৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]

সিলেবাস

Exam - 17

Obstetrics and Gynaecology-01
 1. Core Contents of Obstetrics:
 Conception and development of fetoplacental unit
 (a) Fertilisation, implantation, fetoplacental unit, placental barrier
 (b) Placenta, amniotic fluid and umbilical cord: Development, structure and function
 Anatomical and physiological changes during pregnancy
 Diagnosis of pregnancy
 Counselling in reproductive health
  
 2. Antenatal Care
 (a) Counselling
 (b) Objectives, principles of antenatal care, identification of high-risk pregnancy
 (c) Nutrition during pregnancy and lactation
 (d) Vomiting in early pregnancy
  
 3. Diagnostic Aids in Obstetrics
 (a) Ultrasonography
 • Basics of ultrasound
 • Role in obstetrics
 (b) Fetal monitoring – CTG
 (c) Amniocentesis and other prenatal diagnostic techniques
  
 4. Social Obstetrics
 (a) Maternal & perinatal morbidities and mortalities
 (b) Direct causes of maternal & perinatal morbidity and mortality — contributing socio-economic & environmental factors
 (c) Importance of family planning in prevention of obstetric problems
 (d) Strategies for promotion of maternal health & prevention of illness emphasizing maternal nutrition, hygiene & medical care
 (e) National programs for MCH&FP, EOC, Combined service delivery
 5. Bleeding in Early Pregnancy (continued)
 (i) Hydatidiform mole:
 Types, clinical features, complications, differential diagnosis, management and follow-up
 (ii) Choriocarcinoma:
 Diagnosis and management, follow-up
  
  6. Normal Labour
 (a) Criteria of normal labour
 (b) Stages, mechanism of normal labour
 (c) Diagnosis of labour
 (d) Management of normal labour
 (e) Assessment of progress of labour
 (f) Monitoring maternal and fetal condition
 (g) Partograph
 (h) Pain relief

প্রশ্ন দেখুন অনুশীলন

৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived]

৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ মেডিকেল অংশ [Archived] · তারিখ অনির্ধারিত · ৪০ প্রশ্ন

১.

What is the timing of ovulation after LH surge -

ক
16-24 hours after LH surge
খ
24-36 hours after LH surge
গ
36-48 hours after LH surge
ঘ
48-72 hours after LH surge

ব্যাখ্যা

Explanation :
Explanation :
LH surge:
Sustained peak level of estrogen for 24-36 hours in the late follicular phase ➔ LH surge occurs from the anterior pituitary.
Ovulation approximately occurs 16-24 hours after the LH surge.
LH peak persists for about 24 hours.

The LH surge stimulates completion of reduction division of the oocyte and initiates luteinization of the granulosa cells, synthesis of progesterone and prostaglandins.
Ref : Dc Dutta obstetrics 10th edition page -19

২.

Timing of amniocentesis -

ক
After 10 weeks
খ
11-13 weeks
গ
After 15 weeks
ঘ
18-28 weeks

৩.

Feature of threatened abortion -

ক
Heavy vaginal bleeding
খ
Uterine size corresponds to gestational age
গ
Cervical os -open
ঘ
Blighted ovum present

৪.

Pregnancy test by detecting beta HCG in urine may positive at -

ক
As early as fertilization
খ
8-9 days post fertilization
গ
10 days after missed period
ঘ
2 weeks after missed period

ব্যাখ্যা

Explanation :
Level of hCG at different periods of pregnancy:
hCG is produced by the syncytiotrophoblast of the placenta and secreted into the blood of both mother and fetus.
The plasma half-life of hCG is about 36 hours. By radioimmunoassay, it can be detected in the maternal serum or urine as early as 8-9 days postfertilization.
In the early pregnancy, the doubling time of hCG concentrations in plasma is 1.4-2 days.

The blood and urine values reach maximum levels ranging from 100 to 200 IU/mL between 60 and 70 days of pregnancy.

৫.

