RELEVANT PHYSIOLOGY

Question 1

What are the probable/presumptive signs of pregnancy

Answer 1

Chadwick’s sign aka Jacquiemers sign - bluish discolouration of Cx , vagina , vulva
Hegar’s sign (6 weeks )
Goodles sign - softening of cervix (6 weeks )

Question 2

Mc site of implantation

Answer 2

Upper part of posterior uterine wall

Question 3

Which of the following is true

1. Implanatation is always eccentric (one half bigger then the other side )
2. PISKACEKS SIGN means unequal growth of uterus d/t lateral implantation
3. OSLANDER’S SIGN means lateral vaginal fornix pulsations
4. PALMER’S SIGN means regular rhythmic uterine contraction
5. HARTMAN’S SIGN means spotting during implantation (implantation bleeding not a problem )
6. All these signs at 8 weeks

Answer 3

All of the above are correct

Question 4

Other name of PALMER’S sign

Answer 4

Brackton hick contractions / braxton hicks

Question 5

What is implantation window

Answer 5

D20-D24 of menstural cycle is implanatation window

Question 6

Retaintion of salt and water in pregnant state is brought about by

Answer 6

Estrogen

Question 7

2 conditions in pregnancy where progesterone has no role and are totally controlled by estrogen

Answer 7

Obstetric cholestasis

Salt and water condition

Question 8

Amount of water retention in pregnancy

Answer 8

6.5 L

Question 9

Which of the following is true

1. Plasma osmolality decreases 10mos/kg
2. BMR increases by 10-20%
3. Extra calories required per day

Answer 9

All of the following are TRUE

Extra calories required per day are - 350 k.cal/day

Question 10

Which of the following is false

1. Pregnancy is a state of insulin resistance
2. Pregnancy is characterised by fasting hypoglycaemia and post-prandial hyperglycaemia
3. in pregnancy pt. have hypolipidaemia
4. Pregnant lady have mild hypotrhyroidism
5. Mc anemia in pregnancy is iron deficiency anemia

Answer 10

I pregnancy pt. have hyperlipidaemia

Question 11

Total iron requirement in pregnancy is

Answer 11

1000mg

Question 12

Total iron required by foetus in Px
Iron requirement in 1st half of Px
Iron requirement in 2nd half of Px

Answer 12

300mg
3-4mg/day
6-7mg /day

Question 13

Range of anemia in Px
Anemia
Severe anemia
Very severe anemia

Answer 13

Anemia - <11g/ml
Severe anemia - <7g/ml
Very severe anemia - <4g/ml

Question 14

W.B.C count in pregnancy

W.B.C count immediate after post-partum

Answer 14

Increase upto 15K (neutrophilia)
Upto 30K (d/t physiological)

Question 15

What happens to the avg platelet count in Px

Answer 15

Decreases but thrombocytopenia does not occur

Question 16

What happens to the following clotting factors in pregnancy

1,2,5,7,8,9,10,11,12,13

Answer 16

11 and 13 decreases
2,5,12- constant
1,7,8,9,10-increases

Question 17

The following increase or decreases

1. Fibrinogen
2. CRP
3. ESR

Answer 17

1. Fibrinogen-increases
2. CRP-increases
3. ESR-increases

Question 18

Which of the following is false

1. In pregnancy plasma volume increases by 40%(40-50%)
2. In pregnancy RBC mass increases by 20%
3. Increase in plasma volume begins as early as 6th week
4. Increase in RBC mass begins as early as 6th week

Answer 18

4 is false

Increase in RBC mass begins as early as 8th weeks

Question 19

What happens to O2 carrying capacity in pregnancy

Answer 19

It decreases

Reason being it is function of Hb

Question 20

Cardiac output increases by what % in pregnancy
Starts increasing by which weeks of Px
Maximum at

Answer 20

40%
7th week
30-32 weeks

Question 21

Which of the following is false

1. O2 requirement increased by 20%
2. Arterio-venous O2 gradient is decreased
3. Mean arterial pressure falls by 15-30mmHg

Answer 21

Mean arterial pressure falls by 5-10mmHg

Question 22

CNS changes that occurs in Px

Answer 22

Pituitary gland is mainly effected
Pituitary gland size increases in size by 135%
Pt. may also suffer from Sheehan syndrome

