previous year question on abortion based on neet pg, usmle, plab and fmge or mci screening exams

All of the following are indications of Mifepristone, EXCEPT:

A: AbortionB: Cushing syndromeC: PPHD: Cervical ripeningCorrect Ans:CExplanation

Mifepristone is a progesterone antagonist that causes decidual necrosis in a pregnant uterus, softens the cervix and increases prostaglandin sensitivity. When combined with a prostaglandin analogue it is effective for medical termination. It is highly successful when given within 50days of gestation.

Other indications of Mifepristone are:

Cervical ripening

Emergency contraception

Cushing's syndrome

Sample Previous Year Question on Abortion based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

Which of the following conditions is the most frequent cause of spontaneous abortion in the first trimester of pregnancy?

A: Abruptio placentaeB: ChorioamnionitisC: Chromosomal abnormalitiesD: Placenta previa

Correct Ans:CExplanationAt least 10% to 15% of normally fertilized and implanted ova are lost in the first trimester of pregnancy because of spontaneous abortion. Studies using immunoassay of human chorionic gonadotropin (hCG) for early diagnosis of pregnancy suggest that the percentage of fertilized ova lost in the first trimester might be even higher. The great majority of these cases are attributable to chromosomal abnormalities. Chromosomal studies are not routinely performed in such cases, but they are recommended when a malformed fetus has been identified or when habitual or recurrent abortions occur.

Abruptio placentae, a complication of the third trimester, occurs when the placenta detaches prematurely from its implantation site. Retroplacental hemorrhage develops within the space between placenta and uterine wall, leading to interruption or severe reduction in the blood supply to the fetus.

Chorioamnionitis, a complication of the second and third trimesters, results from ascending infections through the vaginal canal. Infection of chorioamniotic membranes may lead to premature rupture of membranes and abortion or

premature labor. Placenta previa is a placenta implanted in the lower segment of the uterus. When dilatation of this segment begins in late pregnancy, a placenta previa may cause severe bleeding and lead to premature labor.

Ref: Kipps T.J. (2010). Chapter 94. Chronic Lymphocytic Leukemia and Related Diseases. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.


Which of the following best describes the mechanism of induction of labor with use of abortion stick?

A: Stimulation of uterine contractionB: Oxytocin present in the stick

C: Uterme necrosisD: Menstrual bleedingCorrect Ans:AExplanation

Abortion stick is a method of criminal abortion usually performed by professional abortionists (dhais). It is introduced into the vagina or os of uterus and retained there till uterine contractions begin.

Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Chapter 14, Pages 373-76; Parikh's Textbook of Medical Jurisprudence and Toxicology, 6th Edition, Page 5.62


In all of the following conditions exhumation is usually done, EXCEPT:

A: SuicideB: HomicideC: Death as a result of criminal abortionD: Death due to criminal negligence

Correct Ans:A

ExplanationExhumation is the digging out of an already buried body from the grave. Autopsies are performed on exhumed bodies:

In criminal cases, such as homicide, suspected homicide disguised as suicide or other types of death, suspicious poisoning, death as a result of criminal abortion and criminal negligence.

In civil cases, such as accidental death claim, insurance, workmen’s compensation claim, liability for professional negligence, survivorship and inheritance claims or disputed identity.

Ref: The Essentials of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 118.


Drugs acting directly on the uterus are using for criminal abortion. All of the following are drugs which increases uterine contraction, EXCEPT:

A: ArsenicB: Nux vomicaC: ErgotamineD: Quinine

Correct Ans:AExplanation

Drugs which increase uterine contraction:

Ergot Hydrastis canadensis Quinine Lead Pituitary extract Decoctions of cotton root bark, nitrobenzol, picrotoxin, and

strychnine (Nux vomica)

Ref: The Essentials of Forensic Medicine and Toxicology by Dr. K. S. Narayan Reddy, 27th edition, Page 374.


In prenatal diagnostic technique Act 1994 which one of the following is not a ground for carrying out prenatal test?

A: Pregnant women above 35 years of ageB: History of exposure to potentially teratogenic drugsC: History of two or more spontaneous abortion or fetal loss

D:When fetal heart rate is 160 per min at fifth and 120 per min at ninth month

Correct Ans:DExplanationPrenatal diagnostic test is not conducted when fetal heart rate is 160 per minute at fifth and 120 per minute at ninth month. Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Page 347


All the following statements about Listeria are true, EXCEPT:

A: It is a gram negative bacteriaB: It causes abortion in pregnancyC: It causes meningitis in neonatesD: It is transmitted by contaminated milkCorrect Ans:AExplanation

Listeria monocytogenes is a short coccoid, gram positive, catalase positive non spore forming rod with a tendency to occur in chains. They show tumbling motility at 20 - 25 degree centigrade and is non motile at 37 degree.

The major virulence factors are invasion associated surface proteins called internalin and a pore-forming cytotoxin, listeriolysin O (LLO).

Ref: Sherris Medical Microbiology By Kenneth J. Ryan, 5th Edition, Chapter 26 ; Textbook of Microbiology By Ananthanarayan and Panicker, 8th Edition, Page 395


The most common cause of maternal mortality in India is:

A: Obstetric hemorrhageB: Anemia

C: AbortionD: Obstructed labourCorrect Ans:AExplanation

The most common cause leading to maternal mortality is obstetric hemorrhage, both ante partum and post partum. The other causes include eclampsia, pre-eclampsia, infection, obstructed labor and complications of abortion. All these causes seems to be common all through out the world but the maternal mortality rate varies according to the socioeconomic status of the country. (State of Maternal Health in India)

According to the 2001-2003 SRS survey, hemorrhage is the leading cause of maternal mortality. Ref: Park’s Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Pages 23, 444-8; Ministry of Health and Family Welfare: Annual Report 2006-2007


Which of the following regarding Maternal Mortality Rate (MMR) is not TRUE?