What is the constant feature of acute ectopic pregnancy -

ক
Abdominal pain
খ
Vaginal bleeding
গ
Amenorrhea
ঘ
Syncope

ব্যাখ্যা

Explanation :
Abdominal pain (100%) is the most constant feature.
It is acute, agonizing or colicky. Otherwise it may be a vague soreness.
Pain is located at lower abdomen: unilateral, bilateral or may be generalized. Shoulder tip pain (25%) (referred pain due to diaphragmatic irritation from hemoperitoneum) may be present.

৬.

Labour pain is controlled by following way except -

ক
Psychoprophylaxis
খ
Pethidine
গ
NSAIDS
ঘ
Inhalation agent ( N2O+O2)

৭.

What is the most common cause of maternal death in Bangladesh -

ক
Haemorrhage
খ
Infection
গ
Hypertension during pregnancy
ঘ
Unsafe abortion

৮.

What is the timing of appearance of mechonium in fetal GI tract -

ক
12 weeks
খ
20 weeks
গ
32 weeks
ঘ
Term

ব্যাখ্যা

Explanation :
A term fetus shallows around 500 mL of amniotic fluid per day.
The meconium appears from 20th week and at term, it is distributed uniformly throughout the gut up to the rectum indicating the presence of intestinal peristalsis.
In intrauterine hypoxia (vagal stimulation), the anal sphincter is relaxed and the meconium may be voided into the liquor amnii.

Composition of the meconium:
It is chiefly composed of the waste products of the hepatic secretion.
It contains lanugo, hairs and epithelial cells from the fetal skin which are swallowed with the liquor amnii.
Mucus, exfoliated intestinal epithelium and intestinal juices are added to the content.
The greenish black color is due to the bile pigments, especially biliverdin.
Meconium is toxic to the respiratory system. It causes meconium aspiration syndrome.

৯.

Complete mole have -

ক
Absent embryo
খ
Focal degeneration of villi
গ
Karyotype 69,XXX
ঘ
Uterine size less than the date

১০.

What is the average duration of active second stage of labour in multiparae -

ক
30 minutes
খ
2 hours
গ
6 hours
ঘ
12 hours

ব্যাখ্যা

Explanation :
Second stage:
It starts from the full dilatation of the cervix (not from the rupture of the membranes) and ends with expulsion of the fetus from the birth canal.
It has got two phases:
(1) The propulsive or passive phase-starts from full dilatation up to the descent of the presenting part to the pelvic floor.
(2) The expulsive or active phase is distinguished by maternal bearing down efforts and ends with delivery of the baby.

Its average duration is 2 hours (WHO-3 hours) in primigravidae and 30 minutes (WHO-2 hours) in multiparae .

১১.

Which hormone is responsible for galactopoiesis -

ক
Oxytocin
খ
Estrogen
গ
Progesterone
ঘ
Prolactin

১২.

In partograph active phase of labour starts from-

ক
1cm of cervical dilatation
খ
4 cm of cervical dilatation
গ
5 cm of cervical dilatation
ঘ
10 cm of cervical dilatation

ব্যাখ্যা

Explanation :
In partograph active labour starts at 4 cm of cervical dilatation
In WHO labour care guide active phase starts at 5 cm of cervical dilatation.

১৩.

What is the baseline variability in normal reactive CTG -

ক
5-25 bpm
খ
0-5 bpm
গ
>25 bpm
ঘ
Sinusoidal pattern >10/min

ব্যাখ্যা

Explanation :
Fetal Cardiotocography (CTG): A normal tracing after 32 weeks, would show baseline heart rate of 110-160 beats per minute (bpm) with an amplitude of baseline variability 5-25 bpm.
There should be no deceleration or there may be early deceleration of very short duration.

Importantly, there should be two or more accelerations during a 20-minute period.

১৪.

What is the instanteneous changes in fetal circulation after birth -

ক
Closure of the umbilical vein
খ
Closure of the ductus arteriosus
গ
Closure of the umbilical artery
ঘ
Closure of the foramen ovale

ব্যাখ্যা

Explanation :
Closure of the umbilical arteries:
Functional closure is almost instantaneous preventing even slight amount of the fetal blood to drain out.
Actual obliteration takes about 2-3 months.

The distal parts form the medial umbilical ligaments and the proximal parts remain open as superior vesical arteries

১৫.