Question 23

Sheehan syndrome is seen in

Earliest feature of Sheehan syndrome

Answer 23

Post partum haemorrhage 
Blood loss 
Hypovolumic shock 
-lacks lactation 
-ammenorric 
-all ant. Pituitary hormones decrease but post. Pituitary is spared

Question 24

What happens to the gastric emptying time during Px

Comment on the statement - Px pt suffers form reflux esophagitis

Answer 24

It shows no change
Only during labour it increases therefore we keep them on oral fluids
True Px pt suffers from reflux esophagitis ……this occurs due to progesterone that relaxes L.E.S d/t this reflux is increased

Question 25

Comment on spleen in a Pregnant pt

Answer 25

Splenic area increases by 50%

Question 26

Only ALP which is heat stable is

Answer 26

PALP (Placental ALP)

Question 27

Comment on the following during Px ALP ALT AST

Answer 27

AST,ALT shows physiological fall | ALP shows physiological increase (occurs d/t release of placental ALP)

Question 28

Comment on the following during px 1. Size of kidney 2. Renal blood flow 3. Serum creatinine 4. BUN 5. GFR 6. Ureter 7. Bladder pressure

Answer 28

1. Kidney increase in length by 1cm 2. Increase by 80% 3. Decrease 4. Decrease 5. Increase by 50% 6. Hydroureter (smooth muscle relaxation by progesterone ) * hydronephrosis also found 7. Increase from 8cmH2O to 20cm H2O

Question 29

State the following true or false 1. Hydroureteric changes more on right as compared to left Why? Support your answer

Answer 29

True In pregnant female uterus is dextro Therefore right ureter is compressed by uterus on pelvic brim

Question 30

Comment on the following during Px 1. Heart rate 2. Heartsounds 3. Murmur 4. Position of heart 5. ECG 6. Chest X-ray 7. BP

Answer 30

1. Increase at term by 20% 2. Loud , S3 heard (gallop rhythm), splitting of S1 3. -Systolic murmur (physiological upto grade 2 ) -diastolic murmur (pathological) -ejection systolic murmur 4. Heart moves upwards and rotates anteriorly therefore apex beat at 4 ICS 5. Left axis deviation 6. -Straightening of left heart border -cardiac silhoutle appears bigger but no cardiomegaly ( it would be pathological) 7. DBP>SBP (but both falling , SBP more falling

Question 31

When does maximum fall in BP occurs during px | More cases of pre eclampsia tends to aggravate during 3rd trimester. why?

Answer 31

2nd trimester | Because during 3rd trimester BP begins to increase

Question 32

What happens to after load ,preload and central venous pressure in px

Answer 32

After load -Decreases (d/t decrease in systemic vascular resistance ) Preload- increases Central venous pressure - no change

Question 33

Supine hypotension syndrome in px

Answer 33

In left lateral position their is increase in fetal O2 saturation by 10%

Question 34

``` Absence seizures State true or false 1. Loss of consciousness present 2. Tone normal 3. Gradual Onset 4. Last for less than 30 sec 5. No post ictal paralysis 6. Start at age of 4-8 yrs ```

Answer 34

3 is wrong as it has abrupt onset

Question 35

Seizures affecting minor motor movements are | Comment on the remission method of these seizures

Answer 35

Absence seizures they are subtle Motor signs positive that is minor Motor movement seen It has got spontaneous remission 60 to 70% by 18 years of age

Question 36

Diagnosis of absence seizure is made by

Answer 36

EEG In it we find bilateral 2 to 4 Hz spike and wave forms precipitated by hyperventilation Last for 1 to 3 minute Aka Spike and dome pattern

Question 37

What is Spike and dome pattern

Answer 37

Seen in absence seizures on EEG these are bilateral 2 to 4HZ Spike and wave precipitated by hyperventilation

Question 38

What are the features of atypical absence seizures

Answer 38

``` Loss of consciousness is less abrupt Associated with mental retardation Resistant to drugs (anti-epileptic drugs) EEG =2.5 HZ Spike and wave Structural abnormalities ```

Question 39

Causes of myoclonic seizures

Answer 39

Hypoxia Degeneration Metabolic causes

Question 40

A patient with hanging will develop which type of seizure

Answer 40

Myoclonic seizure

Question 41

A patient with any arrythmia will develop which type of seizure

Answer 41

Myoclonic seizure