A: Numerator includes total number of female deaths within 42 days of deliveryB: Denominator includes still births and abortionsC: It is expressed as a rate and not ratioD: It is expressed per 1000

Correct Ans:BExplanationThe denominator in Maternal Mortality Rate includes the total number of live births in a particular area during a particular year and not the number of stillbirths and abortions. The denominator is inclusive of the total number of still births while calculating the Stillbirth Rate and Perinatal Mortality Rate. The numerator of the rate includes the total number of female deaths due to complications of pregnancy, childbirth or within 42 days of delivery from puerperal causes in a particular area during a given year. Maternal Mortality Rate is expressed as a rate and not as a ratio.It is expressed as a rate per 1000 live births. Ref: Park’s Textbook of Preventive and Social Medicine, 19th Edition.


Perinatal Mortality rate includes:

A: Still borns and death within 7 days of birthB: Neonatal deaths within 30 days of birthC: Abortions and Death within 7 days of birthD: Deaths between 7 and 28 days of birth


Perinatal mortality rate has great significance in assessment of both obstetric and pediatric care before and around the time of birth. It includes both stillbirths and early neonatal deaths (neonatal deaths under one week of age). Perinatal mortality accounts for 90% of all fetal and infant mortality in the developed countries. With improved obstetric and perinatal technologies, the perinatal mortality has gradually declined in the developed countries.

PERINATAL MORTALITY RATE (In nations with less established vital records of stillbirths) =

LATE FETAL DEATHS (28 WEEKS GESTATION AND MORE) + EARLY NEONATAL DEATHS (FIRST WEEK) IN ONE YEAR _____________________________________________________ X 1000 LIVE BIRTHS IN THE SAME YEAR

or

PERINATAL MORTALITY RATE (FOR INTERNATIONAL COMPARISONS RECOMMENDED BY WHO)

= LATE FETAL AND EARLY NEONATAL DEATHS WEIGHING OVER 1000 GMS AT BIRTH X 1000

TOTAL LIVE BIRTHS WEIGHING OVER 1000 GMS AT BIRTH

Ref: Park’s Textbook of Preventive and Social Medicine, 19th Edition, Pages 449-451


Janani Suraksha Yojana, under the National Rural Health Mission (NRHM) includes which of the objectives?

A: Tetanus immunizationB: Institutional deliveriesC: Iron supplementationD: Abortions

Correct Ans:BExplanation

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The success of the scheme would be determined by the increase in institutional delivery among the poor families.


Which of the following is true about women's health in india?

A: Unsafe abortion is the most common cause of MMRB: MMR in Karnataka > Andhra Pradesh

C: MMR<100/lakh live birthsD: ANC is better than Thailand and IndonesiaCorrect Ans:BExplanation

MMR AP-195 & Karnataka - 228

Ref: Park, 20th Edition, Page 479-81


21-year-old woman presents to the emergency department complaining of pelvic pain, a yellow-green vaginal discharge, and fever, all of which have been worsening over the last 24 hours. She has no frequency or dysuria. She has no medical problems. Her past surgical history is significant for a cesarean delivery 2 years ago performed for a

nonreassuring fetal heart rate tracing. She takes no medications and is allergic to sulfa drugs. She is sexually active with multiple male partners who sometimes use condoms. She works as a medical assistant. Her temperature is 38.2 Deg C (100.7 F), blood pressure is 100/60 mm Hg, pulse is 110/minute, and respirations are 12/minute. Her abdominal examination is significant for diffuse tenderness, rebound, and guarding. Speculum examination demonstrates a copious greenish vaginal discharge that appears to be coming from the cervix. Pelvic examination is significant for cervical motion tenderness and adnexal tenderness. Laboratory evaluation shows:

Urine hCG: negativeUrinalysis: negativeLeukocytes: 15,000/mm3Hematocrit: 39%Platelets: 200,000/mm3

Which of the following is the most likely diagnosis?

A: Ectopic pregnancyB: Gonococcal cervicitisC: Pelvic inflammatory disease (PID)D: Spontaneous abortion

Correct Ans:CExplanation

Pelvic inflammatory disease (PID) is a significant cause of morbidity among sexually active menstruating women. PID refers to an upper genital tract infection, especially of the endosalpingeal cells that line the fallopian tubes. When the infection involves the fallopian tubes only, it is referred to as a salpingitis. When it involves the ovaries as well, it is then referred to as a salpingo-oophoritis. The endometrium is also often involved (endometritis).

The peak incidence of the disease is in the 15- to 24-year-old-group. This patient presents with the typical symptoms of PID, particularly abdominal/pelvic pain. Fever and vaginal discharge are often present in gonococcal PID, but may be absent in other forms of PID. The diagnosis of PID is made when the patient has abdominal tenderness, cervical motion tenderness, and adnexal tenderness plus a temperature > 38 C (100.4 F), or leukocytosis (>10,000/mm3), or laboratory documentation of chlamydial or gonorrheal infection. Treatment is with antibiotics.

Ectopic pregnancy is ruled out with the negative urine pregnancy test. An ectopic pregnancy is a pregnancy that is implanted abnormally, most often in the fallopian tubes. As a pregnancy, it secretes human chorionic gonadotropin (hCG), which can be found in the blood or urine. When this is not present, ectopic pregnancy is ruled out.

Gonococcal cervicitis presents with findings localized to the cervix. This patient has findings that go beyond a cervicitis. Given her abdominal tenderness with rebound, cervical motion tenderness, and adnexal tenderness, she is manifesting involvement of the fallopian tubes and peritoneum. While the gonococcus may be the offending organism in this case, this patient has more than a gonococcal cervicitis.

A patient with a spontaneous abortion can present in a variety of ways, but most commonly she will present with complaints of vaginal bleeding or the passage of tissue from the vagina. A spontaneous abortion represents a failed pregnancy and this patient has no evidence of a failed pregnancy, and an abundance of evidence for PID.