Characteristics of cephalhaematoma in newborn -

ক
Appears at birth
খ
Soft and compressible
গ
Limited to bone, does not cross the suture line
ঘ
Localized due to effusion of serum

১৬.

What is the absolute contraindications of combined oral contraception-

ক
Smoker <35 years
খ
Unexplained vaginal bleeding
গ
Venous thrombosis
ঘ
Hyperlipidemia

১৭.

Which test is highly sensetive and specific in prenatal genetic testing -

ক
Combined test
খ
Quadriple screening
গ
Soft tissue marker
ঘ
Cell free fetal DNA analysis

১৮.

What is the clinical significance of rapid gain in weight in later months of pregnancy -

ক
Rh incompatibility
খ
Fetal macrosomia
গ
Maternal chronic kidney disease
ঘ
Preeclampsia

ব্যাখ্যা

Explanation :
Importance of weight checking:
Single weight checking is of little value except to identify the overweight or underweight patient. Periodic and regular weight checking is of importance to detect abnormality.

♦ Rapid gain in weight of more than 0.5 kg (l lb) a week or more than 2 kg ( 4 lb) a month in later months of pregnancy may be the early manifestation of preeclampsia and need for careful supervision.

♦ Stationary or falling weight may suggest intrauterine growth retardation or intrauterine death of fetus.

১৯.

What is the sole component of comprehensive emergency obstetrics care -

ক
Manual removal of placenta
খ
Parenteral administration of antibiotics
গ
Blood transfusion
ঘ
Neonatal resuscitation

ব্যাখ্যা

Explanation :
Basic Emergency Obstetric Care (BEmOC)

These are the essential services that should be available at all primary-level health facilities:

1. Parenteral administration of antibiotics

2. Parenteral administration of oxytocic drugs (e.g., oxytocin)

3. Parenteral administration of anticonvulsants (e.g., magnesium sulfate)

4. Manual removal of placenta

5. Removal of retained products (e.g., manual vacuum aspiration)

6. Assisted vaginal delivery (e.g., vacuum or forceps)

7. Neonatal resuscitation

Comprehensive Emergency Obstetric Care (CEmOC)

Includes all BEmOC functions plus:

8. Surgical capability (e.g., Cesarean section)

9. Blood transfusion services

২০.

What is the true transport process across the placental membrane -

ক
Glucose - Active transport
খ
Amino acid - Active transport
গ
Sodium,potassium - Active transport
ঘ
Triglycerides - Active transport

ব্যাখ্যা

Explanation :
Amino acids are transferred by active transport ( energy requiring transport) through enzymatic mechanism (ATPase).
Amino acid concentration is higher in the fetal blood than in the maternal blood. Some proteins (IgG), cross by the process of endocytosis.
Fetal proteins are synthesized from the transferred amino acids and the level is lower than in mother.
Glucose - Facilitated diffusion
Tryglyceride - Directly
Sodium, potassium - Simple diffusion
Ref : Dc Dutta obstetrics 10th edition page -33

২১.

Which investigation is not mandatory in routine booking visit in 24 years healthy primigravida?

ক
Blood for ABO and Rh typing
খ
Cervical cytology
গ
Hb electrophoresis
ঘ
USG to confirm gestational age

২২.

Immunoglobulin present in colostrum -

ক
IgG
খ
IgA
গ
IgD
ঘ
IgE

ব্যাখ্যা

Explanation :
COMPOSITION OF THE COLOSTRUM:
It is deep yellow serous fluid, alkaline in reaction.
It has got a higher specific gravity; a high protein, vitamin A, sodium and chloride content but has got lower carbohydrate, fat and potassium than the breast milk.

Colostrum and milk contain immunologic components such as immunoglobulin A (IgA), complements, antibodies, macrophages, lymphocytes, antibacterial products, lactoferrin and other enzymes (lactoperoxidase).

২৩.

The principle component of placenta developed from -

ক
Chorion frondosum
খ
Amnioblast
গ
Decidua capsularis
ঘ
Decidua basalis

ব্যাখ্যা

Explanation :
The placenta is developed from two sources.

The principal component is fetal which develops from the chorion frondosum and the maternal component consists of decidua basalis.

