What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?
All are causes of anovulatory amenorrhea except which of the following?
Which of the following statements about the postmenopausal state is false?
A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?
Which of the following statements about the contraction stress test (CST) is MOST accurate?
Cardiac output increases maximum at which week?
Least common presentation of twins?
After delivery upto which week is known as puerperium?
What is the definitive treatment for preeclampsia?
Which of the following cannot be treated by laparoscopy?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 61: What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?
- A. Mento anterior presentation
- B. Occipito posterior presentation
- C. Vertex presentation
- D. Contracted pelvis (Correct Answer)
Explanation: ***Contracted pelvis*** - A **contracted pelvis** means the maternal pelvic dimensions are too small to allow for the safe passage of the fetus, making a vaginal birth impossible or highly risky. - This **fetopelvic disproportion** (cephalopelvic disproportion) necessitates a C-section to prevent obstructed labor, fetal distress, and potential harm to both mother and baby. - A contracted pelvis is a **definitive indication** for LSCS as vaginal delivery is contraindicated. *Mento anterior presentation* - In a **mento anterior presentation**, the fetal chin (mentum) is anterior, which is a **favorable position** for vaginal delivery as it allows for proper neck extension and engagement. - This presentation does not typically require a C-section unless there are other complicating factors. *Occipito posterior presentation* - While an **occipito posterior presentation** can sometimes lead to prolonged labor or the need for instrumental delivery, it is **not an absolute indication** for C-section. - Many cases can still deliver vaginally, either spontaneously or with rotation, and surgical intervention is usually reserved for failure to progress or fetal distress. *Vertex presentation* - A **vertex presentation** means the fetal head is flexed and presenting first, which is the **most common and ideal presentation** for a vaginal birth. - This presentation is a sign of a normal, potentially uncomplicated delivery and is the opposite of an indication for C-section.
Question 62: All are causes of anovulatory amenorrhea except which of the following?
- A. Hyperprolactinemia
- B. Drugs
- C. PCOD
- D. Gonadal dysgenesis (Correct Answer)
Explanation: ***Gonadal dysgenesis*** - This condition is a cause of **primary ovarian insufficiency**, leading to amenorrhea but not primarily due to anovulation in a previously cycling individual. - In gonadal dysgenesis, the **ovaries are malformed or absent**, resulting in a lack of follicles and thus no ovulation or estrogen production from the start. *PCOD* - **Polycystic Ovarian Disease** (PCOD/PCOS) is a common cause of anovulatory amenorrhea, characterized by **oligo- or anovulation**, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. - The hormonal imbalance (e.g., elevated **androgens**, high **LH/FSH ratio**) disrupts normal follicular development and ovulation. *Hyperprolactinemia* - **Elevated prolactin levels** inhibit the pulsatile secretion of **GnRH (Gonadotropin-Releasing Hormone)** from the hypothalamus, which in turn reduces FSH and LH release from the pituitary. - This suppression of gonadotropins leads to impaired follicular development and **anovulation**, resulting in amenorrhea. *Drugs* - Various medications can cause anovulatory amenorrhea by interfering with the **hypothalamic-pituitary-ovarian axis**. - Examples include antipsychotics (which can increase **prolactin levels**), certain antidepressants, opioids, and chemotherapy agents that can damage ovarian function.
Question 63: Which of the following statements about the postmenopausal state is false?
- A. High FSH
- B. Low LH (Correct Answer)
- C. Low estrogen
- D. High androgen
Explanation: ***Low LH*** - This statement is **FALSE** because **LH (luteinizing hormone) levels are markedly elevated** in postmenopausal women. - The drop in ovarian estrogen production removes the **negative feedback** on the pituitary, leading to **increased LH and FSH secretion**. - Both gonadotropins (LH and FSH) are characteristically **high in postmenopause**. *High FSH* - This statement is true; **FSH (follicle-stimulating hormone) levels are markedly elevated** in postmenopausal women. - The elevated FSH is a direct consequence of the **lack of negative feedback** from inhibin and estrogen produced by the ovaries. *Low estrogen* - This statement is true; **estrogen levels plummet significantly** after menopause due to the **cessation of ovarian follicular activity**. - This **estrogen deficiency** is responsible for many postmenopausal symptoms, such as hot flashes, vaginal atrophy, and bone loss. *High androgen* - While androgens are still produced by the adrenal glands and ovaries postmenopause, their **absolute levels also decline with age**. - The statement is somewhat ambiguous, but androgens do **not increase** in absolute terms; rather, the **estrogen-to-androgen ratio changes** because estrogen falls more dramatically.