The risk of Asherman syndrome is the highest if Dilatation and Curettage (D & C) is done for the following condition:

A: Medical termination of pregnancyB: Missed abortion

C: Dysfunctional uterine bleedingD: Postpartum haemorrhage

Correct Ans:DExplanationIntrauterine adhesions also known as uterine synechiae and when symptomatic, as Asherman syndrome, are the spectrum of endometrial scarring includes filmy adhesions, dense bands, or complete obliteration of the uterine cavity. Endometrial damage may follow vigorous curettage, usually in association with postpartum hemorrhage, miscarriage, or elective abortion complicated by infection. Damage may also result from other uterine surgery, including metroplasty, myomectomy, or cesarean delivery, or from infection related to an intrauterine device. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 16. Amenorrhea. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH levels were measured as 6 mlU/ml what is the most probable diagnosis:

A: Pituitary failureB: Ovarian failure

C: Fresh pregnancyD: Uterine synechiaeCorrect Ans:DExplanation

Since the lady in the question is having secondary amenorrhea following an abortion, uterine synechiae is the most likely cause. Low normal FSH level is consistent with uterine abnormality. (Normal serum FSH value in adult is woman is 5-20 mlU).

Ref: Novak's, 14th Edition, Chapter 27; Speroff, 7th Edition, Chapter 11; Shaw's, 14th Edition, Pages 263, 264; The Subfertility Handbook : A Clinician's Guide By Gab Kovacs, 2nd Edition, Page 117


Mifepristone is an antiprogestin agent. All of the following are indications of using mifepristone, EXCEPT:

A: AbortionB: Cushing's syndromeC: PPHD: Cervical ripeningCorrect Ans:CExplanation

Therapeutic uses of Mifepristone:

Termination of early pregnancy

Cervical ripening

Postcoital contraceptive

Once a month contraceptive

Induction of labour

Cushing’s syndrome (because of its anti-glucocorticoid activity)

Ref: Essentials of Medical Pharmacology by KD Tripathi, 5th edition, Page 283-284.


A 25 year old woman had premature rupture of membranes and delivered a male child who became lethargic and apnoeic on the 1st day of birth and went into shock. The mother had a previous history of abortion 1 year back. On vaginal swab culture growth of Parahaemolytic colonies on blood agar was found. On staining these were found to be gram positive cocci. Which of the following is the most likely etiological agent?

A: Strptococcus pyogenesB: Strptococcus agalactiaeC: PeptostreptococciD: Enterococcus faecumCorrect Ans:BExplanation

This neonate is presenting with features of systemic infection (lethary apnea & shock) within the first 24 hours of life. Presence of hemolytic colonies on blood agar (p hemolysis) and gram positive cocci in smears is almost diagnostic of Group B hemolytic streptococci infection (streptococcus agalactiae).

Ref: Text Book of Pediatrics By Nelson, 17th Edition, Pages 627, 880


A 25 year old woman had premature rupture of membranes and delivered a male child who became lethargic and apnoeic on the 1st day of birth and went into shock. The mother had a previous history of abortion 1 year back. On vaginal swab culture growth of Parahaemolytic colonies on blood agar was found. On staining these were found to be gram positive cocci. Which of the following is the most likely etiological agent?

A: Strptococcus pyogenesB: Strptococcus agalactiaeC: PeptostreptococciD: Enterococcus faecumCorrect Ans:BExplanation

This neonate is presenting with features of systemic infection (lethary apnea & shock) within the first 24 hours of life. Presence of hemolytic colonies on blood agar (p hemolysis) and gram positive cocci in smears is almost diagnostic of Group B hemolytic streptococci infection (streptococcus agalactiae).

Ref: Text Book of Pediatrics By Nelson, 17th Edition, Pages 627, 880


A 31-year-old woman presents to the emergency department because of two days of abdominal pain without vaginal bleeding. Pelvic examination reveals a closed cervical os and right adnexal pain. The serum beta hCG level is 9,000 mIU/mL. An endovaginal ultrasound demonstrates no intrauterine gestational sac. Which of the following is the most likely diagnosis?

A: Ectopic pregnancyB: Incomplete abortionC: Ovarian torsionD: Ruptured ovarian cystCorrect Ans:AExplanationThe primary use of pelvic ultrasonography in women with lower abdominal pain, vaginal bleeding, and a positive pregnancy test is to establish the diagnosis of intrauterine pregnancy (IUP). Transvaginal ultrasound should visualize an IUP when the serum beta hCG level is more than 1,200 mIU/mL. If an IUP is not present, then the pregnancy lies outside of the uterine cavity, the patient has just had a miscarriage, or the pregnancy is less developed than menstrual dates indicate. The absence of vaginal bleeding and the closed cervical os suggest that an incomplete abortion is unlikely, but place this patient at high risk for ectopic pregnancy.

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 10. Ectopic Pregnancy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


At what gestational age is RU-486, an anti-progesterone drug used in the induction of abortion?

A: 50 daysB: 72 days

C: 88 daysD: 120 daysCorrect Ans:AExplanation

Mifepristone RU-486 is an analogue of progestin (norethindrone) which act as an antagonist, blocking the effect of natural progesterone. This when used along with prostaglandin E1 is used in first trimester abortion. It is highly successful when used within 50 days of gestation.

Ref: Textbook of Obstetrics By D.C.Dutta, 6th Edition, Page 175 ; Clinical Gynaecology By T. F. Kruger, 3rd Edition, Page 358


All of the following statements are true, EXCEPT:

A: Oxytocin sensitivity is increased during deliveryB: Prosglandins may be given for inducing labour during III trimesterC: In lactating women genital stimulation enhances oxytocin releaseD: Oxytocin is used for inducing abortion in 1st trimester

Correct Ans:DExplanation

Oxytocin is not used for induction of 1st trimester abortions. They may be used for this purpose in the second trimester, commonly between 16-20 weeks.

Ref: NMS Physiology By John Bullock, Joseph Boyle, Michael B. Wang, 2001, Page 578 ; Review of Medical Physiology By Ganong 19th Edition, Page 235 and 20th Edition, Page 38 ; Textbook of Obstetrics By D.C.Dutta, 5th Edition, Pages 120, 187


Which of the following is the most common cause of first trimester abortion?

A: SyphilisB: Chromosomal abnormalitiesC: Rhesus isoimmunizationD: Cervical incompetence

Correct Ans:BExplanationMajority (50%) of early miscarriges are due to chromosomal abnormalities in the conceptus. Autosomal trisomy is the commonest cytogenetic abnormality. The most common trisomy is trisomy 16. Polyploidy is seen in 22% of abortuses and monosomy constitutes 20% of abortuses.

