Mifepristone Indications

All of the following are indications of Mifepristone, EXCEPT:
A: Abortion
B: Cushing syndrome
C: PPH
D: Cervical ripening
Correct Ans:C
Explanation
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 placentae
B:
Chorioamnioniti
s
C: Chromosomal abnormalities
D: Placenta previa
Correct Ans:C
Explanation
At 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 contraction
B:
Oxytocin present in the
stick
C: Uterme necrosis
D: Menstrual bleeding
Correct Ans:A
Explanation
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: Suicide

B: Homicide
C: Death as a result of criminal abortion
D: Death due to criminal negligence
Correct Ans:A
Explanation
Exhumation 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: Arsenic
B: Nux vomica
C: Ergotamine
D: Quinine
Correct Ans:A
Explanation
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 age
B: History of exposure to potentially teratogenic drugs
C: 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:D
Explanation
Prenatal 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 bacteria
B: It causes abortion in pregnancy
C: It causes meningitis in neonates
D: It is transmitted by contaminated milk

Correct Ans:A
Explanation
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 hemorrhage
B: Anemia
C: Abortion
D: Obstructed labour
Correct Ans:A
Explanation
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 delivery
B:
Denominator includes still births and
abortions
C: It is expressed as a rate and not ratio
D: It is expressed per 1000
Correct Ans:B
Explanation
The denominatorin 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 denominatoris 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 birth

B:
Neonatal deaths within 30 days of
birth
C: Abortions and Death within 7 days of birth
D: Deaths between 7 and 28 days of birth
Correct Ans:A
Explanation
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 immunization
B:
Institutional
deliveries
C: Iron supplementation
D: Abortions
Correct Ans:B
Explanation
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 poorfamilies.
Which of the following is true about women's health in india?
A: Unsafe abortion is the most common cause of MMR
B:
MMR in Karnataka > Andhra
Pradesh
C: MMR<100/lakh live births
D: ANC is better than Thailand and Indonesia
Correct Ans:B
Explanation
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: negative
Urinalysis: negative
Leukocytes: 15,000/mm3
Hematocrit: 39%
Platelets: 200,000/mm3
Which of the following is the most likely diagnosis?
A: Ectopic pregnancy
B: Gonococcal cervicitis
C: Pelvic inflammatory disease (PID)
D: Spontaneous abortion
Correct Ans:C
Explanation
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 pregnancy
B: Missed abortion
C: Dysfunctional uterine bleeding
D: Postpartum haemorrhage
Correct Ans:D
Explanation
Intrauterine 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 failure
B:
Ovarian
failure
C: Fresh pregnancy
D: Uterine synechiae

Correct Ans:D
Explanation
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: Abortion
B: Cushing's syndrome
C: PPH
D: Cervical ripening
Correct Ans:C
Explanation
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
pyogenes
B: Strptococcus agalactiae
C: Peptostreptococci
D: Enterococcus faecum
Correct Ans:B
Explanation
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
pyogenes
B: Strptococcus agalactiae
C: Peptostreptococci
D: Enterococcus faecum
Correct Ans:B
Explanation
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?
B: Incomplete abortion
C: Ovarian torsion
D: Ruptured ovarian cyst
Correct Ans:A
Explanation
The 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 days
B:
72
days
C: 88 days
D: 120 days
Correct Ans:A
Explanation
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 delivery
B: Prosglandins may be given for inducing labour during III trimester
C: In lactating women genital stimulation enhances oxytocin release
D: Oxytocin is used for inducing abortion in 1st trimester
Correct Ans:D
Explanation
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: Syphilis
B: Chromosomal abnormalities
C: Rhesus isoimmunization
D: Cervical incompetence
Correct Ans:B
Explanation
Majority (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 infections
B: SLE
C: Rh incompatibility
D: Syphilis
Correct Ans:A
Explanation
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 membranes
B: Metronidazole if asymptomatic but significant bacterial vaginosis
C: Antibiotics if asymptomatic but significant bacteremia
D: Antibiotics for Preterm Premature Rupture of Membranes
Correct Ans:A
Explanation
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 Abortion
B:
Ectopic
pregnancy
C: Fibroids
D: Molar Pregnancy
Correct Ans:A
Explanation
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 cytogenetics
B:
Thyroid
profile
C: Antiphospholipid antibodies
D:
TORCH infection
screening
Correct Ans:D
Explanation
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 defects
B:
Uterine
syncytium
C: Unicornuate uterus
D: Uterine agenesis
Correct Ans:A
Explanation
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: C T scan and clinical findings are consistent with necrotizing metritis caused by C lostridium species.
Reason: T his 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 false
D: Assertion is false, but Reason is true
Correct Ans:A
Explanation
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: T his 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 false

D: Assertion is false, but Reason is true
Correct Ans:A
Explanation
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 studies
B: TORCH
C: Hypothyroidism
D: Antiphospholipid syndrome
Correct Ans:B
Explanation
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 defects
B:
Uterine
syncytium
C: Cervical incompetence
D: Uterine agenesis
Correct Ans:A
Explanation
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:
B:
Missed
abortion
C: Threatened abortion
D: Blighted ovum
Correct Ans:D
Explanation