Question 64: A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?
- A. Premature ovarian insufficiency (Correct Answer)
- B. Menopause
- C. Late menopause
- D. Perimenopause
Explanation: ***Premature ovarian insufficiency (POI)*** - The patient's age (35 years) combined with 4 months of **amenorrhea**, increased **FSH** and **LH**, and decreased **estrogen** is characteristic of premature ovarian insufficiency (also called premature ovarian failure). - The hormonal profile (**hypergonadotropic hypogonadism**) indicates ovarian failure occurring before the age of **40 years**, which defines POI. - POI affects approximately **1% of women under 40** and can present with amenorrhea, infertility, and symptoms of estrogen deficiency. *Menopause* - Menopause is diagnosed after **12 consecutive months of amenorrhea** in a woman, typically occurring around age **51 years** (natural menopause). - While the hormonal profile of elevated FSH/LH and low estrogen is consistent with menopause, the patient's **age of 35 years** and **only 4 months of amenorrhea** do not meet the criteria for natural menopause. *Late menopause* - Late menopause refers to menopause occurring at a later age than average, typically after age **55 years**. - This diagnosis is completely inconsistent with the patient's age of 35 years. *Perimenopause* - Perimenopause is the transitional phase leading up to menopause, characterized by **irregular menstrual cycles** and **fluctuating hormone levels**. - While FSH levels may be elevated at times, perimenopause typically shows **variable hormone levels** rather than the sustained pattern of high FSH/LH with low estrogen seen in this case. - The **sustained amenorrhea** and pronounced hormonal shifts indicate ovarian failure (POI) rather than perimenopausal transition.
Question 65: Which of the following statements about the contraction stress test (CST) is MOST accurate?
- A. Invasive method
- B. Detects fetal well being
- C. Negative test is associated with good fetal outcome (Correct Answer)
- D. Oxytocin is never used in the test
Explanation: ***Negative test is associated with good fetal outcome*** - A **negative CST** indicates that there are no late or significant variable decelerations in response to uterine contractions, suggesting the fetus can tolerate labor. - This finding is strongly correlated with **fetal well-being** and a low likelihood of fetal distress in the near future, with a **negative predictive value of approximately 99%**. *Invasive method* - The CST is considered a **non-invasive test**, as it involves external monitoring of fetal heart rate and uterine contractions. - No instruments are inserted into the body, differentiating it from truly invasive procedures like **amniocentesis**. *Detects fetal well being* - While the CST provides valuable information, it specifically assesses **uteroplacental function and fetal oxygenation reserve** during the stress of contractions, rather than comprehensive fetal well-being. - It identifies fetuses at risk for **uteroplacental insufficiency** but does not evaluate other parameters of fetal health. - Other tests like the **biophysical profile** offer a more comprehensive assessment of fetal well-being, including parameters like fetal breathing, movement, tone, and amniotic fluid volume. *Oxytocin is never used in the test* - **Oxytocin** is frequently used to induce uterine contractions if spontaneous contractions are insufficient for the test (oxytocin challenge test or OCT). - Alternatively, **nipple stimulation** can be used to achieve adequate contractions for the CST.
Question 66: Cardiac output increases maximum at which week?
- A. 26-28 wks
- B. 34-36 wks
- C. 32-34 wks
- D. 30-32 wks (Correct Answer)
Explanation: ***30-32 wks*** - **Cardiac output** in healthy pregnant women typically reaches its maximum increase of **30-50%** above pre-pregnancy levels between **28 and 32 weeks** of gestation. - This peak output is sustained until term, primarily driven by a significant increase in **stroke volume** and a moderate increase in **heart rate**. *26-28 wks* - While cardiac output steadily rises throughout pregnancy, the **peak increase** is generally not observed as early as **26-28 weeks**. - At this stage, the increase is substantial but is still progressing towards its **maximum point**. *32-34 wks* - The maximal cardiac output is usually achieved **before** this period, typically by **32 weeks**. - From **32 weeks** onwards, cardiac output tends to **plateau**, not increase further. *34-36 wks* - By **34-36 weeks**, cardiac output has generally already reached its peak and **stabilized**. - There is typically no further increase in cardiac output during this timeframe; rather, it is maintained at its maximal level.
Question 67: Least common presentation of twins?
