symptomatic (50%)
• Torsion is common (15-20%)
• Risk of malignancy is low (1-2%).
• Serum tumor markers: CA 19-9 (common) and CA 125 are elevated.

Explanation :
Laboratory Findings of Iron Deficiency Anaemia:
1. Low Hemoglobin (Hb)

2. Low Mean Corpuscular Volume (MCV) – microcytic

3. Low Mean Corpuscular Hemoglobin (MCH) – hypochromic

4. Low Serum Ferritin – best early indicator

5. Low Serum Iron

6. High Total Iron Binding Capacity (TIBC)

7. Low Transferrin Saturation

8. Peripheral blood smear: microcytic, hypochromic RBCs with anisopoikilocytosis

Explanation :
The ureter is recognised by following features -
Pale glistening appearence
Longitudinal vessels on the surface
Peristalsis

Causes of physiological anaemia in pregnancy :

1. Plasma volume increases more than red cell mass ( Mainly)
→ Leads to haemodilution.


2. Increased iron demand
→ For fetal growth and placenta formation.


3. Increased folate requirement
→ Needed for red blood cell production.


4. Suppressed erythropoiesis in early pregnancy
→ Due to hormonal changes.

Explanation :
Anatomic distribution of anogenit HPV infectiob is :
Cervix 70%
Vulva 25%
Vagina 10%
Anus 20%

Explanation :
Malpresentation in placenta previa :
1. Lower uterine segment is poorly formed
→ Cannot guide the fetal head into the pelvis.
2. Placenta occupies space near internal os
→ Prevents the head from engaging.
3. Polyhydramnios or prematurity often coexist
→ Increases fetal mobility, favoring transverse or breech positions.

Explanation :
HPV variety causes CIN and cervical carcinoma :
HPV-16,18,31,33,45

Fetal anomaly screening timing:

 18–22 weeks of gestation
This is the recommended time for the mid-trimester anomaly scan. 

Detect structural abnormalities (e.g., neural tube defects, cardiac anomalies, limb deformities).

Assess fetal growth, amniotic fluid, placenta, and umbilical cord.

Explanation :
Patient Profile The age is between 30 and 45. The patients are mostly nulliparous or have had one or two children, long years prior to appearance of symptoms.

Explanation :
ALT is more elevated than AST >70 IU/L
But serum LDH is elevated mostly >600 IU/L

Explanation :
Asphexia is brodly classified -
1.Continuation of intrauterine hypoxia ( Placental insufficiency)( Most common)
2.Fetal factors - Preterm labour,RDS
3.Birth trauma
4.Postnatal asphyxia

Explanation :
Low MSAFP:

Down syndrome (Trisomy 21)

Trisomy 18

Gestational trophoblastic disease

Fetal demise

Overestimated gestational age

High MSAFP:

Neural tube defects (e.g., anencephaly, spina bifida)

Abdominal wall defects (e.g., omphalocele, gastroschisis)

Multiple gestation

Underestimated gestational age

Fetal bleeding or maternal–fetal hemorrhage

Explanation :
β-hCG is the most important for monitoring regression or detecting persistent gestational trophoblastic disease (GTD)
Follow up : Weekly upto negetivw HCG
Then monthly upto 6 months.

The third stage of labour is the period from delivery of the baby to the expulsion of the placenta and membranes.


Duration:

Normal duration:

Active management: within 5 minutes

Physiological (expectant) management: up to 15 minutes
But can upto 30-60 mins

Explsnnation :
Karyotype of turners syndrome : 45,XO
Mosaic variety : 46,XX/45,XO

Explanation :
Triad of ectopic pregnancy clinical feature-
1.Short period of amenorrhea (6-8 weeks)  followed by -
2.Abdominal pain(100%)
3.Vaginal bleeding(70%)

Explanation :
Chlamydia trachomatis:
The organisms affect the columnar and transitional epithelium of the genitourinary tract.
It is an obligatory intracellular organisms. The lesion is limited superficially.
As there is no deeper penetration, the pathological changes to produce symptoms may not be apparent.
The infection is mostly localized in the urethra, Bartholin's gland, and cervix. It can ascend upwards like gonococcal infection to produce acute PID.
Too often (20-40%), it is associated with gonococcal infection.
Causes mucopurulent vaginal discharge 

Methods included in LARC (Long-Acting Reversible Contraception): 

1. Copper Intrauterine Device (Cu-IUD)


2. Levonorgestrel-releasing Intrauterine System (LNG-IUS)


3. Subdermal Progestin Implant (e.g., Implanon, Nexplanon)


4. Depot Medroxyprogesterone Acetate (DMPA) 

Explanation :
Tocolytic Drugs :
1. Nifedipine
2. Salbutamol
3. Terbutaline
4. Magnesium sulfate
5. Indomethacin
6. Atosiban
7. Ritodrine

Causes of First Trimester Abortion (≤12 weeks): 

1. Chromosomal abnormalities

2. Maternal infections (e.g., TORCH)

3. Hormonal disorders (e.g.,LPD hypothyroidism, PCOS)

5. Antiphospholipid antibody syndrome

6. Maternal systemic diseases (e.g., diabetes, SLE,
Causes of Second Trimester Abortion (13–24 weeks):

1. Cervical insufficiency

2. Uterine anomalies (e.g., septate uterus)

3. Infections (e.g., TORCH)

4. Placental abruption

5. Maternal chronic illnesses

6. Trauma

Milk let-down reflex is stimulated by:

Oxytocin release from the posterior pituitary, which is stimulated by:

1. Suckling of the nipple (primary stimulus)

2. Crying or sight/sound of the baby (conditioned reflex)
Result: Contraction of myoepithelial cells → milk ejection from alveoli into ducts.

Explanation :
Internal pudendal artery is the parietal branch of the anterior division of internal iliac artery.

Explanation :
Normal Saline — preferred for initial rehydration to correct hypovolemia and prevent Wernicke’s encephalopathy (avoid dextrose first if thiamine is not given).
Added potassium (If not contraindicated)

Progestin-only pills (POP) are safe during lactation as they do not affect milk production, unlike combined pills which contain estrogen. They can be initiated immediately postpartum in breastfeeding women.

The WHO launched the EPI in 1974 to ensure that all children receive protection against six major vaccine-preventable diseases: Diphtheria, Pertussis, Tetanus, Polio, Measles, and Tuberculosis.

Goal 3 of SDG is: “Ensure healthy lives and promote well-being for all at all ages.” It focuses on reducing maternal and child mortality, ending epidemics like AIDS, TB, malaria, and improving healthcare access.

Cohort studies follow exposed and unexposed groups over time, allowing the direct calculation of incidence and hence Relative Risk (RR).

A pandemic is an epidemic that spreads across countries or continents, affecting a large number of people. COVID-19 is a classic example.

Crude Birth Rate (CBR) is defined as number of live births per 1000 mid-year population. Although it uses total population in the denominator, fertile age group is 15–49 years, which is biologically relevant.

Home pregnancy tests detect human chorionic gonadotropin (hCG) in urine, which is secreted by trophoblastic cells after implantation. It can be detected as early as 8–10 days after ovulation.