Ref: Textbook of Obstetrics By D.C.Dutta, 6th Edition, Page 160


All of the following are known causes of recurrent abortion, except:

A: TORCH infectionsB: SLEC: Rh incompatibilityD: Syphilis


SLE is associated with antiphospholipid syndrome (anti cardiolipin antibodies) and is known to cause recurrent abortions.

RH incompatibility is a known cause for spontaneous abortion and may lead to recurrent abortions if it remains unrecognized.Syphilis has also lead to recurrent abortion.TORCH is thus the single best answer of exclusion.

Ref: Gynaecology for Postgraduates and Practitioners By Sengupta, Pages 187-92; Textbook of High Risk Pregnancy By Hemant Deshpande, Hemant, Pages 248-49


A lady presented with features of threatened abortion at 32 weeks of pregnancy. Which of the following statements with regard to antibiotic usage is not correct?

A: Antibiotic Prophylaxis even with unruptured membranesB: Metronidazole if asymptomatic but significant bacterial vaginosisC: Antibiotics if asymptomatic but significant bacteremiaD: Antibiotics for Preterm Premature Rupture of MembranesCorrect Ans:AExplanation The lady in the question at 32weeks of gestation with features of threatened abortion such as closed cervical os, intact membranes and without expulsion of products of conception is in preterm labor. Since, threatened abortion is said to occur before 22weeks of gestation.

There is no benefit from the use of antibiotics for prevention of preterm labour in a women with intact membrane.

Antibiotics along with other measures are used to prevent and treat preterm labour, especially in the setting of chorioamnionitis which occur in case of ruptured membrane.

Ref: Danforth's Obstetrics and Gynecology, 10th Edition, Pages 169, 170, 171, 172; Blueprints Obstetrics and Gynecology, 5th Edition, Page 108; William's Obstetrics, 23rd Edition, Page 163; COGDT, 10th Edition, Pages 281, 278


Mifepristone may be used for all of the following, EXCEPT:

A: Threatened AbortionB: Ectopic pregnancy

C: FibroidsD: Molar PregnancyCorrect Ans:AExplanation

Mifepristone is a antiprogestin which binds to the progesterone receptors and thus prevents the action of progesterone. The administration of mifepristone is usually followed by a synthetic prostaglandin analogue thus effectively brings about abortion. Threatened abortion is a condition diagnosed clinically by the bleeding occurring in the early pregnancy and by the presence of a definite heart sound and a hematoma (sub-chorionic/marginal sinus/retroplacental) ultrasonographically. Every attempt must be taken to preserve the pregnancy in threatened abortion by applying expectant management. Use of a abortificient is not included in the management of threatened abortion.

Ref: Clinical applications of mifepristone (RU 486) By Leslie Z. Benet, Molla S. Donaldson, Pages 3-19 ; Bleeding During Pregnancy: A Comprehensive Guide By Eyal Sheiner, Page 33.


A 23 year old female presents to the clinic with history of recurrent abortions. While investigating this patient for recurrent abortions all of the following tests are to be done EXCEPT:

A: Parental cytogeneticsB: Thyroid profileC: Antiphospholipid antibodiesD: TORCH infection screening


Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks.

Investigations:

1) Blood glucose (fasting and post prandial), VDRL, thyroid function test, ABO and Rh grouping (husband and wife), toxoplasma antibodies IgG&IgM

2) Autoimmune screening - lupus anticoagulant and anticardiolipin antibodies

3) Serum LH on D2/D3 of the cycle

4) Ultrasonography - to detect congenital malformations of uterus, polycystic ovaries and uterine fibroid

5) Hysterosalpingography in the secretory phase

6) Laryngoscopy

7) Karyotyping (husband and wife)

8) Endocervical swab to detect chlamydia, mycoplasma, and bacterial vaginosis


Which is the most common uterine malformation seen in cases of recurrent abortions?

A: Mullerian fusion defectsB: Uterine syncytiumC: Unicornuate uterusD: Uterine agenesis


Mullerian duct anomaly is an important cause of recurrent miscarriage in early and midtrimester. Septate or arcuate uterus is the most common uterine anomaly associated with mullerian fusion defects and it is the most common defect associated with repeated pregnancy loss.


A 22-year-old woman is diagnosed with a septic abortion after an incomplete abortion, fever, and uterine tenderness. She is treated with triple IV antibiotics and D and C of the uterus. After 48 hours of antibiotic therapy, she still has a fever of 102°F (38.88°C), BP of 80/40 mm Hg, and HR of 105 bpm. A CT scan of the abdomen and pelvis is performed revealing pockets of air within the muscle of the uterus.

Assertion: CT scan and clinical findings are consistent with necrotizing metritis caused by Clostridium species.

Reason: This condition is caused by use of inadequately sterilized instruments or incomplete abortion.

A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

B:Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

C: Assertion is true, but Reason is falseD: Assertion is false, but Reason is trueCorrect Ans:AExplanation

This patient has a septic abortion which has been treated conventionally with IV antibiotics and D and C to remove the nidus of the infection. She is still febrile and hypotensive despite antibiotic therapy for 48 hours. CT scan findings showing pockets of air within muscles of uterus indicate that she is suffering from necrotizing endometritis caused by Clostridium species. It is caused because of incomplete abortion.

Ref: Microbiology Recall By Alfa Omar Diallo chapter 55.


A 34-year-old woman undergoes an elective termination of pregnancy at 12 weeks of gestation. Following termination she develops fever, purulent vaginal discharge and lower abdominal pain.

Assertion: This condition in women most commonly occur following illegally induced abortion.

Reason: Sepsis following illegal abortion is due to incomplete evacuation after illegal abortion.

A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

B:Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

C: Assertion is true, but Reason is falseD: Assertion is false, but Reason is trueCorrect Ans:AExplanation

This patient who developed fever, purulent vaginal discharge and lower abdominal pain following termination of pregnancy is most likely suffering from septic abortion. Septic abortion usually occur following illegaly induced abortion. There is increased incidence of sepsis following illegal abortion due to absence of proper septic techniques, incomplete evacuation and due to inadvertent injury to genital organs.