- A. Both breech
- B. Both transverse (Correct Answer)
- C. First vertex and 2nd transverse
- D. Both vertex
Explanation: ***Correct: Both transverse*** - A **transverse lie** means both fetuses are positioned horizontally across the uterus - This is the **rarest twin presentation**, occurring in approximately **0.5% of twin pregnancies** - The limited uterine space and natural tendency of fetuses to settle into longitudinal positions makes this presentation exceptionally uncommon - **Management**: Requires cesarean delivery due to impossibility of vaginal birth with both twins transverse *Incorrect: Both breech* - **Breech presentation** (feet or buttocks first) is more common in twin pregnancies than in singletons - Occurs in approximately **5-10% of twin pregnancies** - While complicated, both twins being breech is **significantly more common** than both transverse *Incorrect: First vertex and 2nd transverse* - The **first twin being cephalic (vertex)** is the most favorable and common position - The **second twin presenting transversely** can occur after delivery of the first twin when increased intrauterine space allows position change - This combination is **more common than both transverse** but requires careful management of the second twin *Incorrect: Both vertex* - **Vertex presentation for both twins** (both head-down) is the **most common presentation**, occurring in **40-45% of twin pregnancies** - This is the **optimal presentation for vaginal delivery** - Offers the best outcomes with lowest intervention rates
Question 68: After delivery upto which week is known as puerperium?
- A. 2 weeks
- B. 4 weeks
- C. 6 weeks (Correct Answer)
- D. 8 weeks
Explanation: ***6 weeks*** - The **puerperium** is the period of approximately **6 weeks** after childbirth during which the mother's body undergoes physiological adaptations to return to its non-pregnant state. - This timeframe allows for the involution of the uterus and the restoration of reproductive organs and systemic physiology. *2 weeks* - This period is too short to encompass the full physiological recovery process after childbirth. - While immediate postpartum changes occur, many maternal systems, such as the reproductive organs, have not fully reverted to their pre-pregnancy state within 2 weeks. *4 weeks* - This duration is still considered an incomplete period for the extensive physiological changes that define the puerperium. - Uterine involution often continues beyond 4 weeks, and other hormonal and systemic adjustments are still ongoing. *8 weeks* - While recovery continues, the primary definition of the puerperium typically concludes at **6 weeks postpartum**. - By 8 weeks, most significant physiological changes have already occurred, and the body is largely back to its pre-pregnant state.
Question 69: What is the definitive treatment for preeclampsia?
- A. Delivery of the baby (Correct Answer)
- B. Use of antihypertensive medications
- C. Dietary modifications
- D. Increased rest and monitoring
Explanation: ***Delivery of the baby*** - **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**. - **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms. *Use of antihypertensive medications* - Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke. - They **do not address the underlying cause** of the disease and are not a curative treatment. *Dietary modifications* - While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia. - There is **no specific diet** proven to cure or prevent preeclampsia. *Increased rest and monitoring* - **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications. - These interventions **do not reverse the disease process** and are not a definitive treatment.
Question 70: Which of the following cannot be treated by laparoscopy?
- A. Non descent of uterus
- B. Ectopic pregnancy
- C. Sterilization
- D. Genital prolapse (Correct Answer)
Explanation: ***Genital prolapse*** - Among the options listed, **genital prolapse** is the condition LEAST suited for complete laparoscopic management, particularly in the context of this examination question. - While **laparoscopic sacrocolpopexy** and **sacral hysteropexy** exist for vault prolapse and uterine prolapse respectively, these procedures were less established at the time of this exam (2012) and require advanced laparoscopic skills. - Most cases of **genital prolapse**, especially complete pelvic organ prolapse, traditionally require **vaginal surgical approaches** or **open abdominal procedures** for comprehensive repair of multiple compartment defects. - The complex anatomical reconstruction needed for severe prolapse (anterior, posterior, and apical compartments) is more challenging via laparoscopy compared to the other listed conditions. *Non descent of uterus* - **Non-descent vaginal hysterectomy** can be performed with **laparoscopic assistance (LAVH/LDVH)** or as **total laparoscopic hysterectomy (TLH)**. - Laparoscopy facilitates dissection of uterine attachments, ligation of vessels, and removal of the uterus with minimal morbidity. *Ectopic pregnancy* - **Ectopic pregnancy** is a standard indication for laparoscopic surgery, performed routinely worldwide. - Procedures include **laparoscopic salpingectomy** (removal of affected tube) or **salpingostomy** (conservative surgery preserving the tube). - Offers advantages of minimal invasiveness, reduced recovery time, and excellent visualization. *Sterilization* - **Laparoscopic tubal sterilization** is one of the most common laparoscopic procedures performed. - Methods include application of **Filshie clips, Falope rings**, or **electrocautery** to occlude fallopian tubes. - Gold standard for permanent contraception with minimal morbidity.