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: Liver
B: Spleen
C: Brain
D:
Lun
g
Correct Ans:D
Explanation
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: Hysteroscopy
B: Testing for Antiphospholipid antibodies
C: Testing for TORCH infections
D: Thyroid function tests.
Correct Ans:C
Explanation
TORCH 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 abortion
B: Induction of labour
C: Menorrhagia
D: Prevention of post-partum hemorrhage (PPH)
Correct Ans:C
Explanation
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 cyst
B: Ectopic pregnancy
C: Complete abortion
D:
None of the
above
Correct Ans:B
Explanation
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 cyst
B: Ruptured ectopic pregnancy
D: Septic abortion
Correct Ans:B
Explanation
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:
B:
Pelvic
hematocele
D: Twisted ovarian cyst
Correct Ans:A
Explanation
With 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 Triploidy
B: Rarely causes Persistent Gestational Trophoblastic Neoplasia
C: Usually present as Missed Abortions

D: Can be reliably diagnosed by USG in early gestation
Correct Ans:D
Explanation
P artial 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, P age 758; Novak's T extbook of Gynecology, 14th Edition, P ages 1588, 1582; O bstetrics
and Gynecology By Beckmann, 6th Edition, P age 360; T extbook of O bstetrics By DC Dutta, 6th Edition, P age 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: Hydatidiform
B: Endometriosis
C: Missed abortion
D: Ectopic pregnancy
Correct Ans:A
Explanation
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 pregnancy
B:
Short
duration
C: Abortion
D: Low beta HCG
Correct Ans:A
Explanation
Modified WHO Prognostic Scoring System as Adapted by FIGO:
Scores 0 1 2 4
Age <40 > 40
- -
Antecedent pregnancy M ole A bortion 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: Prematurity
B: Polyhydramnios
C: Recurrent abortions
D: Pregnancy induced hypertension (PIH)

Correct Ans:B
Explanation
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 pregnancy
B:
Amniocentesis at 16
weeks
C: Intrauterine transfusion at 28 weeks
D: Manual removal of Placenta
Correct Ans:C
Explanation
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 delivery
B: Prosglandins may be given for inducing labour during III trimester
C: In lactating women genital stimulation enhances oxytocin release

D: Oxytocin is used for inducing abortion in 1st trimester
Correct Ans:D
Explanation
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: Prematurity
B: Polyhydramnios
C: Recurrent abortions
D: Pregnancy induced hypertension (PIH)
Correct Ans:B
Explanation
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
abortion
B: Venous thrombosis
C: Pancytopenia
D: Antibody to lupus

Correct Ans:C
Explanation
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 abortions
B:
Polyhydramnio
s
C: IUGR
D: Preterm labour
Correct Ans:B
Explanation
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,
 P reeclampsia
 P lacental abruption
 Recurrent abortions
 Intrauterine growth restriction
 P rematurity
 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 anticoagulant
B: DIC
C: Von willebrand disease
D: Hemophilia
Correct Ans:A
Explanation
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: Retinopathy
B: Spontaneous abortion
C: Cardiac abnormalities
D: Macrocephaly
Correct Ans:D
Explanation
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 abortion
B: Induction of labour
C: Menorrhagia
D: Prevention of post-partum hemorrhage (PPH)
Correct Ans:C
Explanation
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?
B:
Fibroid
uterus
C: Molar pregnancy
D: Habitual abortion
Correct Ans:B
Explanation
Mifepristone, 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
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?
B:
Fibroid
uterus
C: Molar pregnancy
D: Habitual abortion
Correct Ans:B
Explanation
Mifepristone, 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.
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 malformations

C: There may be an increase in nervous system malformations.
D:
There may be an increase in spontaneous abortions and
prematurity.
Correct Ans:D
Explanation
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 rest
B: Misoprost with bed rest
C: Fothergills suture
D: McDonald stitch
Correct Ans:D
Explanation
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: Pancytopenia
B: Recurrent abortions
C: Venous thrombosis
D: Pulmonary hypertension
Correct Ans:A
Explanation
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 ofAPTT
B:
May present with Recurrent
Abortions
C: May occur with minimal clinical manifestations
D:
Thrombotic spells can be followed by severe life threatening
hemorrhage
Correct Ans:D
Explanation
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 only
B: Aspirin + Low molecular weight Heparin
C: Aspirin + Low molecular weight Heparin + Prednisolone
D: No Treatment
Correct Ans:B
Explanation
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
antibody
B: Direct Coombs test to measure IgM anti-Rh antibody
C: Indirect Coombs test to measure IgG anti-Rh antibody
D: Indirect Coombs test to measure IgM anti-Rh antibody
Correct Ans:C
Explanation
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 thrombosis
B:
Livedo
reticularis
C: 3 or more unexplained spontaneous abortions
D: Lupus anticoagulant in plasma
Correct Ans:B
Explanation
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: Lung
B: Liver
C: Meninges
D: Spleen
Correct Ans:A
Explanation
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 valve
B:
Mitral
valve
C: Tricuspid valve
D: Pulmonary valve
Correct Ans:C
Explanation
After 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

Mifepristone Indications

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