Ref: Textbook of Obstetrics by D C Dutta, 6th edn, page 165.


A female came for prepregnancy evaluation for her recurrent abortions. All of the following are causes of recurrent abortions, EXCEPT:

A: Cytogenetic studiesB: TORCH

C: HypothyroidismD: Antiphospholipid syndromeCorrect Ans:BExplanation

Main causes of recurrent abortion:

Parental chromosomal abnormalities

Antiphospholipid antibody syndrome

Uterine abnormalities

Others,

Alloimmunity

Endocrinopathies

Environmental toxins

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 6. First-Trimester Abortion. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


Which among the following is the MOST common congenital uterine malformation that causes recurrent abortions?

A: Mullerian fusion defectsB: Uterine syncytiumC: Cervical incompetenceD: Uterine agenesis


Anatomical abnormalities are responsible for 10-15% of recurrent abortion.

Congenital and acquired anomalies.

Congenital anomalies are due to defects in the Mullerian duct fusion or resorption (e.g. unicornuate, bicornuate, septate or double uterus). This causes about 12% cases of recurrent abortions.

Acquired anomalies are,

Intrauterine adhesions

Uterine fibroids

Endometrosis

Cervical incompetence

Ref: Textbook of Obstetrics by D C Dutta, 6th edition, Page 169.


USG examination of an 8 weeks pregnant female shows a gestational sac with absent fetal parts. The diagnosis is:

A: Ectopic pregnancyB: Missed abortionC: Threatened abortionD: Blighted ovum


Anembryonic pregnancy (previously called blighted ovum) is an ultrasound diagnosis. It is a pregnancy in which the embryo fails to develop or is resorbed after loss of viability. On ultrasound, an empty gestational sac, smaller mean gestational sac diameter, absent fetal echoes and absent fecal cardiac movements is seen. Clinical presentation is similar to that of a missed or threatened abortion: Mild pain or bleeding may be present; however, the cervix is closed, and the nonviable pregnancy is retained in the uterus.

Ref: Textbook of Obstetrics D C Dutta, 6th edition, Page 162.


Kalindi 25 years female admitted as a case of septic abortion with tricuspid valve endocarditis. Vegetation from the valve likely to affect is:

A: LiverB: SpleenC: BrainD: Lung


Bacteria that colonize dead conception products initiate maternal infection within the uterus, and infection may extend to cause parametritis, peritonitis, septicemia, and endocarditis. Septic pelvic thrombophlebitis with or without septic pulmonary embolization is an uncommon but devastating complication of septic abortion. Right sided endocarditis often leads to septic pulmonary emboli causing infarction and lung abscess.

Ref: Tucker R., Platt M. (2011). Chapter 38. Obstetric and Gynecological Emergencies and Rape. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.


For evaluating a case of recurrent spontaneous abortion, which of the following investigation is unwanted?

A: HysteroscopyB: Testing for Antiphospholipid antibodiesC: Testing for TORCH infectionsD: Thyroid function tests.

Correct Ans:CExplanationTORCH infections is not a cause of recurrent spontaneous abortion. Recurrent spontaneous abortion is defined as 3 or more consecutive pregnancy losses at 20 weeks or less or with fetal weights less than 500 grams.

Causes and investigations includes :

Chromosomal abnormalities: karyotypic evaluation of both parents

Genital tract anatomical abnormalities : three-dimensional sonography, hysteroscopy

Autoimmune Factors like SLE: antiphospholipid antibodies

Alloimmune Factors

Inherited Thrombophilias

Endocrinological factors like progesterone deficiency, PCOS, diabetes mellitus, hypothyroidism

Ref: Williams Obstetrics, 23e chapter 9.


Misoprostol has been found to be effective in all of the following except:

A: Missed abortionB: Induction of labourC: MenorrhagiaD: Prevention of post-partum hemorrhage (PPH)Correct Ans:CExplanation

Treatment of Menorrhagia involves administration of prostaglandin inhibitors. Misoprostol (PGE1) is a prostaglandin and is therefore certainly not indicated for treatment of metrorrhagia.

Ref: Textbook of Gynecology By D C Dutta, 6th Edition, Page 505


A young woman with six weeks amenorrhea presents with mass abdomen. USG shows empty uterus. Diagnosis is:

A: Ovarian cystB: Ectopic pregnancyC: Complete abortionD: None of the above


Young woman with six weeks of amenorrhea and mass in the abdomen and USG finding of empty uterus give the diagnosis of ectopic pregnancy.

Ref: Textbook of Obstetrics By D.C.Dutta, 5th Edition, Page 198 ; Ultrasound in Obstetrics and Gynecology, Volume 1 By Eberhard Merz, F. Bahlmann, 2004, Page 73 ; Management of Common Problems in Obstetrics and Gynecology Edited By T. Murphy Goodwin, Martin N. Montoro, Laila Muderspach, Richard Paulson, Subir Roy, 2010, Page 275


A woman presents with amenorrhea of 2 months duration; lower abdominal pain, facial pallor fainting and shock. Diagnosis is:

A: Ruptured ovarian cystB: Ruptured ectopic pregnancyC: Threatened abortionD: Septic abortion


The classic history of acute abdominal catastrophe with fainting attack & collapse, associated with features of intraabdominal haemorrhage in a woman of child bearing age points to a certain diagnosis of acute rupture ectopic.

The women in question fulfills most criteria including the characteristic fainting attack.

Ref: Ultrasound in Obstetrics and Gynecology, Volume 1 By Eberhard Merz, F. Bahlmann, 2004, Page 73 ; Management of Common Problems in Obstetrics and Gynecology edited by T. Murphy Goodwin, Martin N.

