INI-CET 2013 — Obstetrics and Gynecology
2 Previous Year Questions with Answers & Explanations
Which of the following is seen in pregnancy with heart disease, which is not seen in normal pregnancy?
Hormone replacement therapy is not indicated for which of the following conditions?
INI-CET 2013 - Obstetrics and Gynecology INI-CET Practice Questions and MCQs
Question 1: Which of the following is seen in pregnancy with heart disease, which is not seen in normal pregnancy?
- A. Distended neck veins (Correct Answer)
- B. Exertional dyspnea
- C. Pedal edema
- D. Supine hypotension
Explanation: In pregnancy, physiological changes often mimic symptoms of cardiac disease, making clinical differentiation crucial for NEET-PG. **Explanation of the Correct Answer:** **Distended neck veins (Option A)** are a pathological finding in pregnancy. While the plasma volume increases by 40-50%, the healthy maternal heart compensates through remodeling and increased cardiac output. Persistent jugular venous distension (JVD) indicates an inability of the right heart to handle this preload, suggesting **congestive heart failure** or significant valvular disease. Other "red flag" signs include a diastolic murmur, loud systolic murmur (>Grade 3), or generalized cardiomegaly. **Analysis of Incorrect Options:** * **Exertional Dyspnea (Option B):** This is seen in up to 75% of normal pregnancies. It is primarily due to hyperventilation triggered by **progesterone** (increasing sensitivity to CO2) and the upward displacement of the diaphragm. * **Pedal Edema (Option C):** Dependent edema is a common physiological finding caused by the gravid uterus compressing the inferior vena cava (IVC), leading to increased venous pressure in the lower extremities, and a decrease in plasma oncotic pressure. * **Supine Hypotension (Option D):** Also known as "Supine Hypotension Syndrome," this occurs when the heavy uterus compresses the IVC in the recumbent position, reducing venous return and stroke volume. It is a physiological mechanical effect, not a sign of primary heart disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most common heart disease in pregnancy (India):** Rheumatic Heart Disease (Mitral Stenosis is most common). * **Most common heart disease in pregnancy (Global/Developed):** Congenital Heart Disease. * **NYHA Classification:** Used to assess functional capacity; Class III and IV usually contraindicate pregnancy. * **Danger Period:** The risk of heart failure is highest at **28–32 weeks** (peak plasma volume), during **labor**, and **immediately postpartum** (due to autotransfusion from the uterus).
Question 2: Hormone replacement therapy is not indicated for which of the following conditions?
- A. Urogenital atrophy
- B. Vasomotor symptoms
- C. Prevention of osteoporosis
- D. Prevention of coronary artery disease (Correct Answer)
Explanation: **Explanation:** The primary goal of Hormone Replacement Therapy (HRT) is the management of menopausal symptoms and the prevention of bone loss. **Why Option D is correct:** Historically, it was believed that HRT provided cardioprotection. However, large-scale clinical trials, specifically the **Women’s Health Initiative (WHI)**, demonstrated that HRT (especially combined estrogen-progestogen) does not prevent coronary artery disease (CAD). In fact, initiating HRT in older postmenopausal women may **increase** the risk of thromboembolic events and cardiovascular morbidity. Therefore, HRT is strictly **not indicated** for the primary or secondary prevention of CAD. **Analysis of Incorrect Options:** * **A. Urogenital atrophy:** Estrogen deficiency leads to vaginal dryness, dyspareunia, and urinary urgency. Low-dose topical or systemic HRT is the gold standard treatment for these symptoms. * **B. Vasomotor symptoms:** Hot flashes and night sweats are the most common indications for HRT. It remains the most effective treatment for moderate-to-severe vasomotor instability. * **C. Prevention of osteoporosis:** Estrogen inhibits osteoclast activity. HRT is FDA-approved for the prevention of postmenopausal osteoporosis, particularly in women at high risk of fractures who cannot tolerate other therapies. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Opportunity Hypothesis:** HRT is safest and most effective when started within 10 years of menopause or before age 60. * **Contraindications:** Undiagnosed vaginal bleeding, active liver disease, history of VTE, and estrogen-dependent tumors (Breast/Endometrial CA). * **Addition of Progestogen:** In women with an intact uterus, progestogen must be added to estrogen to prevent **endometrial hyperplasia/carcinoma**. For women post-hysterectomy, Estrogen-only therapy (ERT) is used.