All India Institute of Medical Sciences 2003 - Question Paper

44. A perimanopausal lady with well differentiated adenocarcinoma of uterus has more than half myometrial invasion, vaginal metastasis and inguinal lymph node metastasis. She is staged as:

1. Stage III B
2 Stage III C
3. Stage IV a
4. Stage IV b
Ans four Page 1109 CSDT 11 ed. (Table). Only vaginal metastiais would be stage IIIB, only more than half invasion of myometrium would have been stage IC.

45. The subsequent combination of agents are the most preferred for short day care surgeries

1. Propofol, fentanyl, isoflurane
2 Thiopentone sodium, morphine, halothane
3. Ketamine, pethidine halothane
4. Propofol, morphine, halothane
Ans one Ref Lee.

46. All of the subsequent drugs have been used for medical abortion, other than.
1. Mifepristone.
2. Misoprostol
3. Methotrexate
4. Atosiban
Ans four [Page 547 Dutta "Atosiban is an oxytocin analogue, It
counteracts the effect of endogenous oxytocin.So, It can inhibit oxytocin induced preterm labour.]
[Medical abortion: Done when women come within 49 days from LMP.
Protocol is IM Methotrexate (50 mg/metre square) provided on day one and then Misoprostol (prostaglandlin E1) inserted Vaginally on day 5,6,7. Suction curretage may be needed after two weeks if pregnancy appears viable, IF gestational sac persists for more than four weeks after methotraxate or IF excessive bleeding occurs during anytime. (only 10-15 % require Suction curretage)]
[About Mifepristone: = RU-486, It is a synthetic steroid. It occupies progesterone binding sites but does not release heat shock protein[Progesterone does].
So this drug blocks stimulatory effect of progesterone on endometrial growth, also it blocks inhibitory effect of progesterone on uterine contractility--causing abortion.
It has been used with prostaglandlins to reason abortions]
[Team AIPPG; & Murali, Bangalore (MMC)]

47. A 21 year old primigravida is admitted at 39 weeks gestation with painless antepartum haemorrhage. On exam uterus is soft, non tender and head engaged. The management for her would be:

1. Blood transfusion and sedatives.
2. A speculum exam
3. Pelvic exam in OT
4. Tocolysis and sedatives.
Ans 3

48. Which statement is actual regarding VENTOUSE (Vacuum Extractor)
1. Minor scalp abrasions and subgaleal haematomas to new born are moe frequent than forceps.

Earning:   Approval pending.