Montoro, Laila Muderspach, Richard Paulson, Subir Roy, 2010, page 275. ; Textbook of Obstetrics By D.C.Dutta, 5th Edition, Page 198


Young lady presents with acute abdominal pain and history of 1 1/2 months amenorrhoea. On USG examination there is collection of fluid in the pouch of douglas and empty gestational sac. Diagnosis is:

A: Ectopic pregnancyB: Pelvic hematocele

C: Threatened abortionD: Twisted ovarian cystCorrect Ans:AExplanationWith sonographic absence of a uterine pregnancy, a positive assay for beta-hCG, fluid in the cul-de-sac, and an abnormal pelvic mass, ectopic pregnancy is almost certain.

Without early diagnosis, the natural history of "classical" cases is characterized by variably delayed menstruation followed by slight vaginal bleeding or spotting. With rupture, there is usually severe lower abdominal and pelvic pain that is frequently described as sharp, stabbing, or tearing. There is tenderness during abdominal palpation, and bimanual pelvic examination, especially cervical motion, causes exquisite pain. Ref: Leveno K.J., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 10. Ectopic Pregnancy. In K.J. Leveno, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


Which of the following statements about partial mole is false?

A: Usually associated with TriploidyB: Rarely causes Persistent Gestational Trophoblastic Neoplasia

C: Usually present as Missed AbortionsD: Can be reliably diagnosed by USG in early gestationCorrect Ans:DExplanation

Partial mole cannot be diagnosed by ultrasonography at a very early gestational ages, before the chorionic villi have attained vesicular pattern.

Ref: Williams Gynaecology, 1st Edition, Page 758; Novak's Textbook of Gynecology, 14th Edition, Pages 1588, 1582; Obstetrics and Gynecology By Beckmann, 6th Edition, Page 360; Textbook of Obstetrics By DC Dutta, 6th Edition, Page 201.


A 21 year old primigravida presents with vaginal bleed after a period of amnorrhea. UPT shows +ve, USG shows snowstorm appearance. What can be the diagnosis?

A: HydatidiformB: EndometriosisC: Missed abortionD: Ectopic pregnancyCorrect Ans:AExplanation

Molar pregnancy is an abnormal form of pregnancy wherein a non-viable fertilized egg implants in the uterus. There are two varieties of molar pregnancies, complete mole (no fetus), and incomplete mole (fetal parts in addition to molar degeneration.) Persistent or malignant disease will develop in approximately 20% of patients with molar pregnancy. The diagnosis is straight forward snow storm appearance in USG is characteristic of molar pregnancy.


A female underwent abortion after finding out evidence of molar pregnancy. Which of the following is a BAD prognostic factor for choriocarcinoma?

A: Full term pregnancyB: Short duration

C: AbortionD: Low beta HCGCorrect Ans:AExplanation

Modified WHO Prognostic Scoring System as Adapted by FIGO:

Scores 0 1 2 4

Age <40 > 40 - -

Antecedent pregnancy Mole Abortion Term -

Interval months from index pregnancy

<4 4-<7 7-<13 > 13

Pretreatment serum hCG (IU/mL)

< 103

103–< 104 104–< 105 > 105

Largest tumor size (including uterus)

- 3–< 5 cm > 5 cm -

Site of metastases Lung Spleen, kidney

Gastrointestinal

Liver, brain

Number of metastases - 1-4 5-8 >8

Previous failed chemotherapy

- - Single drug 2 or more drugs

Ref: Aghajanian P. (2007). Chapter 53. Gestational Trophoblastic Diseases. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.


Which of the following complication is least likely to be associated with hypothyroidism in pregnancy?

A: PrematurityB: PolyhydramniosC: Recurrent abortionsD: Pregnancy induced hypertension (PIH)Correct Ans:BExplanation

The major associations of hypothyroidism in pregnancy are high fetal wastage, abortion, still birth and prematurity, deficient intellectual function. A high association of pre-eclampsia and anemia are also seen with hypothyroidism. So by exclusion we can put the answer as polyhydramnios.

Ref: Textbook of Obstetrics By D. C Dutta, 6th Edition, Page 290.


All of the following are indications for Anti D prophylaxis, EXCEPT:

A: Medical abortion for 63 days pregnancyB: Amniocentesis at 16 weeksC: Intrauterine transfusion at 28 weeksD: Manual removal of Placenta


Anti D prophylaxis is not given after intrauterine transfusion. Intrauterine transfusion is done to prevent the fetus from dying. If the hydropic fetus is too immature for early delivery, intrauterine transfusion is done. Transfusion is done through intraperitoneal and intravascular routes. This is performed using O-negative, cytomegalovirus negative, washed irradiated packed red cell. The volume to be transfused is roughly calculated by the formula: (weeks of gestation-20) multiplied by 10. Transfusion is repeated whenever fetal hemoglobin levels falls below 10gm/dl.

Ref: Manual of Neonatal Care By John P. Cloherty, 6th Edition, Pages 209-210 ; Textbook of Obstetrics By D.C.Dutta, 6th Edition, Page 334 ; Obstetrics and Gynaecology By Sarabatnam Arulkumaran, Page 68 ; COBGDT, 9th Edition, Page 299


All of the following statements are true, EXCEPT:

A: Oxytocin sensitivity is increased during deliveryB: Prosglandins may be given for inducing labour during III trimesterC: In lactating women genital stimulation enhances oxytocin releaseD: Oxytocin is used for inducing abortion in 1st trimester


Oxytocin is not used for induction of 1st trimester abortions. They may be used for this purpose in the second trimester, commonly between 16-20 weeks.

Ref: NMS Physiology By John Bullock, Joseph Boyle, Michael B. Wang, 2001, Page 578 ; Review of Medical Physiology By Ganong 19th Edition, Page 235 and 20th Edition, Page 38 ; Textbook of Obstetrics By D.C.Dutta, 5th Edition, Pages 120, 187


Which of the following complication is least likely to be associated with hypothyroidism in pregnancy?

A: PrematurityB: PolyhydramniosC: Recurrent abortionsD: Pregnancy induced hypertension (PIH)Correct Ans:BExplanation

The major associations of hypothyroidism in pregnancy are high fetal wastage, abortion, still birth and prematurity, deficient intellectual function. A high association of pre-eclampsia and anemia are also seen with hypothyroidism. So by exclusion we can put the answer as polyhydramnios.