২৪.

Which theory is most commonly related to vomiting in early pregnancy -

ক
Deficiency of vitamin B6
খ
Immunological changes
গ
Excess human chorionic gonadotrophin
ঘ
Decreased gastruc motality

ব্যাখ্যা

Explanation :
Hormonal:
Excess of chorionic gonadotropin or higher biological activity of hCG is associated.
This is proved by the frequency of vomiting at the peak level of hCG and also the increased association with hydatidiform mole or multiple pregnancy when the hCG titer is very much raised;

২৫.

Which infection is the most common risk factor of tubal ectopic pregnancy -

ক
Nesseria gonorrhoeae infection
খ
Chlamydia trachomatis infection
গ
Listeria monocytogens infection
ঘ
Herpes simplex infection

ব্যাখ্যা

Explanation :
Salpingitis and Pelvic Inflammatory Disease (PIO) increases the risk of ectopic pregnancy by six-fold to ten-fold.
(a) Loss of cilia of the lining epithelium and impairment of muscular peristalsis.
(b) Narrowing of the tubal lumen.
(c) Formation of pockets due to adhesions between mucosa! folds.
(d) Peri tubal adhesions resulting in kinking and angulation of the tube.
Chlamydia trachomatis infection is the most common risk factor.
Salpingitis isthmica nodosa also increases the risk.

২৬.

What is the most accurate measurement in pregnancy profile ultrasound in first trimester -

ক
BPD
খ
Gestational sac
গ
CRL
ঘ
HC

ব্যাখ্যা

Explanation :
Gestational age for dating in pregnancy: Ultrasound examination is the best method to estimate the gestational age dating
The error with LMP is due to late ovulation (>14 days after LMP).
CRL is most accurate with an error of 2.1 days in the first trimester.

২৭.

Which is not the warning sign in pregnancy -

ক
Vaginal bleeding
খ
Abdominal pain
গ
Leackage of fluid from vagina
ঘ
Increase in fetal movement

২৮.

What is the sonographic feature in molar pregnancy -

ক
Ring of fire pattern
খ
Snowstrom appearance
গ
Salt in peper appearance
ঘ
Powder burn or match stick appearance

ব্যাখ্যা

Explanation :
Sonography:
Complete mole appears as an echogenic mass with many anechoic cystitic spaces. There is neither the fetus nor the amniotic sac.
Fetus is present in partial mole. Characteristic feature of molar pregnancy is 'snowstorm' appearance.
Sometimes confusion arises with the missed abortion, partial mole or the degenerated fibroid.

২৯.

Physical feature of amniotic fluid -

ক
Hypertonic to maternal plasma
খ
Faintly alkaline
গ
Greenish yellow colour
ঘ
High specific gravity

ব্যাখ্যা

Explanation :
PHYSICAL FEATURES of amniotic fluid -
The fluid is faintly alkaline with low specific gravity of 1.010.
It becomes highly hypotonic to maternal serum at term pregnancy.
An osmolarity of 250 mOsmol/L is suggestive of fetal maturity.
The amniotic fluid's osmolality falls with advancing gestation.
Color: In early pregnancy it is colorless, but near term it becomes pale straw colored due to the presence of exfoliated lanugo and epidermal cells from the fetal skin.
It may look turbid due to the presence of vernix caseosa.

৩০.

Which clotting factor become unchanged or mildly increased in pregnancy -

ক
Fibrinogen
খ
Prothombin
গ
Stuart power factor
ঘ
Anti haemophilic factor A

ব্যাখ্যা

Explanation :
There is increase in plasma levels and activities of clotting factors like VII, VIII, IX, X and I.
The levels of II, V and XII are either unchanged or mildly increased.
The level of factors XI and XIII are slightly decreased.
The clotting time does not show any significant change.
These are all effective to control blood loss and hemostasis after the separation of placenta.
Levels of coagulation factors normalize 2 weeks postpartum

৩১.

First fetal heart beats appear at which days after conception-

ক
Day 12
খ
Day 21
গ
Day 30
ঘ
Day 46

৩২.

Linea nigra is -

ক
Midline brownish black pigments from xiphisternum to symphyses pubis
খ
Linear marks below the umbilicus
গ
Pale glistening white scar area in abdomen
ঘ
Scar mark with oedema

ব্যাখ্যা

Explanation :
Linea nigra: It is a brownish black pigmented area in the midline stretching from the xiphisternum to the symphysis pubis .
The pigmentary changes are probably due to melanocyte stimulating hormone from the anterior pituitary.
However, estrogen and progesterone may be related to it as similar changes are observed in women taking oral contraceptives.
The pigmentation disappears after delivery.

৩৩.

Which contraceptive is contraindicated in 6 months follow up period of molar pregnancy -

ক
DMPA
খ
Progestin implant
গ
Combined oral contraceptive
ঘ
IUCD

ব্যাখ্যা

Explanation :
Use of contraception:
IUD is contraindicated, because
of its frequent association of irregular vaginal bleeding.
This often confuses with choriocarcinoma. Risk of uterine perforation is also high.

Combined oral pills can be used after the hCG value has become normal.
Injection DMPA or progestin implant can be used safely
Barrier method of contraception can also be used.
Surgical sterilization is another alternative when she has completed her family.

৩৪.

What is the developmental source of umbilical cord -

ক
Amnion
খ
Decidua
গ
Body stalk
ঘ
Trophoblastic cells

ব্যাখ্যা

Explanation :
The umbilical cord is developed from the connective stalk or body stalk, which is a band of mesoblastic tissue stretching between the embryonic disk and the chorion

৩৫.

What is the third line antiemetic in Nausea and vomiting in pregnancy -

ক
Proclorperazine
খ
Metoclorpramide
গ
Ondensetron
ঘ
Hydrocortisone

৩৬.

What is the normal change in ECG during pregnancy -

ক
Right axis deviation
খ
Q wave in all lead
গ
Inverted T in lead III and V1-V3
ঘ
M pattern in lead II,III,aVF

ব্যাখ্যা

Explanation :
ECG in pregnancy -
ECG reveals normal pattern except evidences of left axis deviation.
Benign pericardial effusion may be present.

ECG changes are: Q waves in lead II, III and avF and flat on inverted T-waves in lead III and Vl-V3.

৩৭.

True changes in pregnancy -

ক
GFR is decreased
খ
Risk of peptic ulcer is reduced
গ
Ureters become more tonic
ঘ
Raised serum calcium concentration

ব্যাখ্যা

Explanation :
(a) GFR is increased
(c) Ureter become atonic
(d) Increased demand of calcium

৩৮.

What is the most common cause of miscarriage in first trimester -

ক
Genetic factors
খ
Endocrine disorders
গ
Infection
ঘ
Mullerian fusion defect

ব্যাখ্যা

Explanation :
COMMON CAUSES OF MISCARRIAGE First trimester:
(1) Genetic factors (50%), (2) Endocrine disorders (LPD, thyroid abnormalities, diabetes), (3) Immunological disorders (autoimmune and alloimmune), ( 4) Infection, and (5) Unexplained.
Second trimester:
(1) Anatomic abnormalities-(a) Cervical incompetence ( congenital or acquired), (b) Miillerian fusion defects (bicornuate uterus, septate uterus), (c) Uterine synechiae, and (d) Uterine fibroid. (2) Maternal medical illness. (3) Unexplained.

৩৯.

Which factor initiate labour -

ক
Matarnal uterine neuroreceptor
খ
Fetal hypothamopituitary axis
গ
Maternal hypothalamopituitary axis
ঘ
Maternal adrenal gonadal system

ব্যাখ্যা

Explanation :
Fetal hypothalamopituitary axis is considered to initiator of labour.

৪০.

Primary site of nidation -

ক
Ovary
খ
Ampulla of fallopian tube
গ
Anterior wall of the body of uterus
ঘ
Posterior wall of body near cervix

ব্যাখ্যা

Explanation :
IMPLANTATION (Syn: Nidation)
Implantation occurs in the endometrium of the anterior or posterior wall of the body near the fundus on the 6th day which corresponds to the 20th day of a regular menstrual cycle.

Implantation occurs through four stages, e.g., apposition, adhesion, penetration and invasion.