Ref: Textbook of Obstetrics By D. C Dutta, 6th Edition, Page 290.


Antiphospholipid antibody syndrome is associated with all, EXCEPT:

A: Recurrent abortionB: Venous thrombosisC: PancytopeniaD: Antibody to lupusCorrect Ans:CExplanation

Antiphospholipid antibody syndrome usually affects older women. It result from autoantibodies directed against phospholipid. Patients usually develop recurrent episodes of thrombosis, thrombocytopenia and recurrent abortions.

Antibodies commonly found in these patients are anticardiolipin antibody IgG or IgM anti beta 2 glycoprotein 1 IgG or IgM, lupus anticoagulant.

Treatment: Patients with APLA syndrome should be treated with anticoagulation for life. Warfarin is given to patients to maintain an INR of 2-3. Pregnant patients with APLAS are given subcutaneous heparin and low dose aspirin.


A primigravida presented with increased fatigue, sleepiness and cold intolerance. Blood investigations shows increased TSH levels. Hypothyroidism in pregnancy is LEAST likely associated with:

A: Recurrent abortionsB: Polyhydramnios

C: IUGRD: Preterm labourCorrect Ans:BExplanation

The most common cause of hypothyroidism in pregnancy is Hashimoto thyroiditis, characterized by glandular destruction from autoantibodies, particularly antithyroid peroxidase antibodies. There is an increased risk of,

Preeclampsia

Placental abruption

Recurrent abortions

Intrauterine growth restriction

Prematurity

Cardiac dysfunction

Intrauterine fetal demise

Ref: Bannerman C (2013). Chapter 32. Thyroid & Other Endocrine Disorders during Pregnancy. In DeCherney A.H., Nathan L, Laufer N, Roman A.S. (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.


A female with recurrent abortion and isolated prolonged APTT is most likely associated with:

A: Lupus anticoagulantB: DICC: Von willebrand diseaseD: Hemophilia


Miscarriages are more common in women with systemic lupus erythematosus. Many of these women have antiphospholipid antibodies, which are a family of autoantibodies that bind to negatively charged phospholipids, phospholipids-binding proteins, or a combination of the two. A prolongation in the aPTT is observed that does not correct completely on mixing.

Specialized testing such as the hexagonal phase phospholipid neutralization assay, the dilute Russell viper venom time, and platelet neutralization assays can confirm the presence of a lupus anticoagulant.

Ref: (2010). Chapter 9. Abortion. In Cunningham F, Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (Eds), Williams Obstetrics, 23e.


Which of the following is NOT a complication of Congenital Rubella Syndrome (CRS)?

A: RetinopathyB: Spontaneous abortionC: Cardiac abnormalitiesD: Macrocephaly


Pregnant women infected with rubella are at higher risk for spontaneous abortion, fetal infection, growth restriction, and fetal demise. In developing countries without national guidelines for rubella vaccination, the burden of disease is higher, and CRS affects from 10–90 per 100,000 live births.

Common anomalies associated with CRS include deafness (60–75%), eye defects such as cataracts or retinopathy (10–30%), central nervous system anomalies (10–25%), and cardiac malformations (10–20%). Other findings include microcephaly, growth retardation, hepatosplenomegaly, hemolytic anemia, and thrombocytopenia. Late manifestations of CRS include hearing loss, endocrine disorders, immune defects, and panencephalitis.

Ref: Nayeri U., Thung S. (2013). Chapter 15. Congenital Fetal Infections. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.


Misoprostol has been found to be effective in all of the following except:

A: Missed abortionB: Induction of labourC: MenorrhagiaD: Prevention of post-partum hemorrhage (PPH)


Treatment of Menorrhagia involves administration of prostaglandin inhibitors. Misoprostol (PGE1) is a prostaglandin and is therefore certainly not indicated for treatment of metrorrhagia.

Ref: Textbook of Gynecology By D C Dutta, 6th Edition, Page 505


Which of the following is an indication for using mifepristone?

A: Ectopic pregnancyB: Fibroid uterus

C: Molar pregnancyD: Habitual abortionCorrect Ans:BExplanationMifepristone, also known as RU486, is an antiprogestin that has been used for treatment of leiomyomas. Mifepristone diminishes leiomyoma volume by approximately half and it is effective in improving symptoms.

Other uses of mifepristone:

For termination of early pregnancy

For emergency postcoital contraception

Endometriosis

Cushing's syndrome

Breast cancer

Other neoplasms such as meningiomas that contain glucocorticoid or progesterone receptors

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


What is the indication for the usage of mifepristone?

A: Ectopic pregnancyB: Fibroid uterus

C: Molar pregnancyD: Habitual abortionCorrect Ans:BExplanationMifepristone, also known as RU486, is an antiprogestin that has been used for treatment of leiomyomas. Mifepristone diminishes leiomyoma volume by approximately half.

Mifepristone, in combination with misoprostol or other prostaglandins, is available for the termination of early pregnancy.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


A patient with systemic lupus erythematosus very much wants to become pregnant. What should her physician tell her regarding pregnancy in lupus patients?

A: There is no increased risk to the baby.B: There may be an increase in cardiovascular malformationsC: There may be an increase in nervous system malformations.

D:There may be an increase in spontaneous abortions and prematurity.


Systemic lupus erythematosus (SLE) predominantly affects younger women, and so the question of lupus and pregnancy may arise frequently in clinical practice. Patients with SLE have an increased incidence of spontaneous abortion, fetal death in utero, and prematurity. The mother may experience an exacerbation in the activity of her disease in the third trimester or peripartum period, and it may be difficult to distinguish between active SLE and preeclampsia. Therapy of pregnant patients with SLE is problematic, and the generalist should consult the literature or a specialist when such a patient is encountered.Congenital malformations (choices B, C, and D) are not a complication of pregnancies in patients with SLE.

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 54. Connective-Tissue Disorders. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


G3 with previous second trimester abortion presents with 22 week of gestation, abdominal pain, USG shows funneling of internal os. What will be ideal management?

A: Dinoprost and bed restB: Misoprost with bed restC: Fothergills sutureD: McDonald stitch


Incompetent cervix describes a discrete obstetrical entity characterized by painless cervical dilatation in the second trimester. It can be followed by prolapse and ballooning of membranes into the vagina, and ultimately, expulsion of an immature fetus. Funneling is the ballooning of the membranes into a dilated internal os, but with a closed external os.

Once confirmed, classical cervical incompetence is treated with cerclage, which surgically reinforces a weak cervix by some type of purse-string suturing. McDonald cerclage procedure is the simplest procedure used for incompetent cervix. The more complicated operation is a modified Shirodkar cerclage procedure.

Bleeding, uterine contractions, or ruptured membranes are usually contraindications to cerclage.

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 9. Abortion. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


Anti Phospholipid Syndrome (APS) is associated with all of the following, except:

A: PancytopeniaB: Recurrent abortionsC: Venous thrombosisD: Pulmonary hypertensionCorrect Ans:AExplanation

Venous thrombosis, recurrent abortions and pulmonary hypertension are recognized manifestations of Anti Phospholipid Syndrome (APS). So the single best answer of choice by exclusion is pancytopenia.

Ref: Harrison’s Principles of Internal Medicine, 16th Edition, Pages 1681-82, 1959, 1964, 1967; Davidson’s Principles and Practice of Medicine, 19th Edition, Page 954


All of the following statements about Lupus Anticoagulant are true, EXCEPT:

A: May present with an isolated prolongation ofAPTTB: May present with Recurrent Abortions

C: May occur with minimal clinical manifestations

D:Thrombotic spells can be followed by severe life threatening hemorrhage


Catastrophic Life threatening Antiphospholipid Syndrome results from rapid onset thrombosis and ischemia in multiple organ systems and not from severe bleeding. However such bleeding episodes are rare after thrombotic spells even with severe thrombocytopenia, not leading to life threatening hemorrhage and occur as a result of consumptive thrombocytopenia. Hemorrhage is rarely associated with Lupus anticoagulant.

Ref: Hematological Complications in Obstetrics, Pregnancy and Gynecology By Rodger. L. Bick, Pages 150-152; Quality in Laboratory Hemostasis and Thrombosis By Steve Kitchen, Chapter 16;The Lupus Book: A Guide for Patients and Their Families By Daniel J. Wallace, 4th Edition, Chapter 21


Which of the following is recommended in a woman with Antiphospholipid Antibodies and history of prior abortions / still birth?

A: Aspirin onlyB: Aspirin + Low molecular weight HeparinC: Aspirin + Low molecular weight Heparin + PrednisoloneD: No Treatment


Pregnant patients with APLAS are given subcutaneous low molecular heparin and low dose aspirin. Warfarin is contraindicated in pregnancy.

Ref: urrent medical diagnosis and treatment 2012/chapter 20.


A pregnant 38 year old mother of two presents at the office concerned about her pregnancy. She is Rh-negative and her husband is Rh-positive. Both of her children are also Rh-negative. She has had two spontaneous abortions and

carried a third pregnancy to term, but the child died at birth, diagnosed with erythroblastosis fetalis. The test of choice to determine the presence of circulating anti-Rh antibody in the mother is a(n)

A: Direct Coombs test to measure IgG anti-Rh antibodyB: Direct Coombs test to measure IgM anti-Rh antibodyC: Indirect Coombs test to measure IgG anti-Rh antibodyD: Indirect Coombs test to measure IgM anti-Rh antibodyCorrect Ans:CExplanation

The indirect Coombs test would be the test of choice to detect the presence of IgG

(warm agglutinin) anti-Rh antibody circulating in the mother's blood. Serum is collected from the mother and mixed with Rh-positive red blood cells, followed by incubation with complement. If the mother had circulating IgG anti-Rh, it would bind to the Rh antigen on the Rh-positive red blood cells, fixing the complement and lysing the target cells. A titer of greater than or equal to 1:8 is considered diagnostic.The direct Coombs test would be used to determine if anti-IgG or anti-C3 antisera can agglutinate the baby's RBCs. This would not be useful for determining whether circulating IgG antibody to the Rh factor is present in the serum from the mother.An indirect Coombs test to measure IgM anti-Rh antibody would not be informative, since IgM anti-Rh antibody will not cross the placenta.

Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.


All are included in sydney revision of sapporo criteria for Antiphospholipid antibody syndrome:

A: Vascular thrombosisB: Livedo reticularisC: 3 or more unexplained spontaneous abortionsD: Lupus anticoagulant in plasma


Livedo reticularis is not included in the diagnostic criteria for Antiphospholipid antibody syndrome.

Ref: Harrisons principles of internal medicine, 18th edition: Page 2737


A 25 year old female underwent septic abortion, which is the most likely site for embolism of tricuspid valve vegetation?

A: LungB: LiverC: MeningesD: Spleen


Vegetation over tricuspid valve or pulmonary valve result in pulmonary infarction as the blood moves from right ventricles to the lungs and emboli gets lodged in the pulmonary microcirculation resulting in lung infarction.

Clinically, infarcts of the lung present with intense chest pain, respiratory distress and hemorrhagic pleural effusion. Such septic infarcts also produce features of Lung abcess,Pleural rub and or Hemoptysis

Ref: Textbook of Pathology By Datta, Pages 128-129 ; Harrison’s Internal Medicine, 17th Edition, Page 791


Which of the heart valve is most likely to be involved by infective endocarditis following a septic abortion?

A: Aortic valveB: Mitral valve

C: Tricuspid valveD: Pulmonary valveCorrect Ans:CExplanationAfter septic abortion the bacteria spreads via the venous blood and enters the right side of the heart. So in such a case infective endocarditis of the tricuspid valve is more common.

Ref: Echocardiography By Petros Nihoyannopoulos, Page 217 ; Hurst's The Heart, 13th Edition By Valentin Fuste, Chapter 86

previous year question on abortion based on neet pg, usmle, plab and fmge or mci screening exams

Health & Medicine

abortion b

explanation abortion

use of abortion stick

stick c

trimester of pregnancy

placenta previa correct

c explanation mifepristone

method of criminal abortion